Spinal Cord Stimulation: A Reasonable Alternative Treatment in Patients With Symptomatic Adult Scoliosis for Whom Surgical Therapy Is Not Suitable? A Pilot Study

Introduction: In adult scoliosis, dorsal instrumentation and fusion can provide significant improvement of pain and disability scores (Owestry Index); however, complication rates of up to 39% have been reported. As such, recent attempts have been made at expanding the surgical spectrum to include less invasive techniques in patients such as neuromodulation, specifically spinal cord stimulation (SCS). We therefore aimed to evaluate its use in a larger cohort of adult scoliosis patients in the form of a pilot study. Materials and Methods: We analyzed prospectively collected data from 18 adult scoliosis patients receiving SCS treatment in our institution between February 2019 and May 2020. Clinical follow-up was performed at 3, 6, and 12 months following implantation of an epidural SCS System. Patients reported numeric rating scale (NRS) values for the categories of lower back pain (LBP) and regional pain (RP) both at rest and in motion. Further, SF-36, ADS-K, PSQI, and ODI forms were completed. The study was approved by the institutional Ethics Committee (EA2/093/13). Results: Initial preoperative NRS of LBP at rest was significantly reduced following SCS at three (45% reduction, p = 0.005) and six (43% reduction, p = 0.009) months follow-up. LBP in motion was also reduced at three (27% reduction, p = 0.002) and six (33% reduction vs. preoperative, p = 0.005) months. RP at rest was reduced at three (38% reduction, p = 0.003) and six (37% reduction, p = 0.007) and in movement at three (29% reduction, 0.006) and six (32% reduction, p = 0.011). Loss of thoracic kyphosis and increased pelvic incidence were associated with worse NRS response to SCS stimulation at six months follow-up. Discussion: In overweight, older adults for whom the risks of corrective surgery must be carefully considered, neuromodulation can significantly reduce LBP as well as regional pain in the first six months following implantation. These findings may provide a reasonable alternative in patients not willing or eligible to undergo extensive corrective surgery

Validation of novel multiplex technologies

The parallel analysis of multiple factors, such as cytokines, from small sample size is an interesting approach for assessment of in vivo activation signatures and functionality after ex vivo stimulation. One interesting application is for therapy monitoring, such as safety data, pharmacodynamics, evidences for mode-of-action and side effects, particularly useful for accompanying early phase clinical trials. There are different platforms for Multiplex analysis of ligands available. We compared in this study the performance of three different platforms (Luminex Bio-Plex® 200, MesoScale Discovery®, Ella®) which use different ways of achieving parallel measurements of biomarkers from small liquid sample size. We show examples of in house assessment of intra- and inter-assay variations, determination of range and recovery for classical immunological serum markers and discuss advantages and disadvantages for these three platforms in relation to the question addressed

Peripheral nerve stimulation for the treatment of chronic knee pain

Abstract The average age of our population is increasing, resulting in a high incidence of chronic degenerative knee pathologies. Several treatment options, including surgical procedures are available to help mitigate these pathologies. However, the percentage of subjects with chronic post-surgical knee pain is still estimated at 16–20%. Neuromodulation techniques such as spinal cord stimulation and dorsal root ganglion stimulation (DRGS) are treatment options for subjects with chronic knee pain. The evidence for peripheral nerve stimulation (PNS) is minimal due to a limited number of neuromodulation systems capable of targeting the distal part of the lower limbs. This study aimed to investigate the safety and efficacy externally powered PNS systems for the treatment of chronic intractable knee pain targeting the saphenous nerve. Patients suffering from chronic intractable post-surgical knee pain received landmark-guided peripheral nerve stimulation of the branches of the saphenous nerve. All implants were performed with an externally powered PNS system to avoid lead migration as a result of cross-joint lead positions tunneling towards an Implantable Pulse Generator to the trunk. Data were collected retrospectively. Subject-reported outcome was measured via numerical rating scale values on a 10-point scale measuring pain intensity at rest and in motion. Additional data were collected for the subjects treated at the Charité location, including quality of life with the SF-36 form, quality of sleep with the Pittsburgh Sleep Quality Index and mood states with the short form of the General Depression Scale. Thirty-three patients received direct to permanent implant, landmark-guided peripheral nerve stimulation of the saphenous nerve branches. Six (18.2%) subjects reported non-sufficient initial benefit from the therapy and were explanted. Two subjects were explanted due to wound infections. The total study population reported included 25 patients. These subjects reported significant improvements related to pain, quality of life, mood quality, and quality of sleep. Additionally, subjects were able to reduce their opioid medication significantly after PNS therapy. Externally powered PNS at the saphenous nerve branches is a straightforward, selective and safe technique for patients with chronic knee pain. The landmark-guided implantation technique is less invasive than classical neuromodulation techniques such as spinal cord or DRGS and complication rates remain low. Short-term results are promising and show considerable reductions in pain scores and opioid intake. Long-term results are pending

Nutritional behaviour of nurses working night shifts

Hintergrund Schicht- und Nachtarbeit beeinflussen das Ernährungsverhalten. Dies kann zur Entstehung von ernährungsmitbedingten Erkrankungen führen. Dennoch liegen für Gesundheits- und Krankenpfleger, als größte von Schichtarbeit betroffene Berufsgruppe, im Gesundheitswesen bisher kaum Daten vor. Ziel ist es daher, das Ernährungsverhaltens von Gesundheits- und Krankenpflegern (GKP) während des Nachtdienstes zu erfassen. Methode Das Ernährungsverhalten von 19 GKP wurde mithilfe eines „doubly labelled water“ validierten, offenen 3?Tage-Ernährungsprotokolls erfasst. Die ermittelte tägliche Zufuhr verschiedener Lebensmittelgruppen wurde mit den gesundheitsförderlichen Orientierungswerten verglichen. Ergebnisse GKP weisen Defizite bei der Umsetzung der Ernährungsempfehlungen auf. Dies betrifft insbesondere den zu geringen Konsum von Gemüse (1,43?±?0,88 Portionen [P]/Tag), Obst (1,54?±?1,21?P/Tag) und Getreideprodukten (2,36?±?0,93?P/Tag). Diskussion Hinsichtlich des Lebensmittelverzehrs wurden keine Unterschiede zwischen den GKP und der deutschen Bevölkerung erfasst. Stattdessen wurden während der Schichtarbeit eine Umverteilung der Mahlzeiten von Tag zu Nacht, ungewöhnliche und unregelmäßige Essenszeiten sowie ein geringer Verzehr warmer Mahlzeiten beobachtet. Aufgrund dieser Defizite sollten gesundheitsförderliche Maßnahmen auf Verhaltens- und Verhältnisebene in den Klinikalltag integriert werden