bluuebunny/crossref_metadata_2025 huggingface dataset:
La conciencia ambiental en la educación inicial
Authors: Escalante Velez Lisset Stephany
Published: October 2024

En la actualidad el medioambiente es un tema preocupante por el manejo inadecuado de los recursos naturales, dando importancia a la educación ambiental en los primeros años del individuo para contribuir a su conservación y desarrollo. Este estudio tuvo por objetivo analizar las investigaciones sobre la conciencia ambiental en el nivel de educación inicial, a partir del aporte teórico y pragmático en el arte de las investigaciones existentes. Como método se planteó bajo el enfoque cualitativo, usando la modalidad de revisión sistemática de artículos en revistas indexadas: CONCYTEC, DIALNET, SCIELO, PROQUEST, EBSCO y CONACYT, desde 2018 hasta la actualidad. Como conclusión existe un acervo de indagaciones en torno a la conciencia ambiental en la educación inicial, que se asume como una fortaleza docente, pues la toma de conciencia no solo debe ser por parte de los estudiantes, si no de acuerdo con los nuevos enfoques educativos.
Liderazgo directivo en la educación: Una revisión literaria
Authors: Gamarra Huamanttica Julio Cesar
Published: October 2024

El liderazgo directivo en la educación es fundamental para mejorar la calidad educativa y la dinámica escolar. Este estudio revisa cómo características y enfoques del liderazgo impactan en el entorno educativo. por ello, el objetivo de este estudio fue analizar las características y enfoques del liderazgo directivo en la educación y su influencia en la calidad educativa y la cohesión de la comunidad escolar. Se realizó una revisión sistemática de la literatura sobre teorías de liderazgo educativo, incluyendo liderazgo transformacional, distribuido, ético, y enfoques basados en la instrucción y la inclusión. También se examinaron estudios sobre la innovación educativa y la participación familiar. Se concluye en que el liderazgo efectivo, caracterizado por una visión compartida y una gestión del cambio adecuada, es crucial para mejorar la calidad educativa. La participación activa de la comunidad y la promoción de la innovación educativa son esenciales para un entorno escolar positivo.
PENGARUH VARIASI VOLUME SAMPEL DARAH DAN DIAMETER SEDIAAN DARAH TEBAL PADA PEMERIKSAAN Plasmodium falciparum
Authors: Kawaitouw Leberina , Mulia Yuliansyah Sundara , Sulaeman Sulaeman , Rahmat Mamat
Published: October 2024

Pemeriksaan Plasmodium secara mikroskopik merupakan gold standart dalam diagnosis infeksi. Sampel darah yang akan diperiksa dibuat sediaan darah tebal dan tipis. Sediaan darah tebal menggunakan sampel darah lebih banyak sehingga pada kasus malaria ringan, parasit mudah ditemukan. Tujuan penelitian untuk mengetahui perbandingan antara volume sampel darah 8µl, 10µl dan 12µl pada diameter 1cm dan diameter 1,5cm terhadap jumlah parasit P.falciparum. Penelitian ini menggunakan metode quasi eksperimen. Bahan pemeriksaan adalah darah EDTA 3mL yang diperoleh dari pasien terkonfirmasi positif P.falciparum, dilakukan pembuatan sediaan darah tebal dengan volume darah 8µl, 10µl dan 12µl pada diameter 1cm dan 1,5cm yang di multipikasi sebanyak 30 sediaan. Selanjutnya sediaan diwarnai dengan Giemsa 3% dan diperiksa secara mikroskopik menggunakan metode perhitungan kuantitatif. Data dianalisis menggunakan uji statistik Anova dengan derajat kepercayaan 95% didapatkan nilai signifikan pada diameter 1cm nilai 0.106>0.005 maka hipotesa Ha diterima. Pada sediaan darah diameter 1,5cm nilai 0.000<0.005, maka hipotesa Ho diterima. Kesimpulan adalah tidak terdapat perbedaan hasil jumlah P.falciparum pada volume sampel darah 8µl, 10µl dan 12µl pada diameter 1cm dan terdapat perbedaan jumlah P.falciparum pada volume 8µl, 10µl dan 12µl pada diameter 1,5cm.
Visitantes florais e produção de frutos de Cagaiteira (Eugenia desynterica DC.)
Authors: Xavier Torres Gessica , Cardoso Brandão Daniel , Barboza de Souza Eli Regina , Silva-Neto Carlos de Melo e
Published: October 2024

A cagaiteira Eugenia dysenterica é uma importante espécie frutífera nativa dos cerrados brasileiros, pertencente à família Myrtaceae. A polinização representa um dos serviços ambientais de alcance global, desempenhando um papel essencial na preservação da biodiversidade tanto de plantas silvestres quanto agrícolas em âmbito mundial. Com isso, o trabalho objetivou realizar o levantamento dos principais visitantes florais da coleção de E. dysenterica, implantada na área experimental da Escola de Agronomia da Universidade Federal de Goiás em Goiânia, GO. A E. dysenterica recebeu a visita de cerca de 13 espécies de visitantes florais. Dentre os visitantes, as espécies Scaptotrigona depilis, Paratrigona lineata, Exomalopsis analis, vespas (Polybia sp.) e dípteras. A taxa de conversão de flores em frutos para as flores abertas (sem ensacamento) foi de 11%, já as flores que foram isoladas com visitantes florais e potenciais polinizadores, apresentaram taxa de conversão de flor em fruto de apenas 5%.
A Universal Framework for General Prediction of Physicochemical Properties: The Natural Growth Model
Authors: Fan Jinming , Qian Chao , Zhou Shaodong
Published: October 2024

To precisely and reasonably describe the contribution of interatomic and intermolecular interactions to the physicochemical properties of complex systems, a chemical message passing strategy as driven by graph neural network is proposed. Thus, by distinguishing inherent and environmental features of atoms, as well as proper delivering of these messages upon growth of systems from atoms to bulk level, the evolution of system features affords eventually the target properties like the adsorption wavelength, emission wavelength, solubility, photoluminescence quantum yield, ionization energy, and lipophilicity. Considering that such a model combines chemical principles and natural behavior of atom aggregation crossing multiple scales, most likely, it will be proven to be rational and efficient for more general aims in dealing with complex systems.
Incidence Rates and Time Trends of Pancreatic Cancer in the Golestan Province, Northeastern Iran, 2006-2019
Authors: Kaabe Sajjad , Amiriani Taghi , Teimoorian Mehrdad , Besharat Sima , Salamat Faezeh , Hasanpour-Heidari Susan , Sedaghat SeyyedMehdi , Sadeghzadeh Hamideh , Roshandel Gholamreza
Published: October 2024

Background: Pancreatic cancer (PC) is one of the most malignant cancers with a poor prognosis. Despite advances in the diagnosis and management of PC, the survival rate remains low. In Iran, the incidence of PC is increasing, with mortality rates nearly doubling over the past 25 years. Therefore, this study was designed to assess the temporal variations and incidence of PC in Golestan province, as a prominent hub for gastrointestinal cancers in Iran. Methods: In this cross-sectional study, patient information was obtained from the Golestan Population-Based Cancer Registry (GPCR) from 2006 to 2019. We calculated age-standardized incidence rates (ASRs) using the World standard population and reported the rates per 100000 persons-year. To compare ASRs across sexes and residence areas, incidence rate ratios (IRR) were calculated using Poisson regression models. We calculated the estimated annual percentage changes (EAPC) to assess time trends in incidence rates of PC in Golestan during the study period. Results: Among a total of 560 PC new cases (mean age of 63.72 years), 46.61% were diagnosed through clinical or paraclinical methods. The crude incidence rate and ASR were 2.24 and 2.95 (95% CI: 2.70‒3.20) per 100000 persons-year, respectively. The ASR of PC was significantly higher in males (3.78; 95% CI: 3.37‒4.19) than females (2.17; 95% CI: 1.88‒2.46) (IRR=1.71; P<0.01). The ASR was higher in the urban (3.23; 95% CI: 2.88‒3.58) compared to the rural population (2.65; 95% CI: 2.30‒3.00) (IRR=1.23; P=0.02). The ASR of PC increased from 1.97 to 3.53 during 2006 to 2019 with an EAPC of 4.39 (95% CI: -3.56 to 12.75). The EAPCs were 4.85% and 4.37% in women and men, respectively. Conclusion: Our study showed that the incidence of PC is increasing in the Golestan province. Also, the incidence rate was higher in men, elderly people, and the urban population.
Mesoporous Silica Administration as a New Strategy in the Management of Warfarin Toxicity; In Vitro and In Vivo Study
Authors: farjadian fatemeh , parsi fatemeh , Heidari reza , Zarkesh khatereh , Mohammadi Hamid Reza , Mohammadi Samani Soliman , tayebi lobat
Published: October 2024

Purpose: Warfarin is one of the most widely used anticoagulants that function by inhibiting vitamin K epoxide reductase. Warfarin overdose, whether intentional or unintentional, can cause life-threatening bleeding. Here, we present a novel warfarin adsorbent based on mesoporous silica that can act as an antidote to warfarin toxicity. Method: Amino-functionalized mesoporous silica (MS-NH2) was synthesized based on co-condensation method through a soft template technique followed by template removal. The prepared structure and functional group were studied by FT-IR, XRD. The morphology was checked by SEM and TEM. The capacity of MS-NH2 in the adsorption of warfarin was evaluated in vitro, at pH=7.4 and pH=1.2. In vivo evaluation was performed in control and warfarin-overdosed animal models. Overdosed animals were treated with MS-NH2 by oral gavage. Biomarkers of organ injury were assessed in animal serum. Results: The MS-NH2 were relatively uniform, spherical with defined diameters (400 nm) and homogeneous structure. synthesized particles had a large surface area (1015 m2 g-1) and mean pore diameter 2.4 nm which leaded considerable adsorption capacity for warfarin 1666 mg/g. In vivo studies revealed that oral administration of MS-NH2 in mice poisoned with warfarin caused a significant difference (p < 0.05) on International Normalized Ratio (INR) and prothrombin time (PT). Moreover, the warfarin with MS-NH2 group demonstrated a notable decrease in biomarkers associated with tissue damage, such as bilirubin, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Conclusion: The results confirm that MS-NH2 administration can be an effective treatment for warfarin toxicity and could potentially mitigate the adverse effects of warfarin poisoning.
Evaluation of "Age-Friendly City" Indicators in Golestan Province From the Perspective of the Older Adult Population
Authors: Moradi Ali , Akbari Ali , Sanagoo Akram , Abolghazi Maryam , Vodjani Homa , Gharajeh Anita , Talebi Zahra , Jouybari Leila , Nasiri Hossein , Mehravar Fatemeh
Published: October 2024

Objectives: To evaluate age-friendly city indicators from the perspective of the older adults in Golestan province in 2023. Design: A descriptive-analytical cross-sectional study. Setting(s): Golestan province, Iran. Participants: Individuals aged 60 years and above. Outcome measures: A sample of 310 participants was selected using proportional stratified sampling. Data were collected with a validated age-friendly city questionnaire. Results: The mean age of the participants in this study was 70.34±7.73 years (ranging from 60 to 99), with 64.5% being male. Among the three examined components, the component of respect and social security had the highest average among the older adults (4.65±17.72), followed by social participation (4.79±16.30) and civic engagement and employment (4.052±12.20). Agefriendly city indicators demonstrated statistically significant differences in variables such as city of residence (P=0.02), support source (P=0.009), income level (P=0.001), and marital status (P=0.05). Conclusions: None of the examined age-friendly city components in Golestan province met the necessary standards. Recommendations include enhancing efforts by service organizations to improve conditions for older adults.
Anonim Şirketlerde Elektronik Genel Kurul Toplantısı
Authors: Aktepe Gökhan
Published: October 2024

6102 sayılı Türk Ticaret Kanunu’nun getirdiği önemli yeniliklerden birisi de anonim şirketlerde elektronik ortamda genel kurul toplantısı düzenlenmesine izin vermesidir. Kanunun 1527. maddesi ile birlikte kanun koyucu, genel kurul toplantısında fiziken hazır bulunmayan pay sahiplerinin toplantıya elektronik ortamda katılımına yasal bir dayanak oluşturmuştur ve elektronik ortamda katılma, öneride bulunma, görüş açıklama ve oy vermenin, fizikî katılmanın ve oy vermenin bütün hukuki sonuçlarını doğuracağını öngörmüştür. Çalışma kapsamında bilhassa Covid-19 pandemisinde değerini kanıtlamış olan elektronik genel kurulun avantajları ve dezavantajları değerlendirilmiş, karma ve sanal genel kurul toplantıları olmak üzere türleri izah edilmeye gayret edilmiş, hukukumuzdaki düzenlemeler ele alınmış ve Delaware eyaleti, Almanya ve İsviçre’deki gelişmeler ve düzenlemeler incelenerek benimsenebilecek çözüm önerileri arayışına girilmiştir.
Front Matter
Authors: The Editors
Published: October 2024

The Editors
A novel method for the degradation of human blood clot by immobilised bromelain using multi-walled carbon nanotube and polyphenol oxidase
Authors: Al-Sa'ady Ali J. R. , Abdulameer Zainab W. , Saady Sumaya , Al-Obaidi Mohammed J. , Al-Fayyadh Mohanad S. , Hassan Haider A. , Ismael Kefah H. , Hanoon Ahmad Y. , Alqaissy Iftikhar A.
Published: October 2024

Pathological blood clot in blood vessels, which often leads to cardiovascular diseases, are one of the most common causes of death in humans. Therefore, enzymatic therapy to degrade blood clots is vital. To achieve this goal, bromelain was immobilized and used for the biodegradation of blood clots. Bromelain was extracted from the pineapple fruit pulp (Ananas comosus) and purified by ion exchange chromatography after precipitation with ammonium sulphate (0-80 %), resulting in a yield of 70%, purification fold of 1.42, and a specific activity of 1175 U/mg. Bromelain was covalently immobilized on functionalized multi-walled carbon nanotubes (MWCNT), with an enzyme loading of 71.35%. The results of the characterization of free and immobilized bromelain demonstrated that the optimum pH for free and immobilized bromelain activity was 7.0, while the pH range of stability was from 5.0 to 8.5 and 4.0 to 9.0, respectively. The optimum temperature for free and immobilized bromelain activity was 45ºC, whereas the stability was 15 to 50°C and 15 to 55°C, respectively. The immobilized bromelain activity was decreased after the fifth reuse, and the storage period of the free and immobilized bromelain was decreased after 6 and 123 days, respectively. Casein was the best substrate-free bromelain, and fibrin was the best substrate for immobilized bromelain. The results of the purification of polyphenol oxidases (PPO) from potatoes by ion exchange chromatography gave a yield of about 54 %, a purification fold of 1.27, and a specific activity of 2804 U/mg. The current study showed that the immobilized bromelain can significantly biodegrade human blood clots in vitro, while the PPO enzyme has no significant effect on blood clots.
Changes in morphometric indicators of liver blood vessels under conditions of long-term ethanol exposure
Authors: Mykytenko A.O. , Akimov O.Y. , Yeroshenko G.A. , Neporada K.S.
Published: October 2024

Hyperdynamic splanchnic blood circulation is an important component of portal hypertension syndrome, which develops under conditions of chronic alcoholic hepatitis. Angiogenesis caused by alcohol consumption contributes to the development of splanchnic hyperemia and the development of portal-systemic collaterals. The purpose of the study is to study the morphometric indicators of the vascular bed of the liver of rats under the conditions of chronic alcoholic hepatitis modeling. Experiments were performed on 30 white, sexually mature male Wistar rats weighing 180–220 g. The animals were divided into 2 groups: I (control group) contained 6 rats; II – 24 rats that modeled chronic alcoholic hepatitis by the method of forced intermittent alcoholization for 5 days, with a repeat after two days by intraperitoneal injection of a 16.5% ethanol solution in a 5.0% glucose solution, at the rate of 4 ml/kg of body weight. Animals were removed from the experiment on days 35, 42, 49, and 56 by taking blood from the right ventricle of the heart under thiopental anesthesia. On the 35th day of simulation of chronic alcoholic hepatitis, the inner diameter of central veins, lobular arterioles and interlobular veins increased, and interlobular arteries and lobular venules decreased compared to the control. On the 42nd day of simulation of chronic alcoholic hepatitis, the internal diameter of central veins, lobular arterioles and interlobular veins increased, and interlobular arteries decreased compared to the control. On the 49th day of simulation of chronic alcoholic hepatitis, the inner diameter of the central veins, lobular arterioles, and interlobular veins increased, and the interlobular arteries decreased compared to the control. On the 56th day of simulation of chronic alcoholic hepatitis, the inner diameter of the central veins and lobular arterioles increased, and the interlobular arteries and lobular venules decreased compared to the control.

Keywords: arteries, veins, arterioles, venules, sinusoidal capillaries.
The Effect of Stress on Self-injury Behavior in Adolescents: Moderated Mediating Effect of Anxiety by Social Support
Authors:   The Correction Welfare Society of Korea, Park Young Suk , Yoo Ju Young
Published: October 2024

The purpose of this study is to determine whether there is a moderated mediating effect of anxiety through social support in the process of stress influencing self-injury behavior. The subjects of the study were 5,937 elementary, middle, and high school students from the Korea Youth Policy Institute's ‘2021 Mental Health Survey of Teenagers’ data, and the adjusted mediation effect was verified using the Macro Process for SPSS program. The research results are as follows.
First, as a result of examining the mediating effect of anxiety in the relationship between stress and self-injury behavior, it was confirmed that anxiety has a mediating effect in the process of stress affecting self-injury behavior. The results of a bootstrapping analysis to verify the significance of the indirect effect of anxiety, a mediator, showed that the mediation effect was statistically significant. Second, as a result of conducting a moderating effect analysis to determine whether social support plays a moderating role in the relationship between anxiety, which is a mediating variable, and self-injury behavior, which is a dependent variable, it was found that social support has a moderating effect in explaining the relationship between anxiety and self-injury behavior. appear. Third, as a result of analyzing the moderated mediation effect of anxiety through social support in the process of adolescent stress influencing self-injury behavior, the results showed that anxiety was moderated by social support in the process of adolescent stress influencing self-injury behavior. The effect was found to be significant. Based on these results, we proposed measures to manage stress, reduce anxiety, and expand the social support system as part of an effort to reduce self-injury behavior in adolescents.
Transformando la convivencia escolar: estrategias de innovación educativa para abordar el acoso entre agresores y víctimas en educación primaria (España)
Authors: Soriano-Sánchez Jose
Published: October 2024

The development of assertiveness and empathy in the school environment contributes to creating a positive atmosphere, preventing bullying, promoting socio-emotional development, and improving academic performance. Therefore, the objective of this study is to analyze the level of assertiveness and empathy in aggressors and victims in school coexistence in primary education in an urban municipality in the province of Granada (Spain), with the aim of proposing an innovative teaching practice in response to this coexistence environment and improving the quality of education. The approach was quantitative, with a descriptive design. The sample consisted of 47 participants from the 6th grade, aged between 11 and 13 years (M = 11.43; SD = 0.50), to whom the Assertive Behavior Scale for Children (CABS) and the Interpersonal Reactivity Index were applied to measure assertiveness and empathy, respectively. The results revealed that students who act as aggressors or consider themselves victims show lower levels in both competencies (3.90% aggressors, 30.30% victims, 69.70% non-victims). Therefore, assertiveness and empathy are not only independent skills but are interrelated and mutually reinforcing. Thus, to reduce aggressive behaviors and situations of victimization, it is essential to promote both assertiveness and empathy. It is concluded that by developing these skills, more effective and respectful communication is promoted, which can decrease conflicts and improve school coexistence.
Design of Robotics Implementation of A Fingerprint Biometric System
Authors: Idris Aremu , Olalekan Tiamiyu , Serifat Ganiu , Muyis Davies , Mosebolatan Olojede
Published: October 2024

Biometrics, rooted in the Greek terms "bios" (life) and "metrikos" (measure), represents a modern approach to identifying individuals based on their unique physical characteristics, such as fingerprints, facial features, and iris patterns. In today's increasingly digital landscape, traditional security methods like passwords and keys have become inadequate in safeguarding sensitive information. The rise of sophisticated cyberattacks and unauthorized access has highlighted the need for more advanced and secure authentication methods. This project aims to design and implement a fingerprint biometric system using robotics and FPGA technology. The system is intended to provide a more reliable and secure method of verifying identities by capturing and processing fingerprint images. It will extract minutiae points, the unique features within a fingerprint, to create a robust authentication mechanism. This approach promises to enhance security by offering an alternative to conventional methods that are often vulnerable to breaches. In developing this biometric system, the focus will be on ensuring that it can be effectively integrated into various applications where secure access control is crucial. By leveraging the unique and immutable nature of fingerprints, the system will reduce the risks associated with password reuse, theft, and unauthorized sharing. The inclusion of continuous authentication techniques will further strengthen security, ensuring that the user’s identity is verified throughout a session, not just at the initial login. Additionally, the project will incorporate version control mechanisms to track the development and deployment of the system, ensuring that any changes or updates can be easily managed and reviewed. This will help maintain the system's reliability and effectiveness over time, allowing it to adapt to evolving security challenges. Through this work, we aim to contribute to the broader adoption of biometric technologies in securing digital and physical environments, paving the way for more secure and seamless user experiences.
Stunting Prevention in the Preconception Period
Authors: Wizia Lady , Yusrawati Yusrawati , Meinapuri Malinda , Masrul Masrul , Yetti Husna , Afdal Afdal
Published: October 2024

Background: The stunting rate in Indonesia in 2022 was 21.6%. I was reduced when compared to the SSGI data in 2021 of 24.4%. The stunting rate appears to be decreasing from year to year, but a joint commitment is still needed to achieve the target of reducing stunting to 14% by 2024. Stunting prevention is a much more effective step than stunting treatment itself. Prevention of stunting can be done by optimizing the role of mothers in the golden phase of child development. stunting prevention in Indonesia still focuses on pregnancy and toddlers, while prevention during the preconception period is still limited.Purpose:To synthesize and critically effective steps that can be taken to prevent stunting in the preconception periodMethods:The research method employed was a literature review, conducted by using primary studies from PubMed, google scholar, and ScienceDirect with the keywords “stunting; prevention; praconception” published between 2017-2023, in English, open access, and relevant to the topicResults:A total of 397 research articles were screened for eligibility, and 15 articles met the inclusion criteria. Based on the 15reviewed articles, devide into three themes: Nutritional status during preconception, Supplementation during preconception and Lifestyle during preconceptionConclusion: This review found that there are several efforts made in preventing stunting in the preconception period. it is recommended that health workers can optimize the prevention of stunting in the preconception period.
APPLICATION OF A WEIGHTED MOVING AVERAGE FORECASTING MODEL FOR APPAREL PRODUCTION PLANNING AND RESOURCE OPTIMIZATION IN THE FASHION INDUSTRY
Authors: Augusta Amaihian , Chukwuma Miracle , Nsikan John , Onayemi Oluwakemi
Published: October 2024

Demand forecasting is essential for businesses, particularly in the fashion industry, because it predicts future demand for clothing and accessories, thereby aiding in informed production decisions. However, the continuous increase in inventory stock outages, inaccurate forecasting, and inefficient supply chain coordination in the Nigerian fashion industry offers a valid opportunity for empirical investigation. This study examines the effect of the weighted moving average (WMA) demand forecasting on production planning and resource optimization in the fashion industry. A cross-sectional survey of 105 fashion industry professionals was conducted. Data collected through the structured questionnaire were analyzed using partial least squares structural equation modeling (PLS-SEM). The study found that accurate demand forecasting using the WMA positively impacts resource optimization and production planning. Effective resource optimization measures significantly enhance production outcomes. Emphasizing adaptive forecasting methods and dynamic resource management capabilities strengthens the relationship between demand forecasting and production planning. The findings provide valuable insights for fashion industry operation managers to improve demand forecasting practices and resource management, leading to better production planning and enhanced operational efficiency.
Siamo bravi in italiano?
Authors: Patota Giuseppe
Published: October 2024

Ci sono pervenute molte domande che si chiedono se l’aggettivo bravo possa reggere un complemento introdotto non solo dalla preposizione in (bravo in matematica), ma anche da a (bravo a matematica) e se, prima di un verbo, oltre ad a (bravo a fare), si possa usare anche di (bravo di fare). Le stesse incertezze fra le tre preposizioni riguardano il verbo interrogare e il sostantivo interrogazione, nonché  l’espressione prendere un bel voto: si dice ho preso otto in italiano o di italiano o a italiano? 
Peripheral Nerve Stimulation With High-Frequency Electromagnetic Coupling at the Sural and Posterior Tibial Nerves for the Treatment of Complex Regional Pain Syndrome in Lower Extremities: Case Report
Authors: Almonte Wilson
Published: October 2024

BACKGROUND: Complex regional pain syndrome (CRPS) type 1 is a debilitating condition that is notoriously difficult to treat due to its various manifestations. Peripheral nerve stimulation (PNS) is generally recommended when a patient’s symptoms are refractory to conservative measures, as CRPS often is. We present one case of CRPS with intractable lower extremity pain managed effectively with PNS. CASE REPORT: A 32-year-old man developed CRPS after a work-related accident that resulted in multiple injuries, including a crushed pelvis, injured left lower extremity, and a fractured face and skull. After pelvic and hip reconstruction, the patient was left with numbness, tingling, and pain in the left foot affecting functional activities and sleep. Previous therapies, including nerve blocks, physical therapy, narcotics, opioids, anticonvulsants, antidepressants, and nonsteroidal anti-inflammatory drugs, did not alleviate symptoms. The placement of a PNS device, however, led to significant improvement. RESULTS: Pain scores at baseline compared to 12-month follow-up decreased from 6/10 to 2/10 at rest and from 8/10 to 4/10 with activity. Average hours of sleep per night increased from 4 to 8 hours (an improvement of 100%). Antidepressants have been discontinued and opioids reduced to an as-needed basis (once every few days). The patient reports decreased sensitivity to cold, reduced swelling, and improved color changes in the foot. In addition, the patient has been able to increase activity, such as walking, standing, and wearing closed-toed shoes, from 20 minutes to now 4 hours at a time with pain levels maintained at a 4/10. CONCLUSIONS: Subthreshold PNS utilizing high-frequency electromagnetic coupling at the posterior tibial and sural nerves successfully relieved the patient’s chronic, debilitating pain in the lower extremity as a result of CRPS. KEY WORDS: Peripheral nerve stimulation, chronic pain, posterior tibial, sural, CRPS, lower extremity, foot
High-Frequency Cervical and High Thoracic Spinal Cord Stimulation to Treat Refractory Failed Back Surgery Syndrome in a Patient with Chronic Neck and Low Back Pain: Case Report
Authors: Music Stephen
Published: October 2024

BACKGROUND: Failed back surgery syndrome (FBSS) is defined as lumbar spinal pain of unknown origin that persists following surgical intervention or newly presents after spine surgery (1). This pain may originate from surgery, or the surgery may worsen or insufficiently reduce prior pain (1). From 2004 to 2015, the volume of lumbar fusion surgery increased by 62.3% (2). With the frequency of lumbar fusion surgery comes an increased propensity to develop FBSS. The risk of developing FBSS in patients who have undergone lumbar spine surgery is as high as 50% (3). Spinal cord stimulation (SCS) is a well-established, safe, and effective treatment modality for refractory neuropathic pain conditions such as FBSS (4). CASE REPORT: A 47-year-old patient presented to the clinic with a history of cervical radiculopathy status post C4-C7 posterior spinal fusion, lumbar radiculopathy, lumbar spinal stenosis, congenital spondylolisthesis status post L5-S1 anterior lumbar interbody fusion complicated by a malpositioned screw at the L4-L5 level, L4-L5 retrolisthesis, L5-S1 pseudoarthrosis with subsequent T10 to pelvis fusion, which was later extended to T8 after a fall. The patient developed FBSS resulting in debilitating neck and low back pain. Permanent SCS with leads at C7-T3 were placed without complication. The SCS implant resulted in successful treatment of FBSS with an 80% reduction in pain scores, 86% reduction in MME consumption, and an improvement in performance of activities of daily living. CONCLUSION: This case highlights the use of SCS leads placed over the low cervical and high thoracic levels for the treatment of cervical and lumbar back pain. Due to the complex surgical history of the patient, a unique lead implantation location spanning C7-T3 was required. This lead location is significantly cephalad to the typical lead implantation location of T8-L1 for the treatment of chronic lumbar back pain, as the T8-L1 levels are where neurons responsible for back pain are most heavily concentrated (5). This case highlights the effectiveness of SCS therapy implanted at an atypical location for the treatment of FBSS. KEY WORDS: Atypical cervical and thoracic spinal cord stimulation, case report, chronic refractory neck and low back pain, failed back surgery syndrome, neuromodulation
Peripheral Nerve Stimulation With a High Frequency Electromagnetic Coupled Powered Implanted Receiver at the Axillary Nerve for the Treatment of Chronic Shoulder Pain: Case Report
Authors: Soliman George
Published: October 2024

BACKGROUND: The axillary nerve is one of the most common peripheral nerve of the shoulder to be injured. If a patient does not desire invasive surgical intervention, then other options, such as neurostimulation, should be explored. Until recently, there were no specific devices for peripheral nerve stimulation (PNS), and the hardware for spinal cord stimulation was used, but these systems were powered by an implantable battery, which can be difficult to use for PNS. Externally powered systems are the ideal technology to target peripheral nerves. CASE REPORT: A 67-year-old man presented with chronic right shoulder pain after multiple surgeries following a fracture. It was determined that the patient would not likely benefit from any further surgical interventions, and thus the patient was referred to pain management for further evaluation. The decision was made to trial the patient for PNS of the right axillary nerve. RESULTS: The patient reported drastically reduced pain (pain reduction of approximately 90% at 6-month follow-up). Activities of daily living, quality of life, sleep, and range of motion were also all improved at 6 months after the permanent implant procedure. CONCLUSIONS: Subthreshold, externally powered PNS at the axillary nerve was a successful choice for a patient suffering from chronic shoulder pain after multiple surgical interventions. KEY WORDS: Peripheral nerve stimulation, shoulder pain, axillary nerve, externally powered stimulation
Temporary Peripheral Nerve Stimulation for the Treatment of Greater Occipital Neuralgia
Authors: Copeland Royce
Published: October 2024

BACKGROUND: Greater occipital neuralgia (GON), a cause of chronic headaches, can be debilitating and vastly affect one’s quality of life. Recent strides in comprehending the pathophysiology of GON and the ongoing evolution of approaches to the condition’s treatment have led to the pursuit of more effective interventions. Among these, temporary peripheral nerve stimulation (PNS) devices have surfaced as an avenue for management, presenting a minimally invasive yet highly efficient alternative in treating other chronic pain conditions. This study discusses a case of GON successfully managed with temporary (60-day) PNS. CASE REPORT: A 35-year-old man presented with a nearly 8-month history of intractable headaches without any inciting event along the left greater occipital nerve distribution. The patient underwent a series of 2 diagnostic GON blocks and experienced 90% pain relief. A 60-day PNS device was implanted to treat the patient’s left-side GON, and during the 6-month period, the patient received 75% pain with no complications. CONCLUSIONS: Temporary PNS is a promising treatment for painful mononeuropathies. Most PNS devices are implanted permanently to provide benefits, but this new development allows temporary stimulation devices to manage chronic pain. This case demonstrates another potential therapeutic option for pain management providers to alleviate pain in patients suffering from GON. KEY WORDS: Peripheral nerve stimulation, occipital neuralgia, chronic headache, neuromodulation, pain medicine
Intrathecal Methotrexate-Induced Lumbosacral Polyradiculopathy: A Case Report
Authors: Xu Eric
Published: October 2024

BACKGROUND: Polyradiculopathy caused by intrathecal methotrexate (IT MTX) is a rare and serious complication of chemotherapy. The pathophysiology involved is likely due to a drug-induced folate deficiency and subsequent local immune reaction in the spinal cord. CASE REPORT: The authors present a 68-year-old woman with stage I breast cancer and stage III diffuse large B-cell lymphoma who developed low back pain after IT MTX treatment. Further workup revealed diffuse rope-like thickening of the cauda equina nerve roots with subtle linear low-level leptomeningeal enhancement on magnetic resonance imaging and severe primary axonal and motor polyneuropathy affecting the upper and lower extremities on electromyography/nerve conduction studies, likely a result of IT MTX toxicity. Treatment should emphasize conservative measures. Alternatively, intravenous immunoglobulin followed by intravenous methylprednisolone can be considered. CONCLUSIONS: Polyradiculopathy caused by IT MTX is a rare finding that can be treated. It would be beneficial to further study the effects of IT MTX and create treatment protocols for its adverse effects. KEY WORDS: Intrathecal methotrexate, polyradiculopathy, cauda equina, cancer, case report
Missed Emergency Department Diagnosis of Mild Traumatic Brain Injury in Patients with Chronic Pain After Motor Vehicle Collision
Authors: Buchanan Derrick Matthew
Published: October 2024

BACKGROUND: Mild traumatic brain injury (mTBI), or concussion, is the most common presentation of TBI in the emergency department (ED), but a diagnosis of mTBI may be missed in patients presenting with other acute injuries after a motor vehicle collision (MVC). OBJECTIVE: To estimate the frequency of missed diagnoses of mTBI in patients seen in the ED after MVC who later developed chronic pain syndromes. STUDY DESIGN: Retrospective cohort study. SETTING: An interventional pain management clinic. METHODS: Data were drawn from information collected during standardized intake assessments completed by 33 patients involved in an MVC referred to a community-based clinic for chronic pain management. The prevalence of missed mTBI and postconcussion syndrome (PCS) were estimated based on the clinical diagnosis, which included reviewing acute care medical records, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) scores, and patient-reported injury history. RESULTS: There was a high prevalence of presumed mTBI in this sample (69.7%) of patients involved in an MVC, but an acute care diagnosis was made in only 39.1% of cases. Patients diagnosed with mTBI at acute care had significantly lower PCS symptom scores than patients whose diagnosis was missed (P < 0.05). Diagnostic brain imaging (magnetic resonance imaging [MRI] or computed tomography [CT]) was more frequently ordered (P < 0.05) in patients diagnosed with mTBI. Using a modified RPQ developed for use with chronic pain patients, 54.5% of the sample met criteria for PCS. Loss of consciousness, meeting established criteria for mTBI, postinjury headache, and meeting criteria for posttraumatic stress disorder were significantly correlated with the development of PCS. LIMITATIONS: Data may be subject to recall and selection bias. Additional research with a larger study sample is needed to investigate correlations between individual symptoms and the development of PCS following an MVC. CONCLUSION: Patients presenting to the ED following an MVC have a high prevalence of mTBI. Patients whose diagnosis of mTBI is missed end up with significantly more severe postconcussion symptoms. While all patients included in this study were either referred or being treated for chronic pain after an MVC, they all also went on to develop PCS and disability following their accident, suggesting that better screening for mTBI after an MVC might identify those who may require more follow-up or rehabilitation therapy. In particular, those presenting with loss of consciousness, an altered mental state, posttraumatic amnesia, or postinjury headache are at increased risk of PCS. KEY WORDS: Motor vehicle collision, postconcussion syndrome, chronic pain, posttraumatic stress disorder, concussion, mild traumatic brain injury, emergency department
Does Intraoperative Multi-Drug Wound Infiltration Relieve Postoperative Pain Following Single-Level TLIF Surgery? A Randomized Controlled Trial
Authors: Wang Liang
Published: October 2024

BACKGROUND: How to minimize postoperative pain following spinal surgery has been a great challenge for both surgeons and patients. We hypothesized that intraoperative multi-drug wound infiltration could relieve postoperative pain following single-level transforaminal lumbar interbody fusion (TLIF) surgery. OBJECTIVES: To evaluate the effect of intraoperative multi-drug wound infiltration for postoperative pain following single-level TLIF surgery. STUDY DESIGN: A randomized, double-blinded controlled trial (RCT). SETTING: Department of Orthopaedic Surgery, Qilu Hospital of Shandong University. METHODS: The RCT enrolled 50 patients with 25 cases in 2 groups. The study group received intraoperative wound infiltration of mixed solution with lidocaine, ropivacaine, and epinephrine before wound closure. The control group was infiltrated with an equal amount of normal saline. The primary outcome measure was the visual analog scale (VAS) of postoperative incision pain. The secondary outcome measures were the postoperative opioids dosage, the time of first analgesic demand, and the Oswestry Disability Index (ODI). RESULTS: The VAS of postoperative pain in the study group was significantly lower than the control group within postoperative 24 hours. The opioid dosage was significantly less and the time of first analgesic demand of patient-controlled analgesia (PCA) in the study group was significantly longer than the control group. None of the patients in the study group required analgesic supplementation. The side effects of opioids were significantly less in the study group. There was no significant difference in ODI, operation time, intraoperative blood loss, postoperative drainage, and postoperative incision complications between the 2 groups. LIMITATIONS: Single-center study for single-level TLIF surgery. CONCLUSIONS: Intraoperative multi-drug wound infiltration before closure could significantly relieve postoperative pain following single-level TLIF surgery. KEY WORDS: Transforaminal lumbar interbody fusion, postoperative pain, wound infiltration, multi-drug, randomized controlled trial
Does the Choice of Operative Side Affect the Clinical Outcome of Unilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture?
Authors: Hao Ding-Jun
Published: October 2024

BACKGROUND: Studies have found that the rate of improvement in pain after percutaneous kyphoplasty (PKP) is 49% to 90%, and there are still some patients who may continue to sustain intractable back pain after surgery. OBJECTIVES: To compare the clinical efficacy and imaging results between unilateral PKP performed from the symptom-dominating side and the non-dominating side in OVCF treatment. STUDY DESIGN: Prospective study. SETTING: All data were from Honghui Hospital in Xi’an. METHODS: One hundred forty-two patients of osteoporotic vertebral compression fracture (OVCF) treated with unilateral PKP were eventually recruited and randomly assigned to either the A or B group. Patients in group A received PKP from the symptom-dominating side; patients in group B received PKP from the symptom non-dominating side. The demographic characteristics, related surgical information, and complications observed within both groups were recorded. The clinical outcomes evaluation included the visual analog scale (VAS) score for low back pain and the Oswestry Disability Index (ODI). Evaluation of imaging results included anterior height (AH), kyphosis angulation (KA), and contralateral distribution rate of bone cement. RESULTS: One hundred eighteen patients (48 men and 70 women; age range: 60-83 years), including 59 patients in the A group and 59 patients in the B group, were available for the complete assessment. There were 5 cases and 7 cases of bone cement leakage in groups A and B, respectively, which were asymptomatic para-vertebral or inter-vertebral leakage without intra-spinal leakage. Compared with the preoperative data, significant improvements in the VAS scores and ODI were observed at each follow-up interval. The VAS score and ODI in the A group were significantly lower than in the B group only within 2 months (P < 0.05). Compared with the preoperative data, the AH and KA in the 2 groups were improved (P < 0.05). There was no significant difference in AH and KA between the 2 groups at each follow-up interval (P > 0.05). LIMITATIONS: A single-center study. CONCLUSIONS: The unilateral PKP performed via the symptom-dominating side can effectively relieve back pain and improve the patient’s quality of life at the early stage. KEY WORDS: Kyphoplasty, unilateral approach, postoperative pain, operative side, osteoporotic thoracolumbar fracture
Ultrasound-Guided Transversus Abdominis Plane Block in Treating Abdominal Skin Tension Pain After Kyphosis Surgery: A Pilot Study in Enhanced Recovery After Surgery Setting
Authors: Hu Xueyu
Published: October 2024

BACKGROUND: The postsurgical management of patients with ankylosing spondylitis is often only focused on the incision pain, and the pain caused by abdominal skin traction is paid little attention. OBJECTIVES: To explore the effectiveness of ultrasound-guided transversus abdominis plane block (TAPB) in treating abdominal skin tension pain after kyphosis surgery. STUDY DESIGN: Randomized controlled trial. SETTING: This prospective study consecutively enrolled patients scheduled to undergo kyphosis correction surgery at the Department of Orthopedics of Xijing Hospital from March 2021 to December 2021. METHODS: The patients were randomized 1:1 to the TAPB and control groups. The Visual Analog Scale (VAS) for abdominal pain, Bruggrmann Comfort Scale (BCS), abdominal skin tension blisters, bed rest duration, length of hospitalization, and the use of patient-controlled analgesia pumps (PCAPs) were compared. The primary endpoint was pain alleviation at 24 hours after surgery. RESULTS: Thirty-one patients were enrolled, without differences between the 2 groups regarding age, body mass index, preoperative kyphosis severity, operation duration, and blood loss. The TAPB group (n = 16) had lower abdominal VAS scores than the control group (n = 15) at 2, 4, 6, 8, and 12 hours after surgery (P < 0.05). The TAPB group had higher BCS scores than the control group at 4, 6, 8, and 12 hours after surgery (P < 0.05). The TAPB group used PCAPs less frequently than the control group after surgery (P < 0.001). The incidence of tension blisters in the TAPB group was numerically lower than that of the control group, but the difference was not statistically significant (18.8% vs 33.3%, P > 0.05). LIMITATIONS: The sample size of this study is small and a single-center study, there might be data bias. CONCLUSIONS: In the first 24 hours after severe kyphosis surgery, TAPB can reduce the pain from abdominal skin tension and increase the comfort scores, but its effects on tension blisters remain to be further studied. KEY WORDS: Kyphosis, abdominal skin traction, abdominal skin pain, tension blisters, anesthesia, transversus abdominis plane block, visual analog scale, Bruggrmann comfort scale