Rejected

Arteriovenous malformations commonly present with hemorrhage, seizures, headache and other symptomatology. However, AVMs presenting as venous hypertension, owing to downstream stenosis/occlusion of venous sinuses, are very rare. This presentation is much more common in patients with dural AVFs.

Talaromyces Marneffei (Penicillium marneffei, T.marneffei) has been frequently reported in patients with adult acquired immunodeficiency syndrome. Still, cases of children with HIV combined with T.marneffei infection are very rare. This report describes the case of a HIV-child who is a girl from China. Her special clinical manifestations and laboratory diagnosis results can provide clinicians with the basis for diagnosis and treatment of T.marneffei related rare diseases.

Although intraoperative anesthetic management of extensive encircling pulmonary vein isolation (PVI) is essential for the safe performance of this procedure, there is no standardized approach for the use of sedation and analgesia. Therefore, the present study aimed to clarify the optimal fentanyl dosage and timing of administration for the anesthetic management during PVI. A total of 364 patients with atrial fibrillation (AF) who underwent PVI at our institution between June 2017 and October 2020 were recruited. All patients were anesthetized with propofol for induction and maintenance under controlled ventilation via the supraglottic airway without neuromuscular blocking drugs. Among them, 234 patients received less frequent injections (Group 1) and 130 received a scheduled injection of 50 mg of fentanyl (Group 2) in addition to propofol during PVI. We compared the total and additional propofol doses, frequency of additional propofol, and procedure time between the two groups. The mean patient age was 67.2 years, and 69% were male. The total propofol dose was significantly lower in Group 2 than in Group 1 (17.0 ± 5.2 mg/kg vs. 19.0 ± 5.5 mg/kg, p < 0.01). The loading dose and frequency of additional propofol were also significantly lower in Group 2 than in Group 1. The procedure time was significantly shorter in Group 2 than in Group 1 (119 ± 36 min vs. 132 ± 31 min, p < 0.01). During PVI, proper use of fentanyl decreased the propofol dose, additional propofol frequency, and procedure time.

Translation of traditional knowledge of herbs into a viable product for clinical use is still an uphill task. Piperine, a pungent alkaloid molecule derived from and possesses diverse pharmacological effects. Traditionally, pepper is used for arthritis, bronchitis, gastritis, diarrhea, snake bite, menstrual pain, fever, and bacterial infections, etc. The anti-inflammatory, antioxidant and immunomodulatory actions of piperine are the possible mechanisms behind its therapeutic potential. Various and experimental studies have shown piperine as a possible promising molecule in coronavirus disease (COVID-19), ebola, and dengue due to its immunomodulatory and antiviral activities. The other important clinical applications of piperine are due to its bio enhancing effect on drugs, by modulating, absorption in the gastrointestinal tract, altering activities of transporters like p-glycoprotein substrates, and modulating drug metabolism by altering the expression of cytochrome P450 or UDP-glucuronosyltransferase enzymes. Piperine attracted clinicians in treating patients with arthritis, metabolic syndrome, diabetes, skin infections, gastric and liver disorders. This review focused on systematic, evidence-based insight into the use of piperine in clinical settings and mechanistic details behind its therapeutic actions. Also, highlights a number of clinical trials of piperine at various stages exploring its clinical application in cancer, neurological, respiratory, and viral disease, etc.

This study provides one of the first population-based investigations of the longitudinal association between social isolation and sleep difficulty among older adults in China. We analyzed three waves of longitudinal data from the China Longitudinal Aging Social Survey (2014-2018), in which 8456 respondents contributed 16,156 person-year observations. Results from multilevel logistic regression models showed that social isolation was related to a higher risk of sleep difficulty. We also found that socially isolated older adults were more likely to report higher levels of depressive symptoms, a greater prevalence of loneliness and pain, and more chronic diseases compared to their socially integrated counterparts, which in turn increased their risks of sleep difficulty. Moreover, socially isolated older adults with chronic diseases were particularly vulnerable to the risk of sleep difficulty. These findings provide helpful guidance for policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

This meta-analysis aimed to evaluate, using the best level of evidence, the possible benefits and advantages of using peanut ball (PB) in women with an epidural during labour on the maternal and neonatal outcomes. This research was conducted using MEDLINE/PubMed, Embase, LILACS, CINAHL, CENTRAL, PEDro, Web of Science and SCOPUS databases, with no period or language restrictions. The terms 'labor' and 'peanut ball' were used. Clinical trials (randomised and non-randomised) were included when comparing a group of parturients using PB with a control group under usual care. Randomised clinical trials (RCTs) or quasi-randomised were eligible for this systematic review. Two reviewers independently screened studies, extracted data and assessed the quality of evidence which was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applied whenever possible. In this updated review, we included four studies with a total of 818 women in labour after the use of pharmacological analgesia. Our GRADE ratings of evidence ranged from high to low quality. Overall, the included studies varied in their risk of bias, in which most were considered with some concerns. There is high evidence that the use of PB after epidural analgesia reduces the duration of the first period of labour by 87 minutes and moderate evidence that it increases the chance of vaginal delivery 11%. However, there is no evidence about other maternal and neonatal outcomes.Impact Statement The peanut ball (PB) is used after the use of pharmacological analgesia, as it favours the opening of the pelvic canal and helps women to adopt more comfortable postures, but its real effects are not clear. Our results suggest that using the PB reduces the duration of the first period of labour after an epidural and increases the chance of a vaginal birth. These findings recommend the use of a PB after an epidural and further research with women without the use of pharmacological analgesia.

This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries.

The COVID-19 pandemic has markedly increased delays in oncologic surgeries because of the virus's impact on traditional anesthetic management. Novel protocols, developed to protect patients and medical professionals, have altered the ways and instances in which general anesthesia (GA) can be safely performed. To reduce virus exposure related to aerosol-generating procedures, it is now recommended to avoid GA when feasible and promote regional anesthesia instead. At our institution, we observed faster postoperative recovery in patients who received paravertebral blocks for breast cancer surgery instead of GA. This led us to formally evaluate whether regional anesthesia instead of GA helped improve time to hospital discharge.

To evaluate the functional outcomes of nerve-sparing surgery for deep infiltrating endometriosis (DIE) with or without postero-lateral parametrectomy.

To investigate trial of labor after cesarean (TOLAC) success rates among twin gestations with no prior vaginal delivery.