Rejected

One-third of epilepsy of children is refractory, and this study was conducted to evaluate the efficacy and adverse events of levetiracetam as add-on therapy in the treatment of refractory epilepsy of children.

Programmed cell death (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors have been increasingly used in cancer therapy. The aim of this study was conducted a meta-analysis to assess the efficacy and safety of PD-1/PD-L1 inhibitors in patients with unresectable hepatocellular carcinoma (uHCC). A total of 1657 patients were included. The completed phase III trials with details data, such as overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse effects (AEs) were included. The pooled hazard ratio (HR) of OS and PFS were .75 (95% CI: .61-.92) and .74 (95% CI: .56-.97) with heterogeneity between PD-1/PD-L1 inhibitors groups and control groups. Sensitivity analysis revealed IMbrave-150 could be the most important factor of heterogeneity for OS, while CheckMate-459 was the main fact of heterogeneity for PFS. In addition, the relative risk (RR) of ORR and DCR were 2.43 (95% CI: 1.80-3.26) and 1.26 (95% CI: 1.11-1.43) with low heterogeneity in PD-1/PD-L1 inhibitors groups. The therapeutic effect of PD-1/PD-L1 inhibitors was better in females, Asia without Japan, BCLC status C and infected hepatitis groups. The RR of AEs from any cause and serious adverse events (SAEs) for patients receiving PD-1/PD-L1 inhibitors were 1.03 (95% CI: .93-1.13) and 1.13 (95% CI: .89-1.44), respectively. Pruritus was the most common AEs reported in 10% of patients or more (RR = 1.69, 95% CI: 1.33-2.15). In conclusion, PD-L1 inhibitor combined with anti-VEGF antibody could improve the prognosis of patients with uHCC. However, caution should be taken for AEs during patients receiving PD-1/PD-L1 inhibitors.

Orthopaedic surgeons are among the highest prescribers of opioids. This study explores the effect of an educational intervention on orthopaedic surgery residents' opioid knowledge and prescribing practices. Orthopaedic residents were surveyed at three urban academic institutions. A pre-survey was administered to residents prior to an educational lecture and case-based session. This included background on the opioid epidemic, multimodal analgesia, opioid consumption in common orthopaedic procedures, and state laws regulating prescribing. Following this intervention, residents were given a post-survey to complete. There was a significant increase in resident confidence concerning their opioid prescribing training (p = 0.03) and their knowledge of alternative pain management therapies (p = 0.03). This was accompanied by an objective improvement in knowledge of state prescribing laws and of metrics regarding the opioid epidemic. Hypothetical opioid pills prescribed after common orthopaedic procedures decreased between the pre- and post-tests. The educational session significantly improved orthopaedic surgery residents' knowledge about opioids and prescribing habits. Formal resident education on opioid knowledge and evidence-based prescribing strategies is an area of potential improvement to combat the opioid crisis. (Journal of Surgical Orthopaedic Advances 31(1):030-033, 2022).

Nalbuphine as well as butorphanol as adjuvant to intrathecal bupivacaine have been studied in comparison to bupivacaine alone. Both are kappa receptor agonist and have never been compared for its efficacy in terms of postoperative analgesia. The aim of this study was to evaluate duration of postoperative analgesia as well as intraoperative block characteristics using intrathecal nalbuphine hydrochloride (800 μg) or butorphanol (25 μg) as adjuvant to hyperbaric bupivacaine (12.5 mg) in lower limb fracture femur surgeries as compared to active control, that is, saline and bupivacaine.

To assess differences in catastrophizing and kinesiophobia in relation to areas of pain and somatic symptoms among participants with temporomandibular disorders (TMDs) and controls.

Prior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP.

Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma. A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass. Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely.

Selective serotonin reuptake inhibitors (SSRIs) have proven more problematic in terms of some side effects than the original clinical trials suggested. Sertraline may displace warfarin from plasma proteins and may increase the prothrombin time. The aim of this study was to report a rare case of the sertraline- induced severe anal pain and rectal bleeding without concurrent of taking any other drugs including non-steroidal anti-inflammatory drugs (NSAIDs).

The purpose of the Research to Practice column is to review and critique current research articles that directly affect the advanced practice nurse's (APN's) practice in the emergency department. This review examines the findings of Schmidt and Rowbotham's (2017) article, "Aggressive Noninvasive Treatment of Acute Herpes Zoster for the Prevention of Postherpetic Neuralgia. Herpes Zoster: Postherpetic Neuralgia and Other Complications." The authors completed an extensive literature review and created 6 key clinical recommendations for treating acute herpes zoster to prevent postherpetic neuralgia, including prevention, patient education and counseling, proper diagnosing, medication selection, and treatment specific to acute herpes zoster postherpetic neuralgia. This review provides a strategy to allow APNs to confidently recognize and treat acute herpes zoster and postherpetic neuralgia to reduce patient risks and avoid mistreatment of acute herpes zoster and postherpetic pain.

(1) To deepen knowledge on how specialized health care professionals (HCPs) reflect on encounters with children diagnosed with juvenile idiopathic arthritis (JIA) and (2) to outline a theory for orofacial care.