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Given that the insula plays a contributory role in the perception of chronic pain, we examined the resting-state functional connectivity between the insular cortex and other brain regions to investigate neural underpinnings of persisting perception of background pain in patients with complex regional pain syndrome (CRPS). A total of 25 patients with CRPS and 25 matched healthy controls underwent functional magnetic resonance imaging at rest. With the anterior and posterior insular cortices as seed regions, we compared the strength of the resting-state functional connectivity between the two groups. Functional connectivity between the anterior and posterior insular cortices and the postcentral and inferior frontal gyri, cingulate cortices was reduced in patients with CRPS compared with controls. Additionally, greater reductions in functional connectivity between the anterior insula and right postcentral gyrus were associated with more severe sensory pain in patients with CRPS (short-form McGill Pain Questionnaire sensory subscores, r = -.517, P = .023). The present results imply a possible role of the insula in aberrant processing of pain information in patients with CRPS. The findings suggest that a functional derangement of the connection between one of the somatosensory cortical functions of perception and one of the insular functions of awareness can play a significant role in the persistent experience of regional pain that is not confined to a specific nerve territory. [ABSTRACT FROM AUTHOR]

Abstract: The overexpression of tetraspanin CD151 – a transmembrane protein that promotes tumor invasion and metastasis – is associated with poor prognosis in various cancers. However, its clinical significance in non-small cell lung cancers (NSCLCs) has not been fully elucidated. We investigated CD151 expression status by immunohistochemical analysis in paraffin-embedded specimens obtained from 380 patients with surgically resected NSCLCs (245 squamous cell carcinomas [SCCs] and 135 adenocarcinomas [ADCs]) between 1994 and 2001. High CD151 expression was detected in 28.7% NSCLCs (20.8% of SCCs and 42.9% of ADCs) and was significantly associated with male gender, smokers, and ADCs. Moreover, elevated CD151 levels were correlated with reduced overall (OS) and disease-free survival (DFS), and were an independent negative prognostic factor for OS in NSCLC. According to histological type, high CD151 expression was an independent prognostic factor for lower OS in ADC, although not in each subtype, and the elevated CD151 expression levels were more common in solid-predominant tumors (48.3%). In contrast, there was no prognostic correlation in SCC. High CD151 expression appeared to correlate with aggressive behavior in NSCLC, suggesting that it may be a useful prognostic marker for lung ADC patients and a potential molecular target for NSCLC treatment. [Copyright &y& Elsevier]

Background: Neoadjuvant concurrent chemoradiotherapy (CCRT) is an effective treatment option for patients with rectal cancer. In this study, we investigated the clinical efficacy of simple endoscopic scoring of patients with rectal cancer after CCRT., Methods: Between July 2008 and October 2015, medical records including endoscopic imaging from 41 patients with rectal cancer who received CCRT were retrospectively reviewed. Two expert gastroenterologists reviewed the endoscopic images and assigned scores from 0-3 according to post-CCRT findings. The scoring criteria were as follows: 0= scar without marginal elevation; 1= clean-based ulcer without marginal elevation; 2= clean-based ulcer with marginal elevation; 3= non-clean-based ulcer. We evaluated image scores to predict long-term outcomes using Kaplan-Meier curves and Cox regression models., Results: The median follow-up duration was 55 months (interquartile range: 35-76 months). Patients with a low score (≤2) had a 17.2% recurrence rate, whereas patients with a high score [3] had a 50.0% recurrence rate. Patients with a low score had longer disease-free survival (DFS) than those with a high score in log-rank test (P=0.026). In multivariate Cox regression analysis, a high score was a significant predictor of poor DFS in patients with rectal cancer after CCRT treatment (hazard ratio =4.89, 95% confidence interval: 1.11-21.50, P=0.036)., Conclusions: This simple endoscopic scoring approach is helpful for predicting prognosis of patients with rectal cancer after treatment with CCRT., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2019 Journal of Gastrointestinal Oncology. All rights reserved.)

Background/aims: Colorectal cancer (CRC) with microsatellite instability (MSI) has a better prognosis than CRC with microsatellite stable (MSS). Recent studies have reported biological differences according to tumor location in CRC. In this study, we investigated the clinical significance of MSI in patients with right-sided CRC., Methods: The medical records of 1,009 CRC patients diagnosed at our institute between October 2004 and December 2016 with MSI test results were retrospectively reviewed. The long-term outcomes of CRC patients with MSI were assessed with respect to tumor location using Kaplan-Meier curves and Cox regression models., Results: The median follow-up duration for all 1,009 study subjects was 25 months (interquartile range, 15-38). One hundred twenty-four of the study subjects had MSI (12.3%) and 250 had right-sided CRC (24.8%). The patients with MSI and right-sided CRC had better disease-free survival (DFS) than those with MSS as determined by the log-rank test (p=0.013), and this result was significant in females (p=0.035) but not in males with right-sided CRC. Multivariate Cox regression analysis showed MSS significantly predicted poor DFS in patients with right-sided CRC (hazard ratio 3.97, 95% CI 1.30-12.15, p=0.016) and in female patients (hazard ratio 4.69, 95% CI 1.03-21.36, p=0.045)., Conclusions: The study shows MSI is a useful predictor of DFS in patients with right-sided CRC, especially in female patients.

Objective: Cognitive-behavioral therapy (CBT) is effective in patients with chronic pain. However, the efficacy of CBT for impaired empathy has not been studied in this population. We investigated the effect of CBT on empathy in patients with chronic pain., Methods: Patients with severe chronic pain were recruited. Empathy was assessed before and after CBT using the Interpersonal Reactivity Index (IRI). The patients underwent eight sessions over the course of 1 month conducted. Additional symptoms were assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), Beck Depression Inventory, Beck Anxiety Inventory, World Health Organization Quality of Life Scale Abbreviated Version, and the Scale for Suicide Ideation., Results: A total of 26 participants were included. Pre-CBT pain severity assessed using the SF-MPQ was significantly correlated with the IRI-empathic concern subscale score (p=0.021), and the relationship remained significant after adjusting for sex, age, education level, and marital status. After CBT, the IRI-perspective-taking subscale scores (p=0.004) increased significantly and the IRI-personal distress subscale scores (p=0.013) decreased significantly in all participants. The SF-MPQ scores increased significantly (p=0.021)., Conclusion: CBT improved empathy in patients with chronic pain independent of its effect on pain, suggesting that CBT is useful for improving interpersonal relationships in patients with chronic pain.

Objective: The aims of this study were to evaluate differences in empathic abilities between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects (HCs) and to assess correlations between empathic abilities and multidimensional aspects of pain., Methods: Empathic ability was measured in 32 patients with CRPS Type I and in 36 HCs using the Interpersonal Reactivity Index (IRI). A comprehensive assessment of pain was conducted in the patient group using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychiatric symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI), and quality of life was evaluated using the WHO Quality of Life (WHOQOL-BREF) questionnaire., Results: Patients with CRPS showed impaired cognitive and emotional empathic abilities compared with HCs. Significantly lower levels of perspective taking and empathic concern and higher levels of personal distress on the IRI were exhibited by the patient group. Perspective taking and personal distress were associated with affective distress and poor quality of life in social contexts (BDI, BAI, and WHOQOL). However, empathic concern was positively correlated with pain severity and social support from others (WHYMPI)., Conclusion: A tendency toward self-oriented distress in social cognition was exhibited among patients with CRPS Type I. Impaired empathic ability was shown to have potentially negative effects on subjective emotional outcomes and social performance in the lives of patients. Interventions to improve emotional awareness and theory of mind would be beneficial for enhancing social functioning in patients with CRPS Type I.

Objective: Chronic pain frequently coexists with psychiatric symptoms in patients diagnosed with complex regional pain syndrome (CRPS). Previous studies have shown a relationship between CRPS and the risk of suicide. The purpose of this study was to assess risk factors for suicidal ideation in patients with CRPS., Methods: Based on criteria established by the International Association for the Study of Pain, 39 patients diagnosed with CRPS Type 1 or Type 2 were enrolled in this study. Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale (HAMD), and symptoms of pain were evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). Psychiatric symptoms were assessed in using the Structured Clinical Interview for DSM-IV Disorders (SCID-I, SCID-II), the HAMD, the Hamilton Anxiety Rating Scale (HAMA), the Global Assessment of Functioning Scale (GAF), and the Pittsburgh Sleep Quality Index (PSQI)., Results: Twenty-nine patients (74.4%) were at high risk and 10 (25.6%) were at low risk for suicidal ideation. Risk factors significantly associated with suicidal ideation included depression (p=0.002), severity of pain (p=0.024), and low scores on the GAF (p=0.027). No significant correlations were found between suicidal ideation and anxiety or quality of sleep., Conclusion: Significant risk factors for suicidal ideation in patients with CRPS include severity of pain, depressive symptoms, and decreased functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS.