Burgas Free University

Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques-both invasive and non-invasive-have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain. We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman-Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I2 statistic and Cochrane's Q test. Twelve RCTs involving 413 patients (mean age 53years; 55% female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD-0.82; 95% CI [-1.13, -0.50]; p<0.00001; I2=53%) and analgesic consumption (SMD-0.91; 95% CI [-1.63, -0.20]; p=0.01; I2=81%) compared to sham. No significant difference was found in functional disability (SMD-0.31; 95% CI [-0.85, 0.24]; p=0.28; I2=44%). The pooled female proportion was 55% (95% CI [42.99, 66.95]; I2=73%), and the prevalence of adverse effects was 12.48% (95% CI [6.13, 20.39]; I2=0%). This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.

Fractional calculus is an important modern tool in modeling related to natural sciences and pure mathematics. In this paper a Python library for non-integer calculus is presented. It is aimed at facilitating calculations in practice. Python Non-Integer order Calculus Toolkit (PyNICT) is a small software bundle that uses symbolic calculations for fractional and distributed fractional order derivatives, numerical methods for ordinary and fractional differential equations, as well as some related mathematical functions such as the Mittag-Leffler. The symbolic approach has an advantage of providing analytical form of calculated derivatives which facilitates understanding.

This paper presents Multiple Intelligences Agent Deep Q-Network (MIADQN) which is a novel MATLAB-based framework for evaluating and enhancing cognitive skills in humans using a deep reinforcement learning. MIADQN integrates Multi-Agent Deep Q-Networks and the Theory of Multiple intelligences, developed by Howard Gardner. In the system each form of intelligence is modeled as an autonomous agent capable of real-time interaction with other agents and a dynamic, adaptive environment. The MIADQN architecture promotes interagent communication and decision-making, focusing on personalized learning experiences and advancing cognitive growth. Applying the MATLAB computational capabilities, the framework integrates deep reinforcement learning methodologies and enables effective management of shared memory across agents. Preliminary test results demonstrate the framework's ability to identify dominant intelligence and dynamically adjust to users' progress. With future development of the system, there is a potential to support people's individualized instruction across diverse educational settings, including online and hybrid learning environments. By emphasizing adaptability and diversity, this paradigm lays a foundation for future innovations in kindergartens, as well as in STEM and distance learning in schools and universities, integrating artificial intelligence techniques with principles from educational psychology to redefine cognitive skill development.

Background and Objectives: Hypertension is found as the leading cardiovascular disease in Bulgaria and the most frequent lifelong condition with a high risk of non-adherence. The aim of this study is to assess the hypertension patients' adherence to medication therapy in Bulgaria by using the self-efficacy for appropriate medication use scale (SEAMS). Materials and Methods: A cross-sectional study was conducted in the major cardiology settings in the capital Sofia and in Burgas, the fourth largest city in Bulgaria. Data were collected from January 2024 to July 2024. The SEAMS was validated in Bulgarian in a sample of patients with hypertension that made it extremely suitable for our study. We applied 19 questions. Additionally, we used Cronbach's α, ANOVA analysis, Pearson correlation, and covariance tests for statistical significance. Results: A total of 232 patients completed the study. Both genders are almost equally distributed (49.6% male and 50.4% female). The results reveal that the increase in the number of diseases and prescribed medicinal products leads to a worsening adherence level. Advancing age negatively affects the adherence scores. The study showed that in half of the age groups studied (patients' age: 40-49, 60-69, and 70-79), adherence in patients treated with FDCs was better or almost the same (patients' age: 50-59) as those treated with several mono-products. Conclusions: Measuring adherence with SEAMS in the hypertensive Bulgarian population in two regions reveals a good level of adherence. Factors negatively affecting adherence were older age, polypharmacy, co-morbidity, and therapy with monoproducts.

Abstract Lactose intolerance affects more than 65% of the world’s population. Main methods for confirming this condition include hydrogen breath test, oral lactose administration and blood glucose measurements, and also biopsy. An association of lactose intolerance with genetic polymorphisms specific to certain regions is found. In Europe, genetic testing of C/ T13910 is being implemented. Incidence data is available for most countries in Europe. At the time of our study, there is no data on the prevalence of lactose intolerance in Bulgaria. In this study, a questionnaire on the prevalence and awareness of lactose intolerance among the Bulgarian population was created. For the first time, the results of a lactose tolerance test and a genetic test of volunteers have been reported and systematized. The lactose test with oral administration of lactose was designed for self-testing and appeared to be a good choice to establish the current condition but was not definite enough. As many as 45% showed inconclusive results, and the patient’s symptoms were the leading point for the diagnosis. The genetic test results showed a huge prevalence of the recessive allele (C13910) associated with lactose intolerance (97%). New horizons are being opened for studies of the Bulgarian population to establish their lactose resistance in the presence of the recessive allele.

Singing is a cornerstone of holistic education. It promotes emotional well-being, creativity and a deep connection with the world. However, the rise of digital distractions and changing musical habits has meant that singing is less and less present in schools, threatening to lose its collaborative and expressive benefits. This article looks at the cultural and educational significance of singing and explores how music educators can creatively integrate it into modern curricula to develop responsible, connected and musically inspired individuals.

Ankylosing Spondylitis (AS) stands as a chronic inflammatory arthritis within the spondyloarthritis spectrum, notably increasing cardiovascular (CV) risk and mortality through accelerated atherosclerosis compared to the non-affected population. While evidence in some studies supports a higher cardiovascular morbidity in AS patients, results from other studies reveal no significant disparities in atherosclerotic markers between AS individuals and healthy controls. This discrepancy may arise from the complex interaction between traditional CV risk factors and AS inflammatory burden. Endothelial dysfunction, a recognized antecedent of atherosclerosis prevalent among most individuals with AS, demonstrates the synergistic impact of inflammation and conventional risk factors on endothelial injury, consequently hastening the progression of atherosclerosis. Remarkably, endothelial dysfunction can precede vascular pathology in AS, suggesting a unique relationship between inflammation, atherosclerosis, and vascular damage. The role of adhesion molecules in the development of atherosclerosis, facilitating leukocyte adherence and migration into vascular walls, underscores the predictive value of soluble intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels for cardiovascular events. Despite significant progress in comprehending the pathogenesis of AS and its associated cardiovascular implications, the interplay among inflammation, endothelial dysfunction, and atherosclerosis remains partially elucidated. Investigations into the efficacy of therapeutic approaches involving angiotensin receptor blockers and statins have demonstrated reduced cardiovascular risk in AS patients, underscoring the imperative for additional research in this domain.

The saturate, aromatic, resin, and asphaltene content in petroleum (SARA composition) provides valuable information about the chemical nature of oils, oil compatibility, colloidal stability, fouling potential, and other important aspects in petroleum chemistry and processing. For that reason, SARA composition data are important for petroleum engineering research and practice. Unfortunately, the results of SARA composition measurements reported by diverse laboratories are frequently very dissimilar and the development of a method to assign SARA composition from oil bulk properties is a question that deserves attention. Petroleum fluids with great variability of SARA composition were employed in this study to model their SARA fraction contents from their density, flash point, sulfur content, and simulated distillation characteristics. Three data mining techniques: intercriteria analysis, regression, and artificial neural networks (ANNs) were applied. It was found that the ANN models predicted with higher accuracy the contents of resins and asphaltenes, whereas the non-linear regression model predicted most accurately the saturate fraction content but with an accuracy that was lower than that reported in the literature regarding uncertainty of measurement. The aromatic content was poorly predicted by all investigated techniques, although the prediction of aromatic content was within the uncertainty of measurement. The performed study suggests that as well as the investigated properties, additional characteristics need to be explored to account for complex petroleum chemistry in order to improve the accuracy of SARA composition prognosis.

Mucosal immunity and trained innate immunity of the gut play a pivotal role in maintaining intestinal homeostasis and defending against microbial pathogens. This review provides an overview of the mechanisms underlying mucosal immunity and the concept of trained innate immunity in the gut. We discuss the interaction between gut microbiota and the host immune system, highlighting the role of epithelial cells, dendritic cells, and innate lymphoid cells, as well as the novel concept of trained innate immunity and its role in perpetuating or attenuating gut inflammation. We also comment on the current models for investigating mucosal immunity, their limitations, and how they can be overcome. Additionally, we explore the potential therapeutic implications of modulating mucosal immunity and trained innate immunity in gastrointestinal diseases. Only by elucidating the mechanisms underlying mucosal immunity and the concept of trained innate immunity, innovative approaches to modulate immune responses and restore intestinal homeostasis in the context of gastrointestinal disorders could be implemented.