Understanding peripheral neuropathic pain in primary care: diagnosis and management.

OBJECTIVE: To describe an approach that allows for a dedicated clinical assessment and accurate recognition of peripheral neuropathic pain in primary care and to provide an update on the available pharmacologic therapies MATERIALS AND METHODS: Medline was searched using the key word "neuropathic pain". Searches were refined for each pathophysiological mechanism, diagnosis and treatment by adding appropriate key words. RESULTS: The distinction between neuropathic and nociceptive pain is essential for an adequate treatment because these forms of pain differ in their underlying mechanisms and therefore in their response to different drugs. CONCLUSIONS: Chronic pain with neuropathic characteristics presents a significant challenge as it is often unresponsive to conventional analgesics. The correct diagnosis and early management of peripheral neuropathic pain not only improve health-related outcomes, but also yield significant cost benefit to society.

Update on the treatment of androgenetic alopecia.

OBJECTIVE: Androgenetic alopecia is the most common type of hair loss, affecting women (50% of menopausal women and a large number of women of childbearing age) as well as males (over 70% of adult men). Since the condition is of an evolutionary nature, it is important to intervene early in order to prevent the progression of the clinical picture. It is equally important to identify all the factors that may hinder the effectiveness of the therapy. MATERIALS AND METHODS: A literature search was conducted using, as electronic bibliographic database, Medline and the Cochrane library from 1995 until present. RESULTS: Patients who make use of certain supplements can be less responsive to medical treatments. CONCLUSIONS: The therapeutic approach to the patient with androgenetic alopecia should be global as the effectiveness of valid therapies may be affected by the patient overlooking the information received from the specialist.

Complex regional pain syndrome type I: a comprehensive review.

BACKGROUND: Complex regional pain syndrome type I (CRPS I), formerly known as reflex sympathetic dystrophy (RSD), is a chronic painful disorder that usually develops after a minor injury to a limb. This topical review gives a synopsis of CRPS I and discusses the current concepts of our understanding of CRPS I in adults, the diagnosis, and treatment options based on the limited evidence found in medical literature. CRPS I is a multifactorial disorder. Possible pathophysiological mechanisms of CRPS I are classic and neurogenic inflammation, and maladaptive neuroplasticity. At the level of the central nervous system, it has been suggested that an increased input from peripheral nociceptors alters the central processing mechanisms. METHODS: A literature search was conducted using, as electronic bibliographic database, Medline from 1980 until 2014. RESULTS: An early diagnosis and multidisciplinary treatment are necessary to prevent permanent disability. CONCLUSIONS: The pharmacological treatment of CRPS I is empirical and insufficiently effective. Further research is needed regarding the therapeutic modalities discussed in the guidelines. Physical therapy is widely recommended as a first-line treatment. The efficacy of local anesthetic sympathetic blockade as treatment for CRPS I is questionable.

Abnormal metabolic brain networks in Tourette syndrome.

OBJECTIVES: To identify metabolic brain networks that are associated with Tourette syndrome (TS) and comorbid obsessive-compulsive disorder (OCD). METHODS: We utilized [(18)F]-fluorodeoxyglucose and PET imaging to examine brain metabolism in 12 unmedicated patients with TS and 12 age-matched controls. We utilized a spatial covariance analysis to identify 2 disease-related metabolic brain networks, one associated with TS in general (distinguishing TS subjects from controls), and another correlating with OCD severity (within the TS group alone). RESULTS: Analysis of the combined group of patients with TS and healthy subjects revealed an abnormal spatial covariance pattern that completely separated patients from controls (p < 0.0001). This TS-related pattern (TSRP) was characterized by reduced resting metabolic activity of the striatum and orbitofrontal cortex associated with relative increases in premotor cortex and cerebellum. Analysis of the TS cohort alone revealed the presence of a second metabolic pattern that correlated with OCD in these patients. This OCD-related pattern (OCDRP) was characterized by reduced activity of the anterior cingulate and dorsolateral prefrontal cortical regions associated with relative increases in primary motor cortex and precuneus. Subject expression of OCDRP correlated with the severity of this symptom (r = 0.79, p < 0.005). CONCLUSION: These findings suggest that the different clinical manifestations of TS are associated with the expression of 2 distinct abnormal metabolic brain networks. These, and potentially other disease-related spatial covariance patterns, may prove useful as biomarkers for assessing responses to new therapies for TS and related comorbidities.

Observation of a J(PC)=1-+ exotic resonance in diffractive dissociation of 190   GeV/c π- into π- π- π+.

The COMPASS experiment at the CERN SPS has studied the diffractive dissociation of negative pions into the π- π- π+ final state using a 190 GeV/c pion beam hitting a lead target. A partial wave analysis has been performed on a sample of 420,000 events taken at values of the squared 4-momentum transfer t' between 0.1 and 1 GeV2/c2. The well-known resonances a1(1260), a2(1320), and π2(1670) are clearly observed. In addition, the data show a significant natural-parity exchange production of a resonance with spin-exotic quantum numbers J(PC)=1-+ at 1.66 GeV/c2 decaying to ρπ. The resonant nature of this wave is evident from the mass-dependent phase differences to the J(PC)=2-+ and 1++ waves. From a mass-dependent fit a resonance mass of (1660±10(-64)(+0)) MeV/c2 and a width of (269±21(-64)(+42)) MeV/c2 are deduced, with an intensity of (1.7±0.2)% of the total intensity.

Indication of a deeply bound and compact K- pp state formed in the pp- -> pLambdaK+ reaction at 2.85 GeV.

We have analyzed data of the DISTO experiment on the exclusive pp --> pLambdaK+ reaction at 2.85 GeV to search for a strongly bound compact K- pp(approximately = X) state to be formed in the pp --> K+ + X reaction. The observed spectra of the K+ missing mass and the pLambda invariant-mass with high transverse momenta of p and K+ revealed a broad distinct peak of 26-sigma confidence with a mass M(X)=2267+/-3(stat)+/-5(syst) MeV/c2 and a width Gamma(X)=118+/-8(stat)+/-10(syst) MeV. The enormously large cross section indicates formation of a compact K- pp with a large binding energy of B(K)=103 MeV, which can be a possible gateway toward cold and dense kaonic nuclear matter.

First measurement of the transverse spin asymmetries of the deuteron in semi-inclusive deep inelastic scattering.

First measurements of the Collins and Sivers asymmetries of charged hadrons produced in deep-inelastic scattering of muons on a transversely polarized 6LiD target are presented. The data were taken in 2002 with the COMPASS spectrometer using the muon beam of the CERN SPS at 160 GeV/c. The Collins asymmetry turns out to be compatible with zero, as does the measured Sivers asymmetry within the present statistical errors.

Barkas effect for antiproton stopping in H2.

We report the stopping power of molecular hydrogen for antiprotons of kinetic energy above the maximum (approximately 100 keV) with the purpose of comparing with the proton one. Our result is consistent with a positive difference in antiproton-proton stopping powers above approximately 250 keV and with a maximum difference between the stopping powers of 21%+/-3% at around 600 keV.

Rho(0) meson production in the pp-->pppi(+)pi(-) reaction at 3.67 GeV/c.

Total and differential cross sections for the exclusive reaction pp-->pp rho observed via the pi(+)pi(-) decay channel have been measured at p(beam)=3.67 GeV/c. The observed total meson production cross section is determined to be (23.4+/-0.8+/-8) mu b and is significantly lower than typical cross sections used in model calculations for heavy-ion collisions. The differential cross sections measured indicate a strong anisotropy (approximately cos(theta(CM)(rho)) in the rho(0) meson production.