Parasagittal Interlaminar and Transforaminal Epidural Steroid Injections for Radicular Low Back Pain; Which is More Comfortable?

Objective

This study aimed to compare parasagittal interlaminar (PS) and transforaminal (TF) epidural steroid injections for unilateral L5 and S1 radicular lower back pain in terms of patient comfort, efficacy, safety, contrast enhancement, and radiation exposure.

Methods

This was a prospective randomized single-blind study. A total of 59 participants were included in this study. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were obtained. A comfort questionnaire was administered to all participants. The total fluoroscopy time and contrast distribution levels were recorded.

Results

Pre- and post-treatment VAS scores were similar between the groups. The ODI scores increased in favor of the PS group at week 2 (P < 0.041); however, there was no difference between the two groups at other times. The VAS and ODI scores improved significantly with treatment in both the groups (P < 0.001). Total fluoroscopy time was shorter in the PS group (P < 0.001). PS application was more comfortable (P < 0.001). While no complications were observed in the PS group, three complications occurred in the TF group. Anterior epidural contrast spread to three or more levels was observed in 57% of the participants in the PS group, whereas no spread to more than two levels was observed in the TF group.

Conclusion

The PS epidural approach is superior to the TF approach in terms of a low incidence of side effects, less radiation exposure, better patient comfort, higher epidural contrast spread, and single-level needle access.

Scientific Publication Performance of the Erector Spinae Plane Block in Türkiye: A Bibliometric Analysis

Objective

Erector spina plane block (ESPB) was first described in 2016 and is effective in various surgical procedures. Bibliometric analysis is a novel method that evaluates the contribution of scientific studies conducted in a specific field on the existing literature. This study examined articles on ESPB published by anaesthesia clinics in Türkiye in journals under the Science Citation Index Expanded (SCI-E) category.

Methods

Studies on ESPB indexed in the Web of Science Core Collection and published in Türkiye from 2018 to 2022 were evaluated. The primary outcome was to determine the number of studies published in journals under the SCI-E category. The secondary aims were to determine the number of citations and the institutions where the studies were conducted.

Results

A total of 159 publications were analyzed. The journal with the highest number of publications was "Journal of Clinical Anesthesia" (n = 70). The institution that has to date made the most contributions to the literature was Atatürk University (n = 31). The most cited article was "Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study." published by Gürkan et al. (n = 175).

Conclusion

This study reflects the contribution level of Türkiye-addressed anaesthesia clinics to journals under the SCI-E category. Our findings can serve as a benchmark for attracting the attention of national and international researchers.

International Culture Collections and the Value of Microbial Life: Johanna Westerdijk's Fungi and Ernst Georg Pringsheim's Algae

Around the turn of the twentieth century, microbiologists in Western Europe and North America began to organize centralized collections of microbial cultures. Collectors published lists of the strains they cultured, offering to send duplicates to colleagues near and far. This essay explores the history of microbial culture collections through two cases: Johanna Westerdijk's collection of phytopathogenic fungi in the Netherlands and Ernst Georg Pringsheim's collection of single-celled algae at the German University in Prague. Historians of science have tended to look at twentieth-century biological specimen collections as either repositories of communal research materials or storehouses of economically important biological variation. An examination of Westerdijk's and Pringsheim's collections illustrates how collectors, researchers, and patrons ascribed different kinds of value to collections featuring distinctive microbial life forms. This essay argues that characteristics of cultivated microorganisms, such as a fungus's propensity to infect crops or an alga's amenability to experimentation, shaped the trajectories of Westerdijk's and Pringsheim's collections as these collectors developed relationships with colleagues and patrons. Letters between Westerdijk and Pringsheim open a window onto divergences in their approaches to collecting cultures, while also shedding light on the aspirational internationality of the collections that resulted.

Internal microbial zonation during the massive growth of marimo, a lake ball of Aegagropila linnaei in Lake Akan

Marimo (lake ball) is an uncommon ball-like aggregation of the green alga, Aegagropila linnaei. Although A. linnaei is distributed in fresh and brackish waters in the northern hemisphere, marimo colonies are found only in particular habitats. Here, we report the bacterial communities inside various sizes and aggregating structures of natural marimo collected from Lake Akan, Japan. We observed multi-layers composed of sediment particles only in the sizable radial-type marimo with >20 cm diameter and not in the tangled-type marimo. The deeper layers were enriched by Nitrospira, potential sulfur-oxidizing bacteria, and sulfate-reducing bacteria. Microorganisms of the multi-layers would form biofilms incorporating nearby sediment, which would function as microbial “seals” within large radial-type marimo. These findings provide clues to deciphering the growth of endangered marimo.

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The radial type of marimo (lake ball) can grow to over 20 cm in diameter

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The sizable radial-type marimo develops the internal multi-layers and hollow structure

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The layers provide different diverse microbiomes and structural strength

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The internal multi-layers support the massive growth of the radial-type marimo

Editorial for the special issue of the Chinese Association for the Study of Pain

The Ministry of Health of China officially issued a document, adding the first level diagnosis and treatment discipline “Algology” in the list of diagnosis and treatment subjects of medical institutions on July 16, 2007. As the most important pain academic organization in China, the Chinese Association for the Study of Pain has made outstanding contributions in promoting the development of pain discipline and in establishing pain standards and disease diagnosis and treatment guidelines. In this special issue, under the leadership of Yan-Qing Liu, Chairman of the 7^th Committee of the Chinese Association for the Study of Pain, nine consensus and one guideline were included.

Advances in infrared thermography: Surgical aspects, vascular changes, and pain monitoring in veterinary medicine

One of the main functions of infrared thermography (IRT) consists in detecting temperature changes in organisms caused by variations in surface blood circulation. IRT is a useful tool that has been used mainly as a diagnostic method for various stress-causing pathologies, though recent suggestions indicate that it can be used to assess the block quality of certain body regions. In the field of anaesthesiology, IRT has been applied to brachial and epidural blocks, while in algology, changes in surface blood circulation associated with sympathetic activity have been investigated. Thermography has also been employed to complement pain level scales based on the facial expressions of patients in critical condition, or after surgery. In addition, it has been used as a tool in research designed to evaluate different surgical procedures in human medicine, as in the case of surgical burrs for placing dental implants, where IRT helps assess the degree of heating associated with bone devascularisation, reduction in vascular perfusion as a consequence of stroke, and changes in the autonomous nervous system, or the degree of vascular changes in flaps applied to burn patients. In veterinary medicine, thermography has brought several benefits for animals in terms of evaluating lesions, diseases, and surgical procedures. The aim of this review is to evaluate how IRT can be used as a tool in surgical procedures, cases of vascular change, and pain monitoring in veterinary medicine with an emphasis on small animals.

Potential for Heightened Sulfur-Metabolic Capacity in Coastal Subtropical Microalgae

The activities of microalgae support nutrient cycling that helps to sustain aquatic and terrestrial ecosystems. Most microalgal species, especially those from the subtropics, are genomically uncharacterized. Here we report the isolation and genomic characterization of 22 microalgal species from subtropical coastal regions belonging to multiple clades and three from temperate areas. Halotolerant strains including Halamphora, Dunaliella, Nannochloris, and Chloroidium comprised the majority of these isolates. The subtropical-based microalgae contained arrays of methyltransferase, pyridine nucleotide-disulfide oxidoreductase, abhydrolase, cystathionine synthase, and small-molecule transporter domains present at high relative abundance. We found that genes for sulfate transport, sulfotransferase, and glutathione S-transferase activities were especially abundant in subtropical, coastal microalgal species and halophytic species in general. Our metabolomics analyses indicate lineage- and habitat-specific sets of biomolecules implicated in niche-specific biological processes. This work effectively expands the collection of available microalgal genomes by ∼50%, and the generated resources provide perspectives for studying halophyte adaptive traits.

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We have sequenced 20+ microallgal genomes from the subtropics

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This new collection increases the available microalgal genomes by ∼50%

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Metabolomics indicates lineage- and habitat-specificity of biomolecules

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Coastal, subtropical species of microalgae show expansion of sulfur-metabolic genes

Factors affecting results of fluoroscopy-guided facet joint injection: Probable differences in the outcome of treatment between pure facet joint hypertrophy and concomitant diseases

Study Design:

Retrospective cohort study.

Purpose:

Facet joints are considered a common source of chronic low-back pain. To determine whether pathogens related to the facet joint arthritis have any effect on treatment failure.

Materials and Methods:

Facet joint injection was applied to 94 patients treated at our hospital between 2011 and 2012 (mean age 59.5 years; 80 women and 14 men). For the purpose of analysis, the patients were divided into two groups. Patients who only had facet hypertrophy were placed in group A (47 patients, 41 women and 6 men, mean age 55.3 years) and patients who had any additional major pathology to facet hypertrophy were placed in group B (47 patients, 39 women and 8 men, mean age 58.9 years). Injections were applied around the facet joint under surgical conditions utilizing fluoroscopy device guidance. A mixture of methylprednisolone and lidocaine was used as the injection ingredient.

Results:

In terms of Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, no significant difference was found between preinjection and immediate postinjection values in both groups, and the scores of group A patients were significantly lower (P < 0.005) compared with that of group B patients at the end of the third, sixth, and twelfth month.

Conclusion:

For low-back pain caused by facet hypertrophy, steroid injection around the facet joint is an effective treatment, but if there is an existing major pathology, it is not as effective.