Rejected

The promise of personalized genomic medicine is that knowledge of a person's gene sequences and activity will facilitate more appropriate medical interventions, particularly drug prescriptions, to reduce the burden of disease. Early successes in oncology and pediatrics have affirmed the power of positive diagnosis and are mostly based on detection of one or a few mutations that drive the specific pathology. However, genetically more complex diseases require the development of polygenic risk scores (PRSs) that have variable accuracy. The rarity of events often means that they have necessarily low precision: many called positives are actually not at risk, and only a fraction of cases are prevented by targeted therapy. In some situations, negative prediction may better define the population at low risk. Here, I review five conditions across a broad spectrum of chronic disease (opioid pain medication, hypertension, type 2 diabetes, major depression, and osteoporotic bone fracture), considering in each case how genetic prediction might be used to target drug prescription. This leads to a call for more research designed to evaluate genetic likelihood of response to therapy and a call for evaluation of PRS, not just in terms of sensitivity and specificity but also with respect to potential clinical efficacy.

The aim of the present study was to evaluate percutaneous tibial nerve stimulation (PTNS) for treatment resistant chronic anal fissure.

Neuropathic pain (NP) is a debilitating condition that may result from spinal cord injury (SCI). Nearly 75% of all SCI results in NP affecting 17,000 new individuals in the United States every year, and an estimated 7-10% of people worldwide. It is caused by damaged or dysfunctional nerve fibers sending aberrant signals to pain centers in the central nervous system causing severe pain that affects daily life and routine. The mechanisms underlying NP are not fully understood, making treatment difficult. Identification of specific molecular pathways that are involved in pain syndromes and finding effective treatments has become a major priority in current SCI research. Yoga has therapeutic applications may prove beneficial in treating subjects suffering chronically with SCI induced NP, chronic back and associated pains if necessary experimental data is generated.

The flowers of Chrysanthemum indicum, i.e. Ye-ju-hua recorded in the Chinese Pharmacopoeia, has been widely used in China as an important heat-clearing and detoxifying herb for the treatment of inflammation, headache, and vertigo. A phytochemical investigation of this herb has led to the isolation of two new eudesmane sesquiterpenoids, 7-epi-eudesm-4(15),11(13)-diene-1β,3β-diol (1) and 7-epi-1β-hydroxy-β-eudesmol (2). The molecular structures of these new sesquiterpenoids were established based on the comprehensive spectroscopic analyses, including NMR, MS, and IR, and comparing with the literatures.

To evaluate the effectiveness of transforaminal lumbar epidural steroid injections (TFESI) in patients with unilateral radiculopathy due to lumbar intervertebral disc protrusion regarding pain intensity, functional disability, current opioid intake and patients' satisfaction.

The median nerve, along with the ulnar nerve, is often anesthetized when performing a lameness examination in horses. Because of the close proximity of the median nerve to the cubital joint, proximal migration of local anesthetic might ameliorate pain originating from the cubital joint. The objective of this study was to determine if a median nerve block will ameliorate lameness caused by pain in the cubital joint. A forelimb lameness was induced in six healthy horses by injecting 100 ng of recombinant equine interleukin 1 beta (IL-1β) into the cubital joint. The median nerve of the lame leg was anesthetized using 10 mL of 2% mepivacaine hydrochloride. A successful median nerve block was confirmed by loss of skin sensation at the medial aspect of the pastern and typical changes in thermographic images. Gait was assessed before and at 20, 40, and 60 minutes after the median nerve block using an inertial sensor-based motion analysis system (Lameness Locator; Equinosis LLC, Columbia, MO). A full-factorial repeated measures analysis of variance was used to compare treatment effect across time. IL-1β administration resulted in significant transient lameness in all horses (P < .0001). The median nerve block was successfully performed in all horses and did not result in significant improvement (P = .32) of lameness as quantified by the total differential head vector sum. This result has relevant clinical application as it suggests when performing a lameness examination, it is unlikely that blocking the median nerve with 10 mL of local anesthetic will ameliorate pain originating from the cubital joint.

Subacromial impingement syndrome is one of the most common causes of shoulder pain and is associated with substantial shoulder impairments. The initial treatment should be non-operative in form of rotator cuff and scapula strengthening exercises for at least three months. Not all patients respond satisfactorily to non-operative treatment, but only patients with persistent symptoms after sufficiently tried non-operative treatment, should be referred to an orthopaedic specialist.

Treatment of spinal cord injury (SCI) induced neuropathic pain (NP) proves to be extremely clinically challenging as the mechanism behind SCINP is poorly understood. Matrix metalloproteinase (MMP) is largely responsible for the early disruption of the blood spinal cord barrier. This system initiates macrophage infiltration and degradation of myelin, which plays a pivotal role in how NP occurs. In a recent study, we demonstrated that folic acid (FA) treatment to cSCI rats reduced NP and improved functional recovery by repressing MMP-2 expression. We hypothesize that MMP-2 expression is suppressed because FA actively methylates the DNA sequence that encodes for the MMP-2 protein. However, modulation of MMP-2 expression for alleviation of NP is only pertinent to the mid- to late-phase of injury. Therefore, we need to explore alternate therapeutic methods to target the early- to mid-phase of injury to wholly alleviate NP.

Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics.

Caesarean scar pregnancy is an uncommon form of ectopic pregnancy characterized by implantation into the site of a caesarean scar. Common clinical features include vaginal bleeding and abdominal pain; however, a significant proportion of cases are asymptomatic. The primary diagnostic modality is transvaginal ultrasound. There is no current consensus on best-practice management.