Spinal cord stimulation in patients with painful diabetic neuropathy: A multicentre randomized clinical trial

Painful diabetic neuropathy (PDN) is a peripheral neuropathic pain condition that is often difficult to relieve. Spinal cord stimulation (SCS) is a proven effective therapy for various types of mixed neuropathic conditions, yet effectiveness of SCS treatment for PDN is not well established. To our knowledge, ours is the first multicentre randomized controlled trial investigating the effectiveness of SCS in patients with PDN. Sixty patients with PDN in the lower extremities refractory to conventional medical therapy were enrolled and followed for 6 months. They were randomized 2:1 to best conventional medical practice with (SCS group) or without (control group) additional SCS therapy, and both groups were assessed at regular intervals. At each follow-up visit, the EuroQoL 5D, the short form McGill Pain Questionnaire (SF-MPQ) and a visual analogue scale (VAS, ranging 0–100) to measure pain intensity were recorded. The average VAS score for pain intensity was 73 in the SCS group and 67 in the control group at baseline. After 6 months of treatment, the average VAS score was significantly reduced to 31 in the SCS group (P < .001) and remained 67 (P = .97) in the control group. The SF-MPQ and EuroQoL 5D questionnaires also showed that patients in the SCS group, unlike those in the control group, experienced reduced pain and improved health and quality of life after 6 months of treatment. In patients with refractory painful diabetic neuropathy, spinal cord stimulation therapy significantly reduced pain and improved quality of life.     

Transcutaneous spinal direct current stimulation improves locomotor learning in healthy humans

Background

Ambulation is an essential aspect of daily living and is often impaired after brain and spinal cord injuries. Despite the implementation of standard neurorehabilitative care, locomotor recovery is often incomplete.

Yttrium-90 Radioembolization to the Prostate Gland: Proof of Concept in a Canine Model and Clinical Translation

PurposeTo investigate the feasibility, safety, and absorbed-dose distribution of prostatic artery radioembolization (RE) in a canine model.Materials and MethodsFourteen male castrated beagles received dihydroandrosterone/estradiol to induce prostatic hyperplasia for the duration of the study. Each dog underwent fluoroscopic prostatic artery catheterization. Yttrium-90 (⁹⁰Y) microspheres (TheraSphere; Boston Scientific, Marlborough, Massachusetts) were delivered to 1 prostatic hemigland (dose escalation from 60 to 200 Gy), with the contralateral side serving as a control. Assessments for adverse events were performed throughout the follow-up (Common Terminology Criteria for Adverse Events v5.0). Positron emission tomography/magnetic resonance (MR) imaging provided a confirmation after the delivery of absorbed-dose distribution. MR imaging was performed before and 3, 20, and 40 days after RE. Tissue harvest of the prostate, rectum, bladder, urethra, penis, and neurovascular bundles was performed 60 days after RE.ResultsAll the animals successfully underwent RE. Positron emission tomography/MR imaging demonstrated localization to and good coverage of only the treated hemigland. No adverse events occurred. The MR imaging showed a significant dose-dependent decrease in the treated hemigland size at 40 days (25%–60%, P < .001). No extraprostatic radiographic changes were observed. Necropsy demonstrated no gross rectal, urethral, penile, or bladder changes. Histology revealed RE-induced changes in the treated prostatic tissues of the highest dose group, with gland atrophy and focal necrosis. No extraprostatic RE-related histologic findings were observed.ConclusionsProstate ⁹⁰Y RE is safe and feasible in a canine model and leads to focal dose-dependent changes in the gland without inducing unwanted extraprostatic effects. These results suggest that an investigation of nonoperative prostate cancer is warranted.     

Analysis of brain activity involved in chewing‐side preference during chewing: an fMRI study

The aim of this study was to investigate the activation characteristics of cerebral cortex in participants with CSP during rhythmic chewing movement. Sixteen right‐handed participants with left (two males: 29·0 ± 8·4 years old, six females: 32·3 ± 4·8 years old) or right (four males: 31·0 ± 6·1 years old, four females: 30·8 ± 4·7 years old) CSP were scanned by functional magnetic resonance imaging during rhythmic chewing. The on‐off sequence of scanning was 30 s of rhythmic chewing and 30 s of rest (off) a total of five times. The results showed that blood oxygen level‐dependent signals in the contralateral (to the CSP) primary sensorimotor cortex increased more than in the ipsilateral primary sensorimotor cortex in participants with both left and right CSP (P ≤ 0·001). Moreover, the BOLD signal within the right substantia nigra of midbrain, brainstem was more significantly (P ≤ 0·001) activated than its left counterpart in participants with left CSP, while no activation was observed in those with right CSP. The similar activation of the cerebellum was in participants with right CSP. The inferior parietal lobule, inferior frontal gyrus and left insular cortex were significantly (P ≤ 0·001) activated in participants with CSP. These findings suggest a relationship between hemispheric dominance and CSP in the primary sensorimotor cortex responsible for rhythmic chewing movement. The brainstem and the cerebellum might also play important role in the regulation of CSP. Furthermore, the IFG, IPL and insular may contribute to higher cognitive information processing for participants with CSP.     

Carotid Artery-Related Perioperative Stroke Following Anterior Cervical Spine Surgery: A Series of 3 Cases and Literature Review

Background

Vascular complications following anterior cervical spine surgery are rare but potentially devastating. Complications associated with the carotid artery are even more disastrous but largely anecdotal, with no more than 4 reported cases.