Unlike a simple network with just nodes and edges in between them, the real-world networks can contain much more, such as a set of attributes associated with every node in the network. These networks ...opened up a new avenue in community detection called attributed graph clustering (AGC). Furthermore, the clusters in real-world are not usually disjoint, as compared to most of the work that has been carried out in the field of AGC. This raises a need for AGC with fuzzy clusters. In this work, we try to comprehend the problem of attributed graph clustering with the help of a game-theoretic approach called dynamic cluster formation game (DCFG). To address the possibility of fuzzy clusters in a network, we model the problem of AGC as a series of coupled games involving mixed strategies, in contrast to the previous work that was primarily focused on pure strategy equilibrium. We discuss the convergence of the proposed game and the existence of Nash equilibrium at convergence. We also propose a clustering algorithm which uses a game-theoretic approach to partition a network into fuzzy clusters, giving a solution balanced in terms of topology and node attributes. We compare the the results of our work to the state-of-the-art clustering methods available in the literature.
Panoramic X-ray images are the major source used in field of dental image segmentation. However, such images suffers from the disturbances like low contrast, presence of jaw bones, nose bones, spinal ...bone, and artifacts. Thus, to observe these images manually is a tedious task, requires expertise of dentist and is time consuming. Hence, there is need to develop an automated tool for teeth segmentation. Recently, few deep models have been developed for dental image segmentation. But, such models possess large number of training parameters, thus making the segmentation a very complex task. Also, these models are based only on conventional CNN and lacks in exploiting multimodal CNN features for dental image segmentation. Thus, to address these issues, a novel encoder-decoder model based on multimodal-feature extraction for automatic segmentation of teeth area is proposed. The encoder has three different CNN based architectures: conventional CNN, atrous-CNN, and separable CNN to encode rich contextual information. Whereas decoder contains a single stream of deconvolutional layers for segmentation. The proposed model is tested on 1500 panoramic X-ray images and uses very less parameters when compared to state-of-the-art methods. Besides this, the precision and recall are 95.01% and 94.06%, which out performs the state-of-the art methods.
Intraoperative mortality is now rare, but death within 30 days of surgery remains surprisingly common. Perioperative myocardial infarction is associated with a remarkably high mortality. There are ...strong associations between hypotension and myocardial injury, myocardial infarction, renal injury, and death. Perioperative arterial blood pressure management was thus the basis of a Perioperative Quality Initiative consensus-building conference held in London in July 2017.
The meeting featured a modified Delphi process in which groups addressed various aspects of perioperative arterial pressure.
Three consensus statements on intraoperative blood pressure were established. 1) Intraoperative mean arterial pressures below 60–70 mm Hg are associated with myocardial injury, acute kidney injury, and death. Injury is a function of hypotension severity and duration. 2) For adult non-cardiac surgical patients, there is insufficient evidence to recommend a general upper limit of arterial pressure at which therapy should be initiated, although pressures above 160 mm Hg have been associated with myocardial injury and infarction. 3) During cardiac surgery, intraoperative systolic arterial pressure above 140 mm Hg is associated with increased 30 day mortality. Injury is a function of arterial pressure severity and duration.
There is increasing evidence that even brief durations of systolic arterial pressure <100 mm Hg and mean arterial pressure <60–70 mm Hg are harmful during non-cardiac surgery.
Purpose of Review
Topical analgesics are a non-opioid option for the treatment of chronic pain conditions including neuropathic pain, musculoskeletal pain, and osteoarthritis. There are many topical ...medications available; however their efficacy is variable. This article reviews the various topical analgesics, their mechanisms of action, and their efficacy.
Recent Findings
Studies have found topical NSAIDs are useful in treating acute musculoskeletal pain syndromes (strains and sprains) and show some efficacy in treating hand and knee osteoarthritis (Derry et al. Cochrane Database Syst Rev 5:CD008609,
2017
). Topical capsaicin 8% has been shown to be efficacious in the treatment of postherpetic neuralgia, painful diabetic peripheral neuropathy, and HIV-neuropathy (Derry et al. Cochrane Database Syst Rev 1:CD007393,
2017
). Topical lidocaine has been widely studied and found to reduce pain in patients with postherpetic neuralgia (Knezevic et al. Pain Manag 7:537–58,
2017
). Although many other topical analgesics are available, there is limited data to support the efficacy of other agents.
Summary
Topical analgesics are a relatively benign treatment for chronic pain conditions including neuropathic pain, musculoskeletal, and myofascial pain. There is evidence to support the use of topical NSAIDs, high concentration topical capsaicin, and topical lidocaine for various painful conditions.
Relaxation rate dispersion, i.e., nonexponential or multicomponent kinetics, is observed in complex systems when measuring relaxation kinetics. Often, the origin of rate dispersion is associated with ...the heterogeneity in the system. However, both homogeneous (where all molecules experience the same rate but inherently nonexponential) and heterogeneous (where all molecules experience different rates) systems can exhibit rate dispersion. A multidimensional correlation analysis method has been demonstrated to detect and quantify rate dispersion observed in molecular rotation, diffusion, solvation, and reaction kinetics. One-dimensional (1D) autocorrelation function detects rate dispersion and measures its extent. Two-dimensional (2D) autocorrelation function measures the origin of rate dispersion and distinguishes homogeneous from heterogeneous. In a heterogeneous system, implicitly there exist subensembles of molecules experiencing different rates. A three-dimensional (3D) autocorrelation function measures subensemble exchange if present and reveals if the system possesses static or dynamic heterogeneity. This perspective discusses the principles, applications, and potential and also presents a future outlook of two-dimensional fluctuation correlation spectroscopy (2D-FlucCS). The method is applicable to any experiment or simulation where a time series of fluctuation in an observable (emission, scattering, current, etc.) around a mean value can be obtained in steady state (equilibrium or nonequilibrium), provided the system is ergodic.
Background
Chronic pain exerts a significant physical, emotional, and socioeconomic toll on millions of patients worldwide. Traditional pharmacological interventions are often inadequate in providing ...lasting and effective pain relief for patients suffering from severe chronic pain. However, in recent years, intravenous ketamine infusion therapy has emerged as a promising and alternative treatment modality. The effectiveness of intravenous ketamine infusion therapy in treating chronic pain has been investigated in various pain conditions, such as neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS), and phantom limb pain. However, varied patient demographics, different endpoints for measuring analgesia, and inconsistent numbers of patients in studies have led to conflicting results. The objective of the present inquiry is to undertake a contemporary updated meta‐analysis of the application of IV ketamine infusion therapy in the context of persistent pain.
Methods
A search was conducted, adhering to the PRISMA guidelines, to compare the efficacy of IV Ketamine infusion versus control (placebo, midazolam, gabapentin, hydromorphone, and pregabalin) among individuals with chronic pain. During the analysis, Medline, Cochrane, and Embase were thoroughly searched. Two independent investigators identified randomized double‐blind and non‐randomized trials comparing IV Ketamine infusions with controls. Review Manager 5.4.1 was used to scrutinize the data, with the main focus on pain scores. Secondary outcomes such as quality of sleep, as well as side effects such as nausea, hallucinations, and sedation, were also analyzed. Sixteen studies were included involving 1080 patients.
Results
The pain score was significantly reduced by IV Ketamine (Mean difference −1.05; 95% CI −1.72, −0.39; p = 0.002), while the quality of sleep (Mean difference 0.00; 95% CI −0.12, 0.12; p = 1.00) was not significantly different between studies. Nausea (risk ratio 1.42; 95% CI 0.84, 2.39; p = 0.19), hallucinations (risk ratio 1.08; 95% CI 0.67, 1.76; p = 0.75), and sedation (risk ratio 1.05; 95% CI 0.24, 4.54; p = 0.95) outcomes were not significantly different among the studies.
Conclusions
Our meta‐analysis indicates that IV Ketamine infusion is efficacious and safe in patients with chronic pain.
This meta‐analysis examined the efficacy and safety of intravenous ketamine infusion for chronic pain. Results indicated that ketamine significantly reduced pain scores compared with control interventions, with a moderate effect size. Adverse effects such as hallucinations, nausea, and sedation were not significantly higher. Subanesthetic doses of ketamine were found to provide analgesia with an acceptable side effect profile. Further research is needed on dosing protocols, but ketamine seems promising for refractory chronic pain when used with caution.
Purpose of Review
Complex regional pain syndrome (CRPS) is a debilitating pain condition that often requires a multidisciplinary approach including medication, physical therapy, occupational therapy, ...psychological therapy, and interventional procedures to restore the patient’s quality of life. This article reviews the interventional treatments for pain resulting from CRPS.
Recent Findings
Sympathetic nerve blocks (stellate ganglion and lumbar sympathetic) are the first-line interventional treatment options for patients with CRPS of the upper and lower extremities, respectively. Fluoroscopic techniques for lumbar sympathetic blocks have not significantly changed throughout the years. However, both novel fluoroscopic and ultrasound approaches to stellate ganglion blockade have arisen. In addition, novel neuromodulation therapies to treat CRPS have been developed to include new waveforms with dorsal column stimulation and entirely new nerve targets such as dorsal root ganglion stimulation.
Summary
This paper will review the latest interventional treatment options available for the treatment of CRPS.
Intravenous (IV) ketamine has demonstrable efficacy for chronic pain management. Its use in an outpatient setting has provided relief from myriad pain syndromes and additionally may reduce dependence ...on opioids. Nevertheless, its long-term ability to provide these benefits is understudied. Here, we present the case of a 68-year-old female who presented to our clinic with persistent fibromyalgia, accompanied by other pain symptoms that had been recalcitrant to traditional pain management therapy including nerve blocks, ablations, spinal cord stimulation, and morphine medication. We administered seven increasing IV ketamine doses over two weeks. The patient reported significant, widespread pain relief. The patient continued to receive IV ketamine twice weekly for over a year and remains on this schedule. Pain relief has persisted under this regimen, along with a demonstrable improvement in quality of life, a reduced use of morphine, and the cessation of anti-depressant medication. This case indicates that long-term ketamine infusions show promise for chronic pain management and that more longitudinal studies on this treatment are warranted.
Epiretinal membranes (ERMs) typically remain stable or progressively worsen. Here, we report two rare cases of spontaneous ERM regression and one case of ERM separation. This is a case series of ...three patients. The patients’ clinical data were collected and ERMs were evaluated with serial optical coherence tomographies (OCTs).Cases one and two were female patients presenting with floaters. Mild-to-moderate idiopathic ERM was diagnosed which spontaneously regressed over the following years without intervention and evidence of separation. Patients’ vision was slightly decreased or remained stable, respectively. Case three was a female patient presenting with blurry vision. A mild ERM was diagnosed with vitreomacular traction (VMT) and a tiny macular hole. Over the following three months, ERM separation along with VMT release was evidenced on OCT. The macular hole healed simultaneously. Her vision improved from 20/70 to 20/30.The possibility of spontaneous regression of idiopathic ERMs should be a factor to consider in management. Further research must be done to determine the mechanism of this phenomenon.
Introduction
Fibromyalgia is a complex disorder characterized by distributed and persistent pain often associated with fatigue and depression. The underlying causal agents of this dysfunction are not ...clear. Ketamine has been used to treat chronic pain in a variety of pain syndromes, including fibromyalgia, but the dosing protocols used are neither standardized nor consistent across cases. The current case presents an opportunity to contribute to a progression towards a consensus on ketamine dosing for fibromyalgia.
Case Presentation
A 60-year-old female presented with indications of fibromyalgia and was administered a 9-session IV ketamine treatment for pain. The initial dosing was 50 mg, with a concentration of 1.0 mg/ml at an infusion rate of 0.8 mg/kg/hr. This was increased to 200 mg and eventually to 240 mg, maintaining a ketamine concentration 4.0–4.8 mg/ml at an infusion rate of 1.5 mg/kg/hr.
Management and Outcomes
Following the first 9-session therapy, the patient reported >50% pain relief from pre-infusion levels and was placed on a maintenance regimen in perpetuity. This regimen involves two monthly IV ketamine infusions, one day apart for two hours at a maintenance rate of 4.8 mg/kg/hr.
Conclusion
Ketamine by IV is an effective option for pain management in patients with fibromyalgia. Compared to previous case studies, it is recommended that increased total dose, frequent administration, and longer duration of infusions all may be necessary for ketamine to maximize its beneficial effects.
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