Rejected

Introduction The frequency and severity of abdominal pain after endoscopic mucosal resection (EMR) of colonic laterally spreading lesions (LSL) ≥20mm are unknown as are risk factors to predict its occurrence. We aimed to prospectively characterise PPE, determine the rapidity and frequency of its resolution after analgesia and estimate the frequency of needing further intervention. Methods Procedural and lesion data on consecutive patients with LSL undergoing EMR at a single tertiary referral centre were prospectively collected. If PPE, graded using a Visual Analogue Scale (VAS), lasted >5 minutes, 1 gram of paracetamol was administered. PPE lasting >30 minutes lead to clinical review and upgrade to opiate analgesics. Investigations and interventions for PPE were recorded. Results 67/336 (19.9%, 95% confidence interval [95%CI] [16.0-24.5]) of patients experienced PPE (median VAS 5, IQR 3-7). Multivariable predictors of PPE were lesion size ≥40mm, OR 2.15 (95%CI [1.14-3.48]), female sex, OR 1.99 (95%CI [1.22-3.80]) and intraprocedural bleeding requiring endoscopic control, OR 1.77 (95%CI [0.99-3.16]). 51/67 (76.1%, 95%CI [64.7-84.7]) patients with mild PPE had resolution of pain after paracetamol and were discharged without sequelae. The remainder (16, 23.9%) required opiate analgesia (fentanyl) after which 11/16 (68.8% – moderate PPE) could be discharged. 5/67 (7.5%) patients with severe PPE had no resolution despite fentanyl. All settled with hospital admission (median duration 2 days), intravenous analgesia and antibiotics. Conclusion PPE occurs in approximately 20% of patients and resolves rapidly and completely in the majority with administration of intravenous paracetamol. PPE despite opiates heralds a more serious scenario and further investigation should be considered.

Fiber is the initial treatment in chronic functional constipation. However, its role in the group of patients with defecatory dyssynergy is not well established. The objective of the study is to evaluate the efficacy and safety of a high fiber diet in patients with defecatory dyssynergy in the treatment with anorectal biofeedback.

Clinical trials have demonstrated the efficacy of fixed-dose combination calcipotriol/betamethasone (Cal/BD) aerosol foam for the treatment of patients with scalp psoriasis. However, data on the real-world effectiveness of Cal/BD aerosol foam in this subgroup of patients are lacking. Therefore, this study investigated the effectiveness and tolerability of 4 weeks' treatment with Cal/BD aerosol foam in patients with scalp psoriasis in everyday clinical practice.

Femoroiliocaval stenting has become the standard of care for patients with quality-of-life impairing chronic iliofemoral venous obstruction not responding to conservative measures. While improvement following stenting has been noted in multiple large studies, sizing of stents has been subjective in nature with a general tendency to use smaller stents that that would be required to relieve venous hypertension. This study evaluates the authors technique of using the IVUS inflow channel luminal area to guide stent sizing.

A 27-year-old man, with a history of non-Hodgkin lymphoma 8 years ago, was admitted due to 9 months of persistent sternal pain. Chest CT revealed a mass in the sternum. 18F-FDG PET/CT was performed, demonstrating a radioactive accumulation mass in the sternum, accompanied by massive osteogenesis and osteolysis. Histological and immunohistochemical analysis of ultrasound-guided fine-needle aspiration biopsy samples confirmed the diagnosis of aggressive osteoblastoma. We present a rare case of aggressive sternal osteoblastoma, instead of lymphoma recurrence, on 18F-FDG PET/CT in an adult with history of lymphoma.

The inevitability of age-related degeneration makes research on degradation mitigation attractive to humans, while exercise is considered an effective means due to its powerful impact on life and health. Caenorhabditis elegans is a model animal with a short life cycle and is widely used in health and aging studies. In this work, ultrasonic stimuli in the form of surface acoustic waves (SAWs) were used to induce behavioral activities in worms. As the worms grew, ultrasound-elicited behavioral responses started to decrease in the early adulthood stage. However, this situation was significantly ameliorated when ultrasonic training sessions at an effective acoustic pressure of 1.1MPa were performed four times per day for 5 or 7 days, while ultrasonic responses in trained nematodes were stronger than those in untrained ones. These results suggest that long-term ultrasonic training might positively intervene in aging-related degeneration. Besides, it was found that exercise driven by long-term ultrasonic training had insignificant effects on the lifespan of worms. A preliminary exploration of the neural mechanisms underlying the sensation of SAWs was also conducted. The results show that, apart from touch receptor neurons (TRNs), polymodal nociceptors FLP and PVD neurons may also be involved in the perception of ultrasound in C. elegans. The results of this study may inspire related studies on other animals or humans.

Neuraxial analgesia (NA) is the most effective modality in managing labor pain with widespread availability in high-income countries. Previous research has reported a differential obstetric NA use among migrant and native women, but the contribution of language barriers is not well understood. We aimed to investigate whether host-country language proficiency among migrant women influences NA use and satisfaction with pain management during labor, when compared to natives.

In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals.

Accommodation anomalies are frequently caused or exacerbated by psychological problems such as anxiety. Patients share many features with those with other anxiety based somatic symptoms such as stomach-ache, palpitations and headaches. They can be difficult to treat, and the ophthalmic literature rarely goes beyond diagnosis and ocular treatment. This study reports characteristics and outcomes of a short case series of patients with accommodation spasms and weaknesses assessed objectively, and outlines a psychological approach to treatment.

Olmsted syndrome (OS) is a rare genetic disorder, characterized by painful palmoplantar keratoderma (PPK), periorificial and intertriginous hyperkeratoses, and alopecia. Fewer than 75 cases have been described. Variants in TRPV3 result in constitutive activation of transient receptor potential vanilloid 3, leading to increased epidermal growth factor receptor (EGFR) signaling, palmoplantar epidermal hyperproliferation, and exquisite lesional pain. We describe pre-school aged twins with OS with partial improvement from oral erlotinib, an EGFR inhibitor, but dramatic reduction of their persistent palmoplantar thickening and pain from adding acitretin.