Rejected

The effect of caffeine on acupuncture analgesia in humans is unclear. This study aimed to investigate whether caffeine-containing beverage intake influences the effect of electroacupuncture (EA) on static quantitative sensory testing (QST) and dynamic QST in healthy subjects.

Cystic fibrosis (CF) is one of chronic illness affecting many different organs. Although the outcome of CF patients undergoing procedures was not favorable more than half a century ago, it showed a continuous improvement based on the previous reports. However, recent outcome report of CF patients' procedural outcomes is limited. We analyzed CF patients who underwent procedures from 2010 to 2020 in our institution. The mortality of 1,903 procedures performed in 430 CF patients was 0.74%, seen in high-risk procedures such as lung transplantation. We also analyzed the perioperative profiles of CF patients who underwent functional endoscopic sinus surgery (FESS). We identified the preoperative pulmonary function testing result to be predictive of postoperative hospital stay.

It is known that overexpression of -methyl-D-aspartate receptors (NMDARs) contributes to central sensitization and development of neuropathic pain. Tricyclic antidepressants (TCAs), amitriptyline (ATL), and desipramine (DES) exhibit analgetic anti-NMDAR activity and are commonly utilized for pain therapy. This property is determined by their ability to enhance the calcium-dependent desensitization (CDD) of NMDARs. Coincidently ethanol and cholesterol, the ubiquitous food supplements, also modulate NMDAR CDD. The convergence of the effects of these compounds on a similar calcium-dependent process allows to assume their interaction on NMDARs. Since there is no information on whether ethanol supplementation and cholesterol deficit interfere with TCA inhibition of NMDARs at a cellular level, here we investigated this issue. Whole-cell NMDA-activated currents were recorded in rat cortical neurons of primary cultures to study how the IC values for TCA inhibition of NMDARs are influenced by ethanol and cholesterol extraction from the plasma membrane with methyl-β-cyclodextrin. Ethanol at 0.03% did not reliably affect the steady-state NMDA-activated currents. At this threshold concentration ethanol, however, increased ICs for ATL and DES abolishing their calcium-dependent inhibition of NMDARs but did not change IC for clomipramine (CLO), which is calcium-independent. Whereas the ethanol effects on ATL-induced NMDAR inhibition reached a maximum at 2 mM external [Ca], for DES the maximum was achieved already at 1 mM external [Ca], that correlates with the manifestation of the calcium-dependent inhibition of NMDARs by these agents. Cholesterol depletion also increased ICs for both ATL and DES abolishing the calcium-dependent inhibition of NMDARs. The restitution of cholesterol in the plasma membrane reversed the ATL IC back to the low values, by a restoration of calcium-dependence of ATL. These observations are consistent with the explanation that either 0.03% ethanol or cholesterol extraction may interrupt some intermediate step of CDD transduction or augment NMDAR CDD to the maximal level so that ATL and DES could not further enhance CDD. It is likely that anti-NMDAR action of ATL and DES against neuropathic pain could demonstrate peculiarities in therapeutic profiles during cholesterol decline in aging or medical treatments and ethanol supplementations even in quantities that are insufficient to cause the symptoms of intoxication.

Cardiac paraganglioma (CPGL) accounts for 1-3% of cardiac tumors and is usually benign. In total, 35-50% of CPGL lesions secrete catecholamines, causing hypertension, excessive sweating, palpitations, headache, and other symptoms. Preoperative imaging evaluation is important to determine the location of the cardiac mass, its blood supply vessels, and the relationship with surrounding structures. Multimodal imaging techniques combine with morphological and functional information to provide powerful methods for preoperative diagnosis and lesion localization. Furthermore, they can assist to reduce the incidence of intraoperative and postoperative complications and improve patient prognosis.

Chronic pain (CP) prevalence estimates addressing a wide phenotype are still quite fragmented and may vary widely due to the lack of standardized tools of investigation. There is an urgent need to update general population CP estimates.

Dexmedetomidine is a sedative and analgesic increasingly used in children supported with extracorporeal membrane oxygenation (ECMO). No data is available to describe the pharmacokinetics (PK) of dexmedetomidine in this population.

Intravenous paracetamol added to morphine reduces postoperative morphine consumption in (near)term neonates. However, there are only sparse data on intravenous paracetamol as multimodal strategy in extremely low birth weight (ELBW) neonates.

The neutrophil-to-lymphocyte ratio (NLR) is a useful prognostic marker for various diseases and surgery-induced immunosuppression. While opioids are important in general anesthesia, the association between immediate perioperative immune monitoring and opioid consumption for postoperative analgesia after video-assisted thoracoscopic surgery (VATS) is unknown. We aimed to investigate the effect of analgesic techniques on opioid-induced immune perturbation, and the feasibility of NLR as an indicator of opioid-induced immune changes.

Growing evidence suggests that the interactions between astrocytes and neurons exert important functions in the central sensitization of the spinal cord dorsal horn in rodents with diabetes and neuropathic pain (DNP). However, it still remains unclear how signal transmission occurs in the spinal cord dorsal horn between astrocytes and neurons, especially in subjects with DNP. Chemokine CXC receptor 4 (CXCR4) plays critical roles in DNP, and connexin 43 (CX43), which is also primarily expressed by astrocytes, contributes to the development of neuropathy. We thus postulated that astrocytic and neuronal CXCR4 induces and produces inflammatory factors under persistent peripheral noxious stimulation in DNP, while intercellular CX43 can transmit inflammatory stimulation signals. The results showed that streptozotocin-induced type 1 diabetic rats developed heat hyperalgesia and mechanical allodynia. Diabetes led to persistent neuropathic pain. Diabetic rats developed peripheral sensitization at the early phase (2 weeks) and central sensitization at the late phase (5 weeks) after diabetes induction. Both CXCR4 and CX43, which are localized and coexpressed in neurons and astrocytes, were enhanced significantly in the dorsal horn of spinal cord in rats undergoing DNP during late phase of diabetes, and the CXCR4 antagonist AMD3100 reduced the expression of CX43. The nociceptive behavior was reversed, respectively, by AMD3100 at the early phase and by the antioxidant N-acetyl-L-cysteine (NAC) at the late phase. Furthermore, rats with DNP demonstrated downregulation of glial fibrillary acidic protein (GFAP) as well as upregulation of c-fos in the spinal cord dorsal horn at the late phase compared to the controls, and upregulation of GFAP and downregulation of c-fos were observed upon treatment with NAC. Given that GFAP and c-fos are, respectively, makers of astrocyte and neuronal activation, our findings suggest that CXCR4 as an inflammatory stimulation protein and CX43 as an intercellular signal transmission protein both may induce neurons excitability and astrocytes dysfunction in developing DNP.

Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poor recovery. The acute stress response may lead to pain sensitization and widespread pain, thereby compromising recovery. To our knowledge, no longitudinal study has assessed the associations between early PTSS and pain sensitization over time using quantitative sensory testing (QST). The aim of this study was to compare participants with different levels of PTSS, as measured by the impact of event scale (IES; subclinical 0-8, mild 9-25, and clinical ≥ 26) at baseline (<10-day post-injury) and at a follow-up of 1, 3, 6, and 12-month post-injury on pain sensitivity, neck mobility, pain distribution, and pain intensity. In total, 740 participants were recruited from emergency units or general practitioners with acute neck pain after a whiplash injury. The clinical PTSS group showed increased pain sensitivity on all QSTs at all time points compared to the subclinical PTSS group. Also, the clinical PTSS group showed significantly lower neck mobility at all time points except for a 3-month follow-up compared to the subclinical PTSS group. Moreover, the clinical PTSS group showed more widespread pain and self-reported headache and neck pain intensity at all time points compared to the subclinical PTSS group. This study emphasizes that participants with clinical levels of PTSS constitute a high-risk group that is sensitized to pain early after the injury. Hence, screening for PTSS within the 1st week after whiplash injury for those who experience high levels of pain intensity and distress may be an important clinical procedure in the assessment and treatment of whiplash-associated disorders (WAD).