bluuebunny/crossref_metadata_2025 huggingface dataset:
ANALISIS PEMANFAATAN DANAU SENTANI UNTUK PENGEMBANGAN BUDIDAYA KERAMBA JARING APUNG SECARA BERKELANJUTAN
Authors: Djuniawal Iman , Salam Suryawati , Mulyani Sri
Published: February 2021

Penelitian ini bertujuan untuk menganalisis lingkungan internal dan eksternal yang mempengaruhi pengembangan budidaya ikan dan mengkaji strategi yang tepat dalam usaha pengembangan budidaya ikan karamba Jaring apung di Danau Sentani Jayapura, dilaksanakan selama tiga bulan dari Bulan Juni sampai Agustus 2019. Metode yang dilakukan dengan teknik survei melalui observasi dan wawancara mendalam dengan stakeholder terdiri dari pembudidaya, masyarakat pemanfaat dan pemerintah terkait, dianalisis dengan scoring dan SWOT pada sembilan titik stasiun pengamatan berbeda mewakili areal Timur, Tengah dan Barat danau Sentani. Hasil penelitian menunjukkan parameter lingkungan perairan pada wilayah Timur dan Tengah danau Sentani yaitu distrik Puay dan Asei kecil masih layak untuk pengembangan budidaya  Karamba Jaring Apung, berbeda pada wilayah Barat di sekitar Simporo beberapa parameter lingkungan budidaya menunjukkan kurang layak.  Faktor Internal dan eksternal dengan cara peningkatkan pemahaman kelompok budidaya akan pentingnya pemanfaatan sumberdaya danau berpengaruh terhadap pengembangan budidaya karamba jaring apung di danau Sentani. Penguatan sinergitas antara pembudidaya dan kolaboratif dengan berbagai pihak merupakan strategi yang tepat untuk mendorong peningkatan pendapatan dan kesejahteraan pembudidaya 

 

 

This study aims to analyze the internal and external environment that affect the development of fish culture and assess the right strategy in the development of floating net cage fish farming in Sentani Lake Jayapura, carried out for three months from June to August 2019. The method is carried out by survey techniques through In-depth observations and interviews with stakeholders consisting, beneficiary communities and relevant government, were analyzed by scoring and SWOT at nine different observation station points representing the East, Central and West areas of Lake Sentani. The results showed that the environmental parameters of the waters in the East and Central Sentani lakes, namely the districts of Puay and Asei small, were still suitable for the development of floating net Karamba cultivation, differing in the West region around Simporo, some parameters of the aquaculture environment showed that they were less feasible. Internal and external factors by increasing the understanding of aquaculture groups on the importance of the use of lake resources influence the development of floating net cage cultivation in Lake Sentani. Strengthening synergy between farmers and collaboratives with various parties is the right strategy to encourage farmers to increase income and welfare
ANALISIS PENGGUNAAN FERMENTASI PROBIOTIK PADA PAKAN TERHADAP PRODUKTIFITAS UDANG VANAME (Litopenaeus vannamei)
Authors: Wijayanto Agus , Hadijah Hadijah , Mulyani Sri
Published: February 2021

Beberapa tahun terakhir pembudidaya udang Vaname sudah meninggalkan penggunaan antibiotik untuk membantu mengatasi penyakit dalam upaya meningkatkan hasil panen, karena terbukti penggunaan bakteri menjadi semakin meningkatkan resistensi bakteri patogen terhadap antibiotik. Probiotik menjadi solusi terbaik saat ini untuk mendapatkan keberhasilan optimal pada hasil produksi budidaya udang Vaname. Tujuan dari penelitian ini supaya memperoleh pengetahuan konsentrasi terbaik penggunaan probiotik yang diberikan dengan pencampuran pakan dengan berbeda konsentrasi untuk pertumbuhan, sintasan dan FCR udang vaname (Litopenaeus vannamei). Metode yang digunakan pada penelitian ini eksperimental yang terdiri atas 4 perlakuan yaitu A (tanpa penambahan probiotik fermentasi pada pakan), B (penambahan probiotik fermentasi 0,5 liter), C (pakan dengan Probiotik fermentasi 1 liter), dan P3 (pakan dengan Probiotik fermentasi 1,5 liter) pada wadah dengan kepadatan 100 ekor/L. Hasil penelitian menunjukkan rata-rata laju pertumbuhan spesifik udang Vaname berkisar antara 0.16-0,26 %, tingkat kelangsungan hidup berkisar antara 49 – 93 %.
In the last few years, vaname shrimp farmers have abandoned the use of antibiotics to help overcoming the disease as an effort to increase crop yields, because it is proven that the use of bacteria has increased the resistance of pathogenic bacteria to antibiotics. Probiotics are the best solution at this time to obtain optimal success in the production of vaname shrimp. The purpose of this study is to obtain the best concentration of probiotic use given by mixing feed with different concentrations for growth, survival and FCR of vaname shrimp (Litopenaeus vannamei). The method used in this experimental study consisted of 4 treatments namely A (without addition of fermented probiotics in feed), B (addition of 0.5-liter fermented probiotics), C (feed with 1-liter fermented probiotics), and P3 (feed with 1.5-liter fermented probiotics) in containers with a density of 100 ind./L. The results showed that the average specific growth rate of vaname shrimp ranged from 0.16 to 0.26% and the survival rate ranged from 49 to 93%.
The Influence Of Motivation, Job Training, And Information Technology To Performance Of Employee Maxone Hotel & Delia Resort Makassar
Authors: Azis Azhar Asy’ari , Muhibuddin Andi , Saleh Muhammad Yusuf
Published: February 2021

This study aims to determine the effect of motivation, job training and information technology on the performance of employees of Maxone Hotel & Resort Delia Makassar. The research method used is a quantitative method, the data of this study were analyzed using SPSS 24 software. The number of samples in this study were 73 employees. The results showed that motivation had a positive and significant effect on employee performance with unstandardized coefficients 0,371 with tcount 3,42 8> t-table 0,235 with a significance level of 0,001 < 0,05; Job training has a negative but not significant effect on employee performance with unstandardized coefficients 0.168 with t-count of 1.549 > t-table 0.235 with a significance level of 0.126 > 0.05; Information technology has a positive and significant effect on employee performance with unstandardized coefficients 1,549 with t-count 3,727 > t-table 0,235 with a significance level of 0,000 < 0,05; motivation, job training and information technology have a positive and significant effect on employee performance with F-count 46.734 > F-table 2.74 with a significance level of 0.000 < ? 0.05.
The Influence of The Working Discipline, Organizational Commitment and Reply Jasa Against Employee Performance Bappeda East Halmahera Regency
Authors: Abdul Rahman Hasna , Lewangka Osman , Abduh Thamrin
Published: February 2021

This study aims to test and analyze the work discipline of positive and significant effect on performance clerk Bappeda East halmahera Regency, the moderating influence of Retribution against the work performance of the employee discipline Bappeda East halmahera Regency, organizational commitment and significant positive effect on performance clerk Bappeda East halmahera Regency, and retribution to moderate the influence of organizational commitment on performance clerk Bappeda kabupaten East Halmahera. Methods of analysis used in this study was multiple linear regression that analysts used to analyze whether the variable eksogenus (a work discipline, organizational commitment, and retribution) affect variable endogenus (performance employees). The research results showed that the variables work discipline, organizational commitment, and retribution is positive and significant effect on performance in the next variable employee discipline of work and organisational commitment is also positive and significant effect against retribution on halmahera Regency or halmahera bappeda timurdari test results have significance > t-table, or 5,050 > 1,679, then disciplined to work influential and significantly to the performance of the employees. t-female > t-table, or 5,769 > 1,679, then the most influential and significant organizational commitment against the performance of employees.
PENGARUH PROFESIONALISME DAN KOMITMEN ORGANISASI TERHADAP KINERJA AUDITOR INTERNAL DAN REWARD SEBAGAI VARIABEL INTERVENING (Studi Pada Kantor Inspektorat Provinsi Sulawesi Selatan)
Authors: Marewa Yeni Sartika , Saleh Yusuf , Abduh Thamrin
Published: February 2021

Penelitian ini bertujuan menguji dan menganalisis pengaruh langsung profesionalisme terhadap kinerja auditor, pengaruh profesionalisme terhadap reward, pengaruh langsung komitmen organisasi terhadap kinerja auditor, pengaruh komitmen organisasi terhadap reward, dan pengaruh reward terhadap kinerja auditor pada Kantor Inspektorat Provinsi Sulawesi Selatan. Metode analisis yang digunakan dalam penelitian ini adalah analisis regresi linear berganda yang digunakan untuk menganalisis apakah variabel eksogenus (profesionalisme, komitmen organisasi dan reward) mempengaruhi variabel endogenus (kinerja auditor). Hasil penelitian menunjukkan bahwa variabel profesionalisme, komitmen organisasi dan reward berpengaruh positif dan signifikan terhadap kinerja auditor selanjutnya variabel profesionalisme dan komitmen organisasi juga berpengaruh positif dan signifikan terhadap reward  pada Kantor Inspektorat Provinsi Sulawesi Selatan. Dari hasil pengujian memilki signfikansi t-hitung > t-tabel, atau 3,221 > 1.683, maka profesionalisme berpengaruh positif dan signifikan terhadap reward. Dengan ini berarti semakin tinggi sikap profesionalisme seorang auditor maka akan semakin tinggi pula reward yang akan diterima. t-hitung > t-tabel, atau 2.723 > 1.683, maka komitmen organisasi berpengaruh positif dan signifikan terhadap reward, dengan ini berarti pemberian reward dapat meningkatkan komitmen dalam organisasi. t-hitung > t-tabel, atau 6,287> 1.683, maka profesionalisme berpengaruh positif dan signifikan terhadap kinerja auditor,  dengan  ini  berarti  sikap  profesionalisme  dapat  meningkatkan  kinerja auditor, semakin tinggi sikap profesionalisme yang dimiliki oleh auditor maka akan semakin  tinggi  pula  kinerja  auditor.  t-hitung  >  t-tabel,  atau  4.014  >  1.683,  maka komitmen organisasi berpengaruh positif dan signifikan terhadap kinerja auditor, dengan ini berarti komitmen organisasi dapat meningkatkan kinerja auditor. t-hitung > t-tabel, atau 2,591 > 1.683, maka reward berpengaruh positif dan signifikan terhadap kinerja auditor yang berarti reward dapat meningkatkan kinerja seorang auditor.
PENGARUH KUALITAS LAYANAN TERHADAP LOYALITAS PELANGGAN PADA LEMBAGA PENYIARAN PUBLIK RADIO REPUBLIK INDONESIA MAKASSAR
Authors: Ramli Nurhikma Amalia , Remmang Hasanuddin , Ruslan Muhlis
Published: February 2021

Penelitian ini bertujuan untuk mengetahui pengaruh kualitas pelayanan (bukti fisik, kehandalan, daya tanggap, jaminan, dan empati) terhadap loyalitas pelanggan yang dimana dalam hal ini adalah pendengar Radio Republik Indonesia Makassar. Metode penelitian yang digunakan adalah teknik non random sampling dengan menggunakan klaster sampling acak sebanyak 100 orang pendengar radio RRI. Hasil penelitian menunjukkan bahwa variabel keandalan memiliki pengaruh yang signifikan yang artinya siaran RRI Makassar konsisten dalam ketepatan siaran, keakuratan infomasi dan tepat waktu. Ketika menyiarkan program siaran, variabel daya tanggap memilik pengaruh yang signifikan kepada pendengar dalam bentuk layanan seperti menanggapi dan memberikan solusi kepada pendengar saat penyiaran maupun masalah-masalah yang disampaikan oleh pendengar ke penyiaran atau ke RRI Makassar. Variabel   jaminan berpengaruh signifikan yang artinya jaminan yang telah diberikan oleh RRI Makassar telah memberikan kenyaman dalam mendengar dan melayani para pendengar radio RRI Makassar. Variabel empati berpengaruh signifikan artinya empati penyiar dan RRI makassar sudah peka terhadap keinginan dan kebutuhan pendengar. Begitupula dengan variabel bukti fisik memiliki pengaruh yang signifikan yang berarti menunjang siaran RRI Makassar sudah baik seperti alat pendukung siaran yang membuat frekuenzi dan suara penyiar jelas Ketika didengar.
This study aims to study the effect of service quality (physical evidence, reliability, responsiveness, assurance, and empathy) on customer loyalty which in this case was the listener of Radio Republik Indonesia, Makassar. The research method used was a non-random sampling technique using a random cluster sampling of 100 RRI radio listeners. The results showed that the reliability variable had a significant effect, which means that RRI Makassar broadcasts were consistent in broadcasting accuracy, information accuracy, and on time. When broadcasting broadcast programs. The responsiveness variable had a significant effect on listeners in the form of services such as responding and providing solutions to listeners when broadcasting, as well as problems conveyed by listeners to the broadcasting or to RRI Makassar. The assurance variable had a significant effect, which means that the assurance provided by RRI Makassar had provided comfort in hearing and serving listeners of RRI Makassar. The empathy variable had a significant effect, meaning the broadcaster's empathy and RRI Makassar was already sensitive to the wants and needs of listeners. Also, the physical evidence variables had a significant effect, which means that supporting RRI Makassar broadcasts was good, such as broadcast support tools that made frequency and the announcer's voice was clearly heard.
Determinan Bermukimnya Masyarakat di Kawasan Rawan Banjir Kelurahan Lepo-Lepo Kota Kendari
Authors: Susanto Ilham Irawan , Selintung Mary , Muhibuddin A.
Published: February 2021

Penelitian ini bertujuan untuk mengetahui karakteristik banjir yang ada di Kelurahan Lepo-Lepo dan faktor apa saja yang menyebabkan seseorang tetap menetap di daerah kawasan rawan bencana banjir pada Kelurahan Lepo-Lepo Kota Kendari adalah lebih bersifat deskriptif dengan pendekatan positivistik. Dengan metode teknik pendekatan yaitu kuantitatif kedalam metodologi sebuah penelitian tunggal. Teknik analisis dengan metode kuantitatif pada penelitian ini adalah dengan menggunakan teknik statistik deskriptif yang bersifat uraian atau penjelasan dengan membuat tabel atau grafik, mengelompokkan serta menganalisa data berdasarkan pada hasil jawaban kuesioner yang diperoleh. Sedangkan teknik analisis dengan metode kualitatif menggunakan teknik pengamatan dan wawancana dengan imforman terpilih sebagai sumber imformasi. Hasil dari analisis dengan menggunakan uji statistik hubungan antar dua variable (crosstab) di dapat bahwa faktor penyebab yang menentukan seseorang tetap bermukim di Kelurahan Lepo-Lepo Kota Kendari yang rawan akan bahaya banjir yaitu banyaknya responden yang telah bermukim cukup lama secara turun-temurun. Selanjutnya yang menjadi alasan tetap bermukimnya responden dilokasi rawan banjir adalah adanya kerabat yang masih berada dalam satu lokasi yang sama dengan responden dan yang terakhir adalah jenis atau bentuk rumah yang dimiliki responden terutama responden yang memiliki rumah berbentuk panggung dan bertingkat tidak sama sekali berkeinginan untuk pindah.

Kata Kunci: Rawan Banjir, Determinan, Permukiman

 

The Research to determine the characteristics of flooding in Lepo-Lepo Kelurahan and what factors cause a person to remain in a flood prone area in Lepo-Lepo Kelurahan of Kendari City are more descriptive in nature with a positivistic approach. With the technical approach method that is quantitative into a single research methodology. The analysis technique with quantitative methods in this study is to use descriptive statistical techniques that are descriptive or explanatory by making tables or graphs, grouping and analyzing data based on the results of questionnaire answers obtained. While the analysis technique with qualitative methods uses observation and interview techniques with selected informants as sources of information. The results of the analysis using a statistical test of the relationship between two variables (crosstab) can be found that the factors that determine a person still lives in Lepo-Lepo Kelurahan of Kendari which are prone to flooding hazards, namely the number of respondents who have lived for generations. Furthermore, the reason for the permanent residence of respondents in flood-prone locations is the presence of relatives who are still in the same location as the respondents and the last is the type or form of houses owned by respondents, especially respondents who have stilted and terraced houses do not wish to move at all.

 Keywords: Hazard of Flood, Determinants, Settlement.
Prolonged hypoxia induced melanotic pseudotumors in the larvae of blood-sucking mosquitoes
Authors: Buchatskyi L. P.
Published: February 2021

It was found that the presence of mosquito eggs in artificially created conditions of prolonged hypoxia causes the appearance of numerous melanotic pseudotumors in the larvae hatching from such eggs. In the cells of melanotic pseudotumors multilayer concentric membrane-like structures were found in the cytoplasm. In the immediate vicinity of such membranes, small spherical virus-like particles (VLP) with a diameter of about 30 nm were observed. The possible role of hypoxia in the development of melanotic pseudotumors of mosquito larvae is discussed
The Effect of Oxygen Administration on Regional
Cerebral Oxygen Saturation after Stellate
Ganglion Block on the Non-Blocked Side
Authors: Kim Do Hyeong
Published: February 2021

Background: Stellate ganglion block (SGB) causes sympathetic denervation of the head, neck,
and upper extremities. In some studies, it has been reported that cerebral blood flow on the nonblocked side decreases after SGB, so when performing an SGB for pain management of the head,
neck, and arm, the increased risk of cerebral ischemia should be considered.
Objectives: To examine the influence of administration of oxygen via nasal cannula after SGB
on regional cerebral oxygen saturation (rSO2) of the non-blocked and blocked sides using nearinfrared spectroscopy (NIRS).
Study Design: Prospective observational study.
Setting: Outpatient department for interventional pain management at Yonsei University College
of Medicine, Seoul, Korea
Methods: Thirty-eight patients with disease entities in the head, neck, and upper extremity and
3 volunteers were studied. SGB was performed with 10 mL of 1% lidocaine using an anterior
paratracheal approach at the C6 transverse process level. A successful block was determined based
on the appearance of Horner syndrome at 15 minutes after SGB. Oxygen was supplied at a rate of
5 L/min via nasal cannula starting 15 minutes after SGB. rSO2, blood pressure (BP), and heart rate
(HR) were obtained at 5-minute intervals for 30 minutes using NIRS, a non-invasive blood pressure
manometer, an electrocardiogram, and a pulse oximetry.
Results: On the non-blocked side, when compared to the baseline values, there were significant
decreases in the rSO2 (P < 0.001) and after administration of oxygen, there were significant
increases of the rSO2 compared to the rSO2 at 15 minutes (P < 0.001). The lowest rSO2 at 15
minutes on the non-blocked side recovered to greater than the baseline value 5 minutes after
starting oxygen administration. On the blocked side, when compared to the baseline values, there
were significant increases at all time points (P < 0.001) and after administration of oxygen there
were significant increases compared to the rSO2 at 15 minutes (P < 0.001). The rSO2 on the blocked
side and the non-blocked side were significantly different at 15 minutes (P = 0.015). After oxygen
administration, there were no significant differences of rSO2 between the 2 sides.
Limitations: This study is limited by its sample size and observational design. It is difficult to
precisely define the importance of the effect of SGB and oxygen administration on rSO2 change
as we did not examine how the intensity of the nerve block changed with the passage of time.
Conclusion: SGB leads to decreased cerebral blood flow of the non-blocked hemisphere, and
oxygen administration seems to be a simple method to compensate for this response.
Clinical Trial: NCT01532713. IRB No.: 4-2011-0358.
Key words: Brain ischemia, cerebrovascular circulation, nerve block, oximetry, oxygen, regional
blood flow, spectroscopy, near-infrared, stellate ganglion
Bilateral Thoracic Splanchnic Nerve
Radiofrequency Thermocoagulation for
the Management of End-Stage Pancreatic
Abdominal Cancer Pain
Authors: Batistaki Chrysanthi
Published: February 2021

Background: Pancreatic cancer pain is often severe and refractory to conservative therapies.
Several interventional techniques have been described for the management of end-stage
pancreatic cancer pain, with variable results and complications.
Objectives: The aim of this study was to assess the efficacy of bilateral radiofrequency
thermocoagulation of splanchnic nerves for pain relief, the consumption of opioids, and the
quality of life in patients suffering from severe pain due to pancreatic malignancies.
Study Design: A retrospective observational design.
Setting: The study includes patients with end-stage pancreatic abdominal cancer pain, which
is refractory to conservative treatment.
Methods: Thirty-five patients were studied. They were evaluated prior to and after the
radiofrequency thermocoagulation of both splanchnic nerves under fluoroscopic guidance.
The assessment included the pain intensity (Numeric Rating Scale 0 – 10), quality of life (selfreported quality of life score 0 – 10), and 24-hour consumption of opioids with monthly
follow-up visits until the end of life.
Results: Follow-up was completed 6 months after the intervention. The pain scores, quality
of life, and consumption of opioids were significantly improved during the entire follow-up
period. A slight deterioration was noticed during the fifth month because of malignancy
progression. No complications that could be attributed to the technique were observed.
Limitations: The study was not prospective and does not have a control group with a
different intervention for comparisons.
Conclusion: Radiofrequency thermocoagulation of both splanchnic nerves may offer a safe
and effective technique for pain management and quality of life improvement in patients with
end-stage pancreatic cancer towards the end of life.
Key words: Splanchnic nerves, radiofrequency thermocoagulation, pancreatic cancer, pain
Distribution Range of Cervical Interlaminar
Epidural Injections: A Comparative Study with
2.5 mL, 5 mL, and 10 mL of Contrast
Authors: Han Kyung Ream
Published: February 2021

Background: Cervical interlaminar epidural injection (CIEI) is widely used in the management
of acute or chronic neck and upper extremity pain. There is no consensus regarding the optimal
volume of solution to be used for CIEI.
Study Design: Randomized, double blind controlled trial.
Objective: The purpose of this study was to evaluate how many spinal segments would be
covered with different volumes of contrast medium, given by fluoroscopically guided CIEI, in
efforts to establish the optimal volume of medication with consideration of clinical pathologic
lesions.
Methods: One hundred and twenty-six CIEI were performed at C7-T1 in 133 patients. All
patients were divided into 3 groups (A, B, and C) according to the amount of contrast medium
used: 2.5 mL for group A, 5 mL for group B, and 10 mL for group C. The extent of contrast
medium spread was determined by anteroposterior and lateral view under fluoroscopy.
Limitation: We did not evaluate the clinical outcomes with pain measurements during the
study period.
Results: The total number of vertebral segments of contrast media spread and spreading range
of caudad or cephalad were significantly different among the 3 groups (P < 0.001). However,
groups B and C in cephalad spreading and groups A and B in caudad spreading did not show any
significant difference. A proportion of the patients with a cephalad spread of up to C4 and C2
in group A (59.5% and 31%) was significantly different from that in the other 2 groups (92.9%
and 69.1% in group B and 97.6% and 73.8% in group C) (P < 0.001).
Conclusion: Five mL for CIEI at C7-T1 could be an optimal volume for distribution to the lower
cervical spine for degenerative cervical spinal diseases, as well as to the upper cervical spine for
head and facial pain.
Key words: Cervical epidural block, epidural injection, cervical epidural interlaminar injection,
distribution range, fluoroscopy, epidurogram, contrast medium, epidural spread
Complications after Intrathecal Drug Delivery
Due to the Underlying Malignancy in Two
Patients with Intractable Cancer Pain
Authors: Chai Thomas
Published: February 2021

Intrathecal drug delivery is a mode of analgesic delivery that can be considered in those
experiencing both refractory pain and excessive side effects from opioid and adjuvant analgesic
use. Delivery of analgesic agents directly to the cerebral spinal fluid allows binding of the
drug to receptors at the spinal level. Therefore, a reduced analgesic dosage can be afforded,
resulting in reduction of drug side effects due to decreased systemic absorption. Drug delivery
into the intrathecal space provides this benefit, yet it does not eliminate the possibility of drug
side effects or risks of complications.
Complications from this route of administration may be seen in the perioperative period or
beyond, including infection, inflammatory mass, bleeding, and catheter or pump dysfunction,
among others. This may manifest as new/worsening pain or as a neurologic deficit, such as
a sensorimotor change and bladder/bowel dysfunction. Urgent evaluation with a detailed
physical examination, device interrogation, and other workup including imaging is called for
if symptoms suspicious for device-related problems arise. For the cancer pain patient, the
underlying malignancy should also be considered as a potential cause for these new symptoms
after intrathecal system implantation.
We present 2 such cases of complications in the cancer pain patient after intrathecal drug
delivery due to progression of the underlying malignant process rather than to surgical or
device-related problems. The first patient had a history of metastatic osteosarcoma who,
shortly after undergoing an intrathecal drug delivery trial with external pump, presented with
new symptoms of both pain and neurologic changes. The second patient with a history of
chondrosarcoma developed new symptoms of pain and sensorimotor change several days
after intrathecal drug delivery system implantation.
Key words: Intrathecal analgesia, intrathecal drug delivery, perioperative complications,
cancer pain, malignant pain, pain pump
Does Acetaminophen Activate Endogenous
Pain Inhibition in Chronic Fatigue Syndrome/
Fibromyalgia and Rheumatoid Arthritis? A DoubleBlind Randomized Controlled Cross-over Trial
Authors: Meeus Mira
Published: February 2021

Background: Although enhanced temporal summation (TS) and conditioned pain
modulation (CPM), as characteristic for central sensitization, has been proved to be
impaired in different chronic pain populations, the exact nature is still unknown.
Objectives: We examined differences in TS and CPM in 2 chronic pain populations,
patients with both chronic fatigue syndrome (CFS) and comorbid fibromyalgia (FM) and
patients with rheumatoid arthritis (RA), and in sedentary, healthy controls, and evaluated
whether activation of serotonergic descending pathways by acetaminophen improves
central pain processing.
Study Design: Double-blind randomized controlled trial with cross-over design.
Methods: Fifty-three women (19 CFS/FM patients, 16 RA patients, and 18 healthy women)
were randomly allocated to the experimental group (1 g acetaminophen) or the placebo
group (1 g dextrose). Participants underwent an assessment of endogenous pain inhibition,
consisting of an evaluation of temporal summation with and without conditioned pain
modulation (CPM). Seven days later groups were crossed-over. Patients and assessors were
blinded for the allocation.
Results: After intake of acetaminophen, pain thresholds increased slightly in CFS/FM
patients, and decreased in the RA and the control group. Temporal summation was reduced
in the 3 groups and CPM at the shoulder was better overall, however only statistically
significant for the RA group. Healthy controls showed improved CPM for both finger and
shoulder after acetaminophen, although not significant.
Limitations: The influence of acetaminophen on pain processing is inconsistent,
especially in the patient groups examined.
Conclusion: This is the first study comparing the influence of acetaminophen on central
pain processing in healthy controls and patients with CFS/FM and RA. It seems that CFS/
FM patients present more central pain processing abnormalities than RA patients, and that
acetaminophen may have a limited positive effect on central pain inhibition, but other
contributors have to be identified and evaluated.
Key words: Chronic pain, sensitization, acetaminophen, conditioned pain modulation,
temporal summation, chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis
Timing of Neuraxial Pain Interventions
Following Blood Patch for Post Dural Puncture
Headache
Authors: Gritsenko Karina
Published: February 2021

Post dural puncture headache (PDPH) is a common complication of interventional neuraxial
procedures. Larger needle gauge, younger patients, low body mass index, women (especially
pregnant women), and “traumatic” needle types are all associated with a higher incidence of
PDPH. Currently, an epidural blood patch is the gold-standard treatment for this complication.
However, despite the high PDPH cure rate through the use of this therapy, little is known about
the physiology behind the success of the epidural blood patch, specifically, the time course of
patch formation within the epidural space or how long it takes for the blood patch volume to
be resorbed by the body. Of the many unanswered and debated topics related to PDPH and
epidural blood patches, one additional specific question that may alter clinical management
is when it is safe for patients who have experienced a disruption of the thecal space and have
undergone this procedure to have a subsequent epidural or spinal procedure, such as a neuraxial
anesthetic (i.e. a spinal anesthetic for an elective outpatient procedure) or an interventional
pain procedure for chronic pain management. This question becomes more unclear if the
new procedure includes a steroid medication. As an example, an older patient presents with
a history of lumbar disc disease and during lumbar epidural steroid injection, an inadvertent
wet tap occurs leading to PDPH. Following management with fluids, caffeine, medications,
and a successful epidural blood patch, it remains unclear as to when would be the best time
frame to consider a second lumbar epidural steroid injection. We identified the 3 main risk
factors of subsequent interventional neuraxial procedures as (1) disruption of the epidural blood
patch and ongoing reparative processes, (2) epidural procedure failure, and (3) infection. We
looked at the literature, and summarized the existing literature in order to enable health care
professionals to understand the time course of dural repair as well as the risks of subsequent
neuraxial procedures after epidural blood patches. This review poses the question using an
evidence based review to discuss the appropriate time course to proceed.
Key words: Post dural puncture headache, epidural steroid injection, wet tap, timing of
therapy
Short-Term Treatment with Parecoxib for Complex
Regional Pain Syndrome: A Randomized, PlaceboControlled Double-Blind Trial
Authors: Krumova Elena K.
Published: February 2021

Background: Complex regional pain syndrome (CRPS) is characterized by signs and symptoms of
peripheral inflammation, which leads to peripheral neural sensitization associated most frequently
(in about 70%) with blunt pressure hyperalgesia. Therefore, we hypothesized that treatment of
CRPS patients with a selective COX-2-inhibitor would alleviate the abnormally low pressure pain
threshold (PPT) and reduce pain intensity and edema.
Methods: Twenty patients with CRPS type I (n = 16) and II of the upper limb and abnormally
low PPT were double-blind randomised into 2 groups of 10 patients each to receive a 2-day
intravenous treatment of either 80 mg parecoxib per day (group I) or placebo (NaCl 0.9%, group
II). Standardized quantitative sensory testing (QST) using the DFNS protocol was performed before
and after treatment. Pain intensity (NRS 0 – 10); circumferences of the fingers II, IV, and V (mm);
PPT (kPa, thenar/hypothenar); and adverse events were recorded daily. Statistics: Wilcoxon-test,
Mann-Whitney-U-test, Friedman-test, Fisher-test, significance level: P < 0.05.
Study Design: Proof of concept trial performed in randomized, placebo-controlled, double blind
style .
Setting: Pain Management Center in Germany.
Results: There were no group differences in PTT or other QST parameters. After treatment,
PPT decreased insignificantly in group I (median [range]; before: 224.0 [121.0 – 52937] kPa,
afterwards: 186.4 [101.4 – 526.5] kPa) and increased insignificantly in group II (before: 207.6
[170.0 – 320.5] kPa; afterwards: 235.4 [163.5 – 349.9] kPa). Pain scores and finger circumferences
remained unchanged in both groups.
Limitations: Due to difficulty in recruitment the trial was closed after inclusion of 20 patients.
Conclusion: In the present proof-of-concept trial, short-term treatment with the selective COX2-inhibitor parecoxib influenced neither PPT nor edema or pain. COX-2 might be less important
than previously assumed. However, the results are limited due to the small number of patients,
short-term treatment, and focus on the PPT, which could have led to false negative results of the
present study and covered the expected therapeutic effect.
Key words: Parecoxib, complex regional pain syndrome, pressure pain threshold, pressure
hyperalgesia, quantitative sensory testing, inflammation
Optimal Needle Entry Angle for Cervical
Transforaminal Epidural Injections
Authors: Chen Boqing
Published: February 2021

Background: Cervical epidural steroid injections can be performed through either interlaminar
or transforaminal approaches, although the interlaminar approach is more frequently used, for
cervical radicular pain as a result of cervical disc herniation or spinal stenosis. Cervical selective nerve
root block (CSNRB) is an injection that uses a similar approach to that of cervical transforaminal
epidural steroid injection (CTFESI) but CSNRB is mainly used for diagnostic injection, often with
local anesthetic only.
Objective: The aim of this study was to investigate an optimal needle entry angle for cervical
transforaminal epidural steroid injection (CTFESI) or cervical selective nerve root block (CSNRB)
using the fluoroscopically guided anterior oblique approach. The angle for optimal entry into
the neuroforamen was measured at various vertebral levels using cross-sectional cervical spine
computed tomography (CT) scans.
Study Design: Retrospective case series analysis.
Methods: From March 2009 to July 2012, consecutive patients with presumed discogenic neck
pain underwent cervical post discography CT scans. The axial images of these CT scans were used
to measure the optimal angle for needle entry into the neuroforamen. The angles were taken
bilaterally at levels of C3-4, C4-5, C5-6, C6-7, and C7-T1. The average angle between the patient’s
left and right side was calculated. A total of 190 patients were analyzed, including 73 men and 117
women, with ages ranging from 21 to 78 years old.
Results: In both men and women, the mean optimal angle (in degrees) with standard deviation
measured in the 190 patients at C3-4, C4-5, C5-6, C6-7, and C7-T1 were 48 ± 4, 49 ± 4, 49 ±
4, 49 ± 5, 48 ± 6, respectively. The 95% confidence interval for the true value of the parameter is
within 39.84 to 57.56 degrees.
Limitations: The data for the optimal needle entry angle for CTFESI has yet to be tested or
confirmed in clinical studies.
Conclusion: This is the first study investigating the optimal needle entry angle for performing
CTFESIs or CSNRB. Based on a patient population of 190, the optimal entry angle using the anterior
oblique approach appears to be between the range of 33 to 68 degrees with an average of
slightly less than 50 degrees. Further research with angle of needle entry and/or initial fluoroscopic
alignment of approximately 50 degrees in CTFESI or CSNRB is warranted to confirm the usefulness
of these findings.
Key words: Pain medicine, transforaminal, cervical, epidural, cervical selective nerve root block,
cervical disc herniation, interlaminar, neck pain, vertebral artery, radiculomedullary artery
The Effects of Gastroretentive Gabapentin
(Gralise®) on Spinal Stenosis Patients with
Radicular Pain
Authors: Kaye Alan David
Published: February 2021

Background: The health and efficacy profiles of Gralise® in the treatment of pain from
spinal stenosis and radicular symptomatology have not been measured. A review of the
current literature indicates that no studies exist that evaluate the safety and efficacy profiles
of Gralise® in the treatment of pain from spinal stenosis and radicular symptomatology.
Objective: Our study is aimed at determining whether Gralise is a safe and effective
pharmacotherapy for the pain from spinal stenosis and radicular symptomatology.
Study Design: A 4-week prospective open label single arm and single center study of
patients with MRI diagnosis of spinal stenosis with radicular pain.
Methods: The primary measure of efficacy was a change in average daily pain (ADP)
score from baseline to completion of Gralise therapy for 4 weeks. The secondary efficacy
endpoints were the patients’ Patients Global Impression of Change Scale (PGIC), the
clinician’s Clinical Global Impression of Change Scale (CGI) reports, and the Medical
Outcomes Study (MOS) sleep scale of improvement from baseline to completing 4 weeks
of Gralise therapy. The safety and tolerability were evaluated by the incidence of adverse
events reported while on Gralise therapy.
Setting: The study was performed at the Clinical Research Facilities at Tulane Medical
Center, New Orleans, Louisiana, in the period from December 1, 2012, to August 30,
2013.
Results: Thirty-five patients achieved an efficacy point of one-week Gralise medication
treatment. Twenty-seven of 35 (77.2%) patients completed all 5 visits. The PGIC noted a
significant positive change in: (1) activity limitations; (2) symptoms; (3) emotions and overall
quality of life when related to their condition from first visit as well as improved degree
of change when related to their condition from first to last visit. The MOS sleep scale and
sleep diaries noted a significant increase of hours slept on average (an increase in over one
hour per night — 5.8 hours versus 6.86 hours) from the beginning of the study to the end.
The CGI noted a majority of 10 out of 27 with marked significant therapeutic effect with
no side effects. The ADP rating from pain intensity scale and pain diaries noted significant
improvement of lesser levels of pain experienced (P =.5907 and P =.8547 respectively). No
significant adverse effects were noted in the study.
Limitations: Variation in degree of spinal stenosis, small sample size.
Conclusions: Gralise demonstrated moderate efficacy with reduced pain intensity and
increased sleep and was well tolerated in spinal stenosis patients with radicular symptoms.
Key words: Spinal stenosis, gabapentin, Gralise®, radicular pain, neuropathic pain
Prednisolone in Complex Regional Pain
Syndrome
Authors: Atalay Nilgun Simsir
Published: February 2021

Background: Although there are several studies of systemic corticosteroid therapies in various
doses and various durations in complex regional pain syndrome (CRPS), the outcome measurement
parameters are limited to the range of motion measurements, edema, and symptoms of CRPS.
Objective: To investigate the effects of prednisolone on clinical symptoms, pain, hand grip
strength, range of motion, as well as on functional ability and quality of life in patients who
developed CRPS after traumatic upper extremity injury.
Study Design: Retrospective evaluation.
Methods: Forty-five patients who used prednisolone for CRPS of the upper extremity were
retrospectively studied. Prednisolone was started with a dose of 30 mg and tapered by 5 mg every
3 days until discontinuation after 3 weeks. Clinical symptoms (morning stiffness, cold intolerance,
shoulder pain, numbness of fingers, hyperesthesia, abnormal sweating, and cyanosis that is
exacerbated by exposure to cold temperature), pain (Visual Analogue Scale-Rest [VAS-R] and VASActivity [VAS-A]) were reviewed. The muscle strength with grip strength (GS) (kg), lateral pinch
(LP) (pound), tip-to-tip pinch (TP) (pound), and chuck pinch (CP) (pound) measurements; the joint
range of motion with using third finger tip-distal crease distance (FT-DC) (cm); functional ability
with Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score; and quality of life with
Short Form-36 (SF-36) score were evaluated.
Results: Mean age was 43.53 ± 11.43 years. After 3 weeks of therapy, patients showed significant
improvements in clinical symptoms compared to the basal assessments (P < 0.05). The comparison
of pre- and post-treatment results revealed that VAS-R, VAS-A, GS, LP, TP, CP, FT-DC, Q-DASH
scores, and all SF-36 subscores were significantly improved (P < 0.05).
Limitations: The retrospective design and data collection procedure was limited to the medical
records of patients.
Conclusion: A short-term oral prednisolone therapy significantly reduced the symptoms and
signs of CRPS, and improved the functional abilities and quality of life.
Key words: Complex regional pain syndrome, prednisolone, function, quality of life
The Effects of Dexmedetomidine Alone and in
Combination with Tramadol or Amitriptyline in
a Neuropathic Pain Model
Authors: Farghaly Hanan S. M.
Published: February 2021

Background: Interactions between the sympathetic and somatic nervous system play an essential
role in the pathophysiologic mechanisms of neuropathic pain. The α2-adrenoceptor agonists
produce effective antinociception, but sedation is an important adverse effect. Multidrug therapy
is potentially valuable to decrease side effects.
Objective: The aim of the present study was to investigate the possible antinociceptive effect of
dexmedetomidine, an α2-adrenoceptor agonist, and its combination with front-line treatment of
neuropathic pain, i.e., amitriptyline or tramadol, in a chronic constriction injury (CCI) model of the
sciatic nerve in rats.
Study Design: Controlled animal study.
Methods: Following unilateral ligation of the left sciatic nerve, the effect of intraperitoneal (i.p.)
dexmedetomidine (5μg/kg), tramadol (5 mg/kg), and amitriptyline (30 mg/kg) on mechanical
allodynia (measured by electrical von Frey apparatus) and hyperalgesia (measured by Randall and
Selitto test) was studied.
Results: The sham-operated rats and un-operated hind paw (right paw) press normally on
the floor reproduced by a weighted pain score of 0. Behavioral and mechanical tests confirmed
the development of neuropathic pain after CCI. All individual drugs and dexmedetomidine
combination with either tramadol or amitriptyline were effective in reducing mechanical allodynia
and hyperalgesia. Dexmedetomidine, amitriptyline, tramadol, amitriptyline+dexmedetomidine,
and tramadol+dexmedetomidine combination did not produce any sedation/motor impairment
(P > 0.05).
Limitations: Although the combination of these drugs improved the CCI model of neuropathic
pain in this study, an additional interpretation of the underlying mechanism(s) will be needed to
confirm these findings.
Conclusion: The combination of these drugs appears to be more effective in increasing the
pain threshold after peripheral nerve injury, when compared with the administration of either of
amitriptyline or tramadol alone and should be considered as a possible alternative to decrease side
effects of individual drug therapy.
Key words: Allodynia, amitriptyline, chronic constriction injury, dexmedetomidine, hyperalgesia,
neuropathic pain, rat, tramadol
Policies and Events Affecting Prescription
Opioid Use for Non-Cancer Pain Among an
Insured Patient Population
Authors: Ahmedani Brian K.
Published: February 2021

Background: Rising prescription opioid use and abuse have prompted widespread concern.
However, to date there have been few rigorous investigations into the policies and events which
may have contributed to these trends.
Objective: This study investigates trends in opioid use and related adverse events among
individuals with non-cancer pain before and after implementation of major national policies.
Study Design: The study used a longitudinal prospective study design. The analysis was limited
to adults (age ≥ 18 years) without a recorded cancer diagnosis. Pharmacy claims were used to
assess rates of prescription opioid use, the strength of opioids dispensed, the proportion using
opioids chronically, and related adverse events. Time trend analysis was used to identify changes
in these rates over time. The study was Institutional Review Board approved.
Setting: Study patients were members of a large, health maintenance organization in southeast
Michigan, with longitudinal records of prescription opioid use.
Results: The analysis comprised 523,623 individuals and 1,066,700 opioid pharmacy fills from
January 1, 1997, to December 31, 2011. Contemporaneous with the implementation of health
organization accreditation criteria requiring assessment and treatment of pain in all patients
beginning January 2001, we observed a consistent and unabated increase in the rate of opioid fills
and the proportion of chronic use. A parallel increase in the annual rate of adverse events was also
observed. Similarly, we observed a continuous rise in the average strength of opioid fills following
January 2001 with the exception of a single drop in December 2010, which was attributable to
the withdrawal of propoxyphene from the U.S. market.
Limitations: This was an observational study and not a trial. Other long-term opioid-related
benefits or harms, including functional status, quality of life, and substance use disorder, were
not assessed.
Conclusions: This study provides temporal evidence for a rise in prescription opioid use after
implementation of health organization accreditation criteria requiring standardized management
of all individuals with pain.
Key words: Opioid analgesics, chronic pain, chronic drug use, prescription drugs, pain
management, propoxyphene, Joint Commission, adverse drug events, morphine dose equivalents,
opioid epidemic