Rejected

A 43-year-old man with alcoholic cirrhosis and chronic alcoholic pancreatitis was referred for evaluation of chest pain and an enlarging pleural effusion. Computed tomography revealed a bilateral pleural effusion and longitudinal multilocular pancreatic pseudocysts extending to the posterior mediastinum along the esophagus. He was diagnosed with a mediastinal pancreatic pseudocyst rupturing into the pleural cavity and was initially treated with endoscopic ultrasound-guided trans-gastric drainage. After 4 months of stable disease, dysphagia and a severe cough developed due to an esophageal stricture and main bronchial fistula. Considering the inadequate drainage, the trans-gastric drainage stent was surgically exchanged for a percutaneous external drain and the bronchial fistula was repaired using an intercostal muscle flap. After improvement of the mediastinal abscess and the symptoms, he was discharged on post-operative day 72. Two years post-operatively, he is in good health with no recurrence. We herein report a rare case of a bronchial fistula and esophageal stricture after endoscopic trans-gastric drainage of a mediastinal pancreatic pseudocyst. Endoscopic trans-gastric drainage is an effective treatment for mediastinal pancreatic pseudocysts, but it is important to provide appropriate alternative treatment depending on the course of treatment.

Migraine is considered to be a neurovascular disease that manifests as a throbbing headache, possibly caused by the activation of the trigeminovascular system. Several studies have supported the role of inflammation in the pathogenesis of migraine. Chronic periodontitis (CP) is an infectious inflammatory disease triggered by bacterial products evoking an immune response which could result in the destruction of the periodontium. However, little is known about the longitudinal association between CP and migraine. In this study, we designed a nationwide population-based cohort study to investigate the risk of migraine and CP exposure in Taiwan. In total, 68,282 patients with CP were identified from the National Health Insurance Research Database (NHIRD), and 68,282 comparisons were randomly captured and matched by age, sex, monthly income, urbanization and comorbidities. The association between CP exposure and migraine risk was evaluated by Cox proportional hazards regression models. In this study, 785 migraine patients were identified in the CP cohort, and 641 migraine cases were found in the non-CP cohort. The incidence rate of migraine was significantly higher in the CP cohort than the non-CP cohort (adjusted HR: 1.21, 95% CI: 1.09-1.34, < 0.001) during the 13-year follow-up period. Females had a 2.69-fold higher risk for migraine than males (95% CI: 2.38-3.04, < 0.001). In summary, CP is associated with an increased risk of subsequent migraine in Taiwan.

With the rapid growth of optical-based neuroimaging to explore human brain functioning, our research group has been developing broadband Near Infrared Spectroscopy (bNIRS) instruments, a technological extension to functional Near Infrared Spectroscopy (fNIRS). bNIRS has the unique capacity of monitoring brain haemodynamics/oxygenation (measuring oxygenated and deoxygenated haemoglobin), and metabolism (measuring the changes in the redox state of cytochrome-c-oxidase). When combined with electroencephalography (EEG), bNIRS provides a unique neuromonitoring platform to explore neurovascular coupling mechanisms. In this paper, we present a novel pipeline for the integrated analysis of bNIRS and EEG signals, and demonstrate its use on multi-channel bNIRS data recorded with concurrent EEG on healthy adults during a visual stimulation task. We introduce the use of the Finite Impulse Response functions within the General Linear Model for bNIRS and show its feasibility to statistically localize the haemodynamic and metabolic activity in the occipital cortex. Moreover, our results suggest that the fusion of haemodynamic and metabolic measures unveils additional information on brain functioning over haemodynamic imaging alone. The cross-correlation-based analysis of interrelationships between electrical (EEG) and haemodynamic/metabolic (bNIRS) activity revealed that the bNIRS metabolic signal offers a unique marker of brain activity, being more closely coupled to the neuronal EEG response.

In the primary analysis of the DRIVE-SHIFT trial, switching to doravirine/lamivudine/ tenofovir disoproxil fumarate (DOR/3TC/TDF) maintained suppression of HIV-1 through Week 48. Here we present long-term efficacy and safety outcomes through Week 144 of the DRIVE-SHIFT trial.

A 7-year-old girl presented with a 2-day history of right iliac fossa pain, fever and elevated inflammatory markers. Clinical examination supported a diagnosis of appendicitis. The patient was taken to theatre for an open appendicectomy the following morning. Intraoperatively, a right-sided ovarian haemorrhagic cyst with 360 degrees torsion was discovered. The ovary was torted along with the cyst. Both were detorted and the abdomen was closed. The patient was discharged 48 hours later, with gynaecology outpatient follow-up 6-8 weeks later. Paediatric ovarian torsions caused by a haemorrhagic cyst greater than 2 cm are rare. Here, we discuss an atypical presentation of ovarian torsion and how the clinical presentation can mimic appendicitis.

Systemic autoinflammatory disorders comprise an expanding group of rare conditions. They are mediated by dysfunction of the innate immune system and share a core of phenotypic manifestations including recurrent attacks of fever, cutaneous signs, chest or abdominal pain, lymphadenopathy, vasculopathy, and musculoskeletal symptoms. Diagnosis is often established in childhood, but a growing number of adult patients are being recognized with systemic autoinflammatory disorders, including adult-onset disease. In this review, we provide a concise update on the pathophysiology, clinical presentation, and diagnostic approach of systemic autoinflammatory disorders with an emphasis on the adult patient population. Despite the recent advances in genetic testing, the diagnosis of autoinflammatory disease in adult patients is often based on a thorough knowledge of the clinical phenotype. Becoming acquainted with the clinical features of these rare disorders may assist in developing a high index of suspicion for autoinflammatory disease in patients presenting with unexplained episodes of fever or inflammation.

Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in the case of trauma. When there is mountainous topography, as in Switzerland, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders may improve overall treatment. We therefore assessed administration of nasal nalbuphine as an analgesic treatment for trauma patients in Switzerland.

This article will familiarize the reader with the most common cutaneous adverse events with immune checkpoint inhibitors, as well as their grading and treatment.

Spinal surgery can be associated with significant postoperative pain. Erector spinae plane (ESP) block is a new regional anaesthesia technique, which promises effective postoperative analgesia compared with systemically administered opioids, but has never been evaluated in terms of patient-centred outcomes such as quality of recovery and overall morbidity after major thoraco-lumbar spinal surgery.

Intracranial solitary fibrous tumors (ISFTs) are rare neoplasms of mesenchymal origin that originate from the meninges. ISFTs of the skull base can be challenging to treat as resection can be complicated by skull base anatomy.