Peripheral Sensation Research Articles

Penerapan Hydrogel dan Antimicrobial Dressing terhadap Penyembuhan Luka dan Sensasi Perifer pada Pasien Gangrene Pedis

Gangrene is one of Diabetes Mellitus (DM) complication causing tissue death in wound and decreased peripheral sensation. Priority management of gangrene is through tissue reperfusion and wound care with modern dressing to enhance healing and increase periphery circulation. This research aimed to report wound healing progress and peripheral sensation gangrene in a patient who was given hydrogel and antimicrobial dressing. Research design used a descriptive case study approach. Sample involved one inpatient in West Java regional public hospital who was diagnosed with gangrene, had necrotic wounds, and poor peripheral perfusion, currently treated with modern dressing hydrogel and antimicrobial dressing. The instrument used is Bates Jensen Wound Assessment Tools (BJWAT), lowest score shows significant wound healing progress. Decreasing wound healing score using BJWAT questionnaire from 41 to 29, peripheral sensation (+), and monofilament score from 0/9 to 5/9 after the intervention. Modern dressing improved wound healing and peripheral sensation in gangrene pedis patient. Thus, it is expected to examine effectiveness of hydrogel and antimicrobial dressings on healing scores and peripheral sensation in gangrene pedis patients more extensively.

A Case of a Pediatric Finger Tendon Rupture Diagnosed by Point-of-Care Ultrasound

BackgroundPediatric tendon injuries to the finger are rare, and their diagnosis can be challenging due to the difficulty in sensorimotor assessment in pediatric patients. Point-of-care ultrasound (POCUS) has currently been used for identifying tendon injury in adult acute care, but reports of its use in pediatric emergency departments are scarce. Case reportA previously healthy 14-year-old male patient visited our emergency department due to a finger laceration that occurred when he was cutting sausages using a knife. Physical examination revealed a 1.5 cm laceration over the palmer surface of the left fifth proximal phalanx. Tendon exposure was unremarkable, and the peripheral perfusion and sensation of the injured finger were intact. Flexion of the proximal and distal interphalangeal joints was limited due to pain. POCUS showed the disruption of the tendon structure over the laceration site, suggesting the flexor tendon rupture. Wound exploration by the orthopedic team revealed a transected flexor digitorum superficialis and flexor digitorum profundus and a tendon repair was performed. The patient was discharged with immobilization of the injured hand. Why Should an Emergency Physician Be Aware of This?Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging to diagnose due to the difficulty in sensorimotor assessment in pediatric patients. POCUS can directly visualize a tendon structure without procedural sedation or radiation exposure, empowering physicians to diagnose tendon injuries and optimize patient care.

The transmembrane channel-like 6 (TMC6) in primary sensory neurons involving thermal sensation via modulating M channels.

Introduction: The transmembrane channel-like (TMC) protein family contains eight members, TMC1-TMC8. Among these members, only TMC1 and TMC2 have been intensively studied. They are expressed in cochlear hair cells and are crucial for auditory sensations. TMC6 and TMC8 contribute to epidermodysplasia verruciformis, and predispose individuals to human papilloma virus. However, the impact of TMC on peripheral sensation pain has not been previously investigated. Methods: RNAscope was employed to detect the distribution of TMC6 mRNA in DRG neurons. Electrophysiological recordings were conducted to investigate the effects of TMC6 on neuronal characteristics and M channel activity. Zn2+ indicators were utilized to detect the zinc concentration in DRG tissues and dissociated neurons. A series of behavioural tests were performed to assess thermal and mechanical sensation in mice under both physiological and pathological conditions. Results and Discussion: We demonstrated that TMC6 is mainly expressed in small and medium dorsal root ganglion (DRG) neurons and is involved in peripheral heat nociception. Deletion of TMC6 in DRG neurons hyperpolarizes the resting membrane potential and inhibits neuronal excitability. Additionally, the function of the M channel is enhanced in TMC6 deletion DRG neurons owing to the increased quantity of free zinc in neurons. Indeed, heat and mechanical hyperalgesia in chronic pain are alleviated in TMC6 knockout mice, particularly in the case of heat hyperalgesia. This suggests that TMC6 in the small and medium DRG neurons may be a potential target for chronic pain treatment.

Influence of Ambient Temperature on Autonomic Nerve Function and Peripheral Sensation from Moderate-Intensity Treadmill Exercise

Influence of Ambient Temperature on Autonomic Nerve Function and Peripheral Sensation from Moderate-Intensity Treadmill Exercise

DIFFERENTIAL PAIN SENSATION AND GUT MICROBIOME BETWEEN YOUNG AND OLDER ADULTS

Abstract This study aimed to investigate the differences in pain sensation and gut microbiota between young and older adults. Twenty-one healthy young adults (YAs) and sixteen healthy older adults (OAs) were recruited. Quantitative sensory testing data, and stool samples were collected. The 16S rRNA V4 gene region of stool samples were sequenced and processed by using the Mothur 1.42.3 pipeline. The mean ages of YAs and OAs were 20.14 (SD = 1.39) and 63.19 (SD = 8.00), respectively. Eleven of the YAs and 12 of the OAs were female, and 8 of the YAs and 3 of the OAs reported pain. OAs had significantly higher heat pain threshold (HPT), higher pressure pain threshold (PPT), lower cold detection threshold (CDT), and lower cold pain threshold (CPT) than YAs (all p < 0.05). OAs had significantly different a-diversity indices including higher species of observed (Sobs), Chao index and Shannon index, and lower coverage, and significantly different beta diversity indices (Bray-Curtis, Jaccard, and Theta YC) than YAs. The significantly abundant taxa in YAs included Bacteroidaceae, Veillonellaceae, and Alcaligenaceae. Coriobacteriaceae, Streptococcaceae, Lachnospiraceae, Erysipelotrichaceae, and Verrucomicrobiaceae were significantly enriched in OAs. The Spearman correlation analysis showed that the CDT, CPT, and HPT were significantly associated with gut microbiota Sobs, Chao index, Shannon index, and coverage (all p < 0.05). But the directions and coefficients of correlations varied. OAs had distinguished peripheral sensation and gut microbiota profiles than YAs. The changed peripheral sensation and gut microbiota profiles among OAs may be biomarkers of aging-related pain processing.

Human prostate MRI at ultrahigh-performance gradient: A feasibility study.

To demonstrate the technical feasibility and the value of ultrahigh-performance gradient in imaging the prostate in a 3T MRI system. In this local institutional review board-approved study, prostate MRI was performed on 4 healthy men. Each subject was scanned in a prototype 3T MRI system with a 42-cm inner-diameter gradient coil that achieves a maximum gradient amplitude of 200 mT/m and slew rate of 500 T/m/s. PI-RADS V2.1-compliant axial T2 -weighted anatomical imaging and single-shot echo planar DWI at standard gradient of 70 mT/m and 150 T/m/s were obtained, followed by DWI at maximum performance (i.e., 200 mT/m and 500 T/m/s). In comparison to state-of-the-art clinical whole-body MRI systems, the high slew rate improved echo spacing from 1020 to 596 μs and, together with a high gradient amplitude for diffusion encoding, TE was reduced from 55 to 36 ms. In all 4 subjects (waist circumference = 81-91 cm, age = 45-65 years), no peripheral nerve stimulation sensation was reported during DWI. Reduced image distortion in the posterior peripheral zone prostate gland and higher signal intensity, such as in the surrounding muscle of high-gradient DWI, werenoted. Human prostate MRI at simultaneously high gradient amplitude of 200 mT/m and slew rate of 500 T/m/s is feasible, demonstrating that improved gradient performance can address image distortion and T2 decay-induced SNR issues for in vivo prostate imaging.

Evaluation of Corneal Nerve Regeneration After Minimally Invasive Corneal Neurotization.

To evaluate the corneal nerve regeneration after minimally invasive corneal neurotization (MICN) and to further clarify the recovery patterns of sensory and trophic functions of the corneal nerves. A retrospective cohort study based in the Shanghai Ninth People's Hospital. Eighteen patients (18 eyes) who underwent MICN for neurotrophic keratopathy due to intracranial surgery was conducted to analyze their follow-up data at 6, 12, 18, and 24 months after surgery. At 12 months postoperatively, the growth of the central and peripheral corneal nerve fiber density (CNFD) was 11.47±8.56 and 14.73±8.08n/mm 2 with subsequent improvement slowing down, and the patient's corneal epithelium defect was healed ahead of the accomplishment of corneal nerve regeneration. The number of dendritic cells also reached its peak. At 18 months postoperatively, the recovery of central and peripheral corneal sensation was 37.22±23.06mm and 39.38±18.08mm with no subsequent improvement, and the growth of the central and peripheral corneal nerve branch density (CNBD) was 29.69±11.05 and 43.75±1.41n/mm 2 , with a positive and significant correlation between corneal sensation and CNBD (at central r =0.632, P <0.005; at peripheral r =0.645, P <0.005). At 24 months postoperatively, mean CNFD, CNBD, and corneal sensation recovered significantly compared with preoperative, but a few patients' corneal sensation recovered insignificantly with good CNFD recovery and poor CNBD recovery. After MICN, the trophic function of the corneal nerve recovers before the sensory function, and in particular, the recovery of sensation is based on the coexistence of the corneal nerve trunk and branches.

Structural Changes of Cutaneous Immune Cells in Patients With Type 1 Diabetes and Their Relationship With Diabetic Polyneuropathy.

Diabetic polyneuropathy (DPN) is a complication of diabetes characterized by pain or lack of peripheral sensation, but the underlying mechanisms are not yet fully understood. Recent evidence showed increased cutaneous macrophage infiltration in patients with type 2 diabetes and painful DPN, and this study aimed to understand whether the same applies to type 1 diabetes. The study included 104 participants: 26 healthy controls and 78 participants with type 1 diabetes (participants without DPN [n = 24], participants with painless DPN [n = 29], and participants with painful DPN [n = 25]). Two immune cells, dermal IBA1+ macrophages and epidermal Langerhans cells (LCs, CD207+), were visualized and quantified using immunohistological labeling and stereological counting methods on skin biopsies from the participants. The IBA1+ macrophage infiltration, LC number density, LC soma cross-sectional area, and LC processes were measured in this study. Significant difference in IBA1+ macrophage expression was seen between the groups (p = 0.003), with lower expression of IBA1 in participants with DPN. No differences in LC morphologies (LC number density, soma cross-sectional area, and process level) were found between the groups (all p > 0.05). In addition, IBA1+ macrophages, but not LCs, correlated with intraepidermal nerve fiber density, Michigan neuropathy symptom inventory, (questionnaire and total score), severity of neuropathy as assessed by the Toronto clinical neuropathy score, and vibration detection threshold in the whole study cohort. This study showed expressional differences of cutaneous IBA1+ macrophages but not LC in participants with type 1 diabetes-induced DPN compared with those in controls. The study suggests that a reduction in macrophages may play a role in the development and progression of autoimmune-induced diabetic neuropathy.

The co-existence of peripheral and vestibular neuropathy in diabetes: a cross-sectional study

PurposeDiabetic neuropathy can lead to decreased peripheral sensation and motor neuron dysfunction associated with impaired postural control and risk of falling. However, the relationship between decreased peripheral sensation and impaired vestibular function in diabetes mellitus is poorly investigated. Therefore, the aim of this study was to investigate the relationship between peripheral and autonomic measurements of diabetic neuropathy and measurements of vestibular function.MethodsA total of 114 participants with type 1 diabetes (n = 52), type 2 diabetes (n = 51) and controls (n = 11) were included. Vestibular function was evaluated by video head impulse testing. Peripheral neuropathy was assessed by quantitative sensory testing and nerve conduction. Autonomic neuropathy using the COMPASS 31 questionnaire. Data were analyzed according to data type and distribution.ResultsMeasurements of vestibular function did not differ between participants with type 1 diabetes, type 2 diabetes or controls (all p-values above 0.05). Subgrouping of participants according to the involvement of large-, small- or autonomic nerves did not change this outcome. Correlation analyses showed a significant difference between COMPASS 31 and right lateral gain value (ρ = 0.23, p = 0.02,), while no other significant correlations were found.ConclusionDiabetic neuropathy does not appear to impair vestibular function in diabetes, by means of the VOR.Clinical trialsNCT05389566, May 25th, 2022.

Peripheral Nerve Safety of Nerve Growth Factor Inhibition by Tanezumab: Pooled Analyses of Phase III Clinical Studies in Over 5000 Patients with Osteoarthritis.

Tanezumab, a humanized anti-nerve growth factor antibody, was developed for the treatment of pain associated with osteoarthritis. Due to its mechanism of action, peripheral nerve safety was assessed in all clinical studies. To summarize the neurological safety of intravenous (IV) and subcutaneous (SC) tanezumab versus placebo in patients with osteoarthritis. Data were pooled from 3389 patients across seven studies that investigated IV administration, and from 1840 patients across three studies that investigated SC administration. The treatment period of each study ranged from 16 to 24weeks, and follow-up periods ranged from 8 to 24weeks. Neurological safety evaluations focused on adverse events (AEs) of abnormal peripheral sensation (APS), neurologic examinations, and consultations. Across datasets, the incidence of AEs of APS was higher in tanezumab groups versus placebo. Paresthesia and hypoesthesia were the most frequently reported AEs in tanezumab-treated patients, compared with placebo. In both datasets, most AEs were of mild severity, resolved, and rarely resulted in discontinuation. In all treatment groups in both IV and SC studies, over 90% of patients had no new or worsened neurological examination abnormalities at the last study visit. Across datasets, mononeuropathy was diagnosed more frequently in tanezumab groups compared with placebo. Polyneuropathy was diagnosed in ≤ 0.9% of patients in tanezumab and placebo groups. Tanezumab IV or SC had an increased incidence of AEs of APS, such as paresthesia and hypoesthesia, and diagnoses of mononeuropathy compared with placebo. However, tanezumab was not associated with generalized peripheral neuropathy. NCT00733902, NCT00744471, NCT00830063, NCT00863304, NCT00863772, NCT01089725, NCT00985621, NCT02697773, and NCT02709486.

Safe Nail Clippers for Finger Flesh Injury Prevention

As people age, their toenails become thick and hard, making it difficult to trim them. Diabetic patients are prone to nerve and vascular damage due to high blood sugar, affecting blood circulation and sensation in the peripheral limbs. We developed a safety nail clipper designed specifically for the elderly and diabetic patients for healthcare. Trimming nails is a regular activity, and existing nail clipper designs lack warning mechanisms, increasing the risk of skin damage for diabetic patients during nail trimming. The elderly or diabetic patients often have poor vision in trimming their nails, which may lead to cutting too deep and causing paronychia or wounds. Tissue necrosis, suppuration, and infection may occur, potentially resulting in amputation. Therefore, based on the understanding of the difference in conductivity between the nail and skin and using LED indicators, we provided a protective mechanism for diabetic patients with abnormal peripheral limb sensation by using a nail clipper. When it touched the skin, the LED light illuminated to avoid cutting too deep and protect the nail bed.

Peripheral and central sensation: multisensory orienting and recognition across species

Attentional bottlenecks force animals to deeply process only a selected fraction of sensory inputs. This motivates a unifying central-peripheral dichotomy (CPD), which separates multisensory processing into functionally defined central and peripheral senses. Peripheral senses (e.g., human audition and peripheral vision) select a fraction of the sensory inputs by orienting animals' attention; central senses (e.g., human foveal vision) allow animals to recognize the selected inputs. Originally used to understand human vision, CPD can be applied to multisensory processes across species. I first describe key characteristics of central and peripheral senses, such as the degree of top-down feedback and density of sensory receptors, and then show CPD as a framework to link ecological, behavioral, neurophysiological, and anatomical data and produce falsifiable predictions.

Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf soft tissue defects

To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects. The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation ( P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society's functional evaluation standard for replantation of amputated limbs. Weber's quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups. No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group ( P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) ( χ 2=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation ( P>0.05). Flow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.

446 Accurate Localization of Back Pain by Radiomic Assessment of Sigma-1 Receptor Expression

INTRODUCTION: The current diagnostic tools that we have for back pain have low sensitivity and poor accuracy which leads to ineffective and unnecessary treatments, resulting in high health care costs and unwanted outcomes. Sigma-1 receptor (s1R) is broadly implicated in nociceptive signaling and peripheral pain sensation. METHODS: Specific patient selection for full body ([18F]FTC-146) PET/MRI scan was done after clinical and radiological review by a neurosurgeon specializing in spinal surgery. Six patients with various etiologies of back pain were included. For all the study participants, we recorded all relevant clinical details and reviewed prior diagnostic tests. All PET/MRI scans were completed at our institution’s facilities and images were reviewed and correlated by a musculoskeletal radiologist to identify lesions that may be causing patient’s symptoms. RESULTS: Our study results strongly support the likelihood of achieving enhanced diagnostic sensitivity to sources of back pain with the proposed s1r imaging approach. PET/MRI imaging matched the clinical diagnosis in all cases, including disc herniation, nerve compression, stenosis, and arthropathy. Additionally, it offered benefit over traditional MRI by identifying additional “functional” findings both within and outside the spine. This additional functional detail, was useful for patients with either no or multiple structural abnormalities on MRI to pinpoint the true cause of pain demonstrating the synergistic utility of this imaging modality. Such functional detail guided successful interventions including surgery, therapy, and injections in our patient cohort that successfully addressed the pain. CONCLUSIONS: Early results show promise for improved confidence and sensitivity in detecting sources of pain using full body ([18F]FTC-146) PET/MRI scan which can potentially improve patient management and outcomes.

SCN9A rs6746030 Polymorphism and Pain Perception in Combat Athletes and Non-Athletes

One of the genes associated with pain perception is SCN9A, which encodes an α-subunit of the voltage gated sodium channel, NaV1.7, a crucial player in peripheral pain sensation. It has been suggested that a common missense polymorphism within SCN9A (rs6746030; G>A; R1150W) may affect nociception in the general population, but its effects of pain perception in athletes remain unknown. Therefore, the aim of the study was to investigate the association between a polymorphism within SCN9A (rs6746030) and pain perception (pain threshold and pain tolerance) in the group of combat athletes (n = 214) and students (n = 92) who did not participate in sports at a professional level. Genotyping was carried out using TaqMan Real-Time PCR method. No significant differences were found between the SCN9A genotype distributions with respect to the pain threshold. However, the probability of having a high pain threshold was higher in the combat sports group than in the control group. The probability of having a decreased pain tolerance was higher in the carriers of the GA and AA genotype than in the homozygotes of the GG genotype. Moreover, the possibility of having a high pain threshold was higher in the combat athlete group than in the control group. The results of our study suggest that the SCN9A rs6746030 polymorphism may affect pain perception. However, the additional effect of the experimental group may suggest that pain tolerance is significantly modulated by other factors, such as the systematic exposure of the athletes' bodies to short-term high-intensity stimuli during training sessions.

Effect of Resistance and Flexibility Exercise Intervention on Balance in Older Adults

The main objective of our study is to analyze the effect of resistance and flexibility exercise intervention on balance in older adults. Balance is the ability to maintain an upright posture during static and dynamic tasks. Maintaining balance involves a complex interaction between intrinsic factors, including peripheral, visual and vestibular sensation and muscle factors, and the interplay between the neural network and motor output, which are processed and mediated centrally. Programs to increase physical exercise among elderly persons have been found to be beneficial to health. Evidence suggests that training should combine both flexibility exercises and resistance exercises. Berg Balance Scale was the outcome measure. Twenty subjects were selected and divided into two groups. Group A (10 subjects) were given Resisted exercises for 40-45 minutes with two sets of 10 � 12 repetitions for ten weeks. Group B (10 subjects) were given flexibility exercises for 40-45 minutes and included 10�12 repetitions for ten weeks. On comparing the mean values of Group A &amp; Group B on the Berg Balance Scale score, it shows a significant increase in the post-test mean values in both groups, but (Group A - Resistance Exercise) shows 51.10 which has the higher Mean value is effective than (Group B - Flexibility exercise) 46.40 at P = 0.001. Comparing Pretest and Posttest within Group A &amp; B on the Berg Balance Scale score shows a highly significant difference in mean values at P = 0. 001. This study concludes that resisted exercise significantly improved balance in older adults than in flexibility exercise.

PREDICTORS OF 400M WALKING TIME: THE STUDY OF MUSCLE MOBILITY AND AGING (SOMMA)

Abstract Longer 400m walking time has been strongly associated with overall mortality and many other aging-related outcomes in prior studies. Inability to walk 400m defines ‘mobility disability’. We assessed characteristics that might contribute to 400m walking time in SOMMA, a cohort of 879 men and women over age 70. We excluded people with a gait speed &amp;lt; 0.6 m/s. The analysis included 49 factors representing several domains: muscle mass and strength, body composition, oxygen delivery, muscle mitochondrial ATP generation, fitness by cardiopulmonary exercise testing (VO2 peak), fatigability by questionnaire, usual physical activity, depressed mood, cognitive performance, lower extremity pain, lower extremity sensation, smoking, wealth and income, and general health. We used both elastic net and forward step-wise regression to generate multivariate models. Factors associated with longer (worse) walking time in both elastic net and forward step-wise regression models were: *weaker leg power, *fatigue during treadmill testing, *higher BMI, *greater self-reported fatigability, *worse performance on the timed DSST test, *fewer hours spent walking, *taking more medications, *older age, *poorer fitness (VO2peak), *more joint stiffness, *smoking, and *reduced peripheral sensation. These results indicate that 400m walk time is influenced by numerous factors. Some are also associated with overall mortality and aging outcomes and therefore they might underlie the prognostic value of the 400m walk. Additionally, some of the predictors could be improved, such as leg strength, cardiopulmonary fitness, more time walking, quitting smoking, and treatment of joint stiffness, perhaps reducing the risk of mobility disability.

Electroacupuncture alleviates neuropathic pain caused by spared nerve injury by promoting AMPK/mTOR-mediated autophagy in dorsal root ganglion macrophage.

Dorsal root ganglia (DRG) plays an important role in mediating the peripheral sensation transduction through the primary afferent neurons in pain research. Neuropathic pain (NP) is a syndrome of hyperalgesia, spontaneous pain and allodynia caused by central or peripheral nerve injury. Recent trends of study are turning towards the development of therapies for the management of NP. Activation of autophagy in glial cells in the spinal cord has been reported to be associated with attenuation of NP, but the autophagic process in DRG is rarely studied. The analgesic effect of electroacupuncture (EA) was evaluated in NP-induced rats developed using spared nerve injury (SNI). Acupuncture or EA was performed after 7 days of SNI at Zusanli (ST36) and Huantiao (GB30) acupoints. Then, the activation status of autophagy process in DRGs of rats treated with SNI and EA were investigated, and the possible mechanism of the analgesic effect of EA were explored. Application of EA has been found to reduce mechanical hyperalgesia. Autophagy indicator p62 was colocalized with the marker proteins for macrophages (CD11b), but not with NeuN (marker protein for neurons) or GFAP (marker protein for satellite glial cells), as shown by immunofluorescence. Western blots results indicate that the expression levels of p62, Beclin-1 and LC3-II in the L4-L6 DRG of rats in the SNI group were increased, compared with that in the control group. EA treatment resulted in decreased expression of p62 and increased expression of Beclin-1 and LC3-II/LC3-I. Furthermore, we explored the causal relationship between EA-induced suppression of NP and increased levels of autophagy in DRG using electron microscopy and the AMPK (AMP-activated protein kinase) inhibitor compound C. SNI achieved a significant upregulation of autophagy levels in DRG macrophages. Furthermore, EA attenuated NP, which may contribute to the promotion of AMPK/mTOR (mammalian target of rapamycin)-mediated autophagy in DRG macrophages. Therefore, this strategy provides a new target for therapeutic intervention of NP.

Lesions to both somatic and affective pain pathways lead to decreased salience network connectivity.

Human pain is a salient stimulus composed of two main components: a sensory/somatic component, carrying peripheral nociceptive sensation via the spinothalamic tract and brainstem nuclei to the thalamus and then to sensory cortical regions, and an affective (suffering) component, where information from central thalamic nuclei is carried to the anterior insula, dorsal anterior cingulate cortex and other regions. While the sensory component processes information about stimulus location and intensity, the affective component processes information regarding pain-related expectations, motivation to reduce pain and pain unpleasantness. Unlike investigations of acute pain that are based on the introduction of real-time stimulus during brain recordings, chronic pain investigations are usually based on longitudinal and case-control studies, which are limited in their ability to infer the functional network topology of chronic pain. In the current study, we utilized the unique opportunity to target the CNS's pain pathways in two different hierarchical locations to establish causality between pain relief and specific connectivity changes seen within the salience and sensorimotor networks. We examined how lesions to the affective and somatic pain pathways affect resting-state network topology in cancer patients suffering from severe intractable pain. Two procedures have been employed: percutaneous cervical cordotomy (n = 15), hypothesized to disrupt the transmission of the sensory component of pain along the spinothalamic tract, or stereotactic cingulotomy (n = 7), which refers to bilateral intracranial ablation of an area in the dorsal anterior cingulate cortex and is known to ameliorate the affective component of pain. Both procedures led to immediate significant alleviation of experienced pain and decreased functional connectivity within the salience network. However, only the sensory procedure (cordotomy) led to decreased connectivity within the sensorimotor network. Thus, our results support the existence of two converging systems relaying experienced pain, showing that pain-related suffering can be either directly influenced by interfering with the affective pathway or indirectly influenced by interfering with the ascending spinothalamic tract.

Effect of Virtual Reality Based treatment in Geriatric Population on Static Balance, Dynamic Balance and Risk of Fall

Background: With advancing age, the postural control mechanism becomes less efficient due to ageing. Reduced peripheral sensation, muscle weakness, and increased reaction time are significant contributing factors to postural instability in the elderly. Thus age can affect both static and dynamic balance in elderly which will eventually have impact on fear of fall and risk of fall. Virtual Reality Training (VRT) focuses on exercise intensity and feedback that provides the patient with safe and effective training and rehabilitation. The aim of this study is to evaluate the effects of kinect based virtual reality training on Static balance, Dynamic balance and Risk of Fall. Methodology: Ethical clearance was obtained by the Ramaiah Medical College and Hospitals. Based on the inclusion criteria, patients were screened using Time up and go test (TUG) as a screening tool for balance, 31 participants were recruited. Pre and post assessment of static and dynamic balance was done by Four Stage Balance Test (FSBT) and TUG. Explanation and instruction were given to patient about the game controls and exergames with a demo. Results and Conclusion: 30 min of Exergame training for 8 sessions for two week were administered. Paired t-test was used to test for significant change. Pre-post comparison of TUG and FSBT scores showed that there is significant change. (p= &lt;0.001 and &lt;0.001 respectively which is statistically significant).VRT can be an effective means of training basic motor skills to improve the balance, and use of VR in the area of motor learning can be of great benefit in improving balance.