Rejected

The purpose of this randomized controlled trial was to determine if enhanced recovery after surgery (ERAS) would improve outcomes for three-stage minimally invasive esophagectomy (MIE).

Somatosensory neurons have evolved to detect noxious stimuli and activate defensive reflexes. By sharing means of communication, nociceptor neurons also tune host defenses by controlling the activity of the immune system. The communication between these systems is mostly adaptive, helping to protect homeostasis, it can also lead to, or promote, the onset of chronic diseases. Both systems co-evolved to allow for such local interaction, as found in primary and secondary lymphoid tissues and mucosa. Recent studies have demonstrated that nociceptors directly detect and respond to foreign antigens, immune cell-derived cytokines, and microbes. Nociceptor activation not only results in pain hypersensitivity and itching, but lowers the nociceptor firing threshold, leading to the local release of neuropeptides. The peptides that are produced by, and released from, the peripheral terminals of nociceptors can block the chemotaxis and polarization of lymphocytes, controlling the localization, duration, and type of inflammation. Recent evidence shows that sensory neurons interact with innate immune cells via cell-cell contact, for example, engaging group 2D (NKG2D) receptors on natural killer (NK) cells. Given that NK cells express the cognate receptors for various nociceptor-produced mediators, it is conceivable that nociceptors use neuropeptides to control the activity of NK cells. Here, we devise a co-culture method to study nociceptor neuron-NK cell interactions in a dish. Using this approach, we found that lumbar nociceptor neurons decrease NK cell cytokine expression. Overall, such a reductionist method could be useful to study how tumor-innervating neurons control the anticancer function of NK cells and how NK cells control the elimination of injured neurons.

Masquelet and Ilizarov techniques have their advantages and shortcomings in the reconstruction of bone defects. The aim of this study was to evaluate the effectiveness of the combination of both techniques for the management of infected tibial nonunion to combine the advantages of both techniques with avoidance of shortcomings of both of them.

We retrospectively studied the diagnosis and treatment of a case of AAD misdiagnosed as stroke since atypical symptoms as the first manifestation, and discussed the clinical features and manifestations, diagnosis, and differential diagnosis of the case in the context of relevant domestic and international literature. The patient, a 49‑year-old male with herpes zoster for more than 1 month, presented with sudden onset of right-sided chest and back pain, accompanied by numbness and weakness of the left limb, and was tentatively diagnosed with post-herpetic neuralgia combined with stroke due to the history of herpes zoster. Non-specific ST-T alterations, D-dimer 20ug / ml, and non-traumatic angiographic findings in the transthoracic and abdominal aorta demonstrated slight thickening of the patient's ascending aorta, and the lumen of the root sinus region showed intimal flap formation with a larger pseudocoel and smaller true lumen, which ultimately confirmed the diagnosis of acute aortic coarctation with atypical presentation. So clinicians need to improve their basic theoretical knowledge, strengthen the understanding of AAD, focus on physical examination, improve relevant auxiliary examinations expeditiously, and pay attention to the significance of specific auxiliary examinations in order to decrease misdiagnosis and missed diagnosis of atypical manifestations of AAD patients.

Functional somatic symptoms (FSS), or medically unexplained physical symptoms, are common in children and it has been suggested that the incidence is increasing. To determine the incidence and pattern of referrals for FSS to pediatricians, we performed a retrospective analysis including newly referred pediatric patients to our secondary pediatric practice in Zwolle, The Netherlands, ultimately diagnosed with FSS between 2013 and 2018. FSS was defined as functional abdominal pain, chronic fatigue, chronic musculoskeletal pain and chronic headache without an underlying medical diagnosis. In the 6-year period, 10.4% of elective referrals were related to FSS without a significant upward trend. We found clear seasonal variation with peaks in incidences in March (+31%) and November (+21%) and a nadir around August (-48%). In conclusion, FSS account for 1 in 10 non-acute pediatric referrals, without an increase in incidence in the past 6 years. The seasonal pattern is remarkable and warrants further analysis.

We present the case of a 59-years-old woman with a history of abdominal pain and iron-deficiency anemia. Upper and lower gastrointestinal endoscopy turned out negative and further investigation with wireless videocapsule showed an inflammatory stricture in the middle of the small bowel with retention of the videocapsule. Treatment with budesonide was initiated and allowed the spontaneous evacuation of the videocapsule. Retrograde motorized spiral enteroscopy was performed and confirmed an ulcerative stricture 60 cm proximal to the ileocaecal valve. Clinical, iconographic, endoscopic and histological results were compatible with a rare entity described as cryptogenic multifocal ulcerative stenosing enteritis (CMUSE). After the diagnosis budesonide was replaced by azathioprine 100 mg/d as an immunosuppressor. However, azathioprine induced mild pancreatitis and a second course of.

C

Small-bowel capsule endoscopy (SBCE) is a safe and efficient method for diagnosis of small-bowel diseases. Since its development, different models have appeared. The aim of this study was to analyze which of the different models of SBCE has the best diagnostic yield.

Information regarding prehospital ketamine use in the pediatric population is limited as existing literature focuses primarily on critical care and air transport. Our objective was to describe patient characteristics among pediatric EMS patients who received ketamine. Secondarily, we assessed effectiveness, deviation from recommended dosing, and adverse outcomes of pediatric EMS patients who received ketamine. We conducted a retrospective data review of records from the ESO Data Collaborative for all 9-1-1 transports of pediatric patients (≤ 18 years of age) who received ketamine from 2019-2020. We categorized EMS primary impressions as a proxy for medication indication. We defined effectiveness as paramedic-identified clinical improvement, and pain relief as decrease in pain score ≥2 points between initial and final recording. Descriptive statistics were used to summarize clinical characteristics. Non-parametric Wilcoxon signed-rank test was used to assess change in pain score. Out of 422,968 ground-ambulance pediatric patients, 1,291 received ketamine. They were predominately male (842, 65.2%), teenagers (median age 16, IQR: 13-17), Caucasian (810, 62.7%), and from urban areas (1,041, 80.6%). The most common EMS impressions were related to injuries (810, 62.7%) and behavior disorders (281, 21.8%). Only 980/1,291 (75.9%) had weights and identifiable routes recorded. Most patients (960, 74.4%) received single doses of ketamine, with EMS clinicians reporting improvement in 855 (89.1%) of 960 patients. Among non-behavioral emergency patients, 727/1,010 (72.0%) had pain scores recorded. Pain scores decreased significantly from a median of 8 (IQR: 4-10) to 2 (IQR: 0-6) (p < 0.001) with 59% (429) of 727 patients reporting pain score reductions of 2 or more points. Desaturation (<90% SpO) events were noted to be minimal (1.8%). A small number (28, 2.2%) received positive pressure ventilation without advanced airway placement. No prehospital deaths were documented. In this large review of pediatric prehospital ketamine use, ketamine was primarily used for analgesia, but was frequently used for other indications. Most patients were observed to improve after ketamine use, with most injured patients reporting decreases in pain scores. We observed few significant adverse events related to ketamine use in this population.

Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory disease of the pilosebaceous unit leading to formation of painful, inflammatory nodules, abscesses and tunnels in apocrine gland-bearing areas of the skin. Pain and drainage are the most important symptoms associated with reduction of quality of life in HS. On the other hand, an overlooked symptom in quality of life studies is itch, despite the fact that several studies have reported its importance. Various theories have tried to explain the pathogenesis of itch in HS, such as the presence of mast cells in the cell infiltrates and elevated Ig E levels in the lesional skin. Smoking and advanced stage of disease have been found to be associated with increased intensity of itch. A PUBMED search was conducted to perform a systematic literature review using the term "hidradenitis suppurativa" [all fields], the keywords "pruritus", "itching", "itch" [all fields] and with "AND" as operator. Mast cells and mTor signaling were found to be raised in both lesional and perilesional skin. Itch as a presenting symptom has been found in 35-82.6% of patients across multiple studies. It often co-presents with pain and may be misinterpreted as burning, stinging, tickling, tweaking, prickling, etc. The presence of itch is associated with reduced quality of life, depression and impairment of social life. Brodalumab, a monoclonal antibody against IL-17A receptor, produced significant improvements in itch, pain, QoL and depression in patients with moderate to severe HS. Statins have shown some reduction in itch intensity score. Further studies are required to gain a better understanding of the etiopathogenesis and optimal therapeutic modalities for itch in HS that will allow clinicians to better address issue and reduce its impact on quality of life.