Referred cutaneous allodynia in a migraine patient without simultaneous headache

Cutaneous allodynia is defined as the perception of pain when a non-noxious stimulus is applied to normal skin. This phenomenon has been demonstrated in migraine patients during an acute attack. It is thought to result from central sensitization of neurons in the trigemino-vascular system and may spread to areas beyond that of the referred head pain. In a recent study, migraine patients demonstrated increased temporal summation to painful mechanical stimuli in their referred head pain area between attacks. This suggests that changes in physiologic properties of nociceptive neurons may occur in migraine patients between attacks. We describe a migraine patient with interictal cutaneous allodynia contralateral to her usual head pain

Comparison of dynamic (brush) and static (pressure) mechanical allodynia in migraine

Allodynia has been described in migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic migraine (EM) or with transformed migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with a gauze pad and pressure allodynia (PA) was tested using von Frey hairs (VFH). The prevalence of BA and PA in all patients and in the different subgroups was calculated and correlated with migraine features. We recruited 55 migraine patients. Twenty-five had EM and 30 had TM. BA was present in 18 (32.7%) patients and PA in 18–24 (32.7–43.6%). Allodynia to both brush and pressure was found in 13–17 (23.6–30.9%) patients. If a patient had allodynia to one modality only, it was more likely to be PA than BA. Both BA and PA were more common in patients with TM compared with those with EM [BA 46.7% vs. 16.0%; PA (differences significant for the medium and thick VFHs) 50% vs. 20% and 50% vs. 12%, respectively]. Both types of allodynia were also more common in patients with migraine with aura compared with those with migraine without aura (BA 57.1% vs. 17.6%; PA 57.1–61.9% vs. 17.6–32.7%). There was a positive correlation between allodynia score (as obtained by examination) and allodynia index (as obtained by history) for both BA and PA. The incomplete, although considerable, overlap between BA and PA suggests that allodynia to different sensory modalities is associated with sensitization of different neuronal populations. Because PA was more common than BA, it may be a more sensitive indicator of allodynia in migraine. PA can be tested clinically in a practical and systematic manner

Solvent nature effect in preparation of perovskites by flame pyrolysis: 2 : Alcohols and alcohols plus propionic acid mixtures

The effect of either pure alcohols or alcohols + propionic acid mixtures as solvents for the preparation by flame pyrolysis of a standard LaCoO3 catalyst, to be employed for the catalytic flameless combustion of methane, has been investigated. All the catalysts proved very active for the mentioned reaction. Low-MW pure alcohols showed however less suitable than alcohols-propionic acid mixtures, leading to lower perovskite phase purity, less particle size homogeneity and lower specific surface area. The high volatility of the solvent seems to be the major cause, together with the improper behaviour of nitrates (forced by solubility reasons) as perovskite metals precursors. However, the addition of propionic acid to the alcohols allowed to use the acetates as precursors and hence to obtain high perovskitic phase purity, high SSA and Uniform particle size. Moreover, the increase of combustion enthalpy of the solvent, through the addition of higher-MW alcohols, leading to progressively higher flame temperature, strongly improved the thermal resistance of the catalyst, without lowering catalytic performance

Solvent nature effect in preparation of perovskites by flame pyrolysis: 1: carboxylic acids

The effect of a series of carboxylic acids (C(2)-C(8)), as solvents for the preparation by flame spray pyrolysis of LaCoO(3) catalyst for the flameless combustion of methane, has been investigated. Acetic acid showed to be unsatisfactory from several points of view: low phase purity of the catalyst, higher amount of unburnt carbonaceous residua, lower catalytic activity and low thermal stability. By increasing the carbon chain length of the solvent, the consequent increase of flame temperature led to an increase of crystal phase purity and of particle size and to a decrease of specific surface area of the catalyst. Catalytic activity showed only marginally affected by the last parameter, phase purity seeming more important. Thermal resistance showed directly related to flame temperature, i.e. to the combustion enthalpy of the solvent, but a relatively high amount of residual organic matter can negatively affect this property

Visual Outcomes, Efficacy, and Surgical Complications Associated with Intracameral Phenylephrine 1.0%/Ketorolac 0.3% Administered During Cataract Surgery

Aim: The purpose of this study was to compare visual outcomes, surgical time, and perioperative surgical complications after intracameral use of either phenylephrine/ketorolac (P/K) or epinephrine (Epi) during cataract surgery.Methods: This was a single-center, retrospective case review of patients undergoing cataract surgery from August to November 2015. Of the 641 eyes of 389 patients who underwent cataract surgery, 260 eyes were administered phenylephrine 1.0%/ketorolac 0.3% and 381 eyes received Epi in the irrigation solution intraoperatively. All patients received a topical nonsteroidal anti-inflammatory drug regimen (bromfenac 0.07%, nepafenac 0.3%, or ketorolac 0.5%) for 3 days before surgery and topical tropicamide 1.0%, cyclopentolate 1.0%, and phenylephrine 2.5% on the day of surgery.Results: Mean length of surgery (LOS) was 15.4±0.6 minutes. Although a positive correlation was noted between patient age and LOS (p\u3c0.001), P/K was associated with a decrease in the LOS, when controlled for age quartiles. A statistically significant lower incidence of complications (1.1%) was observed with P/K use than Epi (4.5%; p=0.018). Among surgeons who used mydriatic-assist devices more frequently, P/K use was associated with a reduction in the use of these devices (p\u3c0.001). When controlling for age quartile, patients of age groups 69–76 and 76–92 years who received P/K had significantly better uncorrected visual acuity at postoperative day 1 than those receiving Epi (p=0.003).Conclusion: Intracameral use of phenylephrine 1.0%/ketorolac 0.3% during cataract surgery may be effective in maintaining mydriasis. It appears to be superior to intracameral Epi at reducing intraoperative and postoperative complications, need for pupillary dilating devices, and surgical time

Challenges in measuring angles between craniofacial structures

Objective: Three-dimensional (3D) angular measurements between craniofacial planes pose challenges to quantify maxillary and mandibular skeletal discrepancies in surgical treatment planning. This study aims to compare the reproducibility and reliability of two modules to measure angles between planes or lines in 3D virtual surface models. Methodology: Twenty oriented 3D virtual surface models de-identified and constructed from CBCT scans were randomly selected. Three observers placed landmarks and oriented planes to determine angular measurements of pitch, roll and yaw using (1) 3D pre-existing planes, (2) 3D planes created from landmarks and (3) lines created from landmarks. Inter- and intra-observer reproducibility and repeatability were examined using the Intra-Class Correlation (ICC) test. One observer repeated the measurements with an interval of 15 days. ANOVA was applied to compare the 3 methods. Results: The three methods tested provided statistically similar, reproducible and reliable angular measurements of the facial structures. A strong ICC varying from 0.92 to 1.00 was found for the intra-observer agreement. The inter-observer ICC varied from 0.84 to 1.00. Conclusion: Measurements of 3D angles between facial planes in a common coordinate system are reproducible and repeatable either using 3D pre-existing planes, created based on landmarks or angles between lines created from landmarks

Effects of corticosteroids in patients with sickle cell disease and acute complications: a systematic review and meta-analysis

Whether corticosteroids improve outcome in patients with acute complications of sickle cell disease (SCD) is still debated. We performed a systematic review of the literature with the aim of estimating effects of corticosteroids on the clinical course of vaso-occlusive crisis (VOC) or acute chest syndrome (ACS) in patients with SCD. The primary outcome was transfusion requirement during hospitalization. Studies were identified by search of MEDLINE and CENTRAL database. Three randomized clinical trials (RCT) and three retrospective cohort studies (RCS) were included, involving 3,304 participants and 5,562 VOC or ACS episodes. There was no difference between corticosteroids and standard treatment regarding transfusion requirement overall (odds ratio [OR]=0.98, 95% confidence interval [CI]: 0.38-2.53) but there was a significant interaction of the study type (P<0.0001): corticosteroid therapy was associated with a lower risk of transfusion in RCT (OR=0.13, 95% CI: 0.04-0.45) and a higher risk of transfusion in RCS (OR=2.12, 95% CI: 1.33-3.40. In RCT, the length of hospital stay was lower with corticosteroids as compared with standard treatment: mean difference - 24 hours (95% CI: -35 to -14). Corticosteroids were associated with an increased risk of hospital readmission as compared with standard treatment, in RCT, RCS, and the entire cohort: OR=5.91, 95% CI: 1.40-24.83; OR=3.28, 95% CI: 1.46-7.36 and OR=3.21, 95% CI: 1.97-5.24, respectively. Corticosteroids were associated with reduced number of transfusions and length of stay in RCT but not in RCS, with more rehospitalizations overall. Additional RCT should be conducted while minimizing the risk of rehospitalizations