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Autism Spectrum Disorder (ASD) is a highly heterogeneous developmental disorder with diverse clinical manifestations. Neuroimaging studies have explored functional connectivity (FC) of ASD through resting-state functional MRI studies, however the findings have remained inconsistent, thus reflecting the possibility of multiple subtypes. Identification of the relationship between clinical symptoms and FC measures may help clarify the inconsistencies in earlier findings and advance our understanding of ASD subtypes.

Canonical correlation analysis was performed on two-hundred and ten ASD subjects from the Autism Brain Imaging Data Exchange to identify significant linear combinations of resting-state connectomic and clinical profiles of ASD. Then, hierarchical clustering defined ASD subtypes based on distinct brain-behavior relationships. Finally, a support vector machine classifier was used to verify that subtypes were comprised of subjects with distinct clinical and connectivity features.

Three ASD subtypes were identified. Subtype 1 exhibited increased intra-network FC, increased IQ scores and restricted and repetitive behaviors. Subtype 2 was characterized by decreased whole-brain FC and more severe ADI-R and SRS symptoms. Subtype 3 demonstrated mixed FC, low IQ scores, as well as social motivation and verbal deficits. To verify subtype assignment, a multi-class support vector machine using connectomic and clinical profiles yielded an average accuracy of 71.3% and 65.2% respectively for subtype classification, which is significantly higher than chance (33.3%).

The present study demonstrates that combining connectomic and behavioral measures is a powerful approach for disease subtyping and suggests that there are ASD subtypes with distinct connectomic and clinical profiles.
The present study demonstrates that combining connectomic and behavioral measures is a powerful approach for disease subtyping and suggests that there are ASD subtypes with distinct connectomic and clinical profiles.Aim To evaluate the effectiveness of low-intensity focused ultrasound (LIFU) therapy in the management of cancer-related neuropathic pain (CNP). Methods A retrospective review with 22 patients with CNP treated with LIFU therapy (frequency 3 Hz, 3 W/cm2, pulse mode duty cycle 50%) was conducted. Results Out of the 22 patients, 15 had CNP secondary to chemotherapy-induced peripheral neuropathy. Compared with baseline, there was a significant reduction in numeric pain rating scale (p less then 0.001). Additionally, 76.5% of patients (n = 13) were considered to be responders to LIFU therapy. Conclusion LIFU therapy may be a viable treatment modality in the management of CNP, specifically chemotherapy-induced peripheral neuropathy, with a minimal side effect profile. Larger, prospective studies with a structured protocol are necessary.Aim To evaluate the prevalence of self-directed cannabidiol (CBD) use in patients with end-stage degenerative hip and knee arthritis who underwent total hip arthroplasty and total knee arthroplasty. Materials & methods Anonymous surveys for 109 patients were completed at 6 weeks follow-up after either total hip arthroplasty or total knee arthroplasty at a single tertiary care US orthopedic hospital. Results Within the perioperative window encompassing both preoperative and postoperative periods, 22% (95% CI 14-30%) of patients used CBD. Conclusion There was no difference in pain satisfaction between patients who used CBD and patients who did not. Given high rates of self-directed perioperative CBD use and the mixed body of evidence, further research is needed to better understand whether CBD is safe and effective.
Alzheimer's disease (AD) is the most common age-related dementia that promotes a decline in memory, thinking, and social skills. The initial stages of dementia can be associated with mild symptoms, and symptom progression to a more severe state is heterogeneous across patients. Recent work has demonstrated the potential for functional network mapping to assist in the prediction of symptomatic progression. However, this work has primarily used static functional connectivity (sFC) from rs-fMRI. Recently, dynamic functional connectivity (dFC) has been recognized as a powerful advance in functional connectivity methodology to differentiate brain network dynamics between healthy and diseased populations.

Group independent component analysis was applied to extract 17 components within the cognitive control network (CCN) from 1385 individuals across varying stages of AD symptomology. We estimated dFC among 17 components within the CCN, followed by clustering the dFCs into 3 recurring brain states, and then estim with increases in connectivity within the middle frontal gyrus. Also, the very mild AD showed less connectivity within the inferior parietal lobule (in both sFC and dFC) and between this region with the rest of CCN (in dFC analysis). Also, we found within-middle frontal gyrus connectivity increases with AD progression in both sFC and dFC results. Finally, comparing with very mild AD, we found that the normal brain spends significantly more time in a state with lower within-middle frontal gyrus connectivity and higher connectivity between the hippocampus and the rest of CCN, highlighting the importance of assessing the dynamics of brain connectivity in this disease.Aim Faces pain scales are widely used to measure pain. So far, no faces pain scale has ever been constructed by Rasch modeling. Hence the authors aimed to construct a new scale by this method. Methods Rasch modeling was used to provide an initial calibration and development of the 'Balparda-Herrera Pain Scale' (BHPS) and this scale was compared with the existing Faces Pain Scale - Revised. The scale was later refined. Results Both the existing scale and the initial version of the BHPS required category collapsing. Statistical tests demonstrated an excellent concordance between both scales. M344 price The final version of the BHPS was found to behave excellently and to be capable of adequately measuring pain. Conclusion The BHPS provides an excellent instrument for measuring pain in the adult population.The aim of the present study is to determine whether adding shockwave therapy (SWT) to a progressive exercise program improves shoulder pain and function in individuals with rotator cuff tendinopathy (RC tendinopathy). Ninety patients diagnosed with rotator cuff tendinopathy will be randomly allocated into two groups active SWT plus a progressive exercise program or placebo SWT plus a progressive exercise program. Primary outcomes will be measured using the Constant-Murley Score function questionnaire and by assessing patient-reported pain intensity with the numerical pain rating scale. The secondary outcomes will be measured using the Global Perceived Effects Scale and Shoulder Pain and Disability Index. All the outcomes will be measured immediately after the end of treatment and at 3-month follow-up.Aim To investigate the effect of knee osteoarthritis (OA) compartment location on pain relief following genicular radiofrequency ablation. Materials & methods A retrospective chart review was performed on 62 patients. Visual analog scale scores at 3 and 6 months post procedure were compared with baseline and between compartment groups. Results Pain significantly improved for all patients at 3 and 6 months (p less then 0.001 and p = 0.005, respectively). Medial compartment OA was a significant predictor of improvement at 3 months (p = 0.042). Patellofemoral compartment OA was a significant predictor for a higher visual analog scale at 3 months (p = 0.018). Conclusion Compartmental location of knee OA impacts pain relief following genicular radiofrequency ablation. Future protocols could target nerves based on which compartments are more affected on imaging.Background The aim of this study was to assess the prognostic interaction between age and sex on peri-operative and follow-up outcomes following elective carotid endarterectomy (CEA) for asymptomatic and symptomatic carotid stenosis. Patients and methods A retrospective review of all patients admitted to a single vascular unit who underwent elective CEA between January, 2015 and December, 2019 was performed. The primary endpoints of the study were overall survival (from index operation) and cumulative stroke rate at thirty days. Results A total of 383 consecutive patients were included in this study; of these 254 (66.4%) were males. At baseline, males were younger (mean age 73.4±11 vs. 76.3±10 years, p=.01) and with lower proportion of octogenarians (20.4% vs. 28.7%, p=.05). The rate of stroke in symptomatic and asymptomatic patients (males vs. females) were as follows a) whole cohort 1.9% vs. 2% (p=1.00) and 2.7% vs. 1.3% (p=.66), respectively; b) ≥80 years old 3.7% vs. 0% (p=1.00) and 4% vs. 5.9% (p=1.00), respectively; c) less then 80 years old 1.2% vs. 3.3% (p=.47) and 2.5% vs. 0% (p=.55), respectively. The 3-year survival estimates were significantly lower for males (84% vs. 92%, p=.03). After stratification by age groups, males maintained inferior survival rates in the strata aged less then 80 years (85% vs. 97%, p=.005), while no differences were seen in the strata aged ≥80 years (82% vs. 79%, p=.92). Using multivariate Cox proportional hazards, age (HR 2.1, 95% CI 1.29-3.3, p=.002) and male gender (HR 2.5, 95% CI 1.16-5.5, p=.02) were associated with increased hazards of all-cause mortality. Conclusions In this study of elective CEA for asymptomatic and symptomatic carotid stenosis, similar peri-operative neurologic outcomes were found in both males and females irrespective of age. Despite being usually older, females have superior long-term survival rates.Aim To evaluate pain and length of stay outcomes in six patients who received an erector spinae plane block (ESPB) in the emergency department (ED) for low back pain. Materials & methods A case series of six patients who received unilateral or bilateral ESPB after presenting to the ED for acute atraumatic axial low back pain. Results The average visual analog scale pain score reduction was 81.8%, and length of stay after ESPB was 73.5 min. No postprocedure opiates in the ED or after discharge were required. Conclusion The ESPB is a rapid, safe and opiate-sparing option for the treatment of acute low back pain.Aim To analyze the associations between pain duration, pain levels, anthropometric measures, perceived stress and biochemical markers in women with low back pain. Materials & methods Forty-two participants were submitted to body mass, height, abdominal circumference, cortisol and creatine kinase (CK) collections. Pain duration, pain levels and stress were analyzed through specific questionnaires. Results There were positive correlations between abdominal circumference and body mass, duration of pain and age, abdominal circumference, CK and age, CK and BMI, CK and abdominal circumference, and CK and duration of pain (p less then 0.05). Conclusion The higher the level of tissue damage over the years, the greater the tendency for higher levels of low back pain perception. Central fat was related to greater load on the spine.Aim Obesity is one of the most prevalent comorbidities associated with chronic pain, which can severely interfere with daily living and increase utilization of clinical resources. We hypothesized that a higher level of obesity, measured by BMI, would be associated with increased pain severity (intensity) and interference (pain related disability). Materials & methods Participant data was pulled from a multisite chronic pain outpatient database and categorized based on BMI. Results A total of 2509 patients were included in the study. We found significant differences between BMI groups for all pain severity scores (worst, least, average, current) and total pain interference score. Obese patients had significantly higher scores than normal weight patients. Conclusion We found obesity to be associated with increased pain severity and pain interference.
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