Predictive factors for favorable short-term response to interlaminar epidural block for cervical radiculopathy.

PURPOSE: We sought to identify clinical predictors of favorable short-term outcomes associated with cervical interlaminar epidural injection (CIEI). Previous studies investigating the predictive factors of CIEI efficacy have shown inconsistent results. Gaining information on the possible response determinants of CIEI is necessary for appropriate treatment selection and outcomes prediction in the treatment of cervical radiculopathy. METHODS: We analyzed the clinical data of 72 patients who received fluoroscopic-guided CIEI using the paramedian approach for cervical radiculopathy to identify the predictive factors for short-term outcomes of CIEI. Demographic characteristics, history of neck surgery, diagnosis, initial numeric rating score, duration of symptoms, Douleur Neuropathique 4 (DN4) questions, painDETECT questionnaire, neck disability index, and ventral epidural spread of contrast medium were assessed. Treatment success was defined as at least a 50% reduction in the numeric rating score after CIEI and was designated as a good response. RESULTS: The short-term success rate of CIEI for cervical radiculopathy was 55.56%. Multivariate logistic regression analysis established that spinal stenosis (odds ratio 0.183; P = 0.012), a longer duration of > 24 weeks of symptoms (odds ratio 0.206; P = 0.026), and combined positive results for the DN4 and painDETECT (odds ratio, 0.019; P = 0.008) decreased the odds ratio of a good response, 2-3 weeks after CIEI. CONCLUSIONS: CIEI provides a significant short-term outcome in patients with cervical radiculopathy. However, CIEI efficacy may be negatively affected in patients with spinal stenosis, the presence of a chronic state, and a possible neuropathic pain component.

Mercury and other trace elements distribution and profiling of microbial community in the surface sediments of East Siberian Sea.

In this study, total mercury (THg), methylmercury (MeHg), various trace elements, and microbial communities were measured in surface sediments of the East Siberian Sea (ESS). The results showed that the average values of THg and MeHg were 58.8 ± 15.21 µg/kg and 0.50 ± 0.22 µg/kg, respectively. The notable levels of trace elements present in both surface sediment and porewater were Al, Fe, and Mn. The enrichment factor and geoaccumulation index analyses found that both natural phenomena and anthropogenic activities contributed to elevated concentrations of metals in the ESS. The redox proxy metals, pH, and SO42- were the major factors influencing the THg and MeHg distributions. Microbial profiles were substantially affected by metals and other abiotic factors. Proteobacteria and Thaumarchaeota were the most abundant phyla. Overall, the findings presented here facilitate the understanding of the current status of metal contamination, its influencing factors, and metal-microbiota-interactions in ESS.

Thenar Compartment Syndrome Related to Tightened Radial Arterial Line During Robotic Laparoscopic Surgery: A Case Report.

We present a 54-year-old man who developed an unexpected thenar space compartment syndrome after robotic laparoscopic surgery, which was caused when the radial arterial pressure tubing was pulled too tightly around the base of the thumb while changing the surgical position. A conventional method of securing the tubing by looping it around the thumb appeared to be the primary cause. This complication went unnoticed during the surgery because the arm was tucked out of sight; there were no remarkable findings on monitoring. This case highlights the risks of looping tubing around the thumb, especially if continual inspection is not possible.

Inorganic fouling control in reverse osmosis wastewater reclamation by purging carbon dioxide.

Inorganic fouling on the membrane surface is one of the major prevalent issues affecting the performance and cost of reverse osmosis system. Chemical dosage is a widely adopted method for the inhibition of inorganic scale on the membrane surface. In this study, CO2 was used to control inorganic scale formation on surface of reverse osmosis (RO) membrane in wastewater reclamation. The pH of influent could be lowered by purging CO2. It caused an increase in solubility of inorganic salts in water resulting in discharge of principle ions in concentrate stream. A pilot plant study was conducted with four different RO modules including control, with dosage of antiscalant, with purging CO2 and with co-addition of antiscalant and CO2. The effectiveness of CO2 purging was assessed on the basis of operational analysis, in-line analysis and morphological results. Ryznar stability index was used to determine the scaling potential of system. The examined data indicated that CO2 purging was successful to inhibit scale formation on the membrane surface. Moreover, CO2 was found more eco-friendly than antiscalant, as no by-products were generated in concentrate stream.

Synthesis of magnetite from raw mill scale and its application for arsenate adsorption from contaminated water.

The magnetite particles were chemically synthesized from the waste of hot rolling steel industry. The characterization of the synthesized magnetite was done by using Fourier transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), Energy Dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD). The synthesized magnetite particles were used for the adsorptive removal of arsenate from the contaminated water. The maximum adsorption capacity of 7.69 mg was found on the surface of 1 g of the magnetite. The point of zero charge for magnetite is determined at the pH 6. The adsorption capacity of magnetite particles was successfully restored with alkali cleaning. Newly synthesized particles were found to be effective for arsenate removal up to 5 times with regeneration. The synthesis of magnetite from raw mill scale and its application for arsenate adsorption is a cost effective and ecofriendly process.

A comprehensive overview on electro-active biofilms, role of exo-electrogens and their microbial niches in microbial fuel cells (MFCs).

Microbial fuel cells (MFCs) are biocatalyzed systems which can drive electrical energy by directly converting chemical energy using microbial biocatalyst and are considered as one of the important propitious technologies for sustainable energy production. Much research on MFCs experiments is under way with great potential to become an alternative to produce clean energy from renewable waste. MFCs have been one of the most promising technologies for generating clean energy industry in the future. This article summarizes the important findings in electro-active biofilm formation and the role of exo-electrogens in electron transfer in MFCs. This study provides and brings special attention on the effects of various operating and biological parameters on the biofilm formation in MFCs. In addition, it also highlights the significance of different molecular techniques used in the microbial community analysis of electro-active biofilm. It reviews the challenges as well as the emerging opportunities required to develop MFCs at commercial level, electro-active biofilms and to understand potential application of microbiological niches are also depicted. Thus, this review is believed to widen the efforts towards the development of electro-active biofilm and will provide the research directions to overcome energy and environmental challenges.

Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease.

Tumoral calcinosis is a rare syndrome characterized by massive subcutaneous soft tissue deposits of calcium phosphate near the large joints. It is more prevalent in patients with chronic kidney disease undergoing dialysis. A 57-year-old woman was referred to our pain clinic with the complaint of severe pain in the left buttock and lateral hip. The patient had been suffering from chronic kidney disease for 10 years and had been undergoing peritoneal dialysis over the past 5 years. The patient's symptom was initially suspected to be of lumbar origin at the L5 level and a left L5 transforaminal epidural block was performed, but without success. Re-evaluation of the physical examination revealed severe tenderness over the left greater trochanter and piriformis muscle. On ultrasonographic evaluation, multiple mass-like lesions in the left buttock were observed. About 30 mL of fluid was aspirated from the cystic lesions, followed by 30 mL mixture of 0.08% levobupivacaine and triamcinolone 40 mg injected into the bursa under ultrasound guidance, which brought pain relief. Trochanteric bursitis was thought of as the cause of the symptoms. The patient was diagnosed with tumoral calcinosis based on the past medical history, simple plain radiographs, and hip magnetic resonance imaging (MRI). We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosis related to chronic kidney disease in a patient whose symptoms had initially been considered to be radiating leg pain caused by lumbar spinal disease. We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid.

Use of the i-gel™ supraglottic airway device in a patient with subglottic stenosis -a case report-.

The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel™ supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.

Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma -A case report-.

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.

A simple image analysis algorithm for evaluation of extended filaments length based on the enhanced digitized image.

An automated image analysis procedure was developed to determine extended filaments length and floc area to evaluate settling characteristics of activated sludge. Digitized image obtained by Gram staining granted the first step of algorithm, segmentation, to be extremely clear and simple. The image analysis work could become more accurate and less time consuming one to be required only 1 minute of operation time per image. Filamentous bulking phenomenon of the biological sludge was induced in a laboratory-scale bioreactor system under an extreme operational condition, and the non-bulking and filamentous bulking sludge samples captured were examined with image analysis as well as traditional settling test. There existed a linear relationship between DSVI (Diluted Sludge Volume Index) and the extended filaments length. Similar results were also obtained with the extended filaments per floc area. The arithmetic mean extended filaments length showed an excellent linearity with the DSVI. It is believed that the image analysis algorithm developed in this study can be utilized for estimation of the extended filaments length and for evaluation of the settling characteristics of activated sludge effectively.

Improvement of activated sludge dewaterability by humus soil induced bioflocculation.

Effects of humus soil particles on the dewaterability of activated sludge were investigated. Cations leaching increased proportionally with the dosage of humus soil, and the leaching was not significant after 2 h. Divalent cations, Ca2+ and Mg2+, leaching from the humus soil played an important role in improving dewaterability of the biological sludge. On the contrary, dewaterability was not affected or slightly deteriorated by the monovalent cations, K+ and Na+ leached from the humus soil. Improvement in dewaterability of the sludge by addition of humus soil was higher than that of equivalent cations mixture. It seemed that the decrease of supracolloidal bio-particles (1 to 100 microm in diameter) resulted in diminishing of the blinding effect on cake and filter medium. SRF (specific resistance to filtration) of the humus soil added sludge varied in parallel with the M/D (monovalent to divalent cation) ratio, and the M/D ratio could be utilized as a useful tool for evaluation of the sludge dewatering characteristics. Long-term effects of humus soil on the improvement of activated sludge dewaterability were clearly identified by continuous operation results of a bench-scale MLE (Modified Ludzack Ettinger) system combined with a humus soil contactor. On the other hand, dewaterability of the control sludge was only slightly improved by a decrease in M/D ratio of the wastewater influent.