Average Visual Analog Scale Score Research Articles

Patient-reported outcome and preference after craniotomy and laser interstitial thermal therapy ablation: a pilot study.

Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that allows cytoreduction of brain tumors and can be considered as an alternative to craniotomy. The authors surveyed 27 patients who underwent both craniotomy and LITT during distinct stages of their oncology journey to assess patient-reported outcomes comparing both procedures. A 9-question survey was developed and validated to assess patient-reported postoperative recovery, pain level, narcotic use, and procedure preference. The survey was administered to patients with WHO grade II-IV gliomas who underwent both craniotomy and LITT. The survey was reviewed by independent surgeons, patient advocates, and patients for face validity and showed > 90% intrarater agreement over time. The cohort had a mean age of 57 ± 12 years, and 78% had glioblastoma. There was no significant difference in symptomatic improvement postcraniotomy or post-LITT (30% vs 4%, p = 0.17). Similarly, no significance was detected in patient-reported recovery time from craniotomy (time required to return to preoperative state: mean 4.3 ± 9.1 weeks, median 2 weeks) or LITT (mean 2 ± 2.3 weeks, median 1 week; p = 0.21). Notably, postsurgical pain (0-10 on the visual analog scale) and need for narcotic use in the first week (yes/no) after the procedure were significantly lower post-LITT (average visual analog scale score 1.7 vs 5 points, narcotic use 4% vs 81%; p < 0.0001 for both comparisons). When asked which procedure they would choose-having experienced both craniotomy and LITT-surveyed patients overwhelmingly chose LITT over craniotomy (89% vs 11%, p < 0.0001). Of note, the patients who preferred craniotomy experienced improved neurological function postcraniotomy or suffered new deficits post-LITT. In this pilot study, patients reported less pain and narcotic use post-LITT relative to craniotomy and generally preferred the former procedure if given the choice. Validation of these results in future studies can help inform decision-making in clinical scenarios where there is equipoise between LITT and craniotomy.

Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT

BackgroundBetween 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label PDT protocol: ‘PDT light’. MethodsLaser-assisted low irradiance PDT (li-PDT) was performed beginning in 2014. The dosage was gradually lowered to 8-12 J/cm² in 2018, so that we achieved considerable pain reduction while maintaining comparable therapeutic efficacy. A further considerable reduction in pain was achieved from 2018 onwards by combining the advantages of li-PDT with daylight PDT (DLPDT), thereby resulting in 2018 in the new technique ‘PDT light’. Patients with AK Olsen grades 1 or 2 and field cancerization initially received a mild-fractionated CO2 laser pretreatment prior to MAL-incubation (methyl aminolaevulinate, Metvix ®) under occlusion for 1.5-3 h. Then, patients were illuminated on average for 1.02 min with the Aktilite-LED and, after application of an UV-screen on the illuminated area, sent out into daylight for 1 h. ResultsBetween March and November 2019, we successfully treated 152 cases using the enhanced ‘PDT light’ procedure, with 137 cases achieving at follow-up 1 (on average after 8.14 months) good-to-excellent clearance rates (CLA and CLB together 90%) and minimal adverse effects. ConclusionsThe novel ‘PDT light’ protocol proved to be an excellent and nearly painless method with an average visual-analogue scale (VAS) score of 1.19. Additional advantages included reduced illumination time, shorter outpatient stays in the clinic, fewer adverse effects, and better patient compliance than with DLPDT alone.

Efficacy of Extranasal Neurostimulation for Patients With Neuropathic Corneal Pain: A Pilot Study

Purpose: Neuropathic corneal pain (NCP) has been recognized as a distinct disease, yet treatment options remain limited. The aim of this pilot study was to explore the effectiveness of extranasal neurostimulation (EXNS) as a potential pain relief strategy for individuals with the peripheral component of NCP. Methods: A retrospective study was performed to identify patients who were diagnosed with refractory peripheral or mixed NCP and subsequently underwent a single session of EXNS. Visual analog scale (VAS) was used to evaluate pain intensities in the office before and after 60 seconds of EXNS. Demographic information, changes in pain scores, and comorbidities were recorded, and their correlations with pain score changes were analyzed. Results: Twenty-two patients with a mean age of 48.91 ± 3.32 years were included. The average VAS score before EXNS was 5.59 ± 0.41, which was reduced to 2.59 ± 0.43 after EXNS, indicating a 54.88% reduction (P &lt; 0.001). EXNS reduced VAS scores from 4.90 ± 0.72 to 1.60 ± 0.42 (68.40%) for 10 patients with peripheral NCP and from 6.17 ± 0.42 to 3.42 ± 0.62 (43.61%) for 12 patients with mixed (peripheral and central) NCP (P = 0.005 for both groups). Fourteen patients (63.63%) experienced an improvement of at least 50% in their pain scores, 2 patients (9.09%) showed an improvement between 30% and 49.9%, while 6 patients (27.27%) experienced an improvement of less than 30%. No correlations between the change in pain scores and patient demographics, as well as comorbidities were detected. Conclusions: EXNS may be used as an adjuvant therapy to ameliorate pain among patients with NCP with the peripheral pain component.

Reliability of a Flight Helmet-Attached Force Gauge in Measuring Isometric Neck Muscle Strength

INTRODUCTION: Strong neck muscles may decrease the risk of flight-induced neck pain and possible disability among fast jet pilots. The purpose of this study was to examine the intra- and interrater reliability of a commercial force gauge attached to a pilot’s helmet for measuring isometric force production of the neck muscles. METHODS: A total of 41 subjects performed maximal isometric cervical flexion, extension, and lateral flexion in two measurement sessions for intrarater reliability, and 31 of these subjects participated in a third session for measuring interrater reliability. Delayed muscle soreness and neck pain were assessed using the Visual Analog Scale before and after each measurement session. The intraclass correlation coefficient (ICC) was used to compare values between the test and retest assessments. RESULTS: The overall interrater reliability was good (ICC 0.79–0.90), whereas the intrarater reliability varied from moderate to good (ICC 0.58–0.84). In both intra- and interrater reliability, the flexion test had good (ICC 0.84–0.89) reliability, while the lateral flexion test results had moderate to good (ICC 0.73–0.90) reliability. The extension test had the lowest reliability in both intra- (ICC 0.58) and interrater (ICC 0.79) tests. The average visual analog scale score (from 1–100 scale) prior to the second measurement session was 16 ± 18 in delayed muscle soreness and 0 ± 0 in neck pain. DISCUSSION: The present study demonstrated that the helmet-attached force gauge is a reliable, safe, and clinically applicable method to evaluate isometric neck strength in the flexion and lateral flexion directions. Honkanen T, Mattila V, Kinnunen O, Janhunen M, Sovelius R, Vaara JP, Kyröläinen H. Reliability of a flight helmet-attached force gauge in measuring isometric neck muscle strength. Aerosp Med Hum Perform. 2024; 95(10):788–793.

Debridement and Bone Graft Fusion via the Lateral Extracavitary Approach Combined with Lateral and Posterior Screw-rod Fixation in the Treatment of Thoracic Spinal Tuberculosis: A Retrospective Study of 38 Cases

ObjectivesThoracic spinal tuberculosis (TB) is still common, and surgical treatment can rapidly relieve pain, correct deformity, reduce bone loss and prevent further damage to neurological function. We have practiced an efficient and safe surgical method. MethodsFrom January 2013 to April 2021, 38 patients with thoracic spinal TB were included in our study. Debridement and bone grafting were performed via the lateral extracavitary approach, combined with two different fixation methods. Data from these cases were analyzed retrospectively. ResultsFor all cases, the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) of all the patients decreased to normal levels at the last follow-up. The average visual analog scale (VAS) score was 7.5±1.6 preoperatively and 0.6±0.8 at the last follow-up, showing a significant reduction. The average angle of kyphosis correction was 6.3±4.7°, and the loss of correction was 1.4±1.6°. Neurological function was significantly improved in all cases according to the American Spinal Injury Association (ASIA) classification. Solid fusion was observed in all cases at the last follow-up. ConclusionsDebridement and bone graft fusion via the lateral extracavitary approach combined with two fixation methods can be very effective in the treatment of thoracic spinal TB.

Arthrodesis using Iliac Crest autograft in revision surgery of the first metatarsophalangeal joint total arthroplasty for the treatment of Hallux Rigidus: a retrospective study

PurposeThe treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA).Materials and methodsPatients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views.ResultsOf 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41–72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed.ConclusionWe think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.

Clinical profile in relation to age and gender of patients with temporomandibular disorders: a retrospective study

BackgroundThe present study is to evaluate the clinical characteristics of patients with temporomandibular disorders (TMD).MethodsA total of 3362 TMD patients were included. Each participant had complete medical records according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The clinical characteristics including symptoms and signs in relation to age and gender were analyzed.ResultsThe mean age of the patients seeking care was 29.89 ± 13.73Y, and 68.6% of patients were aged 16–35 years. The female-to-male ratio of patients was 2.2: 1, and the average age of males was significantly lower than that of females. The prevalence of clicking symptoms decreased with age, while the prevalence of pain symptoms and limitations in jaw movement increased with age. Females were more likely to have limitations in jaw movement than males. Among the patients with pain, the average visual analogue scale (VAS) was 2.96 ± 1.23. The average VAS score of acute TMD patients (≤ 3 months) was significantly higher than that of chronic TMD patients (> 3 months).ConclusionsThe majority of TMD patients seeking care were young people. The number and average age of female patients was higher than the males. Female patients were more likely to have limitations in jaw movement than males.

Serratiopeptidase with diclofenac sodium for the management of post-operative pain and inflammation in a day care obstetric and gynaecological surgeries

Management of acute post-operative pain and swelling after the obstetric and gynaecological (OBG) surgeries is crucial part of patient care. Reduction or complete elimination of post-operative pain &amp; swelling, without excessive sedation is the most preferred treatment strategy helping patient’s recovery in terms of rapid mobilization and return to independence. Serratiopeptidase a proteolytic enzyme used for its anti-inflammatory properties. Diclofenac Sodium is commonly used to treat the pain and swelling. This study aimed to evaluate the effectiveness and tolerability of the fixed dose combination (FDC) of Serratiopeptidase (10 mg) with Diclofenac Sodium (50 mg) gastro-resistant tablets in day care OBG surgery. This was a single centre, retrospective, observational data collection in real-life scenario. Data of adult women who had undergone day care OBG surgery and received a FDC of Serratiopeptidase (10 mg) with Diclofenac Sodium (50 mg) gastro-resistant tablets TID for period of 24 hours was retrieved and analysed. VAS (Visual Analogue Scale) data on post-operative pain at rest and pain on movement as well as post-operative swelling were analyzed in conjunction with monitoring for adverse events. Among 61 patient’s data included in the study, 40 (65.57%) had undergone Minimally Invasive Vaginal Hysterectomy (MIVH), 4 (6.56%) had MIVH with Bilateral Salpingo-oophorectomy, and 17 (27.87%) had other OBG surgeries. The average VAS scores for pain at rest (VAS), pain on movement (VAS) and swelling were significantly reduced compared to baseline at all-time points (p&amp;#62;0.001). Clinical global impression of efficacy and safety for 95% physician’s and 93.3% patients was good to very good. FDC was found to be well tolerated without any serious adverse reaction. The results of this clinical study confirms the effectiveness and tolerability of FDC of Serratiopeptidase and Diclofenac sodium in day care OBG surgeries in the early post-operative period.

Social Impact Assessment Project on Cholangiocarcinoma Screening and Care Program

The research aims to assess users utility and cost-effectiveness based on the results of rapid antigen test kits for urine and abdominal ultrasound methods. This study uses qualitative methods to analyze liver fluke screening among individuals aged 40 and above in four provinces. Purposive sampling was used, with 373 participants and 379 participants, respectively. Utility measurement tools included a direct Visual Analog Scale (VAS) and indirect EuroQoL (5Q-5D-5L), and willingness to pay value was measured using bidding. The result shows that the sample group has an average VAS score of 76.90, with slight pain or discomfort reported in the five health dimensions. The utility value reflecting daily quality of life is 0.89. The average willingness to pay per use for rapid test kits and abdominal ultrasounds is 187 baht and 796 baht, respectively. Reasons for not paying higher include income factors, high prices, and personal limitations. However, participants believe public hospitals could support examination costs and provide access to benefits. The project benefits people economically, socially, and culturally, and if the Ministry of Public Health and related agencies can effectively use it, it will maximize benefits.

The Real-World Efficacy of Fixed Triple Inhalation Therapy in the Treatment of Moderate COPD Patients (RATIONALE Study).

COPD affects more than 300 million people worldwide, requiring inhalation treatment. Novel triple formulations of ICS, LABAs and LAMAs are becoming the mainstay of treatment, however there is still a lack of clinical evidence for personalized therapy. RATIONALE was a non-interventional, prospective, 52 week study, assessing the effectiveness of beclometasone/formoterol/glycopyrronium-bromide (BDP/FF/G), in symptomatic COPD patients, with moderate airflow obstruction. The study included 4 visits, where data on demographic parameters, exacerbations, symptoms, quality of life (based on the EQ-5D-3L questionnaire) and lung function were collected. Data on adherence to treatment, based on prescriptions filled was collected from the database of the National Health Insurance Fund, with the patients' consent. The primary objective was the change of adherence to treatment during the study, compared to baseline. Altogether 613 patients had been enrolled. Their average age was 64.56 years and 50.5% were female. The average CAT score was 20.86, and most patients had suffered minimum one exacerbation (82.2%). Average FEV1 was 59.6%. Most patients had some limitation in one or more dimensions of EQ-5D-3L, with an average visual analogue scale score (VAS) of 60.31. After 12 months of treatment, adherence improved significantly - proportion of patients in the highest adherence group increased from 29.8% to 69.7% (p<0.001). The average CAT score improved by 7.02 points (95% CI 5.82-8.21, p<0.001). There was a significant improvement in all dimensions of EQ-5D-3L, with an average increase of 17.91 (95% CI 16.51-19.31, p< 0.001) points in the VAS score. Exacerbation frequency also decreased significantly. Although limitations of observational studies are present, we observed that early introduction of fixed triple combination results in a marked improvement in adherence to treatment, symptom scores, exacerbation frequency and quality of life. The optimal choice of treatment is crucial for reaching the highest possible adherence.

Efficacy and safety of the combination of estetrol 15 mg/drospirenone 3 mg in a cyclic regimen for the treatment of endometriosis-associated pain and objective gynecological findings: a multicenter, placebo-controlled, double-blind, randomized study

To evaluate the efficacy and safety of 24-week cyclic administration of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg in Japanese patients with endometriosis. A 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. A total of 162 Japanese women diagnosed with endometriosis. Participants were randomly allocated to the E4/DRSP group or the placebo group. In the E4/DRSP group, participants were orally administered one tablet containing E4 15 mg and DRSP 3 mg daily for 24 days, followed by one placebo tablet for 4 days for a hormone-free interval, constituting a one-cycle regimen. One placebo tablet was administered once daily for 28 days to participants in the placebo group. The treatments were continued for six cycles (24 weeks) throughout the confirmatory period. Changes in visual analog scale scores for the most severe pelvic pain (lower abdominal and back pain) from baseline to six treatment cycles at the end of the confirmatory study period. E4/DRSP showed changes in average visual analog scale scores for the most severe pelvic pain (-33.2 mm) from baseline to the end of the six-cycle treatment. The between-group difference was significant (-8.5 mm, two-sided 95% confidence interval: -16.1 to -0.9 mm), showing superiority to placebo (p=0.028). Responder rates, ≥30% and ≥50% reduction in visual analog scale scores from baseline, were larger in the E4/DRSP group than in the placebo group: 53.2% versus 29.6% (p=0.004) and 36.4% versus 12.3% (p<0.001). Objective gynecological findings (induration of the cul-de-sac, pelvic tenderness, limited uterine mobility) were significantly improved by E4/DRSP treatment, and the proportions of stable and worsened participants were significantly lower than in the placebo group. E4/DRSP reduced the size of endometriomas and improved quality of life, based on quality of life-related questionnaires and global impression scores. No safety concerns were observed with E4/DRSP treatment. Few differences were observed in the proportion of participants with hemostasis parameters outside the reference range between the E4/DRSP and placebo groups. E4/DRSP effectively treats endometriosis-associated pain and improves gynecological findings. E4/DRSP may be a safe, new option for endometriosis treatment with a potentially reduced risk of thromboembolic events.

The Clinical Effects of C2 and C3 Medial Branch Block for Medically Intractable Headache : a Retrospective Study.

This study aimed to evaluate the clinical effects of medial branch blocks (MBB) C2 and C3 in treating patients with medically intractable headaches. The medical records of 81 patients with medically intractable headaches who underwent a C2/3 MBB between January 2019 and March 2022 were retrospectively reviewed. The degrees of pain were evaluated using a visual analogue scale (VAS) score (rating 0-10) on baseline and after procedures. To evaluate patients' satisfaction for the treatment, self-reporting measurements were examined and were categorized as excellent (>90% pain relief), good (50%-90% pain relief), fair (10%-50% pain relief), and none (<10% pain relief). The total number of MBB procedure was 107. The average baseline VAS score was 7.4 ±1.5, which improved significantly to 2.6 ±2.3, 3.6 ±2.6, and 4.5 ±3.2 on 1-3 days, 3-7 days, and 3 months after the procedure, respectively (Wilks' lambda within group test, P <0.001). For the subjective feeling of pain relief, percentages of "excellent" response in the self-reporting measurements were significantly decreased over time (chi-square test; P= 0.001). This study demonstrates clinical effectiveness of C2/3 MBB in patients with medically intractable headaches, with both early and prolonged benefits.

Electroacupuncture with different waveforms for primary dysmenorrhea: A randomized controlled trial

ObjectiveTo observe and compare the clinical effects of different electroacupuncture waveforms on primary dysmenorrhea. MethodsThis was a prospective, randomized, three-group, parallel-controlled trial. Participants with primary dysmenorrhea were randomly divided into dense-sparse wave, continuous wave, and discontinuous wave groups in a 1:1:1 ratio. Two lateral Ciliao (BL 32) points were used. All three groups started treatment 3–5 days before menstruation, once a day for six sessions per course of treatment, one course of treatment per menstrual cycle, and three menstrual cycles. The primary outcome measure was the proportion with an average visual analog scale (VAS) score reduction of ≥50% from baseline for dysmenorrhea in the third menstrual cycle during treatment. The secondary outcome measures included changes in dysmenorrhea VAS scores, Cox Menstrual Symptom Scale scores and the proportion of patients taking analgesic drugs. ResultsThe proportion of cases where the average VAS score for dysmenorrhea decreased by ≥50% from baseline in the third menstrual cycle was not statistically significant (P > .05). Precisely 30 min after acupuncture and regarding immediate analgesia on the most severe day of dysmenorrhea, there was a statistically significant difference in the dense-sparse wave group compared with the other two groups during the third menstrual cycle (P < .05). Additionally, there was a statistically significant difference between the dense-sparse wave and discontinuous wave groups 24 h after acupuncture (P < .05). ConclusionsWaveform electroacupuncture can alleviate primary dysmenorrhea and its related symptoms in patients. The three groups showed similar results in terms of short- and long-term analgesic efficacy and a reduction in the number of patients taking analgesic drugs. Regarding achieving immediate analgesia, the dense-sparse wave group was slightly better than the other two groups.

Pins and Rubbers Traction System for Treatment of Intraarticular Fractures of Distal Interphalangeal Joint.

Background: The pins and rubber traction system (PRTS) has proven effective in managing intra-articular fractures of the proximal interphalangeal joint. However, there is scant evidence in the literature regarding its efficacy in treating distal interphalangeal joint (DIPJ). This study aims to investigate the outcomes of PRTS in the treatment of comminuted intra-articular fractures of the DIPJ. Methods: We conducted a retrospective review of patients with comminuted intra-articular fractures of the DIPJ treated with PRTS between 2017 and 2021. At the final follow-up, we measured and compared the active range of motion (ROM) in both affected and non-injured contralateral fingers. The subjective evaluation utilised the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Visual Analogue Scale (VAS). Results: Ten patients with a mean follow-up of 13.2 months (range: 12-17) were included in the study. Fracture locations included the base of the distal phalanx in two patients, the condyle of the middle phalanx in seven and both in one patient. At the final follow-up, the average VAS score was 0.5 (range: 0-2). The average active motion of the DIPJ was 61° (range: 50°-70°) for the injured side and 76° (range: 75°-80°) for the opposite side. The mean range of DIPJ movement was 80% (range: 68%-87%) of the non-injured side. Extension deficits were observed in five patients, with a median deficit value of 10° (range: 5°-10°). The average Quick-DASH score was 2.9 (range: 0-11.3). Conclusions: The PRTS can be considered as an effective surgical technique in managing comminuted intra-articular fractures of the DIPJ. Level of Evidence: Level IV (Therapeutic).

Minimally Invasive Trans-sacral Canal Plasty for Lumbar Canal Stenosis.

Objective The elderly population is increasing in Japan. Along with the increase in the elderly population, the number of patients with lumbar degenerative diseases is also on the rise. In general, elderly patients tend to have more complications and are at higher risk for surgery. Many elderly people suffer from lumbar degenerative disease. We reviewed our initial experience with trans-sacral canal plasty (TSCP) for patients with lumbar spinal canal stenosis and examined the pertinent literature for this report. Methods An analytical observational study was performed on 120 patients with lumbar spinal canal stenosis who underwent TSCP at our single institution from March 2019 to October 2021. These patients had leg pain and/or lower back pain due to degenerative lumbar disease. Patients who had coagulation abnormality, pregnancy, contrast allergy, pyogenic spondylitis, or spinal metastasis were excluded. Results Immediately after TSCP, the average Visual AnalogScale (VAS) score for back pain improved from 58.2 to 29.3, and for leg pain from 72.0 to 31.3. Two years after TSCP, the average VAS score for back pain increased slightly and the average score for leg pain remained almost the same. Additional surgery was performed in 37 of 120 (31%) patients who underwent TSCP. The additional surgery group had significantly worse back pain at one and three months postoperatively than the conservative treatment group. The additional surgery group had significantly worse leg pain immediately after TSCP and at one and three months postoperatively than the conservative treatment group. Logistic regression analysis demonstrated that a decreased spinal canal area (OR 0.986, p = 0.039) was associated with additional surgery. Conclusions We reviewed the outcomes of TSCP at our hospital. The average VAS score for back pain and leg pain improved. However, 31% of patients who underwent TSCP required additional surgery. It was found that the spinal canal area was a major factor in the need for additional surgery.

Quality Improvement in an Anaesthesiology and Intensive Care Unit Through Pain Assessment and Control.

The aim of the study is to determine whether the assessment of postoperative pain and timely measures to control it improve the quality of medical care in intensive care units (ICUs). To develop an improvement model with a focus on pain assessment and control. 151 patients were included in the study, divided into two groups: a retrospective group (RG)-60 patients and a prospective group (PG)-91 patients. A multimodal approach to pain control was applied to all patients. We administered the Critical Care Pain Observational Tool (CPOT) to PG upon admission to the ICU. Visual analog scale (VAS) for pain assessment was used in all non intubated patients in 6 hours intervals. In the PG, а model for improvement was applied using a PDSA (Plan, Do, Study/ Check, Act) cycle. The following indicators have been used: process, outcome, and balancing indicators. A survey of the PG was also conducted. The developed Model of improvement increased the VAS score reporting success rate from 40 to 95%, which allowed significantly better pain control. In PG the registered CPOT score was 1.71 ± 0.73. 90% of patients in PG have an average VAS score below 5 after the improvement model, while in RG-50% of patients, which is statistically significant (P < 0.001). There was no statistically significant difference in balancing indicators between the two groups. Conclusion: The conducted survey confirmed the positive effect of the model. Quality improvement in the ICU depends on accurate assessment of postoperative pain and timely and adequate treatment.

Reconstruction Strategy for Upper Extremity Defects After Bone Tumor Resection Based on 3D Customized Bone Cement Mold.

Reconstructing bone defects in the upper extremities and restoring their functions poses a significant challenge. In this study, we describe a novel workflow for designing and manufacturing customized bone cement molds using 3D printing technology to reconstruct upper extremity defects after bone tumor resection. Computer tomography data was acquired from the unaffected upper extremities to create a detachable mold, which can be customized to fit the joint precisely by shaping the bone cement accordingly. Fourteen patients who underwent reconstructive surgery following bone tumor resection in the proximal humerus (13 cases) or distal radius (1 case) between January 2014 and December 2022 were retrospectively evaluated. The medical records of this case series were reviewed for the demographic, radiological, and operative data. Metastasis, local recurrence, and complication were also reviewed. Additionally, Musculoskeletal Tumor Society Score (MSTS) and Visual Analogue Scale (VAS) were used to assess clinical outcomes. The mean follow-up period was 49.36 ± 15.18 months (range, 27-82 months). At the end of follow-up, there were no cases of metastasis or recurrence, and patients did not experience complications such as infection, dislocation, or implant loosening. Two cases complicated with subluxation (14.3%), and 1 case underwent revision surgery for prosthetic fracture (7.1%). The average MSTS score was 23.2 ± 1.76 (77.4%, range, 66.7%-86.7%), and the postoperative VAS score was 1.86 ± 1.03 (range, 1-4), which was significantly lower than that before surgery (average preoperative VAS score was 5.21 ± 2.00 (range, 2-8)) (P < .001). Customized 3D molds can be utilized to shape bone cement prostheses, which may serve as a potential alternative for reconstructing the proximal humerus and distal radius following en bloc resection of bone tumors. This reconstruction strategy offers apparent advantages, including precise matching of articular surfaces and comparatively reduced costs.

Evaluation of Three Methods for the Treatment of Dentin Hypersensitivity: A Randomised Clinical Trial

ObjectivesIn this study, we aimed to compare the effectiveness of Gluma and high-power 980-nm diode laser, alone or in combination, in the treatment of cervical dentin hypersensitivity. MethodsA total of 20 patients (5 men and 15 women), aged 25 to 60 years, who met the inclusion criteria, were enrolled in this study. A total of 60 teeth were randomly divided into 4 groups: G1, 980 nm diode laser (in 2 sessions within a 1-week interval); G2, Gluma (in 2 sessions within a 1-week interval); G3, 980 nm diode laser plus Gluma; and G4: control. Thermal (cold spray) and air blast (air syringe of dental unit) stimuli were used to evaluate cervical dentin hypersensitivity in the patients. Their pain response was assessed using a visual analogue scale (VAS) before treatment (baseline), in the first treatment session (15 minutes after treatment), in the second treatment session (after 1 week), and in 2-week, 1-month, and 3-month follow-up sessions. The obtained data were analysed using non-parametric tests, including Kruskal–Wallis test, Friedman test, Mann–Whitney test, and Wilcoxon test, in SPSS Version 22 at a significance level of P < .05. ResultsBased on the results, there was a significant difference in the average VAS scores for cold and air blast stimuli between the 4 groups 1 month after the intervention (P < .05). Meanwhile, the laser group had the lowest VAS score for cold and air stimuli. On the contrary, no significant difference was found between the 4 groups 3 months after the intervention (P ˃ .05). ConclusionThe present results showed that 980-nm diode laser alone was more effective than the other 2 intervention methods for 1 month. Trial registrationThe study was registered in the Iranian Registry of Clinical Trials (IRCT20120901010703N5).

Anatomical Basis for Preservation of Cartilaginous Apophysis in Pediatric Patients Undergoing Iliac Crest Bone Graft Harvest: A Cohort Study.

Background The anterior iliac crest is the workhorse for the harvest of cancellous bone in children undergoing cleft alveolar bone grafting. However, the complexity of the anatomy makes the process of harvesting graft technique sensitive. The aim was todescribe the outcomes of the medially based trap door method of graft harvest in pediatric patients undergoing cleft alveolar bone grafting. Methods A cohort study was conducted, including all the patients in the age group of 8-12 years.Alveolar bone grafting was performed after harvesting a cancellous graft from the iliac crest bone grafting (ICBG) using a medially based trap door approach.Intraoperative time, average blood loss, and postoperative outcomes, including pain score, paresthesia, and gait disturbances, were recorded. Results A total of 28 patients were included in the study based on the inclusion and exclusion criteria. The volume of cancellous bone harvested was between 4-9 cc. The mean intraoperative time was 42 minutes, with an average blood loss of 36 to 48 ml.The average visual analog scale (VAS) score in the postoperative period was 3.5, 6, and 4 on the first, third, and seventh postoperative days. All the patients were ambulated on the second postoperative day, and none of them reported paresthesia. Long-term evaluation of the anterior illum revealed intact crestal morphology with a bone refill on the posterior-anterior (PA) pelvic X-ray. Conclusion A medially based modified trap door approach is more efficaciousand less morbid for the harvest of ICBG in pediatric patients.

Quality of Life Assessment in Patients with Knee Osteoarthritis

IntroductionOsteoarthritis is one of the most common diseases and a leading cause of functional limitation and dependence, significantly impacting the quality of life (QOL).ObjectivesThe aim of this study was to evaluate the impact of knee osteoarthritis on QOL and identify associated factors.Methods This prospective cross-sectional descriptive study was conducted in the Physical Medicine and Functional Rehabilitation Department over a 4-month period, involving patients with symptomatic bilateral knee osteoarthritis (according to the American College of Rheumatology (ACR) criteria). Sociodemographic data, comorbidities, and characteristics of knee osteoarthritis were collected. The assessment of QOL and the functional impact of knee osteoarthritis were based on the KOOS (Knee Injury and Osteoarthritis Outcome Score) self-questionnaire, Lequesne Index, and modified WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) Score. The KOOS questionnaire included 5 subscales: pain (KOOS-Pain), symptoms other than pain (KOOS-Symptoms), activities of daily living (KOOS-ADL), sports and recreational function (KOOS-Sport), and QOL (KOOS-QOL).Results We included 30 patients with an average age of 59.27±6.3; the male-to-female ratio was 0.15. Sixty percent of patients lived in urban areas, with varying levels of education: primary (n=10), secondary (n=4), and university (n=4), while the majority were illiterate (40%). Most of our patients were employed, with 64.28% engaging in significant physical activity, resulting in an average of 6±2 days of work absenteeism every 3 months due to knee pain. The mean duration of knee osteoarthritis was 7.97 years±3.14. The average pain visual analog scale (VAS) score was 5.2±0.4. Knee osteoarthritis was classified as stage 2 in 40% and stage 3 in 60% of cases. Regarding functional impact, the mean WOMAC global index was 16.6±4.68, and the mean Lequesne Index was 11.05±3.45; moderate disability was observed in 16.7%, significant disability in 50%, and severe disability in 16.7% of patients. Furthermore, the KOOS questionnaire revealed decreased KOOS-Sport and KOOS-QOL scores, with mean values of 35±10.2 and 37±8.9, respectively. Our study identified factors associated with a poor quality of life: age &gt; 65 years (p&lt;0.05), disease duration (p=0.02), and VAS pain &gt; 5 (p=0.02).ConclusionsImproving the quality of life is an essential therapeutic goal in managing knee osteoarthritis. Our study demonstrates that advanced age, longer disease duration, and high pain intensity can negatively impact quality of life.Disclosure of InterestNone Declared