Rejected

Although abdominoplasty is growing in popularity, it is still encumbered with considerable postoperative pain, which prolongs recovery.

: Patients infected with SARS-CoV-2 can have persistent symptoms after acute illness, which affects their quality of life (QoL). Research and data about this topic in Latin American ambulatory patients are scarce. : We conducted an observational, prospective, transversal, and analytical study. To measure QoL, we used a validated Spanish version of the MOS/RAND 36-Item Short Form Health Survey (SF-36). : We included 206 outpatients in the study. A total of 73.3% patients had persistence of one or more symptoms. The most frequent persistent symptoms were fatigue (36.9%), anxiety (26.2%), and headache (24.8%). No statistically significant difference in the SF-36 QoL scores and the frequency of persistent COVID-19 symptoms was found when comparing the ≤5 and >5 months groups, except for myalgia, which was less frequently observed in the >5 months group after COVID-19 (26.2% vs. 14.1%, < 0.038). Female gender was associated with an increased risk of persistence of symptoms (OR = 2.95, 95% CI 1.56-5.57). Having comorbidities/sequelae attributed to COVID-19 and persistence of COVID-19 symptoms were associated risk factors for poor physical component summary (PCS); on the other hand, female gender, anxiety, and depression were associated with poor mental component summary (MCS). : Most outpatients had persistent COVID-19 symptoms after infection. Persistence of symptoms was associated with poor MCS and PCS. It is important to follow-up not only patients discharged from the hospital after SARS-CoV-2 infection, but also those under ambulatory management to provide them with rehabilitation and psychological therapy to improve their QoL.

Multiple sclerosis (MS) is the most common demyelinating disease that attacks the central nervous system. Dietary intake of cuprizone (CPZ) produces demyelination resembling that of patients with MS. Given the role of the vagus nerve in gut-microbiota-brain axis in development of MS, we performed this study to investigate whether subdiaphragmatic vagotomy (SDV) affects demyelination in CPZ-treated mice. SDV significantly ameliorated demyelination and microglial activation in the brain compared with sham-operated CPZ-treated mice. Furthermore, 16S ribosomal RNA analysis revealed that SDV significantly improved the abnormal gut microbiota composition of CPZ-treated mice. An untargeted metabolomic analysis demonstrated that SDV significantly improved abnormal blood levels of metabolites in CPZ-treated mice compared with sham-operated CPZ-treated mice. Notably, there were correlations between demyelination or microglial activation in the brain and the relative abundance of several microbiome populations, suggesting a link between gut microbiota and the brain. There were also correlations between demyelination or microglial activation in the brain and blood levels of metabolites. Together, these data suggest that CPZ produces demyelination in the brain through the gut-microbiota-brain axis via the subdiaphragmatic vagus nerve.

Study the effect of the COVID-19 pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints.

Quadratus lumborum and erector spinae plane blocks have been used to provide analgesia in patients undergoing thoracic or abdominal surgeries. Our study compared the analgesic efficacy of the quadratus lumborum type-II block (QLB-II) and the erector spinae plane block (ESPB) in parturients who underwent caesarean section under spinal anaesthesia.

Chronic wounds fail to heal through the three normal stages of healing (inflammatory, proliferative, and remodelling), resulting in a chronic tissue injury that is not repaired within the average time limit. Patients suffering from type 1 and type 2 diabetes are prone to develop diabetic foot ulcers (DFUs), which commonly develop into chronic wounds that are non treatable with conventional therapies. DFU develops due to various risk factors, such as peripheral neuropathy, peripheral vascular disease, arterial insufficiency, foot deformities, trauma and impaired resistance to infection. DFUs have gradually become a major problem in the health care system worldwide. In this review, we not only focus on the pathogenesis of DFU but also comprehensively summarize the outcomes of preclinical and clinical studies thus far and the potential therapeutic mechanism of bone marrow-derived mesenchymal stem cells (BMSCs) for the treatment of DFU. Based on the published results, BMSC transplantation can contribute to wound healing through growth factor secretion, anti-inflammation, differentiation into tissue-specific cells, neovascularization, re-epithelialization and angiogenesis in DFUs. Moreover, clinical trials showed that BMSC treatment in patients with diabetic ulcers improved ulcer healing and the ankle-brachial index, ameliorated pain scores, and enhanced claudication walking distances with no reported complications. In conclusion, although BMSC transplantation exhibits promising therapeutic potential in DFU treatment, additional studies should be performed to confirm their efficacy and long-term safety in DFU patients.

BACKGROUND This retrospective study from a single center in Turkey aimed to compare the surgical results of regional anesthesia and general anesthesia in 203 patients with upper- and lower-extremity amputations. MATERIAL AND METHODS The study population consisted of patients who underwent extremity amputation between 2017 and 2021. Patients' demographic data, comorbidities, American Society of Anesthesiology (ASA) scores, amputated extremities, causes and extents of amputations, length of hospital stay, associated mortality/morbidity, and postoperative 90-day mortality data were comparatively analyzed between the groups created according to the anesthesia methods used in amputations. RESULTS The study consisted of 203 patients, of whom 80.8% were male. The most commonly used anesthesia method was peripheral nerve blocks (32.5%), followed by spinal anesthesia (31.5%), general anesthesia (31.0%), epidural anesthesia (2.0%), combined spinal-epidural anesthesia (1.5%), and sedo-analgesia (1.5%). Of the amputations performed, 37.0% were upper-extremity and 63.0% were lower-extremity. Peripheral nerve blocks were used most frequently in upper-extremity amputations (71.5%), and spinal anesthesia was used most frequently in lower-extremity amputations (48.9%). The mean length of hospital stay of the patients who underwent surgery under regional anesthesia methods was shorter than that of those who underwent general anesthesia (8.7±7.4 days vs 15.0±20.6 days). The mortality rate was 0.5% in the first 24 h, 0.5% in the next 48 h, and 4.9% in total. CONCLUSIONS The study findings demonstrated that performing extremity amputations under regional anesthesia techniques, particularly peripheral nerve blocks, reduces mortality/morbidity, the need for postoperative intensive care, mean length of stay in hospital, and hospital costs.

Prolonged symptoms following SARS-CoV-2 infection, or Long COVID, is common, but few prospective studies of Long COVID risk factors have been conducted.

Corticotropin releasing factor (CRF) receptors have been implicated in stress-induced hyperalgesia. The present study examined the role of CRF receptors Type 1&2 (CRFR1, CRFR2) in stress-induced bladder hyperalgesia in female rats by quantifying changes in receptor and agonist content following chronic (CFS, 7 daily episodes), acute (AFS, single episode) and control (NFS, no episodes) footshock protocols. ELISAs demonstrated that CFS lead to an increase in spinal thoracolumbar and lumbosacral spinal cord CRFR2 content and a decrease in lumbosacral spinal cord CRFR1 content. Content of the endogenous CRFR2 agonist, urocortin 2, was also increased in lumbosacral spinal cord and bladder tissues of CFS-pretreated rats, but urocortin 3 was decreased. Correlative single unit studies of lumbosacral dorsal horn neurons excited by bladder distension, in anesthetized rats that had undergone CFS, AFS or NFS protocols, used a before-after methodology with administration of a CRFR1 antagonist (antalarmin, 24 μg), CRFR2 antagonist (aSVG30, 12 μg) or normal saline topically to the exposed spinal cord following primary characterization. aSVG30 produced a reduction of neuronal responses evoked by bladder distension in CFS-pretreated rats but no statistically significant effects of aSVG30, antalarmin or vehicle were noted in other groups tested with the exception that antalarmin had an inhibitory effect on spontaneous activity in NFS-pretreated rats. The present findings are consistent with previous experiments using reflex responses to bladder distension as endpoints and further support a role for CRFR2-related mechanisms in stress-induced bladder hypersensitivity. This suggests CRFR2 antagonists may have efficacy in the treatment of bladder pain.

Anecdotally, cystic vestibular schwannomas (cVSs) are regarded to have unpredictable biologic activity with poorer clinical results, and most studies showed a less favorable prognosis following surgery. While stereotactic radiosurgery (SRS) is a well-established therapeutic option for small- to medium-sized VSs, cVSs are often larger, thus making upfront SRS more complicated. The purpose of this retrospective study was to assess the efficacy and safety of upfront SRS for large cVSs. The authors reviewed the data of 54 patients who received upfront, single-session Gamma Knife radiosurgery (GKRS) with a diagnosis of large cVS (> 4 cm3). Patients with neurofibromatosis type 2, multiple VSs, or recurrent VSs and < 24 months of clinical and neuroimaging follow-up were excluded. Hearing loss (48.1%) was the primary presenting symptom. The majority of cVSs were Koos grade IV (66.7%), and the most prevalent cyst pattern was "mixed pattern of small and big cysts" (46.3%). The median time between diagnosis and GKRS was 12 months (range, 1-147 months). At GKRS, the median cVS volume was 6.95 cm (range, 4.1-22 cm). The median marginal dose was 12 Gy (range, 10-12 Gy). The mean radiological and clinical follow-up periods were 62.2 ± 34.04 months (range, 24-169 months) and 94.9 ± 45.41 months (range, 24-175 months), respectively. At 2, 6, and 12 years, the tumor control rates were 100%, 95.7%, and 85.0%, respectively. Tumor shrinkage occurred in 92.6% of patients (n = 50), tumor volume remained stable in 5.6% of patients (n = 3), and tumor growth occurred in 1.9% of patients (n = 1). At a median follow-up of 53.5 months, the pre-GKRS tumor volume significantly decreased to 2.35 cm (p < 0.001). While Koos grade 3 patients had a greater possibility of attaining higher volume reduction, "multiple small thick-walled cyst pattern" and smaller tumor volumes decreased the likelihood of achieving higher volume reduction. Serviceable hearing (Gardner-Robertson Scale I-II) was present in 16.7% of patients prior to GKRS and it was preserved in all of these patients following GKRS. After GKRS, 1.9% of patients (n = 1) had new-onset trigeminal neuralgia. There was no new-onset facial palsy, hemifacial spasm, or hydrocephalus. Contrary to what was believed, our findings suggest that upfront GKRS seems to be a safe and effective treatment option for large cVSs.