Rejected

The writing group of formulated the consensus by organizing face-to-face national multi-disciplinary expert meetings for 3 times, combining theoretical and practical experience, and drawing lessons from application of mixed inhalation of nitrous oxide and oxygen sedation and analgesia technology in other disciplines at home and abroad. The consensus carried on the detailed description on the indications, contraindications, possible side effects and corresponding first aid measures, application process, operation conditions, and training of the techndogy in burn surgery,and formulated the relevant solutions.

Congenital absence of the left circumflex artery (CALCx) or an anomalous origin of the left circumflex artery from the right coronary artery is a unique anomaly in the literature that has been incidentally diagnosed with coronary angiography. CALCx is characterized by an angiographical absence of the left circumflex artery, with a super-dominant right coronary artery that provides the postero-lateral wall of the left ventricle. We present a review of the literature of a total of 52 CALCx cases reported so far including our case. In our study, the average age of patients was 52.83 years (median – 55 years; standard deviation – 13.05 years; range 12-76 years) with a male to female ratio of 1.93:1. The chronic coronary syndrome was the most common clinical presentation followed by the acute coronary syndrome. In 45.5% of cases, the associated coronary artery disease was documented. A comprehensive anatomical and functional assessment is required for the appropriate management strategy.

To assess whether a full enhanced recovery after surgery (ERAS) program can further improve perioperative outcomes among patients undergoing gynecologic laparoscopic procedures relative to those receiving limited ERAS management.

In this study, new co-amorphous drug systems were designed using a pharmacologically relevant combination to improve the solubility and dissolution of indomethacin. Combinations of indomethacin-paracetamol (IND-PAR) as an anti-inflammatory/pain killer, and indomethacin-nicotinamide (IND-NCT) for prevention of gastric ulcers caused by IND, were developed for co-amorphization. The effect of PAR and NCT on the solubility, supersaturation, and dissolution of the poorly soluble counterpart, IND, was investigated. PAR and NCT were found to enhance the solubility and supersaturation of IND in biorelevant medium (FaSSIF) and in FaSSIF blank. Differential scanning calorimetry (DSC) showed capability of IND-PAR and IND-NCT binary mixtures to form eutectic mixture. Powder X-ray diffraction and DSC indicated the formation of a homogenous co-amorphous system with single T value. Hydrogen bonding between IND and each of PAR and NCT were found to stabilize the co-amorphous systems as supported by FTIR studies. The intrinsic dissolution rate under sink conditions was improved over that of plain amorphous IND both in FaSSIF and FaSSIF blank. IND-PAR 2:1 and IND-NCT 1:1 were extremely stable and remained amorphous for 7 months at 25 °C, while all co-amorphous formulations were stable at least up to one month at 40 °C under dry condition. The present work demonstrates an improved approach to combine IND-PAR and IND-NCT as promising co-amorphous systems for potential therapeutical applications.

Half of all postmenopausal women report symptoms of vulvar, vaginal or urinary discomfort with significant impact on sexual function and quality of life; underlying mechanisms leading to symptoms are poorly understood. To examine the possibility that the vaginal microbiota and/or mucosal immune response contribute to the severity of bothersome vaginal symptoms we conducted a substudy of samples from a randomized trial of vaginal treatment for genitourinary syndrome of menopause (GSM) to compare these features between women whose symptoms improved vs. those who did not.

Gain-of-function mutations in the TRPV3 gene can cause Olmsted syndrome characterized by palmoplantar and periorificial keratoderma, itch, and hair loss. The mechanism underlying hair loss remains unclear. Here, we engineered an Olmsted syndrome mouse model by introducing the point mutation G568V to the corresponding Trpv3 locus in mice. These mice developed fully penetrant hair loss. The hair loss was associated with premature differentiation of follicular keratinocytes characterized by precocious degeneration of trichohyalin and keratins, increased production of deiminated proteins, elevated apoptosis, and attenuation of transcription regulators (Foxn1, Msx2, Dlx3, and Gata3) known to regulate hair follicle differentiation. These abnormalities occurred in the medial-proximal region of the inner root sheath and the hair shaft, where Trpv3 is highly expressed, and correlated with impaired formation of the hair canal and the hair shaft. The mutant Trpv3 mice also exhibited increased proliferation in the outer root sheath, accelerated hair cycle, reduction of hair follicle stem cells, and miniaturization of regenerated hair follicles. Findings from this study suggest that precocious maturation of postmitotic follicular keratinocytes drives hair loss in Olmsted syndrome patients.

Opioids such as oxycodone are recommended in the management of moderate-to-severe, chronic cancer pain. All opioids can potentially cause constipation, which may be a significant barrier to their use. Multiple randomised clinical trials have shown that the use of naloxone as a peripherally acting mu-opioid receptor antagonist, in combination with oxycodone can prevent or reduce opioid-induced constipation while having equivalent analgesic efficacy to oxycodone alone. However, clinical experience has shown that unexpected events may occur in some patients when unrecognized liver impairment is present. We describe the underlying biological reasons and propose simple, but effective steps to avoid this unusual but potentially serious occurrence. In healthy individuals, naloxone undergoes extensive hepatic first pass metabolism resulting in low systemic bioavailability. However, in patients with hepatic impairment, porto-systemic shunting can increase systemic bioavailability of naloxone, potentially compromising the analgesic efficacy of oral naloxone-oxycodone combinations. This reduced first pass effect can occur in a range of settings that may not always be apparent to the treating clinician, including silent cirrhosis, non-cirrhotic portal hypertension and disruption of liver internal vasculature by metastases. Hepatic function test results correlate poorly with presence and extent of liver disease, and are not indicative of porto-systemic shunting. Presence of hepatic impairment should thus be considered when medication-related outcomes with oxycodone-naloxone combination are not as expected, even if liver function test results are normal.

To describe the evolution of practice patterns for pediatric pyeloplasty and determine how these changes have impacted length of stay (LOS), reoperation rates and return emergency department (ER) visits.

We report a case of reversed rotation (RR) of the midgut, the rarest form of intestinal malrotation (IMR), revealed by a chronic volvulus, in a 42-year-old woman presenting with episodes of abdominal pain occurring after heavy meals. The complete preoperative diagnosis was obtained by contrast-enhanced computed tomography (CT). Classical signs of volvulus were associated with typical findings of RR comprising an unusual position of the third duodenum in front of the mesenteric vessels and a very unusual location of the transverse colon behind these vessels. Complete absence of fixation of the right colon allowed secondary volvulus. A detailed reminder of the embryology of IMR and RR is presented.

Groin pain after transobturator tape is often a self-limiting situation, but can occasionally persist and be associated with serious neurological sequelae. The video is aimed at presenting the surgical management of persistent groin pain and inability to walk after transobturator sling placement and subsequent partial removal.