bluuebunny/crossref_metadata_2025 huggingface dataset:
Abordaje multidisciplinar en paciente con úlcera arterial de origen iatrogénico
Authors: De la Fuente Prieto Aida , Rodríguez Martínez Mª Luz , Valerdíz Casasola Susana
Published: January 2020

Se define iatrogenia como una alteración negativa del estado de salud causada sin intención por la actuación de los profesionales sanitarios tras la administración de un tratamiento, y úlcera iatrogénica, como aquella lesión que cursa con pérdida de la integridad cutánea, provocada, entre otras causas, por diferentes dispositivos utilizados con fines diagnósticos o terapéuticos. Se presenta el caso de una mujer de 91 años, dependiente leve para las actividades de la vida diaria, sin deterioro cognitivo, que presenta úlcera iatrogénica en miembro inferior derecho. Tras caída casual, sufrió fractura bimaleolar de tobillo derecho; se realizó manipulación quirúrgica bajo sedación para reducción cerrada y tratamiento con yeso ortopédico. En la cuarta semana presentó cuadro febril que precisó ingreso hospitalario durante cuatro semanas, retirándose entonces la órtesis y objetivándose gran úlcera supramaleolar externa. Dada de alta y en seguimiento por Atención Primaria, presentó evolución tórpida de la úlcera y patología arterial asociada, por lo que se deriva de forma preferente a Cirugía Vascular, que indica ingreso para angioplastia y limpieza quirúrgica de lesiones. Tras alta hospitalaria, su enfermera comunitaria instauró un plan de cuidados destinado a unificar criterios y disminuir la variabilidad terapéutica, consiguiendo la epitelización de una lesión compleja en paciente frágil, pluripatológica y polimedicada en diez meses de tratamiento. Para la resolución del problema fue preciso un enfoque multidisciplinar e interdisciplinar, para proporcionar a la paciente una atención integral, programando la transición entre niveles y la comunicación entre los profesionales.
Management of Neuropathic Chronic Pain
with Methadone Combined with Ketamine: A
Randomized, Double Blind, Active-Controlled
Clinical Trial
Authors: Ferreira Juliano
Published: January 2020

Background: Methadone and ketamine are used in neuropathic pain management.
However, the benefits of both drugs association are uncertain in the treatment of
neuropathic pain.
Objective: Our primary objective was test the hypothesis that oral methadone
combined with oral ketamine is more effective than oral methadone or ketamine alone
in reducing neuropathic pain.
Study Design: We conducted a randomized, double blind, active-controlled parallelgroup clinical trial.
Methods: Forty-two patients with neuropathic pain refractory to conventional therapy
were randomly assigned to receive oral methadone (n = 14), ketamine (n = 14), or
methadone plus ketamine (n = 14) over a 3-month period.
Results: During these 90 days, we observed pain scores using a visual analogical scale
(VAS), allodynia, burning/shooting pain, and some side effects. All treatments were
effective in reducing pain scores by at least 40%. However, a significant improvement in
pain was observed only in the ketamine alone group compared with both the methadone
or methadone/ketamine groups. No significant differences were observed among the
treatment groups for the reduction of burning or shooting pain, while ketamine alone
was more effective than methadone or methadone/ketamine for the reduction of
allodynia.
Limitations: Formal assessment for awareness of the allocation was not performed,
some co-intervention bias may have occurred, our results could be only relevant to the
patient population investigated and the use of VAS as the primary outcome detect
changes in pain intensity but not to assess neuropathic pain symptoms.
Conclusion: This study indicates that ketamine was better than methadone or
methadone/ketamine for treating neuropathic pain.
Key words: Multimodal analgesia, refractory pain, NMDA receptor, opioid
Prevention of Post-herpetic Neuralgia from
Dream to Reality: A Ten-step Model
Authors: Makharita Mohamed Younis
Published: January 2020

Herpes zoster (HZ) is a painful, blistering skin eruption in a dermatomal distribution caused by
reactivation of a latent varicella zoster virus in the dorsal root ganglia (DRG). Post-herpetic neuralgia
(PHN) is the most common complication of acute herpes zoster (AHZ).
Severe prodrome, greater acute pain and dermatomal injury, and the density of the eruption are
the risk factors and predictors for developing PHN. PHN has a substantial effect on the quality of
life; many patients develop severe physical, occupational, social, and psychosocial disabilities as
a result of the unceasing pain. The long-term suffering and the limited efficacy of the currently
available medications can lead to drug dependency, hopelessness, depression, and even suicide.
Family and society are also affected regarding cost and lost productivity.
The pathophysiology of PHN remains unclear. Viral reactivation in the dorsal root ganglion and its
spread through the affected nerve result in severe ganglionitis and neuritis, which induce a profound
sympathetic stimulation and vasoconstriction of the endoneural arterioles, which decreases the
blood flow in the intraneural capillary bed resulting in nerve ischemia. Our rationale is based on
previous studies which have postulated that the early interventions could reduce repetitive painful
stimuli and prevent vasospasm of the endoneural arterioles during the acute phase of HZ. Hence,
they might attenuate the central sensitization, prevent the ischemic nerve damage, and finally
account for PHN prevention.
The author introduces a new Ten-step Model for the prevention of PHN. The idea of this newly
suggested approach is to increase the awareness of the health care team and the community about
the nature of HZ and its complications, especially in the high-risk groups. Besides, it emphasizes
the importance of the prompt antiviral therapy and the early sympathetic blockades for preventing
PHN.
Key words: Acute herpes zoster, prevention, post-herpetic neuralgia, sympathetic blockade, tenstep model
Ultrasound-Guided Block of the Suprascapular
Nerve in Breast Cancer Survivors with Limited
Shoulder Motion – Case Series
Authors: Ozyemisci-Taskiran Ozden
Published: January 2020

Background: Suprascapular nerve block is performed in the management of chronic shoulder
pain and frozen shoulder.
Objective: To investigate the effects of ultrasound-guided suprascapular nerve block in restoration
of shoulder motion in breast cancer survivors.
Study Design: A cohort study.
Setting: A training and research hospital, outpatient setting.
Methods: A total of 18 breast cancer survivors with limited shoulder motion, pain, and difficulty
in positioning the upper extremity for radiation treatment following surgery were enrolled in
this study. Ultrasound-guided suprascapular nerve blocks were performed while the patients
were seated in a chair without a backrest. After visualization of the suprascapular nerve under
the transverse suprascapular ligament, 20 mg of triamcinolone and 4 mL of 0.5% bupivacaine
were injected. Shoulder range of motion, pain, disability, and upper extremity circumference
measurements were assessed in all participants before and 10 days after the block.
Results: A significant decrease was observed in severity of pain and disability 10 days after the
block. The ranges of shoulder abduction, flexion, and external rotation were improved significantly.
All patients were able to receive radiation therapy without delay.
Limitations: Absence of a control group and absence of randomization reduces the strength of
our findings. Small sample size and absence of long-term follow-up are other limitations of this
study.
Conclusions: This is the first study investigating the effect of ultrasound-guided suprascapular
block on shoulder limitation in breast cancer survivors. The results demonstrate that it may be a
promising treatment approach for rapid recovery of shoulder motion in women with breast cancer
before radiation treatment.
Key words: Breast cancer, upper extremity, shoulder pain, range of motion, disability, ultrasound,
injection, triamcinolone, local anesthetics
Ketamine: An Update on Cellular and
Subcellular Mechanisms with Implications for
Clinical Practice
Authors: Nader Nader D.
Published: January 2020

Background: Ketamine is one of the oldest hypnotic agents used to provide an anesthetic agent
with analgesic properties and minimal suppressive effects on respiration. The ability of ketamine
in modulating glutamatergic (N-methyl D-aspartate) pain receptors has made this anesthetic drug
a new option for the management of patients with chronic pain syndromes. Further preclinical
and clinical findings suggest ketamine may have wide ranging effects on both cognition and
development. Recent advances have revealed an unprecedented role for ketamine in the acute
management of depression.
Objectives: The purpose of this review is to integrate a number of basic science, preclinical,
and clinical studies with the goal of providing insight into the possible signaling events underlying
ketamine’s biological effects in pain management, depression, cognition and memory, and
neurodevelopment.
Study Design: Narrative literature review.
Setting: Health science library.
Methods: A comprehensive literature search was performed for the following medical subject
headings and keywords (ketamine, anesthesia, pain, analgesia, depression, NMDA receptors) on
PubMed, Google Scholar, and Medline from 1966 to the present time. The search was then limited
to those in the English language. The full text of the relevant articles were printed and reviewed
by all authors.
Results: We provided a comprehensive review of the literature that explored the pharmacologic
aspects of ketamine from its conception as an anesthetic to its evolution as a drug used for
treatment of depression and pain. To address the patient response variability observed in clinical
studies, we have provided possible patient-specific factors that could contribute to outcome
variability.
Limitations: Like any review, this study was limited by publication bias and missing information
on negative studies which were denied publication.
Conclusions: Ketamine, an old anesthetic agent with analgesic properties, is currently being
considered for treating patients with chronic pain and depression. The complex pharmacological
characteristics of ketamine make this medication a multifaceted therapeutic option in these cases.
Key Words: Ketamine, anesthetics, pain, depression, pharmacology
Abnormal Local Brain Activity Beyond the Pain
Matrix in Postherpetic Neuralgia Patients: A
Resting-State Functional MRI Study
Authors: Yu Buwei
Published: January 2020

Background: Postherpetic neuralgia (PHN) patients suffer debilitating chronic pain, hyperalgesia,
and allodynia, as well as emotional disorders such as insomnia, anxiety, and depression. The brain
structure and functional basis of PHN are still not fully understood.
Objectives: To identify the changes of regional brain activity in resting-state PHN patients
using regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF)
methods. Correlations between spontaneous pain intensity and ReHo or fALFF were analyzed.
Study Design: Observational study.
Setting: University hospital.
Methods: ReHo, fALFF change was analyzed in 19 PHN patients and 19 healthy controls to detect
the functional abnormality in the brains of PHN patients. Correlations between ReHo, fALFF, and
PHN pain intensity were assessed in the PHN group.
Results: PHN patients exhibited significantly abnormal ReHo and fALFF intensity in several brain
regions, including the brainstem, thalamus, limbic system, temporal lobe, prefrontal lobe, and
cerebellum compared with healthy controls. Correlation analysis showed that most of the ReHo
values of the aforementioned brain regions positively correlated with visual analog scale (VAS)
values. But much less correlation was found between fALFF and VAS.
Limitations: (a) No specific emotional assessment was given for PHN patients before fMRI scans,
therefore we cannot exclude whether the emotional disorders exist in these patients. (b) Relatively
short pain duration (mean 5.4 months) and small sample size (n = 19) for the PHN group.
Conclusions: For PHN patients, the local brain activity abnormality was not restricted to the pain
matrix. Besides regions related to pain perception, areas in charge of affective processes, emotional
activity, and pain modulation also showed abnormal local brain activity in a resting state, which
may suggest complicated supraspinal function and plasticity change in PHN patients. ReHo was
more closely correlated with pain intensity of PHN patients than fALFF. This work indicates that
besides physical and emotional pain perception, mood disorder and pain modulation could be
characteristics of PHN patients. This also supports the potential use of therapeutic interventions
not only restricted to pain alleviation, but also those that attempt to ameliorate the cognitive and
emotional comorbidities.
Key words: Postherpetic neuralgia, resting-state fMRI (rs-fMRI), mood disorder, limbic sy
Platelet Rich Plasma in Musculoskeletal
Pathology: A Necessary Rescue or a Lost Cause?
Authors: Navani Annu H.
Published: January 2020

Background: Platelet rich plasma (PRP) has been used for decades to facilitate surgical
tissue repair; therefore, the current trend of percutaneously injecting PRP to theoretically
enhance tissue regeneration and repair is a logical progression. Applications include
treatment of osteoarthritis, tendinopathy, chondropathy, acute and chronic soft tissue
injuries, muscle or ligament tear, as well as enhancement of healing after bone or tissue
reconstruction. However, there is limited evidence to support the use of PRP in the
abovementioned conditions. Variations in the preparation of PRP and its application in
various conditions influence its effect on various orthopedic conditions.
Objective: To provide a basic overview of the current use of PRP in treating
musculoskeletal conditions.
Methods: Studies relevant to PRP were extracted from the PubMed and Medline
database within the dates ranging from 1990 through 2015. These studies included in
vitro as well as in-vivo animal experiments and careful analysis of the study population,
type of intervention, and outcomes was made.
Results: PRP has been noted to be a beneficial solution for tissue healing based on
limited current literature. However a variety of factors such as method of preparation,
composition, medical condition of the patient, anatomic location of the lesion, and
tissue type can alter outcome.
Conclusion: The effectiveness and potential adverse effects of this treatment require
high quality studies prior to widespread clinical application.
Key words: Growth factors, platelet rich plasma, regeneration, regenerative healing,
tissue repair, stem cells, mesenchymal stem cells, tissue engineering
Pulsed Radiofrequency Ablation of Pudendal
Nerve for Treatment of a Case of Refractory
Pelvic Pain
Authors: Jones Stephanie
Published: January 2020

Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called “Alcock
syndrome.” Pain that develops is often chronic, and at times debilitating. If conservative measures
fail, invasive treatment modalities can be considered. The goal of this case report is to add to
a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used
to treat PN and to show that high resolution MR neurography imaging can be used to detect
pudendal neuropathy.
Case Presentation: We present a case of a 51-year-old woman with 5 years of worsening
right groin and vulva pain. Various medication trials only lead to limited improvement in pain.
The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine
with 6mg of betamethasone using a transgluteal technique and a target of the right ischial
spine; this procedure resulted in ~8 hours of > 50% pain relief. The patient was then referred
for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right
pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical
picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal
pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone
acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results
the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For
this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was
performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6
weeks of significant (> 50%) pain relief.
Discussion and Conclusion: In this paper we presented a case of successful treatment of
PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe
that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those
patients that have failed conservative management. MR neurography employed in this case is
not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other
causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic
mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for
mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a
clinically suspected diagnosis of PN.
Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation,
transgluteal technique, Alcock canal syndrome
Evaluation of Depression in Subacute Low Back
Pain: A Case Control Study
Authors: López Daniel López
Published: January 2020

Background: Low back pain (LBP) is the most common musculoskeletal disorder
affecting the general population and it is believed to be associated with depression.
Objective: The study aim was to describe and compare the impact in a sample of
people with subacute LBP (SLBP) and patients without LBP with normalized reference
values in the light of the scores obtained with regard using the Beck Depression
Inventory (BDI).
Study Design: This was a case-control study.
Settings: Physiotherapist area at a care center.
Methods: A sample of 164 participants of a mean age of 41.45 ± 0.97 came to a
physical therapy clinic where self-reported data were registered, informants’ professional
activity was determined, and the scores obtained were compared in the BDI.
Results: Total BDI scores at SLBP and their controls were 21.52 ± 6.93 (11 – 43) and
17.30 ± 5.09 (11 – 30), respectively (P < 0.001). The SLBP patient has 2.12 times more
likely to have moderate depression (OR 2.12 (1.07 – 4.18) and 18.82 times more likely
to have serious depression (OR 18.82 (1.06 – 331.81) compared to their controls (P <
0.05).
Limitations: The study was not a randomized controlled trial. Although primary
outcome data were self-reported, the assessor was not blinded.
Conclusions: People with SLBP also have a significant increase in depression based on
BDI scores, regardless of gender.
Key words: Depression, low back pain, musculoskeletal diseases
The Effectiveness and Safety of Selective
Lumbar Decompression in Diagnostic Doubt
Patients: A Retrospective Control Study
Authors: Xiaochuan Li
Published: January 2020

Background: Our previous study demonstrated that selective nerve root block (SNRB) can
influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted
for decompression in diagnostic doubt patients (DDPs). However, further studies were needed
to determine whether this selective decompression (SD) procedure would result in similar clinical
outcomes and reduce the perioperative parameters and postoperative complications as compared
to the non-selective decompression (NSD) procedure.
Objective: The specific goal of this study is to compare clinical outcomes, perioperative
parameters, and complications between SD and NSD procedures in DDPs.
Study Design: A retrospective control study.
Setting: Gaozhou People’s Hospital.
Methods: From January 2009 to January 2011, 57 lumbar surgery patients with diagnostic doubt
were retrospectively reviewed. Basic patient parameters, as well as perioperative and postoperative
data were compared between the selective and non-selective decompression groups. Clinical
outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI),
Japanese Orthopaedic Association (JOA) scores, and JOA recovery rates.
Results: Both groups showed significant improvement in VAS, ODI, and JOA scores between
preoperative and postoperative measurements. The differences in VAS and ODI scores between
groups were not significant at 3 and 60 months postoperatively (both P > 0.05). In addition,
there was no significant difference in JOA recovery rate (P = 0.659) and survival rate (P = 0.586)
during the 60 months following surgery. However, distinctly superior perioperative parameters
(operation time and hospital stay, blood loss and drainage volume, laminectomy numbers, and
fusion segment numbers) were observed in the SD group (P < 0.001 for each score). Moreover,
the SD-treated group experienced significantly fewer adverse events postoperatively (P = 0.036).
Limitations: The limitations of this study lie in the size of the study and selection of patients and
in the fact that it was not feasible to include all cases of diagnostic doubt.
Conclusions: On the basis of the 5-year follow-up data, we suggest that the SD procedure
guided by SNRB is an effective and safe method for the surgical treatment of DDPs. This procedure
produces superior perioperative parameters when compared with the conventional NSD procedure,
but has a comparable clinical outcome. Moreover, the benefits of SD surgery include fewer
perioperative and postoperative complications.
Key words: Lumbar spinal surgery, diagnostic doubt, selective nerve root block (SNRB), selective
decompression (SD)
EphrinB-EphB Signaling Induces Hyperalgesia
through ERK5/CREB Pathway in Rats
Authors: Yan Min
Published: January 2020

Background: There are numerous studies implicating that EphB receptors and ephrinB
ligands play important roles in modulating the transduction of spinal nociceptive information.
EphrinB-EphB signaling may contribute to hyperalgesia via various kinds of downstream
molecules, the mechanisms of which have not been completely understood.
Objective: The aim of the present study was to identify whether ephrinB-EphB signaling
could contribute to hyperalgesia through ERK5/CREB pathway.
Study Design: Controlled animal study.
Setting: University laboratory.
Methods: This study attempted to detect the changes of pain behaviors and the protein
level of p-ERK5 and p-CREB by activating EphB receptors in the spinal cord of rats. To further
confirm our hypothesis, we designed LV-siRNA for knockdown of spinal ERK5. When ERK5 was
inhibited, we recorded the changes of spinal p-CREB expression and the pain behaviors of rats
after activating EphB receptors. We also confirmed this conclusion in rat CCI model. Statistical
analyses were performed using GraphPad Prism 5.
Results: Intrathecal injection of ephrinB2-Fc in rats evoked thermal hyperalgesia and
mechanical allodynia, along with activation of ERK5 and CREB in the spinal cord. Knockdown
of ERK5 inhibited ephrinB2-Fc-induced CREB activation and hyperalgesia. Blocking EphB
receptors prevented CCI-induced neuropathic pain and spinal ERK5/CREB activation.
Limitations: More underlying mechanisms that underlie the relationship between ephrinBEphB signaling and ERK5/CREB pathway will need to be explored in future studies.
Conclusions: Our study suggests that ERK5/CREB pathway plays important roles in the
transduction of nociceptive information associated with ephrinB-EphB signaling. This study
provides further understanding of the downstream mechanisms of ephrinB-EphB signaling and
helps to explore new targets for treating pathological pain.
Key words: EphrinB-EphB signaling, MAPK, ERK5, CREB, hyperalgesia, pain, CCI, NMDA
A Novel Combination of Percutaneous
Endoscopic Lumbar Discectomy and
Epiduroscopic Laser Neural Decompression for
Down-migrated Disc Herniation
Authors: Park Choon-Keun
Published: January 2020

Although percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment
for herniated discs, its application in a disc with extensive migration is still challenging.
As such, epiduroscopic laser neural decompression (ELND) provides a new view of the
epidural space as well as an alternative treatment for a herniated disc and epidural
fibrosis. In this paper the authors introduce the novel combination of PELD and ELND for
high grade down-migrated disc herniation.
An 87-year old woman presented with severe pain radiating down her leg due to high
grade down-migrated disc herniation at L4-5. The therapeutic plan was organized into
3 steps. First, the patient underwent PELD to remove the paracentral extruded disc and
open the epidural space between the traversing nerve root and disc space. Second, ELND
was performed to remove the down-migrated disc and simultaneously push the free
fragment to the L4-5 disc space. Lastly, repetitive free fragments were picked up and
streamed upward using ELND. The patient reported significant reduction of pain after
surgery. Postoperative magnetic resonance imaging (MRI) showed complete removal of
the ruptured disc fragment.
A combination of PELD and ELND may be an option of treatments for down-migrated
disc herniation.
Key words: Percutaneous endoscopic lumbar discectomy, epiduroscopic laser neural
decompression, down-migrated disc herniation
Current Concepts of Phenylpiperidine
Derivatives Use in the Treatment of Acute and
Chronic Pain
Authors: Urman Richard
Published: January 2020

Phenylpiperidines are a chemical class of drugs with a phenyl moiety directly attached to piperidine.
These agents have an important role in many aspects of medicine including anesthesia and pain
medicine. After the development of meperidine, fentanyl, which is a second generation synthetic
phenylpiperidine series opioid, was synthesized and introduced into clinical anesthesia practice
as fentanyl citrate in 1968. Fentanyl-mediated or modulated responses involve action at the muopioid receptor as an agonist at the dorsal horn inhibiting ascending pain pathways in the rostral
ventral medulla, increasing pain threshold, and producing both analgesic and sedative effects. Since
fentanyl is metabolized mainly via CYP3A4, potential adverse effects can occur with concomitant
use of any drug which affects CYP3A4 activity. Discontinuation of CYP3A4 inducers can also result
in an increase in fentanyl plasma concentration. Fentanyl-based formulations can be administered
via intravenous, intramuscular, transdermal, transmucosal, and neuraxial routes. We describe the
clinical utility of remifentanil, an ultra short-acting analgesic and newer formulations of sufentanil
currently being evaluated for acute pain management. We examine the routes of administration
and clinical considerations, including the role of opioids such as fentanyl as a natural killer cell
suppressive agent. Fentanyl and other opioids have been shown to potentiate propagation of
infection and cancer. In recent years, fentanyl and other phenylpiperidine formulations have
been developed and successfully marketed for chronic pain management. Because all opioids
have complex physiological responses and potential drug-drug interactions, the clinician should
appreciate all aspects of this drug class and consider all available options in appropriate clinical
settings.
Key words: Fentanyl, remifentanil, sufentanil, opioids, analgesics, pain, perioperative
formulations, management
Effects of Dry Needling on Spinal Mobility and
Trigger Points in Patients with Fibromyalgia
Syndrome
Authors: Castro-Sánchez Adelaida María
Published: January 2020

Background: The etiology of fibromyalgia syndrome (FMS) is inconclusive, but central
mechanisms are well accepted for this pain condition. Myofascial pain syndrome (MPS) is one of
the most common musculoskeletal pain diseases and is characterized by myofascial trigger points
(MTrPs). It has been suggest that MTrPs have an important factor in the genesis of FMS.
Objective: The purpose of the current randomized clinical trial was to compare the effectiveness
of dry needling versus cross tape on spinal mobility and MTrPs in spinal muscles in patients with
FMS.
Study Design: A single-blind randomized controlled trial was conducted on patients with FMS.
Setting: Clinical setting.
Methods: Sixty-four patients with FMS were randomly assigned to an experimental group
receiving dry needling therapy or to a control group for cross tape therapy in the MTrPs in the
latissimus dorsi, iliocostalis, multifidus, and quadratus lumbourum muscles. Spinal mobility
measures and MTrPs algometry were recorded at baseline and after 5 weeks of treatment.
Results: The repeated measures analysis of variance (ANOVA) demonstrated that significant
differences between groups were achieved for the MTrPs in latissimus dorsi muscle (right axillary
portion: F = 9.80, P = 0.003); multifidus muscle (right L2 level: F = 11.80, P = 0.001); quadratus
lumborum (right lateral superficial upper: F = 6.67, P = 0.012; and right lateral superficial lower: F
= 5.38, P = 0.024). In addition, the ANOVA repeated measures test showed significant differences
between groups for the segmental amplitude thoracic spine in the standing erect position (F =
7.33, P = 0.009), and segmental amplitude of lumbar spine (F = 11.60, P = 0.001) in the sitting
erect position.
Limitations: The outcomes were not collected from a long-term follow-up period. Dry needling
therapy or cross tape were used alone when in reality physical therapists usually treat patients with
FMS using a multi-modal approach. A non-treatment control group was not included.
Conclusions: This study has demonstrated that dry needling therapy reduces myofacial trigger
points algometry on thoracic and lumbar muscles. Dry needling and cross tape approaches reported
a similar effect size for spinal mobility measures in patients with FMS.
Key words: Fibromyalgia, trigger points, physical therapy modalities, musculoskeletal
equilibrium, myofascial pain syndromes
Trigeminal Neuralgia Induced by Cobra Venom
Leads to Cognitive Deficits Associated with
Downregulation of CREB/BDNF Pathway
Authors: An Jianxiong
Published: January 2020

Background: Chronic pain often results in cognitive impairment. Our previous study showed
that trigeminal neuralgia induced by cobra venom leads to spatial learning and memory deficits,
although the underlying mechanism remains unclear. However, recent evidence indicates that
the c-AMP-responsive element binding protein (CREB)/brain derived neurotrophic factor (BDNF)
pathway plays a critical role in various etiologies of cognitive deficits.
Objectives: Our aim was to explore the CREB/BDNF pathway to determine the molecular
mechanisms involved in the pathogenesis of cognitive impairment caused by cobra venominduced trigeminal neuralgia.
Study Design: A randomized, controlled animal study.
Setting: Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University.
Methods: Fifty male Sprague–Dawley rats were randomly divided into 3 groups: cobra venom
group, sham group, and control group. Cobra venom or saline was injected into the sheath of the
infraorbital nerve (ION), respectively. Video recordings and mechanical thresholds were used to
analyze changes in behavioral activity 3 days before surgery and 4, 7, 14, 21, 28, and 56 days after
surgery. Morris water maze tests were conducted at 4- and 8-week time points after surgery to
evaluate spatial learning and memory. We also investigated expression changes of phosphorylated
CREB (p-CREB) and BDNF in the hippocampus and prefrontal cortex (PFC) using western blotting
and immunohistochemistry.
Results: Cobra venom-treated rats exhibited significant changes in face grooming, as well as
exploratory and resting behaviors, compared with the control group and sham group (both P <
0.001). Rats in the cobra venom group exhibited slightly impaired acquisition (P < 0.05) without
memory deficits (P > 0.05) in the first water maze protocol. In the second water maze test, rats in
the cobra venom group exhibited spatial learning and memory deficits, with fewer platform site
crossings during the probe trial (P < 0.05). Moreover, results showed decreased p-CREB and BDNF
expressions in the hippocampus and PFC in the cobra venom group, with significant differences at
9 weeks post-surgery (P < 0.05).
Limitations: No signaling inhibitor or genetic manipulation was administered to further confirm
upstream factors of the CREB/BDNF pathway in cognitive deficits caused by chronic trigeminal
neuralgia.
Conclusions: The findings suggest that cognitive impairment caused by cobra venom-induced
trigeminal neuralgia is associated with downregulation of the CREB/BDNF pathway in the
hippocampus and PFC.
Key words: Cognitive impairment, the CREB/BDNF pathway, cobra venom, trigeminal neuralgia,
hippocampus, prefrontal cortex, free behavior, Morris water maze
Resource Allocation for Energy Efficient User Association in User-Centric Ultra-Dense Networks Integrating NOMA and Beamforming,
Authors: Zhang Long , Zhang Guobin , Zhao Xiaofang , Li Yali , Huang Chuntian , Sun Enchang , Huang Wei
Published: January 2020

A coupling of wireless access via non-orthogonal multiple access (NOMA) and wireless backhaul via beamforming is a promising way for downlink user-centric ultra-dense networks (UDNs) to improve system performance. However, the ultra-dense deployment of radio access points in macrocell and the user-centric view of network design in UDNs raise important concerns about resource allocation and user association, among which notably is energy efficiency (EE) balance. To overcome this challenge, we develop a framework to investigate the resource allocation problem for energy efficient user association in such a scenario. The joint optimization framework aiming at the system EE maximization is formulated as a large-scale non-convex mixed-integer nonlinear programming problem, which is NP-hard to solve directly with lower complexity. Alternatively, taking advantages of the sum-of-ratios decoupling and successive convex approximation methods, we transform the original problem into a series of convex optimization subproblems. Furthermore, we solve each subproblem through the Lagrangian dual decomposition, and design an iterative algorithm in a distributed way that realizes the joint optimization of power allocation, sub-channel assignment, and user association simultaneously. Simulation results demonstrate the effectiveness and practicality of our proposed framework, which achieves the rapid convergence speed and ensures a beneficial improvement of system-wide EE.
Audit of peripheral neuromuscular stimulators at the hospitals staffed by the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town
Authors: Joubert AT , Porrill O , Paed J
Published: January 2020

Background: Inadequate monitoring of neuromuscular blockade (NMB) may result in worse patient outcomes, including airway compromise and postoperative pulmonary complications. Therefore, NMB monitor availability is a minimum requirement for perioperative care according to the South African Society of Anaesthesiologists’ (SASA) 2018 guidelines. The authors performed an audit of peripheral nerve stimulators (PNS) functionality and availability at their institution.

Methods: The PNSs were attached to an electrical circuit with a skin equivalent resistance. The resultant current impulses generated using Train-of-Four (TOF) mode and Double Burst Stimulation (DBS) mode were recorded with a voltage scope meter. PNS availability was assessed in theatre and recovery areas.

Results: Of the 65 PNS units assessed, 39 units were dysfunctional and 26 units fully functional. The most frequent fault found (30 units) related to faulty or absent PNS electrode cables. Eight functional PNS units with TOF ratio display capability were found. The working PNSs showed good inter-device peak voltage measurement correlation. Of the 59 areas identified where PNSs should be easily available, only 37 areas met the PNS availability criteria suggested in the SASA guidelines.

Conclusion: This audit highlighted the need for more new generation PNSs with TOF-ratio-display-ability to align the institution with recommendations from SASA standards and the anaesthetic literature. It also highlighted the accuracy and consistency of delivered current bursts by the working PNS devices.
Multi-Level Assessment of Program Outcomes: Assessing a Nontraditional Study Abroad Program in the Engineering Disciplines
Authors: DiBiasio David , Mello Natalie A.
Published: January 2020

At Worcester Polytechnic Institute (WPI) a Global Perspective Program (GPP) has evolved that provides an international experience for most graduates. Currently more than half of WPI students travel internationally to do academic work. The GPP grew from the basic project-based educational structure implemented over 30 years ago. In this paper, we describe the structure and operation but will emphasize the multilevel assessment process used to understand student learning and improve the program. Although our specifics are related to technical education, our assessment design and implementation may be useful to a much wider audience.
The Impact of Short Term Study Abroad on the Identity Development of College Students with Learning Disabilities and/or AD/HD
Authors: Shames Wendy , Alden Peg
Published: January 2020

This article explores the identity changes that college students with LD and/or AD/HD report after participating in a short-term study abroad program. The reflections of thirteen short-term study abroad participants, all of whom have been diagnosed with LD and/or AD/HD are presented. Particular attention is focused on the ways in which these identity changes impacted the students as learners and the factors unique to short-term study abroad that facilitated those identity changes. It concludes by proposing a model of identity development for students with LD and/or AD/HD and recommends methods for greater inclusion of students with LD and/or AD/HD in short-term study abroad programs. We hope that our findings will help to reframe notions about the ability and adaptability of students with LD and/or AD/HD, lower current barriers to participation in study abroad for students with LD and/or AD/HD, and contribute to the dynamic discussion currently underway about study abroad and student outcomes.
American Students in Israel: An Evaluation of a Study Abroad Experience
Authors: Donitsa-Schmidt Smadar , Vadish Maggie
Published: January 2020

The purpose of this research is to investigate changes in self-ascribed identity among study abroad students in Israel as a result of the time spent in the country, and to examine the gains in their Hebrew language proficiency. Attitudes towards the host country and local culture are also explored for the purpose of better understanding the relationship between students’ identity, Hebrew language proficiency and dispositions about Israel (Gardner, 1985; Giles & Byrne, 1982). Since North America has the largest Jewish community outside Israel, North American students (from the United States and Canada) make up the majority foreign population studying in Israel (Cohen, 2003; United Jewish Communities, 2003). The current study concentrated specifically on North American students taking part in a study abroad program in Israel, seeking to understand how the study abroad experience in Israel influenced students’ identities, attitudes and Hebrew language proficiency.
Business Study Abroad Tours for Non-Traditional Students: An Outcomes Assessment
Authors: Peppas Spero C.
Published: January 2020

The purpose of this research was to assess empirically the perceived benefits of a business study tour course in terms of business educational outcomes, cultural awareness and sensitivity, and work-related gains. This study fills a gap in the business-school-related literature by focusing on outcomes of study abroad tours for non-traditional, working adult students.
Влияние кратковременных физических упражнений на гемодинамический аспект функции эндотелия плечевой артерии человека
Authors: MELKUMYANTS A.M. , BALAKHONOVA T.V. , POGORELOVA O.A. , TRIPOTEN M.I.
Published: January 2020

В экспериментах на 10 мужчинах4добровольцах в возрасте 5060 лет без выраженной сердечно4сосудистой патологии исследовали влияние относительно кратковременных (по 3050 мин. в день) физических упражнений, сопряженных с повышением напряжения сдвига в ПА, на величину эндотелий4зависимой вазодилатации этой артерии, вызываемой увеличением в ней скорости кровотока. В контрольном периоде на обеих руках испытуемых регистрировали эндотелий4зависимую дилатацию ПА, вызываемую увеличением кровотока в период реактивной гиперемии, следующей за окклюзией, длительностью 5 мин. После 4 дней, в течение которых каждый испытуемый периодически увеличивал кровоток в сосудах только левой руки, ритмически сжимая ею в течение 3050 мин. в сутки резиновый кистевой эспандер, вновь измеряли поток4зависимую вазодилатацию (ПЗВД) на обеих руках и сопоставляли результаты с данными контрольных измерений. В контрольных измерениях реакции ПА обеих рук на повышение кровотока, вызванного окклюзией, были практически одинаковы (4,98 0,3 на левой руке и 5,07 0,6 на правой руке). После 44дневного цикла упражнений левой рукой величина ПЗВД на правой руке не изменилась (p 0,5), а на левой руке достоверно выросла у всех испытуемых, в среднем до 7,84 0,82 (p 0,01). Таким образом, показано, что даже кратковременные физические упражнения, сопряженные с увеличением действующего на стенку артерий напряжения сдвига, заметно улуч4 шают способность эндотелия расслаблять сосудистые гладкие мышцы при увеличении кровотока. Этот результат подтверждает представление о том, что трансформация эндотелиального гликокаликса под действием напряжения сдвига улучшает механоцептивную функцию эндотелия.
Казеозный кальциноз митрального клапана
Authors: SAIDOVA M.A. , ATABAEVA L.S. , STUKALOVA O.V.
Published: January 2020

Казеозный кальциноз кольца митрального клапана (ККМК) это редкая форма дегенеративного процесса, возникающего вследствие казеозной трансформации внутреннего материала кальциноза кольца митрального клапана. При выполнении трансторакальной эхокардиографии представляет собой округлое гиперэхогенное образование с гипоэхогенным содержимым, локализующееся в области основания задней створки митрального клапана и требующее дифференциальной диагностики с другими объемными образованиями сердца, такими как опухоли, вегетации створок митрального клапана и абсцессы. Мы представляем сравнительную характеристику двух клинических случаев ККМК, требующих разных подходов к тактике лечения вследствие различного течения заболевания.

Caseous calcification of the mitral annulus (CCMA) is a rare form of the degeneration of the mitral valve fibrous ring. The condition arises due to a caseous transformation in the internal material of the mitral annulus calcification. Transthoracic echocardiography demonstrates a round echodense mass with a central echolucent area, typically located at the base of the posterior leaflet of the mitral valve. It can be misdiagnosed as an abscess, a tumor or infective vegetations on the mitral valve. We present a comparative description of two clinical cases of caseous calcification of the mitral annulusrequired different approaches to the treatment due to different course of the disease .
Projeto "O Pulo do Gato: a Medicina Veterinária por uma Saúde Única"
Authors: Galvani Guilherme David , Nardi Larissa Berardi Cerqueira , Martins Maria Helena , Cardoso Sônia Cristina Guirado , Garrido Neto Lupércio Lopes , Ferreira Melissa Campitelli , Barbuglio Fábio Ricardo , Manhoso Fábio Fernando Ribeiro
Published: January 2020

A guarda responsável dos animais de companhia e a educação da sociedade são práticas que visam à promoção do bem-estar animal. Buscando resolver a situação de abandono de felinos existente no Bosque Municipal de Marília, São Paulo, Brasil, foi firmada uma parceria entre a Universidade de Marília (Unimar) e a prefeitura do município para o desenvolvimento do projeto “O Pulo do Gato”. Este, executado no período de 2012 a 2014, foi delineado para conscientizar a população quanto aos prejuízos que os animais abandonados poderiam causar no recinto, bem como às implicações da saúde desses gatos que poderiam, inclusive, refletir na saúde humana. Nesse sentido, foi realizado um levantamento em conjunto com o Centro de Educação Ambiental (CEA) localizado no bosque. Um dos aspectos que o projeto executou foi oeducacional, atingindo 18.100 crianças do ensino fundamental com visitas in loco e distribuição de material impresso, encenação de teatros, além de oficinas. Outro procedimento adotado foi o manejo populacional dos felinos abandonados com o emprego da castração e doação, que no período envolveu 151 animais, 86 machos (57%) e 65 fêmeas (43%), sendo que todos também foram vacinados contra raiva e vermifugados e receberam um microchip de identificação. Pode-se constatar que com essas ações houve uma diminuição considerável do número de felinos abandonados no bosque, bem como o retorno de espécies de animais nativas, principalmente aves que passaram a ser observadas no local com maior frequência. Enfim, o projeto mostrou claramente a importância da medicina veterinária dentro da visão moderna de “saúde única”, ou seja, saúde animal, humana e ambiental.
A Abordagem Design Thinking como proposta de inovação social em um Programa de Visitação Domiciliar na Primeira Infância
Authors: Pola Baptista Coelho Thais , Aparecida Fracolli Lislaine , Chiesa Anna Maria , Soares Correa da silva Flavio , Macedo Ferraz e Souza Junior Hugo , Aparecida da Silva Letícia
Published: January 2020

Objetivo: Utilização da abordagem Design Thinking para melhoria dos protocolos de visitação através da criação de um protótipo escalável, atrativo e que forneça recurso de monitoramento dos resultados do Programa de Visitação Domiciliar “Jovens Mães Cuidadoras”. Método: Estudo de desenvolvimento tecnológico por prototipação através da abordagem Design Thinking (DT). Resultados: O protótipo foi criado em papel (cards) e, após a validação pelos participantes do programa, foi transformado em arquivo de texto digital, cuja íntegra está disponível no anexo deste artigo. Conclusão: o público-alvo deste Programa são gestantes adolescentes e crianças que vivem sob alta vulnerabilidade. Se a compreensão por parte dos gestores for padronizada e inflexível quanto à formulação do programa, corre-se o risco de se negligenciar as camadas que formam o ecossistema da criança atendida. Na melhor das hipóteses, pode-se projetar soluções ou intervenções que tenham um impacto social moderado; e, na pior das hipóteses, é possível que o programa, além de não ter eficácia, reforce as injustiças e a desigualdade social. Por esta razão, recomenda-se que qualquer programa ou serviço de impacto social priorize o desenho de escopo de forma a se adaptar ao contexto de sua aplicação.