Rejected

Topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postoperative inflammation and pain following cataract surgery and for treatment and prophylaxis of pseudophakic cystoid macular edema (CME). Bromfenac is a brominated NSAID with strong in vitro anti-inflammatory potency. Like other ophthalmic NSAIDs, bromfenac is often used outside of the cataract surgery setting. This paper provides an overview of bromfenac's preclinical ocular pharmacology and pharmacokinetics, followed by a review of 23 published clinical studies in which various marketed bromfenac formulations were used for conditions other than cataract surgery or pseudophakic CME. These include: post-refractive eye surgery; macular edema associated with diabetes, uveitis, or retinal vein occlusion; inflammation associated with age-related macular degeneration; pain related to intravitreal injections; and other ocular anterior segment and surface disorders with an inflammatory component. The published evidence reviewed supports the safety and effectiveness of bromfenac in these additional ophthalmic indications. Bromfenac was well tolerated when given alone or in combination with intravitreal anti-vascular endothelial growth factor agents, topical corticosteroids, or topical mast-cell stabilizers. The most common adverse event reported was ocular irritation. No serious adverse events (ie, corneal epithelial disorders) were reported, although the majority of studies did not systematically evaluate potential side effects. Corneal complications, such as melts reported with diclofenac and ketorolac, were not observed with bromfenac in the studies. In summary, published study data support the clinical utility of bromfenac in various ocular disorders beyond post-cataract surgery. Additional studies are warranted to further define the potential role of bromfenac ophthalmic solution in clinical practice.

To evaluate the safety and clinical efficacy of Yangxue Qingnao (YXQN) granules in the treatment of chronic cerebral circulation insufficiency (CCCI), electronic databases-PubMed, Embase, CNKI, VIP, and Wangfang-were searched for randomized controlled trials (RCTs) published up to January 2019. GRADE and RevMan 5.3.0 were used for grading and analysis, respectively. Fifteen trials involving 1211 CCCI patients were included. Subgroup analysis was performed owing to study heterogeneity. Compared to nimodipine plus routine treatment, YXQN granules plus routine treatment were more effective in increasing basilar artery (BA) blood flow velocity (mean difference (MD) = 3.34, 95% confidence interval (CI) = [2.31, 4.37], < 0.00001), vertebral artery (VA) blood flow velocity (MD = 0.52, 95% CI = [0.27, 0.76], < 0.0001), and internal carotid artery (ICA) blood flow velocity (MD = 7.46, 95% CI = [2.01, 12.90], =0.007). In improving the clinical efficacy of traditional Chinese medicine (TCM) for symptoms such as headache, dizziness, and insomnia, YXQN granules plus routine treatment were shown to be superior to the following control treatments: nimodipine plus routine treatment (mean difference (M-H) = 4.21, 95% CI = [2.49, 7.12], < 0.00001), flunarizine plus routine treatment (mean difference (M-H) = 3.92, 95% CI = [1.36, 11.29], =0.01), troxerutin plus routine treatment (mean difference (M-H) = 4.79, 95% CI = [2.20, 10.42], < 0.00001), and routine treatment (mean difference (M-H) = 6.13, 95% CI = [1.48, 25.34], =0.01). Risk of bias was assessed in 15 trials. One analysis was graded using GRADE and showed poor results. Adverse events were not reported explicitly in all but one trial. Thus, this meta-analysis suggests that YXQN granules may be beneficial for patients with CCCI. However, owing to the poor quality of the clinical trials and small sample sizes, a definite conclusion on the efficacy and safety of YXQN granules cannot be drawn from existing information.

The leaves of . have a traditional reputation for the management of pain in Morocco. This study was conducted to investigate the curative effects of (SO) and its major constituents Rosmarinic (ROS) and Caffeic acids (CAF) on peripheral neuropathic pain in mice. Chronic constriction injury (CCI) was induced in mice, and neuropathic pain behaviors tests were evaluated by mechanical, chemical, thermal sensation tests and functional recovery of the sciatic nerve at different time intervals, ., (day 0, 1, 7, 14, and 21). Ethanolic extract of SO (100 and 200 mg/kg, ), ROS (10 and 20 mg/kg, ), CAF (30 and 40 mg/kg, ), and CLOM (5 mg/kg, , a positive control) was given for 21 days after surgery. Hematological and biochemical parameters were also measured as well as histopathological analysis. CCI produced significant development in mechanical and thermal hyperalgesia, cold allodynia, and rise in the sciatic functional index in mice. Chronic treatments with SO extract, ROS, CAF, and CLOM for 3 weeks significantly increased mechanical sensibility, cold, and thermal withdrawal latency and enhanced functional recovery of the injured nerve. The same treatments remarkably ameliorated hematological parameters and did not alter biochemical levels. The histopathological findings had revealed the protective effect of SO, ROS, and CAF against the CCI-induced damage. Our data support the use of SO in folk medicine to alleviate pain. Their main phenolic constituents could be promising antineuropathic compounds, which may be attributed to their biological activities including anti-inflammatory, antioxidant, and neuroprotective effects. SO leaves may be a good candidate to treat neuropathic pain.

"Headache attributed to ingestion or inhalation of a cold stimulus" (HICS) is one of the most common primary headache disorders. Little is known about the pathophysiology of HICS and other headache disorders. The aim of this study was to analyze mean flow velocity (MFV) and cerebrovascular resistance (RI) in both middle cerebral arteries (MCA) upon ingestion of ice water. The MFV and RI in both MCAs was continuously measured by transcranial sonography. HICS was induced by drinking 200 ml of ice water. In all volunteers, the ingestion of ice water led to a decrease in RI, which was accompanied by an increase in MFV. In volunteers with induced HICS, MFV were significantly higher compared to volunteers that did not experience HICS. In volunteers with HICS, MFV increased even more significantly when lacrimation occurred compared to volunteers in which it did not. In volunteers without induced HICS, MFV was higher in those volunteers with a positive history of HICS than in those with a negative HICS history. This study revealed a raised MFV upon ingestion of ice water. Volunteers with a provoked case of HICS had a higher MFV than volunteers without HICS. The increase in MFV was even higher when the headache was accompanied by lacrimation. This may indicate an involvement of the trigeminal-parasympathetic vasodilator reflex.

Brinzolamide as a carbonic anhydrase inhibitor could be combined with other intraocular pressure (IOP) lowering drugs for glaucoma and ocular hypertension (OHT), but the efficacy was controversial. So, this study was used to assess the efficacy and safety of brinzolamide as add-on to prostaglandin analogues (PGAs) or β-blocker in treating patients with glaucoma or OHT who fail to adequately control IOP. We searched PubMed, Embase, MEDLINE, Cochrane Library, and clinicaltrials.gov from inception to October 4, 2018. Randomized controlled trials of brinzolamide as add-on to PGAs or β-blocker for glaucoma and OHT were included. Meta-analysis was conducted by RevMan 5.3 software. A total of 26 trials including 5,583 patients were analyzed. Brinzolamide produced absolute reductions of IOP as an adjunctive therapy for patients with glaucoma or OHT. Brinzolamide and timolol were not significantly different in lowering IOP as add-on to PGAs (9 am: = 0.07; 12 am: = 0.66; 4 pm: = 0.66). Likewise, brinzolamide was as effective as dorzolamide in depressing IOP (9 am: = 0.59; 12 am: = 0.94; 4 pm: = 0.95). For the mean diurnal IOP at the end of treatment duration, there were no statistical differences in above comparisons ( > 0.05). Compared with brimonidine (b.i.d.), there was a significant reduction of IOP in brinzolamide (b.i.d.) at 9 am ( < 0.0001); however, the difference was cloudy in thrice daily subgroup ( = 0.44); at 12 am, brinzolamide (b.i.d.) was similar to brimonidine (b.i.d.) in IOP-lowering effect ( = 0.23), whereas brimonidine (t.i.d.) led to a greater effect than brinzolamide (t.i.d.) ( = 0.02). At 4 pm, brinzolamide (b.i.d.) was superior IOP-lowering effect compared with brimonidine (b.i.d.) ( = 0.0003); conversely, the effect in brinzolamide (t.i.d.) was lower than brimonidine (t.i.d.) ( < 0.0001). For the mean diurnal IOP, brinzolamide was lower in twice daily subgroup ( < 0.00001); brimonidine was lower in thrice daily subgroup ( < 0.00001). With regard to the safety, brinzolamide and dorzolamide had a higher incidence of taste abnormality; moreover, brinzolamide resulted in more frequent blurred vision; dorzolamide resulted in more frequent ocular discomfort and eye pain. Timolol resulted in more frequent blurred vision and less conjunctival hyperemia. Brimonidine resulted in more frequent ocular hyperemia. As to other adverse events (AEs) (conjunctivitis, eye pruritus, foreign body sensation in eyes, and treatment-related AEs), brinzolamide was similar to other three active comparators. Brinzolamide, as add-on to PGAs or β-blocker, significantly decreased IOP of patients with refractory glaucoma or OHT and the AEs were tolerable.

The purpose of this study was to explore the central analgesia mechanism of moxibustion for chronic inflammatory visceral pain (CIVP).

Post-anesthetic shivering incurs discomfort to patients or even exacerbates their condition. However, no ideal drug has been well established for preventing post-anesthetic shivering. Currently, subarachnoid and epidural dexmedetomidine have demonstrated to have an anti-shivering effect.

A case of geyser sign with acromioclavicular (AC) joint cyst with underlying rotator cuff tear is presented. Ultrasound modality is used to diagnose the clinical case of the AC cyst with positive geyser sign. A 91-year-old male patient presented with a complaint of right-sided shoulder and neck pain. The physical examination revealed a large lump on his right shoulder with restricted shoulder movements. During ultrasound examination, a chronic supraspinatus tendon (ST) tear and AC joint cyst with a positive geyser sign was observed. The ultrasound diagnosis was also confirmed with magnetic resonance imaging (MRI). AC joint cyst with geyser sign is a rare condition. Few cases have been published with this type of pathology. To our knowledge, this is the first report of its kind from Pakistani population.

The genus belongs to the family of Asteraceae and comprises about 130 species. Many species belonging to the genus are traditionally used as medicinals mainly in Africa and Asia. The genus is reported to contain diverse secondary metabolites. The aim of this review is to critically evaluate the available research reports on the genus and systematically organize the findings. Information for this study was obtained using various search engines including PubMed and Google Scholar. This review revealed that the genus is used traditionally to treat pain, inflammation, respiratory diseases, diseases caused by different microorganisms, as an aphrodisiac, to fasten expulsion of placenta, and for removal of renal stones. More than 151 secondary metabolites have been reported from the genus in which thiophenic compounds held the biggest share. Various extracts, essential oils, and isolated compounds from members of this genus are shown to exhibit different biological effects mainly anti-microbial, anti-proliferative, and anti-inflammatory. However, there are a number of species in this genus that are claimed to have traditional medicinal uses but their biological effect not yet been evaluated.

The use of tension-free mesh repair techniques for inguinal hernias has led to uniformly low recurrence rates. The main associated morbidity is chronic postoperative inguinal pain. Mesh removal and triple neurectomy is the indicated procedure; there is insufficient evidence to support mesh removal alone without neurectomy in patients with chronic postoperative inguinal pain.