Rejected

To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures.

Paget's disease of bone is characterized by the dysfunction of the bone architecture due to the extreme increase of the osteoclast and osteoblast activity which results in the production of pathological bone. The particular disease afflicts any skeleton bone. Its sources have not been specified yet. There is evidence for the existence of strong genetic background as well as the effect of environmental factors. The neurological complications are relatively rare and are related to the central and peripheral nervous system (headache, ataxia, vertigo, loss of hearing, smell etc.). In our case, we present a patient with vertigo as the first manifestation of Paget's disease.

CREST syndrome, a subtype of scleroderma and Primary Biliary Cholangitis, is an autoimmune disease where the immune system is causing a progressive slow damage to the bile ducts. We report the case of a 67-year-old female patient presenting symptoms indicative of CREST syndrome. During her hospitalization in the internal medicine clinic and after the appropriate imaging and laboratory investigation the diagnosis of CREST syndrome was confirmed, and she was also diagnosed with PBC. This case adds up to a list of literature sources and several case reports which indicate the association of PBC and CREST syndrome, including the accompanied clinical symptoms and musculoskeletal manifestations of the latter.

The United States continues to grapple with an epidemic of opiate/opioid drugs. This crisis initially manifested itself in the use and abuse of opioid pain relievers and has since seen an increase in illicit opiate/opioid drug use mortality. Cuyahoga County (metropolitan Cleveland) has been an area where the crisis has been particularly acute; this paper updates our previous experience. Most notable in the evolution of the drug epidemic has been an increase in mortality associated with fentanyl and an alarming rise in overall deaths, largely attributable to the emergence of fentanyl (a 64% increase in total overdose deaths from 2015 to 2016, with fentanyl increasing 324%). Fentanyl is a synthetic opioid with use in medical analgesia and anesthesia; however, most of the current supply is of clandestinely manufactured origin. Also of concern is the recent appearance of illicit fentanyl analogues, which are briefly described in this report. White males continue to be the most frequent overdose victims in the current crisis. A decrease of age appears to have taken place with the emergence of fentanyl with the most common age group being between 30 and 44 years of age. The majority of decedents are nonurban residents. Educationally, most of these decedents have a high school diploma or less schooling and a significant percentage consists of manual laborers. Medical examiners are an important source of information necessary to develop prevention and interdiction strategies. Challenges faced regarding adequate funding, instrumentation, and staffing are being felt.

We report a case of pancreaticoduodenectomy for pancreatic head cancer with circumportal pancreas (CP). A 76-year-old woman was referred to our hospital with complaint of generalized pruritus. Dynamic computed tomography (CT) revealed an unenhanced mass at the head of the pancreas and a dilated main pancreatic duct (MPD) behind the superior mesenteric vein (SMV). She was diagnosed with pancreatic head cancer with CP and underwent subtotal stomach-preserving pancreaticoduodenectomy (SSpPD). The pancreas was transected both beneath and above the SMV, and the dominant dorsal edge of the pancreas was mobilized and anastomosed with the gut, whereas the ventral edge was closed by suture and attached to the gut. The postoperative course was uneventful without the occurrence of pancreatic fistula or bleeding. CP is a rare anomaly in which a portal vein (PV) is encircled by the annular pancreatic parenchyma. CP is usually asymptomatic without any significant comorbidity but may become a surgical hazard when pancreaticoduodenectomy is performed. We report our successfully treated case, with special references to the technical approach for pancreatic anastomosis.

Adequate pain control can be achieved using a patient-controlled drug delivery system that can provide analgesia to patients as needed. To achieve this objective, we developed a phototriggered microneedle (MN) system that enables the on-demand delivery of pain medications to the skin under external near-infrared (NIR) light stimulation. In this system, polymeric MNs, containing NIR absorbers and analgesics, are combined with a poly(l-lactide-co-d,l-lactide) supporting array. A "removable design" of the supporting array enables the quick implantation of the MNs into the skin to act as a drug depot, thus shortening the patch application time. Upon irradiation with NIR light, the NIR absorbers in the implanted MNs can absorb light energy and induce a phase transition in the MNs to activate drug release. We demonstrated that lidocaine release can be modulated or repeatedly triggered by varying the duration of irradiation and controlling the on and off status of the laser. Lidocaine delivered by the implanted MNs can be rapidly absorbed into the blood circulation within 10 min and has a bioavailability of at least 95% relative to the subcutaneous injection, showing that the proposed system has the potential to provide a rapid onset of pain relief. Such an implantable device may allow pain sufferers receiving the painkiller without the need for multiple needle injections, and may enable controlling pain more conveniently and comfortably.

: The undermanagement of pain in older adults has been identified as a problem worldwide. : The purpose of this research is to identify priority areas in education and research for future development with the aim of improving pain management in older persons. In addition, barriers to addressing these priorities are identified. : This mixed methods study, based on a modified Delphi approach, included three distinct components: (1) a qualitative component using focus groups with key informants or experts in the field of pain management in older adults ( = 17), (2) a scoping review of the literature, and (3) a survey of ranked responses completed by the same key informants who attended the focus groups. Thematic analysis was used to identify the initial list of issues and descriptive statistics were used for ranking them. : A number of concerns related to both education and research were frequently endorsed by participants. For education, they identified the need for more content in both undergraduate and continuing education programs related to documenting about pain; assessing pain, and learning about the complexities of pain. Research priorities included the need to explore successful practice models; costs of untreated pain; effects of mobility on pain; and patient preferences for pain management. Key barriers to addressing these barriers included lack of staff time and resources and unfamiliarity with pain assessment tools. : These findings highlight priority issues related to pain management in older adults from a nationwide perspective.

Whether or not chronic fatigue is reflected in structural changes in the brain is a matter of debate. Primary SS (pSS) is characterized by dryness of the mouth and eyes, migrating muscle and joint pain and prominent fatigue. We aimed to investigate whether the severity of fatigue in pSS was associated with cerebral MRI findings.

: Many chronic pain (CP) awareness and educational initiatives have been achieved, but it is time to take stock of where we are today. : The aim of this study was to describe and identify determinants of knowledge, beliefs, and attitudes of different subgroups of the Quebec population regarding CP and especially toward people suffering from this condition. : A web-based, cross-sectional study was conducted between May and June 2014. : A total of 1958 participants responded, among whom 70.9% reported suffering from CP and 14.4% reported being a health care professional (HCP). Almost half of the participants were not aware that the risk of developing CP is increased after undergoing surgery or that CP affects approximately one in five adults. A minority (10.30%) agreed that HCP are well trained in CP treatment. The two most frequent negative beliefs were that people suffering from CP become dependent on their medications as do drug addicts (16.7%) and that consulting a psychologist is useless unless the person with CP is depressed (16.9%). Multiple regression analysis showed that being a woman, being born in Canada, being unemployed, suffering from CP, and being an HCP were predictors of better knowledge and more positive attitudes toward people suffering from CP (all values < 0.05). Older age and residing in a remote region were associated with poorer knowledge and more negative attitudes. : Our results underline the importance of continuing the efforts and the need for more education programs, awareness campaigns, and stigma reduction activities about CP for HCP, patients, and the general public.

Understanding and modeling the mobility of individuals is of paramount importance for public health. In particular, mobility characterization is key to predict the spatial and temporal diffusion of human-transmitted infections. However, the mobility behavior of a person can also reveal relevant information about her/his health conditions. In this paper, we study the impact of people mobility behaviors for predicting the future presence of flu-like and cold symptoms (i.e. , , , , , , , and ). To this end, we use the mobility traces from mobile phones and the daily self-reported flu-like and cold symptoms of 29 individuals from February 20, 2013 to March 21, 2013. First of all, we demonstrate that daily symptoms of an individual can be predicted by using his/her mobility trace characteristics (e.g. total displacement, radius of gyration, number of unique visited places, etc.). Then, we present and validate models that are able to successfully predict the future presence of symptoms by analyzing the mobility patterns of our individuals. The proposed methodology could have a societal impact opening the way to customized mobile phone applications, which may detect and suggest to the user specific actions in order to prevent disease spreading and minimize the risk of contagion.