Design of a novel multi-epitope vaccine against Marburg virus using immunoinformatics studies.

Marburg virus (MARV) is a highly contagious and virulent agent belonging to Filoviridae family. MARV causes severe hemorrhagic fever in humans and non-human primates. Owing to its highly virulent nature, preventive approaches are promising for its control. There is currently no approved drug or vaccine against MARV, and management mainly involves supportive care to treat symptoms and prevent complications. Our aim was to design a novel multi-epitope vaccine (MEV) against MARV using immunoinformatics studies. In this study, various proteins (VP35, VP40 and glycoprotein precursor) were used and potential epitopes were selected. CTL and HTL epitopes covered 79.44% and 70.55% of the global population, respectively. The designed MEV construct was stable and expressed in Escherichia coli (E. coli) host. The physicochemical properties were also acceptable. MARV MEV candidate could predict comprehensive immune responses such as those of humoral and cellular in silico. Additionally, efficient interaction to toll-like receptor 3 (TLR3) and its agonist (ß-defensin) was predicted. There is a need for validation of these results using further in vitro and in vivo studies.

Managing the low carbon transition pathways through solid waste electricity.

The potential of solid waste as an energy source is clear, owing to its wide availability and renewable properties, which provide a critical answer for energy security. This can be especially effective in reducing the environmental impact of fossil fuels. Countries that rely heavily on coal should examine alternatives such as electricity from solid waste to provide a constant energy supply while also contributing to atmospheric restoration. In this regards, Low Emissions Analysis Platform (LEAP) is used for simulation the entire energy system in Pakistan and forecasted its capital cost and future CO2 emissions in relation to the use of renewable and fossil fuel resources under the different growth rates of solid waste projects like 20%, 30% and 40% for the study period 2023-2053. The results revealed that, 1402.97 TWh units of energy are generated to meet the total energy demand of 1193.93 TWh until 2053. The share of solid waste based electricity in total energy mix is increasing from a mere 0.81% in 2023 to around 9.44% by 2053 under the 20% growth rate, which then increase to 39.67% by 2053 under the 30% growth rate and further increases to 78.33% by 2053 under the 40% growth rate. It is suggested that 40% growth rate for solid waste based electricity projects is suitable for Pakistan until 2053 because under this condition, renewable sources contributes 95.2% and fossil fuels contributed 4.47% in the total energy mix of Pakistan. Hence, CO2 emissions are reduced from 148.26 million metric tons to 35.46 million metric tons until 2053 but capital cost is increased from 13.23 b$ in 2023 to 363.11 b$ by 2053.

Designed Local Electric Fields-Promising Tools for Enzyme Engineering.

Designing efficient catalysts is one of the ultimate goals of chemists. In this Perspective, we discuss how local electric fields (LEFs) can be exploited to improve the catalytic performance of supramolecular catalysts, such as enzymes. More specifically, this Perspective starts by laying out the fundamentals of how local electric fields affect chemical reactivity and review the computational tools available to study electric fields in various settings. Subsequently, the advances made so far in optimizing enzymatic electric fields through targeted mutations are discussed critically and concisely. The Perspective ends with an outlook on some anticipated evolutions of the field in the near future. Among others, we offer some pointers on how the recent data science/machine learning revolution, engulfing all science disciplines, could potentially provide robust and principled tools to facilitate rapid inference of electric field effects, as well as the translation between optimal electrostatic environments and corresponding chemical modifications.

A porphyrin-based molecular cage guided by designed local-electric field is highly selective and efficient.

The present work outlines a general methodology for designing efficient catalytic machineries that can easily be tweaked to meet the demands of the target reactions. This work utilizes a principle of the designed local electric field (LEF) as the driver for an efficient catalyst. It is demonstrated that by tweaking the LEF, we can catalyze the desired hydroxylation products with enantioselectivity that can be changed at will. Using computation tools, we caged a synthetic analog of heme porphyrin (HM1) and investigated the pharmaceutically relevant conversion of tetralin to tetralol, inside the modified supramolecular cage. The QM/MM calculations demonstrate a resulting catalytic efficiency with virtually absolute R-selectivity for the tetralin hydroxylation. Our calculations show that the LEF of the supramolecular cage and HM1 exert a strong electric field along the Fe-O reaction axis, which is the main driving force for enhanced reactivity. At the same time, the supramolecular cage applies a lateral LEF that regulates the enantioselectivity. We further demonstrate that swapping the charged/polar substitution in the supramolecular cage switches the lateral LEF which changes the enantioselectivity of hydroxylation from R to S.

Electrochemical treatment of wastewater containing urea-formaldehyde and melamine-formaldehyde.

The wastewater containing urea-formaldehyde (UF) and melamine-formaldehyde (MF) from the medium-density fiberboard (MDF) lamination factory disposed into the waterbodies adversely affects human health and aquatic life. Therefore, its treatment before discharge is necessary. Researchers have used various techniques to treat this type of wastewater in the past, but none have tried electrochemical (EC). However, EC can potentially remove pollutants such as chemical oxygen demand (COD), total organic carbon (TOC), formaldehyde (FA), total nitrogen (TN), nitrogen nitrate (NO3-N), and other hydrocarbons. Hence, this study uses the EC technique to treat wastewater containing UF and MF with aluminium electrodes. The experiments were run in batch mode with a 250 mL working volume in a 500 mL Pyrex glass beaker using a variable DC power supply (0-30 V and 0-5 A). The impacts of various parameters, including reaction time (RT) 30-240 min, current density (CD) 8.66-51.94 mA/cm2, inter-electrode distance (IED) 1-2 cm, and mixing speed in the range of 60-120 rpm were examined to achieve the best pollutant removals. The best removal percentage was reached at the optimized conditions of 150 min RT, 43.28 mA/cm2 CD, 1.5 cm IED, and 80 rpm: 81.1% TOC, 61.5% COD, 76.7% TN, 28.3% NO3-N, and 55.2% FA. During the EC process, electrodes and energy consumption were estimated at around 2.367 (g/L) and 0.18 (kWh/L), respectively. A kinetic analysis was also carried out to determine the pollutant's removal trend. This study concluded that the pseudo-first-order kinetic model was the best fit for removing TOC and FA with regression coefficients of 0.96 and 0.83, respectively.

Design and Synthesis of Co-initiators via Base-Catalysed Sequential Conjugate Addition: Application in Photoinduced Radical Polymerisation Reaction.

Applications of photochemistry are becoming very popular in modern-day life due to its operational simplicity, environmentally friendly and economically sustainable nature in comparison to thermochemistry. In particular photoinduced radical polymerisation (PRP) reactions are finding more biological applications and especially in the areas of dental restoration processes, tissue engineering and artificial bone generation. A type-II photoinitiator and co-initiator-promoted PRP turned out to be a cost-effective protocol, and herein we report the design and synthesis of a new efficient co-initiator for a PRP reaction via a barrierless sequential conjugate addition reaction. Experimental mechanistic observations have been further complemented by computational data. Time for newly synthesised 1,2-benzenedithiol (DTH) based co-initiator promoted polymerisation of urethane dimethacrylate (UDMA, 70 %) and triethylene glycol dimethacrylate (TEGDMA, 30 %) in presence of 450 nm LED (15 W) under the aerobic conditions is 38 seconds. Polymeric material has high glass transition temperature, improved mechanical strength (860 BHN) and longer in-depth polymerisation (3 cm).

Unraveling key interactions and the mechanism of demethylation during hAGT-mediated DNA repair via simulations.

Alkylating agents pose the biggest threat to the genomic integrity of cells by damaging DNA bases through regular alkylation. Such damages are repaired by several automated types of machinery inside the cell. O6-alkylguanine-DNA alkyltransferase (AGT) is an enzyme that performs the direct repair of an alkylated guanine base by transferring the alkyl group to a cysteine residue. In the present study, using extensive MD simulations and hybrid QM/MM calculations, we have investigated the key interactions between the DNA lesion and the hAGT enzyme and elucidated the mechanisms of the demethylation of the guanine base. Our simulation shows that the DNA lesion is electrostatically stabilized by the enzyme and the Arg135 of hAGT enzyme provides the main driving force to flip the damaged base into the enzyme. The QM/MM calculations show demethylation of the damaged base as a three-step process in a thermodynamically feasible and irreversible manner. Our calculations show that the final product forms via Tyr114 in a facile way in contrast to the previously proposed Lys-mediated route.

Local Electric Fields Dictate Function: The Different Product Selectivities Observed for Fatty Acid Oxidation by Two Deceptively Very Similar P450-Peroxygenases OleT and BSß.

Cytochrome P450 peroxygenases use hydrogen peroxide to hydroxylate long-chain fatty acids by bypassing the use of O2 and a redox partner. Among the peroxygenases, P450OleT uniquely performs decarboxylation of fatty acids and production of terminal olefins. This route taken by P450OleT is intriguing, and its importance is augmented by the practical importance of olefin production. As such, this mechanistic choice merits elucidation. To address this puzzle, we use hybrid QM/MM calculations and MD simulations for the OleT enzyme as well as for the structurally analogous enzyme, P450BSß. The study of P450OleT reveals that the protonated His85 in the wild-type P450OleT plays a crucial role in steering decarboxylation activity by stabilizing the corresponding hydroxoiron(IV) intermediate (Cpd II). In contrast, for P450BSß in which Q85 replaces H85, the respective Cpd II species is unstable and it reacts readily with the substrate radical by rebound, producing hydroxylation products. As shown, this single-site difference creates in P450OleT a local electric field (LEF), which is significantly higher than that in P450BSß. In turn, these LEF differences are responsible for the different stabilities of the respective Cpd II/radical intermediates and hence for different functions of the two enzymes. P450BSß uses the common rebound mechanism and leads to hydroxylation, whereas P450OleT proceeds via decarboxylation and generates terminal olefins. Olefin production projects the power of a single residue to alter the LEF and the enzyme's function.

Can the local electric field be a descriptor of catalytic activity? A case study on chorismate mutase.

The current theoretical perception of enzymatic activity is highly reliant on the determination of the activation energy of the reactions, which is often calculated using computationally demanding quantum mechanical calculations. With the ever-increasing use of bioengineering techniques that produce too many variants of the same enzyme, a fast and accurate way to study the relative efficiency of enzymes is currently in high demand. Here, we propose the local electric field (LEF) of the enzyme along the reaction axis as a descriptor for the enzymatic activity using the example of chorismate mutase in its native form and several variants (R90A, R90G, and R90K/C88S). The study shows a direct correlation between the calculated enzymatic EF and the enzymatic activity for all the complexes. MD simulations of the Michaelis complex and the transition state analog (TSA) show a stabilizing force on the TSA due to the enzymatic EF. QM/MM and QM-only DFT calculations in the presence of an external electric field (EEF) oriented along the reaction axis show that the electric field can interact with the dipole moment of the TS, thereby stabilizing it and thus lowering the activation energy.

Syncope and Sarcoidosis: A Criss-Cross of Diagnoses.

Syncope has a broad range of differential diagnoses. Sarcoidosis, a multisystem inflammatory disorder characterized by the formation of noncaseating granulomas, is a rare but important diagnosis to consider while evaluating patients presenting with presyncopal or syncopal symptoms. Although sarcoidosis is most commonly known to affect the lungs, it is estimated that at least 25% of patients with sarcoidosis have myocardial involvement, with only 5% of these patients showing clinical symptoms. Here, we present the rare case of a Caucasian male patient diagnosed with cardiac sarcoidosis after presenting to the hospital with presyncope. The patient had an internal cardioverter-defibrillator placed during hospitalization and was initiated on prednisone and methotrexate in the outpatient setting. He exhibited clinical and radiographical improvement in the six-month follow-up period after treatment was initiated.

Metabolic effects of exposure to pesticides during gestation in female Wistar rats and their offspring: a risk factor for diabetes?

Some pesticides increase the risk of type 2 diabetes, but whether fetal exposure carries transgenerational risk remains unknown. We evaluated the metabolic effects of gestational exposure to chlorpyrifos and imidacloprid in female Wistar rats and their offspring. We studied female nulliparous Wistar rats, including six exposed to imidacloprid (IMI) and six to chlorpyrifos (CPF) once daily throughout gestation at 1/10 lethal dose 50, while six (control group) received distilled water. These were explored 1 month after the birth of the offspring, while their offspring were explored at weaning (4 weeks) and adult age (12 weeks). Blood glucose, insulin and lipid profile were determined at each stage, while glucose transporter 4 (GLUT4) and nuclear factor kappa beta (NFkß) protein expression was measured in skeletal muscle at the end of follow up. Exposure to pesticides was associated with significantly higher fasting glucose (+25.4 to 30.9%) and insulin (> 100%) levels, with > 100% increased insulin resistance (HOMA-IR), - 18.3 to - 21.1% reduced HDL-cholesterol and + 60.9 to + 102.6% increased LDL-cholesterol in mothers. GLUT4 expression was reduced by 28.9-42.3% while NFkß expression increased by 32.8-35.4% in mothers. In offspring, similar abnormalities were observed at weaning (+ 18.4 to 67.4% fasting glucose, + 57.1 to 72.2% LDL-cholesterol, + 72.3 to 78.2% fasting insulin), persisting at adult age with decreased expression of GLUT4 (- 52.8 to 54.5%) and increased expression of NFkß (+ 30.5 to 30.7%). Gestational exposure to imidacloprid and chlorpyrifos induces hyperglycemia, insulin resistance and dyslipidemia in female Wistar rats and their offspring. The effects on offspring persist until adult age, suggesting intergenerational adverse effects.

Gestational Exposure to Pesticides Induces Oxidative Stress and Lipid Peroxidation in Offspring that Persist at Adult Age in an Animal Model.

Pesticide exposure may induce biochemical alterations including oxidative stress and lipid peroxidation. However, in the context of developmental origin of health and disease, putative trans-generational effect of exposure to pesticides are insufficiently studied. We therefore aimed to evaluate the biochemical effect of gestational exposure to four pesticides on female Wistar rats and their offspring at adult age. We studied 30 female nulliparous Wistar rats divided into 5 equal groups. Group 1 served as the control group and received distilled water while group 2, 3, 4 and 5 received orally pesticide 1 (imidacloprid), pesticide 2 (chlorpyrifos), pesticide 3 (imidacloprid + lambda cyhalothrin) and pesticide 4 (oxamyl) respectively once daily throughout gestation at a dose equivalent to 1/10 lethal dose 50. The mothers were followed up until one month post gestation. The offspring were followed up from birth until adult age (12 weeks). In all animals at each time point we evaluated malondialdehyde (MDA), oxidative stress and liver function enzymes. There was similar variation of total body weight in all the groups during and after gestation. However, Female Wistar rats of the exposed groups had significant alterations in liver SOD (-30.8% to +64.1%), catalase (-38.8% to -85.7%) and GSH (-29.2% to -86.5%) and; kidney catalase (> 100%), GSH (> 100%). Moreover, MDA, alanine transaminase (ALT) and aspartate transaminase (AST) levels were significantly higher in pesticide exposed rats compared to the control group. Similar alterations in antioxidant enzymes, MDA and liver function enzymes were observed in offspring of treated rats evidenced at weaning and persisting until adult age. Exposure to pesticides causes oxidative stress and lipid peroxidation in exposed female Wistar rats and their offspring. The persistence in offspring at adult age suggests transgenerational adverse effects.

Scorpion Sting Management at Tertiary and Secondary Care Emergency Departments.

OBJECTIVES: We sought to review the management of scorpion stings in tertiary and secondary care emergency departments in Oman and determine physician's knowledge of management protocols. METHODS: We conducted a retrospective study of all scorpion stings cases seen in Sultan Qaboos University Hospital (SQUH) emergency department (ED) from March 2016 to July 2017. Additionally, we conducted a survey of ED physicians regarding their management of scorpion stings in three different EDs including SQUH. RESULTS: The total number of scorpion stings seen at SQUH during the study period was 128. Localized pain was seen in 97.7% (n = 125), swelling in 14.8% (n = 19), and local redness in 7.0% (n = 9) of patients. Around 13.0% (n = 17) of patients were found to have systemic symptoms with tachycardia being the most common. Bedside clotting test was done for 11.7% (n = 15) of patients. The most commonly used treatment was local anesthesia (54.7%, n = 70). No patient received scorpion antivenom. In the 89 surveyed physicians the main management method used was analgesia (88.8%, n = 71) followed by local anesthesia (81.1%, n = 65). Most physicians (80.0%, n = 64) believed that local anesthesia was the most effective management. However, 32.5% (n = 26) ordered a whole blood bedside clotting test, 69.2% (n = 18) of which were junior doctors. CONCLUSIONS: Most scorpion sting cases managed in SQUH had local symptoms. Tachycardia was the most common systemic manifestation. Bedside clotting test was not commonly ordered and mainly requested by junior doctors. Local anesthesia infiltration is the recommended management for scorpion sting. Analgesia was the main management followed by local anesthesia.

The relationship between lumbar lordosis angle and low back pain in individuals with transfemoral amputation.

BACKGROUND:: Low back pain is a common secondary disabling condition in the transfemoral amputee population. Transfemoral amputees are at risk of excessive lumbar lordosis; it has been suggested that increased lumbar lordosis may be associated with low back pain. However, the relationship between lumbar lordosis angle and low back pain has not yet been studied in this population. OBJECTIVE:: To determine whether the extent of lumbar lordosis is associated with low back pain in transfemoral amputees. STUDY DESIGN:: Case-control observational study. METHODS:: Participants included eight transfemoral amputees without low back pain and nine transfemoral amputees with low back pain. Etiology of amputation was primarily trauma. All participants underwent lateral view radiographs of the lumbar spine, from which lumbar lordosis angle and sacral inclination angle were measured. RESULTS:: Lumbar lordosis angle mean ± standard deviation was 46.1° ± 12.4° in participants with low back pain and 51.0° ± 12.6° in those without. Sacral inclination angle mean ± standard deviation was 38.3° ± 8.7° in participants with low back pain and 39.1° ± 7.5° in those without. There was no significant difference in lumbar lordosis angle or sacral inclination angle between participants with and without low back pain. CONCLUSION:: This study suggests that increased lumbar lordosis angle and sacral inclination angle are not significantly associated with low back pain in transfemoral amputees of a primarily traumatic etiology. CLINICAL RELEVANCE: Low back pain (LBP) is a common, disabling condition in transfemoral amputees. In the clinical setting, increased lumbar lordosis is implicated in LBP. This study does not support an association between increased lumbar lordosis and LBP; further study is needed to understand the increased prevalence of LBP in this population.

Cytodiagnosis of a Cutaneous Clear Cell Malignancy: Metastatic Renal Cell Carcinoma on Chin.

Clear cell type of renal cell carcinoma (RCC) is most common urological malignancy. Several diagnostic challenges arise when it presents as a cutaneous nodule, being an uncommon presentation. Fine needle aspiration cytology (FNAC) of a cutaneous nodule is crucial for distinguishing primary tumours from metastatic tumours because cutaneous metastases represent a terminal stage of illness. Due to considerable overlap of cytomorphological features determination of primary warrants need of detailed clinical history and close inspection of every cytological detail. We report here a case of cutaneous metastasis of RCC on chin in a patient 11 years after nephrectomy. Though there are reports of RCC metastases diagnosed on histology, there are fewer cytology case reports. Cytological differential diagnosis has been discussed for arriving at the final diagnosis in case of clear cell tumours. Early and accurate diagnosis is mandatory for optimal treatment. Cytodiagnosis of cutaneous metastasis of RCC is uncommon due to its low suspicion index in cutaneous nodules. More so, it presents late and an unusual sites due to its resemblance to common dermatological diseases.

The impact of type 2 diabetes on numeric pain score reduction following cervical transforaminal epidural steroid injections.

OBJECTIVE: This study aimed to determine whether the presence of type 2 diabetes impairs the therapeutic response to transforaminal cervical epidural steroid injections (TF-CESI) in the treatment of pain due to cervical radiculopathy. DESIGN: This is a retrospective cohort study of patients with cervical radiculopathy who underwent TF-CESI performed by a single physician. SETTING: Single community-based multidisciplinary pain clinic and ambulatory surgery center. INTERVENTIONS: Patients underwent from one to three TF-CESI with dexamethasone or triamcinolone. MAIN OUTCOME MEASURES: Change in self-reported numerical pain score. RESULTS: Out of 387 charts reviewed, complete data were available for 329 subjects who underwent TF-CESI from February 2006 through January 2010. The injections consisted of either 40 mg triamcinolone or 15 mg dexamethasone. Of the 329 total subjects, 35 had type 2 diabetes and 294 did not. The diabetic group had a mean age of 58.1 years with standard deviation (SD) of 11.2, mean body mass index (BMI) of 33.1 (SD 7.1), mean pre-procedure pain score of 6.7 (SD 2.2) and mean reduction in pain score of 2.5 (SD 2.4). The non-diabetic group had a mean age of 52.8 (SD 12.4), mean BMI of 28.2 (SD 5.4), mean pre-procedure pain score of 6.7 (SD 1.8), and mean reduction in pain score of 2.4 (SD 2.2). A two-sample t test with equivalent variance showed no statistically significant difference in the mean reduction in pain score between the diabetic and non-diabetic groups. The patients in the diabetic group were typically older and had higher BMIs. CONCLUSIONS: The efficacy of TF-CESI for treating cervical radicular pain in this set of 329 patients was independent of the presence of type 2 diabetes.

Comparison of pain score reduction using triamcinolone vs. dexamethasone in cervical transforaminal epidural steroid injections.

OBJECTIVE: This study aimed to compare the effectiveness of triamcinolone vs. dexamethasone used in transforaminal epidural steroid injections for the treatment of cervical radiculopathy. DESIGN: This is a retrospective cohort study of patients with cervical radiculopathy who underwent cervical transforaminal epidural steroid injections performed by a single physician from February 2005 through January 2010. Data from the subjects were divided into two groups on the basis of the type of corticosteroid preparation used during treatment. A two-sample t test with equivalent variance was used to compare the effectiveness of dexamethasone to triamcinolone. RESULTS: Triamcinolone (40 mg per injection) was used in 220 subjects during the period of February 2005 through August 2007, with a mean reduction in pain score of 2.33 points on a 10-point scale. Dexamethasone (15 mg per injection) was used in 221 subjects during the period of September 2007 through January 2010, with a mean reduction in pain score of 2.38 points on a 10-point scale. A two-sample F test for variance showed no statistically significant difference in the variance of these two groups. The two-sample t test with equivalent variance showed no statistically significant difference in the mean reduction in pain score between the two groups. CONCLUSIONS: The mean reduction in pain score in this set of 441 patients with cervical radiculopathy treated with transforaminal epidural steroid injections was independent of the type of corticosteroid formulation used. Triamcinolone (40 mg) and dexamethasone (15 mg) produced similar benefits as measured by the patients' self-reported pain scores.

Information on the Internet about colorectal cancer: patient attitude and potential toward Web browsing. A prospective observational study.

BACKGROUND: Patients with colorectal cancer who seek to improve their knowledge of health and treatment options can now access in a few seconds data that would previously have required hours of research. Our aim was to evaluate the attitudes of patients toward Web browsing for information on colorectal cancer. METHODS: We surveyed all patients attending a colorectal cancer follow-up clinic between January and August 2007 on their use of the Internet to obtain information on colorectal cancer. RESULTS: In all, 439 patients with mean age of 68.6 years participated in the study. Of these, 24% reported using the Internet to obtain colorectal cancer information. Most participants used the Google search engine. Only 13% of participants confirmed that colorectal cancer information on the Internet was helpful in decision-making. Patients under the age of 65 years were more likely to have Internet access (p < 0.001), more likely to use the Internet to find colorectal cancer information (p = 0.005) and more likely to access a site recommended by a colorectal specialist (p = 0.002). Among Internet users, men were slightly more likely than women to use the Internet, although the difference was not significant (p = 0.20). CONCLUSION: The Internet is a useful tool for disseminating information about colorectal cancer. The best sites are still difficult for patients to distinguish from the thousands of sites returned by search engines. This study demonstrates that the level of potential interest is sufficient to justify the development of a departmental or regional colorectal cancer network of websites and indicates areas of interest for patients.

Prediction of therapeutic response to cervical epidural steroid injection according to distribution of radicular pain.

OBJECTIVE: This study aimed to determine whether the distribution of radicular pain has predictive value in identifying patients who would benefit from transforaminal cervical epidural steroid injections. DESIGN: Retrospective cohort study of subjects with cervical radiculopathy who underwent cervical epidural steroid injections from February 2005 to January 2006. Data from subjects were divided into groups based on pain distribution, imaging-based diagnosis of cervical disk herniation or stenosis, and their response to treatment. χ tests were used to assess the relationships between distribution and benefit. RESULTS: Of the 117 charts reviewed, complete data were available for 94 subjects. Forty-eight subjects had cervical disk herniations and, of these, 52% had pain above the elbow with 60% benefit, and 48% had pain below the elbow with 61% benefit. Forty-six subjects had cervical stenosis and, of these, 57% had pain above the elbow with 62% benefit, and 43% had pain below the elbow with 80% benefit. Benefit was defined as 70% or greater reduction in pain. χ testing demonstrated no statistically significant difference in beneficial response to cervical epidural steroid injections based on pain distributions. CONCLUSIONS: The likelihood of subjects to report a positive benefit from cervical epidural steroid injections as a treatment of their cervical radicular pain was independent of the distribution of their pain. Although our results did not show pain distribution to have a predictive value, additional research is needed in identifying predictive factors to improve outcomes and reduce cost.