Interventional Treatment Options for Trigeminal Neuralgia

Trigeminal neuralgia is characterized by sudden and severe shock-like episodes of transient unilateral pain in the trigeminal nerve distribution. Most cases are idiopathic and are known to respond favorably to anticonvulsants. For patients who fail at least three drug trials or experience intolerable side effects, surgery may be warranted. First, a diagnostic block at the trigeminal nerve or Gasserian ganglion to confirm clinical diagnosis is performed. Surgical intervention can be either ablative or nonablative, each with its respective indications, contraindications, and risk-benefit profile. Most common are the percutaneous rhizotomies: conventional and pulsed radiofrequency ablation (RFA), chemical glycerol injections, and mechanical balloon compression. Stereotactic or gamma knife radiosurgery (GKRS) is the least invasive with only a moderate duration of pain relief, whereas microvascular decompression (VMD) is the most invasive, but associated with greatest long-term benefit. RFA has consistently shown favorable results and is the only modality with evidence of pain relief in ≥50% of patients treated 20 years postoperatively. Auxiliary interventional options such as peripheral neurectomy, botulinum toxin type-A (BTX-A) injections, and cryotherapy are available for those with contraindications to rhizotomies, radiosurgery, or neurosurgery. Ultimately, physicians must tailor their management of trigeminal neuralgia to the needs of the patient

Bilateral Brachial Plexus Home Going Catheters After Digital Amputation for Patient With Upper Extremity Digital Gangrene

Peripheral nerve catheter placement is used to control surgical pain. Performing bilateral brachial plexus block with catheters is not frequently performed; and in our case sending patient home with bilateral brachial plexus catheters has not been reported up to our knowledge. Our patient is a 57 years old male patient presented with bilateral upper extremity digital gangrene on digits 2 through 4 on both sides with no thumb involvement. The plan was to do the surgery under sequential axillary blocks. On the day of surgery a right axillary brachial plexus block was performed under ultrasound guidance using 20 ml of 0.75% ropivacaine. Patient was taken to the OR and the right fingers amputation was carried out under mild sedation without problems. Left axillary brachial plexus block was then done as the surgeon was closing the right side, two hours after the first block was performed. The left axillary block was done also under ultrasound using 20 ml of 2% mepivacaine. The brachial plexus blocks were performed in a sequential manner. Surgery was unremarkable, and patient was transferred to post anesthetic care unit in stable condition. Over that first postoperative night, the patient complained of severe pain at the surgical sites with minimal pain relief with parentral opioids. We placed bilateral brachial plexus catheters (right axillary and left infra-clavicular brachial plexus catheters). Ropivacaine 0.2% infusion was started at 7 ml per hour basal rate only with no boluses on each side. The patient was discharged home with the catheters in place after receiving the appropriate education. On discharge both catheters were connected to a single ON-Q (I-flow Corporation, Lake Forest, CA) ball pump with a 750 ml reservoir using a Y connection and were set to deliver a fixed rate of 7 ml for each catheter. The brachial plexus catheters were removed by the patient on day 5 after surgery without any difficulty. Patient's postoperative course was otherwise unremarkable. We concluded that home going catheters are very effective in pain control postoperatively and they shorten the period of hospital stay

Durability of high-frequency 10-kHz spinal cord stimulation for patients with painful diabetic neuropathy refractory to conventional treatments: 12-month results from a randomized controlled trial

No abstract available

A randomized controlled trial of high frequency (10 kHz) spinal cord stimulation in painful diabetic neuropathy

Importance: Many patients with diabetic peripheral neuropathy experience chronic pain and inadequate relief despite best available medical treatments. Objective: To determine whether 10-kHz spinal cord stimulation (SCS) improves outcomes for patients with refractory painful diabetic neuropathy (PDN). Design, Setting, and Participants: The prospective, multicenter, open-label SENZA-PDN randomized clinical trial compared conventional medical management (CMM) with 10-kHz SCS plus CMM. Participants with PDN for 1 year or more refractory to gabapentinoids and at least 1 other analgesic class, lower limb pain intensity of 5 cm or more on a 10-cm visual analogue scale (VAS), body mass index (calculated as weight in kilograms divided by height in meters squared) of 45 or less, hemoglobin A1c (HbA1c) of 10% or less, daily morphine equivalents of 120 mg or less, and medically appropriate for the procedure were recruited from clinic patient populations and digital advertising. Participants were enrolled from multiple sites across the US, including academic centers and community pain clinics, between August 2017 and August 2019 with 6-month follow-up and optional crossover at 6 months. Screening 430 patients resulted in 214 who were excluded or declined participation and 216 who were randomized. At 6-month follow-up, 187 patients were evaluated. Interventions: Implanted medical device delivering 10-kHz SCS. Main Outcomes and Measures: The prespecified primary end point was percentage of participants with 50% pain relief or more on VAS without worsening of baseline neurological deficits at 3 months. Secondary end points were tested hierarchically, as prespecified in the analysis plan. Measures included pain VAS, neurological examination, health-related quality of life (EuroQol Five-Dimension questionnaire), and HbA1c over 6 months. Results: Of 216 randomized patients, 136 (63.0%) were male, and the mean (SD) age was 60.8 (10.7) years. Additionally, the median (interquartile range) duration of diabetes and peripheral neuropathy were 10.9 (6.3-16.4) years and 5.6 (3.0-10.1) years, respectively. The primary end point assessed in the intention-to-treat population was met by 5 of 94 patients in the CMM group (5%) and 75 of 95 patients in the 10-kHz SCS plus CMM group (79%; difference, 73.6%; 95% CI, 64.2-83.0; P < .001). Infections requiring device explant occurred in 2 patients in the 10-kHz SCS plus CMM group (2%). For the CMM group, the mean pain VAS score was 7.0 cm (95% CI, 6.7-7.3) at baseline and 6.9 cm (95% CI, 6.5-7.3) at 6 months. For the 10-kHz SCS plus CMM group, the mean pain VAS score was 7.6 cm (95% CI, 7.3-7.9) at baseline and 1.7 cm (95% CI, 1.3-2.1) at 6 months. Investigators observed neurological examination improvements for 3 of 92 patients in the CMM group (3%) and 52 of 84 in the 10-kHz SCS plus CMM group (62%) at 6 months (difference, 58.6%; 95% CI, 47.6-69.6; P < .001). Conclusions and Relevance: Substantial pain relief and improved health-related quality of life sustained over 6 months demonstrates 10-kHz SCS can safely and effectively treat patients with refractory PDN. Trial Registration: ClincalTrials.gov Identifier: NCT0322842

Named Entity Recognition from Biomedical Text

As vast amounts of unstructured data are becoming available digitally, computer-based methods to extract relevant and meaningful information are needed. Named entity recognition (NER) is the task of identifying text spans that mention named entities, and to classify them into predefined categories. Despite the existence of numerous and well-versed NER methods, the bio-medical domain remains under-studied. The objective of this research is to identify an efficient technique for NER tasks from biomedical data. This is achieved by investigating using deep learning technologies namely pre-trained BERT [1] model and its variances SciBERT [2] and BioBERT [3]. Preprocessing the data before passing it for training influences model performance. There is also investigation with some preprocessing rules to monitor their effect on model performance. Our model outperforms vanilla BERT, and BioBERT where is Precision: 66.20%, Recall: 98.96%, F1: 79.33%

Semiotic analysis of contemporary Coptic Orthodox church architecture; A case study of Virgin Mary and Saint John the Baptist church in Bab El Louk, Cairo, Egypt

Within the quest of better understanding of architecture, interpretation of signs and symbols play an important role. An article was presented earlier to analyze an ancient Coptic Orthodox church, within the course of an ongoing PhD, studying the visual message of this architecture (Guirguis et al., 2016). Now, a contemporary case study is being examined, to investigate whether the modern architecture of the same building type carries a message as its counter in the antiquity, and what the meanings projected might be. The study uncovers meanings imbued by the building showing that this contemporary architecture is an offspring of the Coptic heritage and that it delivers a message to the congregation. Keywords: Semiotics of architecture, Coptic architecture, Meaning in architecture, Semiotic analysis, Interpretation of architecture, Contemporary Coptic architectur

Patient profile and outcome of pilomatrixoma in district general hospital in United Kingdom

Introduction: A pilomatrixoma is a benign appendage tumour related to hair cells matrix. Most of the literature review about pilomatrixoma is in the form of case reports with fewer cohort studies. The objective of this cohort is to study the variable demographic characteristics, presentation and histopathology of this condition among a larger group of patients. Materials and Methods: We conducted a retrospective study of patients who had excision of pilomatrixoma between February 1998 and August 2011 in a District General Hospital in UK. Results: The study included 67 patients with histopathologically diagnosed pilomatrixoma. The mean age was 32 years. Male to Female ratio was 35:32. The average diameter of the lesion at presentation was 13 mm (range: 2-30 mm). 66 of 67 (98.5%) patients presented with solitary lesion, while 1 patient (1.5%) had two lesions. Conclusion: Pilomatrixoma is not an uncommon benign lesion. It is more common in the maxillofacial area

Development of an Educational Curriculum for Spinal Cord Stimulation.

BACKGROUND: Spinal cord stimulators (SCSs) are used for treating chronic pain. The number of SCSs implanted each year is on the increase. The North American Neuromodulation Society (NANS) education committee aimed to develop a SCS curriculum as a tool to guide physicians at different training levels, based on the most recent evidence. MATERIAL AND METHODS: A multidisciplinary (anesthesiology, physical medicine, neurosurgery, and neurology), taskforce representing the education committee of the NANS met to develop a SCS curriculum following the Accreditation Council for Graduate Medical Education (ACGME) milestones. The task force used the best available evidence and knowledge to develop the curriculum. Once developed, the SCS curriculum was then approved by the NANS board. RESULTS: The task force developed a SCS training curriculum. Milestones included patient care and procedural skills, system-based practice, medical knowledge, interpersonal communication, practice based learning and professionalism. Each milestone was defined for three categories, early learner, advanced learner, and practitioner. CONCLUSION: A multidisciplinary task force of the NANS education committee developed a SCS training curriculum that defines ACGME milestones for basic learners, advanced learners, and practitioners

Pulse Dosing of 10 kHz Paresthesia-Independent Spinal Cord Stimulation Provides Same Efficacy with Substantial Reduction of Device Recharge Time.

OBJECTIVE: This study was designed to assess whether using pulse dosing (PD: regularly-cycled intermittent stimulation) of high-frequency 10 kHz spinal cord stimulation (10kHzSCS) can reduce device recharge time while maintaining efficacy in patients with chronic intractable back pain with/without leg pain. DESIGN: Prospective, multi-center, observational study. METHODS: Patients successfully using 10kHzSCS at 100%ON (no PD) for \u3e3-months were consecutively enrolled. After a 1-week Baseline period of documenting their pain twice-daily using a 0-10 numerical rating scale (NRS) using 100%ON of their favorite program, all subjects were reprogrammed to 14%PD for 10-14 days. If subjects preferred 14%PD to 100%ON, they were programmed to 3%PD; otherwise, they were programmed to 50%PD. Subjects used this next program for another 10-14 days. Subjects then entered a 3-month observational period where they were requested but not limited to use their most preferred %PD program. Towards the end of 3-months, subjects completed a 7-day NRS diary and indicated a final %PD program preference. Study endpoints included %PD preference, mean diary NRS by %PD, and daily minutes and patterns of charging. RESULTS: Of 31 subjects completing the study, 81% preferred less than 100%ON. Preferences: 39% subjects preferred 3%PD, 32% preferred 14%PD, 10% preferred 50%PD, and 19% preferred 100%ON. Average daily charge durations: 3%PD = 8.3 ± 3.1 min, 14%PD = 13.9 ± 4.9 min, 50% PD = 26.2 ± 7.4 min, 100%ON = 43.8 ± 10.9 min. Regression modeling suggested pain relief was weighted more than twice as influential as charging in preference for reduced %PD. CONCLUSIONS: This prospective study suggests that 10kHzSCS therapy with PD may be successfully employed in a large majority of 10kHzSCS responders, maintaining efficacy while reducing device charging time by nearly two-thirds