Rejected

Dexmedetomidine is widely used for non-invasive pediatric procedural sedation. However, the hemodynamic effects of intravenous dexmedetomidine are a concern. There has been a growing interest in the application of intranasal dexmedetomidine as a sedative in children.

Coral reef Aortic Syndrome can result in significant visceral and lower limb ischemia. We present a 72-year-old male with postprandial abdominal pain and intermittent claudication. Computed tomography demonstrated a calcified plaque occluding the thoracoabdominal aorta. Additionally, the celiac axis was stenotic and the superior mesenteric artery was completely occluded. The origin of the inferior mesenteric artery was aneurysmal. Aortic rerouting from the ascending to the infrarenal aorta was performed. The superior mesenteric artery was reconstructed with saphenous vein and the inferior mesenteric artery was divided and anastomosed directly to the aortic bypass. The procedure resulted in complete relief of the ischemic symptoms.

Carvacrol is the predominant monoterpene in essential oils from many aromatic plants. Several animal studies showing analgesic effects of carvacrol indicate potential of carvacrol as a new medication for patients with refractory pain. Voltage-gated sodium channels (Na) are thought to have crucial roles in the development of inflammatory and neuropathic pain, but there is limited information about whether the analgesic mechanism of carvacrol involves Na. We used whole-cell, two-electrode, voltage-clamp techniques to examine the effects of carvacrol on sodium currents in Xenopus oocytes expressing α subunits of Na1.2, Na1.3, Na1.6, Na1.7, and Na1.8. Carvacrol dose-dependently suppressed sodium currents at a holding potential that induced half-maximal current. The half-maximal inhibitory concentration values for Na1.2, Na1.3, Na1.6, Na1.7, and Na1.8 were 233, 526, 215, 367, and 824 μmol/L, respectively, indicating that carvacrol had more potent inhibitory effects towards Na1.2 and Na1.6 than Na1.3, Na1.7, and Na1.8. Gating analysis showed a depolarizing shift of the activation curve and a hyperpolarizing shift of the inactivation curve in all five α subunits following carvacrol treatment. Furthermore, carvacrol exhibits a use-dependent block for all five α Na subunits. These findings provide a better understanding of the mechanisms associated with the analgesic effect of carvacrol.

Vascular anomalies (VA), characterized by the abnormal development or growth of blood and/or lymphatic vessels, encompasses a spectrum of conditions with a range of symptoms and complications. VA are frequently associated with cutaneous complications that can cause significant morbidity. Systemic sirolimus has previously been shown to be effective in the treatment of complicated VA. There are limited studies to date on the use of topical sirolimus for the treatment of cutaneous manifestations of VA.

To investigate the value of repeated bone scintigraphy in the follow-up of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and to characterize the changing pattern of osteoarticular lesions revealed by bone scintigraphy.

Aversive childhood stress and its implications für expert reports using the example of chronic pain Insurance-medical questions regarding the consequences of severe aversive childhood stress arise in the context of psychiatric and psychosomatic expert reports. In psychiatric expert reports, the insurance-medical weighting of disorders of thinking, feeling and behaviour is in the foreground. In psychosomatic expert reports the assessment of limited performance with regard to functional body symptoms are considered to be most important. The majority of expert reports in the psychosomatic field concern people with chronic pain disorders. Pain disorders can develop insidiously over the years or be triggered by accidents. For expert reports of chronic pain conditions, guidelines have been developed by the corresponding specialist bodies in Switzerland. These have been available in German and French since 2019 (www.sappm.ch). The following overview focuses on expert reports of chronic pain disorders and is based on the Swiss guidelines mentioned above. The demanding nature of writing such expert reports is also recognized by specialists in other European countries.

Gastroparesis (GP) is prevalent after lung transplant (Ltx) (50-68%). GP has been associated with symptoms and delayed absorption of medications. Of particular concern after Ltx, GP can predispose to gastroesophageal reflux disease considered the main culprit for chronic allograft dysfunction. Therefore, early diagnosis and treatment is recommended in Ltx patients. Pharmacologic intervention for GP is not efficacious to improve gastric emptying and can induce potential serious side effects. Transcutaneous electric stimulation (TES) has been proposed to improve motility in various gastrointestinal motility disorders METHODS: We tested the hypothesis that TES may improve gastric emptying in Ltx patients. A 4-hour solid-phase gastric emptying study was done for worsening lung function before and after TES. Surveillance gastric emptying study (GEE) was done 2-12 weeks after TES. Five patients (4 female, age 48 ± 8), interval post-transplant (1-10 years), underwent TES as rescue therapy for moderate to severe GP (gastric retention >25% at 4 hours) that failed standard pharmacologic and dietary interventions. TES was delivered in continuous square wave, pulse rate 120 Hz, pulse width 220 µs, and pulse intensity to the maximum tolerated level without pain or muscle twitching. Two cutaneous electrodes were placed between T6 and T10 spinal levels (gastric autonomic segment) over the spine. Patients were instructed to use TES for 30 min after meals and for 30 min at bedtime RESULTS: Following TES, the percentage of gastric retention at 4 hours improved in the majority of patients (42 median, 25-73 min-max before TES; 20 median 7-43 min-max) after TES, p=0.01; figure 1). Three patients reported GP symptoms. Only one patient reported no significant improvement in the severity of symptoms CONCLUSION: TES appears to modulate symptom perception and significantly improves gastric emptying in Ltx patients with moderate to severe gastroparesis.

This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes.

Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy.

The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.