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Purpose Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND. Methods Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5- 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger's State-Trait-Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥10, whereas the secondary outcome was a continuous variable on increases in EPDS score. Results Probable PND (EPDS ≥10) occurred in 10.5% (95% CI 8.0%-13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15-0.57; p=0.0008), but did not meet significance for increased risk of probable PND (p=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted β estimate 0.24, 95% CI 0.02-0.46; p=0.0306) and lower BMI at term (adjusted β estimate -0.04, 95% CI -0.07 to -0.01; p=0.0055) were associated with increased postdelivery EPDS scores. Conclusion No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.

The vortex radio wave carrying orbital angular momentum (OAM) can potentially be exploited to achieve azimuthal super-resolution for target identification and radar imaging realms. A two-dimensional (2D) imaging method for OAM-based radar is presented in this paper. Based on the incrementally phased uniform circular antenna (UCA) arrays, the generation method and the echo signal model of OAM beams for radar imaging are established firstly. Subsequently, the multiple signal classification (MUSIC) algorithm is carried out to realize the 2D joint detection of the multi-target in the elevation and azimuth domain. Compared with the existing OAM-based radar target azimuth imaging, this proposed method can readily achieve 2D joint imaging of target’s elevation and azimuth simultaneously without increasing the cost of hardware. The work and results provide suggestions to the design of OAM-based 2D radar systems.

The effect of chronic insomnia carries along a physical and psychological state of dysfunctionality felt by the individual. The purpose of the study was to investigate the effects of hypnotherapeutic intervention applied in the case of patients who present insomnia accompanied by rumination. We performed the study of 42 patients who underwent the Symptom Checklist-90 (SCL-90) for the psychiatric evaluation and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality at baseline, 1 month after the program and follow-up (2 months) after finalizing the program. Our findings revealed that hypnotherapeutic intervention that involves relaxation and positive self-suggestion leads to positive results among the patient who experience insomnia accompanied by rumination.

Background Childbirth may cause the most severe pain some women experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour and is considered to be the reference standard. Traditionally epidural analgesia has been delivered as a continuous infusion via a catheter in the epidural space, with or without the ability for the patient to supplement the analgesia received by activating a programmable pump to deliver additional top-up doses, known as patient-controlled epidural analgesia (PCEA). There has been interest in delivering maintenance analgesic medication via bolus dosing (automated mandatory bolus - AMB) instead of the traditional continuous basal infusion (BI); recent randomized controlled trials (RCTs) have shown that the AMB technique leads to improved analgesia and maternal satisfaction. Objectives To assess the effects of automated mandatory bolus versus basal infusion for maintaining epidural analgesia in labour. Search methods We searched CENTRAL, MEDLINE, Embase, the World Health Organization International Clinial Trials Registry Platform (WHO-ICTRP) and ClinicalTrials.gov on 16 January 2018. We screened the reference lists of all eligible trials and reviews. We also contacted authors of included studies in this field in order to identify unpublished research and trials still underway, and we screened the reference lists of the included articles for potentially relevant articles. Selection criteria We included all RCTs that compared the use of bolus dosing AMB with continuous BI for providing pain relief during epidural analgesia for labour in women. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Our primary outcomes were: risk of breakthrough pain with the need for anaesthetic intervention; risk of caesarean delivery; risk of instrumental delivery. Secondary outcomes included: duration of labour; local anaesthetic consumption. We used GRADE to assess the certainty of evidence for each outcome. Main results We included 12 studies with a total of 1121 women. Ten studies enrolled healthy nulliparous women only and two studies enrolled healthy parous women at term as well. All studies excluded women with complicated pregnancies. There were variations in the technique of initiation of epidural analgesia. Seven studies utilized the combined spinal epidural (CSE) technique, and the other five studies only placed an epidural catheter without any intrathecal injection. Seven studies utilized ropivacaine: six with fentanyl and one with sufentanil. Two studies used levobupivacaine: one with sufentanil and one with fentanyl. Three used bupivacaine with or without fentanyl. The overall risk of bias of the studies was low. AMB probably reduces the risk of breakthrough pain compared with BI for maintaining epidural analgesia for labour (from 33% to 20%; risk ratio (RR) 0.60; 95% confidence interval (CI) 0.39 to 0.92, 10 studies, 797 women, moderate-certainty evidence). AMB may make little or no difference to the risk of caesarean delivery compared to BI (15% and 16% respectively; RR 0.92; 95% CI 0.70 to 1.21, 11 studies, 1079 women, low-certainty evidence). AMB may make little or no difference in the risk of instrumental delivery compared to BI (12% and 9% respectively; RR 0.75; 95% CI 0.54 to 1.06, 11 studies, 1079 women, low-certainty evidence). There is probably little or no difference in the mean duration of labour with AMB compared to BI (mean difference (MD) −10.38 min; 95% CI −26.73 to 5.96, 11 studies, 1079 women, moderate-certainty evidence). There is probably a reduction in the hourly consumption of local anaesthetic with AMB compared to BI for maintaining epidural analgesia during labour (MD −1.08 mg/h; 95% CI −1.78 to −0.38, 12 studies, 1121 women, moderate-certainty evidence). Five out of seven studies reported an increase in maternal satisfaction with AMB compared to BI for maintaining epidural analgesia for labour; however, we did not pool these data due to their ordinal nature. Seven studies reported Apgar scores, though there was significant heterogeneity in reporting. None of the studies showed any significant difference between Apgar scores between groups. Authors' conclusions There is predominantly moderate-certainty evidence that AMB is similar to BI for maintaining epidural analgesia for labour for all measured outcomes and may have the benefit of decreasing the risk of breakthrough pain and improving maternal satisfaction while decreasing the amount of local anaesthetic needed.

Carotid body tumors (CBT) are rare neuroendocrine neoplasms that usually present in the third or fourth decades of life and are benign in more than 95% of cases. In the angiographic literature, the arterial supply to carotid body tumors is well documented but is often incomplete, with infrequent mention of the glomic artery, a common arterial feeder described in the anatomic and pathologic literature. Through a review of our neuroendovascular patient database, we identified eight patients with CBT undergoing transarterial embolization followed by resection. Mean patient age was 51.5 years (range 29-82), and all patients were female. Mean tumor size was 91.2 cc (standard deviation [SD] 61.1, median 67.7 cc). After embolization, greater than 90% flow reduction was achieved in 5/8 patients (63%); 60-80% flow reduction was achieved in the remaining patients. Mean operative blood loss was 166 cc (SD 100, median 122 cc) and mean operative time was 252 minutes (SD 134.5, median 155 minutes). Pre-embolization angiography was reviewed to identify a glomic artery, defined as a dominant artery supplying the CBT arising from the region of the carotid bifurcation. In six of eight patients (75%) a glomic artery could be identified, arising from the common carotid artery in 4/6 patients and the external carotid artery in 2/6 patients. Thus, glomic artery to supply to CBT was identified in the majority of patients in this series. Knowledge of its presence and identification as a direct supplier, frequently from the common carotid artery itself, provides an avenue for more thorough preoperative embolization of CBT.

Background Pain during childbirth is arguably the most severe pain some women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour. Many women have concerns regarding its safety. Furthermore, epidural services and anaesthetic support may not be available consistently across all centres. Observational data suggest that early initiation of epidural may be associated with an increased risk of caesarean section, but the same findings were not seen in recent randomised controlled trials. More recent guidelines suggest that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labour. The choice of analgesic technique, agent, and dosage is based on many factors, including patient preference, medical status, and contraindications. There is no systematically reviewed evidence on the maternal and foetal outcomes and safety of this practice. Objectives This systematic review aimed to summarise the effectiveness and safety of early initiation versus late initiation of epidural analgesia in women. We considered the obstetric and fetal outcomes relevant to women and side effects of the treatments, including risk of caesarean section, instrumental birth and time to birth. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 February 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (January 1966 to February 2014), Embase (January 1980 to February 2014) and reference lists of retrieved studies. Selection criteria We included all randomised controlled trials involving women undergoing epidural labour analgesia that compared early initiation versus late initiation of epidural labour analgesia. Data collection and analysis Two review authors independently assessed trials for inclusion, extracted the data and assessed the trial quality. Data were checked for accuracy. Main results We included nine studies with a total of 15,752 women.The overall risk of bias of the studies was low, with the exception of performance bias (blinding of participants and personnel). The nine studies showed no clinically meaningful difference in risk of caesarean section with early initiation versus late initiation of epidural analgesia for labour (risk ratio (RR) 1.02; 95% confidence interval (CI) 0.96 to 1.08, nine studies, 15,499 women, high quality evidence). There was no clinically meaningful difference in risk of instrumental birth with early initiation versus late initiation of epidural analgesia for labour (RR 0.93; 95% CI 0.86 to 1.01, eight studies, 15,379 women, high quality evidence). The duration of second stage of labour showed no clinically meaningful difference between early initiation and late initiation of epidural analgesia (mean difference (MD) -3.22 minutes; 95% CI -6.71 to 0.27, eight studies, 14,982 women, high quality evidence). There was significant heterogeneity in the duration of first stage of labour and the data were not pooled. There was no clinically meaningful difference in Apgar scores less than seven at one minute (RR 0.96; 95% CI 0.84 to 1.10, seven studies, 14,924 women, high quality evidence). There was no clinically meaningful difference in Apgar scores less than seven at five minutes (RR 0.96; 95% CI 0.69 to 1.33, seven studies, 14,924 women, high quality evidence). There was no clinically meaningful difference in umbilical arterial pH between early initiation and late initiation (MD 0.01; 95% CI -0.01 to 0.03, four studies, 14,004 women, high quality evidence). There was no clinically meaningful difference in umbilical venous pH favouring early initiation (MD 0.01; 95% CI -0.00 to 0.02, four studies, 14,004 women, moderate quality evidence). Authors' conclusions There is predominantly high-quality evidence that early or late initiation of epidural analgesia for labour have similar effects on all measured outcomes. However, various forms of alternative pain relief were given to women who were allocated to delayed epidurals to cover that period of delay, so that is it hard to assess the outcomes clearly. We conclude that for first time mothers in labour who request epidurals for pain relief, it would appear that the time to initiate epidural analgesia is dependent upon women’s requests.