Rejected

The most common method of local anesthesia of maxillofacial region in the modern surgical practice is conductive anesthesia of the peripheral branches of trigeminal nerve. In order to reach the total anesthesia of the lateral facial region it is necessary to block not only auriculo-temporal and buccal nerves, but also facial branches of great auricular nerve taking part in the innervation of parotid-masticatory area and the part of the cheek. Topographic-anatomical investigations of corpses revealed the anatomical variability of the branching of great auricular nerve on the neck and the head. Taking into account the topographic-anatomical aspects of variability of innervation of the lateral facial region, we developed the method of conductive anesthesia of the facial branches of great auricular nerve.

Incidents in the form of unwanted things at work often occur, including civilians or officials. Like what happened during training at an Active on Duty Military Personnel (ADMP). The incident caused chronic disability and pain that we know as phantom pain limb. The frequency of "phantom pain limb" develops in individuals. Therefore, identifying the best method for treating PLP is very important. This review highlights the field of phantom pain-related investigations, focusing on PLP.

La belle indifference, a term that is inexhaustible to discuss, albeit there is no single definition that best describes the condition. To date, la belle indifference has gotten no place in the DSM-5 criteria for being a distinct entity of mental health issue.

To investigate the role of zinc-fingers and homeoboxes 2 (ZHX2) in regulating μ-opioid receptor expression in the dorsal root ganglion (DRG) in mice with peripheral nerve injury-induced pain hypersensitivity.

To study the clinicopathologic characteristics,immunohistochemical features,differential diagnosis,and prognosis of solitary fibrous tumours(SFT)/hemangiopericytomas(HPC)in the maters(meninx). Methods A series of 7 cases previously diagnosed as SFT/HPC at the Department of Pathology,Peking Union Medical College Hospital,during the period from 2008 to 2018 were analyzed for clinical data,histopathology,and immunohistochemical findings.The patients were followed up and the relevant literatures were reviewed. Results These seven patients included two males and 5 females aged 22 to 77 years(mean,49 years).Headache was the most common symptom.The magnetic resonance imaging of SFT/HPC showed irregularly contoured masses and dural tail sign was observed at the periphery of the lesion in 4 cases.The major axis of the tumor ranged from 1.8 cm to 10 cm(mean,4 cm).The tumors were located in the mater in 6 cases and in the spinal meninx in 1 case.The tumors were surgically removed in all cases.Under light microscope,the tumors were formed by long round,oval or spindle cells,with rich branching vascular pattern and varying quantity of collagenous fibers bands in both sparse areas and dense areas.According the WHO classification,2 cases were in WHO grade Ⅰ,2 cases in WHO grade Ⅱ,and 3 cases in WHO grade Ⅲ.Immunohistochemistry of the paraffin-embedded tissues in all cases showed positive immunoreativity for CD34 and vimentin in all seven cases,along with positive signal transducer and activator of transcription 6 in 4 cases,negative epithelial membrane antigen and S-100 in 7 cases,and negative progestational hormone and somatostatin receptor 2 in 6 cases.The Ki-67 index ranged from 1% to 15%.Five patients with follow-up data(including 1 current case)were alive,while 2 patients were lost to follow-up. Conclusions The SFT/HPC are rare in the maters(meninx)and is clinically difficult to be differentiated from other meningioma.The combination of CD34 and signal transducer and activator of transcription 6 helps to diagnose this disease.

Peripheral neuropathy is a neurological disease characterised by pain, numbness, tingling, swelling or muscle weakness due to nerve damage, caused by multiple factors such as trauma, infections and metabolic diseases such as diabetes. In Kuwait 54% of the diabetic population, has peripheral neuropathy. In this exploratory, qualitative study conducted in Kuwait, 25 subjects with peripheral neuropathy took part in one-on-one, semi-structured interviews lasting 45-60 min. Interviews were transcribed, translated into English and coded using NVivo 12. Four individual patient journeys were mapped out in detail, then compared and condensed into a single process map. The remaining 21 interviews were then reviewed to ensure the final map represented all patient journeys. Participants reported similar healthcare pathways for their peripheral neuropathy and faced various difficulties including lack of psychological support, administrative issues (long waiting referral periods, loss of medical documents, shortage of specialists and lack of centralized electronic medical records) and inadequate medical care (shortage of new treatments and deficient follow-ups). Mapping the patient journey in Kuwait showed similar pharmacological treatment to UK guidelines, except that some medicines were unavailable. The map also indicated the need for an integrated referral approach, the use of technology for electronic medical recording and report transmission, alongside education on self-management, coping mechanisms and treatment options for people living with peripheral neuropathy.

Chronic renal failure (CRF) is a term used to describe a decrease in kidney function caused by irreversible damage. Until now, hemodialysis is the main alternative to replacement therapy for renal function in patients with chronic renal failure because of its lower cost and lower risk of bleeding when compared to peritoneal dialysis. The effects that are felt when undergoing hemodialyses, such as muscle cramps, hypotension, headache, nausea, and vomiting. The psychological impact felt by patients is anxiety. To overcome anxiety in patients undergoing hemodialysis, we need to provide relaxation therapy, one of which is murottal Al-Qur'an. The aim is to find out whether there is an effect of giving Murottal Al-Qur' to the anxiety level of hemodialysis patients in North Sumatra Hospital Medan. The instrument in the form of the Hamilton Rating Scale for Anxiety (HRS A). The conclusion, in this case, is that there is the effect of giving Murottal Al-Qur'an therapy to the anxiety level of hemodialysis patients in North Sumatra Hospital Medan.

To assess patients with hypertensive crisis, classified as urgency, emergency or pseudocrisis, and identify the associated variables.

A 41-year-old woman experienced back pain upon waking up. Immediately afterward, she experienced a continual orthostatic headache. Thereafter, right ear fullness and dizziness also occurred. One month later, she became aware of repeated numbness that started in the right hand and spread to the right half of the body and lower limbs and continued for repeated periods of approximately 20-30 min. Neurological examination revealed no abnormal findings except for orthostatic headache. Electroencephalography showed no epileptic discharge. Head MRI revealed left convexal subarachnoid hemorrhage (cSAH) restricted to the prefrontal sulcus, left frontal cerebral venous thrombosis, diffuse dural thickening with gadolinium enhancement, and subdural hematoma in the posterior cranial fossa. Spinal MRI revealed epidural fluid accumulation around the thoracic spine. CT myelography revealed cerebrospinal fluid leakages at the cervical, thoracic, and lumbar vertebrae levels. The patient was diagnosed with spontaneous intracranial hypotension (SIH), which was treated effectively with a blood patch. In this case, cSAH may have resulted from rupturing of the vessel wall as a result of cortical venous thrombosis induced by SIH. The repeated transient neurologic symptoms suggesting migraine aura may have originated from cSAH, which in turn led to cortical spreading depression. The diagnosis and management of SIH can be often difficult; therefore, repeated migraine-aura-like symptoms are a critical sign of complication with cSAH and cortical venous thrombosis.

Objective The objective of our study was to determine if a correlation exists between maternal total bile acid levels, degree of maternal pruritus, and fetal cardiac troponin-I levels in asymptomatic patients without a diagnosis of intrahepatic cholestasis of pregnancy. Study design In this cross-sectional observational study, patients were enrolled at the time of the scheduled term cesarean section. Maternal blood was drawn for fasting total bile acid levels and cord blood was collected for fetal cardiac troponin-I levels. Pruritus during pregnancy was quantified by the patient on a visual analog scale (VAS). Correlation coefficients between these variables were calculated. Results There was not a positive correlation between any of the primary variables studied (pruritis, total bile acid, cardiac troponin I). Pearson's R between total bile acid and cardiac troponin I was -0.058 (weak correlation in the opposite direction), and between total bile acid and pruritus severity, it was 0.031. Conclusion In patients without intrahepatic cholestasis of pregnancy, higher levels of maternal total bile acids did not correlate with increased cardiac troponin-I (fetal cardiomyocyte damage) or increased pruritus. This supports the current theory that the adverse outcomes associated with intrahepatic cholestasis of pregnancy require a threshold value of total bile acids, one high enough to cause clinically significant maternal pruritis.