Assessing pain intensity with the visual analog scale: a plea for uniformity

Gel instillation sonohysterography (GIS) using Endosgel versus ExEmgel, comparison of pain and image quality and cost benefit analysis: A double blind randomised controlled trial. GISPAIN trial

INTRODUCTION

Pain experience, physical reaction, image quality and adverse events during Gel Instillation Sonohysterography (GIS) can differ using gels with different compositions. As a result, patient satisfaction can also be affected. The effect of two instillation gels, Endosgel versus ExEmgel, using both the Visual Analogue Scale (VAS) and a Continuous Pain Score Meter (CPSM) was therefore compared.

METHODS

This single centre double blind randomised controlled trial included 80 women planned for outpatient GIS, diagnosed with abnormal intrauterine bleeding or fertility disorders and suspicion on an intrauterine abnormality. Patients were randomly allocated to the instillation of Endosgel containing chlorhexidine or ExEmgel without chlorhexidine. Primary outcome was reported pain during the procedure using VAS. Secondary outcomes included pain score measured using CPSM, satisfaction to the procedure and preference at 3 weeks and 3 months after the procedure and image quality. A cost benefit analysis was also performed.

RESULTS

The reported median VAS concerning pain during gel instillation was comparable in the Endosgel and ExEmgel group, 2.50 (IQR 0.00-5.00) and 2.00 (IQR 0.00-5.75) respectively (p = 0.69). The median VAS of the entire procedure was also similar: both 2.00 (IQR 0.00-5.00) (p = 0.86). CPSM-scores were not significantly different either. Both groups were similar in image quality (p = 0.83) and patient's satisfaction (p = 0.36).

CONCLUSION

Concerning the pain experienced during a GIS procedure and patients' satisfaction, the ExEmgel was not proven to be superior to the Endosgel. Our advice is to use the gel that is available at the lowest costs, as the image quality is the same for both Endosgel and ExEmgel.

Five days of inpatient scoliosis-specific exercises improve preoperative spinal flexibility and facilitate curve correction of patients with rigid idiopathic scoliosis

Preoperative spine flexibility plays a key role in the intraoperative treatment course of severe scoliosis. In this cohort study, we examined the effects of 5 day inpatient scoliosis-specific exercise (SSE) on the spinal flexibility of patients with adolescent idiopathic scoliosis before surgery. A total of 65 patients were analyzed. These patients were divided into a prospective cohort (n = 43, age: 15 ± 1.6 years, 36 girls and 7 boys, Lenke class 1 and 2, Cobb angle: 64 ± 11°) who underwent spinal fusion in 2020, and a retrospective cohort (n = 22, age: 15 ± 1.5 years, 17 girls and 5 boys, Lenke class 1 or 2, Cobb angle: 63 ± 10°), who underwent surgery between 2018 and 2019 and did not receive preoperative SSE. Rigid scoliosis was defined as a reduction of less than 50% in Cobb angle between the preoperative fulcrum bending and initial standing curve magnitude. In the prospective cohort, 21 patients (Cobb angle: 65 ± 11°) presented with rigid thoracic scoliosis (pre-SSE fulcrum bending: 40 ± 9°, 39% reduction), and therefore received 5-day SSE to improve their preoperative spinal flexibility (SSE group), whereas 22 patients (Cobb angle: 63 ± 12°) presented with flexible thoracic scoliosis (pre-SSE fulcrum bending: 27 ± 8°, 58% reduction), and therefore underwent surgery without preoperative SSE (non-SSE group). For patients who received 5-day preoperative SSE for 4 h every day, the International Schroth Three-Dimensional Scoliosis Therapy technique was implemented with an inpatient model. After 5 days of SSE, improvements in Cobb angle with post-SSE fulcrum-bending radiography (23 ± 7°, 66% reduction) and pulmonary function (forced expiratory volume in 1 s/forced expiratory volume: 87% before SSE and 92% after SSE, p < 0.01) were observed. At the postoperative day 5, the degree of scoliosis had reduced from 44 ± 6.6° to 22 ± 6° in the SSE group, which is 1° less than the Cobb angle obtained on post-SSE fulcrum-bending radiography. In the non-SSE group, the degree of scoliosis decreased to 26 ± 5.7°. In the retrospective cohort, the degree of scoliosis decreased to 35 ± 5°, with the group also having higher postoperative pain (Visual Analog Scale score = 7, range = 5-10) and an extended hospitalization duration (11 ± 3 days). At 2-year follow-up, curve correction was found to be maintained without adding-on or proximal junctional kyphosis. Compared with the non-SSE group, the SSE group exhibited a greater curve correction (66%) with a shorter hospitalization duration (5 ± 1 days) and a lower degree of postoperative pain (Visual Analog Scale score = 4, range = 3-8). Taken together, our findings indicate that 5 day SSE improves preoperative spinal flexibility and facilitates curve correction.

Hexasodium fytate for the treatment of calciphylaxis: a randomised, double-blind, phase 3, placebo-controlled trial with an open-label extension

Background

In the CALCIPHYX trial, we investigated hexasodium fytate, an inhibitor of vascular calcification, for the treatment of calcific uraemic arteriolopathy (calciphylaxis), a rare condition characterised by painful, non-healing skin lesions.

Methods

In this international, phase 3, randomised, double-blind, placebo-controlled trial, adults with an ulcerated calciphylaxis lesion and pain visual analogue scale (VAS) score ≥50/100 were randomised 1:1 to hexasodium fytate 7 mg/kg or placebo intravenously during maintenance haemodialysis. Primary efficacy outcomes were an 8-item modification of the Bates-Jensen Wound Assessment Tool (BWAT-CUA) and Pain VAS in the intention-to-treat population. ClinicalTrials.gov number: NCT04195906.

Findings

Overall, 34/37 patients randomised to hexasodium fytate and 26/34 patients randomised to placebo completed the 12-week randomised treatment period. At Week 12, both groups (hexasodium fytate versus placebo) showed similar improvements in BWAT-CUA (mean [standard deviation (SD)], -5.3 [5.2] versus -6.0 [6.2]; least squares mean difference, 0.3 [96% confidence interval (CI): -2.5, 3.0]; p = 0.88) and Pain VAS (mean [SD], -19.5 [26.9] versus -32.2 [38.5]; least squares mean difference, 11.5 [96% CI: -4.8, 27.8]; p = 0.15). One patient randomised to placebo briefly received hexasodium fytate in error. Serious adverse events through Week 12 included: calciphylaxis-related events leading to hospitalisation (2/38 [5%] versus 11/33 [33%]) and death (1/38 [3%] versus 5/33 [15%]). During the subsequent 12 weeks of open-label hexasodium fytate and 4 weeks of follow-up, there were no additional calciphylaxis-related events leading to hospitalisation. Over the course of the entire trial, deaths were 2/38 [5%] for the hexasodium fytate group and 7/33 [21%] for the placebo group.

Interpretation

In patients with calciphylaxis, BWAT-CUA and Pain VAS improved similarly in hexasodium fytate- and placebo-treated patients; over the course of the entire trial, there were fewer deaths and calciphylaxis-related events leading to hospitalisation in the hexasodium fytate group.

Funding

Funded by Sanifit, a CSL Vifor company.

Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in laparoscopic cholecystectomy in a middle-income country

BACKGROUND

Laparoscopic cholecystectomy is known for its minimally invasive nature, but postoperative pain management remains challenging. Despite the enhanced recovery after surgery (ERAS) protocol, regional analgesic techniques like modified perichondral approach to thoracoabdominal nerve block (M-TAPA) show promise. Our retrospective study evaluates M-TAPA's efficacy in postoperative pain control for laparoscopic cholecystectomy in a middle-income country.

METHODS

This was a retrospective case-control study of laparoscopic cholecystectomy patients at Hospital General de Mexico in which patients were allocated to the M-TAPA or control group. The data included demographic information, intraoperative variables, and postoperative pain scores. M-TAPA blocks were administered presurgery.

OUTCOMES

opioid consumption, pain intensity, adverse effects, and time to rescue analgesia. Analysis of variance (ANOVA) compared total opioid consumption between groups, while Student's t test compared pain intensity and time until the first request for rescue analgesia.

RESULTS

Among the 56 patients, those in the M-TAPA group had longer surgical and anesthetic times (p < 0.001), higher ASA 3 scores (25% vs. 3.12%, p = 0.010), and reduced opioid consumption (p < 0.001). The M-TAPA group exhibited lower postoperative pain scores (p < 0.001), a lower need for rescue analgesia (p = 0.010), and a lower incidence of nausea/vomiting (p = 0.010).

CONCLUSION

Bilateral M-TAPA offers effective postoperative pain control after laparoscopic cholecystectomy, especially in middle-income countries, by reducing opioid use and enhancing recovery.

The Role of Bone Edema in Plantar Fasciitis Treated with Temperature-Controlled High-Energy Adjustable Multi-Mode Emission Laser (THEAL) and Exercise: A Prospective Randomized Clinical Trial

Plantar fasciitis is one of the most common causes of foot pain; in 35% of cases, it is also associated with bone edema of the heel. The aim of this study was to investigate the relationship between bone edema and the outcomes of temperature-controlled high-energy adjustable multi-mode emission laser (THEAL) and/or exercises in patients with plantar fasciitis. A prospective randomized clinical trial was designed, in which 48 patients suffering from plantar fasciitis, with or without bone edema, were treated with temperature-controlled high-energy adjustable multi-mode emission laser and exercises (the laser group) or with exercises only (the control group). The patients were evaluated at recruitment (T0) and at 2 (T1) and 6 months (T2), monitoring pain (with the Visual Analogue Scale), functionality (with the Foot Function Index), perception of improvement (with the Roles and Maudsley Score), and fascia thickness (with ultrasound examination). In both groups, there was a significant improvement in pain, functional recovery, perception of remission, and a reduction in plantar fascia thickness at T1 and T2. The laser group presented statistically better values at T2 for the Roles and Maudsley Score (z: 2.21; 0.027). The regression analysis showed that a greater reduction in fascia thickness occurred in the laser group (p-value: 0.047). In conclusion, the two conservative treatments were effective in patients suffering from plantar fasciitis, even in the presence of bone edema, but with lesser results.

Ultrasound-Guided Vs Non-Guided Prolotherapy for Internal Derangement of Temporomandibular Joint. A Randomized Clinical Trial

OBJECTIVES

This randomized clinical trial study aims to compare ultrasound-guided versus non-guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ).

MATERIAL AND METHODS

The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non-guided and ultrasound (US)-guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre-injection, 1-, 2-, and 6-months postinjection.

RESULTS

Twenty-two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non-guided group and 24.3 ± 6.9 for the US-guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups.

CONCLUSION

Intra-articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US-guided and non-guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture.

Effectiveness of a Teach-Back Education Program on Perioperative Pain in Patients With Lung Cancer: An Intervention Study Using Behavior Change Wheel

OBJECTIVE

To assess the effect of a teach-back educational intervention using Behavior Change Wheel (BCW) framework on perioperative pain among patients with lung cancer.

METHODS

A prospective quasi-experimental study was conducted in 88 patients with lung cancer from a tertiary hospital in China. According to the order of admission, they were allocated to either control group or intervention group, with 44 patients in each group. Patients in the control group received routine nursing care, while patients in the intervention group were given a teach-back education program based on BCW framework. The visual analog scale (VAS) was adopted to evaluate patients' pain on the day of surgery (T0), 1 (T1), 2 (T2), and 3 (T3) days after surgery. We also recorded the use of patient-controlled analgesia (PCA), the length of hospital stay, and the degree of patients' satisfaction.

RESULTS

Rest pain, pain when coughing, and pain during activity that patients in the intervention group experienced were significantly less severe than those in the control group on T0 and T1. The pain when coughing in the intervention group was also significantly milder on T2 and T3. In addition, the number of self-control time, use duration, and total dose of PCA were significantly lower in the intervention group. Moreover, patients' satisfaction of nursing service was significantly higher in the intervention group.

CONCLUSION

A teach-back education program based on BCW framework was effective in pain management among the perioperative patients with lung cancer. This study demonstrates the application of teach-back method and the BCW in the development of patient education intervention to mitigate perioperative pain.

Smart Use of Skin Biopsy Punch in Treating Keloids: A Single-Center Retrospective Study

BACKGROUND

Treatment of scarring has long been a problem due to high incidence and recurrence. Despite many existing treatment therapies, the efficacy remains unstable.

OBJECTIVES

To determine the efficacy and safety of skin biopsy punch in combination with corticosteroid injection (BPCI) in treating keloids.

APPROACH

This was a retrospective study. In total, 16 patients with keloids received BPCI. Changes in scar appearance, accompanied symptoms, and Vancouver Scar Scale (VSS) were analyzed. Patient satisfaction, VAS scores, and adverse effects were also evaluated.

RESULTS

Scar appearance, accompanied symptoms, and VSS scores improved significantly after the treatment. The total effective rate was 93.75% at an 18-month follow-up on average. The mean reduction rate of VSS score was 58.44% (p < 0.0001), especially in height and pliability (84.44% and 78.19%, p < 0.0001). The recurrence rate in this study was 12.5% (n = 2) at an 18-month follow-up on average. Mild adverse effects of pain, pruritus, hypopigmentation, and telangiectasia were recorded.

CONCLUSIONS

This study demonstrated BPCI might be an effective and safe therapy in keloids with a low long-time recurrence rate and well tolerance for patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Role of Mitochondria in Statin-Induced Myopathy

Statins represent the primary therapy for combatting hypercholesterolemia and reducing mortality from cardiovascular events. Despite their pleiotropic effects in lowering cholesterol synthesis, circulating cholesterol, as well as reducing the risk of other systemic diseases, statins have adverse events in a small, but significant, population of treated patients. The most prominent of these adverse effects is statin-induced myopathy, which lacks precise definition but is characterised by elevations in the muscle enzyme creatine kinase alongside musculoskeletal complaints, including pain, weakness and fatigue. The exact aetiology of statin-induced myopathy remains to be elucidated, although impaired mitochondrial function is thought to be an important underlying cause. This may result from or be the consequence of several factors including statin-induced inhibition of coenzyme Q10 (CoQ10) biosynthesis, impaired Ca2+ signalling and modified reactive oxygen species (ROS) generation. The purpose of this review article is to provide an update on the information available linking statin therapy with mitochondrial dysfunction and to outline any mechanistic insights, which may be beneficial in the future treatment of myopathic adverse events.

Comparison of the Short-Term Effect between Iontophoresis and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial

Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients' symptoms.

METHODS

A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study.

RESULTS

Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8-1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001).

CONCLUSIONS

The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period.

Factors Associated with Symptom Resolution after Aerobic Exercise Intervention in Adolescent and Young Adults with Concussion

BACKGROUND

Aerobic exercise facilitates postconcussion symptom resolution at the group level, but patient-level characteristics may affect the likelihood of treatment efficacy.

PURPOSE

This study aimed to investigate demographic and clinical characteristics, which differentiate postconcussion aerobic exercise treatment efficacy from nonefficacy in the intervention arm of a randomized clinical trial.

METHODS

Adolescent and young adult participants initiated a standardized aerobic exercise intervention within 14 d of concussion, consisting of self-selected exercise for 100 min·wk -1 at an individualized heart rate (80% of heart rate induced symptom exacerbation during graded exercise testing). Treatment efficacy was defined as symptom resolution within 28-d postconcussion. Treatment efficacy and nonefficacy groups were compared on demographics, clinical characteristics, intervention adherence, and persistent symptom risk using the Predicting Persistent Postconcussive Problems in Pediatrics (5P) clinical risk score.

RESULTS

A total of 27 participants (16.1 ± 2.3 yr old; range, 11-21 yr; 52% female) began the intervention, with a mean of 9.5 ± 3.7 d after concussion; half ( n = 13; 48%) demonstrated treatment efficacy (symptom resolution within 28 d postconcussion). Those whose symptoms resolved within 28 d had significantly lower preintervention postconcussion symptom inventory scores (21.2 ± 13.2 vs 41.4 ± 22.2; P < 0.01), greater adherence to the intervention (77% vs 36%; P = 0.05), and longer average exercise duration (median [interquartile range], 49.7 [36.8-68.6] vs 30.4 [20.7-34.7] min; P < 0.01) than those whose symptoms lasted more than 28 d. Groups were similar in age, sex, timing of intervention, and preintervention 5P risk score.

CONCLUSIONS

A standardized aerobic exercise intervention initiated within 14 d of concussion demonstrated efficacy for approximately half of participants, according to our definition of treatment efficacy. This multisite aerobic exercise intervention suggests that lower symptom severity, higher intervention adherence, and greater exercise duration are factors that increase the likelihood of symptoms resolving within 28 d of concussion.

Relationship between 25-Hydroxyvitamin D3 Levels with Pain Intensity and Duration of Labor Stages in Primiparous Women

Background

Prolonged labor is associated with various maternal and neonatal complications. This study aims to investigate the relationship between 25-hydroxyvitamin D3 levels and pain intensity and duration of labor stages in primiparous women.

Materials and Methods

This cross-sectional study was conducted in Iran from November 2021 to January 2022 and comprised primiparous women who were in active labor after a term pregnancy (37-42 weeks). Five milliliter of blood was taken from each subject and centrifuged for the measurement of vitamin D level using the enzyme-linked immunosorbent assay method. The High-Performance Liquid Chromatography (HLPC) method was used to measure 25-OH vitamin D. In addition, through history, examination, and investigations, the subjects were evaluated according to the pain intensity and duration of the first (active phase) and second stages of labor.

Results

The results of the Pearson correlation test indicated a significant relationship between vitamin D and active phase duration (r = 0.64, p = 0.012), second stage duration (r = 0.73, p = 0.001), pain intensity of the active phase (r = 0.61, p = 0.022), and pain intensity of the second stage (r = 0.65, p = 0.026). According to the analysis of variance table, based on vitamin D, there were statistically significant differences between the groups in terms of the active phase duration, second stage duration, pain intensity of the active phase, and that of the second stage of labor (p < 0.05).

Conclusions

Low levels of vitamin D may influence the progress of labor and increase the rate of prolonged labor.

Is temporomandibular joint involvement more frequent in patients with epilepsy? A clinical study

STATEMENT OF PROBLEM

Epileptic seizures may affect the stomatognathic system via transmission of an increased load to the dentition and the temporomandibular joint (TMJ), resulting in temporomandibular joint dysfunction (TMD).

PURPOSE

The purpose of this clinical study was to assess whether TMD was more prevalent in patients with epilepsy than in those without epilepsy.

MATERIAL AND METHODS

A total of 107 participants diagnosed with epilepsy and 100 healthy controls were enrolled in the study. Those with epilepsy were divided according to their dental manageability into 3 subgroups: mild group, moderate group, and severe group. Following general, dental, and TMJ-related history, the range of maximal mouth opening (MMO), laterotrusion, possible deviation and deflection, and presence of crepitation and clicking was recorded, as suggested by the diagnostic criteria for temporomandibular diseases (DC/TMD). Pressure pain threshold (PPT) was also measured by using a pressure algometer on 3 points bilaterally.

RESULTS

Incidence of TMJ complaints was not significantly different between the control (30%) and the group diagnosed with epilepsy (33%); however, the number of complaints experienced was significantly higher in the epilepsy group (C: 3%, E: 16% had 3 or more complaints; P<.001). Joint clicking was significantly more prevalent in the entire epilepsy group (P=.012) and in the mild group (P=.004) than in controls. Crepitation and joint pain were not significantly more common in the epilepsy group. Maximal mouth opening, laterotrusion, and the ratio of restricted mouth opening did not differ significantly in the epilepsy group. Deflection occurred significantly more often in the epilepsy subgroups (mild and moderate groups; P<.001), and the extent of deflection was also significantly higher in all the epilepsy subgroups (P<.001) than in controls. Regarding the pressure pain threshold, significant difference was observed in the severe group at the left masseter muscle points M1 (P=.046) and M2 (P=.028) compared with controls.

CONCLUSIONS

All parameters typical of TMD could be found frequently in patients with epilepsy. Because of the seizures and the consequent joint overload, the TMJ involvement was more common or more serious in those diagnosed with epilepsy. Outcomes of this study support the assumption that epilepsy is a risk factor for the development of TMD.

Network pharmacology-based strategy combined with molecular docking to explore the potential mechanism of agarwood against recurrent aphthous stomatitis

To explore the antiinflammatory mechanism of agarwood on recurrent aphthous stomatitis (RAS). RAS is the most common mucosal disease in the oral cavity. The clinical application of traditional Chinese medicine found that agarwood has significant curative effect on peptic ulcer, but the effect and mechanism of agarwood on RAS remain unclear. This study is intended to predict the potential antiinflammatory mechanisms by which agarwood acts on RAS through network pharmacology and molecular docking. TCMSP database was used to screen the active components of agarwood. RAS targets were screened in Genecards, DisGeNET, and OMIM database. Venny, an online tool, screens for interacting genes between the two. Cytoscape software was used to construct the gene regulation map of active compounds target of agarwood. String Database building protein-protein interaction network. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathways were enriched in DAVID database. The key active ingredients and core targets were further verified by molecular docking. There were 9 effective compounds and 186 target genes in agarwood; RAS has 793 target genes. There were 41 interacting genes between agarwood and RAS. Interleukin 6, tumor necrosis factor, interleukin 1 beta, and cellular component motif ligand 2 may be key targets. Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses predicted multiple pathways associated with RAS. Molecular docking results showed that the active compounds of agarwood combined well and stably with the target. The Chinese herbal medicine agarwood can relieve the inflammation of RAS through multiple targets and various ways. Its active compounds may be nominated as candidates for antiinflammatory drugs of RAS.

Occurrence of Cervical Spine Pain and Its Intensity in Young People with Temporomandibular Disorders

Background: The main aim of this cross-sectional study was to compare the occurrence and severity of cervical spine pain in young adults diagnosed with TMDs with a healthy control group (without TMDs). Methods: The study was conducted from June to July 2023. Inclusion criteria were age (18-30 years), cervical spine pain (for at least 1 month), and consent to participate in the study. The study was conducted based on RDC/TMD protocol, an original questionnaire, and a physiotherapeutic examination focused on detecting TMDs. The cervical pain level was assessed using the Visual Analogue Scale (VAS). Thus, a total of 95 subjects were registered for the trials, 51 people (53.7%) constituted the control group (without TMDs), while 44 (46.3%) people constituted the study group (with TMDs). Results: The mean age of people participating in the study was 22.2 ± 2.2 years in the study group and 22.5 ± 3.1 years in the control group. The largest group was people aged 21-25 (n = 51 people, 53.7%). Patients from the study group more often experienced pain in the stomatognathic system during palpation (both in the muscle, joint, and musculoskeletal groups) and had reduced mobility of the temporomandibular joints in every movement (p < 0.001). People from the study group were also characterized by less mobility of the cervical spine (p < 0.05), apart from extension movement (p > 0.05). The analysis showed that of the 95 people participating in the study, 85.4% reported problems in the cervical spine area (n = 81), of which almost all people in the study group struggled with this problem (n = 43, 97.7%). It was found that cervical spine pain was significantly more common in people with TMDs (p < 0.05, chi2 = 10.118, df = 1, rc = 0.31). The level of pain was significantly higher in people from the study group (p < 0.001, chi2 = 45.765, df = 4, rc = 0.57). Conclusions: Our research has shown that the occurrence of cervical spine pain is more common in the group of young people with temporomandibular disorders (TMDs). In young people, this problem is rarely recognized and properly treated.

Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol

INTRODUCTION

Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA.

METHODS AND ANALYSIS

This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment.

ETHICS AND DISSEMINATION

This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78).

TRIAL REGISTRATION NUMBER

ChiCTR2200065178.

Existing hip joint disease is associated with an increased incidence of hip fracture in adults: A retrospective survey of 9710 individuals from a single center

Objective

In hip disease patients, pain and movement restrictions might cause changes in bone strength and increase the likelihood of falls, finally leading to hip fracture. The aim of this study was to identify the incidence of, characteristics of and risk factors for hip fracture in patients with existing hip disease.

Methods

This was a retrospective cohort study. Patients with existing hip disease treated at both outpatient and inpatient departments of our institute were identified by searching the electronic medical record system and followed retrospectively for the occurrence of hip fracture. Demographic and clinical characteristics, such as age, sex and kind of primary hip disease, were collected from the electronic medical record system. The incidence and timing of hip fracture were estimated, and a Cox regression model was built to identify the independent risk factors for hip fracture in these patients.

Results

A total of 9710 eligible patients were included. After a mean follow-up of 3.97 years, hip fractures were identified in 95 patients, for an estimated incidence of hip fracture of 978.37 per 100,000 patients. The femoral neck was involved in 49 fractures (51.58 %), and the femoral trochanter was involved in 45 fractures (47.37 %). Four independent risk factors and one protective factor for hip fracture in patients with hip diseases were identified: age (HR = 1.116, 95 % CI = 1.094-1.138), the presence of osteonecrosis of the femoral head (HR = 2.201, 95 % CI = 1.217-3.980), a lower Harris hip score (HR = 0.966, 95 % CI = 0.949-0.982), a history of previous hip surgery (HR = 2.126, 95 % CI = 1.304-3.466) and the use of walking aids (HR = 0.588, 95 % CI = 0.354-0.975). A scoring system with a total score of 20 points was built, which included all of the above risk factors. The predictive scores for a low risk (estimated incidence of hip fracture ≤30 %), a moderate risk (estimated incidence of hip fracture 31 %-69 %), and a high risk (estimated incidence of hip fracture ≥70 %) of hip fracture were ≤8.5 points, 9.0-13.0 points and ≥13.5 points, respectively.

Conclusion

The incidence of hip fracture in the special population of patients with existing hip disease was determined. Elderly patients, patients with a history of hip surgery, patients with osteonecrosis and patients with poor Harris hip scores were at increased risk of hip fracture. In patients with a predictive score greater than 9 points, indicating a moderate to high risk of hip fracture, the use of a walking aid might reduce the risk of hip fracture.

Percutaneous calcium sulfate injection versus localized scrape bone grafting: clinical effect comparison in titanium elastic nail treatment of pathological fracture of proximal humerus caused by unicameral bone cysts in children

Objective

A retrospective study was conducted to compare the mid-term clinical efficacy between percutaneous calcium sulfate injection (PCSI) and localized scrape bone grafting (LSBG) in using titanium elastic nails treat humerus pathologic fractures caused by unicameral bone cysts in children.

Methods

Humerus pathologic fracture patients with unicameral bone cysts in our pediatric orthopedic department from January 2015 to January 2020 were retrospectively analyzed. Patients were divided into two groups, namely the PCSI group and the LSBG group, based on the type of bone grafting material they received. Preoperative assessments were made in both groups using the Cyst Index and Cyst activity. During the perioperative phase, assessments were made regarding operative time, bleeding, postoperative VAS scores, and the frequency of reoperation within 2 years. Clinical outcomes were evaluated using the Capanna scale at the last follow-up, and the occurrence of re-fractures during the follow-up period.

Results

A total of 22 patients were included, with a mean follow-up duration of 33.5 ± 5.8 months. No significant differences were found between the two groups in terms of Cyst Index and Cyst activity before the operation. The operative time, bleeding, and postoperative VAS scores in the PCSI group were found to be lower than those in the LSBG group (P < 0.05). The PCSI group also showed a higher frequency of reoperation within 2 years compared to the LSBG group (P < 0.05). However, no significant differences were observed between the two groups in terms of Capanna scale scores at the last follow-up and the incidence of re-fractures during follow-up.

Conclusions

Both titanium elastic nails (TEN) combined with PCSI or LSBG were found to be safe and effective treatments for humerus pathologic fractures caused by unicameral bone cysts in children. PCSI is considered as a less invasive option with shorter operative times, less bleeding, and reduced postoperative pain, although it comes with the risk of multiple injections. On the other hand, LSBG is considered as a more invasive option for the treatment of active bone cysts but is associated with a lower recurrence rate.

Neuropathic pain in patients with primary knee osteoarthritis: A cross-sectional study

INTRODUCTION

Neuropathic pain (NP) is believed to be a distinct subtype of pain associated with knee osteoarthritis (KO). This study aimed to determine the prevalence of NP in patients with primary KO and examine its correlation with various factors.

METHODS

A cross-sectional study was conducted on 195 patients with primary KO who did not have the following conditions: knee surgery, infection, rheumatic diseases, peripheral and central neurological diseases, patients who received treatment for neuropathic pain in the past 6 months, diabetes, renal failure, and alcoholism. NP was evaluated using two standardized questionnaires, the Douleur Neuropathique 4 questions (DN4) and the painDETECT questionnaire.

RESULTS

The majority of patients were female (87.5%), with a mean age of 59.15 ± 7.62 years. NP was detected in 55.9% of patients according to the DN4 questionnaire and in 50.7% of patients according to the painDETECT questionnaire. The DN4 score was positively correlated with age (p=0.041; rs=0.145), visual analogue scale (VAS)-pain at rest (p=0.009; rs=0.188), VAS-pain at movement (p=0.017; rs=0.173), Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain score (p=0.030; rs=0.157), WOMAC stiffness score (p=0.000; rs=0.253), physical function WOMAC score (p=0.000; rs=0.271), total WOMAC score (p=0.000; rs=0.305), Lequesne score (p=0.002; rs=0.221), and negatively correlated with quadriceps circumference (p=0.008; rs=-0.210). Whereas, the painDETECT score was positively correlated with VAS-pain at movement (p=0.002; rs=0.220), WOMAC stiffness score (p=0.043; rs=0.147), physical function WOMAC score (p=0.017; rs=0.172), and total WOMAC score (p=0.012; rs=0.182). NP according to the DN4 was associated with quadriceps circumference (p=0.01), while the painDETECT score was associated with VAS- pain at movement scores (p=0.022) and total WOMAC score (P=0.001).

CONCLUSION

This study found that NP is common among patients with primary KO and is associated with more painful pathology and functional impairment. These findings highlight the importance of recognizing and managing NP in this population to improve patient outcomes.

Reduced knee laxity and failure rate following anterior cruciate ligament reconstruction compared with repair for acute tears: a meta-analysis

BACKGROUND

Following anterior cruciate ligament (ACL) tears, both repair and reconstruction may be performed to restore joint biomechanics and proprioception. The present study compared joint laxity, patient-reported outcome measures (PROMs), and rate of failure following primary repair versus reconstruction for ACL ruptures.

METHODS

This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Google scholar, Embase, and Web of Science were accessed in September 2022. All the clinical investigations comparing repair versus reconstruction for primary ACL tears were accessed. Studies reporting data on multiple ligament injuries settings were not eligible.

RESULTS

Data from eight articles (708 procedures) were collected. The mean length of the follow-up was 67.3 ± 119.4 months. The mean age of the patients was 27.1 ± 5.7 years. Thirty-six percent (255 of 708 patients) were women. The mean body mass index (BMI) was 24.3 ± 1.1 kg/m². The mean time span from injury to surgery was 36.2 ± 32.3 months. There was comparability at baseline with regards to instrumental laxity, Lachman test, International Knee Document Committee (IKDC), and Tegner Scale (P > 0.1). Similarity between ACL reconstruction and repair was found in IKDC (P = 0.2) and visual analog scale (VAS) satisfaction (P = 0.7). The repair group demonstrated greater mean laxity (P = 0.0005) and greater rate of failure (P = 0.004).

CONCLUSION

ACL reconstruction may yield greater joint stability and lower rate of failure compared with surgical repair. Similarity was found in PROMs.

LEVEL OF EVIDENCE

III.

Comparison of self-rated pain and salivary alpha-amylase and cortisol levels during early stages of fixed orthodontic and clear aligner therapy

OBJECTIVES

To compare self-rated orthodontic pain (OP) and whole salivary alpha-amylase (αA) and cortisol levels (CL) during early stages of fixed orthodontic and clear aligner therapy (CAT).

METHODS

In groups 1 and 2, malocclusions were treated using fixed orthodontic appliances and CAT, respectively. In Group-3, individuals had normal occlusion and had never undergone orthodontic therapy. Self-rated OP was assessed using the visual-analogue-scale at baseline (T0); after 24-hours (T1) of appliance activation; and after 30 days (T2). Unstimulated whole saliva was collected and αA and CL were measured using enzyme-linked immunosorbent assay. p < .01 was considered statistically significant.

RESULTS

Twenty-four (Group-1), 24(Group-2) and 25 (Group-3) patients were included. In groups 1 and 2, participants had Class-I malocclusion with anterior-crowding in both arches. At baseline (T0) none of the participants reported pain on mastication. In groups 1 (p < .01) and 2 (p < .01), OP was higher at T1 than T2. In groups 1 and 2, αA and CL were higher at T1 (p < .01) than T0 and T2. At T1 and T2, salivary αA and CL were higher in groups 1 (p < .01) and 2 (p < .01) than Group-3. In groups 1 and 2, a significant correlation was recorded between OP and αA (p < .01) and CL (p < .01) at T1 interval.

CONCLUSION

Self-rated OP and salivary αA and CL during the early stages of fixed OT and CAT are similar. Whole salivary αA and CL and OP and are high during the first 24 hours of fixed OT and CAT activation.

Are There Differences in Pain Reduction and Functional Improvement Among Splint Alone, Steroid Alone, and Combination for the Treatment of Adults With Trigger Finger?

BACKGROUND

Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis.

QUESTION/PURPOSE

Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention?

METHODS

Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath. No patients were lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-to-treat analysis was performed with all 120 patients, and a per-protocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively.

RESULTS

There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses.

CONCLUSION

Splinting alone is recommended as the initial treatment for adults with trigger finger because there were no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting alone.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Effect of a gel containing green tea extract and hyaluronic acid on palate pain scores and wound healing after free gingival graft: a quasi-randomized controlled clinical trial

OBJECTIVES

The aim of this study was to evaluate the effect of a gel containing green tea extract and hyaluronic acid (HA) on pain scores and wound healing in donor sites after free gingival graft (FGG).

MATERIALS AND METHODS

Forty-two patients requiring FGG were included in three groups: (1) control group (n = 14), no material was placed in the donor area; only the clot was kept in position by sutures; (2) placebo group (n = 14), vehicle gel applied 3 times a day for 7 days; and (3) test group (n = 14), gel containing green tea extract and HA applied 3 times a day for 7 days. The wound size by clinical measurement (WS-CM) and photographic image (WS-PI), complete wound epithelialization (CWE), and palatal mucosa color were evaluated after 3 days and 1, 2, and 4 weeks postoperatively. The visual analog scale (VAS) for pain and analgesic consumption were used to assess participant's perception in the same postoperative periods.

RESULTS

A similar progressive reduction in the wound size, associated with an improvement in the color pattern, was observed in all groups (p > 0.05). No significant differences were found for CWE and pain assessment between the examined groups (p > 0.05).

CONCLUSION

The gel containing green tea extract and HA application in palatal wounds after FGG removal does not provide clinical healing benefits using this investigated protocol.

CLINICAL RELEVANCE

This is the first clinical study evaluating the effect of gel containing green tea extract and HA on the palate postoperative pain control and wound healing after FGG.

TRIAL REGISTRATION

http://clinicaltrials.gov : NCT05270161.

The impact of enhanced recovery after surgery on inflammatory indicators and prognosis related to complex appendicitis in children

Objective

To explore the application effect of enhanced recovery after surgery (ERAS) perioperative plan in the treatment of complex appendicitis in children, and further enrich the implementation plan of ERAS in the field of pediatric surgery.

Method

This study selected 122 children who underwent laparoscopic complex appendectomy at Inner Mongolia Maternal and Child Health Hospital and Baotou Fourth Hospital from August 2018 to July 2022, and randomly divided them into a traditional surgery group (TS) and an enhanced recovery surgery group (ERAS). The changes of white blood cell (WBC), hypersensitive C-reactive protein (CRP), pro Calcitonin (PCT) and interleukin 6 (IL-6) before and after surgery were compared. The degree of pain, recovery time of intestinal function, length of hospital stay, hospital costs, postoperative complications and parental satisfaction were compared between the two groups.

Result

The WBC and CRP levels in the ERAS group at 6 h after surgery, as well as the IL-6 levels on the 3rd day after surgery, were lower than those in the TS group. Meanwhile, the analgesic effect of ERAS group at 3 h and 6 h after surgery was better than that of TS group. And the ERAS group had a shorter postoperative first exhaust time, fewer overall hospital stays, and lower hospitalization costs. In addition, the ERAS group had high parental satisfaction during hospitalization. There was no statistically significant difference in postoperative complications between the two groups of children.

Conclusion

ERAS can promote postoperative recovery of children, reduce surgical stress, save family medical expenses, alleviate the pain of children, and improve parental satisfaction. It is a safe and effective method for treating complex appendicitis in children.

The effect of radiofrequency ablation on pain score and non-steroidal painkiller use in osteoid osteoma patients

AIM

CT-guided radiofrequency ablation (RFA) is among the thermal ablative procedures and provides great benefits with a minimally invasive procedure. In this prospective study, we aimed to reveal the significance of a multidisciplinary method in reducing the recurrence and complications in osteoid osteoma patients with CT-guided RFA performed by a team of experts in the field.

MATERIALS AND METHODS

A total of consecutive 40 patients with osteoid osteoma were prospectively evaluated and treated with CT-guided RFA. Before and the post ablation the visual analog scale (VAS) and use of nonsteroidal anti-inflammatory drugs (NSAIDS) were compared.

RESULTS

Post-ablation VAS of the patients at the 1st week and 3rd month after the procedure decreased significantly (p < 0.01) compared to the pre-ablation. The frequency of NSAID use after the ablation decreased significantly (p < 0.01) compared to the pre-ablation time. The pre-procedure NSAID use of our patients included in the study was average 6.93 per week, the NSAID use in the 3rd month post-procedure controls was average 0.53 per week. Recurrence was detected in 4 of our patients, 36 patients had complete recovery.

CONCLUSION

Radiofrequency ablation is an effective treatment method in the management of osteoid osteomas. Radiofrequency ablation has low recurrence rates and provides rapid regression in patients' pain after treatment.

Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger

We investigated the minimal clinically important difference (MCID) of the Michigan Hand Outcomes Questionnaire (MHQ) and the pain visual analogue scale (VAS-pain) after conservative treatment of trigger finger. This secondary analysis of a randomized controlled trial compared pain reduction, symptoms and functional improvement at 12 weeks. Patients included were at least 18 years old and able to complete MHQ and VAS-pain at enrolment and 12 weeks after treatment. The MCIDs of MHQ and VAS-pain were evaluated using a distribution-based, anchor-based and receiver operating characteristic (ROC) curve-based approach. Of the 117 patients, the MCIDs of MHQ and VAS-pain using a distribution-based approach were 5.3 and 0.6, respectively; applying ROC method were 23.5 and 2.5, respectively; and using anchor questions were 15 and 2, respectively. These MCID values by anchor-based method with a minimal difference of 15 for MHQ and 2 for VAS-pain are recommended as primary evidence to determine clinically significant improvement after conservative treatment of trigger finger.Level of evidence: I.

Efficacy and safety of flurbiprofen‑axetil combined with nalbuphine pretreatment on remifentanil‑induced postoperative hyperalgesia: A randomized clinical trial

Remifentanil-induced hyperalgesia (RIH) is a common and complicated issue in patients undergoing laparoscopic cholecystectomy (LC), which significantly reduces patient satisfaction. The present trial was designed to clarify the individual and combined effects of flurbiprofen-axetil and nalbuphine on remifentanil-induced hyperalgesia. This randomized double-blind clinical trial included 120 adult patients who underwent LC at The Second People's Hospital of Wuhu. The individuals were randomized into a flurbiprofen-axetil group (F group), nalbuphine group (N group), flurbiprofen-axetil combined with nalbuphine group (FN group) and saline group (S group). The four groups were given flurbiprofen-axetil (50 mg, iv.), nalbuphine (0.1 mg/kg, iv.), flurbiprofen-axetil (50 mg, iv.) combined with nalbuphine (0.1 mg/kg, iv.) or normal saline respectively prior to skin incision. The primary outcome was the postoperative mechanical pain thresholds at the inner forearm and peri-incisional area. The secondary outcomes were the visual analog scale (VAS) and Ramsay sedation scale at 0.5, 1, 4 and 24 h after surgery, and any other adverse events. The pain threshold of the medial forearm in the FN group did not differ from that in the F and N groups at 24 h after surgery (P=0.310 and P=0.910, respectively). However, the pain threshold around the incision in FN group was significantly lower than that in F and N groups 24 h after surgery (P=0.001). The VAS of the F group, N group and FN group were all significantly lower than that in the S group at 0.5, 1 and 24 h after surgery (P<0.001). No significant differences were observed in the incidence of adverse events between the four groups. Single flurbiprofen-axetil and single nalbuphine effectively prevented RIH 24 h after surgery in LC. The combination of the two analgesic drugs, with different mechanisms of action, was not superior to single therapy. The present study was registered with the Chinese Clinical Trial Registry (registration no. ChiCTR2100045347).

Effects of intraoperative Magnesium sulfate infusion on emergency agitation during general anesthesia in patients undergoing radical mastectomy: a randomized controlled study

BACKGROUND

Emergency agitation is a common postoperative complication in patients under general anesthesia, which can lead to unpredictable damages such as shedding of drainage tube and bleeding from the wound. The purpose of the study is to investigate whether intraoperative infusion of Magnesium Sulfate reduces the incidence of emergency agitation (EA) in patients undergoing radical mastectomy, and to evaluate its safety and efficacy.

METHODS

A total of 70 patients were randomly assigned to two groups: the Magnesium group (M group) and the control group (C group). After a routine intravenous anesthetic induction, patients in the M group received a 30 mg/kg bolus of intravenous magnesium during the first hour and then a continuous infusion of 10 mg/kg ×h until the end of the surgery, patients in the C group received 0.9% saline at the same volume and rate. The sedation-agitation scale (SAS) and the visual analogue scale were used to assess agitation and pain, respectively.

RESULTS

Compared to the C group, the M group reduced the incidence of EA significantly (odds ratio 0.26, 95% confidence interval 0.09-0.71, P = 0.009). The postoperative pain score of the magnesium sulfate group(0(0,1)) was lower than that of the control group(2(0,3)) at T0 (P = 0.011). Additionally, the M group required a lower dosage of remifentanil during surgery compared to the C group(300.4 ± 84 versus 559.3 ± 184 µg, respectively, P<0.001).

CONCLUSIONS

the intraoperative infusion of magnesium sulfate is a safe and effective method for reducing the incidence of emergency agitation in patients undergoing radical mastectomy.

TRAIL REGISTRATION

The study was registered in Chictr.org with the identifier: ChiCTR2300070595 on 18/04/2023.

The Use of Questionnaires in Pain Assessment during Orthodontic Treatments: A Narrative Review

Pain is a complex multidimensional feeling combined with sensorial and emotional features. The majority of patients undergoing orthodontic treatment report various degrees of pain, which is perceived as widely variable between individuals, even when the stimulus is the same. Orthodontic pain is considered the main cause of poor-quality outcomes, patients' dissatisfaction, and lack of collaboration up to the interruption of therapy. A deep understanding of pain and how it influences a patient's daily life is fundamental to establishing proper therapeutic procedures and obtaining the correct collaboration. Because of its multifaced and subjective nature, pain is a difficult dimension to measure. The use of questionnaires and their relative rating scales is actually considered the gold standard for pain assessment. Choosing the most appropriate instrument for recording self-reported pain depends on a patient's age and cognitive abilities. Although several such scales have been proposed, and a lot of them are applied, it remains uncertain which of these tools represents the standard and performs the most precise, universal, and predictable task. This review aims to give an overview of the aspects which describe pain, specifically the pain experienced during orthodontic treatment, the main tool to assess self-perceived pain in a better and more efficient way, the different indications for each of them, and their correlated advantages or disadvantages.

Finger exercise could reduce painfulness and radial artery complications related to coronary artery angiography

OBJECTIVE

To estimate if applying a finger exercise during trans-radial coronary artery angiography (CAG) could help to reduce a patient's painfulness and evaluate its protective effects against radial artery complications.

METHODS

This is a prospective, controlled, single-center trial. Overall, 390 patients who underwent coronary angiography through radial path in our hospital during 2022 were randomized 1 : 1 to the following two groups: test group: finger exercise in addition to routine perioperative care; control group: routine care. The success rate of radial puncture, the incidence of procedural radial artery dissection (RAD) and radial artery spasm (RAS), change of wrist circumference, pain degree related to the operation, occurrence of access site hemorrhagic complications, hemostasis time and postprocedure occurrence of radial artery occlusion (RAO) before discharge were recorded and compared between two groups.

RESULTS

Compared to the control group, the test group had a higher success rate of radial puncture, lower incidence of RAS, RAD and RAO, slighter swelling of wrist and patients who felt less pain in the test group. There was no difference in prolonged hemostasis time or hemorrhagic complications between the two groups.

CONCLUSION

Finger exercise could help to make a patient more comfortable and reduce radial artery complications related to CAG.

Perioperative gabapentin usage in pediatric patients: A scoping review

BACKGROUND

There has been a recent focus among anesthesiologists on reducing the use of perioperative opioids in favor of multimodal analgesic regimens. Gabapentin has played an integral role in this evolution of practice. This comprehensive review assesses the current clinical evidence on the efficacy of perioperative gabapentin regarding postoperative pain and opioid requirements among the pediatric surgery population.

DATA SOURCES

Pubmed, CINAHL, Embase, Scopus, and Web of Science Review.

METHODS

This scoping review of the above databases includes all studies examining the use of gabapentin perioperatively in pediatric patients and its association with postoperative pain intensity and postoperative opioid consumption through July 2021. The inclusion criteria encompassed all studies evaluating gabapentin in the perioperative pediatric population through randomized controlled trials (RCTs) and retrospective studies. Relevant metadata from each study were abstracted and descriptive statistics were used to summarize the results.

RESULTS

Fifteen papers met the inclusion criteria for this review, including 11 RCTs and 4 retrospective studies. Sample sizes ranged from 20 to 144 patients. Administered doses varied widely, mainly between 5 and 20 mg/kg. The studies included primarily orthopedic (10) and neck surgery cases (3). Seven papers had gabapentin provided preoperatively only, two postoperative only, and six both pre- and postoperatively. Of the studies assessing postoperative pain, 6/11 studies saw a decrease in postoperative pain in at least one period for the gabapentin group. Of the studies considering opioid requirements, 6/10 reported a reduction, 1/10 an increase, and 3/10 no difference in opioid requirements for the gabapentin groups. Yet, most of these pain and opioid requirement findings were only significant at one to two time points in the study follow-up periods, and the actual decreases had minimal clinical significance.

CONCLUSIONS

The current data on perioperative gabapentin in pediatric patients are insufficient to support the routine use of gabapentin in pediatric patients. Additional high-quality RCTs with more standardized protocols for gabapentin administration and outcome measures are necessary to provide more definitive conclusions.

Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance

Background

The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons.

Purpose/Hypothesis

The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP.

Study Design

Case series; Level of evidence, 4.

Methods

This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded.

Results

All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months.

Conclusion

ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.

Comparison of dental anesthetic efficacy between the periodontal intraligamentary anesthesia and other infiltration anesthesia: a systematic review and meta-analysis

Background

Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia.

Methods

The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023.

Results

Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81-1.14]; p = 0.65; I²= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [-0.54-8.16]; p = 0.09; I²= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86-12.79]; p < 0.0001; I²= 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia.

Conclusions

Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.

Comparison of unilateral and bilateral percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures associated with scoliosis

To assess the clinical and radiographic effectiveness of unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF) associated with scoliosis, 52 patients with OVCF associated with scoliosis who underwent PKP were retrospectively analysed. The patients were divided into the unilateral PKP group (n=26) and the bilateral PKP group (n=26). The operation time, bone cement injection volume and frequency of intraoperative fluoroscopy were recorded and compared between the groups. Additionally, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, as well as postoperative complications, including bone cement leakage and adjacent vertebral fractures, were also assessed. The operation time, bone cement injection volume and intraoperative fluoroscopy frequency were significantly lower in the unilateral compared with the bilateral group (P<0.001). The VAS score, ODI score, average vertebral body height and kyphotic angle (KA) were improved after surgery in each group with no difference in these clinical parameters between the two groups both before and after surgery. Furthermore, the proportion of cases with bone cement leakage in the unilateral group was significantly lower compared with that in the bilateral group (P<0.05). During the follow-up, there were three cases (11.5%) in the unilateral group and two cases (7.7%) in the bilateral group who suffered adjacent vertebral fractures, but there was no statistically significant difference between the two groups (P>0.05). For treating patients with OVCF accompanied by scoliosis, both unilateral and bilateral PKP could effectively relieve the acute back pain and correct the KA. However, unilateral PKP presents more advantages, such as a short operation duration and reduced intraoperative fluoroscopy frequency and bone cement leakage.

Maxillofacial Soft-tissue Healing Efficacy between Nano-chitosan and Collagen-Chitosan Membrane - A Comparative Study

Introduction

Routine wound management in maxillofacial trauma with soft-tissue injury needs to be addressed in a systematic way to prevent untoward complications. In this study, we examined the effects of a novel surgical dressing material on pain, wound healing and scar and its feasibility to common people. Our aim is to compare the efficacy and potency of the nano-chitosan membrane and collagen-chitosan membrane as surgical dressing materials for soft-tissue wounds in the maxillofacial region.

Materials and Methods

Thirty participants who sustained soft-tissue injury in the maxillofacial region were included in the study. Post-suturing, Group A participants were treated with nano-chitosan membrane impregnated with chlorhexidine, Group B participants were treated with collagen-chitosan membrane impregnated with chlorhexidine and Group C participants had received chlorhexidine powder as conventional wound care management and recalled and evaluated for wound healing, pain and scar at seventh day, one month and three months postoperatively.

Results

The wound healing efficacy of both Group A and B participants was nearly comparable and Group A had better wound healing (P = 0.043) when compared to conventional chlorhexidine dressing material. In relation to pain intensity, Group A was reported with a low intensity of pain and also with better results in scar assessment at the third-month follow-up.

Discussion

This study had proven that even though the wound healing efficacy of both nano-chitosan and collagen-chitosan membranes is nearly comparable, nano-chitosan shows better results on the evaluation of parameters such as wound healing, pain and scar. Nano-chitosan membrane has better wound healing when compared to conventional chlorhexidine dressing material.

Autoantibodies Against Trisulfated Heparin Disaccharide and Fibroblast Growth Factor Receptor-3 May Play a Role in the Pathogenesis of Neuropathic Corneal Pain

PURPOSE

The aim of this study was to describe cases of patients with presumable dysimmune small-fiber neuropathy (SFN)-related neuropathic corneal pain (NCP), presenting with autoantibodies against trisulfated heparin disaccharide (TS-HDS) or fibroblast growth factor receptor-3 (FGFR-3).

METHODS

This study was a case series of 3 patients with NCP with positive anti-TS-HDS and/or anti-FGFR-3 autoantibodies and systemic SFN as confirmed by positive skin biopsy results.

RESULTS

All 3 patients were women with a mean age of 34.3± 6.1 years. They suffered from moderate to severe persistent chronic ocular discomfort (10/10, 10/10, and 9/10 on a visual analogue scale, respectively). Although 1 patient suffered from ocular pain and photophobia alone, the other 2 patients experienced additional non-ocular pain. One of the patients had pain on her face and head, and 1 patient reported neck and lower back pain. Two patients had high anti-TS-HDS IgM titers, whereas 1 patient had both high anti-TS-HDS IgM and anti-FGFR-3 IgG titers. Skin biopsy confirmed the presence of SFN in all patients by demonstrating decreased intraepidermal nerve fiber density.

CONCLUSIONS

The presence of anti-TS-HDS and anti-FGFR-3 autoantibodies in patients with NCP with positive skin biopsy findings for SFN highlights the potential role of dysimmune SFN in the pathogenesis of this disease.

Diacerein versus non-steroidal anti-inflammatory drugs in the treatment of knee osteoarthritis: a meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common musculoskeletal condition affecting millions of people worldwide and posing a significant challenge to clinicians and researchers. Emerging evidence suggests that the multifaceted symptomatology of KOA may be alleviated by diacerein. With this in mind, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of diacerein in patients with KOA.

METHODS

We systematically searched Embase, PubMed, Cochrane Library, Web of Science, Chinese Biomedical Literature Database (CBM), Wanfang Database (WanFang), China National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (VIP) from their inception to August 2022 for randomized controlled trials (RCTs) of diacerein intervention on patients with KOA. Two reviewers independently performed the selection of eligible studies and the extraction of relevant data. The meta-analysis was performed using RevMan 5.4 and R 4.1.3 software tools. Depending on the type of outcome indicator selected, summary measures were expressed as mean differences (MD), standardized mean differences (SMD), or odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

Twelve RCTs with 1732 patients were included. The results revealed that diacerein had comparable efficacy to non-steroidal anti-inflammatory drugs (NSAIDs) in reducing pain indicators such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (SMD = 0.09, 95% CI [-0.10, 0.28], P = 0.34) and visual analogue scale (VAS) (SMD = -0.19, 95% CI [-0.65, 0.27], P = 0.42). However, diacerein outperformed NSAIDs in terms of global efficacy assessment by both patients and investigators (patients: 1.97, 95% CI [1.18, 3.29], P = 0.01; investigator: 2.18, 95% CI [0.99, 4.81], P = 0.05) at the end of treatment and sustained effectiveness in reducing WOMAC score and VAS score at four weeks after treatment. Moreover, there was no significant difference in adverse events incidence between the diacerein and NSAID groups. However, the GRADE evaluation indicated that the majority of the evidence quality was low.

CONCLUSIONS

The results of this study suggest that diacerein could potentially be considered as a pharmacological agent with significant efficacy for the treatment of patients suffering from KOA, offering a potential alternative treatment strategy for those patients contraindicated to NSAIDs. However, further high-quality studies with longer follow-up are needed to make more informed decisions about its efficacy in the treatment of KOA.

The bared external anal sphincter (BEAS), a new technique for high horseshoe anal fistula: a hospital-based cohort study

The aim of this study was to introduce a new technique, the bared external anal sphincter technique, and to evaluate its effectiveness and safety for primary or recurrent high horseshoe anal fistula (HHAF). We used data from a tertiary referral hospital's prospective database of a hospital-based cohort. All the patients underwent the bared external anal sphincter procedure. The main outcomes were short-term clinical outcomes including the 6-month cure rate, Visual Analog Scale pain score (VAS-PS) and Cleveland Clinic Florida incontinence score (CCF-IS). The secondary outcomes included the Quality of Life in Patients with Anal Fistula Questionnaire score (QoLAF-QS), Bristol stool chart and postoperative complications. A total of 48 HHAF patients (39 males) with a mean age of 34.2 years (SD 9.04; range, 21-54) were analyzed in this retrospective study. At the 6-month follow-up, the average VAS-PS and CCF-IS were 0.81 (SD 2.28; range, 0-10) and 1.29 (SD 2.87; range, 0-13), respectively. QoLAF-QS showed that the bared external anal sphincter procedure had no impact over their quality of life in 45 patients (93.75%), limited impact in 2 patients (4.16%), and moderate impact in one patient (2.08%). The Bristol stool scale showed that all patients had normal stool characteristics. The 6-month cure rate was 93.75%. Three patients (6.25%) experienced recurrent symptoms but recovered after surgical management. Urinary retention occurred in 1 case (2.78%). No other postoperative complications were reported. No patient had anal incontinence. The bared external anal sphincter procedure is a safe, effective and sphincter-sparing approach for patients with primary or recurrent HHAF in terms of short-term results.

Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach

Background

This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery.

Methods

Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9±7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Preand postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups.

Results

There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5±0.8 and 2.9±0.8 in the subxiphoid group, respectively, compared to 7.2±0.8 and 3.4±0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5±5.0 and 79.3±7.7, respectively, in the subxiphoid group compared to 72.4±4.3 and 71.3±4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008).

Conclusion

Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of ≤5 cm.

Photobiomodulation for Managing "Dry Socket": A Randomised Controlled Trial

OBJECTIVE

There are no studies that have evaluated the effect of Alveogyl with and without adjunct photobiomodulation therapy (PBMT) in reducing self-rated post-operative pain (SPP) in patients with alveolar osteitis (AO; dry socket). The aim of the present randomised controlled trial was to assess the effectiveness of Alveogyl with and without PBMT for the management of SPP in patients with AO.

METHODS

Adult nonsmokers with diagnosed AO were included. Patients were randomly divided into 4 groups. In Group 1, patients underwent mechanical curettage (MC) with copious normal saline irrigation. In Group 2, patients underwent MC + Alveogyl dressings in extraction sites which were changed every 48 hours until cessation of pain. In Group 3, patients underwent MC + Alveogyl followed by PBMT using a 660-nm indium-gallium-aluminum-phosphide diode laser. In Group 4, patients were treated solely with PBMT. The visual analogue scale was used up to 3 postoperative days to assess SPP up to 3 days at 6- (T0) and 12-hour (T1) intervals. Statistical analyses were performed using the analysis of variance and Bonferroni post hoc adjustment tests. Correlation between SPP scores and age, sex, and eruption status of teeth was assessed using logistic regression models. P values <.01 were nominated as being statistically significant.

RESULTS

In all, 14, 13, 14, and 14 individuals with AO were included in groups 1, 2, 3 and 4, respectively. All patients had undergone extraction of mandibular third molars. At baseline and on day 1, there was no difference in SPP in all groups. On days 2 and 3, mean visual analogue scale (VAS) scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 2 compared with Group 3. On days 2 and 3, mean VAS scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 4 compared with Group 3. There was no difference in SPP in groups 3 and 4 on day 3 at T0 and T1 intervals.

CONCLUSIONS

PBMT following MC and Alveogyl dressing is more efficient in reducing SPP compared with MC with or without Alveogyl dressing in patients with AO.

Auricular therapy for primary dysmenorrhea: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Primary dysmenorrhea (PD) is a common problem among women. It is defined as any degree of perceived cramping pain during menstruation without any evident pathology. Auricular therapy (AT), a widely used alternative medical treatment method as part of traditional Chinese acupuncture, lacks reliable evidence to support its safety and effectiveness for PD. We aimed to conduct a meta-analysis to investigate the efficacy and safety of AT in PD and to investigate possible factors impacting the particular efficacy of AT in PD by meta-regression.

METHODS

This protocol followed the PRISMA guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The following 9 sources will be searched for randomized control trials of AT for PD: the Cochrane Central Register of Controlled Trials, PubMed, Medline, Embase, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Chinese Science and Technology Periodicals (VIP) database and WanFang Database from inception to January 1, 2023. Primary outcomes include visual rating scales and clinical efficacy rates, while secondary outcomes include endocrine hormone indicators related to PD and adverse events. Two reviewers will work independently on study selection, data extraction, and coding, including the risk of bias assessment in the included studies. While conducting a meta-analysis, Review Manager version 5.3 will be employed. Otherwise, a descriptive analysis will be performed. The results will be displayed as a risk ratio with 95% confidence intervals for dichotomous data as well as weight mean difference or standardized mean difference with 95% confidence intervals for continuous data.

RESULTS

This study's protocol will investigate the efficacy and safety of AT in the treatment of PD in a systematic way.

CONCLUSION

This systematic evaluation will objectively and systematically assess the efficacy and safety of AT in PD based on the available evidence, as well as provides clinicians with evidence to support the treatment of the disease.

Decreased serum MMP-9 levels in patients with nontraumatic osteonecrosis of the femoral head

BACKGROUND

Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) are involved in the pathological mechanism of osteonecrosis of the femoral head (ONFH). This study aimed to investigate the relationship of serum MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio with disease severity in patients with nontraumatic ONFH.

METHODS

Serum levels of MMP-9 and TIMP-1 among 102 nontraumatic ONFH patients and 96 healthy individuals were determined by enzyme-linked immunosorbent assay (ELISA). Imaging severity was determined using the FICAT classification system. The Harris hip score (HHS) and visual analogue scale (VAS) were used to evaluate clinical progress. The correlations of serum MMP-9 and TIMP-1 levels with imaging severity and clinical progress was evaluated statistically. The diagnostic value of MMP-9 for NONFH disease severity was evaluated by examining receiver operating characteristic (ROC) curves.

RESULTS

The serum MMP-9 levels and the MMP-9/TIMP-1 ratio were significantly increased in patients with ONFH compared to normal controls, and TIMP-1 levels did not differ between the two groups. Serum MMP-9 levels and the MMP-9/TIMP-1 ratio were positively correlated with FICAT stage and VAS and were negatively correlated with the HHS score. The ROC curve results indicated that MMP-9 could be used as a potential marker of nontraumatic ONFH imaging progression.

CONCLUSIONS

We hypothesize that increased MMP-9 expression and an imbalance in the MMP-9/TIMP-1 ratio play a role in the development of ONFH and are correlate with the severity of ONFH. The determination of MMP-9 can be a useful tool to assess the severity of the disease in patients with nontraumatic ONFH.

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese

PURPOSE

To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version.

DESIGN

Psychometric (methodologic) evaluation of the instrument.

SUBJECTS AND SETTING

Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order.

METHODS

The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors.

RESULTS

The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study.

CONCLUSION

This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.

Platelet-Rich Plasma Injection Can Be a Viable Alternative to Corticosteroid Injection for Conservative Treatment of Rotator Cuff Disease: A Meta-analysis of Randomized Controlled Trials

PURPOSE

To explore whether platelet-rich plasma (PRP) injection can be a viable alternative to corticosteroid (CS) injection for conservative treatment of rotator cuff disease.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, The Cochrane Library, and Web of Science were searched from January 1, 1990, to March 20, 2022, for English-language randomized controlled trials that compared PRP and CS injections for patients with rotator cuff disease. Two evaluators independently screened the literature, extracted data, and assessed the level of evidence and methodologic quality of the enrolled studies. The meta-analysis was conducted using RevMan software (version 5.3.3).

RESULTS

Thirteen nonsurgical randomized controlled trials with 725 patients were included. Compared with CS, PRP provided statistically worse short-term (<2 months) changes in American Shoulder and Elbow Surgeons (ASES) assessment scores, Simple Shoulder Test scores, and Disabilities of the Arm, Shoulder and Hand questionnaire scores but provided better medium-term (2-6 months) changes in Disabilities of the Arm, Shoulder and Hand scores, as well as long-term (≥6 months) changes in Constant-Murley scores, ASES scores, and Simple Shoulder Test scores. No statistically significant differences regarding pain reduction were found between the 2 groups. PRP injections led to worse short-term changes in forward flexion and internal rotation but better medium-term changes in forward flexion and external rotation. PRP showed significantly lower rates of post-injection failure (requests for subsequent injections or surgical intervention prior to 12 months) than CS. No outcome reached the minimal clinically important difference. After sensitivity analyses excluding studies with substantial clinical and/or methodologic heterogeneity, PRP showed better medium-term changes in ASES scores and visual analog scale scores and long-term changes in visual analog scale scores that reached the minimal clinically important difference.

CONCLUSIONS

Without the drawbacks of CS injection, PRP injection is not worse than CS injection in terms of pain relief and function recovery at any time point during follow-up. PRP injection may reduce rates of subsequent injection or surgery, and it might provide better improvements in pain and function in the medium to long term. PRP injection can be a viable alternative to CS injection for conservative treatment of rotator cuff disease.

LEVEL OF EVIDENCE

Meta-analysis of Level I and II studies.

Clinical effects of resurfacing fingertip amputations in long fingers using homodigital dorsal neurofascial broaden pedicle island flaps

The use of homodigital dorsal neurofascial broaden pedicle island flaps (HDNBPIF) to treat fingertip amputations is an ongoing research topic. Here, we evaluated the clinical effects of resurfacing fingertip amputations in long fingers using HDNBPIF. Seventeen patients with 18 long fingers were treated with HDNBPIF from December 2018 to May 2021. Total active motion (TAM) scores, Semmes Weinstein monofilament (SWM) test, static 2PD test, visual analogue scale (VAS), Vancouver scar scales (VSS), and quick DASH scores were evaluated at 12-25 months postoperation. The aesthetic satisfaction of the patients was estimated subjectively using a 5-point Likert scale. The mean defect size was 1.11 × 1.13 cm and mean flap size was 1.32 × 1.32 cm. All flaps survived and the mean TAM of injured fingers was 255.6° (Contralateral side: 268.4°, p < 0.05). Mean SWM score in the flap was 3.90 g, and 3.22 g in the donor zone. Mean static 2PD discrimination in the flap was 5.61 mm and 4.33 mm in the donor zone. Mean quick Dash scores were 5.81 whereas Mean VAS score in the flap was 0.7 and 0.2 in the donor site. Vancouver scar scales at the donor and recipient sites ranged from 0 to 2. At the end of the follow-up, all patients reported good aesthetic appearance and curative effects. These results show that HDNBPIF is a promising strategy that achieves good curative effects and recovery of fingertip functions.Type of Study and Level of Evidence: Therapeutic IV.

A narrative review on pain control interventions for non-surgical pleural procedures

Pleural diseases are common and frequently result in disabling symptoms, impaired health-related quality of life and hospitalisation. Both diagnosis and management often require pleural procedures and despite a variety of pain control strategies available for clinicians to employ, many procedures are still complicated by pain and discomfort. This can interfere with procedure success and can limit patient satisfaction. This review examines the evidence for pain control strategies for people undergoing non-surgical pleural procedures. A systematic literature search was undertaken to identify published studies examining different pain control strategies including pharmacological (sedatives, paravertebral blocks, erector spinae blocks, intrapleural anaesthesia, epidural anaesthesia, local anaesthetic, methoxyflurane, non-steroidal anti-inflammatory drugs [NSAIDs], opioids) and non-pharmacological measures (transcutaneous electric nerve stimulation [TENS], cold application and changes to the intervention or technique). Current literature is limited by heterogeneous study design, small participant numbers and use of different endpoints. Strategies that were more effective than placebo or standard care at improving pain included intrapleural local anaesthesia, paravertebral blocks, NSAIDs, small-bore intercostal catheters (ICC), cold application and TENS. Inhaled methoxyflurane, thoracic epidural anaesthesia and erector spinae blocks may also be useful approaches but require further evaluation to determine their roles in routine non-surgical pleural procedures. Future research should utilise reliable and repeatable study designs and reach consensus in endpoints to allow comparability between findings and thus provide the evidence-base to achieve standardisation of pain management approaches.

Visual Analog Scale and Olfactory Objective Tests in Hyposmia Patients: Is There a Link?

Introduction Olfactory dysfunction (OD) is often a devaluated sensorial affection. The objective evaluation of this dysfunction does not evaluate its compromise in patients' daily life. It is unclear to what extent there is a correlation between the objective evaluation of OD and patient-reported impairment. Objective We aim to search if Sniffin Sticks® correlates with the Visual Analog Scale (VAS) of Hyposmia Symptoms, and therefore if it is a useful method for clinical use. Methods A prospective study was carried out to evaluate and compare consecutive patients who had olfactory impairment due to COVID-19 that were referred to an otolaryngology office. The variables evaluated were gender, age, co-morbidities, and olfactory thresholds (measured according to Sniffin Sticks®). Patients were also enquired about their sense of impairment according to VAS from 1 (worst possible) to 10 (best possible). Statistical analysis was performed using SPSS (IBM SPSS Statistics 26). Normal distribution was checked using both skewness and kurtosis and Kolmogorov-Smirnov tests. Pearson correlation test was used to seek a correlation between VAS and olfactory thresholds. All reported p-values are two-tailed, with a p-value ≤ 0.05 indicating statistical significance. Results Our sample of 47 patients was composed of 30 females (63.8%) and 17 females (36.2%). We found a mean variation between olfactory thresholds before and after the intervention of 3.91±2.466, and an average improvement of 2.29±2.93 in the visual analog scale for subjective evaluation of olfactory impairment. According to the Pearson correlation test, with 95% confidence, there is evidence to claim a moderate association (0.512) between an improvement in olfactory thresholds and VAS (p=0.05). Conclusions There was a moderate correlation between ratings and measures of olfactory function. On an individual basis, there were remarkable differences between measures and ratings of olfactory function. VAS should be considered in the evaluation of the hyposmic patient, due to its simplicity and quick applicability.

Effect of Acupuncture on Postoperative Pain in Patients after Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Objective

To evaluate the efficacy and safety of acupuncture compared to that of parecoxib sodium on postoperative pain (POP), postoperative nausea and vomiting (PONV), and the Bruggemann Comfort Scale (BCS) in patients following laparoscopic cholecystectomy (LC).

Methods

Eligible patients admitted to the hospital for LC were randomly allocated to either acupuncture or control groups in a 1 : 1 ratio. The subjects in the acupuncture group received acupuncture while those in the control group were injected by parecoxib sodium at their requests. The pain score, PONV score, and BCS were assessed at 0 h, 6 h, 9 h, and 12 h after operation. The primary outcome was the pain score. The secondary outcomes included the number of patients asking for parecoxib sodium from the two groups at 0-6 h and 6-12 h, PONV score, and BCS score.

Results

The pain score of the acupuncture group were lower in acupuncture than that in the control group at 6 h and 9 h after operation (P=0.002, P=0.008). However, no difference was found at 12 h. Besides, the number of patients administered parecoxib sodium in acupuncture group was less than that in the control group both at 0-6 h and 6-12 h after operation (P=0.019, P < 0.001). Similarly, there were significantly lower levels of PONV score and higher levels of BCS at 6 h after operation in the acupuncture group than in the control group. However, no difference was found at 9 h and 12 h.

Conclusion

Acupuncture can clinically improve the short-term treatment of postoperative pain after LC and reduce the request for extra analgesics; therefore, acupuncture might be a potential method as one of multimodal analgesia techniques to treat POP following LC. Trial Registrations. This trial is registered with ChiCTR2000036885 (Chinese Clinical Trial Registry).

Safety and Efficacy of Mek Inhibitors in the Treatment of Plexiform Neurofibromas: A Retrospective Study

INTRODUCTION

Plexiform neurofibromas (PN) represent the main cause of morbidity in patients affected by Neurofibromatosis Type 1 (NF1). Until recently, surgery has been the main treatment option in these patients, but it is burdened with a low efficacy rate and a high incidence of side effects as well as recurrence. In recent years, MEK inhibitors (MEKi) such as selumetinib and trametinib have shown great promise.

METHODS

We retrospectively describe a single center cohort of NF1 patients affected by PN1 and treated with MEKi since 2019 to 2021. Patients recruited in the study were affected by PN that were not eligible to complete surgical excision, symptomatic or with major cosmetic deformation or functional neurological deficits.

RESULTS

Most patients experienced improvement in clinical symptoms and quality of life, with reduction or stabilization of lesions. However, no complete response was achieved. The most common adverse effects involved the skin, affecting every patient. Importantly, no life-threatening adverse effects occurred.

CONCLUSIONS

In our experience, MEKi treatment has been shown to be both safe and effective in improving symptomatology and quality of life.