Comparison of Single Lumbar Transforaminal Epidural Steroid Injections for Treatment of Early and Late Recurrent Lumbar Disc Herniation.

AIM: To compare the results of fluoroscopically guided transforaminal epidural steroid injection (TESI) for pain reduction in ipsilateral early recurrent lumbar disc herniation (RLDH) with ipsilateral late RLDH. MATERIAL AND METHODS: A total of 738 patients complaining of radicular pain due to ipsilateral early and late RLDH were assessed. Of these, TESI was administered to 390 subjects for ipsilateral early RLDH and 346 for ipsilateral late RLDH. TESIs were performed based on radicular leg pain; all subjects were followed up and reexamined after 12 weeks of the therapy. Pre- and postprocedural visual analog scale (VAS) scores and all complications were recorded for the study. RESULTS: For radicular pain, the mean pre-, and postprocedural VAS scores for ipsilateral early RLDH were 85.44 ± 6.85 and 20.16 ± 3.77 respectively. For late RLDH, the mean pre-, and postprocedural VAS scores were 72.82 ± 5.12 and 30.87 ± 4.17, respectively. A significant statistical difference for pre- and postprocedural VAS scores were observed between ipsilateral early and late recurrent disc herniation TESI groups (p < 0.05). CONCLUSION: TESI was more effective for early RLDH than for late RLDH during the 12-week follow-up period.

Reference evapotranspiration estimate with missing climatic data and multiple linear regression models.

The reference evapotranspiration (ETo) is considered one of the primary variables for water resource management, irrigation practices, agricultural and hydro-meteorological studies, and modeling different hydrological processes. Therefore, an accurate prediction of ETo is essential. A large number of empirical methods have been developed by numerous scientists and specialists worldwide to estimate ETo from different climatic variables. The FAO56 Penman-Monteith (PM) is the most accepted and accurate model to estimate ETo in various environments and climatic conditions. However, the FAO56-PM method requires radiation, air temperature, air humidity, and wind speed data. In this study in Adana Plain, which has a Mediterranean climate for the summer growing season, using 22-year daily climatic data, the performance of the FAO56-PM method was evaluated with different combinations of climatic variables when climatic data were missing. Additionally, the performances of Hargreaves-Samani (HS) and HS (A&G) equations were assessed, and multiple linear regression models (MLR) were developed using different combinations of climatic variables. The FAO56-PM method could accurately estimate daily ETo when wind speed (U) and relative humidity (RH) data were unavailable, using the procedures suggested by FAO56 Paper (RMSEs were smaller than 0.4 mm d-1, and percent relative errors (REs) were smaller than 9%). Hargreaves-Samani (A&G) and HS equations could not estimate daily ETo accurately according to the statistical indices (RMSEs = 0.772-0.957 mm d-1; REs (%) = 18.2-22.6; R2 = 0.604-0.686, respectively). On the other hand, MLR models' performance varied according to a combination of different climatic variables. According to t-stat and p values of independent variables for MLR models, solar radiation (Rs) and sunshine hours (n) variables had more effect on estimating ETo than other variables. Therefore, the models that used Rs and n data estimated daily ETo more accurately than the others. RMSE values of the models that used Rs were between 0.288 to 0.529 mm d-1; RE(%) values were between 6.2%-11.5% in the validation process. RMSE values of the models that used n were between 0.457 to 0.750 mm d-1; RE(%) values were between 9.9%-16.3% in the validation process. The models based only on air temperature had the worst performance (RMSE = 1.117 mm d-1; RE(%) = 24.2; R2 = 0.423).

Optimal Timing and Outcome of Transforaminal Epidural Steroid Injection for the Management of Radicular Pain due to Extruded Lumbar Disc Herniation.

AIM: To evaluate the optimal timing and outcome of fluoroscopically guided transforaminal epidural steroid injections (TFESI) for the management of radicular pain due to extruded lumbar disc herniation (LDH). MATERIAL AND METHODS: In this clinical study, 305 individuals received fluoroscopically guided TFESI for the management of radicular pain due to extruded LDH. Preprocedural and 12-week postprocedural Visual Analog Scale (VAS) scores measuring radicular pain were statistically compared. The neurological conditions of the patients and the complications of the procedure were also recorded. RESULTS: The intensity of radicular pain evaluated by the mean preprocedural and 12-week postprocedural VASs were 8.765 ± 0.559 and 2.281 ± 0.401, respectively (p=0.001, and t=119.01). A correlation was noted between the short duration of symptoms before the procedure and the effectiveness of the procedure. After 12 weeks of the procedure, 32 of the 58 patients showed improvement in terms of neurological deficit. There was no major complication. Nine patients required lumbar disc surgery after the procedure. CONCLUSION: This clinical research demonstrated that TFESI for the management of extruded LDH may alleviate radicular pain and may decrease the neurological deficit and that it is more effective when performed at the earliest possible time point.

Assessment of pan coefficient models for the estimation of the reference evapotranspiration in a Mediterranean environment in Turkey.

Reference evapotranspiration (ETo) is essential for irrigation practices and the management of water resources and plays a vital role in agricultural and hydro-meteorological studies. The FAO-56 Penman-Monteith (PM) equation, recommended as the sole standard method of calculating ETo by the Food and Agriculture Organization of the United Nations (FAO), is the most commonly used and accurate model to determine the ETo and evaluate ETo equations. However, it requires many meteorological variables, often restricting its applicability in regions with poor or missing meteorological observations. Many empirical and semi-empirical equations have been developed to predict the ET0 from numerous meteorological data. The FAO-24 Pan method is commonly used worldwide to estimate ETo because it is simple and requires only pan coefficients. However, pan coefficients (Kpan) should be determined accurately to estimate ET0 using the FAO-24 Pan method. As the accuracy and reliability of the Kpan models can be different from one location to another, they should be tested or calibrated for different climates and surrounding conditions. In this study, the performance of the eight Kpan models was evaluated using 22-year daily climate data for the summer growing season in Adana, which has a Mediterranean climate in Turkey. The results showed that the mean seasonal pan coefficients estimated by all Kpan models differed significantly at a 1% significance level from those observed by FAO-56 PM according to the two-tail z test. In the study, ETo values estimated by Kpan models were compared against those obtained by the FAO-56 PM equation. The seasonal and monthly performance of Kpan models was varied, and the Wahed & Snyder model presented the best performance for ETo estimates at the seasonal scale. (RMSE = 0.550 mm d-1; MAE = 0.425 mm d-1; MBE = -0.378 mm d-1; RE = 0.134). In addition, it showed a good performance in estimating ETo on a monthly scale. The Orang model showed the lowest performance in estimating ETo among all models, with a very high relative error on the seasonal scale. (RMSE = 1.867 mm d-1; MAE = 1.806 mm d-1; MBE = -1.806 mm d-1; RE = 0.455). In addition, it showed the poorest performance on a monthly scale. Hence, the Wahed & Snyder model can be considered to estimate ETo under Adana region conditions after doing the necessary calibration.

Utilization of biological variation data in the interpretation of laboratory test results - survey about clinicians' opinion and knowledge.

INTRODUCTION: To interpret test results correctly, understanding of the variations that affect test results is essential. The aim of this study is: 1) to evaluate the clinicians' knowledge and opinion concerning biological variation (BV), and 2) to investigate if clinicians use BV in the interpretation of test results. MATERIALS AND METHODS: This study uses a questionnaire comprising open-ended and close-ended questions. Questions were selected from the real-life numerical examples of interpretation of test results, the knowledge about main sources of variations in laboratories and the opinion of clinicians on BV. A total of 399 clinicians were interviewed, and the answers were evaluated using a scoring system ranked from A (clinician has the highest level of knowledge and the ability of using BV data) to D (clinician has no knowledge about variations in laboratory). The results were presented as number (N) and percentage (%). RESULTS: Altogether, 60.4% of clinicians have knowledge of pre-analytical and analytical variations; but only 3.5% of them have knowledge related to BV. The number of clinicians using BV data or reference change value (RCV) to interpret measurements results was zero, while 79.4% of clinicians accepted that the difference between two measurements results located within the reference interval may be significant. CONCLUSIONS: Clinicians do not use BV data or tools derived from BV such as RCV to interpret test results. It is recommended that BV should be included in the medical school curriculum, and clinicians should be encouraged to use BV data for safe and valid interpretation of test results.

Transforaminal Epidural Steroid Injection in the Treatment of Pain in Foraminal and Paramedian Lumbar Disc Herniations.

AIM: To compare the effect of fluoroscopically guided transforaminal epidural steroid injections on radicular pain in foraminal and paramedian lumbar disc herniations. MATERIAL AND METHODS: This study included patients who did not benefit from previous medical treatments or are not suitable for surgery. Transforaminal epidural steroid injections for the treatment of foraminal and paramedian lumbar disc herniation were performed in 370 and 1262 patients, respectively. Every group’s preprocedural visual analogue scale (VAS) and 12-week postprocedural VAS scores were recorded, and statistical analysis was performed. The complications noted were also recorded. RESULTS: The preprocedural and postprocedural mean VAS scores for radicular pain in foraminal disc herniation were 67.11 ± 4.28 and 34.78 ± 3.64, respectively. However, the preprocedural and postprocedural mean VAS scores in paramedian disc herniation were 62.16 ± 6.65 and 19.07 ± 4.50, respectively. Statistical analysis of the varying preprocedural and postprocedural VAS scores showed that transforaminal epidural steroid injections were more effective for paramedian disc herniation than for foraminal disc herniation (p < 0.05). CONCLUSION: Transforaminal epidural steroid injections were more effective for paramedian lumbar disc herniation than for foraminal disc herniation, 12 weeks after the procedure.

High-Intensity Interval Training in Panic Disorder Patients: A Pilot Study.

High-intensity interval training (HIIT) may produce strong physiological but also psychological effects within a short period. However, it is questionable if this type of training is applicable and effective in patients with panic disorder (PD) because they are more vulnerable to the adverse effects of exercise. Twelve PD patients performed a 12-day HIIT trial. Every second day, patients performed 10 high-intensive 1-minute intervals at 77% to 95% of their maximum heart rate separated by 1-minute intervals with moderate to low intensity. All patients completed the 12-day training period. PD severity, agoraphobia, depression, general disorder severity, and endurance performance improved substantially with moderate to large effects sizes. Moreover, the increase in endurance performance was correlated with the reduction of depression and agoraphobia. HIIT was well tolerated by patients with PD and may induce rapid and strong therapeutic effects. A randomized controlled clinical trial is needed to verify our findings.

Comparison of the Effect of Single Lumbar Transforaminal Epidural Steroid Injections for the Treatment of L4-5 and L5-S1 Paramedian Disc Herniation.

AIM: To compare the outcomes of fluoroscopically guided transforaminal epidural steroid injections between L4-L5 paramedian disc herniation and L5-S1 paramedian disc herniation for the treatment of radicular pain. MATERIAL AND METHODS: A total of 593 patients treated by transforaminal epidural steroid injections for the treatment of L4-5 paramedian disc herniation and 504 patients treated by transforaminal epidural steroid injections for the treatment of L5-S1 paramedian disc herniation were included in the study. All the patients were regularly followed up for 12 weeks. Preprocedural Visual Analogue Scale (VAS) scores, 12-week post-procedural VAS scores and complications were recorded. RESULTS: The mean preprocedural and postprocedural VAS scores for L4-5 paramedian disc herniation were 63.09 ± 5.37 and 15.81 ± 3.58, respectively, and the mean preprocedural and postprocedural VAS scores for L5-S1paramedian disc herniation were 61.15 ± 5.45 and 27.06 ± 3.62, respectively, for radicular pain. There was a statistically significant difference between preprocedural and postprocedural VAS scores for L4-5 and L5-S1 paramedian disc herniation (p < 0.05). Transforaminal epidural steroid injections for L4-5 paramedian disc herniation were more effective than transforaminal epidural steroid injections for L5-S1 paramedian disc herniation. CONCLUSION: This study showed that transforaminal epidural steroid injections for L4-5 paramedian disc herniation were more effective than transforaminal epidural steroid injections for L5-S1 paramedian disc herniation in the 12-week follow-up period.