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He Ma,1,2 Juan Perez,2 Julia Bertsch,2 Marissa L Albanese,2 Elizabeth G Korn,2 Ariel Mueller,2 Timothy Houle,2 Briana June Burris,3 Joseph McCain,3 Jingping Wang2 1Department of Anesthesiology, the Second Hospital of Jilin University, Changchun, People’s Republic of China; 2Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 3Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Jingping Wang, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 420, Boston, MA, 02214, USA, Tel +1 (617) 643 2729, Email jwang23@MGH.Harvard.eduBackground: Pain intensity after temporomandibular joint (TMJ) surgery is often underestimated, and inadequate pain control may relate to poor recovery quality, increased opioid consumption, and longer hospital stay. This trial aims to evaluate whether non-opiate anesthesia provides a promising option of pain management for patients undergoing TMJ surgery.Methods: Sixty patients receiving TMJ surgery were randomly assigned to either the control group or the non-opiate group. Non-opiate anesthesia used lidocaine, dexmedetomidine, and ketamine infusion therapy for pain management. The primary outcome was the highest documented pain score while in the post-anesthesia care unit (PACU). Secondary outcomes included perioperative opioid consumption, utilization, dosage, and timing of rescue analgesia in the PACU, incidence of postoperative nausea and vomiting in the PACU and at home, pain satisfaction levels, occurrence of opioid-related adverse effects, duration of PACU and hospital stays, and total consumption of oxycodone-acetaminophen tablets at 24 and 48 hours post-surgery.Results: Patients were predominantly female (88.3%) and had a median age of 37.5 [IQR 26.0, 52.5] years. There were no significant differences observed in the highest documented pain scores (mean difference [MD] − 0.36 points, 95% CI: − 1.84, 1.12, p = 0.63), postoperative oxycodone-acetaminophen consumption (MD 6.68 mg, 95% CI: − 2.48, 15.84, p = 0.15), pain satisfaction (odds ratio [OR] 0.81, 95% CI: 0.23, 2.81, p = 0.74), time to PACU discharge (hazard ratio [HR] 1.24, 95% CI: 0.67, 2.30, p = 0.49) or time to hospital discharge (HR 1.48, 95% CI: 0.80, 2.75, p = 0.21) between the two groups. Similarly, no significant difference was observed in time to rescue analgesia, calculated in minutes from the end of surgery (HR 1.69, 95% CI: 0.79, 3.61, p = 0.18).Conclusion: Non-opiate anesthesia for pain management shows a similar postoperative analgesia effect, compared to opioid-based anesthesia, in patients undergoing arthroscopic TMJ surgery.Keywords: non-opiate, anesthesia, temporomandibular joint disorders, temporomandibular joint, surgery

Summary: Reversing neuromuscular blockade with sugammadex can eliminate residual paralysis, which has been associated with postoperative respiratory complications. There are equivocal data on whether sugammadex reduces these when compared with neostigmine. We investigated the association of the choice of reversal drug with postoperative respiratory complications and advanced healthcare utilisation. We included adult patients who underwent surgery and received general anaesthesia with sugammadex or neostigmine reversal at two academic healthcare networks between January 2016 and June 2021. The primary outcome was postoperative respiratory complications, defined as post‐extubation oxygen saturation < 90%, respiratory failure requiring non‐invasive ventilation, or tracheal re‐intubation within 7 days. Our main secondary outcome was advanced healthcare utilisation, a composite outcome including: 7‐day unplanned intensive care unit admission; 30‐day hospital readmission; or non‐home discharge. In total, 5746 (6.9%) of 83,250 included patients experienced postoperative respiratory complications. This was not associated with the reversal drug (adjusted OR (95%CI) 1.01 (0.94–1.08); p = 0.76). After excluding patients admitted from skilled nursing facilities, 8372 (10.5%) patients required advanced healthcare utilisation, which was not associated with the choice of reversal (adjusted OR (95%CI) 0.95 (0.89–1.01); p = 0.11). Equivalence testing supported an equivalent effect size of sugammadex and neostigmine on both outcomes, and neostigmine was non‐inferior to sugammadex with regard to postoperative respiratory complications or advanced healthcare utilisation. Finally, there was no association between the reversal drug and major adverse cardiovascular events (adjusted OR 1.07 (0.94–1.21); p = 0.32). Compared with neostigmine, reversal of neuromuscular blockade with sugammadex was not associated with a reduction in postoperative respiratory complications or post‐procedural advanced healthcare utilisation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with chronic migraine and chronic daily headache syndromes have greater morbidity than patients with episodic migraine, and are less frequently diagnosed. A screening tool which identifies daily headache syndromes as well as migraine would promote more patients receiving appropriate treatment, including prophylaxis. METHODS: A post-hoc analysis of data obtained to evaluate the prevalence of somatic symptoms in primary care patients was conducted on a convenience sample of primary care patients who completed the Patient Health Questionnaire portion of the PRIME-MD (Primary Care Evaluation of Mental Disorders). Patients who endorsed the symptom of headache were asked to complete the Brief Headache Screen (BHS), a 4-item screening tool, supplemented by 3 clinical questions (nausea, light sensitivity, and noise sensitivity). The data obtained allowed a post-hoc comparison of the BHS with a modified version of the screening tool, IDMigraine(TM) (IDM(TM)). Diagnostic interviews were performed on patients whose diagnoses differed by the 2 screening methods, and on patients who screened positive for daily headache on BHS. RESULTS: Of the 1000 patients who completed the PRIME-MD, 302 (30.2%) indicated headache as a concern, and there were sufficient data for both the BHS and IDM(TM) for 259. There was substantial concordance between the 2 instruments with 82.6% agreement in identified migraine (95% confidence interval: 77.8%-87.4%). The BHS screened positive for migraine in an additional 15.1% of patients who were not identified by IDM(TM), whereas the IDM(TM) identified an additional 2.3% of patients. Of the 173 which both tools recognized as migraine, the BHS identified 42.8% as having a daily headache syndrome (chronic migraine: 23.1%; episodic migraine + chronic tension-type headache [CTTH]: 19.7%). BHS also identified 7 non-migraine patients as having CTTH alone. Diagnostic interviews confirmed that 6/18 (33%) of BHS+ but IDM-, and one of 2 (50%) patients BHS-/IDM+ met full criteria for migraine. Additionally, interviews confirmed the diagnoses of 85.4% of those patients who the BHS identified with daily headache and 67% of those who were identified as medication overuse headache. CONCLUSION: The BHS and a modified IDM(TM) are concordant in screening for migraine in 82.6% of a primary care population who endorsed the symptom of headache. However, the BHS screens effectively not only for migraine but also for chronic daily headache and medication overuse. A screening paradigm based on headache frequency and the frequency of medication use can rapidly and sensitively identify migraine, daily headache syndromes, and medication overuse. This paradigm may improve clinical care by identifying patients who merit preventive as well as acute therapy for migraine. [ABSTRACT FROM AUTHOR]

In this special section, the concept of stress has been linked to the chronification of headache and is considered to be one of several likely mechanisms for the progression of an otherwise episodic disorder to a chronic daily phenomenon. The present review discusses the concept of stress and describes the mechanisms through which stress could influence headache progression. The hypothesized mechanisms include stress serving as a unique trigger for individual attacks, as a nociceptive activator, and as a moderator of other mechanisms. Finally, the techniques used in the screening and management of stress are mentioned in the context of employing strategies for the primary, secondary, or tertiary prevention of headache progression. [ABSTRACT FROM AUTHOR]

The integration of a vertical cavity surface emitting laser (VCSEL) and a photodiode with two microstrip antennas results in low-cost wireless-optical transmitter and receiver modules and the initial microwave-link results are shown. The VCSEL antenna is used as part of a fully bidirectional wireless-optical link and data are successfully transferred between two wireless-enabled laptops. © 2005 Wiley Periodicals, Inc. Microwave Opt Technol Lett 48: 233–237, 2006; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.21315 [ABSTRACT FROM AUTHOR]

The potential of 1.3-μm AlGaInAs quantum-well (MQW) laser diodes for uncooled operation in high-speed optical communication systems is experimentally evaluated by characterizing the temperature dependence of key parameters such as the threshold current, transparency current density, optical gain and carrier lifetime. Detailed measurements performed in the 20°C-100°C temperature range indicate a localized T0 value of 68 K at 98°C for a device with a 208 μm ridge width and 700μm cavity length. The transparency current density is measured for temperatures from 20°C to 60°C and found to increase at a rate of 7.7 A.cm-2 · °C-1. Optical gain characterizations show that the peak model gain at threshold is independent of temperature, whereas the differential gain decreases linearly with temperature, whereas the differential gain decreases linearly with temperature at a rate of 3 × 10-4 A-1 · °C-1. The differential carrier lifetime is determined from electrical impedance measurements and found to decrease with temperature. From the measured carrier lifetime we derive the monomolecular (A), radiative (B), and nonradiative Auger (C) recombination coefficients and determine their temperature dependence in the 20°C-80°C range. Our study shows that A is temperature independent, B decreases with temperature. The experimental observations are discussed and compared with theoretical predictions and measurements performed on other material systems. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most studies of risk factors for alcohol-related problems have focused on biological family history as a primary risk factor. However, other factors, such as early-age heavy drinking, are also risk factors for sustained or progressive heavy consumption. Little is currently known about the mechanisms underlying binge or heavy drinking. METHODS: This study examined the acute subjective and objective effects of ethanol in heavy drinkers versus light drinkers. Thirty-four subjects participated in this within-subjects study consisting of three early-evening testing sessions in which subjects consumed a beverage containing either 0.8 or 0.4 g/kg ethanol or placebo. RESULTS: Compared with lighter drinkers, heavy drinkers were more sensitive to the positive stimulant-like effects of ethanol (p < 0.05), especially during the increasing limb of the blood alcohol curve. Heavy drinkers also showed less sedation and cortisol response after alcohol than the light drinkers (p < 0.05). CONCLUSIONS: The results indicate that young adult binge drinkers show a biphasic alcohol response, with heightened sensitivity to stimulant-like alcohol effects and greater tolerance to sedative alcohol effects compared with their light-drinking counterparts. [ABSTRACT FROM AUTHOR]

Objective: Nicotine and caffeine are vasoconstrictors. Complex regional pain syndrome (CRPS) is defined to involve disproportionate pain and autonomic dysfunction [1]. The objectives of this study were to identify the prevalence of smoking and caffeine intake in CRPS, to explore the relationship of pain intensity with smoking and caffeine consumption, and to explore the relationship of pain intensity, anxiety and disability among CRPS patients who smoke, use caffeine, or both.Design: One hundred eleven patients, with CRPS type I or II, from two academic rehabilitation pain clinics were reviewed. Data were collected retrospectively by reviewing CRPS patients' self-reported pain level using visual analogue scales (VAS), Beck Depression Inventory (BDI), Pain Disability Index (PDI), and Pain Anxiety Symptoms Scale (PASS). Status of daily smoking and caffeine consumption were also recorded.Results: Smoking prevalence among CRPS was significant higher than the national average (p < 0.001). There were no significant relationships between the perceived pain level and either daily smoking, daily caffeine intake, or both (p > 0.430). In patients with CRPS I higher PASS scores were positively associated with dichotomous use of smoking and caffeine (p < 0.05). The PASS scores among patients with CRPS II were not available for analysis.Conclusions: The smoking prevalence was higher than the national average among patients with CRPS I and II. Among patients with CRPS I smoking and caffeine consumption were greater in those who reported more pain-related anxiety, but did not influence pain intensity. The clinical implications of these findings will be discussed. [ABSTRACT FROM AUTHOR]