Treatment Advances in Tumor-Induced Osteomalacia.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by hypersecretion of fibroblast growth factor 23 (FGF23) by typically benign phosphaturic mesenchymal tumors (PMTs). FGF23 excess causes chronic hypophosphatemia through renal phosphate losses and decreased production of 1,25-dihydroxy-vitamin-D. TIO presents with symptoms of chronic hypophosphatemia including fatigue, bone pain, weakness, and fractures.

Surgical frequency analysis of patients clustered according to postoperative pain trajectory: a retrospective study.

Oropharyngeal and orthognathic surgeries cause more postoperative pain than simple dental procedures. The lack of detailed pain pattern analysis after dental surgeries makes pain management challenging. We assessed postoperative pain patterns in patients undergoing various dental surgeries, categorized based on changing pain levels, and identified the most frequent surgical procedures within each pain pattern cluster.

Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study.

Background: Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes.

Methods: HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results.

Economic impact of prolonged tracheal extubation times on operating room time overall and for subgroups of surgeons: a historical cohort study.

Background: Prolonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit.

Norepinephrine titration in patients with sepsis-induced encephalopathy: cerebral pulsatility index compared to mean arterial pressure guided protocol: randomized controlled trial.

Background: Although surviving sepsis campaign (SSC) guidelines are the standard for sepsis and septic shock management, outcomes are still unfavourable. Given that perfusion pressure in sepsis is heterogeneous among patients and within the same patient; we evaluated the impact of individualized hemodynamic management via the transcranial Doppler (TCD) pulsatility index (PI) on mortality and outcomes among sepsis-induced encephalopathy (SIE) patients.

Methods: In this prospective, single-center randomized controlled study, 112 patients with SIE were randomly assigned.

Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis.

Objectives: This study sought to assess the effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA).

Methods: We conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, ClinicalTrials.gov databases and the references from relevant literature published prior to May 2023.

Congestive myelopathy secondary to epidural venous engorgement and venous congestion in a patient with Budd-Chiari syndrome and its management through inferior vena cava stenting.

Budd-Chiari syndrome with obstruction in the inferior vena cava causes increased venous pressure in the azygous-hemiazygous system and paravertebral venous plexus, which is transmitted to the epidural venous plexus, devoid of the valves. It causes epidural venous plexus engorgement and venous congestion and may present rarely with low back pain or radiating pain. However, patients developing lower limb weakness as a complication of Budd-Chiari syndrome is an infrequent and severe presentation.

Case Report: Type Ib Abernethy malformation.

Congenital extrahepatic portosystemic shunt, also known as Abernethy malformation, is a rare anatomic vascular malformation. Patients with Abernethy malformation may present with abdominal pain, abnormal liver function tests, hepatopulmonary syndrome, pulmonary hypertension, and/or portosystemic encephalopathy. Accurate identification of the shunt and portal vein and effective management of complications is vital in these patients.

Acceptability and safety of 3D printed wrist-based orthoses compared to fiberglass casts for the treatment of non-surgical distal radius- and scaphoid fractures: A randomized feasibility trial.

Background: Non-invasiveness and comfort are crucial in the conservative management of distal radius and scaphoid fractures. While fiberglass casts are standard, three-dimensional (3D)-printed orthoses offer a promising alternative.

Purpose: To compare patient experiences, safety perceptions, and satisfaction between a 3D orthosis and fiberglass cast for distal radius or scaphoid fractures.

Osteoarthritis.

Osteoarthritis is a heterogeneous disorder that is increasingly prevalent largely due to aging and obesity, resulting in a major disease burden worldwide. Knowledge about the underlying aetiology has improved, with increased understanding of the role of genetic factors, the microbiome, and existence of different pain mechanisms. However, this knowledge has not yet been translated into new treatment options.

A cross-tissue transcriptome-wide association study identifies new key genes in ischemic stroke.

Background: Ischemic stroke (IS) is an important disease causing death and disability worldwide, and further investigation of IS-related genes through genome-wide association study (GWAS) data is valuable.

Methods: The study included GWAS data from 62,100 IS patients of European origin and 1,234,808 controls in a cross-tissue transcriptome association study (TWAS). A joint analysis was first performed by the Unified Test for Molecular Markers (UTMOST) and FUSION methods.

The effect of fixed-time interval and on-demand analgesia protocols for post cesarean pain on maternal chronic pain and child development - follow up of randomized controlled trial.

Objective: Post-cesarean delivery (CD) acute pain may progress to chronic pain, which may impair maternal bonding and child development. In 2013, we compared the efficacy of versus on-demand oral analgesia for post-caesarean pain in a randomized-controlled-trial. The fixed-time-interval group had received scheduled paracetamol, tramadol, and diclofenac regardless of pain level, and the on-demand group received medication as needed, with oxycodone reserved for unrelieved pain in both groups.

Efficacy and Safety of SHR8554 on Postoperative Pain in Subjects with Moderate to Severe Acute Pain Following Orthopedic Surgery: A Multicenter, Randomized, Double-blind, Dose-explored, Active-controlled, Phase II/III Clinical Trial.

Biased µ-opioid receptor (MOR) agonists enhance pain relief by selectively activating G protein-coupled receptor signaling and minimizing β-arrestin-2 activation, resulting in fewer side effects. This multicenter Phase II/III trial evaluated the optimal dosage, efficacy, and safety of SHR8554, a biased MOR agonist, for postoperative pain management following orthopedic surgery. In Phase II, 121 patients were divided into four groups to receive varying patient-controlled analgesia (PCA) doses of SHR8554 or morphine.

Patients with severe mental illness in the general emergency department: Clinical characteristics, quality of care and challenges.

Background: Morbidity and mortality rates are notably higher among individuals with severe mental illnesses (SMI). People with SMI often have lower access to healthcare services, and the medical care they receive is known to be suboptimal. Consequently, treatment in an acute care setting rather than a community setting is more common.

The Bioefficacy Protocol: Biomarkers identification of TNF inhibitors efficacy in Axial Spondyloarthritis patients using transcriptome and proteome analysis.

Background: Axial Spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition affecting the axial skeleton, leading to pain, stiffness, and fatigue. While biologic therapies have improved clinical management, many patients experience partial or no responses, resulting in delays in disease control. Additionally, the risk of adverse events and increased costs remains a concern.

Efficacy of Transcutaneous Electrical Nerve Stimulation in Management of Cancer Pain: a Meta Analysis.

Purpose Of Review: The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile.

Wake up!: a novel, cadaver-based approach to training emergency physicians in awake intubation.

Despite awake tracheal intubation being considered the safest method of intubation for patients with predicted difficult airways, there is limited evidence and poor availability of training interventions to assist emergency medicine physicians achieve competency in this technique. Here, we describe a novel, cadaver-based course for emergency medicine physicians to acquire skills in awake tracheal intubation. A convenience sample of 15 emergency medicine physicians from across Canada participated in the pilot course.

Efficacy of Immunotherapy for Complex Regional Pain Syndrome: A Narrative Review.

Purpose Of Review: Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportional pain typically affecting an extremity. Management of CRPS is centered around specific symptomatology, which tends to be a combination of autonomic dysfunction, nociceptive sensitization, chronic inflammation, and/or motor dysfunction. Targeting the autoimmune component of CRPS provides a way to both symptomatically treat as well as minimize progression of CRPS.

The Emerging Role of Multimodality Imaging in the Diagnosis and Management of Post Pericardiotomy Syndrome.

Purpose Of Review: This review aims to evaluate current diagnostic and therapeutic strategies for postpericardiotomy syndrome (PPS), with a focus on the evolving role of multimodality imaging, including echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance imaging (CMR). The review also explores the potential benefits of advanced imaging in improving the accuracy and management of PPS.

Recent Findings: PPS, a common complication following cardiac surgery, presents with pleuritic chest pain, fever, and pericardial or pleural effusion.

Efficacy, Indications, and Safety of Intrathecal Baclofen Pump: A Narrative Review.

Purpose Of Review: Baclofen, a muscle relaxant that reduces the release of excitatory neurotransmitters in the pre-synaptic neurons stimulating inhibitory neuronal signals in post-synaptic neurons, has been around for over 5 decades. Baclofen is used primarily for spasticity and since 1982, has had a role as an intrathecal agent. In the present investigation, we review research trends and updates on safety and efficacy of intrathecal baclofen (ITB) pumps.

Efficacy of Transversus Thoracic Plane Block for Pain Management in Cardiac Surgeries.

Purpose Of Review: Effective pain management in cardiac surgery presents as a continuous challenge related to the intensity of postoperative pain and reliance on opioid therapy. The dependance of opioid-based therapies is concerning, as these therapies carry risk future addiction and potential severe side effects. The transversus thoracic plane block (TTPB) has emerged as a promising regional anesthesia technique that blocks the anterior branches of the intercostal nerves in the chest wall, potentially providing improved analgesia for cardiac surgery patients.

Rhomboid Intercostal and Subserratus Plane Block for Acute Pain Management after Abdominal Surgeries: A Narrative Review.

Purpose Of Review: The rhomboid intercostal and subserratus plane (RISS) block is an effective, safer alternative for managing postoperative acute pain following abdominal surgeries. The RISS block offers several advantages over traditional approaches, including reduced incidence of puncture-related complications, lower rates of systemic opioid consumption, and more consistent analgesic coverage of lower thoracic dermatomes.

Recent Findings: Despite a favorable safety profile, the RISS block carries potential risks, such as pneumothorax and local anesthetic systemic toxicity, particularly when long-acting anesthetics such as bupivacaine or ropivacaine are used.

Ethical Use of Cadaveric Images in Anatomical Textbooks, Atlases, and Journals: A Consensus Response From Authors and Editors.

Nowadays, consent to use donor bodies for medical education and research is obtained from the body donors and their families before the donation. Recently, the International Federation of Associations of Anatomists (IFAA) published guidelines that could restrict the appearance of cadaveric images in commercial anatomical resources such as textbooks and other educational products. These guidelines state that the donor must expressly consent to using such images for this purpose.

Surgical Treatment of Coronoid Fracture With Elbow Varus Posteromedial Rotatory Instability: An Instructional Review.

Varus posteromedial rotatory instability (VPMRI) of the elbow is one of the complex elbow instability. The primary sites of injury encompass fractures of the anteromedial coronoid process and injuries to the lateral collateral ligament of the elbow. Some patients may present with involvement of the medial collateral ligament of the elbow.