Rejected

 Minimal alveolar concentration (MAC) of anesthetic agents has been considered a suitable measure of the potency of inhalational anesthetics. Furthermore, it is assumed that equi-MAC concentrations of different anesthetic agents have a similar potency in suppressing responses to painful stimuli. Isoflurane and sevoflurane are two commonly used volatile anesthetic agents in spine surgeries. Therefore, these agents' hypnotic and analgesic potencies should be distinguished and comprehended for the optimal administration of anesthesia. Consequently, we undertook this study to compare the analgesic and hypnotic potencies between these agents at equi-MAC concentrations, using the entropy monitor.  Forty patients undergoing lumbar spine surgery were randomly assigned to two groups receiving either isoflurane (  = 20) or sevoflurane (  = 20). After induction, maintenance of anesthesia was done with age-corrected 1.0 MAC of either isoflurane or sevoflurane. A standardized noxious stimulus was provided to all the patients after achieving a steady state of 1.0 MAC. The state entropy (SE), response entropy (RE), and RE-SE were recorded at baseline, prestimulus, and poststimulus time points in both groups.  Data are presented as frequency and percentages for categorical variables and mean ± standard deviation for continuous variables. The comparison of categorical variables between the two groups was made using the Fisher's exact test, and the Student's -test was used for continuous variables. A -value of < 0.05 was considered to be statistically significant.  At age-corrected 1.0 MAC, there was no significant difference in the SE, RE, and RE-SE in both the groups at any time point.  Our study shows that during a steady state of age-corrected 1.0 MAC single-agent anesthesia, sevoflurane and isoflurane have comparable analgesic and hypnotic potencies as measured by entropy indices when a standardized nociceptive stimulus is provided.

Chronic pruritus (duration ≥ 6 weeks) affects about 91% of patients suffering from atopic dermatitis (AD). Pruritus is often accompanied by sensations such as pain, burning, stinging, and heat, resulting in a high burden of affected patients; sleep and quality of life may be severely impaired. An important pillar of AD treatment is also to achieve sufficient control of pruritus. In addition to intensively used emollients, corticosteroids and calcineurin inhibitors have proven effective. In case of eczema affecting a large part of the body surface area (BSA), phototherapy may contribute to the healing of eczema and the relief of atopic pruritus. As to systemic therapies, several approved biologics (dupilumab, tralokinumab) and small molecules (baricitinib, upadacitinib, abrocitinib) lead to a rapid improvement of pruritus by interfering with the signal transduction of proinflammatory cytokines. While Janus kinase inhibitors initially lead to a faster relief of pruritus than biologics, the antipruritic efficacy of biologics and Janus kinase inhibitors seems to be similar in long-term use.

Cerebral venous sinus thrombosis (CVST) typically presents as headache, papilledema, and seizures. A dural arteriovenous fistula (DAVF) is a rare intracranial vascular malformation, and common symptoms include headache, pulsatile tinnitus, and stroke. The occurrence of CVST as a complication of DAVF is infrequent. Moreover, optic neuropathy presenting as the initial symptom of CVST and secondary DAVF is also unusual. We present a case of a patient with optic neuropathy and persistent intracranial hypertension who underwent head magnetic resonance imaging, which indicated CVST. She received normative anticoagulant and dehydration therapy; however, a repeated lumbar puncture showed dramatically increased intracranial pressure. Further digital subtraction angiography revealed an intracranial DAVF. The patient was finally diagnosed with a DAVF and secondary CVST. This case indicates that intractable optic neuropathy could be an uncommon indicator for CVST and secondary DAVF. Early diagnosis and early treatment are essential for visual rehabilitation and prognosis improvement.

A group of patients with coronavirus disease 2019 (COVID-19) exhibited various persistent or new systemic symptoms, including psychiatric symptoms, sleep disturbances, exercise intolerance, arthralgia, headache, cognitive decline, brain fog, and autonomic symptoms, all of which persisted long after the resolution of infectious symptoms. Several imaging studies have shown that long COVID cases present with decreased glucose metabolism and progressive brain atrophy. Although no single pathological hypothesis thoroughly explains the varied clinical presentations and timings, the following have attracted attention: 1) persistent viral infection, 2) persistent inflammation, 3) involvement of the autoimmune system, and 4) mitochondrial dysfunction. In all these hypotheses, inflammatory cytokines may be involved in orthostatic dysregulation by decreasing the expression and activity of ACE2, consequently changing the blood pressure through vagus nerve hyperactivation. Myopathy and peripheral neuropathy may also be caused by direct infection of the muscles and nerves, hypoxia, mitochondrial damage, and cytokine storm. Furthermore, multiple theories regarding the mechanisms by which systemic inflammatory findings affect the central nervous system have been postulated, including neuroinflammation caused by inflammatory cells crossing the blood-brain barrier via choroid plexus cells and the involvement of various autoantibodies. Despite these findings, no definitive consensus has been reached due to the complexity and diversity of COVID-19 pathophysiology. Thus, it is essential to understand the neurological symptoms and pathophysiology involved in long COVID.

Osteochondral fractures (OCFs) are common injuries during acute patellar dislocation (APD), carrying a high risk of early joint deterioration if left untreated. The recommended approach is reduction and stable fixation; however, data on the results of such treatment are limited.

The gluteus medius originates on the posterior face of the ilium between the posterior and anterior gluteal lines and inserts into the lateral and superoposterior facets of the greater trochanter. Because of the asymmetric nature of the muscle, tears are more likely to occur on the thinner anterolateral portion of the tendon footprint. Gluteus medius tears range from interstitial, partial thickness tears to retracted, full-thickness tears and may result from trauma, but they are more commonly the result of chronic degeneration. Patients commonly present with lateral hip pain aggravated by weight bearing and sleeping on the affected side, weakness in abduction, and the Trendelenburg sign observable on physical examination. Indications for surgery include failed conservative treatment and an ultrasound or magnetic resonance imaging study demonstrating a torn tendon. Surgical intervention aims to reapproximate and secure the torn tendon to the tendon footprint on the greater trochanter via suture anchors. Both open and endoscopic techniques have shown to be effective methods for treating gluteus medius tears at short- and long-term follow-up; however, endoscopic techniques have been shown to result in fewer postoperative complications, such as retear. A recent systematic review and meta-analysis found patients with more severe fatty infiltration (FI) may experience greater improvement after open repair, whereas patients with less severe FI may benefit more from endoscopic treatment. A double-row repair maximizes contact area between tendon and bone and has shown to be superior to single-row repair with an endoscopic technique.

 Langerhans cell histiocytosis is a rare inflammatory bone marrow neoplasia that frequently affects bone, lung, skin and pituitary gland. Due to its broad spectrum of clinical presentation, an appropriate diagnosis might be difficult.

Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy.

Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset.

Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in adults and in children, varying from mild to more debilitant symptoms, including fatigue, headache and dizziness. A series of studies have revealed a possible association between Guillain-Barré syndrome (GBS), the most common cause of acute flaccid paralysis at all ages, and SARS-CoV-2 infection. Case reports of novel coronavirus disease 2019 (COVID-19)-associated GBS mainly include adult patients, while only a few pediatric cases have been reported. The present study describes a case of GBS in an Italian 9-year-old girl with previous SARS-CoV-2 infection as a possible trigger, and also conducts a literature review on pediatric COVID-19-associated GBS cases.