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Introduction: The correlation between cervical alignment and clinical outcome of total disc replacement (TDR) surgery is arguable. We believe that this conflict exists because the parameters that influence the biomechanics of the cervical spine are not well understood, specifically the effect of TDR on different cervical alignments. Methods: A validated osseo-ligamentous model from C2-C7 was used in this study. The C2-C7 Cobb angle of the base model was modified to represent: lordotic (−10°), straight (0°), and kyphotic (+10°) cervical alignment. The TDR surgery was simulated at the C5-C6 segment. The range of motion (ROM), intradiscal pressure, annular stresses, and facet loads were computed for all the models. Results: The ROM results demonstrated kyphotic alignment after TDR surgery to be the most mobile when compared to intact base model (41% higher in flexion-extension, 51% higher in lateral bending, and 27% higher in axial rotation) followed by straight and lordotic alignment, respectively. The annular stresses for the kyphotic alignment when compared to intact base model were higher at the index level (33% higher in flexion-extension and 48% higher in lateral bending) compared to other alignments. The lordotic model demonstrated higher facet contact forces at the index level (75% higher in extension than kyphotic alignment, 51% higher in lateral bending than kyphotic alignment, and 78% higher in axial rotation than kyphotic alignment) when compared among the three alignment models. Conclusion: Preoperative cervical alignment should be an integral part of surgical planning for TDR surgery as different cervical alignments may significantly alter the postsurgical outcomes.

Cervical laminoplasty is a useful for treatment for cervical myelopathy. However, this procedure has limitations for kyphotic cervical alignments. We used the finite element (FE) analysis and investigated the biomechanical changes in intact and laminoplasty models with lordosis, straight, and kyphosis cervical alignments. A three-dimensional FE model of the cervical spine (C2–C7) with ligaments was created from computer tomography. The model was modified with the following cobb angles (a) intact–lordotic model (intact–L; C2–C7 angle: −10°), (b) intact–straight model (intact–S; C2–C7 angle: 0°), and (c) intact–kyphotic model (intact–K; C2–C7 angle: 10°). The C3–C6 laminoplasty was conducted on the three intact models, represented by the laminoplasty–lordosis model (LM–L), laminoplasty–straight model (LM–S), and laminoplasty–kyphosis model (LM–K), respectively. Pure moment with compressive follower load of 100 N to represent the weight of the head/cranium and cervical muscle stabilization was applied to these models and the range of motion (ROM), annular stress, nucleus stress and facet forces were analyzed. ROM of intact–K and LM–K increased when compared to the other models. The LM–K had the highest mobility with 324% increase in ROM observed under extension, compared to LM–L. In addition, the annular stresses and nucleus stresses in intact–K and LM–K were higher compared to the other models. The maximum increase in annular stresses was about 309% in LM–K compared to the LM–L, observed at the C3–C4 segment. However, the facet contact forces were lower in the intact–K and LM–K, compared to the other models. Cases with cervical kyphosis alignment are at a disadvantage compared to cases with lordosis or straight alignment and should be treated with caution.

Notalgia Paresthetica Successfully Treated with Cervical Epidural Injection and Occipital Nerve Block: A Case Report Fabienne Saint-Preux,1 Justin Mendoza,2 Salvador Portugal1 1Department of Physical Medicine and Rehabilitation, NYU School of Medicine, Manhattan NY, USA; 2Spine Care, Active Orthopedics & Sports Medicine, LLC, Hackensack, NJ, USA Correspondence: Fabienne Saint-Preux Department of Physical Medicine and Rehabilitation, NYU School of Medicine, 240 East 38th Street, 15th floor, Manhattan, NY 10016, USA Tel +1 212 263 6110 Fax +1 212 263 6251 Email fabienne.saint-preux@nyulangone.org Background: Notalgia paresthetica (NP) is a benign relapsing and remitting sensory neuropathic syndrome characterized by localized pruritus usually of the unilateral infrascapular region. Treatment of this associated comorbidity may confer relief and thus increase quality of life. [...]we present a treatment approach with epidural steroid injection (ESI) and adjunctive occipital nerve block. NP is usually localized to the T2–T6 dermatomal distribution and accompanied by localized burning, tenderness, hyperalgesia and dysesthesia resulting in chronic itching and a post-inflammatory hyperpigmented patch that is esthetically distressing.1 The etiology of NP is not fully understood; however, it is widely accepted that the sensory neuropathy is caused by musculoskeletal compression of the cutaneous branches of the dorsal primary rami of thoracic spinal nerves T2–T6.1,2 While NP is associated with symptoms in the T2–T6 dermatomes, it has been associated with cervical spinal disease usually at the C4–C6 level even though the spinal pathology seen on imaging does not correlate with the dermatomal distribution of symptoms.2–6 Current first-line therapies include topical treatments such as lidocaine and capsaicin, conservative management with physical therapy, manual manipulation and/or transcutaneous electrical nerve stimulations (TENS) and medications such as gabapentin with varying and/or temporary success. Topical treatments include capsaicin7,8 tacrolimus9 and anesthetic creams.10 Intralesional treatments include botulinum toxin A,11–13 corticosteroids (triamcinolone)14 and cryolipolysis.15 Oral medications include oxcarbazepine,16 gabapentin17,18 and amitriptyline.19 Other therapies documented include TENS,20 EMS,21 Narrow band UV-B,22 osteopathic manipulation,23 acupuncture,24 exercise25 and physiotherapy.3 Paravertebral nerve blocks,26 intravenous lidocaine infusions27 and surgical decompression28 have also been described.

Search Engine Optimization (SEO) has been a preferred and accessible way of marketing products and services by businesses primarily due to the pandemic's limitations. E-commerce platforms like Zalora's marketing approach heavily rely on search engine optimization and the quality of service it offers [Yousef, 2021]. However, web traffic and customer click-through rates do not necessarily result in purchase intention. This study aimed to assess customers' pre-purchasing intent by measuring the search engine optimization (SEO) engagement rate parameters of Zalora and identifying the factors that encourage customer purchase intention. Thus, the quantitative analysis allowed the measurement of customer engagement and purchase intention. The researchers examined the influence of SEO through Stratified Random Sampling and distributed online and printed survey questionnaires to three hundred seventy-five (375) online shoppers within Region III (Central Luzon), specifically Bulacan, Pampanga, and Tarlac. The findings stated that the factors of Quality Content, Website Interface, and Ranking Algorithm have a p-value of less than 0.05 with a probability of 0.0000, significantly influencing online shoppers' purchase intention. Aside from needs and wants, factors such as promos, visible prices, and ecstatic promotional statements within the URL link entice customers to view and purchase from the search results upon browsing the web. Thus, it provides vital information businesses could utilize to select keywords to include in their clickable search results.

Pharmaceuticals in the water are being blamed for severe reproductive problems in many types of fish: The endangered razorback sucker and male fathead minnow have been found with lower sperm counts and damaged sperm; some walleyes and male carp have become what are called feminized fish, producing egg yolk proteins typically made only by females. \"We have no reason to think that this is a unique situation,\" says Erik Orsak, an environmental contaminants specialist with the U.S. Fish and Wildlife Service, pulling off rubber gloves splattered with fish blood at Lake Mead. \"We find pretty much anywhere we look, these compounds are ubiquitous.\" Boxer, D-Calif., said she was \"alarmed at the news\" that pharmaceuticals are turning up in the nation's drinking water, while [Frank Lautenberg], a New Jersey Democrat who said he was \"deeply concerned\" by the AP findings, both represent states where pharmaceuticals had been detected in drinking water supplies, but not disclosed to the public.

Maternal care, including by non-biological parents, is important for offspring survival 1 – 8 . Oxytocin 1 , 2 , 9 – 15 , which is released by the hypothalamic paraventricular nucleus (PVN), is a critical maternal hormone. In mice, oxytocin enables neuroplasticity in the auditory cortex for maternal recognition of pup distress 15 . However, it is unclear how initial parental experience promotes hypothalamic signalling and cortical plasticity for reliable maternal care. Here we continuously monitored the behaviour of female virgin mice co-housed with an experienced mother and litter. This documentary approach was synchronized with neural recordings from the virgin PVN, including oxytocin neurons. These cells were activated as virgins were enlisted in maternal care by experienced mothers, who shepherded virgins into the nest and demonstrated pup retrieval. Virgins visually observed maternal retrieval, which activated PVN oxytocin neurons and promoted alloparenting. Thus rodents can acquire maternal behaviour by social transmission, providing a mechanism for adapting the brains of adult caregivers to infant needs via endogenous oxytocin. Behavioural studies and neural recordings in mice show that virgin mice can acquire maternal behaviour through an oxytocin-dependent mechanism.