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Eur J Med Chem 2018 Nov 28;163:207-214. Epub 2018 Nov 28.

Department of Neurosurgery, Kurume University, School of Medicine, Fukuoka, Japan. Electronic address:

Ischemia-reperfusion injuries produce reactive oxygen species that promote the peroxide lipid oxidation process resulting in the production of an endogenic lipid peroxide, 4-hydroxy-trans-2-nonenal (4-HNE), a highly cytotoxic aldehyde that induces cell death. We synthesized a novel 4-HNE scavenger - a carnosine-hydrazide derivative, l-carnosine hydrazide (CNN) - and examined its neuroprotective effect in a model of transient ischemia. PC-12 cells were pre-incubated with various doses (0-50 mmol/L) of CNN for 30 min, followed by incubation with 4-HNE (250 μM). Read More

Clin Biochem 2018 Dec 3. Epub 2018 Dec 3.

Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia; Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Electronic address:

Objective: Identification of new molecular markers to enhance early diagnosis, prognosis and/or treatment of hepatocellular carcinoma (HCC) is a need. TOM34 (34 kDa-translocase of the outer mitochondrial membrane) protein expression deregulation has demonstrated to be involved in the growth of many cancers. Here, we aimed at evaluating serum TOM34 and some heat shock proteins (HSPA4, HSPA1B, and HSP90AA1) expressions in hepatitis C virus (HCV)-related cirrhosis and HCV-induced HCC relative to controls and correlating these expressions to the clinicopathological data. Read More

Biomarkers 2018 Dec 6:1-15. Epub 2018 Dec 6.

a Children's Medical Center , Taichung Veterans General Hospital , Taichung , Taiwan.

Purpose: Hypercatecholaminemia-related heart failure has been proposed as the main cause of enterovirus A71-related (EV-A71) early mortality. The purpose of this study was to measure urine catecholamine concentrations in severe EV-A71-infected children.

Methods: A total of 35 children, aged 2. Read More

Clin Infect Dis 2018 Dec 6. Epub 2018 Dec 6.

Department of Medicine, Harvard Medical School, Boston, MA, USA.

Immunotherapy using antibodies to immune checkpoint molecules or targeted chimeric antigen receptor-modified T (CAR-T) cells represent dramatic advances in cancer treatment. These therapies mediate immune-related adverse events (irAEs) which may mimic or amplify infectious presentations. Checkpoint inhibitor therapy may be associated with diverse irAEs including mild skin, endocrine and autoimmune manifestations or severe inflammatory processes including colitis, pneumonitis, myocarditis, and shock. Read More

G Ital Cardiol (Rome) 2018 Dec;19(12):672-675

U.O.C. Cardiologia, Ospedale G.B. Morgagni, Forlì - Fondazione Cardiologica "Myriam Zito Sacco", Forlì.

Eur J Anaesthesiol 2019 Jan;36(1):70-71

From the Department of Anaesthesiology and Intensive Care (QM, JB, PEG), Department of Pulmonology (NP), Department of Otorhinolaryngology, Military Hospital Sainte Anne, Toulon (LV) and French Military Health Service Academy Unit, Ecole du Val-de-Grâce, Paris, France (JB).

Shock 2018 Jul 30. Epub 2018 Jul 30.

Department of Pathology and Medical Biology, Medical Biology section.

Tie2 is a tyrosine kinase receptor that is mainly expressed by endothelial cells. In animal models mimicking critical illness, Tie2 levels in organs are temporarily reduced. Functional consequences of these reduced Tie2 levels on microvascular endothelial behaviour are unknown. Read More

Curr HIV Res 2018 Dec 5. Epub 2018 Dec 5.

Pilot Nano-Biotechnology Department, Pasteur Institute of Iran, Tehran. Iran.

Background: HIV-1 Nef protein is a possible attractive target in development of therapeutic HIV vaccines including protein-based vaccines. The most important disadvantage of protein-based vaccines is their low immunogenicity which can be improved by heat shock proteins (Hsps) as an immunomodulator, and cell penetrating peptides (CPPs) as a carrier.

Methods: In this study, the HIV-1 Nef and Hsp20-Nef proteins were generated in E. Read More

Circ Arrhythm Electrophysiol 2018 Nov;11(11):e006305

Yale University School of Medicine, New Haven, CT (J.D., C.B., L.S., F.L., R.J.L.).

Background: Despite safety concerns, many young patients with implantable cardioverter-defibrillators (ICDs) participate in sports. We undertook a prospective, multinational registry to determine the incidence of serious adverse events because of sports participation. The primary end points were death or resuscitated arrest during sports or injury during sports because of arrhythmia or shock. Read More

Sci China Life Sci 2018 Dec 3. Epub 2018 Dec 3.

Department of Cardiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China.

Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%-70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Read More

Dig Dis Sci 2018 Dec 5. Epub 2018 Dec 5.

Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA.

Background: Gastrointestinal hemorrhage (GIH) is reported to occur in 1-8% of patients admitted with acute ischemic stroke (AIS). AIS is considered to be a relative contraindication to GIE.

Aims: Evaluate the outcomes of gastrointestinal endoscopy (GIE) in patients hospitalized with AIS and GIH. Read More

Biomed Res Int 2018 1;2018:8925345. Epub 2018 Nov 1.

Dpt. of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic.

The fluid challenge (FC) is a well-established test of preload reserve. Only limited data exist in regard to the FC efficacy based on infusion time. Slow administration may be associated with lack of effect based on fluid redistribution and external conditions changes. Read More

World J Methodol 2018 Nov 29;8(3):37-39. Epub 2018 Nov 29.

Department Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus.

Lateral elbow tendinopathy (LET) is one of the two most common tendinopathies of the upper limb. The most effective treatment in the management of LET is the exercise program. Clinicians combine exercise program with other physiotherapy, electrotherapeutic and no, techniques. Read More

Antimicrob Resist Infect Control 2018 29;7:148. Epub 2018 Nov 29.

3Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada.

Background: Surgically-managed fractures, particularly open fractures, are associated with high rates of surgical site infections (SSIs). To reduce the risk of an SSI, orthopaedic surgeons routinely clean open fracture wounds in the emergency department (ED) and then apply a bandage to the open wound. Prior to the surgical incision, it is standard practice to prepare the fracture region with an antiseptic skin solution as an additional SSI prevention strategy. Read More

Stand Genomic Sci 2018 29;13:35. Epub 2018 Nov 29.

1Center of Food Safety and Applied Nutrition, U. S. Food and Drug Administration, 8301 Muirkirk Road, Laurel, MD 20708 USA.

is a Gram-negative opportunistic pathogen that causes life- threatening infantile infections, such as meningitis, septicemia, and necrotizing enterocolitis, as well as pneumonia, septicemia, and urinary tract and wound infections in adults. Here, we report 26 draft genome sequences of , which were obtained from dried spices from the USA, the Middle East, China, and the Republic of Korea. The average genome size of the genomes was 4393 kb, with an average of 4055 protein coding genes, and an average genome G + C content of 56. Read More

Infect Agent Cancer 2018 29;13:38. Epub 2018 Nov 29.

1Department of Surgery, Medical School, University of Pécs, Hungary, Ifjuság Street 13, Pécs, 7624 Hungary.

Background: The aims of this study were to evaluate whether HPV infection has a prognostic role in patients with esophageal squamous cell carcinoma who underwent oncological treatment and also to compare the heat shock proteins (Hsp) 90, 27 and 16.2 and growth hormone-releasing hormone receptor (GHRH-R) expression patterns of the pre-treatment tumor biopsies with the HPV status and with the oncological response.

Methods: Pre-treatment tumor biopsies of 74 patients with locally advanced esophageal squamous cell carcinoma were processed retrospectively. Read More

Emerg Med J 2018 Dec 5. Epub 2018 Dec 5.

Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA.

Background And Objectives: Delayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis. Read More

Future Med Chem 2018 Dec 6. Epub 2018 Dec 6.

Department of General Biochemistry, Faculty of Biology & Environmental Protection, University of Łódź, Pomorska 141/3, 90-236 Łódź, Poland.

Aim: To evaluate the level of lipid peroxidation in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy (ESWL).

Materials & Methods: Isoprostane concentration (8-isoPGF) was measured in urine, and thiobarbituric acid reactive substance production in serum and erythrocytes. In addition, the concentrations of selected compounds (uric acid, glucose and creatinine) were measured in serum. Read More

Free Radic Biol Med 2018 Nov 30. Epub 2018 Nov 30.

MRC-Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Institute of Ageing and Chronic Disease, University of Liverpool, L7 8TX, United Kingdom.

Age-associated frailty is predominantly due to loss of muscle mass and function. The loss of muscle mass is also associated with a greater loss of muscle strength, suggesting that the remaining muscle fibres are weaker than those of adults. The mechanisms by which muscle is lost with age are unclear, but in this review we aim to pull together various strands of evidence to explain how muscle contractions support proteostasis in non-muscle tissues, particularly focussed on the production and potential transfer of Heat Shock Proteins (HSPs) and how this may fail during ageing, Furthermore we will identify logical approaches, based on this hypothesis, by which muscle loss in ageing may be reduced. Read More

Proteomics 2018 Dec 3:e1800004. Epub 2018 Dec 3.

Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Heat shock protein 90 (HSP90) is a highly abundant molecular chaperone that interacts with many other intracellular proteins to regulate various cellular processes. However, compositions of the HSP90-interacting complex remain underinvestigated. This study thus aimed to characterize such complex in human embryonic kidney (HEK293T) cells under normal physiologic state using tandem affinity purification (TAP) followed by protein identification using an ultrahigh-resolution tandem mass spectrometer (Qq-TOF MS/MS). Read More

Hum Mol Genet 2018 Dec;27(24):4176-4193

Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL, USA.

Commonalities and, in some cases, pathological overlap between neurodegenerative diseases have led to speculation that targeting of underlying mechanisms might be of potentially shared therapeutic benefit. Alzheimer's disease is characterized by the formation of plaques, composed primarily of the amyloid-β 1-42 (Aβ) peptide in the brain, resulting in neurodegeneration. Previously, we have shown that overexpression of the lysosomal-trafficking protein, human Vps41 (hVps41), is neuroprotective in a transgenic worm model of Parkinson's disease, wherein progressive dopaminergic neurodegeneration is induced by α-synuclein overexpression. Read More

J Trauma Acute Care Surg 2018 Nov 30. Epub 2018 Nov 30.

Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.

Background: Multiple organ failure can develop after hemorrhagic shock (HS). Uric acid (UA) is released from dying cells and can be pro-inflammatory. We hypothesized that UA could be an alternative mediator of organ apoptosis and inflammation after HS. Read More

Pathog Glob Health 2018 Dec 3:1-11. Epub 2018 Dec 3.

c Department of Parasitology, Faculty of medicine , University of Colombo , Colombo , Sri Lanka.

Dengue infection classically presents with fever, thrombocytopaenia, and varying degrees of plasma leakage, giving rise to shock. However, a myriad of other manifestations, involving the cardiovascular system, the nervous system, the liver, the kidneys, the gut and the haematological system have been reported in dengue. This review summarizes these varied presentations. Read More

J Med Chem 2018 Dec 3. Epub 2018 Dec 3.

Protein-protein interactions (PPIs) regulate all signalling pathways for cellular function. Developing molecules that modulate PPIs through the interface of their protein surfaces has been a significant challenge and there has been little success controlling PPI's through standard molecular library screening approaches. PPIs control the cell's protein-folding machinery, and this machinery relies on a multiprotein complex formed with heat shock protein 70 (Hsp70). Read More

Catheter Cardiovasc Interv 2018 Dec 2. Epub 2018 Dec 2.

Department of Cardiovascular Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan.

Background: Periprocedural outcomes of transcatheter mitral valve repair (TMVR) with Mitraclip in patients with pulmonary hypertension (PH) are not well studied.

Methods: Patients who underwent TMVR with Mitraclip between 2011 and 2015 were identified using the National Inpatient Sample (NIS). All missing variables were excluded from the analysis and therefore, complete case analysis was performed. Read More

Pharmacotherapy 2018 Dec 3. Epub 2018 Dec 3.

Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO, USA.

Study Objective: Minimizing the duration of broad-spectrum antimicrobial exposure in the critically ill is a commonly used strategy aimed at preventing resistance. Our objective was to correlate the duration of exposure to antipseudomonal β-lactam antibiotics with the development of new resistance in critically ill patients.

Design: Single-center, retrospective cohort study. Read More

Int J Dent Hyg 2018 Dec 3. Epub 2018 Dec 3.

School of Dentistry, The University of Queensland, Brisbane, Australia.

Objectives: Managing oral health after the treatment for head and neck cancer requires meticulous daily oral hygiene practices, and regular professional dental care; however, the individual factors and health system structures required to achieve oral health are often not well considered. This study aimed to explore how oral health was understood and managed post head and neck cancer treatment and identify factors that influenced oral health behaviours and dental service utilisation.

Methods: A qualitative, inductive approach was used for data collection and analysis. Read More

Pharmacotherapy 2018 Dec 1. Epub 2018 Dec 1.

Department of Pharmacy Practice, University of Pittsburgh School of Pharmacy, Pittsburgh, PA.

Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Read More

J Neurooncol 2018 Dec 1. Epub 2018 Dec 1.

Department of Neurosurgery, University Hospital of Münster, Münster, Germany.

Background: There is an increasing interest in local tumor ablative treatment modalities that induce immunogenic cell death and the generation of antitumor immune responses.

Methods: We report six recurrent glioblastoma patients who were treated with intracavitary thermotherapy after coating the resection cavity wall with superparamagnetic iron oxide nanoparticles ("NanoPaste" technique). Patients underwent six 1-h hyperthermia sessions in an alternating magnetic field and, if possible, received concurrent fractionated radiotherapy at a dose of 39. Read More

Crit Ultrasound J 2018 Dec 2;10(1):32. Epub 2018 Dec 2.

Department of Emergency Medicine, Ben Taub Hospital, Baylor College of Medicine, 1400 Taub Loop, Houston, TX, USA.

Background: Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness. Read More

Cell Stress Chaperones 2018 Dec 1. Epub 2018 Dec 1.

Biotechnology Innovation Centre, Rhodes University, Grahamstown, South Africa.

The etiological agent of the neglected tropical disease African trypanosomiasis, Trypanosoma brucei, possesses an expanded and diverse repertoire of heat shock proteins, which have been implicated in cytoprotection, differentiation, as well as progression and transmission of the disease. Hsp70 plays a crucial role in proteostasis, and inhibition of its interactions with co-chaperones is emerging as a potential therapeutic target for numerous diseases. In light of genome annotations and the release of the genome sequence of the human infective subspecies, an updated and current in silico overview of the Hsp70/J-protein machinery in both T. Read More

Methods Mol Biol 2019 ;1887:175-187

Department of Food Management, Miyagi University, Sendai, Miyagi, Japan.

Lipopolysaccharide (LPS) is related to human inflammation. Therefore, in the probiotics research field, controlling the mechanisms of LPS neutralization and elimination of inflammation of human intestines are important. This chapter presents a description of the identification of LPS elimination protein (LEP) in lactic acid bacteria (LAB), cloning of its protein, and its expression. Read More

mSystems 2018 Nov-Dec;3(6). Epub 2018 Nov 20.

Leishmaniasis Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.

The 90-kDa heat shock protein (HSP90) of eukaryotes is a highly abundant and essential chaperone required for the maturation of regulatory and signal proteins. In the protozoan parasite Leishmania donovani, causative agent of the fatal visceral leishmaniasis, HSP90 activity is essential for cell proliferation and survival. Even more importantly, its inhibition causes life cycle progression from the insect stage to the pathogenic, mammalian stage. Read More

Adv Simul (Lond) 2018 23;3:23. Epub 2018 Nov 23.

1Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Bloco A-1 subsolo, Sao Paulo, SP CEP 05651-901 Brazil.

Background: During in situ simulation, interprofessional care teams practice in an area where clinical care occurs. This study aimed to detect latent safety threats (LST) in a training program, which combined in situ simulation scenarios with just-in-time and just-in-place self-directed task training in an emergency department. We hypothesized this simulation-based training in actual care areas allows the detection of at least one LST per simulation scenario. Read More

J Intensive Care 2018 26;6:78. Epub 2018 Nov 26.

Intensive Care Unit, Okba Ben Nafee Hospital, 45 street, el-Asafra, Alexandria, 21539 Egypt.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 suggested against the use of the early goal-directed therapy (EGDT) in patients with septic shock. This recommendation was based on the three large-scale trials (ProCESS, ARISE, and ProMISe). Although the three trials showed no difference in mortality between EGDT and usual care, the guidelines determined that the potential harms presented by EGDT likely outweigh its potential benefits. Read More

J Intensive Care Soc 2018 Nov 29;19(4):351-353. Epub 2018 Jan 29.

Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.

Background: Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Read More

Transl Psychiatry 2018 Nov 30;8(1):263. Epub 2018 Nov 30.

Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.

Ketamine is a multimodal dissociative anesthetic, which provides powerful analgesia for victims with traumatic injury. However, the impact of ketamine administration in the peri-trauma period on the development of post-traumatic stress disorder (PTSD) remains controversial. Moreover, there is a major gap between preclinical and clinical studies because they utilize different doses and routes of ketamine administration. Read More

Neurol India 2018 Nov-Dec;66(6):1634-1643

Department of Neurology, Government Medical College Kota, Rajasthan, India.

Introduction: Our aim was to study dengue-related immune-mediated neurological complications (IMNC) during the recent epidemic.

Materials And Methods: This was a cross-sectional observational study of 79 IMNC cases from 1627 laboratory confirmed dengue cases from January 2015 to January 2016 and their follow-up for 3 months. According to the World Health Organization, cases were categorized into those having dengue fever (DF), and those having a severe syndrome that includes dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Read More

J Invasive Cardiol 2018 Dec;30(12):456-460

Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.

Objectives: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is most commonly used in patients with cardiac arrest and cardiogenic shock. There are limited data on the use of VA-ECMO for elective, high-risk percutaneous coronary intervention (PCI). We examined the in-hospital and mid-term clinical outcomes in patients undergoing complex, high-risk PCI with VA-ECMO support. Read More

J Invasive Cardiol 2018 Dec;30(12):443-446

Division of Cardiology, Careggi Hospital, Viale Pieraccini 17, I-50134, Florence, Italy. ruben.arg@ gmail.com.

Introduction: It is not clear if differences exist about treating left main bifurcation (LMB) and non-left main bifurcation (non-LMB) lesions by means of percutaneous coronary intervention (PCI).

Methods: We prospectively analyzed all consecutive patients treated at our center for bifurcation lesions from January 1, 2011 to December 31, 2015, including acute myocardial infarction (MI) and cardiogenic shock, and compared the angiographic and clinical outcomes of patients with LMB and non-LMB lesions treated with PCI and second-generation drug-eluting stent (2G-DES) implantation. The primary endpoint was the major adverse cardiac event (MACE) composite, including MI, clinically indicated target-vessel revascularization (TVR), and cardiac death (CD) at 2-year follow-up. Read More

Appl Environ Microbiol 2018 Nov 30. Epub 2018 Nov 30.

Institute of Oceanography, Shanghai Jiao Tong University, Shanghai 200240

The discovery of hyperthermophiles has dramatically changed our understanding of the habitats in which life can thrive. However, the extreme high temperatures in which these organisms live have severely restricted the development of genetic tools. The archaeon A1 is a strictly anaerobic and piezophilic hyperthermophile that is an ideal model for studies of extreme environmental adaptation. Read More

Medicina (B Aires) 2018 ;78(6):417-426

Hospital Prof. Alejandro Posadas, El Palomar, Buenos Aires, Argentina.

Intra-abdominal infections represent a group of intra and retroperitoneal processes, ranging from localized infections to complicated ones, sepsis and septic shock, associated with a significant mortality rate. They are the third most commonly identified cause of sepsis and the second cause of death in the intensive care unit. Although antimicrobial therapy must be started as soon as possible, especially in critically ill patients, the source control procedure is highly relevant. Read More

Immunol Lett 2018 Nov 29. Epub 2018 Nov 29.

Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China. Electronic address:

Endoplasmic reticulum (ER) stress acts as a protein folding and contributes to neuronal damage and neurological deterioration following intracerebral hemorrhage (ICH). Heat Shock Protein A5 (HSPA5) serves as an essential regulator of the endoplasmic reticulum (ER) stress response. However, the specific mechanism has not been will identified. Read More

Jt Comm J Qual Patient Saf 2018 Nov 29. Epub 2018 Nov 29.

is Staff Physician and Quality Officer, Medical ICU, Respiratory Institute, Cleveland Clinic.

Background: The Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) quality measure is complex to abstract, which may lead to discrepancies between abstractors. This study was designed to evaluate inter-rater agreement between abstractors at individual hospitals in a health system and a lead abstractor on abstraction elements and measure compliance for SEP-1.

Methods: Patient cases qualifying for abstraction for SEP-1 over a four-month period in 2016 were initially abstracted at a local hospital and then centrally by a lead abstractor. Read More

Sex Med Rev 2018 Nov 29. Epub 2018 Nov 29.

Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.

Introduction: Peyronie's disease (PD) is a fibrotic disorder that leads to plaque formation in ∼3-9% of adult men. Connective tissue buildup results in plaque formation, penile curvature and shortening, and in some cases, pain. In the active phase of PD, penile pain is a common symptom, often accompanied by progression in curvature. Read More