bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Tolerability of Topical Ophthalmic Triamcinolone Acetonide-Loaded Liposomes Formulation and Evaluation of Its Biologic Activity in Patients with Diabetic Macular Edema
Authors: Navarro-Partida Jose , Altamirano-Vallejo Juan Carlos , Gonzalez-De la Rosa Alejandro , Armendariz-Borunda Juan , Castro-Castaneda Carlos Rodrigo , Santos Arturo
Published: March 2021

Intravitreal injections (IVTs) of corticosteroids as triamcinolone acetonide (TA) are frequently used for the treatment of many vitreous and retinal disorders. However, IVTs are related to severe ocular complications. Lately, a topical ophthalmic TA-loaded liposomes formulation (TALF) was designed to transport TA into the posterior segment of the eye when instilled on the ocular surface. To evaluate the safety, tolerability, and biological activity of TALF, an animal study and a phase I clinical assay were performed. Moreover, four patients with diabetic macular edema (DME) were treated with TALF in order to explore the biological activity of the formulation. No inflammation, lens opacity, swelling, or increase in intraocular pressure were recorded after the instillation of TALF in any of the animal or clinical studies. Mainly, mild and transient adverse events such as dry eye and burning were reported. TALF significantly improves visual acuity and diminishes central foveal thickness in patients with DME. The current data demonstrate the safety, tolerability, and biological activity of TALF. It seems that TALF can be used topically to treat vitreous and retinal diseases that respond to TA such as DME, avoiding the use of corticosteroid IVTs and their associated hazards.
Artificial Intelligence (AI) in Pathology – A Summary and Challenges
Authors: Buch Archana , Kulkarni Rohan
Published: March 2021

This bibliographic study covers Artificial Intelligence (AI)theory and its applications from the healthcare field and in particular from the discipline of pathology. This review includes basics of AI, supervised and unsupervised machine learning (ML), various supervised ML algorithms, and their applications in healthcare and pathology. Digital Pathology with Deep Machine Learning is more advantageous over traditional pathology that is based on ‘physical slide on a physical microscope’. However, various implementation challenges of cost, data quality, multi-center validation, bias, and regulatory approval issues for AI in clinical practice still remain, which are also described in this study.
An Evaluation of TOEFL Benchmark Policy as an Exit Requirement for Undergraduate Students
Authors: Rahma Endah Anisa , Syafitri Rina , Syahputri Veni Nella , Parlindungan Firman
Published: March 2021

This study investigated the TOEFL benchmark policy as an exit requirement for Universitas Teuku Umar students. The research method used was survey design hereby the data from the questionnaire and students' TOEFL score were collected. Under the policy, the students have to pass the standard passing score of TOEFL to graduate. 100 non-English major students from Universitas Teuku Umar participated in this study. The results of the study revealed that the participants gave more positive responses than negative ones. The extend of approval for this policy seemed more related to their abilities, awareness of the importance of learning English, and motivation to learn English. The result from TOEFL scores taken from 2018-2019 found that as many as 58% of students failed to obtain minimum criteria (Ëƒ 400) while only 42% of them reached 400 or above. It indicates that Universitas Teuku Umar students are not ready yet to face this policy.Â  On the other hand, based on the questionnaire result, most students agreed with the implementation of TOEFL as an exit requirement, however, a minimum passing score should be evaluated and a set of students' needs under the policy should be facilitated.
Personnel Management and School Productivity: Evidence from India
Authors: Lemos Renata , Muralidharan Karthik , Scur Daniela
Published: March 2021

This paper uses new data to study school management and productivity in India. We report four main results. First, management quality in public schools is low, and ~2σ below high-income countries with comparable data. Second, private schools have higher management quality, driven by much stronger people management. Third, people management quality is correlated with both independent measures of teaching practice, as well as school productivity measured by student value added. Fourth, private school teacher pay is positively correlated with teacher effectiveness, and better managed private schools are more likely to retain more effective teachers. Neither pattern is seen in public schools.
Quantification and evaluation of chemical footprint of woollen textiles
Authors: JI XIANG , QIAN WEIRAN , TIAN ZEJUN , LI YI , WANG LAILI
Published: March 2021

The chemical pollutants discharged in the production processes of textile products cause severe impact on the
environment. The chemical footprint (ChF) methodology provides a new way to quantify the toxicity impacts caused by
chemical pollutants. ChF does well in identifying priority chemical pollutants and helping enterprises to select greener
chemicals to reduce the environment impacts. In this study, the ChF of woollen yarn were assessed with the data that
collected from the production processes. The results showed that the ChF of dyeing process (4.10E+06 l) accounted for
the largest proportion, because a large number of auxiliaries were used in the dyeing process to prevent uneven dyeing
and colour difference, followed by scouring (7.79E+05 l) and finishing (8.11E+03 l). Among all the discharged chemical
pollutants, polyoxyethylene nonyl phenyl ether (1.37E+06 l) caused the most ecotoxicity severe impact on the
environment due to its high bioaccumulation and high toxicity to ecosystem, followed by sulfuric acid (1.03E+06 l).
Sodium chloride and hydrogen peroxide were the two substances that caused the least environmental load. The overall
uncertainty caused by toxicity prediction data accounting for 20.2% of the total ChF, and the uncertainty of the scouring
process was the most. The results are referable for wool textiles producers to enhance the textile chemicals
management.
Investigating the impact of CO2 emission and economic factors on infants
health: a case study for Pakistan
Authors: NAEEM MUHAMMAD ZAHID , ARSHAD SUMERA , BIRAU RAMONA , SPULBAR CRISTI , EJAZ ABDULLAH , HAYAT MUHAMMAD AZMAT , POPESCU JENICA
Published: March 2021

This study has attempted to investigate the consequences of CO2 emissions on infants’ health in Pakistan over the
period of 1975 to 2013. Several economic factors have been employed in our analysis and the estimates show
insignificant impact of CO2 emissions in affecting children mortality. Increasing health facilities lowers children mortality
over a short period were also observed but the relationship inversed in the long-run. In short-run, urbanization appeared
as a decreasing factor to children mortality. While income inequality remains inversely related with children mortality.
Both poverty and fertility are found enhancing factors to children deaths. The poor sector of the economy seemed to
observe higher children mortality due to inadequate health facilities and low standards of living. Overall, we have
observed greater impact of economic factors in explaining children mortality than CO2 emissions in case of Pakistan.
These issues have a significant impact on the representative industries in Pakistan, such as the cotton textile and
traditional clothing industry (apparel manufacturing).
La dynamique du français des jeunes : deux périodes à sept ans d’intervalle (1987-1994 et 2010-2017)
Authors: Fiévet Anne-Caroline , Podhorná-Polická Alena
Published: March 2021

Cet article propose un bilan de deux études sur la néologie des jeunes Français, effectuées en quatre étapes sur une période de trente ans (1987-2017). Basée sur les résultats des enquêtes du spécialiste de l’argot Marc Sourdot menées avec ses étudiants en 1987 et 1994, l’observation de la circulation et de l’évolution du sémantisme de vingt lexèmes en 2010 et 2017 nous amène à envisager la néologie en tant que phénomène psycho-social réitératif dont la conceptualisation est difficile autant que la dictionnairisation est sélective.
Парцеллят и сегмент: к вопросу о нетривиальных синтаксических позициях словоформ в русском языке
Authors: Pankov Fedor
Published: March 2021

Парцеллят и сегмент – нетривиальные синтаксические позиции словоформ, участвующие в выражении субъективных смыслов. Обе позиции выделяются по отношению к базовой части: парцеллят обычно следует за ней, а сегмент ей предшествует. Парцелляция и сегментированная синтаксическая конструкция (именительный темы) являются важными грамматическими механизмами, которые позволяют субъекту речи в соответствии с коммуникативной целеустановкой адекватно выразить ту или иную мысль.
« Libérer la syntaxe russe » : la question de la ponctuation chez A. Solženicyn
Authors: Zayanchkauskayte Victoria
Published: March 2021

L’objectif de сet article consiste en l’étude des cas particuliers de la ponctuation non normative dans l’œuvre d’A. Solženicyn. Cette problématique est abordée en deux parties. Premièrement, il s’agit de l’analyse des « règles », qui constituent plutôt de légers décalages de ces dernières, proposées par l’écrivain lui-même dans son essai Quelques réflexions sur la grammaire. En deuxième lieu, il est question des cas de la ponctuation, notamment ceux du tiret, qui ne figurent pas dans l’essai de l’écrivain, mais qui représentent une certaine déviation par rapport à la norme, et qui, par leur fréquence, forment un style auctorial particulier. Les exemples analysés montrent que l’emploi des signes de ponctuation, et plus précisément du tiret, résulte d’une stratégie narrative de l’écrivain. Les signes de ponctuation peuvent accomplir plusieurs fonctions dans les textes de l’auteur en tant que procédés stylistiques.
Prépositions russes из vs. от : vers une grammaire des erreurs
Authors: Kor Chahine Irina , Perova Nouvelot Yulia
Published: March 2021

Le présent article est dédié à l’analyse de quelques emplois, spatiaux et non spatiaux, des constructions avec les prépositions russes из et от. Bien que из et от desservent des contextes très proches, ces prépositions disposent de « zones d’action » qui leurs sont propres, et la méconnaissance de ces zones est souvent à l’origine d’erreurs que commettent des étudiants francophones apprenant le russe. L’étude est basée sur l’observation des emplois erronés avec из et от, notamment là où les deux prépositions entrent en concurrence. On observe ainsi que dans les contextes spatiaux, c’est la nature de la localisation qui motive leur choix : si от fonctionne avec la localisation perçue comme point de départ extérieur, из, en revanche, implique l’intérieur d’un endroit-source. La validité de ce principe est aussi soutenue par les emplois causaux de ces prépositions. De plus, le caractère animé / inanimé rentre également en compte dans le choix de ces constructions.
Migrants, Metaphors and Manipulation: a Multimodal Case Study of Trump’s Speeches on Immigration (2015-2017)
Authors: Lafiandra Bérengère
Published: March 2021

This article intends to analyze the use of metaphors in a corpus of Donald Trump’s speeches on immigration; its main goal is to determine how migrants were depicted in the 2016 American presidential election, and how metaphor manipulated voters in the creation of this image. This study is multimodal since not only the linguistic aspect of speeches but also gestures are considered. The first part consists in presenting an overview of the theories on metaphor. It provides the theoretical framework and develops the main tenets of the ‘Conceptual Metaphor Theory’ (CMT). The second part deals with multimodality and presents what modes and gestures are. The third part provides the corpus and methodology. The last part consists in the corpus study and provides the main source domains as well as other rhetorical tools that are used by Trump to depict migrants and manipulate voters.
Brexit and the Myth of Grandeur
Authors: Bonnet Alma-Pierre
Published: March 2021

The decision by the United Kingdom to leave the European Union came as a shock to many. A key player during the referendum campaign was the Vote Leave organisation which managed to convince people that they would be better off outside the European project. Their success was made all the easier as Euroscepticism had been running deep in the country for decades. It is on this fertile ground that Vote Leavers drew to persuade people of the necessity to leave. Using critical metaphor analysis, this paper examines the way Vote Leavers won the argument by developing three political myths, which, once combined, conjured up the notion of British grandeur. Drawing on Jonathan Charteris-Black’s seminal works on the relation between metaphors and the creation of political myths in political rhetoric, this paper posits that the Brexit debate was not won solely on political ground and that the manipulative power of metaphors may have also been a key element. This might explain the current political deadlock, as political solutions might not provide the answers to the questions raised during the campaign.
Researches of the kharanorsk reservoir ecosystem according to the outcomes of the plankton primary production assessment
Authors:   G.T. Tsybekmitova
Published: March 2021

This article presents the results of the assessment of production and destruction processes in the ecosystem of the Kharanorsk reservoir-cooler, used as a cooling pond of the Kharanorsk hydroelectric power station. The content of dissolved oxygen in the water of the reservoir is ubject to seasonal dynamics corresponding to biochemical processes occurring in the reservoir. In spring and autumn, the concentration of dissolved oxygen is in the range from 12.6 to 14.2 mg / L. We attribute the decrease in oxygen content in the summer month to 9.6 mg / L with an increase in air temperature and with the thermal effect of thermal power plants, which in total lead to an intensification of the processes of biochemical decomposition of organic and oxidation of mineral substances. High production capabilities of the ecosystem in both the central and littoral zones were found in July in the surface horizons of the water column (3.53 mgO2 / L – littoral; 3.92 mgO2 / L – center). The formation of organic matter in the direction “surface horizon - bottom layers” of the water column in the central zone decreases due to a decrease in the transparency of the water column. The cessation of the production of organic matter by phytoplankton in the bottom layers of the littoral zone we associate with the competitive relationship of bottom organisms in the use
of nutrients. It has been established that the rate of daily production increases from April to
July and begins to fall in October, but remains high relative to spring indicators in both the
central and littoral zones of the reservoir.
The studies are necessary for subsequent environmental monitoring studies, as well as for making managerial decisions to maintain the sustainability of the reservoir ecosystem.
Smart Digital Mirror
Authors: Al-Abaid Shaimaa Abbas Fahdel
Published: March 2021

Each day, human life becomes simpler and more time efficient. This research article discusses the smart digital mirror, which contributes to a more time-efficient life. The smart digital mirror is the extension of the simple mirror. Features of the simple mirror are enhanced with the help of new emerging technologies. Smart digital mirrors provide information such as time, date, day, weather forecast, reminders for important daily tasks, multimedia news, updates on the user’s health status, and recognition of the user’s emotion. The smart digital mirror is based on some artificial features such as recongnisation, analysis, learning, etc. It works on real-time systems. Raspberry Pi is a micro-controlar and a key part of the smart digital mirror. Essentially, the smart digital mirror recognizes the user based on image processing, and it uses its knowledge of the user to provide personal services. This can give the user enhanced comfort as it helps them feel prepared for their day and presents information and recommendations based on their preferences.. Various algorithms are used for the implementation of the smart digital mirror’s face emotion recognition. In the present study, we reviewed the previous smart mirror system along with various computations using Raspberry Pi.
Transmitter Aperture Diameter Effect in 40 Gb/s Inter-Satellite Optical Wireless Communication System
Authors: Ali Mustafa H. , Al-Rikabi Hazim M. , Hassan Tariq A.
Published: March 2021

Optical wireless communication systems have turned into a state-of-the-art technology because of their superior performance uniqueness and innumerable characteristics, as compared to radio frequency. One optical wireless communication application is Inter-Satellite Optical Wireless Communication. Inter-Satellite Optical Wireless Communication systems can be improved by using, for example, advanced modulation formats and adjusting the aperture diameters. We demonstrate an analysis based on the aperture diameter effect in the transmission of a single channel using a 40 Gb/s Inter-Satellite Optical Wireless Communication system and three different modulation methods, specifically differential phase-shift keying with a duty ratio of 66% or 33% and duobinary. These three modulations were chosen among various modulation formats due to the advantages they provide, i.e., the differential phase-shift keying provides stronger robustness to fiber nonlinearity and duobinary provides higher chromatic dispersion tolerance to mitigate the system requirements for dispersion compensation. The results show the effect of different transmitter aperture diameters (from 2 to 20 cm) at a constant distance (200 km) in terms of the quality factor and minimum Bit Error Rate. We conclude there is a great loss in the small aperture diameter, even in the presence of the best modulation format; therefore, as the aperture diameter increases the Q-factor increases, but some of the increased rise is linear and some changes from linear to non-linear at a fixed Q-factor point equal to 5.63.
A Modified Cylinder Block-IC Engine Experimentation
Authors:   Assistant Professor, Department of Mechanical Engineering, MJCET, Hyderabad, India., Samad Mohd Abdul , Mehdi Syed Nawazish ,   Research Supervisor, Department of Mechanical Engineering, Mewar University, Rajasthan, India., basha Syed Khader ,   Assistant Professor, Department of Mechanical Engineering, MJCET, Hyderabad, India.
Published: March 2021

In Internal combustion Engines, the adequate cooling plays vital role for proper functioning and enhanced efficiencies. In the present scenario, the demand for Air cooled Engines with higher powers is increasing and hence necessity for Augmented heat transfer through fins. The present work confined to fins mounted on the cylinder block.In the present work, Internal Combustion Engine test rig is used, which consist of 4S, single cylinder, vertical, air cooled, SI Engine with Instrumentation panel, Throttle control mechanism and Electrical Loading system. The performance test on IC engine is carried out for three various configurations of cylinder blocks i.e., 1. Actual cylinder block 2.Cylinder block with triangular profile fins 3. Cylinder block with perforated triangular profile fins. Performance parameters are evaluated, plotted and compared & eventually conclusions are made.
Object Detection Based on Faster R-Cnn
Authors:   Department of ECE, Osmania College of Engineering, Hyderabad, India, Sri M. Sushma , Naik B. Rajendra ,   Department of ECE, Osmania College of Engineering, Hyderabad, India, Sankar K. Jaya ,   Department of ECE, Mahatma Gandhi Institute of Technology, Hyderabad, India.
Published: March 2021

In recent years there is rapid improvement in Object detection in areas of video analysis and image processing applications. Determing a desired object became an important aspect, so that there are many numerous of methods are evolved in Object detection. In this regard as there is rapid development in Deep Learning for its high-level processing, extracting deeper features, reliable and flexible compared to conventional techniques. In this article, the author proposes Object detection with deep neural networks and faster region convolutional neural networks methods for providing a simple algorithm which provides better accuracy and mean average precision.
Impact of Service Quality on Customer Satisfaction and Firm Performance in Nepalese Life Insurance Companies
Authors:   Associate Professor, Commerce Campus, T. U, Nepal, Upadhyay Jitendra Prasad , Adhikari Pitri Raj ,   Lecturer, Shanker Dev Campus, T. U, Nepal
Published: March 2021

This paper attempts to examine the impact of service quality on customer satisfaction and firm performance in Nepalese life insurance companies. Data are collected through structured and self-administered questionnaire from 350 respondents of 19 life insurance companies which are based on SERVQAL model. Descriptive and causal-comparative research design have used to achieve the objectives and descriptive statistics, correlation, as well as multiple regression models, have been used to analyze the data. It is observed that reliability, responsiveness, assurance, empathy, and tangibles have a positive and significant impact on customer satisfaction and firm performance. It is also found that responsiveness shows the highest positive correlation with customer satisfaction and performance in terms of ROA and assurance demonstrates the least positive correlation with customer satisfaction and ROA
A vuelo de pájaro por Cali
Authors:   Universidad Santiago de Cali, Castañeda Zuluaga Leydy Lorena
Published: March 2021

Colombia ocupa el segundo lugar en biodiversidad y el primer lugar en el mundo en riqueza de aves aproximadamente 1.900 especies de las cuales 197 de ellas son migratorias. Colombia es un país privilegiado por sus riquezas naturales, por su variedad, su belleza geográfica y por la diversidad de sus ecosistemas. Al ser un país tropical cuenta con una gran variedad de especies que hacen de su riqueza natural un atractivo turístico a nivel internacional (Colciencias, 2016).En esta oportunidad, queremos rescatar la riqueza que encontramos en cada rincón geográfico de Colombia, como lo es el caso del Valle del Cauca; el cual, se encuentra constituido por dos grandes vertientes hidrográficas muy diferenciadas entre sí: la vertiente del Océano Pacífico y la del río Cauca (CVC,FUNAGUA, 2018).
Minimally Invasive Interventional Therapy for
Tarlov Cysts Causing Symptoms of Interstitial
Cystitis
Authors: Freidenstein James
Published: March 2021

Background: Tarlov cysts (TC) are present in 4.6% of the population and represent
a potential source of chronic pain. When present at lumbosacral levels, symptoms
are classically described as perineal pain/pressure, radiculopathy, and headache.
Treatment outlined to date primarily includes cyst drainage with fibrin glue sealant
and surgical interventions.
Objectives: We present 2 cases in which TC presented with signs and
symptomatology consistent with interstitial cystitis who were treated with caudal
epidural steroid injections.
Methods: Patients with urinary bladder pain and urgency received urological
workups demonstrating hallmark features of interstitial cystitis including cystoscopic
evidence of glomerulations. Radiographic imaging identified TC to be present on
sacral nerve roots. Since pelvic pains could represent compressive radiculopathy of
sacral roots, a cautious trial of minimally invasive caudal epidural steroid injections
was performed.
Results: Both patients attained nearly 100% relief of pain for a period ranging
from 6 months to 2 years following low volume, targeted caudal epidural steroid
injection. They continue to be followed clinically and continue to report benefit with
this treatment.
Limitations: This limited case series is retrospective in nature and potential
complications have been noted by others in association with TC.
Conclusions: Use of caudal epidural steroid injections proved beneficial in the
treatment of pelvic pain symptomatology and so may be considered as an option in
patients with identified sacral TC.
Key words: Interstitial cystitis, pelvic pain, caudal epidural steroids, Tarlov cysts
Cardiopulmonary Arrest Following
Cervical Epidural Injection
Authors: Nazari Reza
Published: March 2021

Epidural steroid injection is a common treatment for the management of pain in
a wide variety of patients. It is generally well tolerated and perceived to have few
side effects, with a low risk of serious complications. Only a handful of reports exist
that describe life-threatening complications such as subdural hematoma, respiratory
depression, vasovagal response, and pneumocephalus. This is a case report of a
67-year-old woman with a relatively unremarkable past medical history, other than
rheumatoid arthritis, osteoarthritis, and hypertension, who suffered from chronic
neck pain treated with cervical epidural steroid injection at the C6-C7 level. She went
into immediate cardiopulmonary arrest following the injection. She was brought to
the emergency department by ambulance and resuscitated, and was found to have
pneumocephalus. Ultimately, she made a relatively full recovery over the following
weeks.
Cardiopulmonary arrest is a rare but potentially deadly side effect of epidural steroid
injection. To the best of our knowledge, this is the first report of such an arrest
following a steroid injection in the cervical spinal region. There are several possible
mechanisms for the immediate arrest, including cardioacceleratory center blockade,
severe vasovagal response, iatrogenic pneumocephalus, and involvement of the
phrenic nerve followed by apnea. Our conclusion in this case is that the most likely
scenario was injection of the C6-C7 level led to a blockade of the cardiac accelerator
fibers located just below in the T1-T4 spinal level, causing a sympathetic blockade and
profound bradycardia, leading to cardiopulmonary arrest.
Key words: Cardiopulmonary arrest, cervical epidural steroid injection,
pneumocephalus, cardiac accelerator, vasovagal, chronic neck pain.
Radiofrequency Neurolysis Versus Local Nerve
Infiltration in 42 Patients with Refractory
Chronic Inguinal Neuralgia
Authors: Kastler Adrian
Published: March 2021

Background: Chronic inguinal neuralgia involving ilioinguinal and iliohypogastric nerves is a
frequent complication of surgical procedures involving a lower abdominal incision such as hernia
repair, appendicitis surgery, or cesarean sections. Chronic inguinal neuralgia is a very painful condition
and diagnosis can be challenging as it is an overlooked impairment. Existing specific treatments are
inefficient and often fail.
Objective: The purposes of this study are to describe, evaluate, and compare ilioinguinal and
iliohypogastric radiofrequency neurolysis (RFN) and local injection.
Study Design: Retrospective comparison cohort study from 2005 to 2011.
Setting: A single center, Academic Interventional Pain Management Unit
Methods: Forty-two patients suffering from chronic inguinal pain refractory to specific medication
were included. A total of 18 RFN procedures (14 patients) and 28 injections (28 patients) were
performed. Pain was assessed in both groups using Visual Analog Scale (VAS) scores (0-10)
measured immediately before and after the procedure and at one, 3, 6, 9, and 12 months after
the procedure. Mean duration of pain prior to the procedure and mean duration of pain relief were
noted. Moreover, mean maximum early pain relief was assessed. All procedures were ambulatory
under computed tomography (CT) guidance. Injections contained 1.5 mL of cortivazol and 3 mL of
lidocaine-ropivacaine (30%-70%). Radiofrequency neurolysis was performed using a Neurotherm
RF Generator. In both cases, 22-gauge needles were used. After needle retrieval, control slices were
taken and the patient was supervised for 30 minutes at the CT unit.
Results: The mean age in both groups was 48.7 years. Forty-two patients (97.6%) presented
postsurgical inguinal pain, 62% of which occurred after hernia repair. All included patients had
undergone previously unsuccessful pain therapies. Mean VAS scores were 7.72 in the RF group and
7.46 in the infiltration group. Maximum early pain relief did not statistically differ (77% in the RFN
group and 81.5% in the injection group). Mean duration of pain relief was statistically significant
(P = .005) in the RF group (12.5 months) compared to the infilitration group (1.6 months). Mean
VAS scores during the year following the procedure were all significantly in favor of radiofrequency
neurolysis management.
Limitations: Those inherent to small study samples and retrospective studies.
Conclusion: Radiofrequency neurolysis appears to be significantly more effective than local nerve
infiltrations. It is a safe and effective treatment for chronic inguinal pain. Local steroid injection along
with local injection of anesthetics should be used as a confirmation of ilioinguinal neuropathy before
performing radiofrequency neurolysis.
Key words: Radiofrequency, Ilioinguinal, Iliohypogastric, neuropathy, infiltration, computed
tomography guidance.
Peripheral Nerve Stimulation for Trigeminal
Neuropathic Pain
Authors: Stidd David A.
Published: March 2021

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic
pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the
peripheral nervous system resulting in chronic facial pain over the distribution of the injured
nerve. First line treatment of TNP includes management with anticonvulsant medication
(carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can
be a condition difficult to adequately treat with medical management alone.
Patients with TNP can suffer from significant morbidity as a result of inadequate treatment
or the side effects of pharmacologic therapy. TNP refractory to medical management can
be considered for treatment with a growing number of invasive procedures. Peripheral
nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively
treat medically intractable TNP.
We present a case series of common causes of TNP successfully treated with PNS with
up to a 2 year follow-up. Only one patient required implantation of new electrode
leads secondary to electrode migration. The patients in this case series continue to have
significant symptomatic relief, demonstrating PNS as an effective treatment option for
intractable TNP.
Though there are no randomized trials, peripheral neuromodulation has been shown to
be an effective means of treating TNP refractory to medical management in a growing
number of case series. PNS is a safe procedure that can be performed even on patients that
are not optimal surgical candidates and should be considered for patients suffering from
TNP that have failed medical management.
Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation,
intractable pain, facial trauma, postherpetic neuralgia
Vertebroplasty Using Transoral Approach in
Painful Malignant Involvement of the Second
Cervical Vertebra (C2): A Single-Institution
Series of 25 Patients
Authors: Anselmetti Giovanni Carlo
Published: March 2021

Background: Vertebroplasty is a minimally invasive procedure demonstrated to be safe
and effective in the treatment of painful osteoporotic and malignancy related fractures when
performed in the thoracolumbar spine. Multiple randomized and nonrandomized reports have
demonstrated its effectiveness. Conversely, transoral vertebroplasty (TOV) to treat the second
cervical vertebra (C2) has been described in only a few case reports.
Objectives: Prospective evaluation of clinical results of TOV performed in malignant painful
osteolytic lesions of C2.
Study Design: TOV was performed in 25 consecutive patients suffering from high-grade
cervical pain due to malignant involvement of C2 who failed conservative therapies and did not
have surgical indications. Follow-up was prospectively evaluated with clinical interviews in all
patients. The Internal Review Board approved this study.
Setting: Institute for Cancer Research and Treatment
Methods: Twenty-five patients (16 women and 9 men; mean age 59.3 ± 11.5) suffering from a
painful malignant involvement of C2 who did not respond to conventional therapies and did not
have surgical indications, underwent TOV for pain palliation. The procedure was performed under
general anesthesia with combined digital fluoroscopy and computed tomography guidance.
After a beveled vertebroplasty needle was manually advanced up to the posterior odontoid wall,
bone cement was injected under continuous digital fluoroscopic control. Patients were discharged
from the hospital the next procedural day. The Visual Analog Scale (VAS) for pain, analgesic
requirement, and use of external cervical cast support were used for evaluating efficacy. The main
end point was safety and efficacy at day 15 after the procedure. Furthermore, all the patients
were scheduled to be followed-up at months one, 3, and 6, and every 6 months thereafter.
Results: The median pretreatment VAS of 8 (range 5-10) significantly dropped (P < 0.0001)
to 0 (range 0-10), with 20 patients (80%) achieving complete pain relief at day 15 after TOV.
Differences in pre- and post-treatment analgesic therapy were significant (P < 0.001). Twentythree patients no longer used a cervical cast after TOV (92%, P < 0.001). At median overall
follow-up of 16 months (range 6-60 months), the projected proportion of patients free from
worsening pain at 6, 12, and 24 months was 96%, 96% and 92% respectively.
Limitations: A randomized study of only 25 patients.
Conclusion: TOV is safe, effective, and long-lasting in the treatment of cervical pain resulting
from malignant involvement of C2.
Key words: Vertebroplasty, pain, palliation, cervical spine, metastases.
Percutaneous Cement Vertebroplasty in
the Treatment of Symptomatic Vertebral
Hemangiomas
Authors: Hu ZhenMing
Published: March 2021

Background: Vertebral hemangiomas are benign tumors with a rich vasculature. Symptoms may
vary from simple vertebral pain, sometimes resistant to conservative medical treatment, to progressive
neurological deficit. Surgery or radiotherapy have been the treatment of choice for several years,
but they were worsened by intraoperative and postoperative hemorrhagic complications related to
the rich vascularization that characterize these kinds of lesions, often preceded by a preoperative
embolization in the acute setting. Recently, a percutaneous, minimally invasive technique of
vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical
and radiotherapy treatment of symptomatic vertebral hemangiomas with or without features of
aggressiveness at imaging studies.
Objective: This study aimed to illustrate the validity of treatment with percutaneous vertebroplasty
(PVP) in patients with symptomatic vertebral hemangiomas (VHs).
Study Design: PVP in 26 patients with symptomatic VHs and its clinical effects were evaluated in
3-24 months follow-up.
Setting: An inteventional pain management practice, a medical center, major metropolitan city,
China.
Methods: Twenty-six consecutive patients were treated with PVP; a total of 28 vertebral bodies. All
patients were followed-up for 3-24 months, average 8.6 months. The clinical effects were evaluated
with the visual analog scale (VAS) and 36-item short-form (SF-36) at preoperative and postoperative
and final follow-up, comparing imaging before and post-treatment.
Results: Twenty-six patients (28 vertebral bodies) were treated successfully with a satisfying
resolution of painful symptoms within 24 to 72 hours. Cement distribution was always diffuse
and homogeneous. We found paravertebral cement leakage in 3 cases without any onset of
radicular symptoms related to epidural diffusion. Spinal canal and intervertebral foramen cement
leakage wasn’t noticed. No pulmonary embolism ever occurred and no clinical and symptomatic
complications were observed. Hemangioma was confirmed by pathology examination. VAS scores
decreased from 7.5 ± 1.5 preoperatively to 1.6 ± 0.6 postoperatively, with a final score of 0.7 ± 0.5.
There was significant difference between postoperative and preoperative, and between final followup and preoperative (P < 0.05). At the postoperative and final follow-up, the SF-36 scores of patients
was significantly higher than the preoperative in Role Physical, Bodily Pain, General Health, Vitality,
Social Functioning, Role Emotional, and Mental Health (P < 0.05).
Limitations: An observational study with a relatively small sample size.
Conclusions: PVP is an effective technique to treat symptomatic vertebral hemangioma, which is
a valuable, minimally invasive, and quick method that allows a complete and lasting resolution of
painful vertebral symptoms.
Key words: Percutaneous vertebroplasty, symptomatic, vertebral, hemangiomas.
Rising Complication Rates after Intrathecal
Catheter and Pump Placement in the Pediatric
Population: Analysis of National Data Between
1997 and 2006
Authors: Zuo Dr. Zhiyi
Published: March 2021

Background: Intrathecal delivery of baclofen (ITB) is effective at controlling spasticity. However,
it requires the placement of a catheter into the intrathecal space, and a pump with a reservoir
for the medication. The process of placing the catheter and pump are prone to complications.
Objectives: The objective of this paper is to determine factors contributing to rising
complication rates after intrathecal catheter/pump placement in a national sample of pediatric
patients.
Study Design: This was a retrospective observational database study.
Methods: We queried the Kids’ Inpatient Database for all children greater than 4 years old
and under 20 years old for the years 1997, 2000, 2003, and 2006 who had an intrathecal
catheter and pump placed. We then compared demographics and hospital characteristics of
patients with and without complications. We performed univariate and multivariate analyses
to determine the relative contribution of various factors to the development of complications.
Results: We identified 2,843 patients who met our criteria, and 514 of these patients had
one or more complications after placement of intrathecal pump/catheter. There were 1.14
complications per patient. The complication rate was 10.2% in 1997, and increased to 21.9% in
2006. Mechanical complications were the most common type of complication in this population,
account for nearly two-thirds of all complications occurring. Age, hospital type, hospital size,
and admission source were independent predictors of complications.
Limitations: We did not have access to ASA status, operative details, and access to patient
charts.
Conclusions: Complication rates after placement of intrathecal pump/catheters have increased
in the pediatric population between 1997 and 2006 mainly due to an increase in mechanical
complications.
Key words: Intrathecal, baclofen, catheter, pediatric, kids, complications, spasticity
Treatment of Functional Chest Pain with
Antidepressants: A Meta-Analysis
Authors: Wu Prof. Sheng-Xi
Published: March 2021

Background: Recurrent Functional Chest pain (FCP) with normal coronary anatomy and no
detectable gastroenterological and respiratory causes is a common problem that sometimes
leads to excess use of medical care.
Objective: The purpose of this meta-analysis is to investigate the efficacy of antidepressant
treatments for FCP.
Settings: MEDLINE, PsycINFO, Scopus, and the Cochrane Central Register of Controlled Trials
(CENTRAL) were searched up to July 2011. Randomized controlled trials (RCTs) that tested
any type of antidepressants for FCP with normal coronary anatomy were analyzed. Diagnoses
included non-specific chest pain, noncardiac chest pain, atypical chest pain, syndrome X, or
chest pain with normal coronary anatomy.
Methods: Two authors independently extracted data. Effects were summarized using
standardized mean differences (SMDs), weighed mean differences (WMD), or odds ratio (OR)
by suitable effects model.
Results: Seven RCTs (median duration, 5 weeks; range, 3 - 16 weeks) involving 319 participants
were included. There was strong evidence for an association of antidepressants with reduction
in pain (SMD −1.26; 95% confidence interval [CI], −2.34 to −0.19) and psychological symptoms
(SMD −0.87; 95% CI, −1.67 to – 0.08) as well as increased side effects (OR 0.34; 95% CI, 0.15
to 0.78). Current analysis did not support the association of antidepressants with improved
health related quality of life (WMD 2.00; 95% CI, − 2.54 to – 6.65).
Limitations: Demographics, co-morbidities of study participants and the amount of comedication were not reported, these possible sources of heterogeneity could not be examined.
Conclusions: Antidepressant medications are associated with improvements in pain and
psychological symptoms. The effects of factors including psychiatric co-morbidity, gender, age,
ethnic group, and treating period on the outcomes should be checked further.
Key words: Functional chest pain, antidepressants, meta-analysis
Is the History of a Surgical Discectomy Related
to the Source of Chronic Low Back Pain?
Authors: DePalma Michael J.
Published: March 2021

Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD)
for intervertebral disc herniation has been well documented. The source of low back pain
in these patients has not been examined.
Objective: To compare the distribution of the source of chronic LBP between patients with
and without a history of SD.
Study Design: Retrospective chart review.
Setting: Academic spine center.
Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/
presence of SD in patients who subsequently underwent diagnostic injections to determine
the source of chronic LBP were included resulting in 158 unique cases for analysis.
Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articular
diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection
into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion
hardware. If the initial diagnostic procedure was negative, the next most likely structure
in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not
performed after the source of chronic LBP was identified.
Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint
pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP.
Results: Based on a Fisher’s exact test, there was marginal evidence the distribution of the
source of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability of
DP compared to those without a history of SD (82% versus 41%; P = 0.011). Differences
in the probability of FJP, SIJP, or other sources between the SD history groups were not
significant.
Limitations: Small sample size, restrospective design, and possible false-positive results.
Conclusions: This is the first published investigation of the tissue source of chronic LBP
after SD. It appears that DP is the most common reason for chronic LBP after SD. If more
rigorous study confirms our findings, future biologic treatments may hold value in repairing
symptomatic annular fissures after SD.
Key words: surgical discectomy, chornic low back pain, discogenic pain, facet joint,
sacroiliac joint, low back pain, diagnostic injections, medial branch block, lumbar provcation
discography
A Biomechanical Evaluation of the Epidural
Neurolysis Procedure
Authors: Birkenmaier Christof
Published: March 2021

Background: The epidural lysis of adhesions (ELOA) procedure supposedly has a biomechanical
component in addition to the targeted injection of medications into the epidural space. It is assumed
that the catheters used for the ELOA procedure can release epidural scars and adhesions.
Objectives: To evaluate the possible biomechanical effects of the typically used catheters and to put
these effects into clinical perspective.
Study Design: Experimental study.
Setting: The biomechanical laboratory of an academic orthopedic surgery department.
Methods: Experimental setups were devised that allow for the measurement of the 3 main forces
that can be exerted by manipulating a catheter in the epidural space or by injecting fluids through
such a catheter: axial forces, torsional forces, and hydraulic effects.
Results: The maximum axial forces measured under extremely tight catheter guidance were 7
newton (N), whereas the maximum forces under conditions that more likely reflect a real treatment
situation were between 1 and 2 N. The maximum torsional forces measured were 0.3 N under
extremely tight catheter guidance and 0.01 N under more realistic conditions. The maximum flow
that could be achieved through the typical catheter using normal saline and the maximum possible
thumb pressure onto a 5 mL or a 10 mL Luer-Lock syringe was 0.48 mL/ s. Given these results and
other data available to us, it appears impossible that the ELOA procedure with typically used catheters
has any relevant mechanical effect.
Limitations: Like with any experimental study, the realities of an in vivo situation can only be
modeled to a limited degree. The main limitation of our study is that we cannot calculate, measure,
or simulate neither the flow resistance between an epidural adhesion pocket and the open, local
epidural space nor the flow resistance between the open, local epidural space and the larger epidural
space as well as the retroperitoneal space.
Conclusions: According to our findings and arguments, the ELOA procedure is predominantly a
method for the highly targeted application of epidural medications and possibly also has a lavage
effect. A mechanical lysis of scars or adhesions appears unlikely.
Key words: epidural lysis of adhesions, epidural neurolysis, epidural neuroplasty, biomechanical,
experimental, epidural, catheter, back pain, sciatica