Rejected

Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as inflammation of the lactating breast remains a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for inflammatory conditions of the lactating breast, such as engorgement, blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, mastitis and white spots, which lack agreed or evidence-based aetiology, definitions and treatment. This is the first in a series of three articles which review the research literature concerning benign lactation-related breast inflammation. This article investigates aetiological models. A complex systems perspective is applied to analyse heterogeneous and interdisciplinary evidence elucidating the functional anatomy and physiology of the lactating breast; the mammary immune system, including the human milk microbiome and cellular composition; the effects of mechanical forces during lactation; and the interactions between these. This analysis gives rise to a mechanobiological model of breast inflammation, in which very high intra-alveolar and intra-ductal pressures are hypothesized to strain or rupture the tight junctions between lactocytes and ductal epithelial cells, triggering inflammatory cascades and capillary dilation. Resultant elevation of stromal tension exerts pressure on lactiferous ducts, worsening intraluminal backpressure. Rising leucocyte and epithelial cell counts in the milk and alterations in the milk microbiome are signs that the mammary immune system is recruiting mechanisms to downregulate inflammatory feedback loops. From a complex systems perspective, the key mechanism for the prevention or treatment of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents a critical mass of mechanical strain and rupture of the tight junctions between lactocytes and ductal epithelial cells.

Folliculorum mites (, and ) are part of the common external parasites in humans as the exclusive host of them. The highest focus of these mites is on those parts of the body that have fat glands and fatty products in the skin. This is proven by the dermal – epidermal separation method. In the present study, the presence of is reported in a urine sample containing hematuria, which has not been observed so far according to the previous investigations. The case was related to a 44-yr-old woman with symptoms of headache, chills, and joint pain referring to the medical diagnostic laboratory of Sanandaj, Kurdistan Province, northwest of Iran. After historiography and collecting the urine sample as middle, the live parasite of was observed. The presence or migration of mite in the atypical areas of the body (genital, urinary, eye, etc.), which are close to hairy tissues (especially in women), may be one of the causes of allergic reactions and clinical symptoms in people.

Servicemembers are required to operate at high levels despite experiencing common injuries such as chronic low back pain. Continuing high levels of activity while compensating for pain may increase the risk of musculoskeletal injuries. As such, the purpose of this project was to determine if servicemembers with chronic low back pain have reduced lower extremity performance, and if they use alternate strategies to complete a functional performance task as compared to healthy servicemembers.

Temporomandibular disorders have common signs and symptoms, including pain in the masticatory muscles, limitation or deviation in a mandibular range of motion, and other common patient complaints, such as headache and earache. The main focus of this study was to collect comprehensive and integrated data on the effect of the posterior stop on temporomandibular joint disorders, as well as prevention, treatment, and follow-up care for the patients. The authors conducted the search in PubMed, SCOPUS, Web of Science, Cochrane Library, CINHAL, Medline, ProQuest, Google Scholar, Magiran, IranDoc, SID, and Iranmedex databases for relevant articles. A list of selected study sources, related conferences, and grey literature were manually searched in addition to the databases mentioned above. A 21-year time limit was imposed (2000-2021). Finally, 16 articles were selected to be reviewed in this systematic review. The designs of the included studies were heterogeneous, and due to the low number of studies covered, the authors could not carry out a meta-analysis. The causes of temporomandibular disorders are multifactorial and complex. Therefore, it is difficult to investigate the relationship between this disorder and predictors. The results of the present study indicate that to determine the effect of the posterior stop on temporomandibular joint disorders, more clinical trials and case-control studies should be conducted.

Rhomboid intercostal block is a newer technique for chest wall analgesia and can be an effective alternative to thoracic epidurals and paravertebral blocks. We performed a rhomboid intercostal block after sternoclavicular joint reconstruction surgery. A healthy 26-year-old male who had chronic right sternoclavicular joint instability was scheduled for right medial clavicle resection with sternoclavicular joint allograft reconstruction. We performed a right interscalene single-shot nerve block followed by a rhomboid intercostal block with catheter placement under ultrasound guidance. The patient's pain was well controlled postoperatively with minimal use of opioids. Rhomboid intercostal block with brachial plexus block is a potential option for analgesia after sternoclavicular joint reconstruction surgery.

Vestibular schwannomas (VSs) are slow-growing benign neoplasms commonly located at the cerebellopontine angle. Although clinically significant hemorrhagic VSs are rarely encountered with only 75 patients previously reported, they could be life threatening. We discuss the presentation and outcomes of three patients with hemorrhagic VS as well as review the literature for this phenomenon. Consecutive adult patients with a histologically proven diagnosis of VS over a 9-year period were retrospectively reviewed. Fifty adult patients were identified with three (6%) having clinically significant intratumoral hemorrhage. This was defined as patients having acute to subacute symptoms with frank radiological evidence of hemorrhage. The mean age of diagnosis was 62 ± 9 years and the male-to female ratio was 2:1. The mean duration of symptoms, namely headache, vertigo, and sensorineural hearing impairment, was 26 ± 4 days with one patient presenting with acute coma. Retrosigmoid craniotomy for tumor resection was performed for all patients. Histopathological examination revealed extensive areas of microhemorrhage with considerable macrophage infiltration. All three patients were discharged with no additional neurological deficit and good functional performance. Clinically significant hemorrhagic VSs are rare, and patients may present with acute to subacute (i.e., within a month) symptoms of hearing loss headache, facial, or trigeminal nerve palsy. Macrophage infiltration is frequently encountered in tumor specimens and reflects the pivotal role of chronic inflammation in their pathophysiology. Surgical resection can lead to good outcomes with timely intervention.

Caudal anesthesia has emerged as a reliable and effective anesthetic technique in the pediatric age group. However, the limited duration of action of the local anesthetic drugs proves to one of the major hindrances in the complete utilization of caudal block as an effective analgesic technique. To overcome this shortcoming, adjuvant drugs were introduced into clinical practice.

Patients with shoulder pain may have proprioceptive and balance deficits. However, studies on balance in patients with shoulder pain are scarce.

Detection of recurrence of a brain tumor after treatment is one of the most important and challenging diagnostic problems in neuro-oncological practice. In spite of technical advances in imaging modalities, sometimes, certain clinical presentations and manifestations can lead to a diagnostic dilemma even with the best of the technical know-how. We present a case of recurrence of anaplastic oligoastrocytoma (World Health Organization Grade III), where the patient's initial clinical presentation and the F-18 flourodeoxyglucose positron emission tomography (PET) magnetic resonance imaging findings were suggestive of stroke-like migraine attacks after radiation therapy syndrome. Due to a seizure episode before PET image acquisition, intense gyral uptake was noted in the left parietal lobe which made it difficult to ascertain the presence of a tumor recurrence. However, Tc-99m glucohepatonate single-photon emission computed tomography done after 1 week revealed radiotracer uptake within the site corresponding to the primary tumor, and a diagnosis of recurrence was made.

Traditional total shoulder arthroplasty is performed through the deltopectoral approach and includes subscapularis release and repair. Subscapularis nonhealing or dysfunction may leave patients with persistent pain, impairment, and instability. Alternative approaches that spare the subscapularis include rotator interval and posterior shoulder approaches; however, to our knowledge, a cadaveric study describing pertinent surgical anatomy for a posterior shoulder approach regarding shoulder arthroplasty has not been performed.