Rejected

Low back pain (LBP) is one of the most common spine diseases and represents the most frequent cause of absence from work in developed countries. Approximately 40% of chronic LBP is related to discogenic origin. The goal of the study is producing a review of literature to describe analytically the techniques of intradiscal injections.

Paclitaxel, a commonly used chemotherapeutic agent, is usually associated with peripheral neuropathy. Paclitaxel induced peripheral neuropathy (PIPN) can be dose limiting and may have detrimental influence on patients' quality of life. However, the mechanism of PIPN remains unclear. Medicinal herbs and their formulas might offer neuronal protection with their multitarget and integrated benefits in chemotherapy-induced peripheral neuropathy (CIPN). Siwei Jianbu decoction (J12) is a classic formula of traditional Chinese medicine which can promote blood circulation and treat diabetic nephropathy in clinical with the symptoms of weakness and pain.

An aberrant origin of the right subclavian artery arising as the most distal vessel from the aortic arch is an uncommon but clinically important anomaly. Its abnormal course may result in esophageal compression with dysphagia, or tracheal compression resulting in asthma or stridor, and can greatly complicate radial artery access for coronary angiography. When an aberrant right subclavian artery is obstructed by atherosclerotic plaque, it may produce symptoms of arm ischemia such as pain and weakness. For the past 75 years, the standard treatment approach for symptomatic aberrant right subclavian artery has been surgical correction. There are only three case reports of percutaneous therapy, all for nonocclusive stenosis. There are no reported cases of percutaneous treatment of a completely occluded aberrant right subclavian artery. We report a patient with exertional right arm heaviness and weakness who was found to have a 60-mm long aberrant right subclavian artery occlusion. The blockage was successfully treated with angioplasty and placement of a single stent using percutaneous vascular access. Chest computerized tomography and duplex ultrasonography 5 years after treatment demonstrated a patent stent. At 7-year follow-up, she remained symptom-free and had a normal radial pulse. This case represents the first report of total occlusion of aberrant right subclavian artery treated percutaneously. Long-term durability supports this as a viable alternative to surgery in appropriately selected patients.

Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy.

Emphysematous gastritis is a rare but fatal variant of gastritis. It is caused by gastric wall invasion by gas-forming organisms. It follows disruption of gastric mucosal integrity by a variety of factors, most commonly caustic ingestion and alcohol abuse. Patients typically present with abdominal symptoms with features of septic shock. Emphysematous gastritis carries a high mortality rate warranting early intervention with supportive measures and broad-spectrum antibiotics. It is essential to consider this rare entity in the differential diagnosis of a patient presenting with abdominal pain as timely intervention is crucial for survival.

Oxidative stress (OS) has been implicated in the development of pulmonary hypertension (PH) and ventricular hypertrophy. Xanthine oxidase is a well-recognised source of reactive oxygen species, which lead to OS. The aim of this proof of concept study was to assess whether allopurinol (xanthine oxidase inhibitor) would reduce right ventricular mass (RVM) in patients with PH-associated chronic lung disease (PH-CLD).

Chronic cholecystitis or symptomatic gallbladder is a prolonged mechanical or functional disorder of abnormal gallbladder emptying. Most of the patients have recurrent pain attacks (acute biliary colic), but when pain lasts more than 24 hours, it requires urgent surgical intervention (acute cholecystitis). The length of a fully distended gallbladder is about 7 to 10 cm. We report a case of a huge and severely inflamed gallbladder, as we have just found only a few previous case reports of the huge gallbladder in the literature. This case report and review may help to find a mechanism for the development of a giant gallbladder. The patient was a 36-year-old woman, who had been known to have a symptomatic gallstone for at least three years. The patient underwent laparotomy, and a giant 22 cm roundish severely inflamed and overdistended gallbladder with wall thickening and tight adhesion to adjacent organs was found under the right liver lobe. Femininity and diabetes seem to be risk factors for developing a huge gallbladder, and several hypotheses are encountered: (1) a long-lasting obstructed cystic duct or biliary tree, and accumulation of mucosal secretion from the gallbladder epithelium, (2) an obstructed hepatic/cystic duct junction with a stone acting like a check valve and bile trapping mechanism, and (3) gallbladder dysfunction and cholecystoparesis affecting through reduced cholecystokinin and celiac parasympathetic nerve disturbance in diabetes and diabetic autonomic neuropathy. Open cholecystectomy is the technique of choice in surgical excision of a huge gallbladder; however, laparoscopy could be performed by expert hands.

The accumulation of lipid droplets in the cytoplasm of hepatocytes, known as hepatic steatosis, is a hallmark of non-alcoholic fatty liver disease (NAFLD). Inhibiting hepatic steatosis is suggested to be a therapeutic strategy for NAFLD. The present study investigated the actions of Neurotropin (NTP), a drug used for chronic pain in Japan and China, on lipid accumulation in hepatocytes as a possible treatment for NAFLD. NTP inhibited lipid accumulation induced by palmitate and linoleate, the two major hepatotoxic free fatty acids found in NAFLD livers. An RNA sequencing analysis revealed that NTP altered the expression of mitochondrial genes. NTP ameliorated palmitate-and linoleate-induced mitochondrial dysfunction by reversing mitochondrial membrane potential, respiration, and β-oxidation, suppressing mitochondrial oxidative stress, and enhancing mitochondrial turnover. Moreover, NTP increased the phosphorylation of AMPK, a critical factor in the regulation of mitochondrial function, and induced PGC-1β expression. Inhibition of AMPK activity and PGC-1β expression diminished the anti-steatotic effect of NTP in hepatocytes. JNK inhibition could also be associated with NTP-mediated inhibition of lipid accumulation, but we did not find the association between AMPK and JNK. These results suggest that NTP inhibits lipid accumulation by maintaining mitochondrial function in hepatocytes via AMPK activation, or by inhibiting JNK.

Ultrasound-guided thoracic paravertebral block (TPVB) is an established means for providing postoperative analgesia in thoracic surgery. However, there are conflicting results regarding the efficacy of post-thoracotomy pain management of ultrasound-guided TPVB when compared with that using traditional landmark approach. We therefore conducted a comparative study to evaluate the analgesic efficacy of TPVB when pressure measurement during needle advancement is combined with an ultrasound-guided approach.

Shoulder pain is a common symptom following laparoscopic surgery. This systematic review was undertaken to assess updated evidence regarding the effectiveness and complications of the pulmonary recruitment maneuver (PRM) for reducing shoulder pain after laparoscopic gynecologic surgery.