Rejected

Preterm infants are at risk for severe infections due to their immature immune systems. Factors such as early life pain/stress experiences and feeding may influence immune activation and maturation of immune systems. However, the underlying mechanism remains unclear. Fecal calprotectin (FCP) is a noninvasive surrogate biomarker of mucosal inflammation in the gastrointestinal tract and has been used in detecting intestinal inflammation in specific pediatric gastrointestinal disorders.

A tension-type headache (TTH) is a recurrent headache that is mild to moderate in intensity, unlike migraine (MH), which is accompanied by crippling effects of nausea, vomiting, photophobia, or phonophobia. TTH is more frequent than migraine, but it is less likely to cause severe pain and physical dysfunction. TTHs account for more lost workdays due to their prevalence. The study aimed to evaluate the prevalence, frequency, and disability of MHs and TTHs among the general population in the Eastern Region of Saudi Arabia. A cross-sectional study was employed using a validated questionnaire. The questionnaire implemented the HARDSHIP algorithm to diagnose MH and TTH and questions to correlate their prevalence to socio-demographic data, measurement of the level of disability, headache management, and treatment effectiveness using the chi-square test. The study reviewed 877 subjects (46.6% males . 53.4% females). 52.9% of the participants experienced headaches during the previous three months, and 35.6% experienced headaches recently. The most common type of headache was a probable MH (32.1%), followed by a TTH (26.9%), probable TTH (19.5%), and MH (15%). It was reported that some disability was attributed to 47% of MHs and 26% of TTHs. The most commonly used headache medication was paracetamol (53.5%). This study revealed that TTH and MH are common illnesses in Saudi Arabia's Eastern Region. TTH and MH are correlated with significant individual and social burdens, particularly for MH. Headache sufferers mostly manage their headaches using conventional over-the-counter methods.

Patients presenting with chest pain to the emergency department constitute a diagnostic challenge as 77% of the patients' symptoms are not cardiac. Diagnostic uncertainty is a pervasive issue in primary care. A 56-year-old man presented with non-traumatic chest pain and chronic neck pain for 2 years, as well as numbness in his right third and fourth fingers for 6 months. It was not associated with palpitation, orthopnea or pedal edema. Except for hyperglycemia, no abnormal findings were found in diagnostic tests. At that time, he was being treated for type 2 diabetes using glucose-lowering drugs in order to lower his blood glucose and lessen his risk of heart disease. The cause of his chest pain remained unknown. Following a second opinion from an orthopedist, the patient was diagnosed with cervical radiculopathy and was treated with analgesics and physical therapy. Because the treatments had only provided temporary pain relief for the previous 6 months, he sought chiropractic care for pain relief. The patient's vital signs were stable and within normal limits during the assessment. A restricted neck movement, a positive Spurling test, and hypoesthesia in the right C7 dermatome were seen. Cervical radiographs revealed degenerative spondylosis with right C5/C6 neuroforaminal stenoses and bilateral C6/C7 neuroforaminal stenoses. A provisional diagnosis of cervical spondylotic radiculopathy associated with cervicogenic angina (CA) was made. Chiropractic procedures, including cervical manipulation, instrumented soft tissue mobilization, and motorized intermittent neck traction, were performed two to three times per week. After 3 months, the patient reported that the chest pain, neck pain, and radicular symptoms had completely resolved. Repeated radiographs taken during the 11th month follow-up revealed a comparable improvement in the increased spacing of the restricted neuroforamina, which could signify a beneficial alteration related to cervical function retrieval. CA is an angina-like chest pain caused by cervical spine disorders. This study adds to our understanding of the biomechanical impact of cervical radiculopathy on chest pain, which has largely been overlooked during diagnostic workups. Once cervical radiculopathy has been identified, CA symptoms can be eased by alleviating the noxious input stemming from the pinched nerve roots.

Ulcerative colitis(UC) is a continuous inflammatory bowel disease with the main clinical manifestations of abdominal pain, diarrhea, and mucous bloody stools, mainly attacking the colorectal mucosa and submucosa. It is characterized by high recurrence rate, difficult cure, and clustering and regional occurrence. Chinese medicinal prescriptions for the treatment of UC have good therapeutic effect, multi-target regulation, slight toxicity, and no obvious side effects. In particular, the classical prescriptions highlight the characteristics and advantages of traditional Chinese medicine theory and have attracted much attention in recent years. To enable researchers to timely and comprehensively understand the classical prescriptions in the treatment of UC, we reviewed the studies about the pharmacodynamic material basis, quality control, action mechanism, and clinical application of relevant classical prescriptions. We first introduced the latest research progress in the active components such as alkaloids, polysaccharides, saponins, and flavonoids in relevant classical prescriptions. Then, we reviewed the latest research achievements on the quality control of classical prescriptions for the treatment of UC by gas chromatography, liquid chromatography, mass spectrometry, liquid chromatography-mass spectrometry and the like. Further, we summarized the research advances in the mechanisms of relevant prescriptions in the treatment of UC based on network pharmacology, molecular docking, integrated pharmacology platform, and animal experiments. Finally, we generalized the clinical application of the classical prescriptions for clearing heat and removing dampness, mildly regulating cold and heat, soothing liver and regulating spleen, strengthening spleen and invigorating Qi, and tonifying spleen and stomach. By systematic summary of the research progress in relevant classical prescriptions, we hope to promote the application and development of such prescriptions in UC treatment.

A 67-year-old woman presented with lower abdominal pain, diarrhea, nausea, vomiting and fatigue. Computed tomography was suggestive of cholecystitis, but neither ultrasound nor magnetic resonance cholangiopancreatography found evidence of cholecystitis or biliary ductal dilatation. The patient was started on piperacillin-tazobactam, and blood cultures revealed gram-negative-rod bacteremia. Laparoscopic cholecystectomy was performed and bile cultures grew susceptible to ciprofloxacin, which was identical to the speciation of her positive blood cultures. In addition, pathology revealed adenomyomatous hyperplasia of the gallbladder and chronic cholecystitis. Unlike other cases of cholecystitis, our patient had no significant risk factors for the infection-no history of immunosuppression, diabetes mellitus, nor underlying malignancy. We discuss the current knowledge of infection in the setting of chronic cholecystitis and adenomyomatous hyperplasia.

Severe breakthrough pain is a common occurrence in patients with cancer and is responsible for thousands of emergency department (ED) visits each year. While opioids are the current mainstay of treatment, they have multiple limitations including inadequate control for a quarter of patients with cancer. The ultrasound-guided erector spinae plane block (ESPB) has been used in the ED to effectively treat pain for pathologies such as acute pancreatitis, since it provides somatic and visceral analgesia.

Cervical interlaminar epidural injection (CILEI) is commonly used to treat acute or chronic pain that affects the head, neck, and upper extremities. Thus far, studies on CILEI have focused on determining the optimal volume of contrast medium or analyzing the spread of contrast medium during a CILEI. To our knowledge, few studies have attempted to assess the correlation between epidurogram patterns and clinical outcomes of CILEI.

The prevalence of low back pain (LBP) with primary osteoarthritis (OA) hip undergoing total hip replacement (THA) has been studied. However, secondary OA hip affects younger individuals where changes in the sagittal spinal parameters (SSPs) could be reversible to reduce LBP. The study aims to document changes in clinical and radiological parameters following THA.

Perioperative hemodynamic optimization therapy is used to improve cardiac function to meet the increased demand during the perioperative period and to reduce hypervolemia or hypovolemia, tissue hypoperfusion and other postoperative complications. The present single center retrospective study aimed to compare perioperative hemodynamic optimization therapy and usual protocols in terms of perioperative cardiac function in 252 patients who underwent elective pancreaticoduodenectomy. Patients underwent elective pancreaticoduodenectomy under usual protocols of enhanced recovery after surgery procedures without intraoperative fluid optimization (UC; n=142) or with intraoperative fluid optimization (FO; n=110). For intraoperative fluid and vasoactive medication optimization, the patients of the UG cohort underwent usual cardiovascular monitoring and in the FO cohort, fluid interventions were given if stroke volume variations were >20% during and at the end of surgeries. The length of the hospital stay (discharge from operation theater to discharge from the ward) of the FO cohort was shorter than that of the UC cohort (11.02±2.07 days vs. 14.95±3.97 days; P<0.0001). The fluid balance (total input fluid-total output fluid) was higher in the UC cohort than that in the FO cohort (6,101±695 ml vs. 4,623±358 ml; P<0.0001). The number of patients that required intraoperatively metaraminol was greater in the UC cohort than in the FO cohort (P<0.0001). The number of patients that required intraoperatively noradrenaline (P<0.0001) and dopamine/dobutamine (P<0.0001) administration was greater in the FO cohort than those in the UC cohort. A greater number of patients in the UC cohort suffered from pancreatic fistula, arrhythmia, postoperative delirium, electrolyte disturbances, hyponatremia, refractory analgesia and required intraoperative blood products (P<0.05 vs. FO cohort). Pancreaticoduodenectomy under usual protocol with intraoperative fluid optimization may have perioperative and postoperative benefits (level of evidence, 3; technical efficacy stage, 1).

Renal microvascular endothelial cells (RMECs), which are closely related to regulation of vascular reactivity and modulation of inflammation, play a crucial role in the process of renal ischemia and reperfusion (I/R) injury. Previous studies have reported the protective effects of dexmedetomidine (DEX) against renal I/R injury, but little is known about the role of DEX on RMECs. This study aimed to investigate whether DEX alleviated renal I/R injury via acting on the RMECs. Mice underwent bilateral renal artery clamping for 45 min followed by reperfusion for 48 h, and the cultured neonatal mice RMECs were subjected to hypoxia for 1 h followed by reoxygenation (H/R) for 24 h. The results suggest that DEX alleviated renal I/R injury in vivo and improved cell viability of RMECs during H/R injury in vitro. Gene sequencing revealed that the PI3K/Akt was the top enriched signaling pathway and the endothelial cells were widely involved in renal I/R injury. DEX activated phosphorylation of PI3K and Akt, increased eNOS expression, and attenuated inflammatory responses. In addition, the results confirmed the distribution of α adrenoreceptor (α -AR) in RMECs. Furthermore, the protective effects of DEX against renal I/R injury were abolished by α -AR antagonist (atipamezole), which was partly reversed by the PI3K agonist (740 Y-P). These findings indicated that DEX protects against renal I/R injury by activating the PI3K/Akt-eNOS pathway and inhibiting inflammation responses via α -AR in RMECs.