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2.
Neurology ; 92(18): e2165-e2175, 2019 04 30.
Article in English | MEDLINE | ID: mdl-30952795

ABSTRACT

OBJECTIVE: To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study. METHODS: Participants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session. RESULTS: Ninety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09-3.06]) compared to sham-dTMS (-1.02, 95% CI -2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (-2.96, 95% CI -4.1 to -1.7]) compared to sham-dTMS (-0.78, 95% CI -1.9 to 0.3; p = 0.018). CONCLUSIONS: ACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se. CLINICALTRIALSGOV IDENTIFIER: NCT01932905.


Subject(s)
Cerebral Cortex/physiopathology , Deep Brain Stimulation/methods , Gyrus Cinguli/physiopathology , Neuralgia/therapy , Transcranial Magnetic Stimulation/methods , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Neuralgia/physiopathology , Pain Management/methods , Pain Measurement , Treatment Outcome
3.
Mater Sci Eng C Mater Biol Appl ; 58: 927-34, 2016 Jan 01.
Article in English | MEDLINE | ID: mdl-26478388

ABSTRACT

In this study, a stimuli-responsive, biodegradable and bioactive film was produced by blending cashew gum polysaccharide (CGP) and polyvinyl alcohol (PVA). The film presented malleability and mechanical properties enabling an easy handling. Wetting the film changed the optical property from opacity to levels of transparency higher than 70% and resulted in up to 2-fold increase in its superficial area. Different swelling indexes were obtained varying the pH of solvent, which allows classifying the CGP/PVA film as pH sensitive stimuli-responsive material. The bioactivity was achieved through covalent immobilization of papain, which remained active after storage of CGP/PVA-papain film for 24h in the presence of buffer or in a dry form. These results evidenced that CGP/PVA-papain film is a very promising material for biomedical applications.


Subject(s)
Polysaccharides/chemistry , Polyvinyl Alcohol/chemistry , Anacardium/metabolism , Enzymes, Immobilized/chemistry , Enzymes, Immobilized/metabolism , Hydrogen-Ion Concentration , Microscopy, Electron, Scanning , Papain/chemistry , Papain/metabolism , Polysaccharides/isolation & purification , Spectroscopy, Fourier Transform Infrared , Wettability
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