Spinal Cord Stimulation With Hybrid Lead Relieves Pain in Low Back and Legs

Objective: The failed back surgery syndrome (FBSS) is the most common chronic pain syndrome. Whereas it is relatively easy to achieve pain relief in the lower limbs of FBSS patients with spinal cord stimulation (SCS), it is difficult to manage low back pain with SCS. The performance of a paddle‐shaped SCS lead that can be inserted surgically as well as percutaneously (a hybrid lead) was evaluated in a prospective study on the relief of low back pain and leg pain in patients with FBSS. Materials and Methods: Patients with FBSS being eligible for SCS were enrolled in the study, and a hybrid lead was placed surgically. Outcome measures included pain scores for low back and leg pain assessed by visual analog scale (VAS), pain medication, and patient satisfaction. These scores were assessed before and at regular intervals after implantation. Results: It was shown that a single hybrid lead, generally positioned over the physiological midline of the spinal cord, is capable of alleviating both low back and leg pain in patients with FBSS. Forty‐five subjects were eligible for SCS and received trial stimulation. Forty‐two of them had a successful trial period and were converted to a permanent system. Their average VAS score at baseline was 8.0 for lower limb pain and 7.5 for low back pain. After six months of SCS, these average VAS scores were reduced to 3.2 and 3.5, respectively, and also pain medication was reduced significantly. Conclusion: SCS with a hybrid lead in subjects with FBSS is safe, and causes significant pain relief in both the low back and the lower limbs.     

Neuropsychiatric symptoms in the community-based patients with mild cognitive impairment and the influence of demographic factors

OBJECTIVE: To investigate the pattern of neuropsychiatric symptoms of MCI patients in the Thai population and the influence of demographic factors on the symptoms. METHODS: One hundred and seven participants aged 50 and over diagnosed with MCI (n = 77) and normal (n = 30) were recruited from a community-based unit. The Neuropsychiatric Inventory (NPI) was used to assess behavioral disturbances in the subjects. RESULTS: Compared to normal subjects, MCI patients had higher incidence of anxiety (53% vs 27%, p = 0.013), dysphoria (46% vs 17%, p = 0.006), and sleep problem (45% vs 23%, p = 0.035). Although marginally significant, apathy was more common in MCI patients (12% vs 0%, p = 0.059). The mean total NPI score and NPI distress score were higher in the MCI group (6.8 vs 1.9, p < 0.0005 and 2.9 vs 0.6, p = 0.01, respectively). The MCI patients aged over 65 had higher incidence of hallucinations (18.9% vs 0%, p = 0.018). Males and patients of poor financial status had higher percentage of dysphoria compared to female and patients with better financial status (65% vs 38.5%, p = 0.041 and 75% vs 37.9%, p = 0.008, respectively). Patients with poor financial status also had higher percentage of anxiety (81.3% vs 44.5%, p = 0.01). CONCLUSIONS: MCI is associated with significant neuropsychiatric symptoms which caused caregiver distress. In this study, the pattern of neuropsychiatric symptoms in a Thai MCI population was similar to those reported in western countries. Age, sex, educational level and financial status influenced the neuropsychiatric symptoms of MCI patients.     

Carbamazepine and phenytoin induced Stevens-Johnson syndrome is associated with HLA-B*1502 allele in Thai population

Purpose: Previous studies found a strong association between HLA‐B*1502 and carbamazepine (CBZ)‐induced Stevens‐Johnson syndrome (SJS) in Han Chinese, but not in Caucasian populations. Even in Han Chinese, the HLA‐B*1502 was not associated with CBZ‐induced maculopapular eruptions (MPE). This study seeks to identify whether HLA‐B*1502 is associated with CBZ‐ or phenytoin (PHT)‐induced SJS or MPE in a Thai population. Methods: Eighty‐one Thai epileptic patients between 1994 and 2007 from the Chulalongkorn Comprehensive Epilepsy Program were recruited. Thirty‐one subjects had antiepileptic drug (AED)‐induced SJS or MPE (6 CBZ‐SJS, 4 PHT‐SJS, 9 CBZ‐MPE, 12 PHT‐MPE), and 50 were AED‐tolerant controls. Results: For the first time, a strong association between HLA‐B*1502 and PHT‐induced SJS was found (p = 0.005). A strong association was also found between the HLA‐B*1502 and CBZ‐induced SJS (p = 0.0005), making Thai the first non‐Chinese population demonstrating such an association. Some patients, who were HLA‐B*1502 and suffered from CBZ‐induced SJS, could be tolerant to PHT and vice versa. This suggests that HLA‐B*1502 may be a common attribute required for a Thai patient to develop SJS from these two AEDs; other different elements, however, are also needed for each AED. In addition, no association between HLA‐B alleles and CBZ‐ or PHT‐induced MPE was found. Conclusions: CBZ‐ and PHT‐induced SJS, but not MPE, is associated with HLA‐B*1502 allele in Thai population.     

中国汉族与泰国人群IL-2基因遗传多态性的研究

目的 研究白细胞介素-2基因(IL-2)启动子区-330T/G和第一外显子 114G/T单核苷酸多态性(SNP)在中国成都地区汉族及泰国曼谷地区正常人群的分布.方法 采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测130例成都地区汉族人和105例曼谷地区泰国人IL-2基因-330、 114位点的多态性,并结合文献进行不同种族间的分析比较.结果 在中国成都汉族人群中IL-2基因-330位点TT、TG和GG基因型频率分别为36.9%、53.9%和9.2%,在泰国人群中分别为40.9%、39.1%和20.0%;中国成都汉族人群IL-2基因 114位点GG、GT和TT基因型频率分别为20.8%、55.8%和23.3%,泰国人群分别为50.5%、39.0%和10.5%;两位点基因型分布频率在两群体中的差异具有统计学意义(P均＜0.05).与泰国、日本、西班牙等人群相比较,成都地区汉族正常人群除IL-2基因 114位点多态性与日本人群相近外(P＞0.05),其-330、 114位点的基因型频率与其他国家人群的差异具有统计学意义(P均＜0.05).结论 IL-2基因-330、 114位点的SNP在不同种族间的分布存在明显的差异.这种差异可能是导致一些疾病在不同种族、不同地区间的发生、转归和预后不同的遗传因素之一.     

肾脏常温机械灌注与无缺血肾移植

为了增加扩大标准供者(ECD)肾脏的利用率,肾脏保存方法近年来在不断发展。常温机械灌注(NMP)的使用,促进了离体供肾保存、评估和修复,以及肾移植手术方式革新。中山大学附属第一医院器官移植中心首创的无缺血肾移植(IFKT)手术,利用肾脏NMP机器在供肾获取、保存、移植全过程中,保持供肾血流和供氧不中断,从根本上避免了供肾缺血-再灌注损伤(IRI),降低了术后移植物功能延迟恢复(DGF)和急性排斥反应发生的风险。本文着重总结肾脏NMP的新进展,以及IFKT手术方式和近期疗效,旨在为提高ECD供肾利用率、解决器官短缺的问题提供参考。     

DCD供肾灌注液生物标志物预测肾移植术后移植物功能延迟恢复的临床应用研究

目的  探讨心脏死亡器官捐献（DCD）供肾静态冷保存（SCS）灌注液生物标志物预测肾移植受者术后发生移植物功能延迟恢复（DGF）的可行性。方法  回顾性分析DCD供肾肾移植的64例受者和47例供者的临床资料。根据受者术后是否发生DGF分为DGF组（7例）与即刻肾功能恢复（IGF）组（57例）,比较两组供肾SCS灌注液中4种生物标志物中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肝型脂肪酸结合蛋白（L-FABP）、白细胞介素-18（IL-18）、肾损伤分子-1（KIM-1）的水平并分析其与DGF的相关性,分析各生物标志物对肾移植受者术后发生DGF的预测价值。结果  DCD供肾肾移植受者术后DGF的发生率为11%（7/64）。DGF组供肾灌注液的NGAL水平高于IGF组（P=0.009）,供肾灌注液的NGAL水平与肾移植受者术后DGF的发生呈正相关（r=0.430, P < 0.001）。受试者工作特征（ROC）曲线分析结果显示,灌注液中的NGAL和KIM-1水平升高对肾移植受者术后发生DGF具有一定的预测价值（均为P < 0.05）,当联合检测NGAL和KIM-1时,预测肾移植受者术后发生DGF的曲线下面积（AUC）为0.932[95%可信区间（CI）0.850~1.000],灵敏度为1.000,特异度为0.754（P < 0.05）。结论  DCD供肾SCS灌注液中的NGAL水平与肾移植受者术后DGF的发生存在相关性,联合检测灌注液中的NGAL和KIM-1水平可以较为准确地预测肾移植受者术后DGF的发生。     

Spinal Cord Stimulator (SCS) Placement: Examining Outcomes Between the Open and Percutaneous Approach

BackgroundSpinal cord stimulator (SCS) placement has been gaining traction as an approach to modulate pain levels for several different chronic pain conditions. This procedure can be performed via a percutaneous or open approach. Data regarding SCS complications are relatively limited.ObjectiveThe purpose of this study was to leverage a large national database to examine outcomes between the percutaneous and open SCS placement approaches. Outcomes in this study include length of stay (LOS), complication rates, reoperation rates, and 1-year readmission rates.Materials and MethodsInclusion criteria for the current study is SCS placement between 2015 and 2020, with receipt of an SCS using either a percutaneous approach or an open laminectomy based approach. Encounters included were limited to true SCS placement, such that trial placements were not included in the study. Univariate statistics and multivariable logistic regression was performed to compare outcomes between cohorts.ResultsTotal SCS case volumes were 9935 between the percutaneous (n = 4477, 45.1%) and open (n = 5458, 54.9%) approach. Patients receiving the percutaneous approach were found to have a mean decrease in LOS of 9.91 hours when compared to those receiving the open approach. The percutaneous approach was significantly associated with the need for reoperation within one year compared to the open approach (odds ratio [OR]: 0.663, p < 0.001), as well as with the need for readmission within 30 days (51.2% vs 40.2%, OR: 0.759, p < 0.001).ConclusionThe open approach, when compared to the percutaneous approach, had a longer mean LOS, lower outpatient discharge rates, and higher odds of experiencing an operative complication in comparison to the percutaneous approach. The percutaneous approach had relatively increased odds of thirty-day readmission, although no significant difference in one-year readmission or removal was demonstrated.