bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and Ethnic Disparities in Inpatient Interventional Pain Management for Lumbar Radiculopathy
Authors: Louis Robert
Published: October 2024

BACKGROUND: Chronic pain is a common reason adults seek care; patients often feel that their pain is inadequately managed. Spine-related pain is the most common chronic pain concern, and lumbar radiculopathy is often the cause. Racial and ethnic disparities in the pharmacologic management of pain are well described, but less is known about these disparities regarding interventional procedures. OBJECTIVE: To study the utilization rates of physical therapy, epidural steroid injection, surgery, and spinal cord stimulation in hospitalized patients with lumbar radiculopathy across different races, ethnicities, and genders. STUDY DESIGN: A retrospective cross-sectional study design. METHODS: The National Inpatient Sample was used to identify 252,790 patients with lumbar radiculopathy, after sample weighting, from 2016-2019. Independent variables were race, ethnicity, age, gender, insurance, geography, year, and severity. Dependent variables were physical therapy, epidural steroid injection, spinal cord stimulator, or surgery (reference group). Conservative management was defined as nonoperative treatment ranging from physical therapy to epidural steroid injection. Data were analyzed with a logistic regression for complex surveys. Regressions were adjusted for age, insurance, geography, and other socioeconomic factors. RESULTS: Most patients were white (78.3%) and received surgery (95.0%). Severe disease was most common among African Americans (9.3%), but was similar across other races, ethnicities, and genders. Medicaid was more common among African Americans and Hispanics. An adjusted analysis showed that African Americans and Hispanics received more epidural steroid injections (odds ratio [OR] = 1.52; 95%CI, 1.3 – 1.8) and (OR = 1.43; 95%CI, 1.1 – 1.8) respectively; and physical therapy (OR = 1.65; 95%CI, 1.1 – 2.5) and (OR = 1.83; 95%CI, 1.2 – 2.8) respectively, than whites compared to surgery. African Americans received a spinal cord stimulator less often than whites compared to surgery (OR = 0.63; 95%CI. 0.4 – 0.9). Women received an epidural steroid injection more frequently than men compared to surgery (OR = 1.29; 95%CI, 1.2 – 1.4). LIMITATIONS: Generalizability is limited because conservative therapies are often outpatient treatments. CONCLUSION: Disparities were observed in lumbar radiculopathy treatment after independent variable adjustment. African Americans received conservative therapy more often than whites despite increased disease severity. Hispanics and women had similar disease severity compared to whites and men, respectively, but received more conservative therapies. Further investigation in outpatient settings is needed to definitively describe these disparities. KEY WORDS: Chronic pain, pain management, back pain, lumbar radiculopathy, epidural steroid injection, spinal cord stimulation, low back surgery, physical therapy, racial disparities, gender disparities
Outcomes and Predictors of Response to Pregabalin for the Treatment of Post-Traumatic Trigeminal Neuropathic Pain Following Neuroablative Procedures: A Retrospective Observational Study
Authors: Luo Fang
Published: October 2024

BACKGROUND: Post-traumatic trigeminal neuropathic pain (PTNP) following trigeminal neuralgia (TN)-related neuroablative procedures is relatively rare. Due to the fear of debilitating complications, its treatment has been generally suboptimal. Pregabalin (PGB) has been reported to relieve neuropathic pain. However, the potential role of PGB and the predictors of response of PGB use as a strategy in the treatment of PTNP following TN-related neuroablative procedures have not been identified yet. OBJECTIVES: To report the efficacy and safety of PGB and the identification of predictors of PGB for PTNP following TN-related neuroablative procedures. STUDY DESIGN: Monocentric, retrospective, observational study. SETTING: This study consecutively enrolled patients with PTNP following TN-related neuroablative procedures who were prescribed PGB at Beijing Tiantan Hospital. METHODS: From January 2018 to June 2022, a total of 112 patients were included in this study, of whom 10 were excluded because of incomplete follow-up data and side effects immediately after taking PGB. Final analysis included 102 patients. Demographic data, pain-related baseline data, efficacy of patients with PTNP after one month of PGB evaluated by the Barrow Neurological Institute (BNI) scores for pain, and side effects of PGB were extracted and analyzed. The predictors of pain-relieving effects of PGB were identified by logistic regression analysis. RESULTS: Within one month after the use of PGB alone, 29 out of the 102 (28.4%) patients achieved pain relief with a significant reduction in the BNI scores (P < 0.01). All of the 73 patients who did not respond to PGB monotherapy either switched to other medications (n = 8) or combined additional oral medications to the existing PGB therapy (n = 65). The main side effect of PGB in our study was dizziness. Binary logistic regression analysis showed that longer disease durations (Adjusted odds ratio [OR] = 0.55, 95% confidence interval [CI] 0.43 to 0.72, P = 0.000) and higher Hospital Anxiety and Depression Scale (HADS) scores (Adjusted OR = 0.29, 95% CI 0.10 to 0.87, P = 0.022) were poor predictors of response to PGB. LIMITATIONS: This was a retrospective observational study. Long-term efficacy and safety of PGB in the treatment of PTNP patients were not evaluated. CONCLUSIONS: This study confirms that PGB monotherapy is not a very effective treatment for PTNP following TN-related neuroablative procedures. PGB was more beneficial in patients with shorter disease durations and lower HADS scores. KEY WORDS: Post-traumatic trigeminal neuropathic pain, efficacy, safety, predictor of response, pregabalin
Risk Factors for Recurrence After Radiofrequency Surgery of the V2 Branch of the Trigeminal Nerve
Authors: Xie Keyue
Published: October 2024

BACKGROUND: The factors influencing relapse after radiofrequency operation of the V2 branch of the trigeminal neuralgia are yet to be identified. OBJECTIVES: The risk factors affecting recurrence after radiofrequency operation of the V2 branch of the trigeminal neuralgia were analyzed, and a curative effect prediction model was constructed. STUDY DESIGN: A retrospective study. SETTING: This study was conducted at the Affiliated Hospital of Jiaxing University, People’s Republic of China. METHODS: The records of patients with maxillary nerve pain in the V2 branch of the trigeminal nerve who underwent computed tomography-guided foramen rotundum radiofrequency treatment at the Pain Department of the Affiliated Hospital of Jiaxing College from April 2014 through December 2020 were collected and randomly divided into training (n = 137) and test (n = 59) groups at a 7:3 ratio. The outcome variable was whether or not recurrence was observed 2 years postsurgery. Independent predictors were screened by LASSO (least absolute shrinkage and selection operator) regression analysis. Based on these findings, a nomogram prediction model was explored further and developed using multifactor logistic regression analysis. Also, the feasibility of the nomogram prediction model for recurrence after radiofrequency was assessed using a validation group. Finally, the discriminatory power, accuracy, and clinical utility of the prediction model were evaluated using the receiver operating characteristic (ROC), area under the curve (AUC), calibration curve, and decision curve analysis (DCA), respectively. RESULTS: LASSO regression, combined with multifactorial logistic regression analysis, identified factors such as age, duration, branches, and numbness that influence V2 trigeminal nerve pain recurrence in patients 2 years post-radiofrequency surgery (P < 0.05). The above variables were used to construct the nomogram prediction models. The AUC of the nomogram prediction model predicted that the recurrence post V2 radiofrequency was 0.726 in the training group and 0.611 in the test group. The DCA showed that the columnar plot prediction model predicted the risk of recurrence post-radiofrequency of the V2 branch of the trigeminal nerve had a threshold probability of 0 – 0.9. LIMITATIONS: This was a single-center study. CONCLUSION: A highly accurate nomogram prediction model (predictor variables include age, duration, branches, and numbness) was developed to improve the early identification and screening of patients at high risk of recurrence after V2 trigeminal nerve radiofrequency surgery. KEY WORDS: Trigeminal neuralgia, maxillary neuralgia, radiofrequency, risk factors, prediction model
A Morphometric Study Analyzing the Anterior Epidural Space Volume Throughout Childhood
Authors: Morgan Ryan
Published: October 2024

BACKGROUND: Following disc herniations, fragments migrate into the anterior epidural space within the lumbar spine. Although the volume of this area has been previously described in the adult population, the volume is relatively unknown within children. OBJECTIVES: Investigate the relative volume in the lumbar anterior epidural space within the growing spine by using imaging studies. STUDY DESIGN: Retrospective chart review. SETTING: University Medical Center in Lubbock Texas. A teaching hospital affiliated with Texas Tech University Health Sciences Center. METHODS: We conducted a retrospective review of the charts of pediatric patients seen at our institution from 2018 through 2020. Charts chosen for our investigation contained computed tomography imaging of the lumber spine, showing no deformities. Thirty patients were stratified equally among 3 age groups, 2-5 years old, 10-12 years old, and 16-18 years old. The anterior epidural space was measured in each patient 3 times using the previously reported method used by Teske et al (1). Results were compared with a combination of analysis of variance (ANOVA) and single tail paired t test. RESULTS: There was a statistically significant difference in the anterior epidural space size among age groups at all levels of the lumbar spine. When comparing only 2 groups together, the younger age group had anterior epidural space sizes significantly smaller than the other age group for all levels of the lumbar spine. The 10-12 age group had a significantly smaller space in the anterior epidural space than the 16–18-year olds only at the level of L2, L4, and L5 (P = 0.048,0.039, and 0.031, respectively). Within the 16–18-year age group, the anterior epidural space was significantly different between L4 and L3 and L2 and L3 (P < 0.001 and P = 0.019, respectively). LIMITATIONS: Our study is limited by its retrospective nature and the sample size of the patient groups. Furthermore, the use of computed tomography imaging and not making physical measurements limits our accuracy. CONCLUSION: The volume of the anterior epidural space is smaller in the pediatric population than the adult population. The inability of herniated discs to fit within the epidural space in children and adolescents could potentially be the cause of the increased failure of conservative treatment for pediatric lumbar disc herniations. KEY WORDS: Anterior epidural space, lumbar herniated disc, low back pain, fossa corporis vertebralis dorsalis, free disc fragment, lumbar spine anatomy
Plasma Rich in Growth Factors (PRGF) in the Treatment of Patients With Chronic Cervical and Lumbar Pain: A Prospective Observational Clinical Study
Authors: Anitua Eduardo
Published: October 2024

BACKGROUND: Chronic back pain is a long-lasting disorder, whose main source of pain is often the intervertebral disc that undergoes a degenerative process associated with low-grade inflammation, leading to a reduced quality of life. OBJECTIVES: The aim of our study was to assess the efficacy of intradiscal and epidural injections of plasma rich in growth factors (PRGF) in patients with chronic clinical symptoms due to intervertebral disc (IVD) degeneration. STUDY DESIGN: Prospective observational study. SETTING: A single spine unit in a private clinic. METHODS: Thirty-two patients with cervical and lumbar chronic pain due to IVD degeneration were treated with 2 or 3 series of intradiscal and epidural PRGF infiltrations with 2 weeks between each procedure. The procedures were performed under fluoroscopic guidance and grade 3 sedation in an operating theater. Treatment efficacy was evaluated using the Spine Tango Core Outcome Measure Index questionnaire, Numeric Rating Scale for back pain, and the Oswestry Disability Index questionnaire. In addition, the number of patients who successfully achieved the minimal clinically important change was also determined. These assessments were evaluated at pretreatment (baseline) and at one, 3, and 6 months posttreatment. RESULTS: The Oswestry Disability Index, COMI Spine Tango Core Outcome Measure Index total score, and Numeric Rating Scale showed a statistically significant reduction from the baseline level to the posttreatment first month, third month, and sixth month (P < 0.001). Moreover, 78.1% of the patients reached a pain reduction superior to 30% one month posttreatment, and 87.5% at 6 months posttreatment, which is considered as a clinically significant improvement. LIMITATIONS: This study was prospective and did not have a control group. Only patient-reported outcomes were evaluated. CONCLUSIONS: This observational, prospective study of patients with chronic back pain showed that 2-3 intradiscal and epidural injections of PRGF significantly decreased pain and disability at one month posttreatment and this improvement was maintained, and in some patients even improved, at 3, and 6 months posttreatment. KEY WORDS: Platelet-rich plasma, plasma rich in growth factors, degenerative disc disease, intervertebral disc degeneration, back pain, growth factors, regenerative medicine
Output Current and Efficacy of Pulsed Radiofrequency of the Lumbar Dorsal Root Ganglion in Patients With Lumbar Radiculopathy: A Prospective, Double-blind, Randomized Pilot Study
Authors: Park Sukhee
Published: October 2024

BACKGROUND: Lumbar radicular pain (LRP) is a common but challenging clinical symptom. Pulsed radiofrequency (PRF), a neuromodulation technique that uses short pulses of radiofrequency current, is effective in treating various pain disorders. However, few studies have been conducted on the effects of PRF and its modifying parameters. OBJECTIVES: Our study aimed to determine the intraoperative parameters of PRF of the lumbar dorsal root ganglion (DRG) that are related to clinical effects in patients with LRP unresponsive to transforaminal epidural steroid injections (TFESI). STUDY DESIGN: Prospective double-blind randomized controlled trial, pilot study. SETTING: Single medical center in the Republic of Korea. METHODS: Patients were allocated to one of 2 groups, high-voltage (60 V) or standard-voltage (45 V), according to the preset maximum voltage at which the active tip temperature does not exceed 42°C. Intraoperative parameters, such as output current, sensory threshold, and impedance, were measured. The primary outcomes were radicular pain intensity, physical functioning, global improvement and satisfaction with treatment, and adverse events. The assessments were performed up to 3 months postprocedure. RESULTS: The patients in the standard-voltage group showed significant improvements in the Numeric Rating Scale pain score (P = 0.007) and Oswestry Disability Index (ODI) (P = 0.008) scores at 3 months post-PRF; however, no difference was observed in the high-voltage group. Among the intraoperative parameters, the output current showed a significant negative linear relationship with analgesic efficacy. The output current also showed a significant association with pain intensity (P = 0.005, R2 = 0.422) and ODI score (P = 0.004, R2 = 0.427) at 3 months postprocedure in a multiple regression analysis. The optimal cut-off value of the output current to lower pain intensity after 3 months was 163.5 mA with a sensitivity of 87.5%, specificity of 100%, and an area under the receiver operating characteristic curve value of 0.92 (95% CI. 0.76 – 1.00). LIMITATIONS: Limitations of our study include an imbalance of baseline characteristics, small sample sizes, and short follow-up periods CONCLUSIONS: Lower output currents during PRF application to the lumbar DRG were associated with greater analgesic effects in patients who did not respond to therapeutic TFESI. KEY WORDS: Lumbar radicular pain, pulsed radiofrequency, dorsal root ganglion
Effect of Ultrasound-Guided Rhomboid Interfascial Plane Block on Pain Severity, Disability, and Quality of Life in Myofascial Pain Syndrome – A Case Series With One-Year Follow-Up
Authors: Albayrak Havvanur
Published: October 2024

BACKGROUND: Myofascial pain syndrome (MPS) is a condition characterized by trigger points in the taut bands of skeletal muscles, commonly affecting the trapezius, rhomboid, and supraspinatus muscles. Rhomboid intercostal block (RIB), an interfascial plane block used to assist perioperative analgesia might be a potential treatment option in MPS. OBJECTIVES: To investigate the short and long-term effects of ultrasound-guided RIB in reducing the severity of pain, disability, and improving quality of life in MPS patients with trigger points in the rhomboid muscle. STUDY DESIGN: Retrospective study. SETTING: Physical medicine and rehabilitation outpatient clinic in a university hospital. METHODS: Patients with a diagnosis of MPS who received ultrasound (US)-guided RIB between November 2021 and January 2022 were enrolled in this study. All patients reported pain lasting >= 3 months and severity >= 4/10 on numeric rating scale (NRS), without any comorbidities affecting the neuromuscular system. Trigger points in the rhomboid muscle were treated with US-guided RIB. Pain intensity was evaluated using a NRS at pre-treatment and one week, one month and one year after the injection. At pre-treatment, one month, and one year after treatment, self-administered neck pain and disability scale and Nottingham Health Profile were evaluated. RESULTS: A total of 23 patients were included in this study (5 men and 18 women, with an average age of 45). Pain severity was statistically significantly reduced in approximately 90%, 60-70%, and 50% of the chronic MPS patients at the first week, first month, and first year following injection, respectively. Disability scores improved significantly in 70% and 56% of those patients at the first month and first-year follow-up. Improvement in the quality of life was observed at the first month and maintained at the first-year follow-up. LIMITATIONS: The retrospective design of this study is a limitation. Due to the lack of a control group, this treatment option could not be compared with other treatments. CONCLUSIONS: Our study demonstrated that RIB might be an effective long-term treatment option for MPS in the reduction of pain and disability, improvement of quality of life and overall patient satisfaction. KEY WORDS: Myofascial pain syndrome, trigger point, pain, pain management, interventional ultrasound
Retrospective Review of Intrathecal Hydromorphone Dose Range and Complications
Authors: Charnin Jonathan
Published: October 2024

BACKGROUND: Optimal intrathecal dosing regimens for hydromorphone are not well established for analgesia after abdominal surgery. OBJECTIVES: We reviewed intrathecal hydromorphone doses and complications because dosing variability has been observed among anesthesiologists. We hypothesized that increasing doses of intrathecal hydromorphone would be associated with improved postoperative analgesia, but with increased rates of opioid-related adverse events. STUDY DESIGN: Retrospective analysis. SETTING: A high-volume academic referral center in the United States. METHODS: A retrospective study was conducted of adults undergoing abdominal surgery under general anesthesia supplemented preoperatively with intrathecal hydromorphone for postoperative analgesia from May 5, 2018, through May 31, 2021. Patients were categorized into 3 hydromorphone dosing groups: low-dose (50-100 µg), middle-dose (101-199 µg), and high-dose (200-300 µg). Multivariable logistic regression models were used to assess rates of severe postoperative pain, severe opioid-related adverse events, oversedation, and pruritus in the postanesthesia care unit (PACU) and within 24 hours after PACU discharge. RESULTS: Of 1,846 patients identified, 1,235 (66.9%) were in the low-dose group; 321 (17.3%), middle-dose group; and 290 (15.7%), high-dose group. Patients receiving the 2 higher doses had more extensive procedures. An unadjusted analysis showed differing rates of severe pain in the PACU by group: 306 (24.8%) in the low-dose, 73 (22.7%) middle-dose, and 45 (15.5%) in the high-dose group (P = 0.003); these differences, however, were no longer significant after an adjusted analysis (P = 0.34). Ten severe opioid-related events occurred; all were recognized in the PACU. Five events each occurred in the low-dose and high-dose groups versus none in the middle-dose group (P = 0.02). No other differences were identified with adjusted analyses. LIMITATIONS: Limitations of our study include its retrospective design and its conduct at a single center, along with the apparent, but difficult to characterize, treatment biases in hydromorphone dosing. CONCLUSIONS: No dose response was observed between intrathecal hydromorphone dose and postoperative analgesia, a finding that may reflect treatment bias. Higher rates of severe opioid-related events were detected for patients receiving high-dose hydromorphone in the PACU, but all other safety outcomes were similar between dosing regimens. KEY WORDS: Drug-related side effects, opioid analgesics, outcome assessment, postoperative pain, spinal injections
Predictive Value of Blood Glucose Coefficient of Variation for Prognoses in Patients with Diabetes Mellitus-Associated Herpes Zoster
Authors: Yao Ming
Published: October 2024

BACKGROUND: Herpes zoster (HZ) and diabetes mellitus (DM) are common diseases in middle-aged and older adults aged 50 years or more, and the prevalence of DM-associated HZ is gradually increasing. Several studies have confirmed that DM is a significant risk factor for postherpetic neuralgia (PHN). However, few studies have investigated the correlation between blood glucose-related indices and prognoses in patients with DM-associated HZ. The purpose of this study was to investigate the effect of blood glucose-related indices on the prognoses of these patients. OBJECTIVES: The purpose of this study was to observe the potential value of blood glucose-related indices in predicting prognoses in patients with DM-associated HZ. STUDY DESIGN: A retrospective, observational study. SETTING: The study was carried out in the Pain Department of the First Hospital Affiliated to Jiaxing College in Jiaxing, China. METHODS: Patients with DM-associated HZ admitted to the First Hospital of Jiaxing between October 2019 and February 2022 were enrolled. The patients were divided into PHN and non-PHN groups. Demographic data, including gender, age, period of first clinical visit, site of involvement, history of DM, DM-related complications, comorbidities, and treatment were collected. Simultaneously, blood glucose-related data, including blood glucose level at admission (GLUadm), blood glucose level difference (GLUdif), and blood glucose coefficient of variation (GLUcv) were collected. Univariate and multivariate logistic regression analyses were performed to analyze factors affecting prognosis. A receiver operating characteristic (ROC) curve was constructed to assess the value of GLUcv in predicting prognosis. RESULTS: Overall, 136 patients were included. Among them, 65 and 71 were in the PHN and non-PHN groups, respectively. Univariate analysis showed that gender (x^2 = 2.023, P = 0.044), history of DM (x^2 = 3.850, P < 0.001), DM-related complications (x^2 = 3.238, P = 0.016), comorbidities (x^2 = 2.439, P = 0.019), and GLUcv (x^2 = 3.576, P < 0.001) were associated with PHN. Multivariate logistic regression analysis showed that a history of DM >= 10 years (OR = 4.096, 95% CI: 1.759–10.082, P = 0.001), comorbidities (OR = 2.680, 95% CI: 1.143–6.567, P = 0.026), and GLUcv >= 30.56 (OR = 5.234, 95% CI: 2.325–12.603, P = 0.001) were independent factors. The ROC curve revealed that GLUcv had a high predictive value for PHN (AUC = 0.714, P < 0.001). LIMITATIONS: The nonrandomized, single-center, retrospective design and small sample size are major limitations of this study. CONCLUSIONS: GLUcv has a high predictive value for the prognoses of patients with DM-associated HZ. The higher the GLUcv value, the likelier the patient is to have a poor prognosis. KEY WORDS: Blood glucose, coefficient of variation, herpes zoster, diabetes mellitus
Percutaneous Endoscopic Lumbar Discectomy for Calcified Lumbar Disc Herniation: A Retrospective Cohort Study, Systematic Review and Meta-Analysis
Authors: Song Chao
Published: October 2024

BACKGROUND: Calcified lumbar disc herniation (CLDH) is a subtype characterized by calcification, leading to increased surgical complexity. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique, but its effectiveness and complications in CLDH patients remain to be fully evaluated. OBJECTIVE: To assess the effectiveness and complications of PELD in treating CLDH patients. STUDY DESIGN: A retrospective cohort study combined with a systematic review and meta-analysis. SETTING: Department of Pain Medicine, an affiliated hospital of a university. METHODS: Data from patients who underwent PELD in our department between March 2020 and May 2021 were collected. Forty CLDH patients were included in the study group, and equally matched cases with uncalcified lumbar disc herniation (UCLDH) served as controls. A systematic search was conducted on October 5, 2022, using EMBASE, PubMed, Cochrane Library, the China Biology Medicine disk, the China National Knowledge Infrastructure, and the Wanfang databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to calculate pooled results. RESULTS: Eighty patients were included in the retrospective cohort, and 41 studies were included in the meta-analysis. Both the retrospective cohort and meta-analysis consistently showed a significant decrease in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores in the CLDH group after the operation. In the retrospective cohort, the excellent or good rate according to the MacNab classification was 85%, with no reported complications. The meta-analysis revealed a pooled excellent or good rate of 91.8% and a low complication rate of 2.9%. Combining the findings from our retrospective cohort and meta-analysis, we observed that the CLDH group had longer operation times and slightly higher postoperative ODI scores compared to the UCLDH group. LIMITATIONS: Small sample size and lack of long-term follow-up in the retrospective cohort, as well as limited inclusion of comparative studies in the meta-analysis. CONCLUSION: PELD is an effective and safe treatment option for CLDH patients. In comparison to UCLDH patients, CLDH patients may experience longer operation times and slightly slower functional recovery than those with UCLDH. KEY WORDS: Calcification, lumbar disc herniation, percutaneous endoscopic lumbar discectomy, effectiveness, complication
The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up
Authors: Navani Annu
Published: October 2024

BACKGROUND: Chronic low back pain is one of the most common causes of disability, affecting more than 600 million people worldwide with major social and economic costs. Current treatment options include conservative, surgical, and minimally invasive interventional treatment approaches. Novel therapeutic treatment options continue to develop, targeting the biological cascades involved in the degenerative processes to prevent invasive spinal surgical procedures. Both intradiscal platelet-rich plasma (PRP) and bone marrow concentrate (BMC) applications have been introduced as promising regenerative treatment procedures. OBJECTIVES: The primary objective of this study is to assess the safety and effectiveness of an orthobiologic intradiscal injection, PRP or BMC, when compared to control patients. The secondary objectives are to measure: patient satisfaction and incidence of hospitalization, emergency room visit and spine surgery at predetermined follow-up intervals. STUDY DESIGN: A multicenter, prospective, crossover, randomized, controlled trial. SETTING: Comprehensive Spine and Sports Center and participating centers. METHODS: Forty patients were randomized into saline trigger point injection, intradiscal PRP, or BMC. Follow-up was 1, 3, 6, and 12 months posttreatment. Placebo patients were randomized to PRP and BMC injection if < 50% decrease in numeric rating scale (NRS) scores in 3 months, while PRP and BMC patients to the other active group if < 50% decrease in NRS scores in 6 months. RESULTS: Both PRP and BMC demonstrated statistically significant improvement in pain and function. All the placebo patients reported < 50% pain relief and crossed to the active arm. None of the patients had any adverse effects, hospitalization, or surgery up to 12 months posttreatment. LIMITATIONS: The limitations of our study were the small number of patients and open-label nature of the study. CONCLUSION: This is the only human lumbar disc study that evaluates both PRP and BMC in the same study and compares it to placebo. PRP and BMC were found to be superior to placebo in improving pain and function; however, larger randomized clinical trials are needed to answer further questions on the comparative effectiveness of various biologics as well as to identify outcome differences specific to disc pathology. KEY WORDS: Low back pain, disc, mesenchymal stem cells, platelet-rich plasma, biologics, back pain, degenerative disc disease, intradiscal biologics, lumbar spine, low back, regenerative treatment spine, radiculopathy
TEKNOLOGI TEPAT GUNA (TTG) PAKAN FERMENTASI UNTUK PETERNAK DESA SUKASARI KEPAHIANG
Authors: Definiati Neli , Jafrizal  , Islamuddin  , Rita Wusmalinda , Hayati Rita , Afriyanto
Published: October 2024

Masyarakat petani di Desa Sukasari Kecamatan Kabawetan Kabupaten Kepahiang pada umumnya selain bertani tanaman pangan, perkebunan kopi dan tanaman sayuran sebagai usaha utama, juga beternak hewan ternak antara lain sapi potong, sapi perah, kambing dan domba sebagai usaha sampingan. Dari diskusi mendalam antara tim pengusul dengan masyarakat peternak di Desa Sukasari, terungkap beberapa permasalahan dalam mengembangkan usaha peternakannya, antara lain. Di bidang produksi, konsistensi ketersediaan pakan dari limbah pertanian (jerami, jagung, dan limbah sayuran) yang melimpah pada musim panen dan banyak berkurang pada musim tanam menjelang panen, serta musim hujan yang menghambat petani dalam mencari hijauan segar. Di bidang lingkungan hidup (pengolahan limbah), limbah padat (feses) yang volumenya semakin lama semakin meningkat, saat ini hanya menumpuk dan tentunya membutuhkan waktu yang lama untuk dimanfaatkan sebagai pupuk organik tanaman pertanian. Tujuan dari kegiatan ini adalah untuk meningkatkan pengetahuan dan keterampilan peternak dalam memproduksi pakan fermentasi.Kata Kunci : TT, Pakan Fermentasi
Cuidados paliativos perinatales: un abordaje integral
Authors: Ricaud Vélez Ignacio A. , Hanhausen Estrada Inés , Phillibert Rosas Santiago
Published: October 2024

Los cuidados paliativos perinatales surgieron como una medida esencial para abordar integralmente el tratamiento de pacientes neonatales con diagnósticos prenatales o perinatales de enfermedades graves que puedan poner en riesgo su vida. Estos cuidados están dirigidos a recién nacidos que padecen condiciones que les impiden sobrevivir más allá de unos pocos minutos u horas, o en casos en los que naces sin vida. Los mismos, no se centran solo en el paciente neonatal, sino también en apoyar a la madre y a los familiares cercanos. El objetivo primordial es preservar la dignidad de los recién nacidos y proporcionarles el mayor confort posible durante su transición hacia el final de la vida.
Reflexiones éticas del impacto y desafíos de la inteligencia artificial en la medicina de laboratorio
Authors: Román Collazo Carlos Alberto , Brenner Jonathan , Andrade Campoverde Diego
Published: October 2024

El uso de la Inteligencia artificial (IA) en la Medicina de laboratorio (ML) ha provocado un salto cualitativo en el diagnóstico de enfermedades que aquejan al ser humano. El desarrollo de robots para la medición, cálculo y predicción ha aumentado la confiabilidad, validez y reproducibilidad de las pruebas diagnósticas con IA, induciendo a una fácil elección de dicha tecnología en el laboratorio clínico. Sin embargo, la IA en la ML entraña una serie de reflexiones éticas que deben considerarse. La incipiente tecnología en desarrollo, la presencia de sesgos cognitivos en los algoritmos y datos, la incertidumbre del funcionamiento del robot, las limitaciones tecnológicas, la amenaza a la privacidad y la ausencia de un marco legal abren conflictos éticos que laceran la equidad, la seguridad y la autonomía del hombre. El imperativo tecnológico de la IA en la ML no debe superar la responsabilidad, ni atentar contra la dignidad de la persona.
The Morphosyntax of Proper Names: Individuals, Sets and the Light Noun Hypothesis
Authors: Franco Ludovico , Rugna Giuseppe
Published: October 2024

This paper examines the morphosyntax of proper names, with a focus on Italian. We argue that the morphosyntax of proper names is not uniform. Rather, we show that a crucial distinction lies between names denoting individuals and those denoting sets: while the former types of names undergo Merge in D, the latter do not. Our data moreover challenge the hypothesis that names can involve light nouns in their structure, as recently argued by Moltmann (2022) for German.
Silent Nominal Heads in Manner Adverbials
Authors: Schirato Federico
Published: October 2024

In this study we will start from a suggestion taken from Kayne’s proposal (2016) about silent heads, in order to analyse the structure of some specific adverbial PPs in different languages. It will be argued that behind certain manner constructions consisting of a preposition plus an adjective may lie a full nominal phrase, whose head is generally – but not exclusively – silent. This study will show that there is a cross-linguistic tendency to create manner expressions using a nominal head meaning ‘way’ or ‘manner’, and also that this head may change diachronically, either becoming silent to form idiomatic expressions, or being reanalysed and grammaticalised into a productive adverbial suffix.
On the left periphery of ‘optional’ wh-in-situ: Evidence from Greek
Authors: Vlachos Christos
Published: October 2024

A recent generalization about ‘optional’ wh-in-situ states that wh-in-situ questions are blocked in selected contexts, where the only grammatical option is wh-fronting. In this squib, I show that the generalization is misplaced: Wh-in-situ is not actually blocked in selected contexts, it is simply not visible to selection as a wh-construction. To this end, I provide empirical evidence from Greek wh-in-situ questions, concentrating on issues revolving around selection, movement and the discourse. The analysis proposed treats wh-in-situ as a construction in its own right, being open to labeling possibilities that its wh-fronting counterpart cannot have.
Determinante e doppio determinante nel code-switching arabo-italiano
Authors: Moussaid Yasmina
Published: October 2024

This article explores the phenomenon of code-switching, specifically focusing on bilingual Arabic-Italian determiner phrases which consist of a determiner, such as an article or a demonstrative, followed by a noun phrase as a complement. The data examined were selected from a corpus of Arabic-Italian spontaneous speech with the aim of (1) comparing and describing the characteristics and differences of the determiner systems of the two languages; (2) illustrating the features of code-switching in determiner phrases and the various types found in the collected data; and (3) studying the mutual influence of the two languages in contact contexts. The data analysis revealed two types of code-switching: switching at the beginning of a determiner phrase, where both the determiner and its complement are in the same language, and switching within a determiner phrase, where the determiner and the head noun are from different languages. This latter category also includes determiner phrases with double determiners, which will be analyzed in detail in this article to discuss the features of this linguistic structure in Arabic-Italian bilingual phrases.
Uso del dimostrativo ana-deittico nella comunicazione parlata in italiano LS. Un approccio pragmatico-topicale
Authors: Ni Yang
Published: October 2024

Deixis plays an important role in anchoring the text to the context and it is the most obvious way to reflect the relationship between the structure of languages and context. Based on Levinson’s (1983) theory, deixis has been divided into five types, among which are personal, spatial, temporal, textual and social. This paper examines a particular type of spatial deixis, namely demonstratives. Despite the fact that the international literature attributes an important role to deixis, particularly in the field of pragmatics, there is not much research devoted to it, at least in Italian (except for Watorek 1998; Giuliano 2004; Szantyka 2012). The study intends to observe longitudinally the use of demonstratives in spoken communication in Italian as a Foreign Language and try to explain its functioning by referring to the pragmatic-topical approach. The final considerations which gleaned from the research may provide insights both for educators working in Italian classrooms with Chinese students, as well as for those engaged in teaching Chinese to Italian students.
Syntagmatic and Paradigmatic Analysis of Lexemes for ‘Rain’ in Biblical Hebrew
Authors: Stornaiuolo Pratesi Chiara
Published: October 2024

This research paper presents an analysis of Biblical Hebrew terms for ‘rain’, a relevant corpus formed by six lexemes:
1. ‘rain’, ‘showers’
2. ‘heavy rain’
3. ‘autumn rain’
4. ‘rain’
5. ‘spring rain’
6. ‘light rain’
First it defines and explains the method used, then it realizes a distributional analysis into functional languages and a syntagmatic analysis of each lexeme. The second phase proceed in the paradigmatic analysis of the relationship between each lexeme. An explanation of the results and conclusion round off the paper.The purpose of this research is to indagate and understand the complexity of the relationship between lexemes for rain.
The Relationship between Electronic Marketing and Consumer Behavior "An Applied Study on a Sample of Customers of Al-Rafidain Bank – Iraq"
Authors: Ali Jasim Hussin , Benni Prof. Hazem Sobhi El
Published: October 2024

The current research aims to understanding the relationship between e-marketing and consumer behavior through study applied to a sample of Rafidain Bank customers, and the current research focuses on surveying the opinions of a sample of customers dealing with Rafidain Bank in three Iraqi governorates (Babil, Karbala, and Najaf), numbering (325) Customers. the researcher examined, through a set of hypotheses, the effects of the independent variable, which is electronic marketing, on consumer behavior, and consequently the effects of the latter on the bank’s profitability. A questionnaire was designed to survey the opinions of the individuals in the aforementioned research sample, according to a scale to be respected the quintet, and these phrases included five axes distributed between the study variables, demographic information of the study sample, elements of electronic marketing, elements supporting electronic marketing, indicators of the efficiency of banking services, and finally consumer behavior. The descriptive analysis resulted in tables that displayed the initial statistical results and analytical results that address the research hypotheses, whether negative or positive. the study reached the following conclusions the most important of which is that The dimensions of consumer behavior are arranged as follows: education, attitudes, perception, motives, and finally, the study proved the existence of a strong relationship between the independent variable and the mediator on the bank's profitability clearly, so the recommendations were confirmed that this relationship should be under the attention of the relevant parties in the upper and middle management and that they should take it into account when working on developing the marketing mix strategies for banking services at Rafidain bank to enhance its pioneering role in banking work at the level of Iraq and the world.
Role of Homoeopathic Mother Tincture in Management of Benign Prostatic Hyperplasia - A Review
Authors: Bisen Dr. Bhavesh Kumar
Published: October 2024

Benign prostatic hyperplasia (BPH) is also called enlargement of the prostate. It is an old age disease. it is found in males. It is mostly found above the age of 50. Due to the increase in the size of the prostate, there found various symptoms like difficulty in micturition, and painful urination. Nocturia, lower abdominal pain, incontinence, intermittent. The main cause of Benign prostatic hyperplasia is testosterone excess, which converts into Dihydrotestosterone (DHT) by 5 alpha reductases enzyme. Dihydrotestosterone is an active form of testosterone. Which binds with the glandular tissue of the prostate gland and is responsible for increasing the size of the prostate gland. The homeopathic mother tincture is very effective in treating Benign prostatic hyperplasia. Different types of homeopathic literature present about effects of homeopathic medicine. This article tries to present information for homeopathic physicians and homeopathic practitioners to treat and manage cases of Benign prostatic hyperplasia. This article also helps to reduce complications and severity of symptoms of Benign prostatic hyperplasia. Homeopathic Mother Tincture is effective in treating prostate and helps in avoiding surgery. This search strategy for this review article included all clinical trials, observational studies, and reviews published in the past years. Google, Homeopathic Materia Medica, websites and books, and Wikipedia were also searched to enrich the review. This review has attempted to present this information.
Gut, Cholesterol & Homoeopathy
Authors: Tripathy Dr. Tridibesh , Das Professor Shankar , Dean Prof. D.P. Singh, , Dwivedi Prof. Rakesh , Tripathy Prof. Byomakesh , Sahu Prof, D. R. , Prusty Dr. Umakant , Pradhan Dr. Pramod Bihari , Pattanaik Dr. Jeevan Krushna , Pandey Dr. S.N. , Tripathy Anjali , Tripathy Ms. Sanskriti , Singh Mr. Ranvijay
Published: October 2024

When we discuss homoeopathy, invariably the Bowel Nosodes group drugs are an integral part of homoeopathic materia medica. All these are leading anti-inflammatory & immune-boosting dealing drugs of homoeopathic materia medica, the nosodes from the bowel are the drugs that the article discusses. Nosodes are those drugs in homoeopathy which are prepared from the disease related products or organisms. This means these are the gut bacteria from which medicines are prepared as per the homoeopathic pharmacopeia. The article looks into the role of one such bowel nosode from the Oscillibacter species. The article looks into the scientific aspects of these dealing drugs to deal with hypercholesterolemia. The future use of the drugs in the Non-Communicable Disease (NCD) like high cholesterol levels on a large scale will only benefit the masses. The drugs are cost effective, therapeutically active with no side effects & these properties only augur well for large scale application of homoeopathy on NCDs. The use of these drugs is authenticated by the scientific research of the gut bacteria on reducing cholesterol. For the benefit of the masses, the homoeopathic perspective, use & a treatment protocol is described in this article. The protocol is based on the bowel nosodes that can help in reducing cholesterol. The authority books of homoeopathic materia medica & the encyclopedia of homoeopathy are referred in the article.
"واقع وتحديات السلوك لدى طلبة المدارس الثانوية في منطقة "المثلث الشمالي "من وجهة نظر المرشدين والمستشارين والمختصين التربويين ومقترحات حلها"
Authors:   طالبة الدكتوراه في جامعة النجاح الوطنية,نابلس- فلسطين جامعة النجاح الوطنية- الدراسات العليا برنامج دكتوراه التعليم والتعلم, جبارين سماسم عبد الحليم عباس
Published: October 2024

يتناول هذا البحث واقع وتحديات السلوك لدى طلبة المدارس الثانوية في منطقة المثلث من وجهة نظر المرشدين والمستشارين والمختصين التربويين ومقترحات حلها. وذلك في ظل العصر الحالي الذي أصبح الأفراد في حاجة ملحة للتوجيه والإرشاد بسبب التغيرات السريعة في جميع المجالات المختلفة في الحياه اليومية.ومن أجل مساعدة هؤلاء الأفراد في التكيف مع هذه التغيرات السريعه والمتجدده في كل وقت ، وترى الباحثه انه من الواجب التطرق لهذا الموضوع للمساهمه في حل مشكله ما وايجاد السبل لتحقيق الاهداف المرجوه.
Systemic Lupus Erythematosus, An Unusual Presentation: A Case Report In Azal Hospital, Sana’a, Yemen
Authors: Al-Adhal Adnan , Al-Adhal Amr , Al-Adhal Abdullah
Published: October 2024

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by various clinical presentations and potential involvement of multiple organ systems; it exhibits a significant female predominance, with a peak incidence of middle-aged individuals. In this article, we report a case of a 19 years old female patient who presented with fever, headache, fatigue and neck stiffness. Initial investigations revealed a normal white blood cell count (WBC) with neutrophilia, leading to a diagnosis of bacterial meningitis. The patient responded to antibiotic and analgesic treatment. However, subsequent development of arthritis and skin lesions raised suspicion of systemic lupus erythematosus, which was confirmed by positive anti-dsDNA and antinuclear antibody (ANA) tests.