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Lundgren S, Dreimanis K, Engdahl K, Windahl U, Tegner C. Alpha-chloralose poisoning in 25 cats: clinical picture and evaluation of treatment with intravenous lipid emulsion. J Feline Med Surg 2024; 26:1098612X241235776. [PMID: 38687210 PMCID: PMC11103310 DOI: 10.1177/1098612x241235776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVES The aims of this study were to describe the clinical picture and progression in cats with alpha-chloralose (AC) intoxication and to determine if treatment with intravenous (IV) lipid emulsion (ILE) influenced either the serum concentration of AC or the clinical signs. METHODS Cats with suspected AC poisoning admitted to a university small animal hospital were included. The cats were randomised into two groups: one receiving 20% ILE at a dose of 300 mg/kg as a 2 min bolus, followed by a 1500 mg/kg continuous rate infusion over 30 mins (IL+ group) and the other receiving IV fluid therapy with Ringer's acetate (IL- group). Serum samples were drawn at 0, 2, 12 and 24 h after admission. Samples were tested for AC with a novel validated, quantitative, ultra-high-performance liquid chromatography-tandem mass spectrometry method. Vital and predefined clinical signs were noted at the times of sampling and patients were scored using a previously described intoxication severity score. Telephone interviews were conducted after discharge to assess outcome. RESULTS A total of 25 cats were enrolled: 13 cats in the IL+ group and 12 in the IL- group. The most common clinical signs at presentation were tremor (n = 22, 88.0%), cranial nerve deficits (n = 20, 80.0%) and bradycardia (n = 19, 76.0%). No significant difference in AC concentration or change in intoxication score over time was found between the IL+ and IL- groups at any time point (P >0.05). All cats recovered within 72 h. CONCLUSIONS AND RELEVANCE ILE did not have any effect on the AC serum concentration or clinical signs in AC-poisoned cats. All cats survived until follow-up. In cats with an acute onset of the described neurological signs, AC intoxication is an important differential diagnosis with an excellent prognosis.
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Affiliation(s)
- Sandra Lundgren
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
- AWAKE Animal Hospital, Stockholm, Sweden
| | - Kristoffer Dreimanis
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Evidensia (Uppsala Veterinary Clinic), Uppsala, Sweden
| | - Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ulrika Windahl
- Swedish National Veterinary Institute (SVA), Uppsala, Sweden
| | - Cecilia Tegner
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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2
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Fishman MA, Chitneni A, Abd-Elsayed A, Grodofsky S, Scherer AM, Schetzner B, Klusek M, Popielarski SR, Meloni S, Falowski S, Kim P, Slavin KV, Silberstein SD. Drug-Free Noninvasive Thermal Nerve Block: Validation of Sham Devices. Brain Sci 2023; 13:1718. [PMID: 38137166 PMCID: PMC10741966 DOI: 10.3390/brainsci13121718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Headache is a leading cause of disability and suffering. One major challenge in developing device treatments is demonstrating their efficacy given devices' often-high placebo rate. This paper reviews the importance of validating sham devices as part of finalizing the design for larger-scale prospective randomized controlled trials in patients with chronic headache as well as the results of a prospective, single-blind trial to validate two potential sham noninvasive thermal nerve block devices. Study participants were trained to self-administer thermal nerve block treatment using sham devices in an office visit. Two different sham systems with different temperature profiles were assessed. Devices were offered for patients to use daily at-home for one week to assess the durability of sham placebo effects before participants were given active treatment in a second office visit followed by another optional week of self-administered active treatment at-home use. Sham treatments reduced pain scores by an average of 31% from 6.0 ± 2.3 to 4.3 ± 3.3, including two participants who fell asleep during the in-office treatment and woke up with no pain, but whose pain recurred after returning home during at-home use of the sham system. In-office active treatments reduced pain scores by 52% from 6.7 ± 2.1 to 3.3 ± 2.9 with sustained pain relief during optional at-home use. Successful blinding for the study was confirmed with an ideal Bang's Blinding Index of 0 and an ideal James' Blinding Index of 1. Both the sham and active treatments were viewed by participants as highly credible, and credibility increased from the beginning to end of sham treatments on average.
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Affiliation(s)
- Michael A. Fishman
- Center for Pain Control PC, Lancaster, PA 19610, USA; (M.A.F.); (A.M.S.)
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital—Columbia and Cornell, New York, NY 10065, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | | | - Ashley M. Scherer
- Center for Pain Control PC, Lancaster, PA 19610, USA; (M.A.F.); (A.M.S.)
| | - Brendan Schetzner
- Department of Anesthesiology, St Elizabeths Medical Center, Brighton, MA 02135, USA;
| | - Malvina Klusek
- Peconic Bay Medical Center/Northwell Health, New York, NY 10065, USA;
| | | | - Stephen Meloni
- Thermaquil, Inc., Philadelphia, PA 19610, USA; (S.R.P.); (S.M.)
| | - Steven Falowski
- Neurosurgical Associates of Lancaster, Lancaster, PA 19610, USA;
| | - Philip Kim
- Center for Interventional Pain Spine, LLC, Wilmington, DE 19803, USA;
| | - Konstantin V. Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60607, USA;
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL 60612, USA
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3
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Zhuo J, Weidrick CE, Liu Y, Moffitt MA, Jansen ED, Chiel HJ, Jenkins MW. Selective Infrared Neural Inhibition Can Be Reproduced by Resistive Heating. Neuromodulation 2023; 26:1757-1771. [PMID: 36707292 PMCID: PMC10366334 DOI: 10.1016/j.neurom.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Small-diameter afferent axons carry various sensory signals that are critical for vital physiological conditions but sometimes contribute to pathologies. Infrared (IR) neural inhibition (INI) can induce selective heat block of small-diameter axons, which holds potential for translational applications such as pain management. Previous research suggested that IR-heating-induced acceleration of voltage-gated potassium channel kinetics is the mechanism for INI. Therefore, we hypothesized that other heating methods, such as resistive heating (RH) in a cuff, could reproduce the selective inhibition observed in INI. MATERIALS AND METHODS We conducted ex vivo nerve-heating experiments on pleural-abdominal connective nerves of Aplysia californica using both IR and RH. We fabricated a transparent silicone nerve cuff for simultaneous IR heating, RH, and temperature measurements. Temperature elevations (ΔT) on the nerve surface were recorded for both heating modalities, which were tested over a range of power levels that cover a similar ΔT range. We recorded electrically evoked compound action potentials (CAPs) and segmented them into fast and slow subcomponents on the basis of conduction velocity differences between the large and small-diameter axonal subpopulations. We calculated the normalized inhibition strength and inhibition selectivity index on the basis of the rectified area under the curve of each subpopulation. RESULTS INI and RH showed a similar selective inhibition effect on CAP subcomponents for slow-conducting axons, confirmed by the inhibition probability vs ΔT dose-response curve based on approximately 2000 CAP measurements. The inhibition selectivity indexes of the two heating modalities were similar across six nerves. RH only required half the total electrical power required by INI to achieve a similar ΔT. SIGNIFICANCE We show that selective INI can be reproduced by other heating modalities such as RH. RH, because of its high energy efficiency and simple design, can be a good candidate for future implantable neural interface designs.
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Affiliation(s)
- Junqi Zhuo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Chloe E Weidrick
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Yehe Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael A Moffitt
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - E Duco Jansen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Biophotonics Center, Vanderbilt University, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
| | - Hillel J Chiel
- Department of Biology, Case Western Reserve University, Cleveland OH, USA; Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
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4
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Jiang S, Hong G. Cooling the pain. Science 2022; 377:28-29. [PMID: 35771916 DOI: 10.1126/science.abm8159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A miniaturized, flexible cooling device can be used for precise analgesia.
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Affiliation(s)
- Shan Jiang
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
| | - Guosong Hong
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
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5
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Reeder JT, Xie Z, Yang Q, Seo MH, Yan Y, Deng Y, Jinkins KR, Krishnan SR, Liu C, McKay S, Patnaude E, Johnson A, Zhao Z, Kim MJ, Xu Y, Huang I, Avila R, Felicelli C, Ray E, Guo X, Ray WZ, Huang Y, MacEwan MR, Rogers JA. Soft, bioresorbable coolers for reversible conduction block of peripheral nerves. Science 2022; 377:109-115. [PMID: 35771907 DOI: 10.1126/science.abl8532] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Implantable devices capable of targeted and reversible blocking of peripheral nerve activity may provide alternatives to opioids for treating pain. Local cooling represents an attractive means for on-demand elimination of pain signals, but traditional technologies are limited by rigid, bulky form factors; imprecise cooling; and requirements for extraction surgeries. Here, we introduce soft, bioresorbable, microfluidic devices that enable delivery of focused, minimally invasive cooling power at arbitrary depths in living tissues with real-time temperature feedback control. Construction with water-soluble, biocompatible materials leads to dissolution and bioresorption as a mechanism to eliminate unnecessary device load and risk to the patient without additional surgeries. Multiweek in vivo trials demonstrate the ability to rapidly and precisely cool peripheral nerves to provide local, on-demand analgesia in rat models for neuropathic pain.
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Affiliation(s)
- Jonathan T Reeder
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China.,Ningbo Institute of Dalian University of Technology, Ningbo, China
| | - Quansan Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Min-Ho Seo
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Busan, Republic of Korea
| | - Ying Yan
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Yujun Deng
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Katherine R Jinkins
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Siddharth R Krishnan
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Claire Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Shannon McKay
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Emily Patnaude
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Alexandra Johnson
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Zichen Zhao
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China.,Ningbo Institute of Dalian University of Technology, Ningbo, China
| | - Moon Joo Kim
- Department of Chemical Engineering, Northwestern University, Evanston, IL, USA
| | - Yameng Xu
- The Institute of Materials Science and Engineering, Washington University, St. Louis, MO, USA
| | - Ivy Huang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Emily Ray
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Xu Guo
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China.,Ningbo Institute of Dalian University of Technology, Ningbo, China
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Yonggang Huang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Departments of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Matthew R MacEwan
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Chemistry, Northwestern University, Evanston, IL, USA.,Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
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6
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Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res 2022; 15:925-937. [PMID: 35411187 PMCID: PMC8994628 DOI: 10.2147/jpr.s355096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | | | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | | | - Jarod John
- Argires Marotti Neurosurgical Associates, Lancaster, PA, USA
| | | | - Tony Vanetesse
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
| | | | - Philip Kim
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
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7
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Fishman MA, Scherer AM, Katsarakes AM, Larson L, Kim PS. Temperature-Mediated Nerve Blocks in the Treatment of Pain. Curr Pain Headache Rep 2021; 25:60. [PMID: 34269907 DOI: 10.1007/s11916-021-00978-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Analgesic hot and cold temperatures have been used for both conservative and ablative therapies for millennia. There are well-known locoregional neurovascular changes associated with the application of heat or ice in the literature and in practice. The oscillation between heat and cold has recently been identified as a synergistic mechanism of action with early translational results in humans. RECENT FINDINGS Recent mechanistic work in the feline model has demonstrated that a reliable, reversible nerve block can be achieved within a temperature range that is non-destructive (15-45°C). The underlying mechanism is a newly described hysteresis in the responsiveness of peripheral nerves to alternating thermal stimuli resulting in nerve blockade. Recently presented feasibility data reports positive results in subjects with occipital pain and peripheral scar pain in terms of pain and associated symptom improvement. Temperature-mediated changes in pain and sensation have been observed for hot and cold applications at a variety of temperatures. Recent insights into the synergy between preheating followed by cooling resulting in peripheral nerve fiber block has potential in a variety of conditions in which peripheral nerve etiology is noted. Recent findings in chronic headache patients report decreased pain and symptom improvement. Further studies are ongoing to understand the indications for this novel therapy.
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Affiliation(s)
- Michael A Fishman
- Center for Interventional Pain and Spine (CIPS), 160 North Pointe Blvd Suite 208, Lancaster, PA, 17603, USA.
| | - Ashley M Scherer
- Center for Interventional Pain and Spine (CIPS), 160 North Pointe Blvd Suite 208, Lancaster, PA, 17603, USA
| | - Ashley M Katsarakes
- Center for Interventional Pain and Spine (CIPS), 160 North Pointe Blvd Suite 208, Lancaster, PA, 17603, USA
| | - Lexi Larson
- Center for Interventional Pain and Spine (CIPS), 160 North Pointe Blvd Suite 208, Lancaster, PA, 17603, USA
| | - Philip S Kim
- Center for Interventional Pain and Spine (CIPS), 160 North Pointe Blvd Suite 208, Lancaster, PA, 17603, USA
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