Comparison of trigger point injections versus traditional therapies in the management of post-surgical pain in patients who had anterior cervical surgery: A Retrospective Study

Introduction: The opioid epidemic has launched the United States into a public health crisis, resulting in a greater emphasis on non-opioid multimodal pain control methods. At our institution, postoperative posterior neck stiffness and myofascial pain is a common concern after anterior cervical discectomy and fusion or anterior cervical corpectomy with fusion surgery (hereinafter ACS), likely due to prolonged intraoperative positioning in neck extension. Studies have shown successful analgesic outcomes of trigger point injections with local anesthetic for generalized myofascial pain.1-2 This retrospective pilot study aimed to evaluate whether trigger point injections with bupivacaine decreases postsurgical pain compared with traditional therapies in patients undergoing ACS and thereby decrease the amount of opioid medication used. Methods: After IRB approval, we retrospectively reviewed medical records of all patients who received ACS from January 2019 to March 2020 at a single university hospital. We identified patients who received trigger point injections (TP) versus standard care (SC). We excluded patients if TP was performed \u3e3hr from surgery, in recovery for opioid use disorder, underwent a posterior approach, staged surgery, or sustained cervical trauma. The primary outcomes were pain control through the Visual Analog Scale (VAS) and calculated oral morphine equivalents (OME) taken at 6, 12, and 24 hours post-operatively. Secondary outcomes included length of stay (LOS). Results: 137 patients received anterior cervical surgery (100 SC, 37 TP), 62 were excluded. A total of 75 (47 SC, 28 TP) patients were included in this study. The average OME at 6 hours significantly decreased when comparing SC vs TP (32 vs 22, p=0.025). There was no significant difference in average VAS at all time points and average OME at 12 and 24 hours (Table 1). 50% of patients were discharged by 18 hours. Discussion: Our results suggest that TP with bupivacaine significantly reduce opioid consumption within 6 hours of the postoperative period, without increasing overall pain level. There is an opportunity for TP to be included in non-opioid multimodal pain regimens for postoperative myofascial neck pain, especially during the opioid crisis. Limitations of this retrospective study were the small number of study participants, that many patients were discharged before 18 hours and some may have been on chronic pain therapy. The identified limitations will help inform our future investigations and design a prospective randomized control study

Dusty Wind-Blown Bubbles

Spurred by recent observations of 24 micron emission within wind-blown bubbles, we study the role that dust can play in such environments, and build an approximate model of a particular wind-blown bubble, `N49.' First, we model the observations with a dusty wind-blown bubble, and then ask whether dust could survive within N49 to its present age (estimated to be 5x10^5 to 10^6 years). We find that dust sputtering and especially dust-gas friction would imply relatively short timescales (t ~ 10^4 years) for dust survival in the wind-shocked region of the bubble. To explain the 24 micron emission, we postulate that the grains are replenished within the wind-blown bubble by destruction of embedded, dense cloudlets of ISM gas that have been over-run by the expanding wind-blown bubble. We calculate the ablation timescales for cloudlets within N49 and find approximate parameters for the embedded cloudlets that can replenish the dust; the parameters for the cloudlets are roughly similar to those observed in other nebula. Such dust will have an important effect on the bubble: including simple dust cooling in a wind-blown bubble model for N49, we find that the luminosity is higher by approximately a factor of six at a bubble age of about 10^4 years. At ages of 10^7 years, the energy contained in the bubble is lower by about a factor of eight if dust is included; if dust must be replenished within the bubble, the associated accompanying gas mass will also be very important to wind-blown bubble cooling and evolution. While more detailed models are certainly called for, this work illustrates the possible strong importance of dust in wind-blown bubbles, and is a first step toward models of dusty, wind-blown bubbles.Comment: 13 pages, 14 figures, Accepted to Ap

Z_2 Symmetry Prediction for the Leptonic Dirac CP Phase

Model-independent consequences of applying a generalized hidden horizontal Z_2 symmetry to the neutrino mass matrix are explored. The Dirac CP phase delta_D can be expressed in terms of the three mixing angles as 4 c_a s_a c_s s_s s_x cos delta_D = (s^2_s - c^2_s s^2_x) (c^2_a - s^2_a) where the s_i, c_i are sines and cosines of the atmospheric, solar, and reactor angles. This relation is independent of neutrino masses and whether neutrinos are Dirac- or Majorana-type. Given the present constraints on the angles, delta_D is constrained to be almost maximal, a result which can be explored in experiments such as NOvA and T2K. The Majorana CP phases do not receive any constraint and are thus model-dependent. Also a distribution of theta_x with a lower limit is obtained without specifying delta_D.Comment: 5 pages, 4 figures; Condensed version or PLB with references added; for more details see the previous versio

Lambda Equals 2.4 - 5 Micron Spectroscopy with the JWST NIRCam Instrument

The James Webb Space Telescope near-infrared camera (JWST NIRCam) has two 2'2 x 2'2 fields of view that can be observed with either imaging or spectroscopic modes. Either of two R ~1500 grisms with orthogonal dispersion directions can be used for slitless spectroscopy over lambda = 2.4 - 5.0 microns in each module, and shorter wavelength observations of the same fields can be obtained simultaneously. We describe the design drivers and parameters of the grisms and present the latest predicted spectroscopic sensitivities, saturation limits, resolving powers, and wavelength coverage values. Simultaneous short wavelength (0.6 -- 2.3 microns) imaging observations of the 2.4 -- 5.0 microns spectroscopic field can be performed in one of several different filter bands, either in-focus or defocused via weak lenses internal to NIRCam. The grisms are available for single-object time series spectroscopy and wide-field multi-object slitless spectroscopy modes in the first cycle of JWST observations. We present and discuss operational considerations including subarray sizes and data volume limits. Potential scientific uses of the grisms are illustrated with simulated observations of deep extragalactic fields, dark clouds, and transiting exoplanets. Information needed to plan observations using these spectroscopic modes are also provided

Lambda = 2.4 - 5 Micron Spectroscopy With the James Webb Space Telescope NIRCam Instrument

The James Webb Space Telescope near-infrared camera (JWST NIRCam) has two 2.2' x 2.2' fields of view that can be observed with either imaging or spectroscopic modes. Either of two R 1500 grisms with orthogonal dispersion directions can be used for slitless spectroscopy over 2.4 - 5.0 microns wavelength in each module, and shorter wavelength observations of the same fields can be obtained simultaneously. We describe the design drivers and parameters of the grisms and present the latest predicted spectroscopic sensitivities, saturation limits, resolving powers, and wavelength coverage values. Simultaneous short wavelength (0.6 -- 2.3 microns) imaging observations of the 2.4 -- 5.0 microns spectroscopic field can be performed in one of several different filter bands, either in-focus or defocused via weak lenses internal to NIRCam. The grisms are available for single-object time series spectroscopy and wide-field multi-object slitless spectroscopy modes in the first cycle of JWST observations. Potential scientific uses of the grisms are illustrated with simulated observations of deep extragalactic fields, dark clouds, and transiting exoplanets. Information needed to plan observations using these spectroscopic modes are also provided

Lambda = 2.4 to 5 Micron Spectroscopy with the James Webb Space Telescope NIRCam Instrument

The James Webb Space Telescope near-infrared camera (JWST NIRCam) has two 2'2 x 2'2 fields of view that can be observed with either imaging or spectroscopic modes. Either of two R approx.1500 grisms with orthogonal dispersion directions can be used for slitless spectroscopy over lambda = 2.4 - 5.0 microns in each module, and shorter wavelength observations of the same fields can be obtained simultaneously. We describe the design drivers and parameters of the grisms and present the latest predicted spectroscopic sensitivities, saturation limits, resolving powers, and wavelength coverage values. Simultaneous short wavelength (0.6 - 2.3 microns) imaging observations of the 2.4 - 5.0 microns spectroscopic field can be performed in one of several different filter bands, either in-focus or defocused via weak lenses internal to NIRCam. The grisms are available for single-object time series spectroscopy and wide-field multi-object slitless spectroscopy modes in the first cycle of JWST observations. We present and discuss operational considerations including subarray sizes and data volume limits. Potential scientific uses of the grisms are illustrated with simulated observations of deep extragalactic fields, dark clouds, and transiting exoplanets. Information needed to plan observations using these spectroscopic modes are also provided

GSH 91.5+2-114: A large HI shell in the outer part of the Galaxy

GSH91.5+2-114 is a large HI shell located in the outer Galaxy at a kinematic distance of about 15 kpc. It was first identified in the Canadian Galactic Plane Survey (CGPS) by Pineault et al. (2002) as being possibly associated with objects possessing infrared colors which indicates strong stellar winds. The HI shell has no obvious continuum counterpart in the CGPS radio images at 408 and 1420 MHz or in the IRAS images. We found no evidence for early-type massive stars, most likely as a result of the large extinction that is expected for this large distance. An analysis of the energetics and of the main physical parameters of the HI shell shows that this shell is likely the result of the combined action of the stellar winds and supernova explosions of many stars. We investigate whether a number of slightly extended regions characterized by a thermal radio continuum and located near the periphery of the HI shell could be the result of star formation triggered by the expanding shell.Comment: Accepted for publication in A&A, October 2010. Some figures were degraded to reduce file siz

Systematic search for successful lepton mixing patterns with nonzero theta_13

We perform a systematic search for simple but viable lepton mixing patterns. Our main criterion is that the mixing matrix can be parameterized by three rotation angles, which are simple fractions of pi. These simple rotation angles possess exact expressions for their sines and cosines, and often arise in the flavor symmetry models. All possible parameterizations of the mixing matrix are taken into account. In total, twenty successful mixing patterns are found to be consistent with the latest neutrino oscillation data (including the recent T2K results) in the CP conserving case, whereas fifteen mixing patterns are allowed in the maximal CP violating case. Potential radiative corrections to the constant mixing patterns are also calculated by solving the renormalization group equations.Comment: 10 pages, 4 figures, 2 tables; version to be published in Nuclear Physics