47,695 results match your criteria Epidural Steroid Injections
World Neurosurg 2018 Dec 3. Epub 2018 Dec 3.
Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Via Santa Sofia 86, 95123 - Catania, Italy.
Background: Arachnoiditis ossificans (AO) is a rare condition often associated with previous spine surgery. Here we describe a unique case of a patient affected by ankylosing spondylitis (AS), presenting with progressive neurological deterioration due to AO. We also review the literature on evaluation and management of patients suffering from AO. Read More
J Ultrasound 2018 Dec 5. Epub 2018 Dec 5.
Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye 7 dong 761-7, Nowon-gu, 139-707, Seoul, South Korea.
Purpose: Recent studies have compared the therapeutic efficacy and safety of the procedure using ultrasound and fluoroscopy. However, there are no published studies comparing the therapeutic efficacy and safety of fluoroscopy (FL)-guided cervical interlaminar epidural steroid injection (CIESI) with that of ultrasound (US)-guided selective nerve root block (SNRB). This study aimed to compare the mid-term effects and advantages of US-guided SNRB with FL-guided CIESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. Read More
Int J Colorectal Dis 2018 Dec 5. Epub 2018 Dec 5.
Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
Purpose: A meta-analysis of RCTs was designed to provide an up-to-date comparison of thoracic epidural analgesia (TEA) and patient-controlled analgesia (PCA) in laparoscopic colectomy.
Methods: Our study was completed following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature screening was performed in MEDLINE and Web of Science. Read More
J Pain Res 2018 8;11:2791-2796. Epub 2018 Nov 8.
Institute of Clinical Research, Jiaxing university, Jiaxing, China,
Background: It was reported that epidural volume extension could decrease the ED of intrathecal plain bupivacaine. In this study, we investigated the ED of intrathecal hyperbaric ropivacaine followed by epidural normal saline bolus for cesarean section.
Methods: Sixty parturients were allocated into two groups in this prospective study. Read More
Ginekol Pol 2018 ;89(11):627-636
Department of Nursing, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Nursing, Haining Maternal and Child Health Care Hospital, Haining, China.
Objectives: The purpose of this study was to investigate the effects of pain relief during labor on the occurrence of potential postpartum depression in early postpartum among Chinese women.
Material And Methods: A quasi-experimental study used, with a convenience sample of 565 women who delivered at the Women's Hospital, School of Medicine. Three types of pain relief were administered based on the women's preference (doula, n = 301; transcutaneous electrical nerve stimulation, n = 51; epidural analgesia, n = 213). Read More
Interact Cardiovasc Thorac Surg 2018 Dec 1. Epub 2018 Dec 1.
Section of Biostatistics, Tor Vergata University, Rome, Italy.
Objectives: Nonintubated surgical biopsy (NISB) of interstitial lung disease (ILD) has shown promise in unicentre reports as a reliable method to achieve pathological diagnosis with low morbidity. The aim of this study was to investigate for the first time early outcomes of NISB of ILD using a multicentre retrospective analysis.
Methods: Seven European and extra-European institutions participated in the study. Read More
Spine (Phila Pa 1976) 2018 Dec;43(24):E1454-E1462
Aster MIMS Hospital, Calicut, Kerala, India.
Study Design: A retrospective case series.
Objective: The aim of this study was to report the immunosuppression and secondary bacterial infection after dengue viral infection and the predilection of these infections in the spine. This can trigger further research in to this fact. Read More
Pain Manag 2018 Dec 3. Epub 2018 Dec 3.
Vice Chair for Research & Education, Department of Anesthesiology & Pain Management, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.
Degeneration, whether from age or postsurgical, in the ventral and lateral epidural space can lead to irritation of both the nerve roots and of the nerves present in the epidural space, the peridural membrane and the posterior longitudinal ligament. This irritation is often accompanied by mild scarring. Neuroplasty is a specific procedure designed to relieve this irritation. Read More
J Clin Monit Comput 2018 Nov 30. Epub 2018 Nov 30.
Department of Anesthesia and Surgical Critical Care, Hospital Universitario Rio Hortega (HURH), C/Dulzaina 2, 47012, Valladolid, Spain.
Epidural maintenance technique for labour analgesia updates constantly. Thanks to infusion pumps, the recently developed programmed intermittent epidural bolus (PIEB) may reduce the use of anesthetic drugs and minimize unintended consequences such as cardio or neurotoxicity. Nevertheless, it is not yet a general practice. Read More
Neurol India 2018 Nov-Dec;66(6):1842-1843
Department of Radiology, Military Hospital of Tunis, Montfleury, Tunisia.
Anticancer Res 2018 Dec;38(12):6841-6846
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A.
Background/aim: Prognoses of patients with metastatic epidural spinal cord compression (MESCC) from urothelial carcinoma of the bladder are generally poor. This study aimed to identify prognostic factors that can facilitate personalized care of these patients.
Patients And Methods: In 46 patients, 10 factors were evaluated for overall response (OR), post-radiotherapy (RT) ambulatory status, local control of MESCC and overall survival (OS). Read More
Vet J 2018 Dec 11;242:24-32. Epub 2018 Sep 11.
Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610 USA. Electronic address:
Epidural anesthesia is a commonly performed technique in both human and veterinary medicine. The technique is relatively simple following appropriate training and provides anesthesia and analgesia for acute and chronic pain. Several drug combinations have been administered by this route with variable success and duration. Read More
PM R 2018 Nov;10(11):1271-1278
Department of Rehabilitation Medicine, Center for Comprehensive Spine Care, Weill Cornell Medicine, 525 E 68th Street, 16th Floor, New York, NY 10065(‖). Electronic address:
Acta Cir Bras 2018 Nov;33(11):975-982
MD, Holy House of Mercy of Fortaleza, Professional Master's Degree Program in Minimally Invasive Technology and Simulation in Health, UNICHRISTUS, Fortaleza-CE, Brazil. Conception and design of the study, interpretation and analysis of data, critical revision, final approval.
Purpose: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE).
Methods: Experimental cross - sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. Read More
Surg Laparosc Endosc Percutan Tech 2018 Dec 3. Epub 2018 Dec 3.
Departments of Gastroenterological Surgery.
Purpose: Epidural analgesia (EDA) is an imperative modality for postoperative pain relief after major open abdominal surgery. However, whether EDA has benefits in laparoscopic surgery has not been clear. In this study, the effects of EDA and patient-controlled intravenous analgesia (PCIA) after laparoscopic distal gastrectomy (LDG) were compared. Read More
Clin Nucl Med 2018 Dec 3. Epub 2018 Dec 3.
From the Department of Nuclear Medicine, West China Hospital of Sichuan University, Sichuan, People's Republic of China.
Spinal angiolipomas are benign tumors predominantly found in the epidural space. Infiltrating spinal angiolipoma is an extremely rare type, which tends to invade the surrounding tissue and may mimic an aggressive tumor. Herein, we reported the case of a 64-year-old woman with a thoracic angiolipoma involving the T9 vertebral body and its appendix. Read More
Can J Anaesth 2018 Dec 4. Epub 2018 Dec 4.
Department of Medicine, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Mov Disord Clin Pract 2018 Sep-Oct;5(5):499-505. Epub 2018 Oct 3.
Department of Neurology Catholic University of the Sacred Heart Milan Italy.
Background: The benefits of neurosurgery in Tourette Syndrome (TS) are still incompletely understood. Prefrontal cortical electrical stimulation offers a less invasive alternative to deep brain stimulation.
Objective: To perform a pilot assessment on safety and efficacy of prefrontal cortical bilateral electrical stimulation in TS using clinical and brain metabolic assessments. Read More
Rev Prat 2016 Apr;66(4):384-387
Service de rhumatologie, hôpital Saint-Joseph, Paris, France.
Therapeutic management of nerve root pain in the lower limbs. The treatment of sciatica by disc herniation is foremost, apart from emergencies, conservative treatment. This should start quickly to prevent chronicity of pain. Read More
Theriogenology 2018 Nov 22;126:28-35. Epub 2018 Nov 22.
Section of Obstetrics and Gynecology, Department of Veterinary Medicine, University of Sassari, Sassari, Italy.
In sheep industry, genetic progress rate achieved by artificial insemination (AI) is limited by the convoluted anatomy of the cervix, which does not allow the passage of an insemination catheter for uterine semen deposition. The aim of this study was to test, in 98 pregnant at term Sarda ewes, the effects of: Experiment 1) total or partial ablation of cervical folds and Experiment 2) 4 or 2 incisions of cervical folds, on the passage of an insemination catheter, deposition of frozen-thawed semen and pregnancy rates. Surgical procedures were performed within 24 h from parturition providing deep sedation and epidural anaesthesia. Read More
J Neurosci Methods 2018 Dec 1. Epub 2018 Dec 1.
Department of Anesthesiology, Mayo Graduate School, Mayo Clinic, Rochester, MN, 55902, USA; Department of Oncology, Mayo Clinic, Mayo Graduate School, Mayo Clinic, Rochester, MN, 55902, USA; Translational Science Track, Mayo Graduate School, Mayo Clinic, Rochester, MN, 55902, USA. Electronic address:
Background: Development of new analgesic drugs or gene therapy vectors for spinal delivery will be facilitated by "hyperlocal" targeting of small therapeutic injectate volumes if spine imaging technology can be used that is ready for future clinical translation.
New Method: This study provides methods for MRI-guided drug delivery to the periganglionic epidural space and the dorsal root ganglion (DRG) in the Yucatan swine.
Results: Phantom studies showed artifact-corrected needle localization with frequency encoding parallel to the needle shaft, while maximizing bandwidth (125 KHz) minimized needle artifact. Read More
Paediatr Anaesth 2018 Dec;28(12):1066-1070
Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
Dr. Estela Melman (1939-present), Professor in the Department of Anesthesiology, the American British Cowdray Medical Center, Mexico, is an influential pioneer who has shaped the scope and practice of pediatric anesthesia in Mexico and throughout the world. Her early work to reintroduce neural blockade into routine pediatric anesthetic care, particularly the caudal approach to the epidural space, helped to transform current anesthesia practice. Read More
eNeurologicalSci 2019 Mar 22;14:1-3. Epub 2018 Nov 22.
Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-chou, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.
J Educ Perioper Med 2018 Jul-Sep;20(3):E626. Epub 2018 Jul 1.
Background: The use of epidural analgesia for laboring women is generally unavailable at public hospitals in Guyana despite favorable utilization rates in private institutions. In 2014, a healthcare team completed a targeted mission aimed at neuraxial analgesia training of providers at the preeminent public hospital in Georgetown, Guyana. This study evaluates the impact of the training, including provider attitudes, use, and barriers. Read More
Int J Obstet Anesth 2018 Nov 2. Epub 2018 Nov 2.
Department of Anesthesiology, Perioperative Medicine & Pain Treatment, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University Medical School Ein-Kerem, Jerusalem, Israel.
Background: This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016.
Methods: Prospective survey questionnaire was emailed to obstetric anesthesia unit directors/chairperson of all 25 labor and delivery services units within the jurisdiction of the Israeli Ministry of Health.
Results: The response rate was 100%. Read More
Vet Anaesth Analg 2018 Oct 22. Epub 2018 Oct 22.
Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
Objective: To compare volumes for epidural injection calculated on body weight or the length from sacrococcygeal space to occipital crest in dogs.
Study Design: Prospective study.
Animals: A total of 431 dogs weighing mean ± standard deviation (range) 24. Read More
Pain Physician 2018 Nov;21(6):E643-E650
Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Background: The non-operative treatment of herniated intervertebral discs has long been a fundamental challenge. A novel technique of laser ablation to ablate the nucleus pulposus under a transforaminal epiduroscope (TELA system, Lutronics, Seoul, Republic of Korea) was recently developed.
Objective: The purpose of this study was to evaluate the safety and effectiveness of transforaminal epiduroscopic laser ablation (TELA) for selective ablation of the nucleus pulposus in single-level disc disease. Read More
Pain Physician 2018 Nov;21(6):593-606
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Background: When conventional interventional procedures fail, percutaneous epidural adhesiolysis (PEA), which has moderate evidence for successful treatment of lumbar spinal stenosis (LSS), has been recommended over surgical treatments. In a previous study, we demonstrated the efficacy of a newly developed inflatable balloon catheter for overcoming the access limitations of pre-existing catheters for patients with severe stenosis or adhesions.
Objectives: This study compared the treatment response of combined PEA with balloon decompression and PEA only in patients with central LSS over 6 months of follow-up. Read More
Pain Physician 2018 Nov;21(6):515-540
Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Background: Several cell-based therapies have been proposed in recent years the management of low back pain, including the injection of medicinal signaling cells or mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). However, there is only emerging clinical evidence to support their use at this time.
Objective: To assess the effectiveness of MSCs or PRP injections in the treatment of low back and lower extremity pain. Read More
Pain Med 2018 Nov 29. Epub 2018 Nov 29.
Spine Section Editor, The University of Newcastle, Newcastle, Australia.
World Neurosurg 2018 Nov 27. Epub 2018 Nov 27.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School. Electronic address:
Background: None of the existing prognostic scoring systems in spinal epidural abscess (SEA) include albumin despite albumin's established role in inflammation, nutrition, lipid peroxidation, and regulation of apoptosis. The purpose of this study was to determine the prognostic value of albumin in SEA.
Methods: This was a retrospective, case-control study of two independent datasets. Read More
Clin Imaging 2018 Nov 15;54:15-20. Epub 2018 Nov 15.
Department of Radiology, University of Florida, Gainesville, FL, United States of America.
Differentiation of bone infarct from osteomyelitis is one of the most challenging issues in the evaluation of acute bone pain in sickle cell patients. The imaging modalities that are currently being used for assessment of bone marrow in this population have several limitations. We present a case of an 18-year-old male with a history of sickle cell disease, who was transferred to our emergency department with progressively severe headache and jaw pain for one-week. Read More
Ann Surg 2018 Nov 29. Epub 2018 Nov 29.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Objective: To characterize opioid discharge prescriptions for pancreatectomy patients.
Background: Wide variation in and over-prescription of opioids after surgery contribute to the United States opioid epidemic through persistent use past the postoperative period. Objective strategies guiding discharge opioid prescriptions for oncologic surgery are lacking, and factors driving prescription amount are not fully delineated. Read More
Zh Nevrol Psikhiatr Im S S Korsakova 2018 ;118(10):58-62
Sechenov First Moscow State Medical University, Moscow, Russia.
Disc herniation with radiculopathy is a common cause of severe back pain leading to significant disability and a decrease in patients' quality of life. The authors report a case of 38-year-old female patient with radiculopathy of the first sacral root due to a large (11 mm) sequestered disc herniation between the fifth lumbar and the first sacral vertebrae. Conservative treatment with fluoroscopically-guided epidural steroid injection provided a significant clinical improvement, the patient was able to return to normal daily and professional activity in a short time. Read More
Int Orthop 2018 Nov 29. Epub 2018 Nov 29.
Department of Orthopedic Surgery, Division of Spine Surgery, Newton Wellesley Hospital, Newton, MA, 02462, USA.
Purpose: Lumbar disc surgery is a common procedure in the USA. It is frequently performed with good or excellent results in most patients. This article reviews common causes of persistent radiculopathy after surgical intervention. Read More
Case Rep Otolaryngol 2018 25;2018:6543656. Epub 2018 Oct 25.
Department of Otorhinolaryngology Head & Neck Surgery, Galway University Hospital, Galway, Ireland.
Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. This case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Read More
J Clin Neurosci 2018 Nov 26. Epub 2018 Nov 26.
Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
Spontaneous intracranial hypotension (SIH), caused by CSF leaks, can trigger headaches, and is treated using epidural blood patch (EBP) procedures. We aimed to determine the effectiveness of a newly devised two-site blind EBP procedure as the initial treatment for SIH and compare its effectiveness with that of conventional targeted EBP. We retrospectively reviewed data for 116 patients who underwent EBP for SIH between November 2013 and April 2017. Read More
BMC Anesthesiol 2018 Nov 29;18(1):176. Epub 2018 Nov 29.
Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Background: Epidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the parturient and places them at increased complications from a repeat procedure. The aim of this study was to develop and validate a clinical risk factor model to predict the incidence of epidural catheter re-siting in labour analgesia.
Methods: The data from parturients that received labour epidural analgesia in our centre during 2014-2015 was used to develop a predictive model for epidural catheter re-siting during labour analgesia. Read More
J Neurosurg Spine 2018 Oct 1:1-8. Epub 2018 Oct 1.
OBJECTIVEPercutaneous vertebral augmentation procedures such as vertebroplasty and kyphoplasty are often performed in cancer patients to relieve mechanical axial-load pain due to pathological collapse deformities. The collapsed vertebrae in these patients can be associated with varying degrees of spinal canal compromise that can be worsened by kyphoplasty. In this study the authors evaluated changes to the spinal canal, in particular the cross-sectional area of the thecal sac, following balloon kyphoplasty (BKP) prior to stereotactic radiosurgery (SRS). Read More
J Neurosurg Spine 2018 Nov 1:1-5. Epub 2018 Nov 1.
The pathogenesis of thoracic ventral intradural spinal arachnoid cyst (ISAC) is unknown due to its extremely low incidence. In addition, its surgical treatment is complicated because of the ventral location, large craniocaudal extension, and frequent coexistence of syringomyelia. The optimal surgical strategy for thoracic ventral ISAC remains unclear and continues to be a matter of debate. Read More
J Neurosurg Spine 2018 Nov 1:1-6. Epub 2018 Nov 1.
OBJECTIVELocal epidural steroid application may be associated with decreased pain and narcotic use in the immediate postoperative period following lumbar discectomy. However, local steroid delivery following lumbar fusion procedures has not been well characterized. This study aims to characterize the effect of local intraoperative depomedrol application on perioperative and postoperative outcomes following a single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Read More
J Clin Anesth 2018 Nov 26;54:132-133. Epub 2018 Nov 26.
Department of Anesthesiology and Pain Medicine, University of Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC H1T 2M4, Canada. Electronic address:
Int Orthop 2018 Nov 28. Epub 2018 Nov 28.
Orthopaedic and Trauma Unit, Department of Surgery, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria.
Objective: This was to assess the quality of life and clinical symptoms before and after treatment of patients with symptomatic lumbar degenerative disc disease (LDDD). It was also to determine the superior treatment for well-selected patients: conservative versus surgical treatment.
Study Design: Prospective interventional analytical study. Read More
Surg Neurol Int 2018 23;9:213. Epub 2018 Oct 23.
Department of Neurosurgery, Riverside University Health System, Riverside, California, USA.
Background: Brown-Sequard syndrome (BSS) is a well-known entity that is most commonly caused by a penetrating injury to the spinal cord (e.g., stab wound or gunshot wound). Read More
Surg Neurol Int 2018 23;9:212. Epub 2018 Oct 23.
Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayama, Tennouji, Osaka 543-0035, Japan.
Background: Intraspinal extradural lipomas are very rare and should be differentiated from spinal epidural lipomatosis (SEL) and/or angiolipomas.
Case Description: A 76-year-old male presented with left lower extremity radiculopathy. The magnetic resonance imaging (MRI) revealed hyperplasia of epidural fat at the L2-3 and L3-4 levels accompanied by a lipomatous L4-5 mass. Read More
Surg Neurol Int 2018 23;9:211. Epub 2018 Oct 23.
Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
Background: Ependymomas represent 50-60% of all brain and central nervous system tumors. Previous lumbar spine surgery for resection of an ependymoma should not be considered a relative contraindication for the administration of epidural/subarachnoid anesthesia to patients in labor.
Case Description: A 34-year-old G1P0, who underwent resection of an L1-L3 intramedullary ependymoma 8 years previously, presented in active labor with residual left leg numbness and tingling. Read More
Surg Neurol Int 2018 17;9:209. Epub 2018 Oct 17.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Background: Immunoglobulin G4-related disease (IgG4-RD) is a group of distinct autoimmune disorders affecting nearly every organ system in the body. Although central nervous system involvement is quite rare, it may present as hypertrophic pachymeningitis more frequently affecting the brain than the spine. In this study, we provide a case of spinal IgG4-RD pseudotumor resulting in cord compression, and a comprehensive review of the literature. Read More
Urol Int 2018 Nov 28:1-5. Epub 2018 Nov 28.
Department of Obstetrics and Gynecology, Division of Urogynecology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
Sacrocolpopexy is the gold standard treatment for apical compartment prolapse with reported success rates of 78-100%. Spondylodiscitis is a rare complication of sacrocolpopexy and includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. Here we report a case of spondylodiscitis following laparoscopic sacrocolpopexy with long-term follow-up and discuss management of spondylodiscitis after abdominal sacrocolpopexy, with a review of the literature. Read More
J Neurosurg Spine 2018 Oct 1:1-5. Epub 2018 Oct 1.
Superficial siderosis of the central nervous system (SSCNS) is an uncommon and often unrecognized disorder that results from recurrent and persistent bleeding into the subarachnoid space. Currently, there is no effective treatment for SSCNS. The identification and surgical resolution of the cause of bleeding remains the most reliable method of treatment, but the cause of bleeding is often not apparent. Read More
J Neurosurg Spine 2018 Oct 1:1-2. Epub 2018 Oct 1.