Rejected

Blastomycosis is a local or systemic infection, caused by Blastomyces dermatitidis (B. dermatitidis) or B. gilchristii. Blastomycosis has been described as "the great pretender," alluding to the fact that it manifests in a wide range of symptoms and disease severity. Central nervous system (CNS) involvement, although rare, carries significant mortality. Due to the limited published reports of CNS blastomycosis, we present an updated cohort with eight cases of proven or probable CNS blastomycosis describing presentation, diagnosis, treatment and outcomes. Headache was the most common presenting symptom. Magnetic resonance imaging (MRI) proved to be the superior imaging study. All patients in our cohort were diagnosed by histopathological staining or cultures of tissue or fluid obtained from CNS or extra-CNS lesions. All patients that received treatment with Liposomal amphrotericin B for at least 10 days followed by a prolonged azole therapy did not have relapse. Two patients with late diagnoses died during hospitalization. Our findings confirm the importance of timely diagnosis and treatment of CNS blastomycosis to improve outcomes especially with an azole that have a high CNS penetration and a good intrinsic activity for B. dermatitidis such as voriconazole.

Neuropathic pain caused by traumatic neuromas is an extremely intractable clinical problem. Disorderly scar tissue accumulation and irregular and immature axon regeneration around the injury site mainly contribute to traumatic painful neuroma formation. Therefore, successfully preventing traumatic painful neuroma formation requires the effective inhibition of irregular axon regeneration and disorderly accumulation of scar tissue. Considering that chondroitin sulfate proteoglycans (CSPGs) can act on the growth cone and effectively inhibit axon regeneration, the authors designed and manufactured a CSPG-gelatin blocker to regulate the CSPGs' spatial distribution artificially and applied it in a rat model after sciatic nerve neurectomy to evaluate its effects in preventing traumatic painful neuroma formation.

The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements.

<i>Significance:</i> Wound healing is a complex process involving pain and inflammation, where innervation plays a central role. Managing wound healing and pain remains an important issue especially in pathologies such as excessive scarring (often leading to fibrosis) or deficient healing leading to chronic wounds. <i>Recent Advances:</i> Advances in therapies using mesenchymal stromal cells offer new insights for treating indications that previously lacked options. Adipose-derived mesenchymal stromal cells (AD-MSCs) are now being used to a much greater extent in clinical trials for regenerative medicine. However, to be really valid, these randomized trials must imperatively follow strict guidelines such as CONSORT Statements. Indeed, AD-MSCs because of their paracrine activities and multipotency, have potential to cure degenerative and/or inflammatory diseases. Combined with their relatively easy access (from adipose tissue) and proliferation capacity, AD-MSCs represent an excellent candidate for allogeneic treatments. <i>Critical Issues:</i> The success of AD-MSC therapy may depend on the robustness of the biological functions of AD-MSCs which requires controlling source heterogeneity and production processes, and development of biomarkers that predict desired responses. Several studies have investigated the effect of AD-MSCs on innervation, wound repair, or pain management separately, but systematic evaluation of how those effects could be combined is lacking. <i>Future Directions:</i> Future studies that explore how AD-MSC therapy can be used to treat difficult to heal wounds, underlining the need to thoroughly characterize the cells used, and standardization of preparation processes are needed. Lastly, how this a priori easy-to-use cell therapy treatment fits into clinical management of pain, improvement of tissue healing and patient quality of life, all need to be explored.

Endometriosis is a frequent cause of chronic pelvic pain in women of childbearing age, resulting in a significant deterioration in their quality of life. Inflammation can affect the reproductive organs, rectum and bladder. Medical treatment is considered the first line of management, although it can prove insufficient in many cases. Intestinal endometriosis occurs in approximately 5-12% of cases, with the rectosigmoid junction being the most common place of involvement (65%), followed by the ileocecal valve (20%) and rectum (15%).

We appreciate the opportunity to respond to the comments by Drs. Arian Arjomandi Rad, Robert Vardanyan and Natalie R Tas. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in many countries for the relief of symptoms of pain, inflammation and fever, which reduce the conversion of arachidonic acid to prostaglandins, prostacyclin (PGI2), and thromboxane (Tx) A2 by inhibiting cyclooxygenase (COX). At present, it is recognized that there are two related but different types of COX activity, COX-1 and COX-2.

Phosphate-lowering effects of ferric citrate were reported in several clinical trials, but mostly in small-scale studies. The aim of this meta-analysis was to investigate the efficacy and safety of ferric citrate in controlling hyperphosphatemia and iron-deficiency anemia in chronic kidney disease (CKD) patients.

Anabolic-androgenic steroids (AAS) abuse is common in competitive athletes in order to enhance athletic performances. However, AAS abuse is often associated with deleterious side effects including but not limited to cardiovascular diseases, depression, hormonal abnormalities, and cancer. We present a case of a 31-year-old male with a history of Crohn's disease on infliximab and chronic AAS use who had persistent retrosternal chest pain found to have an acute myocardial infarction (MI) without obvious cardiovascular risk factors.

Post-dural puncture headache is the most common significant adverse event following lumbar puncture. In this study, we investigated the possible systemic factors associated with risk for post-dural puncture headache (PDPH).

To compare differences in self-reported musculoskeletal pain before and after receiving rapid acupuncture for pain at an outpatient emergency department.