Root Infiltration Research Articles

Clinical outcomes of 3T magnetic resonance imaging-guided lumbar and sacral foraminal injections

PurposeThis article evaluates the feasibility, safety, and efficacy of MRI-guided lumbar or sacral nerve root infiltration for chronic back pain. We compared the outcomes of our MRI-guided infiltrations with data from CT-guided infiltrations reported in the literature and explored the potential advantages of MRI guidance.MethodForty-eight MRI-guided nerve root infiltrations were performed using a 3 T MRI machine. The optimal needle path was determined using breathhold T2-weighted sequences, and the needle was advanced under interleaved guidance based on breathhold PD-weighted images. Pain levels were assessed using a numeric rating scale (NRS) before the procedure and up to 5 months after, during follow-up. Procedure success was evaluated by comparing patients’ pain levels before and after the infiltration.ResultsThe MRI-guided infiltrations yielded pain reduction 1 week after the infiltration in 92% of cases, with an average NRS substantial change of 3.9 points. Pain reduction persisted after 5 months for 51% of procedures. No procedure-related complications occurred. The use of a 22G needle and reconstructed subtraction images from T2 FatSat sequences improved the workflow.ConclusionOur study showed that MRI-guided nerve root infiltration is a feasible, safe, and effective treatment option for chronic back pain. Precise positioning of the needle tip and accurate distribution of the injected solution contributed to the effectiveness of MRI-guided infiltration, which appeared to be as accurate as CT-guided procedures. Further research is needed to explore the potential benefits of metal artifact reduction sequences to optimize chronic back pain management.

How Does Anxiety and Depression Affect the Outcome after Periradicular Infiltration Therapy?-A Retrospective Analysis of Patients Undergoing CT-Guided Single-Level Nerve Root Infiltration Due to Chronic Monoradicular Pain.

The aim of this study was to research the influence of psychological confounders on patient-reported outcomes (PROs) after lumbar infiltration therapies of periradicular infiltrations (PRI). Patients who underwent PRI in a single center between June 2018 and December 2019 were included. PRI was performed in patients with predominantly unilateral lumbar radiculopathy which existed for at least 6 weeks based on single-level nerve root compression (caused by a herniated disc, stenosis of the lateral recess, or neuroforamen), confirmed by morphological imaging. The numeric pain rating scale (NRS) for back pain (BP) and leg pain (LP) and the Oswestry Disability Index (ODI) were assessed preinterventionally, on the first day (only NRS) and at 6 weeks, and then 3, 6, and 12 months postinterventionally. The minimally clinically important difference (MCID) served as the threshold for the therapeutic effectiveness evaluation. The health-related quality of life (SF-36) was recorded preinterventionally and after 12 months. Based on the Hospital Anxiety and Depression Scale, the patients were dichotomized into depressed or nondepressed and anxious or nonanxious. Categorical data were evaluated using Fisher's exact test, and continuous data were evaluated using Student's t test. Separate linear mixed models were built to estimate the effect of anxiety or depression on repeatedly measured PROs following PRI. Data were analyzed using SPSS software. The analysis included 102 patients. Most mean baseline PROs were significantly worse in anxious or depressed patients than in nonanxious or nondepressed patients: Anxiety NRS-BP (p = 0.007), ODI (p < 0.001); Depression NRS-BP (p = 0.026), NRS-LP (p < 0.001), ODI (p < 0.001). All patients showed a clinically meaningful reduction in pain and functional improvement over a 12-month follow-up. There was no significant difference in the estimated overall mean PRO between all patients (p > 0.05). In conclusion, anxiety and depression are associated with worse PROs before and after PRI. However, patients with underlying depression or anxiety can expect a similar gain in PRO compared to patients without depressive or anxious symptoms.

Prenatal stress enhances atherosclerosis and telomere shortening in ApoE knockout mouse offspring

Children born to women who experience stress during pregnancy have an increased risk of atherosclerosis in later life, but few animal models have explored mechanisms. To study this phenomenon, timed-bred ApoE knockout mice were determined pregnant with ultrasound and randomly assigned on gestation day 8.5 to either a control (no stress) or prenatal stress (PS) group using 2 h of restraint for five consecutive days. PS significantly increased plasma corticosterone levels in pregnant mice. The litters from PS mice showed increased neonatal mortality within the first week of life. Body weights (at euthanasia) of adult offspring at 25 wk from the PS group were significantly increased compared with weights of controls. Adult offspring from these pregnancies were serially imaged with ultrasound to measure plaque thickness and were compared with plaque macroscopic and microscopic pathology. PS groups had increased plaque thickness determined by ultrasound, gross, histological evaluation and increased aortic root and valve macrophage infiltration at 25 wk. Five-week-old mice from PS group had significant decrease in mean arterial pressure, yet blood pressure normalized by 10 wk. As prenatal stress induced increased atherosclerosis, and telomeres are susceptible to stress, aortas from 10-wk-old mice were compared for telomere lengths and were found to be significantly shorter in PS mice compared with control mice. These studies support future investigation of how stress impacts telomere shortening in animal models and human aortas. This model could be further used to investigate the role of prenatal stress, telomere biology, and atherosclerosis pathogenesis in adults.

Features of primary pancreatic lymphoma: A bi-institutional review with an emphasis on typical and atypical imaging features.

BACKGROUNDPrimary pancreatic lymphoma (PPL) is a rare neoplasm. Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma (PDAC) is important for appropriate management. Unlike PDAC, PPL is highly sensitive to chemotherapy and usually does not require surgery. Therefore, being able to identify PPL preoperatively will not only direct physicians towards the correct avenue of treatment, it will also avoid unnecessary surgical intervention.AIMTo evaluate the typical and atypical multi-phasic computed tomography (CT) imaging features of PPL.METHODSA retrospective review was conducted of the clinical, radiological, and pathological records of all subjects with pathologically proven PPL who presented to our institutions between January 2000 and December 2020. Institutional review board approval was obtained for this investigation. The collected data were analyzed for subject demographics, clinical presentation, laboratory values, CT imaging features, and the treatment received. Presence of all CT imaging findings including size, site, morphology and imaging characteristics of PPL such as the presence or absence of nodal, vascular and ductal involvement in these subjects were recorded. Only those subjects who had a pre-treatment multiphasic CT of the abdomen were included in the study.RESULTSTwenty-nine cases of PPL were diagnosed between January 2000 and December 2020 (mean age 66 years; 13 males/16 females). All twenty-nine subjects were symptomatic but only 4 of the 29 subjects (14%) had B symptoms. Obstructive jaundice occurred in 24% of subjects. Elevated lactate dehydrogenase was seen in 81% of cases, whereas elevated cancer antigen 19-9 levels were present in only 10% of cases for which levels were recorded. The vast majority (90%) of tumors involved the pancreatic head and uncinate process. Mean tumor size was 7.8 cm (range, 4.0-13.8 cm). PPL presented homogenous hypoenhancement on CT in 72% of cases. Small volume peripancreatic lymphadenopathy was seen in 28% of subjects. Tumors demonstrated encasement of superior mesenteric vessels in 69% of cases but vascular stenosis or occlusion only manifested in 5 out of the twenty-nine individuals (17%). Mild pancreatic duct dilatation was also infrequent and seen in only 17% of cases, whereas common bile duct (CBD) dilation was seen in 41% of subjects. Necrosis occurred in 10% of cases. Size did not impact the prevalence of pancreatic and CBD dilation, necrosis, or mesenteric root infiltration (P = 0.525, P = 0.294, P = 0.543, and P = 0.097, respectively). Pancreatic atrophy was not present in any of the subjects.CONCLUSIONPPL is an uncommon diagnosis best made preoperatively to avoid unnecessary surgery and ensure adequate treatment. In addition to the typical CT findings of PPL, such as homogeneous hypoenhancement, absence of vascular stenosis and occlusion despite encasement, and peripancreatic lymphadenopathy, this study highlighted many less typical findings, including small volume necrosis and pancreatic and bile duct dilation.

Magnetic resonance imaging-guided lumbar nerve root infiltrations: optimization of an in-house protocol

BackgroundFor the treatment of radicular pain, nerve root infiltrations can be performed under MRI guidance in select, typically younger, patients where repeated CT exams are not desirable due to associated radiation risk, or potential allergic reactions to iodinated contrast medium.MethodsFifteen 3 T MRI-guided nerve root infiltrations were performed in 12 patients with a dedicated surface coil combined with the standard spine coil, using a breathhold PD sequence. The needle artifact on the MR images and the distance between the needle tip and the infiltrated nerve root were measured.ResultsThe distance between the needle tip and the nerve root was 2.1 ± 1.4 mm. The visual artifact width, perpendicular to the needle long axis, was 2.1 ± 0.7 mm. No adverse events were reported.ConclusionThis technical note describes the optimization of the procedure in a 3 T magnetic field, including reported procedure time and an assessment of targeting precision.

Plasma Rich in Growth Factors (PRGF) in the Treatment of Cervical and Lumbar Back Pain: A Retrospective Observational Clinical Study

Plasma rich in growth factors (PRGF) is a leukocyte-free platelet-rich plasma (PRP) that is an effective biological approach to tissue repair and has been demonstrated to significantly improve multiple conditions, including low back pain and degenerative disc pathology. The objective of this retrospective study was to analyze the effectiveness of treating both cervical and lumbar spine pain with minimally invasive infiltrations of PRGF-Endoret. Retrospective study design. Outpatient private practice facility. The effectiveness of PRGF has been assessed by patient-reported outcomes (PRO) through validated questionnaires, namely Numeric Rating Scale (NRS) for back pain, Spine Tango Core Outcome Measure Index (COMI) Questionnaire for lumbar and cervical pain, and OSWESTRY Disability Index questionnaire for lumbar pain cases. Score differences between pre- and post-treatment have also been assessed stratified for multiple sub-groups of patients based on the sector of the column treated, gender, and age. This study includes 65 patients (18 with cervical pain and 47 with lumbar back pain). The average time of back pain evolution was 10 years. Patients received at least 2 PRGF infiltration series about one month apart. Each patient received intervertebral disc and epidural infiltrations, root infiltrations, in case of radicular injury, and intraarticular infiltrations, in case of osteoarthritis of the facet joints. Results show statistically significant (P < 0.05) improvements on all analyzed scores. Regarding the stratified analyses, 249 (99%) sub-groups showed an improvement in all tests (252 cases overall). From the 249 improving cases, 154 (62%) showed a statistically significant difference between the pre- and the post- treatment periods. This research is a retrospective study with a relatively small sample cohort. Only PRO have been assessed. According to the results obtained in this study, and taking into account their limitations, PRGF infiltrations are an effective and minimally invasive biological strategy in the treatment of both cervical and lumbar pain, evaluated according to PRO.

Safety of CT-guided cervical nerve root infiltrations using a dorsal approach.

Cervical nerve root infiltrations are frequently performed in patients with radiculopathy, and computed tomography (CT) is commonly used for image guidance. With the traditional anterolateral approach, catastrophic side events due to spinal ischemia have been reported. To minimize risk, a dorsal approach has been advised, but the safety of this dorsal approach has not been studied systematically. In a 5-year period, 137 cervical nerve root infiltrations using a dorsal approach were performed on 109 patients and retrospectively reviewed. In our series, no major complications like spinal ischemia, spondylodiscitis, large hematomas with the need for surgery or severe allergic reactions occurred. In conclusion, using a dorsal approach, CT-guided cervical nerve root infiltrations with an extraforaminal needle position seem to be a safe intervention.

Water-Use Efficiency of Potted Pakchoi in Yunnan Laterite with Root Infiltration Irrigation and Anticlogging Emitter

AbstractA method is developed to calculate crop water consumption based on the water balance principle. An independently designed emitter resistant to clogging caused by negative pressure (EK) is a...

Surgical placement of rectus sheath catheters in a cadaveric cystectomy model.

Introduction Surgically inserted rectus sheath catheters (RSCs) are used increasingly for analgesia after cystectomy and other abdominal surgery. Currently, there is little information on the optimal positioning of RSCs to allow maximal spread of local anaesthetic. This study sought to assess the spread of dye injected via RSCs and to highlight the extent of its coverage in a fresh unembalmed cadaveric cystectomy model in order to confirm the nerve endings that are likely to be anaesthetised with RSCs. Methods Four cadavers underwent lower midline incision with limited bladder mobilisation. A RSC was inserted into the eight hemiabdomens. The RSCs were positioned either anterior (n=5) or posterior to the rectus muscle (n=3). Dye was injected down the RSCs to evaluate spread. The eight hemiabdomens were dissected anatomically to determine the surface area of dye spread and nerve root involvement. Results The mean surface area of dye spread with anteriorly placed RSCs was 30.6cm2 anterior and 25.9cm2 posterior to the rectus muscle. The mean surface area of dye spread with posteriorly placed RSCs was 11.3cm2 anterior and 37.3cm2 posterior to the rectus muscle. The mean number of nerve roots stained with anteriorly and posteriorly placed RSCs was 3.8 and 2.7 respectively. Subcutaneous spread of dye was seen with one anterior RSC insertion. Peritoneal spread was seen with one anteriorly positioned RSC. Conclusions This study has demonstrated efficient nerve root infiltration with anteriorly and posteriorly positioned RSCs. It appears that dye spreads between the fibres of the rectus muscle rather than out laterally to the nerve roots when spreading from its initial compartment.

Whole-body diffusion-weighted magnetic resonance imaging in the diagnosis of recurrent ovarian cancer: a clinical feasibility study.

To assess the clinical feasibility of whole-body diffusion-weighted MRI (WB-DWI/MRI) for diagnosis and prediction of complete tumour resection in patients with suspected recurrent ovarian cancer. 51 females clinically suspected for ovarian cancer recurrence underwent 3-T WB-DWI/MRI in addition to contrast-enhanced CT. WB-DWI/MRI was assessed for detection of tumour recurrence, prediction of tumour extent and complete resection compared with CT. Tumour presence was confirmed by pathology obtained by surgery or biopsy, or by imaging follow-up. WB-DWI/MRI showed 94% accuracy for detecting ovarian cancer recurrence, compared with 78% for CT (p = 0.008). WB-DWI/MRI showed better sensitivity [% (95% confidence interval)] than CT for detecting involvement of surgically critical tumour sites including mesenteric root infiltration [92 (62-100) vs 31 (10-61)], small bowel [93 (64-100) vs 21 (6-51)], colon carcinomatosis [91 (57-100) vs 27 (7-61)] and unresectable distant metastases [90 (54-99) vs 20 (4-56)]. WB-DWI/MRI correctly predicted complete resection in 33 of 35 (94%) patients eligible for salvage surgery compared with 17 of 35 (49%) for CT (p < 0.001). WB-DWI/MRI allowed better detection of ovarian cancer recurrence and better prediction of complete resection than CT. Advances in knowledge: WB-DWI/MRI could assist in optimizing treatment planning for recurrent ovarian cancer, particularly by improving patient selection for salvage surgery, thus giving eligible patients the highest chance on prolonged survival and refraining patients who would not benefit from extensive surgery reducing related morbidity and mortality.

Microstructural abnormalities of the trigeminal nerve by diffusion-tensor imaging in trigeminal neuralgia without neurovascular compression.

Microstructural changes of the trigeminal nerve in trigeminal neuralgia due to neurovascular compression have been reported by using diffusion tensor imaging. Other aetiologies such as primary demyelinating lesions, brain stem infarction and nerve root infiltration by tumour affecting the trigeminal pathway may also present as trigeminal neuralgia. The aim of this study was to evaluate the microstructural tissue abnormalities in the trigeminal nerve in symptomatic trigeminal neuralgia not related to neurovascular compression using diffusion tensor imaging. Mean values of the quantitative diffusion parameters of trigeminal nerve, fractional anisotropy and apparent diffusion coefficient, were measured in a group of four symptomatic trigeminal neuralgia patients without neurovascular compression who showed focal non-enhancing T2-hyperintense lesions in the pontine trigeminal pathway. These diffusion parameters were compared between the affected and unaffected sides in the same patient and with four age-matched healthy controls. Cranial magnetic resonance imaging revealed hyperintense lesions in the dorsolateral part of the pons along the central trigeminal pathway on T2-fluid-attenuated inversion recovery sequences. The mean fractional anisotropy value on the affected side was significantly decreased (P = 0.001) compared to the unaffected side and healthy controls. Similarly, the mean apparent diffusion coefficient value was significantly higher (P = 0.001) on the affected side compared to the unaffected side and healthy controls. The cause of trigeminal neuralgia in our patients was abnormal pontine lesions affecting the central trigeminal pathway. The diffusion tensor imaging results suggest that microstructural tissue abnormalities of the trigeminal nerve also exist even in non-neurovascular compression-related trigeminal neuralgia.

The diagnosis of double-crush lesion in the L5 lumbar nerve using diffusion tensor imaging

Background ContextA double-crush lesion is a condition in which the lumbar nerve is compressed both medially and laterally in the spinal canal, where diagnosis can be very difficult, and is a factor leading to poor surgical success rates. PurposeDiffusion tensor imaging (DTI) was used to determine DTI parameter fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) in both intraspinal column lesions alone and in double-crush lesions. Study DesignThis study used a prospective study. Patient SampleOf the 56 cases (mean age: 72.2 years) that underwent laminectomy for lumbar spinal stenosis at our clinic between April 2013 to March, 2015, 10 cases with L5 radiculopathy caused by L4–L5 stenosis (Intraspinal stenosis group (Group I); mean age: 74.7 years), and 5 cases with persistent symptoms caused by L5 foraminal stenosis despite L4–L5 decompression surgery (Double-crush group (Group D); mean age: 77.6 years) were targeted. One patient in Group D was diagnosed through microendoscopic intrapedicular partial pediculotomy and the remaining four cases by nerve root infiltration. Five healthy cases (mean age: 54 years) were studied as controls. Outcome measuresIntraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez) were established as the regions of interest, and the L5 nerve FA and ADC values were determined on the affected side. MethodsDiffusion tensor imaging was performed prospectively by 1.5T magnetic resonance imaging before surgery, and DTI parameters of L5 nerve were evaluated in all patients and healthy volunteers. Student t test was used for group comparisons, and a p<.05 was considered statistically significant. ResultsFractional anisotropy values (Iz, N, Ez) were 0.415, 0.448, and 0.517, respectively, increasing as sites became more distal. Group I values were 0.335, 0.393, and 0.484, and Group D values were 0.296, 0.367, and 0.360. Compared with the healthy volunteers, Group D had significantly lower Iz (p<.05) and Ez (p<.001) values, while Group I had significantly lower Iz (p<.05) values. In Group D, Ez FA values were significantly lower (p<.001) than in Group I. Apparent diffusion coefficient values (Iz, N, Ez) in the healthy control group were 1.270 mm2/s, 1.151 mm2/s, and 0.937 mm2/s with values decreasing as sites grew distal. In Group I, the ADC values were 1.406 mm2/s, 1.184 mm2/s, and 1.001 mm2/s, while in Group D they were 1.551 mm2/s, 1.412 mm2/s, and 1.329 mm2/s. Compared with the healthy volunteers, Iz (p<.05) and Ez (p<.05) values were significantly higher in Group D. The N (p<.01) and Ez (p<.001) ADC values were significantly higher in Group D than in Group I. ConclusionsDepending on where the nerve was compressed, changes in DTI parameters revealed nerve damage (low FA values and increased ADC) in the intraspinal canal in the Intraspinal Group, and over a widespread area in the Double-crush Group spanning the medial to lateral spinal canal. Our research suggests that in cases where double crush is suspected before surgery, failed back surgery syndrome may be prevented by evaluating DTI images.

Transforaminal Epidural Injection for Cervical Disc Herniation: Clinical Outcomes

Introduction To investigate the effect and complications after transforaminal injection for cervical disc herniation. Material and Methods We retrospectively reviewed all the patients submitted to a fluoroscopic-guided transforaminal injection for radiculopathy caused by cervical disc herniation. During the past 7 years, 57 patients (39 females, 18 males, mean age 45.6 years) experiencing cervical radiculopathy underwent fluoroscopically guided nerve root infiltrations by posterolateral approach. The position of the needle was verified after injection of a small amount of contrast. Lidocaine 1% (0.5 mL) and a glucocorticosteroid (0.5 mL) were injected. Results The most treated root was C6 (31 procedures), 14 patients had injections at C7, 7 at C5, and 5 at C4. Eight patients (14%) had complications (three syncopes, three transient hoarseness, one worsening of symptoms, and one hematoma). 42.1% became asymptomatic after the procedure, therefore not requiring surgery. Around 57% needed surgery but it took at least 2 months to become symptomatic again. Conclusion Radicular block for cervical disc herniation is a safe way to avoid surgery. Some patients still need surgery but since they got better with the procedure, they can schedule it at a convenient date.

Long Term Outcomes from CT-guided Indirect Cervical Nerve Root Blocks and their relationship to the MRI findings--A prospective Study.

To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7% at 1-month, 53.9% at 3-months and 68.1% at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. • Good long term outcomes after indirect nerve root infiltrations with non-particulate steroids. • The presence of nerve root compression was a predictive finding of 'improvement'. • Significantly less patients subsequently having surgery had lower NRS scores 1-month post injection. • There is less pain relief in patients with disc extrusions. • There are less improvement in patients with modic type I changes.

Fluoroscopically Guided Infiltration of the Cervical Nerve Root: An Indirect Approach Through the Ipsilateral Facet Joint

Transforaminal infiltrations in the cervical spine are governed by a higher rate of vascular puncture than in the lumbar spine. The purpose of our study is to assess the safety and efficacy of percutaneous, fluoroscopically guided nerve root infiltrations in cases of cervical radiculopathy. An indirect postero-lateral approach was performed through the ipsilateral facet joint. During the last 2 years, 25 patients experiencing cervical radiculopathy underwent percutaneous, fluoroscopically guided nerve root infiltrations by means of an indirect postero-lateral approach through the ipsilateral facet joint. The intra-articular position of the needle (22-gauge spinal needle) was fluoroscopically verified after injection of a small amount of contrast medium which also verified dispersion of the contrast medium periradicularly and in the epidural space. Then a mixture of long-acting glucocorticosteroid diluted in normal saline (1.5/1 mL) was injected intra-articularly. A questionnaire with a Numeric Visual Scale (NVS) scale helped assess pain relief, life quality, and mobility improvement. A mean of 2.3 sessions was performed in the patients of our study. In the vast majority of our patients 19/25 (76%), the second infiltration was performed within 7 – 10 days of the first one. Comparing the pain scores prior (mean value 8.80 ± 1.080 NVS units) and after (mean value 1.84 ± 1.405 NVS units), there was a mean decrease of 6.96 ± 1.695 NVS units [median value 7 NVS units (P &lt; 0.001) in terms of pain reduction, effect upon mobility, and life quality. There were no clinically significant complications noted in our study. Fluoroscopically guided transforaminal infiltrations through the ipsilateral facet joint seem to be a feasible, efficacious, and safe approach for the treatment of patients with cervical radiculopathy. This approach facilitates needle placement and minimizes risk of complications. Key words: Infiltrations, cervical spine, facet joint, transforaminal, pain, mobility, corticosteroid, fluoroscopy

Safety of CT-Guided Lumbar Nerve Root Infiltrations

Selective nerve root infiltrations are frequently performed in patients with lumbar radiculopathy. Computed tomography (CT) is now commonly used for image guidance. Despite the widespread use of CT-guided lumbar nerve root infiltrations few studies have systematically examined the safety of this approach. In a two-year period, 231 lumbar nerve root infiltrations were performed on in-patients and were retrospectively reviewed. No major complications like inflammation (especially spondylodiscitis), large haematomas requiring surgery, severe allergic reactions or spinal ischaemia occurred. In accordance with other published studies, CT-guided lumbar nerve root infiltrations seem to be safe. To minimize the risk of catastrophic neurological complications due to spinal ischaemia, careful needle placement dorsal to the nerve root and the use of a non-particulate corticosteroid, like dexamethasone, are advocated.

Safety of CT-Guided Lumbar Nerve Root Infiltrations. Analysis of a Two-Year Period.

Selective nerve root infiltrations are frequently performed in patients with lumbar radiculopathy. Computed tomography (CT) is now commonly used for image guidance. Despite the widespread use of CT-guided lumbar nerve root infiltrations few studies have systematically examined the safety of this approach. In a two-year period, 231 lumbar nerve root infiltrations were performed on in-patients and were retrospectively reviewed. No major complications like inflammation (especially spondylodiscitis), large haematomas requiring surgery, severe allergic reactions or spinal ischaemia occurred. In accordance with other published studies, CT-guided lumbar nerve root infiltrations seem to be safe. To minimize the risk of catastrophic neurological complications due to spinal ischaemia, careful needle placement dorsal to the nerve root and the use of a non-particulate corticosteroid, like dexamethasone, are advocated.

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. The mean intervention time was 24.9 min. (range: 12 - 36 min.) for MRI-guided infiltration and 19.7 min. (range: 5 - 54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance.

Effects of vinasse application under the physical attributes of soil covered with sugarcane straw

Areas under vinasse application have been associated to favorable physical conditions for root development, aeration, infiltration and water movement in soil profile. This study aimed to evaluate changes on physical attributes of soil under sugarcane straw after vinasse application in two sugarcane growing areas (Area 1 and Area 2) under mechanized management in the state of Paraíba, Brazil. In each area, the samples were collected in the 0-0.20, 0.20-0.40 and 0.40-0.60m layers of the soil, in 36 points, distributed in a 10×10m mesh, one day before and 40 days after vinasse application. The data were submitted to multivariate analysis with repeated measures and geostatistics. The vinasse application decreased soil density and increased total porosity in both Areas and increased organic matter in Area 2. In Area 1 occurred pure nugget effect for the fractions of sand, silt and clay, independent of soil layer. In Area 2, this effect was verified mostly at superficial layers, except for the fraction of clay that presented a moderate degree of spatial dependence.

Abstract 43: The Role of Epsins in Atherosclerosis

Background Epsins are a family of ubiquitin-binding, endocytic clathrin adaptors. Mice lacking both epsins 1 and 2 (Epn1/2) die at embryonic day 10 and exhibit an abnormal vascular phenotype. We have recently published that epsins function as regulators of tumor angiogenesis by controlling the endocytosis of VEGFR2 ( J Clin Invest. 2012). The goal of this project is to define the novel role of epsins in endothelial cells (EC) in regulating inflammation-mediated atherogenesis. Methods and results To examine the role of endothelial epsins in atherogenesis, we engineered mice with constitutive deletion of epsins in EC (EC-DKO). Strikingly, these mice are viable but display markedly attenuated atherogenesis on an ApoE null background in response to hypercholesterolemia. Oil red O staining revealed that ApoE-/- mice with endothelial deletion of epsins had a significant reduction in atherosclerotic lesion area in aortic root and macrophage infiltration compared to ApoE-/- mice after being fed a western diet for 10 weeks. FACS analysis revealed that deletion of epsins greatly reduced TNFα and LPS-induced expression of adhesion molecules (ICAM &amp; VCAM), selectins (P- &amp; E-), CCR2 and MCP-1 in primary mouse aortic EC (MAEC) isolated from EC-DKO mice. Mechanistically, epsins promote TNFR/TLRs signaling and NF-κB and MAPK (JNK and p38) activation by stabilizing the receptor complex formation and enhancing recruitment of NEMO, a crucial player in NF-kB activation. Conversely, epsin deficiency does not affect the surface expression of TNFR1/TLR2/4 by FACS analysis, suggesting that epsins may be dispensable for endocytosis of TNFR1/TLR2/4. We also observed that a synthetic peptide comprising the epsin ubiquitin-interacting motif (UIM) potently disrupts the association of epsins with TNFR/TLR signaling complex in vitro, suggesting a potential pharmacological inhibitory role for this peptide in controlling the atherosclerosis in vivo. Our data demonstrate that epsins control atherogenesis by regulating TNFR/TLR signaling in endothelial cells and provide a potential novel strategy to perturb atherogenesis. Conclusion Our results demonstrated an essential role of epsins in atherogenesis by regulating TNFR/TLR signaling.