Rejected

This study set out to investigate the effect of massage on the Toll-like receptor 4 (TLR4) signalling pathway in the dorsal root ganglia of rats that had undergone spinal nerve ligation (SNL), with the hypothesis that massage could be used as an analgesic. Forty female SD rats were randomly divided into 5 groups: the control group, sham-operated group, model group, sham massage group, and massage group. There were 8 rats in each group. SNL rat models were established in the model group, sham massage group, and massage group. Rats in the sham-operated group underwent surgery to expose the vertebral nerves, but no further procedures were performed. The control group consisted of intact animals. The rats in the massage group underwent massage using a massage simulation machine once a day for 14 d in succession; the hind limbs of the rats in the sham massage group were gently touched with a cloth bag once a day for 14 continuous days. The rats in the control group, the sham-operated group, and the model group did not receive any intervention and were observed for 14 d. Paw withdrawal thermal latency (PWTL) and paw withdrawal mechanical threshold (PWMT) of rats in each group were detected 1 d before modelling and at 1, 3, 7, and 14 d after modelling. Fourteen days after modelling, the expression levels of TLR4, IRAK1, TRAF6, TNF-, and IL-6 were detected in all rats. The PWTL and PWMT of SNL rats were decreased, while these parameters were elevated after massage. SNL rats showed higher levels of TLR4, IRAK1, TRAF6, IL-6, and TNF-, and massage effectively lowered the expression levels of these molecules. Inhibiting activation of the TLR4 signalling pathway, which can reduce the release of inflammatory factors, may be one mechanism by which massage treats neuropathic pain.

Epidural anesthesia minimizes perioperative pain in dogs. It is considered that epidural solution dispersion in cadavers is similar to alive dogs. The objective of the anatomical study was to compare the dispersion of 0.2 mL/kg 0.25% bupivacaine and iohexol via lumbar epidural (L1-L2) under fluoroscopic guidance in 10 thawed cadavers (GC) and 13 female dogs (G0.25) (5-15 kg; body score 4/5). The objective of the clinical study was to evaluate postoperative analgesic consumption and sedation for 6 h after extubation of dogs submitted to ovariohysterectomy when using 0.25% (G0.25; = 10) bupivacaine with the intraoperative use of fentanyl (GF; = 10). Parametric data were compared by the -test and non-parametric data by the Mann Whitney test. Pain and sedation scores were evaluated over time by the Friedman test, followed by the Dunn test. Alive dogs presented greater epidural dispersion (17 ± 3 vertebrae) than thawed cadavers (11 ± 4 vertebrae; = 0.002). All dogs treated with fentanyl and only one dog treated with 0.25% epidural bupivacaine presented pain scores above the cut-off point of the Glasgow Composite Measure Pain Scale Short-Form (GCMPS-SF) and required postoperative rescue analgesia up to 6 h after extubation. The sedation score was higher at all postoperative moments compared to preoperative moments in the G0.25 and GF, except for evaluations performed at 5 and 6 h after extubation in the GF. Greater sedation was observed immediately after extubation in the GF compared to the G0.25, and there was greater sedation in the G0.25 compared to the GF from 3 to 6 h after extubation. The conclusion of the anatomical study was that L1-L2 epidural bupivacaine dispersion is lower in canine thawed cadavers than in alive dogs. Conclusion of the clinical study was that lumbar epidural anesthesia improved postoperative analgesia and produced longer postoperative sedation when compared to fentanyl.

Atypical headaches are uncommon and require special consideration by a primary care physician. We report the case of a 37-year-old male, who presented to the family medicine practice with persistent headaches which subsided postprandial and was later hospitalized for stroke-like symptoms. The lumbar puncture (LP) suggested viral etiology; however, cerebrospinal fluid (CSF) yielded no evidence of a specific virus. The patient computed tomography (CT) was non-diagnostic and magnetic resonance imaging (MRI) confirmed no acute intracranial abnormalities. Electroencephalogram (EEG) showed no definite epileptiform discharges, electrographic seizures, or evidence of non-convulsive status epilepticus. He was started empirically on intravenous (IV) acyclovir 800 mg Q6 for 10 days, followed by another 10 days of oral valacyclovir 500 mg twice a day (BID) antivirals leading to a complete resolution of his symptoms and confirming the diagnosis as viral encephalitis. This case is unique in its presentation due to the postprandial resolution of the patient's headache with no evidence of a specific virus in the CSF. In primary care setting, headaches are often referred routinely to neurologist for further management. However, more insidious causes for a headache, such as viral infections, should not be ruled out; and if the symptoms are acute and severe, an immediate inpatient work-up with empiric treatment for the most probable etiology may be warranted, despite unequivocal exam and laboratory findings.

Neuropathic pain seriously affects life quality, and it is urgent to develop novel drugs with high efficacy and few side effects. Sanguinarine (SG) is a natural plant medicine with anti-inflammatory and neuroprotection effects. This study aimed to investigate the effect of SG on chronic constriction injury (CCI)-induced neuropathic pain.

Uremic pruritus is a highly prevalent and debilitating symptom in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The purpose of this review is to examine current evidence on the mechanisms and treatments of pruritus in CKD and highlight promising areas for future research.

In CT-guided dorsal root ganglion puncture, especially T1-T3, it is often difficult to reach the target due to obstruction of the lamina, transverse process, and ribs. Therefore, a safe and effective puncture method with high success rate is urgently needed to guide us in our clinical work.

In the global context, the health and quality of life of people are adversely affected by either one or more types of chronic diseases. The chronic pain associated with diagnosed patients may include heavy medical expenditure along with the physical and mental suffering they undergo. Usually, unbearable amounts of medical expenses are incurred, to improve or sustain the health condition of the patient. Consequently, the heavy financial burden tends to push households from a comfortable or secure life, or even from bad to worse, towards the probability of becoming poor. Hence, this study is conducted to identify the impact chronic illnesses have on poverty using data from a national survey referred as the Household Income and Expenditure Survey (HIES), with data gathered by the Department of Census and Statistics (DCS) of Sri Lanka in 2016. As such, this study is the first of its kind in Sri Lanka, declaring the originality of the study based on data collected from the local arena. Accordingly, the study discovered that married females who do not engage in any type of economic activity, in the age category of 40-65, having an educational level of tertiary level or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. Moreover, it was inferred that, if a person is deprived from access to basic education in the level of education, lives in the rural or estate sector, or suffers from a brain disease, cancer, heart disease or kidney disease, he is highly likely to be poor. Some insights concluded from this Sri Lankan case study can also be applied in the context of other developing countries, to minimise chronic illnesses and thereby the probability of falling into poverty.

The veterinary pharmacopeia available to treat pain and inflammation is limited in number, target of action and efficacy. Inhibitors of soluble epoxide hydrolase (sEH) are a new class of anti-inflammatory, pro-resolving and analgesic drugs being tested in humans that have demonstrated efficacy in laboratory animals. They block the hydrolysis, and thus, increase endogenous concentrations of analgesic and anti-inflammatory signaling molecules called epoxy-fatty acids. Here, we screened a library of 2,300 inhibitors of the sEH human against partially purified feline, canine and equine hepatic sEH to identify inhibitors that are broadly potent among species. Six very potent sEH inhibitors (IC < 1 nM for each enzyme tested) were identified. Their microsomal stability was then measured in hepatic extracts from cat, dog and horse, as well as their solubility in solvents suitable for the formulation of drugs. The -4-{4-[3-(4-trifluoromethoxy-phenyl)-ureido]-cyclohexyloxy}-benzoic acid (t-TUCB, ) appears to be the best compromise between stability and potency across species. Thus, it was selected for further testing in veterinary clinical trials of pain and inflammation in animals.

Microvascular decompression (MVD) surgery is considered as an effective method with which to treat trigeminal neuralgia (TN). However, sometimes MVD surgery fails due to incomplete decompression of the responsible vessels caused by a poor visual field. In this study, we evaluated the benefits of endoscopic visualization and the value of full endoscopic vascular decompression (EVD) by describing the surgical results of 20 patients with TN after EVD.

Stroke induces a robust inflammatory response. However, it still lacks a systematic view of the various immune cell types due to the limited numbers of fluorophore used in the traditional FACS technique. In our current study, we utilized the novel technique mass cytometry (CyTOF) to analyze multiple immune cell types. We detected these immune cells from the ischemic brain, peripheral blood, spleen, and bone marrow at different time courses after stroke. Our data showed (1) dynamic changes in the immune cell numbers in the ischemic brain and peripheral organs. (2) The expression levels of cell surface markers indicate the inflammation response status after stroke. Interestingly, CD62L, a key adhesion molecule, regulates the migration of leukocytes from blood vessels into secondary lymphoid tissues and peripheral tissues. (3) A strong leukocyte network across the brain and peripheral immune organs was identified using the R program at day 1 after ischemia, suggesting that the peripheral immune cells dramatically migrated into the ischemic areas after stroke. This study provides a systematic, wide view of the immune components in the brain and peripheral organs for a deep understanding of the immune response after ischemic stroke.