Rejected

Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's – Diagnosis, Definitive dental treatment and Drugs – and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment is done can also vary, according to the diagnosis. The final "D" is Drugs – the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.

The extended-release formulation of exenatide for treatment of type II diabetes mellitus is encapsulated in microspheres composed of poly(D,L-lactide-co-glycolide) (PLGA) and administered weekly. This medication has been reported to potentially cause injection-site reactions such as pruritus, transient nodules, and foreign body reaction. Here, we report a case of exenatide-induced granulomatous panniculitis. Our patient is a 63-year-old female with type II diabetes presenting for concerns about painful nodules on her abdomen, developing approximately every week over the past year and migrating. Of note, the lesions appeared following exenatide injections in the same locations. Two 1-cm deep-seated nodules were identified on examination. There were no overlying skin changes, and the lesions were tender to palpation. Punch biopsies of the two lesions were taken and revealed a septal panniculitis containing amorphous material, along with a mixed inflammatory infiltrate. GMS and AFB stains were negative for organisms. On infrared spectroscopy (IR), IR spectral characteristics of (tissue) protein and poly(lactide-co-glycolide) (PLGA) were obtained from the biopsy tissue. Evaluation of the clinical and histopathologic findings, along with the infrared spectroscopy match, determined that exenatide-induced panniculitis was the cause of the patient's nodules. This case highlights the importance of clinician awareness regarding injection site reactions. This article is protected by copyright. All rights reserved.

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. Intermittent claudication is a symptomatic form of PAD that is characterized by pain in the lower limbs caused by chronic occlusive arterial disease. This pain develops in a limb during exercise and is relieved with rest. Propionyl-L-carnitine (PLC) is a drug that may alleviate the symptoms of PAD through a metabolic pathway, thereby improving exercise performance.

Thoracic surgical incisions can be associated with intense pain or discomfort. Postoperative thoracic pain may be multifactorial in origin. Inadequate analgesia causes respiratory dysfunction. Adequate analgesia preserves pulmonary function and may hasten recovery. Intravenous opioids are widely used but sufficient analgesia is seldom achieved in doses that permit safe spontaneous ventilation. Thoracic regional anaesthesia provides profound analgesia, is opiate sparing and has minimal depressant effects on ventilation. Thoracic regional anaesthesia is both an effective alternative to systemic analgesics or can be used as part of a multimodal analgesic technique.

Acute kidney injury (AKI) and chronic kidney disease (CKD) previously have been associated with in-hospital and long-term mortality of patients undergoing support with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Patient selection criteria and survival prediction scores for VA-ECMO often include AKI or CKD, but exclude patients requiring renal replacement therapy (RRT). The need for RRT in ECMO patients is associated with increased intensive unit care and in-hospital mortality. The effect RRT has on mortality beyond hospital survival is not well-reported. The authors hypothesized that the timing of initiation (pre-ECMO v during ECMO) of RRT can have a significant impact on short- and long-term mortality.

Chronic mesenteric ischemia (CMI) involving occlusion and/or stenosis of multiple mesenteric arteries is rare. We report our experience with a 66-year-old man who presented with a more than 3 months history of abdominal pain and vomiting/diarrhea. A diagnosis of CMI due to occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery by median arcuate ligament syndrome was made. Complete revascularization through iliac artery-SMA bypass grafting and arcuate ligament dissection assisted with staged-catheter intervention successfully alleviated the patient's symptoms. The patient has maintained a normal daily diet for 6 months postoperatively.

Chronic migraine (CM) is a highly disabling and burdensome disease. Wuzhuyu decoction (WZYD), a clinical used formula to treat and prevent episodic migraine and CM, has been reported to relieve the hyperalgesia of CM and increase brainstem and blood serotonin (5-hydroxytryptamine, 5-HT) in migraine model rats in previous studies; yet the mechanism is unclear.

To investigate the clinical features and long-term prognosis of patients co-existing with ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE). Totally 358 OMA patients were retrospectively analyzed, who had a minimum of 8 years follow-up after laparoscopic cystectomy, which was performed by one professional endometriosis surgery team at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into DIE group and non-DIE group, and analysis was performed in preoperative characteristics, surgical findings and postoperative outcomes during follow-up. A total of 358 OMA patients were included, of which 190 patients (53.1%, 190/358) were in the DIE group, while other 168 patients (46.9%, 168/358) in the non-DIE group. The average ages between the two groups were (33.7±5.4), (32.5±5.3) years (=0.047), the average parity was (0.4±0.6) times vs (0.3±0.5) times (=0.079). There were significant differences in the proportions of moderate to severe dysmenorrhea [67.4% (128/190) vs 56.5% (95/168)], chronic pelvic pain [24.2% (46/190) vs 7.7% (13/168)], and the increase in CA [79.9% (139/190) vs 65.2% (101/168)] between the two groups (all <0.05). The average operation time in the DIE and non-DIE groups was (75±21) vs (39±36) minutes (<0.01). There was a significant difference in adenomyosis presence between the two groups [41.6% (79/190) vs 22.0% (37/168); =0.001]. All patients were followed up for at least 8 years. At the end of the follow-up, though the DIE group was with higher total rate of disease relapse, yet no significant difference was found between the two groups in statistical comparison [21.6% (41/190) vs 16.1% (27/168); =0.185]. A total of 41 cases in the DIE group recurred, the recurrence rate of pain was 15.8% (30/190), and the recurrence rate of cyst was 8.4% (16/190); 27 cases had recurrence after operation in the non-DIE group, the recurrence rate of pain was 8.9% (15/168), and the recurrence rate of cyst was 10.7% (18/168). There were no significant differences in the pain recurrence rate (=0.067) and cyst recurrence rate (=0.460) between the two groups. As for the successfully pregnant patients, live birth rates were 100.0% (65/65) vs 94.4% (68/72) between DIE group and non-DIE groups (=0.120). Compared with the non-DIE group, OMA patients with concurrent DIE might have severe pain symptoms, higher probability of abnormal CA levels and more severe pelvic adhesions. Although there are no significant differences in the total recurrence rate and the recurrence rate of various types between the two groups, the proportion of pain recurrence in the DIE group is higher than that in the non-DIE group. In terms of fertility outcomes, patients in the DIE group are with lower likelihood of pregnancy after surgery during the long-time follow-up. DIE has no significant influence on the fertility outcome.

Post-cardiac injury syndrome (PCIS) is an inflammatory condition following myocardial or pericardial damage. In response to catheter ablation, PCIS most frequently occurs after extensive radiofrequency (RF) ablation of large areas of atrial myocardium. Minor myocardial injury from right septal slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT) is not an established cause of the syndrome.

People with obesity may require induction of labour (IoL) due to a higher incidence of pre-existing comorbidities and pregnancy complications, as well as to prevent post-term pregnancies and late-term stillbirths. IoL at 39-40 weeks is associated with fewer caesarean births and lower morbidity for the pregnant person and neonate when compared with expectant management. Ensuring the success and safety of IoL in people with obesity requires adherence to evidence-based protocols for the management of labour induction and augmentation. Cervical ripening as well as the latent and active phases of labour in people with obesity may be considerably prolonged, requiring higher cumulative doses of oxytocin. This should be guided by intrauterine pressure catheters and early provision of neuraxial analgesia, where possible. There is insufficient evidence to recommend one method of IoL over another. The need for higher doses of prostaglandins and concurrent agents for cervical ripening should be studied in prospective studies.