Rejected

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm of hematopoietic cell origin.It arises from the translocation of chromosomes 9 and 22, with resultant Philadelphia (Ph) chromosome that contains the BCR-ABL1 gene.CML has three phases: the chronic phase, the accelerated phase, and blast crisis. Tyrosine kinase inhibitors are used as the targeted therapy of CML. This report is about a 30-year-old male who is normally fit and well with no past medical history of note. He was diagnosed previously with CML and presented in a blast crisis. With this blast crisis at presentation, the patient was started on ponatinib. After 12 days from starting ponatinib, the patient presented with abdominal pain and vomiting. Imaging showed small bowel perforation, which required immediate surgery. The patient's cardiovascular risk for such event was low and ponatinib was thought to be the most likely cause of this complication; thus, higher-risk patients for such ischemic events should be observed closely.

Transcutaneous Electrical Nerve Stimulation (TENS) suppresses chronic pain by stimulating deep nerves near the fascia from electrodes on the skin's surface. TENS has different effects on patients of different ages due to the variation of the thickness of skin layers when one becomes older.In this paper, we aim to optimize the stimulation effectiveness of TENS for patients of different ages through investigation of TENS stimulations of three different skin types categorized by age, Young, Old, and Older. In this investigation, the skin layer (stratum corneum, epidermis layer, dermis layer) in each model was created, and the thickness was varied. The effect of sin wave stimulation at 1 Hz, 100 Hz, and 10 kHz on the nerve stimulation effect near the fascia was examined.It is found that besides the well-known effect of stratum corneum, the thickness of the dermis layer significantly affects the stimulating effect. In addition, by using a lumped circuit model, it is showed that the change in the current path causes a mitigation in the stimulation effect in the dermis layer.

Patients with inflammatory bowel disease are at increased risk of thromboembolism. There are various sites for thromboembolism including the cerebral, limbs, abdominal vessels, retina, and lungs. Here, we report a case of a 17-year-old patient with a history of Crohn disease presenting with abdominal pain. Upon further evaluation, the patient was found to have mesenteric vein thrombosis, which was discovered on computed tomographic scan. Potential causes, contributing factors, diagnosis, and treatment are discussed here.

Post-anesthetic shivering is one of the most common complications after anesthesia. Ketamine has been considered to be an effective treatment for post-anesthetic shivering, but the evidence for its therapeutic benefit after spinal anesthesia is limited. The aim of this study was to compare the effects of intravenous ketamine with intrathecal meperidine in the prevention of post-anesthetic shivering after spinal anesthesia for lower limb orthopedic surgeries.

Atraumatic splenic rupture is a rare but dangerous complication of chronic pancreatitis, vastly ignored in emergency literature. The anatomical relationship between the spleen and the tail of the pancreas contributes to the pathophysiology when an inflammatory process is in progress, although the mechanisms are not fully understood. The authors report the case of a 41-year-old male, previously undiagnosed with chronic pancreatitis, presenting with atraumatic splenic rupture. Due to worsening abdominal pain and hemodynamic instability, he underwent total splenectomy. The final diagnosis was obtained through contrast-enhanced abdominal computed tomography scans, intraoperative findings and histopathological examination of the surgical specimen, as frequently reported in previous cases. Total splenectomy is the treatment of choice, as the failure rate of the conservative approach is high. Few of these cases are described and a deeper understanding of the subject is needed. As this condition can worsen in a short time, a prompt diagnosis followed by adequate treatment can impact the morbidity and mortality associated with splenic rupture. High clinical suspicion is essential and increased knowledge about the pathophysiology and presentation of splenic complications in pancreatitis may alert emergency physicians to these fatal complications.

Spinal cord stimulation (SCS) is a widely accepted effective treatment for managing chronic pain. SCS outcomes depend highly on accurate placement of SCS electrodes at the appropriate spine level for a desired pain relief. Intraoperative neurophysiological monitoring (IONM) under general anesthesia provides an objective real-time mapping of the dorsal columns, and has been shown to be a safe and effective tool. IONM applies stimulation to multiple electrode contacts at various intensities and monitors the triggered electromyography (EMG) responses in several muscle groups simultaneously. Therefore, it requires dynamic communication between neurosurgeon and neurophysiologist and continuous real-time annotations of the responses, which makes the procedure complex and experience-based. Here, we describe an automated data visualization tool that generates patient specific activity maps using intraoperatively collected signals. Responses were collected using a High-resolution (HR)-SCS lead with 8 columns of electrodes spanning the dorsal columns. Our JavaScript/Python based graphical user interface (GUI) provides a fast and robust visualization of EMG activity via denoising, feature extraction, normalization, and overlaying of the activity maps on body images in selected colormaps. In contrast to reviewing series of EMG signals, our user-friendly tool provides a rapid and robust analysis of stimulation effects on various muscle groups and direct comparison across subjects and/or stimulation settings. Future work includes expanding analytics capabilities and operating room implementation as a real-time processing tool that can be used in conjunction with the current IONM techniques.

Prurigo nodularis (PN) as an extremely pruritic and hyperplastic chronic dermatosis induces psychologically and physiologically stressful responses. PN-induced responses in the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-gonadal axes and endocannabinoid system are abnormal. Extant studies on the PN's pathogenesis mostly focused on the PN's psychological responses. To date, the PN's physiological responses remain not been fully uncovered yet.

Postoperative nausea and vomiting (PONV) is one of the complications that can occur frequently in the first 24 hours postoperatively. We aimed to investigate the parameters that could predict PONV in patients who underwent thoracoscopic wedge resection for pneumothorax.

Neuromodulation treatments for chronic pain are programmed with limited knowledge of how electrical stimulation of nerve fibers affects the dynamic response of pain-processing neurons in the spinal cord and the brain. By modeling these effects with tractable representations, we may be able to improve efficacy of stimulation therapy. However, pain transmitting neurons in the dorsal horn of the spinal cord, the first pain relay station in the nervous system, have complex responses to peripheral nerve stimulation (PNS) with nonlinearities and history effects. Wide-dynamic range (WDR) neurons are well studied in pain models and respond to peripheral noxious and non-noxious stimuli. We propose to use linear parameter varying (LPV) models to capture PNS responses of WDR neurons of the deep lamina in the dorsal horn in the spinal cord. Here we show that LPV models perform better than a single linear time-invariant (LTI) model in representing the responses of the WDR neurons to widely varying amplitudes of PNS current. In the future, we can use these models alongside LPV control techniques to design closed-loop PNS stimulation that may accomplish optimal pain treatment goals.Clinical Relevance- Electrical nerve stimulation as a therapy for chronic pain is in need of a more informed approach to programming. By describing the effects of stimulation on the pain system with tractable mathematical models, we may be able to titrate the stimulation to more effectively treat chronic pain.

Hidradenitis suppurativa (HS), a chronic, inflammatory, recurrent cutaneous disorder of the hair follicles, is debilitating and has substantial morbidity. Hidradenitis suppurativa-related pain has a profound effect on patient quality of life, yet at present, there are no established pain management algorithms. This comprehensive review provides an update on current treatment of HS-associated pain, including a summary of existing literature surrounding pharmacologic treatments of acute, perioperative, and chronic pain. Additionally, the epidemiology, pathophysiology, and clinical features of the disease are summarized.