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We present a novel approach to estimate the value of primordial non-Gaussianity (f NL) parameter directly from the cosmic microwave background (CMB) maps using a convolutional neural network (CNN). While traditional methods rely on complex statistical techniques, this study proposes a simpler approach that employs a neural network to estimate f NL. The neural network model is trained on simulated CMB maps with known f NL in range of [−50, 50], and its performance is evaluated using various metrics. The results indicate that the proposed approach can accurately estimate f NL values from CMB maps with a significant reduction in complexity compared to traditional methods. With 500 validation data, the |$f^{\rm output}_{\rm NL}$| against |$f^{\rm input}_{\rm NL}$| graph can be fitted as y  = ax + b , where |$a=0.980^{+0.098}_{-0.102}$| and |$b=0.277^{+0.098}_{-0.101}$|⁠ , indicating the unbiasedness of the primordial non-Gaussianity estimation. The results suggest that the CNN technique can be widely applied to other cosmological parameter estimation directly from CMB images. [ABSTRACT FROM AUTHOR]

Understanding the relevant biophysical properties of the spinal dura mater is essential to the design of medical devices that will directly interact with this membrane or influence the contents of the intradural space. We searched the literature and reviewed the pertinent characteristics for the design, construction, testing, and imaging of novel devices intended to perforate, integrate, adhere or reside within or outside of the spinal dura mater. The spinal dura mater is a thin tubular membrane composed of collagen and elastin fibres that varies in circumference along its length. Its mechanical properties have been well-described, with the longitudinal tensile strength exceeding the transverse strength. Data on the bioelectric, biomagnetic, optical and thermal characteristics of the spinal dura are limited and sometimes taken to be similar to those of water. While various modalities are available to visualise the spinal dura, magnetic resonance remains the best modality to segment its structure. The reaction of the spinal dura to imposition of a foreign body or other manipulations of it may compromise its biomechanical and immune-protective benefits. Therefore, dural sealants and replacements are of particular clinical, research and commercial interest. In conclusion, existing devices that are in clinical use for spinal cord stimulation, intrathecal access or intradural implantation largely adhere to traditional designs and their attendant limitations. However, if future devices are built with an understanding of the dura's properties incorporated more fully into the designs, there is potential for improved performance. [ABSTRACT FROM AUTHOR]

Objective Compare therapeutic response of patients to conventional versus high-frequency spinal cord stimulation (SCS). Methods Twelve patients with back and leg pain who met standard clinical criteria for a trial of conventional SCS (low-frequency stimulation [LFS]) participated in a half-day session of high-frequency stimulation (HFS) during their weeklong conventional trial. HFS consisted of frequencies ranging from 50 Hz to 4 kHz, or 100 Hz to10 kHz, at constant voltage settings increasing from 0.5 V to 10 V. Visual Analog Scale scores from 0 to10 were recorded, along with notes of any clinical discomfort and open patient comments. Results Two of 12 patients had no benefit from either LFS or HFS. In the remaining 10 patients, paresthesias were significantly altered by HFS, and four experienced complete elimination of paresthesias. Five patients preferred HFS to LFS, with an additional three preferring both equally. Abrupt sensation to the onset of HFS was described in six patients, and in ten patients, HFS allowed maximum voltage stimulation of 10 V without discomfort. The four patients who did not have a successful trial of stimulation had significantly longer duration of pain compared to the eight patients who went on to permanent implant (11.2 vs. 4.3 years, P = 0.04). Conclusions HFS significantly altered the feeling of paresthesias in the majority of patients (ten of 12), was preferred to LFS in five of 12 patients, and non-inferior to LFS in eight of 12 patients. Both 4 kHz and 10 kHz stimulation allowed patients to benefit from HFS. HFS allowed maximum voltage stimulation without discomfort. [ABSTRACT FROM AUTHOR]

Patients with neuropathic pain commonly present with spontaneous pain, in addition to allodynia and hyperalgesia. Although evoked responses in neuropathic pain models are well characterized, determining the presence of spontaneous pain is more challenging. We determined whether the chronic constriction injury (CCI) model could be used to measure effects of treatment of spontaneous pain, by evaluating dorsal horn neuron (DHN) spontaneous activity and spontaneous pain-related behaviors. We measured conditioned place preference (CPP) to analgesia produced by sciatic nerve block with bupivacaine in rats with established CCI. We undertook another CPP experiment using hind paw incision. We also examined DHN spontaneous activity in CCI rats. Although CCI produced nocifensive responses to mechanical stimuli, CPP to analgesic nerve block was not evident 14 days after injury: Compared with baseline (314 ± 65 seconds), CCI rats did not show a preference for the bupivacaine-paired chamber after conditioning (330 ± 102 seconds). However, sciatic nerve block after hind paw incision produced CPP on postoperative day 1, serving as a positive control. The proportion of spontaneously active DHNs (33%) was not significantly increased in CCI rats compared with the sham (21%). The median rate of spontaneous activity in the CCI group (12.6 impulses per second) was not different from the sham group (9.2 impulses per second). Also, there was no change in DHN spontaneous activity after sciatic nerve block with bupivacaine. Our findings suggest that CCI as a neuropathic pain model should not be used to measure effects of treatment of spontaneous pain driven by the peripheral input. [ABSTRACT FROM AUTHOR]

Leukemia may initially present as a peripheral neuropathy, leading to a delay in diagnosis. Leukemic infiltration of peripheral nerves, or neuroleukemiosis (NL), is exceedingly rare, with no established diagnostic or therapeutic guidelines. Five cases are presented. All patients were men with a median age of 68 years (range 46-72). Three patients had acute myeloid leukemia (AML) and two had chronic lymphocytic leukemia (CLL). In two patients, leukemia presented with peripheral nerve involvement and both were found to have positive cerebrospinal fluid (CSF) cytology, making the diagnosis AML, despite negative bone marrow and peripheral smear. All patients had painful, progressive, motor and sensory deficits. Clinical patterns were mononeuropathy ( n =1), multiple mononeuropathies ( n =1) and plexopathy ( n =3). Magnetic resonance imaging (MRI) detected mass lesions in 4/5 cases, with avid fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) useful in all of these for following clinical disease progression. Three cases of nerve biopsy were performed, two of which were diagnostic of leukemic infiltration. Radiation treatment rapidly relieved pain in patients with mass lesions, in combination with chemotherapy. Four patients had disease relapse, four systemic and one also in peripheral nerves. These cases are discussed in the context of the broader literature. [ABSTRACT FROM AUTHOR]

Biocompatibility, low toxicity, ease of functionalization, ecologically sustainable synthesis, and a diverse variety of applications have all contributed to the current popularity of fluorescent carbon quantum dots (CQDs), a relatively new rising star among zero-dimensional carbon nanomaterials. However, expensive precursors and production, as well as a time-consuming procedure, frequently restrict the economic design that must be addressed. In this work, we report an economical, sustainable and green synthesis of fluorescent CQDs co-doped with N and Ca from mustard (Brassica) flower extract without the need of additional doping element precursors. The quasi-circular or polygonal shaped CQDs were revealed to be yellow-greenish fluorescent in nature with outstanding photo-stability and excellent water solubility, with an average diameter of 4.38 nm and a relative quantum yield of about 15%. The compositional analysis, crystallinity, and functional groups contained in as-synthesized N,Ca-co-doped CQDs were determined by XPS, XRD, and FTIR analysis, respectively. The presence of dominant sp3 hybridized carbons over sp2 was confirmed by 1H NMR and 13C NMR spectroscopy. The plausible fluorescence mechanisms are also proposed. Additionally, a biodegradable bioplastic derived from corn starch was used to develop an N, Ca-co-doped CQDs@bioplastic composite in order to demonstrate how it may be used to produce down-conversion light emitting diodes and optical displays. The impact of CQD concentrations and pH sensitivity were investigated further. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • We report a simple, cost-effective, eco-sustainable synthesis of fluorescent carbon quantum dots derived from precursor Cissus quadrangularis. • The as-synthesized nitrogen doped-CQDs demonstrated a homogeneous size distribution (4–9 nm), green fluorescent nature, great photo-stability, excellent water solubility, and a quantum yield of around 5 %. • A biodegradable wheat-starch-based bioplastic was employed to fabricate an N-doped CQDs@bioplastic composite to demonstrate its potential applications in quantum dot-based optical displays and down-conversion light emitting diodes. • The influence of different CQD concentrations and pH sensitivity were investigated further utilizing fabricated optical displays and LEDs. Carbon quantum dots (CQDs)-based composites as luminous down-conversion materials are becoming more popular due to several advantages such as steady fluorescence, ease of functionalization, tailoring of emission in the visible range, and so on. We report an inexpensive and environmentally sustainable synthesis of fluorescent nitrogen doped-CQDs produced from Cissus quadrangularis , a low-cost plant precursor with therapeutic value. The morphological, structural, and physicochemical features of the material were carefully investigated. Under UV stimulation (365 nm), almost spherical shaped N-CQDs with an average diameter of 5.1 nm were discovered to generate yellow-green fluorescence, have excellent photostability, and strong water solubility, with a quantum yield of up to 5 %. Furthermore, as a solid-phase dispersion matrix for CQDs, ecologically friendly and biodegradable bioplastic is appealing. The down-conversion of solid-state fluorescence of LEDs and UVC tubes was demonstrated by creating a nanocomposite by inserting N-CQDs into the solid matrix of a wheat starch-based bioplastic. Furthermore, employing constructed quantum dot-based optical displays, down-converted LEDs, and UVC tubes, the impacts of varied CQD concentrations and pH sensitivity were examined. [ABSTRACT FROM AUTHOR]

Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS) can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS).The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient's left antecubital area for routine blood check. The patient's pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient's pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain. [ABSTRACT FROM AUTHOR]

Inconel 625 (IN625) is an essential material for the manufacture of turbine blades and seals, aircraft ducting systems, engine components, and pressure valves. Laser Directed Energy Deposition (LDED) process has shown the potential to fabricate IN625 parts with superior mechanical properties and higher corrosion resistance when compared to those fabricated using conventional manufacturing techniques. However, the poor surface quality limits the practical application of LDED fabricated parts, especially in sectors that demand high tribological performance. To this end, this study focuses on improving the surface quality and tribological performance of LDED fabricated IN625 components using Laser Surface Remelting (LSR) as a postprocessing operation. The tribological performance was evaluated using a linear reciprocating ball-on-flat wear test setup. The surface roughness, remelting depth (RD), microstructure, hardness, and tribological performance (coefficient of friction and wear rate) of the remelted (RM) samples were compared with that of as-deposited (AD) samples. Microstructural characterization revealed that LSR resulted in grain refinement, reduced dendrite size, and primary dendritic arm spacing (PDAS). Laser scanning speed effects RD, dendrite size and PDAS via its effect on cooling rates. SEM + EDS analysis confirmed the presence of Laves phase in both AD and RM samples. XRD analysis of RM samples showed an increase in the amount of Laves phase. The refinement in microstructural features and the increased amount of Laves phase among the RM samples led to improvement in microhardness when compared to AD samples. Wear test results revealed a reduction in the coefficient of friction (COF) and wear rate after LSR with wear mechanism being either abrasive or delamination. Reduction in the size of dendrites and refinement in grain size are attributed to the enhanced tribological performance after LSR. • Laser surface remelting (LSR) as a post-processing technique for LDED processed components (AD) has been investigated. • LSR achieved superior surface quality than the AD sample due to remelting of partially melted powder particles. • LSR resulted in grain refinement, improvement in hardness and tribological performance when compared to AD sample. • The scanning speed used for remelting is a key parameter for achieving enhanced tribological performance. [ABSTRACT FROM AUTHOR]

This study demonstrated an environmentally responsible, inexpensive and simple one-step hydrothermal method to synthesize biocompatible fluorescent carbon quantum dots (CQDs) from Aegle marmelos fruit extract. The near-spherical CQDs were discovered to have a naturally distributed size of 3–6 nm, were unintentionally doped with heteroatoms (Ca, K, and N) without the need for doping element precursors due to mineral contents in extract, had a quantum yield of about 4.06%, strong photostability, and excellent water solubility. Several morphological, compositional, physicochemical, and optical properties were studied. Other variables influencing CQD photoluminescence, such as hydrothermal process parameters and pH sensitivity, were also examined. Zeta potential analysis showed a negative surface charge with a zeta potential value of −5.29 mV and good dispersibility in aqueous solution. Furthermore, as an alternative to organic or synthetic probes, there is a huge need for the development of simple, affordable, and non-destructive fluorescent biomarkers. As-synthesized Ca, K, N-doped CQDs have demonstrated good fluorescent staining abilities and may be employed as a helpful probe for bio-imaging of cancer cells and other organisms. Cell survival and cytotoxicity were found to be satisfactory, with 90% of SH-SY5Y and HCT-116 cells surviving, compared to 63–77% for the other organisms, even at higher dosages (200 µg/mL) for up to 4 days. [Display omitted] • A facile heteroatom doped CQDs have been synthesized from Aegle marmelos. • Hydrothermal process dependent and pH responsive PL were examined. • Bio-imaging of cancer cells and other living organisms are demonstrated. • Cytotoxicity were found over 90% of SH-SY5Y and HCT-116 cancer cells. [ABSTRACT FROM AUTHOR]

[Display omitted] • Biocompatible fluorescent N,K,Ca-doped CQDs derived from Chenopodium album. • Fluorescence quantum yield up to 48.12 % was achieved. • Bioimaging of SH-SY5Y human neuroblastoma cells, bacteria, fungal, and plant cells. • The cytotoxicity and cell viability have also been examined. This study demonstrated an economical, ecologically sustainable, and simple method for producing biocompatible fluorescent carbon quantum dots (CQDs) co-doped with N, K, and Ca from bathua (Chenopodium album), a popular medicinal herb leaf extract and nutritious vegetable. The nearly spherical shaped CQDs were discovered to be 3–5 nm in size in nature, with a quantum yield of around 48.12%, robust photo-stability, and excellent water solubility. Various morphological, compositional, physicochemical and optical characteristics were investigated. Additional factors affecting the photoluminescence of CQDs, such as hydrothermal process parameters, pH, and solvent sensitivity, were investigated further. Moreover, the newly synthesized N, K, Ca-doped CQDs were demonstrated to be a useful fluorescent nanoprobe for in vitro cellular imaging of SH-SY5Y human neuroblastoma cells, as well as other living organisms such as bacteria, fungal, and plant cells, as a cost-effective alternative to organic or synthetic fluorescent probes. Cell survival and cytotoxicity were found to be acceptable, with 95% of SH-SY5Y and HCT-116 cells surviving and other organisms able to withstand higher doses (10.9 mg/mL) for up to 4 days. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Basic airway management by junior doctors: assessment and training on human apnoeic subjects in the anaesthetic room," by K. Kidner and A. Laurence in August 2006 issue is presented.

New Findings: What is the central question of this research? Does acute spinal cord stimulation increase vascular conductance and decrease muscle sympathetic nerve activity in the lower limbs of humans? What is the main finding and its importance? Acute spinal cord stimulation led to a rapid rise in femoral vascular conductance, and peroneal muscle sympathetic nerve activity demonstrated a delayed reduction that was not associated with the initial increase in femoral vascular conductance. These findings suggest that neural mechanisms in addition to attenuated muscle sympathetic nerve activity might be involved in the initial increase in femoral vascular conductance during acute spinal cord stimulation. Abstract: Clinical cases have indicated an increase in peripheral blood flow after continuous epidural spinal cord stimulation (SCS) and that reduced muscle sympathetic nerve activity (MSNA) might be a potential mechanism. However, no studies in humans have directly examined the effects of acute SCS (<60 min) on vascular conductance and MSNA. In study 1, we tested the hypothesis that acute SCS (<60 min) of the thoracic spine would lead to increased common femoral vascular conductance, but not brachial vascular conductance, in 11 patients who previously underwent surgical SCS implantation for management of neuropathic pain. Throughout 60 min of SCS, common femoral artery conductance was elevated and significantly different from brachial artery conductance [in millilitres per minute: 15 min, change (Δ) 26 ± 37 versus Δ−2 ± 19%; 30 min, Δ28 ± 45 versus Δ0 ± 26%; 45 min, Δ48 ± 43 versus Δ2 ± 21%; 60 min, Δ36 ± 61 versus Δ1 ± 24%; and 15 min post‐SCS, Δ51 ± 64 versus Δ6 ± 33%; P = 0.013]. A similar examination in a patient with cervical SCS revealed minimal changes in vascular conductance. In study 2, we examined whether acute SCS reduces peroneal MSNA in a subset of SCS patients (n = 5). The MSNA burst incidence in response to acute SCS gradually declined and was significantly reduced at 45 and 60 min of SCS (in bursts per 100 heart beats: 15 min, Δ−1 ± 12%; 30 min, Δ−14 ± 12%; 45 min, Δ−19 ± 16%; 60 min, Δ−24 ± 18%; and 15 min post‐SCS: Δ−11 ± 7%; P = 0.015). These data demonstrate that acute SCS rapidly increases femoral vascular conductance and reduces peroneal MSNA. The gradual reduction in peroneal MSNA observed during acute SCS suggests that neural mechanisms in addition to attenuated MSNA might be involved in the acute increase in femoral vascular conductance. [ABSTRACT FROM AUTHOR]

This study demonstrated an environmentally friendly, cost-effective, and easy method for manufacturing biocompatible fluorescent carbon quantum dots (CQDs) from the leaf extract of the medicinal herb Cissus quadrangularis. As-synthesized nitrogen doped-CQDs had fluorescence quantum yields of up to 5%. The presence of pyrrolic/pyridinic-N, quaternary-N (N–C 3), and O C–N, as verified by X-ray photoelectron spectroscopy, reveals that nitrogen atoms were efficiently doped in CQDs. The size distribution of as-synthesized CQDs was found to be within 4–9 nm using a high-resolution transmission electron microscope. Meanwhile, nuclear magnetic resonance studies showed the presence of a significant proportion of sp2 and sp3 carbon groups. The zeta potential of as-synthesized CQDs was −7.8 mV, demonstrating the presence of a negatively charged surface with good stability in aqueous solution. Furthermore, the development of easy, affordable, and non-destructive fluorescence-based staining agents as an alternative to organic or synthetic dyes is widely sought. In this regard, as-synthesized N-doped CQDs shown remarkable fluorescent staining capabilities in this study and might be employed as a useful probe for optical and bio-imaging of bacteria, fungal, and plant cells. On the other hand, the cytotoxicity and cell viability of pine leaf, mushrooms, algae, fungus, and bacteria have also been examined. Even at higher doses (10.9 mg/ml), cell survival was demonstrated to be rather excellent and cytotoxicity was minimal for up to 4 days. [Display omitted] • A biocompatible fluorescent carbon quantum dots (CQDs) from Cissus quadrangularis leaf extract has been explored. • Fluorescence quantum yields of up to 5% were observed in as-synthesized nitrogen doped-CQDs. • The as-synthesized CQDs have a high water suspension capacity. • N-doped CQDs have been demonstrated as a fluorescent staining agent in bio-labelling of bacteria, fungi, and plant cells. • The cytotoxicity and cell viability of pine leaf, mushrooms, algae, fungus, and bacteria have been examined. [ABSTRACT FROM AUTHOR]

Introduction: Symptoms and signs in women with Charcot-Marie-Tooth disease type 1X (CMT1X) are often milder from those in men, but the available electrophysiologic evidence regarding CMT1X in women has been characterized in some patients as non-uniform or asymmetric.Methods: We retrospectively reviewed electrodiagnostic findings from 45 women and 31 men with CMT1X.Results: Motor nerve conduction parameters in CMT1X women were less abnormal (P < 0.05), and a wider range of motor conduction velocities (CVs) were seen in women (P < 0.001) compared with men. In women, nerve conduction studies showed lack of conduction block without temporal dispersion. Motor CVs were more frequently in the normal range in women compared with men. There was no significant relationship to age of presentation and motor CV or compound muscle action potential in women.Conclusion: NCS parameters in CMT1X women did not demonstrate features suggestive of an acquired demyelinating neuropathy. Muscle Nerve, 2016 Muscle Nerve 54: -, 2016 Muscle Nerve 54: 728-732, 2016. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the sensitivity of F-wave minimal latencies, we compared F-waves with motor and sensory nerve conduction studies (MNCS and SNCS) in patients with peripheral neuropathy.Methods:A retrospective chart review conducted in 484 patients confirmed the clinical evidence of a polyneuropathy, and studies of F-wave minimal latencies as well as MNCS and SNCS in each patient.Results: Overall rate of abnormality reached 469/484 (96.9%) for F-wave minimal latencies as compared to 374/484 (77%) for nerve conduction studies ( p< 0.0001). Nerve-specific abnormalities of F-waves showed 290/354 (82%), 140/171 (82%), 367/398 (92%) and 357/376 (95%) for median, ulnar, peroneal and tibial nerves, respectively. Corresponding values for MNCS consisted of 108/354 (31%), 29/171 (17%), 258/398 (65%) and 189/376 (50%) (allp< 0.0001). In contrast, SNCS revealed abnormalities in 120/333 (36%), 60/159 (38%) and 266/474 (56%) of median, ulnar and sural nerves.Conclusion:F-wave minimal latencies serve as the best predictor of polyneuropathy followed by SNCS and then MNCS. [ABSTRACT FROM AUTHOR]

Objective To compare the degree of discomfort caused by nerve conduction studies ( NCS) versus needle electromyography ( EMG), and to determine what factors predict aversion to one test or the other. Methods Two hundred patients underwent both EMG and NCS, and were asked to indicate which test was more uncomfortable. Responses were then correlated with demographic information, testing characteristics, and medical histories to identify any notable associations. Results Of the 200 patients, 58.5% (117) of the patients found the NCS more uncomfortable than EMG. Sixty-one percent (11/18) of the younger patients (18-29 years old) found EMG more uncomfortable ( P = 0.08), whereas 68% (40/59) of the older patients (age greater than 60 years old) found NCS more uncomfortable ( P = 0.05). Sixty-seven percent (14/21) of the patients whose BMI was less than 22 kg/m2 rated EMG as more uncomfortable ( P = 0.01). Sixty-nine percent (27/39) of the patients whose BMI was greater than or equal to 38 found the NCS more uncomfortable ( P = 0.02). A positive correlation existed between NCS discomfort and number of nerves tested. 67% (35/52) of the patients with polyneuropathy found NCS more uncomfortable. Conclusion Nerve conduction studies are more uncomfortable than needle EMG in the majority of patients, and predictions regarding which test will be more uncomfortable for a given patient are possible. [ABSTRACT FROM AUTHOR]

It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order tomanage the patient's newly onset pain, the patient hadmultiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy. [ABSTRACT FROM AUTHOR]

Title: Survey of the functional priorities in patients with disability due to neuromuscular disorders. Objective: This study attempts to determine the functional priorities for patients with neuromuscular disorders. Methods: A survey asking about functional priorities with respect to activities of daily living, ankle foot orthotic design, and assistive device design, was distributed to patients with neuromuscular disorders to assess the needs of patients from their perspectives. Descriptive statistics were used to analyse answers. Results: A total of 171 subjects with neuromuscular disorders responded to the questionnaire. Of the respondents with weakness in both the upper and lower extremities, 45% stated that if they had to choose between correction of one or the other, they would prefer that of their lower extremities. Activities that patients most frequently wanted to gain independence with were mobility and transfers (46%), followed by toilet use and hygiene (32%). The most popular control mechanism of an assistive device was voice activation (35%). Conclusion: This study assessed the functional priorities of those with neuromuscular disorders. Although such individuals can experience a range of weakness in the upper and/or lower extremities, common functional priorities were reported: independence with mobility, transfers, toilet use and hygiene. Knowledge of these priorities will help guide development of assistive devices that will restore function in the future. Neuromuscular Disorders • Neuromuscular disorders result in disabling weakness; there are few cures and many are unable to carry out activities of daily living. • Information that would be helpful in determining functional priorities is limited. • In a survey of 171 patients with neuromuscular disorders, functional priorities included mobility and transfers (46%), followed by toilet use and hygiene (32%). • Of the respondents with weakness in both the upper and lower extremities, 45% stated that if they had to choose between correction of one or the other, they would prefer that of their lower extremities. • If an assistive device were to be created to help those with neuromuscular disorders, the most popular control mechanism would be voice activation (35%). [ABSTRACT FROM AUTHOR]

Background Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1–2.5 per 50,000 persons) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. Methods In this report, we discuss a 62-year-old woman who presented with a 5-week history of orthostatic headaches associated with nausea, emesis, and neck pain. Despite initial imaging being negative, the patient later developed classic imaging evidence characteristic of SIH. Magnetic resonance imaging was unrevealing for the source of the CSF leak. Radionuclide cisternography showed possible CSF leak at the right-sided C7-T1 nerve root exit site. After failing a blind lumbar EBP, subsequent targeted EBP at C7-T1 improved the patient's symptoms. Two days later she developed a new headache with imaging evidence of worsening SDH with midline shift requiring burr hole drainage. This yielded sustained symptomatic relief and resolution of previously abnormal imaging findings at 2-month follow-up. Results A literature review revealed 174 cases of SIH complicated by SDH. This revealed conflicting opinions concerning the management of this condition. Conclusions Although blind lumbar EBP is often successful, targeted EBP has a lower rate of patients requiring a second EBP or other further treatment. On the other hand, targeted EBP has a larger risk profile. Depending on the clinic situation, treatment of the SDH via surgical evacuation may be necessary. [ABSTRACT FROM AUTHOR]

We are developing a novel intradural spinal cord (SC) stimulator designed to improve the treatment of intractable pain and the sequelae of SC injury. In-vivo ovine models of neuropathic pain and moderate SC injury are being implemented for pre-clinical evaluations of this device, to be carried out via gait analysis before and after induction of the relevant condition. We extend previous studies on other quadrupeds to extract the three-dimensional kinematics of the limbs over the gait cycle of sheep walking on a treadmill. Quantitative measures of thoracic and pelvic limb movements were obtained from 17 animals. We calculated the total-error values to define the analytical performance of our motion capture system for these kinematic variables. The post- vs. pre-injury time delay between contralateral thoracic and pelvic-limb steps for normal and SC-injured sheep increased by ~ 24 s over 100 steps. The pelvic limb hoof velocity during swing phase decreased, while range of pelvic hoof elevation and distance between lateral pelvic hoof placements increased after SC injury. The kinematics measures in a single SC-injured sheep can be objectively defined as changed from the corresponding pre-injury values, implying utility of this method to assess new neuromodulation strategies for specific deficits exhibited by an individual. [ABSTRACT FROM AUTHOR]

Extraskeletal Ewing’s sarcoma (EES) is a rare presentation, representing only 15% of all primary Ewing’s sarcoma cases. Even more uncommon is EES presenting as a primary focus in the spinal canal. These rapidly growing tumors often present with focal neurological symptoms of myelopathy or radiculopathy. There are no classic characteristic imaging findings and thus the physician must keep a high index of clinical suspicion. Diagnosis can only be definitively made by histopathological studies. In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness. Imaging revealed a cervical spinal canal mass. After undergoing cervical decompression, histopathological examination confirmed a diagnosis of Ewing’s sarcoma. A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age age=38. Given the low incidence of this pathology presenting in this age group and the lack of treatment guidelines, each patient’s plan should be considered on a case-by-case basis until further studies are performed to determine optimal evidence based treatment. [ABSTRACT FROM AUTHOR]

The efficacy of spinal cord stimulators is dependent on the ability of the device to functionally activate targeted structures within the spinal cord, while avoiding activation of near-by non-targeted structures. In theory, these objectives can best be achieved by delivering electrical stimuli directly to the surface of the spinal cord. The current experiments were performed to study the influence of different stimulating electrode positions on patterns of spinal cord electrophysiological activation. A custom-designed spinal cord neurostimulator was used to investigate the effects of lead position and stimulus amplitude on cortical electrophysiological responses to spinal cord stimulation. Brain recordings were obtained from subdural grids placed in four adult sheep. We systematically varied the position of the stimulating lead relative to the spinal cord and the voltage delivered by the device at each position, and then examined how these variables influenced cortical responses. A clear relationship was observed between voltage and electrode position, and the magnitude of high gamma-band oscillations. Direct stimulation of the dorsal column contralateral to the grid required the lowest voltage to evoke brain responses to spinal cord stimulation. Given the lower voltage thresholds associated with direct stimulation of the dorsal column, and its possible impact on the therapeutic window, this intradural modality may have particular clinical advantages over standard epidural techniques now in routine use. [ABSTRACT FROM AUTHOR]

We describe a novel spinal cord (SC) stimulator that is designed to overcome a major shortcoming of existing stimulator devices: their restricted capacity to selectively activate targeted axons within the dorsal columns. This device overcomes that limitation by delivering electrical stimuli directly to the pial surface of the SC. Our goal in testing this device was to measure its ability to physiologically activate the SC and examine its capacity to modulate somatosensory evoked potentials (SSEPs) triggered by peripheral stimulation. In this acute study on adult sheep (n = 7), local field potentials were recorded from a grid placed in the subdural space of the right hemisphere during electrical stimulation of the left tibial nerve and the spinal cord. Large amplitude SSEPs (﹥200 μV) in response to SC stimulation were consistently obtained at stimulation strengths well below the thresholds inducing neural injury. Moreover, stimulation of the dorsal columns with signals employed routinely by devices in standard clinical use, e.g., 50 Hz, 0.2 ms pulse width, produced long-lasting changes (﹥4.5 h) in the SSEP patterns produced by subsequent tibial nerve stimulation. The results of these acute experiments demonstrate that this device can be safely secured to the SC surface and effectively activate somatosensory pathways. [ABSTRACT FROM AUTHOR]

Background Ionic contrast, if accidentally injected into the intrathecal space during routine imaging studies or interventional procedures, may significantly interfere with neuronal activity, potentially causing ascending tonic-clonic seizure syndrome and even death. As a result, ionic contrast is strictly contraindicated for intrathecal use. Rapid recognition of the condition followed by prompt management, typically involving aggressive cerebrospinal fluid (CSF) drainage, is critical to improving patient outcome. Lumbar drain has previously been well described as a management strategy. Case Description We present a case of accidental intrathecal injection of an ionic contrast agent, iothalamate meglumine, in a patient undergoing cervical epidural steroid injection. This patient was managed successfully with drainage of CSF using an external ventricular drain alone. Conclusion Our literature review and analysis of the previously published cases demonstrate that aggressive CSF drainage is essential to improve outcomes, and in some cases an external ventricular drain alone may be effectively used. [ABSTRACT FROM AUTHOR]

Background We report a unique finding of a patient whose restless legs syndrome (RLS) symptoms abated after the placement of a spinal cord stimulator for chronic neuropathic pain. RLS is a common disorder, with many patients unable to find sufficient relief from their symptoms. Case Description A patient diagnosed with neuropathic pain who also suffered from RLS symptoms despite medication therapy underwent implantation of a spinal cord stimulator after a successful trial. This patient was interviewed formally about his RLS symptoms immediately before his procedure and at 6 weeks, 6 months, and 2.5 years after the procedure. The patient also completed the International Restless Legs Syndrome Scale questionnaire to objectively quantify the severity of his symptoms. Finally, the patient kept a 5-day journal detailing when the stimulator was in use. The patient reported subjective symptomatic improvement in his RLS symptoms with improved sleep quality and quantity, in addition to improvement in his back pain. The patient's score on the International Restless Legs Syndrome Scale improved after implantation from 33 to 0 on a 40-point scale. Moreover, when asked to keep a journal record of his stimulator use, the patient noted that he only used the stimulator before going to bed to help his RLS symptoms and no longer required any medication for his previous RLS symptoms. Conclusions Epidural stimulation may be an additional, alternative, or novel therapy in the treatment of RLS. [ABSTRACT FROM AUTHOR]