Rejected

It remains unclear how transition readiness is associated with various domains of health in children and young adults. Our objective was to describe the transition readiness of children and young adults with inflammatory bowel disease (IBD) and examine its associations with demographic factors, IBD activity, and measures of physical, psychological, and social health.

Endometriosis is a gynaecological hormone-dependent disorder that is defined by histological lesions generated by the growth of endometrial-like tissue out of the uterus cavity, most commonly engrafted within the peritoneal cavity, although these lesions can also be located in distant organs. Endometriosis affects ~10% of women of reproductive age, frequently producing severe and, sometimes, incapacitating symptoms, including chronic pelvic pain, dysmenorrhea and dyspareunia, among others. Furthermore, endometriosis causes infertility in ~30% of affected women. Despite intense research on the mechanisms involved in the initial development and later progression of endometriosis, many questions remain unanswered and its aetiology remains unknown. Recent studies have demonstrated the critical role played by the relationship between the microbiome and mucosal immunology in preventing sexually transmitted diseases (HIV), infertility and several gynaecologic diseases.

There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype. An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes. Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other. A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.

All health economics reviews on chronic and episodic migraine published to date underline the heterogeneity of results. Currently, the need for the generalizability of economic evaluations across different jurisdictions is considered a key issue to avoid unnecessary overlaps and to minimize the time to reimbursement decisions.

Pain affects a person's physical and psychological well-being, work performance and productivity. Working population bear their pain and continue to work which may contribute to the worsening of their pain condition. However, their pain situation was not well-examined.

This study aimed to determine the differences in the clinical, demographic and polysomnographic characteristics of OSAS between patients older than and younger than 65 years of age. Two groups of OSAS patients under 65 years of age and older who underwent PAP treatment in our sleep center were included in the study. Demographic, clinical, and polysomnographic variables of patients were compared as well as the PAP device usage compliance. The study was conducted with 183 patients (81 females and 102 males) having the diagnosis of OSAS. The ages of the patients ranged from 37 to 85 years (mean: 58.77 ± 12.59). The incidence of apnea, chest pain, arrhythmia, headache, non-concentration, forgetfulness, psychiatric disorders, motor activity, enuresis, libido and impotence complaints as well as the sedative usage rates and incidence of additional diseases were higher in elderly patients. Apnea hypopnea index, inspiratory positive airway pressure, and expiratory positive airway pressure measurements were significantly higher in the elderly group. The rates of NREM2 (%) and NREM3 (%) were lower in elderly patients. Many comorbid medical conditions, concomitant drug use, and age-related physiological changes in sleep architecture and circadian rhythm and their effects on sleep should be considered in the elderly sleep.

Kratom is a coffee-like plant containing compounds that cause opioid and stimulant effects. The most prevalent bioactive alkaloid of kratom is mitragynine (MG). Opioid effects of MG are apparent (e.g. antinociception and nanomolar affinity for μ, κ and δ opioid receptors), but effects encompassing interactions with additional systems, such as adrenergic and dopaminergic, remain undefined. Given that enhanced adrenergic transmission is a mechanism common to most first-line neuropathic pain medications, we tested the hypothesis that MG reduces chemotherapy-induced neuropathic pain through a mechanism involving α-adrenoceptor activation.

BACKGROUND Intussusception is not very common in adults, and acute intestinal obstruction with intussusception due to inflammatory myofibroblastic tumor (IMT) is extremely rare. IMT is an uncommon lesion and has no single defined cause. It predominantly affects the pediatric age group and commonly involves the lungs. Here we present a case of IMT causing ileocolic intussusception leading to acute intestinal obstruction in an adult. CASE REPORT A 40-year-old female came to the emergency department with severe colicky pain in her abdomen, and reported 6 to 7 episodes of vomiting with bilious contents, along with an inability to pass feces and flatus for 3 days. An x-ray of her abdomen in erect posture revealed multiple air-fluid levels. Because she had a previous history of tuberculosis, a possible tubercular stricture as the cause of her acute obstruction was considered; an exploratory laparotomy was performed showing her bowel loops were dilated with ileocolic intussusception. The lead point of intussusception (a well-defined 4×4×3.5 cm solid mass), was found at 15 cm proximal to the ileocecal junction. A right hemicolectomy with ileo-transverse anastomosis was performed. The histopathological examination confirmed the presence of IMT. CONCLUSIONS IMT causing ileocolic intussusception with acute intestinal obstruction is an extremely rare presentation of an uncommon entity in adults. High index of suspicion, and appropriate investigations (x-ray abdomen, ultrasound, computed tomography, and colonoscopy) depending on presentation and clinical condition of the patient can result in prompt diagnosis and early management.

The use of ketamine in conjunction with morphine to reduce postoperative pain has been explored in several different surgery subtypes with conflicting results. Ketamine has shown promise to have both opioid sparing and analgesic effects in the postoperative setting. This study aimed to elucidate ketamine's ability to reduce morphine equivalent consumption and improve patient satisfaction after spinal fusion surgery for the correction of idiopathic scoliosis. This surgery is known to be associated with significant postoperative pain which impedes the ability to improve patient satisfaction, and may complicate the recovery timeline. Currently, the standard therapeutic regimen consists of patient-controlled analgesia morphine and the use of other opioids such as hydromorphone. A prospective, randomized double-blinded, placebo-controlled trial was performed to compare the standard morphine equivalent therapy alone against a standard therapy in conjunction with ketamine. Fifty adolescent patients were enrolled and randomized. Results yielded a significant reduction in postoperative morphine equivalent consumption (p = 0.042), adjusted postoperative pain scores (p < 0.001), and incidence of nausea and vomiting (p = 0.045). The application of ketamine as an analgesic in conjunction with the current standard of morphine equivalent therapy may serve as a superior pain control regimen for spinal surgeries in young population. This regimen enhancement may be generalizable to other surgery subtypes within similar populations. LEVEL OF EVIDENCE: Level I.

Neuronal excitability is classified as type I, II, or III, according to the responses of electronic activities, which play different roles. In the present paper, the effect of an excitatory autapse on type III excitability is investigated and compared to type II excitability in the Morris-Lecar model, based on Hopf bifurcation and characteristics of the nullcline. The autaptic current of a fast-decay autapse produces periodic stimulations, and that of a slow-decay autapse highly resembles sustained stimulations. Thus, both fast- and slow-decay autapses can induce a resting state for type II excitability that changes to repetitive firing. However, for type III excitability, a fast-decay autapse can induce a resting state to change to repetitive firing, while a slow-decay autapse can induce a resting state to change to a resting state following a transient spike instead of repetitive spiking, which shows the abnormal phenomenon that a stronger excitatory effect of a slow-decay autapse just induces weaker responses. Our results uncover a novel paradoxical phenomenon of the excitatory effect, and we present potential functions of fast- and slow-decay autapses that are helpful for the alteration and maintenance of type III excitability in the real nervous system related to neuropathic pain or sound localization.