Fluoroscopic Confirmation of Needle Location in Ultrasound-guided Genicular Nerve Radiofrequency Thermocoagulation.

BACKGROUND: Radiofrequency thermocoagulation of genicular nerves is an effective treatment for chronic pain due to knee osteoarthritis. The procedure can be performed under fluoroscopic or ultrasonographic guidance. OBJECTIVES: The aim of this study was to fluoroscopically check the final location  of the needle in ultrasound-guided genicular nerve radiofrequency thermocoagulation and evaluate the treatment's success in patients with knee pain. STUDY DESIGN: A 2-center, prospective study. SETTING: A private clinic and a tertiary care health center. METHODS: Thirty-two patients who had unilateral knee pain, and grade 3-4 knee osteoarthritis according to the Kellgren-Lawrence classification were included. Following diagnostic genicular nerve blocks in patients whose knee pain was relieved by >= 50%, radiofrequency thermocoagulation was applied to these nerves. The final position of the needle was checked via fluoroscopy in anteroposterior and lateral planes. RESULTS: The needle was located in the one-third anterior portion of the bone shaft in 69 of 96 patients (71.9%), between one-third and two-thirds in 21 (21.9%), and in the one-third posterior portion in 6 (6.3%). The mean Numeric Rating Scale score for pain was 7.69 ± 0.99 before treatment, 4.03 ± 1.26 at one week, 2.53 ± 1.24 at one month, and 2.19 ± 1.71 at 3 months, indicating a statistically significant decrease (P < 0.001). LIMITATIONS: The lack of a study group in which genicular nerve radiofrequency thermocoagulation was performed under fluoroscopy guidance could be cited among the limitations of this clinical study. CONCLUSIONS: The final position of the needle tip in radiofrequency thermocoagulation of genicular nerves can exist at the one-third anterior of the bone shaft, without a need for further advancing the needle to the posterior portion. Although performed more distally compared to fluoroscopy guidance, ultrasound-guided genicular nerve radiofrequency thermocoagulation still provides effective analgesia.

Easy to treat when the diagnosis is made: Three cases of clunealgia and the advantage of ultrasonography.

In this article, we present three cases of clunealgia admitted with low back pain. Their pain relieved with superior cluneal nerve block. The posterior side of the iliac crest, which is the location where the superior cluneal nerve passes, was identified using a high-frequency linear transducer. The drug injected separates the erector spinae muscle and thoracolumbar fascia and accumulates between these two structures. All patients were discharged with a complete pain relief. This report highlights the fact that superior cluneal nerve entrapment should be kept in mind in patients with low back pain and that ultrasound guidance can correctly identify the infiltration and eliminate anesthetization of other surrounding structures.

Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome.

OBJECTIVE: There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS). METHODS: Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups. RESULTS: In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks. CONCLUSIONS: The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.

Voice Analysis to Differentiate the Dopaminergic Response in People With Parkinson's Disease.

Humans' voice offers the widest variety of motor phenomena of any human activity. However, its clinical evaluation in people with movement disorders such as Parkinson's disease (PD) lags behind current knowledge on advanced analytical automatic speech processing methodology. Here, we use deep learning-based speech processing to differentially analyze voice recordings in 14 people with PD before and after dopaminergic medication using personalized Convolutional Recurrent Neural Networks (p-CRNN) and Phone Attribute Codebooks (PAC). p-CRNN yields an accuracy of 82.35% in the binary classification of ON and OFF motor states at a sensitivity/specificity of 0.86/0.78. The PAC-based approach's accuracy was slightly lower with 73.08% at a sensitivity/specificity of 0.69/0.77, but this method offers easier interpretation and understanding of the computational biomarkers. Both p-CRNN and PAC provide a differentiated view and novel insights into the distinctive components of the speech of persons with PD. Both methods detect voice qualities that are amenable to dopaminergic treatment, including active phonetic and prosodic features. Our findings may pave the way for quantitative measurements of speech in persons with PD.

Validation of refractive index structure parameter estimation for certain infrared bands.

Variation of the atmospheric refraction index due to turbulent fluctuations is one of the key factors that affect the performance of electro-optical and infrared systems and sensors. Therefore, any prior knowledge about the degree of variation in the refractive index is critical in the success of field studies such as search and rescue missions, military applications, and remote sensing studies where these systems are used frequently. There are many studies in the literature in which the optical turbulence effects are modeled by estimation of the refractive index structure parameter, C(n)(2), from meteorological data for all levels of the atmosphere. This paper presents a modified approach for bulk-method-based C(n)(2) estimation. According to this approach, conventional wind speed, humidity, and temperature values above the surface by at least two levels are used as input data for Monin-Obukhov similarity theory in the estimation of similarity scaling constants with a finite difference approximation and a bulk-method-based C(n)(2) estimation. Compared with the bulk method, this approach provides the potential for using more than two levels of standard meteorological data, application of the scintillation effects of estimated C(n)(2) on the images, and a much simpler solution than traditional ones due to elimination of the roughness parameters, which are difficult to obtain and which increase the complexity, the execution time, and the number of additional input parameters of the algorithm. As a result of these studies, Atmospheric Turbulence Model Software is developed and the results are validated in comparison to the C(n)(2) model presented by Tunick.

Size control of highly ordered HfO2 nanotube arrays and a possible growth mechanism.

Highly ordered HfO2 nanotube arrays were prepared through an electrochemical anodization in the presence of NH4F and ethylene glycol. The voltage-dependent pore size, wall thickness and porosity were studied using scanning electron microscopy and a wall thickness to pore size ratio was proposed on the basis of the results to serve as a boundary condition additional to the 10% porosity rule introduced by the Gosele group. The average distributions of the tube sizes and wall thicknesses of the nanotubes prepared at 20 V were determined from the small-angle x-ray scattering data using a simple polydisperse core-shell cylinder model fit. Temperature-dependent x-ray diffraction measurements show that the as-grown amorphous nanotube arrays can be converted into crystalline nanotube arrays at a temperature above 500 degrees C. Transmission electron microscopy study of the dimple layer under the as-grown nanotube arrays reveals the presence of a layer of ordered HfO2 nanocrystals. Further microscopic investigation of the nanotube root region indicates that the nanotubes develop from bulbs produced during anodization. A possible gas bubble initiated growth mechanism based on these observations was proposed.