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Ultrashort Echo Time MR Imaging of Osteochondral Junction.

Osteoarthritis is a common chronic degenerative disease that causes pain and disability with increasing incidence worldwide. The osteochondral junction is a dynamic region of the joint that is associated with the early development and progression of osteoarthritis. Despite the substantial advances achieved in the imaging of cartilage and application to osteoarthritis in recent years, the osteochondral junction has received limited attention. This is primarily related to technical limitations encountered with conventional MR sequences that are relatively insensitive to short T2 tissues and the rapid signal decay that characterizes these tissues. MR sequences with ultra-short echo time (UTE) are of great interest since they can provide images of high resolution and contrast in this region. Here we briefly review the anatomy and function of cartilage, focusing on the osteochondral junction. We also review basic concepts and recent applications of UTE MR sequences focusing on the osteochondral junction.

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Primary biliary cholangitis as a roadmap for the development of novel treatments of cholestatic liver diseases.

The discovery of nuclear receptors and transporters has contribute to the development of new drugs for the treatment of cholestatic liver diseases. Especially progress has been made in the second line therapy of PBC. These new drugs can be separated into compounds primarily targeting cholestasis, molecules targeting fibrogenesis and molecules with immune-mediated action. Finally, also drugs aimed at symptom relief ( pruritus and fatigue) are further under investigation. Obeticholic acid is currently the only approved second line therapy for PBC. Drugs in the late phase of clinical development are the PPAR agonists, NorUDCA and the NOX 1&4 inhibitors.

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Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The administration of methylprednisolone (MP) is a component of perioperative multimodal analgesia that mitigates the potentially deleterious effects of postoperative pain and opioid consumption. However, a systematic evaluation of the efficacy and safety of MP is lacking. The present systematic review and meta-analysis was performed to quantify the potential clinical benefits and risks of perioperative MP in lung surgery.

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Rehabilitation of Neuropsychiatric Symptoms in Patients with Long-COVID: Position Statement.

Long-COVID, a term used to describe ongoing symptoms following SARS-CoV-2 (COVID-19) infection, parallels the course of other post-viral syndromes. Neuropsychiatric symptoms of Long-COVID can be persistent and interfere with quality of life and functioning. Within the biopsychosocial framework of chronic illness, rehabilitation professionals can address the neuropsychiatric sequelae of Long-COVID. However, current practice models are not designed to address concurrent psychiatric and cognitive symptoms in adults living with Long-COVID. Thus, we present a biopsychosocial framework for Long-COVID and provide treatment strategies based on evidence from current literature of post-viral chronic illness. These recommendations will guide rehabilitation professionals in 1) identifying common neuropsychiatric symptoms in Long-COVID that can be targeted for intervention and 2) addressing these symptoms via integrative interventions taking into account the biopsychosocial presentation of Long-COVID symptoms.

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Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty.

We questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA).

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Pharmacological management of cancer pain: Novel therapeutics.

Patients diagnosed with cancer often experience pain during their treatment course, making it difficult to care for themselves and continue with their activities of daily living. When cancer is found at later stages, the pain can become severe and constant; reducing their quality of life and significantly affecting mental and physical well-being. Despite opioids being known to provide adequate analgesia for higher pain levels, they are often the reason for under-dosing because of their adverse effects and concern for addiction. There are also patients who do not respond well to opioids because of genetic anomalies or personal preference. Therefore, there is a need for novel non-opioid cancer pain treatments. There are many new cancer pain treatments that are emerging. This manuscript discusses cancer pain, risk factors, epidemiology, guidelines for the treatment of cancer pain, personalization of cancer pain therapy, breakthrough pain, cancer-induced peripheral neuropathy, established cancer pain treatment options, and novel emerging cancer pain treatment options.

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Pneumorrhachis: A rare cause of headache in a patient with a traumatic spinal cord injury due to gunshot wound.

A pneumorrhachis (PR) is a rare phenomenon in which air is found in the spinal canal. There are multiple etiologies, including iatrogenic, nontraumatic, and traumatic. Most traumatic PR are asymptomatic and resolve on their own, but a subset are symptomatic and require urgent surgical intervention. This case describes a traumatic PR in which a headache was the primary symptom.

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Efficacy and safety of curcuminoids alone in alleviating pain and dysfunction for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.

Curcuminoids (CURs) are the principal ingredients of Curcuma longa L. [Zingiberaceae] (CL)-an herbal plant used in east Asia to alleviate pain and inflammation. Thus far, the therapeutic effects of CURs for knee osteoarthritis (OA) uncovered by multiple reviews remained uncertain due to broadly involving trials with different agents-combined or CURs-free interventions. Therefore, we formed stringent selection criteria and assessment methods to summarize current evidence on the efficacy and safety of CURs alone in the treatment of knee OA.

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Antiphospholipid syndrome & lupus anticoagulant-hypoprothrombinemia.

Lupus anticoagulant-hypoprothrombinemia syndrome is a rare cause of hemorrhage. In this syndrome, antiphospholipid antibodies bind to the FII epitope in its carboxy-terminal portion and form antigen-antibody complexes that are rapidly cleared by the reticuloendothelial system, conditioning hypoprothrombinemia and thus a bleeding tendency. Lupus anticoagulant-hypoprothrombinemia syndrome is associated with autoimmune diseases, mainly systemic lupus erythematosus, and less frequently with primary antiphospholipid syndrome, discoid lupus, drugs, celiac disease, and haemato-oncological diseases. Immunosuppressants, mainly steroids, are the mainstay treatment, nevertheless, there is still a concern about the right treatment for this entity since there have been described less than 200 cases around the world. We describe the case of a male patient with a history of primary antiphospholipid syndrome that comes to our hospital with a severe headache due to intracranial hemorrhage, secondary to Lupus anticoagulant-hypoprothrombinemia.

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Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery.

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

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