bluuebunny/crossref_metadata_2025 huggingface dataset:
Broadband and compact rectangular waveguide twist by using rigid waveguide
Authors: Xu Yong , Sun Miao , Peng Ting‐hui , Luo Yong , Pu You‐lei , Wang Jian‐xun , Wu Ze‐Wei , Liu Guo , Yan Ran
Published: May 2018

A broadband and compact rectangular waveguide twist are presented and verified. Adopting an axially rotating 45° ridge waveguide, the rectangular waveguide twist provides a very compact interconnection of two rectangular waveguides with different on‐axis angle rotation. Compared to conventional waveguide twist, the superiority of the proposed waveguide twist is the easiness for manufacturing and the overall dimension is compact, the thickness is only 0.25 times the waveguide wavelength of the TE10 mode. For verification purpose, a Ka‐band 90° waveguide twist has been designed, fabricated, and tested. Measurement results show that the return loss is <−20 dB and the insertion loss is in excess of −0.2 dB. The measurements are in good agreement with simulations and demonstrate the excellent performance of the waveguide twist at the Ka‐band.
Generating hidden extreme multistability in memristive chaotic oscillator via micro‐perturbation
Authors: Wang Lu , Zhang Sen , Zeng Yi‐Cheng , Li Zhi‐Jun
Published: May 2018

By introducing a tiny perturbation into a memristive chaotic oscillator, a new memristive chaotic system without equilibrium is proposed in this letter. Therefore, the resulting attractors are all hidden. Particularly, the attractive phenomenon of hidden extreme multistability is observed. The complex dynamical behaviours are numerically analysed. Furthermore, a hardware experiment is carried out. A good similarity between numerical simulations and experimental results is obtained, which verifies the feasibility and effectiveness of this method.
Analysis of electrical shock hazard caused by electromagnetic coupling effects in parallel overhead high‐voltage power lines
Authors: Nowak Wieslaw , Tarko Rafal
Published: May 2018

The development of power networks encounters numerous problems. On one hand, they result from the high cost of land lots and difficulties in acquiring them from the proprietors. On the other hand, there are technical obstacles related to the constructing lines between new power sources (e.g. wind farms) and power systems. Wind farms are frequently localised in areas where the power network is poorly developed. These difficulties necessitate specific ways in which wind farms can be connected with the existing power systems. One of them lies in locating new lines within the existing line right of way. Owing to the electromagnetic impact between the lines such solutions are not frequent. Too long close‐proximity sections are avoided to reduce the consequences this impact. This study is devoted to the influence of high‐voltage transmission lines on other power lines. The localisation options in a 400 kV line right of way are analysed. The construction process and further exploitation of a 110 kV line in normal and short‐circuit conditions of a 400 kV line are presented. The prospective touch voltages and body currents are determined for these conditions.
Contribution of phase-mixing of Alfvén waves to coronal heating in multi-harmonic loop oscillations
Authors: Pagano P. , Pascoe D. J. , De Moortel I.
Published: May 2018

Context. Kink oscillations of a coronal loop are observed and studied in detail because they provide a unique probe into the structure of coronal loops through magnetohydrodynamics (MHD) seismology and a potential test of coronal heating through the phase mixing of Alfvén waves. In particular, recent observations show that standing oscillations of loops often involve higher harmonics in addition to the fundamental mode. The damping of these kink oscillations is explained by mode coupling with Alfvén waves.

Aims. We investigate the consequences for wave-based coronal heating of higher harmonics and which coronal heating observational signatures we may use to infer the presence of higher harmonic kink oscillations.

Methods. We performed a set of non-ideal MHD simulations in which we modelled the damping of the kink oscillation of a flux tube via mode coupling. We based our MHD simulation parameters on the seismological inversion of an observation for which the first three harmonics are detected. We studied the phase mixing of Alfvén waves, which leads to the deposition of heat in the system, and we applied seismological inversion techniques to the MHD simulation output.

Results. We find that the heating due to phase mixing of Alfvén waves triggered by the damping of kink oscillation is relatively small. We can however illustrate how the heating location drifts from subsequent damping of lower order harmonics. We also address the role of higher order harmonics and the width of the boundary shell in the energy deposition.

Conclusions. We conclude that the coronal heating due to phase mixing does not seem to provide enough energy to maintain the thermal structure of the solar corona even when multi-harmonic oscillations are included; these oscillations play an inhibiting role in the development of smaller scale structures.
The Golden jackal (Canis aureus) as an indicator animal for Trichinella britovi in Iran
Authors: Shamsian Aliakbar , Pozio Edoardo , Fata Abdolmajid , Navi Zahra , Moghaddas Elham
Published: May 2018

Nematodes of the genus Trichinella are zoonotic parasites causing trichinellosis. In Iran, these parasites occur in several animal species and rare cases have been recorded in humans. To monitor the epidemiological pattern of these parasites in the Khorasan-e-Razavi province, Northeastern Iran, muscle tissues were collected from the tongues of roadkill animals between 2016 and 2017: 295 stray dogs, one red fox (Vulpes vulpes), 12 golden jackals (Canis aureus), and one wild boar (Sus scrofa). Trichinella spp. larvae were retrieved using the artificial digestion method and identified to the species level by multiplex PCR. Larvae identified as Trichinella britovi were detected in five stray dogs (1.7%) and one golden jackal (8.3%). The results confirm the circulation of T. britovi in animals of the Khorasan-e-Razavi province, as previously documented. A review of the literature on Trichinella spp. in animals in Iran showed that these parasites were previously detected in 20.02% and 0.04% of carnivore and omnivore mammals, respectively, and that golden jackals can be screened as indicator animals for these zoonotic nematodes. Convenient sampling of Trichinella susceptible roadkill animals may provide a suitable method of monitoring the circulation of these parasites within any given region.
Intestinal Perforation due to Deep Infiltrating Endometriosis during Pregnancy: Case Report
Authors: Carneiro Márcia Mendonça , Costa Luciana Maria Pyramo , Torres Maria Das Graças , Gouvea Patrícia Salomé , Ávila Ivete de
Published: May 2018

We report the case of a 33 year-old woman who complained of severe dysmenorrhea since menarche. From 2003 to 2009, she underwent 4 laparoscopies for the treatment of pain associated with endometriosis. After all four interventions, the pain recurred despite the use of gonadotropin-releasing hormone (GnRH) analogues and the insertion of a levonorgestrel intrauterine system (LNG-IUS). Finally, a colonoscopy performed in 2010 revealed rectosigmoid stenosis probably due to extrinsic compression. The patient was advised to get pregnant before treating the intestinal lesion. Spontaneous pregnancy occurred soon after LNG-IUS removal in 2011. In the 33rd week of pregnancy, the patient started to feel severe abdominal pain. No fever or sings of pelviperitonitis were present, but as the pain worsened, a cesarean section was performed, with the delivery of a premature healthy male, and an intestinal rupture was identified. Severe peritoneal infection and sepsis ensued. A colostomy was performed, and the patient recovered after eight days in intensive care. Three months later, the colostomy was closed, and a new LNG-IUS was inserted. The patient then came to be treated by our multidisciplinary endometriosis team. The diagnostic evaluation revealed the presence of intestinal lesions with extrinsic compression of the rectum. She then underwent a laparoscopic excision of the endometriotic lesions, including an ovarian endometrioma, adhesiolysis and segmental colectomy in 2014. She is now fully recovered and planning a new pregnancy. A transvaginal ultrasound (TVUS) performed six months after surgery showed signs of pelvic adhesions, but no endometriotic lesions.
Status of Some Basic Antioxidants in Pre- and Postmalaria Treatment in Children
Authors: Ayede Adejumoke , Amoo Banke , Anetor John , Adeola Adesegun
Published: May 2018

Malaria is the most common tropical disease to which infants and children are the most susceptible. It is caused by Plasmodium species and is associated with oxidative stress, which has an effect on body antioxidants. The relationship between the degree of parasitemia and copper (Cu), zinc (Zn), and uric acid was evaluated in this study.

Seventy children (mean age: 7.80 ± 0.38 years) microscopically diagnosed positive for malaria parasite were selected. Fifty-six apparently healthy children (mean age: 6.68 ± 0.48 years) served as the control group. The malaria group was classified into pretreatment and posttreatment groups. The pretreatment group was also subgrouped based on parasitemia into four as follows: group A, group B, group C, and group D. Serum Cu and Zn were studied. Uric acid, an abundant endogenous metabolic antioxidant, was also determined.

The serum levels of Cu and Zn were significantly lower in pretreatment malaria patients compared with control. Uric acid level was slightly raised in the malaria patients but not significant (p > 0.05). In the posttreatment malaria patient group, serum uric acid and Cu levels were significantly raised compared with control (p = 0.008). Also, serum Cu and uric acid were significantly higher in the malaria posttreatment compared with the pretreatment group. Serum Zn level though higher in the posttreatment group compared with the pretreatment group was not significantly different (p > 0.05). The result showed a negative correlation between serum Cu level and parasitemia, and serum Zn level and parasitemia while that of uric acid and parasitemia was positively correlated but none of these were significantly correlated with parasitemia.

The observed changes in Cu, Zn, and uric acid levels in this study could be a reflection of progressive upregulation of the antioxidant system to combat the associated oxidative stress in this condition.
Treatment of Non-neurogenic Overactive Bladder with OnabotulinumtoxinA: Systematic Review and Meta-analysis of Prospective, Randomized, Placebo-controlled Clinical Trials
Authors: Arruda Raquel Martins , Takano Claudia Cristina , Girão Manoel João Batista Castelo , Haddad Jorge Milhem , Aleixo Gabriel Francisco , Castro Rodrigo Aquino
Published: May 2018

We performed a systematic review and meta-analysis of randomized placebo-controlled trials that studied non-neurogenic overactive bladder patients who were treated with 100 units of onabotulinumtoxinA or placebo. The primary purpose of our study was to evaluate the clinical effectiveness with regard to urinary urgency, urinary frequency, nocturia, and incontinence episodes. Our secondary purpose consisted of evaluating the adverse effects. Our initial search yielded 532 entries. Of these, seven studies met all the inclusion criteria (prospective, randomized, placebo-controlled studies, ≥ 3 points on the Jadad scale) and were selected for analysis. For all primary endpoints, the toxin was more effective than placebo (p < 0.0001; 95% confidence interval [95CI]), namely: urgency (mean difference = -2.07; 95CI = [-2.55–1.58]), voiding frequency (mean difference = -1.64; 95CI = [-2.10–1.18]), nocturia (mean difference = -0.25; 95CI = [-0.39–0.11]) and incontinence episodes (mean difference = -2.06; 95CI= [-2.60–1.52]). The need for intermittent catheterization and the occurrence of urinary tract infection (UTI) were more frequent in patients treated with onabotulinumtoxinA than in patients treated with placebo (p < 0.0001). Compared with placebo, onabotulinumtoxinA had significantly and clinically relevant reductions in overactive bladder symptoms and is associated with higher incidence of intermittent catheterization and UTI.
Toxicity of Gamma Knife Radiosurgery May Be Greater in Patients with Lower Cranial Nerve Schwannomas
Authors: Ruangkanchanasetr Rawee , Lee John , Nagda Suneel , Geiger Geoffrey , Kolker James , Bigelow Douglas , Ruckenstein Michael , Nasrallah MacLean , Alonso-Basanta Michelle
Published: May 2018

Objective Gamma Knife stereotactic radiosurgery (GK-SRS) is a preferred treatment option for tumors of the jugular foramen. We hypothesized that GK-SRS toxicity is higher for lower cranial nerve schwannomas than for glomus jugulare tumors despite anatomically similar locations.

Methods We performed a retrospective review of all patients who received GK-SRS for glomus jugulare tumors and lower cranial nerve schwannomas at our institution between 2006 and 2014. Because of small sample sizes, Fisher's exact tests and logistic regression techniques were employed using SPSS.

Result We identified 20 glomus jugulare tumors and 6 lower cranial nerve schwannoma patients with a median follow-up of 17 months. Median marginal dose was 16 Gy (range 13–18 Gy) and 12.5 Gy (range 12–14 Gy), respectively. All except one patient had tumor control at last follow-up visit. No worsening of pre-existing neurological deficits was observed. There were seven patients who developed any new neurological deficit after GK-SRS, four from the glomus group, and three from the schwannoma group (20 and 50% of each group, respectively). Only two of seven patients had permanent new neurological deficits. Both of them were in the schwannoma group. Univariate analysis showed that only a diagnosis of schwannoma had a greater risk of permanent new cranial nerve complication after GK-SRS compared with diagnosis of glomus jugulare (p = 0.046).

Conclusion Although the marginal dose for glomus jugulare is greater, our study suggests that the risk of a new permanent neurological deficit after GK-SRS was higher in the schwannoma group compared with the glomus group.
Indexed variation graphs for efficient and accurate resistome profiling
Authors: Rowe Will P M , Winn Martyn D
Published: May 2018

Motivation

Antimicrobial resistance (AMR) remains a major threat to global health. Profiling the collective AMR genes within a metagenome (the ‘resistome’) facilitates greater understanding of AMR gene diversity and dynamics. In turn, this can allow for gene surveillance, individualized treatment of bacterial infections and more sustainable use of antimicrobials. However, resistome profiling can be complicated by high similarity between reference genes, as well as the sheer volume of sequencing data and the complexity of analysis workflows. We have developed an efficient and accurate method for resistome profiling that addresses these complications and improves upon currently available tools.

Results

Our method combines a variation graph representation of gene sets with a locality-sensitive hashing Forest indexing scheme to allow for fast classification of metagenomic sequence reads using similarity-search queries. Subsequent hierarchical local alignment of classified reads against graph traversals enables accurate reconstruction of full-length gene sequences using a scoring scheme. We provide our implementation, graphing Resistance Out Of meTagenomes (GROOT), and show it to be both faster and more accurate than a current reference-dependent tool for resistome profiling. GROOT runs on a laptop and can process a typical 2 gigabyte metagenome in 2 min using a single CPU. Our method is not restricted to resistome profiling and has the potential to improve current metagenomic workflows.

Availability and implementation

GROOT is written in Go and is available at https://github.com/will-rowe/groot (MIT license).

Supplementary information

Supplementary data are available at Bioinformatics online.
Hydrogen station technology development review through patent analysis
Authors: Wen Chengyu , He Guangli
Published: May 2018

This study is a review of hydrogen station patents using the Derwent Innovation system and also a secondary screening. This was undertaken by the researchers to better understand and identify hydrogen station trends. The review focuses on analyzing the developing trends of patent technologies associated with a hydrogen station. The results of the review indicated that the countries with the major distribution of patents were Japan, China, the USA and Europe. Japan is leading the developmental trajectory of hydrogen stations. The results of the analysis found the leading developers of these patented technologies are Kobe Steel, Nippon Oil, Toyota and Honda. Other active patent developers analyzed include Linde, Hyundai and Texaco. The review concludes with a suggestion that using a patent analysis methodology is a good starting point to identify, evaluate and measure the trend in hydrogen station commercial development.
Spontaneous Intracranial Hypotension
Authors: Anitescu Magdalena , Arnolds David
Published: May 2018

Spontaneous intracranial hypotension is a condition that affects young and middle-aged individuals. Women are more frequently affected than men. It is associated with severe positional headache without previous dural puncture and is often confused with other common headache conditions. Delay in diagnosis of the condition may predispose patients to severe complications. Many radiodiagnostic tools carry important risks to patients, including nerve injury and iatrogenic spinal cord injury. Imaging studies must be correlated with a detailed medical history and a thorough physical examination. Epidural blood patch, the mainstay of treatment, may require multiple attempts with increasing amounts of autologous blood. Increased awareness of spontaneous intracranial hypotension will likely contribute to its proper diagnosis and treatment.
Cervicogenic Pain
Authors: Kohan Lynn , Liadis James
Published: May 2018

Cervicogenic pain is a common source of pain in many patients who present with neck and head pain. It is a secondary headache believed to be caused by referral of pain from a variety of upper cervical pain generators. The typical pain generators of cervicogenic headache are structures that are innervated by the upper three cervical nerves and that relay these signals through the trigeminocervical nucleus, resulting in head pain. Imaging studies may help to rule out other pathologies but cannot be used to make a diagnosis of cervicogenic headache. Treatment options include a multidisciplinary approach using physical therapy, medications, and interventional treatments.
Neuropathic Pain
Authors: Khursheed Faraz , Maybauer Marc O.
Published: May 2018

Neuropathic pain is a common condition that arises from injury anywhere along the somatosensory axis. Although the presentation may vary based on mechanisms and locations of injury, most patients have characteristic burning, shocklike, lancinating pain, most often in the distribution of peripheral and spinal nerves or distal extremities. Various peripheral and central processes aggravate pain through abnormal impulse generation, modulation, and processing. Common conditions include complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, spondylotic radiculopathy, and central pain syndromes. A detailed history and physical examination will aid in differentiating various neuropathic pain conditions. Neuropathic pain is best managed using a true multidisciplinary approach.
Chronic Chest Wall Pain in Postherpetic Neuralgia
Authors: Candido Kenneth D. , Kusper Teresa M. , Knezevic Nebojsa Nick
Published: May 2018

Postherpetic neuralgia (PHN) is a debilitating condition that frequently arises after herpes zoster (HZ) caused by the varicella-zoster virus. It is characterized by severe neuropathic pain and sensory disturbances persisting after the resolution of characteristic vesicular skin lesions. Most commonly affected are the thoracic dermatomes. Trigeminal (V1), cervical, and lumbar nerves are other frequently affected sites. Early treatment shortens the duration of acute HZ and may prevent the onset of PHN. A variety of modalities are utilized to treat PHN, including chemical compounds, interventional pain techniques, and neuromodulation. HZ vaccine is recommended for individuals more than 60 years old, and it is currently the best method of averting HZ and consequent progression to PHN.
Chronic Sternal Pain after Cardiac Surgery
Authors: Iqbal Afzaal , Kent Joel
Published: May 2018

Chronic post-sternotomy pain (PSP) is a well-known complication of cardiac surgery that is associated with increased morbidity. The lack of adequate pain relief can compromise the patients’ rehabilitation trajectory and diminish their quality of life. Various factors have been identified that contribute to the development and maintenance of PSP. Local and systemic pain management modalities have been identified to mitigate this condition. It is important to conduct a careful history and exam in these patients in order to rule out other causes of pain and properly guide the patient’s management. Individualized treatment will ultimately result in the most effective relief.
Chronic Abdominal Pain in Children
Authors: Lazar Alina
Published: May 2018

Abdominal pain in the pediatric population is mostly functional. Patients with chronic abdominal pain (typically young females) have a high risk of anxiety, depression, and dysfunctional coping, which are also risk factors for postoperative pain and persistent postsurgical pain. In these patients, peripheral and central sensitization contribute to possible visceral hyperalgesia. When patients with chronic abdominal pain and visceral hyperalgesia undergo surgical procedures, perioperative pain can be difficult to treat. To manage the chronic pain of such patients, their complex biopsychosocial make-up should be considered. A comprehensive plan includes preventive and aggressive multimodal analgesia, adequate patient and parent education, realistic expectations, cognitive-behavioral therapy, and distraction and relaxation techniques.
Testicular Pain
Authors: McNeil Andrew J. , Antony Ajay , Maybauer Marc O.
Published: May 2018

Testicular pain or orchialgia affects nearly 100,000 individuals in the United States each year. It is defined as chronic when the duration of pain exceeds 3 months. Evaluation begins with a thorough history and physical examination followed by focused diagnostic testing. Treatment modalities range from noninvasive measures to medical management and surgical interventions. Key components of treating chronic orchialgia involve identifying anatomic structures involved in the painful condition, ruling out serious underlying causes, and approaching treatment in a stepwise incremental fashion. As randomized controlled trials for treatments of orchialgia have not yet been conducted, it is the job of the clinician to be open to all forms of possible treatment and to tailor interventions based on specific patient pathologies, comorbidities, and treatment goals.
Chronic Back Pain in the Elderly: Spinal Stenosis
Authors: Knezevic Nebojsa Nick , Cantu Benjamin , Knezevic Ivana , Candido Kenneth D.
Published: May 2018

Chronic low back pain (CLBP) is a common reason for physician office visits among the elderly. Predictive factors for CLBP are female sex, social isolation, hypertension, and joint pain. In the elderly, CLBP may be related to degenerative spinal stenosis with disk degeneration and overall spondylosis. A detailed medical history and a targeted, comprehensive physical examination are the initial approaches to rule out underlying disease that requires urgent attention. Clinical and evidence-based approaches to management suggest avoiding early MRI or CT, as imaging in elderly patients has proven both impractical and uneconomical. Instead, good clinical judgment should be used for making diagnoses. Consensus on the best initial approaches for managing CLBP has not yet been achieved, and conservative therapy is suggested, varying from use of pharmacologic agents, physical therapy, electrical stimulation, and physical manipulations to epidural injections. Surgical alternatives are avoided due to confounding and multiple comorbidities in older patients.
Chronic Low Back Pain in a Young Patient
Authors: Knezevic Nebojsa Nick , Kusper Teresa M. , Candido Kenneth D.
Published: May 2018

Chronic low back pain (CLBP) in young adults is a great public health concern. CLBP affects individuals across all age groups with varying frequency, and it is associated with significant disability and morbidity, missed school or work, loss of productivity, and substantial health care expenditures. It can occur suddenly as a result of injury, or develop gradually due to degenerative changes in the spine. Correct diagnosis and proper management, usually involving a multidisciplinary approach, are paramount for optimal pain management. Usually, combinations of conservative management (pharmacologic and nonpharmacologic) with epidural steroid injections can achieve long-term pain relief and relapse prevention.
Head and Neck Cancer Pain
Authors: Caballero-Manrique Esther , Pino Carlos A.
Published: May 2018

In the United States, there are 48,000 new cases of head and neck cancer (HNC) annually. Although HNC used to be associated mainly with smoking and drinking, it is now found in many nonsmokers and nondrinkers in their 50s due to the spread of HPV. Pain is typically present at the time of diagnosis. Treatment usually includes radiation, chemotherapy, and/or surgery, which address the mass effect and pain. Yet, patients continue to experience pain during and after treatment, because the treatment modalities can cause significant inflammation and neuropathy and can lead to central sensitization. Painful mucositis is a complication of chemotherapy and radiation treatment; it can become severe, impacting patients’ ability to speak and eat, and sometimes limiting treatment. Pain treatment for HNC is multimodal, and includes preemptive approaches to prevent neuropathy and central sensitization with antiepileptics, such as gabapentin and pregabalin. Mucositis pain is treated using a stepwise protocol.
Postoperative Abdominal Wall Pain
Authors: Dirzu Dan , Palea Ovidiu , Choxi Sarah
Published: May 2018

Abdominal pain accounts for almost 1.5% of office visits and nearly 5% of emergency department admissions each year in the United States. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall. Postoperative abdominal wall pain is chronic, unremitting pain unaffected by eating or bowel function but exacerbated by postural change. A localized, tender trigger point can be identified, although pain may radiate over a diffuse area of the abdomen. Thorough history and physical examination can distinguish abdominal wall pain from visceral intra-abdominal pain. A positive Carnett’s sign favors an abdominal wall pain generator and not a visceral source. Injection with a local anesthetic and steroid at the area of pain may provide relief and can function also as a diagnostic test for abdominal wall pain. Refractory pain may be treated with chemical neurolysis, radiofrequency ablation, peripheral nerve stimulators, or neurectomy.
Back Pain: It’s Not Always Arthritis
Authors: Malik Tariq M.
Published: May 2018

Back pain is prevalent in adults, and most often its cause is nonspecific and benign. Imaging and interventions are not always helpful and they are generally expensive and low yield. However, in about 10% or fewer cases, a specific etiology is found. A patient history, physical examination, and testing are the methods for finding the cause. Back pain from malignancy must also be considered. Prolonged survival from better chemotherapy has increased the incidence of metastases to bone, especially the spine. Common sources of spinal metastases are cancers of the prostate, kidneys, thyroid, breast, and lungs. The primary treatment is to address the malignancy. Pain from spinal tumors can be treated with chemotherapy, radiotherapy, radiofrequency, or vertebral augmentation therapy. The chapter reviews the epidemiology of spinal cancer pain, evaluation of malignant spinal pain, and what the interventional pain physician can offer patients to alleviate their pain.
Patients with Substance Abuse and Chronic Pain
Authors: Souza Dmitri , Snegovskikh Denis , Hunter Julia K.
Published: May 2018

Treating chronic pain in patients with a substance abuse history is challenging. Patients abusing opioids may have a high pain tolerance, making pain control difficult. Available treatments for acute pain include regional and multimodal analgesia. Non-opioid and nonpharmacological analgesia (including interventional modalities, physical rehabilitation, chiropractic manipulations, and pain psychology) can be used to treat chronic pain. Patients’ past and present opioid use—illicit drug or nonmedical prescription opioid use, maintenance on medication-assisted treatment, or abstinence—should be taken into consideration when choosing between chronic pain treatments. Consultation with an addictionologist can facilitate this population’s successful treatment.
The Treatment of Pain in Pregnancy and Lactation
Authors: Ebrahimi Ali , Nagpal Geeta
Published: May 2018

Almost all women will experience pain of some type during pregnancy. Common musculoskeletal conditions can cause severe pain in an otherwise uncomplicated pregnancy. Some women will enter pregnancy with preexisting painful disorders, and management of ongoing pain and painful exacerbations can be challenging. This chapter reviews the common painful musculoskeletal conditions of pregnancy, as well as migraine, and the approaches to the management of chronic pain during pregnancy and in the breastfeeding mother. Techniques covered include pharmacologic and nonpharmacologic therapies, as well as pregnancy risk classifications of relevant drugs.
Bupivacaine and Glucocorticoid-Induced Myonecrosis
Authors: Gordon David , Khattab Ahmad , Anitescu Magdalena
Published: May 2018

The most frequently used medications for chronic pain are local anesthetics (LA) and glucocorticoids. Common adverse events from LA, such as seizures and cardiotoxicity, are well known. A lesser known side effect is local tissue reaction to the LA concentration. Myotoxicity is one of the common denominators of direct tissue reaction to LA; it results from the disruption of the mitochondria in the muscle cells. All LA produce some degree of myotoxicity; bupivacaine has the greatest effect and procaine the least. If LA is combined with glucocorticoid, muscle breakdown is even more extensive showing a synergistic effect. Myotoxicity depends primarily on LA concentration, is time dependent, and is enhanced by preexisting altered metabolism. It affects mostly young patients. Potential effects of long-term or repeated administration of the combination LA/glucocorticoids medications should always be considered and discussed with patients.
Epidural Blood Patch
Authors: Candido Kenneth D. , Kusper Teresa M. , Dinc Bora , Knezevic Nebojsa Nick
Published: May 2018

Post-dural-puncture headache (PDPH) is a consequence of neuraxial anesthesia, diagnostic lumbar puncture, intrathecal drug delivery systems, or any other technique involving dural trespass. The spinal headache results from a dural puncture that leads to cerebrospinal fluid (CSF) leakage from the subarachnoid space to the epidural space, culminating in intracranial hypotension and development of a low-pressure headache. A key element of PDPH is an increase in pain severity upon a change in position from supine to upright, which corresponds to a gravity-induced influence on CSF pressure dynamics. Age, sex, and design of the needle used correlate with the risk of headache. Sometimes, the headache resolves spontaneously. At other times, conservative treatment or aggressive measures are required to terminate the pain. An autologous epidural blood patch is an established way preventing or treating PDPH. A careful history must be obtained to identify other causes of headache before the blood patch is attempted.
Neuraxial Anesthesia in Coexisting Neurologic Conditions
Authors: Harrison John Henry , Anitescu Magdalena
Published: May 2018

Some patients who need surgery may have coexisting neurologic disorders like multiple sclerosis, amyotrophic lateral sclerosis, peripheral neuropathies (e.g., Charcot-Marie-Tooth disease or Guillain-Barré syndrome), or muscular dystrophies (e.g., Duchenne’s or myotonic dystrophy). When neuraxial analgesia and anesthesia are indicated, the anesthesiologist should be aware of the risks and benefits of the technique. Neuraxial anesthesia is not absolutely contraindicated in nervous system diseases and there are undeniable benefits to ruling out general anesthesia. In patients with coexisting neurologic disorders, prolonged sensory and motor block can be confused with epidural hematoma and abscess when present. Minor nerve injury from local anesthetic cytotoxicity or ischemia and mechanical trauma may cause permanent nerve injury through the double crush phenomenon. Lower concentrations of local anesthetics are generally recommended.
Local Anesthetic Systemic Toxicity: Diagnosis, Prevention, and Management
Authors: Golden Alexandra Dubikovsky , Dickerson David
Published: May 2018

Local anesthetic systemic toxicity is a major concern in both the inpatient and the outpatient setting, especially with the current increased use of regional, local, and tumescent anesthesia. Lack of protective strategies, delays in diagnosis, and the inability to provide timely lipid emulsion treatment are among the leading preventable causes to contribute to patients’ harm.
Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety
Authors: Saunders David , Martin Andres , Taylor Jerome H.
Published: May 2018

This chapter provides a summary of a landmark study evaluating the treatment of anxiety disorders in child and adolescent psychiatry. Is sertraline in combination with cognitive behavioral therapy more effective than monotherapy with either treatment alone in children with anxiety disorders? Also, how do these treatments compare with placebo therapy? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease
Authors: Mecca Adam P. , Tampi Rajesh R.
Published: May 2018

This chapter provides a summary of the Clinical Antipsychotic Trials of Intervention Effectiveness—Alzheimer’s disease (CATIE-AD), a multicenter trial that investigated whether atypical antipsychotics are an effective treatment for psychosis, aggression, or agitation in outpatients with Alzheimer’s disease. The chapter briefly reviews the study design, as well as implications and limitations. A relevant clinical case concludes the chapter. In summary, atypical antipsychotic use for up to 36 weeks did not lead to clinical improvement based on time to discontinuation, or symptom reduction. Risk of discontinuation due to adverse events and side-effects with worse with antipsychotic treatment compared to placebo. In patients with psychosis, agitation, or aggression due to Alzheimer’s disease, the efficacy of atypical antipsychotics is questionable and their use comes with considerable risks of side effects and adverse events.
Risk of Death with Atypical Antipsychotic Medications for Dementia
Authors: Mecca Adam P. , Tampi Rajesh R.
Published: May 2018

This chapter provides a summary of a landmark meta-analysis that investigated the risks of atypical antipsychotic use to treat psychosis, aggression, or agitation in patients with dementia. The chapter briefly reviews the study design, as well as implications and limitations. A relevant clinical case concludes the chapter. In summary, atypical antipsychotic use for 6 to 26 weeks was associated with increased risk of death (Odds Ratio of 1.54 for antipsychotic vs placebo). There were no differences in risk between individual medications, disease severity, indication for antipsychotic, or treatment setting. In patients with psychosis, agitation, or aggression due to dementia, the efficacy of atypical antipsychotics is questionable and their use comes with considerable risks of side effects and adverse events.
Treatment of Delirium in Hospitalized AIDS Patients
Authors: Sun Amanda , Tampi Rajesh R.
Published: May 2018

This chapter provides a summary of a landmark study on cognitive disorders, specifically the assessment of safety and efficacy of pharmacologic treatments for delirium with neuroleptics versus benzodiazepines. What is the comparative efficacy and tolerability of haloperidol, chlorpromazine, and lorazepam for the treatment of the symptoms of delirium in the medically ill? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Memantine in Patients with Moderate to Severe Alzheimer’s Disease Already Receiving Donepezil
Authors: Kitay Brandon M. , Tampi Rajesh R.
Published: May 2018

This chapter provides a summary of a landmark study on the pharmacological management of cognitive disorders. In patients with moderate to severe Alzheimer disease treated with a cholinesterase inhibitor (donepezil), is the addition of a N-methyl-D-aspartate receptor inhibitor (memantine) a safe and efficacious augmentation strategy? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and controversy within the field, concluding with a discussion of implications, and an exemplary clinical case applying the study evidence.
Behavioral and/or Pharmacotherapy for Older Patients with Insomnia
Authors: Ross Robert , Tampi Rajesh R.
Published: May 2018

This chapter provides a summary of a landmark study on short and longterm treatment of insomnia. Should older patients with insomnia be managed with cognitive behavioral therapy, benzodiazepines, or both? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The study shows that bensodiazepines and cognitive behavioral therapy are equally effective for shorterm treatment of insomnia in otherwise healthy elderly participants but cognitive behavioral therapy is far more effective for longterm treatment of insomnia.
Treatment of Depression in Patients with Alcohol or Drug Dependence
Authors: Williams J. Corey , Africano Gustavo A. Angarita
Published: May 2018

This chapter provides a summary of a landmark study on the treatment of major depressive disorder and co-morbid substance use disorders. Are antidepressants efficacious in treatment of combined depression and substance use disorders? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The main study findings suggest that Major Depressive Disorder can be effectively treated with antidepressant medications in patients with co-morbid substance use disorders. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Suicidality in Pediatric Patients Treated with Antidepressant Drugs
Authors: Saunders David , Bloch Michael H.
Published: May 2018

This chapter provides a summary of a landmark meta-analysis on the treatment of major depressive disorder in children and adolescents. The results of this study prompted the Food and Drug Administration to issue a black box warning on antidepressant use in pediatric populations. Do antidepressants increase suicidality in children and adolescents who are depressed? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Initial Severity and Antidepressant Benefits
Authors: Maksimowski Michael , Qayyum Zheala
Published: May 2018

This chapter provides a summary of a landmark study on major depressive disorder. What are the drug–placebo differences among antidepressants when both published and unpublished data are analyzed? Does antidepressant efficacy depend on the severity of initial depression scores? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The main finding from this meta-analysis is that antidepressant-placebo differences are inconsequential for mildly-to-moderately depressed patients and minimal for severely depressed patients. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) Trial
Authors: Gupta Nikhil , Chiles Catherine
Published: May 2018

This chapter provides a summary of a landmark study in psychiatry in primary care to mediate the effect of depression on overall health status . In the treatment of patients with major depression and coronary artery disease, what is the short-term efficacy of a selective serotonin reuptake inhibitor (citalopram) and/or interpersonal therapy? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Buprenorphine versus Methadone During Pregnancy
Authors: Wurmser Rachel , Wilkins Kirsten
Published: May 2018

This chapter provides a summary of a landmark study in women’s mental health. The study addresses the question of whether buprenorphine is an alternative treatment option to methadone for pregnant women with opioid use disorders. The chapter describes the basics of the study, including funding, location, population studied, study design, interventions, results, and limitations. In short, the study demonstrated that neonates born to mothers with opioid dependence taking buprenorphine during pregnancy required less morphine for the treatment of Neonatal Abstinence Syndrome (NAS), shorter periods of treatment for NAS, and shorter hospital stays compared with neonates born to mothers treated with methadone. The chapter briefly reviews other relevant literature and discusses implications. It concludes with a case to help the reader apply the study to clinical practice.
Tardive Dyskinesia with Atypical versus Conventional Antipsychotic Medications
Authors: Lo Emma , Tek Cenk
Published: May 2018

This chapter provides a summary of a landmark study on schizophrenia and specifically examines a common side effect of antipsychotic medications: tardive dyskinesia. How does the incidence of tardive dyskinesia compare among users of atypical and conventional antipsychotics? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Take home points include that the incidence of tardive dyskinesia was lower in the study group taking atypical antipsychotics than the group taking conventional antipsychotics, but not as low as previous studies had indicated.
Clozapine for Treatment-Resistant Schizophrenia
Authors: Lane Chadrick , Srihari Vinod H.
Published: May 2018

This chapter provides a summary of a landmark study on the pharmacologic management of treatment-resistant schizophrenia. This clinical trial, conducted by Kane and colleagues, asks whether clozapine is an effective option in the care of patients with treatment-resistant schizophrenia who have not responded to past trials of first-generation antipsychotics. To answer this question, the chapter reviews the basics of the study, including funding sources, study location, inclusion and exclusion criteria, number of participants, research design, interventions, follow-up, endpoints, results, criticisms, and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Effectiveness of Clozapine versus Other Atypical Antipsychotics
Authors: Yuen Eunice , Tek Cenk
Published: May 2018

This chapter provides a summary of a landmark study on adult patients with schizophrenia. Discussion here is based on the investigation from the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE). What is the role of clozapine among patients with chronic schizophrenia who fail to respond to atypical antipsychotics? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Cost Utility of Atypical Antipsychotics
Authors: Gupta Nikhil , Cahill John
Published: May 2018

This chapter provides a summary of a landmark study on schizophrenia. Are second-generation antipsychotics (SGAs) better than first-generation antipsychotics (FGAs) for individuals with schizophrenia needing an antipsychotic change? Additionally, are there improvements in quality of life and savings in health service use to justify the additional costs of SGAs over FGAs? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
A Cohort Study of Oral and Depot Antipsychotics after First Hospitalization for Schizophrenia
Authors: Ng Stephanie , Tek Cenk
Published: May 2018

This chapter provides a summary of a landmark study on schizophrenia. In patients hospitalized for the first time with a diagnosis of schizophrenia, what is the risk of rehospitalization, drug discontinuation, and total mortality? Also, which antipsychotics and routes of administration are most effective for maintenance after the first hospitalization for schizophrenia? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.