Joint hypermobility syndrome (JHS) is common in patients presenting to rheumatologists and can cause a range of symptoms leading to physical and psychological distress. Chronic musculoskeletal pain in patients with JHS often responds poorly to analgesics, and a pain management approach may be helpful. Since patients with JHS often have beliefs and experiences different to those of other chronic pain patients, they could fare better in JHS-specific programmes. Here, we report on the outcomes of patients in a JHS cognitive behavioural pain management programme. Patients fulfilling the Brighton criteria for JHS, who had suffered pain for at least 3 months, were assessed by a psychologist and physiotherapist for suitability for this programme. Those accepted took part in a programme of 8 days spread over 6 weeks, delivered by a multidisciplinary team and incorporating a cognitive behavioural approach. Outcomes were assessed at baseline, 1- and 5-month post-programme using validated outcome measures. Outcome measures at baseline and 1-month were available for 87 patients (96 % female, mean age 35 years). There were significant improvements in self-efficacy, pain catastrophising, depression, anxiety, frustration, impact of pain and average pain intensity (all P < 0.001). Although by 5 months all these outcomes had regressed towards pre-programme levels there remained significant improvements compared to baseline in all except average pain intensity. This open study shows that patients with JHS experienced significant benefits after attending a JHS-specific pain management programme, which were still evident 5 months later. Longer-term controlled studies are required.
Neuropathic pain (NP) is not easy to understand for those with the diagnosis. Even in specialist medical services, explanation may not be given or may not be integrated with patients' existing beliefs about their conditions. We were curious about how people with NP conceptualised the problem. Web sites relevant to NP were used to recruit 79 people with NP. They were sampled using Q-methodology, which requires sorting according to degree of agreement or disagreement with diverse statements about NP, derived from the widest possible range of sources. The sets of sorted statements are analysed for factors which represent shared constructions. The four factors that we found differed in important ways: (1) identification of nerve damage as cause; (2) the necessity of identifying cause; (3) the acceptability of symptomatic treatment; (4) the existence or not of psychological influences; and (5) the usefulness of psychological treatment. The meaning of these factors was extended by participants' free comments: certain viewpoints showed associations with their medical and treatment histories and with the interference of pain with daily life. Overall, a biopsychosocial model of pain was only weakly represented, and no integrated model of pain emerged across the four different accounts. There was little reference to NP having been explained when the diagnosis was made. This study highlights the need for more accessible explanations of NP within and outside medical services if people with NP are to use their understanding of NP to help them manage their pain and reduce its impact on their lives.
OBJECTIVE: Our aim was to investigate if circulating microRNAs (miR-NAs) in human follicular fluid (FF) could be used as helpful biomarkers for predicting IVF/ICSI outcomes. DESIGN: In this prospective study, a pool of FF was retrieved for each patient during IVF/ICSI procedure. A total of 91 FF samples from women with normal ovarian reserve (n¼91) were collected at oocyte retrieval day. MATERIALS AND METHODS: For each patient, all follicles were aspirated and all FF samples were pooled. MicroRNAs were extracted from each FF pool and quantified by RT-qPCR, using TaqMan technology. The expressions of miR-320a, let-7b and miR-29a were analyzed in FF and related to IVF/ICSI outcomes. RESULTS: FF pools related to low number of mature oocytes (%2) contained significant lower miR-320a expression levels than those related to high number of mature oocytes (>2), respectively (p¼0.03). Moreover, significant high let-7b levels were found in FF pools related to embryo cohorts with a high total blastomere number/total embryo number ratio at day 3 (>8, ie accelerated development) than in those with normal developmental kinetics (ratio between 6 and 8) (p¼0.02). Interestingly, we found a significant and negative correlation between FF let-7b expression levels and blastulation rate (r¼-0.33, p¼0.003). The Receiving Operator Curve (ROC) analysis indicated that the performance of FF let-7b in predicting the expanded blastocyst development was 0.67 (0.54-0.79), with 70% sensitivity and 64.3% specificity (p¼0.02). In addition, the area under the ROC curve (AUC), evaluating the potential of FF miR-29a in predicting clinical pregnancy outcome reached 0.68 [0.55-0.79] with a high sensitivity of 83.3% and a specificity of 53.5% (p¼0.01). CONCLUSIONS: Our results suggest that circulating miRNAs constitute non-invasive powerful tools in IVF process to predict embryo development and clinical pregnancy outcomes, in order to promote personalized IVF strategy.
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