A scoping review of novel spinal cord stimulation modes for complex regional pain syndrome

Background: Paresthesia-based spinal cord stimulation (PB-SCS) is used for the treatment of complex regional pain syndrome (CRPS), but many patients are refractory to PB-SCS or experience attenuation of analgesic effect over time due to tolerance. Novel SCS modes including high-frequency, BurstTM, and high-density (HDTM) stimulation were introduced recently and this systematic review was conducted to summarize the evidence on their role for CRPS. Materials and Methods: We searched MEDLINE and other databases (up to September 21, 2017) for studies including adults with refractory CRPS treated by paresthesia-free SCS (PF-SCS) modes compared to placebo, conventional medical treatment, or PB-SCS. We determined the posttreatment intensity of pain (up to 24 months after intervention), changes in CRPS-associated symptoms, and associated domains. Sustainability and adverse effects were also assessed. Results: We identified 13 studies (seven case series, five conference abstracts, one randomized controlled trial) including 62 patients with upper or lower limb CRPS. Eleven papers reported on outcomes of high-frequency stimulation at 10 kHz (HF-10) and other high frequencies, two papers were on Burst, and one paper was on HD. In 59 patients, pain intensity with novel SCS modes was reduced by 30% to 100% with a corresponding reduction in analgesic medications. Novel SCS modes also attenuated CRPS-associated symptoms and six papers reported significant improvement of quality of life. Conclusions: Novel SCS modes have the potential to provide analgesia in patients with CRPS. However, the low quality of available evidence necessitates definitive and prospective comparative effectiveness studies to establish the role of these modes in CRPS

北陸地方における工業都市発達の要因についての一考察

OBJECTIVE: We aimed to investigate the current practices guiding surgical resection strategies involving epileptogenic zones (EZs) near or in eloquent cortex (EC) at pediatric epilepsy surgery centers worldwide. METHODS: A survey was conducted among 40 respondents from 33 pediatric epilepsy surgery centers worldwide on the weight assigned to diagnostic tests used to define the EZ and EC, how EC is viewed, and how surgeries are planned for foci near or in eloquent cortex. RESULTS: A descriptive analysis was performed that revealed considerable variation in the use of diagnostic tests and resective strategies toward EZ and EC. SIGNIFICANCE: The wide variation in strategies may contribute to undesirable outcomes characterized by poor seizure control with added deficits and underscores the need to establish best practices in pediatric epilepsy surgery. The survey data were used to formulate a set of recommendations to help minimize deficits and to report them consistently

Evaluation of Postsurgical Hyperalgesia and Sensitization After Open Inguinal Hernia Repair: A Useful Model for Neuropathic Pain?

Cutaneous mechanical hyperalgesia can be induced in healthy volunteers in early phase analgesic studies to model central sensitization, a key mechanism of persistent pain. However, such hyperalgesia is short-lived (a matter of hours), and is used only for assessing only single drug doses. In contrast, postsurgical peri-incisional hyperalgesia may be more persistent and hence be a more useful model for the assessment of the efficacy of new analgesics. We undertook quantitative sensory testing in 18 patients at peri-incisional and nonoperated sites before open inguinal hernia repair and up to the 24th postsurgical week. The spatial extent of punctate hyperalgesia and brush allodynia at the peri-incisional site were greatest at weeks 2 and 4, but had resolved by week 24. Heat allodynia, suggestive of local inflammation or peripheral sensitization, was not observed; instead, there were deficits in cold and heat sensory detection that persisted until week 24. The findings suggest that central sensitization contributes significantly to mechanical hyperalgesia at the peri-incisional site. The prolonged duration of hyperalgesia would be advantageous as a pain model, but there was considerable variability of mechanical hyperalgesia in the cohort; the challenges of recruitment may limit its use to small, early phase analgesic studies. PERSPECTIVE: Peri-incisional mechanical hyperalgesia persists for ≥4 weeks after open inguinal hernia repair and reflects central sensitization; this may have usefulness as a model of chronic pain to assess the potential of antineuropathic analgesics.Unrestricted educational grant from GlaxoSmithKline U

Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis.

BACKGROUND Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with Bedaquiline and Delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). METHODS We prospectively determined the effectiveness and safety of combining two new drugs with two repurposed drugs - Bedaquiline, Delamanid, Linezolid, and Clofazimine for 24-36 weeks in adults with pulmonary MDR-TBFQ+ or/and MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as two consecutive negative cultures taken four weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during treatment period. RESULTS Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: four deaths, seven treatment changes, two bacteriological failures, and one withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500msec. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. CONCLUSION After 24-36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully

A 6G White Paper on Connectivity for Remote Areas

In many places all over the world rural and remote areas lack proper connectivity that has led to increasing digital divide. These areas might have low population density, low incomes, etc., making them less attractive places to invest and operate connectivity networks. 6G could be the first mobile radio generation truly aiming to close the digital divide. However, in order to do so, special requirements and challenges have to be considered since the beginning of the design process. The aim of this white paper is to discuss requirements and challenges and point out related, identified research topics that have to be solved in 6G. This white paper first provides a generic discussion, shows some facts and discusses targets set in international bodies related to rural and remote connectivity and digital divide. Then the paper digs into technical details, i.e., into a solutions space. Each technical section ends with a discussion and then highlights identified 6G challenges and research ideas as a list.Comment: A 6G white paper, 17 page

Evaluation of Efficacy of Perineural Steroids and Local Anesthetics for Chronic Post-traumatic Neoropathic Pain

Trauma leading to entrapment or compression of nerves is an important cause of chronic refractory peripheral neuropathic pain (NP). The aim of this thesis was to evaluate benefits and adverse effects (AE) of administering steroids and local anesthetics around peripheral nerves subject to compression or trauma in patients with chronic peripheral NP. The first study, a systematic review and meta-analysis (SR-MA), showed a modest reduction in pain intensity based on numerical rating scale (NRS; 0-10) pain scores for patients receiving perineural steroids compared with those receiving LA or conventional medical management (CMM) (-0.69 points; 95% CI: -1.27 to -0.12; P = 0.02; I2=85%) at one to three months after the intervention. However, the quality of the studies was low. The second study was a retrospective, sequential, double cohort study in patients who sustained work-related injuries and developed trauma- or compression-related chronic peripheral NP of moderate-to-severe intensity in the ankle or the foot. In this study, the median NRS pain scores were lower in those treated by a combination of perineural local anaesthesia/steroids (LA-S) and CMM compared to those treated only with CMM [5.50(IQR 4.00-7.00) and 7.00(IQR 5.00-8.00) respectively; pPh.D

Tuberculosis in San Bernardino County, 1993-2004 : Lifestyle and Environmental Factors

An observational retrospective study was conducted for tuberculosis (TB) cases between San Bernardino County (SBC), Riverside County, and the state of California from 1996 to 2004. A univariate comparison between San Bernardino County and California indicated a higher proportion of U.S. born cases in SBC. Additionally, it was found that San Bernardino had a higher proportion of non-injection drug using TB cases, compared with California in 1996. Further comparisons were made along country of birth between TB cases in San Bernardino County from 1993 to 2004. Notable differences were observed for injection drug use, non injection drug use, alcohol abuse, homelessness, incarceration in a correctional facility, certain age groups, occupations, and type of health care provider. A multivariate logistic regression analysis for San Bernardino County indicated that several factors influenced TB cases from inside the U.S. These included correctional facility residence, age, living in the desert region of San Bernardino County, and unemployment. Several notable factors were associated with people infected with TB who were born outside the U.S. These included Hispanic or non- Latino white race and unemployment. An additional logistic regression analysis, based upon drug use, resulted in a number of significant indicators. These included homelessness, incarceration in a correctional facility, abusing alcohol, U.S. birth, and working in an occupation classified as “other.” Although this study supported the focusing of preventive methods towards certain sections of the population in San Bernardino County, more research is still needed. This would help to better understand the risk factors related to the onset of the disease as well as the preventive care measures that could effectively limit the incidence of TB within San Bernardino County as well as the state of California. Moreover, more detailed surveillance information within the Report of a Verified Cases of Tuberculosis (RVCT) form would contribute toward more clearly determining the indicative lifestyle factors related to TB cases in San Bernardino County

Secondary cutaneous plasmacytoma: A bad prognostic marker

Plasmacytomas are malignancies of plasma cells that may affect skin or other organs. Plasmacytoma of skin is a rare presentation, which may occur either secondary to multiple myeloma or very rarely may originate in the skin. Histopathology with immunohistochemistry is diagnostic. We present a rare case of secondary cutaneous plasmacytoma