Using peripheral nerve stimulation (PNS) to treat neuropathic pain: a clinical series.

OBJECTIVE: We examined the efficacy of peripheral nerve stimulation (PNS) in treating neuropathic and causalgic pain, with a stimulation system specifically designated for PNS itself. MATERIALS AND METHODS: A total of 15 patients were treated between January 2011 and March 2012. The percutaneous lead was implanted on the nerves, exposing it on the electrical nerve stimulation (ENS) guide. The average numeric rating scale (NRS) preimplant was 8.46, and the oxycodone intake was 90 mg/day. RESULTS: Of the 15 patients, 3 failed the trial phase and 12 were implanted with a permanent pulse generator (Lightpulse 100, Neurimpulse, Rubano, PD, Italy). At an average of 9.3 months of follow-up, the average NRS score was 3.46 (p < 0.001), and the average Likert scale score at 7 points was 5.91. Nine patients were working prior to their injuries, seven of whom returned to work after receiving an implant. The average oxycodone consumption decreased to 30 mg/day, and the pregabalin dosage decreased to 75 mg/day. CONCLUSION: Our study results confirm that PNS is an effective modality in managing severe neuropathic and intractable pain following multiple joint surgeries that are complicated by causalgic pain.

Isolation and phenotyping of potential stem cells from the umbilical cord of the bottlenose dolphin(Tursiops truncatus).

We have successfully isolated cells with stem-like properties from bottlenose dolphin (Tursiops truncatus) umbilical cord. Our results show that this cetacean species has embryonic fetal and adult stem cells as do humans and other studied mammals. This accomplishment allows to eventually investigate whether dolphins, due to their unique adaptations to aquatic environments, have special stem cell lineages or distinctive mechanisms of cell programming. Further characterization of their potency to differentiate into multiple cell lineages would fulfill numerous applicative purposes. We characterized, developed and refined a new protocol for obtaining potential stem cells from umbilical cord tissues of the bottlenose dolphin. Tissue samples were taken from umbilical cords of successful deliveries immediately after placenta ejection and collection from the water. Umbilical cord samples (2-3 cm3) were excised and subjected to enzymatic digestion and mechanical dissociation. Viable cells from specimens resident in the Oceanografic Valencia were cultured and subsequently isolated and tested for pluripotent characteristics (cell morphology, phenotype and expression of surface markers). Cell viability was confirmed also after freezing/thawing. The established protocol is suitable for collection/isolation/culture of dolphin potential mesenchymal stem cells from dolphin umbilical cord, which can be deposited in cell banks for future research needs.

Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art.

AIMS: Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages. METHODS AND RESULTS: A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful. CONCLUSIONS: S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.