Rejected

Even though the most recent guidance by the International Society for the Study of Hypertension in Pregnancy (ISSHP) has highlighted the role of angiogenic markers in the diagnosis of preeclampsia in women with chronic hypertension, it has withheld recommending its implementation due to the limited available evidence in this group of women. Therefore, we aimed to evaluate sFlt-1 (soluble fms like kinase 1) and PlGF (placental growth factor) in women with suspected superimposed preeclampsia.

To investigate short and long-term outcome after the open preperitoneal flat mesh technique (OPFMT) for umbilical, epigastric, spigelian, small incisional and "port-site" hernia performed as a day case procedure.

(1) Background: To assess the prevalence of mental disorders (depression and anxiety), psychological distress, and psychiatric medications consumption among persons suffering from COPD; to compare this prevalence with non-COPD controls and to identify which variables are associated with worse mental health. (2) Methods: This is an epidemiological case-control study. The data were obtained from the Spanish National Health Survey 2017. Subjects were classified as COPD if they reported suffering from COPD and the diagnosis of this condition had been confirmed by a physician. For each case, we selected a non-COPD control matched by sex, age, and province of residence. Conditional logistic regression was used for multivariable analysis. (3) Results: The prevalence of mental disorders (33.9% vs. 17.1%; < 0.001), psychological distress (35.4% vs. 18.2%; < 0.001), and psychiatric medications consumption (34.1% vs. 21.9%; < 0.001) was higher among COPD cases compared with non-COPD controls. After controlling for possible confounding variables, such as comorbid conditions and lifestyles, using multivariable regression, the probability of reporting mental disorders (OR 1.41; 95% CI 1.10-1.82).), psychological distress (OR 1.48; 95% CI 1.12-1.91), and psychiatric medications consumption (OR 1.38 95% CI 1.11-1.71) remained associated with COPD. Among COPD cases, being a woman, poor self-perceived health, more use of health services, and active smoking increased the probability of suffering from mental disorders, psychological distress, and psychiatric medication use. Stroke and chronic pain were the comorbidities more strongly associated with these mental health variables. (4) Conclusions: COPD patients have worse mental health and higher psychological distress and consume more psychiatric medications than non-COPD matched controls. Variables associated with poorer mental health included being a woman, poor self-perceived health, use of health services, and active smoking.

Shotgun injuries are a relatively uncommon type of trauma, and therefore may present a challenge in management for trauma surgeons. This is particularly true in the case of surgeons unfamiliar with the unique characteristics of shotgun wounds and the mechanics of shotguns. In many cases, the shot pellets are the primary source of injury. However, a broad understanding of shotgun mechanics is important in recognizing alternative presentations. This article details a case of sabot (a stabilization device used with certain projectiles) retention after a close-range shotgun injury, reviews underlying shotgun mechanics, and discusses strategies for the detection and mitigation of these injuries. The aim of this case report is to increase awareness of and reduce the potential morbidity of close-range shotgun injuries.

Remifentanil can induce postinfusion cold hyperalgesia. N-methyl-d-aspartate receptor (NMDAR) activation and upregulation of transient receptor potential melastatin 8 (TRPM8) membrane trafficking in dorsal root ganglion (DRG) are critical to cold hyperalgesia derived from neuropathic pain, and TRPM8 activation causes NMDAR-dependent cold response. Contribution of P2Y1 purinergic receptor (P2Y1R) activation in DRG to cold pain hypersensitivity and NMDAR activation induced by P2Y1R upregulation in neurons are also unraveled. This study explores whether P2Y1R contributes to remifentanil-induced cold hyperalgesia via TRPM8-dependent regulation of NMDAR phosphorylation in DRG.

The authors retrieved the records of 4 patients that exhibited unusual structural anomalies or pathologies, notably the presence of a fibrous band at the anterior aspect of the tibiotalar joint, observed during arthroscopic exploration or treatment between January and December 2019. Only 1 patient had surgical antecedents on the ipsilateral ankle (extra-articular tenodesis 10 years earlier). The remaining 3 patients had no surgical antecedents on the ipsilateral ankle. The fibrous band was removed in all patients during arthroscopic Brostöm procedure or exploration. For the first 3 patients, the intra-articular fibrous band was not observed prior to arthroscopy by either the senior surgeon or radiologist on any of the images (2 MRIs and 1 CTA), but retrospective inspection confirmed that the intra-articular fibrous band was present but had been overlooked.At a follow-up of 22.3 ± 5.0 months (range, 15-26), all patients reported a decrease in pVAS (- 5.0 ± 2.6, range, 2-8), and an improvement in AOFAS (51.0 ± 17.7, range, 26-65), EFAS (14.5 ± 8.7, range, 6-23) and EFAS sport (8.0 ± 5.3, range, 2-10).This case report corroborates the findings of an earlier discovery of an intra-articular fibrous band in 4 ankles, with more detailed information for clinical and radiologic diagnosis, as well as outcomes of arthroscopic removal. Clinicians should beware of such foreign bodies in the ankle, particularly in patients with history of sprains, and consider arthroscopic removal in cases with persistent pain and/or functional impairment.

The diagnosis of Chiari I malformation, its symptomatology, and the results of its surgical management are still discussed. We report a pediatric series of CMI without associated skull base malformations or cerebellar growth anomalies operated between 2001 and 2018.

There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function.

A 62-yr-old man with left cavernous sinus tumor presented with atypical trigeminal neuralgia refractory to medical treatment. He received Gamma Knife (Elekta) radiation for the tumor. However, the facial pain worsened after radiation. Neuropsychological testing done for memory problems had revealed mild neurocognitive disorder. Neurological examination showed trigeminal distribution numbness and partial abducens nerve paralysis. Imaging revealed an enhancing left cavernous sinus and supra-cavernous mass. Angiography revealed severe stenosis of the left cavernous internal carotid artery (ICA). Computed tomography (CT) perfusion study showed diminished blood flow on the left side, and ischemic changes were seen in fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI).  Surgical resection of the tumor was preferred over ablative treatment for trigeminal neuralgia because of its effectiveness in improving cranial nerve (CN) function.1 The patient underwent staged surgeries. In the first stage, the tumor was partially excised with decompression of the trigeminal ganglion and nerve root in the lateral cavernous sinus wall, Meckel's cave. Postoperatively, MR angiography revealed worsening of the left ICA caliber. Therefore, a high-flow bypass from the external carotid artery to the middle cerebral artery (MCA) was performed with an anterior tibial artery graft. The patient recovered initially but developed enterococcus meningitis postoperatively, which was promptly identified and treated with antibiotics. At 1-yr follow-up, the graft was patent, and the patient had significant relief of his facial pain and cognitively improved.  This 2-dimensional video demonstrates the technique of partial excision of cavernous sinus meningioma with CN decompression, and the technique of a high-flow bypass from the external carotid artery to M2 MCA segment using an anterior tibial artery graft.  The patient gave informed consent for surgery and video recording. All relevant patient identifiers have been removed from the video and accompanying radiology slides.

A 46-year-old woman with a history of end-stage renal disease on chronic haemodialysis presented with 1 week of fever, chills, altered mental status and hand pain. She was febrile and ill-appearing on presentation with a pulse rate of 102 beats per minute. She had a tunnelled dialysis catheter in her right neck. Hand examination demonstrated a swollen, erythematous and tender wrist. Cardiovascular examination demonstrated no murmurs. CT of the hand showed abscesses involving the left forearm. Blood and abscess cultures grew methicillin-resistant (MRSA). Transesophageal echocardiography (TEE) showed a 1.0×1.0 cm mobile vegetation involving the eustachian valve (EV), confirming EV endocarditis. She remained bacteraemic for 18 days despite being on vancomycin with appropriate blood levels. Vancomycin was switched to daptomycin and which cleared her cultures. Repeat TEE showed improved vegetation size. Our case highlights the rarity and management of EV endocarditis and the importance of synergy for treatment of persistent MRSA bacteraemia.