Effectiveness of press needle treatment and electroacupuncture in patients with postherpetic neuralgia: A matched propensity score analysis.

BACKGROUND AND PURPOSE: Postherpetic neuralgia (PHN) is a well-known painful syndrome. Acupuncture is a treatment for PHN. We aimed to compare the effectiveness of pain control between press needle and electroacupuncture (EA) in PHN patients. MATERIALS AND METHODS: We conducted a retrospective cohort study by a review of PHN patients treated with the press needle and the EA and compared the Pain visual analogue scale (VAS) before and after treatment. Propensity score matching was applied to adjust the confounding. RESULTS: 48 patients in each group had a matched propensity score. The absolute reduction of VAS in the press needle and the EA groups were not different (5.4±2.8 vs. 5.4±2.9, p=0.971). The VAS score improvement was not statistically different between groups. CONCLUSION: The Press needle and the EA are equally effective in the treatment of PHN.

Impact of lymph node management on resectable non-small cell lung cancer patients.

BACKGROUND: A surgical lung resection with systematic mediastinal lymph node (LN) dissection is recommended by the National Comprehensive Cancer Network guideline. However, the effective number of dissected LNs, stations and positivity is still controversial. The aim of this study is to identify the impact of total numbers, LN stations and positivity of dissected LNs on tumor recurrence and overall death in resectable non-small cell lung cancer (NSCLC). METHODS: This prognostic study used a retrospective data collection design. Adult patients with clinical resectable NSCLC who underwent pulmonary resection and mediastinal lymphadenectomy at Chiang Mai University between June 2000 and June 2012 were enrolled in this study. A multilevel mixed-effects parametric survival model was used to identify the effect of numbers, LN stations and positivity of dissected LNs to tumor recurrence and mortality. RESULTS: The average number of dissected LNs was 22.7±12.8. Tumor recurrence was found in 51.3% and overall mortality was 43.3%. The number of dissected LNs was a prognostic factor for tumor recurrence [HR 0.98, 95% confidence interval (CI): 0.96-0.99]. There was a significant difference at the cut-pointed value of 11 dissected LNs for tumor recurrence (HR 2.22, 95% CI: 1.26-3.92). Dissection less than 11 nodes and less than 5 stations indicated a poor prognostic factor for tumor recurrence: for 3-4 stations (HR 3.01, 95% CI: 1.22-7.42) and for 1-2 stations (HR 1.96, 95% CI: 1.04-3.72). The positivity of dissected LNs was also a prognostic factor for tumor recurrence and overall mortality (HR 1.01, 95% CI: 1.01-1.02 and HR 1.01, 95% CI: 1.01-1.03, respectively). CONCLUSIONS: Eleven or more LN dissection with at least 5 stations influenced recurrent-free survival. Systematic LN dissection (SLND) should be performed not only to identify the positivity of dissected LNs but also to determine an accurate tumor nodal stage. A larger cohort should be further conducted to support these findings.

Enema reduction of intussusception: the success rate of hydrostatic and pneumatic reduction.

PURPOSE: Intussusception is a common surgical emergency in infants and children. The incidence of intussusception is from one to four per 2,000 infants and children. If there is no peritonitis, perforation sign on abdominal radiographic studies, and nonresponsive shock, nonoperative reduction by pneumatic or hydrostatic enema can be performed. The purpose of this study was to compare the success rates of both the methods. METHODS: Two institutional retrospective cohort studies were performed. All intussusception patients (ICD-10 code K56.1) who had visited Chiang Mai University Hospital and Siriraj Hospital from January 2006 to December 2012 were included in the study. The data were obtained by chart reviews and electronic databases, which included demographic data, symptoms, signs, and investigations. The patients were grouped according to the method of reduction followed into pneumatic reduction and hydrostatic reduction groups with the outcome being the success of the reduction technique. RESULTS: One hundred and seventy episodes of intussusception occurring in the patients of Chiang Mai University Hospital and Siriraj Hospital were included in this study. The success rate of pneumatic reduction was 61% and that of hydrostatic reduction was 44% (P=0.036). Multivariable analysis and adjusting of the factors by propensity scores were performed; the success rate of pneumatic reduction was 1.48 times more than that of hydrostatic reduction (P=0.036, 95% confidence interval [CI] =1.03-2.13). CONCLUSION: Both pneumatic and hydrostatic reduction can be performed safely according to the experience of the radiologist or pediatric surgeon and hospital setting. This study showed that pneumatic reduction had a higher success rate than hydrostatic reduction.

Focal modulation of the primary motor cortex in fibromyalgia using 4×1-ring high-definition transcranial direct current stimulation (HD-tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation.

UNLABELLED: Fibromyalgia is a prevalent chronic pain syndrome characterized by altered pain and sensory processing in the central nervous system, which is often refractory to multiple therapeutic approaches. Given previous evidence supporting analgesic properties of noninvasive brain stimulation techniques in this condition, this study examined the effects of a novel, more focal method of transcranial direct current stimulation (tDCS), using the 4×1-ring configuration of high-definition (HD)-tDCS, on overall perceived pain in fibromyalgia patients. In this patient- and assessor-blind, sham-controlled, crossover trial, 18 patients were randomized to undergo single 20-minute sessions of anodal, cathodal, and sham HD-tDCS at 2.0 mA in a counterbalanced fashion. The center electrode was positioned over the left primary motor cortex. Pain scales and sensory testing were assessed before and after each intervention. A finite element method brain model was generated to predict electric field distribution. We found that both active stimulation conditions led to significant reduction in overall perceived pain as compared to sham. This effect occurred immediately after cathodal HD-tDCS and was evident for both anodal and cathodal HD-tDCS 30 minutes after stimulation. Furthermore, active anodal stimulation induced a significant bilateral increase in mechanical detection thresholds. These interventions proved well tolerated in our patient population. PERSPECTIVE: 4×1-ring HD-tDCS, a novel noninvasive brain stimulation technique capable of more focal and targeted stimulation, provides significant reduction in overall perceived pain in fibromyalgia patients as compared to sham stimulation, irrespective of current polarity. This technique may have other applications in research and clinical settings, which should be further explored.