Preinjection Values Research Articles

Comparison of the efficacy and safety of lacrimal gland botulinum toxin injection in functional versus non-functional epiphora

Objective To determine whether botulinum toxin is effective and safe for the treatment of epiphora, and to compare its utility in functional versus non-functional epiphora using both qualitative and quantitative methods. Materials and Methods Patients were divided into two groups (functional and non-functional epiphora) according to the presence of lacrimal drainage obstruction. All patients were injected with 2.5 units of botulinum toxin into the palpebral lobe of the lacrimal gland, and improvement in epiphora and quality of life were assessed both objectively and subjectively using Schirmer’s I test, indoor and outdoor Munk scores, TEARS score, watery eye quality of life score, and tear meniscus measurements at pre-injection, and 1, 3, and 6 months post-injection. Functional and non-functional epiphora groups were compared. Results Botulinum toxin was injected into 72 lacrimal glands of 65 patients with functional and non-functional epiphora. In both the functional and non-functional epiphora groups, the mean Schirmer’s I test value, indoor and outdoor Munk scores, TEARS score, watery eye quality of life score, tear meniscus height, depth, and area values improved significantly at 1, 3, and 6 months after injection compared with pre-injection values (p < 0.05). There were statistically significant differences in mean Schirmer’s I test, tear meniscus height, depth, and area values between the functional and non-functional epiphora groups at 1, 3, and 6 months after botulinum toxin injection (p < 0.05). In the functional epiphora group, a greater proportion of patients reported improvement than in the non-functional group. All complications were minor and resolved within 2 weeks after the injection. Conclusion Botulinum toxin injection into the lacrimal glands of patients with functional and non-functional epiphora was a simple, effective, and safe treatment. In addition to qualitative methods, quantitative methods, such as tear meniscus measurement, provided direct evidence that symptomatic improvement occurred more in those with functional versus non-functional epiphora after botulinum toxin injection.

Long-term repeated botulinum toxin a treatment over 12 years gradually changes gait characteristics: single-case study

Objective: To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function. Design: Single-case study Patient: A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days. Methods: The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection. Results: The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections. Conclusion: Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.

Immediate response to intravitreal treatment for macular edema due to diabetes and retinal vein occlusion.

To objectively assess the immediate response to intravitreal treatment for macular edema and compare it across different agents. This retrospective, comparative study included patients with macular edema due to diabetic retinopathy (DME) or vein occlusion who were treated with intravitreal injections of either steroids (triamcinolone acetonide or dexamethasone sustained release implant) or anti-vascular endothelial growth factor antibodies (VEGF). The central retinal thickness (CRT) and the best corrected visual acuity (BCVA) were measured 1 day after the injection and compared with immediate pre-injection values. There were 79 eyes (57 patients) including 51 eyes with DME, 18 with branch retinal vein occlusion edema (BRVO-ME), and 10 eyes with central retinal vein occlusion edema (CRVO-ME). The intravitreal agents were triamcinolone acetonide (TA)(n = 15), dexamethasone sustained release implant (DEX)(n = 22), ranibizumab (n = 19), and bevacizumab (n = 23). Statistically significant improvement in CRT was seen in all injection groups (p < 0.05) while improvement in mean BCVA was significant only in the TA group (p = 0.009). The mean change in CRT was maximum with steroids than with anti-VEGFs; viz. 159.47 µ in TA, 115.45 µ in DEX, 86.10 µ in ranibizumab, and 78.78 µ in bevacizumab group. Least amount of change was noted in the spongy type of macular edema (18.73 µ) while improvement in mean BCVA was statistically significant only in the cystoid group (p = 0.01). Comparatively, steroid agents showed better immediate response to therapy than anti-VEGFs. Maximum reduction in central retinal thickness was seen following triamcinolone acetonide injection. Cystoid edema showed better immediate response than spongy retinal thickening.

Immediate effect of anti-VEGF injections on optic nerve head: Correlation between intraocular pressure and anatomical peripapillary changes.

This study was designed to investigate retinal nerve fiber layer (RNFL) and radial peripapillary capillaries (RPC) changes on optical coherence tomography (OCT) angiography and OCT thickness alterations associated with acutely increased intraocular pressure after intravitreal injections. This observational clinical study was conducted on 35 eyes (35 patients) with treatment-naïve age-related macular degeneration (AMD) and type 1 or type 2 MNV were enrolled. All patients underwent anti-vascular endothelial grow factor (VEGF) intravitreal injections with 0.05-mL aflibercept (2 mg) between January 2022 and October 2022. Peripapillary OCT angiography perfusion density, retinal nerve fiber layer thickness, and intraocular pressure (IOP) were measured before and immediately after intravitreal injections. In particular, the analysis was performed at the following visits: (T0) 5 to 15 min before the injection of aflibercept; (T1) 2 to 5 min after the injection of aflibercept. Paired t-test was used to compare pre-injection and post-injection values. The mean baseline IOP (T0) value was 17.26 ± 2.4 mmHg and the immediate post-injection IOP (T1) mean value was 34.7 ± 11.50 mmHg (P < 0.01). The mean global RNFL thickness before and immediately after the injection was 100.9 ± 18.8 m and 98.6 ± 17.4 m (P = 0.001). Furthermore, the topographical RNFL analysis showed significant thickness reduction of the nasal and inferior sectors after the procedure when compared to T0 (P = 0.046 and P = 0.001). On the contrary, the mean RCP density changes at T1 did not reach statistically significant (P = 0.636). Furthermore, we found a significant negative correlation between the retinal nerve fiber layer global thickness and the IOP changes (Pearson's correlation = -0.126; P = 0.031). In particular, the nasal RNFL region showed a significant negative correlations with IOP values (Pearson's correlation = -0.198, P = 0,046). We reported acute IOP changes that are associated with reduced RNFL thickness in a group of patients undergoing intravitreal injections of anti-VEGF drugs for neovascular age-related macular degeneration. Moreover, topographical sub-analysis revealed that the nasal RNFL region is most prone to IOP fluctuations. This finding may explain the sudden visual acuity change in patients immediately after injection and may sustain injuries to optic nerve head structures producing glaucomatous damage.

Immediate Rise in Intraocular Pressure After First-Time Intravitreal Injection of Bevacizumab.

Objective This study aims to report an immediate changein intraocular pressure (IOP) after the first injection of bevacizumab. Materials and methods An interventional case series was carried out at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from November 2018 to April 2020. All patients with various chorioretinal diseases requiring anti-VEGF treatment were included in the study. Patients with a history of previous anti-VEGF or steroid injections and personal or family history of glaucoma were excluded. Bevacizumab in a dose of 1.25 mg (0.05 ml) was injected intravitreally under topical anesthesia maintaining sterile aseptic conditions in the operating room. IOP was checked one hour prior to the injection, and hourly monitoring of it was continued for the next six hours. Data were analyzed using SPSS Statistics to compare the mean IOP readings before and after injection. Results A total of 191 eyes of 147 patients were included in the study. Among them, 92 (62.58%) were male and 55 (37.41%) were female with a mean age of 45.5 ± 8.8 years. The mean pre-injection IOP was measured as 12.12 ± 2.11 mmHg. The frequency of IOP elevation of ˃ 21 mmHg was observed in 169 (88.5%) eyes at five minutes, 104 (54.5%) eyes at 30 minutes, 33 (17.3%) eyes at one hour, and 16 (8.4%) eyes at two hours. The raised mean post-operative IOP was 30.44 ± 6.53 mmHg at five minutes, 26.27 ± 4.65 mmHg at 30 minutes, 26.12 ± 3.31 mmHg at one hour, and 25.63 ± 3.03 mmHg at two hours. The IOP reduced to pre-injection value at three hours measuring12.12 ± 2.11 mmHg and continued to stay at that level for the next three hours. Conclusions The majority of the eyes receiving first-time intravitreal bevacizumab injection showed a significant increase in IOP levelwithin five minutes to two hours post-injection.

Effect of Fluoroscopic-Guided Corticosteroid Injection in Patients With Sacroiliac Joint Dysfunction.

Background Sacroiliac joint dysfunction is a major cause of axial low back pain which can masquerade as pain from lumbar disc diseases. Treatment of axial back pain arising due to sacroiliac joint dysfunction remains a challenge. This study was conducted to evaluate the long and short-term effects ofintra-articularcorticosteroid injection in the relief of pain and disability caused by sacroiliac joint dysfunction. Methodology A total of 83 patients with sacroiliac joint dysfunction were included in this prospective randomized control study. Patients were randomized into two groups by a computer-generated randomization table. These two groups were treated with fluoroscopy-guided corticosteroid and local anesthetic injection (group A) and distilled water and local anesthetic injection (group B). Pre and post-intervention assessment of all patients was done based on the Numeric Pain Rating Scale (NPRS) for pain and Oswestry Disability Index (ODI) for disability. The outcome measures of the study were the NPRS and ODI assessed at the initial visit one (pre-injection), two weeks post-injection (visit 2), and four weeks post-injection (visit 3). Results Demographic data were comparable in both groups. There was no significant difference in pre-injection NPRS and ODI values in both groups. The changes in NPRS and ODI values were significant from pre-injection to two weeks to four weeks. Group A patients performed better in terms of a decrease in the perception of pain and a decrease in the perception of disability compared to group B patients in the second and fourth weeks of follow-up. Conclusions Fluoroscopy-guided corticosteroid injection is an effective measure for reducing pain and disability in patients with sacroiliac joint dysfunction.

Efficacy and Safety of Suprachoroidal Triamcinolone Acetonide in Cases of Resistant Diabetic Macular Edema

Background and Aim: Patients with diabetes are at risk of losing their vision due to diabetic macular edema (DME). Symptoms of diabetic macular edema occur as fluid leaks from retinal vessels into the surrounding neural retina due to hypoglycemia-induced damage to the blood-retina barrier. The current study aimed to assess the safety and efficacy of suprachoroidal triamcinolone acetonide in resistant diabetic macular edema cases. Patients and Methods: This interventional case series was carried out on 32 diabetic macular edema cases in the Department of Ophthalmology, Hayatabad Medical Complex, Peshawar during the period from April 2019 to September 2019. All the patients above 16 years of age with Type-1 DM or Type-2 DM were enrolled in this study. Intraocular Pressure (IOP), Baseline Best Corrected Visual Acuity (BCVA), and Central Subfield Thickness (CST) were determined and recorded. Post-SCTA follow-up was done in one and three months. During follow-up, the measured clinical factors were noted and analyzed in SPSS version 26. Results: Of the total 32 diabetic macular edema cases, 15 (46.9%) were male and 17 (53.1%) were females. The overall mean age was 48.64 ± 8.72 years. The frequency of prior injections received were 6.2 with maximum 12 and minimum four. CST pre-injection mean value was 612.8 ± 198.3 um and CST post-injection mean value at one and three months was 308.6± 62.6 um and 302.72± 58.64 um respectively. Statistical significance was found in pre and post one-month CST injections. The BCVA pre-injection and post-injection mean value at one and three months was 0.8 ± 0.19 and 0.49 ± 0.29 and 0.39 ± 0.20 respectively. At the one and three months post injection, there was statistical significance for both pre and post injection CST. A mean IOP of 12.32 mmHg was recorded pre-injection. Previously, 14.82 mmHg and 14.48 mmHg of intraocular pressure were recorded respectively after one and three months of injection. Conclusion: The present study found that Triamcinolone Acetonide (TA) was administered for anatomical and functional improvement. OCT macular thickness can be improved and refractory diabetic macular edema can be reduced using SCT. Keywords: Resistant diabetic macular edema, Efficacy, Suprachoroidal Triamcinolone

Posterior sub-Tenon triamcinolone injection in the treatment of postoperative cystoid macular edema secondary to pars plana vitrectomy.

To evaluate the efficacy and safety of posterior sub-Tenon triamcinolone (PSTA) in chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy (PPV). Consecutive 22 patients who developed chronic PCME after PPV and underwent PSTA treatment were included in this retrospective study. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured pre injection and post injection at one month, three months, six months, and at last visit. The patients were divided into three groups according to the injection response status: complete, partial, and resistant. The mean follow-up period was 26.4 ± 16.2 months after PSTA. According to pre-injection values, there was a significant improvement in the values of BCVA and CMT at the first, third, and sixth months and at the last examination (P < 0.05). In the final examination, PCME recovered completely in 12 patients, partially in 8 patients, and resistance was observed in 2 patients. Posterior sub-Tenon triamcinolone seems to be effective in chronic PCME following PPV.

Assessment of clinical, biochemical, and radiological outcomes following intra-articular injection of Wharton jelly-derived mesenchymal stromal cells in patients with knee osteoarthritis: A prospective clinical study.

The aim of the present study was to perform clinical, biochemical, and radiological evaluation of the efficacy of mesenchymal stem cells derived from Wharton jelly (WJ) present within the human umbilical cord in the treatment of knee osteoarthritis. Between 2018 and 2019, 10 patients with knee osteoarthritis for whom the conservative treatment was not beneficial were included in the study. Patients were clinically, radiologically, and biochemically evaluated before treatment initiation. Thereafter, the patients were intra-articularly injected using a solution containing 1 × 108 WJ-derived MSCs. Evaluations were performed on day 21 (V1) and 42 (V2) and month 3 (V3), 6 (V4), and 12 (V5) after the procedure. At 1-year post-injection, visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Lequesne scores of patients were lower than those observed during the initial evaluation, whereas the mean 36-Item Short Form Health Survey score was higher. Cartilage thicknesses were found to be increased in all regions except in the medial femur, medial posterior femur, lateral posterior femur, and lateral posterior tibia regions in magnetic resonance imaging. A significant increase was observed in tumor necrosis factor-alpha, interleukin-1β, adiponectin, resistin, and interleukin-6 levels compared with pre-injection values. The leptin levels at 6-month and 1-year controls were lower than the pre-injection levels, and the decrease observed at 6 months was significant. In patients with knee osteoarthritis, intra-articular WJ-derived MSC injection causes significant pain reduction, satisfactory functional improvement, and increased patient satisfaction following a 1-year follow-up. These clinical improvements were supported by magnetic resonance images, along with changes in adiponectin and leptin levels in synovial fluid.Level of evidence: IV.

Oral Vitamin D Supplementation and Clinical Outcomes of Intravitreal Bevacizumab Injection for Macular Edema Secondary to Retinal Vein Occlusions.

PurposeTo evaluate the therapeutic response of retinal vein occlusion (RVO) to intravitreal bevacizumab (IVB) with and without concomitant vitamin D supplementation.MethodsSeventy eyes of 68 patients with macular edema associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) received three monthly IVB injections. Patients with serum 25-hydroxyvitamin D (25(OH) D) higher than 30 ng/ml were considered as the sufficient group. Cases with serum 25(OH) D levels below 30 ng/ml were randomized into the treatment and control groups. The control group received 50,000 IU of oral vitamin D, weekly for two months. One month after the last IVB injection, best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured and compared with the preinjection values.ResultsWhile 43 eyes (61.4%) of 42 patients had BRVO, 27 eyes (38.6%) of 26 patients had CRVO. In BRVO patients, changes of CMT and BCVA were not significantly different between the sufficient, control, and treatment groups (P = 0.58 and 0.64, respectively). In the CRVO group, CMT reduction in the control group was significantly less than the sufficient and treatment groups (P = 0.048). In addition, improvement of BCVA in the control group was significantly less (P = 0.036) than the sufficient and treatment groups.ConclusionOral vitamin D supplement therapy may improve anatomical and functional outcomes in patients with CRVO and vitamin D deficiency.

Comparison of Intravitreal Dexamethasone Implant and Posterior Subtenon Triamcinolone Injection in the Treatment of Diabetic Macular Edema in Vitrectomized Eyes

Introduction: The aim of this study was to compare posterior subtenon triamcinolone (PSTA) application and intravitreal dexamethasone phosphate (DEX) implant in the treatment of diabetic macular edema (DME) in vitrectomized eyes. Methods: This retrospective study included 64 (48.12%) patients who received PSTA and 69 (51.88%) patients who received DEX implants in DME treatment after vitrectomy. Best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed before injection; at 1, 3, and 6 months after injection. The postinjection values were statistically compared with the preinjection value. Results: All postinjection CMT values in both groups were lower than the preinjection value (p < 0.05 for all). There were statistically significant increases in all postinjection BCVAs of the DEX group and postinjection 1-month BCVA of the PSTA group (p < 0.05 for all). However, there was no significant difference in BCVA values of the PSTA group at 3 and 6 months after injection (p > 0.05 for both). There was no statistically significant difference in all postinjection IOP values of the PSTA group (p > 0.05 for all). However, significant increases in IOP were observed in the DEX group at 1 and 3 months after injection (p < 0.05 and p = 0.02, respectively). The number of additional injections between the 3rd and 6th months after the initial injection was statistically higher in the PSTA group (p = 0.006). Conclusion: Both intravitreal DEX and PSTA administration are effective in the treatment of DME after vitrectomy. However, visual improvement persisted longer, and the need for additional injections was less in patients who received DEX.

Functional and radiological outcome of autologous platelet rich plasma in chronic plantar fasciitis: A prospective study

Plantar fasciitis is one of the most common causes of foot pain. It results from sustained stress of weight bearing - hopping, jumping, running -which results in micro trauma to plantar fascia which further leads to plantar fasciitis. It constitutes 11% to 15% of all foot symptoms. Its prevalence is 8% to 10% in general population. It commonly affects at the age of 40 to 60 years. Recently platelet rich plasma was used in treating in degeneration, muscle and tendon injuries. Hence, the present study aimed to assess the treatment outcome of autologous platelet rich plasma injection in treatment of plantar fasciitis. In this prospective study, we enrolled 35 patients with plantar fasciitis coming to OPD or casualty. Patients satisfying inclusion criteria were selected based on consecutive sampling. 11 patients responded well to conservative management and 3 patients had loss of follow up. The different scoring systems were adopted such as VAS and AOFAS for pain assessment. The thickness of plantar fascia was determined by ultrasound technique. Autologous platelet rich plasma was prepared and the same was injected. The outcome analysis was done at 2 weeks, 3 months, and 6 months; and compared with pre injection values. From pre-injection to up to post-6 months period, the VAS reduction was statistically significant (P&amp;#60;0.0001). All the time interval, the AOFAS was increased which was statistically significant (P&amp;#60;0.001). The injection was effective in reducing the thickness of plantar fascia, which was found to be statistically significant at all the time intervals (P&amp;#60;0.001). Autologous PRP injection for chronic plantar fasciitis was found to be an effective treatment modality for chronic plantar fasciitis.

Effect of Intravitreal Bevacizumab on the Optic Nerve Head perfusion in patients with Diabetic Macular Edema

Purpose: To find out the effect of Intravitreal Bevacizumab on optic nerve head perfusion using Ocular Coherence Tomography Angiography (OCTA) in patients with diabetic macular edema (DME). Study Design: Interventional case series Place and duration of study: Ophthalmology Department, Mayo Hospital, Lahore from June 2018 to January 2020. Methods: In this study 57 eyes of patients fulfilling the inclusion criteria were selected from the outpatient department. After informed consent, detailed history and ocular examination was performed. Baseline OCTAwas donein all cases. The patients received intravitreal Bevacizumab (1.25mg in 0.05ml). OCTA was repeated three weeks after injection. Both the pre and post injection ONH perfusion was compared and analyzed using SPSS. Demographic chracteristics like age and gender were calculated. Paired sample t-test was applied to check the significance of difference between pre and post injection values. P-value of &lt;0.05 was considered significant. Results:There were 16(28.1%) males and 41(71.9%) females. Mean age of the patients was 53.54±7.00 years. Pre injection blood flow was 56.11 and post injection was significamtly reduced to 52.69. The mean difference between was 3.423 and confidence interval of the difference was (2.5755-4.2701). P-value 0.000 was &lt;0.05 whichshowed significant reduction in perfusion of ONH. Conclusion:Intravitreal Bevacizumab decreases the optic nerve head blood flow and should be used with care in patients having reduced blood flow states and also in patients with advanced glaucomatous optic neuropathy.

Central Nucleus of Amygdala Mediate Pressor Response Elicited by Microinjection of Angiotensin II into the Parvocellular Paraventricular Nucleus in Rats.

Background: The Paraventricular Hypothalamic Nucleus (PVN) coordinates autonomic and neuroendocrine systems to maintain homeostasis. Microinjection of angiotensin II (AngII) into the PVN has been previously shown to produce pressor and bradycardia responses. Anatomical evidence has indicated that a substantial proportion of PVN neurons is connected with the neurons in the central amygdala (CeA). The present study aimed to examine the possible contribution of the CeA in cardiovascular responses evoked by microinjection of AngII into the parvocellular portion of PVN (PVNp) before and after microinjection of cobalt chloride (CoCl2) into the CeA.Methods: The experiments were conducted at the Department of Physiology of Shiraz University of Medical Sciences, from April 2019 to November 2019. There were two groups of 21 eight-week-old urethane anesthetized male rats, namely saline (n=9 rats) and AngII (n=12 rats) groups. Drugs (100 nL) were microinjected via a single-glass micropipette into the PVNp and CeA. Their blood pressure (BP) and heart rate (HR) were recorded throughout the experiments. The mean arterial pressure (MAP) and heart rate (HR) were compared to the pre-injection values using paired t test, and to those of the saline group using independent t test.Results: Microinjection of AngII into the PVNp produced pressor response (P<0.0001) with no significant changes in HR (P=0.70). Blockade of CeA with CoCl2 attenuated the pressor response to microinjection of AngII into the PVNp (P<0.001).Conclusion: In the PVNp, Ang II increased the rats’ blood pressure. This response was in part mediated by the CeA. Our study suggested that these two nuclei cooperate to perform their cardiovascular functions.

The short-term effects of intravitreal bevacizumab injection on intraocular pressure, cornea, iridocorneal angle, and anterior chamber.

Transient increase in intraocular pressure (IOP), changes in anterior chamber parameters, and changes in aqueous humor dynamics may occur after intravitreal injections because of intravitreal volume changes. In this observational study, we investigated the early effects of intravitreal bevacizumab (IVB) injection on IOP, central corneal thickness (CCT), corneal volume (CV), anterior chamber depth (ACD), and iridocorneal angle (ICA). The patients who had one single-dose IVB (2.5 mg/0.1 mL) injection were included in the study. The patients underwent IOP, CCT, CV, ACD, and ICA measurements before and 1 h and 1 day after the injection. Pre-injection and post-injection values were compared. Forty-two eyes of 42 patients were included in the study, and the mean age of patients was 60.1 ± 7.4 years. The mean IOP measurements before and after injection at 1 h and day 1 were 15 ± 2.4, 17.4 ± 2.4, and 14.7 ± 2.3, respectively. The mean IOP, CCT, and CV values 1 h after injection were significantly higher than pre-injection values (p < 0.05, p < 0.05, and p = 0.02, respectively). Conversely, mean ACD and ICA values 1 h after injection were significantly lower than pre-injection values (p = 0.01 for both). There were no statistically significant differences on the first day after injection for all parameters. IVB (2.5 mg/0.1 mL) injection causes transient increases in IOP and transient decreases in ACD and ICA at the first hour after injection. Related to elevation in IOP, CCT and CV may increase transiently. These changes return to baseline values on the first day after injection.

Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery.

Retrospective study of data collected prospectively. To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life. SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter. We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery. The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (P = 0.044, correlation coefficient = 0.261). No relationship between pain improvement after SNRB and functional outcome was identified. The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.Level of Evidence: 4.

Geochemical reactions and alteration of pore architecture in saturated shale after injection of stimulation fluid

Pore architecture regulates fluid flow between unconventional shale reservoir and hydraulically-induced fractures. Imbibition of stimulation fluid may change this architecture and alter hydrocarbon flow. Hydrothermal experiments were conducted at reservoir conditions (125 °C, 45 MPa) to test two hypotheses: 1) Shale, not stimulation fluid, dominates the geochemistry of an unconventional reservoir containing formation water; and 2) Mineral dissolution and precipitation induced by stimulation fluid is transient and manifests across micro-, meso-, and macro-scales of pore architecture. Experiments replicated a shut-in well in the Cretaceous Baxter Shale, Green River Basin, Wyoming USA. Stimulation fluid was injected into one experiment after formation water (I = 0.35 mol/kg, pH = 6.4) and core reacted for 48 days. This novel approach equilibrated rock and formation water and saturated pores with formation water before introducing stimulation fluid. The second experiment served as a control. Trends of aqueous calcium, silica and aluminum in the injection experiment suggest transient dissolution of calcite and feldspar and/or quartz as well as clay and barite precipitation; mineralogic evidence was limited to calcite dissolution and barite precipitation. The rock maintained reducing conditions (Eh = +0.08 to −0.16 V) despite injection of oxidizing stimulation fluid (Eh = 1.1 V). pH of the stimulation fluid-formation water mixture evolved from 2.3 to pre-injection values (~6) within 24 h. Results indicate that mineral dissolution and precipitation manifest in macropores with barely detectable alteration to micro- and mesopores. Formation water or organic matter in pores may have inhibited access of stimulation fluid to micro- and mesopores

Evaluation and comparison of the efficacy of long-acting betamethasone and dexamethasone as injections in the treatment of idiopathic sudden hearing loss

Introduction & objectiveThe aim of the present study was to determine the efficacy of long-acting betamethasone, and its comparison with Dexamethasone as an intratympanic injection in the treatment of Sudden Sensorineural Hearing Loss (SSNHL). Materials and methodsThirty-one patients who do not respond to systemic steroids and poor prognosis patients were enrolled in this study. The patients divided randomly into two groups: 1- Dexamethasone and 2- Long acting betamethasone. Dexamethasone (0.4 ml/mg) or long-acting betamethasone (0.1 ml/mg) was slowly injected (0.4 to 0.6 cc) into the superior-anterior area of the tympanic membrane as 6 injections twice a week for a total of 3 weeks. Right after the treatment and one, two and six months after completion of treatment, an audiometry was performed and compared with the pre-injection values. ResultsSpeech Reception Threshold (SRT) showed improvements in both groups immediately after treatment and in the follow-up period, compared to baseline. Speech Discrimination Score (SDS) also improved in both groups directly after treatment and at one-month follow-up. The hearing improvement in the Dexamethasone group was clinically better than in the Beta group, but due to the non-parametric data, it was not possible to analyze the hearing improvement process in the variable group. ConclusionAccording to the results obtained in this study, intratympanic corticosteroid injection in the treatment of patients with SSNHL has positive and promising results on improving hearing level.

Spatiotemporal geo-electrical sensing of a Pluronic-coated cobalt ferrite nanoparticle slug in natural sand flow-through columns

Rising industrial interest in the application of nanomaterials for the remediation of contaminated sites has led to concern over the environmental fate of the nanoremediation agents used. A critical requirement in evaluating and understanding nanoparticle (NP) behaviour in porous media is the development of analytical methods capable of in situ monitoring of complex NP transport dynamics. Spectral induced polarization (SIP), a non-invasive geo-electrical technique, offers a promising tool for detecting and quantifying NPs in soil and aquifer media. However, its application for monitoring the spatial migration and attachment behaviour of NPs remains uninvestigated. Here, we present results from flow-through experiments where we monitored the transport of cobalt ferrite nanoparticles (CoFe-NPs) coated with Pluronic, an amphiphilic polymer, in natural aquifer sand columns. We coupled concentration breakthrough curve analysis with SIP monitoring and reactive transport modeling to relate spatiotemporal NP concentration distributions to geo-electrical signals. Changes in the real (σ′) conductivity at three different locations along the columns closely correlated with model-computed total (solid plus aqueous phase) NP concentrations during the propagation of a NP slug. The imaginary conductivity (σ″) correlated closely with the arrival of the NP-slug. However, during the receding front, bimodal σ″-signal peak behaviour was observed propagating through the columns, indicating the existence of complex in situ NP transport dynamics, potentially revealing the rupture of nanoclusters upon straining and their effect on bulk charge storage that may not be obvious from breakthrough curve data alone. Fitting of a double Cole-Cole relaxation model yielded distinct shifts in relaxation time (τ) associated with the polarization of smaller length-scale particles. Post-NP pulse τ and σ″ did not return to pre-injection values; these lingering signals were caused by retained NP concentrations as low as 8.8 mg kg−1. Our results support the applicability of SIP for spatial and temporal monitoring of NP distributions, with implications for the investigation of NP transport and nanoremediation strategies.

Does intravitreal injection of aflibercept affect the corneal endothelium?

Aim: To evaluate the effect of intravitreal aflibercept injections on the corneal endothelium in patients with exudative age-related macular degeneration (AMD), diabetic macular edema (DME), and central retinal vascular occlusion (CRVO). Materials and Methods: The study included 50 eyes of 44 patients who underwent three consecutive intravitreal aflibercept injections with the diagnosis of AMD, DME or CRVO. All patients underwent complete ophthalmological examination and specular microscopy at pre-injection and at one month after the third injection. The pre-injection and post-injection values of endothelial cell density (CD), coefficient of variation (CoV), hexagonality (Hex), central corneal thickness (CCT), and intraocular pressure (IOP) were compared statistically. Results: The mean age of the patients was 71.09 ± 5.6 (40–87) years. Thirty-six eyes had exudative AMD, 10 had DME and 4 had CRVO. There were no significant differences in CD, CoV, Hex, CCT, and IOP between the pre-injection and post-injection measurements. However, in patients with AMD, the mean pre-injection CD was 2439.71 ± 476.16 cells/mm2 and the mean post-injection CD was 2286.18 ± 427.24 cells/mm2. CD values were decreased in the AMD group, but this difference was not statistically significant (p = 0.061). In patients with AMD, the mean pre-injection and post-injection CCT values were 536.1 ± 28.4 µm and 542.5 ± 32.9 µm, respectively, and the difference was statistically significant (p = 0.04). Conclusion: Intravitreal aflibercept injection had no manifest devastating effects on the corneal endothelium. However, the decreasing number of endothelial cells with age may be susceptible to aflibercept injection.