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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.futures.2010.08.026 Byline: M. Atilla Aner Author Affiliation: Yeditepe University, Management Application and Research Center, 26 AAustos YerleAimi, IIBF 413, KayiAdaAi Cad., 34755 AtaAehir, Istanbul, Turkey

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.futures.2008.11.011 Byline: Senem Gol, M. Atilla Aner Abstract: The overall aim of the research is to provide an evaluation of differences in time and space perspectives of individuals in Turkey in order to understand the different approaches, perspectives or priorities that they may bring to futures studies. An empirical study aimed to collect information about the varying differences in time and space perspectives among participant individuals (undergraduate and PhD students at Yeditepe University and managers at Siemens-Turkey) and any other possible factors affecting the participants' choices. Two sets of statements are generated representing the time and space perspectives of participants using the modified constructs found in the literature such as 'Time Strata', 'Space-Time Graph', and 'Different Time Frames and Activities'. Our sample population of 185 individuals indicated a time horizon of 4.8 years and space horizon of 530km. Majority of the sample population is observed to be concerned with issues that affect only their close environment over a short time period of 'next week', along with their larger geographical area as the 'city'. A few of the sample population indicated to have a global perspective on time and space that can further reach into the future. Literature suggesting different individuals having different perspectives on time and space, depending on culture, past experience and the nature of the problems are instrumentalized in our study by relating it to the foresight tools and methodologies. Such varying perspectives may explain individuals/managers' time and space horizon in which they think and act/execute. Based on the analysis of space/time preference of participant individuals, policy makers will benefit from incorporating the diversity of time and space dimensions into their strategic thought and national policy roadmaps. This exploratory study is comprised of the assessment of differing definitions and approaches to the future via individuals' space and time perspectives. It aims to contribute to foresight methodologies and approaches, as well as bringing a significant impact on the quality and success of the national foresight project results. Author Affiliation: Management Application and Research Center, Yeditepe University, 26 AAustos YerleAimi, IIBF #500, KayiAdaAi Cad., KayiAdaAi, 34755 Istanbul, Turkey

Origanum vulgare L. has been proven to be the strongest herbal antiseptic in the world, native to the Mediterranean region, but is widely naturalized elsewhere in the temperate Northern Hemisphere. This study aimed to estimate the phytotoxic effect of three different concentrations of oregano essential oil (O. vulgare) on three selected plant species namely, wheat, tomato and mint using biotest germination and effects on seedling growth, as well as its toxicological properties using Allium test. Our results revealed that oregano essential oil exhibits allelopathic effect on selected species. All three tested concentrations of oregano essential oil caused a significant inhibition of Allium cepa L. root growth, as well as a reduction in the mitotic index values in A. cepa meristem cells. O. vulgare essential oil demonstrated phytotoxic and antiproliferative effects. Further research is needed to confirm our results.

Urban heat islands, characterized by higher temperatures in cities compared to surrounding areas, have been studied using various techniques. However, during heat waves, existing models often underestimate the intensity of these heat islands compared to empirical measurements. To address this, an hourly time-series-based model for predicting heat island intensity during heat wave conditions is proposed. The model was developed and validated using empirical data from the National Monitoring Network in Temuco, Chile. Results indicate a strong correlation (r > 0.98) between the model’s predictions and actual monitoring data. Additionally, the study emphasizes the importance of considering the unique microclimatic characteristics and built environment of each city when modelling urban heat islands. Factors such as urban morphology, land cover, and anthropogenic heat emissions interact in complex ways, necessitating tailored modelling approaches for the accurate representation of heat island phenomena.

Abstract Glioblastoma multiforme (GBM) is the most frequent type of primary astrocytomas. We examined the association between single nucleotide polymorphisms (SNPs) in Aurora kinase A (AURKA), Aurora kinase B (AURKB), Aurora kinase C (AURKC) and Polo-like kinase 1 (PLK1) mitotic checkpoint genes and GBM risk by qPCR genotyping. In silico analysis was performed to evaluate effects of polymorphic biological sequences on protein binding motifs. Chi-square and Fisher statistics revealed a significant difference in genotypes frequencies between GBM patients and controls for AURKB rs2289590 variant (p = 0.038). Association with decreased GBM risk was demonstrated for AURKB rs2289590 AC genotype (OR = 0.54; 95% CI = 0.33–0.88; p = 0.015). Furthermore, AURKC rs11084490 CG genotype was associated with lower GBM risk (OR = 0.57; 95% CI = 0.34–0.95; p = 0.031). Bioinformatic analysis of rs2289590 polymorphic region identified additional binding site for the Yin-Yang 1 (YY1) transcription factor in the presence of C allele. Our results indicated that rs2289590 in AURKB and rs11084490 in AURKC were associated with a reduced GBM risk. The present study was performed on a less numerous but ethnically homogeneous population. Hence, future investigations in larger and multiethnic groups are needed to strengthen these results.

Significant action is needed across the Chilean housing sector to reduce energy consumption and meet climate change mitigation goals. In this study, the performance of a typical house, an optimised house and a Passivhaus in various climates is evaluated and compared, considering eight distinct climatic zones of Chile. For the thermal optimisation of the house, an OpenBIM workflow between REVIT-CYPETHERM and EnergyPlus with JEPlus were interfaced to analyse over a thousand possible combinations of energy optimisation measures for each climate zone. Additionally, a Life Cycle Assessment is used to compare the cases studied. The results show that in the manufacturing stage, building a Passivhaus would have greater environmental impacts than a traditional house. Additionally, it is shown that in warm climatic zones, a thermally optimised house can have an energy performance equivalent to housing constructed to Passivhaus standards but with less environmental impacts in all its phases of the life cycle.

Abstract Background Single nucleotide polymorphisms (SNPs) in genes encoding mitotic kinases could influence development and progression of gastric cancer (GC). Methods Case-control study of nine SNPs in mitotic genes was conducted using qPCR. The study included 116 GC patients and 203 controls. In silico analysis was performed to evaluate the effects of polymorphisms on transcription factors binding sites. Results The AURKA rs1047972 genotypes (CT vs. CC: OR, 1.96; 95% CI, 1.05–3.65; p = 0.033; CC + TT vs. CT: OR, 1.94; 95% CI, 1.04–3.60; p = 0.036) and rs911160 (CC vs. GG: OR, 5.56; 95% CI, 1.24–24.81; p = 0.025; GG + CG vs. CC: OR, 5.26; 95% CI, 1.19–23.22; p = 0.028), were associated with increased GC risk, whereas certain rs8173 genotypes (CG vs. CC: OR, 0.60; 95% CI, 0.36–0.99; p = 0.049; GG vs. CC: OR, 0.38; 95% CI, 0.18–0.79; p = 0.010; CC + CG vs. GG: OR, 0.49; 95% CI, 0.25–0.98; p = 0.043) were protective. Association with increased GC risk was demonstrated for AURKB rs2241909 (GG + AG vs. AA: OR, 1.61; 95% CI, 1.01–2.56; p = 0.041) and rs2289590 (AC vs. AA: OR, 2.41; 95% CI, 1.47–3.98; p = 0.001; CC vs. AA: OR, 6.77; 95% CI, 2.24–20.47; p = 0.001; AA+AC vs. CC: OR, 4.23; 95% CI, 1.44–12.40; p = 0.009). Furthermore, AURKC rs11084490 (GG + CG vs. CC: OR, 1.71; 95% CI, 1.04–2.81; p = 0.033) was associated with increased GC risk. A combined analysis of five SNPs, associated with an increased GC risk, detected polymorphism profiles where all the combinations contribute to the higher GC risk, with an OR increased 1.51-fold for the rs1047972(CT)/rs11084490(CG + GG) to 2.29-fold for the rs1047972(CT)/rs911160(CC) combinations. In silico analysis for rs911160 and rs2289590 demonstrated that different transcription factors preferentially bind to polymorphic sites, indicating that AURKA and AURKB could be regulated differently depending on the presence of particular allele. Conclusions Our results revealed that AURKA (rs1047972 and rs911160), AURKB (rs2241909 and rs2289590) and AURKC (rs11084490) are associated with a higher risk of GC susceptibility. Our findings also showed that the combined effect of these SNPs may influence GC risk, thus indicating the significance of assessing multiple polymorphisms, jointly. The study was conducted on a less numerous but ethnically homogeneous Bosnian population, therefore further investigations in larger and multiethnic groups and the assessment of functional impact of the results are needed to strengthen the findings.

Rheumatoid arthritis is a polygenic disease of unknown etiology, occurs worldwide in both developed and underdeveloped countries and involves all races. The aim of this study is to determine the correlation between hematological parameters (DBC and ESR) and biomarkers of inflammation (CRP) in patients with RA predisposing gene variants HLA-DRB1*04orHLA-DRB1*03. This study analyzed the results of hematological and biochemical parameters of 33 patients diagnosed with RA, carriers ofgene variants of HLA-DRB1*04 or HLA-DRB1*03, and 33 subjects of control group non-carriers for HLA-DRB1*04 or HLA-DRB1*03. All hematological parameters (DBC) were analyzed on a Beckman Coulter DxH 800 hematology counter. The erythrocyte sedimentation rate was expressed in mm/h. The CRP biochemical test was performed on a Cobas c311 automatic analyzer. In groupof RA patients carriers of HLA-DRB1*04orHLA-DRB1*03 gene variants, the values of HGB and HCTwere significantlylower(p < 0.05) while the values of RDW, RDW-SD, MO, BA, MO#, BA#, ESR and CRPwere statistically increased(p < 0.05) from the control group without these variants.

Plantago major L. is a perennial, wild plant that belongs to the Plantaginaceae family, and is used as a good indicator in the assessment of destructive anthropogenic impact on the environment. The aim of the present study was to evaluate cyto/genotoxic effects of methanol extracts of Plantago major, collected from two locations (Tetovo and Smetovi), using Allium cepa test. We demonstrated that the highest concentration of P. major extracts from both locations reduced the mitotic index, while the lowest increased mitotic index value comparing to the positive control. As for genotoxic effects of extract from Tetovo, all concentrations increased the frequency of sticky chromosomes and chromosome missegregations in comparison with both controls, and frequency of multipolar anaphases when compared to the negative control. Higher number of cells with vagrants in comparison with positive control was detected after the treatment with 0.005 and 0.02 mg/ml concentrations. P. major extract from Smetovi (0.005 and 0.01 mg/ml) induced an increase in the number of vagrants as compared to the positive control, and frequency of sticky chromosomes when compared to both controls (0.01 mg/ml). Exposure to extract (0.005 and 0.02 mg/ml) caused increased number of multipolar anaphases in comparison with negative control. Apoptosis were not detected for P. major extract from Smetovi, while its highest concentration (0.02 mg/ml) induced increase in the frequency of necrosis as compared to the positive control. Our results demonstrated that methanol extracts of P. major, collected from Tetovo and Smetovi, showed cyto/genotoxic effects on A. cepa meristem cells.

In Chile, it is estimated that the energy demand will continue to increase if substantial energy efficiency measures in housing are not taken. These measures are generally associated with technical and mainly economic difficulties. This paper aims to show the technical and economic feasibility of achieving Passivhaus standard house in Chile, considering the budget of the maximum state subsidy currently available (Chilean Unidad de Fomento (CLF) 2000 ≈ 81,000 USD). The design was simulated in the Passive House Planning Package software to determine if the house could be certified with the selected standard. At the same time, the value of all the items was quantified in order not to exceed the stipulated maximum budget for a house considered as affordable. It was shown that in terms of design it is possible to implement the Passivhaus standard given the current housing subsidy. The designed housing ensures a reduction of 85% in heating demand and a 60% reduction in CO2 emissions during the operation, compared to an average typical Chilean house.

Introduction: Treatment of cancer has been subject of great interest. Researchers are continuously searching for new medicines. In this sense, ruthenium complexes have big potential. Some evidences suggest that ruthenium compounds possess anticancer activities. We synthesized two recently published ruthenium(III) complexes with bidentate O,N and tridentate O,O,N Schiff bases derived from 5-substituted salicylaldehyde and aminophenol or anilineare. These compounds showed affinity for binding to the DNA molecule, however, insufficient data are available regarding their possible toxic effects on biological systems. Methods: In the present study we evaluated genotoxic, cytotoxic, and cytostatic effects of Na[RuCl2(L1)2] and Na[Ru(L2)2], using the Allium cepa assay. Results: Different toxic effects were observed depending on the substance, tested concentration, and endpoint measured. In general, the tested compounds significantly lowered the root growth and mitotic index values as compared to the control group. Additionally, a wide range of abnormal mitotic stages, both clastogenic and non-clastogenic were observed in the treated cells. Na[RuCl2(L1)2] significantly increased the frequency of sticky metaphases, chromosome bridges, micronuclei, impaired chromosome segregation, as well as number of apoptotic and necrotic cells over the controls. In contrast, Na[Ru(L2)2] did not show significant evidence of genotoxicity with regard to chromosome aberrations and micronuclei, however, significant differences were detected in the number of apoptotic and necrotic cells when the highest concentration was applied. Conclusions: In this study we demonstrated antiproliferative effects of Na[RuCl2(L1)2] and Na[Ru(L2)2]. At clinical level, these results could be interesting for further studies on anticancer potential of the ruthenium(III) complexes using animal models.

Thomas T Simopoulos, Jyotsna Nagda, Musa M AnerArnold Pain Management Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USAPurpose: The objective of this study was to retrospectively evaluate the analgesic effects of continuous radiofrequency lesioning of the suprascapular nerve (SSN) for chronic shoulder pain. The authors sought to obtain insight into the time-sensitive analgesic success and complications of this therapy.Patients and methods: This study was a retrospective case series involving patients with unremitting shoulder pain that had lasted for at least 12 months. Patients were selected if they showed a reduction of at least 50% in pain intensity during the anesthetic phase after SSN block, no additional motor weakness of the shoulder, and pain relief lasting for less than 2 months after separate treatments of the SSN with depot corticosteroids and pulsed radiofrequency. Nine patients were referred to the Arnold Pain Management Center. Of these nine patients, six patients who had significant chronic shoulder pain unresponsive to oral medications and intra-articular injections and who were not considered surgical candidates were selected. These patients were treated with a single radiofrequency lesion of the SSN at 80°C for 60 seconds. The primary outcome was a reduction in pain intensity by 50%, as determined by the numeric rating scale, and duration of this effect. The secondary outcome was improvement in either the passive or the active range of motion (ROM). Patients were also monitored for adverse effects such as weakness or increased pain.Results: The pooled mean numeric rating scale score before the procedure was 7.2 ± 1.2; this fell to 3.0 ± 0.9 at 5–7 weeks post procedure. The duration of pain relief ranged from 3 to 18 months, and all patients underwent at least one additional treatment. The change in baseline ROM improved from an average of 60° ± 28° (flexion) and 58° ± 28° (abduction) to 99° ± 46° (flexion) and 107° ± 39° (abduction). No adverse side effects were observed.Conclusion: Continuous radiofrequency lesioning of the SSN seems to be an effective treatment for chronic shoulder pain. There can be improved ROM of the shoulder following this treatment. More formal, controlled studies are required to confirm these observations.Keywords: pulsed radiofrequency, suprascapular nerve block, pain relief, range of motion

Introduction: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question., Methods: We conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications., Results: Many practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians reported the use of general anesthesia for 10 kHz implants. Additionally, 94% of physicians reported that they have never had a complication related to the use of general anesthesia for a spinal cord stimulator placement., Conclusions: This survey provides initial data on SCS practices among a large cohort of clinicians who utilize SCS. SCS lead placement under deep sedation and general anesthesia appears to be common practice for many physicians who perform implants. This survey should stimulate further research on this topic, given that the current safety guidelines and the rate of physicians reporting the use of deep sedation and general anesthesia for spinal cord stimulator placement remain at odds., (© 2021. The Author(s).)

Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes., Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia., Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain., Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control., Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes., Competing Interests: Conflict of Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021, Author(s).)

Purpose of Review: Post dural puncture headache (PDPH) is a known and relatively common complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes, and is commonly treated with an epidural blood patch (EBP). There have been few publications regarding the long-term safety of EBP for the treatment of PDPH., Recent Findings: The aim of this pilot study was to examine any association of chronic low back pain (LBP) in patients who experienced a PDPH following a LP, and were treated with an EBP. A total of 49 patients were contacted and completed a survey questionnaire via telephone. There was no increased risk of chronic LBP in the dural puncture group receiving EBP (percentage difference 1% [95% CI -25% - 26%], RR: 0.98 [95% CI 0.49 - 1.99]) compared to the dural puncture group not receiving EBP. There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Both groups had higher prevalence of back pain compared to baseline., Summary: Our findings suggest that dural puncture patients undergoing EBP do not experience low back pain with increased frequency compared to dural puncture patients not undergoing EBP. Higher prevalence of LBP compared to baseline and compared to general population was seen in both groups. However, this pilot study is limited by a small sample size and no definitive conclusion can be drawn from this observation. The findings of this study should spur further prospective research into identifying potential associations between LP, EBP and chronic low back pain., (Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.)

Background: Post dural puncture headache (PDPH) is a known complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes. The gold standard for treating a PDPH is an epidural blood patch (EBP). There have been few publications evaluating the long-term outcomes of PDPH treated with EBP. The aim of this pilot study was to examine the incidence of chronic headaches in dural puncture patients who received EBP versus those who did not., Methods: A retrospective case control study was performed at a single large center institution. Forty-nine patients who had intentional dural puncture were identified on chart review and completed a survey questionnaire via phone interview: twenty-six of these patients required a subsequent EBP, while twenty-three did not. The primary outcomes were the development and prevalence of chronic headaches after the procedures. There was no statistically significant difference in the prevalence of current headaches between the EBP group and Non-EBP group (54% vs. 52% p = 0.91). There were no significant differences in the rates of severity and descriptive qualities of headache between the EBP and non-EBP groups. There was higher incidence of tinnitus in the PDPH patients., Summary: This pilot study demonstrates that patients who received an EBP for treatment of a PDPH following LP are no more likely to experience chronic headaches compared to patients who do not receive an EBP. However, both the EBP group and Non-EBP group had high incidence of chronic headaches which may be related to dural puncture or a baseline trait of this cohort given the recall bias. There is a suggestion that tinnitus could be a long-term residual symptom of PDPH treated with EBP., Competing Interests: Compliance with Ethics Guidelines Conflict of Interest The authors declare no conflicts of interest relevant to this manuscript., (Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.)

Introduction: To date, no study has reported the prevalence of cannabis use in chronic pain patients. The aim of this study is to investigate the trends in cannabis use among chronic pain in-patients from 2011 to 2015 in the USA., Methods: Patients were identified from the National Inpatient Sample (NIS) database using the International Classification of Diseases, Ninth and Tenth Revision, diagnosis codes for chronic pain and cannabis use. Annual estimates and trends were determined for cannabis use, patient characteristics, cannabis use among subgroups of chronic pain conditions, cost, length of stay, and associated discharge diagnosis., Results: Between 2011 to 2015, a total of 247,949 chronic pain patients were cannabis users, increasing from 33,189 to 72,115 (P < 0.001). There were upward trends of cannabis use in females (38.7-40.7%; P = 0.03), Medicare insured patients (32.7-40.4%; P < 0.01), patients with lowest annual household income (36.1-40.9%; P = 0.02), patients aged 45-64 years (45.9-49.2%; P < 0.001), and patients with tobacco use disorder (63.8-72.4%; P < 0.0001). Concurrently, cannabis use decreased among patients with opioid use disorder (23.8-19.9%; P < 0.001). Cannabis use increased from 2011 to 2015 in patients with chronic regional pain syndrome, trauma, spondylosis, and failed back surgery syndrome. Adjusted total hospitalization cost increased from $31,271 ($1333) in 2011 to $38,684 ($946) in 2015 (P < 0.001)., Conclusions: Cannabis use increased substantially from 2011 to 2015, while the rates of cannabis use in opioid users down-trended simultaneously. Disparities in cannabis use among subgroups should be explored further.

Objective: To describe and analyze lumbar epidural contrast spread patterns in antero-posterior (AP), lateral, and contralateral oblique (CLO) views., Methods: Lumbar epidural contrast spread patterns after interlaminar injection were prospectively collected in AP, lateral, and several CLO views and analyzed for multiple variables; three-dimensional mapping was also performed., Results: Epidural contrast patterns were prospectively analyzed in 28 subjects. The median volume of contrast injected was 2 mL; the AP view was more sensitive than the lateral view to detect foraminal uptake (13/28, 46%, 95% confidence interval [CI] = 27-66%, vs 7/28, 25%, 95% CI = 11-45% subjects). CLO view demonstrated the most consistent location for epidural contrast spread, with contrast contacting the ventral laminar margin in 28/28 (100%, 95% CI = 87-100%) patients. The most common location of contrast spread in the lateral view was at the facet joint lucency, with only 8/28 (29%, 95% CI = 13%-49%) subjects showing contrast contacting the spinolaminar junction. Lateral view was more sensitive than the CLO view in ventral epidural contrast spread detection. The extent and distribution of the spread did not bear any relationship to the volume injected or to the needle location in AP view., Conclusions: CLO view provides the most consistent landmark for lumbar epidural contrast spread, and lateral view is most suited to confirming ventral epidural spread. The AP view may be the most optimal for determining target access when considering access to the dorsal root ganglia; in an individual patient, the volume injected and needle location in AP view do not reliably predict target access. The volume to be injected and the need to re-access or obtain multisite access must be prospectively determined, based upon observation of the spread., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Tarlov cysts are extradural meningeal cysts with collections of cerebrospinal fluid within the nerve sheath. These cysts are uncommon but tend to present more often in women. Symptomatic Tarlov cysts can lead to a variety of neurologic symptoms and painful conditions, including chronic pelvic pain. There is no consensus regarding the best treatment for symptomatic cysts. Surgical management has high rates of complication, including chronic pain, but better long-term results for symptom and cyst resolution. We describe a patient who developed worsening pelvic pain and lumbar radiculopathy after surgical management of her Tarlov cysts. Medication failed to relieve the pain, as did a variety of other procedures, before the patient ultimately received significant pain relief from high-frequency spinal cord stimulation. This case may provide guidance for physicians when managing patients suffering from symptomatic Tarlov cysts, or worsening pain symptoms after surgical management of these cysts., (© 2020 Published by Elsevier B.V.)

Purpose of Review: Post dural puncture headache (PDPH) is a relatively common complication which may occur in the setting of inadvertent dural puncture (DP) during labor epidural analgesia and during intentional DP during spinal anesthetic placement or diagnostic lumbar puncture. Few publications have established the long-term safety of an epidural blood patch (EBP) for the treatment of a PDPH., Recent Findings: The aim of this pilot study was to examine the association of chronic low back pain (LBP) in patients who experienced a PDPH following labor analgesia and were treated with an EBP. A total of 146 patients were contacted and completed a survey questionnaire via telephone. The EBP group was found to be more likely to have chronic LBP (percentage difference 20% [95% CI 6-33%], RR 2.6 [95% CI 1.3-5.2]) and also LBP < 6 (percentage difference 24% [95% CI 9- 37%], RR 2.3 [95% CI 1.3-4.1]). There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Our findings suggest that PDPH treated with an EBP is associated with an increased prevalence of subsequent low back pain in parturients. The findings of this pilot study should spur further prospective research into identifying potential associations between DP, EBP, and chronic low back pain.

Objectives: The aim of this study was to determine if any of the factors recorded on a standard clinical history of a patient considered for spinal cord stimulation (SCS) would be associated with reduction or cessation of opioids following implantation., Design: Retrospective, single academic center., Methods: Patients included in the chart analysis underwent implantation of percutaneous SCS devices from 1999 to 2015 with follow-up until the end of September 2018. Patients who achieved at least an average of 50% pain reduction were included for analysis of daily opioid intake. Patients were then divided into 4 groups that included no opioid use, stable opioid daily dose, weaned opioid dose, and complete cessation of opioids. Statistical methods were used to analyze for associations between opioid intake after SCS insertion and usual elements of a clinical history, including adjuvant medications, numeric pain rating, past medical history, psychiatric illness, substance abuse, employment, and smoking history., Results: In a group of 261 patients who had undergone implantation, 214 met the criteria for analysis and had a median age of 50 years, with majority having the diagnoses of failed back surgery syndrome and complex regional pain syndrome. The only factor that was associated with complete cessation of opioid use was a median dose of 30 mg of morphine per day (P < 0.01) and was observed in 15% of subjects who used opioids preoperatively., Conclusion: The elimination of opioid dependence following initiation of SCS therapy is highly dependent on the daily dose., (© 2019 World Institute of Pain.)

Objectives: The aims of this study were to identify the reasons for explanation of spinal cord stimulator (SCS) devices and to further quantify the proportions and time lines of these causes of explantation in order to determine improvement opportunities for the development of best practices., Design: Retrospective, single academic center., Materials and Methods: Patients who were implanted with percutaneous SCS devices from 2002 to 2015 and with follow-up available until the end of September 2017 were included in this retrospective chart analysis., Results: Of the 356 patients trialed, 252 underwent implantation of an SCS device with a permanent to trial ratio of 71%. Of the patients who had a permanent implant, 50% had failed back surgery syndrome, 25% had complex regional pain syndrome, and 25% had other diagnoses. At the end of the study period, the explantation rate was 30%. The causes for explantation included biological complications (26.6%), paresthesia limitations or side effects (26.6%), hardware complications (13.3%), ineffective pain control (28%), and no further need for stimulation therapy (5.3%)., Conclusions: Device removal is not uncommon, and opportunities to enhance the long-term success of SCS devices do exist. These include modification of trialing methods, achieving better paresthesia overlay, using magnetic resonance imaging (MRI) conditional equipment, development of robust technologies and hardware to reduce equipment malfunction, and improving efficacy with new innovative wave forms., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Lead fracture is a well-known complication of cylindrical spinal cord stimulator leads. In order to reduce this complication, anchor design and techniques have been modified, but internal lead design has received little attention., Objectives: The goal of this study was to study the impact of lead design by a retrospective determination of the fracture rate of multilumen concentric (MLC) 8-contact leads., Study Design: Retrospective chart review., Setting: University teaching hospital., Methods: A registry of spinal cord stimulator implants and corresponding billing data were used to identify patients. Procedural details were reviewed for technique, lead insertion, anchoring details, manufacturer, and lead longevity from 2002 to 2014. Data storage was in RedCap data-capturing software (REDCap eData Collection web-based application). All analyses were performed using SAS 9.3 (SAS Institute, Cary, NC, U.S.A.)., Results: In a near 12"-year time period, 172 patients received 305 permanently implanted 8-contact leads, with an overall fracture rate of 4.3%. Of these, 191 leads were of the MLC design. No lead fracture was observed in the MLC leads over an average 4.5 years of follow-up., Limitation: Retrospective single center., Conclusion: MLC lead design has the potential to significantly mitigate lead fracture., (© 2018 World Institute of Pain.)

Objectives: A trial of spinal cord stimulation (SCS) is a prerequisite to determine efficacy of the therapy prior to placement of a permanent implanted system. A trial may be conducted employing a percutaneously placed temporary cylindrical lead or via a permanently anchored cylindrical lead placed and subsequently secured via open surgical method. There has been little investigation comparing the two methods of trial. This study is a comparative analysis of the two methods both for prediction of success as well as associated morbidity., Study Design: Retrospective chart review., Materials and Methods: SCS outcomes of percutaneous temporary lead trial or the temporary lead (TL) group and permanent anchored lead trial or permanent lead (PL) group were analyzed for lack of relief, poor paresthesia coverage, false positive trial phase, fading relief, and biological complications., Results: Outcome data was analyzed for 148 patients in the TL group and 138 patients in the PL group. In comparing the two trial methods, false positive rate of trial was higher (p < 0.05) in the PL group as compared to the TL group (6.35 vs. 1.35%). Cumulative wound infections (6.52 vs. 1.35%), and poor wound healing (4.35 vs. 0%) were also significantly higher in the PL group. Rate of success in the trial phase was equal in both groups., Conclusion: The percutaneous temporary lead trial group was associated with fewer false positives and wound related complications as compared to permanent anchored lead trial group. There was very little technical advantage of routinely anchoring the trial lead., (© 2017 International Neuromodulation Society.)

Competing Interests: Competing interests: None declared.

Objective: To describe and to analyze cervical epidural contrast patterns seen in antero-posterior (AP), contralateral oblique (CLO), and lateral view. To identify factors that might help in predicting contrast distribution pattern and extent., Method: Spread of contrast in the cervical epidural space was prospectively studied in AP, lateral, and three CLO views., Results: CLO view showed contrast spread of variable thickness with its posterior margin overlying the ventral interlaminar line (VILL). In the lateral view, the spread was also of variable thickness, but the posterior margin of the contrast lay on the spinolaminar line in only 10 of 24 patients. Ventral contrast spread was not visualized in any patient. In the AP view, bilateral spread was seen in 14 of 24 subjects, and nerve root spread was seen in 16 of 24 subjects. No association of the pattern of spread or dispersion was seen to patient age, volume injected, or needle location., Conclusions: The CLO view provides a consistent radiological landmark for the posterior margin of contrast in the dorsal epidural space; the lateral view fails to provide such a consistent landmark. The thickness of the spread is variable, both in the CLO and in the lateral view. Thick spread extending into the foramen in the CLO view and over the articular pillars in the lateral view is frequent and should not be misconstrued as subdural or intrathecal spread. In contradistinction to previous studies, true ventral spread was not seen in any patient. When using low volumes, contrast spread is independent of patient age, volume injected, or needle tip location in the AP view., (© 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Synovial cysts of the lumbar zygapophysial joints can be treated by percutaneous injection of corticosteroids, with distension and rupture of the cyst. Some cysts can be difficult to access, particularly when they lie deep in relation to the lamina. This technical report describes a fluoroscopy-guided technique for accessing sublaminar pathology. Crucial to the safety of the technique is visualization of the ventral margin of the lamina using a contralateral oblique view, and controlling and limiting the insertion of the needle such that only its tip passes the lamina., (© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Spinal cord stimulation (SCS) is rapidly expanding therapy for the treatment of refractory neuropathic pain. Although technical issues such as battery life and lead migration have been well studied and improved, little is known about the incidence and management of inadvertent dural puncture and consequent headache., Objectives: The goals of this article were to determine the incidence of postdural puncture headache (PDPH) per lead insertion at the various regions of the spine and to detail the use of conservative management and epidural blood patch (EBP). Long-term outcomes are reviewed to validate treatment modalities employed., Methods: Retrospective analysis of electronic medical records identified by patient implant registry and current procedural terminology data for nearly a 13-year time interval. Operative and postoperative notes were reviewed for details on dural puncture, access technique and spinal level, the development of a PDPH, and the treatment employed with particularly emphasis on the use of (EBP)., Results: A total of 745 leads inserted resulted in 6 PDPH that were refractory to conservative measures but responded to EBP without long-term complications. The overall incidence of PDPH per lead insertion was 0.81%. Leads placed anterograde in the thoracolumbar (T11-L3) and Cervicothoracic (C7-T5) regions resulted in an incidence of PDPH per lead of 0.63% and 1.1%, respectively, while 5.9% occurred with lumbar retrograde approach, and none with caudal., Conclusions: Dural puncture during SCS device placement and can result in a PDPH that is severe and refractory to conservative modes of therapy. Even in the presence of hardware, EBP performed with meticulous aseptic technique was found to be safe and efficacious., (© 2016 International Neuromodulation Society.)

Objective: The purpose of this study was to compare the reliability of the lateral fluoroscopic view and several contralateral oblique (CLO) views at different angles in visualizing and accurately predicting the position of the needle tip at the point of access in the posterior cervical and cervicothoracic epidural space., Design: After the epidural space was accessed but before confirmation with contrast fluoroscopy, we prospectively obtained fluoroscopic images at eight different angles. Subsequent contrast injection confirmed epidural spread. Needle tip visualization and location of needle relative to bony landmarks were analyzed., Results: The needle tip was clearly visualized in all CLO projections in all 24 subjects. CLO view at 50 degrees and at obliquity measured on magnetic resonance imaging (MRI) images provided the most consistent needle tip location. In these views, the epidural space was accessed at or just beyond the ventral laminar margin at the ventral interlaminar line or within the proximal half of the predefined CLO area in all patients. The needle tip was poorly visualized in the lateral view and the location of the needle tip was less well defined and independent of the needle location in the anteroposterior (AP) view., Conclusions: This study provides evidence that during cervical and cervicothoracic epidural access, the CLO view at 50 degrees and at MRI-measured obliquity is superior to the lateral view for the purpose of needle tip visualization and in providing a consistent landmark for accessing the epidural space. This article also introduces the concept of zones to describe needle position in the cervical and cervicothoracic spine in AP, lateral, and oblique views., (Wiley Periodicals, Inc.)

Questions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are the signs, symptoms, and diagnosis of complex regional pain syndrome/reflex sympathetic dystrophy.

Questions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patient sand make them more effective self-advocates. The topics addressed in this issue are the signs and symptoms of carpal tunnel syndrome and its treatment.

Background: Chronic hip pain is often a debilitating problem and many patients are not good surgical candidates. Furthermore, hip replacement surgery has significant associated risks. We offer a conservative approach to hip replacement using radiofrequency lesioning., Methods: This is a case series of 4 patients who had anterior and or medial hip pain who underwent percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves. All of the patients had significant co-morbidities and the risks out weighed the benefits of surgery. All the patients had diagnostic blocks with local anesthetic to the sensory articular branches of the obturator and femoral nerves and showed temporary benefit. Continuous radiofrequency lesioning was performed from 60 degrees C to 80 degrees C for 90 seconds. The outcome measures were improvement in visual analogue scale (VAS), improvement in function and the decreased use of pain medications., Results: All four patients had reduction in pain, while 3 of 4 patients had improved functioning. Two of the four patients had decreased use of their pain medication. One of the four patients reported numbness at the hip and there were no other side effects., Conclusion: Percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves appears to be a safe alternative to hip replacement, especially in those patients where surgery is not an option. Further studies are needed to confirm our results.

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.