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Primary acute convexity subarachnoid hemorrhage (cSAH) in older patients can be observed in cerebral amyloid angiopathy (CAA) or idiopathic (with cSAH as potential initial manifestation of suspected CAA). We aimed to analyze baseline, clinical and MRI (including quantitative cSAH surface analysis and topographical probabilistic cSAH mapping) characteristics in elderly cSAH patients with CAA.

The increasing rate of cesarean deliveries warrants obstetric anesthesiologists to deliver high-quality post-cesarean delivery analgesia. The aim of this study was to evaluate the temporal trends in the use of neuraxial morphine for cesarean deliveries and to describe the current postoperative analgesia practices. A retrospective cohort study using nationwide health insurance claims databases was conducted from 2005 to 2020 in Japan. Pregnant women who had undergone cesarean deliveries were included. The annual rate of neuraxial morphine use was extracted and analyzed. Additionally, we explored the patient- and facility-level factors associated with neuraxial morphine use through a multilevel logistic regression analysis. The cohort included 65,208 cesarean delivery cases from 2275 institutions. The prevalence of neuraxial morphine use was 16.0% (95% confidence interval [CI], 15.8-16.3) in the overall cohort. Intrathecal morphine was used in 20.6% (95% CI, 20.2-21.0) of spinal anesthesia cases. The trend in neuraxial morphine use steadily increased from 2005 to 2020. The significant predictors of neuraxial morphine use included spinal anesthesia, recent surgery, large medical facilities, and academic hospitals. Variations in the utilization of postoperative analgesia were observed. Our study described the current trend of neuraxial morphine use and the variation in postoperative analgesia practice in Japan.

Tuberculous meningitis (TBM) is a rare, frequently elusive diagnosis, often characterized by vague symptoms and associated with high rates of morbidity and mortality.

Management of pain from traumatic rib injury is very challenging. Both acute and chronic pain caused by rib injury can cause significant morbidity (pain-induced hypoventilation, pneumonia, respiratory failure) and functional hindrance. Traditional pain management strategies in the emergency department (ED) that target acute traumatic rib pain are limited by the side effects of medications or the temporary half-life of anesthetics used for a nerve block. Both treatment modalities fall short of addressing subsequent chronic sequelae.

Ventral tegmental area (VTA) dopaminergic neurons, which are well known for their central roles in reward and motivation-related behaviors, have been shown to participate in itch processing via their projection to the nucleus accumbens (NAc). However, the functional roles of different dopamine receptor subtypes in subregions of the NAc during itch processing remain unknown. With pharmacological approaches, we found that the blockade of dopamine D1 receptors (D1R), but not dopamine D2 receptors (D2R), in the lateral shell (LaSh) of the NAc impaired pruritogen-induced scratching behavior in male mice. In contrast, pharmacological activation of D2R in both the LaSh and medial shell (MeSh) of the NAc attenuated the scratching behavior induced by pruritogens. Consistently, we found that dopamine release, as detected by a dopamine sensor, was elevated in the LaSh rather than the MeSh of the NAc at the onset of scratching behavior. Furthermore, the elevation of dopamine release in the LaSh of the NAc persisted even though itch-relieving behavior was blocked, suggesting that the dopamine signal in the NAc LaSh represents a motivational component of itch processing. Our study revealed different dynamics of dopamine release that target neurons expressing different dopamine receptors within different subregions of the NAc, and emphasized that D1R in the LaSh of the NAc is important in itch signal processing.Dopamine has been implicated in itch signal processing. However, the mechanism underlying the functional role of dopamine in itch processing remains largely unknown. Here, we examined the role of D1R and D2R in the NAc shell during pruritogen-induced scratching behavior. We demonstrated that D1R in the NAc LaSh might play an important role in motivating itch-induced scratching behavior, while activation of D2R would terminate scratching behavior. Our study revealed the diverse functional roles of dopamine signals in the NAc shell during itch processing.

Pterygoid hamulus syndrome, a painful oral and facial syndrome, has been described in literature to be correlated with morphological changes in the length of the pterygoid hamulus of the sphenoid bone.

Spontaneous pneumomediastinum is a rare and self-limiting clinical entity, often triggered by activities causing acute changes in intrathoracic pressure such as childbirth, strenuous exercise, vomiting, and coughing. We present a case of a young male soldier who developed spontaneous pneumothorax following persistent yelling while attending a soccer match. Spontaneous pneumomediastinum may be preceded by a variety of strenuous activities, and clinicians should be aware of this entity when performing the evaluation of patients with nonspecific symptoms such as chest pain and dyspnea. Patients diagnosed with pneumomediastinum but presenting with additional findings such as vomiting and pleural effusion should be thoroughly evaluated to rule out potentially life-threatening mediastinal organ injury. Return to military duty should be determined by clinical reevaluation and follow-up imaging findings.

BACKGROUND Syphilis is a sexually transmitted infection (STI) caused by Treponema pallidum. If untreated, primary syphilis can progress to secondary syphilis, which has a characteristic rash and diverse systemic features. This report is of a case of secondary syphilis with mucocutaneous, articular, and pulmonary involvement. CASE REPORT A 74-year-old Moroccan man presented with an 8-week history of bilateral knee pain and swelling. On examination, he had bilateral knee effusions. Articular puncture brought an inflammatory fluid with a significant presence of white blood cells. Inflammatory markers were elevated. X-rays of both knees showed bilateral osteoarthritis with intra-articular calcification in the left knee. Nonsteroidal anti-inflammatory drugs and colchicine were prescribed, but were ineffective. A closer clinical examination of the patient revealed pigmented papules on the palms, soles, oral mucosa, trunk, and genitals. Treponema pallidum hemagglutination assay and Venereal Disease Research Laboratory results were positive in the blood (titers 1: 32) and joint fluid. A computed tomography scan of the chest revealed a focal opacity in the lateral basal segment of the right lung. The diagnosis of secondary syphilis with mucocutaneous, articular, and pulmonary involvement was made. The evolution was favorable after a single intramuscular injection of benzathine-penicillin. CONCLUSIONS Arthritis, mucocutaneous involvement, and lung lesions can be manifestations of secondary syphilis. A detailed anamnesis, clinical examination, serology, and imaging techniques are the pillars of diagnosing this condition.

The value of pulsed electromagnetic field (PEMF) in postoperative pain management, due to the inconsistent findings so far, remains unclear. We extended the evaluation of PEMF on postoperative pain and intravenous (IV) analgesic use to a group of post-appendicectomy Asian patients.

Osteoarthritis (OA) is a chronic disease that involves chondrocyte injury and dysfunction. CircRNAs participate in OA progression, but the roles of circRNAs in the occurrence of OA are unclear. In this study, we explore the role of circ_0008365 in OA.