Adverse childhood experiences (ACE) are transdiagnostic developmental risk factors for various mental and physical health issues, including Opioid Use Disorder (OUD). Existing research demonstrated ACE not only affects the onset, severity, and comorbidity of disorders, but also affects treatment responses. To investigate whether and how ACE modulates treatment effects of Mindfulness Based Intervention (MBI), we conducted secondary analysis on the longitudinal data from a recent clinical trial on the effects of a MBI during outpatient buprenorphine treatment. Using data from a RCT that randomized (1:1) a total of 196 patients with OUD into a live online group intervention with either a 24-week MBI or a matched recovery support control group, we conducted temporal path analysis with the following outcome measures: self-critical rumination, pain catastrophizing, pain interference, severity of depression and anxiety. Both treatment arms had significant reduction of all symptom measures, but the MBI arm had a significant mechanistic path of ACE (baseline) ➔Self-Critical Rumination (week 8)➔Pain Catastrophizing (week 16) ➔ Pain Interference (week 24), which was not significant in the control arm. Only in the MBI arm, ACE severity was significantly correlated with score reductions of Self-Critical Rumination (week 8), which was not significant in the control arm. ACE modulated treatment responses to MBI, through a mechanistic path in which symptom changes of Self-Critical Rumination was a mediator between ACE and psychological symptom changes of pain catastrophizing and pain interference, suggesting Self-Critical Rumination can be considered as a therapeutic target in future intervention development.
Methadone treatment dispensed at opioid treatment programs (OTPs) reduces the risk of fatal opioid-related overdose. Access to OTPs is limited in many regions. We utilized location-allocation models to identify gaps in OTP services across Massachusetts and generated descriptive statistics to further prioritize areas for expansion of services for socially vulnerable communities. We used a geographic information system to generate eight location-allocation models, tools to target the placement of new sites based on the distribution of existing sites and demand for services, with a goal of identifying gaps in geographic access to OTPs. We identified potential new OTP locations using 15- and 30-minute walk- and drive-times, considering the location of existing OTPs. We used opioid-related incident (ORI) locations and overdose decedent residences to measure methadone demand. We ranked suggested OTPs for each model by how many ORIs or decedent residences they could serve as the nearest OTP. We calculated mean Social Vulnerability Index scores, population density, fatal opioid-related overdose rates, and ORI rates for census tracts within a 30-minute walk of each suggested site. We also ran supplementary location-allocation analyses that ignored the locations of existing OTPs. Our models consistently recommended new OTP service locations to address unmet needs in the Roxbury and Dorchester neighborhoods of Boston, Lowell, Pittsfield, New Bedford, Gardner, Quincy, Malden, Peabody, Falmouth, Nantucket, and Martha's Vineyard, Massachusetts. Of all suggested new treatment centers, those in Boston, Gardner, Peabody, and Lowell could serve as the closest OTP for the most ORIs or decedent residences. Suggested new OTPs in Boston, Gardner, Springfield, Quincy, New Bedford, and Lowell were in areas with high social vulnerability. Our walk-time models suggested sites in areas with higher community-level social vulnerability than our drive-time models. Areas with existing OTPs had higher average social vulnerabilities than suggested new OTP locations. Location-allocation models that ignored existing OTPs still suggested OTP locations close to current methadone clinics. Through our location-allocation models and vulnerability assessments, we recommended potential locations for new OTPs to provide increased methadone access within areas of high fatal overdose and ORI burden. Results can inform data-to-action expansion of OTP access.
Polygenic scores (PGSs) for body mass index (BMI) may guide early prevention and targeted treatment of obesity. Using genetic data from up to 5.1 million people (4.6% African ancestry, 14.4% American ancestry, 8.4% East Asian ancestry, 71.1% European ancestry and 1.5% South Asian ancestry) from the GIANT consortium and 23andMe, Inc., we developed ancestry-specific and multi-ancestry PGSs. The multi-ancestry score explained 17.6% of BMI variation among UK Biobank participants of European ancestry. For other populations, this ranged from 16% in East Asian-Americans to 2.2% in rural Ugandans. In the ALSPAC study, children with higher PGSs showed accelerated BMI gain from age 2.5 years to adolescence, with earlier adiposity rebound. Adding the PGS to predictors available at birth nearly doubled explained variance for BMI from age 5 onward (for example, from 11% to 21% at age 8). Up to age 5, adding the PGS to early-life BMI improved prediction of BMI at age 18 (for example, from 22% to 35% at age 5). Higher PGSs were associated with greater adult weight gain. In intensive lifestyle intervention trials, individuals with higher PGSs lost modestly more weight in the first year (0.55 kg per s.d.) but were more likely to regain it. Overall, these data show that PGSs have the potential to improve obesity prediction, particularly when implemented early in life.
Purpose The sacroiliac joint (SIJ) is estimated to be a source of pain in 15%-30% of patients presenting for the evaluation of low back pain. The SIJ may develop symptoms in an estimated 43% of patients who have had previous lumbar fusion surgeries. With increased awareness of SIJ as a pain source and for those patients who have intractable pain and who fail nonoperative treatment, surgery to stabilize the SIJ is becoming more common. Thus multiple different technologies and techniques need to be evaluated. The purpose of this study is to report on the clinical and radiographic follow-up of percutaneous lateral-oblique sacroiliac joint fusion with a threaded compression screw performed in an outpatient ambulatory surgery center (ASC). Methods Three consecutive patients were chosen for this technique, and after completion, were followed for at least 24 months as part of a pilot study to see how they responded to the treatment. The medical charts of these patients were reviewed along with follow-up radiographs and computed tomography (CT) scans to assess for radiographic fusion designated as bridging bone across the SIJ with no signs of implant loosening such as haloes around the screws, change in position, or screw breakage. The SacroFuse (Sacrix LLC, Boston, MA) SIJ screws were 12 mm x 60 mm at S1 and 12 mm x 50 mm at S2 with threads for compressive fixation and cannulated for percutaneous placement over a guidewire. We evaluated patients' demographics, the pain visual analog scale (VAS) score, and the Oswestry Disability Index (ODI) preoperatively and postoperatively. Results Our first patient was a 51-year-old male body mass index (BMI) 33.3 kg/m2 with a previous lumbar fusion. He underwent a two-staged SIJ fusion. The first surgery was done as an open direct lateral surgery, and the second stage was performed three months later using a direct percutaneous lateral-oblique technique for three months. The second and third patients, respectively, were 22-year-old female status prior L5-S1 anterior lumbar interbody fusion (ALIF) plus right posterior unilateral pedicle screws. She had a BMI of 38.3 kg/m2. The third patient was a 41-year-old male with a BMI of 29.5 kg/m2 who underwent lateral-oblique bilateral percutaneous SIJ fixation. The latest CT imaging of each patient demonstrated increased bone density adjacent and within implants with intra-articular osseous bridging. There were no implant failures or complications. Conclusion This pilot study demonstrated the feasibility and effectiveness of a new percutaneous lateral-oblique SIJ fusion technique with a threaded compression screw done safely in an ASC. Patients demonstrated early pain relief and long-term fusion of their SIJ. We introduced the Sacrix line as a key fluoroscopic landmark for the success of this percutaneous technique.
This report discusses the case of a male refugee from East Africa who presented with persistent right shoulder pain and was found to have a periscapular mass, whose diagnostic and therapeutic delay was due not only to fragmentation of care, but also a lack of awareness of musculoskeletal manifestations of extrapulmonary tuberculosis. This case underscores the importance of including tuberculosis in the differential diagnosis for a variety of symptoms in patients with risk factors, even if they report previous negative screening.
The primary aim of this pilot study was to determine whether the dexmedetomidine infusion initiated immediately after laparoscopic bariatric surgery, offers an advantage over a morphine infusion with respect to rescue morphine and paracetamol requirements over the first 24 post-operative hours. Sixty morbidly obese adult patients scheduled for laparoscopic bariatric surgery were randomly assigned to receive an infusion of either 0.3 mcg/kg/h dexmedetomidine (Group D) or 3 mg/h Morphine (Group M) for 24 h immediately post-operatively. All patients received standardized general anesthesia and were evaluated and treated for pain in the intensive care unit by providers who were blinded to their treatment group. The primary outcome was the need for supplemental, "rescue" paracetamol (Dolargan. Hikma, Jordan) and morphine titrated to achieve visual analog scales (VAS) of <40 and <70, respectively. A total of 60 patients (77 % female, mean age 33.5 years ± 9.5 and body mass index (BMI) 43.0 ± 4.5) were randomized to Group M and 30 to Group D. There were no significant differences in mean rescue paracetamol and morphine requirements. Mean total morphine requirements in Group D were 6.1 ± 3.1 mg, whereas 72.9 ± 2.2 mg in Group M (p < 0.0001). An intravenous infusion of dexmedetomidine, initiated and continued for 24 h following laparoscopic bariatric surgery, can decrease the overall morphine requirements during this period. This pilot study demonstrated that the post-operative initiation of dexmedetomidine can be morphine sparing following laparoscopic bariatric surgery.
A rare meteorite has revealed evidence of a massive lost world that once orbited the young Sun before being destroyed in a catastrophic collision。 The discovery suggests some early planets formed from dramatically different materials than Earth and Mars, rewriting part of the solar system’s origin story
NASA says a long-running air leak aboard the ISS recently worsened, leading engineers to investigate new suspected crack locations and consider a riskier repair strategy。 Astronauts were temporarily moved into a safe haven as a precaution before the repair was postponed for further analysis
A clever nanoscale redesign may have solved one of superconductivity’s biggest problems。 Researchers in Sweden discovered that by subtly sculpting the surface beneath an ultrathin superconducting material, they could make it stay superconducting at higher temperatures and under much stronger magnetic fields
NASA has selected the Artemis III crew for a high-stakes 2027 mission designed to test the future of lunar exploration。 Astronauts will launch aboard Orion and perform unprecedented docking operations with lunar landers being developed by both Blue Origin and SpaceX。 The mission will require a remarkable sequence of heavy-lift rocket launches and c
A new technique could solve one of the biggest challenges in making future computer chips from ultrathin materials。 Researchers found that coating molybdenum disulfide with oxygen or fluorine lets manufacturers remove just the top layer of atoms much more safely during plasma processing。 The result is a cleaner, more controlled path toward smaller
Physicists have solved a long-standing problem involving systems that appear to violate Newton’s third law, such as bird flocks and bacterial swarms。 By adding carefully designed “imaginary partners” to their models, they can now simulate these complex systems with unprecedented accuracy
JWST has revealed dramatic differences between the dawn and dusk regions of the scorching exoplanet WASP-121 b。 Fierce winds appear to carry heat from the planet’s permanent dayside, making the evening side hotter and more expanded。 Scientists also found signs that water is being broken apart by extreme temperatures and that mysterious mineral clou
Scientists have uncovered a surprising connection between quantum gravity and an exotic quantum state of matter that could explain why the universe isn’t expanding wildly fast。 The study suggests that the very shape of space-time may protect the cosmological constant from disruptive quantum effects
A bold claim that the universe’s accelerating expansion was an illusion has been put to the test—and failed。 Researchers found that the study behind the controversy made key mistakes when analyzing supernova data。 After revisiting the evidence, astronomers concluded that cosmic acceleration remains as strong as ever