Rejected

Stimulation of the dorsal root ganglion (DRG-S) has been shown to be an efficacious treatment option for refractory neuropathic pain syndromes. However, placement of the percutaneous leads for trial implantation can be challenging in patients with prior spinal surgical interventions resulting in anatomical changes and adhesions. This technical report describes the transgrade placement of DRG-S leads in four patients with back pain surgery histories in whom secondary to specific anatomical pathologies the traditional anterograde placement of DRG-S leads was not feasible. In these patients we used a transgrade placement approach entering superior and contralateral to the target level of placement, resulting in uncomplicated and effective placement of DRG-S leads. Transgrade lead placement for DRG-S may be an efficacious alternative to traditional anterograde DRG lead placement in cases where interlaminar access below the level of the DRG is not available, or desirable. Further studies are needed to clarify the safety and applicability of this approach.

Central sensitization driven by glial activation-mediated neuroinflammation is recognized as a key mechanism in pain processing. Laser moxibustion using low-intensity laser irradiation of corresponding acupoints significantly relieves knee osteoarthritis (KOA) pain. However, the underlying mechanism of its effects on KOA pain is still not completely understood. In this study, we aimed to investigate whether laser moxibustion could alleviate KOA pain by inhibiting spinal glial activation and proinflammatory cytokines upregulation in monosodium iodoacetate (MIA)-induced KOA pain in rats. Sprague-Dawley rats were divided randomly into three groups: Saline + Sham Laser, MIA + Laser, and MIA + Sham Laser. A 10.6 μm laser was used to irradiate ST35 (Dubi) for 10 min once every 2 days for a total of seven applications. The paw withdrawal mechanical threshold and weight-bearing distribution were performed to evaluate the nociceptive behaviors. Spinal expressions of microglial marker, ionized calcium binding adaptor molecule-1 (Iba-1); astrocyte marker, glial fibrillary acidic protein (GFAP); pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) were measured 14 days after MIA injection. The results showed that laser moxibustion significantly reversed the MIA-induced mechanical hyperalgesia and weight-bearing difference up to 14 days compared with MIA + Sham Laser group ( < 0.05 or  < 0.01). Moreover, both the protein level and immunofluorescence intensity of Iba-1 in the ipsilateral spinal cord dorsal horn were markedly decreased in the MIA + Laser group than those in the MIA + Sham Laser group ( < 0.01). However, there was no significant difference in the expression of GFAP between groups ( > 0.05). In addition, laser moxibustion decreased the upregulation of TNF-α, IL-1β, and IL-6 compared with the MIA + Sham Laser group ( < 0.01). This study demonstrated that laser moxibustion at ST35 significantly alleviated MIA-induced KOA pain through inhibition of the microglial activation-mediated neuroinflammation, at least partially, by suppressing the production of proinflammatory cytokines, which may provide a potential analgesic target for KOA pain relief.

In 2018-19, Borna disease virus 1 (BoDV-1), the causative agent of Borna disease in horses, sheep, and other domestic mammals, was reported in five human patients with severe to fatal encephalitis in Germany. However, information on case frequencies, clinical courses, and detailed epidemiological analyses are still lacking. We report the occurrence of BoDV-1-associated encephalitis in cases submitted to the Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany, and provide a detailed description of newly identified cases of BoDV-1-induced encephalitis.

Sneddon's syndrome is a rare disease characterized by cerebrovascular events and livedo racemosa. There are often autoimmunological comorbidities, especially antiphospholipid antibody syndrome. The underlying pathophysiology is still not fully clarified. A causal therapy does not exist. The reported case shows a patient with a thrombophilic form of Sneddon's syndrome with the main symptoms of headache and thromboembolic events. Symptoms, laboratory parameters, histology and differential diagnoses are explained.

Calcium pyrophosphate deposition disease (CPPD) is a crystal arthropathy, and may present with various clinical manifestations such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPPD crystal arthritis (formerly pseudogout), and chronic CPPD crystal inflammatory arthritis. It is known that aging, trauma and osteoarthritis are major risk factors for CPPD. Acute CPP arthritis may occur as monoarticular or oligoarticular and usually involves large peripheral joints such as the knees, wrists and ankles. CPPD is characterized by sudden onset of severe pain, swelling and periarticular erythema, and systemic symptoms such as fever, chills, and weakness may occur. On the other hand, axial CPPD has been reported rarely and most cases appear with symptoms related to a mass effect such as foramen magnum syndrome, spinal stenosis, radiculopathy, myelopathy, synovial cyst or cauda equina syndrome. In addition, there are fewer reported cases of spinal CPPD that cause neck and back pain. This clinical condition should be considered in the differential diagnosis of acute neck and back pain.

Post-mastectomy pain syndrome is a prevalent chronic pain condition that affects numerous patients following breast surgery. The mechanism of this pain has been proposed to be neurogenic in nature. As such, we propose a novel surgical method for the prophylactic management of postsurgical breast pain: targeted muscle reinnervation of the breast. This article serves to review the relevant current literature of post-mastectomy pain syndrome and targeted muscle reinnervation, describe our current surgical technique for this operation, and present an initial cohort of patients to undergo this procedure.

Pocket complications are common after cardiac implantable electronic device implantation. We report a rare case of pyoderma gangrenosum (PG) complicating a permanent pacemaker implantation, and the first literature review of 10 published cases.

Early-onset schizophrenia is characterized by greater severity and more functional impairment than adult-onset schizophrenia. Few studies have prospectively evaluated short- or long-term antipsychotic efficacy in treatment-naïve (vs. previously treated) first-episode schizophrenia. The aim of this post-hoc analysis was to evaluate the long-term efficacy of lurasidone in antipsychotic-naïve adolescents with schizophrenia.

In 2019, one novel pharmaceutical agent for horses or food-producing animals was released on the German market: An injection suspension for horses containing chondrogenic-induced equine allogeneic peripheral blood-derived mesenchymal stem cells as the active ingredient (ArtiCell Forte) is now available. Two established veterinary active pharmaceutical ingredients became accessible for additional species: a salicylanilide anthelmintic oxyclozanide (Distocur) for the treatment and control of fascioliasis in sheep as well as a type-I synthetic pyrethroid permethrin (Z-Itch), which now has additionally been authorized for donkeys. Additionally, one veterinary drug with a new combination of active ingredients (toltrazuril + gleptoferron), 2 drugs (permethrin, omeprazole) in a new pharmaceutical formulation, one drug (lidocaine) with a novel route of administration, one drug (amprolium) with a higher content of the active ingredient, as well as one active substance (butylscopolaminium bromide) in mono-preparation have been launched on the market for horses and food-producing animals.