bluuebunny/crossref_metadata_2025 huggingface dataset:
Pushing Distributed Vibration Analysis to the Edge with a Low-Resolution Companding Autoencoder: Industrial IoT for PHM
Authors: Trilla Alexandre , Miralles David , Fern´andez Ver´onica
Published: February 2021

The Industrial Internet-of-Things (IIoT) has disrupted theway of collecting physical data for predictive maintenancepurposes. At present, networks of intelligent wireless sensorsare pervasive, finding success in many environments andindustries, including the railways. However, when it comesto data-intensive applications like vibration monitoring thatrequire the delivery of large amounts of records, the limitationsof these devices arise. The shortfalls are mainly drivenby the low-bandwidth transmission capacity of their radio interfaces,and the low-power features of their battery-operated(and/or energy-harvested) electronics. In sight of these limitedresources, this article explores a vibration data compressionstrategy for diagnosis purposes. To maximise the amountof transferred information with the least amount of bytes thismethod works in three stages: first, it extracts the most usefulfeatures for vibration-based analytics. Then, it compressesthe raw signal waveform using an Autoencoder neural networkwith an undercomplete representation, assessing its optimumregularisation approach: the denoising, sparse, andcontractive configurations. Finally, it reduces the resolutionof the compressed data by quantising all the resulting real valuesinto single-byte unsigned integers. The proposed strategyis evaluated with a dataset of railway axle bearings with differentlevels of degradation. The results of the analysis provethat with compression rates up to 10 the vibration signals arepractically unaffected by this procedure, allowing for manydiagnosis goals like anomaly detection, fault location, andseverity appraisal. This approach yields a wide range of businessopportunities for on-board predictive maintenance withIIoT technology.
Vibration Analysis for Anomaly Detection in Unmanned Aircraft
Authors: Bektash O. , La Cour-Harbo Anders
Published: February 2021

Vibration analysis is a vital measurement tool to provide detailed examination of drone health status by examining signal levels and frequencies. As drones are progressively operating in susceptible airspace where their being might cause harm, signal processing of in-flight data is becoming a necessity to reduce drone risks in sensitive conditions. On that account, this paper investigates how vibration measurements from different flights can be analysed to infer the condition of elements inside the drone. The results should assist safety operators to ascertain whether vibration anomalies can be an indicator of diagnostic and troubleshooting tools of major fault progress in drone flights. In order to track and monitorize the anomalies on the flying drone, this research proposes a vibration spectrum analysis on the inputs from on-board vibration monitoring sensors. The reason for using this analysis is that it can conduct the anomaly detection by providing critical frequency information pinpointing the faulty conditions on the drone platform. The results provides support for the proposed framework, with the ability to determine increasing defect from an unsteady flight with high payload but those results being preliminary to further research. This suggests that further drone safety research can use the same signal processing themes regarding vibration related anomalies when operating in sensitive flight zones.
Life prediction for aircraft structure based on Bayesian inference: towards a digital twin ecosystem
Authors: Wang Teng , Liu Zheng , Liao Min , Mrad Nezih
Published: February 2021

Nowadays, the concept of “digital twin” has received great attention from both academia and industry. However, few methodological solutions have been reported in existing studies. This paper presents a life prediction method for aircraft structure, and illustrates how this method can be embedded into a “digital twin” framework. This method can fuse heterogeneous information acquired from inspected physic entity, fifinite element software, historical database and predictive model, giving an accurate and real-time prediction of remaining useful life (RUL) for aircraft structure. In the operation of this method, the degradation behaviour of inspected structure is observed in an online manner. Historical record document is used for generating prior knowledge. The external load condition is fed into fifinite element software for calculating the stress intensity factor. The well-known Paris law is adopted as predictive model. Finally, the Bayesian inference is used to integrate the information and predict the future degradation of inspected structure. Theoretical deviation and experiment on a public database demonstrate the effectiveness of this method, facilitating the implementation of “digital twin” in real-world scenario.
Evolutionary Algorithm for the Electric Vehicle Routing Problem with Battery Degradation and Capacitated Charging Stations
Authors: Futalef Juan Pablo , Muñoz-Carpintero Diego , Rozas Heraldo , Orchard Marcos
Published: February 2021

As CO2 emission regulations increase, fleet owners increasingly consider the adoption of Electric Vehicle (EV) fleets in their business. The conventional Vehicle Routing Problem (VRP) aims to find a set of routes to reduce operational costs. However, route planning of EVs poses different challenges than that of Internal Combustion Engine Vehicles (ICEV). The Electric Vehicle Routing Problem (E-VRP) must take into consideration EV limitations such as short driving range, high charging time, poor charging infrastructure, and battery degradation. In this work, the E-VRP is formulated as a Prognostic Decision-Making problem. It considers customer time windows, partial midtour recharging operations, non-linear charging functions, and limited Charge Station (CS) capacities. Besides, battery State of Health (SOH) policies are included in the E-VRP to prevent early degradation of EV batteries. An optimization problem is formulated with the above considerations, when each EV has a set of costumers assigned, which is solved by a Genetic Algorithm (GA) approach. This GA has been suitably designed to decide the order of customers to visit, when and how much to recharge, and when to begin the operation. A simulation study is conducted to test GA performance with fleets and networks of different sizes. Results show that E-VRP effectively enables operation of the fleet, satisfying all operational constraints.
Support-Vector Machine Approach for Robust Fault Diagnosis of Electric Vehicle Permanent Magnet Synchronous Motor
Authors: Zhao Chunheng , Li Yi , Wessner Matthew , Rathod Chinmay , Pisu Pierluigi
Published: February 2021

Permanent magnet synchronous motor (PMSM) is a leading technology for electric vehicles (EVs) and other high-performance industrial applications. These challenging applications demand robust fault diagnosis schemes, but conventional strategies based on models, system knowledge, and signal transformation have limitations that degrade the agility of diagnosing faults. These methods require extremely detailed design and consideration to remain robust against noise and disturbances in the actual application. Recent advancements in artificial intelligence and machine learning have proven to be promising next-generation solutions for fault diagnosis. In this paper, a support-vector machine (SVM) utilizing sparse representation is developed to perform sensor fault diagnosis of a PMSM. A simulation model of the pertinent PMSM drive system for automotive applications is used to generate a set of labelled training example sets that the SVM uses to determine margins between normal and faulty operating conditions. The PMSM model includes input as a torque reference profile and disturbance as a constant road grade, against both of which faults must be detectable. Even with limited training, the SVM classifier developed in this paper is capable of diagnosing faults with a high degree of accuracy, suggesting that such methods are feasible for the demanding fault diagnosis challenge in PMSM.
LSTM-Based Online Prediction Method for Building Electric Load During COVID-19
Authors: Tu Hao , Lukic Srdjan , Dubey Abhishek , Karsai Gabor
Published: February 2021

Accurate prediction of electric load is critical to optimally controlling and operating buildings. It provides the opportunities to reduce building energy consumption and to implement advanced functionalities such as demand response in the context of smart grid. However, buildings are nonstationary and it is important to consider the underlying concept changes that will affect the load pattern. In this paper we present an online learning method for predicting building electric load during concept changes such as COVID-19. The proposed methods is based on online Long Short-Term Memory (LSTM) recurrent neural network. To speed up the learning process during concept changes and improve prediction accuracy, an ensemble of multiple models with different learning rates is used. The learning rates are updated in realtime to best adapt to the new concept while maintaining the learned information for the prediction.
Preparación de la defensa de un TFM: de la comunicación verbal a la no verbal
Authors:   Uned, Lavie Alfredo , Flores Tena María José ,   Universidad Autónoma de Madrid, García Pérez María ,   Uned
Published: February 2021

Este capítulo aborda la preparación de la defensa de un trabajo fin de máster, ofreciendo al lector una serie de recomendaciones que permitan la optimización del uso de los recursos disponibles, tanto de los medios de comunicación verbal como de los de tipo no verbal. Su finalidad consiste en dar a conocer los recursos a disposición del candidato ante el reto académico para la superación satisfactoria de esta prueba determinante. Para ello, son analizados los medios visuales y tecnológicos más comunes que permiten la ilustración y exposición más apropiadas para tal fin, así como los criterios para la organización del tiempo y de los apartados que necesariamente han de ser contemplados para garantizar el éxito. Asimismo, se ofrece una serie de recomendaciones de lo que se considera necesario e imprescindible, así como una utilización racional de la tecnología, la cual, en opinión de los autores, nunca debería reemplazar la oratoria espontánea y natural de toda exposición. Por último, se incluye una serie de indicaciones que tener en cuenta de cara al seguimiento de la atención ante las preguntas formuladas para el tribunal y la selección de las respuestas para la réplica.
La gestión de las emociones ante la preparación y defensa del TFM
Authors:   Catedratica de la Universidad Complutense de Madrid, Limón Mendizabal Maria Rosario , Benito Moreno Silvia ,   Uned, Ortega Navas M.ª del Carmen ,   Uned
Published: February 2021

Este capítulo pretende guiar al estudiante en el recorrido de elaboración y defensa oral o virtual de su trabajo fin de máster, dotándolo de estrategias y pautas, con el propósito de que se vean aminoradas la incertidumbre, el estrés y la sensación de miedo ante el fracaso a la hora de enfrentarse a dicha tarea, por lo cual se abordan aspectos como gestionar emociones positivas que influyan en la calidad del producto final que se va a presentar y defender. En primer lugar, las autoras presentan el humor como herramienta protectora para superar la adversidad en el caso de la preparación y defensa del trabajo fin de máster. A continuación, se explica la importancia de la gestión para afrontar y superar los miedos y el estrés negativo, junto con la necesidad de potenciar, por el contrario, una actitud positiva que contribuya a una mejor búsqueda de resultados más satisfactorios a la hora de la preparación y defensa del trabajo fin de máster. En tercer lugar, se presentan recomendaciones para establecer un «plan emocional» para planificar y gestionar las emociones durante la elaboración y defensa del trabajo fin de máster. Finalmente, se presentan estrategias prácticas para la preparación emocional de la defensa.
Orientaciones para la elaboración de textos académicos
Authors:   Uned, Sánchez Verdejo Pérez Francisco Javier , Anguita Acero Juana María ,   Universidad Rey Juan Carlos
Published: February 2021

La correcta elaboración de trabajos académicos, entre los que se encuentran los trabajos fin de máster, es fundamental, ya que buena parte de la calificación obtenida en ellos redunda en la consecución de ciertas titulaciones o certificaciones. En el caso concreto de los trabajos fin de máster, su finalización supone la culminación de un proceso formativo altamente necesario y valorado en el mercado laboral actual. El propósito último de cualquier trabajo fin de máster es realizar una investigación sobre un tema concreto. Dicha investigación no está sujeta a una única tipología, sino que esta puede ser de carácter teórico o de análisis bibliográfico; centrarse en realizar una propuesta de mejora o un proyecto de intervención, o bien ir dirigida a la realización de un estudio empírico, en el cual la recopilación de datos es clave. Así pues, el alumno ha de conocer algunas normas básicas pero esenciales relacionadas con su redacción, estilo y estructura. A ello hay que sumarle que el alumno debe ser consciente de que el trabajo fin de máster suele ser presentado y defendido ante un tribunal (principal aunque no exclusivamente), un momento en el que, además, habrá que demostrar cierto grado de rigor y academicismo. En todo este proceso es prescriptivo que nada quede a merced del azar y que siempre se sigan las directrices marcadas y consensuadas con el tutor o director, puesto que elaborar un texto académico es, sin lugar a dudas, algo más que ponerse a escribir de manera improvisada. El éxito y el fracaso de este tipo de trabajos están ligados a su calidad.
Implicature in Barrack Obama’s Presidential Candicacy Announcement Speech
Authors: Fhitri Widya , Antaridha Rabbi , Shabri Irsyad
Published: February 2021

This research describes the use of implicatures. This study aims to see the message in Barack Obama's campaign speech. Furthermore, this study uses the implicature theory proposed by  Grice and George Yule,  the  language  function  theory  proposed  by  Geoffrey  Leech  and  complemented  by  the ethnographic  theory of communication  by Dell Hymes.  The data is taken from Barack  Obama's utterances delivered in a campaign speech in Springfield, Illinois, USA on February 10, 2007. This research follows the research phase proposed by Sudaryanto. At the basic stage of the data, the writer used the listening method and the technique of listening to the free and speaking competently. At the analysis, the researcher used the pragmatic matching method. Based on the analysis, the researcher found forty-two implicatures contained in the thirty-eight teachings of Barack Obama in the campaign speech. In addition, each implicature has a different function and purpose.
Cervical Interlaminar Epidural Injections at
High Doses Do Not Increase Optic Nerve Sheath
Diameter on a Long-Term Basis
Authors: Kang Sang Soo
Published: February 2021

Background: Cervical epidural injection (CEI) is widely performed on patients with pain
originating from the cervical spine. Studies have shown a good relationship between the optic
nerve sheath diameter (ONSD) and the intracranial pressure (ICP).
Objective: The aim of this study was to evaluate the changes in the ONSD as a non-invasive
surrogate marker of ICP after CEI.
Study Design: Prospective observational study.
Setting: Hospital and ambulatory pain clinic.
Methods: Twenty patients undergoing CEI at the C5-6 level were enrolled in this observational
study. The CEIs were performed using a total of 14 mL of mixture volume via the interlaminar
approach in the right lateral decubitus position. The ONSD through ultrasonography was measured
in the initial supine position (T0, baseline), 30 seconds after the completion of CEI (T0.5), at
30-second intervals for 5 minutes (T0.5~T5), and at one-minute intervals for 5 minutes (T6~T10).
Results: The values of the baseline ONSD (T0) in both eyes were 4.1 ± 0.4 mm. The ONSD
significantly increased from T1 to T10 (P < 0.05) compared with T0. The maximum value of the
ONSD was measured as 5.1 ± 0.4 mm at T4, and the mean difference between the baseline ONSD
and its maximum value was 1.0 mm, which represented about 27%. There was no increase in ICPrelated complications such as dizziness, headache, visual acuity, or retinal hemorrhage.
Limitations: This was an observational study without a control group. All patients were presumed
to have no intracranial pathology.
Conclusion: The 14 mL CEI resulted in an increase in the ONSD by ultrasonography over time.
The most critical increase in ONSD was observed 4 minutes after CEI, but this increase was not
sustained. Further work is needed to confirm the effects of the speed and volume of the injection
and of the position.
Registration: Registered in the Clinical Research Information Service of the Korea National
Institute of Health (https://cris.nih.go.kr/cris/index.jsp), registration number: KCT0001487
Key words: Analgesic techniques, epidural block, intracranial pressure, optic nerve sheath
diameter, ultrasonography
Intravenous Parecoxib and Continuous Femoral
Block for Postoperative Analgesia after Total
Knee Arthroplasty. A Randomized, DoubleBlind, Prospective Trial
Authors: Sarridou Dr Despoina
Published: February 2021

Background: Up until now, the optimal strategy for postoperative pain management after
total knee arthroplasty (TKA) remains to be elucidated.
Objective: The current investigation aimed to examine the analgesic efficacy and the
opioid sparing effects of intravenous parecoxib in combination with continuous femoral
blockade.
Study Design: Randomized, double-blind, prospective trial.
Setting: University hospital in the United Kingdom.
Methods: In total, 90 patients underwent TKA under subarachnoid anesthesia and
received continuous femoral block initially as a bolus with 20 mL of ropivacaine 0.75%.
Infusion of 0.2% on 10 mL/h followed. Patients were randomized into 2 groups. Group D
and Group P received parecoxib and placebo, respectively at 12 hour time intervals. Visual
analog scale (VAS) pain scores were obtained at different time intervals including 4, 8, 12, 24
and 36 hours. The pain scores were measured with patients in a resting position. Morphine
could also be administered with a patient controlled analgesia (PCA) pump if the specified
analgesia was deemed inadequate (VAS > 5).
Results: None of the patients were withdrawn from the study. Parecoxib provided greater
relief than placebo following TKA. The VAS pain scores measured at rest were statistically
significantly lower in parecoxib-treated patients compared to the placebo group (P = 0.007)
at 4 (P = 0.044), 12 (P = 0.001), and 24 hours (P = 0.012), postoperatively. Patients receiving
parecoxib consumed less morphine at all time intervals than patients receiving placebo,
with borderline statistical significance (P = 0.054). In each time period, all patients receiving
continuous femoral block irrespectively of the treatment group, required low morphine
doses.
Limitations: Current protocol did not answer question as to functional recovery.
Conclusion: According to our findings intravenous parecoxib in combination with
continuous femoral block provided superior analgesic efficacy and opioid sparing effects in
patients undergoing TKA.
Key words: Anesthesia, TKA, morphine, opioids, VAS scores, continuous femoral block
Full-Endoscopic Technique Discectomy Versus
Microendoscopic Discectomy for the Surgical
Treatment of Lumbar Disc Herniation
Authors: Yang Huilin
Published: February 2021

Background: Full-endoscopic technique discectomy (FED) or microendoscopic discectomy (MED)
are 2 widely used minimally invasive procedures for the treatment of lumbar disc herniation.
However, there is insufficient literature regarding the differences between these 2 surgical
procedures.
Objective: To compare the clinical outcomes of 2 different minimally invasive methods—fullendoscopic technique discectomy and microendoscopic discectomy—in the surgical treatment of
lumbar disc herniation.
Study Design: Retrospective study.
Setting: Inpatient surgery center.
Methods: Data form 65 patients with lumbar disc herniation treated with one of 2 minimally
invasive procedures were retrospectively analyzed. Patients were divided into 2 groups according
to surgical method: the FED group (n = 35) and the MED group (n = 30). Surgery time, time kept
in bed after surgery, duration of postoperative hospital stay, visual analog scale (VAS; 0 – 10), and
Oswestry Disability index (ODI; 0 – 100%) were assessed and compared between the 2 groups.
Results: There were no significant differences in the preoperative data between the 2 groups (P >
0.05). VAS and ODI scores improved significantly postoperatively in both groups (P < 0.05). Surgery
time was longer in the FED group than in the MED group (P < 0.05). However, the FED group was
superior to the MED group, with less time in bed, shorter hospital stay, and lower VAS scores one
day postoperatively (P < 0.05). There were no significant differences in VAS or ODI scores at one,
3, and 12 months after surgery between the 2 groups (P > 0.05).
Limitations: This is a retrospective study with a relatively short follow-up period.
Conclusions: Although the clinical outcomes of the 2 surgical techniques were similar, the FED
had the advantages of quicker postoperative recovery and more immediate effect.
Key words: Full-endoscopic, microendoscopic, discectomy, lumbar disc herniation, minimally
invasive, surgical treatment
Sympathetic Block as a New Treatment for
Lymphedema
Authors: Lee Pyung-Bok
Published: February 2021

Background: Breast cancer-related lymphedema (BCRL) not only has physical implications,
but also affects the quality of life in breast cancer survivors. Despite numerous studies of various
therapies, the optimal treatment for BCRL is unknown.
Objective: In this study, we investigated the efficacy of sympathetic blockade (thoracic
sympathetic ganglion block, [TSGB]) in treating BCRL.
Study Design: Retrospective study.
Setting: Tertiary referral center/teaching hospital.
Methods: TSGB was performed in 35 patients under fluoroscopic guidance. First, arm
circumference and Lymphedema and Breast Cancer Questionnaire [LBCQ] score were assessed
before TSGB and 2 weeks and 2 months after the procedure. Efficacy was defined as a ≥ 50%
reduction in the LBCQ score and a ≥ 50% decrease in the circumference difference between
the unaffected and affected arms 2 months after TSGB. Second, TSGB efficacy according to the
lymphedema stage and the period between BCRL onset and TSGB (< 6 months vs. > 6 months)
was evaluated.
Results: The arm circumference and LBCQ score significantly decreased at 2 months (P < 0.001),
and 65.7% of patients showed good efficacy. Patients with high stage lymphedema showed
improved efficacy after TSGB compared to those with low stage disease (P = 0.045). The TSGB
efficacy did not differ according to the period between BCRL onset and TSGB.
Limitations: This study was not a randomized prospective controlled study and did not compare
the therapeutic outcomes to those in a conservative treatment group.
Conclusions: TSGB in BCRL patients appears to be effective in decreasing the affected arm
circumference. TSGB may be an alternative option in BCRL patients who do not respond to
conservative therapy.
Key words: Breast cancer, lymphedema, thoracic sympathetic ganglion block, quality of life
Tramadol, Pharmacology, Side Effects, and
Serotonin Syndrome: A Review
Authors: Kaye Alan David
Published: February 2021

Background: Serotonin syndrome is a mild to potentially life-threatening syndrome
associated with excessive serotonergic activity within the central nervous system.
Serotonin syndrome is associated with medication use, drug interactions, and overdose.
While serotonin syndrome is often associated with the use of selective serotonin inhibitors
(SSRI), an increasing number of reports are being presented involving the use of tramadol.
Methods: This review article contains an overview of serotonin syndrome while
specifically looking at tramadol’s pharmacology and risk factors for serotonin syndrome.
With tramadol’s increasing popularity, the goal of this article is to make physicians more
alert and aware of this potential side effect associated with tramadol.
Conclusions: In conclusion, with the increasing incidence of serotonin syndrome,
prescribing physicians should be aware of and educate their patients on the potential
side effects of tramadol. It is important that the prescribing physician reviews patient
medications for concurrent serotonergic drugs and monitors for potential abuse.
Key words: Tramadol, serotonin syndrome, drug interactions, analgesics
Percutaneous Vertebroplasty Combined with
Percutaneous Pediculoplasty for Lytic Vertebral
Body and Pedicle Lesions of Metastatic Tumors
Authors: Deng Zhong-Liang
Published: February 2021

Background: Percutaneous pediculoplasty (PP) consists of the injection of Poly(methyl
methacrylate) (PMMA) into the fractured pedicle or lytic vertebral pedicle lesions, as a technique
derived from vertebroplasty.
Objectives: To evaluate the short-term analgesic effect of percutaneous vertebroplasty (PV)
and percutaneous pediculoplasty (PP) in patients with lytic vertebral body and pedicle lesions of
metastatic tumors.
Study Design: Single-center retrospective observational study.
Setting: An interventional pain management practice, a medical center, major metropolitan city,
China.
Methods: Single-center retrospective observational study of all patients managed with PV and PP
for painful vertebral body and pedicle metastatic tumors between 2007 and 2013. For each patient,
symptom duration and pain intensity were recorded. PP was performed under local analgesia, in
the prone position, with C-arm fluoroscopy guidance. The mixture of PMMA and Doxorubicin was
delivered into the vertebral body with a non-beveled needle for the initial treatment followed by
the mixture delivery into the lytic pedicle during needle withdrawal.
Results: Nine patients (5 women, 4 men) were enrolled in the study with a mean age of 65.9
years (range 57 – 75). Technical success was defined as the ability to access the lesion using
the approach. A positive clinical response for pain relief was achieved in these patients in whom
vertebroplasty and pediculoplasty had been performed. Pain level was not significantly reduced in
3 patients in whom just vertebroplasty has been performed because the medial wall of the pedicle
was destroyed by the metastatic lesion.
Limitations: This study is limited by its sample size.
Conclusions: PV and PP via the transpedicular approach for infiltrated vertebral bodies and
infiltrated pedicles of metastatic tumors may be considered a valid therapeutic option.
Key words: Percutaneous pediculoplasty, percutaneous vertebroplasty, lytic pedicular lesions,
bone cement
Increased Dose of Betamethasone for
Transforaminal Epidural Steroid Injections Is
Not Associated with Superior Pain Outcomes at
4 Weeks
Authors: Maher Dermot P.
Published: February 2021

Background: Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs)
have been shown to provide both immediate and long-term improvement in patients’ selfreported pain. Administration of the lowest possible dose of epidural betamethasone is desired
to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose
of betamethasone will demonstrate equivalent analgesic properties.
Objectives: To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone
for use in FG-TFESI.
Study Design: Retrospective evaluation.
Setting: Academic outpatient pain center.
Methods: One hundred fifty-eight patients underwent FG-TFESI for lumbar back pain
between 2012 and 2013. Depending on the date of service, a dose of 3 mg or a dose of 6 mg
betamethasone was used in the single level unilateral TFESI. Opioid consumption and NRS-11-
11 pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally.
Results: Changes in numerical rating scale (NRS-11-11) pain score (-1.21 + 2.61 vs. -0.81 +
2.40 respectively, P = 0.17) and changes in opioid consumption as measured in oral morphine
equivalents (-2.94 + 16.4 mg vs. -2.93 + 14.8 mg, P = 0.17) were statistically equivalent between
both groups. Intergroup sub-analysis of those with > 50% reduction in baseline NRS-11-11 pain
score was not different (15.2% vs. 34%, P = 0.56), and the proportion with a VRS pain score <
3 were similar (24.5% vs. 23.8%, P = 0.92).
Limitations: Potential selection bias inherent with study design.
Conclusions: Reduction in NRS-11-11 pain scores and narcotic usage at 4 weeks after FG-TFESI
were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone,
suggesting that a lower steroid dose has similar analgesic efficacy.
IRB Number: Cedars-Sinai Medical Center Institutional Review Board Pro00031594
Key words: Low back pain, radiculitis, steroids, epidural, transforaminal epidural steroids,
chronic pain management
Cryoablation for the Treatment of Occipital
Neuralgia
Authors: Kim Chong H.
Published: February 2021

Background: Treatment of occipital neuralgia (ON) can be complex, though many treatment
options exist. Cryoablation (CA) is an interventional modality that has been used successfully in
chronic neuropathic conditions and is one such option.
Objective: To study and evaluate the efficacy and safety of cryoablation for treatment of ON.
Study Design: Retrospective evaluation.
Setting: Academic university-based pain management center.
Methods: All patients received local anesthetic injections for ON. Patients with greater than or
equal to 50% relief and less than 2 week duration of relief were treated with CA.
Results: Thirty-eight pateitns with an average age of 49.6 years were included. Of the 38 patients,
20 were treated for unilateral greater ON, 10 for unilateral greater and lesser ON, and 8 for bilateral
greater ON. There were 10 men and 28 women, with an average age of 45.2 years and 51.1 years,
respectively. The average relief for all local anesthetic injections was 71.2%, 58.3% for patients
who reported 50 – 74% relief (Group 1) and 82.75% for patients who reported greater than 75%
relief (Group 2). The average improvement of pain relief with CA was 57.9% with an average
duration of 6.1 months overall. Group 1 reported an average of 45.2% relief for an average of
4.1 months with CA. In comparison, Group 2 reported an average of 70.5% relief for 8.1 months.
The percentage of relief (P = 0.007) and duration of relief (P = 0.0006) was significantly improved
in those reporting at least 75% relief of pain with local anesthetic injections (Group 2 vs Group
1). Though no significance in improvement from CA was found in men, significance was seen in
women with at least 75% benefit with local anesthetic injections in terms of duration (P = 0.03)
and percentage (P = 0.001) of pain relief with CA. The average pain score prior to CA was 8 (0 –
10 visual analog scale, VAS), this improved to 4.2, improvement of 3.8 following CA at 6 months
(P = 0.03). Of the 38 patients, 3 (7.8%) adverse effects were seen. Two patients reported post
procedure neuritis and one was monitored for procedure-related hematoma.
Limitations: Study limitations include the retrospective nature of the study. Additionally, only the
percentage of relief, pain score, and duration of relief were collected.
Conclusions: CA is safe, and should be considered in patients with ON.
Key words: Cryoablation, cryoanalgesia, occipital neuralgia, treatment, adverse effects
Ultrasound-Guided Pulsed Radiofrequency
Application via the Pterygopalatine Fossa:
A Practical Approach to Treat Refractory
Trigeminal Neuralgia
Authors: Kendall Mark C.
Published: February 2021

Although pharmacological therapy is the primary treatment modality for trigeminal
neuralgia associated pain, ineffective analgesia and dose limiting side effects often
prompt patients to seek alternative pharmacological solutions such as interventional
nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective
analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy
or CT imaging. Ultrasonography allows point of care and real time visualization of needle
placement within the surrounding anatomical structures. The use of ultrasonography with
pulsed radiofrequency therapy for trigeminal neuralgia has not been reported.
Our case is a 66-year-old male suffering from trigeminal neuralgia for 4 years that was
refractory to pharmacologic therapy. Neurological examination was normal with no sensory
deficit. Imaging showed no vascular compression or mass involving the trigeminal nerve.
A diagnostic ultrasound-guided trigeminal nerve block via the pterygopalatine fossa with
4 mL of bupivacaine 0.25% and 4 mg dexamethasone provided immediate pain relief
(100%) with sustained analgesia >50% at 2 weeks. Pain relief was not sustained at one
month, with return to pretreatment symptoms. A series of injections were performed with
similar intermittent analgesic effectiveness. The decision was made that the patient was
a suitable candidate for pulsed radiofrequency application in the pterygopalatine fossa.
We successfully used an alternative approach through the pterygopalatine fossa to treat
trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates
the utility of ultrasound-guidance pulsed radiofrequency treatment in the pterygopalatine
fossa as a potential alternative to other percutaneous techniques for patients with medical
refractory trigeminal neuralgia.
Key words: Pulsed radiofrequency, trigeminal nerve, ultrasound-guided, trigeminal
neuralgia, facial pain
The Successful Treatment of Opioid
Withdrawal-Induced Refractory Muscle Spasms
with 5-HTP in a Patient Intolerant to Clonidine
Authors: Dais Jennfier
Published: February 2021

Instituting drug holidays for chronic opioid using patients is becoming commonplace for pain
practitioners initiating procedures such as intrathecal pump or spinal cord stimulator trials. As such,
pain practitioners need to be adept in their management of acute opioid withdrawal. Successfully
weaning an opioid dependent patient off of chronic opioids requires a thorough knowledge of
the available adjuvants to assist in this process. However, that selection can become exhausted
by adjuvant side effects or by ineffective attenuation of opioid withdrawal symptoms. In that
case, novel drugs, or novel application of currently available medications must be sought after
to assist in the drug holiday. We present a case in which refractory muscle spasms secondary
to opioid withdrawal were successfully treated with an over-the-counter supplement that is not
typically used for the attenuation of opioid withdrawal symptoms. In a patient intolerant to the
side effects of clonidine, we were able to successfully wean chronic opiates by treating refractory
muscle spasms with the serotonin precursor, 5-hydroxytryptophan (5-HTP). We hypothesize
that our success with this medication gives further credence to the role of serotonin in opioid
withdrawal somatic symptomatology, and supports the need for future research to clarify the role
of serotonin precursors or serotonin modulating drugs as potential alternatives in those unable to
follow standard treatment protocols.
Key words: 5-hydroxytryptophan (5-HTP), opioid withdrawal, muscle spasms, serotonin, drug
holiday, chronic pain
Serratus Anterior Plane Block: A New Analgesic
Technique for Post-Thoracotomy Pain
Authors: Gautam Sujeet KS
Published: February 2021

Pain following thoracotomy is of moderate to severe nature. Management of thoracotomy pain is a
challenging task. Post thoracotomy pain has acute effects in the post operative period by affecting
respiratory mechanics, which increases the morbidity. Poorly controlled thoracotomy pain in the
acute phase may also lead to the development of a chronic pain syndrome.
A young male patient underwent esophagectomy and esophago-gastric anastomosis for corrosive
stricture of the esophagus. Epidural analgesia is standard of care for patients undergoing thoracotomy.
Due to hypotension and fluid losses following surgery, he was maintained on intravenous sedatoanalgesia during postoperative mechanical ventilation. The thoracic epidural catheter which was
placed pre-operatively, had developed blockage during the hospital stay. However, during weaning
from ventilation and sedation, he indicated severe pain in the thoracotomy incision. The pain was
severe enough to impair tidal breathing.
We wanted to evaluate the efficacy of the serratus anterior plane block in the management of
thoracotomy pain. The usefulness of this block has been discussed in the management of pain of
rib fractures and breast surgeries. Despite the hypothesis of its usefulness in causing anaesthesia of
the hemithorax, there are no available reports of clinical use for pain relief following thoracotomy.
We performed the serratus anterior place block under ultrasound guidance and placed a catheter
for continuous infusion of local anaesthetic and opioid. The patient had significant pain relief
following a single bolus of the drug. The infusion was started thereafter, which provided excellent
analgesia and facilitated an uneventful recovery. Here, we describe the successful management of
thoracotomy pain using the serratus anterior plane block.
Key words: Serratus anterior plane block, post-thoracotomy pain
A Costly Lesson: Fatal Respiratory Depression
Induced by Clindamycin during Postoperative
Patient Controlled Analgesia
Authors: Wu Hanbin
Published: February 2021

Many drugs can cause neuromuscular blockade. Clindamycin-related neuromuscular
blockade is commonly reported, but fatal clindamycin-induced neuromuscular blockade
is rarely reported. We describe a 47-year-old woman who initially presented with
endometrial carcinoma. She underwent a laparoscopic-assisted vaginal hysterectomy
(LAVH) and bilateral adnexectomy under general anesthesia, secondary to antibiotic
treatment with clindamycin 1.2g in 250 mL for about 30 minutes through the peripheral
intravenous route during postoperative patient controlled analgesia (PCA). She became
unconscious near the end of the infusion, then, despite resuscitation attempts, she died.
Clindamycin appeared to have triggered delayed respiratory depression during PCA. A
combination of clindamycin and fentanyl led to her respiratory depression in the fatal
case.
Key words: Respiratory depression, clindamycin, fatal case, postopertive patient
controlled analgesia
Management of Refractory Trigeminal
Neuralgia Using Extended Duration Pulsed
Radiofrequency Application
Authors: Ahuja Vanita
Published: February 2021

Trigeminal neuralgia (TN) produces incapacitating facial pain that reduces quality of life in
patients. Thermal radiofrequency (RF) ablation of gasserian ganglion (GG) is associated with
masseter weakness and unpleasant sensations along the distribution of the ablated nerve. Pulsed
radiofrequency (PRF) of GG has minimal side effects but literature is inconclusive regarding its
benefit in refractory TN. Increasing the duration of PRF application to 6 minutes in TN produced
encouraging results. PRF application to the saphenous nerve for 8 minutes reported improved
pain relief and patient satisfaction. We report successful management of two patients of classic
TN, which were refractory to medical management and interventional nerve blocks. The lesion
site were confirmed with motor and sensory stimulation through a 22 G, 10 cm RF needle with
5 mm active tip. Both the patients received four cycles of PRF at 42 °C with each cycle of 120
seconds (8 minutres). The visual analogue scale (VAS) in case 1 reduced from pre block score
of 80 to score 10 postblock, while in case 2 the VAS reduced from pre-block score of 85 to
score 15 postblock. During follow up both the patients are now pain free with minimal dose of
carbamazepine at 12 and 6 months respectively. We used PRF for longer duration (8 minutes)
in these patients, which resulted in improved VAS and WHOQOL-BREF score in these patients.
PRF of mandibular division of GG for extended duration provided long-term effective pain relief
and quality of life in patients of refractory classic TN.
Key words: Trigeminal neuralgia pain, pulsed radiofrequency ablation, interventional
approach
The Tragedy of the Implementation of ICD-10-
CM as ICD-10: Is the Cart Before the Horse or Is
There a Tragic Paradox of Misinformation and
Ignorance?
Authors: Manchikanti Laxmaiah
Published: February 2021

The forced implementation of ICD-10-CM (International Classification of Diseases, Tenth
Revision, Clinical Modification) codes that are specific to the United States, scheduled
for implementation October 1, 2015, which is vastly different from ICD-10 (International
Classification of Diseases, Tenth Revision), implemented worldwide, which has 14,400
codes, compared to ICD-10-CM with 144,000 codes to be implemented in the United
States is a major concern to practicing U.S. physicians and a bonanza for health IT and
hospital industry. This implementation is based on a liberal interpretation of the Health
Insurance Portability and Accountability Act (HIPAA), which requires an update to ICD-9-
CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and
says nothing about ICD-10 or beyond. On June 29, 2015, the Supreme Court ruled that
the Environmental Protection Agency unreasonably interpreted the Clean Air Act when it
decided to set limits on the emissions of toxic pollutants from power plants, without first
considering the costs on the industry. Thus, to do so is applicable to the medical industry
with the Centers for Medicare and Medicaid Services (CMS) unreasonably interpreting HIPAA
and imposing existent extensive regulations without considering the cost.
In the United States, ICD-10-CM with a 10-fold increase in the number of codes has resulted
in a system which has become so complicated that it no longer compares with any other
country. Moreover, most WHO members use the ICD-10 system (not ICD-10-CM) only to
record mortality in 138 countries or morbidity in 99 countries. Currently, only 10 countries
employ ICD-10 (not ICD-10-CM) in the reimbursement process, 6 of which have a single
payer health care system.
Development of ICD-10-CM is managed by 4 non-physician groups, known as cooperating
parties. They include the Centers for Disease Control and Prevention (CDC), CMS, the
American Hospital Association (AHA), and the American Health Information Management
Association (AHIMA). The AHIMA has taken the lead with the AHA just behind, both with
escalating profits and influence, essentially creating a statutory monopoly for their own
benefit. Further, the ICD-10-CM coalition includes 3M which will boost its revenues and
profits substantially with its implementation and Blue Cross Blue Shield which has its own
agenda. Physician groups are not a party to these cooperating parties or coalitions, having
only a peripheral involvement.
ICD-10-CM creates numerous deficiencies with 500 codes that are more specific in ICD-9-CM
than ICD-10-CM. The costs of an implementation are enormous, along with maintenance
costs, productivity, and cash disruptions.
Key words: ICD-10-CM, ICD-10, ICD-9-CM (International Classification of Diseases, 10th
Revision, Ninth revision, Clinical Modification), Health Insurance Portability and Accountability
Act (HIPAA), Health Information Technology (HIT), costs of implementation
A Best-Evidence Systematic Appraisal of
the Diagnostic Accuracy and Utility of Facet
(Zygapophysial) Joint Injections in Chronic
Spinal Pain
Authors: Boswell Mark
Published: February 2021

Background: Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred
pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are
unreliable in diagnosing zygapophysial joint pain.
Study Design: A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks.
Objective: To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain.
Methods: A methodological quality assessment of included studies was performed using Quality
Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the
designated inclusion criteria were utilized for analysis.
The level of evidence was classified as Level I to V based on the grading of evidence utilizing best
evidence synthesis.
Data sources included relevant literature identified through searches of PubMed and other electronic
searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the
bibliographies of known primary and review articles.
Outcome Measures: Studies must have been performed utilizing controlled local anesthetic
blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the
ability to perform previously painful movements.
Results: The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of
a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average
prevalence of 16% to 41% and false-positive rates of 25% to 44%.
The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based
on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence
in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to
67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%.
The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II with
80% or higher pain relief as the criterion standard with a prevalence ranging from 34% to 48% and
false-positive rates ranging from 42% to 48%.
Limitations: The shortcomings of this systematic review include a paucity of literature related to
the thoracic spine, continued debate on an appropriate gold standard, appropriateness of diagnostic
blocks, and utility.
Conclusion: The evidence is Level I for the diagnostic accuracy of lumbar facet joint nerve blocks,
Level II for cervical facet joint nerve blocks, and Level II for thoracic facet joint nerve blocks in
assessment of chronic spinal pain.
Key words: Chronic spinal pain, lumbar facet or zygapophysial joint pain, cervical facet or
zygapophysial joint pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial
branch blocks, controlled comparative local anesthetic blocks