bluuebunny/crossref_metadata_2025 huggingface dataset:
Cuidados paliativos: conceptos básicos
Authors: Santacruz Escudero Juan Guillermo , Martínez Gil Luisa Fernanda
Published: March 2021

Históricamente, los cuidados paliativos se han considerado como una intervención en salud, que busca mitigar el sufrimiento e integrar, de forma holística, todos los aspectos del ser: físicos, psicosociales y espirituales. Estos cuidados se aplican a los pacientes con enfermedades crónicas y amenazantes para la vida, tanto malignas como no malignas, exclusivamente en etapas finales. Esta percepción ha ido cambiando con el paso del tiempo, ya que su objetivo se centra en mejo-rar la calidad de vida no solo de los pacientes, sino de las familias que enfrentan este tipo de enfermedades, desde el momento del diagnóstico y a lo largo del progreso de las mismas. Los cui-dados paliativos han demostrado favorecer la adecuada adherencia a los tratamientos en etapas tempranas, e incluso mejorar la sobrevida en algunas entidades, haciéndose más necesarios e intensos en estadios avanzados, a través del adecuado control sintomático y la intervención multidisciplinaria. En este artículo se presentan los conceptos básicos, un marco histórico y se abre una perspectiva para entender el papel de los cuidados paliativos en la nutrición.
Intensification of the Organic Matter Oxidation in Water Solutions in the Process of Processing with Pulsed High-voltage Discharges
Authors:   Yakushin R.V., Kolesnikov V.A., Brodskiy V.A., Chistolinov A.V., Ofitserov Y.N.
Published: March 2021

Applied aspects of the intensification of organic matter oxidation processes in water solutions have been studied. Data on chemical oxygen demand (COD) decrease and pH changes of the model solutions under the impact of barrier and spark pulsed high-voltage discharges have been presented.
Spatial And Temporal Transformation Of Bottom Sediments In The Volga River. Communication 1. Bottom sediments and their transformation as the result of the increase in the water level of the Cheboksary
Authors:   Zakonnov V.V., Komov V.T., Zakonnova A.V.
Published: March 2021

Spatial and temporal patters of the formation, distribution and accumulation of bottom sediments in the Cheboksary Reservoir at the current water level for the period from 1981 to 2010 are considered. The prediction of their state is made taking into consideration the increase in the level of the Baltic system to 65 and 68 m. The effect of sedimentation processes on mercury deposition in sediments is determined. Some hydrobiological and social aspects of the problem are considered.
Spatial/temporal Variability of the Chegem Glacial River Hydro/chemical Characteristics
Authors:   Gazayev H-M.M., Atabiyeva F.A., Kuchmenova I.I., Zhinzhakova L.Z.
Published: March 2021

Analysis of the river water macro- and micro-component composition spatial/temporal dynamics in the mountain/glacial basin of the Chegem River (Kabardino-Balkaria State High-mountain Natural Reserve) has been carried out according the outcomes of 2014 field exploration. Background excess of Mn compounds has been found at the river range under study in respect of heavy metals.
Dynamics of the Copper Content in the Podborenka River Surface Water
Authors:   Naumova M.E., Bukharina I.L.
Published: March 2021

Outcomes of studying of the urbanized environment impact on the status of the Podborenka River that is the part of the catchment area of the Izhevsk Reservoir, an important city-forming body, are presented. The river hydrological and hydro/chemical characteristics and the copper content dynamics in surface waters during the main hydrological phases have been discussed. It has been found that the main mass of copper is supplied into the water body from the local relief with the atmospheric precipitation surface runoff.
Destination Image in the COVID-19 Crisis: How to Mitigate the Effect of Negative Emotions, Developing Tourism Strategies for Ethnocentric and Cosmopolitan Consumers
Authors: Gómez-Díaz Lorena
Published: March 2021

This paper analyses the role of destination image during the COVID-19 crisis in order to offer practical recom-mendations for destination managers in developing countries. It is argued that the negative emotions triggered during the pandemic will have a direct impact on destination image. Targeting ethnocentric and cosmopolitan consumers is suggested as a potential mitigation strategy, as these consumer’s predispositions might moderate the adverse effect. The paper opts for an argumentation and conceptual model based on a thorough literature review of destination image, negative emotions, consumer ethnocentrism and consumer cosmopolitanism. It is argued that the negative emotions triggered by the COVID-19 crisis have a direct influence on destination image. Furthermore, the consumer predispo-sitions of consumer ethnocentrism and consumer cosmopolitanism moderate the impact of destination image on tour-ism outcomes, such as, intentions to visit and willingness to recommend a destination. Managers must distinguish the affective and cognitive components of destination image in order to identify attributes relevant to the development of tourism strategies. This study provides a theoretical and conceptual foundation for differentiating between the cogni-tive and affective components of destination image, which allows for identifying the impact of negative emotions in a time of crisis. The study further enables managers to develop segmentation strategies based on consumer ethnocen-trism and cosmopolitanism.
Entrepreneurial Orientation in Coworking-Spaces for Corporate Entrepreneurship and Venturing
Authors: Bouncken Ricarda B. , Görmar Lars
Published: March 2021

Firms search for new ways of improving their innovativeness and internal entrepreneurship. Entrepreneurial orientation has been shown to be a powerful facilitator for these tasks. Previous research has shown that entrepreneurial orientation increases by empowerment and proper leadership, yet we know little about the spaces in which it proliferates. We argue that social interaction and autonomy, as prevalent in coworking-spaces, strengthens and complements entrepreneurial orientation. Following the literature on entrepreneurial orientation, as well as coworking-spaces, we pursue a multiple case study analysis. We find that the elements of entrepreneurial orientation as outset by previous studies does not fully describe the entrepreneurial orientation in corporate coworking-spaces. Our findings stress that corporate entrepreneurship research and practice needs to pay more attention to the spatial and interior settings for improving innovativeness and internal entrepreneurship.
TINJAUAN PENANGANAN PENYALAHGUNAAN IZIN TINGGAL KUNJUNGAN WARGA NEGARA ASING OLEH KANTOR IMIGRASI KELAS III NON TPP IMIGRASI BAUBAU TAHUN 2019 DALAM PERSPEKTIF KEAMANAN NASIONAL
Authors: Sudirman Faturachman Alputra , Hamzah Opi Purnama Zatun Bay
Published: March 2021

This study aims to identify and explain the forms of abuse of visit residence permits committed by foreign nationals in the working area of the Class III Non-Immigration Checkpoints Baubau; as well as describing the handling of abuse of residence permits visiting foreign nationals by the Immigration Office Class III Non-Immigration Checkpoints Baubau. Using qualitative research methods with an analysis of the national security approach. The results of the study show that throughout 2019 there were three forms of abuse of visit residence permits in the work area of the Baubau Immigration Office, namely overstaying, working in Indonesian territory without using a work visa, and marrying Indonesian citizens outside the applicable regulations in Indonesia. In dealing with the abuse of stay permits for visiting foreign nationals, the Baubau Immigration Office provides administrative sanctions in the form of deportation from the Indonesian Territory under Law Number 6 of 2011 concerning Immigration Article 75 Paragraph (2) letter f.
Classes de polinômios irredutíveis de graus 3 em Q[x]
Authors: Bemm Laerte , Bemm Priscila Costa Ferreira de Jesus
Published: March 2021

Neste trabalho consideramos polinômios com coeficientes inteiros e estudamos sua irredutibilidade em Q[x]. Para isso, definimos uma relação de equivalência sobre Z[x]\{0} e mostrarmos que os polinômios de grau 3 pertencentes a certas classes de equivalência são irredutíveis em Q[x]. Mostramos também que, em alguns casos, o algarismo das unidades dos coeficientes de um polinômio determina sua classe. Finalmente, mostramos como construir polinômios irredutíveis de Q[x] a partir de um polinômio irredutível conhecido, acrescentando dígitos à esquerda do algarismo das unidades dos coeficientes desse polinômio.
Measurement of propagation of local and minute contractile response in layered myocardium
Authors: Obara Yu , Mori Shohei , Arakawa Mototaka , Kanai Hiroshi
Published: March 2021

The in vivo measurement of the contractile response caused by electrical excitation has been studied to detect myocardial ischemia in its early stages. In the present study, we used our previously proposed local velocity estimator to measure the two-dimensional distribution of the strain rate using high-density beam scanning to obtain propagation of the local and minute contractile response in the heart walls of healthy humans. Alternate layers of contraction and relaxation were observed around the time phase representing the onset of the conduction of electrical excitation. The contraction propagated along the direction of the myocardial fiber in the myocardial layer. These results indicated that the electrical excitation conducted in each myocardial layer and the transmural shearing deformation occurred at the boundary between alternate layers of contraction and relaxation. The measurement of the propagation of the local and minute contractile response can reveal the effective contraction with the transmural shearing deformation.
Biblioteca el manglar, con criterios sostenibles en el distrito de buenaventura
Authors:   Universidad del Pacifico, Arroyo Meza Pedro Nicolás , Valencia Segura Fredy ,   Universidad del Pacifico
Published: March 2021

Con el pasar del tiempo la historia nos ha demostrado que la forma de avanzar y evolucionar como seres humanos ha sido el conocimiento, el cual se ha trasmitido de diferentes formas tales como, jeroglíficos en paredes, papiros, libros, etc. Y todos estos expresados o almacenados en espacios dedicados netamente para ellos. En nuestro pacifico la forma de transmitir el conocimiento de generación en generación ha sido por medio del habla, entendiendo que nuestro lugar donde se ha transmitido y conservado todos estos saberes ha sido la calle como espacio de conservación del mismo, situación que nos lleva a pensar en un espacio el cual permita conservar y preservar todos los saberes ancestrales de nuestra cultura afro descendiente.
Cambio climático: adaptación de la vivienda rural vereda Imbili del concejo comunitario alto rio Mira y frontera, Tumaco – Nariño
Authors:   Universitaria de Popayán, Quintero Portilla Diego Alexander , Villaquirán López Lorena ,   Universidad Iberoamericana, Turbay Varona María Isabel ,   Universitaria de Popayán
Published: March 2021

Los países en vía de desarrollo frecuentemente se enfrentan a eventos de origen natural que puedan afectar gravemente un territorio, estos se magnifican debido a las acciones antrópicas, la ocupación de zonas vulnerables es un proceso recurrente de muchas ciudades y regiones latinoamericanas. Esto se debe principalmente a la pobreza reinante en muchos países, que obliga a la ocupación de zonas inadecuadas para el desarrollo, a la negligencia de las entidades encargadas del control, o en muchos casos a la frágil memoria colectiva que borra fácilmente los antecedentes catastróficos. La falta de planificación, o en muchos casos la planificación deficiente, es normalmente un factor relevante en el incremento del riesgo y la vulnerabilidad frente a este tipo de eventos.
Interventional Pain Medicine Practice in the UK
and the USA: A Survey of 242 Pain Physicians
Authors: Gupta Sanjeeva
Published: March 2021

Background: Pain medicine practices vary across different regions within a country and between
countries.
Objectives: The objective of the survey was to study the variation in interventional pain medicine
practices in the United Kingdom (UK) and the United States (US).
Methods: A survey was designed in 2019 on Survey Monkey®. Pain physicians from the UK and
the US were invited to respond.
Results: A total of 120 responses were received from pain physicians in the UK and 122 from the
US. Twenty-six percent and 90% of pain physicians in the UK and US, respectively, are in full-time
pain medicine practice. There was marked variation in the utilization of diagnostic medial branch
blocks before performing radiofrequency denervation (RFD) between the UK and the US. In the
UK, 42% of pain physicians, and 50% in the US, use a 20-gauge or a 22-gauge radiofrequency
needle for lumbar RFD. Around 30% to 50% of pain physicians, both in the UK and the US,
discontinued antithrombotic agents before medial branch blocks at all the spinal levels. Around
50% of pain physicians in the UK and US are stopping anticoagulants before lumbar and cervical
RFD. Over 95% of UK and US respondents stopped antithrombotic agents for interlaminar and
transforaminal epidural injections along the spine. At the lumbar level, 51% of pain physicians in
the UK and 47% in the US use a particulate steroid for the initial lumbar transforaminal epidural
injection (TFESI); and 4% and 14% in the UK and US, respectively, use a particulate steroid for
initial cervical TFESI. Eight percent of pain physicians in the UK and 20% from the US would switch
to a particulate steroid if the initial TFESI with a nonparticulate steroid did not provide satisfactory
pain relief. Ten percent of pain physicians from the United Kingdom and 20% from the US believed
that this switch provides better pain relief.
Limitations: Interventional pain physicians from the UK and the US were invited to respond. This
may not reflect global practice.
Conclusions: Our survey has highlighted the wide variation in interventional pain medicine
practices both in the UK and the US. The relevant governing bodies in the UK and in the US should
encourage clinicians to use at least an 18-gauge radiofrequency needle for RFD at the lumbar
level. Discontinuing antithrombotic agents for the lumbar medial branch block is not justifiable.
Pain physicians must discuss the advantages and disadvantages of using a nonparticulate over a
particulate steroid preparation with the patient before performing TFESI as a standard procedure
during the consenting process.
Key words: Antithrombotic agents, epidural steroid, medial branch blocks, pain practice
variations, particulate and nonparticulate steroids, radiofrequency denervation, spinal interventions
Effectiveness of Superior Hypogastric Plexus
Neurolysis for Pelvic Cancer Pain
Authors: Hernández-Porras Berenice Carolina
Published: March 2021

Background: The superior hypogastric plexus block has been indicated for visceral pelvic
pain treatment associated with malignancy. The first international report of this technique was
published by Plancarte et al, in which a posterior percutaneous approach guided by fluoroscopy
was described by applying neurolytic agents. The considerable variability in the data reported
gave rise to 2 clinical approaches to those who performed the blockade early and those who
executed it at a later stage of cancer.
Objectives: The present study aims to provide more evidence regarding the effectiveness of
this procedure.
Study Design: This is a retrospective, longitudinal, descriptive study.
Setting: The study was held at the pain unit service of the National Cancer Institute, Mexico
City.
Methods: A nonprobabilistic sample was selected; the data collection took place from January
2006 to December 2016 with patients diagnosed with pelvic pain, confirmed by imaging and
biopsy studies. Patients who received any other type of intervention of the sympathetic axis,
patients with a different approach than the classic or paravertebral technique, and patients with
low survival rate were excluded. The Student t test was used to measure the significant difference
between Visual Analog Scale (VAS) and morphine equivalent daily dose. The Cochran–Mantel–
Haenszel test and the Gamma test were used to measure the association between the initial
Karnofsky and blockade success.
Results: The study included a total of 180 patients. The success rate was 59.4% at 1 month,
55.5% at 3 months, and 48.8% at 6 months. There was a sustained and significant VAS
reduction that was 49.55% at 3 months. A significant reduction in opioid consumption of
12.55% was found at 3 months. There was no significant statistical evidence related to either
opioid consumption or the functionality of the patient before the blockade as an influential
variable in the success of the procedure.
Limitations: Retrospective study, developed in a single center.
Conclusions: Although opioids remain the cornerstone of cancer pain treatment, they
produce many deleterious side effects. The superior hypogastric plexus neurolysis represents
a reproducible and effective alternative in the management of pain in this group of patients.
Key words: Pelvic pain, neoplasms, chemical neurolysis, pain management, cancer pain,
palliative care, analgesia, nerve block
Dynamic Pressure Pain Hypersensitivity as
Assessed by Roller Pressure Algometry in Episodic
Cluster Headache
Authors: Fernández-de-las-Peñas César
Published: March 2021

Background: A method for assessing dynamic muscle hyperalgesia (dynamic pressure
algometry) has been developed and applied in tension-type and migraine headaches.
Objectives: To investigate differences in dynamic pressure pain assessment over the
trigeminal area between men with cluster headache (CH) and headache-free controls, and the
association between dynamic and static pressure pain sensitivity.
Study Design: A case-control study.
Setting: Tertiary urban hospital.
Methods: Forty men with episodic CH and 40 matched controls participated. Dynamic
pressure pain sensitivity was assessed with a dynamic pressure algometry set consisting of 8
rollers with different fixed levels (500, 700, 850, 1,350, 1,550, 2,200, 3,850, and 5,300 g).
Each roller was moved at a speed of 0.5 cm/sec over a diagonal line covering the temporalis
muscle from an anterior to posterior direction. The dynamic pressure threshold (DPT; load
level of the first painful roller) and the pain intensity perceived at the DPT level (roller-evoked
pain) were assessed. Static pressure pain thresholds (PPT) were also assessed with a digital
pressure algometer applied statically over the mid-muscle belly of the temporalis. Patients
were assessed in a remission phase, at least 3 months from the last cluster attack, and without
preventive medication.
Results: Side-to-side consistency between DPTs (r = 0.781, P < 0.001), roller-evoked pain
on DPT (r = 0.586; P < 0.001), and PPTs (r = 0.874; P < 0.001) were found in men with CH.
DPT was moderately, bilaterally, and side-to-side associated with PPTs (0.663 > r > 0.793, all
P < 0.001). Men with CH had bilateral lower DPT and PPT and reported higher levels of rollerevoked pain (all P < 0.001) than headache-free controls.
Limitations: Only men with episodic CH were included.
Conclusions: This study supports that a dynamic pressure algometry is as valid as a static
pressure algometry for assessing pressure pain sensitivity in patients with CH. Assessing both
dynamic and static pain sensitivity may provide new opportunities for differentiated diagnostics.
Key words: Cluster headache, dynamic pressure pain, pressure pain threshold
https://painphysicianjournal.com/current
Authors: Halm-Lutterodt Nicholas Van
Published: March 2021

Background: Chronic neck pain is reportedly considered the fourth leading cause of
disability. Cervical interlaminar epidural injections are among the commonly administered
nonsurgical interventions for managing chronic neck pain, secondary to disc herniation
and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin.
Objectives: To systematically review the differences in the effectiveness of cervical
epidural injections with local anesthetics with or without steroids for the management
of chronic neck pain.
Study Design: Systematic review and meta-analysis.
Methods: A comprehensive search of the literature of randomized controlled trials
(RCTs) that compared epidural injections with local anesthetic with or without steroids
was performed, including a search of PubMed, EMBASE, and Cochrane databases for
all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric
Rating Scale, functional status based on the Neck Disability Index, and opioid intake
dosage.
Results: Four studies met the inclusion criteria. A total of 370 patients were divided
into 2 groups: the experimental group received cervical epidural injection with steroid
and local anesthetic, and the control group received injection with local anesthetic only.
Regrading pain relief, no significant difference was observed between both groups
(weighted mean difference [WMD], –0.006; 95% confidence interval (CI), –0.275 to
0.263; P = 0.963; I2
= 0.0% at 12 months). There was also no significant difference in
the improvement of the functional status (WMD, 0.159; 95% CI, –1.231 to 1.549; P =
0.823; I2
= 9.8% at 12 months). Similarly, there was no significant difference in opioid
dosage (WMD, –0.093; 95% CI, –5.952 to 5.766; P = 0.975; I2
= 0.0% at 12 months).
Limitations: Only a few studies on this premise were found in the literature. There
was also a lack of heterogeneity of the included RCT studies.
Conclusions: The addition of steroids to anesthetic injectates was not associated with
better pain and functional score outcomes compared with anesthetic injectate alone in
patients with chronic neck pain.
Key words: Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal
stenosis, facet joint pathology, cervical epidural injections, steroid injections, local
anesthetic injections, systematic review, meta-analysis, randomized control trial
Long-Term Outcomes of Epidurals with Lidocaine
With or Without Steroids for Lumbar Disc
Herniation and Spinal Stenosis: A Meta-Analysis
Authors: An Jianxiong
Published: March 2021

Background: Previous meta-analyses examined only the short-term differences between
lidocaine and steroids vs lidocaine alone in treating lumbar degenerative diseases. Long-term
outcomes (1-2 years) in patients with lumbar disc herniation (LDH) and lumbar central spinal
stenosis (LCSS) have not yet been systematically evaluated.
Objective: The objective of our study was to assess quantitatively the difference in efficacy
at 1 to 2 years between lidocaine alone vs lidocaine and steroids for the management of LDH
or LCSS.
Study Design: We conducted a meta-analysis.
Methods: PubMed, EMBASE, and the Cochrane library were electronically searched up to July
22, 2016, for randomized controlled trials comparing lidocaine alone vs in combination with
steroids for the treatment of LDH and LCSS. Effective pain relief (EPR), Numeric Rating Scale
(NRS-11), Oswestry Disability Index (ODI), opioid intake (OI), and total employed increased
rate (TEIR) were the endpoints. Risk ratios (RRs) or weighted mean difference (WMD) with
95% confidence intervals (CIs) were calculated, and the pooled analysis was conducted using
RevMan 5.2.
Results: Seven trials were included. EPR was not significantly different at 1 and 2 years,
with RR = 1.08 (95% CI, 0.90-1.30; P = .39) and RR = 1.04 (95% CI, 0.92-1.18; P = .51),
respectively, in patients treated with lidocaine alone vs in combination with steroids. The NRS11 was also similar at 1 and 2 years. ODI and OI were not significantly different at 1 and 2
years. A similar TEIR effect was also observed for the 2 treatments.
Limitations: This meta-analysis relied on a small sample size of trials. Significant
heterogeneity among studies was observed. Several significant differences in terms of age of
the patients were reported in one included trial.
Conclusion: This meta-analysis confirmed the similar effects associated with lidocaine alone
vs in combination with steroids for the management of LDH and LCSS. Studies with longer
follow-up periods are still recommended.
Key words: Effective pain relief, lidocaine, long-term, lumbar central spinal stenosis, lumbar
disc herniation, Numeric Rating Scale, opioid intake, Oswestry Disability Index, steroids, total
employed increased rate
The Effect of Preoperative Opioid Dosage on
Postoperative Outcomes in Patients Undergoing
Knee Surgery
Authors: Xing Bohan
Published: March 2021

Background: Opioid prescription before knee replacement surgery is associated with longer
hospital stays, more postsurgical pain, and a higher rate of complications. Despite the growing
evidence against opioids, they remain popular preoperative pain management prescriptions.
Objectives: The purpose of this study was to examine the effects of dosage of preoperative
opioid use on orthopedic knee surgery pain control and postoperative outcomes and
complications.
Study Design: Observational, retrospective evaluation.
Setting: University of Wisconsin Madison hospitals.
Methods: The patients underwent orthopedic knee surgery between May 1, 2014 and
April 30, 2015. We randomly selected 197 patients and divided them into 2 groups that had
preoperative opioid dosages of either low dose ≤ 120 mEq morphine (MME) or high dose
>120 MME. Of 197 patients, 100 were in the low dose morphine group, whereas 97 were
high dose. The cutoff at 120 MME was calculated to be the median dosage across all patients.
The primary outcomes were compared, differences in postoperative pain control, and range of
motion (ROM). Secondary outcomes included anesthetic complications, length of hospital stay,
postoperative opioid dose, and postoperative complications.
Results: There were no statistically significant differences between the groups with regard
to postoperative pain control, ROM, and immediate postoperative complications. Both groups
showed similar length of hospitalization (2.199 to 2.304 days; P = 0.374), rate of postoperative
infection, and joint intervention. The high dose group was more likely to have postoperative
hemarthrosis and emergency department (ED) visits. However, the low dose group was more
likely to have hypertension concurrently.
Limitations: Because the study length was restricted to one year, the lack of data on longer
term prognosis may limit extrapolation of data. Subjectivity of pain is difficult to measure and
compare objectively. This study was not randomized prospectively, which may bias certain
results due to unobserved differences.
Conclusions: Preoperative opioid dose did not affect postoperative pain control or ROM in
patients who received knee surgeries. Higher preoperative opioid doses were associated with
more hemarthrosis and ED visits. Further exploration into quality of life indices and surgical
complications such as need for revision may be a fruitful avenue.
Key words: Opioids, analgesic, knee pain, total knee replacement, knee surgery, preoperative opioids, knee outcomes
Cross-Cultural Adaptation and Test-Retest
Reliability of the Spanish ROWAN Foot Pain
Assessment Questionnaire (ROFPAQ-S)
Authors: López-López Daniel
Published: March 2021

Background: The ROWAN Foot Pain Assessment Questionnaire (ROFPAQ) may be
considered as a self-reported health questionnaire with 45 items to measure foot health
problems such as foot pain. To date, the ROFPAQ has only been validated into an
English-language version.
Objectives: Therefore this study aim was to perform the cross-cultural adaptation
and test-retest reliability of the Spanish ROFPAQ version (ROFPAQ-S).
Study Design: A cross-sectional descriptive study.
Settings: Podiatry and physiotherapy clinical centers.
Methods: The recommended forward/backward translation protocol was applied for
the procedure of translation and cross-cultural adaptation from United Kingdom to
Spain.
Results: An adequate internal consistency (Cronbach α) was shown for the 3 domains
about cognitive (α = 0.763-0.792), affective (α = 0.751-0.801), and sensory (α = 0.741-
0.733) subscales, as well as for the total score (α = 0.822-0.813). Good test-retest
reliability by intraclass correlation coefficients (ICC [95% confidence interval]) was
shown for the total score (ICC = 0.909 [0.850-0.944]), and each domain such as
cognitive (ICC = 0.785 [0.648- 0.869]), affective (ICC = 0.995 [0.991-0.997]), and
sensory (ICC = 0.662 [0.447-0.794]) subscales. The Spearman correlations (rs) were
adequate for the cognitive (rs = 0.81-0.83), affective (rs = 0.73-0.72), and sensory (rs
= 0.67-0.63) subscales.
Limitations: The original ROFPAQ was developed from a podiatry department of the
health care national service.
Conclusions: The ROFPAQ-S was shown as a valid and reliable tool with an acceptable
use in the Spanish population.
Key words: Foot, quality of life, chronic pain, health impact assessment, validation
studies
Effectiveness of Ginger on Pain and Function
in Knee Osteoarthritis: A PRISMA Systematic
Review and Meta-Analysis
Authors: Araya-Quintanilla Felipe
Published: March 2021

Background: Ginger has been proposed as a complementary treatment for musculoskeletal
pain. However, efficacy, type, and safety remains unclear.
Objectives: To determine the effectiveness of consumption or topical application of ginger
for pain relief and knee function improvement in patients with knee osteoarthritis.
Study Design: Systematic review with meta-analysis of randomized clinical trials.
Methods: An electronic search was performed on Medline, Central, CINAHL, PEDro,
SPORTDiscus, and LILACS databases. The eligibility criteria for selecting studies included
clinical trials that compared consumption and/or topical ginger with placebo or other
interventions for the pain relief and knee function in patients with medical diagnosis of knee
osteoarthritis.
Results: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 4
studies were included. For the comparison capsules versus placebo, mean difference for pain
was −7.88 mm; 95% confidence interval (CI), 11.92 to 3.85 (P = 0.00), and standard mean
difference for knee function was −1.61 points; 95% CI, −4.30 to −1.09 (P = 0.24). For the
comparison of topical ginger versus standard treatment, standard mean difference for pain
was 0.79 mm; 95% CI, −1.97 to 0.39 (P = 0.19), and standard mean difference for knee
function was −0.51 points; 95% CI, −1.15 to 0.13 (P = 0.12).
Limitations: The current evidence is heterogeneous and has a poor methodologic quality.
Conclusions: There is insufficient evidence to support the use of oral ginger compared with
placebo in the pain relief and function improvement in patients with knee osteoarthritis. For
other comparisons, no statistically significant differences were found.
Key words: Osteoarthritis, knee osteoarthritis, ginger, pain, randomized clinical trial,
systematic review
Efficacy of Hyalase Hydrodissection in the
Treatment of Carpal Tunnel Syndrome: A
Randomized, Double-Blind, Controlled, Clinical
Trial
Authors: Kamel Emad Zarief
Published: March 2021

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy,
which results from median nerve compression. A lot of nonsurgical modalities are available for the
management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped
median nerve could offer a desirable sustained symptom alleviation.
Objectives: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain,
functional status, and nerve conduction in patients with CTS.
Study Design: A randomized, double-blinded trial.
Setting: Anesthesia, pain, and rheumatology clinics in a university hospital.
Methods: Patients: 60 patients with CTS (> 6 months’ duration). Intervention: patients were
allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2
(HD with 10 mL saline solution only). Measurements: assessment of pain using Visual Analog Scale
(VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6
months after injection. Nerve conduction parameters before injection and postinjection by the end
of 3 and 6 months were evaluated as well.
Results: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ±
1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week,
and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2
± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group
2 during the same time intervals. Nerve conduction study parameters have shown significantly
higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3
and 6 month follow-up.
Limitation: We suggest a longer period could be reasonable.
Conclusions: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient
technique offering a rapid onset of pain relief and functional improvements, and better median
nerve conduction in patients with CTS over 6 months follow-up duration.
Key words: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection
Analgo-Sedative Effects of Oral or Nebulized
Ketamine in Preschoolers Undergoing Elective
Surgery: A Comparative, Randomized, DoubleBlind Study
Authors: Kamel Alshaimaa Abdel Fattah
Published: March 2021

Background: Premedication in children with ketamine is useful to produce mild sedation,
decrease anxiety, help the child separation from parents, and provide postoperative pain relief with
no or little adverse effects.
Objectives: The aims of this study were to compare the level of sedation, parental separation,
successful venous cannulation, and postoperative analgesia of oral or nebulized ketamine in
preschoolers undergoing elective surgery.
Study Design: A prospective, comparative, double-blind, randomized study.
Setting: Zagazig University Hospitals.
Methods: In the preparation room, 30 minutes before induction of anesthesia, 62 children were
randomly divided into 2 groups: group O (n = 31) received oral ketamine 10 mg/kg in 2 mL apple
juice, and group N (n = 31) received nebulized ketamine 3 mg/kg plus 2 mL isotonic saline solution
by a standard hospital jet nebulizer via a mouth mask with a continuous 6 L/min flow of 100%
oxygen.
Results: At 10 minutes after premedication, sedation score was 3 in group O (34.4%) compared
with group N (0%), and at 20 minutes in group O (93.5%) compared with group N (9.6%) (P <
0.001 ). However, at 30 minutes, 51.6% of group O showed a sedation score of 1 versus 0% of
group N (P < 0.001 ). There were 70.9% of group O versus 6.4% of group N who showed an
Emotional State Score of 1 (P < 0.0001), and 29.03% of group O versus 19.3% of group N who
showed an Emotional State Score of 2 (P = 0.37), with statistically nonsignificant adverse effects in
both groups. Low mean modified Children’s Hospital of Eastern Ontario Pain Scale score in group
O compared with group N at 30, 60, 90 minutes (P < 0.0001).
Limitations: In this study, although the dose of nebulized ketamine was 3 mg/kg, which
was more than the optimum dose investigated in previous studies, it was not adequate, so we
recommend conducting more studies investigating higher doses.
Conclusions: Oral ketamine 10 mg/kg as premedication 30 minutes before induction of
anesthesia is more effective than 3 mg/kg nebulized ketamine in producing more sedation,
satisfactory separation from parents, successful venous cannulation, and effective postoperative
analgesia, as it is more tolerable and accepted by preschoolers undergoing elective surgery.
Key words: Nebulized ketamine, oral ketamine, preschooler, elective surgery
Can People with Chronic Neck Pain Recognize
Their Own Digital Pain Drawing?
Authors: Falla Deborah
Published: March 2021

Background: Although the reliability of pain drawings (PDs) has been confirmed in people
with chronic pain, there is a lack of evidence about the validity of the PD, that is, does the PD
accurately represent the pain experience of the patient?
Objectives: We investigate whether people with chronic neck pain (CNP) can recognize their
own PD to support the validity of the PD in reporting the experience of pain. Moreover, we
examined the association between their ability to recognize their own PD with their levels of
pain intensity and disability and extent of psychosocial and somatic features.
Study Design: Experimental.
Setting: University Laboratory.
Methods: Individuals with CNP completed their PD on a digital body chart, which was then
automatically modified with specific dimensions using a novel software, providing an objective
range of distortion and eliminating errors, which could potentially occur in manually controlled
visual-subjective based methods. Following a 10-minute break listening to music, a series of
20 PDs were presented to each patient in a random order, with only 2 being their original PD.
For each PD, the patients rated its likeliness to their own original PD on a scale from 0 to 100,
with 100 representing “this is my pain.”
Results: Overall, the patients rated their original PD with a median score of 92% similarity,
followed by 91.8% and 89.5% similarity when presented with a PD scaled down to 75%
and scaled up by 150% of the original size, respectively; these scores were not significantly
different to the ratings given for their original PD. The PD with horizontal translation by 40
pixels (8%) and vertical translation by 70 pixels (12.8%) were rated as the most dissimilar
to their original PD; these scores were significantly different to their original PD scores. The
Spearman correlation coefficient revealed a significant negative association between their
ability to recognize their original PD and their Modified Somatic Perceptions Questionnaire
scores.
Limitations: The patients in the study presented with relatively mild CNP, and the results may
not be generalized to those with more severe symptoms.
Conclusions: People with CNP are generally able to identify their own PD but that their ability
to recognize their original PD is negatively correlated with the extent of somatic awareness.
Key words: Chronic pain, perception, pain drawings, somatic awareness
Endoscopically-Assisted Percutaneous Unilateral
Atlantoaxial Screw-Rod Nonfusion Fixation
Treatment for Type II Odontoid Fractures in
Geriatric Patients: Case Series and Technical Note
Authors: Deng Zhong-Liang
Published: March 2021

Background: Considerable controversy exists regarding the optimal treatment for type
II odontoid fractures in geriatric patients. Surgical intervention can help patients return to
their prior level of function as rapidly as possible while avoiding the morbidity and mortality
associated with prolonged and bedbound hospitalization. However, the optimal treatment is
still a difficult choice for patients with increased risk from anesthesia.
Objectives: The objective of our study was to describe an innovative method of
endoscopically-assisted percutaneous unilateral C1 lateral mass screw and C2 pedicle screwrod nonfusion fixation for type II odontoid fractures in geriatric patients.
Study Design: A case series design and technical notes.
Setting: This study took place at Second Affiliated Hospital of Chongqing Medical University.
Methods: Seven geriatric patients (> 65 years) with type II odontoid fractures and an
American Society of Anesthesiologists (ASA) score of 2 or higher received endoscopicallyassisted percutaneous unilateral atlantoaxial screw-rod nonfusion fixation. After surgery, all
patients were required to wear a rigid collar full-time for 12 weeks. Intraoperative data, the
bone union time, American Spinal Injury Association (ASIA) scale scores, Neck Disability Index
(NDI) scores, and postoperative complications were collected for assessment.
Results The surgical goal was successfully achieved in all patients, 3 of whom had high ASA
scores (≥3) and underwent surgery under local anesthesia. The operative time ranged from
112 to 169 minutes (mean, 131.1 minutes). No neurovascular complications were observed
intraoperatively or postoperatively. All patients rapidly returned to their prior level of function
and were followed up for 12 to 24 months (average: 16.9 months). Bone union was achieved
in all patients.
Limitations: This study is limited by being a retrospective study.
Conclusions: Endoscopically-assisted percutaneous unilateral atlantoaxial screw-rod
nonfusion fixation is a feasible technique for type II odontoid fractures in geriatric patients.
This method offers a compromise between non-operative and operative treatment and allows
geriatric patients to rapidly return to their prior level of function.
Key words: Endoscopically-assisted surgery; geriatric patient; percutaneous atlantoaxial
fixation; type II odontoid fracture; unilateral nonfusion fixation
Management of Cardiac Implantable Electrical
Devices in Patients Undergoing Radiofrequency
Ablation for Spine Pain: Physician Survey and
Review of Guidelines
Authors: Friedrich Jason
Published: March 2021

Background: More patients with cardiac implantable electrical devices (CIEDs) are presenting to
spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although
the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA
procedures, available guidelines do not specifically address CIED management for percutaneous RFA
for zygapophyseal (z-joint) joint pain, and thus physician practice may vary.
Objectives: To better understand current practices of physicians who perform RFA for chronic
z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines
are also reviewed to specifically address risk mitigation strategies for potential EMI created by
ambulatory percutaneous spine RFA procedures.
Study Design: Web-based provider survey and narrative review.
Setting: Multispecialty pain clinic, academic medical center.
Methods: A web-based survey was created using Research Electronic Data Capture (REDCap). A
survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American
Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain
Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative
review summarizes pertinent case series, review articles, a SIS recommendation statement, and
multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures.
Results: A total of 197 clinicians participated in the survey from diverse clinical backgrounds,
including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and
neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in
provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated
they would like more specific guidelines to aid in management and decision-making around
CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to
perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures.
However, combining the risk mitigation strategies provided in these guidelines, with interventional
pain physician clinical experience allows for reasonable management recommendations to aid in
decision-making.
Limitations: Although this manuscript can serve as a review of CIEDs and aid in management
decisions in patients with CIEDs, it is not a clinical practice guideline.
Conclusions: Practice patterns vary regarding CIED management in ambulatory spine RFA
procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity
of a spine RFA procedure and necessitates some added precautions.
Key words: Radiofrequency ablation, neurotomy, cardiac implantable electrical device,
zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain
Pressure-Induced Referred Pain as a Biomarker of
Pain Sensitivity in Fibromyalgia
Authors: EstebanHerreros Elizabeth Bravo
Published: March 2021

Background: Fibromyalgia (FM) syndrome is characterized by widespread pain, fatigue, and
generalized increased pain sensitivity. Appropriate and simple pain models are methods employed to
assess pain mechanisms that can potentially lead to improved treatments. Pressure pain thresholds
(PPTs) or mapping the referred pain area produced by pressure stimulation at suprathreshold
intensities are used to assess pain mechanisms. The optimal suprathreshold stimulation intensity to
elicit referred pain with minimal discomfort for patients with FM has yet to be determined.
Objectives: The aim of this study was to compare the area and intensity of pressure-induced
referred pain in patients with FM as elicited by systematic increases in PPTs, compared with controls.
Study Design: Observational, crossed-section study.
Setting: Research laboratory.
Methods: Twenty-six patients with FM and 26 healthy controls, age- and gender-matched, were
included. Suprathreshold stimulation was applied to the infraspinatus muscle of the dominant side
at 4 different intensities (PPT +20%, +30%, +40%, and +50%), after which referred pain was
evaluated by measuring the area of pain in pixels using a digital body chart and its intensity on
a Visual Analog Scale. Factors related to anxiety condition, pain catastrophizing, depression, and
quality of life were recorded.
Results: The referred pain areas were larger in the FM group compared with healthy individuals
at 120% (P = 0.024), 130% (P = 0.001), 140% (P = 0.001), and 150% (P = 0.001) PPT, however,
within the FM group no differences were found between the intensity of suprathreshold stimulation
and the size of the referred pain areas (P = 0.135) or pain intensity (P > 0.05). There was a positive
correlation between the size of referred pain areas and pain catastrophizing in the FM group (r =
0.457, P = 0.032).
Limitations: This study presents some limitations, among which is the variability found in the
referred pain areas.
Conclusions: These findings show that referred pain induced by applying a suprathreshold
pressure of 120% PPT can be a useful biomarker to assess sensitized pain mechanisms in patients
suffering from FM.
Key words: Referred pain, pain sensitivity, fibromyalgia, central sensitization, suprathreshold,
pressure pain threshold, biomarker, facilitated pain mechanisms