bluuebunny/crossref_metadata_2025 huggingface dataset:
TP53 Haploinsufficiency Rescues Emergency Granulopoiesis in FANCC−/− Mice
Authors: Hu Liping , Huang Weiqi , Bei Ling , Broglie Larisa , Eklund Elizabeth A.
Published: February 2018

Emergency (stress) granulopoiesis is an episodic process for the production of granulocytes in response to infectious challenge. We previously determined that Fanconi C, a component of the Fanconi DNA-repair pathway, is necessary for successful emergency granulopoiesis. Fanconi anemia results from mutation of any gene in this pathway and is characterized by bone marrow failure (BMF) in childhood and clonal progression in adolescence. Although murine Fanconi anemia models exhibit relatively normal steady-state hematopoiesis, FANCC−/− mice are unable to mount an emergency granulopoiesis response. Instead, these mice develop BMF and die during repeated unsuccessful emergency granulopoiesis attempts. In FANCC−/− mice, BMF is associated with extensive apoptosis of hematopoietic stem and progenitor cells through an undefined mechanism. In this study, we find that TP53 haploinsufficiency completely rescues emergency granulopoiesis in FANCC−/− mice and protects them from BMF during repeated emergency granulopoiesis episodes. Instead, such recurrent challenges accelerated clonal progression in FANCC−/−TP53+/− mice. In FANCC−/− mice, BMF during multiple emergency granulopoiesis attempts was associated with increased ataxia telangiectasia and Rad3-related protein (Atr) and p53 activation with each attempt. In contrast, we found progressive attenuation of expression and activity of Atr, and consequent p53 activation and apoptosis, in the bone marrow of FANCC−/−TP53+/− mice during this process. Therefore, activation of Atr—with consequent Fanconi-mediated DNA repair or p53-dependent apoptosis—is an essential component of emergency granulopoiesis and it protects the bone marrow from genotoxic stress during this process.
Climate-smart agriculture for sustainable agricultural sectors: The case of Mooifontein
Authors: Mathews Jennifer A. , Kruger Leandri , Wentink Gideon J.
Published: February 2018

Climate change is an environmental phenomenon with the potential to exacerbate existing disaster risks and cause extensive human, financial and environmental losses. The Mooifontein agricultural region in South Africa is considered to be a region vulnerable to climate change– associated risks. These climate risks would pose a substantial threat to the livelihoods of farmers in the Mooifontein area. This article aims to explore climate-smart agriculture (CSA) as a resilience-building tool to ensure sustainable agricultural practices. A qualitative research approach was utilised to gain insights into climate change and the lived experiences of farmers and agricultural experts in Mooifontein. The findings revealed that agricultural communities should focus on the identification and application of adaptation strategies like CSA. The adoption of appropriate CSA practices will play a vital role in ensuring sustainable livelihoods and improved community resilience for farming communities in the Mooifontein region.
Genre analysis of essays in the Social Sciences: The case of Botswana students
Authors: Magogwe Joel M. , Nkateng Unity M.
Published: February 2018

Writing is a challenging but requisite skill at university and other life situations. At university, essay writing is generally challenging to first-year students across disciplines or faculties. This study therefore describes the writing challenges of the Faculty of Social Sciences students at the University of Botswana. To that end, this study asks the following research questions: (1) What writing tasks are first-year students in the Faculty of Social Sciences given? (2) What problems do the students encounter when writing essays in the Faculty of Social Sciences? (3) What kind of assistance do students receive on writing essays? This article is underpinned by the English for Academic Purposes genre analysis framework. All in all, the findings of this study point to the need for a more intensive writing programme for first-year students at the University of Botswana in which both faculties and the Communication and Study Skills Unit will cooperatively assist students with writing. Students’ responses clearly indicated the need for such collaboration.
Contractivity and ground state domination properties for non-local Schrödinger operators
Authors: Kaleta Kamil , Kwaśnicki Mateusz , Lőrinczi József
Published: February 2018

We study supercontractivity and hypercontractivity of Markov semigroups obtained via ground state transformation of non-local Schrödinger operators based on generators of symmetric jump-paring Lévy processes with Kato-class confining potentials. This class of processes has the property that the intensity of single large jumps dominates the intensity of all multiple large jumps, and the related operators include pseudo-differential operators of interest in mathematical physics. We refine these contractivity properties by the concept of

L^p

-ground state domination and its asymptotic version, and derive sharp necessary and sufficient conditions for their validity in terms of the behaviour of the Lévy density and the potential at infinity. As a consequence, we obtain for a large subclass of confining potentials that, on the one hand, supercontractivity and ultracontractivity, on the other hand, hypercontractivity and asymptotic ultracontractivity of the transformed semigroup are equivalent properties. This is in stark contrast to classical Schrödinger operators, for which all these properties are known to be different.
Spectral distribution of PDE discretization matrices from isogeometric analysis: the case of $L^1$ coefficients and non-regular geometry
Authors: Garoni Carlo
Published: February 2018

We consider the matrices arising from the Galerkin B-spline Isogeometric Analysis (IgA) approximation of a

d

-dimensional second-order Partial Differential Equation (PDE). We compute the singular value and eigenvalue distribution of these matrices under minimal assumptions on the PDE coefficients and the geometry map involved in the IgA discretization. In particular,

L^1

coefficients and non-regular geometries are allowed. The mathematical technique used in our derivation is entirely based on the theory of Generalized Locally Toeplitz (GLT) sequences, which is a quite general technique that can also be applied to several other PDE discretization methods.
El uso de los medios de comunicación y la elaboración cognitiva: El papel mediador de la eficacia mediática
Authors: Won Kim Ji , Chadha Mónica , Gil de Zúñiga Homero
Published: February 2018

Este articulo presenta los resultados de un estudio sobre la relación entre el uso de los medios de comunicación y la elaboración de noticias mientras se introduce el papel mediador de la percepción que el público tiene de la utilidad de los diferentes medios de comunicación para ayudarles a comprender problemas complejos. El término eficacia mediática se conceptualiza como la percepción que un individuo tiene de la utilidad de un medio noticioso en la comprensión de temas complejos. El análisis de un estudio de panel de dos olas demostró que la relación entre el uso de los medios de comunicación y la elaboración era totalmente mediada por la eficacia mediática. Esta investigación contribuye al desarrollo de los estudios sobre el modelo de mediación cognitiva al introducir una nueva variable mediadora, la eficacia mediática, y analizar su relación con la elaboración.
Incidence d’un apport polyvitaminique sur la yersiniose expérimentale de la truite arc-en-ciel (Salmo gairdnerï)
Authors: Vigneulle Martine , Gérard J. P.
Published: February 2018

La yersiniose, entéro-septicémie hémorragique à Yersinia ruckeri est transmise expérimentalement à des truites arc-en-ciel (Salmo gairdneri). L'apport dans l’aliment de vitamines A (48500 Ul/kg), E (500 mg/kg) et C (8650 mg/kg), pendant 5 jours consécutifs, semble augmenter la résistance des poissons à l'infection, lors d'épreuves effectuées 3 à 8 semaines plus tard.
Changements de régimes alimentaires et variations morphologiques des papilles du rumen chez la vache laitière à haute production
Authors: Mayer E.
Published: February 2018

L’incapacité d'ingestion de plus de 13 à 14 kg de matière sèche par la vache laitière à haute production aussitôt après le vêlage, serait en relation, selon les résultats des études rapportées, avec une régression des papilles du rumen et une diminution d'absorption des acides gras volatils, conditionnées elles-mêmes par une réduction de l’apport énergétique au moment du tarissement. A l’inverse, en effet, le passage à un régime hyperénergétique entraîne une prolifération maximale des papil¬ les correspondant avec une absorption maximale des acides gras volatils.
Fréquence de la présence de l’anticorps anti-aphteux VIA dans le sérum des taureaux d'insémination artificielle français
Authors: Goffaux M. , Larenaudie Bertrand , Remond Michèle , Thibier Michel
Published: February 2018

Les échantillons de sérum de 205 taureaux entretenus dans 13 dépôts de reproducteurs et régulièrement vaccinés contre la fièvre aphteuse ont donné lieu à la recherche, par immuno-précipitation en gélose, de l'anticorps dirigé contre l'antigène VIA des virus aphteux. Trente-deux réactions positives (15,6 %) ont été obtenues.

La variabilité de leur fréquence entre centres d'insémination, essentiellement causée par l'un d'entre eux, entraîne une variabilité selon la race et une irrégularité dans la manifestation de l'effet, d'ailleurs modéré, du délai après la dernière vaccination.

La fréquence des réactions positives passe de 8,3 % pour 1 et 2 vaccinations antérieures à 14,1 % pour 3 et 4 vaccinations et à 23,9 % pour plus de 4 vaccinations. Ces chiffres permettent aux exportateurs de semence vers les U.SA d’apprécier le risque d’un refus pour réactivité sérologique du taureau donneur à l’égard de l'antigène VIA.
Bilan d'une recherche des Salmonella dans la viande hachée par immunofluorescence
Authors: Catsaras Marc
Published: February 2018

La recherche des Salmonella dans 10 g, 1 g ou 0,1 g, qui se traduit par 68 résultats faussement négatifs sur 960, par la voie de la bactériologie classique, est positive 67 fois par immunofluorescence.

Pour 320 séries de tubes (de 10-2 à 10-8), 39 d’entre elles permettent d’obtenir un résultat supérieur par immunofluorescence par rapport à la bactériologie classique. Dans la très large majorité des cas il y a seulement 1 tube d’écart.
Effet de la vasopressine sur la fermeture de la gouttière œsophagienne de la chèvre
Authors: Brugère Henri , Mikhaïl M. , Le Bars Henri
Published: February 2018

Vasopressin effect on closure of reticular groove of goat

Closure of the reticular groove of the goat occurs after an intravenous injection of vasopressin (0.25 i.u./kg).
Les rétroviroses caprines. Modèle expérimental-pour l'étude du SIDA ?
Authors: Fiocre B.
Published: February 2018

L’étude clinique des rétroviroses caprines (Visna Maedi, CAEV) a montré qu’il existait un parallélisme presque parfait entre ces maladies et le SIDA humain, et suggère l’emploi de l’espèce caprine et de ses rétroviroses comme modèle expérimental pour l’étude du SIDA et des vaccins à venir contre cette maladie.
Recherche des résidus dans les animaux et les viandes fraîches
Authors: Willemart Jean-Pierre , Bouffault Jean-Claude , Egron L.
Published: February 2018

Deux Directives récentes (85/358/CEE et 86/469/CEE) traitent du problème de la recherche des résidus dans les animaux vivants et dans les viandes fraîches. Elles énoncent un plan de travail qui paraît complet, coordonné et ambitieux.

Néanmoins, un travail considérable est à faire pour mettre au point les méthodes communes nécessaires et s’assurer de leur application homogène dans les 12 Etats membres. Ceci demandera plusieurs années.

En outre, on peut estimer que le coût de la mise en œuvre de ces Directives posera un problème financier dont la solution n’est pas en vue.
Dermatite staphylococcique du mouton compliquée d’ecthyma : à propos de deux cas
Authors: Gourreau Jean-Marie , Louzis Claude , Rehby Liliane , Capafons Michèle , Gente Dominique , Le Doujet Claudine
Published: February 2018

Staphylococcal dermatitis of sheep associated with contagious pustular dermatitis : study of two cases.

Staphylococcal dermatitis of sheep is a probably frequent but unrecognised affection in France. It can become complicated with contagious pustular dermatitis as the authors describe it through these two observations.
Les perspectives en matière de substances d'intervention thérapeutique et d’aide à la production animale
Authors: Ruckebusch Yves , Raynaud J.-P.
Published: February 2018

Perspectives in therapeutics and animal health control

The chemicals in the future will be not only for the prevention or treatment of innumerable diseases but for animal health control and improvement of the quality of foods. The next step involves slow releasing systems, immunostimulants, more selective antiinflammatory weapons and chemical restraint. Substances able to promote a quality of food as a correct energy to nutrient ratio will be the challenge of the future.
Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Women with Polycystic Ovarian Syndrome
Authors: Chandra Smitha CH , Sailakshmi Mo Orkoth Prasannan Anantha , Nagaratnamma Rangaiah
Published: February 2018

In women of reproductive age polycystic ovary syndrome (PCOS) is the common endocrine disorder. It is one of the common causes of infertility due to anovulation. There is no single criterion for the diagnosis of this syndrome. It is crucial to diagnose PCOS early in its course since it has lifelong implications with increased risk for metabolic syndrome, type II Diabetes mellitus (DM), cardiovascular disease, endometrial hyperplasia, infertility and depression. Screening for the impaired glucose (IGT), allows for proper and timely prevention and management of complications. In this cross sectional study, we planned to detect the prevalence of impaired glucose tolerance and diabetes in women with PCOS which will facilitate prevention of long term sequelae. We also studied the extent of the risk for diabetes in patients with PCOS in relation to age, socioeconomic status, rural and urban areas, BMI, waist/hip circumference ratio, family history of PCOS and diabetes mellitus

How to cite this article

Smitha CHC, Sailakshmi MOPA, Nagaratnamma R. Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Women with Polycystic Ovarian Syndrome. J Med Sci 2017;3(4):116-118.
Opioid management: Addressing the gap in understanding, education, and practice
Authors: Enck, MD Robert E.
Published: February 2018

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Oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients: An overview of its pharmacological and clinical characteristics
Authors: Mystakidou, MD, PhD Kyriaki , Katsouda, MD Emmanuela , Parpa, BA, MA Efi , Tsiatas, MD, PhD Marinos L. , Vlahos, MD, PhD Lambros
Published: February 2018

Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (OTFC; brand name Actiqm, Cephalon Inc., West Chester, PA), a new opioid formulation with a unique delivery system, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), making it an effective treatment for cancer patients who already receive opioids and experience flares of pain. This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.
News Briefs
Authors: DeVito, Jr. Richard A.
Published: February 2018

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Opioid Research: Methods and Protocols.
Authors: Davis, MD, FCCP Mellar P.
Published: February 2018

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Novel Aspects of Pain Management: Opioids and Beyond
Authors: Barkin, PharmD, MBA, FCP, DAPPM Robert L.
Published: February 2018

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The US Supreme Court decision on assisted suicide and the prescription of pain medication: Limit the celebration
Authors: Kapp, JD, MPH Marshall B.
Published: February 2018

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A summary of current Drug Enforcement Administration positions and resulting federal legal and regulatory “standards”
Authors: Bolen, JD Jennifer
Published: February 2018

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Opioids and Down’s syndrome
Authors: Mafrica, MD Federica , Fodale, MD Vincenzo
Published: February 2018

Opioids are used in clinical practice for sedation, anesthesia, and analgesia. Their effects depend on their pharmacokinetic and pharmacodynamic characteristics. The liver is the major site for the biotransformation of most opioids. The major metabolic pathway is oxidation. Metabolism influences distribution, clearance, onset, and offset of opioid drugs. Action also depends on the coupling of opioids with the class of receptors involved and on localization of specific receptors. Three major types of opioid receptors, designated as μ, ẟ, and ϰ, present in the central nervous system, are coupled to G proteins and inhibit adenylyl cyclase. Down’s syndrome is a congenital condition characterized by mental retardation and particular physical features. Neurotransmission alterations are important. Alteration in the concentration of opioids in the cortex of these patients has been demonstrated. Neurobiological abnormalities and, in some, abnormalities in the neurotransmission systems, anxiety, and, in particular, nociception all suggest that structural and functional alterations of opioid receptors may be present. A clear knowledge of these multiple abnormalities is essential for skillful management of the perioperative period and for a good outcome for patients with Down’s syndrome.
Inaugural Opioid Certification Program
Authors: Rowland, Jr., MD, Editor Christopher V.
Published: February 2018

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Reality and responsibility: A commentary on the treatment of pain and suffering in a drug-using society
Authors: Passik, PhD Steven D. , Heit, MD, FACP, FASAM Howard , Kirsh, PhD Kenneth L.
Published: February 2018

While opioids are a necessary part of the armamentarium of pain management, there has been a growing trend toward prescription drug abuse and diversion in our society. Meeting the goal of treating pain while not contributing to drug abuse and diversion requires vigilance and education. Physicians and patients have been singled out as the main players in the societal problem of diversion of prescription drugs. In fact, the problem can only be overcome when not only physicians and patients but also healthcare practitioners, third-party payers, law enforcement agencies and regulators, the pharmaceutical industry, and the media finally work together to prevent it, instead of fingering any one party for the blame.
Opioids and brain imaging
Authors: Balasubramanian, MBBS, MD, FRCA Shyam , Morley-Forster, MD, FRCPC Patricia , Bureau, PhD Yves
Published: February 2018

Since the introduction of the gate-control theory, a plethora of evidence to support the spinal processing of pain signals has come to light. Cognitive and affective aspects of the pain experience indicate the importance of supraspinal structures, but the biological mechanisms have remained inadequately explored. Within the past decade, imaging techniques have emerged that enable in vivo assessment of the central opioidergic system and the central processing of pain. The two most important imaging modalities to this end are functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). This article will describe the underlying principles of these techniques and explain their importance in determining the loci of opioidergic pathways and their neuromodulatory influence on acute and chronic pain conditions, role in placebo effects, implication in drug dependence, and potential role in studying the analgesic efficacy of new drugs.
Calendar
Authors: DeVito, Jr. Richard A.
Published: February 2018

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Dexmedetomidine to treat opioid withdrawal in infants following prolonged sedation in the pediatric ICU
Authors: Tobias, MD Joseph D.
Published: February 2018

This retrospective study aims to report on the use of dexmedetomidine to treat opioid withdrawal following sedation during mechanical ventilation in a cohort of infants. Seven infants in the pediatric intensive care unit of a tertiary care center, ranging in age from three to 24 months (12.4 ± 8.2 months) and in weight from 4.6 to 15.4 kgs (9.9 ± 4.2 kgs), had received a continuous fentanyl infusion, supplemented with intermittent doses of midazolam for sedation, during mechanical ventilation. Withdrawal was documented by a Finnegan score ³ 12. Dexmedetomidine was administered as a loading dose of 0.5 mg/kg/hr, followed by an infusion of 0.5 mg/kg/hr.Dexmedetomidine effectively controlled the signs and symptoms of withdrawal in the seven patients. Subsequent Finnegan scores were £ 7 at all times (median 4, range 1 to 7). Two patients required a repeat of the loading dose and an increase of the infusion to 0.7 mg/kg/hr. These two patients had received higher doses of fentanyl than the other five patients (8.5 ± 0.7 versus 4.6 ± 0.5 mg/kg/hr, p < 0.0005). No adverse hemodynamic or respiratory effects related to dexmedetomidine were noted.This report involves the largest cohort of patients to receive dexmedetomidine in the treatment of withdrawal following opioid and benzodiazepine sedation during mechanical ventilation. We conclude that dexmedetomidine offers a viable option for such issues in the pediatric intensive care unit (PICU) setting.
Methadone for cancer-related neuropathic pain: A review of the literature
Authors: Mannino, MD Rosemarie , Coyne, MSN, APRN Patrick , Swainey, MD Craig , Hansen, PharmD Lea Ann , Lyckholm, MD Laurie
Published: February 2018

Neuropathic pain is commonly seen in cancer patients, either as a direct result of the malignancy or as a consequence of the treatment rendered. In recent years, methadone has been utilized in the treatment of neuropathic pain because of its additional mechanism of action as an NMDA-receptor antagonist. In this paper we discuss the etiology of neuropathic pain in cancer patients, unique properties of methadone, and prior studies on methadone in this patient population. While methadone has been established as a cheap and effective agent in treating cancer pain, specific studies are needed comparing methadone to other opioids in the management of cancer-related neuropathic pain.
A randomized, open-label study of once-a-day AVINZA® (morphine sulfate extended-release capsules) versus twice-a-day OxyContin® (oxycodone hydrochloride controlled-release tablets) for chronic low back pain: The extension phase of the ACTION trial
Authors: Rauck, MD Richard L. , Bookbinder, MD Stephen A. , Bunker, MD Timothy R. , Alftine, MD Christopher D. , Ghalie, MD Richard , Negro-Vilar, MD, PhD Andres , De Jong, MD Egbert , Gershon, MD Steven
Published: February 2018

Study design and objective: The ACTION ® trial, an open-label, randomized, multicenter, two-part study, compared the efficacy and safety of two sustained-release opioids (SROs), AVINZA (A-MQD), morphine sulfate extended-release capsules given once a day, and OxyContin® (O-ER), oxycodone modified-release tablets given twice a day, in subjects with chronic, moderate to severe low back pain. The first part of the study, the evaluation phase, was followed by an optional four-month extension phase aimed at evaluating the long-term stability of pain control, SRO dose, and quality of sleep.Results: Three hundred and ninety-two subjects were enrolled in the study; 220 completed the evaluation phase, and 174 entered the extension phase. During the latter phase, subjects in the A-MQD group (n = 79) continued to report lower pain scores, better quality of sleep, lower daily morphine-equivalent doses (means of 86 mg versus 119 mg), and a comparable usage of ibuprofen compared to subjects in the O-ER group (n = 95). The incidence and severity of elicited opioid side effects were similar between the two groups.Conclusions: Both study drugs resulted in significant pain relief and improved sleep in SRO-naive patients with chronic low back pain, and this outcome was attained with a stable daily SRO dose. In patients who completed opioid dose titration, AVINZA performed significantly better than OxyContin in reducing pain scores and improving sleep—with a lower morphine-equivalent daily dose—during both the evaluation and extension phases.
Pharmacist-physician collaboration in pain management practice
Authors: Strickland, PharmD, BCPS Jennifer M. , Huskey, PharmD Angela , Brushwood, RPh, JD David B.
Published: February 2018

Pain is one of the most common reasons patients seek out healthcare and management typically requires complex medication regimens. Pharmacists have become increasingly more involved in pain management. Historically, pharmacists and physicians have often had adversarial relationships because of regulatory influence. However, as medication experts, pharmacists can play a key role in optimizing outcomes in the management of pain and can be critical to the success of the medication regimen. Numerous opportunities for collaboration exist for pharmacists and physicians in various settings. One example is the VIGIL process, an effective risk management strategy that requires collaboration between pharmacists and physicians. The success of pharmacist-physician collaboration will depend on numerous factors, including strong physician and administrative support. A clear strategy and stepwise approach to developing a pain management pharmacist-physician collaborative practice is the key to its success. Once the collaboration is formalized, a management strategy should also be defined and should include regular chart review and regular feedback from the physician. Through physician-pharmacist collaboration, pain management outcomes can be optimized and risk can be managed.
Sleep and daytime sleepiness problems among patients with chronic noncancerous pain receiving long-term opioid therapy: A cross-sectional study
Authors: Zgierska, MD, PhD Aleksandra , Brown, MD Randall T. , Zuelsdorff, BS Megan , Brown, PhD David , Zhang, PhD Zhengjun , Fleming, MD, MPH Michael F.
Published: February 2018

Objective: Sleep problems are common among patients with chronic pain (CP). Information on sleep problems and associated covariates in opioid-treated patients with CP is limited. The aim of this study was to assess the prevalence, characteristics, and risk factors of sleep and daytime sleepiness problems in this specific population.Design: Cross-sectional.Setting: Primary care outpatient clinics.Participants: Eight hundred and seventy six patients with CP treated with long-term opioids.Main Outcome Measures: Prestudy selected questionnaires: six questions from the Medical Outcomes Study Sleep Scale, Pain Inventory Survey, Pain Patient Profile, Substance Dependence Severity Scale, and medication log.Results: Insomnia-type sleep problems and combined sleep and sleepiness problems were reported by 87 percent and 49 percent of the sample, respectively. Logistic regression analysis showed that depression (adjusted OR, aOR 2.8, 95% CI 2.1-3.7) and pain severity (aOR 1.4, 95% CI 1.1-1.7) were the strongest independent predictors of sleep problems; only depression severity predicted daytime sleepiness (aOR 1.9, 95% CI 1.6-2.2) or combined sleep/sleepiness problems (aOR 2.2, 95% CI 1.8-2.5). Opioid dose was associated with a slight tendency toward unrefreshing sleep (aOR 1.2, 95% CI 1.0-1.4) and worse sleep maintenance (aOR 1.2, 95% CI 1.0-1.4), while use of long-acting opioids was associated with a trend toward increased napping (aOR 1.3, 95% CI 1.0-1.8).Conclusions: Sleep and daytime sleepiness problems are common among opioid-treated primary care patients with CP and seem to be related mainly to depression and pain severity. Physicians caring for opioid-treated patients with CP may want to assess them for sleep disorders as a part of routine CP care.
Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients
Authors: Manchikanti, MD Laxmaiah , Giordano, PhD James , Boswell, MD, PhD Mark V. , Fellows, MA Bert , Manchukonda, BDS Rajeev , Pampati, MSc Vidyasagar
Published: February 2018

Background: Psychopathology (depression, anxiety, somatization disorder) and substance abuse (opioid mis-use and illicit drug use) are common in patients with chronic pain and present problems for public health and clinical management. Despite a body of literature describing various methods for identifying psychopathology, opioid misuse, and illicit drug use in chronic pain patients, the relationship between psychopathologies, substance abuse, and chronic pain has not been well characterized.Methods: This report describes a total of500 consecutive pain patients prescribed and receiving stable doses of opioids. The patients were evaluated for psychopathology, opioid abuse, and illicit drug use during the course of regular pain management treatment. The relationships between psychopathology and drug abuse and/or illicit drug use in chronic pain patients were examined, and psychological evaluation for depression, anxiety, and somatization disorder was performed.Results: Depression, anxiety, and somatization disorder were documented in 59, 64, and 30percent of chronic pain patients, respectively. Drug abuse was significantly higher in patients with depression as compared to patients without depression (12percent with depression versus 5percent without). Current illicit drug use was higher in women with depression (22 percent) than women without depression (14percent) and in men with or without depression (12percent). Current illicit drug use was also higher in men with somatization disorder (22 percent) than men without (9 percent).Conclusion: This study demonstrated that the presence of psychological features of depression and somatization disorder may be markers of substance abuse diathesis in chronic pain patients.
Prevalence and characteristics of breakthrough pain in patients receiving opioids for chronic back pain in pain specialty clinics
Authors: Bennett, MD Daniel S. , Simon, MD, RPh Steven , Brennan, MD Michael , Shoemaker, MD Steven A.
Published: February 2018

Objective: We sought to assess the prevalence and characteristics of breakthrough pain (BTP) in patients with chronic back pain.Design; Researchers utilized a telephone survey using a pain assessment algorithm. This report represents a subset of patients from a larger survey of228patients with chronic pain unrelated to cancer.Participants: This study employed 117subjects taking opioids for a primary diagnosis of back pain and receiving care at geographically dispersed pain treatment centers. Subjects had pain lasting at least six months and had “controlled” baseline pain.Results: Eighty-seven subjects (74 percent) experienced 93 types of BTP. The median number of BTP episodes per day was two; median time to maximum intensity was 10 minutes, and median duration was 55 minutes. Onset could not be predicted for 46 percent of pains. Eighty-three percent of subjects used shorter-acting opioids for BTP. Other medications used for pain included NSAIDs, antidepressants, anticonvulsants, skeletal muscle relaxants, intrathecal local anesthetics, and transdermal local anesthetics.Conclusions: These patients with opioid-treated chronic back pain commonly experienced BTP, which often had a rapid onset and a relatively short duration and was difficult to predict. Opioids were the mainstay of pharmacologic therapy, but nonopioid analgesics and adjuvant analgesics were commonly used.
Early analgesic effects of intravenous parecoxib and rectal diclofenac following laparoscopic sterilization: A double-blind, double-dummy randomized controlled trial
Authors: Ng, MD, FRCA Alexander , Swami, FFARCSI Ajay , Smith, MD, FRCA Graham , Emembolu, FRCOG Joe
Published: February 2018

The aim of this double-blind double-dummy randomized controlled trial was to investigate if there was any difference in analgesia between the maximum recommended doses of rectal diclofenac and iv parecoxib after laparoscopic sterilization. The authors studied 55 ASA I-II patients undergoing gynecological laparoscopy; each patient received either preoperative rectal diclofenac 100 mg and 2 mL of normal saline at induction of anesthesia, or preoperative placebo suppository and 2 mL of parecoxib 40 mg at induction. Pain intensity, sedation, and nausea were measured using a 100-mm visual analogue scale on awakening and at 1, 2, and 3 hour postoperatively. Median (interquartile range) pain intensity at rest on awakening and at 1, 2, and 3 hour postoperatively were 15 (0-40), 37 (10-56), 16 (6-29), and 13 (2-32) mm, respectively, in the parecoxib group, and 3 (0-34), 22 (5-45), 24 (6-37), and 10 (4-21) mm, respectively, in the diclofenac group. There was no significant difference in these scores. Furthermore, there was no significant difference between the two groups in sedation, nausea, rescue analgesia, or rescue antiemetic consumption. Preoperative rectal diclofenac 100 mg and parecoxib 40 mg iv at induction of anesthesia were found to have equianalgesic effects after laparoscopic sterilization. Both drugs appear to be useful after short anaesthetics.
Prescription opioid use in the rural Appalachia: A community-based study
Authors: Havens, PhD, MPH Jennifer R. , Walker, MSW, LCSW Robert , Leukefeld, DSW Carl G.
Published: February 2018

Objective: The purpose of this study is to describe the sample characteristics and methods for a study of rural medical and nonmedical prescription opioid users with a history of OxyContin® use.Design and Setting: Snowball sampling was used to recruit 221 rural Appalachian residents. Participants included those under medical supervision for pain (n = 101) as well as those self-reporting nonmedical use of prescription opioids (n = 120). Participants were given an interviewer-administered questionnaire.Outcome measures: Data relating to demographics, illicit and nonmedical prescription drug use, medical, legal, family, and psychiatric status, as well as pain history were collected. The primary outcomes of interest were differences in past 30 day prescription drug use between pain patients and nonmedical opioid users.Results: A significantly greater proportion of those treated for pain reported using oxycodone and hydrocodone prescribed by a physician in the prior 30 days (p < 0.001); however, more than third of pain participants also reported nonmedical use of OxyContin®, methadone, hydrocodone, benzodiazepines, and marijuana in the prior 30 days.Conclusions: A large proportion of rural opioid users who reported being treated for pain also reported nonmedical use of prescription drugs. Similarly, among the nonmedical users, half of those reported experiencing pain that interfered with their daily life. These results suggest that many rural prescription drug users are being either incorrectly or perhaps inadequately treated for chronic nonmalignant pain. Therefore, developing educational materials and training for rural physicians about pain treatment (including drug seeking behavior) is proposed.
Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery
Authors: Oguzhan, MD Nihal , Gunday, MD Isil , Turan, MD Alparslan
Published: February 2018

Background: Magnesium sulphate administration was initially reported to reduce postoperative analgesic requirements. Subsequent reports, though, were inconsistent. Specifically, we tested the hypotheses that intraoperative magnesium sulfate administration reduces postoperative requirement for opioids, secondary outcomes were intraoperative muscle relaxant, sevoflurane consumptions and postoperative pain.Methods: Fifty American society of anesthesiology status (ASA) I-II patients who gave a written informed consent were scheduled for elective lumbar disc surgery. The Institutional Review Board approved the study. Patients were randomly assigned to the placebo group (n = 25) or magnesium group (n = 25). Patients assigned to the magnesium group were given an initial infusion of 30 mg/kg (over 10 minutes) starting immediately after anesthesia and completed before intubation. The infusion was then continued at 10 mg/kg/hr throughout surgery. General anesthesia was induced with propofol, 2.5 mg/kg, and maintained with sevoflurane 2 percent in a 50 percent O2/50 percent N2O mixture. The sevoflurane concentration was adjusted to keep bispectral index (BIS) values between 45 and 60. Both groups were given atracurium, 0.6 mg/kg, and a remifentanil infusion at an initial dose of 0.1 mg/kg/h. The remifentanil infusion was adjusted to maintain heart rate and mean arterial pressure (MAP) within 20 percent of baseline values. Atracurium administration was repeated when the train of four (TOF) ratio exceeded 0.30. Intubation conditions were scored. At the end of surgery, the authors assessed recovery using early recovery criteria and Aldrete recovery scores. Postoperative analgesia was maintained with morphine via patient-controlled analgesia.Results: Heart rate, MAP, and pulse oximetry (SPO2) values were similar in the groups at all times. Intubating conditions were similar except that the increase in MAP was greater in the placebo group. Neither BIS values nor sevoflurane consumption differed between the groups; however, significantly less atracurium [95% CI = 4.1 (2.8, 5.5)] and remifentanil [95% CI = 0.14 (0.07, 0.20)] was used in the magnesium group. Side effects, Aldrete scores, and early recovery parameters were all similar in the groups. In the first 24 hours, visual analogue scale (VAS) values for pain were greater in the placebo than in the magnesium group. The magnesium group consumed significantly less morphine [95% CI = 11 (6, 16)].Conclusion: Intraoperative magnesium administration significantly reduced muscle relaxant and opioid requirements; more importantly, it also reduced postoperative pain and opioid use.
Low-dose intrathecal naloxone to enhance intrathecal morphine analgesia: A case report
Authors: Hamann, MD, PhD Scott , Sloan, MD Paul Alexander , Witt, MD William
Published: February 2018

Ultra low doses of opioid antagonists such as naloxone block excitatory opioid receptor pathways may paradoxically enhance morphine analgesia. This case study reports safety and efficacy of ultra low-dose intrathecal (IT) naloxone added to IT morphine for the treatment of severe refractory chronic low back pain. A 56-year-old man with a history of severe chronic low back pain (postlaminectomy syndrome) was evaluated. Extensive multidisciplinary therapies had all failed. Initial treatment at our clinic was a lumbar IT trial of morphine (unsuccessful) up to 50 mg/day. We administered an IT bolus of morphine 2 mg combined with IT naloxone of 20 ng with the patient’s consent and approval. The onset of pain relief was within 20 minutes and peaked at 1 hour with a 50 percent reduction in VAS pain score. There were no signs of adverse drug toxicity or hemodynamic compromise. An IT infusion of daily morphine 5 mg and naloxone 50 ng was started. Throughout the 3-year follow-up period, the patient maintained pain reduction of 60 to 80 percent, with a return to daily activities and no further hospitalizations.
Out-of-hospital opioid therapy of palliative care patients with “acute dyspnoea”: A retrospective multicenter investigation
Authors: Wiese, MD Christoph H. R. , Bartels, MD Utz E. , Graf, MD Bernhard M. , Hanekop, MD Gerd G.
Published: February 2018

Background: Prehospital emergency physicians (EP) are often confronted with the acute care of palliative care patients. Dyspnoea is a frequent acute symptom and its causes often differ from the generally known emergency medical causes. Till now, there have been no relevant concepts for emergency care of palliative care patients for their specific symptoms.Methods: Over a 24-month period, the authors retrospectively investigated all out-of-hospital emergency medical services for palliative care patients with acute dyspnoea at four emergency physician support points. The evaluation of these services was followed retrospectively on the basis of the therapy carried out by the EP (Group 1: therapy with morphine and oxygen; Group 2: therapy with morphine, bronchodilator effective drugs and oxygen; Group 3: therapy with bronchodilator effective drugs and oxygen; Group 4: therapy with oxygen; Group 5: no medical treatment). Moreover, EPs were interviewed about their actions and their uncertainties in the treatment of palliative care patients.Results: The diagnosis of acute dyspnoea in palliative care patients occurred 121 times (116 patients were integrated in the present investigation) within the defined period. In total, 116 patients were included (Group 1: 21, Group 2: 29, Group 3: 31, Group 4: 28, and Group 5: 7). Dyspnoea was satisfactorily treated in 41 percent of the patients (Group 1: 67 percent, Group 2: 52 percent, Group 3: 22 percent, Group 4: 18 percent, and Group 5: 71 percent). Most EPs (70 percent) revealed uncertainties in emergency medical therapy for patients at the end of life.Conclusions: The current investigation showed a significant relief of acute dyspnoea when using opioids, in contrast with the established out-of-hospital emergency medical therapy for acute dyspnoea. Therefore, opioids should be recommended for emergency medical therapy of dyspnoea in palliative care patients. Clinical studies that recommend the use of effective opioids for the treatment of dyspnoea in palliative care patients are supported by the current retrospective study. Most EPs felt uncertain in the treatment of palliative care patients. Therefore, advanced training in palliative care medicine and endof-life care should be integrated into emergency medical training.
Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future directions
Authors: Aggarwal, PhD Sunil K. , Carter, MD, MS Gregory T. , Sullivan, MD, PhD Mark D. , ZumBrunnen, PhD Craig , Morrill, PhD Richard , Mayer, PhD Jonathan D.
Published: February 2018

Cannabis (marijuana) has been used for medicinal purposes for millennia, said to be first noted by the Chinese in c. 2737 BCE. Medicinal cannabis arrived in the United States much later, burdened with a remarkably checkered, yet colorful, history. Despite early robust use, after the advent of opioids and aspirin, medicinal cannabis use faded. Cannabis was criminalized in the United States in 1937, against the advice of the American Medical Association submitted on record to Congress. The past few decades have seen renewed interest in medicinal cannabis, with the National Institutes of Health, the Institute of Medicine, and the American College of Physicians, all issuing statements of support for further research and development. The recently discovered endocannabinoid system has greatly increased our understanding of the actions of exogenous cannabis. Endocannabinoids appear to control pain, muscle tone, mood state, appetite, and inflammation, among other effects. Cannabis contains more than 100 different cannabinoids and has the capacity for analgesia through neuromodulation in ascending and descending pain pathways, neuroprotection, and anti-inflammatory mechanisms. This article reviews the current and emerging research on the physiological mechanisms of cannabinoids and their applications in managing chronic pain, muscle spasticity, cachexia, and other debilitating problems.
Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State
Authors: Aggarwal, PhD, MD Candidate Sunil K. , Carter, MD, MS Gregory T. , Sullivan, MD, PhD Mark D. , ZumBrunnen, PhD Craig , Morrill, PhD Richard , Mayer, PhD Jonathan D.
Published: February 2018

Objectives: This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).Design: Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.Setting: Regional pain clinic staffed by university faculty.Participants: Inclusion criteria: age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.Main Outcome Measures: Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.Results: Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patientyears of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use. There were no other gender-specific trends or factors. Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent). Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain. In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.Conclusions: Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.
Can the cognitively impaired safely use patient-controlled analgesia?
Authors: Licht, MD Eugene , Siegler, MD Eugenia L. , Reid, MD, PhD M. Carrington
Published: February 2018

Although patient-controlled analgesia (PCA) is considered the standard in postoperative pain control, research examining PCA use among cognitively impaired older adults is lacking. The authors reviewed a case series of 10 adults aged 65 years and older admitted to the geriatrics or orthopedic services of an urban tertiary care center in New York City with acute pain and cognitive impairment or dementia who were administered PCA. Four patients from this cohort are presented in detail, demonstrating the challenges of PCA use in this population. A series of clinical pearls follows each case, outlining strategies for improving pain management. The authors’ findings suggest that cognitive evaluations limited to alertness and orientation and failure to perform functional assessments may hinder the identification of patients who are poor candidates for PCA. Once PCA has been initiated, clinicians must regularly review device use and document cognitive function and pain score patterns to identify PCA underuse or misuse. Finally, rapid fluctuations in cognitive or functional status may require adoption of a more flexible pain management strategy. Despite these challenges, a subset of cognitively impaired older adults can successfully understand and operate PCA devices. Additional research is needed to (1) develop screening tools for identifying and monitoring older adults who may benefit from PCA and (2) create innovative approaches for improving pain management in the cognitively impaired.