Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines?

MYTH: Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.

Scope and Nature of Pain- and Analgesia-Related Content of the United States Medical Licensing Examination (USMLE).

Background: "The ongoing opioid crisis lies at the intersection of two substantial public health challenges-reducing the burden of suffering from pain and containing the rising toll of the harms that can result from the use of opioid medications" [1]. Improved pain education for health care providers is an essential component of the multidimensional response to both still-unmet challenges [2,3]. Despite the importance of licensing examinations in assuring competency in health care providers, there has been no prior appraisal of pain and related content within the United States Medical Licensing Examination (USMLE). Methods: An expert panel developed a novel methodology for characterizing USMLE questions based on pain core competencies and topical and public health relevance. Results: Under secure conditions, raters used this methodology to score 1,506 questions, with 28.7% (432) identified as including the word "pain." Of these, 232 questions (15.4% of the 1,506 USMLE questions reviewed) were assessed as being fully or partially related to pain, rather than just mentioning pain but not testing knowledge of its mechanisms and their implications for treatment. The large majority of questions related to pain (88%) focused on assessment rather than safe and effective pain management, or the context of pain. Conclusions: This emphasis on assessment misses other important aspects of safe and effective pain management, including those specific to opioid safety. Our findings inform ways to improve the long-term education of our medical and other graduates, thereby improving the health care of the populations they serve.

Monitoring Charge Separation Processes in Quasi-One-Dimensional Organic Crystalline Structures.

We perform the transient absorption spectroscopy experiments to investigate the dynamics of the low-energy collective electron-hole excitations in α-copper phthalocyanine thin films. The results are interpreted in terms of the third-order nonlinear polarization response function. It is found that, initially excited in the molecular plane, the intramolecular Frenkel exciton polarization reorients with time to align along the molecular chain direction to form coupled Frenkel-charge-transfer exciton states, the eigenstates of the one-dimensional periodic molecular lattice. The process pinpoints the direction of the charge separation in α-copper phthalocyanine and similar organic molecular structures. Being able to observe and monitor such processes is important both for understanding the physical principles of organic thin film solar energy conversion device operation and for the development of organic optoelectronics in general.

C-Arm Fluoroscope Angle Settings for Fluoroscopically Guided Lumbar Transforaminal Epidural Injections.

BACKGROUND DATA: Minimizing fluoroscopy time in spine interventions is critical for time of procedure as well as radiation safety of the patient and medical personnel. Specific fluoroscopy angle settings for fluoroscopically guided L4-S1 transforaminal epidural injections (TFEIs) have not been described. OBJECTIVES: To describe the most common encountered settings for the C-arm fluoroscope angles for fluoroscopically guided L4-S1 (TFEI). METHODS: Each subject was placed in prone position on a flat fluoroscopy table without utilizing any device to alter innate lumbar spine curvature. The data from 246 consecutive patients at their first encounter in the fluoroscopy suite for a single level subpedicular lumbosacral TFEI was retrospectively analyzed. Most procedures occurred at the L4-5, L5-S1, and S1 levels (227 subjects). The C-arm angles including the oblique, cephalad/caudal were recorded for each subject upon observing final needle positioning for successful completion of the procedure according to ISIS Guidelines. RESULTS: For the L4-5 level, 71% of cases had oblique angle of 30°±5° and 94% of cases had neutral cephalad/caudal tilt (0°±5°) observed. For the L5-S1, 72% of cases had oblique angle of 30°±5° and 62% of cases had cephalad tilt angle of 15°±5° observed. For the S1 level, 73% of cases had oblique angle of 5°±5° and 69% of cases had cephalad tilt angle of 15°±5° observed. DISCUSSION/CONCLUSION: This retrospective descriptive study suggests fluoroscope angles for L4-S1 TFEI as a starting point before fine tuning views accounting for individual anatomy. Angles suggested for each level (oblique/cephalad tilt angles) are as follows: L4-5 (30/0°), L5-S1 (30/15°), and S1 (5/15°). Prospective studies using these guidelines would need to be undertaken to prove reproducibility between interventionalists, time efficiency, and radiation exposure reduction.

A Microscopy Evaluation of Emergence Profile Surfaces of Dental Custom CAD-CAM Implant Abutments and Dental Implant Stock Abutments.

Recently, due to the high demand for dental implants, the use of dental implant stock abutments has increased significantly, especially dental custom CAD/CAM implant abutments milled by dental technicians in their laboratories. The purpose of this study is to analyze the surface quality of the emergence profile of dental custom CAD/CAM implant abutments made by a non-industrial milling machine, compared to original and compatible dental implant stock abutments made by industrial machines. Thirty dental implant abutments were divided into six study lots. Lot 1 (control group): original dental implant stock abutments-industrial machined; lot 2 (study group): compatible dental implant stock abutments-industrial machined; lots 3, 4, 5, and 6 (study groups): compatible custom CAD/CAM dental implant abutments-non-industrial milled with hyperDENT CAM software and Paragon Tools. The Nikon SMZ745T stereomicroscope was used to analyze the emergence profile surface of each dental implant abutment. The structure of the analyzed surfaces did not show significant differences between original and compatible abutments that were industrially machined. As for the customized dental implant abutments, the greatest similarity with the original was obtained for lot 6, and a significant statistical difference was obtained for lot 4. Stepover and Feed Rate parameters of the milling process influenced the surface roughness of the emergence profile for the customized dental implant abutments. The digital technology of non-industrial milling compatible custom CAD/CAM dental implant abutments is reliable and within the correct milling parameters.

Influential role of ethereal solvent on organolithium compounds: the case of carboranyllithium.

The influence of ethereal solvents (diethyl ether (Et(2)O), tetrahydrofuran (THF) or dimethoxyethane (DME)) on the formation of organolithiated compounds has been studied on the 1,2-C(2)B(10)H(12) platform. This platform is very attractive because it contains two C(c)-H adjacent units ready to be lithiated. On would expect that the closeness of both C(c)-H units would induce a higher resistance of the second C(c)-H unit being lithiated following the first lithiation. However, this is not the case, which makes 1,2-C(2)B(10)H(12) attractive to get a better understanding of the ethereal solvent influence on the lithiation process. The formation of carboranyl disubstituted species has been attributed to the existence of an equilibrium in which the carboranyl monolithiated species disproportionates into dilithium carborane and pristine carborane. The way Li(+) binds to C(c) in the carboranyl fragment and how the solvent stabilizes such a binding is paramount to drive the reaction to the generation of mono- and disubstituted carboranes. In fact, the proportion of mono- and disubstituted species is a consequence of the formation of contact ion pairs and, to a lesser extent, of separated ion pairs in ethereal solvents. All ethereal solvents generate contact ion pairs in which a large degree of covalent C(c)-Li(solvent) bonding can be assumed, according to experimental and theoretical data. Furthermore, Et(2)O tends to produce carboranyllitium ion pairs with a higher degree of contact ion pairs than THF or DME. It has been determined that for a high-yield preparation of monosubstituted 1-R-1,2-C(2)B(10)H(11), in C(c)-R (R=C, S or P) coupling reactions, the reagent type defines which is the most appropriate ethereal solvent. In reactions in which a halide is generated, as with ClPPh(2) or BrCH(2) CH=CH(2), Et(2)O appears to produce the highest degree of monosubstitution. In other situations, such as with S(8), or when no halide is generated, THF or DME facilitate the largest degree of monosubstitution. It has been shown that upon the self reaction of Li[1,2-C(2)B(10)H(11)] to produce [LiC(4)B(20)H(22)](-) the nucleophilicity of the carboranyllithium can even be further enhanced, beyond the ethereal solvent, by synergism with halide salts. The mediation of Li(+) in producing isomerizations on allyl substituents has also been demonstrated, as Et(2)O does not tend to induce isomerization, whereas THF or DME produces the propenyl isomer. The results presented here most probably can be extended to other molecular types to interpret the Li(+) mediation in C-C or other C-X coupling reactions.

Enhancing memory of stair height by the motor experience of stepping.

A concept emerging from recent studies on obstacle avoidance in quadrupeds is that working memory of the height of an obstacle established by visual information is enhanced by motor interactions with the obstacle. In this investigation, we found that this concept is valid in adult humans when viewing and walking up stairs. The main finding was that the memory of the height of stairs was enhanced when information about stair height was gained by walking up a short flight of stairs compared to when information about stair height was gained by vision alone. By measuring the maximum toe clearance when subjects step onto a stair, we observed that maximum toe clearance increased after diverting vision from the stair for a few seconds prior to stepping. Most of this increase occurred within a 2-s period between diverting vision from the stair and initiating the step. By contrast, this increase in maximum toe clearance after diverting vision from a stair was significantly reduced after subjects walked up two stairs prior to stepping onto a stair without vision. This reduction persisted for delays as long as 10 s between diverting vision from the stair and initiating the step. In four of twelve subjects, the maximum toe clearance after these long periods without vision of the stair was close to the value when steps were made with full vision of the stairs.

The Role of Interventional Pain Management in Proteus Syndrome: A Case Report.

Proteus syndrome (PS) is a rare overgrowth disease process with only a few hundred cases being reported in the literature. Abnormal formation of the vertebral bodies causing scoliosis and spinal stenosis are common features that lead to debilitating pain in these patients. We present a case of a 35-year-old male landscaper with a history of PS causing severe scoliosis and vertebral overgrowth who underwent recurrent sets of multilevel zygapophyseal joint injections for management of his axial back pain. This case illustrates the utility of interventional spinal procedures in patients with progressive pain from PS.