Exposure Area Research Articles

Retrosigmoid versus Retrolabyrinthine Posterior Petrosal Route to the Petroclival Area: Quantitative Assessment of Endoscope-Assisted Approaches and Correlations with Morphometric Features

Using a cadaveric model, we compared endoscope-assisted retrosigmoid (EAR) and endoscope-assisted retrolabyrinthine posterior petrosal (EARPP) approaches towards the petroclival area, regarding surgical exposure and instrument maneuverability, also verifying how some petroclival morphometric parameters correlate with these variables. In five cadaver heads, EAR approach was performed on one side and EARPP on the other (10 approaches). Under endoscopic view, neuronavigation coordinates were acquired to compute areas of exposure (petroclival and pontomedullary) and maneuverability at Dorello's canal entrance to run the comparison. Correlations of these variables with petroclival angle and clival depth were also analyzed. EAR and EARPP showed equivalence regarding surgical exposure (petroclival: 365.85 ± 133.12 mm2 and 320.62 ± 103.44 mm2, respectively, P= 0.69; pontomedullary: 255.83 ± 88.26 mm2 and 229.80 ± 74.39 mm2, respectively, P= 0.83), but EAR afforded greater maneuverability at Dorello's canal (1155.88 ± 134.35 mm2, P= 0.03). The petroclival angle and clival depth showed different strong correlations with maneuverability depending upon the route, but not with surgical exposure in both approaches. Endoscopic techniques can spare the need for additional steps of greater morbidity when approaching the petroclival area in both routes. A simpler and faster approach as EAR was favored over EARPP in this standardized quantitative assessment. The petroclival angle and clival depth may interfere with maneuverability, but not with surgical exposure in both endoscope-assisted approaches.

The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities

This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC.

The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation.

The petroclival region represents the "Achille's heel" for the neurosurgeons. Many ventral endoscopic routes to this region, mainly performed as isolated, have been described. The aim of the present study is to verify the feasibility of a modular, combined, multiportal approach to the petroclival region to overcome the limits of a single approach, in terms of exposure and working areas, brain retraction and manipulation of neurovascular structures. Four cadaver heads (8 sides) underwent endoscopic endonasal transclival, transorbital superior eyelid and contralateral sublabial transmaxillary-Caldwell-Luc approaches, to the petroclival region. CT scans were obtained before and after each approach to rigorously separate the contribution of each osteotomy and subsequentially to build a comprehensive 3D model of the progressively enlarged working area after each step. The addition of the contralateral transmaxillary and transorbital corridors to the extended endoscopic endonasal transclival in a combined multiportal approach provides complementary paramedian trajectories to overcome the natural barrier represented by the parasellar and paraclival segments of the internal carotid artery, resulting in significantly greater area of exposure than a pure endonasal midline route (8,77 cm2 and 11,14 cm2 vs 4,68 cm2 and 5,83cm2, extradural and intradural, respectively). The use of different endoscopic "head-on" trajectories can be combined in a wider multiportal extended approach to improve the ventral route to the most inaccessible petroclival regions. Finally, by combining these approaches and reiterating the importance of multiportal strategy, we quantitatively demonstrate the possibility to reach "far away" paramedian petroclival targets while preserving the neurovascular structures.

Medial Elbow Exposure: Modified Taylor-Scham Versus Flexor Carpi Ulnaris-Split.

To compare the exposure of the coronoid process, anteromedial facet, and anterior band of the medial collateral ligament using the flexor carpi ulnaris (FCU)-splitting approach with the Taylor-Scham approach modified with an ulnar nerve transposition. Thirty approaches were performed on 15 fresh cadavers using a randomized cross-over design and standardized incision. Access to key anatomic landmarks was assessed, and a calibrated digital image was taken from the surgeon's best perspective of each approach. Images were analyzed using ImageJ (National Institutes of Health) software to calculate the area of osseous exposure. All key anatomic landmarks were visualized using both approaches. The average area of exposure for the Taylor-Scham was 19.5 cm 2 compared with 13.6 cm 2 for the FCU-splitting ( P < 0.0001). The distal extent of the FCU-splitting approach is limited by the ulnar nerve and its branches to the humeral head of the FCU. The Taylor-Scham approach provides a more extensile exposure of the anteromedial coronoid and proximal ulna than the FCU-splitting approach while avoiding cross-tensioning of the ulnar nerve.

Two routes of administration of mitomycin C in a trabeculectomy.

The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates. https://youtu.be/RLEbK4IeRtU.

Growth cone advance requires EB1 as revealed by genomic replacement with a light-sensitive variant.

A challenge in analyzing dynamic intracellular cell biological processes is the dearth of methodologies that are sufficiently fast and specific to perturb intracellular protein activities. We previously developed a light-sensitive variant of the microtubule plus end-tracking protein EB1 by inserting a blue light-controlled protein dimerization module between functional domains. Here, we describe an advanced method to replace endogenous EB1 with this light-sensitive variant in a single genome editing step, thereby enabling this approach in human induced pluripotent stem cells (hiPSCs) and hiPSC-derived neurons. We demonstrate that acute and local optogenetic EB1 inactivation in developing cortical neurons induces microtubule depolymerization in the growth cone periphery and subsequent neurite retraction. In addition, advancing growth cones are repelled from areas of blue light exposure. These phenotypes were independent of the neuronal EB1 homolog EB3, revealing a direct dynamic role of EB1-mediated microtubule plus end interactions in neuron morphogenesis and neurite guidance.

Influence of reed beds (Phragmites australis) and submerged vegetation on pike (Esox lucius)

Eutrophication and reduced grazing have led to an expansion of the common reed (Phragmites australis) in archipelago areas in the Baltic Sea, while at the same time the composition of submerged vegetation has changed. Although reed is important as nursery habitat for many fish species, extensive emergent vegetation may reduce biodiversity and abundance of predatory fish. Pike (Esox lucius) is a predatory fish whose larvae and young-of-the-year find both food and shelter in reed but use different micro-habitats during different life-stages. Here we investigate the influence of reed and submerged vegetation on abundance and body size of adult pike during the spawning season. We predicted that coastal bays with extensive but heterogeneous reed beds with higher cover of submerged vegetation would have more and larger pike than bays with smaller, homogenous reed belts or with less submerged vegetation. To test these predictions, we estimated abundance and size-structure of adult pike from catches in angling fishing among 22 bays in the Stockholm archipelago at the Swedish Baltic Sea coast. Our analyses show that catches of adult pike were positively associated with both extensive reed beds and cover of rooted submerged vegetation. However, pike size was not correlated with any vegetation variable, but instead increased with wave exposure and bay area. Our study suggests that reed beds and submerged vegetation are important for adult pike during the spawning season, and even the most extensive reed beds had no evident negative effect on pike populations. We could not see any clear relationship between emergent reed habitat and cover of submerged vegetation among the studied bays, and conclude that to maintain pike population during the spawning season it is important that coastal bays have sufficient amounts of both reed beds and rooted submerged vegetation.

Development of a Computer System for Automatically Generating a Laser Photocoagulation Plan to Improve the Retinal Coagulation Quality in the Treatment of Diabetic Retinopathy

In this article, the development of a computer system for high-tech medical uses in ophthalmology is proposed. An overview of the main methods and algorithms that formed the basis of the coagulation plan planning system is presented. The system provides the formation of a more effective plan for laser coagulation in comparison with the use of existing coagulation techniques. An analysis of monopulse- and pattern-based laser coagulation techniques in the treatment of diabetic retinopathy has shown that modern treatment methods do not provide the required efficacy of medical laser coagulation procedures, as the laser energy is nonuniformly distributed across the pigment epithelium and may exert an excessive effect on parts of the retina and anatomical elements. The analysis has shown that the efficacy of retinal laser coagulation for the treatment of diabetic retinopathy is determined by the relative position of coagulates and parameters of laser exposure. In the course of the development of the computer system proposed herein, main stages of processing diagnostic data were identified. They are as follows: the allocation of the laser exposure zone, the evaluation of laser pulse parameters that would be safe for the fundus, mapping a coagulation plan in the laser exposure zone, followed by the analysis of the generated plan for predicting the therapeutic effect. In the course of the study, it was found that the developed algorithms for placing coagulates in the area of laser exposure provide a more uniform distribution of laser energy across the pigment epithelium when compared to monopulse- and pattern-based laser coagulation techniques.

Determinants of exposure to Aedes mosquitoes: A comprehensive geospatial analysis in peri-urban Cambodia

Aedes mosquitoes are some of the most important and globally expansive vectors of disease. Public health efforts are largely focused on prevention of human-vector contact. A range of entomological indices are used to measure risk of disease, though with conflicting results (i.e. larval or adult abundance does not always predict risk of disease). There is a growing interest in the development and use of biomarkers for exposure to mosquito saliva, including for Aedes spp, as a proxy for disease risk. In this study, we conduct a comprehensive geostatistical analysis of exposure to Aedes mosquito bites among a pediatric cohort in a peri‑urban setting endemic to dengue, Zika, and chikungunya viruses. We use demographic, household, and environmental variables (the flooding index (NFI), land type, and proximity to a river) in a Bayesian geostatistical model to predict areas of exposure to Aedes aegypti bites. We found that hotspots of exposure to Ae. aegypti salivary gland extract (SGE) were relatively small (< 500 m and sometimes < 250 m) and stable across the two-year study period. Age was negatively associated with antibody responses to Ae. aegypti SGE. Those living in agricultural settings had lower antibody responses than those living in urban settings, whereas those living near recent surface water accumulation were more likely to have higher antibody responses. Finally, we incorporated measures of larval and adult density in our geostatistical models and found that they did not show associations with antibody responses to Ae. aegypti SGE after controlling for other covariates in the model. Our results indicate that targeted house- or neighborhood-focused interventions may be appropriate for vector control in this setting. Further, demographic and environmental factors more capably predicted exposure to Ae. aegypti mosquitoes than commonly used entomological indices.

Measure and spatial identification of social vulnerability, exposure and risk to natural hazards in Japan using open data

Understanding the location of risk to natural hazards, namely the areas of high exposure and vulnerability is a major priority that was identified by the Sendai framework for Disaster Reduction 2015–2030 in order to reach substantial reduction of disaster risk. It is also a necessary decision-making tool for disaster mitigation policy-makers in Japan and around the world. This paper successfully develops a simple methodology using only open data to build the first large-scale (whole country), fine resolution (sub-municipal level) social vulnerability analysis in the context of five different types of natural hazards (earthquake, tsunami, storm surge, flooding and landslide). The result is then compared to an indicator of exposure of population to these hazards in Japan in order to propose a representation of disaster risk. Results show that vulnerability in Japan is highly heterogeneous with urban/rural and north/south fractures. Combining the social vulnerability index with exposure analysis, results show a wide variety of spatial patterns of risk areas in Japan.

Quantification of human polyomaviruses MCPyV and HPyV6 in malignant and non-malignant skin lesions

BackgroundHuman Polyomaviruses such as MCPyV and HPyV6 are frequently found as part of healthy skin microbiota and have been associated with Merkel cell carcinoma (MCC), pruritic and dyskeratotic dermatoses, respectively. Their presence in other types of skin conditions varies greatly depending on lesion type and population. ObjectiveTo analyse comparatively the presence of MCPyV and HPyV6 in nonmelanoma skin cancers and healthy skin. MethodsThe authors utilized qPCR techniques to quantify these pathogens in NMSC, premalignant diseases, and healthy skin of 87 patients. ResultsMCPyV was detected in over 40% of samples, while HPyV6 was in 9.6%. MCPyV load was higher in squamous cell carcinomas (SCC) compared to basal cell carcinomas (BCC) (p=0.016) and HPyV6 showed a higher percentage of infected cells in areas of low solar exposure as well as normal skin (p=0.012). A fair agreement (kappa=0.301) was found between MCPyV detection in lesions and their respective perilesional skin, indicating a random process of local dissemination of the virus. Study limitationsThe lack of a larger sampling of different lesion types and protein expression analyses limits the correlation findings. ConclusionThis is the first report of HPyV6 detection in the healthy skin of a Brazilian population, but the role of both polyomaviruses in NMSC has yet to be demonstrated.

Multi-exposure electric power monitoring image fusion method without ghosting based on exposure fusion framework and color dissimilarity feature.

To solve the ghosting artifacts problem in dynamic scene multi-scale exposure fusion, an improved multi-exposure fusion method has been proposed without ghosting based on the exposure fusion framework and the color dissimilarity feature of this study. This fusion method can be further applied to power system monitoring and unmanned aerial vehicle monitoring. In this study, first, an improved exposure fusion framework based on the camera response model was applied to preprocess the input image sequence. Second, the initial weight map was estimated by multiplying four weight items. In removing the ghosting weight term, an improved color dissimilarity feature was used to detect the object motion features in dynamic scenes. Finally, the improved pyramid model as adopted to retain detailed information about the poor exposure areas. Experimental results indicated that the proposed method improves the performance of images in terms of sharpness, detail processing, and ghosting artifacts removal and is superior to the five existing multi-exposure image fusion (MEF) methods in quality evaluation.

Exposure region of the Kawase approach and its correlation with skull base anatomy: An evaluation with digital models.

The Kawase approach is one of the most used trajectories in skull base surgery. The exposure range of the approach and its correlation with skull base anatomy still demand more exploration. With the help of digital rebuilding, analysis, and measurement, we evaluated the exposure range of the Kawase and extended Kawase approaches and analyzed the correlation between the exposure range and the variants of the petrosal and clival anatomy. The finding of the study demonstrated that compared to the sub-temporal approach, the Kawase approach and the extended Kawase approach significantly added the exposure range in the upper, middle, and partial inferior regions of the clivus. The gains in the exposure volume and area are more when the manipulation angle is less than 135°.

Evaluating future climate change exposure of marine habitat in the South East Pacific based on metabolic constraints

IntroductionOn-going climate change is now recognized to yield physiological stresses on marine species, with potentially detrimental effects on ecosystems. Here, we evaluate the prospect of using climate velocities (CV) of the metabolic index (Φ) for assessing changes in habitat in the South East Pacific.MethodsOur approach is based on a species with mean ecophysiotype (i.e. model species) and the use of a global Earth System Model simulation (CESM-LE) under RCP 8.5 scenario. The SEP is chosen as a case study as it hosts an Oxygen Minimum Zone and seamounts systems sustaining local communities through artisanal fisheries.Results and DiscussionOur results indicate that CVΦ pattern is mainly constrained by the oxygen distribution and that its sign is affected by contrasting oxygen trends (including a re-oxygenation in the upper OMZ) and warming. We further show that CVΦ is weakly dependent on physiological traits composing Φ, which conveys to this metrics some value for inferring the projected mean displacement and potential changes in viability of metabolic habitat in a region where physiological data are scarce. Based on sensitivity experiments to physiological traits and natural variability, we propose a general method for inferring broad areas of climate change exposure regardless of species-specific Φ. We show in particular that for the model used here, the upper OMZ region can be considered a “safe” area for the species with ecophysiotype close to that of 71 species used to derive the model species. Limitations of the approach and perspectives of this work are also discussed.

Effect of Microwave Pretreatment on the Leaching and Enrichment Effect of Copper in Waste Printed Circuit Boards.

The use of efficient and clean methods for the recycling of waste circuit boards is an ongoing challenge. In this research, the effect of microwave pretreatment on the leaching and enrichment of copper from waste print circuit board (WPCB) was studied. The morphology and chemical structure of WPCB particles before and after microwave pretreatment were analyzed by SEM/EDS and Fourier infrared spectroscopy. Leaching experiments and copper enrichment tests were designed to investigate the effect of different microwave irradiation powers and microwave irradiation times on the copper leaching rate and copper enrichment rate in WPCB. The leaching experiment results showed that microwave pretreatment can effectively improve the leaching rate of WPCB. When the microwave irradiation power was 700 W, the irradiation time was 120 s, and the leaching time was 15 min, the copper leaching rate in WPCB was 57.01%, which was 24.34% higher than that in the untreated condition. The results of copper enrichment experiment show that microwave pretreatment can effectively improve the copper enrichment of WPCB. After microwave pretreatment, copper was effectively enriched in the 4-2 and 2-1 mm particle sizes. When the microwave irradiation time was 120 s, the copper enrichment rates in the 4-2 and 2-1 mm particle sizes were 1.74 and 1.66, which increased by 0.63 and 0.32, respectively, compared to the untreated condition. Microwave pretreatment enables the effective separation of metallic copper from non-metallic components in WPCB, increasing the exposure area of copper and promoting the monomer separation of copper, thus improving the leaching and enrichment of copper.

Association between serum periostin levels and the severity of arsenic-induced skin lesions.

Arsenic is a potent environmental toxicant and human carcinogen. Skin lesions are the most common manifestations of chronic exposure to arsenic. Advanced-stage skin lesions, particularly hyperkeratosis have been recognized as precancerous diseases. However, the underlying mechanism of arsenic-induced skin lesions remains unknown. Periostin, a matricellular protein, is implicated in the pathogenesis of many forms of skin lesions. The objective of this study was to examine whether periostin is associated with arsenic-induced skin lesions. A total of 442 individuals from low- (n = 123) and high-arsenic exposure areas (n = 319) in rural Bangladesh were evaluated for the presence of arsenic-induced skin lesions (Yes/No). Participants with skin lesions were further categorized into two groups: early-stage skin lesions (melanosis and keratosis) and advanced-stage skin lesions (hyperkeratosis). Drinking water, hair, and nail arsenic concentrations were considered as the participants' exposure levels. The higher levels of arsenic and serum periostin were significantly associated with skin lesions. Causal mediation analysis revealed the significant effect of arsenic on skin lesions through the mediator, periostin, suggesting that periostin contributes to the development of skin lesions. When skin lesion was used as a three-category outcome (none, early-stage, and advanced-stage skin lesions), higher serum periostin levels were significantly associated with both early-stage and advanced-stage skin lesions. Median (IQR) periostin levels were progressively increased with the increasing severity of skin lesions. Furthermore, there were general trends in increasing serum type 2 cytokines (IL-4, IL-5, IL-13, and eotaxin) and immunoglobulin E (IgE) levels with the progression of the disease. The median (IQR) of IL-4, IL-5, IL-13, eotaxin, and IgE levels were significantly higher in the early-and advanced-stage skin lesions compared to the group of participants without skin lesions. The results of this study suggest that periostin is implicated in the pathogenesis and progression of arsenic-induced skin lesions through the dysregulation of type 2 immune response.

Cutaneous Horn over a Psoriatic Plaque – A Rare Case Report

Cutaneous horns are focal, hyperkeratotic, white-to-yellowish conical skin projections resembling animal horns. They generally present as a solitary, asymptomatic lesion and are most commonly confined to the areas of sun exposure affecting the elderly population. The source of origin of cutaneous horns can be an epidermal inclusion cyst, verruca vulgaris, keratoacanthomas, actinic keratosis, basal cell carcinoma, and squamous cell carcinoma. A rare association with malignant transformation was also reported. There are very few case reports of cutaneous horn arising from a psoriatic plaque and hereby we have reported such a rare occurrence of a cutaneous horn arising from a psoriatic plaque.

Predicting core areas of flatback turtle hatchlings and potential exposure to threats

The lack of data on distribution of juvenile marine species can limit conservation efforts. As hatchlings, marine turtles are too small to track using satellite telemetry, so their at-sea distribution remains unknown. This knowledge gap is critical, as hatchlings already experience high mortality in coastal zones. In addition, further risks to their survival may occur beyond these areas, linked to threats associated with in-water artificial infrastructure and/or attraction to artificial lights and thus increased mortality from higher risk of predation or exhaustion from disorientation. To fill this gap, we used particle tracking forced by an ocean circulation model to predict the dispersal of flatback turtle Natator depressus hatchlings from 12 nesting sites off the coast of Western Australia. We used the model outputs to calculate the distribution of these ‘virtual hatchlings’ and infer the core area of hatchling use over 3 dispersal phases (1-4, 10-15 and 25-30 d). We then calculated the overlap between core areas and 2 anthropogenic threats (in-water artificial infrastructure and light pollution). Core areas were predominately located on the continental shelf during all dispersal phases, supporting the hypothesis that flatback turtles remain in neritic areas. Most (70-80%) of the core area during early dispersal (Days 1-4 and 10-15) contained at least one threat. However, less than half of the area used between Day 25 and 30 was exposed to threats. In the absence of empirical data on hatchling distribution, our results have predicted the core areas used by early life stage flatback turtles to assist in conservation management of these threatened species.

An Exploratory Case Study: Risk Filter Applicability to the Digital Strategy of the Education System in Romania. The Light at the End of the COVID-19 Tunnel

By probing into the Strategy regarding the digitalization of education in Romania updated in 2021 by the Romanian Ministry of Education and Research after the COVID-19 and aligned with the latest European Digital Agenda for 2020-2030 published by the European Commission, we are hoping to offer future researchers a set of propositions to continue the inquiry on possible opportunities derived from emerging risks associated with the digitalization. This exploratory case study aims to identify a positive application of the risk filter that is capable to assess not only the range of risks, but also their systematicity, while planning a governmental digital strategy in a critical system like education. We believe that this topic deservers immediate attention, because of the unique opportunity offered by the COVID-19 pandemic, and because a good implementation plan is one of the strongest predictors of a successful strategy. As researchers, our hope is that by understanding the systematicity of risks which could influence the implementation of digital strategy in the education system in Romania, policies and programs can be developed further based on risk analysis and correct prioritization of operational plans. This research was an exploratory case study in which a digital strategy was analysed, and the characteristics of systemic risks have been mapped to the operational plans. It was concluded that the systematic filters identified for the risks could be used for planning the projects, to identify areas of risk exposure during planning and at various stages during the preparation of projects. The final outcome of the case study is that the identification of systemic risks can help with the management of each project and could lay the foundation to a project database.

Неинвазивная нейромодуляция как метод обезболивания в комплексной терапии хронической боли в нижней части спины

Aim: To describe the Russian and foreign experience in the use of non-invasive neuromodulation for pain management in patients with chronic lower back pain (LBP); to present various neuromodulation techniques and other rehabilitation methods which can be used in combination with neuromodulation in patients with LBP; to describe neuromodulation parameters and programs for an optimal analgesic effect. Key points. LBP is a common (affecting 7.5 % of the world population) and socially significant condition (one of the leading causes of disability worldwide). The efficiency of drug pain management in chronic LBP is approximately 40 %, therefore, non-drug treatment options are required. The neuropathic component of chronic LBP is associated with reorganization in cortex brain structures Hence, neural stimulation is a most promising approach to chronic LBP management, while transcranial direct current electrotherapy stimulation (TEdC) and rhythmic transcranial magnetic stimulation (rTMS) are the most efficient and safest neural stimulation methods. rTMS is an efficient and safe approach to the management both of nociceptive and neuropathic pain, which is a common component of chronic conditions, in particular of LBP. The main area of exposure is motor cortex areas (М1). As compared to TEdC, rTMS is better tolerated by patients and demonstrates better pain management results. Conclusion. Pain syndrome is a significant limitation to rehabilitation in patients with LBP, and drug pain management is inefficient. We suggest that anaesthetic neuromodulation be included into a complex therapy of such patients. The most widely used and efficient neuromodulation techniques are TEdC and rTMS. Keywords: lower back pain, rehabilitation, transcranial magnetic stimulation, neuropathic pain.