From acute to long-term alterations in pain processing and modulation after spinal cord injury: mechanisms related to chronification of central neuropathic pain.

ABSTRACT: A severe and debilitating consequence of a spinal cord injury (SCI) is central neuropathic pain (CNP). Our aim was to investigate the processes leading to CNP emergence and chronification by analyzing causal relationship over time between spinothalamic function, pain excitability, and pain inhibition after SCI. This longitudinal follow-up study included 53 patients with acute SCI and 20 healthy controls. Spinothalamic, pain excitability, and intrasegmental and extrasegmental pain inhibition indices were repeatedly evaluated at 1.5, 3, and 6 months post-SCI. Between- and within-group analyses were conducted among those patients who eventually developed CNP and those who did not. Healthy controls were evaluated twice for repeatability analysis. Patients who developed CNP, compared with those who did not, exhibited increased thermal thresholds (P < 0.05), reduced pain adaptation (P < 0.01), and conditioned pain modulation (P < 0.05), early post-injury, and the CNP group's manifestations remained worse throughout the follow-up. By contrast, allodynia frequency was initially similar across SCI groups, but gradually increased in the subacute phase onward only among the CNP group (P < 0.001), along with CNP emergence. Early worse spinothalamic and pain inhibition preceded CNP and predicted its occurrence, and early worse pain inhibition mediated the link between spinothalamic function and CNP. Crossover associations were observed between early and late pain inhibition and excitability. Inefficient intrasegmental and extrasegmental inhibition, possibly resulting from spinothalamic deafferentation, seems to ignite CNP chronification. Pain excitability probably contributes to CNP maintenance, possibly via further exhaustion of the inhibitory control. Preemptive treatment promoting antinociception early post-SCI may mitigate or prevent CNP.

Biomarkers for predicting central neuropathic pain occurrence and severity after spinal cord injury: results of a long-term longitudinal study.

Central neuropathic pain (CNP) after spinal cord injury (SCI) is debilitating and immensely impacts the individual. Central neuropathic pain is relatively resistant to treatment administered after it develops, perhaps owing to irreversible pathological processes. Although preemptive treatment may overcome this shortcoming, its administration necessitates screening patients with clinically relevant biomarkers that could predict CNP early post-SCI. The aim was to search for such biomarkers by measuring pronociceptive and for the first time, antinociceptive indices early post-SCI. Participants were 47 patients with acute SCI and 20 healthy controls. Pain adaptation, conditioned pain modulation (CPM), pain temporal summation, wind-up pain, and allodynia were measured above, at, and below the injury level, at 1.5 months after SCI. Healthy control were tested at corresponding regions. Spinal cord injury patients were monitored for CNP emergence and characteristics at 3 to 4, 6 to 7, and 24 months post-SCI. Central neuropathic pain prevalence was 57.4%. Central neuropathic pain severity, quality, and aggravating factors but not location somewhat changed over 24 months. Spinal cord injury patients who eventually developed CNP exhibited early, reduced at-level pain adaptation and CPM magnitudes than those who did not. The best predictor for CNP emergence at 3 to 4 and 7 to 8 months was at-level pain adaptation with odds ratios of 3.17 and 2.83, respectively (∼77% probability) and a cutoff value with 90% sensitivity. Allodynia and at-level CPM predicted CNP severity at 3 to 4 and 24 months, respectively. Reduced pain inhibition capacity precedes, and may lead to CNP. At-level pain adaptation is an early CNP biomarker with which individuals at risk can be identified to initiate preemptive treatment.

Natural History of Contralateral Nodules After Lobectomy in Patients With Papillary Thyroid Carcinoma.

Background: Bilateral thyroid nodularity is considered an indication for total thyroidectomy in papillary thyroid carcinoma (PTC). However, the natural history and outcome of contralateral nodules have never been studied. Objective: To investigate the natural history of nonsuspicious contralateral nodules after lobectomy for PTC. Methods: We included patients who had one or more solid nodules (≥3 mm) in the contralateral lobe with benign cytology before surgery or small nonsuspicious nodules per ultrasonography. Results: One hundred and twelve patients were included. Median age was 57 years, and median size of the PTC (initial lobectomy) was 8 mm (range, 0.5 to 28 mm). On the contralateral side, the median size of nodules was 7 mm (range, 3 to 30 mm). Thirty-three nodules (29%) had fine-needle aspiration (FNA) before surgery, and all were benign. After a median follow-up of 6 years, median growth was zero (range, -20 to 19 mm). Twenty-six nodules (23%) increased ≥3 mm in size (median, 6 mm; range, 4 to 19 mm). Twenty patients (18%) developed new nodules. Twelve patients (11%) underwent completion thyroidectomy for growth (three), suspicious FNA (seven; Bethesda III to V), malignancy (one), or unknown reason (one). Overall, according to the completion thyroidectomy specimen, six patients (5%) were diagnosed with contralateral PTC (five micro-PTCs, one 20 mm), and all were without evidence of disease at the end of follow-up. There were no surgical difficulties or local complications during completion surgery. Conclusions: Lobectomy for low-risk patients with a small PTC and nonsuspicious contralateral thyroid nodule(s) is a reliable and safe initial treatment option. In the few patients who required completion thyroidectomy, treatment with surgery and radioiodine was effective.

Radiotherapy in early-stage tongue squamous cell carcinoma with minor adverse features.

BACKGROUND: Treatment for early-stage tongue squamous cell carcinoma (SCC) is usually surgery alone. There is ambiguity regarding the impact of minor adverse features (MAFs) on outcome and the role of postoperative radiotherapy (PORT) in tongue SCC. METHODS: A retrospective analysis was performed on 48 patients diagnosed with tongue SCC treated in our center. Patients with MAFs received adjuvant PORT. Disease outcome in patients with MAFs, and the effect of PORT were analyzed using the Kaplan-Meier method and log-rank test. RESULTS: Thirty-one patients had T1 and 17 had T2 disease. PORT was given to 7 patients with MAFs. Mean follow-up time was 70 months. The 2-year overall survival (OS) rate was 86%. Perineural invasion had a significant impact on disease-free survival (DFS; p =.05). There was an improved DFS in patients with MAFs treated with PORT (p =.01). CONCLUSION: MAFs may have an impact on outcome in tongue SCC, and PORT can improve disease outcome in these patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 147-150, 2017.

Radiation-Induced Thyroid Cancer: Gender-Related Disease Characteristics and Survival.

BACKGROUND: Radiation exposure is a well-known risk factor for well-differentiated thyroid cancer (WDTC). However, gender disparity in disease characteristics is not completely understood. The purpose of this study was to determine the behavior of radiation-induced thyroid cancer according to gender. METHODS: Charts of all patients diagnosed with WDTC after radiation exposure between the years 1985 and 2013 in a tertiary referral center were retrieved. RESULTS: Forty-three patients were reviewed, 29 females and 14 males. Mean age of exposure for women and men were 17.1 ± 19.5 and 15.5 ± 12.5 years, respectively (P = .78). Age at diagnosis were 47.5 ± 15.5 and 41.5 ± 15 years for women and men, respectively (P = .18). Mean disease-specific survival was 44.1 and 43.7 years for women and men, respectively (P = .50). CONCLUSIONS: Similar disease characteristics, tumor pathology, disease-free survival, and overall survival in both genders. In sporadic well-differentiated thyroid carcinoma, female gender is associated with better tumor behavior and prognosis. However, our results suggest that women are more affected by radiation than men and therefore have the same prognosis as men.

Epidemiological features of invasive Kingella kingae infections and respiratory carriage of the organism.

The age, sex, and seasonal distributions of invasive Kingella kingae infections in southern Israel were examined and compared to the epidemiology of respiratory carriage of the organism. Medical records of all patients diagnosed between 1988 and 2002 were reviewed, and 2,044 oropharyngeal specimens were cultured on selective media during two periods (February to May and October to December) in 2001. Invasive infections significantly affected children (73 of 74 patients [98.6%] were younger than 4 years), 50 patients (67.8%) were males (P = 0.045), and 55 episodes (74.3%) occurred between July and December (P = 0.004). Carriage was higher in the 0- to 3-year-old group and decreased with increasing age (P for trend = 0.0008). Carriage rates were similar in both sexes and did not significantly differ between the February-to-May and October-to-December periods. The highest rate of carriage of K. kingae coincided with the age (less than 4 years) at which invasive infections were especially frequent. The peculiar sex and seasonal distributions of invasive disease, however, cannot be readily explained by the epidemiology of respiratory carriage. Viral infections and other yet-to-be-defined cofactors may play a role in the causation of invasive K. kingae infections.