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Background An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. We hypothesized that the United Nations Istanbul Protocol (UNIP) would have a sensitivity of approximately 15% for pain detection, and that the use of a validated pain screen would improve its sensitivity by at least 29%, as compared to the reference standard (pain specialist evaluation). Methods and findings This prospective blind-comparison-to-gold-standard study of survivors of torture, as defined by the World Medical Association, took place at Weill Cornell Medicine between February 1, 2017, and June 21, 2019. 11 women and 9 men, for a total of 20 participants, were included in the analysis. Five participants received 2 UNIP evaluations, for a total of 25 unique evaluations included in the analysis. Participants were representative of a global population, with home countries in Africa, Central America, South Asia, the Caribbean, and the Middle East. Methods of torture experienced were homogeneous, following the predictable pattern of systematic torture. Participants first received the standard evaluation protocol for torture survivors (UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory-Short Form [BPISF]) followed by a noninvasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. Trained evaluators performing the initial assessment with the UNIP (index test) were blinded to the study, and the pain specialist physician (reference standard) was blinded to the outcome of the initial UNIP evaluation and

q RSNA, 2015 Purpose:To determine if myeloperoxidase (MPO) is involved in epileptogenesis and if molecular nuclear imaging can be used to noninvasively map inflammatory changes in epileptogenesis. Materials and Methods:The animal and human studies were approved by the institutional review boards. Pilocarpine-induced epileptic mice were treated with 4-aminobenzoic acid hydrazide (n = 46), a specific irreversible MPO inhibitor, or saline (n = 42). Indium-111-bis-5-hydroxytryptamide-diethylenetriaminepentaacetate was used to image brain MPO activity (n = 6 in the 4-aminobenzoic acid hydrazide and saline groups; n = 5 in the sham group) by using single photon emission computed tomography/computed tomography. The role of MPO in the development of spontaneous recurrent seizures was assessed by means of clinical symptoms and biochemical and histopathologic data. Human brain specimens from a patient with epilepsy and a patient without epilepsy were stained for MPO. The Student t test, one-way analysis of variance, and Mann-Whitney and Kruskal-Wallis tests were used. Differences were regarded as significant if P was less than .05. Results:MPO and leukocytes increased in the brain during epileptogenesis (P , .05). Blocking MPO delayed spontaneous recurrent seizures (99.6 vs 142 hours, P = .016), ameliorated the severity of spontaneous recurrent seizures (P , .05), and inhibited mossy fiber sprouting (Timm index, 0.31 vs 0.03; P = .003). Matrix metalloproteinase activity was upregulated during epileptogenesis in an MPO-dependent manner (1.44 vs 0.94 U/mg, P = .049), suggesting that MPO acts upstream of matrix metalloproteinases. MPO activity was mapped during epileptogenesis in vivo in the hippocampal regions. Resected temporal lobe tissue from a human patient with refractory epilepsy but not the temporal lobe tissue from a patient without seizures demonstrated positive MPO immunostaining, suggesting high translational potential for this imaging technology. Conclusion:The findings of this study highlight an important role for MPO in epileptogenesis and show MPO to be a potential therapeutic target and imaging biomarker for epilepsy.q RSNA, 2015

Objective This study aimed to describe symptom prevalence and quality of life impact from lower urinary tract symptoms (LUTS) in women living with female genital mutilation (FGM) in the United States. Methods A convenience sample of English-speaking women with FGM were invited to complete an anonymous survey including the Female Lower Urinary Tract Symptoms questionnaire to assess symptom prevalence and bother and the Pelvic Floor Impact Questionnaire-7 to assess quality of life impact from pelvic floor disorders. Data are reported as median (interquartile range). Correlations were calculated using Spearman ρ. Results Thirty women with an age of 29 (24–40) years were included. Sixty-seven percent self-identified as black/African and 77% were Muslim. Women reported being circumcised between ages 1 week and 16 years (median, 6 years). Forty percent reported type I circumcision, 23% reported type II, 23% reported type III, and 13% were unsure. Fifty percent were vaginally parous. Seventy-three percent of women reported the presence of LUTS. Twenty-seven percent voided at least 9 times per day, and 60% had nocturia at least 2 times. Bothersome voiding symptoms were commonly reported: urinary hesitancy (40%), strained urine flow (30%), and intermittent urine stream (47%). Fifty-three percent reported urgency urinary incontinence and 43% reported stress urinary incontinence. Symptom prevalence and bother were correlated for all 12 items (ρ = 0.51–0.90, P < 0.001). Median Pelvic Floor Impact Questionnaire-7 score was 102 (8–144), with 63% reporting urinary symptoms having “moderate” or “quite a bit of” impact on their activities, relationships, or feelings. Conclusion Lower urinary tract symptoms are common and bothersome in women with FGM. Providers caring for patients with FGM should inquire about LUTS.