Comparison of tonic spinal cord stimulation, high-frequency and burst stimulation in patients with complex regional pain syndrome: a double-blind, randomised placebo controlled trial

BACKGROUND: Complex Regional Pain Syndrome (CRPS) is a disabling disease that is sometimes difficult to treat. Although spinal cord stimulation (SCS) can reduce pain in most patients with CRPS, some do not achieve the desired reduction in pain. Moreover, the pain reduction can diminish over time even after an initially successful period of SCS. Pain reduction can be regained by increasing the SCS frequency, but this has not been investigated in a prospective trial. This study compares pain reduction using five SCS frequencies (standard 40 Hz, 500 Hz, 1200 Hz, burst and placebo stimulation) in patients with CRPS to determine which of the modalities is most effective. DESIGN: All patients with a confirmed CRPS diagnosis that have unsuccessfully tried all other therapies and are eligible for SCS, can enroll in this trial (primary implantation group). CRPS patients that already receive SCS therapy, or those previously treated with SCS but with loss of therapeutic effect over time, can also participate (re-implantation group). Once all inclusion criteria are met and written informed consent obtained, patients will undergo a baseline assessment (T0). A 2-week trial with SCS is performed and, if successful, a rechargeable internal pulse generator (IPG) is implanted. For the following 3 months the patient will have standard 40 Hz stimulation therapy before a follow-up assessment (T1) is performed. Those who have completed the T1 assessment will enroll in a 10-week crossover period in which the five SCS frequencies are tested in five periods, each frequency lasting for 2 weeks. At the end of the crossover period, the patient will choose which frequency is to be used for stimulation for an additional 3 months, until the T2 assessment. DISCUSSION: Currently no trials are available that systematically investigate the importance of variation in frequency during SCS in patients with CRPS. Data from this trial will provide better insight as to whether SCS with a higher frequency, or with burst stimulation, results in more effective pain relief. TRIAL REGISTRATION: Current Controlled Trials ISRCTN3665525

The reliability of side to side measurements of upper extremity activity levels in healthy subjects

<p>Abstract</p> <p>Background</p> <p>In both clinical and occupational settings, ambulatory sensors are becoming common for assessing all day measurements of arm motion. In order for the motion of a healthy, contralateral side to be used as a control for the involved side, the inherent side to side differences in arm usage must be minimal. The goal of the present study was to determine the reliability of side to side measurements of upper extremity activity levels in healthy subjects.</p> <p>Methods</p> <p>Thirty two subjects with no upper extremity pathologies were studied. Each subject wore a triaxial accelerometer on both arms for three and a half hours. Motion was assessed using parameters previously reported in the literature. Side to side differences were compared with the intraclass correlation coefficient, standard error of the mean, minimal detectable change scores and a projected sample size analysis.</p> <p>Results</p> <p>The variables were ranked based on their percentage of minimal detectable change scores and sample sizes needed for paired t-tests. The order of these rankings was found to be identical and the top ranked parameters were activity counts per hour (MDC% = 9.5, n = 5), jerk time (MDC% = 15.8, n = 8) and percent time above 30 degrees (MDC% = 34.7, n = 9).</p> <p>Conclusions</p> <p>In general, the mean activity levels during daily activities were very similar between dominant and non-dominant arms. Specifically, activity counts per hour, jerk time, and percent time above 30 degrees were found to be the variables most likely to reveal significant difference or changes in both individuals and groups of subjects. The use of ambulatory measurements of upper extremity activity has very broad uses for occupational assessments, musculoskeletal injuries of the shoulder, elbow, wrist and hand as well as neurological pathologies.</p

Aptamers as molecular recognition elements for electrical nanobiosensors

Recent advances in nanotechnology have enabled the development of nanoscale sensors that outperform conventional biosensors. This review summarizes the nanoscale biosensors that use aptamers as molecular recognition elements. The advantages of aptamers over antibodies as sensors are highlighted. These advantages are especially apparent with electrical sensors such as electrochemical sensors or those using field-effect transistors

Vacuum-assisted closure:indications and clinical experience

The use of subatmospheric pressure to promote wound healing has gradually found support in the past few years. The vacuum-assisted closure system uses a pump providing a continuous negative pressure of preferably 125 mmHg, which is distributed over the wound surface by an airtight covered foam. The exact mechanisms of vacuum therapy are not yet understood, but clinically soft tissue defects seem to heal faster when subatmospheric pressure is applied. Our experience with the first 100 patients with soft tissue defects of different origin that were treated with vacuum therapy is presented. In 29 patients, the wounds healed without further surgical intervention, 53 patients underwent secondary wound closure and 11 patients required more than one procedure. Seven patients died due to their underlying disease. Few complications were seen. Vacuum sealing is a new therapeutic concept in wound healing which can precede and sometimes replace surgical wound closure

Vacuum-assisted closure:indications and clinical experience

The use of subatmospheric pressure to promote wound healing has gradually found support in the past few years. The vacuum-assisted closure system uses a pump providing a continuous negative pressure of preferably 125 mmHg, which is distributed over the wound surface by an airtight covered foam. The exact mechanisms of vacuum therapy are not yet understood, but clinically soft tissue defects seem to heal faster when subatmospheric pressure is applied. Our experience with the first 100 patients with soft tissue defects of different origin that were treated with vacuum therapy is presented. In 29 patients, the wounds healed without further surgical intervention, 53 patients underwent secondary wound closure and 11 patients required more than one procedure. Seven patients died due to their underlying disease. Few complications were seen. Vacuum sealing is a new therapeutic concept in wound healing which can precede and sometimes replace surgical wound closure

Economic impacts of marine ecological change: Review and recent contributions of the VECTORS project on European marine waters

Marine ecological change is likely to have serious potential economic consequences for coastal economies all over the world. This article reviews the current literature on the economic impacts of marine ecological change, as well as a number of recent contributions to this literature carried out under the VECTORS project. We focus on three main types of change, namely invasive alien species; outbreak-forming species, such as jellyfish and toxic algae; and gradual changes in species distribution and productivity. The case studies available in the literature demonstrate that the impacts of invasions and outbreaks on fisheries, aquaculture, and tourism can potentially amount to several tens of millions of dollars each year in some regions. Moreover, stated preference studies suggest a substantial impact on coastal tourism and non-use values that is likely not visible in case studies of specific outbreak events. Climate-driven gradual changes in distribution and productivity of commercial fish stocks will have an impact on fisheries, although these impacts are likely to be overshadowed by much larger changes in prices of seafood and fuel