bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound Guided Intercostobrachial Nerve
Blockade in Patients with Persistent Pain after
Breast Cancer Surgery: A Pilot Study
Authors: Wijayasinghe Nelun
Published: February 2021

Background: Persistent pain after breast cancer surgery (PPBCS) affects 25 – 60% of breast
cancer survivors and damage to the intercostobrachial nerve (ICBN) has been implicated as the
cause of this predominantly neuropathic pain. Local anesthetic blockade of the ICBN could
provide clues to pathophysiological mechanisms as well as aiding diagnosis and treatment of
PPBCS but has never been attempted.
Objectives: To assess the feasibility of ICBN blockade and assess its effects on pain and sensory
function in patients with PPBCS.
Study Design: This prospective pilot study was performed in 2 parts: Part 1 determined the
sonoanatomy of the ICBN and part 2 examined effects of the ultrasound-guided ICBN blockade
in patients with PPBCS.
Setting: Section for Surgical Pathophysiology at Rigshospitalet, Copenhagen, Denmark.
Methods: Part 1: Sixteen unoperated, pain free breast cancer patients underwent systematic
ultrasonography to establish the sonoanatomy of the ICBN. Part 2: Six patients with PPBCS
who had pain in the axilla and upper arm were recruited for the study. Summed pain intensity
(SPI) scores and sensory function were measured before and 30 minutes after the block was
administered. SPI is a combined pain score of numerical rating scale (NRS) at rest, movement,
and 100kPa pressure applied to the maximum point of pain using pressure algometry (max
= 30). Sensory function was measured using quantitative sensory testing, which consisted of
sensory mapping, thermal thresholds, suprathreshold heat pain perception as well as heat and
pressure pain thresholds. The ICBN block was performed under ultrasound guidance and 10 mL
0.5% bupivacaine was injected.
Outcome Assessment: The ability to perform the ICBN block and its analgesic and sensory
effects.
Results: Only the second intercostal space could be seen on ultrasound which was adequate to
perform the ICBN block. The mean difference in SPI was -9 NRS points (95%CI: -14.1 to -3.9),
P = 0.006. All patients had pre-existing areas of hypoesthesia which decreased in size in 4/6
patients after the block.
Limitations: The main limitation of this pilot study is its small sample size, but despite this, a
statistically significant effect was observed.
Conclusion: We have successfully managed to block the ICBN using ultrasound guidance and
demonstrated an analgesic effect in patients in PPBCS calling for placebo-controlled studies.
Key words: Anesthesia, local; intercostobrachial nerve; mastectomy; nerve block; neuralgia
Intrathecal Pump Exposure to Electromagnetic
Interference: A Report of Device Interrogation
following Multiple ECT Sessions
Authors: Bicket Mark
Published: February 2021

Background: Intrathecal drug delivery systems represent an increasingly common treatment
modality for patients with a variety of conditions, including chronic pain and spasticity. Pumps rely
on electronic programming to properly control and administer highly concentrated medications.
Electromagnetic interference (EMI) is a known exposure that may cause a potential patient safety
issue stemming from direct patient injury, pump damage, or changes to pump operation or flow
rate.
Objectives: The objective of our case report was to describe an approach to evaluating a patient
with a pump prior to and following exposure to EMI from electroconvulsive therapy (ECT), as well
as to document findings from device interrogations associated with this event.
Study Design: Case report.
Setting: Academic university-based pain management center.
Results: We present the case of a patient with an intrathecal pump who underwent multiple
exposures to EMI in the form of 42 ECT sessions. Interrogation of the intrathecal drug delivery
system revealed no safety issues following ECT sessions. At no time were error messages,
unintentional changes in event logs, unintentional changes in pump settings, or evidence of pump
stall or over-infusion noted.
Conclusion: Communication with multiple entities (patient, family, consulting physicians, and
device manufacturer) and maintaining vigilance through device interrogation both before and after
EMI exposure are appropriate safeguards to mitigate the risk and detect potential adverse events
of EMI with intrathecal drug delivery systems. Given the infrequent reports of device exposure to
ECT, best practices may be derived from experience with EMI exposure from magnetic resonance
imaging (MRI). Although routine EMI exposure to intrathecal drug delivery systems should be
avoided, we describe one patient with repeated exposure to ECT without apparent complication.
Key words: Baclofen, intrathecal drug delivery system, electromagnetic interference,
electroconvulsive therapy, safety, pump interrogation, intrathecal pump, pump stall
Comparison Between the Effectiveness of
Complex Decongestive Therapy and Stellate
Ganglion Block in Patients with Breast
Cancer-Related Lymphedema: A Randomized
Controlled Study
Authors: Seo Kwan Sik
Published: February 2021

Background: Breast cancer-related lymphedema (BCRL) of the upper extremities often
follows breast cancer treatment. Although complex decongestive therapy (CDT) is currently
the standard treatment for BCRL, stellate ganglion block (SGB) has also been reported to be
effective.
Objectives: This study aimed to determine the effectiveness of SGB in the treatment of
BCRL, and to assess the impact of the treatment on the quality of life (QoL) compared to
CDT.
Study Design: A randomized controlled trial.
Setting: A single academic hospital, outpatient setting.
Methods: A total of 38 patients with BCRL were recruited. Patients were randomly divided
into 2 groups. Patients enrolled in the CDT group underwent 10 sessions of CDT for 2 weeks,
whereas patients in the SGB group received 3 consecutive SGBs every 2 weeks. Changes in
circumference, volume, and bioimpedance in the upper extremity were measured at baseline
and 2 weeks after treatment and compared between the 2 groups. EuroQol-5 dimensions
(EQ-5D) and EuroQol visual analog scale (EQ VAS) for QoL and subjective improvement were
monitored.
Results: In both groups, side-to-side difference of circumference after the treatment was
decreased significantly from baseline (P < 0.05), and side-to-side difference of volume was
reduced significantly in the SGB group (P < 0.05). No statistically significant difference was
noted in the treatment effect between the 2 groups. Results of the EQ-5D, EQ VAS, and
questionnaires regarding subjective symptoms administered at baseline and 2 weeks after
each intervention revealed no statistically significant difference in the treatment effects
between CDT and SGB.
Limitations: Further long-term follow-up studies with a greater number of patients that
include analysis according to the severity and duration of symptoms are needed.
Conclusions: The results of this study suggest that SGB is an effective treatment for BCRL
and may be considered as an alternative to CDT.
Key words: Stellate ganglion block, complex decongestive therapy, breast cancer,
lymphedema, breast cancer-related lymphedema, quality of life, bioimpedance, secondary
lymphedema
The Relevance of the OPRM1 118A>G Genetic
Variant for Opioid Requirement in Pain
Treatment: A Meta-Analysis
Authors: Chu Haichen
Published: February 2021

Background: There is obvious difference in individual response to opioids. Many studies have
examined the correlation between the μ-opioid receptor 1 (OPRM1) 118A>G genetic variation and
opioid requirement in pain treatment, but the conclusion remains elusive.
Objectives: To investigate whether the OPRM1 118A>G genetic variation is associated with the
opioid requirement.
Study Design: Systematic review and meta-analysis.
Methods: PubMed, Cochrane library, and EMBASE databases were systematically searched up to
May 5, 2018, using the keywords “OPRM1,” “genetic variant,” “opioid,” and “pain” to identify
reviews or meta-analyses on this topic. Two independent reviewers performed the data extraction
and assessed study quality. The authors investigated the standardized mean difference (SMD) of
opioid requirement between AA homozygotes and G allele carriers. The authors also examined the
association between the OPRM1 118A>G genetic variation and adverse effects such as nausea and
vomiting. Potential bias was assessed using the Egger’s test and the Begg’s test.
Results: A total of 530 articles were retrieved from the databases searched, and 36 studies involving
8,609 patients were included in the final analysis. G allele carriers required a higher mean opioid dose
(SMD: 0.17; 95% confidence interval [CI]: [0.12, 0.22]; P < 0.001) and displayed less nausea risk
difference (RD): –0.04; 95% CI: [–0.06, –0.01]), but the incident rate of vomiting has no relationship
with the genetic variant than AA homozygotes in a random-effects meta-analysis. Although there
was no evidence of publication bias (Begg’s test: P = 0.333; Egger’s: P = 0.561), heterogeneity was
present among studies (I2
= 54.3%). In the subgroup meta-analyses, there was also significance
observed in the postoperative pain setting.
Limitations: In all of the articles reviewed, postoperative pain and cancer pain were mostly
discussed except for one in other pain setting.
Conclusions: In this meta-analysis, the results indicate the OPRM1 A118G polymorphism was
associated with the opioid requirement and the adverse effects in pain treatment especially in
postoperative pain. This may provide valuable information for clinicians to adopt personalized pain
management by properly using the opioids in individual patients.
Key words: OPRM1, genetic variation, opioid, pain, side effect, review, meta-analysis
Ultrasound-Guided Block of the Axillary Nerve:
A Prospective, Randomized, Single-Blind
Study Comparing Interfascial and Perivascular
Injections
Authors: Kim Young Hoon
Published: February 2021

Background: The ultrasound-guided block of the axillary nerve may be complicated in
cases in which the posterior circumflex humeral artery (PCHA) follows an abnormal course.
Objectives: To develop a new technique that does not rely on direct visualization of the
PCHA or the axillary nerve, and to compare interfascial injection and conventional perivascular
injection for a block of the axillary nerve.
Study Design: A prospective randomized study.
Setting: An interventional pain-management practice in a university hospital.
Methods: A total of 56 patients received ultrasound-guided block of the axillary nerve
with either interfascial injection (IF Group) or perivascular injection with nerve stimulation
(PV Group). The primary outcome was procedure duration, defined as the time interval from
when the transducer contacted the skin to when the needle was removed from the skin.
Results: The mean procedure time was significantly shorter in the IF Group than in the
PV Group (64 seconds [SD 28.3] vs. 135 seconds [50.3], difference of −71.4 seconds; 95%
confidence interval, −93.2 to −49.5) (P < 0.001). There were no differences in secondary
outcomes, including the quality of blocks, between the 2 groups.
Limitations: The practitioner was not blinded to the group to which the patients belonged.
Conclusions: Ultrasound-guided block of the axillary nerve with interfascial injection can
be performed without placing the needle near the PCHA.
Key words: Block of axillary nerve, ultrasound-guided block, posterior circumflex humeral
artery, interfascial injection
Updated Review and Treatment
Recommendations on Paraneoplastic
Neurologic Syndromes and Chronic Pain
Authors: Chakravarthy Krishnan
Published: February 2021

Background: This comprehensive review of pain in paraneoplastic neurological syndromes
focuses on current mechanisms that lead to pain, including autoimmune processes as well as the
systemic secretion of factors that sensitize nociceptive nerves. Systemic secretion of functional
molecules is a well-recognized phenomenon in endocrine paraneoplastic syndromes; however,
cancer pain research has predominantly focused on cytokine-nerve interactions in the tumor
microenvironment, and few groups have applied the molecular mechanisms of local pain to study
widespread neuropathic pain resulting from systemic secretion. We present a novel perspective in
the field of pain research by converging data from clinical oncology with recent molecular pain
research on cytokine-mediated sensitization of nociceptive nerves.
Objective: Our objective was to conduct a review of paraneoplastic neurological syndromes and
provide updates on therapeutic recommendations.
Study Design: We used a narrative review design.
Methods: This review was done using searches of PubMed, MEDLINE/OVID, SCOPUS, and manual
searches of the bibliographies of known primary and review articles from inception to the present
date. Other data sources included hand searches of publications driven by manuscript authors.
Search terms included concepts of paraneoplastic syndrome and chronic pain with emphasis on
both preclinical and clinical studies.
Results: Articles were screened by title, abstract, and full article review. They were then analyzed
by specific clinical indications and appropriate data was presented based on critical analysis of
those articles.
Limitations: More studies that distinguish autoimmune paraneoplastic pain syndromes from
those related to systemic cytokine secretion are required.
Conclusion: By providing a unified review across disciplines, we illustrate that neuropathic pain
related to the systemic secretion of cytokines may represent another category of paraneoplastic
neurological syndromes distinct from the well-known autoimmune neuronopathies. In addition,
we discuss the clinical significance of distinguishing autoimmune paraneoplastic pain syndromes
from those related to systemic cytokine secretion and highlight the need for further research at
the intersection of these fields. This review takes a look at both past and current literature with
a critical analysis of findings and respective recommendations. In addition, based on review of
the literature we provide updated therapeutic recommendations for the consideration of pain
practitioners when dealing with this patient population.
Keywords: Paraneoplastic neurologic syndromes, chronic pain, neuropathic pain, treatment
guidelines, cytokines
Opioid Prescription in Switzerland: Appropriate
Comedication use in Cancer and Noncancer
Pain
Authors: Wertli Maria M.
Published: February 2021

Background: In Europe, limited information on the use of opioids is available.
Objectives: To assess how guideline recommendations to manage opioid-related adverse
events were followed in cancer- and noncancer-related opioid use.
Study Design: Analysis of health insurance data of one of the major health insurers in
Switzerland.
Setting: All opioid claims between 2006 and 2014.
Methods: Opioid episodes were cancer-related when cancer treatments were used within ±
3 months of the first opioid claim. Recurrent strong episodes were defined as ≥ 2 opioid claims
with at least one strong opioid claim. Episode duration were acute (< 90 days), subacute, or
chronic (≥ 120 days/≥ 90 days + ≥ 10 claims).
Results: Out of 591,633 opioid episodes 76,968 (13%) were recurrent episodes: 94%
were noncancer related (83% in recurrent episodes) and 6% cancer related (17% recurrent).
Chronic opioid use was observed in 55% (noncancer) and 58% (cancer) recurrent episodes.
Recommended laxatives were used in 50% noncancer and in 67% cancer episodes. Antiemetic
drugs were used in 54% noncancer and in 83% cancer episodes. Not recommended
coprescription of benzodiazepines was observed in 34% recurrent noncancer and 46% cancer
episodes.
Limitations: No clinical information was available to assess the indication for opioid use.
Conclusions: In this study, opioids were primarily used outside the context of cancer-related
treatment. In noncancer-related opioid use, we found a substantial higher proportion without
recommended laxative and antiemetic medications. Coprescription of benzodiazepines may
increase the risk for opioid overdose and was present in one-third of the noncancer episodes
and in almost every second cancer episode.
Key words: Pain medications, opioids, nonopioids, benzodiazepines, health insurance claims
data, cancer pain, noncancer pain, chronic opioid use, adverse events prevention, guideline
recommendations
C-Arm Guided Percutaneous Radiofrequency
Thoracic Sympathectomy for Treatment of
Primary Palmar Hyperhidrosis in Comparison
with Local Botulinum Toxin Type A Injection,
Randomized Trial
Authors: Mostafa Tarek A.H.
Published: February 2021

Background: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality of
life, occupational activities, and social interactions.
Objectives: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the
second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A)
injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient
satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over
one-year follow-up.
Study Design: This is a randomized single-blinded trial.
Setting: This study took place in a single hospital.
Methods: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2
interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n
= 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity
Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after
intervention. The number of patients who required repetition of the procedure later on and the time
at which they needed it were recorded, and possible side effects were assessed.
Results: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group
at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were
statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at
one week, one month, and 2 months of follow-up, there was no statistically significant difference
between both groups. The number of patients who required that the procedure be repeated was
statistically significantly lower in the RF group than in the BTX-A group. The time at which patients
needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first
intervention. All patients in this group showed an increase in HDSS scores within this one-year followup. In the RF group, however, only one patient complained of increased HDSS scores after 8 months.
There was no statistically significant difference in side effects between both groups.
Limitations: The first limitation of this study is that results were based on subjective scales. The
second is the radiation exposure associated with the technique described.
Conclusions: This study supports percutaneous C-arm guided RF ablation of the second and third
thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and
rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved
to be more effective, with longer effectiveness time and better patient satisfaction, compared to local
intradermal BTX-A injection.
Effectiveness Analysis of Percutaneous
Kyphoplasty Combined with Zoledronic Acid in
Treatment of Primary Osteoporotic Vertebral
Compression Fractures
Authors: Xiao Shao-Xiong
Published: February 2021

Objective: To investigate the therapeutic effectiveness of percutaneous kyphoplasty (PKP)
combined with zoledronic acid in treatment of primary osteoporotic vertebral compression
fractures.
Study Design: A perspective cohort study was conducted at a single institution for patients,
who received PKP operation due to primary osteoporotic vertebral compression fracture between
January 2014 and January 2015.
Setting: According to whether they received postoperative zoledronic acid or not, patients were
divided into treatment or control groups, with 30 randomly-selected cases per group.
Methods: The visual analogue scale (VAS), which was used to assess the degree of pain, and the
bone mineral density, was analyzed at 1-, 6-, and 12-month follow-ups.
Results: In general, patients experienced marked pain relief after surgery. No significant
difference in pain relief was observed in the control group between the 6 and 12-month followup. In contrast, the VAS score of the treatment group at 12-month follow-up was significantly
lower than that at 6-month (P value = 0.03). Moreover, it was also significantly lower than the VAS
score in the control group at the 12-month follow-up (P value = 0.0018). The bone mineral density
of patients from the treatment group increased significantly and progressively after the surgery
(pre-operation versus 6-month follow-up: P value = 0.01; 6-month versus 12-month follow-up: P
value < 0.001), and it was also remarkably higher than that of the control group at the 12-month
follow-up (P value < 0.0001).
Limitations: Patients were collected from a single hospital. The maximum postoperative followup time was 12 months. The sample size was relatively small. Thus, bias could occur in the selection
of cases if they are not representative of the population.
Conclusion: The combined treatment of zoledronic acid with PKP for primary osteoporotic
vertebral compression fractures safely and effectively relieved low back pain, significantly increased
bone density, and improved the quality of life. The clinical effectiveness is promising and worthy
of further study.
Key words: Kyphoplasty, zoledronic acid, primary osteoporotic vertebral compression fractures
Risk Factors for Early Recurrence After
Transforaminal Endoscopic Lumbar Disc
Decompression
Authors: Park Chan Hong
Published: February 2021

Background: Transforaminal endoscopic lumbar disc decompression (TELD) has emerged as
a treatment alternative to open lumbar discectomy, but rates of herniated lumbar disc (HLD)
recurrence after TELD are higher by comparison.
Objectives: We conducted this study to identify factors correlating with early HLD recurrence
after TELD.
Study Design: Retrospective study.
Setting: The Department of Anesthesiology and Pain Medicine, Neurosurgery at Spine Health
Wooridul Hospital.
Methods: As a retrospective review, we examined all patients undergoing TELD between 2012
and 2017, analyzing the following in terms of time to recurrence: age, gender, body mass index
(BMI), comorbid conditions (diabetes mellitus [DM], hypertension [HTN]), smoking status, nature
of disc herniation (central, paramedian, or foraminal), Modic changes, migration grade (rostral
vs. caudal track + degree), herniated disc height (Dht) and base size (Dbase), and the presence of
spondylolisthesis on magnetic resonance imaging.
Results: During the 5-year study period, 1,900 patients underwent TELD procedures, resulting
in 209 recurrences (11.0%). In 27 of these patients (12.9%), herniation recurred within 24 hours
after surgery. Recurrences most often developed within 2-30 days (n = 76). The smaller the size
of a herniated disc, the earlier it recurred. Recurrences were unrelated to gender, BMI, DM or
HTN, smoking status, migration grade, nature (Dht or Dbase of herniated disc), or the presence of
spondylolisthesis.
Limitations: In addition to variables assessed herein, other clinical and radiologic parameters
that may be important in recurrent disc herniation should be included. Furthermore, only
univariate analyses were performed, making no adjustments for potential confounders, therefore,
independent risk factors could not be assessed. A prospective study would likely generate more
precise results, especially in terms of standardized sampling and data classification. Finally, multiple
causes for primary discectomy failures may have rendered our patient groups nonhomogeneous,
and inequalities in surgical options or physician-dictated surgical choices may have had an effect.
Conclusions: In patients undergoing TELD procedures, smaller-sized herniated discs are linked
to early recurrences.
Key words: Disc herniation, lumbar, endoscopic, recurrence, early
Factors Influencing Receipt of Interventional
Pain Management Among Medicaid
Beneficiaries with Cancer
Authors: Halpern Michael T.
Published: February 2021

Background: Pain is common among cancer patients. Nonclinical factors may affect receipt of
pain management among Medicaid beneficiaries with cancer.
Objectives: To examine associations of patient characteristics and US state-level Medicaid
policies on receipt of interventional pain management among Medicaid beneficiaries with breast
or colorectal cancer.
Study Design: A retrospective analysis of 2006-2008 Medicaid claims data.
Setting: Claims data from facilities providing care to Medicaid beneficiaries.
Methods: Interventional pain management among Medicaid beneficiaries aged 18-64 years
with breast or colorectal cancer was identified using procedure codes in Medicaid claims data.
State-level Medicaid policy variables included physician visit reimbursements, required patient
copayments, and time period for Medicaid eligibility recertification (12 vs. < 12 months). Analyses
also examined beneficiary race/ethnicity, age, comorbidities, and cancer treatment. Generalized
estimating equations controlling for clustering by state assessed factors influencing receipt of
interventional pain management.
Results: The study included 8,438 Medicaid beneficiaries with breast or colorectal cancer.
Colorectal cancer (vs. breast cancer) patients were significantly more likely to receive interventional
pain management. Medicaid policies were not significantly associated with receipt of interventional
pain services. Among breast cancer patients, older age and non-Hispanic white race/ethnicity
were associated with decreased likelihood of receiving interventional pain management; more
comorbidities and receipt of breast conserving surgery were associated with increased likelihood.
Demographic characteristics were not significantly associated with receipt of interventional pain
management among colorectal cancer patients.
Limitations: Sample size of Medicare beneficiaries with cancer receiving interventional pain
management; limited information included in Medicare claims data.
Conclusions: State-level Medicaid policies were not significantly associated with receipt of
interventional pain management for breast or colorectal cancer patients; disparities in receipt
of these services were observed only for breast cancer patients. These results may help develop
policies to enhance access to appropriate pain management services.
Key words: Cancer pain, pain management, Medicaid, health care disparities, breast neoplasms,
colorectal neoplasms, health policies, physician practice patterns, retrospective studies, claims
analyses
Therapeutic Effects and Safety of Percutaneous
Disc Decompression with Coblation Nucleoplasty
in Cervical Vertigo: A Retrospective Outcome
Study with 74 Consecutive Patients and Minimum
1-Year Follow-Up
Authors: Rong Limin
Published: February 2021

Background: Surgical treatment of cervical vertigo has been rarely reported. This is the first
retrospective study to evaluate the clinical outcomes of percutaneous disc decompression with
coblation nucleoplasty (PDCN) for treatment of cervical vertigo.
Objectives: To assess the clinical outcomes of patients with cervical vertigo who failed to improve
with conservative care and who were subsequently treated with PDCN.
Study Design: This study used a retrospective design.
Setting: The research was conducted within an interventional vertigo management and spine
practice.
Methods: Seventy-four consecutive patients with cervical vertigo underwent PDCN and were
followed for at least one year. Outcome measures included the dizziness intensity Visual Analog
Scale (VAS), dizziness frequency, the Dizziness Handicap Inventory (DHI), and neck pain intensity.
Clinical efficacy was assessed by rating scale and the modified MacNab evaluation criteria. Surgical
complications during the operation and follow-up were also recorded.
Results: The vertigo VAS score, frequency of dizziness, DHI, and neck pain intensity were all
decreased significantly from evaluation before surgery to one week after surgery and to the last
follow-up, giving a mean effective rate of 94.6% one week after surgery and 90.6% at the last
follow-up. Good to excellent results were attained in 85.1% of these patients one week after
PDCN and in 75.7% of the sufferers at the last follow-up (P < 0.001). There were 5 patients with
transient adverse effects (6.25%) reported within the first month after surgery; they all recovered
after conservative treatment. No neurological complications were found and no patient went on
to spinal fusion surgery thereafter.
Limitations: The rate of follow-up was 70% and a placebo effect cannot be excluded. There is
no gold standard for the diagnosis and treatment of cervical vertigo so far.
Conclusion: The clinical outcomes of PDCN for cervical vertigo were satisfactory in both the
early and late postoperative period. PDCN is an effective, low-complication, minimally invasive
procedure used to treat cervical vertigo. Further prospective randomized controlled trials are
essential to verify this conclusion.
Key words: Cervical vertigo, percutaneous disc decompression, coblation nucleoplasty, longterm outcome, dizziness intensity, dizziness frequency, dizziness handicap inventory, clinical
efficacy, surgical complication, retrospective study
Efficacy of Atlantoaxial Joint Glucocorticoid
Injection in Patients with Rheumatoid Arthritis:
A Randomized Trial
Authors: Hetta Diab Fuad
Published: February 2021

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion.
Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid
arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally
spinal cord compression.
Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ
on neck pain and disability.
Study Design: A prospective randomized, controlled clinical trial.
Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt.
Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized
into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of
bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2
tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone
tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a
mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of
patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at
1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at
2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of
AAJ (assessed 4 weeks postoperatively) were all evaluated.
Results: There was significant reduction in the percentage of patients who showed ≥ 50%
reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one
month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months
(53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in
group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005)
and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings
revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4%
vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI
compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a
significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9
[11%]; P = 0.041).
Limitations: The study follow-up period was limited to only 3 months.
Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a
potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened
recovery of the joint from an acute inflammatory stage.
Key words: Rheumatoid arthritis, atlantoaxial joint injection
Ultrasound-Guided Pectoral Nerve Block I and
Serratus-Intercostal Plane Block Alleviate
Postoperative Pain in Patients Undergoing
Modified Radical Mastectomy
Authors: Wang Wei
Published: February 2021

Background: Simultaneous application of pectoral nerve block and serratus-intercostal plane
block (SPB) is one of the most desirable multimodal analgesic strategies, with wide implementation
of the enhanced recovery after surgery pathway for modified radical mastectomy (MRM).
Objectives: The aim of the present study was to investigate the efficacy and safety of ultrasoundguided pectoral nerve block I (PECS I) and SPB for postoperative analgesia following MRM.
Study Design: A randomized, prospective study.
Setting: An academic medical center.
Methods: A total of 61 women undergoing MRM were randomly divided into 2 groups. The
control group (group C, n = 32) received general anesthesia only, whereas the PECS I + SPB treated
group (group PS, n = 29) received a combination of pectoral nerve block and SPB in addition to
general anesthesia.
Results: Pain scores on a visual analog scale, opioid consumption, the duration at the
postanesthesia care unit, and the incidence of adverse events were lower in group PS, compared
with that of the group C. Moreover, PECS I together with SPB contributed to better sleep quality
and higher patient satisfaction of pain relief.
Limitations: This study was limited by its sample size.
Conclusions: These results suggest that the combination of PECS I and SPB provide superior
perioperative pain relief in breast cancer surgery.
Key words: Pectoral nerve block, serratus-intercostal plane block, postoperative analgesia,
modified radical mastectomy
A Prospective, Randomized Cross-Over Trial of
T2 Paravertebral Block as a Sympathetic Block
in Complex Regional Pain Syndrome
Authors: Kim Eung Don
Published: February 2021

Background: Sympathetic block is commonly performed in clinical practice for management
of intractable pain conditions. However, stellate ganglion block (SGB) alone often does not
achieve sufficient sympatholysis of the upper extremity. The paravertebral space continues
up to the cervical sympathetic chain and includes the stellate ganglion. We compared the
sympatholytic and analgesic effect of paravertebral block performed at the T2 level (T2 PVB)
with that of SGB in patients with complex regional pain syndrome (CRPS) of the upper extremity.
Objectives: The aim of this study was to compare the sympatholytic property of T2 PVB with
that of the conventional SGB in patients with CRPS of the upper extremity.
Study Design: Prospective, randomized cross-over trial.
Setting: University hospital pain center in Korea.
Methods: Fifteen patients with upper extremity CRPS were randomly assigned to 1 of 2
intervention methods (SGB or T2 PVB). After effects of the first block receded, the patients
were crossed over to the second procedure. A difference in temperature increase between
the treated side and the opposite side (ΔT) ≥ 1.5°C was considered as a successful primary
outcome. Rate of successful primary outcome, degree of pain reduction, duration of effect,
and patient satisfaction scores were compared between the 2 intervention methods.
Results: Rate of successful primary outcome (ΔT ≥ 1.5°C) was significantly higher in the T2
PVB cases than in the SGB cases (80.0% vs. 20.0%; P = 0.003). Numeric Rating Scale scores
after the procedure were significantly lower in the T2 PVB group. Patient satisfaction scores
were significantly higher, and the duration of the block was significantly longer in the T2 PVB
cases than in the SGB cases.
Limitations: The relatively small sample size from a single center, and the lack of
standardization of the injected volume of T2 PVB and SGB were limitations.
Conclusions: T2 PVB showed superior sympatholytic effect than SGB; other clinical outcomes
were also better with T2 PVB than with SGB. T2 PVB can be a useful option for producing
sympatholytic and analgesic effect in patients with CRPS of the upper extremity.
Key words: Sympathetic block, Complex Regional Pain Syndrome, paravertebral block,
stellate ganglion block
Effect of Shock Wave on Vascular Lesions in
Diabetic Rats
Authors: He Chunjinig
Published: February 2021

Background: Diabetes is one of the most common diseases in today’s society. Diabetes can
cause multiple vascular lesions in the body, renal insufficiency, blindness, and so on. However, the
evidence concerning the role of extracorporeal shock wave therapy in diabetic vascular disease is
insufficient.
Objectives: Observation of the effect of shock wave on vascular lesions in diabetic rats.
Study Design: This study used an experimental design.
Setting: The research took place in the laboratory research center at The Third Military Medical
University.
Methods: Eighteen healthy adult male Sprague Dawley rats were randomly divided into 3 groups:
normal control group (group A), diabetic group (group B), and diabetes + shock wave treatment
group (group C). Groups B and C were established by intraperitoneal injection of streptozotocin
60 mg/kg to demonstrate a diabetic rat model. Shock wave treatment was performed on the
left lower extremity femoral artery in group C for 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4
weeks (T4) while the other 2 groups were reared normally. At the end of T4 shock wave treatment,
the femoral arteries of each group were observed under an electron microscope. The expression
of vascular endothelial growth factors (VEGF), endothelial nitric oxide synthase (eNOS), and
angiotensin type 1 (AT1) were measured by western blot, and the changes of VEGF expression
were detected by real-time polymerase chain reaction.
Results: The VEGF and eNOS in group C were higher than those in group B (P < 0.05). The AT1
of the rats in the B and C groups was significantly higher than that in the A group (P < 0.05), but
the C group was significantly lower than the B group (P < 0.05). After shock wave therapy, the
surface of vascular endothelium in group C was flatter and smoother than that in group B, and the
endothelial basement membrane and foot process were relatively tight.
Limitations: Potential mechanisms that underlie the relationship between vascular dysfunction
and diabetic neuropathy pain were not examined in this study.
Conclusions: Shock wave may promote the formation of new blood vessels and improve
vasomotor function by upregulating VEGF, eNOS, and downregulation of AT1 in diabetic rats and
improve the damage of blood glucose to blood vessels to some extent.
Key words: Shock wave, diabetic rats, vascular dysfunction, neovascularization
Development and Validation of a Screening
Tool for Surgery-Specific Neuropathic Pain:
Neuropathic Pain Scale for Postsurgical Patients
Authors: Andersen Kenneth G.
Published: February 2021

Background: Despite the existence of several screening tools for neuropathic pain, none of
these are specific to surgery. We have developed a simple questionnaire tool, the Neuropathic
Pain scale for Postsurgical patients (NeuPPS), to measure neuropathic pain in postsurgical
patients.
Objectives: The aim was to validate this tool in a breast cancer population using an item
response theory model, resulting in an easy-to-use scale.
Study Design: Development was based on literature reviews and interviews with patients
and experts and consisted of 6 items. It was tested among 2,217 long-term breast cancer
survivors, and cross-validated in another data set of breast cancer survivors with 18 months
follow-up.
Setting: We tested the questionnaire tool among breast cancer survivors in 2 cohorts,
one nationwide and one of consecutively treated patients at Rigshospitalet, Copenhagen,
Denmark.
Methods: Items were assessed for criterion-related construct validity using the Rasch model,
and for convergent validity by comparison to another neuropathic pain screening tool, the
self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS)
pain scale.
Results: The selected 5-item model showed good fit, unidimensionality, monotonicity, and
homogeneity. This result was reproducible in the cross-validation population. In a combined
dataset with data from both studies, the model displayed a slightly lower fit, suggesting
that items to some degree may vary over time. The Spearman rank correlation between the
NeuPPS and S-LANSS was P = 0.57.
Limitations: We observed differential item functioning between the primary study
population and the cross-validation population, meaning that some items behave differently
at different follow-up times or study populations.
Conclusions: With the NeuPPS, we have validated a simple and easy-to-fill-out questionnaire
tool for the measurement of neuropathic pain among postsurgical patients. The items are
additive, giving a total score that measures neuropathic pain symptoms.
Key words: Scale validation, Rasch analysis, item response model, persistent postoperative
pain, intercostobrachial nerve, neuropathy, neuropathic pain, quantitative sensory testing,
breast cance
Secularism form an Islamic prospection
Authors: ‘Nasrat’ Abdul Naser
Published: February 2021

This article looks or reviews the contemporary discourse of
secularism from Islamic Prospection.
Observation of facts, including a religious consciousness, and the politicalreligious language of recent times, it is shown that there is no natural given
boundary separating the two dimensions, the whole discussion derives from
an advanced or traditional state from a religious mind.
In the nineteenth and the twentieth-century thoughts in an international era
by invaders, for example, in the fields of law, education, administration,
and mass culture, there was experienced a visible process of change towards
secularity.
A CORRELATIVE STUDY OF ELECTROCARDIOGRAPHY,
ECHOCRDIOGRAPHY AND
HEMATOLOGICAL FINDINGS IN CHRONIC OBSTRUCTIVE LUNG
DISEASE
Authors: Kumar B.Pani , Arshida Arshida , kumar Sravan
Published: February 2021

INTRODUCTION
Chronic obstructive pulmonary disease is one of the commonest cause
of mortality and morbidity in our country. It is dened as “a common
preventable and treatable disease characterised by persistent
respiratory symptoms and airflow limitation that is due to airway
and/or alveolar abnormalities usually caused by significant
exposure to noxious particles or gases.” COPD is currently fourth
leading cause of death in the world1 but is projected to be the third
leading cause of death by 2020. Advances in understanding the
pathogenesis of COPD have the potential for identifying new
therapeutic targets that could alter the natural history of this
devastating disorder.
Nature Republic dan Innisfree Sebagai Soft Power Brand Ambasador and Personality Korea Selatan di Indonesia
Authors: Pratama Aditya Putra
Published: February 2021

Brand Ambassador is an instrument of achieving the interests of the state which is popularly used South Korea as one example of countries that use their Brand Using (Hallyu) as the mediums to get achieved success in Indonesia. in 2002, Indonesia began to look at South Korea by showing Korean drama with the introduction of Korean drama in Indonesia through private television. The reason for the development of Korean pop culture (Korean Wave) in Indonesia is the embodiment of globalization. In the communication and cultural dimensions, South Korea is increasingly recognized by the Indonesian public drama that aired in Indonesia became the gateway for the entry of other Korean cultural products or known by the name Hallyu / Korean Wave, such as Korean pop music (K-Pop), Korean food (K-Food ), and Korean language and letters (Hangeul). It also makes many products made in Korea also enter Indonesia, including cosmetics, automotive, electronics, etc. As a form of Korean Nation Brand in Indonesia. So, Indonesian people can feel about  (Hallyu) that came in. The purpose of this study will look at how Indonesia's attitude in responding to it and what is driving Indonesia's response to the phenomenon of Korean Skincare that uses as Diplomacy in Indonesia.
Return on Asset dan Investment Opportunity Set dalam Memprediksi Dividend Payout Ratio Perusahaan Manufaktur Sektor Consumer Goods
Authors: Fathony Moch
Published: February 2021

Among factors that may be instrumental in affecting the dividend payout decision, this study aims to determine the effect of return on assets (ROA) and investment opportunities on dividend distribution in a company. Using secondary data from 10 Consumer Goods companies listed on the Stock Exchange in the period 2015 - 2019, the data were analyzed using panel regression using EVIEWS. This study found that ROA and investment opportunities can predict the Dividend Payout Ratio in the Consumer Goods Industry. The results suggest that the more profitable a company is, the more likely it is to pay high dividends. Also, high investment opportunities are good position increases a firm's ability to pay dividends.
Pengaruh Perencanaan Anggaran, Pelaksanaan Anggaran, Kualitas Sumber Daya Manusia, dan Pengadaan Barang dan Jasa Terhadap Tingkat Penyerapan Anggaran Daerah
Authors: Gustavo Puluala Muhammad
Published: February 2021

Salah satu bentuk dari reformasi pengelolaan keuangan daerah dan implementasi dari otonomi daerah adalah Pemerintah Pusat dan Daerah. Dengan adanya ini maka pemerintah melahirkan Anggaran Pendapatan dan Belanja Daerah (APBD) yang merupakan sumber pendanaan yang digunakan oleh pemerintah daerah dalam menjalankan roda pemerintahan untuk memberikan seluasluasnya kebijakan dalam membangun dan mengembangkan kesejahteraan daerahnya masing-masing sesuai dengan perundang-undangan. Permasalahan yang sering terjadi hingga saat ini di berbagai daerah di Indonesia, dalam pelaksanaan anggaran adalah tingkat penyerapannya yang rendah, hal tersebut terlihat pada Laporan Realisasi Anggaran.Penelitian ini bertujuan untuk mengetahui: Pengaruh Perencanaan Anggaran, Pelaksanaan Anggaran, Kualitas Sumber Daya Manusia, dan Pengadaan Barang dan Jasa terhadap Tingkat Penyerapan Anggaran Daerah. Metode pengumpulan data dalam penelitian ini menggunakan teknik kuesioner. Jumlah sampel dalam penelitian adalah 124 pengelola anggaran pada Organisasi Perangkat Daerah Kota Salatiga dengan teknik pengambilan sampel sensus. Uji validitas menggunakan uji Pearson Correlation, sedangkan uji reliabilitas menggunakan Cronbach Alpha. Teknik analisis data yang digunakan adalah uji asumsi klasik, analisis regresi berganda, koefisien determinasi, uji F, dan uji t . Hasil penelitian menunjukkan bahwa: variabel Perencanaan Angagran dan Kualitas Sumber Daya Manusia berpengaruh terhadap Tingkat Penyerapan Anggaran Daerah. Sedangkan variabel Pelaksanaan Anggaran dan Pengadaan Barang dan Jasa tidak berpengaruh terhadap Tingkat Penyerapan Anggaran Daerah.
PENYELESAIAN SENGKETA PERBANKAN BERKAITAN DENGAN PERLINDUNGAN KONSUMEN
Authors: Herlambang Dian , Ridho Wijaya Muhammad
Published: February 2021

The economy is one aspect of human life that is vulnerable to offense and even evil in it. As the development of the electronic world and the turnover of global money increasingly fast, demanded that people connect with other parties that are banking institutions to manage the money he has. It can be utilized by the person who is not responsible for dredge profit by utilizing the weakness of the banking system both using conventional and electronic media use. The problem in this article is how the banking dispute resolution mechanism relates to consumer protection? The approach to the problem used is normative juridical with the literature study method. The results showed that the banking dispute resolution mechanism in relation to consumer protection can be through two banking dispute resolution mechanisms, namely internal dispute resolution and external dispute resolution of the dispute.