Comparison of the Low Back Pain Relief and Spread Level After Upper and Lower Lumbar Erector Spinae Plane Block.

BACKGROUND: The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. OBJECTIVES: The purpose of this study is to compare the analgesic efficacy and spread level of the upper and lower lumbar ESPBs . STUDY DESIGN: Prospective, randomized design. SETTING: The pain clinic of a tertiary university hospital. METHODS: This study included 84 patients with low back pain with or without leg pain who received lumbar ESPB at L2 (L2 ESPB group) or L4 (L4 ESPB group) using 10 mL of 0.2% ropivacaine mixed with 10 mL of the contrast medium. After finishing 20 mL of the local anesthetic mixture injection, a fluoroscopic examination was performed to evaluate the spread level. Analgesic efficacy was assessed using an 11-point Numeric Rating Scale (NRS-11) and a Back Pain Functional Scale. RESULTS: The number of patients who showed excellent-to-moderate low back pain relief was 35 (83.3%) and 36 (78.5%) in the L2 and L4 ESPB groups, respectively. Significant reductions in pain on the NRS-11 and improvements in disability were found in both groups. The total number of vertebral segments to which the anesthetic drugs spread was significantly higher in the L2 ESPB group than in the L4 ESPB group (2.7 ± 0.5 vs 2.0 ± 0.2, P = 0.002). LIMITATIONS: The analgesic efficacy of lumbar ESPB was evaluated with only short-term outcomes. CONCLUSIONS: Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group.

Metastatic intestinal adenocarcinoma with osseous metaplasia in two Domestic Korean Shorthair cats.

Two Domestic Korean Shorthair cats presented with dyschezia and vomiting. Computed tomography revealed a colonic mass with calcification and lymph node metastasis in case 1, and a small intestinal mass with disseminated mesenteric metastasis and calcification in case 2. Histopathology revealed intestinal adenocarcinoma with osseous metaplasia. Case 1 died two months after surgery from distant metastasis; and case 2 showed no metastasis for five months but presented with anorexia, euthanized seven months after diagnosis. Metastatic intestinal adenocarcinoma with bone formation should be considered as differential diagnosis for calcification on imaging, and lymph node metastasis at diagnosis may indicate poor prognosis.

Hornerin mediates phosphorylation of the polo-box domain in Plk1 by Chk1 to induce death in mitosis.

The centrosome assembles a bipolar spindle for faithful chromosome segregation during mitosis. To prevent the inheritance of DNA damage, the DNA damage response (DDR) triggers programmed spindle multipolarity and concomitant death in mitosis through a poorly understood mechanism. We identified hornerin, which forms a complex with checkpoint kinase 1 (Chk1) and polo-like kinase 1 (Plk1) to mediate phosphorylation at the polo-box domain (PBD) of Plk1, as the link between the DDR and death in mitosis. We demonstrate that hornerin mediates DDR-induced precocious centriole disengagement through a dichotomous mechanism that includes sequestration of Sgo1 and Plk1 in the cytoplasm through phosphorylation of the PBD in Plk1 by Chk1. Phosphorylation of the PBD in Plk1 abolishes the interaction with Sgo1 and phosphorylation-dependent Sgo1 translocation to the centrosome, leading to precocious centriole disengagement and spindle multipolarity. Mechanistically, hornerin traps phosphorylated Plk1 in the cytoplasm. Furthermore, PBD phosphorylation inactivates Plk1 and disrupts Cep192::Aurora A::Plk1 complex translocation to the centrosome and concurrent centrosome maturation. Remarkably, hornerin depletion leads to chemoresistance against DNA damaging agents by attenuating DDR-induced death in mitosis. These results reveal how the DDR eradicates mitotic cells harboring DNA damage to ensure genome integrity during cell division.

Qualitative metabolomics-based characterization of a phenolic UDP-xylosyltransferase with a broad substrate spectrum from Lentinus brumalis.

Wood-decaying fungi are the major decomposers of plant litter. Heavy sequencing efforts on genomes of wood-decaying fungi have recently been made due to the interest in their lignocellulolytic enzymes; however, most parts of their proteomes remain uncharted. We hypothesized that wood-decaying fungi would possess promiscuous enzymes for detoxifying antifungal phytochemicals remaining in the dead plant bodies, which can be useful biocatalysts. We designed a computational mass spectrometry-based untargeted metabolomics pipeline for the phenotyping of biotransformation and applied it to 264 fungal cultures supplemented with antifungal plant phenolics. The analysis identified the occurrence of diverse reactivities by the tested fungal species. Among those, we focused on O-xylosylation of multiple phenolics by one of the species tested, Lentinus brumalis. By integrating the metabolic phenotyping results with publicly available genome sequences and transcriptome analysis, a UDP-glycosyltransferase designated UGT66A1 was identified and validated as an enzyme catalyzing O-xylosylation with broad substrate specificity. We anticipate that our analytical workflow will accelerate the further characterization of fungal enzymes as promising biocatalysts.

Fluoroscopic Analysis of Cannula Tip Location During Radiofrequency Thermocoagulation of the Trigeminal Ganglion.

BACKGROUND: Trigeminal neuralgia (TN) is the most common excruciating cranial neuralgia in the elderly population. Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an alternative treatment for medically intractable patients with TN. RFT cannula tip position is an important issue since it is related to treatment outcome and patient safety. OBJECTIVES: The purpose of this study was to evaluate the fluoroscopic position of a cannula tip when a maximal stimulation-induced paresthesia was obtained and the treatment outcome using a Barrow Neurological Institute (BNI) pain scale. STUDY DESIGN: Retrospective analysis. SETTING: An interventional pain management practice in South Korea. METHODS: The final cannula tip position obtained under maximal electrical stimulation of the face was analyzed using previously saved fluoroscopic images. RESULTS: The cannula tip was located exactly in the clival line in 10 patients (29.4%) with maxillary division (V2) TN. There were 24 patients of V2 TN (70.5% ) in whom the cannula tip was located below the clival line. Over 50% of cannula tips were located at -11 mm to -15 mm below the clival line in mandibular division (V3) TN. Forty-four patients (83%) who received RFT in the trigeminal ganglion demonstrated BNI I or II. LIMITATIONS: The number of patients with V3 TN was smaller than that of V2 TN. Only short-term efficacy was evaluated, but not long-term efficacy or recurrence rate of facial pain. CONCLUSIONS: Nearly 70% of patients in V2 TN and all patients in V3 TN, the cannula tip was positioned below the clival line. RFT of the trigeminal ganglion showed a successful treatment outcome with BNI I or II in 83% of patients.

Evaluation of deodorization techniques using cyclodextrins on the headspace volatiles and antioxidant properties of onion.

Sulphur-containing volatiles in onion produce unpleasant odors and this limit their usage in foods. To expand its application, several additives including α-cyclodextrin (α-CD), ß-cyclodextrin (ß-CD), 2-hydroxypropyl-ß-cyclodextrin (HP-ß-CD), and chitosan were added to onion solution and evaluated for their effect on sulphur-containing volatiles. Also, antioxidant property using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay and oxidative stabilities in an oil-in-water (O/W) emulsion were carried out. The total volatile contents were decreased in the order of α-CD (50.1%), ß-CD (49.3%), HP-ß-CD (46.2%), and chitosan (7%). Meanwhile, HP-ß-CD showed the highest DPPH radical scavenging ability followed by ß-CD, α-CD, and chitosan with decreasing order. The ß-CD significantly enhanced the oxidative stability of the O/W emulsion, whereas α-CD and ß-HP-CD showed prooxidative behavior. Overall, ß-CD might be used as a sulphur-containing volatile decreasing agent, which could keep the antioxidant properties of onion in the O/W emulsion.

Racial Differences in the Relationship Between Pain and Suicide Desire in Older Adults.

Older adults are reported to die by suicide at higher rates than the general population. Suicide desire among older adults is associated with pain, and pain experiences have been found to differ based on race. To investigate the relationship between pain and suicidal desire, 437 racially diverse older adults who receive home-based services (home-delivered meals) in the Southeastern region of the United States completed standardized measures of psychological pain, chronic physical pain, and suicidal desire. Results identified race moderated the relationship between pain and suicidal desire, indicating a stronger relationship between pain and suicidal desire among Black older adults than White older adults. Chronic physical pain (i.e., emotional burden) interacted with race to predict Perceived Burdensomeness (p = .011) and Thwarted Belongingness (p = .032). Greater attention to pain experiences among Black older adults is warranted, considering the impact of COVID-19 on racial/ethnic minorities' mental health.

Ginsenoside Rg1 suppresses cancer cell proliferation through perturbing mitotic progression.

Background: Although the tumor-suppressive effects of ginsenosides in cell cycle have been well established, their pharmacological properties in mitosis have not been clarified yet. The chromosomal instability resulting from dysregulated mitotic processes is usually increased in cancer. In this study, we aimed to investigate the anticancer effects of ginsenoside Rg1 on mitotic progression in cancer. Materials and methods: Cancer cells were treated with ginsenoside Rg1 and their morphology and intensity of different protein were analyzed using immunofluorescence microscopy. The level of proteins in chromosomes was compared through chromosomal fractionation and Western blot analyses. The location and intensity of proteins in the chromosome were confirmed through immunostaining of mitotic chromosome after spreading. The colony formation assays were conducted using various cancer cell lines. Results: Ginsenoside Rg1 reduced cancer cell proliferation in some cancers through inducing mitotic arrest. Mechanistically, it inhibits the phosphorylation of histone H3 Thr3 (H3T3ph) mediated by Haspin kinase and concomitant recruitment of chromosomal passenger complex (CPC) to the centromere. Depletion of Aurora B at the centromere led to abnormal centromere integrity and spindle dynamics, thereby causing mitotic defects, such as increase in the width of the metaphase plate and spindle instability, resulting in delayed mitotic progression and cancer cell proliferation. Conclusion: Ginsenoside Rg1 reduces the level of Aurora B at the centromere via perturbing Haspin kinase activity and concurrent H3T3ph. Therefore, ginsenoside Rg1 suppresses cancer cell proliferation through impeding mitotic processes, such as chromosome alignment and spindle dynamics, upon depletion of Aurora B from the centromere.

Comparison of Efficacy of an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid.

BACKGROUND: The leakage of cerebrospinal fluid (CSF) can be encountered spontaneously or after procedures such as epidural or spinal anesthesia, intrathecal chemotherapy, CSF tapping, or other various spinal procedures. The leakage of CSF can lead to intracranial hypotension, which is associated with an orthostatic headache. For such patients with this type of headache, an epidural blood patch is the treatment of choice. OBJECTIVE: The purpose of this study is to compare the clinical features and efficacy of an epidural blood patch for patients with spinal leakage of CSF. STUDY DESIGN: Retrospective study. SETTING: University hospital inpatients referred for consultation to the pain clinic. METHODS: Identification of patients with orthostatic headache was performed using the program Clinical Data Warehouse (CDW) v 2.5. Search word in CDW for analysis was "epidural blood patch." We carefully evaluated the demographics, etiology, clinical features of headache, associated phenomena other than headache, level and types of CSF leakage, and frequencies and outcomes of epidural blood patches. We allocated patients into 2 groups according to the cause of headache: spontaneous intracranial hypotension (group SIH) and post-dural puncture headache (group PDPH). RESULTS: The number of patients needing repeated epidural blood patches was significantly higher in the SIH group SIH in the PDPH group (P = 0.007). In the PDPH group, a targeted epidural blood patch was possible in 100% of the cases, whereas it was possible in only 66.7% of the patients in the SIH group, indicated by previous examination (P < 0.001). Forty patients (90.9%) and 17 patients (70.8%) achieved complete recovery from headache after a single epidural blood patch in the PDPH group and SIH group, respectively (P < 0.001). LIMITATION: The number of patients allocated to each group was not balanced because of the retrospective design. CONCLUSION: Most patients in the PDPH group required a single epidural blood patch to achieve complete recovery from headache. However, patients in the SIH group required repeated epidural blood patches for complete pain relief.

Digital health care and arrhythmia: a case of WPW syndrome in South Korea, 2020.

BACKGROUND: The digital health care field is expanding from the daily monitoring of chronic diseases to the detection of acute diseases, such as arrhythmia. Wolff-Parkinson-White (WPW) syndrome, a congenital cardiac disorder due to accessory pathways, causes tachycardia, syncope, and even sudden death. CASE PRESENTATION: We presented a 26-year-old female office worker with WPW syndrome managing the disease with a wearable device and discussed its significance in occupational medicine. After reviewing the worker's electrocardiogram results, symptoms, and pulse rate records extracted from the wearable device, we referred the worker to a cardiologist for further evaluations such as electrophysiology study. The worker monitors her symptom recurrence with the wearable device following successful radiofrequency catheter ablation of the bypass tract. CONCLUSIONS: A case of an office worker with WPW syndrome managing the disease using a smart watch is presented. Further research is required to ensure its scientific validity, and we suggest policymakers promptly introduce digital health care to occupational environments.

The Effect of Normal Saline Injection Volumes on the Optic Nerve Sheath Diameter during Thoracic Epidural Analgesia.

BACKGROUND: Saline or local anesthetic injection into the epidural space increases intracranial pressure (ICP), at least transiently. Measurement of the optic nerve sheath diameter (ONSD) using ocular ultrasonography is one of the noninvasive methods for ICP assessment. OBJECTIVES: The purpose of this study is to investigate the effects of the different volume on the ONSD and cerebral oxygen saturation (rSO2) during thoracic epidural saline injection under awake conditions. STUDY DESIGN: Prospective randomized, controlled trial. SETTING: An interventional pain management practice in South Korea. METHODS: This study included 71 patients receiving thoracic epidural catheterization for pain management, following upper abdominal or thoracic surgery. Following successful epidural space confirmation, patients were randomly allocated to receive 5 mL (5 mL group), 10 mL (10 mL group), and 20 mL (20 mL group) of epidural normal saline. Transorbital sonography was performed to measure the ONSD. This was measured at 3 mm posterior to the optic nerve head. An rSO2 was measured using cerebral oximeter sensors. RESULTS: All 3 groups showed significant increases of ONSD from 10 minutes to 40 minutes as compared to baseline (before procedure). Among the 3 groups, the 20 mL group demonstrated the most significantly increased ONSD, as compared to the 5 mL and 10 mL groups. At the 20 minute and 40 minute time points, the ONSD showed a volume-dependent increase (P = 0.0005, P = 0.014). All 3 groups showed the rSO2 to be distributed between 60~70% without any statistical difference. LIMITATIONS: We could not determine the returning point of the normalized ONSD value. CONCLUSION: Twenty milliliters of normal saline epidural injection resulted in a significant increase of ONSD, as compared to the 5 mL and 10 mL groups. Our results also indicate that an increase of ONSD occurs in accordance with the injected volume of normal saline.

Comparison of Intravascular Injection Incidences and Technical Easiness Between Anteroposterior and Oblique Approaches During S1 Transforaminal Epidural Injection.

BACKGROUND: Transforaminal epidural injection (TFEI) is a useful intervention for radicular leg pain. Compared to TFEI in lumbar level, S1 TFEI is reported to have higher incidence rates of intravascular injection as well as technical difficulties. OBJECTIVE: The purpose of this study is to compare the incidence rates of intravascular injection and foramen passage time between anteroposterior (AP) and oblique (OB) approaches. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: One hundred forty-seven patients receiving S1 TFEI for radicular leg pain were randomly assigned to one of 2 approach methods (AP view vs OB view). For S1 TFEI in the OB view group, lineup of the L5-S1 endplate was performed by adjusting the cephalad-caudad tilt. Then C-arm was rotated at an ipsilateral oblique angle, approximately 10° to 15°. After final confirmation of intravascular injection with real time fluoroscopy, the foramen passage time and amount of radiation exposure during S1 TFEI were measured. RESULTS: The incidence rate of intravascular injection in the AP view group was 24.2% (24/99), whereas that of intravascular injection in the OB view group was 10.1% (17/99, P = 0.008). The radiation dose required to pass the S1 foramen was significantly higher in the AP view group than in the OB view group (51.3 ± 27.2 cGy/cm2 vs 41.0 ± 17.0 cGy/cm2, P = 0.002). The foramen passage time during S1 TFEI was significantly higher in the AP view group than in the OB view group (103.5 ± 44.1 second vs 84.9 ± 21.0 second, P = 0.001). The failure rate of S1 TFEI was significantly higher in the AP view group than in the OB view group (13% vs 4%, P = 0.022). LIMITATION: The physicians involved in the present study were not blinded to the type of approach method (AP view vs OB view) by fluoroscopy. CONCLUSION: Our study demonstrated reduced incidence rates of intravascular injection and reduced foramen passage time and radiation dosage with the use of OB view method during S1 TFEI.

A Cadaver Study Confirming the Location of Dye after Trigeminal Ganglion Rhizotomy.

BACKGROUND: Radiofrequency thermal rhizotomy demonstrates an excellent treatment outcome with a high success rate among patients of intractable trigeminal neuralgia. The triangular plexus which is an immediate retrogasserian portion of the trigeminal root is suggested as the best place of lesioning during radiofrequency thermal rhizotomy. However, the anatomy of the triangular plexus has been relatively unrecognized, while the anatomical study related to therapeutic procedure is scarce. OBJECTIVE: The purpose of this study is to confirm with gross and microscopic finding of the trigeminal system whether, if an electrode tip is placed on the petroclival junction in lateral cranial view, it actually arrives at the triangular plexus or not. In relation to therapeutic procedure, we examined the triangular plexus with morphological and histological methods. STUDY DESIGN: Human cadaveric study. SETTING: An anatomical laboratory in South Korea. METHODS: Percutaneous procedure of radiofrequency thermal rhizotomy under C-arm guidance was performed in 8 cadavers. Final target of the electrode tip was the petroclival junction under true lateral cranial view. The location of the electrode tip was determined under observation of the presence of an injected dye. Triangular plexus size was measured grossly and microscopically. Gross and microscopic evaluation of the triangular plexus was performed. RESULTS: Among 15 trigeminal systems, 8 showed dye appearance in the triangular plexus, while 6 showed it in the trigeminal ganglion. Overall, 53% of radiofrequency thermal rhizotomy could reach the triangular plexus when an electrode tip was placed on the petroclival junction. The grossly measured average triangular plexus vertical and transverse diameters were 0.8 cm and 1.3 cm, respectively. LIMITATION: Only radiologic landmark was used to confirm the location of the electrode tip. However, further study confirming the location of the electrode tip under the guidance of electrical stimulation is needed. CONCLUSION: When an electrode tip was placed on the petroclival junction, 53% of radiofrequency thermal rhizotomy could reach the triangular plexus.

Wip1 controls the translocation of the chromosomal passenger complex to the central spindle for faithful mitotic exit.

Dramatic cellular reorganization in mitosis critically depends on the timely and temporal phosphorylation of a broad range of proteins, which is mediated by the activation of the mitotic kinases and repression of counteracting phosphatases. The mitosis-to-interphase transition, which is termed mitotic exit, involves the removal of mitotic phosphorylation by protein phosphatases. Although protein phosphatase 1 (PP1) and protein phosphatase 2A (PP2A) drive this reversal in animal cells, the phosphatase network associated with ordered bulk dephosphorylation in mitotic exit is not fully understood. Here, we describe a new mitotic phosphatase relay in which Wip1/PPM1D phosphatase activity is essential for chromosomal passenger complex (CPC) translocation to the anaphase central spindle after release from the chromosome via PP1-mediated dephosphorylation of histone H3T3. Depletion of endogenous Wip1 and overexpression of the phosphatase-dead mutant disturbed CPC translocation to the central spindle, leading to failure of cytokinesis. While Wip1 was degraded in early mitosis, its levels recovered in anaphase and the protein functioned as a Cdk1-counteracting phosphatase at the anaphase central spindle and midbody. Mechanistically, Wip1 dephosphorylated Thr-59 in inner centromere protein (INCENP), which, subsequently bound to MKLP2 and recruited other components to the central spindle. Furthermore, Wip1 overexpression is associated with the overall survival rate of patients with breast cancer, suggesting that Wip1 not only functions as a weak oncogene in the DNA damage network but also as a tumor suppressor in mitotic exit. Altogether, our findings reveal that sequential dephosphorylation of mitotic phosphatases provides spatiotemporal regulation of mitotic exit to prevent tumor initiation and progression.

The Effect of Different Posture on Normal Saline Injection in Optic Nerve Sheath Diameter in Thoracic Epidural Anesthesia.

BACKGROUND: Thoracolumbar or caudal epidural anesthesia affects intracranial pressure (ICP) in both animals and humans. Epidural injection increases ICP at least transiently. Measurement of the optic nerve sheath diameter (ONSD) using ultrasonography is one of the noninvasive methods for ICP assessment. OBJECTIVES: The purpose of this study was to investigate the effect of the different posture during epidural saline injection to the ONSD under awake conditions. STUDY DESIGN: Prospective, randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: This study included 44 patients receiving thoracic epidural catheterization for pain management after upper abdominal or thoracic surgery. Following successful epidural space confirmation, patients were randomized to receive epidural saline while supine (A group) or in sitting position (B group), respectively. Transorbital sonography was performed for the measurement of the ONSD, and the ONSD was measured at 3 mm posterior to the optic nerve head. RESULTS: Both A and B groups showed significant increases of ONSD according to time. Mean ONSD values measured at T10, T20, and T40 significantly increased from the baseline value (T0) (*P < 0.05 vs. T0, †P < 0.001 vs. T0, ‡P < 0.005 vs. T0). The mean ONSD values measured at any of the time points and degrees of changes (T10-T0, T20-T0, and T40-T0) between groups A and B did not show any significant changes. LIMITATIONS: Epidural pressure and ONSD measurement can make this study more reliable. Further study showing changes of epidural pressure with ONSD measurement is required. CONCLUSIONS: Thoracic epidural injection of 10 mL of normal saline resulted in a significant increase of ONSD compared with the baseline. However, the different posture did not affect the increase of ONSD.

Comparison of Epidural Pressure Decrease Pattern According to Different Lumbar Epidural Approaches.

BACKGROUND: During lumbar epidural injection (LEI) using a midline approach, we might encounter failure of identifying the epidural space owing to an equivocal or absent loss of resistance (LOR) sensation. The reason for such absence of LOR sensation has been suggested as paucity of midline ligamentum flavum, paravertebral muscle, and cyst in the interspinous ligament of the lumbar spine. Despite its low specificity, LOR is the most commonly used method to identify the epidural space. OBJECTIVES: The purpose of this study was to analyze lumbar epidural pressure decrease patterns and identify factors contributing to this pressure decrease. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: This prospective study included 104 patients receiving LEI due to lumbar radiculopathy. A midline or paramedian approach of LEI was determined with randomization. Among various factors, gender, age, body mass index (BMI), and diagnosis were analyzed using a subgroup that included 60 cases of only a paramedian approach. RESULTS: Grades I, II (abrupt decrease), and III (gradual decrease) were found as patterns of epidural pressure decrease. Abrupt pressure decrease was more frequently observed in the paramedian group (P < 0.001). Age, gender, BMI, and diagnosis did not show any significant difference in frequencies between abrupt and gradual pressure decrease. LIMITATIONS: We could not match LOR sensation with epidural pressure decrease shown in the monitor. CONCLUSIONS: This study demonstrates that abrupt pressure decrease occurs more frequently with the paramedian approach. However, age, gender, BMI, or diagnosis did not affect the incidence of epidural pressure decrease. KEY WORDS: Epidural, paramedian, midline, pressure decrease.

c-Cbl Acts as an E3 Ligase Against DDA3 for Spindle Dynamics and Centriole Duplication during Mitosis.

The spatiotemporal mitotic processes are controlled qualitatively by phosphorylation and qualitatively by ubiquitination. Although the SKP1-CUL1-F-box protein (SCF) complex and the anaphase-promoting complex/cyclosome (APC/C) mainly mediate ubiquitin-dependent proteolysis of mitotic regulators, the E3 ligase for a large portion of mitotic proteins has yet to be identified. Here, we report c-Cbl as an E3 ligase that degrades DDA3, a protein involved in spindle dynamics. Depletion of c-Cbl led to increased DDA3 protein levels, resulting in increased recruitment of Kif2a to the mitotic spindle, a concomitant reduction in spindle formation, and chromosome alignment defects. Furthermore, c-Cbl depletion induced centrosome over-duplication and centriole amplification. Therefore, we concluded that c-Cbl controls spindle dynamics and centriole duplication through its E3 ligase activity against DDA3.

Fluoroscopically Guided Thoracic Interlaminar Epidural Injection: A Comparative Epidurography Study Using 2.5 mL and 5 mL of Contrast Dye.

BACKGROUND: Thoracic epidural anesthesia (TEA) is frequently used to maintain intraoperative analgesia. After injecting the initial bolus dose of epidural local anesthetics (LA), intermittent injection of LA through an epidural catheter is required to maintain the intraoperative analgesia. For intermittent epidural administration, usually 2 - 5 mL of LA has been used. However, no studies have suggested an optimal volume of LA of TEA for intermittent epidural administration of TEA. OBJECTIVE: We focused on identifying an optimal volume of LA of TEA using epidurography of the thoracic level with 2 different volumes of contrast dye. STUDY DESIGN: Prospective, randomized study. SETTING: An interventional pain management practice in South Korea. METHODS: After Institutional Review Board approval, 70 patients undergoing thoracic epidural catheterization for upper abdominal and thoracic surgery were randomly assigned to one of the 2 contrast dye volume groups of 35 patients each (A, 2.5 mL and B, 5.0 mL). Epidurography was evaluated to confirm how many spinal segments were covered by contrast dye. The spreads in the cephalad and caudad directions were also evaluated. RESULTS: The total number of vertebral segments evaluated by contrast dye were 7.5 ± 2.0, and 8.4 ± 2.6, respectively in groups A and B. The number of patients who showed contrast dye spread of more than 5 vertebral segments was 34/35 (97%) in both groups. Group B resulted in higher contrast dye distribution in the cephalad direction compared to group A (T2.6 vs. T3.6 ). LIMITATIONS: We used a test dose of contrast dye to confirm the contrast was in epidural space, not intrathecal or vascular, before injection of the main dose of contrast dye. The present study did not include the volume of test dose. CONCLUSION: The volume of 2.5 mL for intermittent epidural administration would be enough for the analgesic effect of upper abdominal and thoracic surgery while avoiding excessive upper thoracic and cervical spread. KEY WORDS: Thoracic epidural anesthesia, intermittent epidural administration, optimal volume, epidurography, cephalad, caudad, analgesic effect.

Clinical Effectiveness and Prognostic Indicators of Parasagittal Interlaminar Epidural Injection.

BACKGROUND: Interlaminar epidural steroid injection (ESI) is a well-established intervention to improve radicular leg pain. However, few studies have demonstrated the prognostic factors for interlaminar ESI. OBJECTIVE: To investigate the clinical effectiveness and prognostic indicators of parasagittal interlaminar ESI during a 2-week follow-up. STUDY DESIGN: Prospective evaluation. SETTING: An interventional pain management practice in South Korea. METHODS: After Institutional Review Board approval, parasagittal interlaminar ESI under fluoroscopic guidance was performed in 55 patients with central spinal stenosis. The numerical rating scale (NRS) and the Oswestry Disability Index (ODI) (%) were used to evaluate clinical efficacy and prognostic indicators. To determine the prognostic indicators, treatment outcomes were classified as successful (decreased NRS ≥ 50%, decreased ODI ≥ 40%) and unsuccessful (decreased NRS < 50%, decreased ODI < 40%) results. RESULTS: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores after 2 weeks compared to those measured pretreatment. Paresthesia provocation (P = 0.006) was a significant prognostic factor on the NRS, whereas the Beck Depression Inventory (BDI) score (P = 0.007), paresthesia provocation (P = 0.035), and epidurography finding (P = 0.038) were significant on the ODI (%) score between patients with successful and unsuccessful outcomes. LIMITATIONS: We included the method of parasagittal interlaminar ESI only, therefore, direct comparison with other techniques was not available. CONCLUSION: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores. Paresthesia provocation was a prognostic indicator on the NRS and ODI (%) scores, and BDI scores and epidurography findings were prognostic indicators for the ODI (%) score.

Whitacre Needle Reduces the Incidence of Intravascular Uptake in Lumbar Transforaminal Epidural Steroid Injections.

BACKGROUND: Transforaminal epidural steroid injection (TFESI) is a commonly used interventional pain management procedures to treat radicular leg pain. Although most reported complications of TFESI are minor, serious morbidity has also been demonstrated including spinal cord infarction, paraplegia, and quadriparesis. Suggested mechanisms include direct vascular injury or intravascular injection of particulate steroid. OBJECTIVE: We compared 2 different needle types, Whitacre and Quincke type needles, with regard to intravascular injection rate with total procedure time and the amount of radiation during lumbar TFESI. STUDY DESIGN: Prospective, randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: After Institutional Review Board approval, 149 patients undergoing lumbar TFESI for radicular leg pain were randomly assigned to one of 2 needle groups (Whitacre needle or Quincke type needle). After final confirmation of intravascular injection with digital subtraction angiography, total procedure time and amount of radiation exposure during TFESI were measured. RESULTS: The overall incidence of intravascular injection was 10.4% (28/269). We analyzed the overall incidence of intravascular injection according to the 2 different needle types. The incidence of intravascular injection of the Whitacre needle was 5.4% (8/146), whereas the incidence of intravascular injection of the Quincke needle was 16.2% (20/123). Total procedure time and amount of radiation required to complete the TFESI in the Whitacre and Quincke needle groups was 168.4 ± 57.9 (seconds) and 33.4 ± 15.9 (cGy/cm2), 131.9 ± 46.0 (seconds) and 33.2 ± 15.8 (cGy/cm2), respectively. LIMITATIONS: The physician who performed the TFESI was not blinded to the type of needle for detecting intravascular injection. This study was focused on lumbar TFESI, however, most TFESIs are performed at the L4-5 or L5-S1 level. CONCLUSION: The Whitacre needle had the benefit of reducing the incidence of intravascular injection with minimal differences in technical difficulties and the amount of radiation exposure during lumbar TFESI.