Rejected

Paracetamol is one of the most frequently used analgesics for people with low back pain, but despite its frequent use there is still debate regarding its efficacy and safety for this indication.

Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide, but the mechanism of OA is far away understood. Acupuncture has been widely used in treating with chronic pain, but how does acupuncture work is still unclear. In this essay, we investigated the molecular target of acupuncture and found new mechanism of the pathogenesis in knee OA. Our results could provide new analgesic mechanisms and find new targets for acupuncture analgesia in OA. In a word, the study can help further understanding and provides more evidence of the clinical use of acupuncture in treating OA.

Treatment for neuropathic pain as a refractory disease remains unsatisfactory and represents a significant clinical challenge. A highly effective drug is thus urgently needed for neuropathic pain treatment. Dihydromyricetin (DMY) is a flavonoid with a wide range of biological activities. The purpose of this research is to explore the effects of DMY on neuropathic pain and the underlying mechanism of its effect.

A wide range of pathogens can cause meningitis or meningoencephalitis.Guiding symptoms of meningitis are headache, fever, nausea, vomiting and meningism.Guiding symptoms of meningoencephalitis are headache, fever, qualitative or quantitative disturbances of consciousness, signs of meningism are possible, optional focal neurological signs can occur.Crucial prognostic factor in treatment of acute meningitis and meningoencephalitis is rapid diagnosis and early initiation of therapy. An early start of therapy is crucial. In addition to rapid pathogen-specific treatment, specialized neurological intensive care medicine is life-saving.

The Japanese Society for Dialysis Therapy recommends superficialization of the brachial artery (BA) for vascular access in patients with comorbidities. We describe a novel minimal incision superficialization surgery of a BA through a single small incision. A 78-year-old male, who underwent chronic hemodialysis through an arterio-venous fistula, was transferred to our hospital for treatment of heart failure. We chose superficialization of the right BA for new vascular access. Under tumescent local analgesia, though a single 2-cm long incision, the BA was superficialized for 10-cm long. To complete procedures in the narrow and deep space, vessel branches were ligated by vascular clip and knot-less barbed suture was applied for closure of the brachial fascia beneath the BA. The hemodynamic status during the hemodialysis improved and the New York Heat Association (NYHA) classification grade improved from IV to II. This technique can be an alternative for arterio-venous fistula in patients with comorbidities.

The ERAS (Enhanced Recovery After Surgery) protocol, originated in the 1990s when two groups of researchers presented different proposals to improve the postoperative evolution of patients undergoing elective surgery. In 2001, the ERAS group was organized, consisting of different surgery units from northern Europe (Scotland, Sweden, Denmark, Norway, and the Netherlands). This group made a consensus that they called the ERAS project, characterized by a multimodal rehabilitation program for surgically operated patients on ascheduled basis. The protocol includes a combination of preoperative, intraoperative, and postoperative strategies based on scientific evidence. That improves the recovery and functionality of patients after the surgical event minimizes the response to surgical stress. Besides, this action on factors involved in the biological response to aggression impacts postoperative complications and decreases hospital stay and hospitalization costs. The professionals in charge of the patient are responsible for three key elements that affect the outcome after surgery: the first is the control of stress reactions to surgery, the second is fluid therapy, and the third is analgesia. The trimodal approach leads to improving the results in urological surgery, such as radical cystectomy.

Zoledronic acid is recommended for patients with osteoporosis. To report a case of unilateral anterior uveitis after zoledronate infusion. An osteoporotic patient presented with pain, visual loss, hyperemia, photophobia, and watering from the left eye after zoledronate infusion. Circumcorneal injection, keratic precipitates, cells, and flare suggested anterior uveitis. Her symptoms resolved completely after 20 days of prednisolone acetate with atropine eye drops. Uveitis is a rare complication of zoledronic acid with an unclear mechanism. Proinflammatory cytokines may play a role in pathogenesis. Zoledronic acid may be associated with rare but serious inflammatory ocular adverse drug reactions.

Central skull base osteomyelitis is a rare entity that can demonstrate confounding radiologic, clinical, and laboratory data leading to a delay in diagnosis. The morbidity and mortality for skull base osteomyelitis are both high, thus a rapid diagnosis is required for appropriate treatment. In this case report, we discuss a 68-year-old male who presented with acute left facial nerve paralysis in the setting of chronic headache and left mucoid middle ear effusion. Radiologic evaluation revealed abnormal hypointense marrow of the central skull base on T1 weighted magnetic resonance imaging, preclival mass-like tissue, and short segment luminal narrowing of the left cervical ICA with mycotic aneurysm formation. Extensive workup via a multidisciplinary approach, including neurology, otolaryngology, neurosurgery and radiology led to a diagnosis of central skull base osteomyelitis. A familiarity of this disease process is important for the radiologist in order to facilitate appropriate patient referral and treatment. This case emphasizes the importance of considering this diagnosis in the setting of headache, cranial neuropathy, and abnormal skull base imaging with adjacent preclival soft tissue mass.

Local anaesthetics are being combined clinically with amikacin in intravenous regional limb perfusion (IVRLP), with limited knowledge on the analgesia provided and its onset and duration of action after tourniquet application and release.

Heart failure is a complex clinical syndrome of cardiovascular disease. Heart failure occurs when the heart muscle is weakened and cannot pump enough blood to meet the body's needs for blood and oxygen. It is characterised by several attacks of dyspnoea, chest pain, orthopnea and pulmonary or systemic congestion. The heart inability to fulfill the demands of the body further failure of heart to pump the blood with normal efficiency. Lack of patients' adherence to their treatment may affect their clinical compensation.