Objective To evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbosacral radiculopathy.Design A multicenter randomized study conducted between 2011 and 2014. ...Computer generated randomization was stratified by site. Patients and evaluating physicians were blinded to treatment outcomes.Settings Eight military, Veterans Administration, and civilian hospitals.Participants 145 people with lumbosacral radicular pain secondary to herniated disc or spinal stenosis for less than four years in duration and in whom leg pain is as severe or more severe than back pain.Interventions Participants received either epidural steroid injection plus placebo pills or sham injection plus gabapentin.Main outcome measures Average leg pain one and three months after the injection on a 0-10 numerical rating scale. A positive outcome was defined as a ≥2 point decrease in leg pain coupled with a positive global perceived effect. All patients had one month follow-up visits; patients whose condition improved remained blinded for their three month visit.Results There were no significant differences for the primary outcome measure at one month (mean pain score 3.3 (SD 2.6) and mean change from baseline −2.2 (SD 2.4) in epidural steroid injection group versus 3.7 (SD 2.6) and −1.7 (SD 2.6) in gabapentin group; adjusted difference 0.4, 95% confidence interval −0.3 to 1.2; P=0.25) and three months (mean pain score 3.4 (SD 2.7) and mean change from baseline −2.0 (SD 2.6) versus 3.7 (SD 2.8) and −1.6 (SD 2.7), respectively; adjusted difference 0.3, −0.5 to 1.2; P=0.43). Among secondary outcomes, one month after treatment those who received epidural steroid injection had greater reductions in worst leg pain (−3.0, SD 2.8) than those treated with gabapentin (−2.0, SD 2.9; P=0.04) and were more likely to experience a positive successful outcome (66% v 46%; number needed to treat=5.0, 95% confidence interval 2.8 to 27.0; P=0.02). At three months, there were no significant differences between treatments.Conclusions Although epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.Trial registration ClinicalTrials.gov Identifier: NCT01495923.
Despite a longstanding recognition that radiological protection is not only
a matter of science, but also ethics, ICRP publications have rarely addressed the
ethical foundations of the system of ...radiological protection explicitly. The purpose
of this publication is to describe how the Commission has relied on ethical values,
either intentionally or indirectly, in developing the system of radiological protection
with the objective of presenting a coherent view of how ethics is part of this system.
In so doing, it helps to clarify the inherent value judgements made in achieving the
aim of the radiological protection system as underlined by the Commission in
Publication 103. Although primarily addressed to the radiological protection community,
this publication is also intended to address authorities, operators, workers,
medical professionals, patients, the public, and its representatives (e.g. NGOs) acting
in the interest of the protection of people and the environment. This publication
provides the key steps concerning the scientific, ethical, and practical evolutions of
the system of radiological protection since the first ICRP publication in 1928. It then
describes the four core ethical values underpinning the present system: beneficence/
non-maleficence, prudence, justice, and dignity. It also discusses how these core
ethical values relate to the principles of radiological protection, namely justification,
optimisation, and limitation. The publication finally addresses key procedural values
that are required for the practical implementation of the system, focusing on
accountability, transparency, and inclusiveness. The Commission sees this publication
as a founding document to be elaborated further in different situations and
circumstances.
Summary
Numerous reports have shown that a diet containing large amounts of trans fatty acids (TFAs) is a major risk factor for metabolic disorders. Although recent studies have shown that TFAs ...promote intestinal inflammation, the underlying mechanisms are unknown. In this study, we examined the effects of dietary fat containing TFAs on dextran sodium sulphate (DSS)‐induced colitis. C57 BL/6 mice were fed a diet containing 1·3% TFAs (mainly C16:1, C18:1, C18:2, C20:1, C20:2 and C22:1), and then colitis was induced with 1·5% DSS. Colonic damage was assessed, and the mRNA levels of proinflammatory cytokines and major regulators of T cell differentiation were measured. The TFA diet reduced survival and exacerbated histological damage in mice administered DSS compared with those fed a TFA‐free diet. The TFA diet significantly elevated interleukin (IL)‐6, IL‐12p40, IL‐23p19 and retinoic acid‐related orphan receptor (ROR)γt mRNA levels in the colons of DSS‐treated animals. Moreover, IL‐17A mRNA levels were elevated significantly by the TFA diet, with or without DSS treatment. We also examined the expression of proinflammatory cytokines in lipopolysaccharide (LPS)‐stimulated RAW264.7 cells and peritoneal macrophages. These cells were exposed to TFAs (linoelaidic acid or elaidic acid) with or without LPS and the mRNA levels of various cytokines were measured. IL‐23p19 mRNA levels were increased significantly by TFAs in the absence of LPS. Cytokine expression was also higher in LPS‐stimulated cells exposed to TFAs than in unexposed LPS‐stimulated cells. Collectively, our results suggest that TFAs exacerbate colonic inflammation by promoting Th17 polarization and by up‐regulating the expression of proinflammatory cytokines in the inflamed colonic mucosa.
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