Rejected

The choroid plexus has been shown to play a crucial role in CNS inflammation. Previous studies found larger choroid plexus in multiple sclerosis (MS) compared with healthy controls. However, it is not clear whether the choroid plexus is similarly involved in MS and in neuromyelitis optica spectrum disorder (NMOSD). Thus, the aim of this study was to compare the choroid plexus volume in MS and NMOSD.

Laparoscopic pectopexy is an alternative to sacrocolpopexy utilizing fixation points in the anterior pelvis for vaginal vault suspension; it was originally developed for an obese population. This is a retrospective case series of 7 women who underwent laparoscopic pectopexy at one academic Institution between October 2019 and December 2020. The patients had preoperative vaginal vault prolapse (pelvic organ prolapse quantification system [POP-Q], stage 2 and 3). Pectopexy was performed because of relative contraindications to sacrocolpopexy, including use of antiplatelet therapy, extensive adhesions, and chronic back pain with lumbo-spinal fusion. No intraoperative complications were documented in this cohort. Average blood loss was 32.9 mL. All the patients were discharged home within 24 hours. One patient experienced urinary retention that required release of the retropubic midurethral sling placed at the time of pectopexy. The most recent follow-up examination occurred at an average of 127 days after the procedure. All 7 patients had a resolution of their prolapse (POP-Q ≤1). This case series highlights the application of pectopexy for patients with extensive adhesions, use of antiplatelet therapy and lumbar or sacral spinal surgical history. The complication rates and operative results are comparable with sacrocolpopexy at intermediate-term follow-up in this small case series, indicating that pectopexy may be a promising alternative for patients with relative contraindications to sacrocolpopexy. This is the first report of the application of the technique in North America.

Mushroom poisoning occurs from consumption of the wild variants of mushroom containing varied forms of toxins. Among those toxins, amatoxin containing mushrooms are known for the significant morbidity and mortality from hepatic toxicity and delayed gastroenteritis. Although not a very common cause of poisoning, it is prevalent in the north-eastern region of India, especially during the rainy summer seasons when the wild variants are found abundantly and often confused with the edible variants.

Leptomeningeal carcinomatosis is a rare complication of metastatic systemic malignancy, with lung cancer being the most common cause. We present a case of a 75-year-old man with a past medical history of right non-small cell lung carcinoma and ischemic stroke who presented with a persistent headache and swallowing difficulties. On evaluation, the patient was initially diagnosed with a subacute infarct of the right posterior frontal lobe following magnetic resonance imaging (MRI). The patient's headache and dysphagia worsened, increasing the possibility of brain metastasis. The patient underwent cerebrospinal fluid analysis including cytology and multiple MRI studies with no obvious explanation for the symptoms. The patient eventually developed multiple cranial nerve palsies, and a diagnosis of leptomeningeal carcinomatosis was made with neuroradiology consultation for the MRI.

Introduction Despite the theoretical advantages of bleeding control, there is increased morbidity in postoperative pain, sleep disturbance, allergy, toxic shock syndrome, and mucosal injury with the nasal packing in septoplasty procedure for deviated nasal septum. Trans-septal suturing after septoplasty has been advocated as an effective alternative to conventional nasal packing. The current study aims to compare the frequency of subjective symptoms, such as postoperative nasal pain, nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora between the trans-septal suturing technique and nasal packing in septoplasty surgery. Methods We prospectively recruited all adult septoplasty patients for a one-year duration. Trans-septal nasal suturing was done for hemostasis after septoplasty in the case group. Anterior nasal packing after septoplasty was performed in the control group. The postoperative subjective symptoms were evaluated, such as postoperative nasal pain, nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora. Procedure-related complications were compared between the two groups. Results A total of 50 patients were recruited for the study (25 in each group). The postoperative symptoms evaluation suggested that the number of patients with postoperative pain was significantly higher in the control group on both occasions. Besides pain, a significantly higher number of patients in the control group had symptoms of nasal bleeding, postnasal drip, sleep disturbance, dysphagia, headache, and epiphora. Conclusion Trans-septal suture technique is an effective alternative to nasal packing with a low risk of nasal pain, bleeding, postnasal drip, epiphora, headache, dysphagia, and sleep disturbance. In addition, there is a low risk of complications like nasal bleeding, septal hematoma, septal perforation, and synechiae formation. The only disadvantage of trans-septal suturing compared to PVA-coated nasal packing is the increase in the operative time.

Percutaneous nephrolithotomy (PCNL) is the first-line and guideline-recommended treatment for large renal calculi. Multimodal analgesia (MMA) comprising a combination of different analgesics is an increasingly popular method for pain control as it has been shown to reduce postoperative pain and reduce opioid use and the risk of opioid misuse, with a shorter recovery time in various procedures and patient populations.

A continuous interscalene brachial plexus block (CIBPB) is usually administered before surgery in awake patients. However, the use of CIBPB before surgery could hinder the identification of nerve injuries after total shoulder arthroplasty (TSA). This study aimed to compare the analgesic effects of preoperatively and postoperatively initiated CIBPBs in patients undergoing TSA. The medical records of patients who underwent TSA between January 2016 and August 2020 were retrospectively reviewed. The following analgesic phases were used: intravenous (IV) patient-controlled analgesia (PCA) phase (IV PCA group, = 40), preoperative block phase (PreBlock group, = 44), and postoperative block phase (PostBlock group, = 33). The postoperative initiation of CIBPB after a neurologic exam provided better analgesia than IV PCA and had no differences with the preoperative initiation of CIBPB, except for the worst pain at the postanesthetic care unit. Opioid consumption was significantly greater in the IV PCA group, but there were no differences between the PreBlock and PostBlock groups on operation day after the transfer to the general ward. The initiation of CIBPB after a patient's emergence from general anesthesia had comparable analgesic efficacy with preoperative CIBPB but offered the chance of a postoperative neurologic exam.

This study aimed to investigate the effect of chronic traction apophysitis of the medial epicondyle (MEC) on medial ulnar collateral ligament (MUCL) insufficiency in high school baseball players.

Pulmonary functions are controlled by afferent nerves which convey peripheral information to the central nervous system. Cell bodies of these afferent nerves are found predominantly in the vagal ganglia (VG) with some in the dorsal root ganglia (DRG). These neurons are highly heterogeneous based on their developmental origins, anatomical sources, and physiochemical properties. Vagal ganglia are composed of nodose (placode origin), and jugular ganglia (neural crest origin). Most vagal afferent nerves innervating the lung are unmyelinated C-fibers which are activated by capsaicin, the selective agonist of transient receptor potential vanilloid 1 (TRPV1). TRPV1 detects noxious stimuli and its activation results in defensive reflexes. Both nodose and jugular ganglia have TRPV1+ nociceptive C-fiber but it is not currently known where they terminate within the lung. In addition, there is lack of information regarding pulmonary afferent nerves projecting from the DRG, which also are derived from the neural crest. Here, we used cell-type specific Cre knock-in strains in combination with injections with adeno-associated viral vectors (AAV) carrying a Cre-sensitive reporter allele to label specific subsets of vagal and DRG afferent nerves in lung. Pirt-cre (marker for all sensory neurons), TRPV1-cre (nociceptors) and Tac1-cre (jugular, DRG) strains received unilateral injections of AAV9-flex-EGFP into nodose ganglia, and/or AAV9-flex-tdTomato into thoracic DRG (between T1-T3). VG, DRG and lung were collected 4 weeks post-injection and cryosectioned. Native fluorescent signals were amplified using anti-DsRed and anti-GFP immunoreactivity, and images were taken using an Andor Dragonfly spinning disk confocal microscope. Viral transfection was confirmed by expression of GFP in VG or tdTomato in DRG. Lung images were analyzed for VG/DRG nerve innervations based on diameters of airways (small: ≤175 µm, medium: 175-376 µm, large: ≥376 µm). >95% of the conducting airways was innervated by vagal Pirt+ afferent nerves. About half of the conducting airways also had vagal Pirt+ fibers which projected out into the alveolar regions (mean distance 200±50 µm). Only 20% of the airways were innervated by Pirt+ DRG fibers, none of which projected into the alveolar regions. Vagal-Pirt(+) nerves innervate most of the airways regardless of size, but DRG-Pirt(+) nerves innervate mostly large diameter airways. ~75% of airways are innervated by vagal TRPV1+ afferents, some of which project into the alveolar regions. There is virtually no TRPV1+ innervation of the lung projected from the DRG. ~75% of large/medium sized airways were innervated by vagal originating nerves in Tac1-cre, but none of these fibers projected into the alveolar spaces. Some large diameter airways were also innervated by Tac1+ fibers from DRG neurons. Together, our approach with the unilateral intraganglionic injections of AAV, into the VG and DRG, carrying a cre-dependent reporter allele allows identification of specific subsets of afferent nerves in the VG and DRG innervating the lung.