bluuebunny/crossref_metadata_2025 huggingface dataset:
False Loss of Resistance in Cervical Epidural
Injection: The Loss of Resistance Technique
Compared with the Epidrum Guidance in
Locating Epidural Space
Authors: Sim Dr. Woo Seog
Published: February 2021

Background: Epidural block failures can occur due to a misleading loss of resistance (LOR)
signal.
Objective: This study was designed to evaluate the false LOR rate and to determine whether
the Epidrum, which is an LOR device for identifying the epidural space, improves the ability to
find the epidural space during cervical epidural injection compared the LOR technique.
Study Design: A randomized, single-blind trial.
Setting: Single academic medical center.
Methods: A total of 150 patients undergoing cervical interlaminar epidural injections at
C7-T1 were randomized to receive either the LOR technique with a syringe (group C) or the
Epidrum guidance (group E). Fluoroscopic images were used to confirm the accuracy of the
needle placement within the epidural space. The rate of misleading epidural signals and
adverse effects were recorded and analyzed.
Results: The false LOR rate was 74.7% for group C, 62.7% for group E, and 68.7% overall.
The incidence of false LOR was not significantly different between the 2 groups. Also, the
success rate and the rate of true epidural signals were similar between the 2 groups.
Limitations: The Epidrum cannot be used to confirm whether the needle has entered the
vascular space without fluoroscopy.
Conclusions: In this study, we did not find any difference in accuracy between the Epidrum
and the LOR technique with a syringe for detecting the cervical epidural space. The overall
higher false LOR rate suggests that the combined use of fluoroscopy and LOR technique with
a syringe or the Epidrum is necessary to increase the rate of finding the true cervical epidural
space.

Clinical Trials registration: KCT0001333
Key words: Cervical epidural injection, epidural space, Epidrum, false positive, false negative,
loss of resistance
Radiofrequency Neurolysis for Lumbar Pain
Using a Variation of the Original Technique
Authors: León Jorge Felipe Ramirez
Published: February 2021

Background: Zygapophysial joint arthrosis is a pathology related with axial lumbar pain. The
most accepted treatment, after failure of medical management, is the thermal denervation
of the medial branch. Nonetheless, the placement of the heat probe remains a challenge to
surgeons, even when using the fluoroscope. Using a variation of Shealy’s and Bogduk’s original
techniques, which includes ablation of the medial branch and the nerves present in the joint
capsule, we hypothesize that we can obtain similar outcomes to those found in the literature.
Objective: To present the results attained over the last 8 years in the treatment of axial
lumbar pain from zygapophysial joints degeneration, by employing a variation of the lumbar
medial branch neurotomy technique, called 360-degree facet rhizotomy with radiofrequency.
Study Design: Retrospective evaluation.
Setting: Spine Center – Minimally Invasive Surgery in Bogotá, Colombia.
Methods: A medical chart review was conducted for patients diagnosed with axial lumbar
pain from zygapophysial joint arthrosis and treated with 360-degree facet rhizolysis with a high
frequency radiofrequency energy source between 2008 and 2014. Data were evaluated under
modified MacNab and pre- and postoperative visual analog scale (VAS) criteria.
Results: We obtained a total of 73 patients. The average population age was 58.6 years. The
preoperative VAS obtained was 7.3, which changed to 1.7 one year after the procedure. The
MacNab criteria 12 months after the surgery gave satisfactory outcomes (excellent and good)
from 91.7% of the patients.
Limitations: This retrospective study includes inherent limitations and only offers one year
follow-up data.
Conclusions: Thermal therapy for zygapophysial joint arthrosis constitutes a safe and
effective technique. The one year follow-up data presented here show that the ablation of
the medial branch and nerves present in the joint capsule leads to satisfactory results in a high
percentage of patients.
Key words: Zygapophysial joint, lumbar axial pain, high frequency radiofrequency, facet
arthrosis, neurolysis, thermal therapy, facet joint thermocoagulation
Different Influences of Lipofection and
Electrotransfection on In Vitro Gene Delivery to
Primary Cultured Cortex Neurons
Authors: Xiao Lan
Published: February 2021

Background: Many pain states are linked to central nervous system (CNS) diseases involving
the dysfunction of dendritic arborization, making restoration a promising therapeutic
strategy. Transfection of primary cortex neurons offers the possibility to study mechanisms
which are important for the restoration of proper arborization. Its progress is, however,
limited at present due to the lack of suitable gene transfer techniques.
Objective: To obtain better insight into the transfection potential of currently used
techniques, 2 non-viral transfection methods, lipofection and gene electrotransfer (GET),
were compared.
Study Design: This is a comparison study performed on cultured cells.
Methods: The transfection efficiency and neuronal viability, as well as the neuronal dendritic
arborization after lipofection or GET, were compared. Primary cultured cortex neurons were
transfected with the pEGFP-N1 plasmid, either using Lipofectamine 2000 (2, 3, or 4μL) or
with electroporation, with our previously optimized protocol (200V/25 ms).
Results: Transfection efficiency and cell viability were inversely proportional for lipofection.
The appropriate ratio of Lipofectamine and plasmid DNA provides optimal conditions for
lipofection. Although GET offered higher transfection efficiency, it could not induce complex
dendritic arborization, which made it unsuitable for in vitro gene transfer into cortex neurons.
Limitations: Limitations include species variability and translational applicability for CNS
diseases and pain states related to potential toxicity.
Conclusions: Based on these findings, lipofection might be advantageous for in vitro
application to primary cultured cortex neurons. Pain states, stress mediated pathogenesis,
and certain CNS diseases might potentially utilize this important technique in the future as
a therapeutic modality.
Key words: Lipofection, gene electrotransfer, CNS diseases, pain states, dendritic
arborization, transfection of primary cortex neurons
Successful Identification and Assessment of the
Superior Cluneal Nerves with High-Resolution
Sonography
Authors: Lieba-Samal Doris
Published: February 2021

Background: Low back pain is a disabling and common condition, whose etiology often
remains unknown. A suggested, however rarely considered, cause is neuropathy of the medial
branch of the superior cluneal nerves (mSCN)—either at the level of the originating roots or at
the point where it crosses the iliac crest, where it is ensheathed by an osseo-ligamentous tunnel.
Diagnosis and treatment have, to date, been restricted to clinical assessment and blind infiltration
with local anesthetics.
Objective: To determine whether visualization and assessment of the mSCN with high-resolution
ultrasound (HRUS) is feasible.
Study Design: Interventional cadaver study and case series.
Methods: Visualization of the mSCN was assessed in 7 anatomic specimens, and findings were
confirmed by HRUS-guided ink marking of the nerve and consecutive dissection. Further, a patient
chart and image review was performed of patients assessed at our department with the diagnosis
of mSCN neuropathy.
Results: The mSCN could be visualized in 12 of 14 cases in anatomical specimens, as confirmed
by dissection. Nine patients were diagnosed with mSCN syndrome of idiopathic or traumatic
origin. Diagnosis was confirmed in all of them, with complete resolution of symptoms after HRUSguided selective nerve block.
Limitations: These findings are first results that need to be evaluated in a systematic, prospective
and controlled manner.
Conclusion: We hereby confirm that it is possible to visualize the mSCN in the majority of
anatomical specimens. The patients described may indicate a higher incidence of mSCN syndrome
than has been recognized. mSCN syndrome should be considered in patients with low back pain
of unknown origin, and HRUS may be able to facilitate nerve detection and US-guided nerve
block.
Key words: Superior cluneal nerves, high-resolution ultrasound, peripheral neuropathy,
entrapment syndrome, nerve trauma, low-back pain, diagnostic blockade, anatomic study,
interventional study, Maigne syndrome
The Effectiveness of Alcohol Versus Phenol
Based Splanchnic Nerve Neurolysis for the
Treatment of Intra-Abdominal Cancer Pain
Authors: Koyyalagunta Dhanalakshmi
Published: February 2021

Pancreatic and other upper abdominal organ malignancies can produce intense visceral pain
syndromes that are frequently treated with splanchnic nerve neurolysis (SNN) or celiac plexus
neurolysis (CPN). Although commonly performed with either alcohol or phenol, there is scant
literature on the comparative effectiveness, duration of benefit, and complication profile
comparing the 2 agents. This study presents a retrospective chart review of 93 patients who
underwent SNN for cancer-related abdominal pain in order to describe patient characteristics,
examine comparative efficacy, duration of benefit, and incidence of complications with alcohol
vs. those of phenol. Consistent with previous studies, SNN reduced reported pain scores while not
significantly reducing opioid consumption. No difference in pain outcomes was found comparing
alcohol versus phenol based neurolytic techniques. Celiac axis tumor infiltration and pre-procedural
local radiation therapy did not change the effectiveness of the procedure. Our data demonstrated
that 44.57% of patients had ≥ 30% pain reduction while 43.54% did not have pain reduction.
Interestingly, the procedure produced significant improvements in anxiety, depression, difficulty
thinking clearly, and feeling of well-being. In addition, no difference in complications was seen
between the agents either. SNN was an effective and relatively safe procedure for the treatment
of pain associated with pancreatic and other upper abdominal organ malignancies in our sample
of patients. Choice of neurolytic agent can appropriately be left to the clinical judgment and local
availability of the treating physician. The change in ancillary symptoms has a theoretical basis that
supports a biopsychosocial model of pain since changes in one target area (pain) impact other
related ones (depression and anxiety).
Key words: Celiac plexus, splanchnic nerves, neurolysis, nerve block, alcohol, ethanol, phenol,
pain, cancer pain, abdominal pain, visceral pain, symptom assessment
What Is the Role of Epidural Steroid Injections
in Lumbar Spinal Disease with Moderate
Disability?
Authors: Hong Jae-Young
Published: February 2021

Epidural steroid injections have been gaining popularity as an alternative to surgical treatment of
radicular pain with associated spinal derangement. To determine the effectiveness and indications
of lumbar epidural steroid injections in patients with or without surgery, we performed a prospective
observational study.
We gathered data from 262 degenerative short-segment spinal disease patients (affected at one
or 2 levels) with greater than 12 weeks of medication-resistant radicular pain without neurological
deficits but with moderate disability (visual analog scale < 6.5; Oswestry Disability Index < 35). All
patients received initial fluoroscopically guided transforaminal epidural steroid injections of the
affected vertebral level(s) corresponding to their symptoms. Those with inadequate responses or
who wanted subsequently surgery underwent decompression surgery. Clinical and demographic
characteristics were assessed to compare the differences between the groups.
Results: Of the 262 patients who received epidural steroid injections, 204 did not have operations
for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations
and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and
pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients
who underwent surgery, the mean disability and pain scores were not significantly decreased after
injection compared to those in the injection-alone group, although the scores for the injection
plus surgery patients decreased significantly after surgery (P < 0.05). In contrast, patients who
underwent epidural steroid injection alone experienced a significant decrease in disability and pain
after injection, and that persisted up to one year of follow-up (P < 0.05).
Epidural steroid injection can decrease the pain and disability in the majority of a moderate disability
group for up to one year, although a significant number of patients underwent surgery regardless
of injection. We recommend epidural steroid injection as a first-line treatment in patients with
moderate disability that can be converted to surgery without significant delay.
Key words: Epidural steroid injection, spinal surgery, lumbar spinal disease, lumbar radiculopathy,
lumbar radicular pain
Effect of 3 Different Doses of Intrathecal
Dexmedetomidine (2.5µg, 5µg, and 10 µg)
on Subarachnoid Block Characteristics: A
Prospective Randomized Double Blind DoseResponse Trial
Authors: Gupta Dr Mayank
Published: February 2021

Background: The extended analgesic efficacy of intrathecal dexmedetomidine (ITD) has been
investigated in a few clinical trials; however, there is a lack of conclusive evidence upon its ideal
dosage.
Objectives: To elucidate the dose-response relationship between ITD and subarachnoid block
characteristics, particularly the duration of analgesia and differential analgesia (DA: defined as time
difference from the offset of motor blockade to the first analgesic requirement on numerical rating
scale ≥ 4.0).
Study Design: Prospective, randomized double blind active control trial.
Setting: Medical college teaching hospital.
Methods: Ninety adult (18 – 60 years) patients undergoing elective lower abdominal and lower limb
surgeries were randomized into 3 groups to receive intrathecal 0.5% bupivacaine 3 mL with 2.5 µg
(group BD2.5), 5µg (group BD5), or 10 µg (group BD10) dexmedetomidine in 0.5 mL normal saline.
The 2 segment sensory regression times (TSSRT), duration of motor blockade analgesia, DA, and
perioperative adverse effects were assessed. The primary outcome was duration of analgesia and DA.
Statistics: ANOVA, Kruskal Wallis test, Chi-square (χ2), and Fisher’s exact test, significance: P < 0.05.
Results: The onset of sensory block was significantly earlier in group BD10 compared with group
BD5 (P = 0.035) and BD2.5 (P = 0.010) while the onset of motor block was significantly earlier in group
BD10 compared with BD2.5 (P = 0.020). There was a significant and dose-dependent prolongation of
the duration of sensory block (127.50, 149.17, and 187.50 minutes; P < 0.001), motor block (258.50,
331, and 365 minutes; P < 0.001), analgesia (306.17, 396.50, and 512 minutes; P < 0.001), and DA
(47.67, 65.50, and147 minutes; P < 0.001) with escalating doses of ITD, respectively. Group BD10
required significantly fewer rescue analgesics compared with other 2 groups (P = 0.001). Except for
mild sedation which was significantly higher in group BD10; all the groups were comparable with
respect to hemodynamic and other adverse effects.
Limitations: Lack of placebo group, exclusion of higher doses (15µg) of ITD, and short duration of
postoperative follow-up.
Conclusions: The addition of 10 µg compared with 2.5 µg or 5µg ITD to 0.5% hyperbaric bupivacaine
is associated with significantly earlier onset of sensory and motor block as well as prolonged duration
of sensory block, motor block, analgesia, and DA with a comparable adverse effect profile.
Key words: Analgesia, bupivacaine, dexmedetomidine, differential analgesia, intrathecal, pain,
spinal anaesthesia
Motor Neuron Diseases Accompanying Spinal
Stenosis: A Case Study
Authors: Choi Yun Suk
Published: February 2021

A 75-year-old man, who was healthy, visited the hospital because of shooting
pain and numbness in both lower limbs (right > left). The patient had an L4/5
moderate right foraminal stenosis and right subarticular disc protrusion and
received a lumbar epidural block. The patient experienced severe weakness in the
right lower limb after 2 days. Lumbar and cervical magnetic resonance images
were taken and electromyography and a nerve conduction study were performed
to arrive at the diagnosis of a motor neuron disease. The patient expired 4 months
later with respiratory failure due to motor neuron disease. This case suggests that
any abnormal neurological symptoms that occur after an epidural block should
be examined thoroughly via testing and consultations to identify the cause of the
symptoms.
Key words: Leg pain, epidural steroid injections, motor neuron disease
Pain Physician 2016; 19:E455-E458
Serratus Plane Block for Persistent Pain
after Partial Mastectomy and Axillary Node
Dissection
Authors: Takimot Kayo
Published: February 2021

Persistent pain after breast cancer surgery (PPBCS) is defined as chronic neuropathic pain
that persists for more than 3 months after surgery. The pain can be sufficiently severe to
cause long-term disabilities and interfere with sleep and daily life. Serratus plane block (SPB)
is a novel, ultrasound-guided regional anesthetic technique that is suggested to achieve
complete anesthesia of the anterolateral chest wall. Here, we demonstrate the efficacy
of SPB as one of the treatment modalities for patients with PPBCS. A 73-year-old woman
underwent a left partial mastectomy and axillary node dissection for breast cancer. Four
months after surgery, she experienced burning pain with nocturnal exacerbation rated 10/10
on a numerical rating scale (NRS), hot flashes, numbness, and hyperesthesia of the left axilla.
Pharmacological therapy did not improve her symptoms, and 15 months after the surgery, she
experienced depression. We treated her with SPB with 10 mL of 1% lidocaine; this treatment
was repeated 10 times over 6 months at 2- to 4-week intervals and she was simultaneously
treated with pharmacological, physical, and cognitive behavioral therapy. With her improved
pain control, she was able to perform physical therapy and subsequently experienced marked
improvement in her functional status and ability to perform daily activities. She has not
required any interventional pain management since the last SPB performed 11 months ago.
SPB represents one of the treatment modalities for PPBCS and is an advantageous technique
because it can be performed more safely and easily than neuraxial approaches.
Key words: Persistent pain after breast cancer surgery, serratus plane block, SPB, chronic
pain, peripheral nerve block, ultrasound, interventional pain management
Bipolar Radiofrequency Neurotomy to Treat
Neck and Back Pain in Patients with Automatic
Implantable Cardioverter Defibrillator
Authors: Bautista Alexander
Published: February 2021

We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency
ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable
cardioverter defibrillator (AICD).
Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA
of the facet joints. One presented with axial neck pain and the other with axial back pain. The
histories and physical examinations were consistent with facetogenic pain. Diagnostic medial
branch block resulted in more than 70% pain relief lasting for several days, allowing patients
to perform routine daily activities without significant pain. However, we were concerned about
the use of conventional RFA of the medial branches of nerves for the fear of interference with
the function of AICD by the RF currents and energy. We took advantage of the localized and
limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints
avoiding any interference with the function of AICD. The procedures provided long-term pain
relief to the patients, and marked improvement in their functional status without any evident
complications related to the function of their AICD.
This case report describes the safe and successful completion of bipolar RFA of the medial
branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality
of treatment may be considered in patients with AICD. We are finding it to be increasingly
common that patients who present with chronic neck and back pain have AICDs in place.
Key words: Back pain, neck pain, facet, AICD, radiofrequency neurotomy, bipolar lesioning
Severe Scapular Pain Following Unintentional
Cervical Epidural Air Injection
Authors: Henthorn Randall W.
Published: February 2021

This a unique case of severe scapular pain following unintentional epidural space air injection
during epidural steroid injection.
A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid
injection. Three injection attempts were made using the loss of resistance with air technique. On
the first attempt the epidural space was entered, but contrast injection showed that the needle
was intravenous. On the second attempt an equivocal loss of resistance with air was perceived
and 5 mL of air was lost from the syringe. The needle was withdrawn and redirected, and upon
the third needle passage the contrast injection showed appropriate epidural space filling up to
the C4-5 level. Injection of betamethasone mixed in lidocaine was initially uneventful.
However, 20 minutes post-injection the patient experienced sudden sharp and continuous pain
along the medial edge of the scapula. After failing to respond to multiple intravascular analgesics,
the patient was transferred to the emergency room. Her pain subsided completely following an
intravenous diazepam injection. Cervical spine computerized tomography showed obvious air in
the posterior epidural space from C4-5 to C6-7 as well as outside the spinal canal from (C4-T2).
Having recovered fully, she was discharged the following morning.
In reviewing the procedure, the equivocal loss of resistance on the second passage was actually
a true loss of resistance to epidural space and air was unintentionally injected. Surprisingly, severe
scapular pain resulted in a delayed manner after the steroid solution was injected. The authors
theorize that unintentional prefilling of the epidural space with air prior to the injection of the
subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided
C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The
subsequent intravenous diazepam provided cervical muscle relaxation and facilitated foramina
passage of air out of the spinal canal.
This case demonstrates that under certain conditions entry of air into cervical epidural space can
lead to unexpected, albeit temporary, neurological symptoms.
Key Words: Pheumorrhacis, cervical, epidural, steroid, complication, pain, radiucular, air
Sequential Transarterial Embolization Followed
by Percutaneous Vertebroplasty Is Safe and
Effective in Pain Management in Vertebral
Metastases
Authors: Xiao En-hua
Published: February 2021

Background: Vertebral metastases are the most frequent vertebral tumor. Transarterial
embolization (TAE) devascularizes the tumor, resulting in tumor necrosis. Percutaneous
vertebroplasty (PVP), a minimally invasive procedure, can effectively relieve tumor-related pain
and improve spine stability. Unfortunately, the PVP technique is of limited use in controlling the
progression of vertebral tumor, especially for paravertebral metastases. TAE combined with PVP
may achieve a better control on vertebral metastases with paravertebral extension, but little
information regarding the combination is available.
Objectives: The present study is intended to assess the safety and effectiveness of the combination
of TAE and PVP in patients suffering from vertebral metastases with paravertebral extension.
Study Design: Sequential TAE followed by PVP was used in 25 patients with symptomatic
vertebral metastases. The safety and effectiveness of the sequential therapy were evaluated.
Setting: Three hospitals’ clinical research centers.
Methods: This retrospective study was conducted with 25 consecutive patients (11 women and
14 men; mean age 59.3 years, range 38 – 80 years) with vertebral and paravertebral metastases
from March 2009 to March 2014. The patients were treated with TAE, and 5 – 7 days later with the
PVP procedure. The clinical outcomes were assessed by the control of pain using visual analog scale
(VAS) scores, and computed tomography (CT) imaging. X2 or Fisher exact testing was performed
for univariate analysis of variables. The VAS scores between groups were compared using ONEWAY ANOVA, with a P-value of less than 0.05 considered statistically significant.
Results: All the TAE and PVP procedures were successfully done. Mean VAS scores decreased
after TAE (from 8.64 ± 0.58 to 5.32 ± 1.46, P < 0.05) and further decreased after PVP (from 5.32
± 1.46 to 2.36 ± 0.54, P < 0.05), and the decrease in VAS lasted until the third month (3.08 ±
1.52, P > 0.05) follow-up. However, VAS scores at the sixth month were statistically higher than
those at the third month (4.8 ± 1.24 versus 3.08 ± 1.52, P < 0.05), VAS scores at the twelfth
month were statistically higher than those at the sixth month (6.29 ± 1.07 versus 4.8 ± 1.24, P <
0.05). We found paravertebral cement leakage in 6 cases. No clinical or symptomatic complications
were observed. In the follow-up, no patient showed further vertebral compression or spinal canal
compromise.
Limitations: This is a retrospective clinical study of a small number of patients.
Conclusion: The sequential TAE followed by PVP is safe and effective in treating vertebral
metastases with paravertebral extension.
Key words: Spine, metastases, pain, embolization, vertebroplasty, interventional radiology, PVP,
TAE
The Role of Immunoglobulin E in the
Pathogenesis of Ketamine Related Cystitis
and Ulcerative Interstitial Cystitis: An
Immunohistochemical Study
Authors: Kuo Dr. Hann-Chorng
Published: February 2021

Background: A previous study revealed elevated serum Immunoglobulin E (IgE) in ketamine
related cystitis (KC) patients. IgE might participate the pathogenesis of different types of bladder
pain syndromes, including KC and interstitial cystitis (IC).
Objectives: To investigate the IgE expression in KC and IC bladder tissue.
Study Design: Prospective evaluation.
Setting: The study was conducted in a tertiary teaching hospital, Hualien Tzu Chi Hospital.
Methods: We investigated the bladder IgE with immunofluorescence staining and quantification.
The active mast cells were measuring using tryptase. The symptoms and urodynamic study results
were recorded. Double immunofluorescence staining of tryptase and IgE was also performed.
Sixteen KC patients, 10 ulcerative IC patients, and 20 non-ulcerative IC patients participated. The
history and urodynamic parameters were investigated in these patients. The bladder mucosa was
biopsied during cystoscopic hydrodistention. Bladder biopsies were also taken from 22 patients
with bacterial cystitis and 12 healthy controls.
Results: Bladder IgE was positive in 15 (93.8%) KC patients, 9 (90%) ulcerative IC patients, one
(5%) non-ulcer IC patient, 8 (36.4%) bacterial cystitis patients, and 2 (16.7%) controls (P < .001).
The bladder IgE was greater in the patients with KC than in the others (P < .001). After excluding
KC patients, bladder IgE was significantly higher in the patients with ulcerative IC than the others
(P < .001). The bladder IgE was significantly correlated with pain on a visual analogue scale (r2 =
0.156, P = .017) and maximum bladder capacity (r2 = 0.423, P < .001). Tryptase expression did
not show a significant difference between KC, ulcer IC, and non-ulcer IC (P = 0.222). Double
immunofluorescence staining showed co-expression of tryptase and IgE.
Conclusions: IgE-mediated inflammation played a significant role in the pathogenesis of KC and
ulcerative IC.
Key words: Immunoglobulin E, ketamine cystitis, interstitial cystitis
Microstructural Abnormalities in Gray Matter
of Patients with Postherpetic Neuralgia: A
Diffusional Kurtosis Imaging Study
Authors: Yu Buwei
Published: February 2021

Background: Changes in functional activity and connectivity have been shown in patients
experiencing postherpetic neuralgia (PHN) pain. However, PHN-induced structural changes,
particularly in the gray matter of which volume and density was widely reported to be altered by
other chronic pain, have not been well characterized.
Objective: In this study, we aimed to detect the difference in the microstructure of gray matter
of PHN patients as compared to the healthy controls, and to analyze the correlation between
microstructural alterations and clinical features of PHN patients.
Study Design: Observational study.
Setting: University hospital.
Methods: Diffusional kurtosis imaging (DKI) was performed in 19 patients with PHN and in 19
age- and gender-matched healthy controls. Maps of axial kurtosis (K//), mean kurtosis (MK), radial
kurtosis (K⊥) in gray matter were calculated and compared between the 2 groups. Correlations
between kurtosis metrics in the regions where between-group difference was detected and pain
intensity as well as lesion duration were tested by Pearson’s correlation.
Results: Compared with healthy controls, PHN patients exhibited significantly decreased DKI
parameters in the bilateral insula and superior temporal gyrus, left middle frontal gyrus and
occipital lobe, right cerebellum anterior lobe, right thalamus, caudate and parahippocampal gyrus.
K// in the bilateral insula and MK in the right insula were negatively correlated with visual analogue
scale (VAS) scores of PHN patients, whereas no correlation was found between DKI parameters and
lesion duration of PHN pain.
Limitation: Relatively small sample size. We still cannot determine the causal and effect
relationship between the microstructural abnormalities in the gray matter and PHN.
Conclusions: DKI can specifically reflect pathophysiological microstructural alterations in the
cerebral gray matters of PHN patients. This feature enables magnetic resonance imaging (MRI)
to be a potentially valuable technique for objectively estimating the severity of PHN pain, which
would provide an opportunity for elucidating the central mechanisms underlying PHN as well.
Key words: Postherpetic neuralgia, diffusional kurtosis imaging, insula cortex, gray matter,
voxel-based analysis
Ultrasound-Guided Phrenic Nerve Block for
Intractable Hiccups following Placement of
Esophageal Stent for Esophageal Squamous
Cell Carcinoma
Authors: Arsanious David
Published: February 2021

Hiccups are actions consisting of sudden contractions of the diaphragm and intercostals
followed by a sudden inspiration and transient closure of the vocal cords. They are generally
short lived and benign; however, in extreme and rare cases, such as esophageal carcinoma,
they can become persistent or intractable, up to and involving significant pain, dramatically
impacting the patient’s quality of life.
This case involves a 60-year-old man with a known history of squamous cell carcinoma of the
esophagus. He was considered to have high surgical risk, and therefore he received palliative
care through the use of fully covered metallic esophageal self-expandable stents due to
a spontaneous perforated esophagus, after which he developed intractable hiccups and
associated mediastinal pain. Conservative treatment, including baclofen, chlorpromazine,
metoclopramide, and omeprazole, provided no relief for his symptoms. The patient was
referred to pain management from gastroenterology for consultation on pain control. He
ultimately received an ultrasound-guided left phrenic nerve block with bupivacaine and
depomedrol, and 3 days later underwent the identical procedure on the right phrenic nerve.
This led to complete resolution of his hiccups and associated mediastinal pain. At followup, 2 and 4 weeks after the left phrenic nerve block, the patient was found to maintain
complete alleviation of the hiccups.
Esophageal dilatation and/or phrenic or vagal afferent fiber irritation can be suspected
in cases of intractable hiccups secondary to esophageal stenting. Regional anesthesia of
the phrenic nerve through ultrasound guidance offers a long-term therapeutic option for
intractable hiccups and associated mediastinal pain in selected patients with esophageal
carcinoma after stent placement.
Key words: Esophageal stent, esophageal stenting, intractable hiccups, intractable
singultus, phrenic nerve block, phrenic nerve, ultrasound, palliative care, esophageal
carcinoma
Ultrasound-Guided Diagnosis and Treatment of
Meralgia Paresthetica
Authors: Ata Ayse Merve
Published: February 2021

Meralgia paresthetica refers to the entrapment of the lateral femoral cutaneous nerve at the
level of the inguinal ligament. The lateral femoral cutaneous nerve – a purely sensory nerve –
arises from the L2 and L3 spinal nerve roots, travels downward lateral to the psoas muscle, and
then crosses the iliacus muscle. Close to the anterior superior iliac spine, the nerve courses in
contact with the lateral aspect of the inguinal ligament and eventually innervates the lateral
thigh. The entrapment syndrome is usually idiopathic but can also ensue due to trauma/
overuse, pelvic and retroperitoneal tumors, stretching of the nerve due to prolonged leg/trunk
hyperextension, leg length discrepancies, prolonged standing, external compression by belts,
weight gain, and tight clothing. The diagnosis of Meralgia paresthetica is usually clinical, i.e.,
based on the following symptoms: paresthesia, numbness, burning sensation, dysesthesia,
and pain over the anterolateral aspects of the thigh. These complaints may be worsened by
walking or prolonged standing and typically disappear after weight loss, abdominal muscle
strengthening, or elimination of the underlying cause. Although there are several reports on
the confirmatory role of electrodiagnostic studies in the diagnosis of Meralgia paresthetica,
electromyographers would usually prefer/suggest not to perform nerve conduction studies in
daily clinical practice. Herewith, due to its several advantages, ultrasound imaging has been
proposed as an alternative diagnostic method in the recent literature. It not only confirms
the entrapment morphologically, but also uncovers a likely underlying cause and provides
immediate interventional guidance. The pertinent sonographic findings would be hypoechoic
and swollen lateral femoral cutaneous nerve.
Key words: Meralgia paresthetica, ultrasound, diagnosis, treatment
Auto-Targeted Neurostimulation Is Not
Superior to Placebo in Chronic Low Back Pain:
A Fourfold Blind Randomized Clinical Trial
Authors: Nijs Jo
Published: February 2021

Background: Myofascial trigger points (MTrPs) are common in people with musculoskeletal
pain and may play a role in chronic nonspecific low back pain (CLBP). One of the potential
treatments of MTrPs is the Nervomatrix Soleve® auto-targeted neurostimulation device,
providing targeted transcutaneous electrical nerve stimulation (TENS) to MTrPs in the lower
back muscles. To date, no controlled studies have evaluated the effectiveness of this device for
the pain management of this population.
Objective: To examine whether the Nervomatrix Soleve® auto-targeted neurostimulation
device is superior over placebo for the treatment of CLBP.
Study Design: A fourfold-blind randomized controlled trial was conducted.
Setting: Brussels University Hospital, health care centers and pharmacies around Belgium.
Methods: Participants with CLBP for at least 3 months were randomly assigned to the
experimental (the Nervomatrix Soleve® auto-targeted neurostimulation device providing
TENS-stimulation and mechanical pressure) or placebo group (the Nervomatrix Soleve® autotargeted neurostimulation device providing mechanical pressure alone without current). The
treatment protocol in both groups consisted of 6 treatment sessions per patient. Participants
were evaluated at baseline prior to the intervention, immediately following treatment, and at
one month follow-up. Pain and pain behavior (steps climbed) were assessed as primary outcome
measures. Secondary outcome measures were pain functioning, health beliefs, symptoms of
central sensitization, pain catastrophizing, and kinesiophobia.
Results: In total, 39 participants were included in the study. Participants in both groups
improved significantly for pain and functioning, but no significant differences were observed
between groups. These improvements were not clinically meaningful for any of the reported
measures. The health beliefs changed significantly in both groups (P < 0.05), with superior
results at follow-up in the placebo group.
Limitations: The follow-up period is limited to one month.
Conclusions: Treatment of MTrPs with the Nervomatrix Soleve® auto-targeted
neurostimulation device in patients with CLBP does not result in a better outcome than
placebo-treatment in terms of pain, pain behavior, functioning, central sensitization, pain
catastrophizing, and health beliefs.
Key words: Low back pain, chronic pain, randomized controlled trial, electric stimulation
therapy, trigger points
Predictive Factors of Chronic Post-Surgical Pain at
6 Months Following Knee Replacement: Influence
of Postoperative Pain Trajectory and Genetics
Authors: Lloret-Linares Dr Célia
Published: February 2021

Background: The frequency of chronic postsurgical pain (CPSP) after knee replacement remains
high, but might be decreased by improvements to prevention.
Objectives: To identify pre- and postsurgical factors predictive of CPSP 6 months after knee
replacement.
Study Design: Single-center prospective observational study.
Setting: An orthopedic unit in a French hospital.
Methods: Consecutive patients referred for total or unicompartmental knee arthroplasty from
March to July 2013 were prospectively invited to participate in this study. For each patient, we
recorded preoperative pain intensity, anxiety and depression levels, and sensitivity and pain
thresholds in response to an electrical stimulus. We analyzed OPRM1 and COMT single-nucleotide
polymorphisms. Acute postoperative pain (APOP) in the first 5 days after surgery was modeled by
a pain trajectory. Changes in the characteristics and consequences of the pain were monitored 3
and 6 months after surgery. Bivariate analysis and multivariate logistic regression were conducted
to identify predictors of CPSP.
Results: We prospectively evaluated 104 patients in this study, 74 (28.8%) of whom reported
CPSP at 6 months. Three preoperative factors were found to be associated with the presence
of CPSP in multivariate logistic regression analysis: high school diploma level (OR = 3.83 [1.20 –
12.20]), consequences of pain in terms of walking ability, as assessed with the Brief Pain Inventory
short form “walk” item (OR = 4.06 [1.18 – 13.94]), and a lack of physical activity in adulthood
(OR = 4.01 [1.33 – 12.10]). One postoperative factor was associated with the presence of CPSP: a
high-intensity APOP trajectory. An association of borderline statistical significance was found with
the A allele of the COMT gene (OR = 3.4 [0.93 – 12.51]). Two groups of patients were identified
on the basis of their APOP trajectory: high (n = 28, 26%) or low (n = 80, 74%) intensity. Patients
with high-intensity APOP trajectory had higher anxiety levels and were less able to walk before
surgery (P < 0.05).
Limitations: This was a single-center study and the sample may have been too small for the
detection of some factors predictive of CPSP or to highlight the role of genetic factors.
Conclusion: Our findings suggest that several preoperative and postoperative characteristics
could be used to facilitate the identification of patients at high risk of CPSP after knee surgery.
All therapeutic strategies decreasing APOP, such as anxiety management or performing knee
replacement before the pain has a serious effect on ability to walk, may help to decrease the risk
of CPSP. Further prospective studies testing specific management practices, including a training
program before surgery, are required.
Key words: Chronic postsurgical pain, opioids, arthroplasty, pain trajectory, genetics, COMT,
predictive factors
Ultrasound-Guided Genicular Nerve Pulsed
Radiofrequency Treatment For Painful Knee
Osteoarthritis: A Preliminary Report
Authors: Kesikburun Dr. Serdar
Published: February 2021

Background: Genicular nerve ablation with radiofrequency (RF) has recently emerged as a
promising treatment in the management of osteoarthritis related knee pain. To date, genicular
nerve injections have been performed under fluoroscopic guidance.
Objective: To evaluate the effect of ultrasound-guided genicular nerve pulsed RF treatment on
chronic knee pain and function in patients with knee osteoarthritis.
Study Design: Single-arm prospective study.
Setting: University hospital and rehabilitation center in Turkey.
Methods: A review was made of 29 patients with medial knee osteoarthritis who had
undergone genicular nerve block in the previous 6 months. Patients with at least 50% reduction
in the visual analog scale (VAS) score after genicular nerve block and with no on-going pain
relief were selected for the study. Ultrasound-guided genicular nerve pulsed RF was applied to
15 knees of 9 patients. Pain and knee function were assessed with 100-mm VAS and Western
Ontario and McMaster Universities (WOMAC) index throughout 3 months.
Results: A significant reduction in VAS scores was detected over time after the pulsed RF
procedure (f: 69.24, P < 0.01). There was a significant improvement in the WOMAC scores (f:
539.68 , P < 0.01).
Limitations: The small number of participants, the lack of a control group, and short followup period were limitations of the study.
Conclusions: Genicular nerve pulsed RF treatment has been found to be safe and beneficial
in osteoarthritis related knee pain. Further studies with a larger population and randomized
controlled study design are warranted to confirm the positive findings of this preliminary report.
Key words: Knee pain, osteoarthritis, genicular nerve, ultrasonography, pulsed radiofrequency
Pancreatitis aguda, ¿otra manifestación de COVID-19?
Authors: Rodríguez-Chávez Luis Ángel , Vargas-Machuca Carranza Christian Alberto
Published: February 2021

La COVID-19 tiene manifestaciones extrapulmonares variadas. Dada su capacidad de comprometer el sistema digestivo, se ha encontrado manifestaciones como dolor abdominal, diarrea, síndrome de mala absorción, etc. Se presenta el caso de un paciente que inició con sintomatología respiratoria de COVID-19 que, posteriormente, evolucionó a pancreatitis aguda necrotizante severa que finalmente le ocasionó la muerte. Se revisa la literatura alrespecto.
Current and Future Best Practices for Pothole Repair in Illinois
Authors:   University of Illinois at Urbana-Champaign, Hajj Ramez , Lu Yujia ,   University of Illinois at Urbana-Champaign
Published: February 2021

This report presents a review of flexible pavement pothole-patching materials, equipment, and techniques within Illinois Department of Transportation as well as other transportation agencies in the United States. The research team conducted a literature review to examine recent studies and available state department of transportation guidance on pothole patching. Overall, this review revealed a lack of recent studies on this topic, and a greater need for them. The review also revealed that most states do not have centralized guidance for pothole repair best practices. The researchers also met with all nine Illinois Department of Transportation districts to determine their current state of practice for pothole patching. The meetings revealed a wide range of materials and techniques in use among the nine districts as well as areas where improvements can be made. The final chapter of this report includes overall recommendations for improvement.
Keragaman Bulu Babi (Echinoidea) di Perairan Pantai Pulau Merah Pesanggaran Banyuwangi
Authors: Aimatuzzahro Aimatuzzahro , Sufajar Agus , Nurchayati N.
Published: February 2021

Echinoidea has found in many marine defferences. This invertebrates were usually live in individualisia or in groups. They are live in rough substrate like rock and coastal but there are small group of  echinoidea has live in sandy and muddy subtrate. The purpose of  this research was to obtain the diversity ofechinoideain pulau merah shore Banyuwangi this research has been done in july 2016. This research used transek quadrat methode, divide 3 station. Station 1 lie down in side bouder of cea water, station 2 lie down in the middle of sea water and station 3 lie down prorude from sea water. In each station divide in 3 transeks and every transecs there were 3 plot. The result of this research showed there were 4 luind of echinoidea, Trineustes gratilla, Echinometra mathaei, Diadema sitosum, Sea urchin. the most many quantities of echinoidea species that found al most in all of the station was Echinometra mathaei the most hig herst diversity indees was Trineustes gratilla in station 2 (H’=1) in station 3(H’=1). In station 3 (H’=1). The most highast dominancy andecs was Echinometra mathaei in station 2 (D=0,664)
Smart Digital Mammographic Screening System for Bulk Image Processing
Authors: M Duraipandian , R Vinothkanna
Published: February 2021

Treating breast cancer is easier at early stages. However, proper diagnosis is essential for this purpose. Mammography helps in early detection of cancer cells. Existence of masses, calcification and mammogram are the evidences that help radiologists in early cancer identification. This paper proposes a smart digital mammographic screening system for processing images in large volumes irrespective of the nature of images. Watershed segmentation is performed based on appropriate selection of internal and external markers using multiple threshold extended maxima transformations in this technique. Distinguishing between healthy breast tissue and masses can be performed efficiently using a two-stage classifier. Extreme Learning Machine based single layer feed forward network along with Bayesian classifier is used for reducing false positive areas. Feature vector with features like texture and contrast are calculated using these approaches. Digital Mammography Screening database (DMS) is created with 100 mammographic images for the purpose of evaluation. Further, online databases like Breast Cancer Database (BCDB) and BreakHis are also used for analysis. Overall sensitivity of the datasets using the Bayesian classifier and Extreme Learning Machine is found to be 85% and 90% respectively.
IoT based Smart Motor Cycle Helmet
Authors: Shahare Bhavesh , Chawde Shivani , Gudafwar Rakesh , Pal Harshada , Bobade Purvi , Bawankar Shyam
Published: February 2021

The main purpose of this paper is to urge the two wheeler motor cycle riders to wear a helmet. In India, most of the death cases occur due to the two wheeler accidents. In most of the cases, rider suffers head injuries, which leads to death. In order to reduce the number of accidents, this research work proposes a smart helmet, which will be very useful for the two-wheeler riders. In general, two-wheeler accidents occur due to the high consumption of alcohol by the rider. The proposed smart helmet ensures the safety of the rider, while driving on the road. The proposed model comprises of an alcohol detection, accident identification, location tracking, hands-free device, solar powered module and fall detection. The proposed smart helmet will be connected to the ignition. Henceforth, if the rider does not wear a helmet, the ignition will not be triggered to start the two-wheeler. For handling an emergency situation, GSM module is used to send an alert message to the registered mobile number.