Pain Phenomena Research Articles

Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomised, double-blind, placebo-controlled study

BackgroundPain after resolution of peripheral nerve block, known as ‘rebound pain’ (RP), is a major problem in outpatient surgery. The primary objective was to evaluate the benefit of intraoperative ketamine at an anti-hyperalgesic dose on the incidence of rebound pain after upper limb surgery under axillary plexus block in ambulatory patients. The secondary objective was to better understand the rebound pain phenomenon (individual risk factors). MethodsIn this prospective, double-blind study, patients were randomised to receive either a single dose of i.v. ketamine (0.3 mg kg−1) or a placebo. Preoperative mechanical temporal summation and central sensitization inventory were applied to question underlying central sensitisation. Pain catastrophising and Douleur Neuropathique 4 questionnaires were used. Rebound pain was defined as pain intensity score >7 (numeric rating scale, 0–10) after block resolution. Postoperative pain was recorded at Days 1, 4, and 30 after discharge. ResultsA total of 109 subjects completed the study, and 40.4% presented with rebound pain. Ketamine administration did not reduce rebound pain incidence or intensity. Temporal summation and central sensitisation inventory scores did not differ between subjects with and without rebound pain. The predictive risk factors were bone surgery (odds ratio [OR]=5.2; confidence interval [CI], 1.9–14.6), severe preoperative pain (OR=4.2; CI, 1.5–11.7), and high pain catastrophising (OR=4.8; CI, 1.0–22.3). At Day 30, the average daily pain was higher in the rebound pain group involving neuropathic characteristics. ConclusionKetamine at an anti-hyperalgesic dose showed no benefit on rebound pain development. Although central sensitisation might not be involved, preoperative pain intensity, and catastrophising stand as risk factors. Because rebound pain remains frequent despite adequate procedure-specific postoperative analgesia, future studies should focus on patient-specific pain management.

Transpedal and Tibiopedal Retrograde Revascularization for Peripheral Vascular Disease

Peripheral vascular disease, or peripheral artery disease (PAD), is a chronic and debilitating disease that affects millions of people worldwide. PAD is associated with abnormal arterial narrowing, specifically outside of the heart and brain. PAD is primarily observed in the legs, but it can also affect the kidneys, arms, and neck. Patients with PAD often complain of acute leg pain that occurs when walking. However, the pain resolves with rest. The phenomenon of acute pain due to narrowed arteries is known as intermittent claudication. Common symptoms of PAD include abnormal hair and nail growth, bluish skin, skin ulcers, and cold skin. Untreated and unmanaged PAD can lead to serious complications such as tissue infection or necrosis, which in turn could lead to amputation. In rare cases, PAD may cause a stroke or coronary artery disease.Among all the management options available, the endovascular approach remains the recommended and the gold standard nowadays. In this paper, we examine and analyze the transpedal and tibiopedal retrograde revascularization in PAD patients in which the conventional antegrade approach is not successful intra-operatively with emphasis on the challenges and postoperative complications. It also correlates the different studies and its outcomes with an up-to-date worldwide results.

Quantitative Sensory Testing Across Chronic Pain Conditions and Use in Special Populations.

Chronic pain imposes a significant burden to the healthcare system and adversely affects patients' quality of life. Traditional subjective assessments, however, do not adequately capture the complex phenomenon of pain, which is influenced by a multitude of factors including environmental, developmental, genetic, and psychological. Quantitative sensory testing (QST), established as a protocol to examine thermal and mechanical sensory function, offers insight on potential mechanisms contributing to an individual's experience of pain, by assessing their perceived response to standardized delivery of stimuli. Although the use of QST as a research methodology has been described in the literature in reference to specific pain populations, this manuscript details application of QST across a variety of chronic pain conditions. Specific conditions include lower extremity chronic pain, knee osteoarthritis, chronic low back pain, temporomandibular joint disorder, and irritable bowel syndrome. Furthermore, we describe the use of QST in placebo/nocebo research, and discuss the use of QST in vulnerable populations such as those with dementia. We illustrate how the evaluation of peripheral sensory nerve function holds clinical promise in targeting interventions, and how using QST can enhance patient education regarding prognostic outcomes with particular treatments. Incorporation of QST methodology in research investigations may facilitate the identification of common mechanisms underlying chronic pain conditions, guide the development of non-pharmacological behavioral interventions to reduce pain and pain-related morbidity, and enhance our efforts toward reducing the burden of chronic pain.

Endometriosis, an Ongoing Pain-Step-by-Step Treatment.

Endometriosis is a disease that is becoming more and more challenging for the medical community. The current therapeutic concepts (surgical therapy and/or hormonal therapies) often do not lead to sufficient pain control, and late diagnosis and high recurrence rates mean that women affected by the disease can suffer for decades before receiving proper treatment. Although the introduction of certified endometriosis centers has created contact points for surgical therapies performed by endometriosis experts, these centers are not sufficient to offer the affected patients the all-encompassing long-term support they need. In recent years, new findings regarding the pathogenesis and correlations of the pain phenomena caused by endometriosis have shown that conventional therapy strategies are not adequate and individual long-term concepts must be developed. Not only can endometriosis cause nociceptive pain, but it can also lead to a nociplastic reaction with central sensitization. Hence, aside from the classic cyclic complaints, patients increasingly suffer from atypical pain. Due to the high number of affected patients who are treated inadequately, it is necessary for gynecologists in private practices to become familiar with multimodal treatment concepts since they are the central point of contact of their patients. The following article will provide an overview of treatment strategies for chronic symptomatic endometriosis.

Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes.

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

АПОФАТИКА БОЛИ В ПОЭМЕ С.А. ЕСЕНИНА «ЧЕРНЫЙ ЧЕЛОВЕК» (ЛИМИНАЛЬНЫЕ СОСТОЯНИЯ В РУССКОЙ КУЛЬТУРЕ)

The object of the article is apophaticism as a phenomenon of artistic culture. The subject is apophaticism of the phenomenon of pain, which is perceived from metaphysical positions in the Russian philosophical thought. The material for the article is represented by S.A. Yesenin’s poem “Black Man” and his early poems. The ethos of life and death in the poet’s art is subject to hermeneutic reconstruction. Much attention is given to the Russian folklore tradition in the poet’s works, which is expressed both explicitly and implicitly. One can find liminal, i.e. borderline states in the Russian folklore, in folkloric accounts, in fairy tales in which the hero stays. These states are associated with temporal death and going through the initiation path. The research methodology represents a holistic ontohermeneutical analysis aimed at highlighting the folklore paradigm in S.A. Yesenin’s poetic style. Much attention is paid to the oneiric space in his figurative system, as well as to the phenomenon of “black” colour which is ambivalent in the world culture. The research results lie in revealing the cultural potential of the poem “Black Man” for further study of the apophatic aspect of the phenomenon of pain as well as apophaticism as a specific feature of the Russian culture associated with the phenomenon of pain and death. The results can also be used in courses on Russian literature, culturology and philosophy.

ДИНАМИКА КЛИНИЧЕСКОГО СОСТОЯНИЯ ПАЦИЕНТОВ С ШИЗОФРЕНИЕЙ С ПОСТПСИХОТИЧЕСКОЙ ДЕПРЕССИЕЙ, С ДУШЕВНОЙ БОЛЬЮ ПОД ВЛИЯНИЕМ БИНАУРАЛЬНОЙ СТИМУЛЯЦИИ ГОЛОВНОГО МОЗГА

In some cases, in the depressive symptoms of schizophrenia, the phenomenon of mental pain or «vital melancholy» is traced, which often has an obsessive nature and proceeds with suicidal intentions. The low effect of existing methods of therapy of this condition with the help of psychopharmacotherapy is noted. In this study, the authors attempted to additionally influence this symptom complex using binaural stimulation of the brain, along with psychopharmacotherapy. The authors used Th e Psychach e Scal e t o asses s mental pain and measure it numerically, and the PANSS scale to diagnose the clinical symptoms of schizophrenia. In the main group of patients receiving binaural brain stimulation, it was possible to achieve better treatment results for a number of symptoms related to the negative cluster, the cluster of general symptoms and one more additional symptom: emotional lability than in the control group that did not receive this specific additional treatment. The use of binaural brain stimulation in combination with drug therapy has significantly reduced the severity of mental pain in patients with schizophrenia.

EMPIRICAL STUDY OF THE FEATURES OF THE INFLUENCE OF MOTIVATION AND ATTITUDES ON THE PRESERVATION OF THE PSYCHOLOGICAL HEALTH OF YOUTH

This article reveals a topical topic of today: the influence of motivation and attitudes on preserving the psychological health of young people. After conducting an analysis of modern domestic and foreign research on the psychological health of an individual, it is determined that psychological health is a state of mental well-being (comfort), an adequate attitude to the surrounding world, and the absence of painful mental phenomena (phobias, neuroses). It was revealed that among a number of author’s positions, scientific views prevail, according to which psychological health is understood as an individual’s ability to self-realization, selfactualization, adequate self-perception of oneself and the world. It has been established that the level of human health is determined by the conditions of his life: education, work and life, well-being and hygienic culture, and most of all – the way of life. Lifestyle includes such categories as standard of living, quality of life and style. A significant influence of motivation and personality attitude on one’s psychological health is determined. A motive is a justification for a decision to satisfy or not satisfy a specified need in a given objective and subjective environment, and an attitude is an unconscious state of readiness for a certain behavior or activity. The installation is most often formed as a result of repeated repetition of situations in which a person reacts in a certain way. The installation distinguishes three components: cognitive (cognitive); emotional and evaluative; behavioral.

Особенности субъективного переживания боли

This is a review of various approaches to the study of the peculiarity of subjective experience of pain, namely the emotional aspect of pain perception is considered. Within the framework of this study, the main theoretical approaches to the study of the emotional well-being of patients suffering from pain syndrome has been identified. Also, the literature review showed the presence of a persistent relationship of pain syndromes with emotional disor- ders, in particular the depressive spectrum. This relationship is largely due to the physiology of the course of neu- rotransmitter changes in pain and depression. To take into account the constitutional features and nosogenic reac- tions, an integrated approach to the study of the phenomenon of pain is required.

PAIN: the Word, the Image and the Concept in the Dostoevsky’s Thought and Speech Space

The article is devoted to the study of the linguistic expression of the phenomenon of pain in the texts of F.M. Dostoevsky. The material of the analysis is the texts of works of fiction, journalism and letters of the Great Russian writer. The study of Dostoevskys texts is preceded by an analysis of entries in explanatory and specialized dictionaries and encyclopedias, including articles in the Dictionary of Dostoevskys Language. The relevance of the study is determined by the approaching bicentennial of F.M. Dostoevsky, in whose works the phenomenon of pain has become one of the important subjects of the image. The specificity of this work lies in the reliance on linguistic methods of studying the phenomenon of pain while maintaining the interdisciplinary focus of the research as a whole. Various associative connections of the word pain and its derivatives in the contexts of the writers works of different genres are being studied. At the initial stage, the selection of material is carried out by the method of continuous sampling using the DiaWin software system of the Department of Experimental Lexicography of the V.V. Vinogradov Russian Language Institute of the Russian Academy of Sciences. The material thus obtained, is subjected to a multilevel analysis, in course of which the specificity of the conceptualization of pain in language and culture is revealed and the features of the depiction and interpretation of the phenomenon of pain in the discourse of Dostoevsky and his characters are revealed. Conclusions are formulated about the stable associative connections of the lexeme pain, the specificity of the linguistic depiction of various states of pain in the writers texts is revealed, the original interpretations of the concept of pain in the discourses of heroes-ideologists are analyzed. As a result, the analyzed phenomenon appears in multidimensional illumination. The general structure of the frame is established. The relationship between external symptoms and internal sensations of physical and mental pain is revealed. It is postulated that the explication of the concept of pain by a native speaker is fraught with significant difficulties, since pain is introspective and subjectively experienced. This special state is experienced and lived on. The contextual combinations of meanings of the word pain in Dostoevskys texts are highlighted. The specificity of the figurative representation of pain situations in the writers works is revealed. The increments of meaning characteristic of Dostoevskys contexts are analyzed. As a result, pain is interpreted as a complex phenomenon of language and culture and an important concept in the discourse of F.M. Dostoevsky.

What lies behind and beyond acute COVID-19 pain?

In this issue of the European Journal of Pain you will find the article by Oguz-Akarsu and collaborators entitled “Insight into Pain Syndromes in Acute Phase of Mild-to-Moderate COVID-19: Frequency, Clinical Characteristics, and Associated Factors” (Oguz-Akarsu et al., 2021). This observational cohort was one of the handful yet to have described in detail the phenomenon of pain during acute COVID-19 and, to the best of our knowledge, the first to have examined the associations between distinct pain syndromes in such context. The authors conducted phone interviews with 222 subjects (aged 42 ± 14 years old; 47% female), diagnosed with symptomatic but mostly mild-to-moderate COVID-19 (63% were hospitalized, only 1% in intensive care unit) within the past 1.5 to 3 months. They found that pain was reported by 72%, more specifically: myalgia (50%), headache (49%), pain with neuropathic symptoms (25%) and polyarthralgia (14%). It was noticeable that widespread pain occurred in about a third of their sample and that 59% of them reported having suffered from more than one of the aforementioned pain syndromes. These impressive figures generally fall in line with those of previous work in this field, such as the case-control study published by Soares et al, which showed a prevalence of 65% for new-onset pain and 20% for new-onset chronic pain among COVID-19 survivors (Soares et al., 2021). Most interestingly, Oguz-Akarsu et al demonstrated that these pain syndromes were statistically associated among themselves. They also had many similar features, for example both headache and myalgia occurred very early, in the first few days of the infection; female sex and anosmia were significantly more common among patients who developed myalgia, headache and/or neuropathic symptoms. Larger samples of well-described patients would be of great interest to conduct additional multivariable analysis and further explore these associations. Nonetheless, currently, these results strongly point to the existence of shared underlying mechanisms for such distinct pain syndromes. There are, however, more than a few candidates for this role. Disease-specific complications, such as prolonged hypoxemia, loss of cardiopulmonary performance, and thrombosis due to hypercoagulable states may be involved. Moreover, treatment-related elements may also be implicated, for example prolonged immobilization, sedation, pain resulting from invasive procedures, prolonged use of corticosteroids and neuromuscular blocking. Nonetheless, Oguz-Akarsu et al study included largely mild-to-moderate, although clearly symptomatic, COVID-19 survivors, which significantly reduces the probability that any of these factors was a major common driver for the studied pain syndromes in this population. Direct viral invasion of some tissues (such as cartilage, smooth muscle and vessels) may play a role, but direct evidence of invasion to neurons and skeletal muscle remains elusive. Furthermore, although it cannot be denied the contribution of psychological factors, such as post-traumatic stress disorder and social isolation, it is unlikely that they alone may explain the pain phenomenon as a whole. A more likely hypothesis for a common mechanism underpinning these distinct pain syndromes possibly is the inflammatory response. Indeed, a cytokine storm has been described to occur during COVID-19. Moreover, a recently published case-control study has indicated that COVID-19 patients who develop headache during the acute phase of this infection may have a specific interleukin and cytokine signature (Trigo et al., 2021). When compared to patients who had not developed headache, these subjects presented with significantly higher levels of interleukin-10 (Trigo et al., 2021). Similar work for other pain syndromes would certainly be welcome in the near future. The importance of developing a more in-depth understanding of the biological processes that generate the distinct pain syndromes in acute COVID-19 cannot be overemphasized. Besides possibly leading to significant implications for the treatment of pain in this setting, this knowledge may also shed a light on the mechanisms that will eventually result in the persistence of pain for some of these survivors, as well as on how to predict and prevent it. In this sense, work such as this from Oguz-Akarsu et al, aimed at describing the phenotype and clinical correlations of pain in acute COVID-19, are valuable starter points that may show the direction for further basic research in this field, and corroborate its findings. As the world slowly moves towards the lifting of social distancing measures, and clinical research with in-person interviews and physical examination becomes ever more feasible, the opportunity arises for future studies that will improve our knowledge about the clinical features of pain in the acute COVID-19 setting, and their implications. None. GTK wrote the first draft of the commentary and both authors validated the final text.

On the pathogenesis of pain in peptic ulcer disease and diagnostic value

The phenomenon of percussion pain was described by Mendel in 1903. I. Ya. Razdolsky (1927, 1930) discovered painful zones of the anterior abdominal wall in peptic ulcer disease and made a "map" of these zones in the epigastric region in certain sections.

Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia

Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients’ physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema.

The state of psychological resources in patients with chronic dorsalgia

Basic personality parameters include introversion-extraversion, neuroticism, and psychoticism. When chronic pain occurs, a change in the psychoemotional state of patients is noted. Quite often this occurs in the case of chronic nonspecific back pain — in chronic dorsalgia. There are different aspects of the impact on human life. The emerging neurological manifestations, motor and sensory, are accompanied by a disorder in the ability to perform daily and professional skills. At the same time, the phenomena of sensory modality (pain, paresthesia, synestopathy), caused by organic and functional reasons, significantly deteriorate the prognosis, disrupt emotional and adaptive functioning, and affect the quality of sleep. The ability to assess different aspects of the clinical «consequences» of chronic pain phenomena in dorsalgia improves their diagnosis and treatment. Purpose of the study — to evaluate psychological resources (personality traits, goals and meaningfulness, life guidelines, attitude to pain) in patients with chronic dorsalgia. Materials and methods. In a prospective controlled study in patients with chronic pain of the lumbosacral localization, the test data on the state of psychological resources were analyzed. The results of the examination of 66 patients aged 23–56 years were studied. In the presented sample, the following were used: LSS Methodology — the test of meaningful life orientations; the Big Five test by R. McCrae and P. Costa [1]; McGill questionnaire — a method for determining the level of pain syndrome; theTampa Scale — a method for measuring kinesiophobia [2]. Results. Based on the results of the use of the tests that assess personality parameters and psychological resources, the features of manifestation in chronic dorsalgia were established. When assessing the scales of meaning-to-life orientation, an emotionally rich emotional and personal sphere was found in both women and men. Gender differences on the «Life Performance» scale in the section on satisfaction with self-realization, the assessment of the period of life passed was higher in men (25.46 ± 4.30). At the same time, the general indicator of the meaningfulness of life was 28.6 points for men and 45.6 — for women. The assessment of test results using the Big Five questionnaire sets comparable parameters for men and women in the section of emotional stability (21.6 and 22.17, respectively) with a significant difference from the generally accepted assessment results in the population — 28 points. In the block for assessing the level of extraversion, similar values were also observed: significantly higher scores for men (30.0) and 27.64 — for women, which in comparison with the norm had a lower value (31 points). When analyzing the McGill pain assessment questionnaire, significantly higher scores for the sensory component were found in women than in men in the sample (16.8 and 12.1 points, respectively). The methodology for assessing the level of kinesiophobia by the Tampa scale established high values for testing according to the total index of kinesiophobia — more than 40 points: 43.7 points for women and 37.8 points for men. Conclusion. The features of personality parameters in patients with chronic dorsalgia indicate that high parameters of meaningfulness of life are diagnosed (there are not high parameters in the block «goals in life», the level of control «life process» — emotional and psychological satisfaction will remain quite significant). Locus of control «I» allows to express an opinion on a sufficient level of assessment of the idea of personality traits and the ability to control the state of one's disease. Control capabilities in the «Locus of Control — Life» testing block indicate the ability to make decisions and influence life processes. The emerging manifestations of chronic dorsalgia have certain characteristics of the course and personal resources in women and men with a more significant criterion «Emotionality» among women. Despite the long-standing component of the existing pain as the leading aspect of the disease, there is a significantly predominant sensory component in both men and women.

G. Katz (Med. Klin., № 33, 1931)

(Med. Klin., No. 33, 1931) in a group of cases of chronic arthritis established cerebral disorders, the clinical picture of which is surprisingly similar in its similarity to the painful phenomena in encephalitis.

Gene Expression Profiling of Contralateral Dorsal Root Ganglia Associated with Mirror-Image Pain in a Rat Model of Complex Regional Pain Syndrome Type-I.

BackgroundMirror-image pain (MIP), which develops from the healthy body region contralateral to the actual injured site, is a mysterious pain phenomenon accompanying many chronic pain conditions, such as complex regional pain syndrome (CRPS). However, the pathogenesis of MIP still remains largely unknown. The purpose of this study is to perform an expression profiling to identify genes related to MIP in an animal model of CRPS-I.MethodsWe established a rat chronic post-ischemic pain (CPIP) model to mimic human CRPS-I. RNA-sequencing (RNA-Seq), bioinformatics, qPCR, immunostaining, and animal behavioral assays were used to screen potential genes in the contralateral dorsal root ganglia (DRG) that may be involved in MIP.ResultsThe CPIP model rats developed robust and persistent MIP in contralateral hind paws. Bilateral DRG neurons did not exhibit obvious neuronal damage. RNA-Seq of contralateral DRG from CPIP model rats identified a total 527 differentially expressed genes (DEGs) vs sham rats. The expression changes of several representative DEGs were further verified by qPCR. Bioinformatics analysis indicated that the immune system process, innate immune response, and cell adhesion were among the mostly enriched biological processes, which are important processes involved in pain sensitization, neuroinflammation, and chronic pain. We further identified DEGs potentially involved in pain mechanisms or enriched in small- to medium-sized sensory neurons or TRPV1-lineage nociceptors. By comparing with published datasets summarizing genes enriched in pain mechanisms, we sorted out a core set of genes which might contribute to nociception and the pain mechanism in MIP.ConclusionWe provided by far the first study to profile gene expression changes and pathway analysis of contralateral DRG for the studying of MIP mechanisms. This work may provide novel insights into understanding the mysterious mechanisms underlying MIP.

Effect of Perioperative Lignocaine Infusion on Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy

Background: Pain is a common complaint of patients after surgery. Different techniques or medications including local anesthetics infiltration, non-steroidal anti-inflammatory drugs or opioids have been used for postoperative analgesia. Lidocaine is an amide local anesthetic agent that works by influencing the complex phenomenon of pain. Aim: To compare the mean pain score with intraoperative lidocaine versus control in patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: 350 patients aged 20-60 years of either sex scheduled for laparoscopic cholecystectomy were included in the study. Patients with allergy to lidocaine; patients with neuromuscular disease, endocrine or metabolic disorder and pregnant patients were excluded from study. Patients were randomly divided in two groups by using lottery method after taking informed consent. On arrival to the operating room, monitor was attached to display continuous ECG, mean arterial blood pressure, and arterial oxygen saturation. Results: In lidocaine group, the mean age of patients was 39.93±11.56years. In control group, the mean age of patients was 37.93±11.83years. In lidocaine group, there were 91 (52%) males and 84 (48%) females. In control group, there were 77 (44%) males and 98 (56%) females. In lidocaine group, the mean BMI of patients was 26.66±4.81kg/m2. In control group, the mean BMI of patients was 26.77±4.76kg/m2. In lidocaine group, the mean pain score of patients was 1.00±0.84. In control group, the mean pain score of patients was 2.39±1.10. The difference was significant (p<0.05). Conclusion: Thus lidocaine is found to be more effective in reducing postoperative pain than control. Keywords: General anesthesia, laparoscopic cholecystectomy, lidocaine, postoperative pain.

Prevalence in News Media of Two Competing Hypotheses about COVID-19 Origins

The COVID-19 pandemic has been one of the most disruptive and painful phenomena of the last few decades. As of July 2021, the origins of the SARS-CoV-2 virus that caused the outbreak remain a mystery. This work analyzes the prevalence in news media articles of two popular hypotheses about SARS-CoV-2 virus origins: the natural emergence and the lab-leak hypotheses. Our results show that for most of 2020, the natural emergence hypothesis was favored in news media content while the lab-leak hypothesis was largely absent. However, something changed around May 2021 that caused the prevalence of the lab-leak hypothesis to substantially increase in news media discourse. This shift has not been uniformed across media organizations but instead has manifested itself more acutely in some outlets than others. Our structural break analysis of daily news media usage of terms related to the laboratory escape hypothesis provides hints about potential sources for this sudden shift in the prevalence of the lab-leak hypothesis in prestigious news media.

Syringomyelia case

Syringomyelia, well studied both clinically and from the pathological and anatomical side, is most often found in the form of typical painful phenomena from the upper extremities and upper body.

Role of Fibroblast Growth Factor-23 in Coronary Slow Flow Phenomenon Pathogenesis

The phenomenon of angina chest pain without significant epicardial coronary artery stenosis, but accompanied by a slowdown in coronary blood flow is often found in patients with symptoms of acute coronary syndrome who undergoing invasive coronary angiography. This phenomenon of slow coronary blood flow is then called the coronary slow flow phenomenon (CSFP). The pathogenesis mechanism of CSFP remains unclear. The pathogenesis of CSFP is thought to be multifactorial. Endothelial dysfunction, small vessel disease, inflammation, renin system angiotensin aldosterone, atherosclerosis are thought to be involved in the pathogenesis of CSFP. Cardiovascular disease incidence and death were associated with elevated levels of Fibroblast growth factor-23 (FGF-23). High levels of FGF-23 can lead to formation of blood vessel calcification, left ventricular hypertrophy, arterial stiffness, endothelial dysfunction, increased inflammatory markers and elevated levels of angiotensin II. It is suspected that FGF-23 has a role in this event other than as a regulator of bone and mineral metabolism. This literature review aims to determine the relationship between fibroblast growth factor-23 and the pathophysiology of CSFP. Based on the broad role of FGF-23, it is possible that FGF-23 is involved in the pathogenesis of CSFP.