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During the second stage of labor, in case of need for a fetal extraction at mid-cavity, the choice between an attempt at operative vaginal delivery and a cesarean section is difficult. Guidelines on this subject are not clear.

Electroacupuncture is a non-pharmacological intervention for analgesia that is widely recognized as therapy for pain. However, the clinical efficacy of electroacupuncture combined with patient-controlled intravenous analgesia for postoperative analgesia after cesarean section remains unclear.

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome characterized by acute or subacute onset of neurological symptoms (e.g., headache, seizure, confusion, vomiting, and diminished eyesight) and impaired endothelial barrier function of the cerebral circulation that leads to bilateral subcortical vasogenic edema, while exhibiting a "reversible" feature in most cases. Clinically, various predisposing or precipitating conditions have been identified, such as hypertension, autoimmune diseases, renal dysfunction/failure, preeclampsia/eclampsia, post-transplantation conditions, and certain therapeutic agents. Among several putative mechanisms, the immune activation hypothesis prevails, as up to 50% of patients with PRES harbor abnormalities related to autoimmunity, such as concurrent systemic lupus erythematosus. In this Review, we summarize the clinical and laboratory evidence that places PRES in the context of autoimmunity.

We evaluated the efficacy of once daily (QD) upadacitinib 45 mg, an oral, reversible Janus kinase inhibitor, on early symptomatic improvement for ulcerative colitis (UC). Post hoc analyses were performed on pooled data from two replicate, phase 3, multicenter induction trials, U-ACHIEVE Induction and U-ACCOMPLISH, to determine the earliest timepoint of efficacy onset.

Extensive research into potential sources of neck pain and referred pain into the upper extremities and head has shown that the cervical facet joints can be a potential pain source confirmed by precision, diagnostic blocks.

Pheochromocytomas are rare adrenal tumors that are often diagnosed in workup for endocrine causes of refractory hypertension, as an incidental imaging finding, or in patients with classic symptoms of headache, palpitations, and/or diaphoresis. We describe a case of pheochromocytoma presenting in a 63-year-old woman with spontaneous and multifocal subarachnoid and intracerebral hemorrhage without underlying vasculopathy. The patient previously had no documented episodes of hypertension and took no regular medications. She experienced sudden-onset severe headache and presented with hypertensive crisis. Cranial imaging showed bifrontal and right temporal convexal subarachnoid and intracerebral hemorrhage of unknown etiology. Cranial arterial catheterization showed no vascular malformation underlying the site of hemorrhage. Given concern for potential malignant etiology, cross-sectional body imaging was performed that revealed a 7-cm right adrenal heterogeneous mass. Biochemical workup demonstrated markedly elevated plasma metanephrine and normetanephrine levels, diagnostic of pheochromocytoma. She underwent α- and β-blockade, and evaluation with a multidisciplinary team including repeat intracranial imaging to ensure resolution of the intracranial bleeding before definitive surgical management. She then underwent successful laparoscopic adrenalectomy. This case demonstrates that the workup of cryptogenic intracranial hemorrhage and hypertensive crisis should include evaluation for catecholamine-secreting tumors.

Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic autoimmune disease affecting multiple organs. Ranging from minor features, such as headache or mild cognitive impairment, to serious and life-threatening presentations, j-neuropsychiatric SLE (j-NPSLE) is a therapeutic challenge. Thus, the diagnosis of NPSLE remains difficult, especially in pediatrics, with no specific biomarker of the disease yet validated.

<b> Introduction:</b> Lichtenstein hernioplasty has been a gold standard of hernioplasty for 30 years now. However, the procedure may be followed by an unacceptably high rate of chronic pain, numbness and discomfort. </br></br> <b>Aim:</b> To compare outcomes of Lichtenstein repair using a Parietene ProGrip self-fixing mesh versus the standard lightweight macroporous mesh. </br></br> <b>Material and methods:</b> As many as 141 patients with unilateral primary inguinal hernia participated in this single-centre, randomised, prospective, single-blind (patient-blinded) study. Randomisation yielded two treatment groups: control group of 88 patients treated with Lichtenstein method using lightweight standard mesh (LS) and study group of 53 patients receiving treatment with self-fixing mesh (PG). Patients were followed up for 6 months. Primary outcome was the presence and severity of postoperative pain at discharge, at 30 days and 6 months post-procedure. Other study parameters were: duration of the procedure, duration of hospitalisation, presence of early and late complications, time needed to return to full activity and patient satisfaction. </br></br> <b>Results:</b> No statistically significant differences in pain severity were demonstrated at discharge or at long-term follow-up. In the first 30 days post-procedure the patients in the PG group complained of pain of greater severity on the NRS (2.0 vs 1.4) (P = 0.0466). The duration of the procedure in the PG group was 9.4 minutes shorter than in the LS group (P = 0.0027). No statistically significant differences between the groups were found in other studied parameters. </br></br><b>Conclusions:</b> Self-fixing mesh can be safely used in inguinal canal repair procedures. It significantly shortened the duration of the procedure but at the same time did not reduce the severity of pain, including the rate of chronic postoperative inguinal pain.

<b> Introduction:</b> Inguinal hernia repair is the most common operation worldwide. The essential factors in hernia repair have been the postoperative quality of life, early return to work, low recurrence rate, and chronic pain prevention. </br></br> <b>Aim:</b> The aim of this study was to compare the short- and long-term results of the self-adhesive mesh and the conventional polypropylene mesh in Lichtenstein repair. </br></br> <b> Material and methods:</b> A total of 100 male patients were randomized and operated on, 50 with the self-adhesive mesh (S group), 50 with the conventional polypropylene mesh (P group). Prospectively, the patients were followed for an average of 36 months. The two groups were compared for the duration of surgery, duration of hospital stay, duration of daily activity/resumption of work, postoperative pain, chronic pain, recurrence, wound infection, hematoma/seroma formation, and postoperative analgesic consumption. </br></br> <b>Results:</b> The study involved 39 patients in the P group and 37 patients in the S group who underwent inguinal hernia surgery. The P group had a longer mean operation time than the S group, and the difference between the two groups was statistically significant (45.1 ± 6.6 min vs. 28.8 ± 3.0 min, P = 0.0001). In recurrence, postoperative discomfort, chronic pain, length of hospital stay, daily activity/return to work, wound infection, hematoma/seroma, and postoperative analgesic use, there was no statistically significant difference between the two groups. </br></br> <b>Conclusion:</b> It was found that the self-adhesive mesh did not produce statistically significant advantages over the conventional polypropylene mesh, except for operative time, in the Lichtenstein repair.

Inflammation and oxidative stress represent physiological response mechanisms to different types of stimuli and injury during critical illness. Its proper regulation is fundamental to cellular and organismal survival and are paramount to outcomes and recovery from critical illness. A proper maintenance of the delicate balance between inflammation, oxidative stress, and immune response is crucial for resolution from critical illness with important implications for patient outcome. The extent of inflammation and oxidative stress under normal conditions is limited by the antioxidant defense system of the human body, whereas the antioxidant capacity is commonly significantly compromised, and serum levels of micronutrients and vitamins significantly depleted in patients who are critically ill. Hence, the provision of antioxidants and anti-inflammatory nutrients may help to reduce the extent of oxidative stress and therefore improve clinical outcomes in patients who are critically ill. As existing evidence of the beneficial effects of antioxidant supplementation in patients who are critically ill is still unclear, actual findings about the most promising anti-inflammatory and antioxidative candidates selenium, vitamin C, zinc, and vitamin D will be discussed in this narrative review. The existing evidence provided so far demonstrates that several factors need to be considered to determine the efficacy of an antioxidant supplementation strategy in patients who are critically ill and indicates the need for adequately designed multicenter prospective randomized control trials to evaluate the clinical significance of different types and doses of micronutrients and vitamins in selected groups of patients with different types of critical illness.