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We described two cases and the techniques for using the ultrasound (US) to guide lumbar intradiscal injection with platelet-rich plasma (PRP). The two cases suffered from chronic low back pain. Magnetic resonance imaging revealed posterior annular tear of the L5/S1 intervertebral disc (IVD) in the first case and L4/5 and L5/S1 IVDs in the second case. For the US-guided lumbar intradiscal injection, the patient was placed in a prone position. By placing the transducer in the axial plane at the interlaminar space, the needle was directed toward the center of the aimed IVD. The needle tip was ensured inside the IVD by using the end-feel of sudden reduction of resistance and the poking technique with the transducer oriented in the paramedian sagittal oblique plane. At the follow-up, both patients had significant improvement after the intradiscal PRP injections (visual analogue scale from 7.5 to 1.5 on average). The report indicated US-guided lumbar intradiscal PRP injection to be a feasible approach for treatments of low back pain. Familiarization of the anatomy and sonoanatomy of the lumbar spine is fundamental to achieve the success of intradiscal injection.

Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves the injection of an anesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue, fascia, or adjacent structures. Animal models suggest the potential for minimal compression to initiate and perpetuate neuropathic pain. Mechanical benefits of HD may relate to release of nervi nervorum or vasa nervorum compression. Pathologic nerves can be identified by examination or ultrasound visualization. The in-plane technique is the predominant and safest method for nerve HD. Five percent dextrose may be favored as the preferred injectate based on preliminary comparative-injectate literature, but additional research is critical. Literature-based hypotheses for a direct ameliorative effect of dextrose HD on neuropathic pain are presented., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/6KDpw2cYH9o

This chapter presents a model that helps Information systems (IS) and project managers assess and ultimately narrow the gaps between customer needs and project outcomes. In many IS organizations, the primary measure of project success lies in meeting some combination of project specifications, a project deadline, and a project budget. To ensure success, IS and project managers should link project planning to control actions that relate customer goals to end results. IS and project managers must envision and apply a model that translates customer requirements into a specific sequence of management actions. The project team understands the importance of remote sales and marketing access to the data base as a desired feature in the order management system. The order management system, the project team is unable to execute what is an adequate plan because it lacks expertise in database design or the requisite hardware cannot be supplied in a timely manner by the customer or a vendor.

Objective Ultrasonography has been used to measure the cross-sectional area (CSA) of peripheral nerves, but the CSA of the brachial plexus has not previously been reported. The purpose of this study was to establish a reference range of values for the CSA of the brachial plexus, subclavian artery, and peak systolic velocity (PSV) of the subclavian artery in healthy subjects using ultrasonography. Methods Thirty-two asymptomatic subjects (19 men, 13 women) from a chiropractic college with an average age of 29.5 ± 9.6 participated in the study. The brachial plexus and subclavian artery CSA were measured at 3 locations: interscalene, first rib, and infraclavicular. The PSV of the subclavian artery was measured in both supraclavicular and infraclavicular locations. Each subject was imaged bilaterally. Means and 95% confidence intervals were calculated. Interexaminer reliability was evaluated between 2 examiners on 15 randomly selected subjects. Results The average CSA for the brachial plexus at the interscalene space, first rib, and infraclavicular location was 0.75 ± 0.05, 0.96 ± 0.07, and 0.98 ± 0.07 cm 2 , respectively. The average CSA for the subclavian artery at the same locations was 0.35 ± 0.03, 0.38 ± 0.03, 0.35 ± 0.03 cm 2 , respectively. The average subclavian artery PSV in supraclavicular and infraclavicular locations was 98 ± 8 and 93 ± 7 cm/s, respectively. The overall interexaminer reliability was poor at 0.39 (0.20-0.55). Conclusions This is the first study to obtain normative CSA measurements of the brachial plexus and subclavian artery in multiple locations of the thoracic outlet as well as interexaminer reliability data. These data may be beneficial in future studies designed to assess the brachial plexus and subclavian artery in patients with thoracic outlet syndrome.

Background Dextrose injection is reported to improve knee osteoarthritis (KOA)−related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. Objective To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA. Design Case series with blinded arthroscopic evaluation before and after treatment. Setting Physical medicine and day surgery practice. Participants Symptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection. Intervention Four to 6 monthly 10-mL intra-articular injections with 12.5% dextrose. Main Outcome Measures Visual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by 3 arthroscopy readers masked to pre-/postinjection status (total 54 zones evaluated per reader); biopsy of a cartilage growth area posttreatment, evaluated using hematoxylin and eosin and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points). Results Six participants (1 female and 5 male) with median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain duration received a median of 6 dextrose injections and follow-up arthroscopy at 7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers agreed that the posttreatment zone showed cartilage growth compared with the pretreatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points ( P = .013). Self-limited soreness after methylene blue instillation was noted. Conclusions Positive clinical and chondrogenic effects were seen after prolotherapy with hypertonic dextrose injection in participants with symptomatic grade IV KOA, suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data. Level of Evidence IV

Effective project management involves not only meeting schedules, budgets, and specifications, but also the strategic issue of whether project outcomes meet customer needs. The extent to which they do not is most often the result of one or more performance gaps in project planning and execution. This article presents a model that helps IS managers assess and narrow these gaps and foster a continuous cycle of improvement typical of learning organizations.

Objective This study sought to use high-resolution ultrasound to measure changes in plantar fascia thickness as a result of tissue creep generated by walking and running. Methods Independent samples of participants were obtained. Thirty-six walkers and 25 runners walked on a treadmill for 10 minutes or ran for 30 minutes, respectively. Standardized measures of the thickness of the plantar fascia were obtained in both groups using high-resolution ultrasound. Results The mean thickness of the plantar fascia was measured immediately before and after participation. The mean plantar fascia thickness was decreased by 0.06 ± 0.33 mm SD after running and 0.03 ± 0.22 mm SD after walking. The difference between groups was not significant. Conclusion Although the parameters of this study did not produce significant changes in the plantar fascia thickness, a slightly higher change in the mean thickness of the plantar fascia in the running group deserves further investigation.

Background Western corn rootworm (WCR) is one of the most significant insect pests of maize in North America. WCR has dramatically increased its range in the last century, invading key maize production areas in the US and abroad. In addition, this species has a history of evolving traits that allow it to escape various control options. Improved genetic and genomic resources are crucial tools for understanding population history and the genetic basis of trait evolution. Here we produce and analyze a transcriptome assembly for WCR. We also perform whole genome population resequencing, and combine these resources to better understand the evolutionary history of WCR. Results The WCR transcriptome assembly presented here contains approximately 16,000 unigenes, many of which have high similarity to other insect species. Among these unigenes we found several gene families that have been implicated in insecticide resistance in other species. We also identified over 500,000 unigene based SNPs among 26 WCR populations. We used these SNPs to scan for outliers among the candidate genes, and to understand how population processes have shaped genetic variation in this species. Conclusions This study highlights the utility of transcriptomic and genomic resources as foundational tools for dealing with highly adaptive pest species. Using these tools we identified candidate gene families for insecticide resistance and reveal aspects of WCR population history in light of the species’ recent range expansion. Electronic supplementary material The online version of this article (doi:10.1186/1471-2164-15-195) contains supplementary material, which is available to authorized users.

Background. To use sonography to measure the cross-sectional area (CSA) of the greater occipital nerve (GON) and the adjacent obliquus capi- tis inferior muscle (OCI) in normal subjects. Methods. Data from 30 asymptomatic subjects between the ages of 22 and 35 were collected. CSA and circumference of the GON and CSA of OCI were measured using sonography. Interexaminer reliability analysis was performed using the intraclass correla- tion coefficient. Results. The CSA of the GON and OCI were 2 mm 2 6 1m m 2 and 1.86 cm 2 6 0.51 cm 2 , respectively. The average circumference of the GON was 4.8 mm 6 1.3 mm. The interexaminer reliability of the measure- ments was excellent with intraclass correlation coeffi- cient coefficients of 0.91, 0.84, and 0.73 for the GON CSA, GON circumference, and OCI CSA, respectively. Conclusion. We report the normal values of the CSA of the GON and OCI. Knowledge of these normal values may facilitate the diagnosis of GON entrap- ment and provide outcome measures in therapeutic interventions. V

Objective(s): To assess biological and clinical effects of intra-articular hypertonic dextrose injections in painful severe knee osteoarthritis (KOA). Hypertonic dextrose injection is reported to improve KOA-related pain, stiffness and function, but its effect on articular cartilage is unknown. Design: Open label pilot study. Setting: Outpatient pain medicine and day surgery practice. Participants: Adults with knee pain for at least 6 months, arthroscopyconfirmed medial compartment Outerbridge IV KOA, and temporary pain relief with intra-articular lidocaine injection. Interventions: 6 monthly 10 mL intra-articular injections with 12.5% dextrose. Main Outcome Measure(s): Assessed at baseline and 7.5 2.0 (range 4.59.5) months: Video arthroscopy of 9 standardized medial condyle zones was performed before and after treatment; semi-quantitative visual cartilage growth assessment of each zone (+1.0,-1) was performed by 3 surgeon-reviewers. Biopsies of cartilage growth-area was obtained posttreatment and evaluated using HE Fleiss kappa Z0.901).Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibroand hyaline-like cartilage. Compared with baseline status, participants reported improved WOMAC scores (17.6 4.7 points; pZ.013). Self-limited soreness after methylene-blue instillation was noted. Conclusions: Positive clinical and chondrogenic effects were seen after hypertonic dextrose injection in symptomatic grade IV KOA suggesting disease-modifying effects and the need for confirmation in controlled studies.

Noradrenergic function may be altered in depressive illness and thereby contribute to decreased pineal production of melatonin levels, as previously described in some depressed subjects. In the present study, the hypothesis was tested that pineal beta-adrenergic binding would be increased in persons committing suicide with evidence of depressive disorders, reflecting diminished noradrenergic input. Initially, post-mortem human pineal glands were obtained at autopsy. Diagnostic and symptomatic information was then systematically collected from family members using standardized interview techniques. Seven subjects who committed suicide and suffered from major depression, and without exposure to treatment for depressive symptoms were age- and sex-matched with control subjects. Pineal beta-adrenergic binding was assessed by quantitative autoradiography employing four concentrations of [125I]pindolol. Because of possibly complex adrenergic regulation of the pineal, beta-adrenergic receptor binding were subtyped using the selective blocker ICI 89406. No differences in beta-adrenergic receptors were detected between subjects with major depression compared to the matched controls.

Objective : This study tested the hypothesis that cocaine depletes dopamine levels in the brain. Method : Levels of dopamine, serotonin, and their metabolites in the frontal cortex and striatum of nine cocaine users and nine matched control subjects who had never used cocaine were determined from postmortem autopsy material. Results : The cocaine users had significantly lower dopamine levels and higher serotonin levels in the frontal cortex than the control subjects. Levels in other brain areas did not differ between the two groups. Conclusions: Alterations of dopamine and serotonin levels might contribute to symptoms of cocaine withdrawal and craving.

Animal studies suggest that chronic cocaine exposure may increase the function and/or synthesis of the dopamine transporter (DAT) under certain conditions, but the literature is complex. In order to test the hypothesis that cocaine exposure alters the DAT in humans, preliminary studies were done characterizing [3H]WIN 35428 binding in human striatum from normal controls. Following these experiments, the effects of chronic cocaine were examined in post mortem striatal specimens from 7 cocaine users and 7 controls matched for age and post mortem interval, employing quantitative autoradiography. Initial saturation experiments indicated that a one-site model was preferred with a Kd of 11 +/- 4 nM. [3H]WIN 35420 binding was then examined in cocaine users and controls at 0.5, 5, 10, and 50 nM radioligand concentrations. At each concentration of [3H]WIN 35420, optical densities for cocaine-exposed subjects were increased in caudate, putamen, and accumbens. The results suggest that total numbers of binding sites were increased in cocaine users. Based on the present and previous results, it appears that the regulation of the DAT is fairly plastic, and is highly sensitive to cocaine dosing regimes and withdrawal intervals. Chronic adaptations induced by cocaine in the DAT could contribute to the symptoms of binging, withdrawal depression, and/or craving.

Beta-adrenergic binding in frontal cortex samples from suicide victims has been reported to be increased, unaltered, and decreased compared to matched controls. Subject's diagnoses and drug exposures in these studies were not equivalently documented and were possibly different. In the present study, diagnostic and symptomatic information was systematically collected from family members of 15 subjects committing suicide and 15 matched controls using standardized interview techniques. The goal was to test the hypothesis that alterations in beta-adrenergic binding were more likely to be found in subjects with evidence of depressive disorders. [125I]pindolol binding in frontal cortex was found to be significantly lower in the group committing suicide compared to the matched controls (21.1 +/- 1.1 fmol/mg protein vs. 24.8 +/- 0.8 fmol/mg protein, p.02). However, no diagnostic subgroup among the suicide victims appeared distinct.

Amino acids have markedly different taste properties depending upon their chirality and the structure of their side chains. They can modify the taste quality of foods in which they are found naturally or to which they are added depending on their concentrations. In this study, the influence of chirality of amino acids on the growth in perceived taste intensity with concentration was examined. Serial dilutions of 19 D-amino acids were presented to young subjects who indicated the relative intensities of the dilutions using the magnitude estimation procedure. The slopes of the psychophysical functions for 13 of the 19 D-amino acids which related log concentration and log perceived intensity were greater than the slopes for L-amino acids that have been reported in a previous study. The ratio (average slope D-amino acids)/(average slope L-amino acids) was found to be 1.21. The ratio of the slopes for individual enantiomers bears some relationship to taste quality. No conclusive relationships between the slopes of the psychophysical functions were found with chemical structure or thresholds, however. Implications for receptor mechanisms and nutrition are discussed.

Serial dilutions of twenty-three amino acids were presented to young and elderly subjects who rated the relative intensities of the dilutions using the magnitude estimation procedure. In each case the slope of the psychophysical function relating concentration and perceived intensity was flatter for the elderly subjects: the mean ratio (slope (young)/slope (elderly)) was 2.55. This result could be due to an age-related decline in gustatory apparatus or associated central areas as well as memory loss and decline in performance often found in the elderly. No conclusive relationships between the slopes of the psychophysical functions were found with chemical structure, taste quality, or solubility.

Seventeen sweeteners varying widely in chemical structure were arranged in a three-dimensional space by two multidimensional scaling procedures, INDSCAL and ALSCAL. Fructose, glucose, sorbose, xylitol and xylose tended to fall near one another. Two sweeteners with a syrupy component, maltose and sorbitol, fell further away. Ca cyclamate and the dipeptide aspartame were the two artificial sweeteners which fell closest to and thus tasted most like the sugars. The proteins monellin and thaumatin, as well as the chalcone glycoside, neohesperidin dihydrochalcone, all have long aftertastes and thus tended to fall proximate to one another. Stimuli with the highest metallic and bitter ratings (acetosulfam, sodium saccharin, rebaudioside and stevioside) tended to fall near one another with the amino acid d-tryptophan located a little farther away. Adjective scales were related to the spatial arrangement. Wide variability in the patterns of intensity ratings over subjects suggests that the sweet taste may be mediated by several peripheral receptor mechanisms.

Taste detection thresholds for 11 sweeteners varying widely in chemical structure were determined for young and elderly subjects. The rank orders of the thresholds for young and elderly were highly correlated (Spearman's rho=0.976) although the thresholds were 2.72 times higher on the average for the elderly when compared with the young. This decreased sensitivity was statistically highly significant, p=0.000266. Sweeteners with the lowest detection thresholds tended to have the greatest number of units (AH-B systems) capable of intermolecular hydrogen bonding. In addition, use of the method of magnitude estimation with 10 sweeteners revealed that the elderly perceived less growth in intensity with increasing concentration than young subjects. The slopes of the psychophysical functions relating concentration and perceived intensity were flatter in all cases for elderly subjects; the mean ratio, slope(young)/slope(elderly), was 2.06. The largest relative decline in slope was found for those stimuli with the greatest number of possible AH-B types, suggesting that the possibilities for concerted intermolecular hydrogen bonding may decline with age. If the elderly compensate for their diminished taste acuity with increased consumption, they may constitute a population with higher than average risk of any adverse dose-related biological effects of artificial sweeteners.

Background There is no universally accepted imaging method to diagnose scapholunate ligament (SLL) tears. Our aim was to use sonography to evaluate the reliability of SLL length at baseline compared with a standardized dynamometer maneuver in healthy normals. Materials and methods Sonographic exams from 31 consented asymptomatic patients between 18 years and 45 years of age were collected on a total of 60 wrists. The length of the SLL was measured superficially and at a depth of 3.0 mm during static and dynamic squeeze maneuver. Inter- and intraexaminer reliability was performed using the intraclass correlation coefficient (ICC). Results The superficial ligament length measured 0.60 cm ± 0.11 cm with a deep measurement of 0.20 cm ± 0.06 cm. Dynamic evaluation revealed superficial and deep measurements at 0.62 ± 0.12 cm and 0.20 ± 0.06 cm, respectively. There was no significant difference between the SLL length at rest and during the squeeze test. The interexaminer and intraexaminer reliability was rated at fair to very good. Conclusion The evaluation of the dorsal SLL by sonographic squeeze test is reliable. Future studies will apply this method to suspected SLL tears.

Although not all applications of simulation are successful, simulation's failures are due more to its misuse than to its own intrinsic faults as a methodology. Too often simulation's function as a management tool is understood to be both predictive and analytical, whereas the two are separate problems and should be treated as such.

Excerpt As yet, there have been no reports of the occurrence of agranulocytosis resulting from the use of penicillin. As a matter of fact, penicillin is one of the most frequently used therapeutic ...