Nonsurgical Treatment of Neuralgia and Cervicogenic Headache:A Systematic Review and Meta-Analysis

BACKGROUND: Extracranial compression of peripheral sensory nerves is one of many origins of chronic headaches. Identifying these patients can be difficult, and they are often diagnosed with neuralgia or cervicogenic headache. The recent literature provides the outcomes of surgical decompression in patients with these headaches. This study aimed to give an overview of the current literature on the nonsurgical treatment options and to evaluate the effectiveness of these treatments in patients with neuralgia and cervicogenic headache. METHODS: Databases were searched to identify all published clinical studies investigating nonsurgical treatment outcomes in patients with neuralgia or cervicogenic headaches. Studies that reported numerical pain scores, nonnumerical pain scores, headache-free days, or the number of adverse events after nonsurgical treatment were included. RESULTS: A total of 22 articles were included in qualitative analysis. The majority of studies included patients who received injection therapy. Treatment with oral analgesics achieved good results in only 2.5% of the patients. Better outcomes were reported in patients who received local anesthetics injection (79%) and corticosteroid injection (87%). Treatment with botulinum toxin injection yielded the highest percentage of good results (97%; 95% CI, 0.81–1.00). The duration of headache relief after injection therapy varied from 30 minutes to 5 months. CONCLUSIONS: The nonsurgical treatment of patients with neuralgia or cervicogenic headache is challenging. Injection therapy in patients with these types of headaches achieved good pain relief but only for a limited time. Surgical decompression may result in long-lasting pain relief and might be a more sustainable treatment option

A second order cone formulation of continuous CTA model

The final publication is available at link.springer.comIn this paper we consider a minimum distance Controlled Tabular Adjustment (CTA) model for statistical disclosure limitation (control) of tabular data. The goal of the CTA model is to find the closest safe table to some original tabular data set that contains sensitive information. The measure of closeness is usually measured using l1 or l2 norm; with each measure having its advantages and disadvantages. Recently, in [4] a regularization of the l1 -CTA using Pseudo-Huber func- tion was introduced in an attempt to combine positive characteristics of both l1 -CTA and l2 -CTA. All three models can be solved using appro- priate versions of Interior-Point Methods (IPM). It is known that IPM in general works better on well structured problems such as conic op- timization problems, thus, reformulation of these CTA models as conic optimization problem may be advantageous. We present reformulation of Pseudo-Huber-CTA, and l1 -CTA as Second-Order Cone (SOC) op- timization problems and test the validity of the approach on the small example of two-dimensional tabular data set.Peer ReviewedPostprint (author's final draft

High Median Nerve Paralysis:Is the Hand of Benediction or Preacher's Hand A Correct Sign?

High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher’s hand. This study aimed to show that the hand of benediction or preacher’s hand is incorrectly associated with a high median nerve paralysis. METHODS: A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion. RESULTS: All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon. CONCLUSIONS: The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher’s hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries

Phantom Limb Pain and Painful Neuroma After Dysvascular Lower-Extremity Amputation:A Systematic Review and Meta-Analysis

Background: Phantom limb pain (PLP) and symptomatic neuroma can be debilitating and significantly impact the quality of life of amputees. However, the prevalence of PLP and symptomatic neuromas in patients following dysvascular lower limb amputation (LLA) has not been reliably established. This systematic review and meta-analysis evaluates the prevalence and incidence of phantom limb pain and symptomatic neuroma after dysvascular LLA. Methods: Four databases (Embase, MEDLINE, Cochrane Central, and Web of Science) were searched on October 5th, 2022. Prospective or retrospective observational cohort studies or cross-sectional studies reporting either the prevalence or incidence of phantom limb pain and/or symptomatic neuroma following dysvascular LLA were identified. Two reviewers independently conducted the screening, data extraction, and the risk of bias assessment according to the PRISMA guidelines. To estimate the prevalence of phantom limb pain, a meta-analysis using a random effects model was performed. Results: Twelve articles were included in the quantitative analysis, including 1924 amputees. A meta-analysis demonstrated that 69% of patients after dysvascular LLA experience phantom limb pain (95% CI 53-86%). The reported pain intensity on a scale from 0-10 in LLA patients ranged between 2.3 ± 1.4 and 5.5 ±.7. A single study reported an incidence of symptomatic neuroma following dysvascular LLA of 5%. Conclusions: This meta-analysis demonstrates the high prevalence of phantom limb pain after dysvascular LLA. Given the often prolonged and disabling nature of neuropathic pain and the difficulties managing it, more consideration needs to be given to strategies to prevent it at the time of amputation.</p

Symmetric vs asymmetric protection levels in SDC methods for tabular data

The final publication is available at link.springer.comProtection levels on sensitive cells—which are key parameters of any statistical disclosure control method for tabular data—are related to the difficulty of any attacker to recompute a good estimation of the true cell values. Those protection levels are two numbers (one for the lower protection, the other for the upper protection) imposing a safety interval around the cell value, that is, no attacker should be able to recompute an estimate within such safety interval. In the symmetric case the lower and upper protection levels are equal; otherwise they are referred as asymmetric protection levels. In this work we empirically study the effect of symmetry in protection levels for three protection methods: cell suppression problem (CSP), controlled tabular adjustment (CTA), and interval protection (IP). Since CSP and CTA are mixed integer linear optimization problems, it is seen that the symmetry (or not) of protection levels affect to the CPU time needed to compute a solution. For IP, a linear optimization problem, it is observed that the symmetry heavily affects to the quality of the solution provided rather than to the solution time.Peer ReviewedPostprint (author's final draft

Prevalence of post-traumatic neuropathic pain after digital nerve repair and finger amputation

Introduction: Post-traumatic neuropathic pain is a major factor affecting the quality of life after finger trauma and is reported with considerable variance in the literature. This can partially be attributed to the different methods of determining neuropathic pain. The Douleur Neuropathique 4 (DN4) has been validated to be a reliable and non-invasive tool to assess the presence of neuropathic pain. This study investigated the prevalence of neuropathic pain after finger amputation or digital nerve repair using the DN4 questionnaire. Methods: Patients with finger amputation or digital nerve repair were identified between 2011 and 2018 at our institution. After a minimal follow-up of 12 months, the short form DN4 (S-DN4) was used to assess neuropathic pain. Results: A total of 120 patients were included: 50 patients with 91 digital amputations and 70 patients with 87 fingers with digital nerve repair. In the amputation group, 32% of the patients had pain, and 18% had neuropathic pain. In the digital nerve repair group, 38% of the patients had pain, and 14% had neuropathic pain. Secondly, of patient-, trauma-, and treatment-specific factors, only the time between trauma and surgery had a significant negative influence on the prevalence of neuropathic pain in patients with digital nerve repair. Conclusion: This study shows that persistent pain and neuropathic pain are common after finger trauma with nerve damage. One of the significant prognostic factors in developing neuropathic pain is treatment delay between trauma and time of digital nerve repair, which is of major clinical relevance for surgical planning of these injuries.</p

Automatic Structure Detection in Constraints of Tabular Data

Abstract. Methods for the protection of statistical tabular data—as controlled tabular adjustment, cell suppression, or controlled rounding— need to solve several linear programming subproblems. For large multi-dimensional linked and hierarchical tables, such subproblems turn out to be computationally challenging. One of the techniques used to reduce the solution time of mathematical programming problems is to exploit the constraints structure using some specialized algorithm. Two of the most usual structures are block-angular matrices with either linking rows (primal block-angular structure) or linking columns (dual block-angular structure). Although constraints associated to tabular data have intrin-sically a lot of structure, current software for tabular data protection neither detail nor exploit it, and simply provide a single matrix, or at most a set of smallest submatrices. We provide in this work an efficient tool for the automatic detection of primal or dual block-angular struc-ture in constraints matrices. We test it on some of the complex CSPLIB instances, showing that when the number of linking rows or columns is small, the computational savings are significant

Statistical disclosure control in tabular data

Data disseminated by National Statistical Agencies (NSAs) can be classified as either microdata or tabular data. Tabular data is obtained from microdata by crossing one or more categorical variables. Although cell tables provide aggregated information, they also need to be protected. This chapter is a short introduction to tabular data protection. It contains three main sections. The first one shows the different types of tables that can be obtained, and how they are modeled. The second describes the practical rules for detection of sensitive cells that are used by NSAs. Finally, an overview of protection methods is provided, with a particular focus on two of them: “cell suppression problem” and “controlled tabular adjustment”.Postprint (published version