199 research outputs found

    Ethnicity, steroid hormones, and pain perception

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    African Americans Show Alterations in Endogenous Pain Regulatory Mechanisms and Reduced Pain Tolerance to Experimental Pain Procedures

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    In order to examine ethnic differences in pain sensitivity 51 African Americans (24 men, 27 women) and 55 individuals from Other ethnic groups (primarily Caucasian; 26 men, 29 women) were tested for pain sensitivity to ischemia, heat, and cold pressor tests after both mental stress and rest. Resting and stress-induced blood pressure (BP), plasma norepinephrine (NE), and cortisol were assessed. African Americans had lower pain tolerance relative to Caucasian/Others for all pain tests. Only the Caucasian/Other group showed the expected inverse relationship between BP and pain sensitivity. African Americans exhibited lower cortisol concentrations overall and blunted NE and systolic BP responses to stress. Only in Caucasians/Others was the relationship seen between higher stress-induced BP, cortisol, and NE levels and greater pain tolerance. The results suggest that there are alterations in endogenous pain regulatory mechanisms in African Americans, which may contribute to their greater rate of clinical pain symptoms

    Citrate salts for preventing and treating calcium containing kidney stones in adults

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    Background: kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain.Objectives: the objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones.Search methods: we searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.Selection criteria: we included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months.Data collection and analysis: two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.Main results: we included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89).Author's conclusions: nitrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.</p

    Ethnicity and pain: psychosocial stress and stress Responses

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    The purpose of this study was to examine biopsychosocial factors related to ethnic differences in pain sensitivity. Forty-four African Americans (22 men, 22 women) and 44 non-Hispanic Whites (22 men, 22 women), recruited to be of equivalent SES, were tested for pain sensitivity to ischemic pain, cold pressor pain, and the temporal summation of heat pulses. There were no ethnic differences in perceived stress, but African Americans reported more frequent discrimination than non-Hispanic Whites. African Americans had similar pain thresholds, but lower pain tolerance to both the ischemic and cold pressor pain tasks. Additionally, African Americans exhibited enhanced temporal summation relative to non-Hispanic Whites. When examining ethnic differences in cardiovascular and neuroendocrine variables, African Americans had lower baseline cortisol than non-Hispanic Whites. However, there were no ethnic differences in blood pressure, norepinephrine, or cortisol responses to stress. Regression analyses indicated that, biological variables (heart rate, systolic blood pressure, and norepinephrine) predicted pain sensitivity in non-Hispanic Whites, while psychosocial variables (income, education, discrimination) predicted pain sensitivity in African Americans. The results of these studies suggest that there may be ethnically-related differences in biopsychosocial pain regulatory mechanisms

    Tabu search heuristic for the single source capacited facility location problem

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    Orientador: Vinicius Amaral ArmentanoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Eletrica e de ComputaçãoResumo: Localização de facilidades é uma das atividades da área de logística que envolve decisões do número, localização e tamanho das facilidades a serem usadas. A localização de facilidades é uma questão central no planejamento estratégico de empresas públicas e privadas e está associada à variação da população em uma região, capital de investimento e estimativa de clientes que podem ser servidos. Este trabalho aborda o problema de localização de facilidades com restrições de capacidade e fonte única para atender a demanda de clientes. A fonte única impõe que um cliente seja atendido por uma única facilidade, e o objetivo é minimizar os custos de instalação e atendimento dos clientes. Este problema tem diversas aplicações, incluindo a localização de concentradores em redes de telecomunicações. Trata-se de um problema complexo de otimização combinatória, em que métodos exatos não produzem uma solução ótima em tempo viável, e portanto o uso de métodos heurísticos é pertinente. O objetivo deste trabalho é o desenvolvimento e implementação de um algoritmo de busca tabu para o problema, e comparação de seu desempenho com outros métodos apresentados na literatura. Palavras-chave: Localização de Facilidades, Otimização Combinatória, Heurística, Busca TabuAbstract: Facility location is a logistic problem that involves the decision on the number, location and capacity of facilities to be opened. Facility location is an important area in the strategic planning of public and private companies and is associated with population changes, money availability for investment and the estimation of the number of customers to be served. This work addresses on single source capacitated facility location problem. Single source imposes that each customer must be assigned to only one facility, and the objective is to minimize the installation and transportation costs. This problem has several applications, including the network concentrator location problem. It is a complex combinatorial optimization problem, which cannot be solved by exact methods in small computational times; therefore, heuristics methods are indicated. The objective of this thesis is the development and implementation of a tabu search algorithm for the problem and a comparative analysis with other methods available in the literature. Keywords: Facility location, Combinatorial Optimization, Heuristic, Tabu SearchMestradoAutomaçãoMestre em Engenharia Elétric

    The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

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    To examine the role of psychosocial factors in mediating the relationship between African American (AA) race and both increased pain sensitivity and blunted stress reactivity

    Menstrual cycle phase does not influence gender differences in experimental pain sensitivity

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    Influence of menstrual cycle phase on experimental pain sensitivity in women and on gender differences in pain sensitivity was examined in 48 men and 49 women in response to cold pressor, heat, and ischemic pain. Each woman was tested at three points in their menstrual cycle in randomized order, the early follicular, late follicular, and luteal phases, while men were also tested three times, controlling for number of days between test sessions. Cycle phase was confirmed via serum hormone levels. As expected, women were significantly more sensitive to cold pain (p < .01), to heat pain (p < .0001), and to ischemic pain (p < .01) than men. However, pain perception during each task was not influenced by the menstrual cycle in women, nor did the menstrual cycle influence the magnitude of the gender differences in pain sensitivity. These results indicate that although women are more sensitive to a variety of noxious stimuli than men, menstrual cycle phase does not appear to moderate those differences in healthy men and women

    Race and Histories of Mood Disorders Modulate Experimental Pain Tolerance in Women

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    Thirty-two African American and 23 non-Hispanic White women were compared for experimental pain threshold and tolerance to thermal, ischemic, and cold pressor pain. Approximately half of each group had prior mood disorders (17 African Americans, 13 non-Hispanic Whites), though all were free of current mood disturbance. Women with prior mood disorders were less sensitive to ischemic pain than women with no prior mood disorders (p<.05), while African Americans were more sensitive to ischemic pain than non-Hispanic Whites, though only at pain tolerance (p<.001). For cold pressor pain, the effects of race were only seen in women with prior mood disorders, since African Americans with prior mood disorders were more sensitive than non-Hispanic Whites with prior mood disorders (p<.05). These results indicate that experimental pain sensitivity in women is influenced by both race and histories of mood disorders

    The relationship of allopregnanolone immunoreactivity and HPA-axis measures to experimental pain sensitivity: Evidence for ethnic differences☆

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    In animal models, allopregnanolone (ALLO) negatively modulates the hypothalamic-pituitary-adrenal (HPA) axis and has been shown to exert analgesic effects. The purpose of this study was to assess the relationship between plasma ALLO immunoreactivity (ALLO-ir), HPA-axis measures, and pain sensitivity in humans. Forty-five African Americans (21 men, 24 women) and 39 non-Hispanic Whites (20 men, 19 women) were tested for pain sensitivity to tourniquet ischemia, thermal heat, and cold pressor tests. Plasma ALLO-ir, cortisol, and β-endorphin concentrations were taken following an extended rest period. Lower concentrations of ALLO-ir were associated with increased pain tolerance to all three pain tests and increased pain threshold to the thermal heat pain task in the non-Hispanic Whites only (rs = -.35 to -.49, ps < .05). Also, only in the non-Hispanic Whites was cortisol associated with thermal heat tolerance (r = +.39, p<.05) and threshold (r = +.50, p < .01) and cold pressor tolerance (r = +.32, p < .05), and was β-endorphin concentrations associated with cold pressor tolerance (r = +.33, p<.05). Mediational analyses revealed that higher cortisol levels mediated the relationship between lower ALLO-ir and increased thermal heat pain threshold in the non-Hispanic Whites only. These results suggest that lower ALLO-ir concentrations are associated with decreased pain sensitivity in humans, especially in non-Hispanic Whites, and that this relationship may be mediated by HPA-axis function
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