The roles of media, language, and practice on solving the Tower of Hanoi problem

The current study presents findings of a study conducted on the Tower of Hanoi problem. The Tower of Hanoi problem is a logical puzzle involving recursion in which there are three pegs with discs stacked in ascending order on the left peg. The object is to restack the discs on the right peg in ascending order, moving one disc at a time and never having a larger disc placed on top of a smaller one. The fewer the moves to accomplish this, the more successful the trial is judged to be. Subjects were randomized into one of eight cells and all were measured on their ability to solve the 4-disc version of the Tower of Hanoi in terms of three dependent variables: total number of moves, total moves-to-optimal moves ratio, and completion time. In a 2 X 2 X 2 between subjects factorial design, subjects were assigned to three different conditions with two levels each. Subjects performed either a computerized or physical version of the TOH; verbalized their strategies while doing so or were instructed to remain silent; and were allowed to practice on easier two-disc and three-disc versions or were not given the benefit of doing so. Main effects were found in that subjects completing the physical TOH did so more efficiently than those completing it on the computer. Subjects also benefitted from verbalizing their strategies over remaining silent. Interaction effects were also found for practice and verbalization. (Author abstract)Worth, E., Mercieri, A., and Douglas, A. (2014). The roles of media, language, and practice on solving the Tower of Hanoi problem. Retrieved from http://academicarchive.snhu.ed

Drug-resistant chronic cluster headache successfully treated with supraorbital plus occipital nerve stimulation. A rare case report

Chronic cluster headache (CCH) is a rare and extremely disabling headache syndrome with a recent clinical systematization of its clinical frame from the European Headache Federation [1]. We present a case of a young man affected by drug-resistant chronic CH (rCCH) who showed improvement after a two-time combined supraorbital and occipital nerve stimulation (S-ONS). The clinical improvement was still present at 6-month follow-up

Stewart's approach

bstract Surgery is the only curative treatment for primary hyperparathyroidism (pHPT). Surgical exploration is recommended for all patients with biochemically documented pHPT and signs or symptoms of the disease. Some patients are asymptomatic, others have subtle symptoms that disappear after parathyroid surgery. Felix Mandl successfully performed the first parathyroidectomy in 1925, using a bilateral neck exploration (BNE) with examination of all four glands and this remained the procedure of choice for pHPT into the 1990s. As over 80% of pHPT cases are due to a single parathyroid adenoma, many authors have questioned the need of BNE and have proposed directed unilateral approaches, termed "mini-invasive parathyroidectomies". The aim of this report is to define which is the actual role of the conventional surgical approach to pHPT

Spinal cord stimulation for intractable chronic limb ischemia: a narrative review

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is not possible or fails, spinal cord stimulation (SCS) may be a treatment option. Currently, SCS is primarily prescribed as a symptomatic treatment for painful symptoms. It is used to treat intractable pain arising from various disorders, such as neuropathic pain secondary to persistent spinal pain syndrome (PSPS) and painful diabetic neuropathy. Data regarding the effect of SCS in treating CLI are varied, with the mechanism of action of vasodilatation in the peripheral microcirculatory system not yet fully understood. This review focuses on the surgical technique, new modalities of SCS, the mechanisms of action of SCS in vascular diseases and the parameters for selecting CLI patients, along with the clinical outcomes and complications. SCS is a safe and effective surgical option in selected patients with CLI, where surgical or endovascular revascularization is not feasible

Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind, randomized, active-controlled trial

Abstract Background Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia. Methods Sixty-four patients, undergoing remifentanil infusion during general anaesthesia and major lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25 μg h −1 for 24 h) or morphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and three months postoperatively. Results A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9 min ( P =0.002). At 30 min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine ( P =0.009). At three months, no differences between groups were noted. Conclusions Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up

Emergency awake laparotomy using neuraxial anaesthesia: a case series and literature review

Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using neuraxial anaesthesia as the primary anaesthetic technique in emergency laparotomies. We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Neuraxial anaesthesia was employed as the main anaesthetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoperative pain control, the incidence of postoperative complications, and mortality rates. Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in seven patients (44%). The observed mortality rate was relatively low at 6% (one patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that neuraxial anaesthesia may be a useful alternative in emergency settings. However, the occurrence of postoperative complications in 44% of patients indicates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this technique on patient outcomes in emergency laparotomies

Web search trends on fibromyalgia: development of a machine learning model

Objective Fibromyalgia (FM) is a chronic pain condition characterised by widespread musculoskeletal pain, fatigue, and cognitive dysfunction. The growing reliance on the internet for health-related information has transformed how individuals seek medical knowledge, particularly for complex conditions like FM. This study aimed to analyse online search behaviours related to FM across multiple countries, identify temporal trends, and assess machine learning models for predicting search interest. Methods Google Trends data (2020–2024) were analysed across sixteen countries. Time-series analysis, linear regression, and the Mann-Kendall trend test assessed monotonic trends, while seasonal decomposition identified periodic fluctuations. An Auto-Regressive Integrated Moving Average (ARIMA) model forecasted search volumes for 2025. Machine learning models, including Random Forest (RF) and Extreme Gradient Boosting (XGBoost), were used to predict search trends, with feature importance evaluated using SHAP (Shapley Additive Explanations) values. Results Search interest in FM varied across countries, with China, the UK, the USA and Canada showing the highest engagement, while Peru, Spain and Turkey had the lowest. Brazil, Italy and the UK exhibited rising search trends, whereas Argentina, Canada, Greece and the USA showed declines. Seasonal analysis revealed mid-year peaks in Brazil and Italy, while Turkey saw late autumn increases. ARIMA forecasting predicted stable or increasing trends in Brazil, Canada and Mexico, while Germany and Venezuela showed slight declines. Machine learning analysis identified short-term search history (search volumes from the previous day, week, and month) as the most influential predictor. Conclusion Understanding online search behaviour can enhance FM education. Targeted awareness campaigns and improved digital health literacy initiatives could sustain engagement and improve patient knowledge. Future efforts should focus on optimising online health resources and integrating evidence-based decision aids

Manuale illustrato di Gastroenterologia - Epatologia

In questo volume della collana presentiamo le malattie dell'apparato digerente, fegato, pancreas e vie biliari. Nella prima parte tratterremo le malattie digestive, nella seconda le malattie del fegato e nella terza parte le malattie del pancreas e delle vie biliari. Come è nostra abitudine l'esposizione degli argomenti si fonda su solide basi anatomiche e fisiologiche in modo che le malattie possano poi essere studiate con il necessario bagaglio fisiopatologico da cui deriva il razionale diagnostico e terapeutico