Ultrasound-Guided Cervical Intervertebral Disc Injection Without Fluoroscopy.

Cervical disc degeneration commonly results in referred neck pain, which is traditionally diagnosed via fluoroscopy-guided provocative discography. Herein, we discuss three cases of neck and shoulder pain treated with cervical intradiscal injections administered under ultrasound (US) guidance. The most painful intervertebral disc was identified using the sonopalpation technique, which involved palpation while visualizing anatomical structures using US. Injectant spread within the intervertebral disc was validated using superb microvascular imaging rather than fluoroscopy. Symptoms significantly improved following blocks at the identified sites, suggesting that US can be used to guide cervical intradiscal injections even in the examination room.

Diagnosis of Lumbar Transverse Process Fractures in Orthopedic Clinics Using Sonography.

Sonography is conventionally used to diagnose fractures by identifying cortical discontinuity in the bone. However, its usefulness for diagnosing lumbar transverse process fractures (LTPFs) remains unknown. In this series, we describe static and stress sonography findings during manual application of compression stress on the lateral lumbar vertebrae in 17 patients with LTPFs. Features of LTPFs on static sonography included cortical discontinuity (89.3%), hematoma (71.4%), step-off deformity (67.9%), and focal reverberation echo (78.6%). All LTPFs were confirmed on stress sonography. Thus, stress sonography should be considered for the detection of LTPFs when there is at least one static sonographic fracture sign.

The Isometric Quadriceps Contraction Method for Intra-Articular Knee Injection.

The intra-articular injection is the most important technique for treating not only rheumatoid arthritis but also osteoarthritis of the knee. However, 1 problem is that the drug is often inaccurately injected outside of the joint, especially when no effusion is present. According to a previous systematic review by Maricar et al., the use of a superolateral patellar approach without ultrasonography had a higher success rate (87%) than both a medial midpatellar approach (64%) and an anterolateral joint-line approach (70%). For knees with little effusion, we devised a method of intra-articular injection in which the needle is inserted into the suprapatellar pouch while the patient maintains isometric contraction of the quadriceps. This method, which we call the isometric quadriceps contraction (IQC) method, is based on the concept that isometric contraction of the quadriceps induces contraction of the articularis genus muscle complex, thus expanding the volume of the suprapatellar pouch. The major steps of the procedure are (1) patient positioning and knee placement, (2) finding the puncture point, (3) isometric quadriceps contraction, and (4) needle approach to the suprapatellar pouch and injection. We also show the ultrasound evaluation of the suprapatellar pouch expansion under IQC and the accuracy of the IQC method compared with that of the non-activated quadriceps method. The results of this injection method indicate that the suprapatellar pouch is likely to expand during IQC, improving the probability of successful intra-articular injections. We believe that the IQC method is therapeutically effective and achieved a success rate of 93.3% despite the presence of little effusion and no use of ultrasonography.

Isometric Contraction of the Quadriceps Improves the Accuracy of Intra-Articular Injections into the Knee Joint via the Superolateral Approach.

BACKGROUND: Intra-articular injection is an important technique for treating rheumatoid arthritis and osteoarthritis of the knee. However, medication is often inaccurately injected outside of the joint. We devised an intra-articular injection method in which the needle is inserted into the suprapatellar bursa while the patient maintains isometric contraction of the quadriceps. This isometric contraction method is based on the concept that isometric contraction of the quadriceps induces contraction of the articularis genus muscle, thus expanding the lumen of the suprapatellar bursa. METHODS: Intra-articular injections were performed on 150 osteoarthritic knees without effusion. The knees were alternately assigned to the isometric quadriceps method group (75 knees) and non-activated quadriceps method group (75 knees). Prior to joint injection, the anterior-posterior dimension of each suprapatellar bursa was measured to ascertain its expansion. The isometric quadriceps method was performed with the quadriceps and the articularis genus muscle maintained in a contracted state. The non-activated quadriceps method was performed in a relaxed state. Ultrasound guidance was not used for either method. Subsequently, an ultrasonic probe was used only to confirm whether the intra-articular injections were successful. We compared the accuracy of injections performed between the 2 groups. RESULTS: Suprapatellar expansion was significantly larger (p < 0.001) using the isometric quadriceps method (2.1 ± 1.4 mm [range, 0 to 5 mm]) than using the non-activated quadriceps method (0.8 ± 0.7 mm [range, 0 to 2 mm]). The percentage of accurate intra-articular injections was significantly higher (p = 0.0287) using the isometric quadriceps method (93%) compared with the non-activated quadriceps method (80%). CONCLUSIONS: In comparison with the non-activated quadriceps method, the isometric quadriceps method led to a larger expansion of the suprapatellar bursa, which should lead to more accurate intra-articular injections. The isometric quadriceps method is effective in reducing inaccurate injections into the synovium or surrounding fatty tissues. CLINICAL RELEVANCE: Putting force on the quadriceps muscle increases the success rate of intra-articular injection of the knee. The results of this study could provide a clinically relevant injection technique for future treatment.

Acetaldehyde-induced cytotoxicity involves induction of spermine oxidase at the transcriptional level.

Ethanol consumption causes serious liver injury including cirrhosis and hepatocellular carcinoma. Ethanol is metabolized mainly in the liver to acetic acid through acetaldehyde. We investigated the effect of ethanol and acetaldehyde on polyamine metabolism since polyamines are essential factors for normal cellular functions. We found that acetaldehyde induced spermine oxidase (SMO) at the transcriptional level in HepG2 cells. The levels and activities of ornithine decarboxylase (ODC) and spermidine/spermine acetyltransferase (SSAT) were not affected by acetaldehyde. Spermidine content was increased and spermine content was decreased by acetaldehyde treatment. Knockdown of SMO expression using siRNA reduced acetaldehyde toxicity. Acetaldehyde exposure increased free acrolein levels. An increase of acrolein by acetaldehyde was SMO dependent. Our results indicate that cytotoxicity of acetaldehyde involves, at least in part, oxidation of spermine to spermidine by SMO, which is induced by acetaldehyde.

Characterization of nitrifying granules produced in an aerobic upflow fluidized bed reactor.

Since nitrification is the rate-determining step in the biological nitrogen removal from wastewater, many research studies have been conducted on the immobilization of nitrifying bacteria. In this research, granulation of nitrifying bacteria in an aerobic upflow fluidized bed (AUFB) reactor in a nitrification process for inorganic wastewater containing 500 g/m(3) of NH(4)(+)-N was investigated. It was observed that spherical, pseudocubic and elliptical granules with a diameter of 346 microm were produced at the bottom of the reactor after 300 days. Denaturing gradient gel electrophoresis analysis revealed that Nitrosomonas-like bacteria were the dominant ammonia-oxidizing species in the granules. Many colonies of Nitrosomonas-like bacteria were found in the outer part of the granules based on the spatial distribution analysis by fluorescence in situ hybridization. By stepwise reduction of the hydraulic retention time, the ammonia removal rate of the AUFB reactor containing these nitrifying granules finally reached 1.5 kg-N/m(3)/day. Results suggested that the use of granules realizes the retention of a large amount of nitrifying bacteria in the reactor, which guarantees a highly efficient nitrification.