Rejected

Abdominal surgery is one of the most definitive and mainstay treatment options for abdominal pathologies in clinical practice. Acute postoperative pain is a major challenge in the postoperative period. Although opioids are commonly used for analgesia after major abdominal surgeries, they can lead to side effects, such as nausea and vomiting, constipation, pruritus, and life-threatening respiratory depression. Regional anesthetic techniques are commonly used to prevent or minimize these side effects. The objective of this meta-analysis is to assess the effectiveness of erector spinae plane block (ESPB) and standard medical (no block) pain management after major abdominal surgeries.

To explore whether ulinastatin combined with glutamine (Gln) can improve the liver function and inflammation in patients with severe acute pancreatitis (SAP).

Postoperative cognitive dysfunction affects the quality of recovery, particularly affecting the elderly, and poses a burden on the health system. We hypothesize that the use of sugammadex (SG) could optimize the quality of postoperative cognitive function and overall recovery through a neuroprotective effect.

Shoulder pain is one of the most common musculoskeletal problems of the world's population. In particular, in water polo athletes, the frequency of injuries or pain to this joint is very high. The incidence of psychosocial factors in musculoskeletal pain is well recognized, even if they seem to be more present in chronic pain, rather than in acute pain.

Since its initial reporting in December 2019, the novel coronavirus SARS-CoV-2 has emerged as a global health problem after its official declaration as a pandemic by the World Health Organization, with an estimated 346 million cases and over 5.9 million fatalities as of January 22, 2022. Studies on the prevalence of COVID-19 among severe cases have shown that comorbidities and risk factors such as obesity, increased aging, and chronic cardiovascular and respiratory diseases play a role in the severity of SARS-CoV-2 infections. The interactions between such factors and their involvement with the progression of infection and mortality remain unclear. While it is known that SARS-CoV-2 damages the lungs, various morbidities such as acute kidney disease and thyroid dysregulation have recently emerged in symptomatic COVID-19 patients. Conditions that alter thyroid hormones, which play a critical role in regulating metabolic pathways, have a role in the level of infectivity of the SARS-CoV-2. The capability of the SARS-CoV-2 to invade and affect any organ system is dependent on its access to the angiotensin-converting enzyme II (ACE2) commonly expressed among various host cells. This binding puts any system at high risk of direct viral injury, inevitably creating an excessively high concentration of anti-inflammatory mediators and cytokines to predispose COVID-19 patients to a state of severe immunosuppression. This case report describes a 62-year-old female who tested positive for COVID-19, with a medical history of hypothyroidism, who presented with a unique combination of acute bacterial hemorrhagic pyelonephritis and ureteral obstruction. She experienced intermittent dysuria, urinary urgency, and hematuria over the past five days. She developed chills, diaphoresis, nausea, and vomiting after administering acetaminophen for her headache. Ageusia and anosmia accompanied her respiratory illnesses despite receiving the Pfizer double dose vaccine six months before her arrival. A computerized tomography (CT) scan revealed severe to moderate inflammation surrounding the enlarged kidney with a 1 mm ureteral stone. Blood and urine cultures showed the growth of gram-negative bacilli. Chest X-rays displayed a patchy appearance in the right infrahilar airspace, reflecting atelectasis in part for the diagnosis of COVID-19 with additional laboratory findings of profoundly elevated C-reactive protein, fibrinogen, and d-dimer levels. Abdominal CT scans revealed a hemorrhagic ureteral obstruction and massive swelling of the renal parenchyma persistent to pyelonephritis and hydronephrosis.

Central sensitization refers to a state of hypersensitivity in the central nervous system and is associated with the development and maintenance of chronic pain. Central sensitization plays an essential role in various diseases. Nevertheless, there has been no bibliometric analysis before in this field. The purpose of this study was to provide critical themes and trends in the area of central sensitization, to build a network of knowledge, and to facilitate the future development of relevant basic and clinical research.

Polyarteritis nodosa (PAN) is a systemic necrotizing inflammatory disease of the medium and small arteries which has variable clinical manifestations, course, and organ involvement. Intestinal necrosis resulting from PAN is rare, and successful treatment of such cases is even more uncommon. Here, we report the first successful treatment of PAN with intestinal necrosis in a young Chinese child. A 5-year-old boy was admitted to our hospital with a 5-day history of abdominal pain. The patient underwent an emergency exploratory laparotomy, which showed skipping necrosis of the intestinal wall. Intestinal resection and anastomosis failed to improve his abdominal pain. The patient's blood pressure remained high (140/120 mmHg), despite captopril treatment. The erythrocyte sedimentation rate (ESR) and D-dimer level were also elevated at (106.00 mm/h and 11.16 mg/L, respectively), as was the 24-hour urine protein (197.6 mg/24 h). Echocardiography revealed that the diameters of the left and right coronary arteries were increased (0.45 and 0.49 cm, respectively). Ultrasound showed polyarteritis in the anterior tibial, radial, iliac, and renal arteries. Histopathologic examination revealed elastic fiber rupture and partial mesenteric arteriolar stenosis with occlusion. After 2 months of treatment with systemic methylprednisolone, cyclophosphamide, and prednisone, the patient's abdominal pain was relieved. Furthermore, the patient's ESR and D-dimer levels had reduced to 5 mm/h and 0.63 mg/L, respectively; his 24-hour urine protein was normal (60.0 mg/24 h); and his blood pressure had dropped to 101/46 mmHg. The left and right coronary arteries had reduced to 0.35 and 0.38 cm in diameter, respectively; however, no significant improvement was observed in the other vessels involved. Unfortunately, the child's parents did not continue to seek medical attention; therefore, his long-term outcome is unknown. In this case, the patient was operated on immediately after symptom onset. The postoperative infection was also quickly controlled, avoiding the occurrence of septic shock. Vascular B-ultrasound and pathology aided in establishing a clear and timely diagnosis, which allowed systematic medical treatment to be delivered, achieving good short-term results.

Transcutaneous electrical nerve stimulation (TENS) has been used as analgesic therapy in many diseases. It is already known that studies that have observed the relationship between pain and cytokines have found that patients who report less severe pain have less production of proinflammatory cytokines. However, one another accepted mechanism is that decreasing proinflammatory cytokines results in decreased pain intensity. Analyzing the literature, the authors describe that, in addition to the analgesic effect, TENS has shown systemic effects, and clinically, the reduction of proinflammatory cytokines could be a protective factor against inflammation. To test the inflammatory effect of TENS, we researched the literature for clinical conditions that suggest that proinflammatory cytokines are one of the main mediators of the disease process. Chronic inflammation is one of the risk factors mentioned for the development of a new cancer; at the same time, it is indicated as an indicator of the worst prognosis. Studies also suggest that the worst prognosis of breast cancer, one of the types with the highest incidence in the world, may be related to increased inflammatory activity. Considering that inflammation is increased in breast cancer and that TENS can reduce proinflammatory cytokines even without blocking the pain pathway, our hypothesis is that the anti-inflammatory effect of TENS can bring benefits to these patients. The aim of this study will be to evaluate the effect of TENS on blood reduction of proinflammatory cytokines in breast cancer patients.

Morton's neuroma (MN) is a painful, proliferative fibrosis of perineural tissue caused by pressure or recurrent irritation that was previously thought to affect only the common interdigital nerve of the foot. We present a case of a bilateral MN of both the ulnar and radial proper digital nerves of the fifth finger in a 30-year-old patient, following multiple surgeries on the aforementioned finger. The patient was referred to our center by a peripheral hospital after traumatic fingertip amputation distal the DIP joint, where the fingertip was initially simply sutured. Because of progressive neuropathic pain, he underwent two revision surgeries, in which the distal phalanx was removed, two neuromas were excised, and the nerve stumps were shortened, but both were unsuccessful. A final, more extensive revision surgery was then carried out, in which two club-like enlargements were excised and the nerve stumps coadapted to form a loop. Histopathological examination of the excised specimen revealed perineural fibrosis in the context of a Morton's neuroma. This is, to our knowledge, the first documented case of a bilateral MN of the hand, which may have resulted from an inadequate primary finger and nerve shortening, resulting in high pressure from the surrounding soft tissue. Finally, this report emphasizes the significance of optimal treatment for finger amputation injuries, as well as the fact that for neuromas, simple nerve resection should be avoided whenever possible, because of the high recurrence rates.

Articular cartilage allows the human body to buffer and absorb stress during normal exercise. It is mainly composed of cartilage cells and the extracellular matrix and is surrounded by the extracellular microenvironment formed by synovial fluid and various factors in it. Studies have shown that chondrocytes are the metabolic center of articular cartilage. Under physiological conditions, the extracellular matrix is in a dynamic balance of anabolism and catabolism, and various factors and physical and chemical conditions in the extracellular microenvironment are also in a steady state. This homeostasis depends on the normal function of proteins represented by various ion channels on chondrocytes. In mammalian chondrocyte species, ion channels are mainly divided into two categories: cation channels and anion channels. Anion channels such as chloride channels have become hot research topics in recent years. These channels play an extremely important role in various physiological processes. Recently, a growing body of evidence has shown that many pathological processes, abnormal concentration of mechanical stress and chloride channel dysfunction in articular cartilage lead to microenvironment disorders, matrix and bone metabolism imbalances, which cause partial aseptic inflammation. These pathological processes initiate extracellular matrix degradation, abnormal chondrocyte death, hyperplasia of inflammatory synovium and bony. Osteoarthritis (OA) is a common clinical disease in orthopedics. Its typical manifestations are joint inflammation and pain caused by articular cartilage degeneration, but its pathogenesis has not been fully elucidated. Focusing on the physiological functions and pathological changes of chloride channels and pathophysiology of aseptic inflammation furthers the understanding of OA pathogenesis and provides possible targets for subsequent medication development.