Rejected

There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been described in the pelvis of patients with PMR. We aimed to evaluate the performance of inflammatory ceMRI signals at predefined pelvic sites as a diagnostic test for PMR.

In commercial flocks of laying hens, keel bone fractures (KBFs) are prevalent and associated with behavioural indicators of pain. However, whether their impact is severe enough to induce a depressive-like state of chronic stress is unknown. As chronic stress downregulates adult hippocampal neurogenesis (AHN) in mammals and birds, we employ this measure as a neural biomarker of subjective welfare state. Radiographs obtained longitudinally from Lohmann Brown laying hens housed in a commercial multi-tier aviary were used to score the severity of naturally-occurring KBFs between the ages of 21-62 weeks. Individual birds' transitions between aviary zones were also recorded. Focal hens with severe KBFs at 3-4 weeks prior to sampling (n = 15) had lower densities of immature doublecortin-positive (DCX) multipolar and bipolar neurons in the hippocampal formation than focal hens with minimal fractures (n = 9). KBF severity scores at this time also negatively predicted DCX cell numbers on an individual level, while hens that acquired fractures earlier in their lives had fewer DCX neurons in the caudal hippocampal formation. Activity levels 3-4 weeks prior to sampling were not associated with AHN. KBFs thus lead to a negative affective state lasting at least 3-4 weeks, and management steps to reduce their occurrence are likely to have significant welfare benefits.

A fundamental challenge for Emergency Department (ED) clinicians is to relieve severe, acute pain while simultaneously avoiding adverse events associated with opioid analgesics. Because there is evidence that intravenous (IV) acetaminophen is an effective adjuvant analgesic in post-operative settings, we examined whether it also has a role in the ED.

Iron deficiency (ID) is globally prevalent, and apart from anemia is associated with thrombocytosis. While considered benign, studies linking thrombotic events with prior ID anemia suggest otherwise. Herein we used animal models to assess the influence of ID on thrombotic tendency. Sprague-Dawley rats were fed control or iron deficient diets and ferric carboxymaltose was used to reverse ID. Thrombosis was induced via stenosis of the inferior vena cava or damage to the right carotid artery using ferric chloride. Thrombi were evaluated histologically and via high frequency ultrasound in the venous model. ID consistently induced thrombocytosis alongside anemia. Venous thrombus growth and final dimensions in both arterial and venous thrombi were largest in ID. In both models, platelet numbers correlated with the final thrombus size, with ID thrombi having the largest platelet areas. Platelet function was also evaluated in surgically naive rats. Coagulability on thromboelastography and hemostasis on tail transection were augmented in ID. Platelet and plasma P-selectin expression were both higher in ID. Platelet adhesion and aggregation in ID was impaired under shear flow but was intact on static assays. Iron replacement therapy reversed all ID-related changes in hematological parameters, thrombus dimensions, and platelet assays. In summary, ID alone increases thrombotic tendency. Iron replacement therapy reverses these changes, making it a viable strategy for prevention of ID-related thrombotic disease. This may be of importance in patients with chronic illnesses which may already be at increased risk for thrombosis such as inflammatory bowel disease, chronic kidney disease, or cancer.

The aim of this single-center, two-arm, parallel-group, double-blinded, randomized controlled trial was to investigate the disputed specific effectiveness of acupuncture by comparing acupuncture on specific and non-specific points among patients with non-chronic, painful TMDs.

: This study aimed to investigate the prevalence of temporomandibular disorders (TMD) in patients with chronic hemodialysis and evaluate the risk factors of developing TMD.: One hundred forty-six subjects were included in the study. The examination for TMD was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders. Axis I protocol was used to evaluate the prevalence of TMD sub-diagnoses.: The prevalence of TMD was 41.5% in hemodialysis patients and significantly higher than in the control group. The most common symptom was TMJ pain, and the most common TMD subtype was muscular type. Female patients had significantly higher TMD than males. C-reactive protein, hemoglobin, parathyroid hormone, and albumin were significantly associated with TMD.: There was an elevated prevalence of TMD in hemodialysis patients.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

The main purpose of our study has been to establish a link between the administration of intravenous fluids during Labor and the weight loss experienced by infants during hospitalization. We conducted a retrospective observational study using a descriptive and comparative method. We studied 150 records of patients who gave birth at term (low-risk pregnancy) of a single healthy new born with breastfeeding in a university hospital center between 1 January 2016 and 31 July 2016. Maternal, obstetrical and neonatal characteristics were registered to determine the influence of vascular filling by univariate and multivariate analysis and identified factors that may lead to increase neonatal weight loss. One hundred and fifty mother-child couples were studied. Newborns whom mothers received at least 1500 mL of solute during Labor lose significantly more weight until the third day of life ( < .001) compared to women who received less than 1500 mL, also observed for neonatal weight loss greater than 8% ( = .043). In addition, the obstetrical factors most significantly associated with an increase in the volume of solute injected were the duration of Labor ( < .001), the administration of oxytocin ( < .001), epidural analgesia ( = .01) and emergency cesarean section during Labor ( < .001). We found a link between vascular volume injected during Labor and increased risk of neonatal weight loss. Taking this factor into account when monitoring Labor in the birth room is essential to prevent and adapt neonatal management in the event of excessive weight loss. Influence of intrapartum maternal fluids on weight loss in breastfed newborns.

We report the case of a 64-year-old pseudophakic patient in a rural area who chronically suffered from headache with eye pain and was on analgesics for pain relief but never turned up to an ophthalmologist. There was lack of awareness to visit an ophthalmologist for headache as he thought that after undergoing cataract surgery, the role of ophthalmologist was limited. His approach to our centre was only after intense headache with sudden loss of vision. He had actually developed secondary glaucoma due to pupillary block angle closure as a late complication following yttrium aluminium garnet capsulotomy. After medical and surgical management, he regained his complete vision with total relief from headache.

A 56-year-old man undergoing immunotherapy treatment for metastatic melanoma presented with sudden onset testicular pain radiating into his abdomen. On examination, the abdomen was generally tender with associated guarding. Imaging revealed a perforation of the small bowel at the site of a metastatic lesion. Histology revealed that this process was non-inflammatory in nature. A diagnosis of small bowel perforation secondary to immunotherapy driven rapid tumour regression was made. The patient was treated with a small bowel resection plus anastomosis and made a full recovery. This case highlights the rare potential side effect of immunotherapy in causing non-inflammatory bowel perforations secondary to rapid tumour regression.