Do Corticosteroids Still Have a Place in the Treatment of Chronic Pain?

Corticosteroids have played a standard role in the multimodal pain management in the treatment of chronic spinal pain (cervical and lumbar) and osteoarthritis pain over the past three decades. In this review we discuss different types of injectable steroids that are mainly used for injection into the epidural space (for the treatment of radicular back and neck pain), and as intra-articular injections for different types of osteoarthritis related pain conditions. Furthermore, we discuss different approaches taken for epidural corticosteroid injections and spinal surgical rates when injections fail to resolve painful conditions, as well as the possibility of using local anesthetics alone for neuraxial injections, instead of in combination with corticosteroids. While we present some beneficial effects of newly available treatment options for low back pain and osteoarthritis pain, such as use of PRP and hyaluronic acid, corticosteroids remain important considerations in the management of these chronic pain conditions.

The NuMask® is as Effective as the Face Mask in Achieving Maximal Preoxygentation.

Background: Preoxygenation before anesthetic induction is a widely accepted maneuver to increase oxygen reserves and delay desaturation during apnea. There is limited data regarding the use of the NuMask® in the perioperative setting, and no data as to its efficacy in achieving maximal preoxygenation. We hypothesize that the NuMask® may be a useful alternative to the face mask in achieving maximal preoxygenation. Methods: After IRB approval, the NuMask® was compared with the classic face mask with respect to achieving maximal pre-oxygenation in 30 healthy volunteers using tidal volume breathing. All volunteers were tested for three periods of 5 minutes intervals and the following parameters were recorded every 30 seconds: inspired, and end-tidal oxygen concentration and endtidal carbon dioxide concentration. Results: The mean ETO2 of ≥90% was achieved with both masks at 3.5 minutes (SD = 1.62 and 1.98 for facemask and NuMask® respectively) and thereafter the ETO2 remained above 90%. There were no statistical differences noted in FiO2 and ETO2 between the face mask and the NuMask® in the same time periods. ETCO2 values were also not statistically different between the two masks. Conclusions: The study showed that the NuMask® is as effective as the classic face mask in achieving maximal pre-oxygenation during tidal volume breathing. Introduction

Mesenchymal change and drug resistance in neuroblastoma.

BACKGROUND: Metastatic initiation has many phenotypic similarities to epithelial-to-mesenchymal transition, including loss of cell-cell adhesion, increased invasiveness, and increased cell mobility. We have previously demonstrated that drug resistance is associated with a metastatic phenotype in neuroblastoma (NB). The purpose of this project was to determine if the development of doxorubicin resistance is associated with characteristics of mesenchymal change in human NB cells. MATERIALS AND METHODS: Total RNA was isolated from wild type (WT) and doxorubicin-resistant (DoxR) human NB cell lines (SK-N-SH and SK-N-BE(2)C) and analyzed using the Illumina Human HT-12 version 4 Expression BeadChip. Differentially expressed genes (DEGs) were identified. Volcano plots and heat maps were generated. Genes of interest with a fold change in expression >1.5 and an adjusted P < 0.1 were analyzed. Immunofluorescence (IF) and Western blot analysis confirmed microarray results of interest. Matrigel invasion assay and migration wounding assays were performed. RESULTS: Volcano plots and heat maps visually demonstrated a similar pattern of DEGs in the SK-N-SH and SK-N-BE(2)C DoxR cell lines relative to their parental WT lines. Venn diagramming revealed 1594 DEGs common to both DoxR cell lines relative to their parental cell lines. Network analysis pointed to several significantly upregulated epithelial-to-mesenchymal transition pathways, through TGF-beta pathways via RhoA, PI3K, and ILK and via SMADs, as well as via notch signaling pathways. DoxR cell lines displayed a more invasive phenotype than respective WT cell lines. CONCLUSIONS: Human SK-N-SH and SK-N-BE(2)C NB cells display characteristics of mesenchymal change via multiple pathways in the transition to a drug-resistant state.