Outcomes after selective nerve root blockade for lumbar radicular pain from lumbar disc hernia or lumbar spinal stenosis assessed by the PROMIS-29 - a prospective observational cohort study.

PURPOSE: Selective nerve root blocks (SNRB) are used both as a therapeutic and diagnostic tool for lumbar radicular pain. Most studies evaluate the effect of SNRB simply by its relation to pain reduction. It is well known that pain is associated with other factors such as depression, anxiety, inactivity and sleeping disorders, but these patient-related outcomes are seldom evaluated. This study evaluated the influence of SNRB on pain-related outcomes including depression, anxiety, fatigue, pain interference, activity and sleep. METHODS: One hundred three patients with lumbar radicular pain were treated with a SNRB. Patient-reported outcome measures (PROMs) were assessed with the PROMIS-29 for 12 weeks (84 days) following the SNRB. Patients were stratified based on their pain reduction at the 14-day follow up as responders (≥ 30% pain reduction) and non-responders (< 30% pain reduction). Post-treatment duration was estimated with the Kaplan-Meier analysis with return to baseline as an event. A paired t-test was used to compare pre- and post-treatment responses at specific time intervals. RESULTS: Forty-four percent (n = 45) of the patients were responders and showed significant improvement in all parameters throughout the 84-days follow-up, the exception was sleep that lost significance at day 70. The mean post-treatment duration among responders was 59 (52-67) days. Non-responders showed significant improvements in pain interference and pain intensity until day 35 and in ability for social participation until 21-day. CONCLUSION: SNRB can improve pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance and the ability to participate in social roles.

Sequential extraction of sulfide-rich tailings remediated by the application of till cover, Kristineberg mine, northern Sweden.

A sequential extraction has been carried out on sulfide-rich mine tailings. The purpose was to investigate how elements released by oxidation are secondarily retained in the tailings and the possible consequences of the remediation. After investigating the solid tailings, seven samples were chosen for sequential extractions. Two samples were oxidised, situated just above the oxidation front; two samples from just below the former oxidation front with increased concentrations of several elements; two unoxidised samples were from an intermediate depth, and the deepest sample was from the tailings-peat boundary at the bottom of the impoundment. Five phases were extracted: adsorbed/exchangeable/carbonate; labile organics; amorphous Fe-oxyhydroxides/Mn-oxides; crystalline Fe-oxides; and organics/sulfides. The addition from dried porewater to the extracted fractions has been calculated and considered as minor. In the oxidised tailings, the sulfide fraction still dominates for elements such as Fe, S, Cd, Co, Cu, Hg and Zn, although the concentrations are low compared to the unoxidised tailings. Generally, the second most important fraction is the adsorbed/exchangeable/carbonate fraction. Below the oxidation front, the sulfide content of the tailings sharply increases. In the secondary enrichment zone, the total element concentrations increase compared with the deeper unoxidised samples, mainly due to secondary retention. For some elements, secondary retention is greater than the total amount extracted for the deeper unoxidised samples. In the secondary enrichment zone the adsorbed/exchangeable/carbonate fraction represents approximately 20 wt.% or more for Cd, Co, Mn, Ni and Zn. The amorphous iron oxyhydroxide or the crystalline iron oxide fractions are less important at this level, although for As, Ba and Cu the amorphous iron oxyhydroxide fraction represents up to 20 wt.%. At the lower border of the enrichment zone, the total concentration for most metals is lower, but the importance of the adsorbed/exchangeable/carbonate fraction is further enhanced for Cd, Cu, Ni and Zn. These elements have 35-60 wt.% of the total amount from this fraction. For As, Cd, Cu, Ni and Pb, the secondary fractions extracted (extractions A-D) represent between 60 and 80 wt.% of the total content. At greater depth in the impoundment the relative importance of the adsorbed/exchangeable/carbonate fraction decreases, whilst the importance of amorphous iron oxyhydroxide and crystalline iron oxide fractions increases. The adsorbed/exchangeable/carbonate fraction is the most easily remobilised fraction. A raised groundwater table previously situated below the enrichment zone may result in the release of secondarily retained metals.