Gastrodin Inhibits Allodynia and Hyperalgesia in Painful Diabetic Neuropathy Rats by Decreasing Excitability of Nociceptive Primary Sensory Neurons

Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus and adversely affects the patients’ quality of life. Evidence has accumulated that PDN is associated with hyperexcitability of peripheral nociceptive primary sensory neurons. However, the precise cellular mechanism underlying PDN remains elusive. This may result in the lacking of effective therapies for the treatment of PDN. The phenolic glucoside, gastrodin, which is a main constituent of the Chinese herbal medicine Gastrodia elata Blume, has been widely used as an anticonvulsant, sedative, and analgesic since ancient times. However, the cellular mechanisms underlying its analgesic actions are not well understood. By utilizing a combination of behavioral surveys and electrophysiological recordings, the present study investigated the role of gastrodin in an experimental rat model of STZ-induced PDN and to further explore the underlying cellular mechanisms. Intraperitoneal administration of gastrodin effectively attenuated both the mechanical allodynia and thermal hyperalgesia induced by STZ injection. Whole-cell patch clamp recordings were obtained from nociceptive, capsaicin-sensitive small diameter neurons of the intact dorsal root ganglion (DRG). Recordings from diabetic rats revealed that the abnormal hyperexcitability of neurons was greatly abolished by application of GAS. To determine which currents were involved in the antinociceptive action of gastrodin, we examined the effects of gastrodin on transient sodium currents (INaT) and potassium currents in diabetic small DRG neurons. Diabetes caused a prominent enhancement of INaT and a decrease of potassium currents, especially slowly inactivating potassium currents (IAS); these effects were completely reversed by GAS in a dose-dependent manner. Furthermore, changes in activation and inactivation kinetics of INaT and total potassium current as well as IAS currents induced by STZ were normalized by GAS. This study provides a clear cellular basis for the peripheral analgesic action of gastrodin for the treatment of chronic pain, including PDN

The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study

Amaresh Vydyanathan,1 Priya Agrawal,2 Naveen Shetty,3 Singh Nair,1 Nancy Shilian,4 Naum Shaparin1 1Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA; 2Sutter Health System, Oakland, CA, USA; 3Department of Anesthesiology, New York University, New York, NY, USA; 4Department of Family Medicine, Mount Sinai South Nassau Hospital, Oceanside, NY, USACorrespondence: Amaresh Vydyanathan, 1250 Waters Place, Tower II, 8th Floor, Bronx, NY, USA, Tel +216-702-5965, Fax +929-263-3950, Email [email protected]: Ultrasound guidance during nerve blockade poses the challenge of maintaining in-plane alignment of the needle tip. The needle guidance device maintains needle alignment and assists with in-plane needle visualization. The purpose of this study is to evaluate the utility of this device by comparing procedure performance during brachial plexus blockade with the conventional approach.Methods: After the Institutional Review Board approval and obtaining informed consent, 70 patients receiving either interscalene or supraclavicular nerve blocks were randomly assigned into 2 groups, a conventional approach versus utilizing the needle guidance device. An independent observer recorded: total procedure time; needle insertion time; number of unplanned redirections; and number of reinsertions. Additionally, physician satisfaction and ease of needle visualization were assessed.Results: Data from seventy patients were analyzed. The median [25th percentile-75th percentile] time to complete the block by the device assisted needle guidance group was 3 (2– 3.75) minutes and 4 (3– 6) minutes in the conventional approach group (p < 0.001). Additionally, subgroup analyses were performed in the supraclavicular block and interscalene block. Supraclavicular blockade, needle insertion time (median [25th percentile-75th percentile] in seconds) (106 [92– 162] vs 197 [140– 278]), total procedure time (3 [2– 3] vs 4.5 [4– 6] in minutes) and unplanned needle redirections (2 [1– 5] vs 5.5 [3– 9]) were significantly lower in needle guidance group (p < 0.001). With interscalene blockade, needle insertion time (86 [76– 146] vs 126 [94– 295]) and unplanned needle redirections (2 [1– 3] vs 4 [2– 8.5]) were significantly lower with needle guidance (p < 0.001), but total procedure time was similar. All the physicians reported that they would use the needle guidance again, and 90% would prefer it for in-plane blocks.Conclusion: Performing regional blocks using the needle guidance device reduces needle insertion time and unplanned needle redirections in brachial plexus blockade. Moreover, physician satisfaction also improved compared to the use of the conventional technique.Keywords: brachial plexus blockade, ultrasound guidance, peripheral nerve blockade, needle guidance, needle visualizatio

Defining Personas of People Living with Chronic Pain: An Ethnographic Research Study

Melissa Cullens,1 Cyan James,1 Meran Liu,1 Amaresh Vydyanathan,2– 4 Naum Shaparin,3– 5 Michael Schatman,6,7 Jacob Hascalovici2,3,5,8 1Clearing Relief Labs Inc., New York City, NY, USA; 2Relief Medical Group P.A, New York City, NY, USA; 3Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA; 4Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA; 5The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA; 6Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York City, NY, USA; 7Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York City, NY, USA; 8Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USACorrespondence: Jacob Hascalovici, Relief Medical Group P.A, 169 Madison Ave, Suite 2412, New York City, New York City, 10016, USA, Email [email protected]: Pain is the leading reason for which people seek medical care in the United States, and chronic pain (CP) affects approximately 50 million people in the US Pain perception is deeply personal, is highly correlated with behavioral and emotional disorders, and is greatly influenced by physiological and environmental factors. The patient-provider relationship can have profound implications for clinical outcomes within the context of treating CP. However, limited access to pain specialists, the complex nature of many CP-causing conditions, the absence of instruments for objective pain measurement, and the need to foster a trust-based patient-provider relationship throughout treatment pose unique challenges.Objective: To support a more optimal CP care delivery system that leverages a healthy therapeutic patient-provider relationship, we systematically gathered deeper knowledge of the behaviors, interpersonal dynamics, home environment, values, and mindsets of people who experience CP.Methods: We employed ethnographic research methods to collect and analyze data on views, habits, strategies, attitudes, and life circumstances of a range of participants living with CP. We aggregated, analyzed, and summarized participant data to identify trends and similarities.Results: Our findings suggest that patients can be broadly categorized into five predominant pain typologies, or “personas”, which are characterized by respective symptom durations, care management preferences, values, communication styles, and behaviors.Conclusion: Identifying CP personas may enhance the ability to personalize CP care and help foster more robust therapeutic relationships, which may lead to greater trust, improved patient satisfaction, and better clinical outcomes.Keywords: chronic pain, personas, biopsychosocial, doctor–patient relationshi

Mapping filtering streaming applications

International audienceIn this paper, we explore the complexity of mapping filtering streaming applications on large-scale homogeneous and heterogeneous platforms, with a particular emphasis on communication models and their impact. Filtering applications are streaming applications where each node also has a selectivity which either increases or decreases the size of its input data set. This selectivity makes the problem of scheduling these applications more challenging than the more studied problem of scheduling "non-filtering" streaming workflows. We address the complexity of the following two problems: Evaluation: Given a mapping of nodes to processors, how can one compute the period and latency? Optimization: Given a filtering workflow, how can one compute the mapping and schedule that minimize the period or latency? A solution to this problem requires generating both the mapping and the associated operation list--the order in which each processor executes its assigned tasks. We address this general problem in two steps. First, we address the simplified model without communication cost. In this case, the evaluation problems are easy, and the optimization problems have polynomial complexity on homogeneous platforms. However, we show that the optimization problems become NP-hard on heterogeneous platforms. Second, we consider platforms with communication costs. Clearly, due to the previous results, the optimization problems on heterogeneous platforms are still NP-hard. Therefore we come back to homogeneous platforms and extend the framework with three significant realistic communication models. Now even evaluation problems become difficult, because the mapping must now be enriched with an operation list that provides the time-steps at which each computation and each communication occurs in the system: determining the best operation list has a combinatorial nature. Not too surprisingly, optimization problems are NP-hard too. Altogether, this paper provides a comprehensive overview of the additional difficulties induced by heterogeneity and communication costs

The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty

Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7+1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve

A distributed task allocation algorithm for a multi-robot system in healthcare facilities

Various ambient assisted living (AAL) technologies have been proposed for improving the living conditions of elderly people. One of them is to introduce robots to reduce dependency on support staff. The tasks commonly encountered in a healthcare facility such as a care home for elderly people are heterogeneous and are of different priorities. A care home environment is also dynamic and new emergency priority tasks, which if not attended shortly may result in fatal situations, may randomly appear. Therefore, it is better to use a multi-robot system (MRS) consisting of heterogeneous robots than designing a single robot capable of doing all tasks. An efficient task allocation algorithm capable of handling the dynamic nature of the environment, the heterogeneity of robots and tasks, and the prioritisation of tasks is required to reap the benefits of introducing an MRS. This paper proposes Consensus Based Parallel Auction and Execution (CBPAE), a distributed algorithm for task allocation in a system of multiple heterogeneous autonomous robots deployed in a healthcare facility, based on auction and consensus principles. Unlike many of the existing market based task allocation algorithms, which use a time extended allocation of tasks before the actual execution is initialised, the proposed algorithm uses a parallel auction and execution framework, and is thus suitable for highly dynamic real world environments. The robots continuously resolve any conflicts in the bids on tasks using inter-robot communication and a consensus process in each robot before a task is assigned to a robot. We demonstrate the effectiveness of the CBPAE by comparing its simulation results with those of an existing market based distributed multi-robot task allocation algorithm and through experiments on real robots