Rejected

Erector spinae plane (ESP) block is an alternative to neuraxial block for post-surgical pain in nephrectomy patients. However, no clinical trial has directly compared ESP block with a control group.

Leptomeningeal carcinomatosis (LC) is a rare complication of primary malignancy that spreads to leptomeninges and cerebrospinal fluid (CSF). Due to its rarity, it is often diagnosed as a late complication of an advanced tumor. This report presents a case study of a 72-year-old nonsmoking female with multiple comorbidities with two-week rapidly progressive cognitive decline and extrapyramidal symptoms (EPS). She presented with speech difficulties, tension headaches, and episodes of inattention. On examination, she had a masked face, mild bradykinesia, mild rigidity more apparent in the limbs than axially, and slight hyperreflexia in the lower limbs with a normal plantar reflex (down-going). Magnetic resonance imaging (MRI) of the brain with gadolinium showed diffuse leptomeningeal dissemination. CT of the right lower lobe showed lobe apical segment mass lesion with air bronchogram extension to the hilum, which raised the suspicion that the patient had lung cancer. The microscopic analysis of cerebrospinal fluid (CSF) cytology showed poorly differentiated malignant cells favoring adenocarcinoma. Based on these investigations, leptomeningeal dissemination on the MRI led to a wide differential diagnosis; however, given the findings in the CT scan and CSF, the patient was diagnosed with leptomeningeal carcinomatosis secondary to metastatic lung cancer. Although LC is a rare terminal complication that presents with a wide range of symptoms, typically including headache, altered mental status, diplopia, back pain, cerebral signs, and leg weakness, our patient presented with an uncommon presentation, which was EPS. Therefore, this case report highlights the importance of early detection of LC in any patient presenting with unspecific neurological manifestations.

Aerial parts of Brocchia cinerea (Vis.) (Asteraceae family) are traditionally used for the treatment of pain, fever and inflammation. The present study aimed to investigate the phenolic profile, the acute oral toxicity, and anti-inflammatory, analgesic and antipyretic activities of the aqueous extracts from fresh (FBC) and dry (DBC) aerial parts of Brocchia cinerea (Vis.). Phenolic profile from FBC and DBC was characterized by HPLC-PDA/ESI-MS. The anti-inflammatory, analgesic and antipyretic of both FBC and DBC were evaluated by carrageenan induced paw edema, acetic acid induced writhing and brewer's yeast-induced pyrexia in Wistar rats, respectively. The results achieved showed that thirteen phenolic compounds were detected in the aqueous extracts obtained from the aerial parts of FBC and DBC, highlighting a quite different quantitative profile. The FBC and DBC administrated orally at a dose of 400 mg/kg significantly reduced edema, after 2 h of the injection of carrageenan (p < 0.001) with a percentage inhibition of 47.73% and 50.01% respectively. On the other hand the rats treated with DBC at the same dose significantly lowered the writhing induced by the injection of acetic acid (18.52 ± 0.38) with respect to the ones treated with FBC (20.47 ± 0.92). Moreover, a significant reduction in rectal temperature was observed in rats treated with FBC/DBC and at doses of 200 and 400 mg/kg. Furthermore, no acute toxicity symptoms were observed on oral administration of all doses of both FBC and DBC in Wistar rats. The results of the present study indicate that the aerial part of Brocchia cinerea extracts exhibit strongly anti-inflammatory, analgesic, and antipyretic properties and they can be potentially used in the treatment of inflammation, pain and fever.

The aim of this case report is to present a rare case of acute slipped femoral capital on a chronic slipped capital femoral epiphysis (SCFE) after spinal fusion due to idiopathic scoliosis. A 14 year old male patient underwent posterior spinal fusion due to idiopathic thoracic scoliosis. Post-operatively, the patient presented with acute pain in the left hip and a reduced range of motion, which revealed acute SCFE. The patient was then referred to the Second Orthopaedic Department of Agia Sofia Children Hospital in Athens, and underwent percutaneous pinning of the left femur, after which he was discharged uneventfully. The follow up was excellent with no impact on the patient's daily life. The case described is extremely rare in the current literature. The significance of the pre-operative planning is underlined by this case, as well as the need for the spinal surgeon to be aware of the possibility of acute pain in the hip in young adolescents, as SCFE is more common amongst this demographic.

Extraintestinal manifestations in irritable bowel disease (IBD), Crohn's disease and ulcerative colitis are reported in different system of the body. We aimed to investigate the factors determining disease severity and evaluate extraintestinal manifestations in patients with irritable bowel disease based on disease activity scoring system.

The Affordable Care Act has been associated with increased Medicaid coverage for childbirth among low-income US women. We hypothesized that Medicaid expansion was associated with increased use of labor neuraxial analgesia.

The giant aneurysm of the subclinoid portion of the internal carotid artery is a relatively rare disease that can present serious complications. We present the case of a 40-year-old guy who was suffering from a headache and had complete ophthalmoplegia in his right eye. A brain scan shows a right temporal subdural hematoma, associated with subarachnoid hemorrhage, and total Sylvian subacute ischemic stroke. CT angiography and MRI showed a ruptured and partially thrombosed aneurysm of the subclinoid portion of the right internal carotid artery complicated by subarachnoid hemorrhage, a right subdural temporal hematoma, and total Sylvian ischemic stroke. Our purpose is to recognize the possibility of an aneurysmal rupture when evaluating an acute subdural hematoma, alone or in combination with Ischemic stroke.

To investigate the effects of intrathecal injection of IRF8 SiRNA on the pain threshold and activation of spinal cord microglia in rats with postoperative persistent pain. One hundred and twenty male Sprague-Dawley rats were randomly divided into sham group (SH, =12), SMIR group (SM, =48), SMIR + DEPC group (SD, =12) and SMIR + SiRNA group (SS, =48). In the SM group, the persistent postsurgical pain(PPsP) model was established according to the skin/muscle incision and retraction (SMIR), and the SH group was only incised without retracted. The SD group and SS group received intrathecal catheterization one week before SMIR, the SS group was injected with 20 μl of IRF8 SiRNA solution (dissolved in DEPC-treated water, 150 pmol) intrathecally on the 5 and 6 day after SMIR, and the SD group was injected with the same amount of DEPC-treated water. The paw withdrawal threshold (PWT) of each group was measured and recorded before SMIR and on the 1, 3, 7, 12, 22 and 33 days after SMIR. Western blot was used to detect the expression of Iba-1 in the dorsal horn of spinal cord on the 12 days after SMIR, and the saphenous nerves in the SH group and SM group were collected to observe their ultrastructural changes under electron microscope. The flow cytometry was used to detect the activation of microglia in spinal cord dorsal horn before SMIR and on the 1 3, 7, 12, 22 and 33 days after SMIR in the SM group and SS group. Compared with D0, the PWT of SM group was decreased on the 1 to 22 day after SMIR (＜0.05 or ＜0.01), and returned to normal level on the 33 day after SMIR (＞ 0.05). Compared with the SH group, the PWT of the SM group was decreased on the 1 to 22 day after SMIR (＜0.05 or ＜ 0.01). However, compared with the SD group, the PWT of the SS group was increased on the 7 to 22 day after SMIR (＜0.05 or ＜0.01). Compared with SH group, the PWT of SS group was decreased on the 7 to 22 day after SMIR (＜0.05 or ＜0.01). The average thickness of saphenous nerve myelin was (377.0 3±69.60) nm in the SH group and (369.50±73.26) nm in the SM group, and there was no significant difference between the two groups (＞0.05). Compared with the SH group, the expression level of Iba-1 was increased significantly (＜0.01) in the SM group. Compared with the SD group, the expression of Iba-1 was inhibited (＜0.05) in the SS group, and compared with the SH group, the expression of Iba-1 was also statistically different (＜0.05) in the SS group, while the expression of Iba-1 was not statistically significant between the SM group and the SD group (＞0.05). Compared with D0, the activation ratio of microglia was increased significantly on the 3 to 22 day after SMIR (＜0.01) in the SM group , while the activation of microglia reached a peak on 3rd day after SMIR (＜0.01) in the SS group. After intrathecal administration, the activation rate of microglia in the spinal dorsal horn of the SS group was decreased significantly, and compared with the SM group, it was decreased significantly on the 7 to 12 day after SMIR (＜0.01). The significant and persistent mechanical hyperalgesia in PPsP induced by SMIR was caused non-obvious peripheral nerve injury, which may be mediated by the activation of microglia in the dorsal horn of the spinal cord. IRF8 SiRNA administrated by intrathecal injection could inhibit the activation of microglia and reverse SMIR-induced hyperalgesia.

The purpose of this case study is to describe chiropractic care of the cervical spine for a patient who previously underwent cervical total disk replacement (CTDR) of the C5-6 and C6-7 disks.