Rejected

The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair.

One of the most undesirable results after total knee arthroplasty (TKA) is severe immediate postoperative pain, resulting in patient dissatisfaction. We aimed to evaluate nefopam's analgesic efficacy after primary TKA along with related outcomes, including morphine consumption and adverse events.

This article discusses the complex relationship between acute ischemic stroke and migraine with aura, and critical nursing interventions.

In the USA, spinal cord injury (SCI) occurs in 40 people per million every year due to events such as car accidents, falls, violence, or sports injury. Secondary complications that arise from SCI are life-threatening and should be treated as early as possible. In some cases, it is not completely obvious what complication a patient may have until it is too late. Therefore, biomarkers are required to assess the levels of secondary complications after SCI. As there are several complications that pose different warning signs, different biomarkers may be beneficial in early detection, maintenance, and long-term care for patients with SCI.

To explore the diagnostic performance of cardiac magnetic resonance imaging (CMR) with T1 mapping and T2 mapping for detection of acute phase of ischemic cardiomyopathy.

Cutaneous T-cell lymphomas (CTCL) are malignant lymphoproliferative disorders accompanied by persistent pruritus. Pruritogenic role of interleukin-31 (IL-31) has been studied extensively and was proven in atopic dermatitis (AD), while its role in CTCL is still rather vague.

Pseudotumor cerebri syndrome (PTCS) is a condition caused by an abnormal elevation of intracranial pressure (ICH), which may be primary (idiopathic intracranial hypertension) or because of an identifiable secondary cause. We present a rare case of an obese male who complained of gradual bilateral vision loss for one year without headaches and tinnitus. On fundoscopy, he had high-grade bilateral papilledema and, on lumbar puncture, he had an elevated intracranial pressure of 260 mmH2O. Cerebrospinal fluid (CSF) was unique for eight restricted oligoclonal bands while extensive other demyelinating workup was negative. He was started on acetazolamide initially and subsequently proceeded with bilateral optic nerve sheath fenestration (ONSF) with mild improvement in the right eye and no improvement in the left eye. Although the causative mechanism of PTCS is a matter of debate, immune-mediated processes are one of the proposed mechanisms that may play a role in the pathophysiology of PTCS, evidenced by the presence of oligoclonal bands (OCBs) and pro-inflammatory markers in CSF. PTCS diagnosed in men and patients with OCBs poses an increased risk of vision loss as this case and literature documented. Therefore, prompt treatment through therapeutic lumbar punctures, acetazolamide therapy concurrently with weight loss, and surgical intervention in severe or refractory cases are necessary.

Below-knee surgeries are among the most commonly performed orthopedic or plastic and reconstructive procedures. They are associated with significant postoperative pain despite the use of systemic analgesics. The regional analgesia (RA) technique has been proven beneficial for better patient outcomes when used as an adjunct to multimodal analgesia in the early postoperative period. However, apprehension of an acute compartment syndrome (ACS) can limit the administration of appropriate RA techniques in such surgeries, leading to more opioid consumption to meet the increasing analgesic demands. Many modifications in the RA related to techniques and the local anesthetic type, concentration, and volume have been described to tackle such situations. The ideal RA technique should provide procedure-specific analgesia below the knee joint without affecting motor power and/or causing any delay in diagnosing or treating ACS. The high-volume proximal adductor canal (Hi-PAC) block is a novel RA technique described as motor-sparing and procedure-specific for the below-knee surgeries. The Hi-PAC block, a single-injection technique, is administered in the proximal adductor canal targeting the saphenous nerve and depositing local anesthetics (LA) adjacent to the femoral artery below the vasoadductor membrane (VAM). By directly blocking the saphenous nerve and indirectly the sciatic nerve, it covers the entire innervation of the pain-generating components involved in the below-knee surgeries. This article describes the anatomical and technical considerations of the Hi-PAC block and provides background knowledge of the relevant anatomy and sonoanatomy for a better understanding of its intricacies.

Background Low back pain represents 2-3% of Emergency Department (ED) visits. In this study, we aimed to identify patient and treatment-related variables that contributed to repeat visits to the ED for low back pain within a 12-month period. Methodology We conducted a retrospective review of adult patients presenting to the ED of one hospital over a two-year period with the primary diagnosis of low back pain. The primary outcome included return to the ED within 12 months with the same complaint, and the secondary outcome included return to the ED within 30 days or six months. Results A total of 793 patients met the inclusion criteria. The rate of return to the ED with the same complaint within 30 days, six months, and 12 months of the first visit was 7%, 11%, and 14%, respectively. Patients who received opioids at discharge were more likely to return within 12 months (68% vs. 55%; p = 0.0075) and six months (68% vs. 56%; p = 0.0184) compared to those who did not receive opioids at discharge. Undergoing an X-ray decreased the odds of a 30-day return visit by 70% (p = 0.0067), and by 59% within 12 months (p = 0.0032). Receiving opioids at discharge also doubled the odds of return within 12 months (odds ratio = 2.030, p = 0.0183), while receiving nonsteroidal anti-inflammatory drugs (NSAIDs) reduced the odds by 60% (p = 0.0028). Conclusions Patients who received opioids at discharge were more likely to have a return visit for low back pain within six and 12 months. Patients who underwent X-rays at the index visit and were prescribed NSAIDs at discharge were less likely to return to the ED for low back pain.

To improve pain relief for refractory pain condition, spinal cord stimulation (SCS) needs to target the dedicated neuronal fibers within the dorsal columns. Intraoperative feedback from the patient can optimize lead placement but requires "awake surgery", allowing interaction between patient and surgeon. This can produce negative effects like anxiety and stress. To better manage these aspects, we propose to combine intraoperative hypnosis with awake anesthesia. Seventy-four patients (35 females, 22-80 years) presenting with chronic refractory pain, were offered intraoperative hypnosis during awake SCS lead implantation. Interactive conversational hypnosis was used as well as interactive touch, which was enhanced during painful moments during the lead intraoperative programming. All patients participated actively during the intraoperative testing which helped to optimize the lead positioning. They kept an extremely positive memory of the surgery and of the hypnotic experience, despite some painful moments. Pain could be reduced in these patients by using interactions and touch, which works on Gate Control modulation. Positive memory was reinforced by congratulations to create self-confidence and to induce positive expectations, which could reinforce the Diffuse Noxious Inhibitory Controls at the spinal level. Cooperation was improved because the patient was actively participating and thus, much more alert when feedback was required. Combining intraoperative hypnosis with awake anesthesia appears helpful for SCS lead implantation. It enhances patient cooperation, allows optimization of lead positioning, and leads to better pain control, positive and resourceful memory.