Lumbar Percutaneous Facet Denervation

In this chapter, we summarize the pertinent anatomy and technique of the percutaneous facet denervation technique in the lumbar spine. We also review the current literature on the outcome of lumbar facet denervation.</p

4. Painful diabetic polyneuropathy

Introduction: Pain as a symptom of diabetic polyneuropathy (DPN) significantly lowers quality of life, increases mortality and is the main reason for patients with diabetes to seek medical attention. The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades. Methods: The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized. Results: The etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra-spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain-phenotyping and genotyping based on patient-specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of “probable PDPN” is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism-based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and/or radiofrequency ablation (SLCN/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise. Conclusions: The diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.</p

Unravelling peer assessment: Methodological, functional, and conceptual developments

Peer assessment is an educational arrangement where students judge a peer’s performance quantitatively and/or qualitatively and which stimulates students to reflect, discuss and collaborate. However, empirical evidence for peer assessment effects on learning is scarce, mostly based on student self-reports or involving comparison of peers’ and teachers’ ratings or anecdotal evidence from case studies. Systematic investigation of learning effects necessitates methodological, functional, and conceptual development in peer assessment research. This implies sound (quasi-)experimental studies, the definition of specific peer assessment mechanisms, and affiliations with other research domains. The articles in this special issue address these three needs and offer new directions for research

Peer feedback content and sender’s competence level in academic writing revision tasks: Are they critical for feedback perceptions and efficiency?

Peer feedback content is a core component of peer assessment, but the impact of various contents of feedback is hardly studied. Participants in the study were 89 graduate students who were assigned to four experimental and a control group. Experimental groups received a scenario with Concise General (CGF) or Elaborated Specific (ESF) feedback by a high or low competent peer. ESF by a high competent peer was perceived as more adequate, but led to more negative affect. Students in CGF groups outperformed ESF groups during treatment. Groups with a low competent peer outperformed groups with a high competent peer during the posttest. Feedback perceptions and performance were uncorrelated

Radiofrequency Treatment of Facet-related Pain: Evidence and Controversies

Pain originating from the lumbar facet joints is estimated to represent about 15% of all low back pain complaints. The diagnostic block is considered to be a valuable tool for confirming facetogenic pain. It was demonstrated that a block of the ramus medialis of the ramus dorsalis is preferred over an intra-articular injection. The outcome of the consequent radiofrequency treatment is not different in patients reporting over 80% pain relief after the diagnostic block than in those who have between 50% and 79% pain relief. There is one well-conducted comparative trial assessing the value of one or two controlled diagnostic blocks to none. The results of the seven randomized trials on the use of radiofrequency treatment of facet joint pain demonstrate that good patient selection is imperative for good clinical outcome. Therefore, we suggest one block of the ramus medialis of the ramus dorsalis before radiofrequency treatment

Structural basis of GM-CSF and IL-2 sequestration by the viral decoy receptor GIF.

Subversion of the host immune system by viruses is often mediated by molecular decoys that sequester host proteins pivotal to mounting effective immune responses. The widespread mammalian pathogen parapox Orf virus deploys GIF, a member of the poxvirus immune evasion superfamily, to antagonize GM-CSF (granulocyte macrophage colony-stimulating factor) and IL-2 (interleukin-2), two pleiotropic cytokines of the mammalian immune system. However, structural and mechanistic insights into the unprecedented functional duality of GIF have remained elusive. Here we reveal that GIF employs a dimeric binding platform that sequesters two copies of its target cytokines with high affinity and slow dissociation kinetics to yield distinct complexes featuring mutually exclusive interaction footprints. We illustrate how GIF serves as a competitive decoy receptor by leveraging binding hotspots underlying the cognate receptor interactions of GM-CSF and IL-2, without sharing any structural similarity with the cytokine receptors. Our findings contribute to the tracing of novel molecular mimicry mechanisms employed by pathogenic viruses