Remodeling of Neuronal Circuits After Reach Training in Chronic Capsular Stroke

Background. Subcortical capsular stroke has a poor prognosis, and it is not yet fully understood how and under what circumstances reach training contributes to motor recovery. Objective. This study was performed to investigate changes in neuronal circuits and motor recovery in a chronic capsular stroke model in the presence or absence of reach training. Method. We generated photothrombotic capsular lesions in 42 Sprague-Dawley rats and evaluated motor recovery with or without daily training in a single-pellet reaching task (SPRT). We used 2-deoxy-2-[18F]-fluoro-D-glucose-microPET (positron emission tomography) to assess remodeling of neuronal circuits. Results. SPRT training was selectively beneficial only for the group with incomplete capsular destruction (P < .05), suggesting the relevance of plasticity in the remaining capsular fibers for motor recovery. Groups that did not receive SPRT training showed no motor recovery at all. The microPET analysis demonstrated that motor recovery was correlated with a reduction in cortical diaschisis in ipsilesional motor and sensory cortices and in the contralesional sensory cortex (Pearson's correlation, P < .05). We also observed training-dependent subcortical activation in the contralesional red nucleus, the internal capsule, and the ventral hippocampus (P < .0025; false discovery rate q < 0.05). The groups without reach training did not show the same degree of reduction in diaschisis or activation of the red nucleus. Conclusions. Our results suggest that motor recovery and remodeling of neuronal circuits after capsular stroke depend on the magnitude of the capsular lesion and on the presence or absence of reach training. Task-specific training is strongly indicated only when there is incomplete destruction of the capsular fibers.

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Engaging Cervical Spinal Cord Networks to Reenable Volitional Control of Hand Function in Tetraplegic Patients

Background. Paralysis of the upper limbs from spinal cord injury results in an enormous loss of independence in an individual's daily life. Meaningful improvement in hand function is rare after 1 year of tetraparesis. Therapeutic developments that result in even modest gains in hand volitional function will significantly affect the quality of life for patients afflicted with high cervical injury. The ability to neuromodulate the lumbosacral spinal circuitry via epidural stimulation in regaining postural function and volitional control of the legs has been recently shown. A key question is whether a similar neuromodulatory strategy can be used to improve volitional motor control of the upper limbs, that is, performance of motor tasks considered to be less "automatic" than posture and locomotion. In this study, the effects of cervical epidural stimulation on hand function are characterized in subjects with chronic cervical cord injury. Objective. Herein we show that epidural stimulation can be applied to the chronic injured human cervical spinal cord to promote volitional hand function. Methods and Results. Two subjects implanted with a cervical epidural electrode array demonstrated improved hand strength (approximately 3-fold) and volitional hand control in the presence of epidural stimulation. Conclusions. The present data are sufficient to suggest that hand motor function in individuals with chronic tetraplegia can be improved with cervical cord neuromodulation and thus should be comprehensively explored as a possible clinical intervention.

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ON THE NATURE OF UNINTENTIONAL ACTION: A STUDY OF FORCE/MOMENT DRIFTS DURING MULTI-FINGER TASKS

We explored the origins of unintentional changes in performance during accurate force production in isometric conditions seen after turning visual feedback off. The idea of control with referent spatial coordinates suggests that these phenomena could result from drifts of the referent coordinate for the effector. Subjects performed accurate force/moment production tasks by pressing with the fingers of a hand on force sensors. Turning the visual feedback off resulted in slow drifts of both total force and total moment to lower magnitudes of these variables; these drifts were more pronounced in the right hand of the right-handed subjects. Drifts in individual finger forces could be in different direction; in particular, fingers that produced moments of force against the required total moment showed an increase in their forces. The force/moment drift was associated with a drop in the index of synergy stabilizing performance under visual feedback. The drifts in directions that changed performance (non-motor equivalent) and in directions that did not (motor equivalent) were of about the same magnitude. The results suggest that control with referent coordinates is associated with drifts of those referent coordinates toward the corresponding actual coordinates of the hand - a reflection of the natural tendency of physical systems to move toward minimum of potential energy. The interaction between drifts of the hand referent coordinate and referent orientation leads to counter-directional drifts in individual finger forces. The results also demonstrate that the sensory information used to create multi-finger synergies in necessary for their presence over the task duration.

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Subspace mapping of the three-dimensional spectral receptive field of macaque MT neurons

Neurons in the middle temporal (MT) visual area are thought to represent the velocity (direction and speed) of motion. Previous studies suggest the importance of both excitation and suppression for creating velocity representation in MT; however, details of the organization of excitation and suppression at the MT stage are not understood fully. Here, we examine how excitatory and suppressive inputs are pooled in individual MT neurons by measuring their receptive fields in a three-dimensional (3-D) spatiotemporal frequency domain. We recorded the activity of single MT neurons from anesthetized macaque monkeys. To achieve both quality and resolution of the receptive field estimations, we applied a subspace reverse correlation technique in which a stimulus sequence of superimposed multiple drifting gratings was cross-correlated with the spiking activity of neurons. Excitatory responses tended to be organized in a manner representing a specific velocity independent of the spatial pattern of the stimuli. Conversely, suppressive responses tended to be distributed broadly over the 3-D frequency domain, supporting a hypothesis of response normalization. In spite of the nonspecific distributed profile, the total summed strength of suppression was comparable to that of excitation in many MT neurons. Furthermore, suppressive responses reduced the bandwidth of velocity tuning, indicating that suppression improves the reliability of velocity representation. Our results suggest that both well-organized excitatory inputs and broad suppressive inputs contribute significantly to the invariant and reliable representation of velocity in MT.

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Megamap: Flexible representation of a large space embedded with nonspatial information by a hippocampal attractor network

The problem of how the hippocampus encodes both spatial and nonspatial information at the cellular network level remains largely unresolved. Spatial memory is widely modeled through the theoretical framework of attractor networks, but standard computational models can only represent spaces that are much smaller than the natural habitat of an animal. We propose that hippocampal networks are built upon a basic unit called a megamap, or a cognitive attractor map in which place cells are flexibly recombined to represent a large space. Its inherent flexibility gives the megamap a huge representational capacity and enables the hippocampus to simultaneously represent multiple learned memories and naturally carry nonspatial information at no additional cost. On the other hand, the megamap is dynamically stable, as the underlying network of place cells robustly encodes any location in a large environment given a weak or incomplete input signal from the upstream entorhinal cortex. Our results suggest a general computational strategy by which a hippocampal network enjoys the stability of attractor dynamics without sacrificing the flexibility needed to represent a complex, changing world.

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Prefrontal and Anterior Cingulate Cortex Neurons Encode Attentional Targets Even When They Do Not Apparently Bias Behavior

Neurons in anterior cingulate and prefrontal cortex (ACC/PFC) carry information about behaviorally relevant target stimuli. This information is believed to affect behavior by exerting a top-down attentional bias on stimulus selection. However, attention information may not necessarily be a biasing signal, but could be a corollary signal that is not directly related to ongoing behavioral success, or it could reflect the monitoring of targets similar to an eligibility trace useful for later attentional adjustment. To test this suggestion we quantified how attention information relates to behavioral success in neurons recorded in multiple subfields in macaque ACC/PFC during a cued attention task. We found that attention cues activated three separable neuronal groups that encoded spatial attention information but were differently linked to behavioral success. A first group encoded attention targets on correct and error trials. This group spread across ACC/PFC and represented targets transiently after cue onset, irrespective of behavior. A second group encoded attention targets on correct trials only, closely predicting behavior. These neurons were not only prevalent in lateral prefrontal, but also in anterior cingulate cortex. A third group encoded target locations only on error trials. This group was evident in ACC and PFC and was activated in error trials 'as if' attention was shifted to the target location but without evidence for such behavior. These results show that only a portion of neurally available information about attention targets biases behavior. We speculate that additionally a unique neural subnetwork encodes counterfactual attention information.

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Spontaneously active NaV1.5 sodium channels may underlie odor sensitivity

The olfactory system is remarkably sensitive to airborne odor molecules, but precisely how very low odor concentrations bordering on just a few molecules per olfactory sensory neuron can trigger graded changes in firing is not clear. This report re-examines signaling in olfactory sensory neurons in light of the recent account of Na_V1.5 sodium channel-mediated spontaneous firing. Using a model of spontaneous channel activity, the study shows how even sub-millivolt changes in membrane potential elicited by odor are expected to cause meaningful changes in Na_V1.5-dependent firing. The results suggest that the random window currents of Na_V1.5 channels may underpin not only spontaneous firing in olfactory sensory neurons, but the cellular response to odor as well, thereby insuring the robustness and sensitivity of signaling that is especially important for low odor concentrations.

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Dopamine D1 receptor modulation of calcium channel currents in horizontal cells of mouse retina

Horizontal cells form the first laterally interacting network of inhibitory interneurons in the retina. Dopamine, released onto horizontal cells under photic and circadian control modulates horizontal cell function. Using isolated, identified horizontal cells from a connexin-57-iCre x ROSA26-tdTomato transgenic mouse line, we investigated dopaminergic modulation of calcium channel currents (I_Ca) with whole cell patch-clamp techniques. Dopamine (10 µM) blocked 27% of steady-state I_Ca, an action blunted to 9% in the presence of the L-type Ca channel blocker verapamil (50 µM). The dopamine type 1 receptor (D1R) agonist SKF38393 (20 µM) inhibited I_Ca by 24%. The D1R antagonist SCH23390 (20 µM) reduced DA and SKF38393 inhibition. Dopamine slowed I_Ca activation, blocking I_Ca 38% early in a voltage step. Enhanced early inhibition of I_Ca was eliminated by applying voltage prepulses to +120 mV for 100 ms, increasing I_Ca by 31% and 11% for early and steady state currents, respectively. Voltage-dependent facilitation of I_Ca and block of DA inhibition after preincubation with a Gβ blocking peptide, suggested involvement of Gβ proteins in the D1R mediated modulation. When the G-protein activator GTPS was added intracellularly, I_Ca was smaller and showed the same slowed kinetics seen during D1R activation. With GTPS in the pipette, additional block of I_Ca by dopamine was only 6%. Strong depolarizing voltage prepulses restored the GTPS-reduced early I_Ca amplitude by 36% and the steady-state I_Ca amplitude by 3%. These results suggest that dopaminergic inhibition of I_Ca via D1Rs is primarily mediated through the action of Gβ proteins in horizontal cells.

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Prevalence of asymptomatic peripheral vascular disease in patients with type 2 diabetes by color Doppler study

2016-05-18T04-18-31Z
Source: International Journal of Advances in Medicine
Sanda Mallikarjuna Rao, Vemula Narendar.
Background: A diagnosis of peripheral vascular disease in patients with diabetes mandates a multifaceted treatment approach, involving aggressive risk factor modification, anti-platelet therapy and revascularization procedures. Objective of the study is to study the prevalence of asymptomatic Peripheral vascular disease in patients with type 2 diabetes mellitus by color Doppler study and to correlate it with risk factors and ischemic heart disease. Methods: A total of 40 patients of type 2 diabetes mellitus patients attending outpatient department at Mahatma General Hospital, Khammam during the period of August 2008 to August 2009 were selected randomly and a cross sectional analysis was done. The initial history was directed towards obtaining details regarding age/sex of the patient, symptoms/duration of type 2 diabetes, diet/treatment compliance, glycemic control based on HbA1c, presence of hypertension, habit of smoking, family history, symptoms suggestive of limb ischemia, past history of diabetic foot lesions, assessment of physical activity. Results: The prevalence of asymptomatic peripheral vascular disease in type 2 diabetes mellitus was found to be 30%. Age more than 50 years, male sex, smoking, duration of type 2 diabetes mellitus more than 10 years, poor glycemic control (HbA1c > 8%), increased waist hip ratio, overweight and obesity (BMI > 25 kg/m2), increased waist circumference, increased serum cholesterol, increased serum LDL, increased serum Triglycerides, decreased serum HDL, hypertension, abnormal ECG, poor physical activity were found to be risk factors for peripheral vascular disease and they were statistically significant. But the factors like family history of diabetes, diet/treatment compliance were not found to be statistically significant. Conclusions: Age more than 50 years, male sex, smoking, duration of type 2 diabetes mellitus more than 10 years, poor glycemic control (HbA1c > 8%), increased waist hip ratio, overweight and obesity (BMI > 25 kg/m2), increased waist circumference, increased serum cholesterol, increased serum LDL, increased serum Triglycerides, decreased serum HDL, hypertension, abnormal ECG, poor physical activity were found to be risk factors for peripheral vascular disease.


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Clinical and echocardiographic study of atrial fibrillation

2016-05-18T04-18-31Z
Source: International Journal of Advances in Medicine
Vemula Narendar, Sanda Mallikarjuna Rao.
Background: Atrial fibrillation is associated most commonly with mitral valve disease. Atrial fibrillation is reported to occur in 29% of patients who have isolated mitral stenosis and in 16% who have isolated mitral regurgitation. The incidence increases to 52% in mitral stenosis combined with regurgitant lesions of rheumatic etiology. Objective is to study the incidence, clinical features, etiology and complications of atrial fibrillation. Methods: A hospital based cross sectional study was conducted among 60 cases of atrial fibrillation at Mamata General Hospital, Khammam from July 2008 to March 2009. All cases were examined in detail as per the questionnaire with special reference to cardiovascular system. In each case, history of present and past illness was carefully inquired into so as to obtain a complete historical background of the case. Investigations, electrocardiogram and echocardiography were carried out. Data was entered in Microsoft Excel sheet and analyzed using proportions. Results: There was female predominance. The age ranged from 19 years to 85 years. Atrial fibrillation patients with rheumatic etiology commonly presented below 50 years. The chief complaints were found to be dyspnoea, palpitations, pedal edema, chest pain, hemoptysis and weakness of the limbs. The duration of symptoms ranged from 15 days to 20 years. Rheumatic heart disease was found to be the most common cause in 73.33% of cases. Mitral stenosis was the most common lesion among patients with rheumatic heart disease. The ventricular rate ranged between 60-180/min. Congestive cardiac failure was the commonest complication. Conclusions: Chronic atrial fibrillation due to rheumatic etiology was more common in younger group. Females were more commonly affected than males. Rheumatic heart disease was the commonest cause followed by ischemic heart disease and hypertension. The common complications were congestive cardiac failure, angina and embolic stroke. Most of the cases of chronic atrial fibrillation were associated with large left atrial size.


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Effects of cartoon programs on behavioural, habitual and communicative changes in children

2016-05-18T04-06-47Z
Source: International Journal of Community Medicine and Public Health
Shailesh Rai, Bhagwan Waskel, Salil Sakalle, Sanjay Dixit, Rajendra Mahore.
Background: Children have become much more interested in cartoons over many years and it has become a primary action to some lives. This has become a problem because too many children are watching too much cartoon program and they have become violent and addictive. Methods: An observational cross sectional study was conducted on 200 children of 5 to 15 years of age watching cartoon programs using simple random sampling in indore city over the period of 4 months. Pre designed, pre tested, semi structured questionnaire was used for data collection. Data was analysed using MS excel & SPSS version 20. Results: 33% of children showed an increase in violent behavior. 39% of children watch both (violent & nonviolent) type of cartoon programs. 64% of children neglect things told by parents while watching cartoon programs, 45% of children throw things/becomes violent when parents either switch off T.V/ask him to do some other work, 61% of children try to copy stunts after they have started watching cartoon programs. 81% of children have shown increased interest towards creative subjects and 73% of children have become sensitive towards others since they have started watching cartoon programs. Conclusions: Watching cartoons programs had significant effect on behaviour of children. Changes were negative and positive both. Majority of the children behave the way they watch people performing activities on the television screen and follow them in their everyday life.


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Influence of the cytochrome P450 2D6 *10/*10 genotype on the pharmacokinetics of paroxetine in Japanese patients with major depressive disorder: a population pharmacokinetic analysis.

Objective: Although the reduced function of the cytochrome P450 2D6*10 (CYP2D6*10) allele is common among Asian populations, existing evidence does not support paroxetine therapy adjustments for patients who have the CYP2D6*10 allele. In this study, we attempted to evaluate the degree of the impact of different CYP2D6 genotypes on the pharmacokinetic (PK) variability of paroxetine in a Japanese population using a population PK approach. Methods: This retrospective study included 179 Japanese patients with major depressive disorder who were being treated with paroxetine. CYP2D6*1, *2, *5, *10, and *41 polymorphisms were observed. A total of 306 steady-state concentrations for paroxetine were collected from the patients. A nonlinear mixed-effects model identified the apparent Michaelis-Menten constant (Km) and the maximum velocity (Vmax) of paroxetine; the covariates included CYP2D6 genotypes, patient age, body weight, sex, and daily paroxetine dose. Results: The allele frequencies of CYP2D6*1, *2, *5, *10, and *41 were 39.4, 14.5, 4.5, 41.1, and 0.6%, respectively. There was no poor metabolizer who had two nonfunctional CYP2D6*5 alleles. A one-compartment model showed that the apparent Km value was decreased by 20.6% in patients with the CYP2D6*10/*10 genotype in comparison with the other CYP2D6 genotypes. Female sex also influenced the apparent Km values. No PK parameters were affected by the presence of one CYP2D6*5 allele. Conclusion: Unexpectedly, elimination was accelerated in individuals with the CYP2D6*10/*10 genotype. Our results show that the presence of one CYP2D6*5 allele or that of any CYP2D6*10 allele may have no major effect on paroxetine PKs in the steady state. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Definition and risk factors for chronicity following acute idiosyncratic drug-induced liver injury

Journal of Hepatology

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Negative effects on psychological health and quality of life of genuine irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease

Clinical Gastroenterology and Hepatology

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Targeted agents in GI radiotherapy: Clinical efficacy and side effects

Best Practice & Research Clinical Gastroenterology

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Alcohol intake increases the risk of hepatocellular carcinoma in patients with hepatitis C virus-related compensated cirrhosis: a prospective study

Journal of Hepatology

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Challenging chemoresistant metastatic colorectal cancer: Therapeutic strategies from the clinic and from the lab

Annals of Oncology

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Psychiatric and substance use disorders in HIV/hepatitis C virus (HCV)-coinfected patients: does HCV clearance matter? [Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) HEPAVIH CO13 cohort]

HIV Medicine

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Self-identification and management of hand-foot syndrome (HFS): effect of a structured teaching program on patients receiving capecitabine-based chemotherapy for colon cancer

Supportive Care in Cancer

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Association of acute gastroesophageal reflux disease with esophageal histologic changes

JAMA

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Regulation of GLI underlies a role for BET bromodomains in pancreatic cancer growth and the tumor microenvironment

Clinical Cancer Research

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Randomized phase III study of bevacizumab plus FOLFIRI and bevacizumab plus mFOLFOX6 as first-line treatment for patients with metastatic colorectal cancer (WJOG4407G)

Annals of Oncology

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Is there value in alvimopan in minimally invasive colorectal surgery?

The American Journal of Surgery

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Metastatic gastroesophageal adenocarcinoma patients treated with systemic therapy followed by consolidative local therapy: A nomogram associated with long-term survivors

Oncology

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Inflammatory bowel disease, cancer and medication: cancer risk in the Dutch population based IBDSL cohort

International Journal of Cancer

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A randomized phase III trial comparing S-1 versus UFT as adjuvant chemotherapy for stage II/III rectal cancer (JFMC35-C1: ACTS-RC)

Annals of Oncology

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Comprehensive genomic profiling of anal squamous cell carcinoma reveals distinct genomically defined classes

Annals of Oncology

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Routine anti-Helicobacter immunohistochemical staining is significantly superior to reflex staining protocols for the detection of Helicobacter in gastric biopsy specimens

Helicobacter

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Electroencephalogram variability in patients with cirrhosis associates with the presence and severity of hepatic encephalopathy

Journal of Hepatology

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Gluten sensitivity: fact or fashion statement?

Current Opinion in Otolaryngology and Head & Neck Surgery

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A prospective, randomized, placebo controlled trial evaluating the efficacy and safety of propofol sedation by anesthesiologists and by gastroenterologist-led teams using computer-assisted personalized sedation during upper and lower GI endoscopy

Digestive Endoscopy

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Cancer stem-like properties in colorectal cancer cells with low proteasome activity

Clinical Cancer Research

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Prevalence of thyroid dysfunction in the patients visiting Tertiary Health Care Hospital, Firozabad; Uttar Pradesh

2016-05-18T01-10-49Z
Source: International Journal of Medical Science and Public Health
Mushir Ahmad, Shahid Iqbal, Naved Ahmad, Iqbal Mohammad Khan.
Background: Thyroid disorders (hypothyroidism and hyperthyroidism) are a widespread thyroid problem, but there are no reports on the incidence and prevalence of thyroid disorders in this part of Western Uttar Pradesh of India. Objective: The aim of this study was to assess the prevalence of thyroid disorders in Firozabad and its adjoining areas. Materials and Methods: This retrospective hospital-based study involved 982 patients having undergone thyroid function assay, in the central clinical biochemistry laboratory of F. H. Medical College and Hospital, Firozabad. Firozabad is a city in western Uttar Pradesh of India about 40 km from Agra. These patients were evaluated for thyroid hormonal assay- total tri iodo thyronine (T3), total tetra iodo thyronine (T4), and thyroid stimulating hormone (TSH) by Vidas auto analyzer using enzyme-linked fluorescent assay technique. Statistical analysis was performed by SPSS version 17 software. Result: Our study shows high prevalence of abnormal thyroid hormone levels (hypothyroidism including subclinical hypothyroidism 43% and hyperthyroidism was 26%) with female preponderance. Conclusion: The study has defined thyroid function status in thyroid patients of Firozabad, Uttar Pradesh, India. Higher prevalence of hypothyroidism was observed in patients (especially females) in third decade of life. The findings also support the indication of thyroid hormone screening during third decade of life and afterwards.


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Single-incision totally extraperitoneal inguinal hernia repair is safe and feasible in elderly patients: A single-center experience of 365 procedures

Abstract

The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair in elderly patients. A retrospective analysis of 365 patients who underwent of SILS for totally extraperitoneal inguinal hernia repair from January 2012 to November 2015 at Osaka Police Hospital was performed, and the outcomes of patients aged <80 years and those aged ≥80 years were compared. There was a greater proportion of patients with an ASA score ≥3 among those ≥80 years than among those <80 years. The mean operative time for unilateral inguinal hernia was 94 min in patients <80 years and 98 min in patients ≥80 years. The mean operative time for bilateral inguinal hernia was 133 min in patients <80 years and 130 min in patients ≥80. Intraoperative bleeding was minimal in all patients. Conversion to a different operative procedure occurred in 3% (10/322) of patients <80 years and in 5% (2/43) of patients ≥80 years (P = 0.6). The mean postoperative hospital stay was 2.2 days for patients <80 years and 2.2 days for patients ≥80 years. The mean follow-up period 21 ± 14 months (range, 3–50 months) for patients <80 years and 17 ± 14 months (range, 3–50 months) for patients ≥80 years (P = 0.3). Postoperative complications were seen in 12% (38/322) of patients <80 years and in 14% (6/43) of patients ≥80 years (P = 0.7). A seroma was seen in 9% (28/322) of patients <80 years and in 12% (5/43) of patients ≥80 years (P = 0.6). A wound infection occurred in 2% (8/322) of patients <80 years. These seromas and wound infections were managed conservatively. Pulmonary embolism was seen in one patient <80 years (0.3%). There was no mortality or recurrence in either group. SILS for totally extraperitoneal inguinal hernia repair has good cosmesis and can be performed in elderly patients with acceptable morbidity and mortality.

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Long-term outcome of peroral endoscopic myotomy for achalasia treatment in a 9-year-old female patient

Abstract

Achalasia is a primary motility disorder with incomplete lower esophageal sphincter relaxation; it has an annual incidence of 0.11 cases per 100 000 children. Peroral endoscopic myotomy (POEM) is a new endoscopic treatment method for achalasia. Reports about POEM in pediatric patients are rare. We herein report the case of a 9-year-old female patient with achalasia who underwent POEM. The patient underwent endoscopic balloon dilatation because medication was not effective at a previous hospital; however, endoscopic balloon dilatation was not effective either. She then underwent successful POEM upon admission at our hospital. The patient was symptom-free at 2 years postoperatively with no signs of esophagitis in the absence of proton-pump inhibitor therapy.

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Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial.

Objective: In this study, we aimed to determine if stellate ganglion block (SGB) could reduce symptoms of posttraumatic stress disorder (PTSD) in comparison with sham therapy in military service members. Methods: In a randomized trial in which both participants and assessors were blind, participants with PTSD received either an SGB or a sham procedure. Posttraumatic stress disorder symptoms were measured using the CAPS (Clinician-Administered PTSD Scale) and self-report measures of PTSD, depression, anxiety, and pain. Subjects underwent assessment before the procedure and at 1 week, 1 month, and 3 months after the procedure. Patients receiving sham injections were allowed to cross over to the treatment group, and participants who maintained criteria for PTSD were allowed to receive a second SGB treatment. Results: Posttraumatic stress disorder, anxiety, and depression scores all showed improvement across time, but there was no statistically or clinically relevant difference in outcomes between the active and control groups. Individuals who crossed over from sham treatment to SGB similarly showed no greater improvement with the SGB treatment. Improvement in CAPS was greater with a second SGB treatment than after the first treatment. Conclusions: Although previous case series have suggested that SGB offers an effective intervention for PTSD, this study did not demonstrate any appreciable difference between SGB and sham treatment on psychological or pain outcomes. Future studies should examine if differences in treatment methods or patient population could allow individuals with PTSD to benefit from SGB, but current evidence does not support widespread or indiscriminant clinical use of the procedure for PTSD. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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