Tolerability of NGX-4010, a capsaicin 8% dermal patch, following pretreatment with lidocaine 2.5%/prilocaine 2.5% cream in patients with post-herpetic neuralgia

<p>Abstract</p> <p>Background</p> <p>Post-herpetic neuralgia (PHN) is a common type of neuropathic pain that can severely affect quality of life. NGX-4010, a capsaicin 8% dermal patch, is a localized treatment that can provide patients with significant pain relief for up to 3 months following a single 60-minute application. The NGX-4010 application can be associated with application-site pain and in previous clinical trials pretreatment with a topical 4% lidocaine anesthetic was used to enhance tolerability. The aim of the current investigation was to evaluate tolerability of NGX-4010 after pretreatment with lidocaine 2.5%/prilocaine 2.5% anesthetic cream.</p> <p>Methods</p> <p>Twenty-four patients with PHN were pretreated with lidocaine 2.5%/prilocaine 2.5% cream for 60 minutes before receiving a single 60-minute application of NGX-4010. Tolerability was assessed by measuring patch application duration, the proportion of patients completing over 90% of the intended treatment duration, application site-related pain using the Numeric Pain Rating Scale (NPRS), and analgesic medication use to relieve such pain. Safety was assessed by monitoring adverse events (AEs) and dermal irritation using dermal assessment scores.</p> <p>Results</p> <p>The mean treatment duration of NGX-4010 was 60.2 minutes and all patients completed over 90% of the intended patch application duration. Pain during application was transient. A maximum mean change in NPRS score of +3.0 was observed at 55 minutes post-patch application; pain scores gradually declined to near pre-anesthetic levels (+0.71) within 85 minutes of patch removal. Half of the patients received analgesic medication on the day of treatment; by Day 7, no patients required medication. The most common AEs were application site-related pain, erythema, edema, and pruritus. All patients experienced mild dermal irritation 5 minutes after patch removal, which subsequently decreased; at Day 7, no irritation was evident. The maximum recorded dermal assessment score was 2.</p> <p>Conclusion</p> <p>NGX-4010 was well tolerated following pretreatment with lidocaine 2.5%/prilocaine 2.5% cream in patients with PHN. The tolerability of the patch application appeared comparable with that seen in other studies that used 4% lidocaine cream as the pretreatment anesthetic. This study is registered at <url>http://www.clinicaltrials.gov</url> as number <a href="http://www.clinicaltrials.gov/ct2/show/NCT00916942">NCT00916942</a>.</p

Antisense-Mediated Knockdown of NaV1.8, but Not NaV1.9, Generates Inhibitory Effects on Complete Freund's Adjuvant-Induced Inflammatory Pain in Rat

Tetrodotoxin-resistant (TTX-R) sodium channels NaV1.8 and NaV1.9 in sensory neurons were known as key pain modulators. Comparing with the widely reported NaV1.8, roles of NaV1.9 on inflammatory pain are poorly studied by antisense-induced specific gene knockdown. Here, we used molecular, electrophysiological and behavioral methods to examine the effects of antisense oligodeoxynucleotide (AS ODN) targeting NaV1.8 and NaV1.9 on inflammatory pain. Following complete Freund's adjuvant (CFA) inflammation treatment, NaV1.8 and NaV1.9 in rat dorsal root ganglion (DRG) up-regulated mRNA and protein expressions and increased sodium current densities. Immunohistochemical data demonstrated that NaV1.8 mainly localized in medium and small-sized DRG neurons, whereas NaV1.9 only expressed in small-sized DRG neurons. Intrathecal (i.t.) delivery of AS ODN was used to down-regulate NaV1.8 or NaV1.9 expressions confirmed by immunohistochemistry and western blot. Unexpectedly, behavioral tests showed that only NaV1.8 AS ODN, but not NaV1.9 AS ODN could reverse CFA-induced heat and mechanical hypersensitivity. Our data indicated that TTX-R sodium channels NaV1.8 and NaV1.9 in primary sensory neurons played distinct roles in CFA-induced inflammatory pain and suggested that antisense oligodeoxynucleotide-mediated blocking of key pain modulator might point toward a potential treatment strategy against certain types of inflammatory pain

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Direction of arrival tracking of an underwater acoustic source using particle filtering: Real data experiments

In the past, both theoretical work and practical implementation of particle filtering (PF) method have been extensively studied. However, its application in underwater signal processing has received much less attention. This paper intends to introduce PF approach for underwater acoustic signal processing. Particularly, we are interested in direction of arrival (DOA) estimation using PF. A detailed introduction along with this perspective is presented in this paper. Since the noise usually spreads the mainlobe of likelihood function and causes problem in subsequent particle resampling step, an exponential weighted likelihood model is developed to emphasize particles at more relevant area. Hence, the the effect due to background noise can be reduced. Real underwater acoustic data collected in SWELLEx-96 experiment are employed to demonstrate the performance of the proposed PF approaches for underwater DOA tracking. © 2013 IEEE

Three-dimensional localization of multiple acoustic sources in shallow ocean with non-Gaussian noise

In this paper, a low-complexity algorithm SAGE-USL is presented for 3-dimensional (3-D) localization of multiple acoustic sources in a shallow ocean with non-Gaussian ambient noise, using a vertical and a horizontal linear array of sensors. In the proposed method, noise is modeled as a Gaussian mixture. Initial estimates of the unknown parameters (source coordinates, signal waveforms and noise parameters) are obtained by known/conventional methods, and a generalized expectation maximization algorithm is used to update the initial estimates iteratively. Simulation results indicate that convergence is reached in a small number of (<= 10) iterations. Initialization requires one 2-D search and one 1-D search, and the iterative updates require a sequence of 1-D searches. Therefore the computational complexity of the SAGE-USL algorithm is lower than that of conventional techniques such as 3-D MUSIC by several orders of magnitude. We also derive the Cramer-Rao Bound (CRB) for 3-D localization of multiple sources in a range-independent ocean. Simulation results are presented to show that the root-mean-square localization errors of SAGE-USL are close to the corresponding CRBs and significantly lower than those of 3-D MUSIC. (C) 2014 Elsevier Inc. All rights reserved

Signal Detection in Generalized Gaussian Noise by Nonlinear Wavelet Denoising

In this paper, a nonlinear suboptimal detector whose performance in heavy-tailed noise is significantly better than that of the matched filter is proposed. The detector consists of a nonlinear wavelet denoising filter to enhance the signal-to-noise ratio, followed by a replica correlator. Performance of the detector is investigated through an asymptotic theoretical analysis as well as Monte Carlo simulations. The proposed detector offers the following advantages over the optimal (in the Neyman-Pearson sense) detector: it is easier to implement, and it is more robust with respect to error in modeling the probability distribution of noise

Narrowband signal detection techniques in shallow ocean by acoustic vector sensor array

This paper presents the formulation and performance analysis of four techniques for detection of a narrowband acoustic source in a shallow range-independent ocean using an acoustic vector sensor (AVS) array. The array signal vector is not known due to the unknown location of the source. Hence all detectors are based on a generalized likelihood ratio test (GLRT) which involves estimation of the array signal vector. One non-parametric and three parametric (model-based) signal estimators are presented. It is shown that there is a strong correlation between the detector performance and the mean-square signal estimation error. Theoretical expressions for probability of false alarm and probability of detection are derived for all the detectors, and the theoretical predictions are compared with simulation results. It is shown that the detection performance of an AVS array with a certain number of sensors is equal to or slightly better than that of a conventional acoustic pressure sensor array with thrice as many sensors

Design and performance analysis of a signal detector based on suprathreshold stochastic resonance

This paper presents the design and performance analysis of a detector based on suprathreshold stochastic resonance (SSR) for the detection of deterministic signals in heavy-tailed non-Gaussian noise. The detector consists of a matched filter preceded by an SSR system which acts as a preprocessor. The SSR system is composed of an array of 2-level quantizers with independent and identically distributed (i.i.d) noise added to the input of each quantizer. The standard deviation sigma of quantizer noise is chosen to maximize the detection probability for a given false alarm probability. In the case of a weak signal, the optimum sigma also minimizes the mean-square difference between the output of the quantizer array and the output of the nonlinear transformation of the locally optimum detector. The optimum sigma depends only on the probability density functions (pdfs) of input noise and quantizer noise for weak signals, and also on the signal amplitude and the false alarm probability for non-weak signals. Improvement in detector performance stems primarily from quantization and to a lesser extent from the optimization of quantizer noise. For most input noise pdfs, the performance of the SSR detector is very close to that of the optimum detector. (C) 2012 Elsevier B.V. All rights reserved

Combining OOK with PSM Modulation for Simple Transceiver of Orthogonal Pulse-Based TH-UWB Systems

<p>Abstract</p> <p>This paper describes a combined modulation scheme for time-hopping ultra-wideband (TH-UWB) radio systems by using on-off keying (OOK) and pulse-shape modulation (PSM). A set of orthogonal pulses is used to represent bits in a symbol. These orthogonal pulses are transmitted simultaneously in the same pulse repetition interval resulting in a composite pulse. This scheme transmits the same number of bits by using fewer orthogonal pulses and receiver correlators than those used in PSM and biorthogonal PSM (BPSM). The proposed scheme reduces multiple-access interference and multipulse interference considerably by using crosscorrelation properties of orthogonal pulses. Since each bit is individually received by OOK, the proposed scheme requires less power. Hence, it is applicable for energy constrained and low-cost TH-UWB systems. The bit-error-rate (BER) performance is analyzed both mathematically and through computer simulations under the different channel environments. The performance of this scheme is compared with that of existing PSM and its combined modulation schemes by using two sets of orthogonal pulses.</p

Efficient Hardware Operations for the Residue Number System by Boolean Minimization

Residue number systems (RNS) represent numbers by their remainders modulo a set of relatively prime numbers. This paper proposes an efficient hardware implementation of modular multiplication and of the modulo function (X(mod P)), based on Boolean minimization. We report experiments showing a performance advantage up to 30 times for our approach vs. the results obtained by state-of-the-art industrial tools