Rejected

To analyse the use, indications and potential risks of tricyclic antidepressants (TCAs), using a technological system of clinical alerts at the time of prescription.

Fluorine-18 fluorodeoxyglucose positron emission tomography (F-FDG PET) imaging was conceived in the early 1970 by investigators at the University of Pennsylvania as a research technique to measure brain metabolism and function by employing a non-invasive imaging approach. Soon after the introduction of whole-body PET instruments, F-FDG was utilized in the assessment of a variety of solid tumors and certain hematological malignancies. Yet, the role of F-FDG in assessing benign and uncommon malignant disorders of the bone marrow has not been investigated to a great extent. Fluorine-18-FDG as a molecular probe has the proven capacity to reflect the abnormal glycolytic activities inherent to a variety of disorders, where such information may serve as a guide to the clinical course of the respective disease. Recent efforts have studied bone marrow and extra-medullary disease activity in certain malignancies like chronic lymphocytic leukemia. Nonetheless, few studies have explored the role of F-FDG in assessing the metabolic basis of benign disorders of red marrow. Moreover, the introduction of novel imaging analysis schemes in recent years has allowed for the global assessment of red marrow disease, which can provide a superior means for characterizing the systemic nature and burden of these disorders. Accordingly, semi-quantitative global analysis techniques as applied to the skeletal structures in F-FDG PET may provide a tool to better understand these complex marrow abnormalities. Functional imaging of red bone marrow may also reveal critical information specifically regarding the extra-medullary extension of such hematological disorders that cannot be assessed by other diagnostic or imaging techniques. Myleoproliferative neoplasms (MPN) are an apt category of hematological disease that confer significantly altered systemic metabolic rates of hematopoietic stem cells (HSC) in the marrow, as such they are primed for exploration with F-FDG PET. The hallmark of such disorders involves the excess production of particular cellular components in blood. After a period of excess production, scar tissue may develop in place of the HSC leading to myleofibrosis and decreased hematopoietic activity. One of the least studied disorders within the larger category of MPN with respect to the nuclear medicine is polycythemia. Polycythemia may be either primary, polycythemia vera (PV), or secondary. PV involves a JAK2+ in HSC which allows for the excessive proliferation of immature erythrocytes and depressed erythropoietin levels as a result. Secondary polycythemia occurs in response to decreased oxygen intake, often as a result of smoking, which results in increased erythropoietin and hematocrit levels. Primary and secondary polycythemia lead to an increase in overall red marrow activity and a diffusion of active red marrow into the appendicular skeleton. Clinical presentation often includes redness or irritation of the skin along with headache, fatigue and excessive bleeding. Based upon the mentioned precedent, it is evident that PET imaging with F-FDG and other tracers will play a meaningful role in assessing diffuse bone marrow disorders such as hematological malignancies and myeloproliferative abnormalities. Semi-quantification studies of global bone marrow activity in such an application will be a vital means in accurately assessing the systematic nature and global burden of such benign hematological disorders such a polycythemia. Accordingly, the derived metabolic data projects to be a useful tool in the prospective clinical and scientific aspects of the diagnosis of these benign hematological disorders and the assessment of disease progression in light of relevant biological treatments. Given the nature of the disease and the enumerated capabilities of F-FDG PET it is expected that one would be able to capture the systematic abnormalities inherent to the disease. Moreover, the handful of case studies supports this possibility. Three case studies have all illustrated diffuse elevated F-FDG uptake throughout the axial and appendicular skeleton that reflects the hyper-metabolic red bone marrow as related to polycythemia. Moreover, the use of various functional imaging tracers, in addition to F-FDG, may indirectly reflect hypermetabolism in red bone marrow through abnormal tracer accumulation in the skeletons of patients. The whole body F-FDG scan of a JAK2+ PV patient before treatment (a) as compared to a matched subject (b) is found below; of note is the PV patient's elevated uptake in the pelvis, femur and spine.

A 22-year-old man sustained complete transection of his right distal biceps femoris tendon by a hockey skate. He experienced persistent pain and disability, symptoms of peroneal neuritis, and an inability to return to hockey. At 3-months postinjury, he underwent biceps femoris repair and peroneal neurolysis. At 9-months postoperatively, the patient returned to full activity and played a full season collegiate hockey.

In the second part of this review article we will describe the imaging features of non- spondyloarthritis (SpA) pathologies that may mimic sacroiliitis on Magnetic Resonance Imaging (MRI), and that readers should be aware (part 2). Based on the established literature, there is currently an "overcall" of sacroiliitis on MRIs. In this setting, differential diagnoses and their imaging features come into play. In fact, non-SpA related sacroiliac joints (SIJs) pathologies are more commonly found than true sacroiliitis on MRI of the SIJs, even in patients with inflammatory type back pain. An imaging literature review, highlighting "easy-to-use" learning points regarding MRI interpretations in patients with suspected sacroiliitis and/or nonspecific lumbar back pain is presented. This two-part article aims to be a snapshot of the most common inflammatory versus non-inflammatory entities found on SIJs imaging studies in routine practice, while trying to keep this review article simple, educational and above all, practical.

. Severe early childhood caries (S-ECC) is a rapid form of dental caries that firstly affects primary upper incisors of children less <3 years of age and can cause interference in child's health by pain, nutritional deficiencies and sleep disorders. It seems there are many unknown factors in the etiology as well as progression of S-ECC. The aim of this study was to assess parents' views in this relation. . In this qualitative study parent's views and their 1‒3-year-old children were studied when they visited pediatric medical clinics in Kerman. After cleaning the children teeth and examination of them to discover caries, they were placed in 2 groups with or without S-ECC. Then each parent was interviewed separately and their comments were collected and studied. Examinations and interviews continued with parents until they did not express anything new. . Parents of children without S-ECC had better understanding about S-ECC related factors than parents of children with S-ECC and greater number of them (without significant differences) expressed known reasons for occurrence of S-ECC. There were differences among known reasons and proposed reasons mostly in parents of children with S-ECC, although the differences were not significant. Maternal stress and amount of breast milk's lactose were factors that were reported by some parents while there were unknown factors related to the etiology of S-ECC. Furthermore, no parents mentioned factors like saliva or mode of delivery. . The most important achievement of the study was the attention of some parents to the role of their chronic stress in the occurrence of S-ECC. Another important consideration was that none of the parents mentioned the important role of the quality and quantity of saliva in preventing S-ECC, which should be promoted in the community.

In the spinal cord, altered protein transcription and translation have received a lot of recent attention for their role in neural plasticity, a major mechanism leading to the development of chronic pain. However, changes in brain plasticity are also associated with the maintenance of pain symptoms, but these cellular mechanisms remain less clear. The mechanistic/mammalian target of rapamycin (mTOR) is a master regulator of protein synthesis, and controls several neuronal functions, including neural plasticity. While aberrant changes in mTOR signaling are associated with sensitization of the pain pathway (sensory neurons and spinal cord), there are various nervous system diseases that have pain as a comorbidity and altered mTOR activity in the brain. Here, we provide a brief review of mTOR changes in the brain that are associated with some neurological disorders and focus on how these changes may be relevant to the pain of the underlying condition and chronic pain itself.

Radiologists as a group face unique occupational health hazards among which musculoskeletal injuries, chronic eye strain, and others are yet to receive adequate attention. Constant mental strain due to demanding turnaround times and work pressures may lead to burnout and depression. These combine to decrease overall work satisfaction and productivity.

Genetically modified mice are widely used in studies on human and animal physiology and pharmacology, including pain research. The experimental design usually includes comparisons of genetically modified mice with wild-type littermates, requiring biopsy material for genotyping and methods for unequivocal identification of individual mice. Ethical standards and, in some countries, legislation require that both needs are reached with a single procedure. Clipping of the most distal phalanx of up to two toes per paw (toe clipping) is the favored procedure in most research fields, but it may be problematic in sensory physiology and pain research.

Psychological therapies, such as cognitive behavioral therapy, are widely used multifaceted approaches that have been shown to improve pain-related functioning. A small but growing number of studies have used brain imaging to support the use of psychological therapies for pain. Although these studies have led to an increased understanding of how therapies may engage neural systems, there are multiple technical and conceptual challenges to consider. Based on the current literature, several components of effective psychological therapies for pain may be supported by changes in neural circuitry, which are most consistently represented by diminished activation and/or reduced hyperconnectivity in brain regions related to pain processing, emotion, and cognitive control. Findings may vary based on methodological approaches used and may also differ depending on targets of treatment. To provide a nuanced understanding of the current literature, specific targets and components of effective treatments for which a neural basis has been investigated are reviewed. These treatment components include catastrophic thinking about pain, increasing self-efficacy, mindfulness, anxiety symptom reduction, and exposure-based approaches. In general, such strategies have the potential to normalize regional hyperactivations and reduce hyperconnectivity in brain regions associated with nociceptive processing, cognition, and emotion, although additional research is needed. By determining if there are indeed distinct brain mechanisms engaged by different components of psychological therapy and evidence for specific changes in neural function after these interventions, future therapies may be more optimally tailored for individuals afflicted with chronic pain.

To test and re-examine the diagnostic criteria for neurovascular orofacial pain (NVOP) compared to posttraumatic trigeminal neuropathy (PTTN).