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Central pain sensitivity (CS) is defined as an increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold inputs. The main aim of this paper is to investigate if and how specific psychological constructs are related with CS burden in patients with chronic headache (CH). Specifically, research question 1 explores the association of temperament, personality, childhood adversities, defense mechanisms and mental pain with CS burden. Research question 2 aims to test the role of the best predictors of CS burden in affecting the quality of life (QoL) using path analysis. A total of 508 women with CH completed a psycho-diagnostic survey. Results showed that higher levels of low sensory threshold (β = 0.200), bodily threat traumatic experiences (β = 0.156), neurotic defenses (β = 0.109) and mental pain (β = 0.343) emerged as the best predictors of higher CS burden. The model presented demonstrated a satisfactory fit (GFI = 0.984; NFI = 0.966; CFI = 0.979; RMSEA = 0.056 [95% CI 0.028–0.085]) with large and medium effect sizes on physical (−0.654) and psychological QoL (−0.246). The study showed a key role of psychological dimensions in CS burden levels and their relationships with QoL in CH patients. From a clinical perspective, these results suggest the importance of evaluating the level of CS burden during the clinical assessment for chronic pain conditions such as CH, since it may contribute to guide patients to tailored psychological and medical treatments, thereby saving time and costs on diagnostic procedures for chronic pain. [ABSTRACT FROM AUTHOR]

Naturally occurring vitamin E is a lipophilic plant-derived molecule corresponding to the 2 R forms of alpha-tocopherol. A series of natural analogs or tocochromanols are present in nature, including β-, γ- and δ-tocopherol (βT, γT, δT), the corresponding tocotrienols (αTE, βTE, γTE, δTE) and tocomonoenols. Differences between these analogs as lipophilic antioxidants and modulators of molecular processes suggest specific therapeutic properties against various disorders associated with acute and chronic inflammation. However, hepatic metabolism of these compounds via cytochrome P450-initiated side chain ω-oxidation involves the production of long-chain metabolites (LCMs) followed by intermediate (ICMs) and short-chain metabolites (SCMs), respectively. Despite the initial studies indicating these metabolites as catabolic-end products, recent findings identify their importance in providing biological functions. In this scope, LCMs, especially 13'-carboxychromanols (13'-COOHs), have been reported to hold stronger anti-inflammatory capacity than their unmetabolized precursors due to their ability to inhibit 5-lipoxygenase and cyclooxygenase-catalyzed eicosanoid formation, as well as their modulation of the pro-inflammatory transcriptional protein nuclear factor κB (NF-κB). Also, these LCMs have been reported to enhance detoxification and lipid metabolism pathways associated with cellular inflammation by modulating the nuclear receptors peroxisome proliferator-activated receptor-γ (PPARγ) and pregnane x receptor (PXR). These properties of LCMs will be described in this narrative review article focusing on recent information regarding their bioavailability, anti-inflammatory effects, and mechanisms of action in acute and chronic inflammatory disorders.

Background: Non-metastatic pancreatic ductal adenocarcinoma (PDAC) presents a challenging scenario: the rarity of the disease, the limited number of completed prospective trials, and the shortcomings of comparability across series produce several controversial topics and unanswered questions. Guideline recommendations usually include all the different therapeutic options, de facto transferring to the multidisciplinary team the responsibility on the final decision. This secondary analysis of the GARIBALDI study was aimed to explore the correlation of center type, self-declared volume, and commitment with the overall survival (OS) in patients with non-metastatic PDAC., Patients and Methods: Treatment-naïve patients aged ≥18 years with a pathological diagnosis of non-metastatic PDAC, enrolled between July 2017 and October 2019, were analyzed. OS was defined as the time from treatment start to death. The impact of centers and clinical-demographic characteristics on OS was evaluated using Cox models., Results: Overall, 402 patients enrolled in 41 centers were eligible for this analysis. The median age was 68.4 years (range 35.6-88.8 years), 49.5% were females, 93.5% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, 16.7% had prior cancer history, and the median CA 19-9 level was 171.5 IU/ml (first-third quartile 24.5-937.5 IU/ml). For 79.8% of patients treatment started within 1 month from diagnosis. Thirty six point six percent of patients underwent upfront surgery and 91.8% of these received a subsequent adjuvant chemotherapy; 14.2% received chemotherapy followed by surgery and 49.3% chemotherapy without surgery. The preferred chemotherapy schemes were gemcitabine (54.8%) for adjuvant chemotherapy and nab-paclitaxel + gemcitabine (55.3%) for upfront chemotherapy. The median follow-up was 57.6 months and 300 patients died. A statistically significant shorter OS was observed in both low- [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.12-2.32, P = 0.0099] and medium-commitment (HR 1.57, 95% CI 1.10-2.23, P = 0.0120) compared to high-commitment institutions, when adjusting for clinically relevant covariates., Conclusion: The GARIBALDI study suggests that the volume and the academic brand are not associated with OS in patients with non-metastatic PDAC, while center commitment warrants further exploration., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)