bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Randomized Noninferiority Trial
Comparing Upper and Lower One-Third Joint
Approaches for Sacroiliac Joint Injections
Authors: Kim Young Hoon
Published: October 2019

Background: Sacroiliac intraarticular injection using the upper one-third joint technique is
recommended for injections that are difficult with the lower one-third joint technique.
Objective: To evaluate the success rate of intraarticular sacroiliac joint (SIJ) injections using the
upper and lower one-third joint techniques.
Study Design: Prospective randomized noninferiority study.
Setting: An interventional pain-management practice in a university hospital.
Methods: In this single-blind, noninferiority trial, 181 patients were randomly assigned to either
the upper (group U, 90 patients) or lower (group L, 91 patients) one-third joint techniques. The
primary end point was the rate of successful intraarticular injections (%), with a noninferiority
margin of 10 percentage points. The secondary end points included numeric rating scale (NRS)
pain scores before, during and after the procedure, procedure time, degree of contrast spread, and
occurrence of intravascular uptake or complications.
Results: The intraarticular injection rate was 93.3% (84 of 90 patients) in group U and 95.6% (87 of
91 patients) in group L (difference, 2.6 percentage points; 95% confidence interval, –8.9 to 4.4). This
study found no significant between-group differences in the degree of contrast spread throughout
the joint (88.1% with group U and 87.4% with group L, P = 0.883), intravascular incidence (11.1%
and 9.9%, respectively; P = 0.789), rate of complications (1.1% and 1.1%, respectively; P = 1.000),
inadvertent spread beyond the joint (12.2% and 19.8%, respectively; P = 0.201), or mean postprocedural NRS score for pain (2.24 ± 1.87 and 2.52 ± 1.97, respectively; P = 0.342). However, the
mean procedure time (111.2 ± 72.7 and 77.8 ± 60.4 s, respectively; P = 0.001), and mean NRS score
for pain during the procedure differed significantly between the groups (2.28 ± 1.45 and 1.77 ± 0.99,
respectively; P = 0.006).
Limitations: This study was designed as a noninferiority study of successful intraarticular
injection rates and did not evaluate long-term outcomes.
Conclusions: The upper one-third joint technique for performing SIJ injections was not inferior
to the lower one-third joint technique in terms of the intraarticular injection success rate.
Key words: Fluoroscopy, low back pain, lower one-third joint technique, sacroiliac joint, sacroiliac
joint injection, upper one-third joint technique
Comparison of Epidural Spreading Patterns and
Clinical Outcomes of Transforaminal Epidural
Steroid Injection with High-Volume Injectate
via the Subpedicular Versus the Retrodiscal
Approach
Authors: Park Hahck Soo
Published: October 2019

Background: The effect of transforaminal epidural steroid injection (TFESI) appears to be
influenced by the volume of the injected material because there is a positive correlation between
injection volume and extent of pain relief.
Objectives: The purpose of this study was to examine how many vertebral segments are covered
by the subpedicular (SP) approach and the retrodiscal (RD) approach and to compare the clinical
outcomes of the 2 approaches in TFESI with high-volume injectates.
Study Design: A randomized, active control trial.
Setting: Medical University centers.
Methods: Fifty patients were randomly assigned to either the SP group or the RD group. TFESI
was performed with high-volume injectates. A total of 9 mL injectate was divided into 3 injections
(0.5 mL, 2.5 mL, and 6 mL) given at 10-second intervals. The primary outcome measure was
injectate distribution. The spreading patterns were described as unilateral, bilateral, ventral, or
dorsal. Ventral or dorsal flow was also described as being cephalad or caudad, respectively. The
secondary outcome measures were pain relief and reduction of functional disability at 4 weeks
after the procedure.
Results: The total numbers of vertebral segments and median levels of contrast spread from the
injection site were not significantly different between the 2 groups. However, in 3 mL of injectate,
the injectate spread showed more extensive bilateral distribution in the RD group. At 4 weeks
after treatment, both groups demonstrated statistically significant pain relief and improvement in
functional status. No significant differences were observed between the 2 groups.
Limitations: We enrolled only a small number of patients and did not analyze long-term
outcomes. Patients with severe spinal stenosis or herniated nucleus pulposus were included.
Slightly different methods were used in the 2 groups to determine the number of levels at which
the injectate was spread.
Conclusions: Epidural spreading patterns and clinical outcomes of lumbar TFESI with highvolume injectate were not significantly different between the SP approach and the RD approach.
Institutional Review Board (IRB) approval: Institutional Review Board of Ewha Womans University
Hospital (EUMC 2015-05-003-003). Clinical trials registration number: Clinical Research
Information Service (CRIS, registration number: KCT0002288; RCT URL: https://cris.nih.go.kr/cris/
search/search_result_st01.jsp?seq=7309)
Key words: Epidural injections, epidural space, low back pain, radiating pain, disability evaluation,
steroids, local anesthetics, intervertebral disc disease, spinal stenosis
Response to Cervical Medial Branch Blocks
In Patients with Cervicogenic Vertigo
Authors: Klessinger Stephan
Published: October 2019

Background: Among the various causes of vertigo, the so-called cervicogenic vertigo (CV) has
been the most controversial. However, perturbations of proprioceptive signals and abnormal
activity of the cervical afferents can induce vertigo. Medial branch blocks (MBBs) are a diagnostic
tool designed to test whether a patient’s neck pain is mediated by one or more of the medial
branches of the dorsal rami of the spinal nerve. It is unknown whether MBBs are also suitable for
testing symptoms other than pain.
Objectives: The purpose of this study was to test whether MBBs of the cervical spine can be used
as a diagnostic tool to identify patients with CV.
Study Design: A retrospective practice audit (clinical observation).
Setting: An interventional pain management and spine practice.
Methods: An electronic medical record system was used to identify patients in a single spine
center. Included were consecutive patients with neck pain and vertigo, who had received cervical
MBBs in a period from July 2001 to April 2016. The patients were tested with a MBB of about 1
mL of bupivacaine (0.25%) and 20 mg triamcinolone. Injections were performed with fluoroscopic
visualization using established techniques in 2 or 3 levels on one or both sides. Vertigo was analyzed
through the global clinical impression of the patient (i.e., “gone,” “better,” “the same,” or “worse”).
Results: One-hundred seventy-eight patients met the inclusion criteria. One-hundred eleven
patients (62.4%) experienced a significant improvement of the vertigo. In 47 patients (26.4%), no
information about the vertigo was available at follow-up; these patients were assumed to have no
improvement (worst-case scenario). Hence, altogether 67 patients (37.6%) had a negative result.
The median relief of the vertigo was 2 months. Differences in age, gender, level of treatment, or
pain duration between patients with relief of the vertigo and without relief were not found. Nine
patients with a whiplash injury in their medical history were also tested. They experienced a lower
success rate and had longer duration of pain before the treatment; however, these differences are
not statistically significant.
Limitations: It was the primary intention to treat neck pain; the assessment of vertigo was
an additional aim. Therefore, the history taken and the clinical examination were not targeted
specifically to vertigo. A placebo effect cannot be excluded. Further studies with the primary focus
on CV are necessary to prove the significance of MBBs.
Conclusions: This is the first study to demonstrate that MBBs of the cervical spine can be a useful
tool for the diagnosis of CV, because they temporarily block cervical afferents. In 63.4% of patients
with neck pain and suspected CV, the vertigo was significantly improved. Further placebo-controlled
studies with the primary intention on CV are necessary to prove the significance of MBBs.
Key words: Cervicogenic vertigo, medial branch block, facet joint, zygapophysial joint, neck
pain, differential diagnosis
Cebranopadol: A Novel, First-in-Class, Strong
Analgesic: Results from a Randomized Phase IIa
Clinical Trial in Postoperative Acute Pain
Authors: Scholz Andreas
Published: October 2019

Background: Cebranopadol is a potent, first-in-class analgesic with a novel mechanistic approach
combining nociceptin/orphanin FQ peptide (NOP) and opioid peptide receptor agonism.
Objective: We aim to evaluate, for the first time, the analgesic efficacy, safety, and tolerability of
cebranopadol in patients suffering from moderate to severe acute pain following bunionectomy.
Study Design: We conducted a phase IIa, randomized, multi-center, double-blind, double-dummy,
placebo- and active-controlled, parallel group clinical trial.
Methods: A total of 258 patients who underwent a primary bunionectomy were randomly assigned
to receive a single oral administration of cebranopadol 200 μg, 400 μg, or 600 μg, morphine controlledrelease (CR) 60 mg, or placebo. The primary efficacy end-point was the sum of pain intensity (SPI) 2 to
10 hours (SPI2–10) after the first investigational medicinal product (IMP) intake time-point.
Results: Cebranopadol doses of 400 µg and 600 µg were more effective in reducing postoperative
acute pain compared to placebo, from 2 hours until approximately 22 hours after the first IMP intake
time-point. No difference was observed between cebranopadol 200 μg and placebo. Per the subject
global impression of the IMP assessment, patients who received cebranopadol 400 μg and 600 μg
were more satisfied with the ability of the medication to treat their pain compared to those who
received morphine CR 60 mg. On the primary end-point, the effect of morphine CR 60 mg was
smaller than that of cebranopadol 400 μg and 600 μg. However, the analgesic effect of morphine CR
60 mg emerged later relative to IMP intake, as shown by the fact that similar SPI results as seen for
cebranopadol 400 μg and 600 μg were obtained for later time windows. Cebranopadol treatment
was safe, and single-dose administrations of 400 µg were better tolerated than morphine CR 60
mg. The relative frequency of patients with at least one treatment-emergent adverse event (TEAE)
increased with increasing cebranopadol doses and was highest in the morphine CR 60 mg group.
Limitation: Although a double-dummy design was used to ensure blinding, a limitation of this trial
was that cebranopadol and morphine CR were administered at 2 different time-points post-surgery,
given the anticipated difference in the time to reach the maximum plasma concentration between
the 2 treatments.
Conclusion: Administration of single cebranopadol doses of 400 µg and 600 µg induced more
effective analgesia following bunionectomy surgery compared to the traditional opioid morphine on
the primary end-point (SPI2–10), while both cebranopadol doses and morphine ensured adequate 24-
hour pain relief. Moreover, cebranopadol was better tolerated and received a better overall rating
by the patients.
Key words: Opioids, morphine, µ-opioid receptor, nociceptin/orphanin FQ peptide receptor,
analgesic, bunionectomy, surgery, post-operative pain, single hallux valgus repair
Is Fibromyalgia Risk Higher Among Male and
Young Inflammatory Bowel Disease Patients?
Evidence from a Taiwan Cohort of One Million
Authors: Tseng Chun-Hung
Published: October 2019

Background: Prior literatures have shown inflammatory bowel disease (IBD) could increase
fibromyalgia (FM) risk. However, studies about gender and age distributions of FM risk among
patients with IBD are rare. With large study samples, this study aimed to evaluate the FM risk
among IBD patients with different gender and different age.
Objective: We aim to estimate the FM risk among male and younger IBD patients with a
large patient sample.
Study Design: A retrospective cohort study was arranged in this research.
Setting: The data used in this research were selected from the Taiwan National Health
Insurance Research Database (NHIRD).
Methods: From the Taiwan NHIRD, we selected 4,510 patients with IBD and 18,040 randomly
gender- and age-matched patients without a history of IBD from the beginning of 2000 to
the end of 2005 to analyze the development of FM over a 12-year follow-up period (2000–
2011). The Cox regression model was used to assess the effects of IBD on the risk of FM by
adjusting for gender, age, and comorbidities, including hypertension, diabetes, hyperlipidemia,
depression, anxiety, and sleep disorder.
Results: After adjusting suitable covariates, the IBD patients had a greater FM risk (adjusted
hazard ratio [aHR] 1.70, 95% confidence interval [CI] 1.59–1.83) than the controls. Male IBD
patients had a higher FM risk than female IBD patients did (aHR 2.00, 95% CI 1.79–2.23 and
aHR 1.52, 95% CI 1.38–1.67, respectively). The greatest age-specific FM risk occurred in the
youngest IBD subgroup (≤ 39 years old) (aHR 1.92, 95% CI 1.68–2.19).
Limitations: The information about personal behaviors was unobtainable in the Taiwan
NHIRD. Other risk factors for cardiovascular disease that might augment FM cannot be excluded
entirely in this study.
Conclusion: IBD is disclosed to be correlated with an enhanced risk to develop FM, particularly
in male and younger IBD patients. For preventing FM, it is necessary to pay more attention to
the management of the IBD patients. Future researches are needed to further confirm the
findings in this study.
Key words: Inflammation, inflammatory bowel disease, fibromyalgia, Taiwan National Health
Insurance Research Database
Volume Navigation with Fusion of RealTime Ultrasound and CT Images to Guide
Posterolateral Transforaminal Puncture in
Percutaneous Endoscopic Lumbar Discectomy
Authors: Wang Chuang-Feng
Published: October 2019

Background: The use of percutaneous endoscopic lumbar discectomy (PELD) is increasing in
the treatment of lumbar disc herniations (LDH). Nerve and vessel injury may happen during the
establishment of the transforaminal working channel. Also, there is usually exposure to intraop
radiation when the C-arm is used to help establish the location of the transforaminal working
channel.
Objective: To evaluate the accuracy and safety of the volume navigation technique for guiding
transforaminal puncture in cadaver and clinical patient treatment.
Study Design: Cadaver experiment and comparative clinical research.
Setting: Changhai Hospital, the Second Military Medical University.
Method: Volume navigation guided transforaminal puncture was performed in 15 cadavers. The
registration error, time of overall puncture, ultrasound (US) observed distance between needle tip
and target (DNT), and puncture error were recorded. Clinical research was performed in 63 patients
who had undergone PELD. Comparative research was done between 2 groups: Those who had
transforaminal puncture carried out under C-arm guidance (n = 30), and those patients whose
transforaminal puncture was carried out under volume navigation guidance (n = 33). Puncture
times and frequency of fluoroscopy were recorded. Both groups were evaluated with Oswestry
Disability Index (ODI), and visual analog scale (VAS) before surgery at 1, 3, and 6 months, and 1
year post-surgery.
Results: In the cadaver experiment, mean registration error was 2.66 ± 1.10 mm; DNT 20.08 ±
1.32 mm; puncture error 2.91 ± 1.29 mm; overall time of puncture 22.10 ± 5.20 min. In the clinical
patient research, puncture times and frequency of fluoroscopy were significantly lower in the
volume navigation group compared with the C-arm group (P < 0.001). There were no significant
differences between the 2 groups in ODI and VAS scores (P > 0.05) at different time points.
Limitations: The correlation between the registration errors and the puncture errors requires
further analysis. Also, due to the relatively small number of cases studied, additional cases need to
be collected to obtain reliable results.
Conclusion: The volume navigation technique can be used for PELD because it helps to guide
percutaneous posterolateral transforaminal puncture accurately with reduced puncture times and
intraop radiation.
Key words: Lumbar disc herniation (LDH), ultrasound volume navigation (US VNav), percutaneous
endoscopic lumbar discectomy (PELD), foramen, puncture
Evaluation of an Experimental Pain Model by
Noncompartmental Analysis of Results from a
Randomized Placebo Controlled Trial
Authors: Varin France
Published: October 2019

Background: Understanding analgesic pharmacodynamics (PD) in the elderly is key to optimising
pain management. Electrically stimulated pain models (ESPM) permit assessment of pain responses
in humans. C and Aδ sensory fibres convey pain and respond to low frequency electrical stimulus
(5 and 250 Hz, respectively). Human research suggests pain tolerance threshold (PTT) is similar or
decreases with age.
Objectives: To determine whether an ESPM is able to detect a difference in PTT in elderly (≥
75 years) and young (20-40 years) subjects after single dose administration of a placebo and
tramadol, a low potency analgesic.
Study Design: Two-cohort, randomized, placebo-controlled, cross-over study.
Methods: A noncompartmental analysis of data at 17 timepoints on 5 Hz and 250 Hz PTT over
24 h.
Results: Young (16) and elderly (13) patients showed similar baseline (E0) PTT between active
and placebo both overall and by age group in both frequencies. Net drug effect took into account
negative and positive changes from E0. In the elderly, net peak effect on PTT produced by active
treatment was significantly greater for both 5 Hz (34%) and 250 Hz (30%). Net area under the
24-h effect-time curve during active treatment was significantly higher for both 5 Hz (163 %) and
250 Hz (175%) stimulations in the elderly. No clinically significant difference was observed in the
young.
Limitations: High variability in young subjects, despite efforts to remove outliers limited
our ability to draw conclusions in that age group. Generalizability of results obtained from an
experimental pain model in volunteers to treatment of elderly patients may be limited.
Conclusion: ESPM can detect a difference for pain tolerance threshold between placebo and
tramadol administration in the elderly. Although both 5 Hz and 250 Hz stimulations can detect a
difference, the effect size for 5 Hz is larger and seems more precise and reliable, particularly in the
elderly.
Key words: Electrical pain model, elderly, geriatric, tramadol, placebo, opioid, area under the
effect curve, noncompartmental analysis
Transforaminal vs Interlaminar Epidural Steroid
Injection for Acute-Phase Shingles:
A Randomized, Prospective Trial
Authors: Fujiwara Aki
Published: October 2019

Background: The acute phase of shingles is characterized by severe pain, and one of the
complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged
pain. Although factors predicting the development of PHN, as well as its preventative measures,
have been investigated, there is no single treatment effective for PHN. Some studies showed
effectiveness of epidural injection to alleviate pain associated with acute-phase shingles.
In these studies, epidural injection was performed by interlaminar (IL) approach. However,
transforaminal (TF) approach may be more effective as it enables injection of steroids and local
anesthetics closer to the dorsal root ganglion where inflammation primarily occurs. There have
not been any studies comparing the analgesic effects of epidural injection approaches for pain
associated with acute-phase shingles.
Objective: We compared the analgesic effects of IL and TF epidural injection approaches for
pain associated with acute-phase shingles.
Study Design: We conducted a randomized prospective trial.
Setting: Nara Medical University Hospital, Department of Anesthesiology.
Methods: Forty patients with acute-phase shingles were randomly assigned to receive
epidural steroid injections by TF or IL approaches. Patients were evaluated at the baseline, as
well as at 1 month and 3 months after the treatment using the VAS and SF-36 scores. Patients
with VAS score of over 40 at the 3-month follow-up were considered as having PHN, and the
number of patients with PHN was compared between the IL and TF groups.
Results: Except the mental component of the SF-36 score and severity of skin rash, patient
characteristics were not significantly different between the groups. VAS scores at 1 and 3-month
follow-up were significantly lower than those at the baseline, and there was no difference
between the groups. All SF-36 scores were not significantly different between groups at 1- and
3-month. There was no significant difference in the occurrence of PHN between the groups.
Limitations: We had a small sample size that did not reach the number of patients needed
by the power analysis in the study. Then, our follow-up period of 3 months was relatively short.
Conclusions: VAS scores, the SF-36 RCS and MCS scores improved in both groups, however,
there was no difference in the analgesic effects of the IL and TF epidural steroid injections at 1
and 3 months for acute-phase shingles patients.
Key words: Shingles epidural steroid injection interlaminar approach; transforaminal
approach, fluoroscopic, postherpetic neuralgia, VAS, SF-36
Pulsed Radiofrequency Application on
Femoral and Obturator Nerves for Hip Joint
Pain: Retrospective Analysis with 12-Month
Follow-up Results
Authors: Tinnirello Andrea
Published: October 2019

Background: Osteoarthritis of the hip joint is a common cause of pain and disability. Patients not
responding to conservative management often cannot undergo joint replacement due to the presence
of multiple comorbidities, while some other patients prefer to postpone surgery as long as possible.
Radiofrequency denervation of articular branches of the femoral and obturator nerves, which supply
innervation of the joint, is a novel technique to reduce hip joint pain. Previous studies reported positive
results after application of continuous radiofrequency to the target nerves; however, this approach
carries the potential risk of neuritis and neuroma formation. Pulsed radiofrequency (PRF) is a safer
alternative to continuous radiofrequency not creating necrosis but a complex neuromodulatory effect
on target nerves. There is no published evidence of PRF efficacy after 3 month follow-up.
Objectives: This single-center study objective was to evaluate the short and medium term
effectiveness of PRF on the femoral articular branches and obturator nerves in patients with chronic
hip pain.
Study Design: Retrospective single-center study.
Setting: Italian National Health Service Public Hospital.
Methods: Retrospective analysis of 14 patients treated with PRF for severe hip joint pain (mean
numeric rating scale (NRS) 7.7 ± 1.2 mean Oxford Hip Score (OHS) 20 ± 8.4). Mean pain and disability
scores were evaluated with NRS and OHS respectively at 1, 3, 6, and 12-month follow-up. All patients
were treated with pulsed radiofrequency applied under fluoroscopy on the articular branches of the
femoral and obturator nerves for 300 seconds each.
Results: Eight patients out of 14 (57%) reported an NRS reduction > 50% at 1 month post procedure.
Overall, both pain and disability scores were significantly (P < 0.01) lower at all follow-up until 6
months, mean NRS at 1, 3, and 6 months was 3.6 ± 3; 4.1 ± 3.3; 4.8 ± 2.9 while OHS was 37.6 ±
17.7; 35.8 ± 17.7; 35.8 ± 14 respectively. At 12 months, NRS was 5.8 ± 2.4 while OHS 23.3 ± 12.7,
it must be pointed out that even if both scores are significantly (P < 0.01) lower than basal, only 3
patients out of 14 (21%) maintained a NRS reduction > 50% from basal at 12 months post procedure.
We reported 2 femoral artery punctures without any significant complication.
Limitations: Retrospective study, small sample size.
Conclusions: Pulsed radiofrequency is a safe and effective modality to treat hip joint pain in the
short and medium term. Definition of positive outcome predictors is required to reserve radiofrequency
treatment only for those patients who can benefit from this procedure.
Key words: Hip joint pain, pulsed radiofrequency, obturator nerve, femoral nerve, interventional
pain management, radiofrequency
Quantitative 3D Trajectory Measurement for
Percutaneous Endoscopic Lumbar Discectomy
Authors: Liu Xiaoguang
Published: October 2019

Background: Percutaneous endoscopic lumbar discectomy (PELD) has become an
increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD,
the focus of decompression has shifted from the central nucleus to the subannular-protruded
disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal
leads to the greater possibility of bony structure obstruction, thus the location and direction
of the working channel are crucial. The existing preoperative measuring methods mainly rely
on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the
trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure
and the working channel cannot be precisely evaluated.
Objectives: To investigate a 3D method and quantitatively evaluate the trajectory for
percutaneous endoscopic lumbar discectomy (PELD).
Study Design: Technical note.
Setting: Pain medicine center of a university hospital.
Methods: Twenty patients suffering from L4/5 disc herniation were enrolled in this study.
After reconstructing the preoperative CT images, the virtual trajectory was placed into the
intervertebral foramen through gradient-changing angulations in relation to the coronal and
transverse planes. The overlapping portion of the virtual trajectory and the lumbar vertebrae
was evaluated. In addition, the probability of atypical structure involvement was calculated.
Results: As cephalad angulation (CA) increased, the intersection volume of the L4 inferior
articular process increased, while the total intersection volume, the intersection volume of the L5
superior articular process, the intersection volume of the facet joint, and the volume proportion
of L5 superior articular process intersection in the facet joint all decreased. As coronal plane
angulation (CPA) increased, the total intersection volume, the intersection volume of the L4
inferior articular process, and the intersection volume of the facet joint all increased, while the
volume proportion of the L5 superior articular process intersection in the facet joint decreased.
When CA increased to 15°-20°, there was a high probability of atypical structure involvement,
whereas such a probability in the groups of CA 0° (CPA 15°, 20°, and 25°), CA 5° and CA 10°
was low.
Limitations: Only patients with L4/5 herniation were evaluated in this study.
Conclusions: In terms of the regularity, the ideal angulation for L4/L5 PELD is CPA 5°-10°
and CA 5°-10°, which can lead to a relatively low level of total damage to the bony structure,
minimal damage to the facet joint, and negligible involvement of atypical structures.
Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD),
transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure
obstruction
Six-Month Results of Cervical Intradiscal
Oxygen-Ozone Mixture Therapy on Patients
with Neck Pain: Preliminary Findings
Authors: Beyaz Serbülent Gökhan
Published: October 2019

Background: Numerous techniques have been developed for the treatment of disc herniation.
Oxygen-ozone (O2
-O3
) mixture therapy is a minimally invasive percutaneous treatment for disc
herniation.
Objective: The aim of the study is to investigate the 6-month efficacy and safety of O2
-O3
mixture therapy in patients with cervical disc herniation (CDH) and chronic neck pain.
Study Design: This is a cross-sectional, single-center study.
Setting: The study was conducted from January 2012 to May 2016 on patients visiting Sakarya
University Training and Research Hospital’s pain clinic.
Methods: Each patient was evaluated before the procedure (baseline) and at 2 weeks (W2), 6
weeks (W6), and 6 months (M6) after the procedure using the visual analog scale (VAS) and the
Oswestry Disability Index scores.
Results: A total of 44 patients with CDH underwent the same treatment with an O2
-O3
mixture.
Significant pain relief was observed compared with preoperative pain at W2, W6, and M6
according to patient self-evaluation (P = 0.01). The mean VAS score was 7.89 ± 1.13 before
the procedure, 4.22 ± 1.62 at W2, 3.03 ± 1.66 at W6, and 2.27 ± 1.25 at the end of M6. No
significant complications or side effects were reported during or after the procedure.
Limitations: Our study was conducted retrospectively, which resulted in problems obtaining
follow-up data. In addition, this study was performed in a small patient group.
Conclusion: Based on our results, intradiscal injection of an O2
-O3
mixture treatment showed
a beneficial long-term effect.
Key words: Cervical disc herniation, chemonucleolysis, injection, intradiscal, oxygen-ozone
mixture, percutaneous treatment
Earlier Vertebroplasty for Osteoporotic
Thoracolumbar Compression Fracture May
Minimize the Subsequent Development of
Adjacent Fractures: A Retrospective Study
Authors: Lee Ru-Ping
Published: October 2019

Background: Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic
vertebral compression fractures (OVCFs). The influence of timing (early vs. late) of PVP on the
development of adjacent vertebral fractures (AVF) has rarely been discussed.
Objective: This study aimed to compare the incidence of AVF among patients who received
early PVP (≤ 30 days after symptom onset, EPVP) or late PVP (> 30 days after symptom onset,
LPVP) in the thoracolumbar region (T10 to L2) after a 1-year follow up.
Study Design: A retrospective cohort study.
Setting: Department of Orthopedic, an affiliated hospital of a medical university.
Methods: Patients who had single-level, T-score ≤ -2.5 of lumbar bone mineral density (BMD),
primary OVCF in the thoracolumbar region (T10 to L2) and who received PVP between July
2012 and June 2014 were included in the study. They were divided into early PVP and late
PVP groups according to the interval between symptom onset and treatment. The risk factors
associated with subsequent AVFs were analyzed.
Results: Of the 225 patients reviewed, 124 met the criteria and were followed for a minimum
of 1 year. Eleven patients (14.1%) in the EPVP group (n = 78) and 18 patients (39.1%) in
the LPVP group (n = 46) experienced an AVF during the first year following vertebroplasty.
Outcomes were significantly better in patients with higher bone mineral density, lower cement
volume, and without cement leakage (P < 0.01). Cox regression indicated an increase risk for
AVF for LPVP, with an adjusted hazard ratio of 6.08 (95% confidence interval: 2.50–14.81).
Limitation: The incidence of AVFs could be over estimated due to this being a retrospective
study with a small case number and lack of either biomechanical study of intra-vertebral
cement distribution by times to support the result.
Conclusions: Compared with later interventions, PVP performed within 30 days after fracture
development may be associated with a lower risk of adjacent fractures in the thoracolumbar
region.
Key words: Percutaneous vertebroplasty, osteoporosis, osteoporotic vertebral compression
fracture, adjacent vertebral fracture
Patients’ Perceptions of Chronic Pain
During the Economic Crisis: Lessons
Learned from Greece
Authors: Batistaki Chrysanthi
Published: October 2019

Background: Chronic pain is well known to be influenced by various social factors; however,
the impact of financial issues on pain has not been extensively studied.
Objective: The aim of this study was to investigate the impact of the economic crisis on pain
and quality of life in Greek patients suffering from chronic pain.
Study Design: The study employed a prospective, open-label design.
Setting: The study setting was the Pain Unit of Attikon University Hospital in Athens, Greece.
Methods: The study surveyed 200 randomly selected outpatients with chronic pain during two
different time periods (2012 and 2016). Patients completed a structured questionnaire to assess
the impact of the economic crisis on multiple aspects of pain and pain management, health care,
and quality of life. Personality characteristics and stress were also evaluated using the DASS-42
and the LOT-R questionnaires.
Results: Most patients in both periods believed that the economic crisis led to a worsening of
their symptoms (75%) and quality of life (97%). Most patients (97.5%) also believed that the
intensity of their pain would have been improved if their financial status had been better. Their
main concerns about the future were “the possibility of not having access to health care facilities
and medication” (94.5%), “stress” (43%), and “fear of financial strain” (30.5%). Higher levels
of anxiety, stress, and pessimism were associated with higher levels of pain and lower quality of
life.
Limitations: The study is based on a small sample size.
Conclusions: This study identified impacts of the financial crisis on chronic pain and quality of
life, pointing to the need for measures to solve this problem.
Key words: Pain, global financial crisis, quality of life, quality of health care, psychosocial
factors
Percutaneous Epidural Adhesiolysis Using
Inflatable Balloon Catheter and Balloon-less
Catheter in Central Lumbar Spinal Stenosis
with Neurogenic Claudication: A Randomized
Controlled Trial
Authors: Choi Seong-Soo
Published: October 2019

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.
Study Design: This study used a randomized, single-blinded, active-controlled trial design.
Setting: This study took place in a single-center, academic, outpatient interventional pain
management clinic.
Methods: This randomized controlled study included 60 patients with refractory central LSS who
suffered from chronic lower back pain and/or lumbar radicular pain. Patients failed to maintain
improvement for > 1 month with epidural steroid injection or PEA using a balloon-less catheter.
Patients were randomly assigned to one of 2 interventions: balloon-less (n = 30) and inflatable
balloon catheter (n = 30). The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI),
Global Perceived Effect of Satisfaction (GPES), and Medication Quantification Scale III were each
measured at 1, 3, and 6 months after PEA.
Results: There was a significant difference between groups in NRS-11 reduction ≥ 50% (or 4
points), ODI reduction ≥ 30% (or 10 points), GPES ≥ 6 and ≥ 4 points at 6 months, and NRS11 reduction ≥ 50% (or 4 points) at 3 months after PEA (P < .03). The proportion of successful
responders was higher in the balloon group than in the balloon-less group throughout the total
follow-up period. Furthermore, there was a statistically significant difference between groups at 6
months after PEA (P = .035).
Limitations: The results may vary according to the definition of successful response. Follow-up
loss in the present study seemed to be high.
Conclusion: PEA using the inflatable balloon catheter leads to significant pain reduction and
functional improvement compared to PEA using the balloon-less catheter in patients with central
LSS.
The study protocol was approved by our institutional review board (2012-0235), and written
informed consent was obtained from all patients. The trial was registered with the Clinical Research
Information Service (KCT 0002093).
Key words: Balloon decompression, central, chronic pain, epidural adhesiolysis, lumbar,
percutaneous, radiculopathy, spinal stenosis
The Effect Of Storage Temperature On The Quality Of Honey
Authors: Tulandi Silvester Maximus
Published: October 2019

Honey is natural liquid produced by honey bees. In reality, the quality can be reduced if the storage is not done properly. Diastase enzyme activity is one of the important honey quality parameters. The purpose of this research was to determine the quality of honey that was influenced by storage temperature on the activity of the diastase enzyme using Spectrophotometry method. Samples were obtained from the beekeeping area of East Jakarta. The results showed that, storage temperature greatly affects the quality of honey. Diastase enzyme activity was significantly different in each treatment at storage temeprature (P-Value < 0,05). Honey’s best storage temperature was at room temperature (26oC) compared to hot (50oC) and cold (±5oC) temperatures.
نموذج مقترح لتنمية التفكير الاستراتيجي لدى القادة بالجامعات الليبية
في ضوء بعض النماذج والتطبيقات الأجنبية
Authors: الرقيعي كريمة المبروك , فـــــــــرج فتحي عيســـــــــــــى
Published: October 2019

هدف البحث الحالي إلى إقتراح تصور لتنمية التفكير الاستراتيجي لدى القادة بالجامعات الليبية في ضوء بعض النماذج والتطبيقات الأجنبية، وبالتالي في ضوء ما سبق سيتم تحديد مشكلة البحث الحالي في السؤال الرئيس التالي:
ما هو النموذج المقترح لتنمية التفكير الاستراتيجي لدى القادة بالجامعات الليبية في ضوء بعض النماذج والتطبيقات الأجنبية ؟ ويتفرع من السؤال الرئيس الأسئلة الفرعية التالية:
1- ما الإطار الفكري للتفكير الاستراتيجي لدى قادة التعليم الجامعي؟
2- ما هي أبرز النماذج والتطبيقات الأجنبية للتفكير الاستراتيجي؟
3- ما هي ملامح النموذج المقترح المستخلص من الأدبيات لتنمية التفكير الاستراتيجي لدى القادة بالجامعات الليبية في ضوء بعض النماذج الأجنبية؟
واعتمد البحث على المنهج الوصفي لتحقيق أهدافه، وتم التوصل لعدد من النتائج وهي:
1. أن تنمية التفكير الاستراتيجي لدى قادة الجامعات هي أعظم استثمارات الجامعة لراس مالها الفكري والقادر على تحقيق الميزة التنافسية.
2. ضرورة نشر ثقافة التفكير الاستراتيجي داخل البيئات الجامعية بداية من رؤساء الأقسام العلمية ومروراً بعمداء الكليات الجامعية حتى رؤساء الجامعات.
الكلمات المفتاحية: التفكير الاستراتيجي – القادة – التعليم الجامعي
درجة توفر معايير ضمان الجودة في برنامج إعداد المعلمين بكلية التربية
Authors: المنقوش حليمة عبدالله , بن صلاح أحلام عبد القادر
Published: October 2019

هدف البحث التعرف على درجة توفر معايير ضمان الجودة في برنامج إعداد المعلمين بكلية التربية جامعة مصراتة وفي مجالات الاستبانة (أهداف برنامج إعداد المعلم، محتوى البرنامج، طرق التدريس، التقويم، التربية العملية) وتم استخدام المنهج الوصفي التحليلي، واستخراج الصدق الداخلي للاستبانة ومعامل الثبات (0.84) وتكون مجتمع البحث من جميع الطلاب المتوقع تخرجهم من كلية التربية للفصل الدراسي ربيع (2019) والبالغ عددهم (312) طالب وطالبة، وتم اختيار عينة عشوائية طبقية (60) طالبًا وطالبة موزعين على أقسام الكلية العلمية والأدبية وتوصل البحث إلى النتائج التالية:- أن درجة توفر معايير ضمان الجودة في برنامج إعداد المعلمين بكلية التربية جاءت(متوسطة) بمتوسط حسابي قدره (3.24) .وجاءت درجة توفرها وفق المجالات: مجال التربية العملية بدرجة توفر(عالية) وبمتوسط حسابي(3.40)يليه مجال محتوى البرنامج حيث جاء بدرجة توفر (متوسطة) وتحصل على متوسط حسابي(3.16) ثم مجال أهداف برنامج إعداد المعلم بدرجة توفر(متوسطة) ومتوسط حسابي (3.15) وتحصل مجال التقويم على درجة توفر(متوسطة) ومتوسط حسابي (3.04) ومجال طرق التدريس بدرجة توفر(متوسطة) أيضاً وبمتوسط حسابي(2.91).
الكلمات المفتاحية: معايير، ضمان الجودة، برنامج إعداد المعلم.
METAPHOR AND ITS CLASSIFICATION
Authors: Grin Nadezhda
Published: October 2019

The article deals with the problems of metaphor and its classification. The range of

linguistic researches is rather wide, from lecsicology to grammar and typology, from spoken speech to

scientific style and fiction style, from the problem of metaphor comprehension to studying its sign nature. Metaphor classification differs a great varieties it can be explained by multifaceted a complexity

of the classified phenomena, as well as foundations differences in the given classifications.
PENGGUNAAN KATETER INTRAPLEURA (WATER SEALED DRAINAGE, INDWELLING PLEURAL CATHETER, PIGTAIL CATHETER) PADA PENATALAKSANAAN KANKER PARU DENGAN EFUSI PLEURA MASIF
Authors: Tamsil Tamam Anugrah , Syahruddin Elisna , Soehardiman Dicky
Published: October 2019

Massive pleural effusion is one of the problems in lung cancer treatment that cause death. The main treatment of cancer patient with massive pleural effusion is the placement of intrapleural catheter. This is a preliminary study which is aimed to assess tolerancies and  efficacies of intrapleural catheter (WSD, IPC or pigtail catheter) in  lung cancer with massive pleural effusion. This study is a retroscpective observational cohort study. Subjects are lung cancer patients with massive pleural effusion and catheterized with intrapleural catheter (WSD, IPC or pigtail catheter). The datas were taken from medical record at RSUP Persahabatan and assessed for tolerancies (acute or late complication) and efficacies ((length of hospital admission after catheter placement, duration and the reason of retraction) of intrapleural catheter. Tolerancies and efficacies of intrapleural catheter (WSD, IPC or pigtail catheter) in lung cancer patients with massive pleural effusion are quite good and safe. Prospective cohort studies are needed in the future to determine which type of intrapleural catheter is better for the treatment of massive pleural effusion in lung cancer patients.
A pesquisa em Ensino de Botânica: contribuições e características da produção científica em periódicos
Authors: Leopoldo Lucas Dias , Bastos Fernando
Published: October 2019

Esta pesquisa teve como objetivo apresentar os resultados e contribuições de publicações sobre o Ensino de Botânica, relacionadas ao âmbito de um setor de produção e divulgação científica. A metodologia consistiu na escolha de quatro periódicos de referência pertencentes à área de Ensino de Ciências, na realização de levantamentos em edições compreendidas entre os anos de 2010 a 2016, e discussões envolvendo os resultados e contribuições obtidos. Os aspectos encontrados refletiram uma produção incipiente de artigos que realizassem uma interlocução entre o Ensino de Botânica e a pesquisa em Ensino de Ciências. Tal cenário implica na necessidade de maiores estudos sobre a produção de conhecimentos para a área, a fim de se identificar lacunas em outros setores de produção e promover uma maior divulgação do ensino de botânica.
Avaliação de materiais didáticos: uma proposta de ensino do conteúdo geometria molecular para alunos com deficiência visual
Authors: Barros Ana Patrícia Martins , Dantas Filho Francisco Ferreira
Published: October 2019

A pesquisa apresenta contribuições de um deficiente visual responsável pelo departamento de educação inclusiva, quanto às potencialidades de uma proposta didática e os materiais nela utilizados, para o desenvolvimento da compreensão do conteúdo Geometria molecular em uma sala de aula inclusiva. Qualitativamente, este estudo possibilitou validar tais instrumentos observando o contexto da investigação e suas implicações ao propor esta averiguação. Do ponto de vista teórico nos pautamos em Manzato e Santos (2018), Gil (2002), Marconi e Lakatos (2003), Manzato e Santos (2016). A pesquisa exploratória aponta validar instrumentos e proporcionar familiaridade com o campo de estudo. Compõe a primeira etapa de um estudo mais amplo, e é comumente utilizada em pesquisas cujo tema foi pouco explorado, podendo ser aplicada em estudos iniciais para se obter uma visão geral acerca de determinados fatos. Os resultados são animadores tendo em vista que se trata de uma iniciativa para um maior diálogo e percepção para um campo epistemológico, visando uma construção significativa de uma educação inclusiva, principalmente, em uma área ainda tão carente de materiais que possibilite essa inclusão, que é o ensino de Química.
Análise de pesquisas em Educação em Ciências e Ensino de Biologia sobre Educação de Jovens e Adultos(EJA) em periódicos brasileiros
Authors: Pereira Marsílvio Gonçalves , Oliveira Julio César Rufino Ramos de , Ferreira Thiago Dos Santos
Published: October 2019

O artigo investiga publicações sobre Educação de Jovens e Adultos (EJA) em pesquisas em Educação em Ciências e Ensino de Biologia em periódicos nacionais. Foram identificados 20 trabalhos em cinco periódicos brasileiros do extrato Qualis A da CAPES (Ciência & Educação; Investigações em Ensino de Ciências; Ensaio: Pesquisas em Educação em Ciências; Revista Brasileira de Pesquisa em Educação em Ciências e Alexandria). Entre estes, foram analisados 14 artigos através do título, resumo, palavras-chave e leitura integral dos mesmos. As produções foram caracterizadas e classificadas segundo alguns descritores: distribuição geográfica (região de origem das pesquisas), foco temático e procedimentos metodológicos de investigação. Os resultados mostram que as pesquisas estão mais voltadas para estudos sobre ‘estratégias para o ensino-aprendizagem de Ciências na EJA’, ‘concepções dos alunos acerca de temas relacionados à Ciência e à EJA’ e ‘currículo’. Aparecem ainda em pequena quantidade, pesquisas que focalizam em ‘concepções de professores acerca do ensino de ciências na EJA’; ‘análise de aspectos culturais do ensino na modalidade EJA’ e ‘formação de professores’.
Proposta Metodológica para o Ensino de Química Utilizando o Tema Alimentação Saudável
Authors: Rodrigues Rogério Pacheco , Ferreira Danyelle Stéphane Tavares , Da Silva Débora Augustinho , Mateus Kelma Alves , Dos Santos Lucilene Cândida , Felicio Cinthia Maria
Published: October 2019

Trata-se de uma proposta de ensino em que a contextualização e o trabalho interdisciplinar a partir da temática alimentação saudável pode servir como articuladora de relações entre diferentes áreas do conhecimento em ciências e matemática. Utilizando os três momentos pedagógicos de Delizoicov e levantamento de questões sócio científicas (QST), os alunos serão levados a refletirem sobre suas escolhas e pensarem alternativas para se buscar uma alimentação mais saudável. A oficina pedagógica pode ser desenvolvida em diferentes espaços pedagógicos seja em sala de aula ou laboratórios para ensino de ciências e várias estratégias didáticas são propostas, como a utilização de vídeos educativos, análise crítica de artigos científicos, sala de aula invertida e aulas experimentais. Desta forma, acreditamos que este trabalho possa ser de extrema importância para a área do ensino de ciências, pois apresentamos sugestões de como se pode trabalhar diferentes conteúdos de ensino com determinado tema de uma maneira interdisciplinar e em escala macroscópica por meio do desenvolvimento Da experimentação e protagonismo do aluno.