Rejected

To evaluate the effect of scheduled intravenous acetaminophen administration versus nonsteroidal anti-inflammatory drugs on postoperative pain and short-term outcomes after esophagectomy.

Chronic pain is a significant and costly problem all over the world. Despite significant progress in identifying the best treatment approaches, there are still significant obstacles that must be overcome in order for the treatment to be truly beneficial. There is evidence to support the cost-effectiveness of interdisciplinary treatment programs for patients with chronic pain. Creating an interdisciplinary service is not easy and certainly is much more complicated than simply placing different services in one clinic. However, when such interdisciplinary programs are instituted, they increase the effectiveness of chronic pain management significantly; bring satisfaction to doctors and are economically attractive (interdisciplinary treatment programs for patients suffering from pain not only provide the best clinical treatment, but are also the most cost-effective in the long run).

Corticosteroid associated osteonecrosis is bone death resulting from the use of chronic glucocorticoids and most commonly affects the femoral head, although the bones such as around knee joint, wrist joint and ankle joint can be affected. The pathogenesis is likely multifactorial, with genetic and environmental factors playing a role. Epigenetics may be the mechanism by which environment exerts it effects. In spite of recent discoveries, the exact pathogenesis of corticosteroid associated osteonecrosis is unknown. Over the past few years, more miRNA's have been found to be associated with osteonecrosis. The older mechanisms such as a coagulopathy, abnormalities in apoptosis and lipid metabolism dysfunction are still believed to play a role. The role of inflammatory pathways including the PDK1/AKT/mTOR signaling pathway, the PERK and Parkin pathways have been increasingly recognized as playing a mechanistic role. Histological damage to the joint can occur before the presence of symptoms. The most common symptoms are pain and an inability to bear weight. Differential diagnosis includes infection, bone marrow edema syndrome or subchondral fracture. Early detection is important for successful management of the condition. MRI is the best radiologic technique to diagnosis femoral head osteonecrosis. Multiple staging systems for osteonecrosis have been used over the years, including the Ficat and Arlet system and the Steinberg criteria. The later stages of these staging systems are irreversible. Both non-surgical (conservative) and surgical modes of therapy are used in the treatment of osteonecrosis.

To study the correlation between the level of C-reactive protein (CRP) and the severity of pain in the post-operative period with primary total knee arthroplasty and to conduct a comparative assessment of these indicators with various methods of pain relief. The primary hypothesis of the investigation was that post-operative CRP level is likely to be correlated with the severity of post-operative pain after total knee arthroplasty. The secondary points were the evaluation of CRP and pain syndrome in the groups, as well as the identification of the correlation between the level of CRP and the method of analgesia.

The incidence of migraine is higher among women than men and peaks during the reproductive years, when contraceptive medication use is common. Atogepant, a potent, selective antagonist of the calcitonin gene-related peptide receptor-in development for migraine prevention-is thus likely to be used by women taking oral contraceptives. This phase 1, open-label, single-center, 2-period, fixed-sequence study examined the effect of multiple-dose atogepant 60 mg once daily on the single-dose pharmacokinetics of a combination oral contraceptive, ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg (EE/LNG), in healthy postmenopausal or oophorectomized women. For participants in period 1, a single dose of EE/LNG was followed by a 7-day washout. In period 2, atogepant was given once daily on days 1-17; an oral dose of EE/LNG was coadministered with atogepant on day 14. Plasma pharmacokinetic parameters for EE and LNG were assessed following administration with and without atogepant. Twenty-six participants aged 45-64 years enrolled; 22 completed the study in accordance with the protocol. The area under the concentration-time curve extrapolated to infinity (AUC ) of LNG was increased by 19% when administered with atogepant. Coadministration of atogepant and a single dose of EE/LNG did not substantially alter the pharmacokinetics of EE; the ∼19% increase in plasma AUC of LNG is not anticipated to be clinically significant. Overall, atogepant alone and in combination with EE/LNG was generally well tolerated, with no new safety signals identified.

Aiming to investigate the prevalence of chronic pain and its impact on quality of life of lung transplantation (LTx) recipients, we performed a transversal study collecting data using a standard interview model in 2 different periods: first, in 2016 we studied LTx recipients after 3 to 11 months of the transplantation; and second, in 2019, we studied the same patients after 39 to 55 months of transplantation surgery. The chosen questionnaires were the Brief Pain Inventory and Short-Form Health Survey. Chronic pain was identified in 47.2% of the analyzed recipients at the initial interview and in 40.7% at the second evaluation. In both periods, the domain quality of life was the most affected in contrast to functional capacity, which was the least affected. On the first analysis, a moderate negative correlation was found between pain intensity and functional capacity domains (-0,42/P = .010), pain (-0,46/P = .005), and mental health (-047/P = .004); meanwhile, the second survey showed a moderate/high negative correlation for most of the domains, except for the mental health (-0,036/P = .120). We conclude that the prevalence of chronic pain after LTx is high, and the pain intensity had a moderate negative correlation with domains such functional capacity, mental health, and pain at the first analysis in contrast to the moderate/high negative correlation for almost every domain, except mental health, at the second analysis.

This retrospective observational study analyses the outcomes of patients undergoing surgery for anal fistula at a single centre in order to assess recurrence and re-operation rates after different surgical techniques. During January 2005 and May 2013, all patients with anal fistula were included. Baseline characteristics, details of presentation, fistula anatomy, type of surgery, post-surgical outcomes and follow-up data were collected. The primary endpoints were long-term closure rate and recurrence rate after 2 years. Secondary endpoints were persistent pain, postoperative complications and continence status. A total of 65 patients were included. From a total amount of 93 operations, 65 were fistulotomies, 13 mucosal advancement flaps, 7 anal fistula plugs and 8 cutting-setons. The mean follow up was 80 months. Healing was achieved in 85%. The highest recurrence rate was seen in anal fistula plug with 42%. On the other hand, no recurrence was observed in the cutting-seton procedures. For all included operation no persistent postoperative pain nor incontinence was observed. In conclusion, despite all existing anal fistula operations up to date, the optimal technique with low recurrence rate and assured safety for the anal sphincter is still lacking. Nonetheless, according to our promising results for the cutting-seton technique, this technique, otherwise considered obsolete, should be further evaluated in a prospective study.

Patients with chronic widespread pain (CWP) are often unfit for work and go through lengthy treatment. In Denmark, this includes contacts with the job center in their municipality, their general practitioner (GP) and one or more hospital units. Little is known about how coordination around patients with CWP functions and is perceived by professionals. Therefore, our aim is to explore how GPs, social workers from municipality job centers and hospital staff experience interprofessional coordination for patients with CWP. Interviews with 7 GPs, 12 social workers, and 10 hospital staff were analyzed using interpretative phenomenological analysis. The participants experienced challenges with coordination, primarily in the relations between social workers and GPs. There was an over-reliance on written communication in situations where the actors had divergent agendas, opposing professional roles and conflicting approaches to time. GPs tended to lengthen the time spans for treating patients, while social workers tried to shorten them so that patients could get back to work. Applying the theory of relational coordination (RC), the findings correspond to a low level of RC, indicating a need for shared accountability, and strengthened interpersonal communication between professionals.: CWP: Chronic widespread pain; GPs: General practitioners; RC: Relational coordination; IPA: Interpretative phenomenological analysis.

To examine the idea that symptoms of persistent postural perceptual dizziness (PPPD) are more common than previously assumed and lie on a spectrum in the general population, thus challenging current theories that PPPD is only a consequence of a vestibular insult.