Rejected

To characterize the clinical symptoms and magnetic resonance imaging (MRI) findings of unilateral cortical FLAIR-hyperintense Lesions in Anti-MOG-associated Encephalitis with Seizures (FLAMES).

Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures. Analgesia and procedural sedation outside the operating room are often required, but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications.

Complex mechanisms involved in neuropathic pain that represents a major health concern make its management complicated. Because neurosteroids are bioactive steroids endogenously synthesized in the nervous system, including in pain pathways, they appear relevant to develop effective treatments against neuropathic pain. Neurosteroids act in paracrine or autocrine manner through genomic mechanisms and/or via membrane receptors of neurotransmitters that pivotally modulate pain sensation. Basic studies which uncovered a direct link between neuropathic pain symptoms and endogenous neurosteroid production/regulation, paved the way for the investigations of neurosteroid therapeutic potential against pathological pain. Concordantly, antinociceptive properties of synthetic neurosteroids were evidenced in humans and animals. Neurosteroids promote peripheral analgesia mediated by T-type calcium and gamma-aminobutyric acid type A channels, counteract chemotherapy-induced neuropathic pain and ameliorate neuropathic symptoms of injured spinal cord animals by stimulating anti-inflammatory, remyelinating and neuroprotective processes. Together, these data open interesting perspectives for neurosteroid-based strategies to manage/alleviate efficiently neuropathic pain.

Changes in different regions of the brain due to postural disturbances were found in patients with chronic low back pain (LBP). The aims of the current study were to investigate the short- and long-term enhancing effects of concurrent postural training and primary motor cortex (M1) anodal transcranial direct current stimulation (a-tDCS) on balance, postural stability and pain in chronic LBP patients with postural impairment. In this clinical trial study, thirty eight patients with chronic LBP were randomly assigned to a-tDCS and training, sham a-tDCS and training,and training only groups. All groups received identical postural training for 20 min, three sessions per week for two weeks. The length of stimulation, which used concurrent with postural training in the active a-tDCS group was also 20 min. Before, immediately and one-month after the interventions, postural stability, balance and pain were assessed using Biodex Balance System, Berg Balance Scale (BBS) and Visual Analog Scale (VAS), respectively. The postural stability indices, BBS and VAS scores significantly improved immediately and one-month after the intervention in the a-tDCS and training group (P < 0.001), while there were significant differences between active a-tDCS and other two groups (P < 0.001). Postural stability indices, the BBS and VAS scores were not significantly different between the sham and training only groups after the interventions (P > 0.05). M1 a-tDCS significantly improves the effects of postural training on postural stability, balance and pain in patients with chronic LBP. Two-week postural training alone cannot improve postural impairment in patients with chronic LBP.

The use of nonsteroidal anti-inflammatory drugs is an effective adjunct in managing perioperative pain. We sought to determine if the use of intraoperative ketorolac as part of a multimodal ERAS protocol increased the risk of bleeding complications in breast surgery.

Osteoporosis is a skeletal disease with decreased bone mass and alteration in microarchitecture of bone tissue, and these changes put patients in risk of bone fracture. As a common symptom of osteoporosis and complication of osteoporotic fracture, chronic pain is a headache for clinicians. Nonsteroidal anti-inflammatory drugs (NSAIDs), selective COX-2 inhibitors and opioid drugs can temporarily reduce osteoporotic pain but have relevant side effects, such as addiction, tolerability and safety. The review summarized the recent advancements in the study of CB receptors in osteoporosis and osteoporotic pain and related mechanisms.

Roughly 17 million abdominal surgeries are performed annually in the U.S. Up to 17% of those may be readmitted for adhesion related problems. This study evaluated the effectiveness of soft tissue mobilization (STM) techniques at improving chronic pain, mobility restrictions and functional deficits following complex abdominal surgery.

The mechanism of action of Platelet Rich Plasma (PRP) is thought to be related to the biomolecules present in α-granules. However, for the healing process to occur, an inflammatory phase is also deemed necessary. Leukocytes present in the inflammatory phase release both pro- and anti-inflammatory molecules. The latter may play an important role in the process of "inflammatory regeneration". Thus, we propose that in the context of healing, both platelets and leukocytes play an important role, specifically due to the macrophage's plasticity to switch from the M1 to M2 fraction. Therefore, we propose that PRP products derived from the buffy coat may be more beneficial than detrimental from a standpoint of the regenerative potential of PRP.

This article critically discusses the current assessment guidelines valid since 2014 which must be applied to determine the driving aptitude of patients with dizziness and balance disorders (in the official document called "disorders of the sense of balance"). With all due respect for the meticulous work of the expert commission who established the guidelines – the likes of which are not known anywhere else – we consider their revision imperative. On the basis of our many years of experience in the German Center for Dizziness and Balance Disorders of the LMU Munich it is our opinion that these restrictions are too strict and the required dizziness-free intervals are too long.The guidelines now stipulate the following for drivers with a group 1 driving licence ("private"):1) Patients with Meniere's disease (attacks without prodromes) must have had no attacks for 2 years before it is possible to drive a car again.2) Patients with vestibular migraine without prodromes must not have had any attacks for 3 years.The following stipulations hold for drivers with a group 1 and group 2 driving licence ("professional driver"):3) Patients with bilateral vestibulopathy as a rule are considered to have a driving disability, likewise4) Patients with central vestibular forms of vertigo, e. g., oculomotor disorders like downbeat and upbeat nystagmus syndromes are also as a rule regarded as having a driving disability.5) Patients with functional (psychogenic) forms of dizziness (e. g., phobic postural vertigo) who have a group 1 driving licence are considered to have a driving disability if dizziness occurs while driving. Those with a group 2 driving licence are in general considered to have a driving disability. However, many patients with episodic or chronic dizziness have such minor symptoms that their driving fitness is not relevantly impaired or if they do have an attack, they are able to stop driving in a controlled manner. In contrast, the restrictions on other illnesses that are accompanied by attack-like disorders of cognition and consciousness like the epilepsies are less strict. Depending on the type of attack or its trigger, the attack-free interval for such patients with a group 1 driving licence amounts to 3 months up to 1 year, although they clearly are not fit to drive during an attack.