Rejected

Morphological differences that can lead the trigeminal nerve to neurovascular conflict and a new solitary pontine lesion are associated with the pathogenesis of trigeminal neuralgia (TN). In this case-control study, we aimed to contribute to the current discussions about the pathogenesis of TN by investigating the anatomical structures that may have an effect on the morphometric parameters of the trigeminal nerve.

Pleural effusion is the accumulation of extra fluid between the layers of the pleura outside the lungs, also known as water on the lungs. Pleura are thin membranes that lubricate and aid breathing by lining the lungs and the inside of the chest cavity. The pleural space typically contains only a few teaspoons of watery fluid, which enables the lungs to move easily inside the chest cavity when breathing. Several barriers limited the patient's capacity to carry out daily activities successfully and efficiently. Loculated effusions are most frequently associated with diseases such as empyema, hemothorax, or tuberculosis that result in severe pleural inflammation. Hence, a physiotherapy program is started to help improve the patient's symptoms. A 59-year-old male presented to the hospital with the chief complaint of left-sided chest pain, fever, and breathlessness. On the Modified Medical Research Council dyspnea scale, breathlessness was grade 3.

Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES) is a common but under recognised cause of chronic abdominal wall Pain. This survey was carried out to understand the clinical course of the condition following interventions such as nerve blocks and surgical release of entrapped nerve.

Ischial avulsion fractures classically occur in the pediatric population and are relatively uncommon. These injuries are treated conservatively; however, in cases where there is greater than 2 cm of displacement, surgical intervention is recommended. In some cases, displaced fractures are either misdiagnosed or proper treatment is neglected, and patients who transition into adulthood are left with chronic nonunions that can become a source of pain and disability. Here we present a surgical technique for a chronic ischial avulsion fracture nonunion that is excised, and the hamstring tendons are then primarily repaired to the ischium using suture anchors.

: The aim of this study was to evaluate the impact of sagittal imbalance based on pelvic incidence-lumbar lordosis (PI-LL) mismatch on the analgesic efficacy of epidural steroid injection in geriatric patients. : Patients aged 65 years or older who received lumbar epidural steroid injections under fluoroscopy were enrolled. The cutoff of PI-LL mismatch >20° was used as an indicator of a marked sagittal imbalance. The cross-sectional area of the psoas and paraspinal muscles, as well as the paraspinal fat infiltration grade were measured. A 50% or more decrease in pain score at four weeks after injection was considered as good analgesia. Variables were compared between PI-LL ≤ 20° and >20° groups and multivariate analysis was used to identify factors related to pain relief after injection. : A total of 237 patients consisting of 150 and 87 patients in the PI-LL ≤ 20° and >20° groups, respectively, were finally analyzed. Female patients, patients with lumbar surgery history, and the smaller cross-sectional area of the psoas muscles were predominantly observed in patients with sagittal imbalance. There was no difference in analgesic outcome after injection according to the PI-LL mismatch (good analgesia 60.0 vs. 60.9%, = 0.889). Multivariate analysis showed that pre-injection opioid use, moderate to severe foraminal stenosis, and high-graded paraspinal fat infiltration were significantly associated with poor analgesia after injection. : There was no significant correlation between sagittal spinopelvic alignment and pain relief after lumbar epidural steroid injection for geriatric patients.

L. of Combretaceae family is a traditional medicine that is widely used for various gastrointestinal discomfort including stomach pain, constipation, and digestive problem. In this study, the potential repeated dose toxicity and genotoxicity of a standardized L. extract (HU033) were determined under good laboratory practice conditions. For the repeated dose toxicity test, HU033 was orally administered to Sprague-Dawley (SD) rats at doses of 500, 1000, and 2000 mg/kg/day for 13 consecutive weeks. The genotoxicity of HU033 was determined with a standard battery of genotoxicity test, including an in vitro bacterial reverse mutation test, an in vitro chromosomal aberration test, and an in vivo micronucleus test. After 13 weeks of repeated dose of HU033 by oral administration, there was no treatment related adverse clinical sign including food consumption, organ weights, and histopathological findings or significant decrement in bodyweight. The no-observed-adverse-effect level of HU033 was higher than 2000 mg/kg in both male and female SD rats. No target organs were identified. In addition, no evidence of HU033 genotoxicity was detected based on results from the bacterial reverse mutation test, chromosomal aberration test, and micronucleus test. Based on results of this study, HU033 could be safely used in food and medical products within the tested dose range.

Population and study's methodology heterogenicity became clinical evolution of chronic spontaneous urticaria (CSU) highly variable.

John Fitzgerald Kennedy (JFK), the 35th President of the USA, had chronic low back pain deemed to be centralized pain. Reportedly, attention-deficit/hyperactivity disorder (ADHD) could associate with centralized pain. Based on his biographies, JFK could have had ADHD, a plausible cause of pain that afflicted him.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection caused the pandemic of coronavirus disease 2019 (COVID-19). Gastrointestinal (GI) involvement is common among patients with COVID-19, and GI symptoms can appear earlier than respiratory symptoms. Except for direct infectious effects, patients infected with SARS-CoV-2 are at risk of complications requiring gastroenterological management. Diarrhea is the most common GI symptom in patients with COVID-19 and occurs in up to half of them. Other GI symptoms, such as anorexia, discomfort, nausea, abdominal pain, loss of taste sensation, and vomiting, have been reported. GI symptoms are associated with a poor prognosis. Fecal viral excretion may have clinical significance because of the possible fecal-oral transmission of infection. In the present narrative review article, six different aspects of studies published to date are summarized as follows: GI manifestations of COVID-19, the roles of fecal-oral transmission, poor prognosis of GI symptoms; abnormal abdominal imaging findings, COVID-19 in patients with irritable bowel disease, and prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. Timely understanding of the association between COVID-19 and the digestive system and effective preventive measures are critical to improve this disease and help clinicians take appropriate measures to mitigate further transmission.

A 21-year-old woman reported continuous moderately severe headache in the right frontotemporal region, accompanied by exacerbations with cranial autonomic symptoms and restlessness. The exacerbations appeared several times a week over one to several hours. The patient was diagnosed with hemicrania continua (HC) according to the 3rd edition of the International Classification of Headache Disorders. Because production of the oral indomethacin was discontinued in April 2020, acemetacin, a prodrug of indomethacin, was administered (90 mg/day) and gradually increased to 180 mg/day over 2 months. No recurrence of HC developed. No reports of HC treated with acemetacin have been previously reported in Japan. We suggest that randomized control trials should be performed.