YokoCo

Lumbar disc herniation is one of the leading causes of chronic low back pain. Surgery remains the therapy of choice when conservative approaches fail. Full-endoscopic approaches represent a promising alternative to the well-established microsurgical technique. However, high-grade evidence comparing these techniques is still scarce.

Colebrookea oppositifolia Sm. is a valuable traditional therapeutic plant belonging to the family Lamiaceae. It is a dense and wool-like shrub that is mostly found in subtropical regions of some countries of Asia, such as China and India. It has been widely used for the mitigation of nervous system disorders like epilepsy. The active constituents of the plant have exhibited antioxidant, anti-microbial, and antifungal properties, which are considered due to the presence of polyphenols and flavonoids as chief chemical constituents. Flavonoids like quercetin, landenein, chrysin, and 5, 6, 7-trimethoxy flavones cause protein denaturation of the microbial cell wall.

This retrospective study aimed to introduce a novel method for simultaneous Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion and to evaluate the feasibility of this method.

Posterior reversible encephalopathy syndrome (PRES) is a relatively rare neurotoxic disorder. Our patient was a 56-year-old male who underwent an elective coronary angiography. Few hours postprocedure, the patient developed bilateral painless vision loss, headache, vomiting and hypertension and was subsequently diagnosed with PRES. Possible trigger factors could be contrast agent used, or hypertension. Contrast agent-induced PRES in hypertensive patients is benign and reversible, and a high-grade suspicion about this possibility is critical for precise management. Our patient was successfully treated with supportive management and was doing well on follow-up.

Back pain is common in the gravid population and spinal cord infarction (SCI) or chronic osteomyelitis are exceptionally rare underlying causes of back pain in this population. No case report to date has described this unexpected adverse event in a gravid woman with suspected history of IV drug use (IVDU). This diagnosis could potentially become more common with increasing rates of IVDU, and increased education could result in sooner recognition.

To explore the efficacy and safety of remimazolam for procedural sedation during ultrasound-guided nerve block administration in patients undergoing abdominal tumor surgery, in order to improve and optimize remimazolam use in procedural sedation and clinical anesthesia.

Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators.

Neuroprognostication in severe traumatic brain injury (sTBI) is challenging and occurs in critical care settings to determine withdrawal of life sustaining therapies (WSLT). However, formal pediatric sTBI neuroprognostication guidelines are lacking, brain death criteria vary and dilemmas regarding WLST persist which lead to institutional differences. We studied WLST practice and outcome in pediatric sTBI to provide insight into WLST-associated factors and survivor recovery trajectory ≥ 1 year post-sTBI. This retrospective, single center observational study included patients < 18 years admitted to the Pediatric Intensive Care Unit (PICU) of Erasmus MC-Sophia (a tertiary university hospital) between 2012 and 2020 with sTBI defined as a Glasgow Coma Scale (GCS) ≤ 8 and requiring intracranial pressure (ICP) monitoring. Clinical, neuroimaging and electroencephalogram (EEG) data were reviewed. Multidisciplinary follow-up included the Pediatric Cerebral Performance Category (PCPC) score, educational level and commonly cited complaints. Seventy-eight children with sTBI were included (median age 10.5 years; IQR 5.0 – 14.1; 56% male; 67% traffic-related accidents). Median ICP monitoring was 5 days [IQR 3-8], 19 (24%) underwent decompressive craniectomy. PICU mortality was 21% (16/78): clinical brain death (cBD, 5/16), WLST due to poor neurological prognosis (WLST_neuro, 11/16). Significant differences (p < 0.001) between survivors and nonsurvivors: first GCS score, first pupillary reaction and first lactate, Injury Severity Score (ISS), pre-hospital cardiopulmonary resuscitation and Rotterdam CT score. WLST_neuro decision timing ranged from 0 to 31 days [median 2 days, IQR 0-5]. WLST_neuro decision (n=11) was based on neurologic examination (100%), brain imaging (100%) and refractory intracranial hypertension (5/11; 45%). WLST discussions were multidisciplinary with 100% agreement. Immediate agreement between medical team and caregivers was 81%. The majority (42/62, 68%) of survivors were poor outcome (PCPC score 3 to 5) at PICU discharge, of which 12 (19%) in a vegetative state. One year post-injury no patients were in a vegetative state and the median PCPC score had improved to 2 [IQR 2-3]. No patients died after PICU discharge. Twenty percent of survivors could not attend school two years post-injury. Survivors requiring an adjusted educational level increased to 45% within this timeframe. Chronic complaints were headache, behavioral and sleeping problems. In conclusion, two thirds of sTBI PICU mortality was secondary to WLST_neuro and occurred early post-injury. Median survivor PCPC score improved from 4 to 2 with no vegetative patients one year post-sTBI. Our findings show the WLST decision process was multidisciplinary and guided by specific clinical features at presentation, clinical course and (serial) neurological diagnostic modalities of which the testing combination was determined by case-to-case variation. This stresses the need for international guidelines to provide accurate neuroprognostication within an appropriate timeframe whereby overall survivor outcome data provides valuable context and guidance in the acute phase decision process.

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) remains a promising strategy for neurorehabilitation. The stimulation intensity (SI) influences the after-effects observed. Here, we examined if single sessions of a HF-rTMS protocol, administered at different suprathreshold SI, can be safely administered to able-bodied (AB) individuals.

In this study, a series of structurally novel N-(benzene sulfonyl) acetamide derivatives were designed, synthesized, and biologically evaluated as COX-2/5-LOX/TRPV1 multitarget inhibitors for anti-inflammatory and analgesic therapy. Among them, 9a and 9b displayed favorable COX-2 (9a IC=0.011 μM, 9b IC=0.023 μM), 5-LOX (9a IC=0.046 μM, 9b IC=0.31 μM) and TRPV1 (9a IC=0.008 μM, 9b IC=0.14 μM) inhibitory activities. The pharmacokinetic (PK) study of 9a in SD rats at the dosage of 10 mg/kg demonstrated a high oral exposure, an acceptable clearance and a favorable bioavailability (Cmax=5807.18 ± 2657.83 ng/mL, CL=3.24 ± 1.47 mL/min/kg, F=96.8%). Further in vivo efficacy studies illustrated that 9a was capable of ameliorating formalin-induced pain and inhibiting capsaicin-induced ear edema.