Rejected

Inflammation plays a central role in knee osteoarthritis (OA) pathogenesis (C. R. Scanzello, 2017). The synovial membrane inflammation is associated with disease progression and represents a primary source of agony in knee OA (L. A. Stoppiello et al., 2014). Many inflammatory mediators may have biomarker utility. To identify synovium related to knee OA pain biomarkers, we used canonical correlation analysis to analyze the miRNA-mRNA dual expression profiling data and extracted the miRNAs and mRNAs. After identifying miRNAs and mRNAs, we built an interaction network by integrating miRWalk2.0. Then, we extended the network by increasing miRNA-mRNA pairs and identified five miRNAs and four genes (TGFBR2, DST, TBXAS1, and FHLI) through the Spearman rank correlation test. For miRNAs involved in the network, we further performed the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses, whereafter only those mRNAs overlapped with the Online Mendelian Inheritance in Man (OMIM) genetic database were analyzed. Receiver operating characteristic (ROC) curve and support vector machine (SVM) classification were taken into the analysis. The results demonstrated that all the recognized miRNAs and their gene targets in the network might be potential biomarkers for synovial-associated pain in knee OA. This study predicts the underlying risk biomarkers of synovium pain in knee OA.

Detection of defective deep brain stimulation (DBS) contacts/electrodes is sometimes challenging.

A 77-year-old woman reported a spiral right humeral shaft fracture, which was treated by closed reduction and fixation with elastic bundle retrograde intramedullary nail. Despite a proper closed reduction and a minimally invasive surgery obtained, nonunion arose. The patient refused the advised second surgical treatment. At 12 months, the patient was admitted to our department as a consequence of persistent pain and unnatural humeral shaft mobility. New X-ray imaging highlighted intramedullary nail rupture due to excessive implant mobility at the nonunion site. Consequently, nail removal was performed, and plate and screws were then fixed, and a bone allograft was placed to allow fracture healing and proper stabilization. The literature reports optimal outcomes with elastic bundle intramedullary nailing. It is strongly suggested to obtain a closed reduction and minimally invasive dynamic fixation. Nonetheless, it may lead to several complications such as nonunion, for which surgical treatment is technically demanding and highly invasive.

Polyneuropathy in patients with diabetes mellitus is manifested by a lesion of peripheral sensory, motor and autonomic nervous system. Different severity of damage of sensory, motor and autonomic fibers in typical and atypical forms of diabetic polyneuropathy, requires a differentiated approach to therapy, but not the rejection of its implementation. In an interdisciplinary consensus, consultations are held with physicians from different regions of the Russian Federation, and modern methods of diagnosing and assessing the severity of diabetic polyneuropathies, which determine the algorithm for treating patients, are discussed.

Despite the large number of studies and clinical observations on timely analgesia in the postoperative period, there are no clearly formulated views on the nature of the pain syndrome, and there are no modern protocols for the treatment of pain after tonsillectomy.

Emiroğlu M, Çelebi B. First report of human ehrlichiosis in Turkey. Turk J Pediatr 2019; 61: 267-270. Ehrlichiosis, a tick-borne infection, can cause severe and fatal disease. A 6-year-old boy was admitted with fever, chills, malaise, headache, anorexia, rhinorrhoea, and cough lasting two days. He had had contact with a dog 10 days prior, and a tick had been removed the day before. Fever, minimal conjunctival injection, oropharyngeal hyperemia and cracked, hyperemic lips were observed. Laboratory tests were normal except for lymphopenia and hyponatremia. Cytoplasmic morulae in the monocytes and granulocytes were seen on peripheral blood smear. Doxycycline was started immediately, and the fever subsided within 48 hours. Given the Ehrlichia was positive but Anaplasma negative by real-time PCR, he was diagnosed as ehrlichiosis, subspecies identification could not be performed. This is the first human ehrlichiosis case in Turkey.

Research regarding the relationship between core muscle endurance and performance is limited. The purpose of this study was to analyze the association between core/trunk endurance and athletic performance. Seventy-four healthy participants between 18 and 45 years old participated in this study (Age: 26.0 ± 6.5 years; Mass: 74.6 ± 12.8 kg; Height: 1.74 ± 0.08 m; BMI: 19.0 ± 6.8 kg/m). The core endurance was measured using the McGill protocol, consisting of the following tests: trunk flexion, back extension, and side-bridge. Functional performance was evaluated with push-ups, sit to stand, T-run test, countermovement jump (CMJ), Yo-Yo test, maximum dynamic strength-one repetition maximum (1RM) and muscle power on the bench press, pull row, and leg press. The regression results between the McGill protocol (proxy for core/trunk endurance) and the dependent variables were: 1RM pull row: = 0.109 with = 0.046; RM bench press: = 0.149 with = 0.012; RM leg press: = 0.144 with = 0.013 and power pull row: = 0.151 with = 0.016; power bench press: = 0.136 with = 0.026; power leg press: = 0.122 with = 0.013), push-ups: = 0.157 with < 0.001, sit to stand: = 0.198 with < 0,001), functional movement score: = 0.209 with < 0.001). Nevertheless, core endurance scores were not able to predict jump ability ( = 0.014, = 0.807) or agility (-test: 0.036 with = 0.497). In conclusion, core endurance exerted no significant influence the agility and jump performance but influenced the ability to run intermittently, exert maximum power and strength in different actions (push, pull, and lift exercises) related to the better quality of movement (FMS).

Hereditary multiple exostoses (HME), also called hereditary multiple osteochondromas, is a rare genetic disorder characterized by multiple osteochondromas that grow near the growth plates of bones such as the ribs, pelvis, vertebrae and especially long bones. The disease presents with various clinical manifestations including chronic pain syndromes, restricted range of motion, limb deformity, short stature, scoliosis and neurovascular alteration. Malignant transformation of exostosis is rarely seen. The disease has no medical treatment and surgery is only recommended in symptomatic exostoses or in cases where a malignant transformation is suspected. HME is mainly caused by mutations and functional loss of the EXT1 and EXT2 genes which encode glycosyltransferases, an enzyme family involved in heparan sulfate (HS) synthesis. However, the peculiar molecular mechanism that leads to the structural changes of the cartilage and to osteochondroma formation is still being studied. Basic science studies have recently shown new insights about altering the molecular and cellular mechanism caused by HS deficiency. Pediatricians, geneticists and orthopedic surgeons play an important role in the study and treatment of this severe pathology. Despite the recent significant advances, we still need novel insights to better specify the role of HS in signal transduction. The purpose of this review was to analyze the most relevant aspects of HME from the literature review, give readers an important tool to understand its clinical features and metabolic-pathogenetic mechanism, and to identify an effective treatment method. We focused on the aspects of the disease related to clinical management and surgical treatment in order to give up-to-date information that could be useful for following best clinical practice.

: Chronic pain is one of the most widely recognized, disabling, and expensive health problems in Canada. Interdisciplinary multimodal pain management is effective in helping chronic pain patients lessen symptoms and reclaim functionality, but most patients lack access to such treatments. : The aim of this study was to describe the development and implementation of a publicly funded and patient-centered model of care in the community. : The study was set in the Pain & Wellness Centre (PWC) in Vaughan, the only community-based chronic pain clinic in Ontario funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC) as a demonstration project of a template for similar future community clinics. The study is descriptive, including a brief review of the Ontario comprehensive pain strategy framework and an overview of the PWC and the process involved in the development of an interdisciplinary pain program (IDP), based on the biopsychosocial model of chronic pain management. : During a 2.5-year period, the PWC has offered 1055 new patient medical consultations and 1921 follow-up visits and admitted 242 patients in the IDP program (demonstrating significant success in patient outcomes at the 3-month exit from the program). It established robust outcomes research, organized educational programs for pain trainees, and cultivated a collaborative relationship with the Toronto Academic Pain Medicine (TAPMI) network and the community at large. : This demonstration program has shown the feasibility and applicability of the principles of the MOHLTC comprehensive pain strategy, providing an effective, evidence-based, and accountable approach to chronic pain diagnosis and management in the community.

The concept of access to pain management as a human right has gained increasing currency in recent years. Commencing as individual advocacy, it was later embraced by the disciplines of pain medicine and palliative care and by mainstream human rights organizations.Today, United Nations and regional human rights bodies have accepted the concept and incorporated it into key human rights reports, reviews, and standards. We review the foundations in law of this right and the obligations that flow from it to governments. We analyze the nature and content of the obligation in the context of acute, chronic nonmalignant and cancer pain.Finally, we examine this right in light of the twin crises of inadequate access to pain management and the opioid crisis in the United States and other nations.