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Background: Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers. Methods: Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction. Results: At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012). Conclusion: Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.
Background: Painful diabetic neuropathy (PDN) is a frequent complication of diabetes mellitus. Current treatment recommendations are based on short-term trials, generally of ≤3 months’ duration. Limited data are available on the long-term outcomes of this chronic disease. The objective of this study was to determine the long-term clinical effectiveness of the management of chronic PDN at tertiary pain centres. Methods: From a prospective observational cohort study of patients with chronic neuropathic non-cancer pain recruited from seven Canadian tertiary pain centres, 60 patients diagnosed with PDN were identified for analysis. Data were collected according to Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials guidelines including the Brief Pain Inventory. Results: At 12-month follow-up, 37.2% (95% confidence interval [CI], 23.0-53.3) of 43 patients with complete data achieved pain reduction of ≥30%, 51.2% (95% CI, 35.5-66.7) achieved functional improvement with a reduction of ≥1 on the Pain Interference Scale (0-10, Brief Pain Inventory) and 30.2% (95% CI, 17.2-46.1) had achieved both these measures. Symptom management included at least two medication classes in 55.3% and three medication classes in 25.5% (opioids, antidepressants, anticonvulsants). Conclusions: Almost one-third of patients being managed for PDN in a tertiary care setting achieve meaningful improvements in pain and function in the long term. Polypharmacy including analgesic antidepressants and anticonvulsants were the mainstays of effective symptom management.
We present the KMOS (K-band Multi-Object Spectrograph) Cluster and VIRIAL (VLT IRIFU Absorption Line) Guaranteed Time Observation (GTO) programs. KMOS provides 24 arms each feeding an integral field unit (14×14 spaxels of 0.2″ pixels) for IZ, YJ, H and K band near infrared (NIR) medium resolution spectroscopy (R ∼ 3500). Targets are selected from a 7.2′ diameter patrol field. Ultra-deep spectroscopy of ∼ 80 early-type cluster galaxies (∼ 20hr on source) and ∼ 200 (∼ 10hr on source) early-type field galaxies at 1 < z < 2 will dramatically improve the situation at z > 1 for which measurements of stellar velocity dispersions and absorption indices are limited to a few, often relatively young passively evolving galaxies (e.g. Bezanson 2013). In ESO Periods P92 and P93, 15 nights worth of data has been collected for KMOS-Clusters and 6 nights for VIRIAL: this will be supplemented with more data in upcoming semesters. All galaxies have multiband HST imaging including existing or upcoming WFC3 IR imaging, providing stellar mass maps and sizes. Combined with our dispersion measurements, this will allow us to examine the fundamental plane and the dynamical mass of a large sample of z > 1 galaxies for the first time, for both cluster and field galaxies.
We report on experiments aimed at the generation and characterization of solid density plasmas at the free-electron laser FLASH in Hamburg. Aluminum samples were irradiated with XUV pulses at 13.5 nm wavelength (92 eV photon energy). The pulses with duration of a few tens of femtoseconds and pulse energy up to 100 µJ are focused to intensities ranging between 1013 and 1017 W/cm2. We investigate the absorption and temporal evolution of the sample under irradiation by use of XUV and optical spectroscopy. We discuss the origin of saturable absorption, radiative decay, bremsstrahlung and atomic and ionic line emission. Our experimental results are in good agreement with simulations.
The development activity of a new experimental technique for the study of the fast electron transport in high density matter is reported. This new diagnostic tool enables the X-ray 2D imaging of ultrahigh intensity laser plasmas with simultaneous spectral resolution in a very large energy range to be obtained. Results from recent experiments are discussed, in which the electron propagation in multilayer targets was studied by using the Kα. In particular, results highlighting the role of anisotropic Bremsstrahlung are reported, for the sake of the explanation of the capabilities of the new diagnostics. A discussion of a test experiment conceived to extend the technique to a single-shot operation is finally given.
Six wheat/Agropyron intermedium addition lines are described on the basis of their phenotype and biochemical markers. An assessment of homoeology of each addition chromosome is made. Chromosome morphology, plant phenotype, isozyme and protein studies are compared with similar data for other wheat/alien addition lines and other members of the Triticeae. These comparisons give consistent results and it is concluded that addition lines L1, L2, L3, L4, L5 and L7 carry Agropyron chromosomes of homoeologous groups 7, 3, 1, 4, 5 and 6 respectively. This agrees with previously published work with one exception: the L5 chromosome belongs to homoeologous group 5 and not group 2 as proposed by Figueiras et al. (1986).
The aim of the reported research is to contribute to investigation of new processes and methods interlinking nuclear and laser-plasma physics. With respect to requirements of nuclear experiments at medium-size high-power lasers, the selection of proper candidates for studying the excitation and decay of low-lying nuclear states is reviewed. An experimental approach to the identification of low-energy nuclear transitions is discussed, simple estimates of the 181Ta excitation yield in the laser-generated plasma provide a theoretical basis for planning future work. First tests and results of the experiments at the laser facility PALS are presented.
Laser plasma interaction experiments have been performed using an fs Titanium Sapphire laser. Plasmas have been generated from planar PMMA targets using single laser pulses with 3.3 mJ pulse energy, 50 fs pulse duration at 800 nm wavelength. The electron density distributions of the plasmas in different delay times have been characterized by means of Nomarski Interferometry. Experimental data were compared with hydrodynamic simulation. First results to characterize the plasma density and temperature as a function of space and time are obtained. This work aims to generate plasmas in the warm dense matter (WDM) regime at near solid-density in an ultra-fast laser target interaction process. Plasmas under these conditions can serve as targets to develop X-ray Thomson scattering as a plasma diagnostic tool, e.g., using the Vacuum ultraviolet (VUV) free-electron laser (FLASH) at Dentsches Elektronen-Synchrotron (DESY) Hamburg.
Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002.
Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography.
During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations.
Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.
Intense continua of electromagnetic radiation of very
brief duration are formed in the interaction of focused
ultra-short terawatt laser pulses with matter. Two different
kinds of experiments, which have been performed utilizing
the Lund 10 Hz titanium-doped sapphire terawatt laser system
are being described, where visible radiation and X-rays,
respectively, have been generated. Focusing into water
leads to the generation of a light continuum through self-phase
modulation. The propagation of the light through tissue
was studied addressing questions related to optical mammography
and specific chromophore absorption. When terawatt laser
pulses are focused onto a solid target with high nuclear
charge Z, intense X-ray radiation of few ps duration
and with energies exceeding hundreds of keV is emitted.
Biomedical applications of this radiation are described,
including differential absorption and gated-viewing imaging.
In view of the interest of Columella's De Re Rustica it is strange that it is not better known. Indeed, it is difficult to secure a text of it, since the last complete edition was published in the eighteenth century and the nearest approach to an English edition is a short selection from his works published in Dublin in 1732.
As to the man himself our knowledge is derived almost wholly from his own writings. His full name was Lucius Junius Moderatus Columella. He was a contemporary and friend of Seneca, who lived from 4 b.c. to A.D. 65 and, like Columella, was a native of Spain, and of Seneca's brother Gallio, proconsul of Achaea, who figures in the Acts of the Apostles (xviii. 12) as ‘caring for none of these things’, and also died in A.D. 65. The elder Pliny (A.D. 23–79) quotes freely from Columella. Without going into further detail, I think we may say that the De Re Rustica was probably published in the sixties of the first century A.D.
Columella was born and spent his early years at or near the town of Gades, the modern Cadiz, in the south-west corner of Spain. He does not mention his parents but often speaks of his uncle Marcus, who was also a keen agriculturist and lived in the Spanish province of Baetica in which Gades was situated. Possibly Columella lived with his uncle during his early years. At some period of his life he found himself on military service at Tarentum, where an inscription has been discovered which describes him as a military tribune of the Sexta Legio Ferrata, which is known to have been recruited at Gades.