Background There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.Methods Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (>= 75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.Results This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.Conclusions In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.
BACKGROUND:Accessible, accurate screening tests are necessary to advance tuberculosis case finding and early detection in high-burden countries. METHODS:We prospectively screened adults with ≥2 weeks of cough at primary health centers in the Philippines, Vietnam, South Africa, Uganda, and India. Participants underwent chest radiography, Cepheid Xpert TB Host Response (Xpert HR) testing, and point-of-care C-reactive protein (CRP) testing (Boditech). Chest radiographs were processed using CAD4TB v7, a computer-aided detection (CAD) algorithm. We assessed diagnostic accuracy against a microbiologic reference standard (sputum Xpert Ultra, culture). Optimal cutoff points were chosen to maximize specificity at 90% sensitivity. Two-test screening algorithms were considered, using (1) sequential negative serial screening (with positive defined as positive on either test) and (2) sequential positive serial screening (with positive defined as positive on both tests). RESULTS:Between July 2021 and August 2022, a total of 1392 participants with presumptive tuberculosis had valid index tests and reference standard results, and 303 (22%) had confirmed tuberculosis. In head-to-head comparisons, CAD4TB v7 showed the highest specificity at 90% sensitivity (70.3% vs 65.1% for Xpert HR [95% confidence interval for absolute difference in specificity, 1.6%-8.9%] and vs 49.7% for CRP [17.0%-24.3%]). Three 2-test screening algorithms met World Health Organization target product profile minimum accuracy thresholds and had higher accuracy than any test alone. At 90% sensitivity, the specificity was 79.6% for Xpert HR-CAD4TB (sequential negative), 75.9% for CRP-CAD4TB (sequential negative), and 73.7% for Xpert HR-CAD4TB (sequential positive). CONCLUSIONS:CAD4TB achieves target product profile targets and outperforms Xpert HR and CRP. Combining screening tests further increased accuracy. Clinical Trials Registration. NCT04923958.
We define a natural extension of pluriclosed flow aiming at constructing solutions of the Hull-Strominger system. We give several geometric formulations of this flow, which yield a series of a priori estimates for the flow and also for the Hull-Strominger system. The evolution equations are derived using the theory of string algebroids, a class of Courant algebroids which occur naturally in higher gauge theory. Using this, we interpret the flow as generalized Ricci flow and also as a higher/coupled version of Hermitian-Yang-Mills flow, proving furthermore that it is compatible with symmetry reduction. Regarding analytical results, we prove a priori C infinity estimates for uniformly parabolic solutions. This in particular settles the question of smooth regularity of uniformly elliptic solutions of the Hull-Strominger system, generalizing Yau's C3 estimate for the complex Monge-Amp & egrave;re equation. We prove global existence and convergence results for the flow on special backgrounds, and discuss a conjectural relationship of the flow to the geometrization of Reid's fantasy. (c) 2025 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
A recent discovery of Eldan and Gross states that there exists a universal C > 0 such that for all Boolean functions f: {-1,1}(n) -> {-1,1}, integral({-1,1}n) root s(f)(x)d mu(x) >= CVar(f) root log(1 + 1/Sigma(n)(j=1)Inf(j)(f)(2)) where s(f)(x) is the sensitivity of f at x, Var(f) is the variance of f, Inf(j)(f) is the influence of f along the j-th variable, and mu is the uniform probability measure. In this note, we give an alternative proof that applies to biased discrete hypercube, and spaces having positive Ricci curvature lower bounds in the sense of Bakry and Emery. (c) 2025 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
For 0 < p < infinity and alpha > - 1 let A(alpha)(p) (D-2) denote the weighted Bergman space over the unit D-2 in C-2. Given a holomorphic self-map Phi of D-2, we investigate the jump phenomenon of the composition operator Co acting from A(alpha)(p)(D-2)to A(beta)(p)(D-2). A theorem of Stessin and Zhu ([18]) establishes that C-Phi: A(alpha)(p)(D-2)-> A(2 alpha+2)(p)(D-2) is always bounded. Additionally, it is known ([9]) that C-Phi:A(alpha)(p)(D-2)negated right arrow A(alpha+1/4-epsilon)(p)(D-2) for any epsilon>0 if C-Phi:A(alpha)(p)(D-2)negated right arrow A(alpha)(p)(D-2)and Phi is an element of C-1 (D-2). We show that there is a jump phenomenon at the upper end as well, providing a complete analysis of both lower and upper jumps in the weight. We prove that there is a minimal jump of size alpha + 3/2 at the upper end, i.e.,C-Phi:A(alpha)(p)(D-2)negated right arrow A(2 alpha+2-)(p)epsilon(D-2) for any epsilon>0 if C-Phi:A(alpha)(p)(D-2)negated right arrow A(alpha+1/2)(p)(D-2) and Phi is an element of C-1 (D-2). Furthermore, we provide a complete characterization of when C-Phi:A(alpha)(p)(D-2)-> A(alpha+1/4)(p)(D-2) is bounded for Phi is an element of C-2 (D-2) and when C-Phi:A(alpha)(p)(D-2)-> A(alpha+1/2)(p)(D-2) is bounded for Phi is an element of C-1 (D-2) (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, Al training, and similar technologies.
