Alcohol Injection Research Articles

Characteristic pancreatic and splenic immune cell infiltration patterns in mouse acute pancreatitis

BackgroundA systemic evaluation of immune cell infiltration patterns in experimental acute pancreatitis (AP) is lacking. Using multi-dimensional flow cytometry, this study profiled infiltrating immune cell types in multiple AP mouse models.MethodsThree AP models were generated in C57BL/6 mice via cerulein (CAE) injection, alcohol and palmitoleic acid (EtOH + POA) injection, and alcohol diet feeding and cerulein (EtOH + CAE) injection. Primary pancreatic cells and splenocytes were prepared, and multi-dimensional flow cytometry was performed and analyzed by manual gating and computerized PhenoGraph, followed by visualization with t-distributed stochastic neighbor embedding (t-SNE).ResultsCAE treatment induced a time-dependent increase of major innate immune cells and a decrease of follicular B cells, and TCD4+ cells and the subtypes in the pancreas, whereas elicited a reversed pattern in the spleen. EtOH + POA treatment resulted in weaker effects than CAE treatment. EtOH feeding enhanced CAE-induced amylase secretion, but unexpectedly attenuated CAE-induced immune cell regulation. In comparison with manual gating analysis, computerized analysis demonstrated a remarkable time efficiency and reproducibility on the innate immune cells and B cells.ConclusionsThe reverse pattern of increased innate and decreased adaptive immune cells was consistent in the pancreas in CAE and EtOH + POA treatments. Alcohol feeding opposed the CAE effect on immune cell regulation. Together, the immune profiling approach utilized in this study provides a better understanding of overall immune responses in AP, which may facilitate the identification of intervention windows and new therapeutic strategies. Computerized analysis is superior to manual gating by dramatically reducing analysis time.

A retrospective multicenter study comparing bupivacaine and ropivacaine in endoscopic ultrasound guided celiac plexus neurolysis.

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely practiced to palliate cancer pain in patients with inoperable abdominal malignancy. During CPN, the dehydrated alcohol is injected to ablate neural tissue and local anesthetics is to minimize the discomfort from alcohol injection. This study aims to compare the efficacy and safety of bupivacaine and ropivacaine in EUS-CPN. We retrospectively pooled and analyzed two large EUS centers' 150 consecutive patients underwent EUS-CPN from January 2012 to March 2019. Patients were divided into 3 groups based on the selection of anesthetics: 0.5% ropivacaine (ROPI, n=23), 0.375% bupivacaine (0.375% BUPI, n=21), 0.75% bupivacaine (0.75% BUPI, n=106). Visual analogue scale (VAS) was used to measure pre/post-operative pain at 11 observation points. Additional data were collected from medical records. The incidence of procedure-related pain within 12 hours after CPN was significantly different among the three groups, 10.38% in 0.75% BUPI [OR =0.26 (95% CI: 0.07-0.94); P=0.04], 26.09% in ROPI and 23.81% in 0.375% BUPI group, respectively. The risk of post-procedural arrhythmia was similar between the 0.375% and 0.75% BUPI groups (19.05% versus 18.87%), while relatively lower in ROPI group (13.04%). No patients in any group developed symptoms of CNS toxicity related to anesthetics. Compared with 0.375% bupivacaine and 0.5% ropivacaine, 0.75% bupivacaine in CPN can reduce post-procedural pain. Ropivacaine shows a tendency of less arrhythmogenic effect in CPN.

Analysis of cases with maxillofacial arteriovenous malformation treated with balloon temporary block and percutaneous puncture sclerotherapy

To analysis the treatment effectiveness of maxillofacial arteriovenous malformation (AVM) by means of temporary balloon block and percutaneous puncture sclerotherapy. The treatment outcomes of 20 patients with AVM of maxillofacial deformity, aged (26.8±3.0) 18-36 years, from Dec 2012 to Dec 2019 were collected and retrospectively analyzed. All patients had been diagnosed AVM by digital substraction angiography (DSA). All the cases were treated by using balloons to temporary block responsible artery of the AVM in order to change the high-flow malformations into low-flow venous malformation. Then injection of polyethylene foam cinnamyl alcohol was conducted via percutaneous puncturing for hardening the vascular malformation. Comparing the symptoms and imaging changes before treatment with those 1-6 months after treatment according to Achauer curative effect evaluation standard. Totally 60% (12/20) of the cases were type Ⅱa AVM, and their treatments were effective. However, the treatment effects of type Ⅲb and type Ⅳ patients were relatively poor. The clinical effective rate was 85% (17/20), and the clinical curative rate was 50% (10/20). No skin necrosis, organ damage and other serious complications were observed for the 20 patients. The AVM patients with a main supply artery treated by using a balloon artery temporary block to make high flow malformations into low-flow and followed by percutaneous puncture sclerotherapy, could get good curative effect. It seemed that this approach was safe and effective.

Infiltrative Therapy of Morton's Neuroma.

The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone infiltrative therapy for treatment of Morton’s neuroma. As many kinds of substances are injected, the main outcome defines which treatment provides the best results in term of patient’s satisfaction and pain relief, so that it would be possible to choose the best option. Many electronic databases were searched on July 2021; we have included prospective and retrospective case series, and randomized controlled trials of infiltrative treatments in patients with primary diagnosis of Morton’s neuroma. The search returned 25 studies which met the inclusion criteria, with a total of 2243 cases. The incidence of outcomes was extracted and analyzed. Although many studies demonstrated favorable results in terms of pain relief and patient’s satisfaction employing different substances for infiltration, alcohol injection appears results on long run. (www.actabiomedica.it)

Effects of sympathectomy on myocardium remodeling and function

OBJECTIVES:To evaluate the effects of sympathectomy on the myocardium in an experimental model.METHODS:The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached.RESULTS:The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09).CONCLUSION:These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.

Surgery for Vertebral Hemangioma in Resource-Constrained Environment

Background: Vertebral hemangiomas are benign, highly vascular lesions of the vertebra. Asymptomatic hemangiomas are common, but they rarely enlarge in size and present with myelopathy. The aim of this study was to analyze the long-term outcome of patients of vertebral hemangioma presenting with myelopathy who were managed in a resource-constrained environment, the majority of whom were treated by our novel three-pronged strategy of alcohol injection, posterior decompression, and short segment fixation. Methods: All patients of symptomatic vertebral hemangioma with myelopathy treated at our hospital from 2001 to 2015 with follow up till January 2018, with at least 2 year follow up were included. The operative procedure, blood loss and complications were recorded. Clinical outcomes were measured using ASIA score. Results: Out of 60 patients operated, 44 (26 males, 18 females) fulfilled the inclusion criteria. 41 hemangiomas were located in the thoracic spine two in lumbar spine and one in cervical spine. Upper thoracic spine involvement was more common than lower thoracic spine involvement. Mean age was 29.34 years (range 10 - 68 years). Mean follow up was 74.63 months (range 24 - 180 months). All patients had improvement in motor strength postoperatively. Local pain, which was present in two patients resolved, bladder symptoms present in 13 patients also resolved. Conclusions: Our experience in treating symptomatic vertebral hemangiomas, along with the long term follow up data suggests that good postoperative results can be achieved with minimal complications, in carefully selected patients. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: Approval for the study was taken from the institutional ethical board.

The changing scenario of hepatocellular carcinoma in Italy: an update.

Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15years. Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004-2008, 2009-2013 and 2014-2018). The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non-viral cases and, particularly, of 'metabolic' and 'metabolic+alcohol' HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients. During the last 15years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients.

Abstract 15351: Changes in Left Ventricular End-diastolic Pressure Following Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Background: LVEDP is a representation of left ventricular diastolic function. An increased LVEDP correlates to decreased compliance and increased left ventricular workload, which can be seen in HOCM. In HOCM, the interventricular septum is hypertrophied creating a LVOT obstruction and elevated LVEDP. ASA induces a targeted septal infarction to reduce the size of the septum and relieve the LVOT obstruction. Non-targeted infarction in a MI can increase LVEDP. Our study aims to determine the immediate effect of ASA on LVEDP in HOCM patients. It is hypothesized that ASA immediately reduces LVEDP. Methods: Retrospective study of 113 patients where pre and post-ablation LVEDP were compared. LVEDP was measured at the end-expiratory R wave of the ECG tracing during the procedure. LVEDP measurements were recorded at the post-“a” wave points at the immediate start of the procedure (Group A), prior to the alcohol injection under mild sedation (Group B), and at the conclusion of the successful ablation (Group C). Results: Groups A, B, and C were compared using two-tailed t-tests. We found no statistical difference between groups A and B (mean A=31.34 vs. mean B=31.54; p=0.695). LVEDP was significantly lower in group C when compared to group A (mean A=31.34 vs. mean C=25.82; p=6.525E-9). LVEDP was also significantly lower in group C when compared to group B (mean B=31.54 vs. mean C=25.82; p=4.047E-9). A linear regression model showed no significant correlation between LVEDP and LVOT gradient reduction following ASA (R 2 =0.0258, Significance F=0.0891). Conclusion: This data supports our hypothesis that ASA immediately reduces LVEDP despite inducing an infarct of the septal myometrium. There is no effect of sedation on LVEDP during the procedure. Since LVEDP reduction does not seem to correlate with LVOT gradient reduction, the reduction in LVEDP is likely related to other hemodynamics improvements including reduction in mitral regurgitation and immediate improvement in diastolic function. Future studies can include evaluating a correlation between LVEDP reduction and immediate hemodynamic changes. They could also evaluate a correlation between the immediate drop in LVEDP and long-term outcomes to predict the prognosis of HOCM patients based on their ASA outcomes.

Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up

There is a paucity of literature on vertebroplasty in hemangioma. The effectiveness with short-term and long-term follow-up is an important insight for research. This study aims to evaluate the effectiveness and the long-term efficacy of vertebroplasty in the treatment of the patient with symptomatic vertebral hemangioma. Materials and methodsThis is a retrospective cohort study. The outcome was evaluated by immediate post-procedure and 3 months, 1 year, and 5 years of follow-up clinical status of the patients. The significance was determined by using a paired t-test between the pre-procedure and post-procedure severity of pain, activity score, and analgesic. The P-value < 0.05 indicated statistical significance. ResultsA total of 38 vertebroplasties were performed in 34 patients. Additionally, the embolization of residual soft tissue was performed in 4 patient and Percutaneous alcohol injection for posterior elements involvement was performed in 9 patients. Immediate after the procedure, 44.12% of patients became asymptomatic, 38.23% of patients showed significant improvement, 11.77% of patients remained static and 2.94% of patients deteriorated and needed laminectomy. The complication rate was 29.4%, but only 2 patients were symptomatic and needed surgical decompression. There was significant relief of pain (P < 0.05), reduced analgesic intake (P < 0.05), and increased activity (P < 0.05) immediately after the procedure, 3 months, 1 year, and 5 years follow-up. ConclusionPVP is an effective therapeutic option for the treatment of VH with fewer complications. The additional procedures like preprocedural embolization and percutaneous alcohol injection enhance the outcome and avoid complicated surgical interventions.

Effect of Withania somnifera (L.) Dunal aqueous root extract on reinstatement using conditioned place preference and brain GABA and dopamine levels in alcohol dependent animals

Ethnopharmacological relevanceWithania somnifera (L.) Dunal (WS), a known‘Rasayana’ (rejuvenating agent) as per Ayurveda is prescribed to promote health, to increase longevity and to hasten recovery in disease convalescent stages. WS has demonstrated protective effect on alcohol dependence and withdrawal anxiety in previous experimental studies. Aim of the studyTo evaluate effect of WS on conditioned place behavioral paradigm (model of relapse) and on GABA and dopamine levels in critical brain areas in alcohol dependent animals. MethodologyFollowing Animal Ethics Committee permission, the mice (n = 24) were divided into the following study groups for experiment 1: 1 -distilled water (vehicle control), 2 -WS and 3 -Naltrexone. They were conditioned on conditioned place preference (CPP) using alcohol (2 gm/kg)/saline (1 ml) administered intraperitoneally for 8 days. WS and Naltrexone were administered during the period of extinction (6–8 days). Effect of WS (650 mg/kg) on reinstating behaviour of mice (time spent in alcohol paired compartment) primed with alcohol injection was noted. In experiment 2, effect of WS (450 mg/kg/) on GABA and dopamine levels in the midbrain, striatum and cortex (ng/gm) were measured in alcohol dependent rats (n = 24) following the first phase of standardisation assay (n = 36). The rats were made alcohol dependent for 15 days (intermittent access model) and WS was administered concurrently. GABA and dopamine levels were measured on Day 16. ResultsWS group showed decrease in time spent in alcohol paired compartment alike Naltrexone and it differed significantly compared to the distilled water control group (p < 0.05) Alcohol-dependent rats showed significant decrease in GABA and increase in dopamine levels vs distilled water in the midbrain, striatum and cortex. WS and Naltrexone administration showed rise in GABA and fall in dopamine in all the isolated brain parts in the respective groups (p < 0.05 vs alcohol treated group). ConclusionWithania somnifera protected animals from relapse and showed beneficial effects on the brain neurotransmitters involved in alcohol dependence. The study provides substantial evidence for its potential application in alcohol use disorder.

Assessment of outcomes of combined minimally invasive perineal procedures for treatment of complete rectal prolapse in children: an approach to reduce recurrence rate

Background Rectal prolapse in children is common in developing countries with low health resources. Open and laparoscopic abdominal approaches are ideal for the treatment of rectal prolapse but they are not suitable for frail children and countries with poor medical resources. Perineal procedures are usually well tolerated and simple but have high recurrence rates. Objective Our objective is to assess the short-term outcomes of combined minimally invasive perineal procedures, including anal encirclement, submucosal alcohol injection, and Gant–Miwa procedure, in the management of full-thickness rectal prolapse in children. Through this combination, we looked forward toward magnifying the advantages of perineal procedures and allaying their complications, particularly recurrence rates. Patients and methods A total of 31 children with complete rectal prolapse were recruited during the period from May 2017 to June 2019. All the patients underwent three combined perineal procedures: mucosal plication (Gant’s technique), anal encirclement, and submucosal injection sclerotherapy. Results The study group included children with a median age of 6.55±2.14 years (range, 3.0–10.0 years). Mean operative time was 37.58±5.61 min (range, 30.0–45.0 min). The end results of our study were renovating anorectal physiology by correcting the rectal prolapse and improving continence (93.5%) and constipation (93.5%), with no mortality (0%) and low recurrence rates (3.2%). Conclusion Our approach (combined minimally invasive perineal procedures) is simple, effective, and less invasive, with minimal morbidity and a negligible recurrence rate, particularly for children with complete rectal prolapse.

Anhydrous Ethanol Improves Efficiency of Radiofrequency Ablation for the Treatment of Benign Thyroid Nodules:A Prospective Randomized Controlled Trial

Objective To investigate the value of injecting a small amount of absolute ethanol into the benign solid nodules of the thyroid before radiofrequency ablation(RFA)to improve the efficiency of radiofrequency ablation. Methods A total of 98 eligible patients(98 nodules)with pathologically confirmed benign solid nodules who were treated in our center from December 2016 to February 2018 were included and randomized into ethanol ablation(EA)combined with radiofrequency ablation(RFA)group(EA+RFA group)and RFA group,with 49 patients in each group.Routine ultrasound,contrast-enhanced ultrasound(CEUS),and thyroid function test were performed before treatment and 1,3,6,and 12 months after treatment.The general information,treatment time,ablation energy,ablation power,postoperative nodule volume reduction ratio(VRR),symptom score(SS)and cosmetic score(CS),thyroid function level,and incidence of complications were compared between these two groups. Results The mean treatment time [(441.30±243.31)s vs.(790.70±349.82)s;t= 4.403, P=0.000],mean ablation energy [(3.92±2.01)kJ vs.(5.15±2.12)kJ;t=2.709, P=0.009],and mean ablation power [(6.07±1.44)W vs.(7.30±1.29)W;t=3.612, P=0.006] were significantly lower in the EA+RFA group than in the RFA group.At 3,6 and 12 months after surgery,the VRR in the EA+RFA group was(57.73±11.07)%(t=-3.16, P<0.001),(64.40±10.56)%(t=-5.45, P<0.001),and(77.29±8.48)%(t=-10.46, P<0.001),respectively;the VRR in the RFA group was(55.44±13.01)%(t=-1.76, P<0.001),(65.28±11.33)%(t=-5.09, P<0.001),and(75.17±9.84)%(t=-8.93, P<0.001),which were significantly smaller than those before surgery.There was no significant difference in VRR between the EA+RFA group and the RFA group at 1(t=3.41, P=0.33),3(t=2.05, P=0.21),6(t=2.77, P=0.49),and 12 months(t=5.05, P=0.10)after treatment.During the follow-up,no recurrence of nodules was observed on CEUS.In the EA+RFA group,the SS [(1.77±0.86)vs.(5.54±2.15);t=9.63, P<0.001] and the CS[(1.39±0.77)vs.(3.32±0.61);t=10.09, P=0.004]at 12 months after surgery were significantly lower than those before surgery.In the RFA group,SS [(1.63±1.04)vs.(5.90±1.79);t=12.72, P<0.001] and CS [(1.64±0.83)vs.(3.15±0.72);t=8.13, P=0.012] at 12 months after surgery were also significantly lower than those before surgery.The CSS in the EA+RFA group was significantly lower than that in the RFA group [(0.93±0.55)vs.(2.44±0.53);t=-11.70, P=0.007].Both groups had no significant change in thyroid function during the follow-up period,and no serious complications were observed. Conclusion Anhydrous alcohol injection can effectively improve the efficiency of radiofrequency ablation in treating benign solid thyroid nodules and is effective in reducing nodule volume,alleviating compressive symptoms,and decreasing cosmetic discomfort.

Telescopic coronary sinus cannulation for mapping and ethanol ablation of arrhythmia originating from left ventricular summit.

The radiofrequency ablation (RFA) of left ventricular (LV) summit arrhythmia is a challenging procedure due to complexity of the anatomy. Retrograde coronary venous ethanol injection may be successful in selected patients, but there is no uniformly accepted technique for gaining coronary sinus access and the duration of the procedure is relatively long. Patients with LV summit ventricular tachycardia after a failed endocardial RFA scheduled for retrograde ethanol ablation were included. The technique of telescopic coronary sinus catheterization which consisted of an 8F SL0 catheter, a 5F JR/IM catheter and a microcatheter was designed and applied in all patients. The efficacy of the system was validated and the duration of crucial points were measured (coronary sinus intubation and venography, mapping with angioplasty wire and alcohol injection). The transcoronary sinus procedure was performed in 4 (age 17-65 years) without complications (total procedural duration: 100-246 min). The coronary sinus was intubated with an SL0 catheter in 2-5 min, the first contrast injection to venous branches was delivered after 17-29 min, and the time form venous angiography to first alcohol injection was 28-31 min. The total transcoronary procedural duration ranged 66-86 min. The telescopic system was easy to control, allowed rapid electrodes and catheter replacement and no obstacles or complications were noted during mapping and therapy. The telescopic system for retrograde coronary venous ethanol injection consisted of an 8F SL0 catheter, a 5F JR/IM catheter and microcatheter is useful and allows the delivery of therapy, thus, decreasing the duration of the procedure.

Dose-dependent effects of alcohol injections on omission-contingency learning have an inverted-U pattern

Previous examinations of the long-term effects of alcohol exposure on omission-contingency learning have produced mixed results across different age or sex groups, with evidence for faster learning or no effect. However, none of these experiments made comparisons using the same exposure-dose across the age/sex groups. Here, we exposed rats to 6 weeks of alcohol injections (3 days/week, 1.75 or 3.5 g/kg/24-h, i.p. broken up into 2 injections/day) in adolescent/early adult males or females (PND27-66) or adult males (PND62-101). We then tested the rats in autoshaping and omission-contingency tasks. In contrast to our hypotheses, the low 1.75-g/kg/24-h dose led to slower omission learning and the higher 3.5-g/kg/24-h dose had no effect. There were no age- or sex-differences in omission learning. Additionally, during autoshaping training, rats exposed in adolescence/early adulthood had a faster shift to sign-tracking in their sign-tracking/goal-tracking ratios than rats exposed in adulthood, with no consistent effect of alcohol exposure or sex-differences. Our results suggest complex effects of alcohol on the neural substrates of omission-contingency learning at different doses, which will require future investigation.

728 SUSTAINED CLINICAL RESPONSE WITH EUS GUIDED RFA OF PANCREATIC INSULINOMA

Insulinoma is the commonest functional Pancreatic Neuro-Endocrine Tumor (f-PNET). Surgical resection is the standard management, often associated with significant morbidity. Alternate less invasive management options with EUS guided local therapy (Radio-frequency ablation or alcohol injection) are reportedly effective in short term follow-up. To evaluate the long-term efficacy of EUS guided RFA (EUS-RFA) used for the ablation of f-PNET. EUS-RFA of f-PNET was performed using a dedicated internally cooled 19G device. Lesions located close (≤5mm) to the pancreatic duct (PD) underwent prophylactic PD stent. Patients with a persistent symptomatic lesion or those with multiple lesions were considered for subsequent session/s of EUS-RFA. All patients post RFA underwent systematic follow up (3 monthly in the first year, 6 monthly in next year and at 1-year interval thereafter). 10 Insulinoma patients with 13 lesions underwent EUS-RFA over 5 years. One patient had 4 lesions. The mean tumor size was 11.5 mm (range ?). Three patients had prophylactic PD stent. Eight subjects had one EUS-RFA session. Two patients required >1 session. All subjects had rapid relief of symptoms along with biochemical improvement (blood sugar, insulin, C-peptide) within 24 hours that has remained sustained over the next 10 – 64 months. Post-procedure, one subject had mild self-limiting abdominal pain. Another patient developed acute pancreatitis after 3rd session of EUS RFA leading to pseudocyst that required EUS drainage. Tumor size decreased in 10/14 lesions (undetectable in 6, significantly reduced in 4). Remaining 4 lesions are stable in size with reduced vascularity. EUS guided RFA is safe and effective with sustained beneficial outcomes for Pancreatic Insulinoma.

Utilization of primary alcohols in dual-fuel injection mode in a gasoline direct injection engine

Due to the higher octane rating of alcohols, they can be used in gasoline direct injection (GDI) engines at relatively higher compression ratios. However, relatively higher particulate matter (PM) emissions from GDI engines still remain a major challenge. To resolve this issue, this study is focused on exploring use of dual-fuel injection technology, in which alcohols are injected into the port and gasoline is injected directly in the engine combustion chamber. To investigate the effect of fuel properties on combustion, performance and emission characteristics of a dual-fuel engine, three different alcohols (methanol, ethanol and butanol) were injected in the intake port in different premixed ratios (15% and 30% energy replacement). All experiments were carried out at constant engine speed (2000 rpm), fixed engine load (22 Nm) and identical fuel injection parameters. Results showed that dual-fuel operation of alcohols (especially methanol and butanol) resulted in superior combustion and performance compared to baseline GDI engine. Injection of alcohol in the port reduced emissions of carbon monoxide (CO) and oxides of nitrogen (NOx), however, HC emissions increased slightly. Significant reduction in PM emissions from dual-fuel operation is an important finding of this study. Use of alcohols reduced both PM number as well as PM mass, however, emission of nanoparticles (NP) increased slightly (for ethanol and butanol). Increasing premixed ratio of alcohols in the port further improved the engine combustion, performance and PM emission characteristics of dual-fuel GDI engine. Overall, this study suggested dual-fuel operation as a potential solution for GDI engines in order to reduce PM emissions.

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms.

The proximity of the endoscopic ultrasound (EUS) transducer to the pancreas and the possibility to place needles or other accessories into a target located adjacent to the wall of the GI tract have encouraged researchers to develop various EUS-guided local treatments directed towards pancreatic neuroendocrine neoplasms (PanNENs). The use of pre-operative EUS-guided tattooing or fiducial marker placement to facilitate intraoperative tumor localization has proven effective in reducing operative time of laparoscopic surgeries. To reduce the mortality and morbidity rates of surgical resection, which is presently the mainstay treatment of PanNENs. EUS-guided loco-regional treatments, such as injection of alcohol and radiofrequency ablation have been proposed and results are hitherto promising. The present paper summarizes currently available data in the field of EUS-guided interventions to pancreatic neuroendocrine tumors, as well as possible future applications.

Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review.

Purpose of ReviewThis is a comprehensive literature review of the available evidence and techniques of foot injections for chronic pain conditions. It briefly describes common foot chronic pain syndromes and then reviews available injection techniques for each of these syndromes, weighing the available evidence and comparing the available approaches.Recent FindingsFoot and ankle pain affects 20% of the population over 50 and significantly impairs mobility and ability to participate in activities of daily living (ADLs), as well as increases fall risk. It is commonly treated with costly surgery, at times with questionable efficacy. Injection therapy is challenging when the etiology is anatomical or compressive. Morton’s neuroma is a budging of the interdigital nerve. Steroid, alcohol, and capsaicin injections provide some benefit, but it is short lived. Hyaluronic acid (HA) injection provided long-term relief and could prove to be a viable treatment option. Achilles tendinopathy (AT) is most likely secondary to repeat tendon stress—platelet-rich-plasma (PRP) and prolotherapy have been trialed for this condition, but more evidence is required to show efficacy. Similar injections were trials for plantar fasciitis and achieved only short-term relief; however, some evidence suggests that PRP injections reduce the frequency of required therapy. Tarsal tunnel syndrome, a compressive neuropathy carries a risk of permanent neural injury if left untreated. Injection therapy can provide a bridge to surgery; however, surgical decompression remains the definitive therapy. When the etiology is inflammatory, steroid injection is more likely to provide benefit. This has been shown in several studies for gout, as well as osteoarthritis of the foot and ankle and treatment-refractory rheumatoid arthritis. HA showed similar benefit, possibly due to anti-inflammatory effects. Stem cell injections may provide the additional benefit of structure restoration.SummaryChronic foot pain is common in the general population and has significant associated morbidity and disability. Traditionally treated with surgery, these are costly and only somewhat effective. Injections provide an effective alternative financially and some evidence exists that they are effective in pain alleviation. However, current evidence is limited and the benefit described from injection therapy has been short-lived in most cases. Further studies in larger populations are required to evaluate the long-term effects of these treatments.

Treatment of Bleeding Gastric Varices by Endoscopic Cyanoacrylate Injection: A Developing-country Perspective.

IntroductionGastric varices (GV) are less commonly seen but bleed more severely than esophageal varices (EV). Transjugular intrahepatic portosystemic shunt (TIPS), alcohol injection, and N-butyl-2-cyanoacrylate (NBCA) are generally used for GV bleed management. NBCA is usually injected endoscopically and is known to be quite successful in the treatment of GV bleeding. This study was conducted with the objective of determining the outcomes in patients with GV treated with NBCA.MethodsWe conducted a retrospective review of medical records and reports of endoscopy performed between March 2015 and June 2018 at a large tertiary care center. Patients of any age and gender having a history of chronic liver disease, those presenting with hematemesis or melena, and those who were found to have GV bleed on endoscopy and treated with NBCA were included. All the endoscopy procedures were undertaken within 24 hours of admission. Informed written consent was obtained from all the patients before the procedure. The outcomes were measured in terms of rate of mortality, hemostasis achieved, duration of stay at the hospital, and requirement of blood transfusion.ResultsA total of 31 patients met the inclusion criteria; (58.1%) were males and 13 (41.9%) were females. The mean age was 55.23 ±8.77 years; 12.9% were Child-Pugh class-A, 64.5% were class B, and 22.6% were class C. Out of the 31 patients, 27 (87%) patients achieved hemostasis. Moreover, 22 (71%) patients had hospital stay ranging between 5-8 days. The overall mortality rate was 9.7% (3 patients). No complication was reported from NBCA injection.ConclusionThe injection of NBCA can provide a safe and effective method for the management of GV bleeding as demonstrated by the results of our study, which showed hemostasis in a majority of the cases after the initial injection with no procedure-related complications, a reduced hospital stay, and a reduced rate of mortality.

Physical violence inside female prisons in Brazil: prevalence and related factors.

The present study aims to identify the prevalence of physical violence against female prisoners in Brazil, as well as related factors. This is a cross-sectional national survey conducted in 15 female prisons in five regions of Brazil selected in multiple stages. The following types of analysis were performed: univariate analysis; stratified analysis relating the outcome (suffer physical violence inside prison) to predictor variables, using the Pearson chi-square test; calculation of the Odds Ratio (O.R.); and multiple logistic regression. The Hosmer-Lemeshow test was used for analysis of goodness of fit and adequacy of the model. The prevalence of physical violence inside female prisons was 37.4%. There was a correlation between physical violence victimization in prison and the following variables: physical victimization prior to arrest (p = 0.013), solitary confinement (p = 0.000), mental suffering (p = 0.003), current or previous abusive intake of alcohol (p = 0.011), current or previous injection of cocaine (p = 0.002) and not performing prison labor (p = 0.003). Physical violence has become inherent in the Brazilian female prison system. Continued studies are needed to monitor the situation and to develop interventions to prevent physical violence inside the facilities.