Rejected

Rheumatoid arthritis (RA) as a long-term autoimmune disease is characterized by pain, swelling and joints destruction. The therapeutic efficacy of Guluronic acid (G2013) (patented, DEU: 102016113017.6) was reported in phase I/II clinical trial in RA patients. In this study, we aimed to evaluate the effect of G2013 as a novel non-steroidal anti-inflammatory drug (NSAID) with immunosuppressive property on genes expression of anti-inflammatory and pro-inflammatory cytokines and their transcription factors in the blood sample of RA patients. This study was performed on 12 patients with RA who had an inadequate response to conventional treatments which were disease-modifying anti-rheumatic drugs (DMARDs), NSAID, and biologics. G2013 was administered orally at a dose of 500 mg twice daily for 12 weeks. Before and after the treatment of patients with drug G2013, the peripheral blood mononuclear cells (PBMCs) were isolated for evaluating the gene expression level of interleukin 10 (IL10), interleukin 22 (IL22), interferon γ (IFNγ), and transcription factors specific to the T helper cell lineages, forkhead box P3 (Fox-P3), Aryl hydrocarbon receptor (AHR) and T-box-containing protein expressed in T cells (T-bet) using the real-time PCR method. Since these cytokines have a key role in the progression of RA and disease condition expected induction of IFNγ, AHR, IL22, T-bet, and reduction of IL10, Fox-P3. Results indicated a significant reduction in the level of IFNγ, AHR and a significant induction in IL10, Fox-P3 gene expression in comparison with the control group. In conclusion; the results of this investigation showed a part of the immunological mechanism of G2013 as a novel anti-inflammatory that could reduce pro-inflammatory cytokine and their transcription factors. Furthermore, it increased the anti-inflammatory cytokine and its transcription factor (clinical trial identifier: IRCT2016092813739N5).

Introduction Even though the liver is the main targeted organ in hepatitis C, the manifestations of the disease are not limited to hepatic involvement. Other tissue types are often involved as well. Hepatitis C has dermatological and mucocutaneous manifestations. Methods This study was conducted from May 2016 to April 2017 in the gastroenterology unit of Ghulam Muhammad Mahar Medical College, Sukkur, Sindh, Pakistan. All participants with a clinical diagnosis of hepatitis C with cutaneous manifestations were included in the study after securing informed consent. Demographic data and detailed cutaneous examination results with full morphological descriptions were recorded in patient-completed questionnaires. Results Of the 212 participants, 141 (66.6%) were males and 71 (33.4%) were females. The mean age was 32 (±9) years (range: 17-58 years). The most common cutaneous manifestation was pruritus (33.96%), followed by lichen planus (LP) (23.5%). Conclusion Physicians should try to recognize extrahepatic manifestations of a hepatitis C infection as it may help in early diagnosis efforts. While managing hepatitis C, we recommend a multidisciplinary approach to tackle cutaneous and other extrahepatic manifestations.

Alterations in atmospheric pressure have been long associated with headaches. The purpose of this review article is to investigate the association of barometric pressure with headache, classifying into two broad categories primary headache disorders (barometric pressure triggering migraine or tension-type headache) and secondary headache disorders (barometric pressure triggering high-altitude headache and headache attributed to airplane travel), discussing the pathophysiology and possible treatments.

Total skin electron beam radiation therapy (TSEBT) is an effective treatment for primary diffuse cutaneous lymphomas in humans. While several techniques exist, they all require significant commitment of staff time and resources. In veterinary medicine, canine-specific techniques and strategies have been adapted and delivered but deemed not "realistically" clinically implementable given the time commitment of over 2.5 h plus per fraction or have been relegated to palliative intent. Leveraging these technologies of helical tomotherapy and 3D printing, we developed and clinically implemented a radiotherapeutic treatment strategy for the management of medically refractory diffuse cutaneous lymphoma in the dog.

Monostotic fibrous dysplasia (MFD) involving the spine is rare, and the treatment options are controversial. Surgery is needed when patients suffer from persistent pain, spinal cord compression/injury, and vertebral collapse/instability. Treatment methods include biopsy/observation, corpectomy with instrumented fusion, posterior fusion, vertebroplasty (VP), curettage and bone graft, and complete removal of the vertebra with a combined anterior and posterior fusion procedure.

Optogenetics is an emerging field, which uses light and molecular genetics to manipulate the activity of live cells by expressing light-sensitive proteins. With the discovery of bacteriorhodopsin, a light-sensitive bacterial protein, in 1971 Oesterhelt and Stoeckenius laid the pavement of optogenetics. However, the cross-integration of different disciplines is a little more than a decade old. The toolbox contains fluorescent sensors and optogenetic actuators which enable visualization of signaling events and manipulation of cellular activities, respectively. Neuropathic pain is a pain caused either by damage or disease that affects the somatosensory system. The exact mechanism for the neuropathic pain is not known, however proposed mechanisms include immune reactions, ion channel expressions, and inflammation. Current regimen for the disease provides about 50% relief for only 40-60% of patients. Recent in vivo and in vitro studies demonstrate the potential therapeutic applications of optogenetics by manipulating the activity of neurons. This review summarizes the basic concept, therapeutic applications for neuropathy and potential of optogenetics to reach from bench to bedside in the near future.

Most women of child-bearing age want a safe method of contraception. Numerous methods are available, with different modes of application. In situations involving particular risks, the selection of the right method poses a special challenge.

There has been substantial interest in the role of exercise for managing impairments, limitations, and disability progression among persons with multiple sclerosis (MS). Despite established benefits of exercise training for persons who have mild-to-moderate MS, the ability to deliver exercise to persons who experience higher disability remains challenging. One promising approach for exercise in this population is functional electrical stimulation (FES) cycling. This review provides a summary of the current evidence for FES cycling as an exercise training modality in persons with MS with respect to prescription, safety, tolerability, and acute and chronic effects.

The anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS).

While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria's impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York.