Predicting seizure outcomes and functional outcomes after hemispherotomy: are we any better?

INTRODUCTION: Present study attempted to analyze seizure freedom and detailed functional outcomes after functional hemispherotomy and utility of hemispherotomy outcome prediction scale (HOPS) scores in predicting outcomes. METHODS: Patients who underwent functional hemispherotomy were analyzed for clinical presentation, neuroimaging, seizure outcomes, and functional outcomes. RESULTS: A total of 76 procedures were performed on 69 patients. Mean age at the surgery was 8 ± 6.1 years. Fourteen patients were < 2 years. Age of onset epilepsy of the cohort was 2.0 ± 3.3 years. All had severe catastrophic epilepsy with multiple daily seizures. All patients had motor deficits with 36 (52%) patients had contralateral dysfunctional hand. Perinatal stroke (49%) was most common substrate followed by cortical malformations (21.7%). Eight patients had contralateral imaging abnormalities. Fifty-nine (86.76%) patients remained seizure free (Engle 1a) at 41 + -20.9 months. HOPS scores were available for 53 patients and lowest seizure outcome was 71% for HOPS score of 4. Lower HOPS scores predicted better seizure outcomes. Cortical malformations operated earlier than 2 years predicted poor seizure outcomes (66.6%). Positive functional outcomes are recorded in 80% of patients with 78% reporting improvement from the pre-surgical level. Five (7.2%) patients underwent shunt surgery. One mortality recorded. CONCLUSIONS: Hemispherotomy has excellent seizure outcomes. Early surgery in cortical malformations appears to be predictor of poorer seizure outcomes. HOPS score is a good tool to predict the seizure outcomes. Hemispherotomy is perceived to improve the Cognitive and functional performance.

Formulation and Evaluation of Chitosan-PLGA Biocomposite Scaffolds Incorporated with Quercetin Liposomes Made by QbD Approach for Improved Healing of Oral Lesions.

The current research aims to develop and evaluate chitosan-PLGA biocomposite scaffolds in combination with quercetin liposomes to accomplish the desired impact in oral lesions where pharmacotherapeutic agent treatment through circulation could only reach the low content at the target. Optimization of quercetin-loaded liposomes was carried out using 32 factorial design. The preparation of porous scaffolds comprising produced quercetin-loaded liposomes by thin-film method was carried out in the current study using a unique strategy combining solvent casting and gas foaming procedures. The prepared scaffolds were tested for physicochemical properties, in vitro quercetin release study, ex vivo drug permeation and retention research using goat mucosa, antibacterial activity, and cell migration studies on fibroblast L929 cell lines. Improved cell growth and migration were seen in the order control < liposomes < proposed system. The proposed system has been examined for its biological and physicochemical features, and it has the potential to be utilized as an efficient therapy for oral lesions.

Primary Prophylaxis Patterns for Hepatic Encephalopathy in Patients with Liver Cirrhosis: What are the Current Prescribing Trends in Specialty Practice?

INTRODUCTION: Hepatic encephalopathy (HE) is a significant complication of severe chronic liver insufficiency characterized by altered sensorium, motor, and cognitive dysfunction. This was a cross-sectional multicenter, epidemiological study to understand the prescribing pattern for primary prophylaxis of overt HE (OHE) in patients with cirrhosis in India. METHODS: The study was conducted at eight centers across different geographical regions of India. A total of 200 patients (100%) were screened, of which 197 (98.50%) met all the inclusion criteria. The prescribing pattern of the physicians was studied by calculating the percentage (subject to availability of sufficient data) of OHE-naïve patients with cirrhosis who were prescribed with different classes of drugs as primary prophylaxis of HE (such as lactulose, rifaximin, neomycin, sodium benzoate, and L-ornithine L- aspartate). The risk factors responsible for initiation of primary prophylaxis of HE was also determined. RESULTS: All the 197 patients (100%) were prescribed with prophylactic treatment. The factors that were considered by treating physicians to pose a risk for precipitating OHE for which prophylaxis was initiated were constipation in 111 (56.35%), infections in 51 (25.89%) and gastrointestinal bleeding in 35 (17.77%). Of the total 197 patients, 122 (61.93%) patients were prescribed a monotherapy, and 75 (38.07%) were prescribed a combination therapy. Of the patients on combination therapy, 68 (34.52%) patients were prescribed with two primary prophylaxis agents (dual therapy), and seven (3.55%) patients were prescribed with three primary prophylaxis agents (triple therapy). Lactulose was the most commonly prescribed agent for primary prophylaxis, followed by rifaximin. CONCLUSION: These findings may guide recommendations on primary prophylaxis for OHE in patients with liver cirrhosis that may help reduce the occurrence of first episode of overt HE, and thereby prevent subsequent cognitive impairment in these patients.

Nanoindentation of Graphene-Reinforced Silica Aerogel: A Molecular Dynamics Study.

In the present work, we performed nanoindentation tests using molecular dynamics (MD) simulations on graphene, native silica aerogels, and single- and multi-layered graphene-reinforced silica aerogel nanocomposites. This work mainly focused on the two aspects of nanoindentation simulations: first, the resultant indentation force-depth curves, and second, the associated mechanical deformation behavior. We found that in the single-layer graphene-reinforced silica aerogel nanocomposite, the indentation resistance was four-fold that of native silica aerogels. Moreover, the combined system proved to be higher in stiffness compared to the individual material. Furthermore, the indentation resistance was increased significantly as we proceeded from single- to two-layered graphene-reinforced silica aerogel nanocomposites. The results of the study provide a detailed understanding of the mechanical behavior during the indentation tests of nanocomposites, which helps to design advanced nanoscale multi-layered materials.

Comparison between Urine Sodium and Clinical Evaluation to Assess Saline Responsiveness in Severe Hyponatremia - A Prospective Study.

INTRODUCTION AND BACKGROUND: Hyponatremia is a commonly encountered electrolyte disturbance seen in diverse clinical settings. The recently published European guidelines comprehensively summarize the present status of evaluation for hyponatremia. The guidelines emphasize the poor predictability of clinical criteria and instead suggest that the urine sodium (UNa) may be a better way to initially evaluate the cause of hyponatremia. AIMS AND OBJECTIVES: Aim of the study is to comparison between urine sodium and clinical evaluation to assess saline responsiveness in severe hyponatremia. MATERIALS AND METHODS: Prospective Cross sectional study carried out in Departments of Nephrology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala. Study Period between October 2014 to October 2016 (2 years), Patients diagnosed as Severe hyponatremia S.Sodium < 125mEq/L based on clinical and laboratory evaluations. INCLUSION CRITERIA: All clinically and lab confirmed cases of severe hyponatremia, Age >18 years. Outpatients, Inpatients admitted to medical wards and ICU, who give informed consent and serum sodium of less than 125mEq/L constitute the study population. These patients meeting the following criteria: blood glucose level less than 200mg/dl would be included. EXCLUSION CRITERIA: Patients with overt hypervolemia due to cardiac, hepatic, and renal disease with gross edema were excluded. RESULTS: Among 50 patients in the study 70% were found at age group > 60 yrs. 30% patients were < 60 years age group. Youngest patient was 14 yrs old and oldest patient was 83 yrs old. 21 (42%) were Females and Males were 29 (58%). Majority of the cases were symptomatic at time of presentation n=38 (76%). All were having hypotonic hyponatremia among them 14 patients (28%) were euvolemic, 3 patients (6%) were hypervolemic and 33 patients (66%) were hypovolemic. 31 patients (62%) had serum Sodium levels between 115-125mEq/L and 19 patients (38%) had serum Sodium levels between 100-114mEq/L. Among the 33 patients (66%) Hyponatremia due to volume depletion by clinical assessment by the Nephrologist and who were given saline 26 (78%) were saline responsive and 7 patients (22%) were saline non responsive. Among the 7 patients who are saline non responders 6 patients (85.7%) had UNa > 20 and 1 patient (14.3%) had UNa < 20, which is statistically not significant (p=0.840). Among the 44 patients who are saline responders 18 patients are saline responsive. Among the 44 patients 20 (76.9%) had UNa > 20 and 6 (23.1%) had UNa < 20, statistically not significant (p=0.604). Duration for normalizing sodium was noted during the study 17 cases, 1-3 days were needed, 22 cases needed 4-7 days. CONCLUSION: Volume status of patients with hyponatremia can be assessed clinically with a high degree of reliability if the hyponatremia is severe. Thus we re-emphasize the importance of measuring volume status in patients with hyponatremia and classify patients on basis of volume status prior to triaging management. The measurement of UNa had a poor correlation with saline responsiveness and this shows that the laboratory measure is subject to errors due to prior treatments given to the patient and has to be interpreted with the prior clinical scenario in mind.

A novel nonlinear nano-scale wear law for metallic brake pads.

In the present work, molecular dynamics simulations were carried out to investigate the temperature distribution as well as the fundamental friction characteristics such as the coefficient of friction and wear in a disc-pad braking system. A wide range of constant velocity loadings was applied on metallic brake pads made of aluminium, copper and iron with different rotating speeds of a diamond-like carbon brake disc. The average temperature of Newtonian atoms and the coefficient of friction of the brake pad were investigated. The resulting relationship of the average temperature with the speed of the disc as well as the applied loading velocity can be described by power laws. The quantitative description of the volume lost from the brake pads was investigated, and it was found that the volume lost increases linearly with the sliding distance. Our results show that Archard's linear wear law is not applicable to a wide range of normal loads, e.g., in cases of low normal load where the wear rate was increased considerably and in cases of high load where there was a possibility of severe wear. In this work, a new formula for the brake pad wear in a disc brake assembly is proposed, which displays a power law relationship between the lost volume of the metallic brake pads per unit sliding distance and the applied normal load with an exponent of 0.62 ± 0.02. This work provides new insights into the fundamental understanding of the wear mechanism at the nano-scale leading to a new bottom-up wear law for metallic brake pads.

Suppression of charcoal rot in soybean by moderately halotolerant Pseudomonas aeruginosa GS-33 under saline conditions.

Charcoal rot severely limits the soybean crop yield under saline conditions. The present studies focus on biocontrol and plant growth promoting potential of phenazine producing moderately halotolerant Pseudomonas aeruginosa (GS-33) in soybean under saline soil conditions. A marine isolate; GS-33 was identified as P. aeruginosa based on polyphasic characterization. This strain showed potent in vitro biocontrol activity against charcoal rot causing fungus Macrophomina phaseolina. It was capable of producing phenazine-1-carboxylic acid even at elevated salt concentrations. Moreover, GS-33 possessed other biocontrol traits like production of siderophores, HCN and protease under saline conditions. Multiple traits for plant growth promotion such as synthesis of IAA, NH3 , and solubilization of phosphate were also exhibited by GS-33. Plant growth promoting and biocontrol control potentials of GS-33 were evaluated by pot assay under saline soil conditions. Higher biomass and chlorophyll content were observed in GS-33 treated seedlings. A greater reduction in charcoal rot caused by fungal pathogens under both normal and saline soil conditions in GS-33 treated seedlings was observed. In a nut shell, phenazine producing halotolerant strain GS-33 could mitigate saline soil conditions (abiotic stress) and infestation of M. phaseolina (biotic stress) in soybean.

A Rare Cause of Dysphagia--Kommerell's Diverticulum.

A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch with associated ventricular septal defect. Fewer than 50 cases have been reported in literature so far. Our patient presented with short duration of dysphagia without any syncope or left subclavian steal syndrome. The major morbidity was caused by Barrett's oesophagus with reflux and a mixed paraoesophageal and hiatal hernia. There was associated psoriasis. An attempt at repair was not undertaken because of the high operative risk and a small aneurysm. Left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method.

Rate-dependent behavior of the amorphous phase of spider dragline silk.

The time-dependent stress-strain behavior of spider dragline silk was already observed decades ago, and has been attributed to the disordered sequences in silk proteins, which compose the soft amorphous matrix. However, the actual molecular origin and magnitude of internal friction within the amorphous matrix has remained inaccessible, because experimentally decomposing the mechanical response of the amorphous matrix from the embedded crystalline units is challenging. Here, we used atomistic molecular dynamics simulations to obtain friction forces for the relative sliding of peptide chains of Araneus diadematus spider silk within bundles of these chains as a representative unit of the amorphous matrix in silk fibers. We computed the friction coefficient and coefficient of viscosity of the amorphous phase to be in the order of 10(-6) Ns/m and 10(4) Ns/m(2), respectively, by extrapolating our simulation data to the viscous limit. Finally, we used a finite element method for the amorphous phase, solely based on parameters derived from molecular dynamics simulations including the newly determined coefficient of viscosity. With this model the time scales of stress relaxation, creep, and hysteresis were assessed, and found to be in line with the macroscopic time-dependent response of silk fibers. Our results suggest the amorphous phase to be the primary source of viscosity in silk and open up the avenue for finite element method studies of silk fiber mechanics including viscous effects.

Activation of mGlu2/3 receptors as a new approach to treat schizophrenia: a randomized Phase 2 clinical trial.

Schizophrenia is a chronic, complex and heterogeneous mental disorder, with pathological features of disrupted neuronal excitability and plasticity within limbic structures of the brain. These pathological features manifest behaviorally as positive symptoms (including hallucinations, delusions and thought disorder), negative symptoms (such as social withdrawal, apathy and emotional blunting) and other psychopathological symptoms (such as psychomotor retardation, lack of insight, poor attention and impulse control). Altered glutamate neurotransmission has for decades been linked to schizophrenia, but all commonly prescribed antipsychotics act on dopamine receptors. LY404039 is a selective agonist for metabotropic glutamate 2/3 (mGlu2/3) receptors and has shown antipsychotic potential in animal studies. With data from rodents, we provide new evidence that mGlu2/3 receptor agonists work by a distinct mechanism different from that of olanzapine. To clinically test this mechanism, an oral prodrug of LY404039 (LY2140023) was evaluated in schizophrenic patients with olanzapine as an active control in a randomized, three-armed, double-blind, placebo-controlled study. Treatment with LY2140023, like treatment with olanzapine, was safe and well-tolerated; treated patients showed statistically significant improvements in both positive and negative symptoms of schizophrenia compared to placebo (P < 0.001 at week 4). Notably, patients treated with LY2140023 did not differ from placebo-treated patients with respect to prolactin elevation, extrapyramidal symptoms or weight gain. These data suggest that mGlu2/3 receptor agonists have antipsychotic properties and may provide a new alternative for the treatment of schizophrenia.

Ambiguity of Primary Patellar Tuberculous Osteomyelitis as a Pre-Patellar Bursitis: A Case Report.

CASE: A 47-year-old male with swelling over the patella and associated pain, subsiding with medicines but recurring after a few days. Diagnosed as prepatellar bursitis by the family physician, it eventually turns out to be osteomyelitis of the patella. Treated with curettage, biopsy, and placement of bio-composite mixed with antibiotics. Intra-operative findings and histopathology confirmed tuberculosis of the patella. On follow-up after 6 years and the completion of anti-tuberculosis treatment, the patient showed full functional and radiological recovery without recurrence. CONCLUSION: Early treatment with antibiotics and surgery gives excellent results. Identifying it as a tuberculous osteomyelitis is challenging when the condition is closely resembles pre-patellar bursitis.

Tuberculous Flexor Tenosynovitis with Median Nerve Compression: A Case Report.

CASE: A 65-year-old female patient presented with complaints of diffuse pain and swelling in her right wrist with paresthesia in her right hand with thenar wasting. Her magnetic resonance imaging scan was suggestive of flexor tenosynovitis of the wrist with compression of the median nerve with multiple rice bodies. She underwent excisional biopsy along with median nerve decompression. Mycobacterium tuberculosis was detected by polymerase chain reaction (GeneXpert), and histopathology identified caseous granulomas. The patient was started on antitubercular chemotherapy postoperatively. CONCLUSION: In endemic countries such as India, tuberculous flexor tenosynovitis must always be a differential diagnosis in cases of wrist swelling with rice bodies.

Efficacy of tDCS on craving in patients of alcohol dependence syndrome: A single-blind, sham-controlled trial.

Background: Craving is attributed as one of the main reasons for relapse in alcohol dependence syndrome. Neurostimulation techniques targeting craving in substance use disorders are being researched. Neuroimaging has shown dorsolateral prefrontal cortex (DLPFC) as one of the potential targets responsible for craving, with frontal dysfunction being quintessential in alcohol use disorder. Evidence suggests that stimulation of DLPFC with low-dose current can help in reducing craving. Objectives: To study the effectiveness of transcranial direct current stimulation (tDCS) on craving in patients with alcohol dependence syndrome. Materials and Methods: We performed a single-blind, sham-controlled study involving 76 patients with alcohol dependence syndrome (according to ICD-10 DCR). Participants with Clinical Institute of Withdrawal Assessment in Alcohol Withdrawal (CIWA-Ar) scores less than 10, not on any anti-craving medications were included in the study. Patients were allocated to active and sham tDCS groups in a ratio of 1:1. Such that 38 patients received active, and 38 patients sham tDCS stimulations; with anode as right DLPFC and cathode as left DLPFC receiving 2 mA current (twice daily session, total of 10 sessions). The Alcohol Craving Questionnaire (ACQ-NOW) was administered to measure the severity of alcohol craving at baseline and after the last tDCS session. Results: Our study showed a significant reduction in craving in the Post-tDCS, ACQ-NOW scores as compared to sham tDCS. There was a significant reduction in the compulsivity and emotionality domain of craving after tDCS. The effect size for treatment with time interaction was (0.58). Conclusions: tDCS was superior to sham in reducing caving in patients with alcohol dependence syndrome.

Force distribution analysis of mechanochemically reactive dimethylcyclobutene.

Internal molecular forces can guide chemical reactions, yet are not straightforwardly accessible within a quantum mechanical description of the reacting molecules. Here, we present a force-matching force distribution analysis (FM-FDA) to analyze internal forces in molecules. We simulated the ring opening of trans-3,4-dimethylcyclobutene (tDCB) with on-the-fly semiempirical molecular dynamics. The self-consistent density functional tight binding (SCC-DFTB) method accurately described the force-dependent ring-opening kinetics of tDCB, showing quantitative agreement with both experimental and computational data at higher levels. Mechanical force was applied in two different ways, namely, externally by a constant pulling force and internally by embedding tDCB within a strained macrocycle-containing stiff stilbene. We analyzed the distribution of tDCB internal forces in the two different cases by FM-FDA and found that external force gave rise to a symmetric force distribution in the cyclobutene ring, which also scaled linearly with the external force, indicating that the force distribution was uniquely determined by the symmetric architecture of tDCB. In contrast, internal forces due to stiff stilbene resulted in an asymmetric force distribution within tDCB, which indicated a different geometry of force application and supported the important role of linkers in the mechanochemical reactivity of tDCB. In addition, three coordinates were identified through which the distributed forces contributed most to rate acceleration. These coordinates are mostly parallel to the coordinate connecting the two CH3 termini of tDCB. Our results confirm previous observations that the linker outside of the reactive moiety, such as a stretched polymer or a macrocycle, affects its mechanochemical reactivity. We expect FM-FDA to be of wide use to understand and quantitatively predict mechanochemical reactivity, including the challenging cases of systems within strained macrocycles.

Percutaneous transvenous tricuspid commissurotomy in a patient with congenitally corrected transposition of great arteries: a case report.

Percutaneous balloon tricuspid valvotomy was successfully performed in a 45-year-old female with congenitally corrected transposition of great arteries with severe rheumatic left atrioventricular (tricuspid) valve stenosis. Technical modifications in the standard procedure were made keeping in mind the left-handed ventricular loop, left and anterior aorta, wedged pulmonary valve between the interatrial septum and the mitral valve with deviation of the atrial septum away from the ventricular septum, side-by-side positioned ventricles with an added superoinferior obliquity produced by excessive tilting, and an abnormal orientation of ventricular mass in relation to the thorax, with the apex pointing slightly rightwards. A final valve area of 1.4 cm(2) and a fall in the peak/mean left atrial pressures from 37/32 mm Hg to 13/10 mm Hg were achieved without complications. This case of percutaneous transvenous commissurotomy is unique in view of the rarity of the combination of this congenital heart disease and rheumatic heart disease and successful commissurotomy in such an unusual cardiac anatomy using the Inoue technique.

PEG mediated synthesis and pharmacological evaluation of some fluoro substituted pyrazoline derivatives as antiinflammatory and analgesic agents.

A new series of fluoro substituted pyrazoline derivatives 5a-g and 6a-g were synthesized in good to excellent yield from the corresponding pyrazole chalcones, 4a-g, by using polyethylene glycol-400 (PEG-400) as an alternative reaction medium. The newly synthesized compounds were characterized and screened for their in vivo antiinflammatory and analgesic activity. Compounds 5g and 6g were found to be more potent than standard drug Diclofenac and six other compounds 5b, 5c, 5f, 6b, 6c and 6f showed significant antiinflammatory activity as compared to standard drug. Compounds 5c, 5d, 5e, 5f, 6c, 6d, 6e and 6f showed significant analgesic activity as compared to standard drug Aspirin.

Analysis of occupational radiation dose data and determination of suitable probability distribution.

The first study on fitting dose data for workers was performed by Gale(  1) in 1965 where log-normal and normal distributions were used. Since then, various models of dose distribution have been proposed. The log-normal distribution and its different forms have been widely used for fitting the dose data. Most of the studies included one or two distributions under consideration. In this study five distributions are considered for fitting and four distributions are selected based on observation of Cullen-Frey graph. The Akaike's Information criteria (AIC) and Bayesian Information criteria (BIC) are applied to find the suitable distribution to fit the occupational dose data. The maximum likelihood method was used for calculation of AIC, BIC values and parameter estimation. A computer code is written in R-language and environment for statistical computing and graphics for analysis of occupational dose data of three institutions.

Epilepsia partialis continua and unilateral cortical-subcortical FLAIR-hyperintense lesion in Rasmussen's encephalitis: Is it diagnostic?

OBJECTIVE: Rasmussen encephalitis (RE) is a focal encephalitis, characterized by epilepsia partialis continua (EPC) with or without seizures and progressive unilateral deficits. Imaging characteristics of RE have been rarely described in detail in relation to EPC. So, the study aimed to explore if any relationship exists between the imaging characteristics and the presence or evolution of EPC in patients with RE. METHODS: This retrospective study included 11 patients with RE fulfilling the European consensus statement on RE followed between 2015 and 2020. RESULTS: The mean age for onset of seizures was 12 years (range 2.5-24 years). Seven patients had limb EPCs, two had face EPCs, face, and limb EPC in one, and lingual EPC in one patient. The first MRI was done within 1 day to 1 month of the onset of seizures. It was normal in two patients and showed only cortical atrophy, focal or hemispheric in four patients, caudate atrophy in two, and cortical or subcortical hyperintensity (HI) in six patients. Follow-up MRI, within 3 weeks to 6 months of the onset of EPC (mean 1.6 months) showed paramedian frontal HI with limb EPC in six patients. Insular HI in four patients; two had facial EPCs while lingual EPC and limb EPC with facial EPC was observed in one patient each. SIGNIFICANCE: Fluid-attenuated inversion recovery (FLAIR) HI and focal cortical atrophy on MRI is the most common finding in the early course of RE. T2 and FLAIR hyperintensity in the paramedian frontal or insular cortex may antedate the onset of EPC or may occur simultaneously with EPC.

Health care resource utilization and costs in patients with painful diabetic neuropathy treated with 10 kHz spinal cord stimulation therapy.

BACKGROUND: Diabetic peripheral neuropathy, a common comorbidity of diabetes, is a neurodegenerative disorder that targets sensory, autonomic, and motor nerves frequently associated with painful diabetic neuropathy (PDN). PDN carries an economic burden as the result of reduced work and productivity. A recent multicenter randomized controlled trial, SENZA-PDN (NCT03228420), assessed the impact of high-frequency (10 kHz) spinal cord stimulation (SCS) on pain relief. The effects of high-frequency SCS on health care resource utilization and medical costs are not known. OBJECTIVE: To evaluate the effect of high-frequency (10 kHz) SCS on health care resource utilization (HRU) and medical costs in patients with PDN using data from the SENZA-PDN trial. METHODS: Participants with PDN were randomly assigned 1:1 to receive either 10 kHz SCS plus conventional medical management (CMM) (SCS treatment group) or CMM alone (CMM treatment group). Patient outcomes and HRU up to the 6-month follow-up are reported here. Costs (2020 USD) for each service was estimated based on publicly available Medicare fee schedules, Medicare claims data, and literature. HRU metrics of inpatient and outpatient contacts and costs are reported as means and SDs. Univariate and bivariate analyses were used to compare SCS and CMM treatment groups at 6 months. RESULTS: At 6-month follow up, the SCS arm experienced approximately half the mean rate of hospitalizations per patient compared with the CMM treatment group (0.08 vs 0.15; P = 0.066). The CMM treatment group's total health care costs per patient were approximately 51% higher compared with the SCS treatment group (equivalent to mean annual cost per patient of $9,532 vs $6,300). CONCLUSIONS: Our analysis of the SENZA-PDN trial indicates that the addition of 10 kHz SCS therapy results in lower rates of hospitalization and consequently lower health care costs among patients with PDN compared with those receiving conventional management alone.