Yoga is effective for treating chronic pain in veterans with Gulf War Illness at long-term follow-up

BACKGROUND

Clinical Practice Guidelines for Gulf War Illness (GWI) recommend integrative health approaches such as yoga for relief from symptoms, yet little is known about the long-term efficacy of yoga in reducing symptoms of GWI. Here, we evaluated the long-term efficacy of yoga and cognitive-behavioral therapy (CBT) chronic pain treatment in a randomized controlled trial (RCT) of 75 Veterans (57 men, 42-71 ± 7.1 years of age) with Gulf War Illness (GWI).

METHODS

Participants received either 10 weeks of yoga or 10 weeks of CBT for chronic pain. The primary outcome measures were pain severity, and pain interference (Brief Pain Inventory-Short Form). The secondary outcome measures were fatigue, as indicated by a measure of functional exercise capacity (6-Minute Walk Test), depression, autonomic symptom severity, and quality of life. Piecewise linear mixed models were used to examine study hypotheses.

RESULTS

Compared to the CBT group, yoga was associated with greater reductions in pain severity during the 6-month follow-up period (group × time interaction: b = 0.036, se = 0.014, p = .011). Although we did not find between-group differences in the other primary or secondary outcome measures during follow-up (p's > 0.05), exploratory analyses revealed within-group improvements in pain interference, total pain (an experimental outcome variable which combines pain severity and interference), and fatigue in the yoga group (p's < 0.05) but not in the CBT group.

CONCLUSIONS

This is the first study to report long-term follow-up results of yoga as a treatment for GWI. Our results suggest that yoga may offer long-term efficacy in reducing pain, which is a core symptom of GWI.

TRIAL REGISTRATION

Secondary analyses of ClinicalTrials.gov NCT02378025.

Investigating Inter- and Intra-individual Differences in Tai Chi Practice Time, Pain, and Mood Among Participants with Chronic Nonspecific Neck Pain: Secondary Analysis of a Randomized Controlled Trial

Background: Tai Chi is emerging as a promising treatment for a variety of pain conditions, including chronic nonspecific neck pain. Given this trend, it is important to better understand the dose-response relationship and how pain, anxiety, and depression impact this relationship. Method: This secondary analysis used data from the Tai Chi arm (age = 52.03 ± 10.92 years; 73.68% female; n = 38) of a randomized controlled trial for chronic nonspecific neck pain. The authors tested whether (1) greater home practice time or cumulative practice time during the intervention predicted greater post-treatment reductions in neck pain intensity and (2) reporting greater neck pain intensity during the current week relative to other weeks was associated with lower home practice time during the current week. Post hoc analyses were conducted to evaluate whether baseline anxiety and depression levels moderated the association between weekly pain intensity and weekly home practice time. Results: While cumulative Tai Chi practice time (i.e., home practice + class time) was associated with post-treatment reductions in neck pain intensity, home practice time alone was not associated with post-treatment reductions in neck pain. Participants with low and moderate baseline anxiety were found to practice less than usual on weeks when pain intensity was worse, while participants with high baseline anxiety were found to practice more than usual on weeks when pain intensity was worse. Baseline depression levels did not moderate the effect of weekly pain intensity on weekly home practice time. Conclusions: Combined class and at-home exposure to Tai Chi appears to be critical to reductions in chronic nonspecific neck pain. In addition, anxiety may be an important characteristic that partially governs the dose-response relationship in participants with chronic nonspecific neck pain. Clinical Trial Registration: NCT02222051.

Examining the temporal dynamics of anxiety and depressive symptoms during a therapist-supported, smartphone-based intervention for depression: Longitudinal observational study

OBJECTIVE

This study examined the temporal dynamics of anxiety and depressive symptoms during a 12-week therapist-supported, smartphone-delivered digital health intervention for symptoms of depression and anxiety.

METHODS

A total of 290 participants were included in the present analyses (age Mean = 39.64, SD = 10.25 years; 79% female; 54% self-reported psychotropic medication use). Linear mixed models were used to examine the concurrent anxiety-depression association and (2) the lead-lag anxiety-depression relationship, with greater anxiety predicted to precede an increase in depression.

RESULTS

In support of Hypothesis 1, greater anxiety during the current biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment. In support of Hypothesis 2, greater anxiety during the prior biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment but not vice-versa.

CONCLUSION

These findings demonstrate that anxiety and depressive symptoms may overlap and fluctuate in concert, with anxiety symptoms predicting subsequent depressive symptoms but not vice-versa. With sensitivity to study limitations, implications for future intervention designs are discussed.

A prospective study of social competence in survivors of pediatric brain and solid tumors

BACKGROUND/OBJECTIVES

Survivors of pediatric brain tumors are at increased risk for difficulties with social competence, including poor social information processing (SIP) and peer relationships. Improved survival rates heighten the need to better understand these challenges and if they are specific to survivors of pediatric brain tumors versus survivors of other childhood cancers.

METHODS

Fifty-one survivors of pediatric brain tumors and 34 survivors of pediatric solid tumors completed evaluations of SIP and peer relationship quality within six months of completing treatment and one year later. Caregivers completed a measure of social skills. Linear mixed models evaluated differences between survivors of pediatric brain and solid tumors on SIP and social skills and how indices of SIP were associated with peer relationships over time.

RESULTS

The two groups did not differ on indices of SIP or social skills over time. A three-way interaction between measures of SIP, group, and time predicted peer relationships. Survivors of pediatric solid tumors showed a positive association between baseline social skills and theory of mind and peer relationships over time, whereas survivors of pediatric brain tumors showed an inverse association between baseline social skills and theory of mind and peer relationships over time.

CONCLUSION

Findings revealed unanticipated associations between baseline SIP and social skills and peer relationships over time among survivors of pediatric brain tumors. Additional research is needed to elucidate the factors most influential on peer relationships in this group to inform interventions.

Mutual synchronization of spin-torque oscillators within a ring array

An array of spin torque nano-oscillators (STNOs), coupled by dipolar interaction and arranged on a ring, has been studied numerically and analytically. The phase patterns and locking ranges are extracted as a function of the number N, their separation, and the current density mismatch between selected subgroups of STNOs. If \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$N\ge 6$$\end{document}N≥6 for identical current densities through all STNOs, two degenerated modes are identified an in-phase mode (all STNOs have the same phase) and a splay mode (the phase makes a 2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pi$$\end{document}π turn along the ring). When inducing a current density mismatch between two subgroups, additional phase shifts occur. The locking range (maximum current density mismatch) of the in-phase mode is larger than the one for the splay mode and depends on the number N of STNOs on the ring as well as on the separation. These results can be used for the development of magnetic devices that are based on STNO arrays.

Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors

Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors' aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator's experience, identifying with the perpetrator's aggression, and replacing one's agency with that of the perpetrator were significantly associated with survivors' inward and outward aggression. Moreover, profile type-that is, having high versus low levels of identification with the aggressor-was implicated in participants' SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.

Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial

IMPORTANCE

Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD.

OBJECTIVE

To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment.

DESIGN, SETTING, AND PARTICIPANTS

In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020.

INTERVENTIONS

CBGT and MBSR.

MAIN OUTCOMES AND MEASURES

Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment.

RESULTS

Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (β, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment.

CONCLUSIONS AND RELEVANCE

The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02036658.

Evening salivary cortisol as a single stress marker in women with metastatic breast cancer

BACKGROUND

Flattened diurnal salivary cortisol patterns predict shorter subsequent survival with breast, lung, and renal cell carcinomas. The underlying cause of this flattened slope is undetermined, though it has been hypothesized to be secondary to a deficit in the amplitude of the circadian clock. To gain greater insight into the portions of the diurnal salivary curve that are associated with cancer survival, we examined (1) which points in the diurnal curve are predictive of the slope of the curve and (2) whether elevated evening cortisol levels alone are associated with reduced HPA-axis feedback inhibition (i.e., decreased sensitivity to the dexamethasone suppression test).

METHOD

We examined study hypotheses on adult women with advanced breast cancer (age = 54.3 ± 9.58 years; n = 99) using non-parametric Wilcoxon's rank-sum tests, Spearman correlation coefficients and an accuracy formula based on a confusion matrix. Cortisol was sampled five times per day for three consecutive days, with dexamethasone administered late on the second day.

RESULTS

Salivary cortisol concentrations did not vary between those with flat and steep slopes during the morning (p's > .05), but did vary in the evening (p's < 0.05). Furthermore, the concentration of the 2100h alone was 86% accurate in discriminating between individuals classified as having "flat" or "steep" slopes. Dexamethasone suppression was only associated with diurnal salivary cortisol slope (p = .0042).

CONCLUSIONS

Evening cortisol levels are a sensitive indicator flattened diurnal cortisol slope, suggesting evening cortisol may also be a useful predictor of breast cancer survival. Future research should focus on determining the causes of abnormally increased evening cortisol.

Magnetostatic interaction between two bubble skyrmions

A detailed analytic and numerical analysis of the interaction between two bubble skyrmions has been carried out. The results from the micromagnetic calculations show that when the skyrmions are in the same plane, the magnetic parameters vary weakly as a function of the separation between them. On the other hand, when the skyrmions are located in the same vertical axis, the magnetic parameters show a strong variation as a function of the separation of the skyrmions. In particular, when a magnetic disk is over another, there is a transition from a Bloch-like skyrmion configuration to a Néel-like skyrmion configuration as the distance between the disks decreases, as a consequence of the magnetostatic interaction. Therefore, it is possible to stabilize a bubble skyrmion with a Néel configuration without the Dzyaloshinskii-Moriya interaction. Thus, these results can be used for the control of the skyrmion parameters in magnetic spintronic devices that need to use these configurations.

Ultrafast domain wall propagation due to the interfacial Dzyaloshinskii-Moriya interaction

It is shown that the interplay between curvature and interfacial Dzyalonshinsky-Moriya interaction (DMI) is a pathway to ultrafast domain wall (DW) dynamics in ferromagnetic nanotubes. In this work, we theoretically study the effect that interfacial DMI has on the average velocity of a vortex DW in thin ferromagnetic nanotubes grown around a core composed of heavy atoms. Our main result shows that by delaying the Walker breakdown instability, the DW average velocity is of the order of 10³ m s^-1, which is greater than usual values for these systems. The remarkable velocities achieved through this configuration could greatly benefit the development of spintronic devices.

Synchronization of two spin-transfer-driven nano-oscillators coupled via magnetostatic fields

The magnetization dynamics of nano-oscillators may be excited by both magnetic fields and spin-polarized currents. While the dynamics of single oscillators has been well characterized, the synchronization of several ones is not fully understood yet. An analytical and numerical study of the nonlinear dynamics of two magnetostatically coupled spin valves driven by spin-transfer torques is presented under the macrospin approximation. The oscillators interact via magnetostatic fields and exhibit a robust synchronized magnetization motion. We describe the magnetization dynamics of the system using the Landau-Lifshitz-Gilbert-Slonczewski equation. Using a modal decomposition technique, we describe the dynamics, synchronization, and competition of oscillatory modes as a function of the current density, and the geometrical parameters of the setup. Simulations of the Landau-Lifshitz-Gilbert-Slonczewski equation show good agreement with an approximate analytic solution.

Abstract P4-11-04: Palliative care and older women with advanced breast cancer in Mexico

Background: Mexico is an upper-middle income country, as other developing regions, there is an accelerated aging of the population that will double the absolute number of new breast cancer (BC) cases by 2035. Unfortunately, the incidence of stage III and IV in women older than 65 years old represented 45% of new cases (higher than high-income regions); also, 21% had diabetes, 41.1% hypertension and 71% overweight/obese. These factors make our older adults patients with BC a high-risk population of recurrence and dead from disease.

Objective: Describe the characteristics of older women with BC that received palliative care in a multidisciplinary setting.

Patients and Methods:A cross-sectional, retrospective, descriptive of 178 patients with advanced breast cancer, older than 65 years from our data based, that were referred to palliative service during 2010-2016 at National Cancer Institute, Mexico. Statistical analysis was done with STATA V12.0. We described clinical, pathological and sociodemographic characteristics of this older women with advanced BC and analyzed the risk factors that influence dead. Approval from IRB was obtained.

Results:The median age was 75 years old (range 69-82), 71(41%) was widows, 51(29%) had none education, 93(52%) had elementary school. Highlights that 93 (52%) of the patients evaluated had any income source. Diabetes was present in 43(24%), hypertension in 81 (46%) and cardiopathy in 17(10%) of cases. ECOG-2 were 58 (33%) patients, ECOG-3 was in 47 (26%)patients and ECOG-4 was reported in 19 (11%). None patient had geriatric assessment. Affected metastasis sites were bone 90 (51%), lung 66 (37%), central nervous system 31 (17%), liver 27 (15%). 69 (62%) patients had hormonal receptor positive, 17 (15%) triple negative, 12 (11%) HER2positive and 13(12%) of the cases were triple positive, 41 (74%) patients had Ki-67 higher than 50%. Polypharmacy was identified in 77 (43%) of the patients. The median survival after the admission in the palliative service was 2 months (IQR 0-10). After a logistic regression univariate Ki-67&gt;20% (OR 10.25), triple negative (OR 1.5), HER2 positive (OR 2.3), influence negative survival.

Conclusions: Management of BC in the elderly is complex. Our data show that we have highly vulnerable population. Additionally, we found an unfortunate late reference to palliative care services that limited the impact of the multidisciplinary approach. We need to identify the barriers that influence this delay. Health care provides have a challenge in early reference of older women with advanced breast cancer patients to the palliative care and need to think in integrate to the multidisciplinary team a geriatrician with oncology perspective.

Citation Format: Cabrera-Galeana P, Sánchez N, Verastegui E, Rodriguez C, Bargallo E, Monreal E, Allende S. Palliative care and older women with advanced breast cancer in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-04.

Tailoring the nucleation of domain walls along multi-segmented cylindrical nanoelements

The magnetization reversal of three-segment cylindrical nanoelements comprising alternating nanowire and nanotube sections is investigated by means of Monte Carlo simulations. Such nanoelements may feature a three-state behaviour with an intermediate plateau in the hysteresis curve due to a metastable pinning of the domain walls (DWs) at the wire-tube interfaces. It turns out that vortex as well as transverse DWs contribute to the magnetization reversal. By varying the geometric parameters, the sequence, or the material of the elements the nucleation location of DWs, as well as their nucleation field, can be tailored. Especially interesting is the novel possibility to drive DWs coherently in the same or in opposite directions by changing the geometry of the hybrid nanoelement. This important feature provides additional flexibility to the construction of logical devices based on DW movement. Another prominent outcome is that DWs can be nucleated near the centre of the element and then traverse to the outer tips of the cylindrical structure when the applied field is increased, which also opens the possibility to use these three-segment nanoelements for the field-induced delivery of DWs as substitutes for large nucleation pads.

Asymmetric hysteresis loop in magnetostatic-biased multilayer nanowires

The hysteresis of multilayer nanowires composed by a soft magnetic cylindrical wire, a non-magnetic spacer layer and an external hard magnetic shell is investigated. The external magnetic shell originates a non-homogeneous magnetic field on the inner wire, which is responsible for a displacement and a change of the width of the hysteresis curve of the wire. Moreover, different reversal modes occur at each branch of the hysteresis loop, which can be understood by analyzing the interaction magnetostatic field along the wire. Our results open the possibility of controlling two parameters of the hysteresis loop, the coercivity and the bias, providing an interesting system to be investigated.

Goserelin followed by assisted reproduction: results in infertile women with endometriosis

OBJECTIVE

Demonstrate the usefulness of combined treatment of a Gn-RH agonist and assisted reproduction in the management of infertile women with endometriosis.

DESIGN

A prospective evaluation of goserelin's action (Gn-RH(a)) in the extension of endometriosis, of its suppression and clinical improvement, and in pregnancy rates after an immediate assisted reproduction program. SITE: Infertility clinic at a private hospital related to other university hospitals.

PATIENTS

18 infertile patients with laparoscopically-confirmed endometriosis.

METHOD

All women were submitted to general laboratory tests, FSH, LH and estradiol measurements, and laparoscopy before and after treatment. All were treated for 6 months with goserelin and, when menstruating, the patients were submitted to an assisted reproduction program with a scheme of HMG + FSH + HCG.

MAIN OUTCOME MEASURES

Improvement of endometriosis and achievement of pregnancy.

RESULTS

An improvement of the endometriosis score was confirmed in 100% of the cases. The average pretreatment score of 44.8 points decreased to 18.3 after treatment. Similarly, the pain reported by eight of the patients practically disappeared after using the Gn-RH analogue. During treatment with goserelin, all women had amenorrhea. Their periods resumed in an average of 80.5 days after the last injection. In three (17.6%) cases, no follicular response was obtained, and stimulation was suspended. The remaining responses were good: eight GIFT procedures, four IVF-ET procedures and two IUIs resulted in eight pregnancies (57.1%), one of which terminated in an abortion (the patient became pregnant again). The eight pregnancies had good results: one was double and another quadruple. Most importantly, all pregnancies were achieved during the first treatment attempt.

CONCLUSION

Combined treatment of goserelin with immediate assisted reproduction is a satisfactory procedure, which achieves a high percentage of pregnancies at the first try and with few abortions in cases of infertile women with endometriosis.

Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer

BACKGROUND AND OBJECTIVES

Neurolytic superior hypogastric plexus block has been shown to be safe and effective in selected cancer patients. A large cohort of patients was studied to evaluate the continued efficacy and safety of this block in cancer patients with advanced disease.

METHODS

A total of 227 pelvic pain patients with gynecological, colorectal, or genitourinary cancer who experienced poor pain control due to either progression of disease or to untoward side effects were enrolled in this study during a 3-year period. All pain patients receiving oral opioids were eligible to participate. A bilateral percutaneous neurolytic superior hypogastric plexus block with 10% phenol was performed 1 day after a successful diagnostic block with 0.25% bupivacaine.

RESULTS

All patients reported a visual analog scale (VAS) pain score of 7-10/10 before the block. A positive response to a diagnostic block was obtained in 159 patients (79%). Overall, 115 patients of the 159 patients who responded to a diagnostic block (72%, 95% confidence interval of 65-79%) had satisfactory pain relief (VAS < 4/10), 99 (62%) after one block, and 16 (10%) after a second block. The remaining 44 patients (28%) had moderate pain control (VAS 4-7/10) after two blocks and received oral pharmacological therapy and epidural analgesic therapy with good results. Both groups experienced significant reductions in oral opioid therapy after the neurolytic blocks. No additional blocks were required by patients who had a good response during a follow-up period of 3 months. No complications related to the block were detected.

CONCLUSIONS

Neurolytic superior hypogastric plexus block provided both effective pain relief and a significant reduction in opioid usage (43%) in 72% of the patients who received a neurolytic block. Overall, this represents 51% of the patients enrolled in the study. Poor results should be expected in patients with extensive retroperitoneal disease overlying the plexus because of inadequate spread of the neurolytic agent.

Opioid availability in Latin America: the declaration of Florianopolis

Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.