Rejected

Cutaneous wound pain causes physical and psychological stress for patients with wounds. Previous studies reported that stress induces hyperalgesia and deteriorates wound healing. However, the effect of the stress response such as in hypothalamic-pituitary-adrenal (HPA) axis, on local wound area is unclear. We aimed to investigate the effects of a stress response on the mechanical withdrawal threshold in the local wound area and describe the identification of a wound pain exacerbation. We topically injected adrenocorticotropic hormone (ACTH) into the granulation tissue of full-thickness cutaneous wound model rats on the fifth day post wounding, and measured the mechanical withdrawal thresholds, cytochrome P450 2Bs levels, and concentration of 5,6-epoxyeicosatrienoic acid in wound exudate. We found that ACTH induced mechanical hypersensitivity at 4 and 6 hours after injection (P = 0.004 and 0.021, respectively), and increased gene expression of cytochrome P450 2B12 expression (P = 0.046). Concentration of 5,6-EET in the wound exudate was moderately correlated with the mechanical withdrawal threshold (r = -0.630). Finally, the mechanical withdrawal threshold in the 5,6-EET group was significantly lower than that in the control group at 2 hours after the injection (P = 0.015). We propose that 5,6-EET is one of the most promising contributors of the wound pain exacerbation. These findings could guide clinical wound and pain management. This article is protected by copyright. All rights reserved.

Acute acalculous cholecystitis (AAC), an inflammatory process of the gallbladder (GB) in the absence of gallstones, typically occurs in seriously ill patients. AAC can complicate primary Epstein-Barr virus (EBV) infection, but it is an atypical clinical presentation.

High-mobility group box 1 (HMGB1) is actively secreted from inflammatory cells and acts via a non-cell-autonomous mechanism to play an important role in mediating cell proliferation and migration. The HMGB1-RAGE (receptor for advanced glycation end products) axis upregulates tyrosine hydroxylase (TH) expression in response to extracellular insults in dopaminergic neurons in vitro, but little is known about HMGB1 in modulation of dopaminergic neurons in vivo. Here, using immunohistochemistry, we show that HMGB1 and RAGE expression are higher in the nigral area of MPTP (methyl-4-phenyl-1,2,3,6-tetrahydropyridine)-treated mice, a toxin-induced Parkinsonian mouse model, compared with saline-treated controls. HMGB1 was predominantly localized to astrocytes and may affect neighboring dopaminergic neurons in the MPTP mouse model, owing to co-localization of RAGE in these TH-positive cells. In addition, MPTP induced a decrease in TH expression, an effect that was potentiated by inhibition of c-Jun N-terminal kinase (JNK) or RAGE. Moreover, stereotaxic injection of recombinant HMGB1 attenuated the MPTP-induced reduction of TH in a Parkinsonian mouse model. Collectively, our results suggest that an increase of HMGB1, released from astrocytes, upregulates TH expression in an acute MPTP-induced Parkinsonian mouse model, thereby maintaining dopaminergic neuronal functions.

This study examined the sedative, analgesic, behavioral, and clinical effects of a combination of xylazine (XY) and nalbuphine-xylazine (NA-XY) in camels. A total of five adult camels were used in a prospective randomized cross-over design with a wash out period of two weeks. Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5, 15, 30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation ( < 0.001) and analgesia ( < 0.01). The behavioral parameters showed higher scores with a NA-XY combination than xylazine alone. Although a XY injection resulted in a significant decline in the heart and respiratory rate, the NA-XY combination group revealed a non-significant change in both clinical parameters compared to the baseline. In conclusion, the use of a NA-XY combination in camels improved the sedative and analgesic onset and duration with an improved outcome in the behavioral scores, as well as in both the heart and respiratory rates compared to XY alone.

Gastrointestinal tract duplication is a rare congenital malformation in young patients and in adults, that occur anywhere from the mouth to the anus and their macroscopic structure may be cystic or tubular. Intestinal duplication does not show specific symptoms, indeed they can present with a variety of symptoms including abdominal distension and pain, sickness, hemorrhage, chronic respiratory disorders, as well as non-painful abdominal mass. Nonetheless, intestinal duplication can remain completely asymptomatic and be diagnosed as an incidental finding. Presentation with acute complications such as intestinal invagination or mechanical occlusion is quite rare. We present a case of asymptomatic ileum duplication cyst in young female who referred to the emergency department for trauma and was screened by eco-Focus Assessment Sonography for Trauma (eco-FAST), followed by MR and CT. The patient underwent ileal resection and prophylactic appendicectomy with ileo-cecal termino-lateral anastomosis. In this case, the intestinal duplication cyst was an asymptomatic incidental finding.

It is reported that both adductor canal block (ACB) and femoral nerve block (FNB) are commonly used methods for postoperative analgesia in anterior cruciate ligament (ACL) reconstruction. Currently, no record has compared the efficacy of postoperative pain relief and the influence to quadriceps strength between them. This study aims to provide a protocol to compare the efficacy and safety between ACB and FNB for the postoperative analgesia of ACL reconstruction.

Multi-fragmental intra-articular middle phalanx base fractures mostly occur in young adults during sports or work-related activities. If left untreated properly proximal interphalangeal joint (PIPJ) instability and pain persists, thus impairing the hand's function and the patient's quality of life. Joint surface reconstruction with hamate osteochondral graft can be used for multi-fragmental middle phalanx base reconstruction. A retrospective study was conducted. The technique was used for 17 patients. Follow-up was performed at least 6 months after the surgery. Patients were asked to fulfil multiple surveys: Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE) and Modern Activity Subjective Survey 2007 (MASS07). Objective measurements included strength of the power and pinch grip, range of motions (ROM) in both proximal interphalangeal and distal interphalangeal (DIPJ) joints. All measurements were taken on both hands, on operated and contralateral fingers. Out of 17 patients 5 were females and 12 males, mean age 40 (ranged 22-65 years) Eleven patients agreed to participate in the follow-up. All patients were right-handed, 8 patients had injured their right hand. The injuries' aetiologies were sports (n = 3), fighting (n = 2) and work-related (n = 4). Six patients were treated with immobilisation before the surgery, which was performed on average 45 days after the injury (ranged 1-184 days). Two patients developed arthrosis post-operatively and received synthetic joints. Mean DASH score was 6.9, PRWE score was 5.2 and mean MASS07 score was 6.8. Patients achieved on average 90% of power grip and 100% of pinch grip with their injured hand compared to their healthy hand. Average ROM in PIPJ was 82.2° and in DIPJ 68.9°. No patients experienced joint instability or chronic pain. Hemi-hamate arthroplasty provides satisfactory results in patients with both acute and chronic dislocated intra-articular middle phalanx base fractures.

The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery.

Many novel interfascial plane blocks have been developed in the last 10 years in the effort to improve perioperative pain management that are safe, efficacious, efficient, and inexpensive. These blocks have been widely adopted into clinical practice despite relatively few high-quality clinical investigations of the techniques and how they affect perioperative outcomes. This article defines interfascial plane blocks, discusses the potential benefits, reviews the most common techniques and evidence supporting their indication, and guides clinicians in selecting an appropriate interfascial plane block for different types of surgical procedures.

This study aims to assess the validity and reliability of a Turkish version of the identification (ID) pain (ID pain-T) questionnaire in Turkish patients.