Rejected

FROM DIAGNOSIS TO MULTIDISCIPLINARY TREATMENT IN INTESTINAL STOKE UNIT Acute mesenteric ischemia (AMI) is a severe vascular and intestinal emergency, most commonly related to the occlusion (mesenteric occlusive disease or emboli) of the superior mesenteric artery (SMA). Such as myocardial infarction or stroke, SMA occlusion is responsible of an intestinal infarction. In case of an early revascularization of the SMA, AMI can be reversible with no need for bowel resection. However, when left untreated, AMI fatally leads to irreversible intestinal necrosis and death following multiple organ failure. Considering its poor prognosis, AMI might be systematically suspected in case of a sudden, unusual and intense abdominal pain. Because AMI has a nonspecific clinical presentation, delayed diagnosis are frequent and unfortunately associated with poor outcomes. Therefore, general and emergency doctors, along with gastroenterologists, have a key role to play in the recognition of early AMI. In any case of clinically suspected AMI, an abdominal computed tomography angiogram might be urgently performed. Chronic mesenteric ischemia can also be revealed by postprandial abdominal pain associated with food fear and weight loss. In recent years, there has been a major improvement in the treatment of AMI following the creation of a French intestinal stroke center, gathering the expertise of specialized gastroentorologists, vascular and digestive surgeons, radiologists and intensivists. A multimodal and multidisciplinary approach combining the use of a systematic medical protocol, early revascularization of viable bowel and resection of non viable bowel when needed, has dramatically improved the prognosis of AMI, with current survival rates of 80 % and bowel resection being avoided in nearly two thirds of patients.

issues an pertaining to a published article in the October 2021 issue of the journal entitled, "Self-Administration of Auricular Acupuncture in Rural Veterans with Chronic Pain: A Pilot Project," by Brian Lee James, John Welch, and Clint Williamson. (Med Acupunct 33(5):2021.349-352; doi: 10.1089/acu.2021.0007) The journal has received communications from several sources raising significant concerns regarding the claims made in this article as they pertain to the self-administration of Battlefield Acupuncture and patient self-use of acupuncture needles. Each communication states that acupuncture needles are considered FDA-approved medical equipment and are not intended for patient self-administration. An official inquiry with the authors' institution has been launched by the editors and publisher of the journal. Such an inquiry may be a protracted process but the journal will update this notice once a resolution has been reached. There has been little research on self-administration of auricular acupuncture by patients. This study was conducted to assess the safety and feasibility of self-administration of Battlefield Acupuncture (BFA) with semipermanent needles at intervals of 2 weeks over a timeperiod of 6 months. This study was conducted at the Chillicothe Veterans Affairs Medical Center, Chillicothe, OH, USA, and its satellite Community-Based Outpatient Clinics in Ohio. The participants were 12 healthy veteran volunteers (10 males and 2 females) who previously had repeated good responses to BFA administration by a provider. Outcomes of treatment-emergent adverse events and subjective perception of pain relief, compared with provider-administered BFA, were collected telephonically every 2 weeks for 6 months. No treatment-emergent adverse events were reported by any participant over a 6-month time period. Of 12 participants,10 (83%) were able to perform BFA on themselves reliably after a didactic session. Pain relief from self-administration experienced by participants was comparable to that experienced when administered by a provider. In this small pilot study, self-administration of BFA was safe and effective for individuals who had previously received repeated benefit from provider-administered BFA. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. This research is registered at ClinicalTrials.gov as NCT #: NCT04208659.

Although spinal cord stimulation (SCS) can be a treatment option for intractable postherpetic neuralgia (PHN), obtaining proper stimulation at the thoracic dermatome is difficult. Dorsal root ganglion (DRG) stimulation may be an effective treatment for patients with insufficient efficacy in SCS only.

: Interventional pain management has been recognized over the last couple of decades for treating chronic-pain syndromes. Acupuncture is a nonpharmacologic therapeutic option for pain management and may be an option for different patients with contraindications for interventional pain management. This review explores this options. : This limited review examines the role of acupuncture for managing head-and-neck pain and lower-back pain, according to interventional pain management. : Acupuncture at various points, corresponding to the stellate ganglion, which is ST 10 , and corresponding to the splanchnic nerve and the facet joint of the lumbar vertebra-which are Ex-B2 paravertebra-can be applied for pain management in the head-and-neck area and in the lower-back area. According to various research findings, acupuncture is effective and safe for reducing pain in the head and neck area, as well as in the lower back.

Gasserian ganglion radiofrequency thermoablation is a good treatment option for the management of pain in trigeminal neuralgia. We report a case in which the patient of trigeminal neuralgia combined with anterior cerebral artery aneurysm was treated successfully by gasserian ganglion thermoablation without any complication.

Endometriosis is an important cause of chronic pain and infertility. Surgery is considered the gold standard for diagnosis and treatment. In this study, we aim to describe the clinical outcomes of women who undergo laparoscopic surgery for endometriosis.

In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult.

Traditionally, the standard advice to individuals suffering from migraine and tension-type headache was that the best way to prevent headaches is to avoid the triggers. This advice has been challenged in recent years and the Trigger Avoidance Model of Headache has been proposed, which suggests that one pathway to developing a headache disorder is by avoiding triggers resulting in trigger sensitization. The objective of the study was to evaluate a novel intervention for primary headache comprising a new approach to trigger management that includes exposure to some triggers with the goal of trigger desensitization (learning to cope with triggers [LCT]) integrated into a cognitive-behavioral therapy (CBT) program (LCT/CBT).

Generally, lactate levels > 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is often defined as lactate > 4 mmol/L. Although hyperlactatemia is common finding in liver transplant (LT) candidates, association between lactate and organ failures with Acute-on-chronic Liver Failure (ACLF) is poorly studied. We searched the important variables for pre-LT hyperlactatemia and examined the impact of preoperative hyperlactatemia on early mortality after LT.

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.