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In order to assess how effective information systems are, end-user computing satisfaction (EUCS) is essential. This study evaluates EUCS among 354 employees of the Iraqi Kurdistan Region's (KRI) Ministry of Higher Education and Scientific Research. Through factor analysis, the findings indicate 16-item instrument measuring five core components: content, accuracy, format, ease of use, and timeliness. The results show important patterns and connections, emphasizing how important it is to improve these parts in order to increase user satisfaction. Accuracy had the highest impact on user satisfaction (Standardized Beta = 0.347, p < 0.001), and timeliness were particularly important, while format and ease of use had a direct impact on usability. This study gives useful information for improving IT infrastructure and user support. This will help the Ministry create a better, more efficient, and easier-to-use computer environment that meets the needs and expectations of the workforce. In the end, this will lead to higher productivity and user satisfaction.

Natsuki Sugimura,1,2 Koji Aso,1 Hiroyuki Wada,1 Masashi Izumi,1 Masahiko Ikeuchi1 1Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan; 2Department of Orthopedic Surgery, Hata Prefectural Hospital, Sukumo, Kochi, 788-0785, JapanCorrespondence: Natsuki Sugimura, Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku, Kochi, 783-8505, Japan, Tel +81-88-880-2386, Fax +81-88-880-2388, Email sugimura.n@kochi-u.ac.jpPurpose: Some patients experience chronic postsurgical pain (CPSP) after total knee arthroplasty (TKA) despite the absence of clinical or radiographic abnormalities. Postoperative synovitis as a cause of CPSP after TKA has received limited research attention. This study aimed to investigate the relationship between synovitis after TKA and CPSP.Patients and Methods: A total of 111 knees of 85 patients, with at least 1-year post-TKA follow-up, were assessed retrospectively and cross-sectionally. Power Doppler (PD) ultrasonography was used to detect the synovial hypervascularity associated with synovitis. The knee joint was divided into 15 areas, and PD signals were graded semi-quantitatively (0– 3) in each area, the sum of which was defined as the total PD score. Clinical information regarding CPSP, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscales, was recorded. The relationship between pain and PD ultrasonography findings was accessed. Patients were divided into two groups (CPSP+ and CPSP− groups) based on pain severity. Clinical information, including PD ultrasonography findings and other possible causes, was compared between the groups.Results: The WOMAC pain subscale was significantly correlated with the total PD score and maximum PD grade (r=0.3977, p< 0.0001; r=0.2797, p=0.0029; respectively). The CPSP+ group had a significantly higher maximum PD grade and total PD score than the CPSP− group (median [interquartile range]: 2 [1, 2] vs 1 [1, 2], p=0.0001; 6 [2, 11] vs 2 [1, 4], p=0.0002; respectively). Multiple and logistic regression analyses showed that the total PD score was an independent factor for the WOMAC pain subscale (β=0.3822, 95% confidence interval [CI]=0.1460, 0.6184, p=0.00176) and CPSP (odds ratio=1.19, 95% CI=1.01, 1.41, p=0.0424).Conclusion: This study indicated a possible association between the total PD score and chronic pain after TKA; however, further studies are needed to corroborate these findings.Keywords: chronic postsurgical pain, synovitis, ultrasonography

Naoki Aoyama, Masashi Izumi, Toru Morimoto, Hiroyuki Wada, Junpei Dan, Yusuke Kasai, Yoshinori Satake, Koji Aso, Masahiko Ikeuchi Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, JapanCorrespondence: Masashi Izumi, Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku, 783-8505, Japan, Tel +81-88-880-2386, Fax +81-88-880-2388, Email izumim@kochi-u.ac.jpPurpose: The mechanisms underlying chronic postsurgical pain after joint replacement (JR) are complex, and it has been suggested that chronic postsurgical pain can develop as a result of inadequate acute pain management. Few studies have addressed acute pain after JR using specific animal models. This study aimed to develop a novel JR model focused on postsurgical pain assessment and the time course of pain recovery.Materials and Methods: Rats were allocated to the following three groups: sham (joint exposure), joint destruction (JD; resection of the femoral head), and JR (femoral head replacement using an originally developed implant). The time course of postsurgical pain behavior was measured using a dynamic weight-bearing apparatus, along with radiological assessments. The expression of calcitonin gene-related peptide-immunoreactive (CGRP-IR) neurons in the dorsal root ganglion (DRG) was evaluated by immunohistochemistry on days 28 and 42.Results: The ratio of weight-bearing distribution in the JR group gradually recovered from day 14 and reached the same level as that in the sham group on day 42, which was significantly greater than that in the JD group after day 7 (p< 0.05). Radiologically, no significant issues were found, except for transient central migration of the implant in the JR group. The percentage of CGRP-IR DRG neurons in the JR group was significantly lower than that in the JD group on day 28 (mean, 37.4 vs 58.1%, p< 0.05) and day 42 (mean, 32.3 vs 50.0%, p< 0.05).Conclusion: Our novel JR model presented acute postsurgical pain behavior that was successfully recovered to the baseline level at day 42 after surgery. Difference of the pain manifestation between the JR and JD groups could be supported by the expression of CGRP-IR in DRG neurons. This model is the first step toward understanding detailed mechanisms of post-JR pain.Keywords: joint replacement, postsurgical pain, dynamic weight bearing, CGRP

Yusuke Kasai, Koji Aso, Masashi Izumi, Hiroyuki Wada, Junpei Dan, Yoshinori Satake, Toru Morimoto, Masahiko Ikeuchi Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, 783-8505, JapanCorrespondence: Koji AsoDepartment of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku, 783-8505, JapanTel +81-88-880-2386Fax +81-88-880-2388Email koji.aso@gmail.comPurpose: Nonunion bone fracture can be a cause of persistent pain, but the pathophysiology remains largely unknown. The objective of this study was to identify how nonunion affect persistent pain after fracture. Specifically, we evaluated the association of neuropeptide change in dorsal root ganglia (DRG) and nerve proliferation at fracture sites with pain.Methods: Rat union and nonunion fracture models were created. A piece of latex glove was placed at the fracture site to create a nonunion model. At 6 weeks after surgery, bone healing was assessed using radiography. In addition, the presence of calcitonin gene-related peptide-immunoreactive (CGRP-IR) DRG at the level of L3 and anti-growth associated protein 43-immunoreactive (GAP43-IR) nerve fibers in the scar tissue between the bone fragments were evaluated. Pain-related behavior was assessed using forced treadmill running.Results: In radiological images at 6 weeks after surgery, callus formation was formed continuously between bone fragments in the union models. On the one hand, a clear gap was detected between fragments in nonunion models. The percentage of CGRP-IR DRG cells and the density of GAP43-IR nerve fibers in the scar tissue between the bone fragments in nonunion models was significantly higher than that in union models (p < 0.05). An increase in inflammatory cell infiltrate was observed in scar tissues in the nonunion models. During forced treadmill running, rats in the union model could run significantly longer than those in the nonunion models.Conclusion: Increased CGRP expression in DRG cells and abnormal nerve proliferation secondary to prolonged inflammation could lead to persistent pain after bone fracture. In clinical practice, early achievement of bone union may minimize the development of persistent pain after fractures.Keywords: fracture pain, nerve proliferation, nonunion of fractures

Yoshinori Satake,1 Masashi Izumi,1 Koji Aso,1 Yoichi Igarashi,2 Nao Sasaki,3 Masahiko Ikeuchi1 1Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan; 2Department of Orthopaedic Surgery, Tosa Municipal Hospital, Kochi, Japan; 3Medicines Development Unit Japan, Eli Lilly Japan K.K., Hyogo, JapanCorrespondence: Yoshinori SatakeDepartment of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi 783-8505, JapanTel +81 88 880 2387Fax +81 88 880 2388Email y-satake@kochi-u.ac.jpPurpose: Patients with knee osteoarthritis (OA) complain of various types of pain, divided into two main categories: pain on movement and pain at rest. A thorough understanding of pain is essential for managing knee OA; however, few studies have investigated the mechanisms underlying the two different types of pain. This study aimed to clarify the predisposing factors for pain in patients with knee OA with a focus on differences between pain on walking and pain at rest.Patients and Methods: This study involved 93 patients, aged 44– 90 years, with knee OA, including 74 women. We assessed demographic variables (sex, age, body mass index [BMI], side), visual analogue scale (VAS) score on walking, VAS score at rest, Kellgren and Lawrence (KL) grade on radiograph, synovitis score and bone marrow lesion (BML) score on magnetic resonance imaging, and pressure pain threshold (PPT), and used univariate and multiple regression analyses to investigate factors predisposing patients to pain at rest or pain on walking.Results: In the univariate analyses, we found significant correlations between VAS score on walking and BMI (r=0.31, p< 0.01), KL grade (r=0.40, p< 0.01), synovitis score (r=0.26, p=0.01), and BML score (r=0.36, p< 0.01), whereas VAS score at rest correlated with PPT (r=− 0.23, p=0.02) and BMI (r= 0.26, p=0.01). Multiple regression analysis showed that significant explanatory factors for VAS score on walking were BMI (β=0.22, p=0.03) and KL grade (β=0.27, p=0.03). By contrast, PPT was the only significant explanatory factor for VAS score at rest (β=− 0.27, p=0.01).Conclusion: Predisposing factors were significantly different between pain on walking and pain at rest, indicating that different pain mechanisms exist in the two types of pain. Pain on walking was more strongly associated with mechanical and structural factors, while pain at rest was associated with mechanical hyperalgesia of the knee.Clinical Registration: University Hospital Medical Information Network Clinical Trials Registration number; 000041190.Keywords: knee osteoarthritis, pain at rest, hyperalgesia

Shota Oda,1 Masashi Izumi,1,2 Shogo Takaya,1,2 Nobuaki Tadokoro,2 Koji Aso,2 Kristian Kjær Petersen,3 Masahiko Ikeuchi1,2 1Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan; 2Department of Orthopedic Surgery, Kochi University, Nankoku, Kochi, Japan; 3Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, DenmarkCorrespondence: Masashi IzumiDepartment of Orthopedic Surgery, Kochi University, Oko-Cho Kohasu, Nankoku, Kochi, Japan, 783-8505 Tel +81-88-880-2386Fax +81-88-880-2388Email izumim@kochi-u.ac.jpPurpose: Clinically, arthrogenic muscle inhibition (AMI) has a negative impact on functional recovery in musculoskeletal disorders. One possible technique to relieve AMI is motor imagery, which is widely used in neurological rehabilitation to enhance motor neuron excitability. The purpose of this study was to verify the efficacy of visually-assisted motor imagery against AMI using a human experimental pain model.Methods: Ten healthy volunteers were included. Experimental ankle pain was induced by hypertonic saline infusion into unilateral Kager’s fat pad. Isotonic saline was used as control. Subjects were instructed to imagine while watching a movie in which repetitive motion of their own ankle or fingers was shown. H-reflex normalized by the motor response (H/M ratio) on soleus muscle, maximal voluntary contraction (MVC) force of ankle flexion, and contractile activities of the calf muscles during MVC were recorded at baseline, pre-intervention, post-intervention, and 10 minutes after the pain had subsided.Results: Hypertonic saline produced continuous and constant peri-ankle pain (VAS peak [median]= 6.7 [2.1– 8.4] cm) compared to isotonic saline (0 [0– 0.8] cm). In response to pain, there were significant decreases in the H/M ratio, MVC and contractile activities (P< 0.01), all of which were successfully reversed after the ankle motion imagery. In contrast, no significant changes were observed with the finger motion imagery.Conclusion: Visually-assisted motor imagery improved the pain-induced AMI. Motor imagery of the painful joint itself would efficiently work for relieving AMI. This investigation possibly shows the potential of a novel and versatile approach against AMI for patients with musculoskeletal pain.Keywords: arthrogenic muscle inhibition, experimental ankle pain model, visually-assisted motor imagery

In this study, we address the pressing need to improve e-government services by conducting a comprehensive evaluation of document management practices within the Ministry of Higher Education in the Kurdistan Region of Iraq. Employing structural equation modeling and regression modeling techniques, we assess the effectiveness of key variables using the six factors (digitalization, utility, reliability, efficiency, user satisfaction, and accessibility) under the e-government assessment model. Our findings reveal that user satisfaction and ease of access are pivotal for the success of e-government services, with digitization and efficiency significantly impacting operational effectiveness. Furthermore, it also concerns that without improving the overall user satisfaction, the level of acceptance and use of e-government remains low. High user satisfaction can make a lot of difference in overall engagement besides improving service delivery among organizations. Through insights specific to the Kurdistan Region, we underscore the importance of balancing technical infrastructure with user experience. Our proposed six-factor model offers valuable guidance for policymakers and practitioners globally, aiming to enhance e-government services.

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