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Cañueto J, Muñoz-Couselo E, Cardona-Machado C, Becerril-Andrés S, Martín-Vallejo J, Serra-Guillén C, Soria A, Serrano-Domingo JJ, Ortiz-Velez C, Lostes J, García-Castaño A, Puig S, Fernández de Misa R, Medina J, Aguado C, Ayala de Miguel P, Navarro-Navarro I, Masferrer E, Delgado M, Bellido-Hernández L, Sanmartin O. Efficacy and safety of cemiplimab in the treatment of advanced cutaneous squamous cell carcinoma: A multicentre real-world retrospective study from Spain and systematic review of the published data. J Eur Acad Dermatol Venereol 2024; 38:e666-e670. [PMID: 38308557 DOI: 10.1111/jdv.19821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
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Ambron E, Garcea FE, Cason S, Medina J, Detre JA, Coslett HB. The influence of hand posture on tactile processing: Evidence from a 7T functional magnetic resonance imaging study. Cortex 2024; 173:138-149. [PMID: 38394974 DOI: 10.1016/j.cortex.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/19/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024]
Abstract
Although behavioral evidence has shown that postural changes influence the ability to localize or detect tactile stimuli, little is known regarding the brain areas that modulate these effects. This 7T functional magnetic resonance imaging (fMRI) study explores the effects of touch of the hand as a function of hand location (right or left side of the body) and hand configuration (open or closed). We predicted that changes in hand configuration would be represented in contralateral primary somatosensory cortex (S1) and the anterior intraparietal area (aIPS), whereas change in position of the hand would be associated with alterations in activation in the superior parietal lobule. Multivoxel pattern analysis and a region of interest approach partially supported our predictions. Decoding accuracy for hand location was above chance level in superior parietal lobule (SPL) and in the anterior intraparietal (aIPS) area; above chance classification of hand configuration was observed in SPL and S1. This evidence confirmed the role of the parietal cortex in postural effects on touch and the possible role of S1 in coding the body form representation of the hand.
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Coslett HB, Medina J, Goodman DK, Wang Y, Burkey A. Can they touch? A novel mental motor imagery task for the assessment of back pain. FRONTIERS IN PAIN RESEARCH 2024; 4:1189695. [PMID: 38375366 PMCID: PMC10875043 DOI: 10.3389/fpain.2023.1189695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 12/22/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction As motor imagery is informed by the anticipated sensory consequences of action, including pain, we reasoned that motor imagery could provide a useful indicator of chronic back pain. We tested the hypothesis that mental motor imagery regarding body movements can provide a reliable assessment of low back pain. Methods Eighty-five subjects with back pain and forty-five age-matched controls were shown two names of body parts and asked to indicate if they could imagine moving so that the named body parts touched. Three types of imagined movements were interrogated: movements of arms, movements of legs and movements requiring flexion and/or rotation of the low back. Results Accuracy and reaction times were measured. Subjects with back pain were less likely to indicate that they could touch body parts than age-matched controls. The effect was observed only for those movements that required movement of the low back or legs, suggesting that the effect was not attributable to task difficulty or non-specific effects. There was an effect of pain severity. Compared to subjects with mild pain, subjects with severe pain were significantly less likely to indicate that they could move so that named body parts touched. There was a correlation between pain ratings and impaired performance for stimuli that involved the lower but not upper body. Discussion As the Can They Touch task is quick, easy to administer and does not require an explicit judgment of pain severity, it may provide useful information to supplement the assessment of subjects with chronic pain.
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Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. Variation in Rates of Post-Mastectomy Radiotherapy Among Women with Early Invasive Breast Cancer in England and Wales: A Population-Based Cohort Study. Clin Oncol (R Coll Radiol) 2023; 35:e549-e560. [PMID: 37321887 DOI: 10.1016/j.clon.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
AIMS This study examined whether patterns of post-mastectomy radiotherapy (PMRT) among women with early invasive breast cancer (EIBC) varied within England and Wales and explored the role of different patient factors in explaining any variation. MATERIALS AND METHODS The study used national cancer data on women aged ≥50 years diagnosed with EIBC (stage I-IIIa) in England and Wales between January 2014 and December 2018 who had a mastectomy within 12 months of diagnosis. A multilevel mixed-effects logistic regression model was used to calculate risk-adjusted rates of PMRT for geographical regions and National Health Service acute care organisations. The study examined the variation in these rates within subgroups of women with different risks of recurrence (low: T1-2N0; intermediate: T3N0/T1-2N1; high: T1-2N2/T3N1-2) and investigated whether the variation was linked to patient case-mix within regions and organisations. RESULTS Among 26 228 women, use of PMRT increased with greater recurrence risk (low: 15.0%; intermediate: 59.4%; high: 85.1%). In all risk groups, use of PMRT was more common among women who had received chemotherapy and decreased among women aged ≥80 years. There was weak or no evidence of an association between use of PMRT and comorbidity or frailty, for each risk group. In women with an intermediate risk, unadjusted rates of PMRT varied substantially between geographical regions (range 40.3-77.3%), but varied less for the high-risk (range 77.1-91.6%) and low-risk groups (range 4.1-32.9%). Adjusting for patient case-mix reduced the variation in regional and organisational PMRT rates to a small degree. CONCLUSIONS Rates of PMRT are consistently high across England and Wales among women with high-risk EIBC, but variation exists across regions and organisations for women with intermediate-risk EIBC. Effort is required to reduce unwarranted variation in practice for intermediate-risk EIBC.
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Ambron E, Medina J. Examining constraints on embodiment using the Anne Boleyn illusion. J Exp Psychol Hum Percept Perform 2023; 49:877-892. [PMID: 37276125 DOI: 10.1037/xhp0001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Using a mirror box, the concurrent stroking of the lateral side of the fifth finger behind the mirror along with stroking the empty space next to the mirror-reflected hand's fifth finger results in a strong sense of having a sixth finger-the Anne Boleyn illusion. We used this illusion to understand what constraints illusory embodiment. In Experiment 1, we manipulated the anatomical constraints, posture, and stroking of the sixth finger, along with other variants. Given evidence from other body illusions, we predicted no illusory embodiment in conditions in which the sixth finger was created in a manner incompatible with a typical hand, when the mirror and viewed hands were in different posture, and when stroking differed. Surprisingly, the illusion was persistent in most variants, including those with curved fingers, elongated fingers, and even with mismatches between the posture of the viewed and hidden hand. In Experiment 2, we manipulated the orientation, shape, and length of the illusory sixth finger, presenting more extreme versions of the illusion. The illusion was significantly diminished only when the sixth finger was far from the hand, or in a very implausible posture. This evidence suggests that body representations are extremely flexible and allow for embodiment of empty space in conditions not seen in other body illusions. We suggest that bottom-up information from concurrent visuotactile input, combined with reduced constraints provided by the "blank canvas" of empty space, results in a particularly robust illusion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study. Clin Oncol (R Coll Radiol) 2023; 35:e265-e277. [PMID: 36764877 DOI: 10.1016/j.clon.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
AIMS Clinical trials of post-mastectomy radiotherapy (PMRT) for early invasive breast cancer (EIBC) have included few older women. This study examined whether the association between overall survival or breast cancer-specific survival (BCSS) and receipt of PMRT for EIBC altered with age. MATERIALS AND METHODS The study used patient-level linked cancer registration, routine hospital and radiotherapy data for England and Wales. It included 31 243 women aged ≥50 years diagnosed between 2014 and 2018 with low- (T1-2N0), intermediate- (T3N0/T1-2N1) or high-risk (T1-2N2/T3N1-2) EIBC who received a mastectomy within 12 months from diagnosis. Patterns of survival were analysed using a landmark approach. Associations between overall survival/BCSS and PMRT in each risk group were analysed with flexible parametric survival models, which included patient and tumour factors; whether the association between PMRT and overall survival/BCSS varied by age was assessed using interaction terms. RESULTS Among 4711 women with high-risk EIBC, 86% had PMRT. Five-year overall survival was 70.5% and BCSS was 79.3%. Receipt of PMRT was associated with improved overall survival [adjusted hazard ratio (aHR) 0.75, 95% confidence interval 0.64-0.87] and BCSS (aHR 0.78, 95% confidence interval 0.65-0.95) compared with women who did not have PMRT; associations did not vary by age (overall survival, P-value for interaction term = 0.141; BCSS, P = 0.077). Among 10 814 women with intermediate-risk EIBC, 59% had PMRT; 5-year overall survival was 78.4% and BCSS was 88.0%. No association was found between overall survival (aHR 1.01, 95% confidence interval 0.92-1.11) or BCSS (aHR 1.16, 95% confidence interval 1.01-1.32) and PMRT. There was statistical evidence of a small change in the association with age for overall survival (P = 0.007), although differences in relative survival were minimal, but not for BCSS (P = 0.362). CONCLUSIONS The association between PMRT and overall survival/BCSS does not appear to be modified by age among women with high- or intermediate-risk EIBC and, thus, treatment recommendations should not be modified on the basis of age alone.
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Beisheim-Ryan EH, Hicks GE, Pohlig RT, Medina J, Sions JM. Body image and perception among adults with and without phantom limb pain. PM R 2023; 15:278-290. [PMID: 34914201 PMCID: PMC10211469 DOI: 10.1002/pmrj.12750] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/28/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Following lower-limb amputation, phantom limb pain (i.e., pain perceived as coming from the amputated portion of the limb) is common. Phantom limb pain may be associated with impaired body image and perception, which may be targets for rehabilitative intervention. OBJECTIVE To compare measures of body image and perception between adults with and without phantom limb pain post amputation and evaluate associations between measures of body image and perception and phantom limb pain. DESIGN Survey. SETTING Online, remote assessment. PARTICIPANTS Seventy-two adults ≥1 year post unilateral lower-limb loss (n = 42 with phantom limb pain, n = 30 without phantom limb pain or pain in the remaining portion of the limb). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported outcome measures assessing body image (i.e., Amputee Body Image Scale-Revised), perceptual disturbances associated with the phantom limb (i.e., a modified Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale), and prosthesis satisfaction (i.e., Trinity Amputation and Prosthesis Experience Scale) were administered; participants with phantom limb pain reported pain interference via the Brief Pain Inventory-Short Form. Between-group comparisons of self-reported outcome measure scores were conducted using Mann Whitney U or chi-square tests, as appropriate (a = .05). RESULTS Compared to peers without phantom limb pain, adults with phantom limb pain reported more negative body image; increased phantom limb ownership, attention, and awareness; and reduced prosthesis satisfaction and embodiment (U = 175.50-364.00, p < .001 to .034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p = .086 to >.999). More negative body image was associated with increased phantom limb pain interference (τb = .25, p = .026). CONCLUSIONS Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with nonpainful phantom sensations. Mind-body treatments that target impaired body image and perception may be critical interventions for adults with phantom limb pain.
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Povedano M, Vázquez-Costa J, Pitarch I, López-Lobato M, Medina J, Fernández-Ramos J, Lafuente-Hidalgo M, Rojas-García R, Caballero-Caballero J, Málaga I, Eirís J, De Lemus M, Cattinari M, Madruga-Garrido M, Branas M, Cabello-Moruno R, Díaz-Abós P, Terrancle A, Maurino J, Rebollo P. VP.55 Fatigue, pain, breathing, voice, fatigability, sleep, rest and vulnerability as meaningful outcomes in SMA care: the patients´ and caregivers' voice. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jiménez I, Medina J, Marcos-García A, Garcés G. [Translated article] Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Leach WT, Medina J. Understanding components of embodiment: Evidence from the mirror box illusion. Conscious Cogn 2022; 103:103373. [PMID: 35751927 DOI: 10.1016/j.concog.2022.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
Past studies have examined embodiment in the rubber hand illusion, using principal components analysis (PCA) to identify factors from questionnaire responses during synchronous and asynchronous stroking. To better understand the phenomenology of embodiment, we used PCA in the mirror box illusion to examine performance across conditions that varied in movement synchrony to examine multisensory integration and movement type to vary the amount of multisensory congruence. We found three dissociable components in all conditions: embodiment, deafference and attentiveness. We also examined how these embodiment ratings varied across the four conditions. As hypothesized, embodiment ratings were highest for synchronous movement, with feelings of deafference highest for asynchronous movement. Furthermore, there was a movement by timing interaction, such that sliding resulted in greater differences in synchronous versus asynchronous ratings than tapping. These results suggest that embodiment or deafference can be changed as a function of the amount of multisensory congruence.
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Medina J. Using single cases to understand visual processing: The magnocellular pathway. Cogn Neuropsychol 2022; 39:106-108. [PMID: 35677970 DOI: 10.1080/02643294.2022.2083949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Gannon MR, Dodwell D, Miller K, Horgan K, Clements K, Medina J, Kunkler I, Cromwell DA. Change in the Use of Fractionation in Radiotherapy Used for Early Breast Cancer at the Start of the COVID-19 Pandemic: A Population-Based Cohort Study of Older Women in England and Wales. Clin Oncol (R Coll Radiol) 2022; 34:e400-e409. [PMID: 35691761 PMCID: PMC9151525 DOI: 10.1016/j.clon.2022.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022]
Abstract
Aims Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). Materials and methods Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT. Results Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from <1% in February 2020 to 70% in April 2020. Regional variation in the use of 26Gy5F during April to July 2020 was similar by age, ranging from 49 to 87% among women aged ≥70 years. Use of 26Gy5F was characterised by no known nodal involvement, no comorbidities and initial breast-conserving surgery. Of those patients receiving radiotherapy to the breast/chest wall, 85% had 26Gy5F; 23% had 26Gy5F if radiotherapy included regional nodes. Among 5139 women receiving postoperative radiotherapy from April to July 2020, nodal involvement, overall stage, type of surgery, time from diagnosis to start of radiotherapy were independently associated with fractionation choice. Conclusions There was a striking increase in the use of 26Gy5F dose fractionation regimens for EBC, among women aged ≥50 years, within a month of guidance published at the start of the COVID-19 pandemic in England and Wales.
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Fitzsimons KJ, Hamilton MJ, van der Meulen J, Medina J, Wahedally M, Park MH, Russell C. Range and Frequency of Congenital Malformations Among Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2022:10556656221089160. [PMID: 35382604 DOI: 10.1177/10556656221089160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To assess the range and frequency of additional congenital malformations identified among children born alive with CL/P. Analysis of patient-level data from a national registry of cleft births linked to national administrative data of hospital admissions. National Health Service, England. Children born between 2000 and 2012 receiving cleft care in English NHS hospitals. The proportion of children with ICD-10 codes for additional congenital malformations, according to cleft type. The study included 9403 children. Of these 2114 (22.5%) had CL±A, 4509 (48.0%) had CP, 1896 (20.2%) had UCLP, and 884 (9.4%) had BCLP. A total of 3653 (38.8%) children had additional congenital malformations documented in their hospital admission records. The prevalence of additional congenital malformations was greatest among children with CP (53.0%), followed by those with BCLP (33.5%), UCLP (26.3%), and then CL±A (22.2%) (P < .001). Among those with UCLP, children with right-sided clefts were more likely to have additional malformations than those with left-sided clefts (31.6% vs 23.0%, P < .001). Malformations of the skeletal system and circulatory system were most common, affecting 10.5% and 10.2% of the included children, respectively. A total of 16.8% of children had additional congenital malformations affecting 2 or more structural systems. Congenital malformations are common among children born alive with a cleft, affecting over half of some cleft subgroups. Given the frequency of certain structural malformations, clinicians should consider standardized screening for these children. Establishing good links with pediatric and genetic services is recommended.
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Beisheim E, Pohlig R, Medina J, Hicks G, Sions J. Body representation among adults with phantom limb pain: Results from a foot identification task. Eur J Pain 2022; 26:255-269. [PMID: 34490685 PMCID: PMC8671232 DOI: 10.1002/ejp.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impaired body representation (i.e. disrupted body awareness or perception) may be a critical, but understudied, factor underlying phantom limb pain (PLP). This cross-sectional study investigated whether adults with lower-limb loss (LLL) and PLP demonstrate impaired body representation as compared to Pain-Free peers with and without LLL. METHODS Participants (n = 41 adults with PLP, n = 27 Pain-Free peers with LLL, n = 39 Controls with intact limbs) completed an online foot identification task. Participants judged whether randomized images depicted left or right feet (i.e. left-right discrimination) as quickly as possible without limb movement. Using two Generalized Estimating Equations, effects of group, image characteristics (i.e. side, foot type, view, angle) and trial block (i.e. 1-4) were evaluated, with task response time and accuracy as dependent variables (a ≤ 0.050). RESULTS Adults with PLP demonstrated slower and less accurate performance as compared to Controls with intact limbs (p = 0.018) but performed similarly to Pain-Free peers with LLL (p = 0.394). Significant three-way interactions of group, view and angle indicated between-group differences were greatest for dorsal-view images, but smaller and angle-dependent for plantar-view images. While all groups demonstrated significant response time improvements across blocks, improvements were greatest among adults with PLP, who also reported significant reductions in pain intensity. CONCLUSIONS Adults with PLP demonstrate body representation impairments as compared to Controls with intact limbs. Body representation impairments, however, may not be unique to PLP, given similar performance between adults with and without PLP following LLL. SIGNIFICANCE Following lower-limb loss, adults with phantom limb pain (PLP) demonstrate impaired body representation as compared to Controls with intact limbs, evidenced by slower response times and reduced accuracy when completing a task requiring mental rotation. Importantly, 80% of participants with pre-task PLP reported reduced pain intensity during the task, providing compelling evidence for future investigations into whether imagery-based, mind-body interventions have positive effects on PLP.
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Ruiz-Cabello Subiela J, Martinez-Sepulveda T, Medina J, Varona JF, Zorita B, Fuertes B, Pastor A, Osende J, Palomo J, Castellano JM, Parra Jimenez FJ, Fernandez-Friera L, Lopez-Melgar B. Usefulness of carotid and femoral plaque burden quantification by 3-dimensional vascular ultrasound for cardiovascular risk assessment in the cardiovascular disease prevention unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Subclinical atherosclerosis improves cardiovascular risk assessment and is considered a risk modifier in individuals at borderline-to-intermediate estimated risk by clinical risk scores.
Purpose
We seek to propose a new decision algorithm for statin allocation based on the quantification of carotid and/or femoral atherosclerosis burden by novel 3-dimensional vascular ultrasound (3DVUS) and to explore its potential additive value when used in combination with conventional risk evaluation.
Methods
We conducted an observational study in all outpatients without previous history of cardiovascular events assessed in the Cardiovascular Disease Prevention Unit during 2017–2020. Cardiovascular risk was assessed with the ACC/AHA 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm to establish the indication for initiating statin therapy following current clinical guidelines. All patients underwent 3DVUS evaluation for carotid plaque burden (CPB) calculated as the sum of all plaque volumes present in bilateral carotid arteries. Femoral 3DVUS evaluation was included later in the study protocol. Global plaque burden (GPB) was calculated in patients with both carotid and femoral 3DVUS as the sum of all plaque volumes present in bilateral carotid and femoral arteries. Carotid and global plaque burden was classified as high, moderate and low if a patient presented a percentile (p) >75, p50–75 and p<50, respectively, based on the age and sex-adjusted reference values reported by PESA study (1). We determined the percentage of patients reclassified for considering (p>75) or discouraging (p<50) statin therapy over clinical recommendation.
Results
One hundred sixty-three patients (age 51±8 years; 72,4% men; 10y-ASCVD 5,9%±4,8%) were included, being the most frequent reason for referral the presence of metabolic syndrome (37%), followed by intermediate or indeterminate estimated CV risk (33%), one markedly elevated single risk factor (15%) and family history of early CVD (13%). 10y-ASCVD score classified 80 (49%) patients as low-risk without recommendation for initiating statins, 18 (11%) as high-risk indicating statin therapy and 65 (40%) patients that needed clinical-patient risk discussion. Among patients under risk discussion, the CPB percentile re-stratified 51 (78%) of them, recommending statins in 26 (40%) and discouraging statins in 25 (38%). In addition, CPB re-stratified 24 (30%) low-risk patients to recommend statins. A sub-group of 114 patients additionally underwent femoral 3DVUS, and calculated GPB led to similar results of patient re-stratification (Figure).
Conclusions
Quantification of 3D atherosclerosis burden and its percentile would re-stratify a significant number of patients with intermediate risk, becoming a potentially useful tool for clinical decision making. In addition, it possibly improves the detection of low-risk patients who would benefit from statin therapy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dr. Lόpez-Melgar has received a grant from the Spanish Society of Cardiology “Proyecto de investigaciόn traslacional en Cardiología 2020” Patient re-stratification with CPB/GPB
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Beisheim-Ryan EH, Pohlig RT, Hicks GE, Horne JR, Medina J, Sions JM. Mechanical Pain Sensitivity in Postamputation Pain. Clin J Pain 2021; 38:23-31. [PMID: 34620753 PMCID: PMC8639794 DOI: 10.1097/ajp.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postamputation, clinical markers of pain-related peripheral and central nervous system hypersensitivity remain understudied. This study aimed to identify whether adults with postamputation pain demonstrate greater pain sensitivity in primary (ie, amputated region) and secondary (ie, nonamputated region) sites, as compared with pain-free peers and controls with intact limbs. METHODS Ninety-four participants postunilateral, transtibial amputation (59 with pain, 35 pain-free) and 39 controls underwent pain-pressure threshold (PPT) testing at 10 sites. Pain-pressure thresholds were normalized to sex-specific control data using Z score conversions. Normalized primary-site and secondary-site PPTs were compared between groups using multivariate analysis of variance (P<0.050). RESULTS Compared with pain-free peers, adults with postamputation pain demonstrated reduced normalized PPTs across primary and secondary sites (mean difference=0.61-0.74, P=0.001 to 0.007). Compared with controls, adults with postamputation pain demonstrated reduced normalized PPTs (mean difference=0.52, P=0.026) only at primary sites. DISCUSSION Adults with postamputation pain demonstrate greater amputated region pain sensitivity as compared with pain-free peers or controls with intact limbs, indicating peripheral sensitization persists even after limb healing. Secondary-site pain sensitivity was similar between controls and adults with postamputation pain, suggesting central nervous system hypersensitivity may not be ubiquitous with postamputation pain. Studies are needed to investigate mechanisms underlying pain sensitivity differences between adults with and without postamputation pain.
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Manzano J, Martín-Liberal J, Fernandez-Morales L, Benítez G, Medina J, Quindós M, García-Castaño A, Fernández O, Vilchez Simo R, Majem M, Bellido Hernández L, Ayala de Miguel P, Campos B, Espinosa E, Macías Cerrolaza J, Gil-Arnaiz I, Lorente D, Martínez-Fernández A, Martín-Sánchez E, Cerezuela-Fuentes P. 1088P Adjuvant dabrafenib plus trametinib (DT) treatment completion in patients with resected melanoma in Spain: A retrospective observational study (GEM 1901 - DESCRIBE-AD). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Jiménez I, Medina J, Marcos-García A, Garcés GL. Out-of-sheath corticosteroid injections through the dorsal webspace for trigger finger and trigger thumb. A prospective cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:260-266. [PMID: 34366261 DOI: 10.1016/j.recot.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits. MATERIAL AND METHOD A total of 126 consecutive patients were included. A subcutaneous (out-of-sheath) corticosteroid injection was performed through the dorsal webspace in all digits. In cases where signs or symptoms persisted, a second injection was offered. Visual analog scale for pain during the injection, DASH questionnaire, success rate and complications were collected. RESULTS There were 86 women and 40 men with a mean age of 61 years. The mean visual analog scale for pain during the injection was 3.8. Twelve patients were lost to follow-up. The overall success was 68% and success after a single injection was 54%. The best result was achieved on the ring finger. Patients who were not previously operated on carpal tunnel syndrome responded better. No complications were noted. CONCLUSIONS The extra-sheath corticosteroid injection through the dorsal webspace is effective and safe. It seems to be less painful than the reported scores for the palmar midline technique although it should be assessed in a comparative study.
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Jauhari Y, Gannon MR, Dodwell D, Horgan K, Clements K, Medina J, Cromwell DA. Surgical decisions in older women with early breast cancer: patient and disease factors. Br J Surg 2021; 108:160-167. [PMID: 33711149 PMCID: PMC7954278 DOI: 10.1093/bjs/znaa042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/27/2020] [Accepted: 09/19/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer . METHODS Women aged 50 years or above with unilateral stage 1-3A early invasive breast cancer diagnosed in 2014-2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery. RESULTS Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70-74, 75-79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness. CONCLUSION The reasons for the observer differences should be further explored to ensure consistency in treatment decisions.
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Liu Y, Medina J. Visuoproprioceptive conflict in hand position biases tactile localization on the hand surface. J Exp Psychol Hum Percept Perform 2021; 47:344-356. [PMID: 33492163 DOI: 10.1037/xhp0000893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The location of touch can be represented in a somatotopic reference frame and, combined with proprioceptive information, in an external reference frame. There is evidence that body position influences where individuals feel touch on the skin surface, indicating that proprioceptive information affects tactile localization in a somatotopic reference frame. In conditions with visual and proprioceptive mismatch of body position, where do individuals feel touch on the body? We used the mirror box illusion to address this question. Participants placed 1 hand on each side of a mirror aligned with the body midline, such that the hand reflection in the mirror looked like the hand hidden behind the mirror. The illusion creates a spatial mismatch between the actual hidden hand position and where the participant perceives their hand to be (the mirror image location). Across three experiments, localization judgments on the hidden hand were consistently and systematically biased toward the actual hand position relative to the viewed hand position. These findings provide evidence that proprioceptive estimates of limb position influence tactile localization and are discussed in relation to two models of tactile localization. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Ortez C, Carrera L, Exposito J, Natera D, Zambudio S, Colomer J, Bazán A, Pareja A, Bobadilla E, Sáez V, Medina J, Jou C, Codina A, Corbera J, Yubero D, Martorell L, Jimenez-Mallebrera C, Nascimento A. AUTOPHAGIC MYOPATHIES / MYOFIBRILLAR MYOPATHIES / DISTAL MYOPATHIES / POMPE DISEASE. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miller K, Gannon M, Medina J, Clements K, Dodwell D, Horgan K, Cromwell D. Surgery of the primary tumour in women with metastatic breast cancer at diagnosis in England and Wales – how do treatment rates vary at an individual and regional level? Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jiménez I, Garcés G, Caballero-Martel J, Medina J. Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Medina J, Aramburu F, González Montagut C, Sánchez D, Loza E. OP0122 SUBCLINICAL ATHEROSCLEROSIS OF FEMORAL ARTERIES IN RHEUMATOID ARTHRITIS. AN ULTRASOUND STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cardiovascular morbidity and mortality is increased in patients with rheumatoid arthritis (RA). This cannot be entirely explained by traditional risk factors. Inflammation and autoimmunity may play a role in the cardiovascular risk excess. Subclinical atherosclerosis is associated with a risk comparable to established coronary heart disease. In RA it has been investigated by carotid artery ultrasound and carotid atherosclerotic plaques are more prevalent in RA patients than controls. EULAR recommendations for cardiovascular disease risk management consider that carotid ultrasound may be part of the risk evaluation in patients with RA. Recent studies in general population have shown that plaques in femoral arteries are more common and are associated with higher cardiovascular risk.Objectives:To study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis and its ability to improve cardiovascular risk assessment in RA patients.Methods:Cross-sectional observational study of prevalence in 140 RA patients aged 40 to 65 years. Subclinical atherosclerosis was evaluated by carotid and femoral artery ultrasound.Results:Atherosclerotic plaques were found in 86.4% of RA patients (60.7% in carotid arteries and 78.6% in femoral arteries). Patients with plaques were older and more frequently past or present tobacco users. Femoral plaques were larger and more numerous than the carotid plaques and people with plaques in both locations had more extensive subclinical atherosclerotic disease (table). Only 7.9% of RA patients were considered as having very high cardiovascular risk by clinical factors, after carotid ultrasound this increased to 57.1% and after femoral ultrasound to 86.4%.Conclusion:Ultrasound examinations of the femoral artery in addition to the carotid artery increased the detection of subclinical atherosclerosis and determine a group of patients with higher intensity of atherosclerotic disease. Examinations of both arteries allowed a greater number of RA patients previously considered to have low to moderate cardiovascular risk to be classified as very high cardiovascular risk.References:[1]Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017 Jan;76(1):17–28.[2]Ambrosino P, Lupoli R, Di Minno A, Tasso M, Peluso R, Di Minno MND. Subclinical atherosclerosis in patients with rheumatoid arthritis. A meta-analysis of literature studies. Thromb Haemost. 2015 May;113(5):916–30.[3]Laclaustra M, Casasnovas JA, Fernández-Ortiz A, Fuster V, León-Latre M, Jiménez-Borreguero LJ, et al. Femoral and Carotid Subclinical Atherosclerosis Association With Risk Factors and Coronary Calcium: The AWHS Study. J Am Coll Cardiol. 2016 Mar 22;67(11):1263–74.TableOnly carotid plaquesn= 11Only femoral plaquesn= 36Femoral and carotid plaquesn= 74Number of carotid plaques per patient1,3 ± 0,5-2,5 ±2,0*Carotid plaques size (mm)1,63 ±0,20-2,08 ±0,69*Number of femoral plaques per patient-2,3 ±1,73,7 ± 2,9**Femoral plaque size (mm)-2,20 ± 0,593,10 ± 1,10**Total number of plaques per patient1,3 ± 0,52,3 ± 1,7*6,2 ± 4,3***†Results in mean ± sd. *p<0,05 vs only carotid plaques. **p<0,05 vs only femoral plaques. ***p<0,05 vs only carotid plaques and only femoral plaques.Disclosure of Interests:Julio Medina: None declared, Francisco Aramburu: None declared, Carmen González Montagut: None declared, Dolores Sánchez: None declared, Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi
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Sanchez Leon C, Cordones Cano I, Gomez Climent M, Carretero Guillen A, Cheron G, Medina J, Marquez Ruiz J. P101 Assymetric immediate and long-term effects induced by transcranial direct current stimulation on alert mice somatosensory cortex. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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