Comparative Effectiveness of Parasagittal Interlaminar and Transforaminal Cervical Epidural Steroid Injection in Patients with Cervical Radicular Pain: A Randomized Clinical Trial

Background: Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy. Objectives: This clinical trial aimed to compare the effectiveness of the parasagittal IL and TF approaches for cervical ESI in patients who were suffering from cervical radicular pain. Study Design: A prospective randomized assessor-blind study. Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. Methods: This prospective randomized, assessor-blind trial included 80 patients with cervical radicular pain. We randomly assigned patients to the TF or parasagittal IL approach for cervical ESI. The effectiveness of the 2 groups was compared based on pain intensity using the Numeric Rating Scale (NRS-11) at 1 and 3 months. The Neck Disability Index (NDI), Medication Quantification Scale (MQS), and responders at 1 and 3 months between the 2 groups were compared. Results: The pain intensity of both groups significantly reduced after 1 and 3 months after each procedure (P < 0.001). Two-way repeated measures of analysis of variance showed no significant interaction between group and time for cervical radicular pain (P = 0.266), although NRS-1 1 pain score was lower in the TF group than the parasagittal IL group after 1 month (P = 0.010). NDI, MQS, and successful responders were not different between the 2 groups at 1 and 3 months after the procedure. We observed 7 cases (18.4%) of vascular visualization in the TF group, although no serious complications were found in either group. Limitations: This study had no placebo control group and limited follow-up time. Conclusions: Parasagittal IL ESI may be recommended over the TF ESI in reducing cervical radicular pain, considering both clinical effectiveness and safety

A Prospective Randomized Comparison of Postoperative Pain and Complications after Thyroidectomy under Different Anesthetic Techniques: Volatile Anesthesia versus Total Intravenous Anesthesia

While the postoperative outcome is favorable, post-thyroidectomy pain is considerable. Reducing the postoperative acute pain,therefore, is considered important. This study investigated whether the pain intensity and need for rescue analgesics during the immediate postoperative period after thyroidectomy differ according to the methods of anesthesia. Seventy-two patients undergoing total thyroidectomy under general anesthesia were examined. Patients were randomly assigned to undergo either total intravenous anesthesia with remifentanil and propofol (TIVA, n=35) or propofol induction and maintenance with desflurane and nitrous oxide (volatile anesthesia [VA], n=37). The mean administered dose of remifentanil was 1977.7 ± 722.5 μg in the TIVA group, which was approximately 0.268 ± 0.118 μg/min/kg during surgery. Pain scores based on a numeric rating scale (NRS)and the need for rescue analgesics were compared between groups at the postoperative anesthetic care unit (PACU). The immediate postoperative NRS values of the TIVA and VA groups were 5.7 ± 1.7 and 4.7 ± 2.3, respectively (P=0.034). Postoperative morphine equianalgesic doses in the PACU were higher in the TIVA group than in the VA group (16.7 ± 3.8 mg vs. 14.1 ± 5.9 mg, P=0.027). The incidence of immediate postanesthetic complications did not differ significantly between groups. In conclusion, more rescue analgesics were required in the TIVA group than in the VA group to adequately manage postoperative pain while staying in the PACU after thyroidectomy

Relationship of epidural patient-controlled analgesia with postoperative bleeding after unilateral total knee arthroplasty: a propensity score-matching analysis

Although epidural patient-controlled analgesia (PCA) to control postoperative pain after total knee arthroplasty (TKA), the relationship of epidural PCA with postoperative bleeding remains controversial. Therefore, we aimed to evaluate the effect of epidural and intravenous PCA on postoperative bleeding in patients undergoing unilateral TKA. Total of 2467 patients who underwent TKA were divided to intravenous PCA (n=2339) or epidural PCA (n=128) group. After 1:1 propensity score-matching, 212 patients were analyzed to assess the associations between the perioperative blood loss and epidural PCA between the groups. Mean postoperative blood loss was significantly greater in epidural PCA than in intravenous PCA (900.9 +/- 369.1 mL vs. 737.8 +/- 410.1 mL; P=0.007). The incidence of red blood cell (RBC) administration (>3 units) was significantly higher in epidural PCA than in intravenous PCA (30.2% vs. 16.0%; OR 2.5; 95% CI 1.201-5.205; P=0.014). Epidural PCA may be strongly related to postoperative bleeding and the incidence of RBC transfusion of more than 3 units after unilateral TKA, as compared to intravenous PCA. Therefore, the use of epidural PCA may be carefully considered for postoperative pain management in TKA

Recognition of Degree of Rehabilitation for Walking Movement Using Noncontact Doppler Radar Sensor

본논문에서는도플러레이다기반보행환자의실시간재활정도인식알고리즘을제안한다. 먼저, 보행하는사람의복소수신신호1차원위상성분에이동평균필터및미분연산을적용하여몸전체거동에따른1차원시계열거동속도정보를추정한다. 다음으로복소수신신호2차원스펙트로그램에기존도플러주파수궤적추출기법및칼만필터를적용하여1차원시계열속도정보를추정한후, 1차원시계열거동속도정보를빼줌으로써양다리미세움직임에따른1차원 시계열미세속도정보를추정한다. 추정된정보의극대값은각다리보행움직임에따라반복적으로나타나기에, 극값에대한보폭시간및최대속도정보를각다리별로분리하여추출한다. 최종적으로추출된각다리별정보들을활용하여실시간재활정도를나타내는새로운물리량을정의한다. 도플러레이다를활용한실험결과, 제안된기법을통해 정상적인 보행과비정상적인 보행간의실시간인식이가능함을확인할수있었다.22Nkc

HIV-1 protease has a gentic T-cell Adjuvant effect which is negatively regulated by proteolytic activity

2