OBJECTIVE: To assess the importance of appropriate opioid administration methods according to nociceptive monitoring.
METHODS: We conducted a randomized controlled trial involving 54 patients who underwent robot-assisted laparoscopic radical prostatectomy at our hospital. Patients were randomly allocated to either receive nociception level (NOL)-directed intraoperative opioid management with a minimum flow of remifentanil (NOL group) or conventional intraoperative analgesic management (control group). The primary outcome was the mean intraoperative remifentanil infusion flow rate (intraoperative remifentanil usage [μg]/ideal body weight [kg]/operation time [min]). The main secondary outcomes were plasma concentrations of three perioperative inflammatory biomarkers (interleukin-6, C-reactive protein [CRP], and cortisol levels) and postoperative pain (Numeric Rating Scale [NRS]) scores 2 h postoperatively and on postoperative days 1, 2, 3, and 7.
RESULTS: Compared with standard analgesia management, NOL-directed analgesic management reduced remifentanil consumption by 20% ( - 0.038; 95% confidence interval, - 0.059 to - 0.017; p = 0.0007). NOL-directed management did not lead to an increase in IL-6, CRP, or cortisol levels compared with conventional analgesic management. Furthermore, this protocol led to improvements in the NRS scores at rest 2 h postoperatively and upon movement up to postoperative day 3.
CONCLUSIONS: NOL-directed analgesic management reduced remifentanil consumption by 20% and the NRS scores at rest 2 h postoperatively and upon movement up to postoperative day 3 without an increase in inflammatory marker levels.
UNASSIGNED: Japan Registry of Clinical Trials, JRCTs052220034.

BACKGROUND: The presence of psychiatric comorbidity in some neurological disorders is common. A bi-directional influence between some psychiatric and neurological disorders has been discussed, but not widely studied. There is an absence of literature on the typology and rates of neurology consultations in different types of psychiatric inpatients.
METHODS: Cross-sectional study based on real world data on patients who had a neurological consultation during hospitalization on a psychiatric ward.
RESULTS: The most frequent reasons for visits to neurologists in our study were cluster \'Epilepsy/other types of non-epileptic seizures\' (n = 177, 36.44%), followed by cluster \'Movement disorders\' (n = 77, 20.48%), \'Cognitive disorder\' (n = 69, 18.35%), and finally cluster \'Neuropathy\' (n = 21, 5.59%). The most frequent type of psychiatric patient who required neurologic consultation presented a psychotic disorder (n = 100, 26.60%), follow by problem behavior (n = 82, 21.81%), bipolar disorder (n = 78, 20.78%), depressive disorder (n = 42, 11.17%) and autism spectrum disorder (n = 20, 5.32%). We found a statistically significant relationship between (problem behavior and intellectual disability) and neurologic consultation for epilepsy/other types of non-epileptic seizures, and between (depressive disorder, bipolar disorder, autism spectrum disorder and intellectual disability) and neurologic consultation for movement disorders.
CONCLUSIONS: This is the first study in the literature which analyzes the rates and typology of neurologic consultations in people hospitalized with psychiatric disorders. A deep knowledge of epilepsy, movement disorders and cognitive disorders should be required for health professionals to treat psychiatric inpatients appropriately. Patients with particular psychiatric disorders seem to require a higher number of neurologic consultations than others during their hospitalization.
BACKGROUND: Comorbilidad neurológica en pacientes psiquiátricos ingresados: evidencia sobre interconsultas de neurología en un centro español.
Introducción. La presencia de comorbilidad psiquiátrica en algunos trastornos neurológicos es frecuente. Se ha discutido sobre una influencia bidireccional entre algunos trastornos psiquiátricos y neurológicos, pero este hecho no se ha estudiado ampliamente. Existe escasa información en la bibliografía sobre la tipología y la prevalencia de las interconsultas de neurología en los diferentes tipos de pacientes psiquiátricos hospitalizados. Materiales y métodos. Estudio transversal basado en datos reales sobre pacientes que necesitaron una interconsulta de neurología durante su hospitalización en salud mental. Resultados. Los motivos más frecuentes que requirieron una interconsulta de neurología en nuestro estudio fueron el clúster ‘Epilepsia/otros tipos de crisis no epilépticas’ (n = 177; 36,44%), seguido del clúster ‘Trastornos del movimiento’ (n = 77; 20,48%), el clúster ‘Trastorno cognitivo’ (n = 69; 18,35%) y, por último, el clúster ‘Neuropatía’ (n = 21; 5,9%). El tipo más frecuente de paciente psiquiátrico que requirió consulta neurológica presentó un trastorno psicótico (n = 100; 26,6%), seguido de problemas de conducta (n = 82; 21,81%), trastorno bipolar (n = 78; 20,78%), trastorno depresivo (n = 42; 11,17%) y trastorno del espectro autista (n = 20; 5,32%). Se encontró una relación estadísticamente significativa entre problemas de conducta y discapacidad intelectual e interconsulta de neurología por epilepsia/otros tipos de crisis no epilépticas, y entre trastorno depresivo, trastorno bipolar, trastorno del espectro autista y discapacidad intelectual e interconsulta de neurología por trastornos del movimiento. Conclusiones. Éste es el primer estudio en la bibliografía que analiza la frecuencia y la tipología de las interconsultas de neurología en personas hospitalizadas con trastornos psiquiátricos. Debe requerirse a los profesionales que traten a pacientes de salud mental hospitalizados un conocimiento profundo en epilepsia, trastornos del movimiento y trastornos cognitivos. Algunos pacientes con determinados trastornos psiquiátricos parecen necesitar un mayor número de interconsultas de neurología que otros durante su hospitalización.

BACKGROUND: Dental radiography is an integral part of intraoral evaluation. Children are often uncomfortable during the placement of film or sensor due to the impingement of the soft tissues. Thus, the perception of pain with three intraoral radiographic methods in children was evaluated using three subjective pain rating scales.
OBJECTIVE: To evaluate the discomfort with three different techniques, that is, intraoral periapical (IOPA) radiograph, charge-coupled device (CCD), and photostimulable phosphor (PSP) luminescence (PSPL), using the Wong-Baker Faces Pain Rating Scale (WBFPRS), numerical rating scale, and visual analog scale (VAS).
METHODS: A sample of 35 children aged 6-12 years were divided into two groups: group 1 (6-8 years) and group 2 (9-12 years). For each child, simulations of the three radiological methods (IOPA, CCD, and PSPL) were performed. The meaning of each facial expression on the WBFPRS, VAS, and the numbers on the numerical rating scale was explained to each child before the procedure.
METHODS: A one-way analysis of variance (ANOVA) test and paired-samples t-test are used.
RESULTS: The results revealed that the CCD sensors elicited higher pain scores than those obtained with IOPA and PSPL, whereas the IOPA film showed the least pain score. Higher score values were obtained in group 1 than in group 2, indicating that children aged 6-8 years felt higher discomfort than the 9- to 12-year age group for the same procedure. This difference was statistically significant (P < 0.001).
CONCLUSIONS: It was concluded that conventional IOPA films were tolerated better by children when compared to PSP plates and CCD sensors.

OBJECTIVE: Compare the efficacy of 2% lidocaine with adrenaline (1:200,000) and 4% articaine with adrenaline (1:100,000) in inferior alveolar nerve block prior to extraction of bilateral teeth posterior to canine in interval of one week.
METHODS: Thirty-five patients were selected for the study. Patients were divided into two different groups: Group 1 - (2% lignocaine with adrenaline (1:200,000)) and Group 2 - (4% articaine with adrenaline (1:100,000)) solution. The study variables for each anaesthetic agent were: onset of action and depth of anaesthesia. A pulp tester was used to demonstrate quantitative values and a visual analogue scale (VAS) was used for qualitative evaluation of the two anaesthetic drugs in 2 min cycle for 10 min with respect to test canine. Anaesthesia was considered successful when pulp tester value 64 was achieved in 10 min for both the anaesthetic agent.
METHODS: The difference in the efficacy of lignocaine and articaine was analysed using Student\'s t test. Within group comparison of the response to the pulp vitality test and VAS over various time periods was analysed using repeated measures Analysis of Variance (ANOVA) with post-hoc Bonferroni test.
RESULTS: Data analysis showed statistical differences in onset and depth of anaesthesia between the two groups (P < 0.05).
CONCLUSIONS: 4% Articaine with adrenaline (1:100,000) onset of action is faster and depth of anaesthesia is better compared to 2% lignocaine with adrenaline (1:200,000). Many previous studies reported onset of anaesthesia, but this study evaluates onset and depth of both the anaesthetic agent quantitatively and qualitatively.

OBJECTIVE: To comparatively evaluate the effect of normal saline gel and ozonated saline-ozonated gel (ozone therapy) on pain, inflammation, soft tissue, and crestal bone loss in dental implant surgery.
METHODS: Forty adult patients scheduled to undergo implant were randomized into two groups: Twenty patients (n = 20) received ozone therapy and controls (n = 20) received normal saline and gel during implant placement. Inflammation and pain were noted at days 1 and 7 and 3 month intervals by estimating C-reactive protein (CRP) levels and assessing visual analogue scale (VAS) scores. At 3 months, soft tissue outcomes were noted in terms of plaque index, gingival index, and pocket depth, while crestal bone loss was noted via a radiograph.
RESULTS: Mean CRP levels were significantly higher in the control group as compared to that in the case group on day 1 and day 7 follow-ups (P < 0.05). Mean VAS scores for pain were also lower in the case group as compared to the control group at all follow-ups, but the difference was significant statistically only at day 1 (P = 0.061). The plaque index was significantly lower in the case group as compared to the control group (P = 0.011) at final follow-up. No significant difference between two groups was observed for crestal bone loss.
CONCLUSIONS: Ozone therapy during implant placement was effective in reduction of pain, systemic inflammation, and plaque deposition in dental implant patients.

OBJECTIVE: To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN).
METHODS: Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3-4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score - 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI).
RESULTS: Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group (p<0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months (p<0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group (p<0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain.
CONCLUSIONS: Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.
UNASSIGNED: Определение распространенности инсомнии и эффективности ее коррекции у пациентов с болевой формой диабетической полинейропатии (ДПН).
UNASSIGNED: Пятьдесят пациентов с болевой формой ДПН случайным образом разделены на 2 группы: группу стандартной (СТ) и группу расширенной (РТ) терапии. В группе СТ проводилось однократное занятие по гигиене сна, в группе РТ — 3—4 очных индивидуальных сессии по коррекции инсомнии в течение 2 нед. Обеим группам проведено анкетирование на момент госпитализации, через 3 и 6 мес. Оценка выраженности полинейропатии и характера нейропатических болей проводилась с помощью шкалы нейропатических нарушений в ногах (NIS-LL) и шкалы общей оценки симптомов нейропатии (NTSS-9); интенсивность болевого синдрома оценивалась с помощью Визуальной аналоговой шкалы (ВАШ). Анализ нарушений сна проводился с использованием Питтсбургского индекса качества сна (PSQI) и Индекса тяжести инсомнии (ISI).
UNASSIGNED: У 82% пациентов при первичном опросе имелись нарушения сна различной степени выраженности. В обеих группах на фоне лечения отмечалось улучшение качества сна в динамике, однако достоверно лучшие результаты отмечены в группе РТ: для группы СТ балл по шкале ISI через 6 мес составил 7,15±2,08, для группы РТ — 3,07±2,49 (p<0,0001). В группе СТ значимого снижения интенсивности болевого синдрома и выраженности полинейропатии в динамике обнаружено не было. В группе РТ обнаружено статистически значимое снижение баллов по шкалам NTSS-9 и ВАШ при первичном опросе и через 6 мес (p<0,0001). Интенсивность болевого синдрома также достоверно снизилась в группе РТ в сравнении с группой СТ (p<0,0001) по окончании наблюдения, что свидетельствует о значимости нормализации сна в лечении нейропатической боли.
UNASSIGNED: У большинства пациентов с болевой формой ДПН имеется инсомния. Коррекция инсомнии показала свою эффективность в рамках мультимодального подхода к лечению нейропатической боли при ДПН и повышению качества жизни пациентов.

UNASSIGNED: This study aimed to explore potential barriers and facilitators to the adoption of regular exercise practice in patients at risk of a recurrence of low back pain (LBP).
UNASSIGNED: Eleven patients, who recovered from a previous episode of LBP, participated in two focus groups. The semi-structured interview schedule was informed by the Behaviour Change Wheel and the Theoretical Domains Framework. Focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis was performed by two researchers independently.
UNASSIGNED: Eighteen barriers and 19 facilitators were identified. The most common barriers included \"lack of knowledge on how to manage a recurrence of LBP,\" \"lack of behavioural regulation strategies and having other priorities\" and \"lack of self-efficacy/confidence to practice exercise autonomously and deal with a new episode of LBP.\" \"Knowledge on exercise and recurrences,\" \"regular exercise habits,\" \"having specific behavioural regulation strategies,\" \"exercise practice with others,\" \"willingness to practice exercise and considering it a priority,\" and \"presence of positive emotions related with exercise practice\" were the most common facilitators.
UNASSIGNED: These findings will inform the development of a behaviour change-informed exercise intervention to promote regular exercise practice among patients at risk of a recurrence of LBP.
Exercise interventions are the most effective strategies to reduce the risk of a recurrence of LBP, but patients do not exercise regularly.Exercise interventions targeting specific determinants of behaviour change are needed to support the adoption of this practice.The findings of this study will allow the design of a health intervention to promote the adoption of regular exercise practice for people at risk of having a recurrence of LBP.Researchers, health professionals and policymakers should promote the implementation of evidence- based and theory-driven interventions for the secondary prevention of LBP to reduce its burden on health systems.

Eagle\'s syndrome is a condition characterized by an elongated styloid process or a calcified stylohyoid ligament, which can lead to a plethora of symptoms, such as neck and facial pain upon movement, dysphagia, pharyngeal foreign body sensation, headache, and vertigo-like sensations. This pathology may affect one or both of a patient\'s styloid processes (unilateral or bilateral), with most of these cases going undiagnosed due to the vague nature of their symptoms. Nonetheless, the diagnosis of Eagle\'s syndrome must derive from the combined findings of both clinical examination and radiographic imaging. Symptomatic patients may require conservative or surgical treatment.

Genomic sequence of HLA-DPA1*01:03:01:73, -DPA1*01:03:01:80, DPA1*01:03:01:82, -DPA1*01:155:01:02, -DPA1*02:02:02:16 alleles in Spanish individuals.

This study compared the number of postural shifts and perceived discomfort while leaning and sitting on an air-filled seat cushion for 1 hour. Sixty office workers typed a standard text while leaning on a cushion placed behind the low back, sitting on a cushion placed under the buttocks, and sitting without a cushion (a control condition). The number of postural shifts was collected using a seat pressure mat device. Low back discomfort was assessed using the Borg CR-10 scale. Leaning on a seat cushion (22 shifts/h) led to a significantly higher number of postural shifts than sitting on a seat cushion (18 shifts/h) and the control condition (20 shifts/h). Leaning or sitting on a seat cushion significantly decreased low back discomfort compared to the control condition (p < 0.05). Leaning on a seat cushion placed behind the low back may be an effective means of preventing low back pain among office workers.
During prolonged sitting, using a seat cushion, whether leaning or sitting on it, may be more efficient in preventing low back pain compared to not using one. Particularly, leaning on a seat cushion led to more postural shifts during sitting compared to sitting on one or not using any.