IES brain potentials reflect secondary hyperalgesia

Central sensitization (CS), the increased sensitivity of the central nervous system to somatosensory inputs, accounts for secondary hyperalgesia, a typical sign of several painful clinical conditions. Brain potentials elicited by mechanical punctate stimulation using flat-tip probes can provide neural correlates of CS, but their signal-to-noise ratio is limited by poor synchronization of the afferent nociceptive input. Additionally, mechanical punctate stimulation does not activate nociceptors exclusively. In contrast, low-intensity intraepidermal electrical stimulation (IES) allows selective activation of type II Aδ-mechano-heat nociceptors (II-AMHs) and elicits reproducible brain potentials. However, it is unclear whether hyperalgesia from IES occurs and coexists with secondary mechanical punctate hyperalgesia, and whether the magnitude of the electroencephalographic (EEG) responses evoked by IES within the hyperalgesic area is increased. To address these questions, we explored the modulation of the psychophysical and EEG responses to IES by intraepidermal injection of capsaicin in healthy human subjects. We obtained three main results. First, the intensity of the sensation elicited by IES was significantly increased in participants who developed robust mechanical punctate hyperalgesia after capsaicin injection (i.e., responders), indicating that hyperalgesia from IES coexists with punctate mechanical hyperalgesia. Second, the N2 peak magnitude of the EEG responses elicited by IES was significantly increased after the intraepidermal injection of capsaicin in responders only. Third, a receiver-operator characteristics analysis showed that the N2 peak amplitude is clearly predictive of the presence of CS. These findings suggest that the EEG responses elicited by IES reflect secondary hyperalgesia and therefore represent an objective correlate of CS.This work was funded by the Wellcome Trust Pain Consortium (COLL JLARAXR to GDI and AHD), a UCL Grand Challenges studentship (to JON), the National Natural Science Foundation of China (81571659 to ML) and the Natural Science Foundation of Tianjin (15JCYBJC55100 to ML).This is the author accepted manuscript. The final version is available from the American Physiological Society via http://dx.doi.org/10.1152/jn.00013.201

Brain potentials evoked by intraepidermal electrical stimuli reflect the central sensitization of nociceptive pathways

Central sensitization (CS), the increased sensitivity of the central nervous system to somatosensory inputs, accounts for secondary hyperalgesia, a typical sign of several painful clinical conditions. Brain potentials elicited by mechanical punctate stimulation using flat-tip probes can provide neural correlates of CS, but their signal-to-noise ratio is limited by poor synchronisation of the afferent nociceptive input. Additionally, mechanical punctate stimulation does not activate nociceptors exclusively. In contrast, low-intensity intra-epidermal electrical stimulation (IES) allows selective activation of type-II Aδ mechano-heat nociceptors (II-AMHs), and elicits reproducible brain potentials. However, it is unclear whether hyperalgesia from IES occurs and co-exists with secondary mechanical punctate hyperalgesia, and whether the magnitude of the EEG responses evoked by IES within the hyperalgesic area is increased. To address these questions, we explored the modulation of the psychophysical and EEG responses to IES by intra-epidermal injection of capsaicin in healthy human subjects. We obtained three main results. First, the intensity of the sensation elicited by IES was significantly increased in participants who developed robust mechanical punctate hyperalgesia after capsaicin injection (i.e., responders), indicating that hyperalgesia from IES co-exists with punctate mechanical hyperalgesia. Second, the N2 peak magnitude of the EEG responses elicited by IES were significantly increased after the intra-epidermal injection of capsaicin in responders only. Third, a receiver-operator characteristics analysis showed that the N2 peak amplitude is clearly predictive of the presence of CS. These findings suggest that the EEG responses elicited by IES reflect secondary hyperalgesia, and therefore represent an objective correlate of CS

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

BACKGROUND: To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. METHODS: Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. RESULTS: From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). CONCLUSION: There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

The genetic epidemiology of joint shape and the development of osteoarthritis

Congruent, low-friction relative movement between the articulating elements of a synovial joint is an essential pre-requisite for sustained, efficient, function. Where disorders of joint formation or maintenance exist, mechanical overloading and osteoarthritis (OA) follow. The heritable component of OA accounts for ~ 50% of susceptible risk. Although almost 100 genetic risk loci for OA have now been identified, and the epidemiological relationship between joint development, joint shape and osteoarthritis is well established, we still have only a limited understanding of the contribution that genetic variation makes to joint shape and how this modulates OA risk. In this article, a brief overview of synovial joint development and its genetic regulation is followed by a review of current knowledge on the genetic epidemiology of established joint shape disorders and common shape variation. A summary of current genetic epidemiology of OA is also given, together with current evidence on the genetic overlap between shape variation and OA. Finally, the established genetic risk loci for both joint shape and osteoarthritis are discussed

Low-Bandgap Conjugated Polymer Dots for Near-Infrared Fluorescence Imaging

Low-bandgap conjugated polymers attract significant research interests because of their broad light absorption spectra in the red and near-infrared regions, making them desirable materials for solar photovoltaics. To date, low-bandgap conjugated polymers yield some of the best power conversion efficiencies offered by polymer solar cells. In addition to their applications as solar photovoltaic materials, nanoparticles of these polymers may be potentially beneficial for cell imaging because of their red and near-infrared absorption features, which are required for significant light penetration into biological samples. In this work, conjugated polymer dots (CPdots) of PCPDTBT, PSBTBT, PTB7, PCDTBT, and PBDTTPD are prepared in aqueous solution using nanoprecipitation. The maximum fluorescence wavelengths of these CPdots range from 800 to 1000 nm. The CPdots exhibit an average zeta potential of -30 mV, giving rise to colloidal stability of these nanoparticles. Dynamic light scattering results show that the CPdots have a hydrodynamic diameter of approximately 100 nm. Furthermore, analyses of atomic force microscopy images of the low-bandgap donor-acceptor CPdots show an average height of approximately 20 nm. The CPdots are introduced to live THP-1 cells, a human monocytic cell line, and the internalization of CPdots by these cells is observed. Confocal fluorescence microscopy images of cells labeled with the low-bandgap CPdots show the presence of these bright nanoparticles in the cells. In short, we demonstrate the preparation of low-bandgap CPdots as an aqueous dispersion and their applications in cell imaging