1 33 129 A CASE STUDY OF CHIROPRACTIC MANAGEMENT OF PREGNANCY-RELATED HEARTBURN WITH POSTULATED FETAL EPIGENOME IMPLICATIONS. OBJECTIVE: THIS CASE STUDY REPORTS ON CHIROPRACTIC CARE FOR PREGNANCY-RELATED HEARTBURN. THE PURPOSE OF THIS ARTICLE IS TO RELATE THE BENEFIT OF CHIROPRACTIC TREATMENT FOR ONE INDIVIDUAL, TO CONTRAST CHIROPRACTIC MANAGEMENT WITH THE BIOMEDICAL STANDARD OF CARE FOR PREGNANCY-RELATED HEARTBURN, AND TO POINT TO POTENTIAL EPIGENETIC IMPLICATIONS OF THE STANDARD OF CARE. CLINICAL FEATURES: A 32-YEAR-OLD WOMAN WHO WAS 24 WEEKS PREGNANT PRESENTED WITH PERSISTENT HEARTBURN THAT SHE WAS TREATING WITH RANITIDINE (ZANTAC(R)) AND CALCIUM CARBONATE (TUMS(R)) DAILY AT THE INITIATION OF CHIROPRACTIC CARE. INTERVENTION AND OUTCOME: FINDINGS OF THE INITIAL EXAMINATION WERE THORACIC INTERSEGMENTAL DYSFUNCTION AND PAIN UPON PALPATION OF THE DIAPHRAGM, WITH HYPERTONICITY NOTED. THERAPY LOCALIZATION WAS POSITIVE FOR REFLEXES ASSOCIATED WITH THE ESOPHAGUS AND LOWER ESOPHAGEAL SPHINCTER, SUGGESTING SPASMS. EMOTIONAL COMPONENTS ALSO WERE IDENTIFIED IN ASSOCIATION WITH THE SYMPTOMS BY THE USE OF A MIND-BODY THERAPY CALLED NEUROEMOTIONAL TECHNIQUE. THE PATIENT WAS TREATED BY ADJUSTING THE THORACIC SPINE, MANUALLY RELEASING THE DIAPHRAGM SPASMS, AND RELEASING THE ESOPHAGEAL SPASM WITH AN ACTIVATOR (A SMALL HAND-HELD INSTRUMENT THAT CREATES A PERCUSSIVE FORCE). THE PATIENT WAS SYMPTOM-FREE AND DID NOT USE MEDICATION AFTER THE FIFTH TREATMENT. SHE WAS FOLLOWED THROUGHOUT THE REMAINDER OF HER PREGNANCY AND WAS ASYMPTOMATIC AND REQUIRED NO FURTHER TREATMENT. CONCLUSIONS: A LARGER STUDY SHOULD INVESTIGATE THE EFFECTIVENESS OF CHIROPRACTIC CARE FOR THE TREATMENT OF PREGNANCY-RELATED HEARTBURN. 2012 2 5845 24 STUDY PROTOCOL FOR THE EPIGENETIC CHARACTERIZATION OF ANGOR PECTORIS ACCORDING TO THE AFFECTED CORONARY COMPARTMENT: GLOBAL AND COMPREHENSIVE ASSESSMENT OF THE RELATIONSHIP BETWEEN INVASIVE CORONARY PHYSIOLOGY AND MICRORNAS. BACKGROUND: MICRORNAS (MIRNAS) ARE NONCODING RNAS INVOLVED IN POST-TRANSCRIPTIONAL GENETIC REGULATION WITH A PROPOSED ROLE IN INTERCELLULAR COMMUNICATION. MIRNAS ARE CONSIDERED PROMISING BIOMARKERS IN ISCHEMIC HEART DISEASE. INVASIVE PHYSIOLOGICAL EVALUATION ALLOWS A PRECISE ASSESSMENT OF EACH AFFECTED CORONARY COMPARTMENT. ALTHOUGH SOME STUDIES HAVE ASSOCIATED THE EXPRESSION OF CIRCULATING MIRNAS WITH INVASIVE PHYSIOLOGICAL INDEXES, THEIR GLOBAL RELATIONSHIP WITH CORONARY COMPARTMENTS HAS NOT BEEN ASSESSED. HERE, WE WILL EVALUATE CIRCULATING MIRNAS PROFILES ACCORDING TO THE CORONARY PATTERN OF THE VASCULAR COMPARTMENT AFFECTATION. STUDY AND DESIGN: THIS IS AN INVESTIGATOR-INITIATED, MULTICENTRE, DESCRIPTIVE STUDY TO BE CONDUCTED AT THREE CENTRES IN SPAIN (NCT05374694). THE STUDY WILL INCLUDE ONE HUNDRED CONSECUTIVE PATIENTS OLDER THAN 18 YEARS WITH CHEST PAIN OF PRESUMED CORONARY CAUSE UNDERGOING INVASIVE PHYSIOLOGICAL EVALUATION, INCLUDING FRACTIONAL FLOW RESERVE (FFR) AND INDEX OF MICROVASCULAR RESISTANCE (IMR). PATIENTS WILL BE INITIALLY CLASSIFIED INTO FOUR GROUPS, ACCORDING TO FFR AND IMR: MACROVASCULAR AND MICROVASCULAR AFFECTATION (FFR/=25), ISOLATED MACROVASCULAR AFFECTATION (FFR0.80 / IMR >/=25) AND NORMAL CORONARY INDEXES (FFR>0.80 / IMR<25). PATIENTS WITH ISOLATED MICROVASCULAR AFFECTATION OR NORMAL INDEXES WILL ALSO UNDERGO THE ACETYLCHOLINE TEST AND MAY BE RECLASSIFIED AS A FIFTH GROUP IN THE PRESENCE OF SPASM. A PANEL OF MIRNAS PREVIOUSLY ASSOCIATED WITH MOLECULAR MECHANISMS LINKED TO CHRONIC CORONARY SYNDROME WILL BE ANALYSED USING RT-QPCR. CONCLUSIONS: THE RESULTS OF THIS STUDY WILL IDENTIFY MIRNA PROFILES ASSOCIATED WITH PATTERNS OF CORONARY AFFECTATION AND WILL CONTRIBUTE TO A BETTER UNDERSTANDING OF THE MECHANISTIC PATHWAYS OF CORONARY PATHOLOGY. 2023 3 500 21 ASSOCIATION BETWEEN NEUROPATHIC PAIN CHARACTERISTICS AND DNA METHYLATION OF TRANSIENT RECEPTOR POTENTIAL ANKYRIN 1 IN HUMAN PERIPHERAL BLOOD. ELUCIDATION OF EPIGENETIC MECHANISMS CORRELATING WITH NEUROPATHIC PAIN IN HUMANS IS CRUCIAL FOR THE PREVENTION AND TREATMENT OF THIS TREATMENT-RESISTANT PAIN STATE. IN THE PRESENT STUDY, ASSOCIATIONS BETWEEN NEUROPATHIC PAIN CHARACTERISTICS AND DNA METHYLATION OF THE TRANSIENT RECEPTOR POTENTIAL ANKYRIN 1 (TRPA1) GENE WERE EVALUATED IN CHRONIC PAIN PATIENTS AND PREOPERATIVE PATIENTS. PAIN AND PSYCHOLOGICAL STATES WERE PROSPECTIVELY ASSESSED IN PATIENTS WHO SUFFERED CHRONIC PAIN OR WERE SCHEDULED FOR THORACIC SURGERY. NEUROPATHIC CHARACTERISTICS WERE ASSESSED USING THE DOULEUR NEUROPATHIQUE 4 (DN4) QUESTIONNAIRE. DNA METHYLATION LEVELS OF THE CPG ISLANDS IN THE TRPA1 GENE WERE EXAMINED USING WHOLE BLOOD. FORTY-EIGHT ADULT PATIENTS WERE ENROLLED IN THIS STUDY. INCREASES IN DNA METHYLATION RATES AT CPG -51 SHOWED POSITIVE CORRELATIONS WITH INCREASES IN THE DN4 SCORE BOTH IN PREOPERATIVE AND CHRONIC PAIN PATIENTS. COMBINED METHYLATION RATES AT CPG -51 IN THESE PATIENTS ALSO SIGNIFICANTLY INCREASED TOGETHER WITH INCREASE IN DN4 SCORES. NEUROPATHIC PAIN CHARACTERISTICS ARE LIKELY ASSOCIATED WITH METHYLATION RATES AT THE PROMOTER REGION OF THE TRPA1 GENE IN HUMAN PERIPHERAL BLOOD. 2020 4 1785 22 EFFECT OF APABETALONE ON CARDIOVASCULAR EVENTS IN DIABETES, CKD, AND RECENT ACUTE CORONARY SYNDROME: RESULTS FROM THE BETONMACE RANDOMIZED CONTROLLED TRIAL. BACKGROUND AND OBJECTIVES: CKD AND TYPE 2 DIABETES MELLITUS INTERACT TO INCREASE THE RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS (I.E., CARDIOVASCULAR DEATH, NONFATAL MYOCARDIAL INFARCTION, OR STROKE) AND CONGESTIVE HEART FAILURE. A MALADAPTIVE EPIGENETIC RESPONSE MAY BE A CARDIOVASCULAR RISK DRIVER AND AMENABLE TO MODIFICATION WITH APABETALONE, A SELECTIVE MODULATOR OF THE BROMODOMAIN AND EXTRATERMINAL DOMAIN TRANSCRIPTION SYSTEM. WE EXAMINED THIS QUESTION IN A PRESPECIFIED ANALYSIS OF BETONMACE, A PHASE 3 TRIAL. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: BETONMACE WAS AN EVENT-DRIVEN, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL COMPARING EFFECTS OF APABETALONE VERSUS PLACEBO ON MAJOR ADVERSE CARDIOVASCULAR EVENTS AND HEART FAILURE HOSPITALIZATIONS IN 2425 PARTICIPANTS WITH TYPE 2 DIABETES AND A RECENT ACUTE CORONARY SYNDROME, INCLUDING 288 PARTICIPANTS WITH CKD WITH EGFR <60 ML/MIN PER 1.73 M(2) AT BASELINE. THE PRIMARY END POINT IN BETONMACE WAS THE TIME TO THE FIRST MAJOR ADVERSE CARDIOVASCULAR EVENT, WITH A SECONDARY END POINT OF TIME TO HOSPITALIZATION FOR HEART FAILURE. RESULTS: MEDIAN FOLLOW-UP WAS 27 MONTHS (INTERQUARTILE RANGE, 20-32 MONTHS). IN PARTICIPANTS WITH CKD, APABETALONE COMPARED WITH PLACEBO WAS ASSOCIATED WITH FEWER MAJOR ADVERSE CARDIOVASCULAR EVENTS (13 EVENTS IN 124 PATIENTS [11%] VERSUS 35 EVENTS IN 164 PATIENTS [21%]; HAZARD RATIO, 0.50; 95% CONFIDENCE INTERVAL, 0.26 TO 0.96) AND FEWER HEART FAILURE-RELATED HOSPITALIZATIONS (THREE HOSPITALIZATIONS IN 124 PATIENTS [3%] VERSUS 14 HOSPITALIZATIONS IN 164 PATIENTS [9%]; HAZARD RATIO, 0.48; 95% CONFIDENCE INTERVAL, 0.26 TO 0.86). IN THE NON-CKD GROUP, THE CORRESPONDING HAZARD RATIO VALUES WERE 0.96 (95% CONFIDENCE INTERVAL, 0.74 TO 1.24) FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND 0.76 (95% CONFIDENCE INTERVAL, 0.46 TO 1.27) FOR HEART FAILURE-RELATED HOSPITALIZATION. INTERACTION OF CKD ON TREATMENT EFFECT WAS P=0.03 FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND P=0.12 FOR HEART FAILURE-RELATED HOSPITALIZATION. PARTICIPANTS WITH CKD SHOWED SIMILAR NUMBERS OF ADVERSE EVENTS, REGARDLESS OF RANDOMIZATION TO APABETALONE OR PLACEBO (119 [73%] VERSUS 88 [71%] PATIENTS), AND THERE WERE FEWER SERIOUS ADVERSE EVENTS (29% VERSUS 43%; P=0.02) IN THE APABETALONE GROUP. CONCLUSIONS: APABETALONE MAY REDUCE THE INCIDENCE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH CKD AND TYPE 2 DIABETES WHO HAVE A HIGH BURDEN OF CARDIOVASCULAR DISEASE. 2021 5 6418 27 THE TEMPORAL EXPRESSION OF CIRCULATING MICRORNAS AFTER ACUTE EXPERIMENTAL PAIN IN HUMANS. BACKGROUND: MICRORNAS (MIRNAS) CAN MODULATE SEVERAL BIOLOGICAL SYSTEMS, INCLUDING THE PAIN SYSTEM. THIS STUDY AIMED TO EVALUATE THE TEMPORAL EXPRESSION OF CIRCULATING MIRNAS IN THE PLASMA OF HEALTHY VOLUNTEERS AS A MARKER FOR EPIGENETIC CHANGES BEFORE AND AFTER AN ACUTE, EXPERIMENTAL, PAIN PROVOCATION BY INTRAMUSCULAR HYPERTONIC SALINE INJECTION. METHODS: TWENTY VOLUNTEERS WERE RANDOMLY ALLOCATED INTO TWO GROUPS AND RECEIVED EITHER HYPERTONIC (PAIN) OR ISOTONIC (CONTROL) SALINE INJECTION IN THE FIRST DORSAL INTEROSSEOUS MUSCLE OF THEIR DOMINANT HAND. PAIN INTENSITY WAS CONTINUOUSLY RECORDED FOR 20 MINUTES AFTER INJECTION ON A VAS SCALE FROM 0 TO 100 (0 INDICATES NO PAIN AND 100 THE WORST IMAGINABLE PAIN). BLOOD SAMPLES WERE TAKEN AT BASELINE, 30 MINUTES, 3 HOURS, AND 24 HOURS POST-INJECTION, AND PLASMA WAS SEPARATED. MIRNA EXTRACTS WERE USED FOR RNA SEQUENCING WITH THE ILLUMINA NEXTSEQ PLATFORM. MIRNA TRANSCRIPTS WERE COMPARED BETWEEN THE PAIN AND THE NO-PAIN, CONTROL GROUP AT EVERY TIME POINT. SIGNIFICANT DIFFERENCES WERE CONSIDERED WHEN FOLDS WERE >2 AND THE FALSE DISCOVERY RATE WAS P < 0.05. RESULTS: AFTER 30 MINUTES, 4 MIRNAS WERE SIGNIFICANTLY ALTERED IN THE PAIN GROUP COMPARED TO CONTROLS, WHICH INCREASED TO 24 AFTER 3 HOURS AND TO 42 AFTER 24 HOURS FROM BASELINE (P < 0.0001). TWO MIRNAS WERE CONSISTENTLY UPREGULATED THROUGHOUT THE EXPERIMENT. ENRICHMENT ANALYSIS SHOWED SIGNIFICANT MIRNAS INVOLVED IN BRAIN PERCEPTION OF PAIN, BRAIN SIGNALLING AND RESPONSE TO STIMULI. CONCLUSIONS: THIS EXPLORATORY STUDY IS THE FIRST TO REPORT ON THE TEMPORAL EXPRESSION OF CIRCULATING MIRNAS AFTER AN ACUTE, HUMAN EXPERIMENTAL MUSCLE PAIN MODEL. SIGNIFICANCE: THIS EXPLORATORY STUDY EVALUATED THE TEMPORAL PROFILE OF CIRCULATING MIRNAS IN THE PLASMA OF HEALTHY SUBJECTS AFTER ACUTE EXPERIMENTAL PAIN. SEVERAL MIRNAS WERE ALTERED IN SUBJECTS AT THE TIMES OF FOLLOW-UP AFTER THE ACUTE PAIN MODEL WHEN COMPARED TO CONTROLS. MIRNAS PREVIOUSLY ASSOCIATED WITH PAIN PROCESSES WERE ALTERED IN THE PAIN GROUP. OUR RESULTS, BY SHOWING THE FAST AND PROLONGED MODIFICATIONS OF MIRNA ELICITED BY THE ACUTE EXPERIMENTAL PAIN MODEL, ADD NEW PERSPECTIVES TO THE TOPIC OF EPIGENETICS AND PAIN. 2023 6 4708 27 NO ASSOCIATION OF POLYMORPHISMS IN NAV1.7 OR NERVE GROWTH FACTOR RECEPTOR GENES WITH TRIGEMINAL NEURALGIA. OBJECTIVE: TRIGEMINAL NEURALGIA IS DEFINED AS A SUDDEN SEVERE SHOCK-LIKE PAIN WITHIN THE DISTRIBUTION OF THE TRIGEMINAL NERVE. PAIN IS A SUBJECTIVE EXPERIENCE THAT IS INFLUENCED BY GENDER, CULTURE, ENVIRONMENT, PSYCHOLOGICAL TRAITS, AND GENES. SODIUM CHANNELS AND NERVE GROWTH FACTOR PLAY IMPORTANT ROLES IN THE TRANSMISSION OF NOCICEPTIVE SIGNALS AND PAIN. THE AIM OF THIS STUDY WAS TO INVESTIGATE THE OCCURRENCE OF NAV1.7 SODIUM CHANNEL AND NERVE GROWTH FACTOR RECEPTOR TRKA GENE POLYMORPHISMS (SCN9A/RS6746030 AND NTRK1/RS633, RESPECTIVELY) IN TRIGEMINAL NEURALGIA PATIENTS. METHODS: NINETY-SIX SUBJECTS FROM PAIN SPECIALTY CENTERS IN THE SOUTHEASTERN REGION OF BRAZIL WERE DIVIDED INTO 2 GROUPS: 48 WITH CLASSICAL TRIGEMINAL NEURALGIA DIAGNOSIS AND 48 CONTROLS. PAIN WAS EVALUATED USING THE VISUAL ANALOG SCALE AND MULTIDIMENSIONAL MCGILL PAIN QUESTIONNAIRE. GENOMIC DNA WAS OBTAINED FROM ORAL SWABS IN ALL INDIVIDUALS AND WAS ANALYZED BY REAL-TIME POLYMERASE CHAIN REACTION. RESULTS: NO ASSOCIATION WAS OBSERVED BETWEEN EVALUATED POLYMORPHISMS AND TRIGEMINAL NEURALGIA. FOR ALLELE ANALYSES, PATIENTS AND CONTROLS HAD SIMILAR FREQUENCIES FOR BOTH GENES. GENOTYPE DISTRIBUTION OR ALLELE FREQUENCIES OF POLYMORPHISMS ANALYZED HERE DID NOT CORRELATE TO PAIN SCORES. CONCLUSIONS: ALTHOUGH NO ASSOCIATION OF EVALUATED POLYMORPHISMS AND TRIGEMINAL NEURALGIA DIAGNOSIS OR PAIN SEVERITY WAS OBSERVED, OUR DATA DO NOT EXCLUDE THE POSSIBILITY THAT OTHER GENOTYPES AFFECTING THE EXPRESSION OF NAV1.7 OR TRKA ARE ASSOCIATED WITH THE DISEASE. FURTHER STUDIES SHOULD INVESTIGATE DISTINCT GENETIC POLYMORPHISMS AND EPIGENETIC FACTORS THAT MAY BE IMPORTANT IN EXPRESSION OF THESE MOLECULES. 2019 7 448 26 APABETALONE MEDIATED EPIGENETIC MODULATION IS ASSOCIATED WITH FAVORABLE KIDNEY FUNCTION AND ALKALINE PHOSPHATASE PROFILE IN PATIENTS WITH CHRONIC KIDNEY DISEASE. BACKGROUND/AIMS: THE ASSOCIATION BETWEEN SERUM ALKALINE PHOSPHATASE (ALP) WITH ADVERSE CARDIOVASCULAR OUTCOMES, IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS HAS PREVIOUSLY BEEN REPORTED AND MAY BE A RESULT OF INCREASED VASCULAR CALCIFICATION AND INFLAMMATION. HERE WE REPORT, FOR THE FIRST TIME, THE EFFECTS OF PHARMACOLOGIC EPIGENETIC MODULATION ON LEVELS OF ALP AND KIDNEY FUNCTION VIA A NOVEL ORAL SMALL MOLECULE BET INHIBITOR, APABETALONE, IN CKD PATIENTS. METHODS: A POST-HOC ANALYSIS EVALUATED PATIENTS WITH ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) <60 ML/MIN/1.73M2, WHO PARTICIPATED IN THE APABETALONE PHASE 2 RANDOMIZED CONTROLLED TRIALS (SUSTAIN AND ASSURE). 48 CKD SUBJECTS WITH A HISTORY OF CARDIOVASCULAR DISEASE (CVD) WERE TREATED WITH 100MG TWICE-DAILY OF 24 AND 26 WEEKS OF APABETALONE OR PLACEBO. ALP AND EGFR WERE MEASURED PRIOR TO RANDOMIZATION AND AT FINAL VISITS. RESULTS: PATIENTS WHO RECEIVED APABETALONE (N=35) VERSUS PLACEBO (N=13) OVER 6 MONTHS SHOWED SIGNIFICANTLY (P=0.02) LOWERED SERUM ALP -14.0% (P<0.0001 VERSUS BASELINE) VERSUS -6.3% (P=0.9 VERSUS BASELINE). THE EGFR IN THE APABETALONE GROUP INCREASED BY 3.4% (1.7 ML/MIN/1.73 M2) (P=0.04 VERSUS BASELINE) AND DECREASED BY 5.8% (2.9 ML/MIN/1.73 M2) (P=0.6 VERSUS BASELINE) IN THE PLACEBO GROUP. APABETALONE WAS WELL TOLERATED. CONCLUSION: A POST-HOC ANALYSIS OF CKD SUBJECTS FROM THE SUSTAIN AND ASSURE RANDOMIZED CONTROLLED TRIALS DEMONSTRATED FAVORABLE EFFECTS OF APABETALONE ON ALP AND EGFR, AND GENERATED THE HYPOTHESIS THAT EPIGENETIC MODULATION BY BET INHIBITION MAY POTENTIALLY OFFER A NOVEL THERAPEUTIC STRATEGY TO TREAT CVD AND PROGRESSIVE KIDNEY FUNCTION LOSS IN CKD PATIENTS. THIS IS BEING EXAMINED IN THE PHASE III TRIAL BETONMACE. 2018 8 4522 24 MULTIDIMENSIONAL EVALUATION OF THE PAIN PROFILE AS PROGNOSTIC FACTOR IN INDIVIDUALS WITH HIP OR KNEE OSTEOARTHRITIS RECEIVING TOTAL JOINT REPLACEMENT: PROTOCOL OF A 2-YEAR LONGITUDINAL PROGNOSTIC COHORT STUDY. INTRODUCTION: KNEE AND HIP OSTEOARTHRITIS ARE TWO HIGHLY PREVALENT MUSCULOSKELETAL PAIN CONDITIONS. UNSUCCESSFUL RATES AFTER HIP/KNEE REPLACEMENT RANGE FROM 10% TO 20%. SUBJECTS WITH SENSITISATION MANIFESTATIONS ARE VULNERABLE TO WORSE CLINICAL OUTCOMES. MOST STUDIES HAVE ANALYSED OUTCOMES UP TO 1 YEAR AFTER SURGERY. THE AIM OF THIS 2-YEAR LONGITUDINAL STUDY WILL BE TO EVALUATE SENSORY-RELATED, PSYCHOLOGICAL AND PSYCHOPHYSICAL PAIN SENSITISATION MANIFESTATIONS AND A POTENTIAL EPIGENETIC BIOMARKER AS PROGNOSTIC CLINICAL OUTCOMES FOR THE DEVELOPMENT OF CHRONIC POSTOPERATIVE PAIN AFTER KNEE OR HIP REPLACEMENT. METHODS AND ANALYSIS: A PROSPECTIVE LONGITUDINAL STUDY WITH A 2-YEAR FOLLOW-UP PERIOD WILL BE CONDUCTED. THE PROGNOSTIC VARIABLES WILL INCLUDE PAIN, FUNCTION, RELATED-DISABILITY, ANXIETY, DEPRESSION, QUALITY OF LIFE, SENSITISATION-ASSOCIATED SYMPTOMS, KINESIOPHOBIA, NEUROPATHIC PAIN AND CATASTROPHISING, AND EXPECTATIVE OF THE INTERVENTION WILL BE ASSESSED BEFORE SURGERY. WE WILL ALSO EVALUATE THE PRESENCE OF THE VAL158MET POLYMORPHISM AS A POSSIBLE EPIGENETIC MARKER. CLINICAL OUTCOMES INCLUDING PAIN, RELATED-DISABILITY AND SELF-PERCEIVED SATISFACTION, SENSITISATION-ASSOCIATED SYMPTOMS AND NEUROPATHIC PAIN WILL BE ASSESSED 3, 6, 12, 18 AND 24 MONTHS AFTER SURGERY. THESE VARIABLES WILL BE USED TO CONSTRUCT THREE PREDICTION MODELS: (1) PAIN AND FUNCTION, (2) SENSITISATION-ASSOCIATED SYMPTOMATOLOGY AND (3) NEUROPATHIC PAIN FEATURES CLASSIFYING THOSE PATIENTS IN RESPONDERS AND NON-RESPONDERS. DATA FROM KNEE OR HIP OSTEOARTHRITIS WILL BE ANALYSED SEPARATELY. STATISTICAL ANALYSES WILL BE CONDUCTED WITH LOGISTIC REGRESSIONS. ETHICS AND DISSEMINATION: THE STUDY HAS BEEN APPROVED BY THE ETHICS COMMITTEE OF BOTH INSTITUTIONS INVOLVED (HOSPITAL UNIVERSITARIO FUNDACION ALCORCON (HUFA) 19-141 AND UNIVERSIDAD REY JUAN CARLOS (URJC) 0312201917319). PARTICIPANTS WILL SIGN THE WRITTEN INFORMED CONSENT BEFORE THEIR INCLUSION. STUDY RESULTS WILL BE DISSEMINATED THROUGH PEER-REVIEWED PUBLICATIONS AND PRESENTATIONS AT SCIENTIFIC MEETINGS. 2023 9 6304 29 THE QUEBEC LOW BACK PAIN STUDY: A PROTOCOL FOR AN INNOVATIVE 2-TIER PROVINCIAL COHORT. INTRODUCTION: THE NEUROBIOLOGICAL MECHANISMS UNDERLYING RECOVERY FROM OR PERSISTENCE OF LOW BACK PAIN (LBP) REMAIN MISUNDERSTOOD, LIMITING PROGRESS TOWARD EFFECTIVE MANAGEMENT. WE HAVE DEVELOPED AN INNOVATIVE TWO-TIER DESIGN TO STUDY THE TRANSITION FROM ACUTE TO CHRONIC LBP. THE OBJECTIVE OF THE FIRST TIER IS TO CREATE A PROVINCIAL WEB-BASED INFRASTRUCTURE TO RECRUIT AND MONITOR THE TRAJECTORY OF INDIVIDUALS WITH ACUTE LBP. THE OBJECTIVE OF THE SECOND TIER IS TO FUEL HYPOTHESIS-DRIVEN SATELLITE DATA COLLECTION CENTERS WITH SPECIALIZED EXPERTISE TO STUDY THE ROLE OF BIOMECHANICAL, EPIGENETIC, GENETIC, NEUROANATOMICAL, ONTOLOGICAL, PHYSIOLOGICAL, PSYCHOLOGICAL, AND SOCIOECONOMIC FACTORS IN LBP CHRONICITY. METHODS: THIS ARTICLE DESCRIBES THE FIRST TIER OF THE PROTOCOL: ESTABLISHMENT OF THE CORE DATASET AND COHORT. ADULTS WITH ACUTE LBP WILL BE RECRUITED THROUGH NETWORKS, MEDIA, AND HEALTH CARE SETTINGS. A WEB-BASED INTERFACE WILL BE USED TO COLLECT SELF-REPORTED VARIABLES AT BASELINE AND AT 3, 6, 12, AND 24 MONTHS. ACUTE LBP WILL BE DEFINED ACCORDING TO THE DIONNE 2008 CONSENSUS. MEASUREMENTS WILL INCLUDE THE CANADIAN MINIMUM DATA SET FOR CHRONIC LBP RESEARCH, DN4 FOR NEUROPATHIC PAIN, COMORBIDITIES, EQ-5D-5L FOR QUALITY OF LIFE, AND LINKAGE WITH PROVINCIAL MEDICO-ADMINISTRATIVE DATABASES. THE PRIMARY OUTCOME WILL BE THE TRANSITION TO CHRONIC LBP, AS DEFINED BY DEYO 2014. SECONDARY OUTCOMES INCLUDE HEALTH CARE RESOURCE UTILIZATION, DISABILITY, SICK LEAVE, MOOD, AND QUALITY OF LIFE. PERSPECTIVE: THIS STUDY BRINGS TOGETHER DIVERSE RESEARCH EXPERTISE TO INVESTIGATE THE TRANSITION FROM ACUTE TO CHRONIC LBP, CHARACTERIZE THE PROGRESSION TO RECOVERY OR CHRONICITY, AND IDENTIFY PATTERNS ASSOCIATED WITH THAT PROGRESSION. 2020 10 3850 27 IS GENDER A FACTOR AFFECTING LONG-TERM HETEROTOPIC OSSIFICATION INCIDENCE AFTER SINGLE-LEVEL CERVICAL DISC ARTHROPLASTY? BACKGROUND: CERVICAL DISC DISEASES HAVE BEEN TREATED BY CERVICAL DISC ARTHROPLASTY (CDA). NEVERTHELESS, SOME PATIENTS WILL EXPERIENCE A MOBILITY FAILURE IN THEIR CERVICAL PROSTHESES OVER TIME BECAUSE OF HETEROTOPIC OSSIFICATION. THE AIM OF THIS STUDY WAS TO INVESTIGATE THE ROLE OF GENDER IN LONG-TERM OUTCOMES AFTER CDA. METHODS: A RETROSPECTIVE, SINGLE-CENTER STUDY OF PATIENTS WHO UNDERWENT SINGLE-LEVEL CDA WITH A BRYAN CERVICAL DISC PROSTHESIS WAS PERFORMED, INCLUDING A NARRATIVE REVIEW ABOUT GENDER DIFFERENCES IN BOTH STRUCTURAL AND BIOMECHANICAL FEATURES OF THE CERVICAL SPINE. RESULTS: STUDY PATIENTS (14 MEN, 30 WOMEN) HAD AN AVERAGE FOLLOW-UP OF 9.8 +/- 3.2 YEARS. SIGNIFICANT DIFFERENCES EMERGED BETWEEN GENDERS FOR SPECIFIC ITEMS IN NECK DISABILITY INDEX PREOPERATIVE EVALUATION, WITH WOMEN REPORTING WORSE PAIN SCORES (P = 0.05). AFTER STRATIFICATION BY AGE, WE FOUND A HIGHER PREOPERATIVE OVERALL NECK DISABILITY INDEX SCORE FOR FEMALE PATIENTS <36 YEARS OF AGE (P = 0.03). IN AN INTERGENDER, BODY MASS INDEX-SPECIFIC COMPARISON, WE ALSO FOUND A SIGNIFICANT DIFFERENCE IN NECK DISABILITY INDEX PREOPERATIVE SCORE WITH NORMAL-WEIGHT MALE PATIENTS FARING WORSE THAN OVERWEIGHT MALE PATIENTS (P = 0.05). AT A RADIOLOGICAL LEVEL, WE FOUND A TENDENCY TOWARD A HIGHER HETEROTOPIC OSSIFICATION INCIDENCE IN MALE PATIENTS (62% IN MEN, 17% IN WOMEN, P = 0.06). THE FEMALE CERVICAL SPINE HAS DISTINCTIVE FEATURES, INCLUDING BONE STRUCTURE, MUSCULAR ACTION, SOFT TISSUE RESPONSE, AND GENETIC AND EPIGENETIC RESPONSE TO OSTEOARTHRITIS. CONCLUSIONS: THE INCIDENCE OF MOBILITY FAILURE IN OUR SERIES OF SINGLE-LEVEL CDA WAS LOWER IN FEMALE PATIENTS. SEVERAL GENDER-SPECIFIC FACTORS BOTH IN STATIC AND IN DYNAMIC FEATURES MAY PLAY A SIGNIFICANT ROLE IN SPINAL PATHOLOGY AND CDA LONG-TERM RADIOLOGICAL OUTCOME. 2022 11 447 25 APABETALONE LOWERS SERUM ALKALINE PHOSPHATASE AND IMPROVES CARDIOVASCULAR RISK IN PATIENTS WITH CARDIOVASCULAR DISEASE. BACKGROUND AND AIMS: IN PATIENTS WITH CARDIOVASCULAR DISEASE, CONSIDERABLE RESIDUAL RISK REMAINS DESPITE EVIDENCE-BASED SECONDARY PREVENTION MEASURES. ALKALINE PHOSPHATASE (ALP) HAS BEEN SUGGESTED AS A MODIFIABLE CARDIOVASCULAR RISK FACTOR. WE SOUGHT TO DETERMINE WHETHER CARDIOVASCULAR RISK REDUCTION BY THE BROMODOMAIN AND EXTRA-TERMINAL (BET) PROTEIN INHIBITOR APABETALONE IS ASSOCIATED WITH THE CONCOMITANT LOWERING OF SERUM ALP. METHODS: IN A POST-HOC ANALYSIS OF 795 PATIENTS WITH ESTABLISHED CORONARY HEART DISEASE AND STATIN TREATMENT, WHO PARTICIPATED IN PHASE 2 PLACEBO-CONTROLLED TRIALS OF APABETALONE, WE DETERMINED THE EFFECT OF ASSIGNED TREATMENT FOR UP TO 24 WEEKS ON THE INCIDENCE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE) AND SERUM ALP. RESULTS: BASELINE ALP (MEDIAN 72 U/L) PREDICTED MACE (DEATH, NON-FATAL MYOCARDIAL INFARCTION, CORONARY REVASCULARIZATION, OR HOSPITALIZATION FOR CARDIOVASCULAR CAUSES), INDEPENDENT OF HIGH-SENSITIVITY C-REACTIVE PROTEIN (HSCRP), SEX, AGE, RACE, STUDY, CARDIOVASCULAR RISK FACTORS, CHRONIC KIDNEY DISEASE (CKD), LIVER FUNCTION MARKERS AND TREATMENT ALLOCATION (HAZARD RATIO [HR] PER STANDARD DEVIATION [SD] 1.6, 95% CI 1.19-2.16, P = 0.002). MEAN PLACEBO-CORRECTED DECREASES IN ALP FROM BASELINE WERE 9.2% (P < 0.001) AFTER 12-14 WEEKS AND 7.7% (P < 0.001) AFTER 24-26 WEEKS OF APABETALONE TREATMENT. IN THE APABETALONE GROUP, A 1-SD REDUCTION IN ALP WAS ASSOCIATED WITH A HR FOR MACE OF 0.64 (95% CI 0.46-0.90, P = 0.009). CONCLUSIONS: SERUM ALP PREDICTS RESIDUAL CARDIOVASCULAR RISK, INDEPENDENT OF HSCRP, ESTABLISHED CARDIOVASCULAR RISK FACTORS AND CKD, IN PATIENTS WITH CARDIOVASCULAR DISEASE ON STATIN TREATMENT. APABETALONE LOWERS SERUM ALP, WHICH WAS ASSOCIATED WITH A LOWER RISK OF CARDIOVASCULAR EVENTS. WHETHER THE BENEFICIAL CARDIOVASCULAR EFFECTS OF APABETALONE ARE CAUSALLY RELATED TO ALP REDUCTION REMAINS UNDETERMINED. 2019 12 67 30 A LONGITUDINAL STUDY OF THE ASSOCIATIONS OF BDNF GENOTYPE AND METHYLATION WITH POSTSTROKE ANXIETY. BACKGROUND: ALTHOUGH THE PRECISE ETIOLOGY OF POSTSTROKE ANXIETY (PSA) HAS YET TO BE FULLY ELUCIDATED, IT IS KNOWN THAT BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) IS IMPORTANT FOR NEURAL PLASTICITY AND LONG-TERM POTENTIATION, ASSOCIATED WITH THE PATHOPHYSIOLOGY OF ANXIETY. THE EXPRESSION OF BDNF IS REGULATED BY EPIGENETIC AND GENETIC PROFILES. THUS, WE INVESTIGATED THE ASSOCIATION BETWEEN BDNF METHYLATION STATUS AND PSA AT 2 WEEKS AND 1 YEAR AFTER STROKE WHILE ACCOUNTING FOR INTERACTIONS WITH THE BDNF VAL66MET POLYMORPHISM. METHODS: THE BASELINE SAMPLE COMPRISED 286 PATIENTS WHO WERE ASSESSED AT 2 WEEKS AFTER STROKE; OF THESE PATIENTS, 222 (78%) WERE FOLLOWED UP WITH AT 1 YEAR AFTER STROKE. THE PRESENCE OF PSA WAS DETERMINED USING THE ANXIETY SUBSCALE OF THE HOSPITAL ANXIETY AND DEPRESSION SCALE (HADS), AND THE EFFECTS OF BDNF METHYLATION STATUS AND POLYMORPHISMS ON PSA STATUS WERE ASSESSED WITH MULTIVARIATE LOGISTIC REGRESSION MODELS. RESULTS: THE PREVALENCE OF PSA WAS SLIGHTLY LOWER (27 [9.4%]) AT BASELINE, AND 35 (15.8%) PATIENTS WERE IDENTIFIED AS HAVING PSA AT THE 1-YEAR FOLLOW-UP. STROKE PATIENTS WITH A HIGHER AVERAGE METHYLATION STATUS WERE MORE LIKELY TO HAVE PSA AT 1 YEAR. THE BDNF VAL66MET POLYMORPHISM WAS NOT INDEPENDENTLY ASSOCIATED WITH PSA DURING EITHER THE ACUTE OR CHRONIC PHASE AFTER STROKE, BUT THERE WAS A SIGNIFICANT INTERACTIVE EFFECT BETWEEN BDNF METHYLATION AND GENOTYPE ON PSA AT 2 WEEKS. CONCLUSIONS: IN THIS STUDY, BDNF METHYLATION IN COMBINATION WITH THE MET/MET BDNF POLYMORPHISM (VAL66MET POLYMORPHISM) WAS ASSOCIATED WITH PSA. THESE FINDINGS MAY HELP IDENTIFY PATIENTS AT HIGHER RISK FOR PSA. 2019 13 190 23 ACETYL-L-CARNITINE IN PAINFUL PERIPHERAL NEUROPATHY: A SYSTEMATIC REVIEW. ACETYL-L-CARNITINE (ALC) HAS SHOWN A NEUROPROTECTIVE EFFECT IN PATIENTS WITH PERIPHERAL NEUROPATHIES OF DIFFERENT ETIOLOGIES. PRECLINICAL STUDIES DEMONSTRATED A CENTRAL ANTI-NOCICEPTIVE ACTION, BOTH IN NEUROPATHIC AND NOCICEPTIVE PAIN MODELS. THE PRESENT REVIEW AIMS TO PROVIDE THE KNOWLEDGE ON THE EFFICACY OF ALC IN PATIENTS WITH PAINFUL PERIPHERAL NEUROPATHY, BASED ON THE EVIDENCE. CONSISTENT WITH THE PRISMA STATEMENT, AUTHORS SEARCHED PUBMED, EMBASE AND THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS FOR RELEVANT PAPERS, INCLUDING THOSE ISSUED BEFORE APRIL 2018. TWO AUTHORS INDEPENDENTLY SELECTED STUDIES FOR INCLUSION AND DATA EXTRACTION: ONLY TRIALS INCLUDING PATIENTS WITH A DIAGNOSIS OF PERIPHERAL NEUROPATHY AND INVOLVING AT LEAST 10 PATIENTS WERE CONSIDERED FOR THE PURPOSES OF THIS REVIEW. FOURTEEN CLINICAL TRIALS WERE REVISED, TO PROVIDE THE LEVEL OF EVIDENCE FOR NEUROPATHY. TO ASSESS THE GLOBAL EFFICACY OF ALC IN PAINFUL PERIPHERAL NEUROPATHY, A META-ANALYSIS OF FOUR RANDOMIZED CONTROLLED TRIALS WAS PERFORMED. MEAN DIFFERENCE IN PAIN REDUCTION AS MEASURED ON A 10-CM VAS, AND 95% CIS WERE USED FOR POOLING CONTINUOUS DATA FROM EACH TRIAL. FOUR RANDOMIZED CONTROLLED TRIALS TESTED ALC IN PATIENTS WITH NEUROPATHY SECONDARY TO DIABETES AND TO ANTIRETROVIRAL THERAPY FOR HIV. COMPARED TO PLACEBO, ALC PRODUCED A SIGNIFICANT PAIN REDUCTION EQUAL TO 20.2% (95% CI: 8.3%-32.1%, P<0.0001) WITH RESPECT TO BASELINE. CLINICAL TRIALS ALSO SHOWED BENEFICIAL EFFECTS ON NERVE CONDUCTION PARAMETERS AND NERVE FIBER REGENERATION, WITH A GOOD SAFETY PROFILE. THESE DATA INDICATE THAT ALC PROVIDES AN EFFECTIVE AND SAFE TREATMENT IN PATIENTS WITH PAINFUL PERIPHERAL NEUROPATHY. WE RECOMMEND FURTHER STUDIES TO ASSESS THE OPTIMAL DOSE AND DURATION OF THE THERAPEUTIC EFFECT (ALSO AFTER TREATMENT WITHDRAWAL). 2019 14 1344 27 DETECTION OF BRAIN AMYLOID BETA DEPOSITION IN PATIENTS WITH NEUROPSYCHOLOGICAL IMPAIRMENT AFTER TRAUMATIC BRAIN INJURY: PET EVALUATION USING PITTSBURGH COMPOUND-B. OBJECTIVE: TRAUMATIC BRAIN INJURY (TBI) IS AN EPIGENETIC RISK FACTOR FOR ALZHEIMER'S DISEASE (AD) AND AMYLOID BETA (ABETA) DEPOSITION IS OBSERVED HISTOPATHOLOGICALLY IN THE TRAUMATIZED BRAIN. THIS STUDY WAS CONDUCTED TO DETECT CEREBRAL ABETA DEPOSITION USING AMYLOID POSITRON EMISSION TOMOGRAPHY (PET) IN PATIENTS WITH NEUROPSYCHOLOGICAL IMPAIRMENT AFTER TBI. METHODS: TWELVE PATIENTS WITH POST-TRAUMATIC NEUROPSYCHOLOGICAL IMPAIRMENT (11 MEN AND ONE WOMAN, AGE RANGE = 21-78 YEARS) WERE EXAMINED USING PITTSBURGH COMPOUND B ((11)C-PIB) PET AT THE CHRONIC STAGE AFTER TBI (RANGE = 5-129 MONTHS). RESULTS: (11)C-PIB WAS POSITIVE IN THREE PATIENTS AND NEGATIVE IN THE OTHER NINE PATIENTS. THERE WAS NO CORRELATION BETWEEN (11)C-PIB DEPOSITION AND THE SEVERITY OF INJURY; INITIAL CT FINDINGS; ELAPSED TIME FROM THE INJURY; AND NEUROPSYCHOLOGICAL TEST SCORES. CONCLUSIONS: THE ABSENCE OF ABETA DEPOSITION IN MANY PATIENTS WITH CHRONIC NEUROPSYCHOLOGICAL IMPAIRMENT AFTER TBI DOES NOT SUPPORT THE PREMISE THAT ABETA PATHOLOGY PROGRESSES OVER TIME IN THE TRAUMATIZED BRAIN. EARLY AND SEQUENTIAL (11)C-PIB PET EXAMINATION MAY CLARIFY THE TIME COURSE OF ABETA DEPOSITION IN THE TRAUMATIZED BRAIN AND THE RELATIONSHIP BETWEEN TRAUMATIC BRAIN INSULT AND SUBSEQUENT NEUROPSYCHOLOGICAL IMPAIRMENT. 2013 15 1490 34 DNA DIRECTED PRO-DOPAMINE REGULATION COUPLING SUBLUXATION REPAIR, H-WAVE((R)) AND OTHER NEUROBIOLOGICALLY BASED MODALITIES TO ADDRESS COMPLEXITIES OF CHRONIC PAIN IN A FEMALE DIAGNOSED WITH REWARD DEFICIENCY SYNDROME (RDS): EMERGENCE OF INDUCTION OF "DOPAMINE HOMEOSTASIS" IN THE FACE OF THE OPIOID CRISIS. ADDICTION IS A COMPLEX MULTIFACTORIAL CONDITION. ESTABLISHED GENETIC FACTORS CAN PROVIDE CLEAR GUIDANCE IN ASSESSING THE RISK OF ADDICTION TO SUBSTANCES AND BEHAVIORS. CHRONIC STRESS CAN ACCUMULATE, FORMING DIFFICULT TO RECOGNIZE ADDICTION PATTERNS FROM BOTH GENETIC AND EPIGENETIC (ENVIRONMENTAL) FACTORS. FURTHERMORE, PSYCHOLOGICAL/PHYSICAL/CHEMICAL STRESSORS ARE TYPICALLY CATEGORIZED LINEARLY, DELAYING IDENTIFICATION AND TREATMENT. THE PATIENT IN THIS CASE REPORT IS A CAUCASIAN FEMALE, AGED 36, WHO PRESENTED WITH CHRONIC PAIN AND PARTIAL DISABILITY FOLLOWING A SURGICALLY REPAIRED TRIMALLEOLAR FRACTURE. THE PATIENT HAD A HISTORY OF UNRESOLVED ATTENTION DEFICIT DISORDER AND AN MRI SCAN OF HER BRAIN REVEALED ATROPHY AND FUNCTIONAL ASYMMETRY. IN 2018, THE PATIENT ENTERED THE BAJAJ CHIROPRACTIC CLINIC, WHERE INITIAL TREATMENT FOCUSED ON RE-ESTABLISHING INTEGRITY OF THE SPINE AND LOWER EXTREMITY BIOMECHANICS AND GRADUATED INTO COGNITIVE BEHAVIOR STABILIZATION ASSISTED BY DNA PRO-DOPAMINE REGULATION GUIDED BY GENETIC ADDICTION RISK SEVERITY TESTING. DURING TREATMENT (2018-2021), PROGRESS ACHIEVED INCLUDED: IMPROVED COGNITIVE CLARITY, FOCUS, SLEEP, ANXIETY, AND EMOTIONAL STABILITY IN ADDITION TO PAIN REDUCTION (75%); ELIMINATION OF POWERFUL ANALGESICS; AND REDUCED INTAKE OF PREVIOUSLY UNADDRESSED ALCOHOLISM. TO HELP REDUCE HEDONIC ADDICTIVE BEHAVIORS AND PAIN, COUPLING OF H-WAVE WITH CORRECTIVE CHIROPRACTIC CARE SEEMS PRUDENT. WE EMPHASIZE THE IMPORTANCE OF GENETIC ASSESSMENT ALONG WITH ATTEMPTS AT INDUCING REQUIRED DOPAMINERGIC HOMEOSTASIS VIA PRECISION KB220PAM. IT IS HYPOTHESIZED THAT FROM PREVENTIVE CARE MODELS, A NEW STANDARD IS EMERGING INCLUDING SELF-AWARENESS AND ACCOUNTABILITY FOR REWARD DEFICIENCY AS A FUNCTION OF HYPODOPAMINERGIA. THIS CASE STUDY DOCUMENTS THE PROGRESSION OF A PATIENT DEALING WITH THE COMPLEXITIES OF AN INJURY, PAIN MANAGEMENT, COGNITIVE IMPAIRMENT, ANXIETY, DEPRESSION, AND THE APPLICATION OF UNIVERSAL HEALTH PRINCIPLES TOWARDS CORRECTION VERSUS PALLIATIVE CARE. 2022 16 524 32 ASSOCIATIONS OF BDNF GENOTYPE AND PROMOTER METHYLATION WITH ACUTE AND LONG-TERM STROKE OUTCOMES IN AN EAST ASIAN COHORT. BACKGROUND: BRAIN DERIVED NEUROTROPHIC FACTOR (BDNF) HAS BEEN SHOWN TO PLAY AN IMPORTANT ROLE IN POSTSTROKE RECOVERY. BDNF SECRETION IS INFLUENCED BY GENETIC AND EPIGENETIC PROFILES. THIS STUDY AIMED TO INVESTIGATE WHETHER BDNF VAL66MET POLYMORPHISM AND PROMOTER METHYLATION STATUS WERE ASSOCIATED WITH OUTCOMES AT TWO WEEKS AND ONE YEAR AFTER STROKE. METHODS AND FINDINGS: A TOTAL OF 286 PATIENTS WERE EVALUATED AT THE TIME OF ADMISSION AND TWO WEEKS AFTER STROKE, AND 222 (78%) WERE FOLLOWED ONE YEAR LATER IN ORDER TO EVALUATE CONSEQUENCES OF STROKE AT BOTH ACUTE AND CHRONIC STAGES. STROKE OUTCOMES WERE DICHOTOMISED INTO GOOD AND POOR BY THE MODIFIED RANKIN SCALE. STROKE SEVERITY (NATIONAL INSTITUTES OF HEALTH STROKE SCALE), PHYSICAL DISABILITY (BARTHEL INDEX), AND COGNITIVE FUNCTION (MINI-MENTAL STATE EXAMINATION) WERE MEASURED. ASSOCIATIONS OF BDNF GENOTYPE AND METHYLATION STATUS ON STROKE OUTCOMES AND ASSESSMENT SCALE SCORES WERE INVESTIGATED USING LOGISTIC REGRESSION, REPEATED MEASURES ANOVA AND PARTIAL CORRELATION TESTS. BDNF VAL66MET POLYMORPHISM WAS INDEPENDENTLY ASSOCIATED WITH POOR OUTCOME AT 2 WEEKS AND AT 1 YEAR, AND WITH WORSENING PHYSICAL DISABILITY AND COGNITIVE FUNCTION OVER THAT PERIOD. HIGHER BDNF PROMOTER METHYLATION STATUS WAS INDEPENDENTLY ASSOCIATED WITH WORSE OUTCOMES AT 1 YEAR, AND WITH THE WORSENING OF PHYSICAL DISABILITY AND COGNITIVE FUNCTION. NO SIGNIFICANT GENOTYPE-METHYLATION INTERACTIONS WERE FOUND. CONCLUSIONS: A ROLE FOR BDNF IN POSTSTROKE RECOVERY WAS SUPPORTED, AND CLINICAL UTILITY OF BDNF GENETIC AND EPIGENETIC PROFILE AS PROGNOSTIC BIOMARKERS AND A TARGET FOR DRUG DEVELOPMENT WAS SUGGESTED. 2012 17 3280 27 HERPES ZOSTER OPHTHALMICUS FOLLOWING ONABOTULINUMTOXINA ADMINISTRATION FOR CHRONIC MIGRAINE: A CASE REPORT AND LITERATURE REVIEW. BACKGROUND: THERE IS A GROWING BODY OF LITERATURE DOCUMENTING LOCAL HERPES ZOSTER OUTBREAK FOLLOWING PROCEDURES. THE MECHANISM UNDERLYING THESE OUTBREAKS REMAINS ELUSIVE. WE PRESENT A CASE OF ZOSTER FOLLOWING ONABOTULINUMTOXINA (BTX) FOR MIGRAINE AND A LITERATURE REVIEW. METHODS: CHART AND LITERATURE REVIEW. CASE: A 72-YEAR-OLD WOMAN WITH CHRONIC MIGRAINE RECEIVED BTX INJECTIONS FOR 3 YEARS WITHOUT INCIDENT. SHE HAD A HISTORY OF THORACIC ZOSTER WITH SUBSEQUENT POST-HERPETIC NEURALGIA. IN AUGUST 2013, 48 HOURS AFTER RECEIVING BTX INJECTIONS, SHE DEVELOPED A PAINFUL RASH IN THE RIGHT V1 DISTRIBUTION CONSISTENT WITH HERPES ZOSTER OPHTHALMICUS. ONE WEEK LATER THE RASH HAD RESOLVED WITHOUT TREATMENT. LITERATURE REVIEW: WE IDENTIFIED 65 (INCLUDING 2 FROM JUEL-JENSON) CASES OF ZOSTER REACTIVATION FOLLOWING MINOR PROCEDURES. THESE CASES TEND TO BE IN YOUNG PATIENTS WITHOUT SPECIFIC RISK FACTORS. OUTBREAKS CHARACTERISTICALLY OCCUR AT THE LEVEL OF EXPOSURE TO LOCAL TRAUMA. DISCUSSION: OUR REVIEW SUGGESTS THAT LOCAL TRAUMA, REGARDLESS OF THE NATURE OF STIMULI, MAY BE SUFFICIENT FOR ZOSTER REACTIVATION. WE HYPOTHESIZE THAT THE STRESSORS IN THESE REPORTED CASES EXERT A LOCAL EPIGENETIC INFLUENCE ON VIRAL TRANSCRIPTION, ALLOWING FOR VIRAL REACTIVATION. CONCLUSION: ZOSTER IS A POTENTIAL COMPLICATION OF BTX ADMINISTRATION FOR CHRONIC MIGRAINE IN ADULTS. PHYSICIAN AWARENESS CAN REDUCE THE SIGNIFICANT MORBIDITY ASSOCIATED WITH THIS DISEASE. 2015 18 6043 25 THE COMBINED PROGNOSTIC SIGNIFICANCE OF ALKALINE PHOSPHATASE AND INTRACRANIAL ARTERIAL CALCIFICATIONS IN HEMODIALYSIS PATIENTS. INTRODUCTION: THE PREVALENCE OF INTRACRANIAL ARTERIAL CALCIFICATION (ICAC) IN MAINTENANCE HEMODIALYSIS (MHD) PATIENTS IS ABOUT 90%, AND ITS SEVERITY IS CORRELATED WITH AGE, HEMODIALYSIS VINTAGE, AND MINERAL BONE DISEASE. ELEVATED CONCENTRATIONS OF CALCIUM AND PHOSPHORUS ARE NOT SUFFICIENT FOR MEDIAL CALCIFICATION BECAUSE OF INHIBITION BY PYROPHOSPHATE. ALKALINE PHOSPHATASE (ALP) PROMOTES CALCIFICATION BY HYDROLYZING EXTRACELLULAR PYROPHOSPHATE. EPIGENETIC MECHANISMS INVOLVING ALP INHIBITION BY APABETALONE WERE INVESTIGATED AS A POTENTIAL TARGET FOR PREVENTING VASCULAR CALCIFICATIONS (VCS). THIS STUDY ASSESSED THE COMBINED IMPACT OF VCS AND ELEVATED SERUM ALP ON MORTALITY AMONG CHRONIC HD PATIENTS. METHODS: VCS REPRESENTED BY ICAC WERE MEASURED SIMULTANEOUSLY WITH MINERAL BONE DISEASE PARAMETERS INCLUDING SERUM ALP OF MHD PATIENTS WHO UNDERWENT NONCONTRAST BRAIN COMPUTED TOMOGRAPHY FROM 2015 TO 2018 IN OUR INSTITUTION. RESULTS: THIS RETROSPECTIVE STUDY INCLUDED 150 MHD PATIENTS (MEAN AGE 71.3 +/- 12.1 YEARS, 60.1% MALE). OF THE TOTAL COHORT, 12 (7.8%) HAD NO BRAIN CALCIFICATIONS AND 69 (45.1%) HAD MULTIPLE INTRACRANIAL CALCIFICATIONS. CONSIDERING THE PATIENTS WITH NORMAL ALP AND NO CALCIFICATION AS THE REFERENCE GROUP YIELDED ADJUSTED ODDS RATIOS FOR ALL-CAUSE MORTALITY OF 4.6 (95% CI: 1.7-12.7) AMONG PATIENTS WITH BRAIN CALCIFICATIONS AND NORMAL ALP (P = 0.003) AND ODDS RATIOS FOR ALL-CAUSE MORTALITY OF 6.1 (95% CI: 2.1-17.7) AMONG PATIENTS WITH BRAIN CALCIFICATIONS AND ELEVATED ALP (P= 0.001). CONCLUSION: WE FOUND AN INDEPENDENT ASSOCIATION BETWEEN ICAC AND THE RISK OF DEATH AMONG MHD PATIENTS. THE COMBINED EFFECT OF ICAC AND ELEVATED ALP WAS ASSOCIATED WITH A HIGHER ODDS RATIO FOR ALL-CAUSE MORTALITY IN MHD PATIENTS AND MAY CONTRIBUTE TO THE RISK STRATIFICATION OF THESE PATIENTS. 2021 19 1292 26 DECREASED BLOOD PRESSURE IS RELATED TO CHANGES IN NF-KB PROMOTER METHYLATION LEVELS AFTER BARIATRIC SURGERY. BACKGROUND: OBESITY IS CHARACTERIZED BY A CHRONIC, LOW-GRADE INFLAMMATION, AND BARIATRIC SURGERY IS PROPOSED AS AN EFFECTIVE TREATMENT FOR REDUCING THE OBESITY-RELATED CO-MORBIDITIES. EPIGENETIC MODIFICATIONS COULD BE INVOLVED IN THE METABOLIC IMPROVEMENT AFTER SURGERY. OBJECTIVE: THE MAIN AIM OF THIS STUDY WAS TO EVALUATE WHETHER DNA METHYLATION PATTERN FROM GENES RELATED TO INFLAMMATION AND INSULIN RESPONSE IS ASSOCIATED WITH THE METABOLIC IMPROVEMENT AFTER BARIATRIC SURGERY IN MORBIDLY OBESE PATIENTS AND IF THESE CHANGES DEPEND ON THE SURGICAL PROCEDURE. SETTING: UNIVERSITY HOSPITAL, SPAIN. METHODS: WE STUDIED 60 SEVERELY OBESE PATIENTS; 31 UNDERWENT ROUX-EN-Y GASTRIC BYPASS AND 29 UNDERWENT LAPAROSCOPIC SLEEVE GASTRECTOMY. ALL PATIENTS WERE EXAMINED BEFORE AND AT 6 MONTHS AFTER BARIATRIC SURGERY. DNA METHYLATION PROFILE OF GENES RELATED TO THE INFLAMMATORY RESPONSE AND INSULIN SENSITIVITY WAS MEASURED BY PYROSEQUENCING. RESULTS: THE PROMOTER METHYLATION LEVELS OF THE NFKB1 GENE WERE INCREASED SIGNIFICANTLY AFTER SURGERY (2.16 +/- .9 VERSUS 2.8 +/- 1.03). THE DECREASE IN BLOOD PRESSURE, BOTH SYSTOLIC AND DIASTOLIC, AFTER SURGERY WAS SIGNIFICANTLY ASSOCIATED WITH THE CHANGES IN THE PROMOTER METHYLATION LEVELS OF THE NFKB1 GENE (BETA = -.513, P = .003 AND BETA = -.543, P = .004, RESPECTIVELY). A DECREASE IN INFLAMMATION STATUS, MEASURED BY HIGH SENSITIVITY C-REACTIVE PROTEIN VALUES, WAS ASSOCIATED WITH CHANGES IN SLC19A1 METHYLATION LEVELS. CONCLUSION: OUR STUDY SHOWS FOR THE FIRST TIME AN ASSOCIATION BETWEEN NFKB1 METHYLATION LEVELS AND BLOOD PRESSURE AFTER BARIATRIC SURGERY, HIGHLIGHTING THE POSSIBLE FUNCTION OF THIS GENE IN THE REGULATION OF ARTERIAL PRESSURE. REGARDING SLC19A1, THIS GENE COULD POSITION AS A POTENTIAL TARGET LINKING INFLAMMATION AND INSULIN RESISTANCE. 2018 20 3337 22 HISTONE DEACETYLASE INHIBITORS PREVENT PERSISTENT HYPERSENSITIVITY IN AN OROFACIAL NEUROPATHIC PAIN MODEL. CHRONIC OROFACIAL PAIN IS A SIGNIFICANT HEALTH PROBLEM REQUIRING IDENTIFICATION OF REGULATING PROCESSES. INVOLVEMENT OF EPIGENETIC MODIFICATIONS THAT IS REPORTED FOR HINDLIMB NEUROPATHIC PAIN EXPERIMENTAL MODELS, HOWEVER, IS LESS WELL STUDIED IN CRANIAL NERVE PAIN MODELS. THREE INDEPENDENT OBSERVATIONS REPORTED HERE ARE THE (1) EPIGENETIC PROFILE IN MOUSE TRIGEMINAL GANGLIA (TG) AFTER TRIGEMINAL INFLAMMATORY COMPRESSION (TIC) NERVE INJURY MOUSE MODEL DETERMINED BY GENE EXPRESSION MICROARRAY, (2) H3K9 ACETYLATION PATTERN IN TG BY IMMUNOHISTOCHEMISTRY, AND (3) EFFICACY OF HISTONE DEACETYLASE (HDAC) INHIBITORS TO ATTENUATE DEVELOPMENT OF HYPERSENSITIVITY. AFTER TIC INJURY, IPSILATERAL WHISKER PAD MECHANICAL SENSITIZATION DEVELOPS BY DAY 3 AND PERSISTS WELL BEYOND DAY 21 IN CONTRAST TO SHAM SURGERY. GLOBAL ACETYLATION OF H3K9 DECREASES AT DAY 21 IN IPSILATERAL TG . THIRTY-FOUR GENES ARE SIGNIFICANTLY ( P < 0.05) OVEREXPRESSED IN THE IPSILATERAL TG BY AT LEAST TWO-FOLD AT EITHER 3 OR 21 DAYS POST-TRIGEMINAL INFLAMMATORY COMPRESSION INJURY. THE THREE GENES MOST OVEREXPRESSED THREE DAYS POST-TRIGEMINAL INFLAMMATORY COMPRESSION NERVE INJURY ARE NERVE REGENERATION-ASSOCIATED GENE ATF3, UP 6.8-FOLD, AND TWO OF ITS REGENERATION-ASSOCIATED GENE EFFECTOR GENES, SPRR1A AND GAL, UP 174- AND 25-FOLD, RESPECTIVELY. ALTHOUGH TRANSCRIPTION LEVELS OF 25 OF 32 GENES SIGNIFICANTLY OVEREXPRESSED THREE DAYS POST-TRIGEMINAL INFLAMMATORY COMPRESSION RETURN TO CONSTITUTIVE LEVELS BY DAY 21, THESE THREE REGENERATION-ASSOCIATED GENES REMAIN SIGNIFICANTLY OVEREXPRESSED AT THE LATER TIME POINT. ON DAY 21, WHEN TISSUES ARE HEALED, OTHER DIFFERENTIALLY EXPRESSED GENES INCLUDE 39 OF THE TOP 50 UPREGULATED AND DOWNREGULATED GENES. REMARKABLY, PREEMPTIVE MANIPULATION OF GENE EXPRESSION WITH TWO HDAC INHIBITORS (HDACI'S), SUBERANILOHYDROXAMIC ACID (SAHA) AND MS-275, REDUCES THE MAGNITUDE AND DURATION OF WHISKER PAD MECHANICAL HYPERSENSITIVITY AND PREVENTS THE DEVELOPMENT OF A PERSISTENT PAIN STATE. THESE FINDINGS SUGGEST THAT TRIGEMINAL NERVE INJURY LEADS TO EPIGENETIC MODIFICATIONS FAVORING OVEREXPRESSION OF GENES INVOLVED IN NERVE REGENERATION AND THAT MAINTAINING TRANSCRIPTIONAL HOMEOSTASIS WITH EPIGENETIC MODIFYING DRUGS COULD HELP PREVENT THE DEVELOPMENT OF PERSISTENT PAIN. 2018