Effects of Paraspinal Intramuscular Injection of Atelocollagen in Patients with Chronic Low Back Pain: A Retrospective Observational Study.

Background/Objectives: Atelocollagen is used for soft tissue repair and reconstruction by replacing defective or damaged muscles, membranes, ligaments, and tendons. This study aimed to evaluate the clinical efficacy and safety of additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection for reducing pain and improving functional capacity of patients with chronic low back pain (CLBP). Methods: We retrospectively enrolled 608 consecutive patients with CLBP who received lumbar epidural steroid injection with or without additional paraspinal intramuscular injection of atelocollagen. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure, and three months after the injection. Also, we analyzed the relationship between the additional paraspinal intramuscular injection of atelocollagen and the success rate. Results: Both Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups at three months after injection. However, there was a significant difference between the two groups. Furthermore, the success rate was significantly higher in the additional paraspinal intramuscular injection of atelocollagen group. Conclusions: This study's results showed that additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection reduced pain and improved functional capacity for patients with CLBP. Therefore, the paraspinal intramuscular injection of atelocollagen may be a promising option for the treatment of patients with CLBP.

A Comparative Study of Endoscopic versus Percutaneous Epidural Neuroplasty in Lower Back Pain: Outcomes at Six-Month Follow Up.

Background and Objectives: Endoscopic epidural neuroplasty (EEN) facilitates adhesiolysis through direct epiduroscopic visualization, offering more precise neural decompression than that exhibited by percutaneous epidural neuroplasty (PEN). We aimed to compare the effects of EEN and PEN for 6 months after treatment with lower back and radicular pain in patients. Methods: This retrospective study compared the visual analog scale (VAS) and Oswestry disability index (ODI) scores in patients with low back and radicular pain who underwent EEN or PEN with a steering catheter. The medical records of 107 patients were analyzed, with 73 and 34 undergoing EEN and PEN, respectively. Results: The VAS and ODI scores decreased at all time points after EEN and PEN. VAS and ODI scores decreased more in the EEN group than those in the PEN group at 1 day and 1- and 6-months post-procedure, indicating superior pain relief for both lower back and radicular pain through EEN. Conclusions: EEN is a superior treatment of pain control than PEN in lower back and radicular pain patients.

Effects of Remimazolam Anesthesia with Two Induction Doses on Hemodynamics and Recovery Profile in Older Patients: Comparison with Propofol Anesthesia.

Remimazolam has advantages such as hemodynamic stability and rapid onset. We investigated the effects of induction doses on hemodynamics and recovery profiles for remimazolam compared to propofol in older patients. Sixty-nine patients aged >65 years were randomly assigned to either the propofol anesthesia group (P group) or the remimazolam anesthesia group with an induction dose of 6 mg/kg/h (R6 group) or 12 mg/kg/h (R12 group), followed by 1 mg/kg/h. P group was anesthetized with 4 µg/mL of propofol effect-site concentration (Ce) with target-control infusion, followed by 2.5-3 µg/mL of Ce. The primary outcome was the difference between the baseline mean arterial pressure (MAP) and the lowest MAP during anesthesia (ΔMAP). ΔMAP was comparable between the P, R6, and R12 groups (43.8 ± 13.8 mmHg, 39.2 ± 14.3 mmHg, and 39.2 ± 13.5 mmHg, p = 0.443). However, the frequencies of vasoactive drug use were 54.5%, 17.4%, and 30.4% (p = 0.029), and the median doses of ephedrine 3 (0-6) mg, 0 (0-0) mg, and 0 (0-0) mg (p = 0.034), which were significantly different. This study showed remimazolam anesthesia with an induction dose of 6 mg/kg/h, rather than 12 mg/kg/h, could reduce the requirement for vasoactive drugs compared to propofol anesthesia.

Changes in facial temperature measured by digital infrared thermal imaging in patients after transnasal sphenopalatine ganglion block: Retrospective observational study.

Sphenopalatine ganglion block (SPGB) is a technique developed in the 1990s for the management of head and neck pain patients. Recently, transnasal sphenopalatine ganglion block (TN-SPGB) has been widely used for these patients; however, no objective methods exist for validating the success of TN-SPGB. In this study, we measured the changes in facial temperature before and 30 minutes after TN-SPGB by using digital infrared thermal imaging (DITI) to validate its success.The medical records of patients, who underwent TN-SPGB and facial DITI between January 2016 and December 2017, were reviewed. TN-SPGB and facial DITI were performed 36 times in 32 patients. The changes in facial temperatures measured at the forehead (V1), maxillary area (V2), and mandibular area (V3) by using DITI before and 30 minutes after TN-SPGB were recorded and compared. The temperatures on the ipsilateral and contralateral sides of these areas were also compared. The comparison between pain relief group and pain maintenance group was analyzed.After TN-SPGB, the temperature decreased significantly on both sides of V1 (P = .0208, 0.0181). No significant differences were observed between the ipsilateral and contralateral sides (P > .05). There was no correlation between changes in temperature and changes in pain score in the pain regions after the procedure (P > .05).The temperature decreased significantly in V1 area at 30 minutes after TN-SPGB compared with the temperature before TN-SPGB. Based on these results, we propose using DITI to measure temperature changes as an objective method for verifying the success of TN-SPGB.

Effect of Size and Location of Nevi on Postoperative Pain and Emergence Agitation in Children Undergoing Nevi Excision.

Congenital melanocytic nevi need surgical excisions. However, the effect of the size and location of the nevi on pain and emergence agitation have yet to be studied. The objective of this study was to evaluate (1) the ideal parameter of the nevus size and (2) the effects of the size and location of the nevus on pain and emergence agitation. This observational study enrolled 100 children scheduled for an excision of a nevus under sevoflurane anesthesia. The parameters of the nevus size included the long diameter, the area before resection, the area of resection, and the proportion (the area of resection/total body surface). The nevus locations included the trunk, face, scalp, and extremities. The proportion of the nevi was the most ideal parameter in evaluating the pain and emergence agitation. A large size showed a higher emergence agitation than a small size (median (range); 6 (0⁻20) in small groups vs. 12.5 (0⁻20) in large groups, p = 0.021). However, the pain was comparable. The nevus location did not influence pain or emergence agitation. In a multivariate regression analysis, a younger age and an extensive excision were associated with higher pain and emergence agitation. In conclusion, large nevi induced more severe emergence agitation. However, the nevus location did not affect the outcome. In addition, a younger age was associated with pain and emergence agitation. Clinicians need to consider the proportion of nevi when managing children undergoing a nevus excision.

Effect of Combined Treatment of Ketorolac and Remote Ischemic Preconditioning on Renal Ischemia-Reperfusion Injury in Patients Undergoing Partial Nephrectomy: Pilot Study.

We evaluated postoperative renal function in patients with/without combined therapy of ketorolac and remote ischemic preconditioning during partial nephrectomy. Sixteen patients were randomly allocated to either the ketorolac combined with RIPC group (KI, n = 8) or control group (n = 8). The KI group received both remote ischemic preconditioning before surgery and intravenous ketorolac of 1 mg/kg before renal artery clamping. Renal parameters were measured before induction, after anesthesia induction, and 2, 12, 24, 48, and 72 h after renal artery declamping. Acute kidney injury was assessed by Acute Kidney Injury Network criteria. The estimated glomerular filtration rate decreased in both groups, but then increased significantly at 48 h and 72 h after declamping only in the KI group compared to 24 h (p = 0.001 and p = 0.016). Additionally, it was higher at 48 h and 72 h after declamping in the KI group compared to the control group (p = 0.025 and p = 0.044). The incidence of acute kidney injury was significantly reduced in the KI group (13%) compared to the control group (83%) (p = 0.026). FENa was markedly increased at 2 h after declamping, and recovered in both groups, but it was more significant at 12 h after declamping in the KI group (p = 0.022). Urinary N-acetyl-1-ß-D-glucosoaminidase and serum neutrophil gelatinase-associated lipocalin were similar (p = 0.291 and p = 0.818). There is a possibility that combined therapy of ketorolac and remote ischemic preconditioning prior to ischemia may alleviate renal dysfunction and reduce the incidence of acute kidney injury in patients undergoing partial nephrectomy.

The Major Postharvest Disease of Onion and Its Control with Thymol Fumigation During Low-Temperature Storage.

Onion (Allium cepa L.) is one of the major vegetable crops in Korea that are damaged and lost by pathogenic fungal infection during storage due to a lack of proper storage conditions. The aim of this study was to determine an appropriate control measure using thymol to increase the shelf life of onions. To control fungal infections that occur during low-temperature storage, it is necessary to identify the predominant fungal pathogens that appear in low-temperature storage houses. Botrytis aclada was found to be the most predominant fungal pathogen during low-temperature storage. The antifungal activity of the plant essential oil thymol was tested and compared to that of the existing sulfur treatments. B. aclada growth was significantly inhibited up to 16 weeks with spray treatments using a thymol solution. To identify an appropriate method for treating onions in a low-temperature storage house, thymol was delivered by two fumigation treatment methods, either by heating it in the granule form or as a solution at low-temperature storage conditions (in vivo). We confirmed that the disease severity was reduced up to 96% by fumigating thymol solution compared to the untreated control. The efficacy of the fumigation of thymol solution was validated by testing onions in a low-temperature storage house in Muan, Jeollanam-do. Based on these results, the present study suggests that fumigation of the thymol solution as a natural preservative and fungicide can be used as an eco-friendly substitute for existing methods to control postharvest disease in long-term storage crops on a commercial scale.

Clinical Study of a Flap Advancement Technique Without Vertical Incision for Guided Bone Regeneration.

PURPOSE: The aim of this study was to introduce a novel method of flap advancement without a vertical releasing incision for guided bone regeneration (GBR) and to discuss its clinical outcomes. MATERIALS AND METHODS: This retrospective study involved patients who had received GBR for dental implants between April 2012 and April 2013. In all patients, a typical midcrestal incision was made on the edentulous alveolar ridge, and a sulcular incision was extended to the adjacent two teeth; however, no vertical incision was performed. Instead, a wide periosteal releasing incision and an additional releasing incision that selectively cut part of the facial expression muscles (the orbicularis oris or the buccinator) were used. Postoperative complications, such as swelling, pain, paresthesia, signs of infection, and membrane exposure, were evaluated at 1, 2, 4, 12, and 24 weeks after surgery. RESULTS: Forty sites in 34 patients were evaluated. At all surgical sites, flap advancement of more than 7 mm was attained, and clinically passive primary closure was achieved. All patients experienced slight or mild postoperative swelling without functional limitation or discomfort during mouth opening, eye opening, and swallowing. No long-lasting pain (more than a week), paresthesia, or signs of infection occurred during the follow-up period of 6 months. However, delayed exposure of titanium mesh after 4 months was observed in two patients who had used a provisional removable prosthesis. Within 2 weeks, the exposures closed spontaneously after prosthesis use was halted and careful daily dressing was undertaken. CONCLUSION: The flap advancement technique presented in this study easily enables clinically passive primary closure, and there was no obvious failure of primary closure. This technique could be used successfully in GBR procedures.

Naringin exhibits in vivo prokinetic activity via activation of ghrelin receptor in gastrointestinal motility dysfunction rats.

BACKGROUND AND PURPOSE: Poncirus fructus (PF), also known as the dried immature fruit of Poncirus trifoliata (L.) Raf., has long been used as a cure for the treatment of various gastrointestinal disorders in eastern Asia. Recently, it was reported that naringin, a flavonoid constituent of the PF extract, causes the activation of ghrelin receptor in vitro. Although the ghrelin receptor is involved in the enhancement of intestinal motility, there are no studies as yet involving in vivo action of naringin. Therefore, the purpose of the present study is to investigate whether naringin exhibits a prokinetic effect in vivo. METHODS: We measured the intestinal transit rate in rats with gastrointestinal motility dysfunction (GMD) and performed a pharmacokinetic analysis of naringin to investigate the effect of naringin on prokinetic activity in vivo. RESULTS: The results of this study show that the aqueous extract of PF and its constituent naringin have a strong prokinetic activity in GMD rats via activation of the ghrelin receptor. Surprisingly, pharmacokinetic analysis revealed that naringin has low bioavailability (11%), implying that the prokinetic effect of naringin was largely due to the local activation of ghrelin receptor in the intestine rather than a systemic effect after absorption. Indeed, it turned out that intravenous administration of naringin led to a lower prokinetic effect than when administrated orally to rats, indicating that naringin prefers to act on the intestinal wall rather than getting absorbed into the systemic circuit. This local mode of action might be advantageous for preventing possible systemic side effects since naringin is not well absorbed into the system circuit. CONCLUSIONS: Naringin exhibits an in vivo prokinetic activity by a preferable local activation of ghrelin receptor. Moreover, we propose that naringin could play a role as a leading compound for the development of ghrelin receptor-based prokinetic agents.

Comparison of an accelerometer and a condenser microphone for mechanomyographic signals during measurement of agonist and antagonist muscles in sustained isometric muscle contractions.

The purpose of this study was to investigate the influence of the force tremor (FT) on mechanomyographic (MMG) signals recorded by a condenser microphone (MIC) and an accelerometer (ACC) during measurement of agonist and antagonist muscles in sustained isometric contractions. Surface electromyographic (EMG) signals and MMG signals by MIC (MMG-MIC) and ACC (MMG-ACC) were recorded simultaneously on biceps brachii (BB) and triceps brachii (TB). Following determination of the isometric maximum voluntary contraction (MVC), 10 male subjects were asked to perform sustained elbow flexion and extension contractions at 30% MVC until exhaustion. We analyzed the root mean square (RMS) for all signals and compared the sum of the power spectrum (SPA) for 3-6 Hz and 8-12 Hz and the ratio of the sum of SPA for 3-6 Hz and 8-12 Hz in SPA for 3-100 Hz (SPA-FT/SPA-(3-100 Hz)) between MMG-MIC and MMG-ACC. During all sustained muscle contractions, the RMS of EMG and MMG-(MIC) was significantly (p<0.05) increased in antagonistic muscle pairs, while the increase was more noticeable for the agonist than for the antagonist. In addition, the antagonist had a significantly (p<0.05) smaller amplitude than the agonist muscle. The RMS of MMG-ACC, however, showed no significant (p>0.05) difference in RMS amplitude and slope between agonist and antagonist muscles during flexion. In extension, the MMG-ACC-RMS amplitude showed a tendency to be higher in the antagonist than in the agonist, while their slopes showed no significant (p>0.05) difference. The SPA for 3-6 Hz and 8-12 Hz in MMG-(MIC) showed a tendency to be higher in the agonist than the antagonist, and the slopes of the agonist were significantly (p<0.05) higher than those of the antagonist in all contractions. In MMG-ACC, SPA and slopes for 3-6 Hz and 8-12 Hz tended not to differ between agonist and antagonist. The SPA-FT/SPA-(3-100 Hz) in MMG-ACC showed that the antagonist was higher than that of the agonist in all contractions. The MMG-(MIC), however, showed a tendency toward no difference between the agonist and antagonist. In the assessment of muscle activity during simultaneous measurement of the agonist and antagonist during sustained muscle contractions, the MMG signal detected by MIC appeared to be less affected by FT than by ACC due to the different inherent characteristics of the two transducers.

Influence of force tremor on mechanomyographic signals recorded with an accelerometer and a condenser microphone during measurement of agonist and antagonist muscles in voluntary submaximal isometric contractions.

The purpose of this study was to investigate the influence of force tremor (FT) on the mechanomyogram (MMG) recorded by a condenser microphone (MIC) and an accelerometer (ACC) for the measurement of agonist and antagonist muscles during submaximal isometric contractions. Following determination of the isometric maximum voluntary contraction (MVC), 10 male subjects were asked to perform elbow flexion and extension at 20%, 40%, 60%, and 80% MVC. Surface electromyogram (EMG) and MMG of the biceps brachii (BB) and triceps brachii (TB) were recorded simultaneously using a MIC (MMG-(MIC)) and an ACC (MMG-(ACC)). We analyzed the root mean square (RMS) for all signals and compared the sum of the power spectrum amplitude (SPA) at 3-6 Hz and 8-12 Hz between the MMG-(MIC) and the MMG-(ACC). During elbow flexion and extension, the RMS of the EMG and the MMG-(MIC) of the agonist were significantly (p<0.05) higher than those of the antagonist in each contraction level. The RMS of the MMG-(ACC) of the antagonist showed no significant (p>0.05) difference from that of the agonist, or tended to be higher than the agonist. The SPA of the MMG-(MIC) of the agonist at 3-6 Hz and 8-12 Hz tended to be higher than the antagonist in elbow flexion and extension at each contraction level. The SPA of the MMG-(ACC) of the agonist and that of the antagonist showed no significant (p>0.05) difference, or the antagonist MMG-(ACC) tended to be higher than that of the agonist. These results suggest the MMG detected by a MIC appears to be less affected by FT than is the ACC because of its inherent characteristic to reduce FT in simultaneously evaluated agonist and antagonist muscles by means of MMG during submaximal isometric contraction.