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Introduction: Small fiber neuropathies (SFN) are associated with a reduction in quality of life. In adults, epidermal nerve fiber density (END) analysis is recommended for the diagnosis of SFN. In children, END assessment is not often performed. We analyzed small nerve fiber innervation to elucidate the potential diagnostic role of skin biopsies in young patients with pain., Methods: Epidermal nerve fiber density and sudomotor neurite density (SND) were assessed in skin biopsies from 26 patients aged 7 to 20 years (15 female patients) with unexplained chronic pain. The results were compared with clinical data., Results: Epidermal nerve fiber density was abnormal in 50% and borderline in 35% of patients. An underlying medical condition was found in 42% of patients, including metabolic, autoimmune, and genetic disorders., Discussion: Reduction of epidermal nerve fibers can be associated with treatable conditions. Therefore, the analysis of END in children with pain may help to uncover a possible cause and guide potential treatment options., (© 2019 The Authors. Muscle & Nerve published by Wiley Periodicals, Inc.)

The progression of heart failure with reduced ejection fraction is promoted by sympathovagal imbalance. Baroreflex activation therapy (BAT) by the electrical stimulation of baroreceptors at the carotid sinus significantly improved exercise capacity and NT-proBNP levels in a randomized trial; however, no significant difference in left ventricular ejection fraction (LV-EF) between groups was found. Here, we report the case of a 30-year-old man with a long history of dilated cardiomyopathy and severely reduced LV-EF despite optimal medical therapy, who was treated with BAT since October 2014 and showed a remarkable improvement in both symptoms and LV-EF under this treatment.

The preparation and characterization of mononuclear complexes of the dinucleating 24-membered hexazadithiophenolate macrocycles H2L2 and H2L3 and their open-chain N3S2 analogues H2L4 and H2L5 are reported. The highly crystalline compounds [Ni(L4)] (4), [Ni(L5)] (5), [Co(L5)] (6), [NiH2(L2)]2+ (7), [ZnH2(L2)]2+ (8), and [NiH2(L3)]2+ (9) could be readily prepared by stoichiometric complexation reactions of the hydrochlorides of the free ligands with the corresponding metal(II) dichlorides and NEt3 in methanolic solution. All complexes were characterized by X-ray crystallography. Monometallic complexes 4-6 of the pentadentate ligands H2L4 and H2L5 feature distorted square pyramidal MN3S2 structures (tau = 0.01 to 0.44). Similar coordination geometries are observed for the macrocyclic complexes 7-9 of the octadentate ligands H2L2 and H2L3. The two hydrogen atoms in 7-9 are attached to the noncoordinating benzylic amine functions and are hydrogen bonded to the metal-bound thiophenolate functions. A comparison of the structures of 4-9 reveals that the macrocycles L2 and L3 have a rather flexible ligand backbone that do not confer unusual coordination geometries on the metal ions. We also report on the ability of the monometallic complexes 7 and 8 to serve as starting materials for the preparation of dinuclear complexes.