Treatment Strategies and Effective Management of Phantom Limb-Associated Pain.

PURPOSE OF REVIEW: Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions. It is estimated that phantom limb pain (PLP) affects anywhere from 40 to 80% of amputees. RECENT FINDINGS: Psychiatric illnesses such as depression, anxiety, and mood disorders have higher prevalence in amputees than in the general population. Pharmacologic treatment has been used as first-line therapy for amputees suffering from PLP with agents including gabapentinoids, amitriptyline, and other tricyclic anti-depressants, opioids, and local anesthetics. Non-invasive treatment modalities exist for PLP including sensory motor training, mirror visual therapy, and non-invasive neuromodulation. Non-invasive neuromodulation includes interventions like transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation. While many promising therapies for PLP exist, more clinical trials are required to determine the efficacy and protocols needed for maximum benefit in patients suffering from PLP.

Biomass recycling and Earth's early phosphorus cycle.

Phosphorus sets the pace of marine biological productivity on geological time scales. Recent estimates of Precambrian phosphorus levels suggest a severe deficit of this macronutrient, with the depletion attributed to scavenging by iron minerals. We propose that the size of the marine phosphorus reservoir was instead constrained by muted liberation of phosphorus during the remineralization of biomass. In the modern ocean, most biomass-bound phosphorus gets aerobically recycled; but a dearth of oxidizing power in Earth's early oceans would have limited the stoichiometric capacity for remineralization, particularly during the Archean. The resulting low phosphorus concentrations would have substantially hampered primary productivity, contributing to the delayed rise of atmospheric oxygen.