Transient Pain Research Articles

Establishing a Common Term and Definition for Non-Structural Postoperative Radicular Pain Following Lumbar Decompression: A Scoping Review

Background: Patients often report recurrent or new radicular pain after direct or indirect lumbar decompressions. Such pain may result from structural causes such as implant subsidence or incomplete decompression, but often the pain lacks a clear structural cause. The wide variability in terms used to define non-structural, postoperative radicular pain complicates its analysis. Purpose: We aimed to elucidate the terminology and classification systems used to describe postoperative radicular pain after lumbar decompression and/or fusion surgery without clear structural etiology and to propose a new clinical definition. Methods: We conducted a scoping review that followed the Joanna Briggs Institute scoping review methodology and the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews guidelines. The search included studies from 2011 to 2023 involving patients over 18 years of age experiencing postoperative radicular pain after lumbar decompression and/or fusion. Results: Our analysis of 20 included articles found the most common terms used for non-structural radicular pain after lumbar decompression and/or fusion surgery were “postoperative radiculitis” (8 studies, 40%) and “failed back surgery syndrome” (FBSS) (5 studies, 25%). “Radiculitis” and related terms typically described short-term, self-limited radicular pain; “FBSS” and similar terms referred to chronic, treatment-resistant back, and leg pain. The incidence of non-structural postoperative radicular pain ranged from 0.9% to 43.8%. Conclusions: This scoping review found inconsistencies in the terms used to describe postoperative radicular pain after lumbar decompression and/or fusion surgery, and we therefore propose defining “postoperative radiculitis” as transient radicular pain, without structural pathology or motor weakness, typically emerging after initial symptom resolution (within 3 months of surgery) and resolving within 6 months of surgery. Future studies should focus on validating diagnostic metrics, exploring risk factors, and identifying prevention strategies and treatments for postoperative radiculitis.

Comparative analysis of short-term efficacy between robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus.

To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT). This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery. All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (P < 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups. Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.

#370 Macroscopic hematuria-associated severe acute kidney injury from thin basement membrane disease

Abstract Background Macroscopic hematuria-associated acute kidney injury (MH-AKI) is a rare condition reported in IgA nephropathy and others, and the mechanism of renal tubular damage caused by red blood cells in the tubules appears to be similar to that of anticoagulant nephropathy. Case presentation A 66-year-old Japanese woman with no previous medical history was referred to our hospital with anuric severe kidney injury. Seven days earlier, she had transient acute lumbar back pain, which was followed by gradual worsening of malaise and loss of appetite. On admission, her serum BUN was 147.8 mg/dL, serum Cr 18.57 mg/dL, hemoglobin 11.2 g/dL, urinary red blood cells&amp;gt; 100/HPF, urinary protein 28.8 g/gCr, no hydronephrosis in either kidney, but a small stone in the right kidney. After admission, while starting hemodialysis, she was treated with methylprednisone 1000 mg for 3 days followed by prednisone 40 mg/day because of suspected rapidly progressive glomerulonephritis, but both MPO-/PR3-ANCA and anti-GBM antibodies were negative. Renal biopsy from left kidney showed acute tubular injury with large amounts of red blood cells and red blood cell casts filling the distal tubules (Figure), and prednisone was discontinued. Subsequently, urine flowed out with gross hematuria, and her hematuria and renal function improved with increased urine output, and she was weaned from hemodialysis. Electron microscopy showed glomerular thin basement membrane (TBMD) (Figure). Her renal function and hematuria slowly improved and the right kidney stone disappeared. Microscopic hematuria eventually disappeared, and her serum Cr level was 1.1 mg/dL one year after onset. Conclusions This is the first report of MH-AKI in TBMD without a background of anticoagulation, severe thrombocytopaenia, or iron overload. In one report, compared to IgA nephropathy, TBMD is associated with increased urinary Ca and uric acid excretion, which is associated with gross hematuria and back pain [1]. In this case of MH-AKI from TBMD, both red blood cells and crystal formation in the tubular lumens may have transiently and synergistically caused renal tubular obstruction and heme iron-induced tubular damage.

Uso da Toxina Botulínica Tipo A em pacientes com Neuralgia Trigeminal

This article provides a systematic review of the efficacy of Botulinum Toxin Type A (TBA) in treating trigeminal neuralgia (TN), a painful disorder affecting the trigeminal nerve. TN is described in the literature as a facial pain of acute nature, often unilateral, characterized by episodes of intense and transient pain, comparable to electric shocks. The diagnosis is made through a detailed evaluation that includes anamnesis, characterization of symptoms, and imaging tests to exclude similar pathologies. Conventional therapy for TN involves the use of carbamazepine; however, in cases of pharmacological resistance or ineffectiveness of standard treatments, TBA emerges as a viable therapeutic alternative. The efficacy of TBA, as demonstrated in retrospective and prospective studies, is due to its ability to inhibit the release of neurotransmitters responsible for pain transmission and inflammatory processes. Various studies corroborate the efficacy of TBA, especially in patients over 50 years old, observing substantial improvement in symptoms with minimal adverse effects. The administration of TBA is carried out directly in the trigger zones, where it has proven to be well-tolerated, providing significant improvement in the quality of life of the affected patients. Despite promising results, the literature suggests the need for additional studies to optimize the dosage protocols and application of TBA, aiming to ensure its efficacy and safety in the long term. In conclusion, this article reiterates that TBA represents an effective and minimally invasive therapeutic alternative for the treatment of TN. However, it is essential to develop individualized therapeutic protocols and conduct more comprehensive studies to consolidate its use as the treatment of choice.

Unilateral biportal endoscopy via two different approaches for upper lumbar disc herniation: a technical note

BackgroundThe traditional surgical procedures for upper lumbar disc herniation (ULDH) usually lead to frequent complications. We aim to investigate the clinical efficacy of the unilateral biportal endoscopy (UBE) technique in treating upper lumbar disc herniation (ULDH).MethodsFrom January 2020 to December 2021, the clinical data of 28 patients with ULDH treated with the UBE technique were collected and analyzed for surgery time under UBE, postsurgical drainage, postsurgical hospital stay, and complications. The clinical efficacy was evaluated according to the modified MacNab score, Oswestry disability index (ODI), and visual analogue scale (VAS) of low back pain and lower limb pain before the surgery; one week, one month, and three months after the surgery; and at the last follow-up.ResultsAll patients underwent the UBE surgery successfully. The surgery time under UBE for non-fusion cases was 47.50 ± 11.84 min (monosegment) and 75.00 ± 20.66 min (two segments), while that for fusion cases was 77.50 ± 21.02 min. The postsurgical drainage for non-fusion cases was 25.00 ± 13.94 mL (monosegment) and 38.00 ± 11.83 mL (two segments), while that for fusion cases was 71.25 ± 31.72 mL. The postsurgical hospital stay was 8.28 ± 4.22 days. The follow-up time was 15.82 ± 4.54 months. The VAS score for each time period after the surgery was significantly lower (P < 0.05), while the ODI was significantly higher than that before the surgery (P < 0.05). According to the modified MacNab scoring standard, the ratio of excellent to good was 96.43% at the last follow-up. Two patients experienced transient numbness and pain in their lower limbs and no activity disorder after the surgery, and they recovered after conservative treatment.ConclusionsThe clinical effect of UBE technique in treating ULDH was reliable. According to the needs of the disease, the interlaminar approach or paraspinal approach of the UBE technique was selected. This technique took into account the effect of treatment, achieved the purpose of minimal invasiveness, and did not require special instruments. Therefore, it has the potential for clinical application.

Lateral Pelvis and Lumbar Motion in Seated and Standing Office Work and Their Association With Transient Low Back Pain.

To assess frontal plane motion of the pelvis and lumbar spine during 2 h of seated and standing office work and evaluate associations with transient low back pain. Although bending and twisting motions are cited as risk factors for low back injuries in occupational tasks, few studies have assessed frontal plane motion during sedentary exposures. Twenty-one participants completed 2 h of seated and standing office work while pelvic obliquity, lumbar lateral bending angles, and ratings of perceived low back pain were recorded. Mean absolute angles were compared across 15-min blocks, amplitude probability distribution functions were calculated, and associations between lateral postures and low back pain were evaluated. Mean pelvic obliquity (sit = 4.0 ± 2.8°, stand = 3.5 ± 1.7°) and lumbar lateral bending (sit = 4.5 ± 2.5°, stand = 4.1 ± 1.6°) were consistently asymmetrical. Pelvic obliquity range of motion was 4.7° larger in standing (13.6 ± 7.5°) than sitting (8.9 ± 8.7°). In sitting, 52% (pelvis) and 71% (lumbar) of participants, and in standing, 71% (pelvis and lumbar) of participants, were considered asymmetric for >90% of the protocol. Lateral postures displayed weak to low correlations with peak low back pain (R ≤ 0.388). The majority of participants displayed lateral asymmetries for the pelvis and lumbar spine within 5° of their upright standing posture. In short-term sedentary exposures, associations between lateral postures and pain indicated that as the range in lateral postures increases there may be an increased possibility of pain.

Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt.

Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity. This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion. A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established. A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients. Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.

Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli.

This study aimed to investigate whether analgesia nociception index (ANI) could be an indicator of perioperative pain during laparoscopic trocar insertion. A total of 280 participants of anesthesia receiving laparoscopic surgery were enrolled. Anesthesia induction and maintenance were performed using the Marsh model for target propofol and the Minto model for remifentanil. Systolic blood pressure (SBP), heart rate (HR), and ANI were recorded at skin incision, the first-, second, the last-trocar insertion, and 5 min after the last trocar insertion. ANI was significantly different among the five groups in the last four time points (all P < 0.05). Pearson's correlation showed that ANI was negatively correlated with SBP (r = -0.114, P = 0.077) and HR (r = -0.247, P < 0.001). The area under the curve of ANI was positively correlated with those of SBP (r = 0.493, P < 0.001) and HR (r = -0.420, P < 0.001). Multivariate logistic regression showed that the ANI was an independent factor associated with intraoperative hemodynamic adverse events only at 5 min after the last trocar insertion. Under general anesthesia, the change in ANI was consistent with changes in the balance between analgesia and nociceptive stimuli. The ANI can reflect the extent of transient pain but had a poor predictive performance for hemodynamic adverse events.

Anti-inflammatory Activity of Polyphenols from Labisia pumila Leaves Extract

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) represent a class of pharmaceutical agents that are frequently misused and misconstrued within the medical landscape. While demonstrably efficacious in providing transient pain relief, NSAIDs do not effectively address the fundamental etiology of pain and are associated with a spectrum of potential adverse effects. Labisia pumila var alata also known as "Kacip Fatimah" has been traditionally used which is attributed to its antioxidant properties. Nonetheless, little attempt has been made to examine its antioxidant and anti-inflammatory characteristics. This study determined the molecular interactions and inhibitory activity profiles of L. pumila methanolic extract (LPE) against the corresponding enzymes via in chemico and in silico approaches. In chemico analysis was done on antioxidant activity and anti-inflammatory properties of L. pumila. The findings indicated that LPE exhibit the potent anti-inflammatory activity. Through high-performance liquid chromatography, it was shown that LPE had the highest gallic acid concentration at 10.74 ± 2.23 mg/mL. LPE did not exhibit cytotoxicity up to 100 µg/mL and displayed optimal protective against UVB-irradiation at 50 µg/mL towards HSF1184 Fibroblast cell line. LPE exhibited potent anti-inflammatory activity as it inhibited elastase and COX-2. Molecular docking studies indicated that gallic acid has a good affinity for collagenase (˗5.68 kcal/mol), elastase (˗4.88 kcal/mol) and COX 2 (˗4.91 kcal/mol). These findings collectively suggested that L. pumila extract has significant potential for the formulation of the natural anti-inflammatory remedies which offer a safer alternative treatment for pain relief, especially for long-term use replacing the conventional NSAIDs medicines.

Transient pain and discomfort when wearing high-heeled shoes

In the dynamic world of fashion, high-heeled footwear is revered as a symbol of style, luxury and sophistication. Yet, beneath the facade of elegance of classy footwear lies the harsh reality of discomfort and pain. Thus, this study aims to investigate the influence of wearing high-heeled shoes on the sensation of pain across different body regions over a period of 6 h. It involved fifty female participants, all habitual wearers of high-heeled shoes, aged between 20 and 30 years. Each participant kept a record of their perceptions of pain and discomfort every hour for a total of 6 h using a 0–10 pain scale with 0 indicating no pain and 10 indicating severe pain. The findings reveal a progressive rise in pain throughout wear, with the most intense pain reported in the back, calcaneus, and metatarsals. The analysis shows that after approximately 3.5 h, participants experience significant increases in pain levels. However, the relationship between heel height and pain is not linear. It appears that a heel height of 7.5 cm is the threshold where overall body pain becomes significant. The study suggests that a duration of 3.5 h of wear and a heel height of 7.5 cm serve as critical points to decrease overall body pain. Moreover, beyond this heel height, knee pain diminishes compared to other body areas possibly due to the shift towards a more neutral posture. The study findings, coupled with the recommendations, can assist footwear designers in crafting not only stylish but also comfortable shoes.

Definition and Assessment of Paediatric Breakthrough Pain: A Qualitative Interview Study.

Infants, children and young people with life-limiting or life-threatening conditions often experience acute, transient pain episodes known as breakthrough pain. There is currently no established way to assess breakthrough pain in paediatric palliative care. Anecdotal evidence suggests that it is frequently underdiagnosed and undertreated, resulting in reduced quality of life. The development of a standardised paediatric breakthrough pain assessment, based on healthcare professionals' insights, could improve patient outcomes. This study aimed to explore how healthcare professionals define and assess breakthrough pain in paediatric palliative care and their attitudes towards a validated paediatric breakthrough pain assessment. This was a descriptive qualitative interview study. Semi-structured interviews were conducted with 29 healthcare professionals working in paediatric palliative care across the UK. An inductive thematic analysis was conducted on the data. Five themes were generated: 'the elusive nature of breakthrough pain', 'breakthrough pain assessment', 'positive attitudes towards', 'reservations towards' and 'features to include in' a paediatric breakthrough pain assessment. The definition and assessment of breakthrough pain is inconsistent in paediatric palliative care. There is a clear need for a validated assessment questionnaire to improve assessment, diagnosis and management of breakthrough pain followed by increased healthcare professional education on the concept.

Nociceptor spontaneous activity is responsible for fragmenting non-rapid eye movement sleep in mouse models of neuropathic pain.

Spontaneous pain, a major complaint of patients with neuropathic pain, has eluded study because there is no reliable marker in either preclinical models or clinical studies. Here, we performed a comprehensive electroencephalogram/electromyogram analysis of sleep in several mouse models of chronic pain: neuropathic (spared nerve injury and chronic constriction injury), inflammatory (Freund's complete adjuvant and carrageenan, plantar incision) and chemical pain (capsaicin). We find that peripheral axonal injury drives fragmentation of sleep by increasing brief arousals from non-rapid eye movement sleep (NREMS) without changing total sleep amount. In contrast to neuropathic pain, inflammatory or chemical pain did not increase brief arousals. NREMS fragmentation was reduced by the analgesics gabapentin and carbamazepine, and it resolved when pain sensitivity returned to normal in a transient neuropathic pain model (sciatic nerve crush). Genetic silencing of peripheral sensory neurons or ablation of CGRP+ neurons in the parabrachial nucleus prevented sleep fragmentation, whereas pharmacological blockade of skin sensory fibers was ineffective, indicating that the neural activity driving the arousals originates ectopically in primary nociceptor neurons and is relayed through the lateral parabrachial nucleus. These findings identify NREMS fragmentation by brief arousals as an effective proxy to measure spontaneous neuropathic pain in mice.

Giant Cell Arteritis.

Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with potential bilateral blindness. Neither clinical nor laboratory evidence is simple and unequivocal for this disease, which usually requires rapid and reliable diagnosis and therapy. The ophthalmologist should consider GCA with the following ocular symptoms: visual loss or visual field defects, transient visual disturbances (amaurosis fugax), diplopia, eye pain, or new onset head or jaw claudication. An immediate ophthalmological examination with slit lamp, ophthalmoscopy, and visual field, as well as color duplex ultrasound of the temporal artery should be performed. If there is sufficient clinical suspicion of GCA, corticosteroid therapy should be initiated immediately, with prompt referral to a rheumatologist/internist and, if necessary, temporal artery biopsy should be arranged. Numerous developments in modern imaging with colour duplex ultrasonography, MRI, and PET-CT have the potential to compete with the classical, well-established biopsy of a temporal artery. Early determination of ESR and CRP may support RZA diagnosis. Therapeutically, steroid-sparing immunosuppression with IL-6 blockade or methotrexate can be considered. These developments have led to a revision of both the classification criteria and the diagnostic and therapeutic recommendations of the American College of Rheumatologists and the European League against Rheumatism, which are summarised here for ophthalmology.

Current Status of Cognition and Clinical Practice of Refractory Cancer Pain in Shanghai: A Questionnaire Survey.

This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai. From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China. A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training. Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.

Arterial Embolization: A Superior Treatment for Massive Urinary Tract Bleeding in Emergency Care

Objective: To analyze the effect of arterial embolism (AE) in patients with massive urinary system bleeding (MBUS). Methods: From September 2018 to September 2023, 175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay. Among them, 85 cases (September 2018 – September 2020) underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter (Group A), and 90 cases (October 2020 – September 2023) underwent AE treatment (Group B). The treatment effects of the two groups were compared. Results: The treatment effectiveness of Group B is higher than that of Group A (P &lt; 0.05). The urinary hemoglobin level of Group B is lower than that of Group A at 1, 6, 12, and 24 hours after treatment (P &lt; 0.05). Among the 90 cases treated with AE, 7 cases had a fever, with body temperatures ranging from 37.3°C to 38.9℃, with a mean temperature of 38.2 ± 0.3℃. Four cases experienced local pain, nausea, and vomiting, while two cases of intra-iliac AE showed transient buttock pain. These patients with adverse reactions were treated symptomatically for 7 days. All patients recovered after treatment. Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition, the renal function returned to normal, and the blood urea nitrogen and blood creatinine test results were within the normal range. After 1 year of follow-up, no hypertension occurred. Conclusion: AE treats MBUS patients in the emergency department with remarkable efficacy. It has the advantages of less damage to the body, rapid hemostasis, high safety, and maximum preservation of organ function.

Transient binocular vision loss and pain insensitivity in Klippel–Feil syndrome: a case report

BackgroundKlippel–Feil syndrome is a rare congenital bone disorder characterized by an abnormal fusion of two or more cervical spine vertebrae. Individuals with Klippel–Feil syndrome exhibit diverse clinical manifestations, including skeletal irregularities, visual and hearing impairments, orofacial anomalies, and anomalies in various internal organs, such as the heart, kidneys, genitourinary system, and nervous system.Case presentationThis case report describes a 12-year-old Pashtun female patient who presented with acute bilateral visual loss. The patient had Klippel–Feil syndrome, with the typical clinical triad symptoms of Klippel–Feil syndrome, along with Sprengel’s deformity. She also exhibited generalized hypoalgesia, which had previously resulted in widespread burn-related injuries. Upon examination, bilateral optic disc swelling was observed, but intracranial pressure was found to be normal. Extensive investigations yielded normal results, except for hypocalcemia and low vitamin D levels, while parathyroid function remained within the normal range. Visual acuity improved following 2 months of calcium and vitamin D supplementation, suggesting that the visual loss and optic nerve swelling were attributed to hypocalcemia. Given the normal parathyroid function, it is possible that hypocalcemia resulted from low vitamin D levels, which can occur after severe burn scarring. Furthermore, the patient received a provisional diagnosis of congenital insensitivity to pain on the basis of the detailed medical history and the findings of severe and widespread loss of the ability to perceive painful stimuli, as well as impaired temperature sensation. However, due to limitations in genetic testing, confirmation of the congenital insensitivity to pain diagnosis could not be obtained.ConclusionThis case highlights a rare presentation of transient binocular vision loss and pain insensitivity in a patient with Klippel–Feil syndrome, emphasizing the importance of considering unusual associations in symptom interpretation.

Clinical tests predictive of temporary low back pain development during the prolonged standing test in physical therapy students.

Low back pain among physical therapists is a common musculoskeletal disorder that first occurs early in their career or as a student. This observational prospective study assessed the ability of hip and lumbopelvic neuromuscular control, endurance and hip range of motion tests to predict the development of transient low back pain development during a standing task. Seventy-two physical therapy students without low back pain completed nine performance tests and a 2-hour standing test on two separate days. Participants were classified as transient pain developers (PD) if they reported a ≥ 10mm increase in low back pain on a visual analog scale. Transient back pain was reported by 37.5% of students during the standing test. A cluster of three positive tests, self-rated active hip abduction (somewhat difficult or more), bilateral total hip internal rotation greater than 81 degrees, and non-dominant limb single-leg squat (moderate deviations), demonstrated an increased probability (94.9%) of identifying PDs. Negative findings on the same three tests decreased the probability to 10.7%. Overall, the classification accuracy for the three-test model was 72.2%. The sensitivity for the model was 63% and the specificity was 77.8%.

Amplatzer or Figulla Flex II Occluder: a comparative study of outcomes after transcatheter patent foramen ovale closure.

Percutaneous closure of a patent foramen ovale (PFO) for the prevention of recurrent paradoxical thromboembolic events has been shown to be safe and effective in randomized controlled trials. However, it remains uncertain if differences in the structure and design of the occluder devices impact the outcomes. The aim of this study was to compare results of percutaneous PFO closure using 2 widely used double-disc occluders. Consecutive patients who underwent percutaneous PFO closure with the Abbott Amplatzer occluder (APO) or the Occlutech Figulla-Flex-II occluder (OPO) at the Heart Center Lucerne between February 2017 and December 2022 were included in a registry. The primary endpoint was effective closure of the PFO, defined as a residual shunt grade 0 or 1, assessed by contrast echocardiogram at 6-month follow-up. Secondary endpoints included procedural efficacy/safety and major adverse cardiovascular events during the hospital stay and at 6-month follow-up. One hundred ninety-three consecutive patients (mean age 51.7 ± 12.5 years; 39% women; Risk of Paradoxical Embolism (RoPE) score = 7, IQR = 6-8) underwent percutaneous PFO closure with the APO (120 patients, 62.2%) or the OPO (73 patients, 37.8%). Main indications for closure were crypotogenic stroke in 168 patients (87.1%) and peripheral embolism in 13 patients (6.7%). At baseline, right-to-left shunt (RLS) greater than or equal to grade 2 was present in 189 patients (97.9%). Immediate procedural success was 99.5%. In 1 patient, an air embolism occurred during positioning of the APO occluder with transient chest pain and electrocardiogram changes, but without further sequelae to the patient. At 6-month follow-up, effective closure was achieved in 185 patients (95.8%; APO: 96.6% vs OPO: 94.5%, P = .30). Rates of atrial fibrillation and recurrent thromboembolic events were 4.2 and 0.5%, respectively. PFO closure is safe and effective when performed with either the self-expanding Abbott Amplatzer or Occlutech Figulla Flex II PFO occluder.

MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review.

Contemporary surgical management of dystonia includes neuromodulation via deep brain stimulation (DBS) or ablative techniques such as radiofrequency (RF) ablation. MRI-guided focused ultrasound (MRgFUS) is an emerging modality that uses high-intensity ultrasound to precisely ablate targets in the brain; this is incisionless, potentially avoiding the surgical risks of a burr hole and transcortical tract to reach the anatomical target. There is some evidence of efficacy in essential tremor and Parkinson's disease (PD), but, to date, there is no study aggregating the evidence of MRgFUS in dystonia. In this narrative review, we searched Medline, Embase, CINAHL, EBSCO, and ClinicalTrials.gov for primary studies and clinical trials on MRgFUS in the treatment of dystonia. Data were analyzed concerning dystonia phenotype, reported outcomes, and complications. PD-related dystonia was also included within the scope of the review. Using our search criteria, six articles on the use of MRgFUS in adult dystonia and three articles on the use of FUS in dystonia in PD were included. Four trials on the use of FUS in dystonia were also found on ClinicalTrials.gov, one of which was completed in December 2013. All included studies showed evidence of symptomatic improvement, mostly in focal hand dystonia; improvements were also found in dystonia-associated tremor, cervicobrachial dystonia, and dystonia-associated chronic neuropathic painas well as PD-related dystonia. Reported complications included transient neurological deficits and persistent arm pain in one study. However, the evidence is limited to level-4 case series at present. MRgFUS is an emerging modality that appears to be safe and effective, particularly in focal hand dystonia, without major adverse effects. However, the quality of evidence is low at present, and long-term outcomes are unknown. High-quality prospective studies comparing MRgFUS to other surgical techniques will be useful in determining its role in the management of dystonia.

Bisphosphonate treatment for skeletal complications in paediatric cancer-Experience from a single tertiary centre.

The aim was to analyse the use and safety of bisphosphonate treatment for metabolic bone complications in paediatric cancer patients. We retrospectively describe our experience with bisphosphonate treatment in 25 childhood cancer patients (aged <18 years) in a single tertiary hospital between 1999 and 2020. The most common primary diagnosis was acute lymphoblastic leukaemia (n = 16) and Hodgkin lymphoma (n = 3). Eleven patients (44%) had received allogeneic stem cell transplantation and two patients autologous stem cell transplantation. Sixteen patients (64%) had been treated with radiotherapy, either total-body (n = 11) or local (n = 5). The main indication for bisphosphonates was osteoporosis with vertebral compression fractures in 13/25, osteonecrosis in 6/25 and hypercalcaemia in 2/25. The bisphosphonate treatment was started on average 13 (range 0-76) months after the diagnosis of the bone complication. Bisphosphonate treatment lasted between weeks (hypercalcaemia) to 5 years (severe osteoporosis). Mild, non-symptomatic hypophosphatemia (n = 8), hypocalcaemia (n = 6) and moderate, transient pain (n = 6) were the most common adverse effects. No severe side effects were observed even when bisphosphonates were administered concomitantly with chemotherapy. Bone mineral density significantly improved with the bisphosphonate treatment (mean lumbar spine Z-score -1.17 vs. -0.07, p < 0.001). Bisphosphonate treatment was well tolerated in this paediatric patient cohort.