Long-term clinical outcome of peripheral nerve stimulation for chronic headache and complication prevention

Background: Subcutaneous peripheral nerve stimulation (PNS) has emerged as a useful tool in the treatment of intractable headaches. However, complications such as skin erosion, infection and lead migration have adversely affected clinical outcome, and occasionally led to treatment cessation. Objectives: Here we report the results of peripheral nerve stimulator implantation performed on 24 patients with various chronic headaches at our center over a period of 9 years. We describe the complications of the procedure and their prevention with a modified surgical technique. Patients and Methods:We searched our database for patients with chronic refractory headacheswhohad undergone PNS. Patients were assessed before being considered for PNS, and their pain characteristics were reviewed. Following a successful trial, patients were implanted with a permanent peripheral nerve stimulator. Selection of target nerves was based on headache diagnosis and head pain characteristics. Patients were followed for an average of 4.9 years. Headache characteristics before and after treatment were compared. Results: Twenty four patients were included in the study. All patients reported on improvement in head pain intensity, duration and frequency three months after permanent device implantationMeantotal pain index (TPI) decreased significantly, from 516±131 before the procedure to 74.8±61.6 at the last follow up (P \u3c 0.00001). There were no acute post-operative infections. Three patients had their stimulator removed. The self-rated treatment satisfaction was excellent in 54% of the patients, very good or good in 42%, and fair in 4%. Conclusions: Our results support the use of PNS insomepatients with refractory chronic headaches. Appropriate surgical planning and technique are important to achieve good clinical outcome and to minimize complications. © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). All rights reserved

Trans-sacrococcygeal Joint Ganglion Impar Injection for Treatment of Pudendal Neuralgia (3 cases report)

History Three patients, 2 male and 1 female were diagnosed with pudendal neuralgia. The female patient developed pudendal neuralgia secondary to post-herpetic neuralgia. The two male patients were caused from likely repetitive sitting injury. One patient was a truck driver causing him to sit for long periods of time and the other patient was a professional writer. The three patient initially all attempted conservative therapies, however their pain persisted. They elected to undergo Trans-sacrococcygeal joint ganglion impar injection for treatment of pudendal neuralgia

The Significance of Percutaneous Aspiration of the Zygapophysial Facet Joint Synovial Cyst: A Case Series

Cysts that are clearly associated with threat of progressive neurological loss or intractable, unremitting symptoms should be released by a decompression procedure. In our case series, percutaneous aspiration has been successfully used for 3 of 4 PTs with marked decrease in size of cyst on imaging and clinical improvement. Obstructing pathology and ultimately the location of the cyst can be major factors in determining the success of the procedure. Our study demonstrated that a minimally invasive aspiration of a ZP SC can often achieve clinical improvement. This may save the PT from undergoing an invasive surgical decompression

Effects of the Addition of Dendrobium officinale on Beer Yeast Fermentation

Dendrobium officinale is a precious Chinese medicinal plant that is rich in polysaccharides, flavonoids, polyphenols, and other bioactive ingredients, and has a variety of biological activities. To explore the effects of D. officinale on the growth and metabolism of Saccharomyces cerevisiae, different concentrations (0, 10, 30, 50, and 100 g/L) of fresh D. officinale were added to the wort during the fermentation. The amount of yeast, alcohol content, reducing sugars, total acidity, pH, CO2 loss, and foam height were analyzed. Meanwhile, the glucose uptake, cell viability, key enzyme activity of yeast, total phenolics, antioxidant activity, volatile compounds, and consumer acceptance of brewed samples were also analyzed. The results showed that the growth and metabolism of yeast could be promoted by a suitable dosage of D. officinale but were inhibited at high dosage (100 g/L). The addition of D. officinale increased the activities of glucose-6-phosphate dehydrogenase and alcohol dehydrogenase, while the highest concentration of D. officinale (100 g/L) decreased the glucose uptake and cell activity of the yeast. The contents of total phenolics and esters, along with the scavenging activity against ABTS radicals, were increased, indicating that the antioxidant activity and aromatic characteristics of beer would be improved by the addition of D. officinale

Treatment of Cerebrospinal Fluid Leak During Spinal Cord Stimulator Implantation with Epidural Blood Patches

Conclusion: Our data is consistent with prior studies in demonstrating that the incidence of dural puncture and CSF leak with SCS procedures is rare. Based on our experiences, performing an epidural blood patch intra-operatively on the contra-lateral side under fluoroscopy could prevent PDPH. This treatment should especially be considered in patients undergoing SCS trials in order to accurately assess the level of pain reduction. Patients with prior spine surgeries might pose higher risks for dural puncture and more extensive pre-operative assessment could be beneficial

Assessing environmental suitability of Ligusticum chuanxiong based on ecological analyses with chemical and molecular verification

Ligusticum chuanxiong Hort. as an important Chinese medicinal herb clinically used as anti-inflammatory, antioxidant, and hepatoprotective agents, is widely planted in China. However, related studies on L. chuanxiong’s distribution and significant environmental factors that affect its growth are insufficient. Based on climatic, topographic and soil factors, this study predicted current and future distributions of L. chuanxiong and analyzed the distribution transformation under different scenarios. Moreover, the most important environmental factors for modeling were explored using maximum entropy models, chemical analysis and molecular analysis. Results suggested that the predicted distribution of L. chuanxiong was wider than previously reported. Among these environmental variables, climate factors, especially the minimum temperature of the coldest month (Bio6, 46.7%) and solar radiation (SRAD, 43.4%) contributed more than others to L. chuanxiong’s distribution with optimum values of 0–1.5 °C and 5000–11,000 kJ/m2 per day. Total and highly suitable areas respectively increased by 26,788–943,820 km2 and 34,757–340,417 km2 in the future (2061–2080, 2081–2100). The distribution centers of suitable zones were predicted to migrate north in the future, and the migration distance was 135.74–479.77 km from current center. Results of chemical content determination suggested that L. chuanxiong should be cultivated in high-suitable places to improve medicinal quality by evaluating contents of ferulic acids and Z-ligustilide. Correlation analysis suggested that both chemical contents and gene expression levels decreased with decreasing habitat suitability, suggesting a strong link between environments, chemical constituents, and gene expression. These findings improve the comprehension of the effects of environments on the distribution patterns of L. chuanxiong, as well the relation between environmental suitability and medicinal quality. These findings provide a useful foundation for the planting, cultivation and conservation of L. chuanxiong

Control of Charge Carriers Trapping and Relaxation in Hematite by Oxygen Vacancy Charge: <i>Ab Initio</i> Non-adiabatic Molecular Dynamics

Ultrafast charge recombination in hematite (α-Fe₂O₃) severely limits its applications in solar energy conversion and utilization, for instance, in photoelectrochemical water splitting. We report the first time-domain <i>ab initio</i> study of charge relaxation dynamics in α-Fe₂O₃ with and without the oxygen vacancy (O_v) defect, using non-adiabatic molecular dynamics implemented within time-dependent density functional theory. The simulations show that the hole trapping is the rate-limiting step in the electron–hole recombination process for both neutral and ionized O_v systems. The electron trapping is fast, and the trapped electron are relatively long-lived. A similar asymmetry is found for the relaxation of free charge carriers: relaxation of photoholes in the valence band is slower than relaxation of photoelectrons in the conduction band. The slower dynamics of holes offers an advantage to water oxidation at α-Fe₂O₃ photoanodes. Notably, the neutral O_v defect accelerates significantly the charge recombination rate, by about a factor of 30 compared to the ideal lattice, due to the stronger electron-vibrational coupling at the defect. However, the recombination rate in the ionized O_v defect is decreased by a factor of 10 with respect to the neutral defect, likely due to expansion of the local iron shell around the O_v site. The O_v defect ionization in α-Fe₂O₃ photoanodes is important for increasing both electrical conductivity and charge carrier lifetimes. The simulations reproduce well the time scales for the hot carrier cooling, trapping and recombination available from transient spectroscopy experiments, and suggest two alternative mechanisms for the O_v-assisted electron–hole recombination. The study provides a detailed atomistic understanding of carrier dynamics in hematite, and rationalizes the experimentally reported activation of α-Fe₂O₃ photoanodes by incorporation of O_v defects