Rejected

To compare and analyze the clinical features and potential risk factors of intracranial and extracranial arterial dissection. A total of 241 consecutive patients with cervicocerebral artery dissection (CAD) in the First Affiliated Hospital of Zhengzhou University from 2010 to 2019 were observed. The 241 CAD patients were divided into extracranial artery dissection group (EAD) (81) and intracranial artery dissection group (IAD) (160), clinical characteristics and risk factors were compared between the two groups. Compared with EAD, the National Institute of Health Stroke Scale (NIHSS) score was higher in patients with ischemic stroke in the IAD group (0.015). Patients with IAD were more likely to present with headache (58.8% vs 37.0%, 0.001), and dissection Aneurysms (76.3% vs 38.3%, 0.001). Patients with EAD more likely to have a history of mild head and neck injuries (11.1% vs 4.4%, 0.047) and often involved the anterior circulation (77.8% vs 20.0%, 0.001). Multivariate Logistic regression analysis showed differences in a history of minor head and neck trauma (3.53, 95 1.04-11.97, 0.042), anterior circulation involvement (0.09, 95 0.05-0.19, 0.001), dissection aneurysms (4.98, 95 2.80-8.84, 0.001), headache (2.42, 95 1.39-4.20, 0.002) remained significant, and the NHISS score lost its significance. EAD often involves the anterior circulation and a history of mild injury to the head and neck. IAD is more prone to exhibit headache symptoms, and it is more likely to form a dissection aneurysm, and the symptoms of ischemic stroke are more severe.

Neurotensin (NTS) is a neuropeptide neurotransmitter expressed in the central and peripheral nervous systems. Many studies over the years have revealed a number of roles for this neuropeptide in body temperature regulation, feeding, analgesia, ethanol sensitivity, psychosis, substance use, and pain. This review will provide a general survey of the role of neurotensin with a focus on modalities that we believe to be particularly relevant to the study of reward. We will focus on NTS signaling in the ventral tegmental area, nucleus accumbens, lateral hypothalamus, bed nucleus of the stria terminalis, and central amygdala. Studies on the role of NTS outside of the ventral tegmental area are still in their relative infancy, yet they reveal a complex role for neurotensinergic signaling in reward-related behaviors that merits further study.

Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting.

The authors describe benefits of the recognised adverse effects of prostaglandin analogues on periocular structures in patients with unilateral proptosis and intraocular pressure rise. This case points to intentional consideration of prostaglandin analogue therapy in this selected cohort of patients with secondary ocular hypertension and proptosis.

BACKGROUND Due to its rareness, we present a case of chronic, bilateral, painful glossopharyngeal neuropathy, which developed after nasal septum and inferior concha surgery, and was non-surgically treated with percutaneous pulsed radiofrequency at the glossopharyngeal nerve, using an extra-oral approach. CASE REPORT A 41-year-old Caucasian female patient (60 kg, 1.57 m, body mass index 24.8 kg/m²) was referred to the Pain Center by her general practitioner because of ongoing pressing pain in her throat 4 months after nasal septum and inferior concha surgery. Based upon medical history, physical examination and the results of additional questionnaires, a probable diagnosis of atypical neck pain was made, based on ongoing glossopharyngeal stimulation, involvement of the pterygopalatine ganglion or/and superior cervical ganglion, with secondary involvement of the muscles of the neck. We changed the analgesic regimen and performed a pulsed radiofrequency treatment of the glossopharyngeal nerve on both sides. The patient had made progress and reported that she actually felt better but she asked for repeat treatment because of residual complaints. We performed the procedure for a second time on both sides. The results of the questionnaires before (T0) treatment, 3 months after the first (T1) and 3 months after the second (T2) treatment are provided. After the second procedure, the patient reported that her swallowing complaints had further diminished, as well as the pain behind her ears. She stopped using pregabalin. Residual complaints were manageable. CONCLUSIONS In patients with painful glossopharyngeal neuropathy, a non-surgically treatment with percutaneous pulsed radiofrequency at the glossopharyngeal nerve, using an extra-oral approach, seems to be an effective and safe method to use.

The aims of this study were to identify: (1) whether an after-hours emergency department (ED) collaborative care service using primary contact physiotherapists (PCPs) improves treatment times for musculoskeletal and simple orthopaedic presentations; and (2) differences in orthopaedic referral rates and analgesia prescription for patients managed by PCPs compared with secondary contact physiotherapists.A prospective observational study was conducted of diagnosed, matched patients seen in a 4-day week after-hours ED primary contact physiotherapy service in a tertiary referral ED. Patients presenting with a musculoskeletal or simple orthopaedic diagnosis reviewed by a physiotherapist as either the primary or secondary physiotherapy contact between 1630 and 2030 hours from Saturday to Tuesday were included in the analysis. Outcome measures collected included ED length of stay, orthopaedic referrals in the ED, follow-up plan on discharge from the ED and analgesia prescriptions.There were no adverse events, missed diagnoses or re-presentations for any patients managed by an ED PCP. Mean (±s.d.) treatment time for patients seen by an ED PCP was 130±76min, compared with 240±115min for those seen by a secondary contact physiotherapist (P<0.001). There were significant differences between patients managed by PCP versus secondary contact physiotherapists, with decreases of 20.4% for referrals to orthopaedics in the ED, 21.2% for orthopaedic clinic referrals on discharge and 8.5% in analgesia prescriptions for patients managed by an ED PCP (P<0.001). In addition to these reductions, there was a 17.5% increase in general practitioner referrals on discharge for patients managed by an ED PCP (P<0.001).An after-hours ED physiotherapy service is a safe service that reduces ED treatment times, as well as analgesia prescriptions and orthopaedic referrals for patients managed by a PCP.PCPs are capable of providing safe and effective care to patients in the ED who present with musculoskeletal complaints. Patients managed by physiotherapists as the primary contact require fewer X-rays and have reduced treatment times.Compared with previously published articles, this study demonstrates similar reductions in ED treatment times in an after-hours setting for patients managed by an ED PCP. However, this was achieved by physiotherapists who have less reported experience. Furthermore, this study found that management of patients by PCPs resulted in a reduction in the amount of analgesia prescribed and orthopaedic input required for these patients.PCPs can be trained to operate in the ED with minor or no prior ED experience while facilitating reductions in the amount of analgesia prescribed, orthopaedic referrals required (in ED and on discharge) and reducing treatment times for patients.

To validate the current criteria of visual snow and to describe its common phenotype using a substantial clinical database.

The rudimentary noncommunicating horn with a functional endometrial cavity is rare and often challenging to diagnose because of the variety in clinical features. We present a case of a patient for whom the diagnosis of a uterine horn was missed during the prior cesarean section, which later successfully treated with robotic-assisted laparoscopic removal of a rudimentary noncommunicating horn of uterus and ipsilateral tube.

The intestinal epithelium compartmentalizes the sterile bloodstream and the commensal bacteria in the gut. Accumulating evidence suggests that this barrier is impaired in sepsis, aggravating systemic inflammation. Previous studies reported that cathelicidin is differentially expressed in various tissues in sepsis. However, its role in sepsis-induced intestinal barrier dysfunction has not been investigated.

In 2018, ARPANSA published updated national DRLs for adult CT, which were first published in 2012, and augmented the national DRL categories. This paper presents the updated national DRLs and describes the process by which they were produced.