David George Foster

Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors

INTRODUCTION Vulvodynia constitutes a highly prevalent form of chronic genital pain in women, and current information regarding its definition, prevalence, impact, and pathophysiologic factors involved is needed. AIM To update the scientific evidence published in 2010 from the Third International Consultation of Sexual Medicine pertaining to the definition, prevalence, impact, and pathophysiologic factors of womens sexual pain. METHODS An expert committee, as part of the Fourth International Consultation of Sexual Medicine, comprised of researchers and clinicians from biological and social science disciplines, reviewed the scientific evidence on the definition, prevalence, impact, and pathophysiologic factors related to chronic genital pain. MAIN OUTCOME MEASURES A review of the definition, prevalence, impact, and pathophysiological factors involved in vulvodynia. RESULTS Vulvodynia is a prevalent and highly impactful genital pain condition. Numerous factors have been implicated in its development and maintenance. CONCLUSION What is becoming increasingly apparent is that it likely represents the end point of different factors that can differ from patient to patient. Longitudinal research is needed to shed light on risk factors involved in the expression of vulvodynia, as well as in potential subgroups of affected patients, in order to develop an empirically supported treatment algorithm.

Nanoparticle coatings for enhanced capture of flowing cells in microtubes.

Recently, a flow-based selectin-dependent method for the capture and enrichment of specific types of cells (CD34+ hematopoetic stem and progenitor cells and human leukemia HL60) from peripheral blood was demonstrated. However, these devices depend on a monolayer of selectin protein, which has been shown to have a maximum binding efficiency as a function of surface area. A novel surface coating of colloidal silica nanoparticles was designed that alters the surface roughness resulting in increased surface area. The nanoparticles were adhered using either an inorganic titanate resinous coating or an organic polymer of poly-L-lysine. Using Alexa Fluor 647 conjugated P-selectin, an increase in protein adsorption of up to 35% when compared to control was observed. During perfusion experiments using P-selectin-coated microtubes, we observed increased cell capture and greatly decreased rolling velocity at equivalent protein concentration compared to nonparticle control. Atomic force microscopy showed increased surface roughness consistent with the nanoparticle mean diameter, suggesting a monolayer of particles. These results support the coatings potential to improve existing cell capture implantable devices for a variety of therapeutic and scientific uses.

Vulvodynia: Current state of the biological science

http://dx.doi.org/10.1016/j.pain.2014.05.010 0304-3959/ 2014 Published by Elsevier B.V. on behalf of International Association for the Study of Pain. ⇑ Corresponding author. Address: Box 668, Department of Obstetrics and Gynecology, Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY 14642, USA. Tel.: +1 585 487 3420; fax: +1 585 276 1956. E-mail address: david_foster@urmc.rochester.edu (D. Foster). Ursula Wesselmann , Adrienne Bonham , David Foster c,⇑

Scaling of Roughness in Silver Electrodeposition

The electrodeposition of silver from thiosulfate solutions and its surface roughness are studied using scaling methods. Although silver electrodeposition from photographic fixing baths containing thiosulfate has been done successfully for many years, the vast majority of information about this process remains empirical. A comparison is made between plating silver from ammonium- and sodium-thiosulfate-containing solutions. Atomic force microscopy is used to study surface roughness, which is then analyzed by scaling methods. Silver electrodeposition from sodium-thiosulfate-containing solutions was found to be smoother than from ammonium-thiosulfate-containing solutions. The obtained scaling exponents, found after correction for local effects, depend strongly on the nature of the electrolyte; the growth exponents β are 0.13 and 0.71 for sodium and ammonium thiosulfate solutions, respectively. Local effects are observed only for the sodium but not for the ammonium thiosulfate solution.

The Effect of Rate of Surface Growth on Roughness Scaling

The effect of rate of deposition on the scaling properties of roughness during surface growth is studied by silver electrodeposition in a flow cell and atomic force microscopy measurements. The rate of growth is controlled by the applied current density. The Ag-electrodeposited surface becomes rougher as the current density increases, approaching the diffusion limiting current. Furthermore, as the current density increases, the number of growth sites decreases and the lateral surface features become wider. Scaling analysis of the self-affine surface indicates that the saturated root-mean-square height increases with increasing current density, over a range of 2 decades; however, below saturation, the dependence is more complicated: Initially, there is no local effect; however, as the rate increases, negative local effect is observed, indicating that the local roughness grows more slowly at higher rates, as the current approaches the diffusion limiting current in the electrolyte. The discrepancy between the obtained average roughness exponent a = 0.52 and the growth rate exponent β r = 0.3, similar to experiments under low deposition rate and for various deposition times (a = 0.62, β t = 0.71), indicates that the rate plays a decisive role in the selection of the growth kinetics by affecting the initial number of nucleation sites and their subsequent merge. Only at low rates, the rate and the time of growth behave interchangeably, and therefore the roughness scales with the average height, the product of the rate, and the time of growth.

Scaling behavior of cyclical surface growth

The scaling behavior of cyclical surface growth (e.g., deposition/desorption), with the number of cycles, n, is investigated. The roughness of surfaces grown by two linear primary processes follows a scaling behavior with asymptotic exponents inherited from the dominant process while the effective amplitudes are determined by both. Relevant nonlinear effects in the primary processes may remain so or be rendered irrelevant. Numerical simulations for several pairs of generic primary processes confirm these conclusions. Experimental results for the surface roughness during cyclical electrodeposition/dissolution of silver show a power-law dependence on n, consistent with the scaling description.

Presenting symptoms among premenopausal and postmenopausal women with vulvodynia: a case series.

Objective:The aim of the study was to determine whether there are differences in the clinical presentation of symptoms and vulvar pain ratings in postmenopausal women compared with premenopausal women with provoked vestibulodynia (PVD) enrolled in a clinical trial, after correcting for estrogen deficiency. Methods:Questionnaire data were collected from 76 premenopausal and 24 postmenopausal women enrolled in a clinical trial for PVD. The questionnaire obtained information about the presence or absence of vulvar pain, the characteristics of this pain, and information about the womens demographic characteristics and reproductive health history. Participants were clinically confirmed to have PVD by a positive cotton swab test on pelvic examination and either absence of or corrected vulvovaginal atrophy based on Ratkoff staining with less than 10% parabasal cells. Women completed a standardized questionnaire describing their vulvar symptoms and rated daily pain on a visual analog scale (0 = no pain to 10 = worse pain imaginable) from sexual intercourse, tampon insertion (as a surrogate measure of intercourse) and 24-hour vulvar pain for 2 weeks during the screening period. Pretreatment data were analyzed before pharmacologic intervention. Chi-square was used to determine differences between pre- and postmenopausal women in demographic characteristics and clinical presentation, and independent t tests were used to analyze pain ratings by (0-10) numeric rating scale (NRS). Results:The average ages of premenopausal and postmenopausal women were (30.6 ± 8.6 y) and (54.4 ± 6.5 y), respectively. The groups significantly differed with regard to relationship status (P = 0.002) and race (P = 0.03), but did not differ in years of education (P = 0.49), income level (P = 0.29), or duration of symptoms (P = 0.09). Postmenopausal women reported significantly more vulvar burning (70.00% vs 43.42%, P = 0.03), but there were no differences in vulvar itching (20.00% vs 22.37%, P = 0.82), vulvar stinging (40.00% vs 36.84%, P = 0.79), vulvar aching (50.00% vs 63.16%, P = 0.28), and vulvar stabbing (60.00% vs 71.06% P = 0.34) or in mean number of symptoms (2.40 ± 1.0 vs 2.37 ± 1.4, P = 0.92). Of the 70 participants completing diaries and meeting tampon insertion pain, there were no significant differences in mean (±SD) NRS pain ratings of postmenopausal compared with premenopausal women for tampon insertion (5.66 ± 1.93 vs 5.83 ± 2.15, P = 0.77), daily vulvar pain (3.20 ± 2.55 vs 3.83 ± 2.49, P = 0.38) and sexual intercourse (6.00 ± 2.53 vs 5.98 ± 2.29, P = 0.98). Conclusions:Pre- and postmenopausal women with PVD have similar pain scores, and with the exception of a higher incidence of burning in postmenopausal women, similar presenting clinical symptoms. The statistical power of this conclusion is limited by the small number of postmenopausal women in the study. Further research on the vulvar pain experience of the older woman with PVD is warranted.

Milnacipran in Provoked Vestibulodynia: Efficacy and Predictors of Treatment Success

Objective This study aimed to collect preliminary evidence on the efficacy of milnacipran in reducing pain in women with provoked vestibulodynia (PVD) and to identify which patient characteristics predict treatment success. Materials and Methods A 12-week open-label trial was conducted in 22 women with PVD. The Pain Rating Index of the McGill Pain Questionnaire was the primary outcome measure. Other outcome measures included daily diaries, Beck Depression Inventory, State-Trait Anxiety Inventory, Female Sexual Function Index, Brief Pain Inventory, a personal or family history of fibromyalgia, and PVD subtype. Results Milnacipran (50–200 mg/d) significantly reduced pain severity on the Pain Rating Index (p = .001), coital pain (p = .001), tampon pain (p = .003), and mean vulvar pain (p ⩽ .001). Scores were also decreased on the Beck Depression Inventory (p = .015), State-Trait Anxiety Inventory (p = .046), and Brief Pain Inventory (p = .019) and increased on the Female Sexual Function Index (p = .004). Fibromyalgia history, PVD subtype, presence of depression or anxiety, and level of impairment did not affect treatment response. By logistic regression analysis, it was noted that the odds of treatment success was 3 times higher among women who, at pretreatment, had a sexually satisfying relationship compared to those who did not (odds ratio = 3.30, confidence interval = 1.04–10.50, p = .043). Conclusions Milnacipran significantly reduced vestibular pain in women with PVD. Treatment success was predicted by pretreatment sexual satisfaction. A larger randomized controlled trial is necessary to confirm the efficacy of milnacipran in PVD and to identify other possible predictors of treatment outcome.

Roughness scaling in cyclical surface growth.

The scaling behavior of cyclical growth (e.g., cycles of alternating deposition and desorption primary processes) is investigated theoretically and probed experimentally. The scaling approach to kinetic roughening is generalized to cyclical processes by substituting the number of cycles n for the time. The roughness is predicted to grow as n(beta) where beta is the cyclical growth exponent. The roughness saturates to a value that scales with the system size L as L(alpha), where alpha is the cyclical roughness exponent. The relations between the cyclical exponents and the corresponding exponents of the primary processes are studied. Exact relations are found for cycles composed of primary linear processes. An approximate renormalization group approach is introduced to analyze nonlinear effects in the primary processes. The analytical results are backed by extensive numerical simulations of different pairs of primary processes, both linear and nonlinear. Experimentally, silver surfaces are grown by a cyclical process composed of electrodeposition followed by 50% electrodissolution. The roughness is found to increase as a power law of n, consistent with the scaling behavior anticipated theoretically. Potential applications of cyclical scaling include accelerated testing of rechargeable batteries and improved chemotherapeutic treatment of cancerous tumors.

The Prevalence of Fibromyalgia by Tender Point Tenderness in Women With Localized Provoked Vestibulodynia [2D]

INTRODUCTION: Provoked vestibulodynia (PVD) is a chronic pain condition of the vulva, diagnosed by eliciting pain on the vestibule, “the cotton-swab test.” Fibromyalgia (FM) is a chronic musculoskeletal pain condition, diagnosed by eliciting pain with pressure on 11 out of 18 defined tender points (TPT). Both conditions are of unknown etiology. Fibromyalgia has been recognized as a co-morbidity of vulvodynia but the number of women with PVD who have fibromyalgia is not clear. Our objectives were: to determine the prevalence of FM, diagnosed by TPT exam, in women with PVD. 2. To compare the prevalence of FM by TPT with the reported prevalence of personal or family history (FH) in the same women. METHODS: Women aged 18 or older diagnosed with PVD were screened for FM with a TPT examination. Medical history, collected prior to examination, was reviewed to determine reported prevalence of personal or FH of FM. RESULTS: All 147 women enrolled in the study underwent TPT evaluation. Twenty six women screened positive for fibromyalgia, prevalence of 17.7%. Of the 143 women with a completed medical history, 12 had a personal or FH of FM, prevalence 8.4%. CONCLUSION: Women with PVD had a higher prevalence of FM by TPT than that which is reported in the general population (17.7% vs 2–6.4%), and a higher prevalence of FM by TPT than would be expected by personal and FH (17.7% vs 8.4%). Future studies may determine if treatment of co-morbidities improves outcomes in this population.