Rejected

A Baker's cyst is usually an incidental finding in adults being investigated for a joint arthropathy, and its rupture preceding the diagnosis of juvenile idiopathic arthritis (JIA) is rare in children. Here, we describe a case of a 4-year-old girl who presented to the Emergency Department with right calf pain, swelling, and no preceding history of trauma. MRI confirmed a ruptured Baker's cyst with inflammatory arthropathy alongside an extensive synovial proliferation throughout the knee joint with large joint effusions and associated soft tissue oedema tracking superiorly and inferiorly along the medial head of gastrocnemius and anteriorly along the tibia. Further investigations revealed bilateral uveitis consistent with a diagnosis of juvenile idiopathic arthritis.

Ketamine, a nonselective NMDA receptor antagonist, is used widely in medicine as an anesthetic agent. However, ketamine's mechanisms of action lead to widespread physiological effects, some of which are now coming to the forefront of research for the treatment of diverse medical disorders. This paper aims at reviewing recent data on key nonanesthetic uses of ketamine in the current literature. MEDLINE, CINAHL, and Google Scholar databases were queried to find articles related to ketamine in the treatment of depression, pain syndromes including acute pain, chronic pain, and headache, neurologic applications including neuroprotection and seizures, and alcohol and substance use disorders. It can be concluded that ketamine has a potential role in the treatment of all of these conditions. However, research in this area is still in its early stages, and larger studies are required to evaluate ketamine's efficacy for nonanesthetic purposes in the general population.

Chronic pathological pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Despite much progress we have made in understanding chronic pain in the last decades, its underlying mechanisms remain elusive. It is assumed that abnormal increase of calcium levels in the cells is a key determinant in the transition from acute to chronic pain. Exploring molecular players mediating Ca entry into cells and molecular mechanisms underlying activity-dependent changes in Ca signaling in the somatosensory pain pathway is therefore helpful towards understanding the development of chronic, pathological pain. Canonical transient receptor potential (TRPC) channels form a subfamily of nonselective cation channels, which permit the permeability of Ca and Na+ into the cells. Initiation of Ca entry pathways by these channels triggers the development of many physiological and pathological functions. In this review, we will focus on the functional implication of TRPC channels in nociception with the elucidation of their role in the detection of external stimuli and nociceptive hypersensitivity.

A patient was diagnosed with ulcerative colitis (UC) in 2010. In March 2015, she had abdominal pain, diarrhea, bloody stool, and UC has relapsed. In June 2015, pain and sensory disturbance of both lower limbs appeared. Blood flow at the distal femoral artery was not confirmed with magnetic resonance angiography, and it was diagnosed as bilateral acute inferior limb ischemia. Arterial thrombolectomy with Fogarty's balloon catheter was performed and blood flow was improved. The severity of UC was moderate with Mayo score 8. Thrombosis is considered to be a complication with a high incidence in inflammatory bowel disease. Reports of arterial thrombosis are very rare. It is important to evaluate the risk of bleeding and thrombosis in active or severe cases in UC and need to do thrombotic prophylactic treatment simultaneously with UC treatment.

WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies.

Acute thrombophlebitis of the superficial veins is an urgent problem as it can spread to the deep veins with the subsequent development of pulmonary embolism. The social implications of varicotrombophlebitis are the long-term disability of most patients up to complete disability, so finding the least invasive methods of correction of the discussed disease is a pressing issue of modern phlebology. The research objective is to carry out a comparative analysis of the quality of life of patients with acute ascending thrombophlebitis of the great sapheneous vein after treatment with high-frequency endovenous welding and standard phlebectomy. The results of treatment of 63 patients with acute ascending thrombophlebitis of great saphenous vein (GSV) with III and IV class of thrombophlebitis, who were hospitalized in the surgical wards of the Municipal Clinical Hospital No. 8 of Kyiv from 2017 to 2018, were analyzed. Welding of the thrombotic vein segment was performed using an endovenous welding catheter (WC). Quality of life (QOL) results were assessed using CIVIQ2 (Chronic Venous Insufficiency Questionnaire). According to ultrasound duplex scanning, complete vein ablation occurred in 97.22% of patients after endovenous welding (EW) of thrombotic GSV. In all patients of Group I already on day 2, the total rate of QOL by all factors (pain, physical, social, psychological) significantly (p<0.05) exceeded the presurgery values and was 79.3%, when before treatment this indicator was 4.3% higher. At follow-up, QOL values continued to improve over all observation periods compared to the previous term (p <0.05). Quality of life restriction in connection with pain, social and psychological factors after EW decreased 2.1 times(p<0.05), when in control group patients – only 1.2 times. The revealed advantages of the method of high-frequency endovenous welding by all indicators of quality of life over standard phlebectomy allow recommending this method for wide practical application.

Labor pain is a severe form of agony that females experience while giving birth. A lot of pregnant women prefer epidural anesthesia (EA) to avoid labor pain.

Electroacupuncture (EA) is reported effective in alleviating pain-related emotion; however, the underlying mechanism of its effects still needs to be elucidated. The NPS-NPSR system has been validated for the involvement in the modulation of analgesia and emotional behavior. Here, we aimed to investigate the role of the NPS-NPSR system in the anterior cingulate cortex (ACC), hypothalamus, and central amygdala (CeA) in the use of EA to relieve affective pain modeled by complete Freund's adjuvant- (CFA-) evoked conditioned place aversion (C-CPA). . CFA injection combined with a CPA paradigm was introduced to establish the C-CPA model, and the elevated O-maze (EOM) was used to test the behavioral changes after model establishment. We further explored the expression of NPS and NPSR at the protein and gene levels in the brain regions of interest by immunofluorescence staining and quantitative real-time PCR.

AutoInflammatory Diseases (AIDs) are a group of innate immune system disorders characterized by sterile inflammation without evidence of pathogenic autoantibodies or auto-reactive T lymphocytes. An expanding spectrum of genes and molecular pathways are associated with AIDs. Inflammasomopathies are secondary to dysregulation of multi-protein complexes, called inflammasomes, leading to an excessive maturation and secretion of IL1β and IL18. Patients present with persistent or recurrent systemic inflammation, abdominal and chest pain, skin rashes and are sensible to IL1 inhibitors. Unfolded proteins response causes a small number of AIDs that we propose to call immuno-proteinopathies, characterized by recurrent fevers and deep tissues inflammation. Other inflammatory conditions can occur in case of abnormalities of actin polymerization and the term of immuno-actinopathies is proposed. Generalized pustular psoriasis is a marker of autoinflammation mainly affecting the keratinocytes. Specific treatment targeting the p40 subunit of IL12 and IL23 or IL-17 are usually effective. Granulomatous inflammation characterizes AIDs related to NOD2 signaling defects. Defects in the ubiquitin-proteasome system cause a group of relopathies and some interferonopathies related to defect of the proteasome function (CANDLE syndrome). Gain of function of proteins regulating the production of type I interferons lead to severe inflammatory conditions, called interferonopathies. The JAK/STAT inhibitors are usually effective in these latter conditions. In conclusions, the identification of the main intracellular pathways involved in rare monogenic AIDs allows not only the proper classification of different conditions, but also highlight a pivotal role of possible novel therapeutic targets for the future.

An estimated 1.6 to 3.8 million concussions occur in sport and recreational activities annually. A sport related concussion (SRC) is contemporarily defined as a traumatic brain injury induced by biomechanical forces. Symptoms of concussion are caused by the metabolic cascade that includes excitatory neurotransmitter release, abnormal ion fluxes, increased glucose metabolism, lactic acid accumulation, elevated cerebral blood flow, energy deficit, and inflammation. These changes in the brain are responsible for the hallmark symptoms of a concussion such as headache, nausea, loss of consciousness, and pressure in the head. Most concussions resolve within 2-4 weeks, but approximately 10-33% of individuals have persistent symptoms for months after the initial injury. An associated comorbidity following concussion is post-concussion syndrome (PCS). Clinical diagnostic criteria for PCS requires a history of brain injury and the presence of at least two symptoms for a minimum of four weeks. Having three of eight symptoms (headache, dizziness, fatigue, irritability, insomnia, concentration problems, memory difficulty, or intolerance of stress emotion or alcohol) for at least four weeks has also been identified as grounds for PCS classification. The mainstay of treatment for a SRC traditionally is rest followed by a stepwise return to learn, then physical activity, and finally return to sport. Time lost due to concussion is at least five days following symptom resolution when following best practices for full return to contact sports. Currently, prescribed rest in which patients avoid physical and cognitive activity is the most widely used intervention. Recent research indicates that strict rest longer than one to two days following a concussion does not improve outcomes and may potentially cause an increase in symptom reporting. The increase in symptom reporting especially in athletes after prescribed rest may be due to physical deconditioning and the development of secondary symptoms such as fatigue and reactive depression. Exercise in general has benefits for body composition, skeletal health, cardiorespiratory fitness, depression, anxiety, and academic achievement, and it also improves cognition through increased cerebral blood flow, oxygen extraction, brain metabolism, and neuroplasticity. Aerobic exercise conducted at subsymptom and submaximal intensities has been proposed as a potential intervention for the negative effects of inactivity following a concussion. Subsymptom aerobic exercise has been defined as aerobic exercise performed at an intensity and duration that does not exacerbate post-concussion symptoms. The American College of Sports Medicine defines submaximal exercise as aerobic activity occurring at 85% of the age adjusted maximum heart rate. These terms used by different authors often refer to similar exercise intensities, but they cannot be used interchangeably. Therefore, the purpose of this critically appraised topic is to examine the safety of varying aerobic exercise intensities in patients with a concussion. In appraising the safety of controlled aerobic activity in comparison to complete rest clinicians will be able to determine if physical activity can be implemented in the plan of care for patients with a concussion.