Average VAS Score Research Articles

Clinical analysis of lateral cervical approach in the treatment of cervical lymphatic tuberculosis complicated with parapharyngeal space abscess

Objective:To investigate the clinical effect of lateral cervical approach in the treatment of cervical lymphatic tuberculosis complicated with parapharyngeal space abscess. Methods:A total of 10 patients with cervical lymph node tuberculosis complicated with tuberculous abscess in parapharyngeal space were treated. Surgery was performed using a transcervical approach. The operation time and blood loss were recorded. The level of ESR, C-reactive protein（CRP）, VAS score and the rating of Kubota drinking test before and 2 weeks after operation were compared. The incision healing, symptoms of tuberculosis poisoning, and the CT findings of the cervical lesions were compared before operation, 2 weeks after operation and at the last follow-up. Results:The operation time ranged from 65 to 130 min with an average of （99.00±21.45） min. The intraoperative blood loss ranged from 100 to 250 mL with an average of （155.00±43.78） mL. The average pre-and post-operative level of ESR was （67.60±21.94） mm/1h and （30.30±13.76） mm/1h, respectively（U=5.500, P<0.01）; The average pre-and post-operative level of CRP was （69.70±31.13） mg/L and （42.40±19.70） mg/L, respectively（U=22.500, P<0.05）; The average pre-and post-operative VAS score was （5.60±1.26） points and （2.50±1.27） points, respectively（U=4.500, P<0.01）. As for Kubota drinking test, the rating was between 1-2 two weeks postoperatively. After relieving the compression, there was no obvious choking and coughing in drinking water. During the follow-up period （range: 6-24 months）, the surgical wound healed completely, and the symptoms of systemic tuberculosis poisoning disappeared. No obvious residual cavity or effusion was found in the parapharyngeal space by CT examination, nor was any protruding tissue in oropharynx. The edema of soft tissue surrounding the operational area disappeared, and the enlarged lymph nodes were significantly reduced. No sign of liquefaction, necrosis, suppuration or recurrence was observed. Conclusion:Surgery using transcervical approach effective in treating cervical lymph node tuberculosis with parapharyngeal space abscess.

RATIONAITY AND INTERVENTION EFFICIENCY OF CLINICAL PHARMACIST IN USAGE PAINKILLERS AFTER OPERATION

Objectives: To evaluate the rationality and effectiveness of clinical pharmacist’s intervention in the use of painkillers for post-operative pain treatment at the General Surgery Department of Cai Nuoc General Hospital. Objects and methods: Cross-sectional descriptive study on 172 patients (patients) undergoing surgery at General Surgery Department, Cai Nuoc General Hospital. Results: There were 38.95% of patients studied with adverse effects when using painkillers. The average duration of painkiller use after surgery was 5.6 ± 4.0 days. The differences in the mean time to take the drug between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. On 2 research groups, in general, the average VAS score after 1 day surgery was 4.2 ± 1.9 points and after 7 days was 1.1 ± 0.8 points. Increase the reasonable rate in choosing drugs group 2 with reasonable rate was had a reasonable rate of 68.18%, much higher than group 1 with 46.43%. Conclusion: The incidence of adverse effects was low. The differences in the mean time to take the drug 70.45%, much higher than group 1 with 42.86%; drug dose, group 2 had reasonable rate was 82.95%, much higher than group 1 with 55.95%; the rationality of drug use, group 2 between the 2 groups were statistically significant. VAS pain scores of the study samples tended to decrease gradually over 1, 3, 5, 7 days after surgery. Increase the rationality of drug selection, drug dosage, and general rationality of post-operative pain treatment.

Study of functional outcome of proximal fibular osteotomy in medial compartment osteoarthritis of knee

Aim: To explore the effects of proximal fibular osteotomy as a new surgery for pain relief and improvement of medial joint space and function in patients with knee osteoarthritis. Methods: From September 2017 to December 2020, 24 patients (six cases were bilateral so total 30 knees) who underwent proximal fibular osteotomy for medial compartment osteoarthritis in Bapuji Hospital and Chigateri hospital attached to JJM Medical college, were followed up. Preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained to analyze the alignment of the lower extremity and ratio of the knee joint space (medial/lateral compartment). Knee pain was assessed using a visual analogue scale, and knee ambulation activities were evaluated using the KSS score. Results: A total of 22 patients and 30 knees were followed-up. Of these, 7 were male and 15 were female patient. The average age was 57.15 years. The average preoperational VAS score, KSS functional score were 6.3 points, 33.5 points, respectively. According to KL grading, there were 18 knees of grade 2 and 2 knees of grade 3. The average post-operational VAS score, KSS functional score were 2.8 points and 83.7 points respectively. the medial joint space has improved significantly from preoperatively 1.15mm to postoperatively 3.4mm. Conclusion: We thereby conclude by stating that PFO is a promising alternative procedure in the management of medial compartment arthritis of the knee. It is a simple, effective, easy to perform procedure which is cost effective and gives excellent pain relief postoperatively. It is associated with lesser complications and a shorter recovery period as compared to High tibial osteotomy and Unicondylar knee replacement.

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

Aim: To compare the screw accuracy and clinicaloutcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and open TLIF in the treatment of one-level lumbar degenerative disease. Materials & methods: From May 2018 to December 2019, a consecutive series of patients undergoing robot-assisted minimally invasive one-level lumbar fusion procedures were retrospectively compared with matched controls who underwent one-level open TLIF procedures for clinical and quality-of-life outcomes. Results: A total of 52 patients underwent RA MIS-TLIF procedures (robot-assisted [RA] group) and 52 matched controls received freehand open TLIF procedures (open [OP] group). The RA group had more grade A screws with 96.2% one-time success rate of screw placement (p < 0.05). Besides, the RA group experienced less intraoperative blood loss and shorter length of hospital stay, while the OP group had shorter operative duration and cumulative radiation time (p < 0.001). What is more, the average VAS score for low back pain and ODI score in the RA group were lower than that in the OP group 1 month after operation (p < 0.05). Conclusion: The use of real-time, image-guided robot system may further expand the advantages of MIS-TLIF technique in terms of accuracy and safety.

Results of posterior only approach for adolescent idiopathic scoliosis

Introduction: Adolescent Idiopathic Scoliosis (AIS) is most common type of scolisis which is affecting girls more than boys. Affecting children between age 10 to18. AIS curves progress during radip growth period of child. Locate usually at thoracic level and involves right convex curve. Due to cosmetic reasons, pain and in some cases due to neurological involvement such cases needs operative involvement. In this study involves 20 such patients operated with posterior spinal approach and fixation for the same and followed up for one months for radiographic and clinical outcomes.Materials and Methods: 20 patients out of which 5 male and 15 female with AIS were managed with posterior spinal pedicle screws instrumentations and follow-up with various criteria regarding its outcomes such as postoperative pain relief, cobb’s angle, average screws insertion, average level of fixation, mean duration of surgery, blood loss, and post operative complications such as neurological deficit, infection or implant failure.Results: In this study which was done on 20 patient. Most common type of lenke’s curve is Type-1. Average Pre operative VAS score was 8.5 that Reduced to 1.9 Post operative. Average Pre operative cobb’s angle in all patients were 57.15 which is average 11.65 post operative, after 1 year of follow-up average cobb’s angle were 17.2 degrees. So average loss in correction after 1 year is 5.55. Average screw needed in this fixation is 15.6. Range minimum of 12 to maximum 19 screws required in fixation. In all 20 patients average 1.35 screws were fixed per level vertebrae. So basically, it is low density pedicle screw fixation. Average duration of surgery time is mean 6 hours 25 minutes. Range from minimum of 5 hours to max 9 hours. Mean age was 16.1. Mean blood loss was 773.5 mL. one patient developed post operative neurological deficit which progressively recovered within six months, no other significant complication in any patient was observed.Conclusion: Based upon the results obtained from this review of 20 patients of AIS with minimum one year of follow-up we suggest that the all-screw method is efficient and safe.The outcomes in three-dimensional correction are satisfactory and comparable.The curve maintenance is good with minimal loss of correction. Compared with age-matched healthy populations, these patients did present some limitations on their physical health, as assessed by the SRS-30 questionnaire.

Functional outcome of ligament reconstruction with tendon interposition after failed first carpometacarpal joint prosthesis

The purpose is to determine if ligament reconstruction with tendon interposition (LRTI) is a recommendable salvage option for failed total joint prosthesis of the first carpometacarpal joint. Twenty-two patients in our database met the in- clusion criteria for this retrospective study, with at least 6 months follow-up. Fourteen participated and were invited for a clinical examination and asked to fill out two questionnaires. They were evaluated for pain (VAS), impairment (NHS), disability (Quick DASH), opposition (Kapandji test) and grip strength (hydraulic dynamometer). Results of the questionnaires were compared to a cohort study of primary LRTI's. Kapandji test and grip strength were compared to the contralateral side. Compared to primary LRTI's, revision surgery showed mild deterioration of impairment and disability. The average VAS score was 2.9 out of 10. Twelve patients mentioned a sense of strength loss, which could be quantified with the dynamometer : a mean of 15.1 kg (operated thumb) versus 20.5 kg (contralateral). There was a relatively small decline of opposition with Kapandji 8.6 versus 9.9. The overall satisfaction was good for 8 patients, fair for 3 and poor for the remaining 3 (mainly based on strength loss). One patient needed a second revision. Failed first carpometacarpal joint replacement can be salvaged by ligament reconstruction with tendon interposition, providing an acceptable functional outcome in 79% of cases studied. However, compared to the functional outcome of primary LRTI's, mild aggravation of impairment and disability should be taken into account.

Effect of Autologous Expanded Bone Marrow Mesenchymal Stem Cells or Leukocyte-Poor Platelet-Rich Plasma in Chronic Patellar Tendinopathy (With Gap >3 mm): Preliminary Outcomes After 6 Months of a Double-Blind, Randomized, Prospective Study

Background: Patellar tendinopathy is common. The success of traditional management, including isometric or eccentric exercises combined with shockwave therapy and even surgery, is limited. Therefore, it is important to determine whether biological treatments such as ultrasound-guided intratendinous and peritendinous injections of autologous expanded bone marrow mesenchymal stem cells (BM-MSCs) or leukocyte-poor platelet-rich plasma (Lp-PRP) improve clinical outcomes in athletic patients with patellar tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A prospective, double-blinded, randomized, 2-arm parallel group, active controlled, phase 1/2 single-center clinical study was performed in patients who had proximal patellar tendinopathy with a lesion >3 mm. A total of 20 participants (age 18-48 years) with pain for >4 months (mean, 23.6 months) and unresponsive to nonoperative treatments were randomized into 2 groups. Of these, 10 participants were treated with BM-MSC (20 × 106 cells) and 10 with Lp-PRP. Both groups performed the same postintervention rehabilitation protocol. Outcomes included the Victorian Institute of Sport Assessment for pain (VISA-P), self-reported tendon pain during activity (visual analog scale [VAS]), muscle function by dynamometry, tendon thickness and intratendinous vascularity by ultrasonographic imaging and Doppler signal, ultrasound tissue characterization (UTC) echo type changes, and magnetic resonance imaging (MRI) T2-weighted mapping changes. Participants were followed longitudinally for 6 months. Results: The average VAS scores improved in both groups at all time points, and there was a significant reduction in pain during sporting activities (P < .05). In both groups, the average mean VISA-P scores at 6 months were significantly increased compared with baseline (66 BM-MSC group and 72.90 Lp-PRP group), with no significant differences in VAS or VISA-P scores between the groups. There were statistically significant greater improvements in tendon structure on 2-dimensional ultrasound and UTC in the BM-MSC group compared with the Lp-PRP group at 6 months. Similarly, the BM-MSC group demonstrated significant evidence of restoration of tendon structure on MRI compared with the Lp-PRP group at 6 months. Only the participants in the BM-MSC group showed evidence of normalization of tendon structure, with statistically significant differences between the groups on T2-weighted, fat-saturated sagittal and coronal scans and hypersignal in T2-weighted on spin-echo T2-weighted coronal MRI scan. Both treatments were safe, and no significant adverse events were reported in either group. Conclusion: Treatment with BM-MSC or Lp-PRP in combination with rehabilitation in chronic patellar tendinopathy is effective in reducing pain and improving activity levels in active participants. Participants who received BM-MSC treatment demonstrated greater improvement in tendon structure compared with those who received Lp-PRP. Registration: 2016-001262-28 (EudraCT identifier); NCT03454737 (ClinicalTrials.gov identifier)

The outcome of platelet-rich plasma injection therapy in chronic plantar fasciitis

Background: Plantar Fasciitis is a frequently encountered problem in the everyday practice oforthopaedics. Treatment of Plantar Fasciitis is challenging to treating surgeon. Various conservativenon-invasive treatment modalities are available like rest, casting, night splinting, NSAIDs. Ifconservative management fails then corticosteroid injection over the medial tuberosity of calcaneumis an effective treatment. But in recent years Platelet-rich plasma (PRP) has proved to be a safealternative approach with less complication. This study aims to find out the effectiveness of PRPinjections in Plantar Fasciitis. Material and Method: In this study, 60 patients with Plantar Fasciitiswere included. Regular follow up was done at an interval of 4 weeks, 8 weeks and 6 months afterPRP injection. Pain intensity was measured before and after injection on every follow up using theVisual Analogue Scale (VAS). Patients who have undergone at least 4 weeks of conservativetreatment were included in the study. Results: After analysis of data, the average VAS score beforeinjection was 7.01±1.35. Whereas at the end of the last visit (i.e. 6 months) average VAS scorereduced to 2.2±1.25. This difference was statistically significant (ANNOVA test p &lt;0.0001).Conclusion: we concluded that injection of PRP is a safe, convenient and effective approach to treatchronic Plantar Fasciitis.

EQ-5D-5L reference values for the German general elderly population

BackgroundReference values are a helpful tool to facilitate comparisons of sampled values against a specified reference population. The aim is to describe the health profile and to provide visual analogue scale (EQ VAS) and utility reference values for the EQ-5D-5L from a normative sample of the general elderly population (65+) in Germany.MethodsWe analysed a sub-set of data from the German EQ-5D-5L valuation study using self-reported information based on EQ-5D-5L. We examined the share of respondents in each severity level per dimension as well as means, standard deviations (SD) and 95% confidence intervals for the index and EQ VAS values stratified by age groups and gender. Age was categorised in four groups (65–69, 70–74, 75–79 and > 79 years) to facilitate a more detailed examination of age-related health-related quality of life (HRQoL).ResultsThe average index and EQ VAS scores were 0.84 (SD 0.22) and 73.2 (SD 18.5), respectively. In total, 21.4% reported no problems in all dimensions. With higher age, health problems were reported more frequently, which, in turn, lead to monotonically decreasing index and EQ VAS values. Overall, men reported fewer problems than women and this difference was largest beyond the age of 80.ConclusionHRQoL in the oldest old appears to be less stable and differs from the young elderly. However, the conventional age categorisation of earlier population norms studies seems to mask these differences. Hence, the more detailed provision of EQ-5D-5L reference values for the elderly population seems helpful for future German studies.

Application of a double reverse traction repositor in the retrograde intramedullary nailing of distal femur fractures

ObjectiveThe purpose of this prospective study was to introduce the application of a double reverse traction repositor (DRTR) in the retrograde intramedullary nailing (RE-IMN) of AO/OTA 33A distal femur fractures.Patients and methodsA total of 27 patients with AO/OTA type 33A distal femur fractures who were admitted from January 2015 to May 2017 to a level I trauma center of a tertiary university hospital were enrolled in this prospective study. A DRTR was used to facilitate RE-IMN for the reduction of distal femur fractures in all patients. The demographic and fracture characteristics, surgical data, postoperative complications, and prognostic indicators of 24 patients were recorded.ResultsThe DRTR helped achieve and maintain the reduction of all distal femur fractures in the present study. All surgeries were conducted by closed reduction, and excellent alignment was observed in the postoperative X-ray images. In the present study, 18 males and 6 females were included, and the average age of all patients was 51.3 years (range, 24–68 years). The mean operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of postoperative hospital stay were 137 min (range from 80 to 210 min), 320 ml (range from 200 to 600 ml), 28 (from 24 to 33), and 9 days (from 5 to 14 days), respectively. Eleven patients were found to have postoperative deep venous thrombosis before discharge. No cases of wound infection were observed. No cases of nonunion or malunion were observed. The average follow-up duration was 21 months (18–30 months). The average HHS, LKFS, and VAS scores at the 1-year follow-up were 89.9 (86–97), 79.1 (75–87), and 2.1 (from 0 to 5). No complications associated with DRTR were found.ConclusionsA DRTR can be successfully applied in the treatment of distal femur fractures with RE-IMN, and it can not only help achieve or maintain the reduction of distal femur fractures with closed methods but also promote fixation with RE-IMN.

Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

IntroductionEndometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis.MethodsTwenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome.ResultsAverage follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54).ConclusionOur data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

10 kHz Spinal Cord Stimulation for Treatment of Painful Diabetic Neuropathy - A Multicenter Randomized Controlled Trial

10 kHz Spinal Cord Stimulation for Treatment of Painful Diabetic Neuropathy - A Multicenter Randomized Controlled Trial

A Survey on the Safety of and Patient Satisfaction After Nipple-Areola Tattooing.

Nipple-areolar tattooing is well accepted as part of breast reconstruction, but the clinical data on its safety and patient satisfaction after the procedure are insufficient. We aimed to evaluate the complications of and patient satisfaction after nipple-areola tattooing in Japanese post-mastectomy breast reconstruction patients. Patients who visited our center after undergoing nipple-areola tattooing from January 2017 to March 2020 were given an unmarked questionnaire with questions about complications related to their nipple-areola tattoo. Patients' registered their subjective evaluation responses regarding nipple-areola appearance using visual analog scale and that regarding overall satisfaction using 5-point Likert scale and free-text responses. Patients who were followed up within 6 months after tattooing or those with incomplete data were excluded. Sixty-two patients (average age: 49.7 ± 9.8 years), with an average post-tattooing period of 21.2 ± 10.5 months, were included. No patient had infections or allergic reactions. The average VAS score for nipple-areola appearance was high (8.5), and 59 patients (95.3%) answered that they were satisfied. In the free-text patient responses, 25 patients answered that they now felt comfortable going to the hot spring or taking a bath with their children, and 19 patients reported improved mental health after the procedure. Post-breast reconstruction nipple-areola tattooing with sterilized inorganic pigments could achieve high esthetics and patient satisfaction, without serious complications. It is recommended for Japanese individuals with a culture of visiting hot springs and public baths. This journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. 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 .

Outcomes of Gastrocnemius Recession in Patients with Plantar Fasciitis and Achilles Tendinosis: A Retrospective Study of 160 Patients

Category:HindfootIntroduction/Purpose:Plantar fasciitis and achilles tendonopathy are two of the most common foot and ankle overuse conditions encountered in clinical practice. Several recent studies have shown isolated gastrocnemius recession to be a viable treatment option for these conditions when conservative management has failed. Patient outcomes have primarily been assessed through pain and functionality scores. While pain improvement and motion restoration are of utmost importance, plantar flexion power and endurance are also key to patients’ ability to return to everyday activities. Here, we assess patient outcome scores of individuals that underwent gastrocnemius recession for plantar fascitis and achilles tendonopathy to see if surgery was beneficial.Methods:We reviewed 160 patients who underwent isolated gastrocnemius recession for chronic plantar fasciitis and achilles tendinopathy by a single surgeon from June 2011 to August 2018. Data was collected regarding patient pre-operative and post- operative pain scores at 3 months, 1 year, and final follow-up, and post-operative PROMIS physical function (PF), pain interference (PI), and depression (D) t-scores at final follow-up. We also collected data regarding time to full weight bearing, time to 50% and 100% pain relief, time to return to work, time to return to ADL, and time for patient to be out of boot. The patient population was then stratified by preoperative diagnosis and if patients received formal physical therapy. The cohorts consisted of patients that had plantar fasciitis, Achilles tendinosis, or a combination of both. The other cohorts were patients that received formal physical therapy and those that did not receive physical therapy.Results:The average preopeartive VAS score fot plantar fasciitis Achilles tendinosis and a combination of both was 4.27 4.10 and 4.93 respectively. For patients that had 3 month follow up (96) all three cohorts saw a decrease in VAS scores at 3 months (1.98, 1.50, and 1.80 respectively). Patients who received physical therapy saw a larger decrease in VAS scores (2.05 vs 1.03 respectively). Patients in all three groups were able to be fully weight baring within 30 days. 20.27 days in the plantar fasciitis, 19.25 for Achilles tendinopathy, and 28.3 days in the combination cohort. Patients with Achillis tendinosis had were able to get out of their boot the fastest (29.75 days). PROMIS scores were similar across all cohorts.Conclusion:This study is the first to complete a through evaluation of patient outcomes after gastrocnemius recession. Additionally, the study is one of the largest cohorts. This study helps to confirm that the surgery is beneficial for both plantar fasciitis and achilles tendinosis. In all cohorts patients pain improved with surgical intervention despite preoperative diagnosis and physical therapy status. Additionally, PROMIS scores across all of the patients were similar and did not indicate any signifcant decreases in physical function or increases in pain.

Analysis of Short-Term Outcome of Osteotomy Combining with Soft Tissue Surgery in the Treatment of Symptomatic Children with Flexible Flatfoot

Category:Hindfoot; OtherIntroduction/Purpose:To evaluate the short-term curative effect of clinical results and imaging of osteotomy and soft tissue surgery for the treatment of children with flexible flatfoot.Methods:From July 2014 to October 2016, 28 patients (47 feet) with flexible flatfoot were treated with osteotomy combining with soft tissue surgery, included 16 males (26 feet) and 12 females (21 feet) with the average age of (11.7+-2.1) years old ranging from 9 to 14 years old. The VAS score, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, Maryland score were evaluated before and after the operation to study the clinical effect. Patient satisfaction was also investigated at the end of the follow-up. The talo-navicular coverage angle (TNCA), the talo-1st metatarsal angle (T1MA), the talo-2nd metatarsal angle (T2MA) in the weight-bearing anteroposterior view and the calcaneal inclination angle (Pitch angle), the talo-1st metatarsal angle (Meary’s angle), the talo-calcaneal angle (Kite angle) and final follow-up time to study the imaging data.Results:Superficial tissue infection occurred in 2 cases (3 feet) after surgery, wound healing was achieved through debridement and short-term oral antibiotics. The average VAS score of the final follow-up was significantly lower than that before surgery (P < 0.01). The average AOFAS score and the average Maryland score were significantly higher than pre-operation (P < 0.01). Patient satisfaction at the last follow-up: very satisfaction 20 (71.43%), satisfaction 7 (25%), general 1 (3.57%). The the talo-navicular coverage angle (TCA) ,the talo-1st metatarsal angle (T1MA), the talo-2nd metatarsal angle (T2MA) in the weight-bearing anteroposterior view of the final follow-up were significantly improved compared with preoperation (P＜0.01), the Pitch Angle, Meary’s Angle and Kite Angle in the weight-bearing lateral view ere significantly improved compared with preoperation (P＜0.05).Conclusion:Osteotomy combined with soft tissue surgery has good short-term effect on children’s flexible flatfoot, and the effect of correction of malformation is obvious, but the medium-term and long-term effects need to be further studied.

Redefining Pregnancy-Induced Rhinitis.

Pregnancy-induced rhinitis (PIR) is a form of chronic non-allergic rhinitis not present before pregnancy that manifests itself during pregnancy with complete resolution of symptoms after delivery. The objective of this ambidirectional longitudinal cohort study is to evaluate the prevalence of PIR and to investigate the appearance and character of its symptoms, and its impact on the quality of life.Methodology: Six hundred eighty-one (681) women were recruited in the study. They completed questionnaires about nasal symptoms a day after delivery and each woman with nasal symptoms was interviewed 30 days later and data on symptom duration and quality were recorded. The prevalence of PIR was 31.86% (N = 217), 47.14% (N = 321) women had no nasal symptoms and 21% (N = 143) of participants had prior sinonasal disease. The clinical presentation of pregnancy rhinitis included nasal obstruction as the most common symptom, followed by rhinorrhea, postnasal secretion, nose itching, sneezing, and hyposmia. The median duration of PIR was 4 months with their complete resolution of symptoms between 2th and 16th day after delivery in the majority of respondents. PIR was diagnosed significantly more often if the women carried a female child. PIR affected their quality of life during pregnancy in 53,9% women (N = 117), with an average VAS score of 8. It seems that pregnancy may affect the course of previously present sinonasal disease (allergic rhinitis, chronic rhinosinusitis, nonallergic rhinitis, or non-infectious rhinitis prior to the pregnancy). PIR is a common clinical entity with a wide range of symptoms with a direct impact on the quality of life in pregnancy. We propose a new definition of pregnancy-induced rhinitis.

Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study.

To evaluate the functional outcomes as they relate to the preservation of urinary continence and sexual function after treatment with the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel); a novel minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Men with symptomatic BPH (IPSS ≥ 10, Qmax < 12ml/s, and prostate volume (PV) < 120ml) were invited to participate in this single-arm, prospective multicenter study (MT06). Patients were not washed out of BPH medications before the procedure. The iTind was implanted through a 22F rigid cystoscope under intravenous sedation and was removed 5-7days later through a 22F Foley catheter under local anesthesia. Post-operative VAS and complications (Clavien Dindo-Grading System) were recorded. Preservation of urinary continence and erectile and ejaculatory function were assessed according to ISI, MSHQ-EjD and SHIM questionnaires. Post-operative IPSS, QoL, Qmax and PVR were also assessed at 1, 3, and 6months post-operatively. This interim report includes data out to 6months on the first 70 patients enrolled in the study. The median age was 62.31years, and the mean prostate volume was 37.68ml (15-80ml). Baseline and follow-up data are reported in Table 1. No intraoperative complications were observed, the average post-operative VAS score was 3.24 ± 2.56. On average patients returned to daily life after 4.3days following the retrieval procedure. Sexual function and urinary continence were preserved in all subjects according to the ISI, SHIM and MSHQ-EjD questionnaires and significant improvements (p < 0.0001) from baseline levels were recorded in IPSS, QoL and peak flow. iTind is a well-tolerated, minimally invasive treatment for BPH-related LUTS which preserves sexual function and urinary continence, offers a rapid recovery and return to daily life, and a significant improvement of symptoms and urinary flow at 6-month follow-up.

Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis

BackgroundOne advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS).MethodsThis is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis.ResultsThe most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery.ConclusionThe PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.

Improving Tolerance and Compliance with Topical Immunomodulators Using Micro-Emulsion Lipid Layer Artificial Tears.

PurposeTo investigate the efficacy of a micro-emulsion (ME) lipid layer artificial tear in improving tolerance of immunomodulator eye drops for the treatment of dry eye disease.Patients and MethodsA total of 33 patients with previously diagnosed dry eye disease were given the micro-emulsion lipid layer artificial tear in conjunction with either lifitegrast or cyclosporine. Patients were queried on their tolerance of the regimen by reporting VAS scores before starting the adjunctive eye drop, immediately after starting, and 2–3 weeks later. Tolerance was statistically compared over time and with respect to previous medication compliance, timing of the adjunctive eye drop, age, gender, and ethnicity.ResultsAcross all patients, the VAS pre-treatment score (6.8 ± 0.6) was significantly higher than both the VAS 1-day post ME lipid tear instillation time point (3.0 ± 0.7) (post hoc Bonferroni, p < 0.001) and the VAS 2–3-week post instillation time point (1.7 ± 0.7) (post hoc Bonferroni, p < 0.001), with the mean VAS score improving over time (post hoc Bonferroni, p < 0.028). Average VAS scores did not vary with respect to specific medical therapy or the timing of instillation of this artificial tear. Both the “at-risk” and “conversion” groups independently had significant improvements at both 1-day and 2–3-week time points compared to baseline.ConclusionThe micro-emulsion lipid layer artificial tear was effective as an adjunctive eye drop to improve tolerance of lifitegrast and cyclosporine for patients with dry eye disease who were at risk of failing or had previously failed immunomodulatory therapy.

A Revised Surgical Strategy for the Distal Tibiofibular Interosseous Osteochondroma

Osteochondroma is one of the most common benign bone tumor; however, the surgical treatment still remains a challenge for those that occur at the distal tibiofibular interosseous location. Previously, the transfibular approach has been successfully described, but the potential damage of the syndesmosis would give rise to the instability of the ankle joint and thus may result in the unfavorable long-term outcome. Here, a revised strategy which can protect the syndesmotic complex is introduced. From 2010 to 2017, eleven patients with the distal tibiofibular interosseous osteochondroma who underwent the revised surgery were collected. The distal fibular osteotomy and posterior tibial osteotomy were performed to keep the inferior syndesmosis intact for better stability of the ankle joint. Both the anterior tibiofibular ligaments (AITFL) and posterior tibiofibular ligaments (PITFL) have been preserved successfully, and thus, the stability of the ankle joint has been maintained due to our strategy. The VAS and AOFAS scores were utilized to assess the clinical outcome and function. Postoperatively, all the patients were pain-free and were able to wear the appropriate shoes at the last follow-up. Preoperative and postoperative AOFAS scores were 93.63 ± 6.91 and 47.27 ± 5.27 (P < 0.05), respectively. Moreover, the average VAS score was 1.73 ± 0.27 (compared with preoperative as 7.45 ± 2.15, P < 0.05), demonstrating obvious improvement after the operation. To our best knowledge, this is the first time to perform the resection of the distal tibial interosseous osteochondroma involving the fibula without interrupting the inferior syndesmotic complex especially the AITFL and PITFL. We believe that this strategy may pave a new way for optimized clinical outcome for these patients with distal tibiofibular interosseous osteochondroma. This clinical trial study is registered with number ChiCTR1900024690.