bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of non-effervescent riboflavin gastroretentive floating tablets using mixture design
Authors: Katha Umme Tabassum Arobi , Sapiyan Muhammad Sofwan , Ahmad Puad Fatini Nasuha , Nik Aris Nik Sofea Aliya , Azhar Mohd Akmal bin
Published: October 2024

Gastroretentive Floating Drug Delivery Systems (GRFDDS) are long-acting oral dosage forms that float on gastric juice and remain in the stomach for an elongated period gradually delivering drug substances to the upper part of the gastrointestinal system. This study aims to develop and enhance the bioavailability and stomach retention of non-effervescent riboflavin floating tablets by using a variety of polymers. In this investigation, both pre-compression evaluation and post-compression of all the tablet materials were performed according to USP specifications. In vitro, buoyancy analyses were carried out to achieve minimum floating lag time and maximum floating duration. The tablet employed direct compression methods using HPMC K17, Carbopol 940p, and polypropylene foam powder. In vitro, buoyancy studies were performed to achieve minimum floating lag time and maximum floating duration. Tablets were evaluated for physicochemical properties according to USP specifications. An optimized tablet with a floating lag time of 0.77 minutes and a floating time of 48.74 minutes was developed using Design of Experiments (DoE). The results indicated that the optimized formulation, designated as Y, performed the best. It consists of 0.45% polypropylene foam powder, 0.15% HPMC K17, and 0% Carbopol 940p. The developed non-effervescent riboflavin floating tablets have the potential to improve the bioavailability and therapeutic efficacy of riboflavin by enhancing its gastric residence time.
Screening of microbial population in Sabah tea kombucha pellicle for its potential as prebiotic and probiotic supplement
Authors: Nasir Nurul Farhana , Mohamad Nurul Elyani , Yew Chee Wei , Saallah Suryani , Alitheen Noorjahan Banu
Published: October 2024

This research aimed to determine and analyze the microbial population in kombucha pellicles derived from Sabah black tea, specifically focusing on bacteria and yeast, to gain insights into their abundance, diversity, and potential as prebiotic and probiotic supplements. Despite the growing interest in kombucha in Malaysia, the specific microbial composition of the pellicle from locally sourced Sabah black teas remains underexplored. Understanding this composition could reveal its potential as a sustainable source of health-promoting microbes. It is hypothesized that Sabah tea kombucha pellicle harbours a beneficial microbial population that can be utilized as a low-cost prebiotic and probiotic supplements. The kombucha pellicle was prepared using 10 g of Sabah black tea, 1 L of sterile water containing 10% sugar (w/v), and a 10% kombucha symbiotic culture of bacteria and yeast (SCOBY). The process included boiling black tea with sugar, adding SCOBY culture, and allowing fermentation for 30 days to obtain cellulosic pellicles. After fermentation, the pellicle was separated, homogenized, and stored for further use. Then, kombucha pellicle genomic DNA was extracted and subjected to 16S and ITS metagenomic analysis to identify the bacteria and fungi population. The 16S and ITS metagenomic results showed that Sabah tea kombucha pellicle contains a potentially beneficial microbial population, mainly Komagataeibacter, Zygosaccharomyces and Starmerella, that may serve as a sustainable probiotic. This current study provides promising evidence for using Sabah tea kombucha pellicle as a low-cost prebiotic and probiotic supplement. This will indirectly help advertise and commercialize Sabah tea as one of the local products in Sabah.
The Impact of Accessibility to Child and Youth Pornography on Voluntary Consumption: Focusing on the Moderating Effect of Perceived Social Harm
Authors:   The Correction Welfare Society of Korea, Lee Jin Hyuk , Kang Joo Young
Published: October 2024

Child and youth pornography has emerged as a serious social problem. However, empirical research aimed at assessing the current state of the issue and developing countermeasures remains insufficient. To address this gap, this study utilized data from the “National Awareness and Effective Regulatory Measures for Child and Youth Pornography” survey conducted by the Korean Institute of Criminology, involving 5,000 people nationwide. The study examined the impact of accessibility to child and youth pornography on voluntary consumption and verified the moderating effect of perceived social harm on this relationship. The results revealed that higher accessibility to child and youth pornography significantly increased the likelihood of voluntary consumption. Furthermore, a moderating effect was observed, whereby higher levels of perceived social harm reduced the influence of accessibility on the consumption of child and youth pornography. These findings suggest that physical access control measures for child and youth pornography should be implemented in conjunction with efforts to raise awareness of its harmfulness among members of society. The study derives policy and practical implications based on these results.
Uncovering the reasons behind irregular visits by patients with type 2 diabetes mellitus
Authors: Kuntari Titik , Khotijah Alfreda Amelia , Basya Hana Nuraisa , Cakranegara Rama , Ariant Zinedine Yusuf , Handayani Nina Tiwi
Published: October 2024

Background: Type 2 diabetes mellitus (DM) is a non-communicable disease with an increasing incidence. DM is associated with deaths caused by several complications. One of the efforts to manage DM is to control blood glucose by maintaining regular check-ups and treatment compliance. Unfortunately, many people with DM still need to visit health facilities regularly.Purpose: This study aimed to explain the factors associated with the irregularity of type 2 DM patients having check-ups at the public health center (puskesmas).Methods: This cross-sectional study used the medical record data from Grabag II Public Health Center. The subjects were 135 outpatients with type 2 DM and complete medical records.Results: The results showed that visit irregularity was significantly associated with sex (OR = 3.8; 95% CI = 1.12-12.79), distance from home (OR = 0.2; 95% CI =  0.06-0.52), and duration of diagnosis (OR = 0.3; 95% CI=  0.12-0.85), but not with age, insurance, comorbidities, and types of therapy.Conclusion: Factors associated with type 2 diabetes mellitus patients' irregular visits to Puskesmas are sex, distance from home, and duration of diagnosis. Educational interventions at all levels of society should be carried out to increase knowledge about DM and the importance of regular check-ups and medication
Current density–voltage characteristics of exciplex-type organic light-emitting diodes expressed by a simple analytic equation
Authors: Yasuda Takeshi , Sakamoto Kenji
Published: October 2024

Exciplex-type bilayer organic light-emitting diodes (OLEDs) with ohmic contacts exhibited current density–voltage (J–V) characteristics that closely matched a simplified analytical model proposed by Nikitenko and Bässler. The analytical model is based on the following key assumptions: (i) complete hole–electron recombination at the interface between a hole transport layer (HTL) and an electron transport layer (ETL), (ii) ohmic contacts at the interfaces between metal electrodes and carrier transport layers, and (iii) electric-field-independent carrier mobilities in both HTL and ETL. The excellent matching shows that the simplified analytical model is sufficient to describe the J–V characteristics of the OLEDs. We also demonstrated that if the carrier mobility of one carrier transport layer is known, that of the other transport layer can be estimated using the equation derived by the simplified analytical model. The simplified analytical model provides a useful method to estimate carrier mobilities within carrier transport layers themselves in OLEDs.
High-resolution mid-infrared image transport by a chalcogenide multi-core fiber
Authors: Nakatani Asuka , Matsumoto Morio , Sakai Goichi , Suzuki Takenobu , Ohishi Yasutake
Published: October 2024

We have successfully demonstrated high-resolution mid-infrared image transport by a multi-core fiber made of chalcogenide glasses. The fiber cores are arranged on a triangular lattice and adjacent cores have different core diameters to reduce cross-talk between them. We tested the resolution of the fiber using different fineness patterns and found that it can resolve better than 25 lp/mmat a wavelength of 9.3 μm. This demonstrates the potential of the fiber for high-resolution thermal imaging inside the human body.
Marcación de biomoléculas con radionúclidos
Authors: Cabral Pablo , Camacho Damata Ximena Aida
Published: October 2024

Introducción: la marcación de biomoléculas con radionúclidos es una técnica fundamental en la medicina nuclear que permite la visualización y tratamiento de diversas enfermedades, especialmente el cáncer.
Materiales y métodos: este trabajo aborda en detalle los métodos y aplicaciones de esta tecnología, incluyendo la selección de radionúclidos, la conjugación con biomoléculas mediante agentes quelantes como Ácido dodecano tetraacético (DOTA), Ácido Dietilen Triamino Penta Acético (DTPA) y Ácido hidracinonicotínico (HYNIC), y los procesos de purificación y caracterización.
Resultados: se presentan ejemplos específicos, como la marcación de Bevacizumab y Tocilizumab con 99mTc y 177Lu, destacando sus aplicaciones en la imagenología y terapia del cáncer. Además, se exploran las aplicaciones clínicas y futuras investigaciones en el campo, enfatizando el potencial de la medicina personalizada y las terapias combinadas.
Discusión: la tecnología de marcación con radionúclidos continúa avanzando, prometiendo mejoras significativas en el diagnóstico y tratamiento de enfermedades complejas, ofreciendo herramientas precisas y eficientes para la gestión de la salud. Presentamos una visión exhaustiva de las técnicas, estudios de caso y el impacto de esta metodología en la práctica clínica.
Este artículo fue aprobado por el Comité Editorial.
Recibido para evaluación: marzo 2024.
Aceptado para publicación: junio 2024.
Correspondencia: Centro de Investigaciones Nucleares. Mataojo 2055. CP. 11400, Montevideo, Uruguay. Tel: 598(2)99472572.
E-mail de contacto: pcabral@cin.edu.uy
Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial
Authors: Francescato Torres Sarina
Published: October 2024

BACKGROUND: Acupuncture is one of the most widely used therapies to treat chronic low back pain, whose analgesic effect seems to be potentiated by the addition of electric current (electroacupuncture). However, we are not aware of any clinical trial that has evaluated the effectiveness of this technique in adults > 65 years. OBJECTIVE: To evaluate the effect of electroacupuncture in the treatment of chronic low back pain in the elderly. STUDY DESIGN: Triple-blind, controlled, and randomized clinical trial. SETTING: Faculty of Medicine, University of São Paulo (USP); Sector of Biological Sciences - Physiotherapy Course, Federal University of Paraná (UFPR). METHODS: The study included 125 elderly people with chronic nonspecific low back pain who were randomized to one of 5 study groups: 3 of electroacupuncture; one control; and one placebo, all of them treated for 5 weeks. The primary endpoint was pain intensity, and secondary endpoints included the qualitative aspect of pain, functional disability (Roland-Morris and sit and stand test), emotional functioning (depression and anxiety), and psychosocial factors. Data analysis followed the intention-to-treat principle. The confidence interval was set at 95% and the significance level at 5%. RESULTS: All groups achieved a reduction in pain intensity; however, a significant difference was only detected between electroacupuncture and placebo, where the latter showed greater pain reduction. Regarding secondary outcomes, all groups showed good posttreatment results for all assessments but without statistical significance. Among the groups, the placebo was the one that obtained the best results between the pre- and post-treatment for depression, qualitative aspect of pain, and functional disability, but only for the qualitative aspect of pain and for the sit-and-stand test was a significant reduction found in the intergroup comparison. The analysis of the overall effect perceived by the participants in relation to low back pain revealed that individuals from all groups felt close to full recovery. LIMITATIONS: Absence of follow-up and a relatively small number of patients. CONCLUSIONS: This study provides evidence that there is no one frequency of electroacupuncture that is most effective in treating chronic low back pain in the elderly and that electroacupuncture is not superior to manual acupuncture or placebo treatment. KEY WORDS: Electroacupuncture, acupuncture, low back pain, aged, health of the elderly, rehabilitation, clinical trial, interdisciplinary research Clinical trials registration: NCT03802045 (January 2019).
Sub-Anesthesia Dose of S-Ketamine Reduces Postoperative Pain and Anxiety in Patients Receiving Breast and Thyroid Surgery: A Randomized, Controlled Trial
Authors: Gong Xingrui
Published: October 2024

BACKGROUND: Postoperative pain and anxiety affect patients’ recovery and increase the family burden. S-ketamine presents analgesic effects and anti-depressive effects in clinics. The effect of a sub-anesthesia dose of S-ketamine on postoperative pain and anxiety remains to be clarified. OBJECTIVES: This study aimed to evaluate the analgesic and anxiolytic effects of a sub-anesthesia dose of S-ketamine on postoperative pain and anxiety and explored the risk factors for postoperative pain in patients receiving breast or thyroid surgery under general anesthesia. STUDY DESIGN: A randomized, double-blind, controlled trial. SETTING: A university hospital. METHODS: One hundred twenty patients receiving breast or thyroid surgery, stratified by surgery type, were randomized to S-ketamine and control groups in a 1:1 ratio. S-ketamine (0.3 mg/kg) or an equal volume of normal saline was administrated after anesthesia induction. Visual analog scale (VAS) of pain and self-rating anxiety scale (SAS) were tested before surgery and on postoperative day 1, 2, and 3. VAS and SAS score between the 2 groups were compared, and the risk factors for postoperative moderate to severe pain were explored with logistic regression analysis. RESULTS: Intraoperative S-ketamine decreased VAS and SAS scores on postoperative day 1, 2, and 3 (P < 0.05, 2-way ANOVA for repeated measurements followed by Bonferroni post-analysis). Subgroup analysis showed S-ketamine decreased VAS and SAS scores both in breast surgery and thyroid surgery patients on postoperative day 1, 2, and 3. Logistic regression identified S-ketamine and regular exercise are protective factors, and anxiety before surgery is a risk factor for postoperative moderate to severe pain (P < 0.05). LIMITATIONS: The anxiety score in our study is not so high, which may under-evaluate the anxiolytic effect of S-ketamine. However, S-ketamine decreased the SAS scores postoperatively in our study. CONCLUSIONS: Intraoperative sub-anesthesia dose of S-ketamine reduces postoperative pain and anxiety intensity. Anxiety before surgery is a risk factor, and S-ketamine and regular exercise are protective factors for postoperative pain. The study was registered at www.chictr.org.cn with the number: ChiCTR2200060928. KEY WORDS: S-ketamine, pain, anxiety, breast, thyroid
Multiple Sterile Withdrawals from Iohexol Bottles Does Not Increase Contamination Risk
Authors: Purtill Caroline
Published: October 2024

BACKGROUND: There is a global shortage of iohexol contrast media, commonly used in epidural injections, as a result of lockdown and decreased production due to COVID-19. Iohexol bottles are designated for single use, which, depending on the vials available, often leads to wasting up to 95% of this limited resource. However, avoiding multiple withdrawals may be unnecessary if withdrawing multiple times using sterile technique does not increase the risk for contamination. OBJECTIVES: The purpose of our study is to determine whether multiple withdrawals from iohexol injection bottles using a sterile technique poses a greater risk of introducing contaminants than a single withdrawal. Furthermore, we wish to determine the extent to which bacteria can survive and grow in the contrast media. STUDY DESIGN: Experimental. SETTING: Outpatient fluoroscopic suite and laboratory. METHODS: Twenty-one 100 mL 300 mg(iodine)/mL iohexol injection bottles, after one clinical use, were tested after the first and last withdrawals (withdrawal one and withdrawal 9 or 10) for bacterial and fungal specimens using culture media and 3M™ Petrifilms™. To determine the ability of methicillin-susceptible Staphylococcus aureus (MSSA) to survive or grow in the media, MSSA was added to different concentrations (0, 25, 50, 75, and 100%) of iohexol contrast media. RESULTS: There was no growth observed in cultures or on Petrifilms among the first and last draws of any of the samples. When bacteria were grown in different dilutions of the media, there was a significant, approximately one log decrease in counts from 0% contrast media to 100% contrast media (8.4 x 108 vs 5.6 x 107, P < 0.01). LIMITATIONS: Our study is limited in the number of samples tested and would benefit from additional investigation before consideration of clinical application. CONCLUSIONS: Our results suggest that single-use 300 iohexol bottles may be reusable and that the contrast media is mildly antimicrobial, but not enough to retard contamination. In setting of shortages, contrast media bottles can safely be reused. This is valuable for conserving resources and limiting unnecessary health care-associated costs. KEY WORDS: Contrast media, antimicrobial, infection, antibacterial
Bed Rest as a Protective Factor for Subdural Hematoma in Spontaneous Intracranial Hypotension: A Retrospective Study
Authors: Zhu Qiongbin , Huang Bo , He Lei , Hu Xingyue
Published: October 2024

BACKGROUND: Subdural hematoma (SDH) is a potentially life-threatening complication in patients with spontaneous intracranial hypotension (SIH). Though bed rest is the basis of conservative treatment, no clear evidence exists regarding the association between bed rest and the later complication of SDH in these patients. OBJECTIVES: This study aimed to evaluate the association between bed rest and SDH development in patients with SIH. STUDY DESIGN: A retrospective study was conducted from March 2013 through December 2019. Four hundred twenty adult patients diagnosed with SIH were enrolled. Clinical presentations and radiographic findings were recorded. The cumulative duration of bed rest in hours was used to measure the bed rest length. The clinical outcomes during follow-up were assessed. METHODS: Categorical data were compared using chi-square tests; continuous data were compared using the Mann-Whitney U test or Kruskal-Wallis test. A backwards stepwise Cox proportional hazard regression model adjusted with confounders which differed between SDH and non-SDH in univariate analysis was used to estimate the risk of cumulative duration of bed rest for SDH. A stratified Cox regression was performed to exclude the effect of the treatment algorithm. RESULTS: Of the 420 patients with SIH, 88 (21%) were in the SDH Group and 332 (79%) were in the non-SDH (NSDH) Group. The cumulative duration of bed rest in hours was a protective factor for SDH in SIH (Hazard Ratio [HR] = 0.997; P < 0.001). A stratified Cox regression analysis showed that the cumulative duration of bed rest remained a protective factor for SDH both in patients who received conservative treatment before admission (HR = 0.997; P < 0.001) and in those who did not (HR = 0.996; P = 0.061). Age (HR = 1.029, 95% CI, 1.009-1.050; P = 0.004) and orthostatic headache (HR = 4.770, 95% 95% CI, 2.177-10.450; P < 0.001) were risk factors for SDH in SIH. The clinical outcomes, including length of hospital stay, epidural blood patch (EBP) therapy, and repeated EBP therapy, were higher in the SDH Group. The revisit rate was similar between the 2 groups. LIMITATIONS: Retrospective studies are susceptible to different radiological procedures and therapeutic strategies. A bed rest score based on a patient’s memory is susceptible to recognition and reporting bias. This is a single-center study and the sample size is not large. The validity of the bed rest scale has not been previously evaluated in any other study. CONCLUSIONS: Bed rest was a protective factor for SDH in patients with SIH. With more time and proper treatment, patients with SIH who have an SDH can achieve good prognosis in the long term. KEY WORDS: Spontaneous intracranial hypotension, complication, subdural hematoma, bed rest, protective factor, conservative treatment, epidural blood patch, prognosis
The Value of the Optic Nerve Sheath Diameter (ONSD) in Predicting Postdural Puncture Headache (PDPH): A Prospective Observational Study
Authors: Xia Xiaoqiong
Published: October 2024

BACKGROUND: Postdural puncture headache (PDPH) is one of the serious complications after lumbar puncture, but there is no effective tool to predict it. OBJECTIVES: To explore whether ultrasound measurement of optic nerve sheath diameter (ONSD) as a predictor of PDPH can be a reliable tool supported by reliable protocols and data. STUDY DESIGN: A prospective observational study. SETTING: Department of Anesthesiology. METHODS: This prospective observational study was performed in 156 patients undergoing cesarean section (CS). The patient’s ONSD was recorded before anesthesia (T0), 10 minutes after anesthesia (T1), at the end of the operation (T2), at the first postoperative day (T24), at the second postoperative day (T48), and the third postoperative day (T72). During the 3-day follow-up, the patients were evaluated, identified, and divided into a PDPH group and a non-PDPH group. Age, weight, height, ASA, lumbar puncture location, and the number of lumbar puncture attempts were also recorded. We mainly analyzed the changes and differences between the 2 groups of ONSD. RESULTS: Twenty-four patients (15%) developed PDPH. The ONSD was significantly lower in the PDPH group than in the non-PDPH group at T2, T24, T48, and T72. All patients showed a significant reduction in ONSD at T1 compared to T0. Women whose ONSD continued to fall without recovery from T0 to T2 were more likely to experience PDPH (RR 5. 022; 95 CI 3.343 to 7.508). The ONSD at T24 was the best predictor of PDPH (ACU 0. 9787, 95 CI 0.9578 to 0.9996), with a cutoff value of 0.40 cm (sensitivity 92%, specificity 94%). LIMITATIONS: This is a single-center study, and ONSD may vary in different regions or ethnic groups. CONCLUSIONS: We believe that continuous measurements of ONSD may be a useful tool for predicting PDPH. KEY WORDS: Postdural puncture headache (PDPH), Optic nerve sheath diameter (ONSD), Combined spinal-epidural anesthesia (CSEA), cesarean section
Compliance and Documentation for Evaluation and Management Services in Interventional Pain Management Practice
Authors: Manchikanti Laxmaiah
Published: October 2024

Evaluation of new and established patients is an integral part of interventional pain management. Over the last 3 decades, there has been significant confusion over the proper documentation for evaluation and management (E/M) services in general and for interventional pain management in particular. Interventional pain physicians have learned how to evaluate patients presenting with pain on the basis of their specialty training. Although modern training programs are introducing residents and fellows to the intricacies of E/M services and federal regulations, this has not always been the case. Multiple textbooks about pain management, physiatry, and neurology, and numerous journal articles have described the evaluation of pain patients, but they have not been specific to chronic pain patients and may not meet the regulatory perspective. A multitude of these issues led to the development of guidelines in 1995 and 1997, which were highly complicated and difficult to follow. These also led to significant criticism from clinicians. Consequently, further guidance was developed to be effective January 2021. The crucial concept in the present system of coding for E/M services is medical decision making, which includes 3 elements since 2021: 1. The number and complexity of problems addressed 2. Amount or complexity of data to be reviewed and analyzed 3. Risk of complications and/or morbidity or mortality of patient management In order to select a level of E/M service, 2 of the 3 elements of medical decision making (MDM) must be met or exceeded. This is in contrast to prior guidelines wherein for new patients, all 3 elements with history, physical examination and MDM , and for established patients have been met. For ease of appreciation, an algorithmic approach created by the American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS) approved a new MDM table outlining all of the appropriate criteria. This review systematically describes the changes and provides an algorithmic approach for application in interventional pain management practices. KEY WORDS: Evaluation and management services, new patient, established patient, level of service, CPT coding, medical decision making, complexity of problems
Diet Composition’s Effect on Chronic Musculoskeletal Pain: A Narrative Review
Authors: Kurapatti Mark , Carreira Dominic
Published: October 2024

BACKGROUND: In the medical setting, clinicians frequently attend to patients with chronic musculoskeletal pain. Recent literature demonstrates diet may play a role in inflammation and musculoskeletal pain. OBJECTIVES: The purpose of this narrative review is to present the most current literature on the effect of common diet regimes, additions, and eliminations on chronic musculoskeletal pain. STUDY DESIGN: This is a narrative review of the literature on the effect of 1) Mediterranean diets; 2) vegetarian and vegan diets; 3) oils, seafood, and omega-3 fatty acids; 4) fruits; 5) spices and herbal teas; and 6) elimination diets on patient-reported musculoskeletal pain scores. METHODS: In January 2023, the Google Scholar and PubMed databases were reviewed to identify research on the effect of common diet regimes and additions on self-reported pain outcomes in patients with chronic musculoskeletal pain. RESULTS: A total of 32 original research articles and a systematic review were included and used to develop grades of recommendation. There is fair evidence that diverse, plant-based Mediterranean, vegetarian, and vegan diets may reduce musculoskeletal pain. Other dietary considerations, including adding marine oils, seafood, omega-3 fatty acids, antioxidant-rich fruits, and turmeric may also benefit patients with chronic musculoskeletal pain. There is poor-quality or insufficient evidence to support adding olive oil, ginger, or herbal teas to reduce pain. While eliminating aspartame and monosodium glutamate may reduce inflammation, there is poor-quality evidence that it reduces musculoskeletal pain. LIMITATIONS: This narrative review is not systematic in nature; instead, it aims to provide a current update on the effect of various diet regimes, additions, and eliminations on chronic musculoskeletal pain. The studies in this review are limited in sample size, study period, and robust comparisons to controls. This review is limited to studies on patients with either rheumatoid arthritis, osteoarthritis, or fibromyalgia due to the lack of relevant literature on other musculoskeletal pain conditions. CONCLUSIONS: Clinicians can play a role in the well-being of patients with chronic musculoskeletal pain through holistic interventions such as a dietary emphasis on plant-based regimes. Further research is necessary to elucidate the relationship between diet, inflammatory markers, and disease states, as well as the safety and contraindications of these dietary changes. KEY WORDS: Pain, musculoskeletal, diet, fibromyalgia, rheumatoid arthritis, osteoarthritis, mediterranean, vegetarian, vegan
Comparison of the Low Back Pain Relief and Spread Level After Upper and Lower Lumbar Erector Spinae Plane Block
Authors: Hong Ji Hee
Published: October 2024

BACKGROUND: The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. OBJECTIVES: The purpose of this study is to compare the analgesic efficacy and spread level of the upper and lower lumbar ESPBs . STUDY DESIGN: Prospective, randomized design. SETTING: The pain clinic of a tertiary university hospital. METHODS: This study included 84 patients with low back pain with or without leg pain who received lumbar ESPB at L2 (L2 ESPB group) or L4 (L4 ESPB group) using 10 mL of 0.2% ropivacaine mixed with 10 mL of the contrast medium. After finishing 20 mL of the local anesthetic mixture injection, a fluoroscopic examination was performed to evaluate the spread level. Analgesic efficacy was assessed using an 11-point Numeric Rating Scale (NRS-11) and a Back Pain Functional Scale. RESULTS: The number of patients who showed excellent-to-moderate low back pain relief was 35 (83.3%) and 36 (78.5%) in the L2 and L4 ESPB groups, respectively. Significant reductions in pain on the NRS-11 and improvements in disability were found in both groups. The total number of vertebral segments to which the anesthetic drugs spread was significantly higher in the L2 ESPB group than in the L4 ESPB group (2.7 ± 0.5 vs 2.0 ± 0.2, P = 0.002). LIMITATIONS: The analgesic efficacy of lumbar ESPB was evaluated with only short-term outcomes. CONCLUSIONS: Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group. KEY WORDS: Erector spinae plane block, spread level, low back pain, analgesic efficacy
Development and Validation of a Prognostic Model for the Risk of Recurrent Lumbar Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy
Authors: Yuan Feng
Published: October 2024

BACKGROUND: Recurrence of lumbar disc herniation (LDH) is an adverse event after percutaneous endoscopic transforaminal discectomy (PETD). Accurate prediction of the risk of recurrent LDH (rLDH) after surgery remains a major challenge for spine surgeons. OBJECTIVES: To develop and validate a prognostic model based on risk factors for rLDH after PETD. STUDY DESIGN: Retrospective study. SETTING: Inpatient surgery center. METHODS: Clinical data were retrospectively collected from 645 patients with LDH who underwent PETD at the Affiliated Hospital of Xuzhou Medical University from January 1, 2017 to January 1, 2021. Predictors significantly associated with rLBH were screened according to least absolute shrinkage and selection operator (LASSO) regression, and a prognostic model was established, followed by internal model validation using the enhanced bootstrap method. The performance of the model was assessed using receiver operating characteristic (ROC) curves and calibration curves. Finally, the clinical usefulness of the model was analyzed using decision curve analysis (DCA) and clinical impact curves (CICs). RESULTS: Among the 645 patients included in this study, 56 experienced recurrence of LDH after PETD (8.7%). Seven factors significantly associated with rLDH were selected by LASSO regression, including age, type of herniation, level of herniation, Modic changes, Pfirrmann classification, smoking, and history of high-intensity physical work. The bias-corrected curve of the model fit well with the apparent curve, and the area under the ROC curve was 0.822 (95% confidence interval, 0.76-0.88). The DCA and CIC confirmed that the prognostic model had good clinical utility. LIMITATIONS: This is a single-center study, and we used internal validation only. CONCLUSIONS: The prognostic model developed in this study had excellent comprehensive performance and could well predict the risk of rLDH after PETD. This model could be used to identify patients at high risk for rLDH at an early stage to individualize the patient’s treatment modality and postoperative rehabilitation plan. KEY WORDS: Recurrent lumbar disc herniation, prognostic model, percutaneous endoscopic transforaminal discectomy, individualized treatment
Novel Ultrasound-guided Injection Method for Thoracic Outlet Syndrome Based on Anatomical Features: A Cadaveric Study
Authors: Kim Hee-Jin
Published: October 2024

BACKGROUND: Despite the positive effect of botulinum neurotoxin (BoNT) injections in thoracic outlet syndrome (TOS) treatment, there is insufficient anatomical evidence of its use in the anterior scalene (AS) and middle scalene (MS) muscles. OBJECTIVES: This study aimed to provide safer and more effective guidelines for the injection of botulinum neurotoxin into scalene muscles for the treatment of thoracic outlet syndrome. STUDY DESIGN: The study was based on an anatomical study and ultrasound studies. SETTING: This study was conducted at the Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry (Seoul, Republic of Korea) METHODS: Ten living volunteers underwent ultrasonography, and the depths of the anterior scalene (AS) and middle scalene (MS) muscles were calculated from the skin surface. In cadaveric specimens, fifteen AS and 13 MS muscles were stained using the Sihler staining procedure; the neural arborization pattern was identified, and localized dense portions were investigated. RESULTS: The mean depth of the AS was 9.19 ± 1.56 mm, and that of the MS was 11.64 ± 2.73 mm at 1.5 cm above the clavicle. At 3 cm above the clavicle, the AS and MS were clearly located 8.12 ± 1.90 mm and 10.99 ± 2.52 mm deep, respectively. The nerve ending points were highest in the lower three-quarters of the AS (11/15 cases) and MS muscles (8/13 cases), followed by the lower quarter (AS muscle, 4/15 cases; MS muscle, 3/13 cases). LIMITATIONS: There are many difficulties for clinics to directly perform ultrasound-guided injections in clinical practice. However, results of this study can be used as basic data. CONCLUSION: According to anatomical features, the appropriate location for botulinum neurotoxin injection in the AS and MS muscles for the treatment of TOS is the lower portion of the scalene muscles. Therefore, it is recommended to inject at a depth of approximately 8 mm for AS and 11 mm for MS at a point 3 cm above the clavicle. KEY WORDS: Thoracic outlet syndrome, ultrasound-guided injection, nerve arborization pattern, botulinum neurotoxin, noninvasive treatment, scalene muscles, anterior scalene, middle scalene
Ultrasound- Versus Computed Tomography-Guided Cervical Dorsal Root Ganglia Pulsed Radiofrequencies via Intervertebral Foramen for the Treatment of Postherpetic Neuralgia: A Retrospective Cohort Study
Authors: Han Ying
Published: October 2024

BACKGROUND: Pulsed radiofrequency (PRF) treatment of the dorsal root ganglia (DRG) has recently been used as an important option for postherpetic neuralgia (PHN) patients who do not respond well to drugs. This procedure is commonly guided by computed tomography (CT) or fluoroscopy, but they cannot be performed in real time and are associated with radiation exposure. Ultrasound (US) is a potential alternative option, but no reliable method of US-guided DRG PRF treatment has been reported. OBJECTIVES: The goal of this study was to propose a method for performing US-guided transforaminal PRF on cervical DRG. By comparing the results with those of CT guidance, we also sought to assess the accuracy, safety, and efficacy of this new approach in the treatment of PHN. STUDY DESIGN: A retrospective cohort study. SETTING: The study took place at the department of pain management of a single academic medical center. METHODS: The data of 73 PHN patients receiving 2 sessions of US-guided (US group, n = 26) or CT-guided (CT group, n = 47) cervical DRG PRF were reviewed. US-guided DRG PRF was performed using our proposed protocol. The one-time success rate was used to assess accuracy. The average radiation dose, the number of scans per operation, and the rate of complications were recorded for safety assessment. For the evaluation of pain amelioration, a Numeric Rating Scale (NRS-11), the daily sleep interference score (SIS), and oral medication (i.e., anticonvulsants and analgesics) usage 2 weeks, 4 weeks, 12 weeks, and 24 weeks after treatment were compared to the baseline values and between groups. RESULTS: The one-time success rate in the US group was significantly higher than that in the CT group (P < 0.05). Compared those of the CT group, the mean radiation dose and number of scans per operation were both obviously lower in the US group (P < 0.05). The average operation time was also shorter in the US group (P < 0.05). No obvious serious complications occurred in either group. No obvious between-group difference was found in the NRS-11 score, daily SIS, or rate of oral medications at any of the time points (P > 0.05). The NRS-11 score and SIS significantly decreased after treatment at each follow-up time point (P < 0.05) in both groups. Compared with those at baseline, the use rate of anticonvulsants and analgesics obviously decreased 4 weeks, 12 weeks, and 24 weeks after treatment (P < 0.05). LIMITATIONS: This study was limited by its nonrandomized and retrospective design. CONCLUSIONS: US-guided transforaminal DRG PRF is a safe and effective method for the treatment of cervical PHN. It is a reliable alternative option to the CT-guided procedure, demonstrating great advantages in reducing radiation exposure and the operation time. KEY WORDS: Ultrasound, pulsed radiofrequency, dorsal root ganglion, postherpetic neuralgia, transforaminal
Incidence and Mortality of Vertebral Compression Fracture Among All Age Groups: A Nationwide, Population-based Study in the Republic of Korea
Authors: Ahn Hyeong Sik
Published: October 2024

BACKGROUND: Although several studies have examined the epidemiological features of vertebral compression fractures (VCF) among elderly patients, few studies have reported the epidemiology of VCF among younger individuals. OBJECTIVE: To examine trends in the incidence and mortality of VCF in both the old (>= 65 years) and young (< 65 years) age groups. This study aimed to investigate the incidence and mortality of VCF among all age groups in Korea. STUDY DESIGN: Population-based cohort study. SETTING: A nationwide, population-based setting. METHODS: Using the Korean National Health Insurance database, which has complete population coverage, we identified patients diagnosed with VCF between 2005 to 2018. Differences in incidence, survival and mortality were compared across groups using Kaplan-Meier analysis and Cox regression for all age groups and both genders. RESULTS: We identified a total of 742,993 VCF patients and the annual incidence was 140.09/100,000 individuals. Although the incidence of VCF was significantly higher in the older age compared to younger age group (556.38/100,000 vs. 44.09/100,000 individuals), the mortality rate ratio for VCF patients was higher among younger compared to older individuals (old: 1.59 vs. young: 2.87). In our multivariable-adjusted analysis, the hazard ratio for multiple fractures, traumatic injury and osteoporosis were higher in patients aged < 65 years compared to patients aged >= 65 years, suggesting that the impact of these clinical variables on mortality is more significant in the younger age group. LIMITATION: A limitation of this study was its lack of information on clinical features, such as disease severity and laboratory data. The precise cause of death of VCF patients could not be confirmed from the study database. CONCLUSIONS: The mortality rate ratio and hazard ratio were significantly higher among younger patients with VCF, indicating the need for further research on VCF in younger age groups. KEY WORDS: Cohort study; hazard ratio; incidence; mortality; mortality rate; mortality rate ratio; population-based cohort study; vertebral compression fracture
Reduction of SIRT1-Mediated Epigenetic Upregulation of Nav1.7 Contributes to Oxaliplatin-Induced Neuropathic Pain
Authors: Liu Cui-Cui
Published: October 2024

BACKGROUND: Clinically, neuropathic pain is a severe side effect of oxaliplatin chemotherapy, which usually leads to dose reduction or cessation of treatment. Due to the unawareness of detailed mechanisms of oxaliplatin-induced neuropathic pain, it is difficult to develop an effective therapy and limits its clinical use. OBJECTIVES: The aim of the present study was to identify the role of sirtuin 1 (SIRT1) reduction in epigenetic regulation of the expression of voltage-gated sodium channels 1.7 (Nav1.7) in the dorsal root ganglion (DRG) during oxaliplatin-induced neuropathic pain. STUDY DESIGN: Controlled animal study. SETTING: University laboratory. METHODS: The von Frey test was performed to evaluate pain behavior in rats. Real-time quantitative polymerase chain reaction, western blotting, electrophysiological recording, chromatin immunoprecipitation, and small interfering RNA (siRNA) were used to illustrate the mechanisms. RESULTS: In the present study, we found that both the activity and expression of SIRT1 were significantly decreased in rat DRG following oxaliplatin treatment. The activator of SIRT1, resveratrol, not only increased the activity and expression of SIRT1, but also attenuated the mechanical allodynia following oxaliplatin treatment. In addition, local knockdown of SIRT1 by intrathecal injection of SIRT1 siRNA caused mechanical allodynia in naive rats. Besides, oxaliplatin treatment enhanced the action potential firing frequency of DRG neurons and the expression of Nav1.7 in DRG and activation of SIRT1 by resveratrol reversed this effect. Furthermore, blocking Nav1.7 by ProTx II (a selective Nav1.7 channel blocker) reversed oxaliplatin-induced mechanical allodynia. In addition, histone H3 hyperacetylation at the Nav1.7 promoter in DRG of rats following oxaliplatin treatment was significantly suppressed by activation of SIRT1 with resveratrol. Moreover, both the expression of Nav1.7 and histone H3 acetylation at the Nav1.7 promoter were upregulated in the DRG by local knockdown of SIRT1 with SIRT1 siRNA in naive rats. LIMITATIONS: More underlying mechanism(s) of SIRT1 reduction after oxaliplatin treatment needs to be explored in future research. CONCLUSIONS: These findings suggest that reduction of SIRT1-mediated epigenetic upregulation of Nav1.7 in the DRG contributes to the development of oxaliplatin-induced neuropathic pain in rats. The intrathecal drug delivery treatment of activating SIRT1 might be a novel therapeutic option for oxaliplatin-induced neuropathic pain. KEY WORDS: SIRT1, neuropathic pain, dorsal root ganglion, NAV1.7 voltage-gated sodium channel, oxaliplatin
Ultrasound-guided Injection of the Levator Scapulae Muscle in a Cadaver Model
Authors: Lee Ji-Hyun
Published: October 2024

BACKGROUND: Despite the advantages of ultrasound and previous anatomical data on neuromuscular junction locations, to the best of our knowledge, the feasibility and accuracy of precise ultrasound-guided injection techniques into the proposed injection site of botulinum neurotoxin for the levator scapulae muscle have not been assessed in any publication. OBJECTIVE: In the present cadaver-based study, the ultrasound-guided injection technique in the middle and distal portions of the levator scapulae muscle was evaluated to determine whether this method distributes injections properly to the target muscle in fresh cadavers. STUDY DESIGN: Cadaveric study. SETTING: A cadaver laboratory. METHODS: Twenty fresh cadavers were used. Real-time B-mode ultrasound scanning was performed interfaced with a linear array transducer. A mixture of 0.5 mL of dye and yellow filler was injected transverse in-plane with a 6 cm 21-G. needle. Each specimen was dissected to determine whether the dye was correctly targeted to the middle and distal portions of the levator scapulae muscle and to evaluate the accuracy of the injections and any complications. RESULTS: All 40 injections were successfully injected within the middle and distal portions of the levator scapulae muscle. When dissecting the cadavers, the dye spread was evenly distributed along the muscle fiber. Limitation: Despite successful injection into the middle and distal portions of the levator scapulae muscle, the usefulness of this technique was not verified in clinical practice. CONCLUSIONS: The ultrasound-guided injection technique presented in this study might facilitate precise visualization and localization of the levator scapulae muscle, thereby enhancing the effectiveness and safety of botulinum neurotoxin treatment in cervical dystonia. KEY WORDS: Levator scapulae muscle, ultrasonography, injections, pain, cervical dystonia, cadaver
Ultrasound-guided Retroclavicular Approach Versus Costoclavicular Approach of Infraclavicular Brachial Plexus Block for Upper Limb Surgeries
Authors: Attia Josef Zekry
Published: October 2024

BACKGROUND: Regional anesthesia for an upper limb provides many advantages over general anesthesia, especially in orthopedic surgery. OBJECTIVES: This trial aimed to compare a retroclavicular approach to the infraclavicular brachial plexus with a costoclavicular approach in term of needle time, image time, and procedure time, and comparing both with the classic technique for upper limb surgeries guided by ultrasound. STUDY DESIGN: Prospective, randomized, single-blinded controlled trial. SETTING: Minia University, Faculty of Medicine, Anesthesia and Intensive Care Department. METHODS: Sixty patients of both sees with an American Society of Anesthesiologists Classification of I and II, a BMI (kg/m2) of 20-35, aged from 18-60 years who were scheduled for a forearm or hand surgery under infraclavicular brachial plexus block were divided into 3 parallel equal groups. Group I (RC) received a retroclavicular approach. Group II (CC)received a costoclavicular approach. Group III (CT) received the classic technique. Procedure time, the sum of the imaging and needling times, was our primary outcome. Secondary outcomes were the motor and sensory block success rate 30 minutes postinjection of local anesthesia, duration of motor and sensory block, Visual Analog Score, first analgesic need, total analgesia requirements during the first postoperative 24 hours, and any complications. RESULTS: The procedure and needle times were significantly decreased in the retroclavicular group due to better needle visibility. There was no significant difference regarding sensory and motor block data. The VAS score in the first postoperative 24 hours showed no statistical significance. Regarding analgesic data and patient satisfaction, there was no statistical significance among the 3 studied groups. There were no complications in any of the used approaches. LIMITATION: Our trial did not include patients with a BMI > 35. CONCLUSIONS: The retroclavicular approach is superior because of its decreased procedure time and needle time than both the costoclavicular approach and classic approach. KEY WORDS: Retroclavicular, costoclavicular, infraclavicular brachial plexus block, upper limb surgery