Change In Visual Analog Scale Research Articles

Management of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction vs. Marginal Convergence (236)

Objectives:Irreparable rotator cuff tears can be challenging to manage in younger patients who are not well indicated for reverse total shoulder replacement. Treatment options in this patient population include both marginal convergence (MC) and superior capsular reconstruction (SCR). While both treatment options have demonstrated good short term outcomes, they have vastly different associated costs and operative times. Thus, the purpose of this study was to compare range of motion (ROM), patient reported outcomes, and re-operation rates following MC and SCR. We hypothesized that SCR would outperform MC regarding functional and subjective outcomes.Methods:A retrospective review was conducted on 44 patients from two surgeons with irreparable rotator cuff tears that underwent either MC (28 patients, 28 shoulders) or SCR (16 patients, 16 shoulders) from 2014-2019 at a single academic center. Patient inclusion criteria were the following: failed conservative or prior surgical management, no or mild glenohumeral arthritis, Goutallier grade 3 or 4 fatty infiltration of the involved muscles, Hamada grade 1 or 2 rotator cuff arthropathy, intact or repairable subscapularis tear and minimum of 1 year follow-up. Visual Analogue Scale (VAS) for pain, active forward flexion (FF) and external rotation (ER) range of motion, reoperation rate, and rate of conversion to reverse total shoulder arthroplasty were evaluated. For statistical analysis, t-tests were used to determine differences in functional outcomes and VAS, while Chi-Squared tests were used to determine differences in the rate of re-operation and conversion to arthroplasty (*p < 0.05).Results:The mean age at the time of surgery for the MC and SCR groups was 64.4 and 58.5 years, respectively, with an average follow-up of 31.5 months for the MC group and 17.8 months for the SCR group. There were no significant differences in the mean age at the time of surgery, gender, body mass index, pre-operative FF and ER, and pre-operative VAS between the groups. The MC group did not have a significant improvement FF with a mean pre-operative FF of 144.4°(range: 30-170°) and post-operative FF of 150.5°(range: 90-180). The same was true for the SCR group, with a mean pre-operative FF 127.5°(range: 40-170°) and post-operative FF of 146.3°(range: 40-170). There was also no significant improvement in ER post-operatively in either group. Both the MC and SCR group had significant improvements in VAS for pain from an average of 7.3 (range: 1-10) pre-operatively to 2.5 (range: 0-10) post-operative for the MC group (p < 0.01) and from 7.3 (range: 3-10) pre-operatively to 1 (range: 0-4) post-operative for the SCR group (p < 0.01). There were no significant differences in the post-operative FF or ER, change in FF or ER, post-operative VAS, or change in VAS between the two treatment groups. The rate of conversion to arthroplasty was not significantly different between the groups at 3.6% for the MC group and 12.5% for the SCR group. Additionally, the overall reoperation rate was not significantly different between the MR and SCR groups at 10.7% and 12.5%, respectively.Conclusions:There were no significant differences between the MC and SCR treatment groups. While both MC and SCR were effective in improving VAS for pain, neither treatment consistently resulted in significant improvement in ROM. Further studies with long term outcomes are needed to determine if there are certain indications for which one treatment results in better outcomes.

Does Neuromuscular Electrical Stimulation Have an Additive Effect on Disability, Pain and Abdominal and Lumbar Muscle Thickness in Chronic Low Back Pain? – A Randomized Controlled Double-Blind Study

Abstract Objective To examine the effect of neuromuscular electrical stimulation (NMES) combined with core stabilization exercises (CSE) in patients with chronic low back pain (CLBP). Methods Thirty-six patients (mean age 33.6±12.6 years) with CLBP were randomly assigned to 4 weeks (12 sessions) of NMES group (NMES combined with CSE) (n=18) vs. Control group (sham NMES and CSE) (n=18). After the 4 weeks, same exercises were given as home exercise program without NMES. The outcome measures were Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Nottingham Health Profile (NHP) and ultrasonography. Ultrasonography was used for measuring transversus abdominis (TrA), internal oblique (IO), external oblique (EO) muscles thickness and lumbar multifidus muscle thickness and area. Assessments were performed at baseline and 4th week and eighth week follow-up. Results In both groups, the change of ODI, VAS and NHP values of the first measurement according to the values of the 4th week and the eighth week were found statistically significant (p=0.001; p&lt;0.01). There were no statistically significant differences in ODI, VAS and NHP scores between the 4th week and the eighth week in both groups (p&gt;0.05). None of NMES and control group measurements with US showed a statistically significant increase in the TrA, IO, EO thickness and multifidus thickness and area (p&gt;0.05). Conclusions It was shown that NMES can be tolerated by patients with CLBP, but the addition of simultaneus NMES to CSE had no contribution to the clinical outcome measures.

Effects of Transcutaneous Spinal Direct Current Stimulation (tsDCS) in Patients With Chronic Pain: A Clinical and Neurophysiological Study.

Background and Aims: Chronic pain is a complex clinical condition, often devastating for patients and unmanageable with pharmacological treatments. Converging evidence suggests that transcutaneous spinal Direct Current Stimulation (tsDCS) might represent a complementary therapy in managing chronic pain. In this randomized, double-blind and sham-controlled crossover study, we assessed tsDCS effects in chronic pain patients.Methods: Sixteen patients (aged 65.06 ± 16.16 years, eight women) with chronic pain of different etiology underwent sham and anodal tsDCS (anode over the tenth thoracic vertebra, cathode over the somatosensory cortical area: 2.5 mA, 20 min, 5 days for 1 week). As outcomes, we considered the Visual Analog Scale (VAS), the Neuropathic Pain Symptom Inventory (NPSI), and the components of the lower limb flexion reflex (LLFR), i.e., RIII threshold, RII latency and area, RIII latency and area, and flexion reflex (FR) total area. Assessments were conducted before (T0), immediately at the end of the treatment (T1), after 1 week (T2) and 1 month (T3).Results: Compared to sham, anodal tsDCS reduced RIII area at T2 (p = 0.0043) and T3 (p = 0.0012); similarly, FR total area was reduced at T3 (p = 0.03). Clinically, anodal tsDCS dampened VAS at T3 (p = 0.015), and NPSI scores at T1 (p = 0.0012), and T3 (p = 0.0015), whereas sham condition left them unchanged. Changes in VAS and NPSI scores linearly correlated with the reduction in LLFR areas (p = 0.0004).Conclusions: Our findings suggest that tsDCS could modulate nociceptive processing and pain perception in chronic pain syndromes.

Two kinds of lateral retinacular release for lateral patellar compression syndrome:a retrospective comparative study

Objective: To compare the clinical effects of arthroscopic lateral retinacular proximal release and "L" type release for lateral patellar compression syndrome. Methods: Sixty four lateral patellar compression syndrome (LPCS) patients were recruited who had arthroscopic surgery during September 2004 to January 2019 at Department of Sports Medicine,Peking University Third Hospital by the same group of doctors and a retrospective comparative study was conducted accordingly. Among them,24 cases underwent the traditional proximal release of lateral patellar retinaculum (traditional group),including 7 males and 17 females with an age of (42.9±14.6)years(range:23 to 72 years); 40 cases were treated with novel lateral retinacular release of "L" type release revised based on the previous experiences (novel group), consisting of 12 males and 28 females with an age of (54.9±13.1) years (range:28 to 76 years).All the patients participated surveys for the visual analogue scale (VAS),Lysholm score and International Knee Documentation Committee (IKDC) knee function subjective evaluation before and after the operation. The comparison of scores within groups was performed by Wilcoxon test,and comparison between groups was performed by Mann-Whitney U test and Chi-square test. Multivariate analysis was used to evaluate the related factors affecting each score. Results: The follow-up durations of traditional group and novel group were (12.6±1.0) years (range:11.7 to 15.3 years) and (2.2±1.0)years(range:1.0 to 4.4 years) respectively. At the last follow-up,VAS(0(1.0)to 6.0(2.0),Z=-5.471,P<0.01),Lysholm score(98.0(10.0)to 48.0(40.0),Z=-5.511,P<0.01),and IKDC score(82.8(11.2)to 37.4(18.5),Z=-5.444,P<0.01) in novel group were statistically significantly improved,and the postoperative excellent rate of Lysholm score was 97.5% in general. There was no significant difference in the changes of the three scores (P>0.05) between the traditional group and the novel group. However,20.8% (5/24)patients in the traditional group reported significant weakness of the knee extension after surgery,while no such complain was received in the novel group (P<0.01).The results of univariate analysis showed that surgical method was a related factor affecting the changes of VAS before and after surgery (P<0.05).The results of multivariate analysis showed that whether or not with osteoarthritis and operation type were independent factors affecting the changes of Lysholm and IKDC scores (P<0.05). Conclusions: The long-term effect of arthroscopic lateral retinacular release for the treatment of LPCS is satisfactory. Compared with the traditional proximal release surgery,the "L" type release can effectively avoid the complication of significant weakness of the knee extension significantly.

Intra-articular corticosteroid injection and genicular nerve block under ultrasound guidance in pain control of knee osteoarthritis

BackgroundChronic knee osteoarthritis (OA) is a frequent disease among the elderly. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate knee OA-related pains. Recently, Genicular nerve block (GNB) has emerged as a new alternative technique. The current study aimed to investigate the efficacy of those two approaches when guided with ultrasound and to determine which one offers better results. This study included 40 patients with painful chronic knee OA (Nine males and 31 females, age ranged from 44 to 65 years) and were randomly assigned to two equal groups. Groups 1 was managed with ultrasound-guided IACSI and group 2 with ultrasound-guided GNB using a mixture of lidocaine and Triamcinolone Acetonide. The baseline mean visual analogue scale (VAS) and Oxford knee score (OKS) for the group 1 were 87.10 and 51.3, while for group 2 were 87.75 and 53.25 respectively. Follow up values were obtained at 2, 4 and 8 weeks using VAS and OKS.ResultsThe VAS score and OKS score were significantly lower in the GNB group and IACSI group at 2, and 4 weeks after the procedure (p < 0.001 for all), then returned near baseline values at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (mean reduction of 58.5, 53.3, and 9.25 points at 2, 4, and 8 weeks versus 44.9, 39.4, and 5.6 points at the IACSI groups, p < 0.001 at 2 and 4 weeks, p < 0.006 at 8 weeks). Similarly at the OKS, the GNB group showed significantly better results (33.50, 28.60, and 8.5 at GNB and 26.45, 20.10, 5.25 at IACSI. p < 0.001 at all periods).ConclusionsBoth GNB and IACSI are effective methods to relieve chronic knee osteoarthritis-related pains. When compared to each other, GNB showed more significant pain relief and functional improvement than IACSI.

A comparative evaluation of kambin’s triangle approach versus safe triangle approach for lumbar transforaminal epidural injection in patients with lumbar radiculopathy - A prospective, randomized, double blind study

Background: Epidural injection of steroid and local anaesthetic is a common modality for management of radicular pain. Transforaminal approach is preferred for epidural injection in case of radiculopathy.&#x0D; Aims and Objectives: To compare the effect of the Kambin’s triangle and subpedicular approaches of transforaminal epidural injection (TFEI) in patients of lumbar radiculopathy.&#x0D; Materials and Methods: Forty patients with lumbar radicular pain were enrolled and randomly assigned to each group (Group K for Kambin’s triangle approach and Group S for subpedicular approach). All procedures were performed under fluroscopic guidance. The frequency of complications during the procedure and the effect of TFEI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual Analog scale (VAS). Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors and the therapeutic effect.&#x0D; Result: VAS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VAS between these two groups. Spinal nerve pricking occurred in one case of the subpedicular and in none of the cases of the Kambin’s triangle approach (p&lt;0.05).&#x0D; Conclusion: Kambin’s triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). So, Kambin’s triangle approach may be an alternative method for TFEI in cases where needle tip positioning in the anterior epidural space is difficult.

The effect of gender differences on the use of valproic acid for migraine prophylaxis

Aim: The efficacy of the drugs used for migraine prophylaxis remains unclear. At our headache polyclinic, when we observed the difference in prophylactic response especially in valproic acid (VA) treatment between genders, the response of male was found to be better than that of females so we wanted to document this difference by collecting data retrospectively&#x0D; Material and Method: 46 chronic migraine without aura patients with VA who were enrolled in our headache outpatient clinic between 2015 - 2018 were included in the study (29 male, 17 female). In these patients, after VA the frequency of montly attacks between sexes, changes in VAS (Visual analogue scale) scores, single VA prophylaxis and the addition of a second prophylaxis drug were evaluated. &#x0D; Results: None of the men needed an additional second drug while 11 of 17 women needed the addition of a second drug. There was no gender difference in monthly attack frequency before treatment, whereas monthly attack frequency after treatment with VA was found to be significantly lower in men ( before treatment; female 20,9±11,3 male 17,7±11,5, p&gt;0.05) (after treatment; male 1,2±5,5 female 12,0±12,2, p0.05)(after treatment; female 4,4±2,8 male 2,3±2,8, p

Effects of an Amylopectin-Chromium Complex Plus Whey Protein on Strength and Power After Eight Weeks of Resistance Training

Background: Previously we reported that acute supplementation with an amylopectin- chromium complex combined with a six-gram dose of whey protein increased rates of muscle protein synthesis. The purpose of this study was to examine if chronic supplementation with the same amylopectin-chromium complex plus a higher dose of protein could impact resistance training adaptations, recovery, and biomarkers of safety.Methods: Using a randomized, active-controlled, double-blind design, 35 recreationally active men (mean ± age, height, weight: 40.9 ± 7.6 y, 180.2 ± 6.1 cm, 95.8 ± 14.5 kg) were matched according to HOMA-IR and resistance-training experience and then randomly allocated to one of three groups: an active group consisting of 2 g amylopectin-chromium complex + 15 g whey protein isolate (V15P), an equivalent dose of whey protein isolate (15 g of whey protein, 15P), or a 30 gram dose of whey protein isolate (30P). Subjects consumed their respective supplement immediately following resistance exercise on days when training occurred and at the same time of day on non-training days. At 0, 4, and 8 weeks of training, body composition (4C via DXA, Bod Pod, Bioimpedance), whole-body protein balance (oral 15N-alanine), upper body and lower body performance (bench press, squat, jump power), and visual analog scale (VAS) scores for recovery, sleep quality, energy, willingness to train, and muscle soreness were assessed. Safety assessments included systemic hemodynamics, complete blood count, and comprehensive metabolic panels. Results: All groups gained strength, increased fat-free mass, and improved muscle size. Similarly, all groups increased squat repetitions to failure (RTF), with V15P experiencing a greater increase (+25.3 reps, p = 0.02) when compared to 15P (+12.0 reps) and 30P (+13.9 reps). After normalizing data to body mass, vertical jump power increased (p = 0.03) more for V15P (+2.1 Watts/kg) than either 15P (+0.4 Watts/kg) or 30P (+0.3 Watts/kg). Vertical jump height calculated from power output increased more in V15P (+8.7 cm, p = 0.04) than 15P (+1.6 cm) and 30P (+0.9 cm). Net protein balance was greater (p = 0.04) in V15P compared to 15W and 30W at four weeks (p &lt; 0.05), but this difference was not observed after eight weeks (p = 0.51). No changes in VAS were identified between groups. Diastolic blood pressure decreased in V15P (p = 0.002) compared to the other groups, and outside of an interaction for creatinine and aspartate aminotransferase (which still remained well within clinical limits), all blood- based markers of safety demonstrated no differences between groups.

Clinical efficacy of nanohydroxyapatite-containing toothpaste at relieving dentin hypersensitivity: an 8 weeks randomized control trial

ObjectiveThe objective of this study was to investigate and compare the effectiveness of several toothpastes containing nanohydroxyapatite (nano-HAP) to relieve dentin hypersensitivity (DHS) with that of a commercial desensitizing dentifrice containing calcium sodium phosphosilicate (CSPS).Materials and methodsIn this double-blind, randomized, parallel-group clinical trial, patients diagnosed with DHS and qualified to participate were randomized into four groups: toothpaste containing 10% nano-HAP (10%nano-HAP), 15% nano-HAP (15%nano-HAP), 10% nano-HAP supplemented with potassium nitrate (KNO3) (10%nano-HAPKN), or CSPS. Subjects’ baseline and post-treatment sensitivities were assessed using visual analog scale (VAS) after the application of ice-cold and air stimuli. Subjects used their assigned toothpaste for routine toothbrushing twice daily. Post-treatment sensitivity was assessed every 2 or 8 weeks. Mean change in VAS (mm) from baseline at each time point were compared using random-intercept, mixed-model analysis and Duncan test (P < 0.05).ResultsWith either air or cold stimulus, VAS indicated a significant (P < 0.001) reduction from baseline DHS at each time point with all test toothpastes. Among the nano-HAP toothpastes, 15%nano-HAP and 10%nano-HAPKN were consistent in DHS reduction with both stimuli. With either stimuli, the CSPS did not significantly differ from 15%nano-HAP and 10%nano-HAPKN at any time point.ConclusionsToothpaste containing nano-HAP (10 or 15%) alone or supplemented with KNO3 was as effective as CSPS for relief of DHS symptoms when used at least twice daily.

Alteration of Brain Functional Network and Cortisol Level During Induction and Release of Stress: An EEG Study in Young Male Adults

Acute stress in a long period of time could drastically influence one's behavioral and cognitive performances. Therefore, it is important to control the stressful situation and release it after a stressful event. In this regard, understanding of brain mechanism of the stress release will help to introduce new practical approaches. In this study, we hypothesized that induction and release of stress will change the brain functional connectivity pattern. Therefore, by recruiting 20 healthy-subjects and exposing them to stressful events using the trier social stress paradigm, we aimed to investigate patterns of these changes. In a session consist of 23 minutes of psychological stress induction and 20 minutes of recovery, subjects' stress was scored by visual analogue scale (VAS). In addition, salivary cortisol level and EEG data of the subjects were also recorded. Subsequently, brain functional connectivity (FC) maps were calculated in a frequency-specific manner. Then, the effects of inducing and release of stress on the changes of VAS, cortisol level, and FC maps were assessed. Our results revealed that inter-hemispheric FCs of the right frontal regions with other regions of the brain decrease; while it increases at the left frontal regions during inducing of mental stress. Interestingly, the release of stress presented a recovery pattern of inter-hemispheric FCs and meaningful FC changes significantly correlate with changes in the cortisol level. our findings highlight important roles of bihemispheric associations in adaptation and coping with stressful conditions.

Comparison of Ultrasound-Guided Prolotherapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized Clinical Trial

This study aimed to compare the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose prolotherapy on pain and foot functions in patients with chronic plantar fasciitis with a prospective randomized-controlled trial. A total of 29 patients in whom conservative care failed were enrolled for the study after the clinical and ultrasonographic assessment. The patients were randomly assigned to receive ESWT (ESWT group, n = 15) or dextrose prolotherapy (dextrose prolotherapy group, n = 14). ESWT group received 1800 to 2000 focused shock waves (session of 0.20-0.30 mJ/mm2 with a frequency of 4-6 Hz) followed by soft tissue 3000 to 3500 radial pulses (session of 1.8-3.0 bar with a frequency of 15-21 Hz). Dextrose prolotherapy group underwent an injection of 5 ml 15% dextrose solution with 2% lidocaine. ESWT and dextrose prolotherapy were repeated 3 times by 2 weeks apart. A 100-mm Visual Analog Scale (VAS) for overall and morning pain, Foot Function Index (FFI) and the Roles and Maudsley Scale score (RMS) were assessed at baseline, 6 weeks, and 12 weeks after the last intervention. Overall VAS, Morning VAS, RMS and FFI scores improved significantly in both treatment groups at 6 weeks and 12 weeks compared to baseline (p < .001). Comparison of changes in overall VAS, Morning VAS, RMS and FFI scores did not show a significant difference between the groups at each time point (p > .05) In our study dextrose prolotherapy and ESWT had similar effectiveness in patients with chronic plantar fasciitis who have not respond to conservative care. The results showed ESWT and dextrose prolotherapy were not superior to each other

PCN214 Responsiveness and Responder Definitions for the NCCN/FACT Bladder Symptom Index (NFBISI-18) in Individuals With Locally Advanced or Metastatic Urothelial Cancer (UC)

NFBlSI-18 assesses advanced bladder cancer–associated quality of life (QOL) and symptoms with a total score and 4 subscores. The total scale (TOT) and physical disease–related symptoms subscale (DRS-P) are frequently used for clinical trials. We aimed to estimate the longitudinal psychometric properties of these scales. This was a prespecified interim analysis of the JAVELIN Bladder 100 trial (NCT02603432), which enrolled 700 patients with unresectable locally advanced or metastatic UC (mUC). TOT and DRS-P change scores (cycle 1 to end of treatment [EOT]) were calculated for each patient. Higher scores indicate improved QOL. With mixed-effects longitudinal models, we estimated trends on TOT and DRS-P based on progression-free survival (PFS) tertiles and best overall response (progressive disease [PD] vs stable disease [SD] vs complete response/partial response [CR/PR]). Change scores for TOT and DRS-P were each regressed on EQ-5D utility index (UI) and separately on visual analog scale (VAS) change scores to estimate meaningful group change. Responder definitions for individual change were estimated using the reliable change index. Of enrolled patients, 433 (62%) and 420 (60%) had DRS-P and TOT assessments at EOT, respectively. Compared with PFS >7 months, patients with 0-2 and 3-7 months had lower score trends in TOT and DRS-P (p<0.001 for both). Compared with CR/PR, patients with PD and SD had lower score trends in TOT and DRS-P (p<0.001 for both). At the group level, a 0.10-point change in UI was associated with a 2.4-point change in TOT and a 1.2-point change in DRS-P. A 10.0-point change in VAS was associated with a 2.7-point change in TOT and 1.3-point change in DRS-P. At the individual level, responder thresholds in TOT and DRS-P were 8.3 and 5.1, respectively. The NFBISI-18 TOT and DRS-P are responsive and clinically relevant for assessing QOL in mUC patients.

Voiding dysfunctions in patients with non-Hunner's ulcer interstitial cystitis/bladder pain syndrome do not affect long-term treatment outcome.

The role of urodynamic study in the diagnosis and prognostication of interstitial cystitis/bladder pain syndrome (IC/BPS) is still controversial. This study evaluated the correlation of the baseline voiding dysfunctions and long-term treatment outcome in patients with non-Hunner's ulcer IC (NHIC). A total of 211 NHIC patients were enrolled. All patients underwent videourodynamic (VUDS) examination at baseline to identify their voiding conditions and received subsequent treatments. The primary endpoint was Global Response Assessment (GRA) at the interview. Secondary endpoints included O'Leary-Sant symptom score (OSS), Visual Analogue Scale (VAS) for pain and the rate of IC symptom flare-up. The mean age was 56.8±12.8years, and mean duration of IC was 16.0±9.9years. At baseline, 83 (39.3%) patients had a voiding dysfunction and 132 (62.7%) had 1 to 3 co-morbidities. The duration, co-morbidities, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA and flare-up rate showed no significant difference among different subgroups. When we divided patients by their storage and voiding conditions, patients with non-hypersensitivity bladder (HSB) (n=32) had significantly greater MBC (P=.002) whereas those with HSB with (n=76) or without (n=103) voiding dysfunction had higher glomerulation (P=.021). When we analysed voiding dysfunction subgroups by GRA, patients with a GRA of ≥2 had a significantly shorter duration of disease (13.9±8.6years, P=.021). There were also significant associations between GRA and the changes of OSS (P<.001) and VAS (P<.001). VUDS can disclose voiding dysfunction in 39.3% of NHIC patients. With adequate therapy, the voiding dysfunctions in NHIC patients do not affect long-term treatment outcome.

Association of health-related quality of life (HRQoL) and treatment safety with nivolumab (NIVO) in patients (pts) with resected stage IIIB/C or IV melanoma: Analysis of CheckMate 238 four-year follow-up (FU) data.

9574 Background: In CheckMate 238, NIVO 3 mg/kg vs ipilimumab 10 mg/kg showed significantly longer recurrence-free survival and a lower rate of grade 3–4 treatment-related adverse events (TRAEs) in pts with completely resected stage IIIB/C or IV melanoma. This analysis assessed the association of long-term HRQoL and TRAEs in NIVO-treated pts in this trial. Methods: HRQoL was assessed using EORTC QLQ-C30 (global health status [GHS] and physical/emotional functioning) and EQ-5D-3L visual analogue scale (VAS) questionnaires administered after randomization, during 1 y of treatment (wk 5, 7, 11, 17, 25, 37, and 49), at posttreatment FU visits 1 and 2 (FU1 and FU2; 30 and 114 days after last dose), and at survival FU visits up to 4 y after last dose (EQ-5D-3L only). NIVO-treated pts were grouped based on whether they had experienced a grade 3–4 TRAE, any-grade TRAE leading to NIVO discontinuation, or any-grade select (immune-related) TRAE on treatment or up to 100 days after last dose. Longitudinal change from baseline (BL) in scores was assessed for pts with and without TRAEs having patient-reported outcome data at BL and ≥1 post-BL assessment (HRQoL population) using descriptive statistics. QLQ-C30 subscale and VAS changes of 10 and 7, respectively, were considered clinically meaningful. Results: The HRQoL population comprised 446 of 453 pts randomized to NIVO. EQ-5D-3L assessments were completed by 81% of survivors (263/324) after 4 y post-randomization. Grade 3–4 TRAEs occurred in 17% of NIVO-treated pts (77/446). A slight trend toward deterioration of GHS from BL on treatment was noted, with clinically meaningful deterioration at posttreatment FU1 (mean [SD], −13.8 [25.0]) and FU2 (−10.3 [22.0]; last available time point). For the VAS, a similar trend on treatment was noted (−6.9 [28.3] at wk 11), with a clinically meaningful deterioration after NIVO discontinuation (−9.9 [27.0] at FU1) and a return to BL level by the start of survival FU. For pts without grade 3–4 TRAEs, mean change from BL scores remained stable (ie, no clinically meaningful deterioration on treatment or during FU). Any-grade TRAEs led to NIVO discontinuation in 9% of pts (42/446); HRQoL findings were similar to those for pts with grade 3–4 TRAEs. The most common any-grade TRAE was fatigue (35%). No clinically meaningful deterioration in VAS was noted for any select TRAE during FU except for hyperthyroidism (8%), with which deterioration occurred at FU1. EORTC QLQ-C30 physical and emotional functioning results will be presented. Conclusions: In CheckMate 238, pts with TRAEs showed early HRQoL deterioration after NIVO discontinuation, but HRQoL returned to BL levels with no sustained deterioration during survival FU. Overall, HRQoL was maintained on treatment and over a long-term FU period in pts with resected melanoma receiving adjuvant NIVO. Clinical trial information: NCT02388906.

COMPARATIVE STUDY BETWEEN INTRA-ARTICULAR CORTICOSTEROID INJECTION AND GENICULAR NERVE BLOCK UNDER ULTRASOUND GUIDANCE IN PAIN CONTROL OF KNEE OSTEOARTHRITIS

Recently, genicular nerve block (GNB) was introduced as a new technique to relieve knee pain in chronic knee osteoarthritis patients. While intra-articular corticosteroid injection (IACSI) used to be a traditional treatment option to relieve knee osteoarthritis related pains. Both techniques have been used. However, whether one is superior to the other remains controversial.Aim of work: This study aims to investigatethe efficacy of ultrasound-guided GNB and IACSI in the management of knee osteoarthritis-related pains and to determine which technique carried better results.Methods:Forty patients with chronic knee osteo-arthritis were randomly treated with either genicular nerve block (GNB) (n = 20) or intra-articular corticosteroid injection (IACSI) (n = 20). Clinical response was assessed using Visual analog scale (VAS), and Oxford Knee Score (OKS) at baseline and 2, 4, and 8 weeks post procedure. Results: The VAS score and OKS score were significantly low in the GNB group and IACSI group at 2, and 4 weeks after the procedure (P < 0.001 for all), then returned near baseline at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (P < 0.001 for 2 and 4 weeks and < 0.006 for 8 weeks) and improvement in function (P < 0.001 for 2, 4 and 8 weeks) compared to IACSI group.

Sex differences in the Buffalo Concussion Treadmill Test in adolescents with acute sport-related concussion

ObjectivesThe Buffalo Concussion Treadmill Test (BCTT) is a safe and validated tool to assess exercise tolerance after sport-related concussion (SRC). Sex differences may affect the interpretation of this systematic exertion test in the concussed population, which is important for clinicians. The purpose of this study was to examine sex differences in BCTT performance in adolescents with acute SRC. DesignProspective cohort. MethodsMale (n = 103, 15.3 ± 2 years) and female (n = 87, 15.1 ± 2 years) adolescents with SRC performed the BCTT within 10 days of injury. Heart rate (HR), HR threshold (HRt), Delta HR (difference between resting HR and HRt), symptom severity on Visual Analog Scale (VAS) and symptoms exacerbated on the BCTT were collected and compared. ResultsMales had lower resting HR (M: 70.9 ± 12 vs F: 75.7 ± 13 bpm, p < 0.01) and reached a lower HRt than females (M: 134.7 ± 23 vs F: 141.5 ± 25 bpm, p = 0.05). Sexes did not differ on Delta HR (M: 63.8 ± 26 vs F: 65.9 ± 24 bpm, p = 0.57), total treadmill time (M: 9.3 ± 5 vs F: 8.4 ± 4 min, p = 0.20), maximum VAS (M: 5.0 ± 2 vs F: 5.4 ± 2, p = 0.18) or incidence of a change in VAS (M: 91% vs F: 94%, p = 0.43) on the BCTT. ConclusionsAlthough males may reach symptom exacerbation at a slightly lower mean HRt than females on the BCTT within 10 days of SRC, the BCTT provides comparable information and both sexes reach symptom exacerbation at similar Delta HR.

Comparing novel versus conventional technique of platelet-rich plasma therapy in periorbital hyperpigmentation: A randomized prospective split-face study.

Platelet-rich plasma (PRP) has been found to be effective in treating periorbital hyperpigmentation (POH). PRP prepared by double-spin (DS) method and activated by calcium has been used conventionally. PRP can be prepared by single spin (SS) and activated at low temperature (novel method), but the evidence is limited. To compare the novel and conventional PRP in the treatment of periorbital hyperpigmentation. We selected 21 patients of POH and randomly divided the face into two halves. One-half of the face (group A) was treated with novel PRP (SS and low-temperature activation). The other half (group B) was treated with conventional PRP (DS and calcium activation). A total of 3 PRP injections were given at 4 weekly intervals. Patients were observed and assessed on 12th week by photography, dermoscopy, visual analog scale (VAS) score, and Dermatology life quality index (DLQI). Platelet counts and growth factors were assessed in PRP. Mean platelet count in novel and conventional PRP was 7.41±1.76 lacs and 8.17±2.23 lacs (p=0.348). Mean photographic and dermoscopic assessment at the end of the study in group A and group B was 52.33±6.468 and 53.14±6.99 (p=0.151). Change in VAS in groups A and B was 3.85±1.27 and 3.90±1.04 (p=0.895). Levels of various growth factors assessed by ELISA did not differ significantly. There was significant decline in DLQI. The novel method is not inferior to conventional method of PRP in the treatment of periorbital hyperpigmentation.

The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study.

To evaluate clinical and ultrasonographic efficacy of high-intensity laser therapy (HILT) in patients with hemiplegic shoulder pain (HSP) accompanied by partial thickness rotator cuff tear (PTRCT). The study was designed as a prospective, randomized, controlled trial. Patients with HSP accompanied by PTRCT (n = 44) were randomly assigned to HILT and control groups. Both groups were treated with a multidisciplinary stroke rehabilitation and a therapeutic exercise program to the affected shoulder supervised by physiotherapists. In addition, HILT group received 3 sessions of the intervention per week for 3 weeks. Primary outcome measure was visual analogue scale (VAS) for pain. Secondary outcome measures were range of motion (ROM) of the shoulder joint, Shoulder Pain and Disability Index (SPADI), Brunnstrom Recovery Stage (BRS), Modified Ashworth Scale (MAS), Nottingham Health Profile (NHP), Functional Independence Measure (FIM), and ultrasonographic PTRCT size. Participants were assessed at pre- and post-treatment. A total of 41 patients completed the study. A statistically significant improvement was observed in VAS, ROM, FIM, SPADI, NHP, and PTRCT parameters in HILT group at post-treatment compared to pre-treatment (all P < 0.05). However, control group indicated significant improvement only in VAS, ROM, and SPADI parameters (all P < 0.05). When differences in clinical parameters at pre- and post-treatment assessment were compared between two groups, change in VAS, FIM, BRS, SPADI, NHP, and PTRCT in HILT group was significantly better than control group (all P < 0.05). HILT combined with therapeutic exercise seems to be clinically and ultrasonographically more effective in the treatment of patients with HSP accompanied by PTRCT than therapeutic exercise alone in the short term. Further studies are needed with long-term follow-up. CinicalTrials.gov Identifier: NCT04669405.

Repetitive transcranial magnetic stimulation (rTMS) versus transcranial direct current stimulation (tDCS) in the management of patients with fibromyalgia: A randomized controlled trial

ObjectivesThe aim of this study was to compare the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on pain and quality of life in patients with fibromyalgia. MethodsThirty participants were randomized into two groups of 15 patients, to receive 3 sessions of either high-frequency (10 Hz) rTMS or 2 mA, 20 min anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex (DLPFC) over 1 week. Pain was assessed using a Visual Analog Scale (VAS) before treatment, immediately after treatment, 6 and 12 weeks later. Quality of life was evaluated using the Revised Fibromyalgia Impact Questionnaire (FIQR) and psychiatric symptoms were measured using the Depression Anxiety Stress Scale-21 Item (DASS-21) before treatment, and 6 and 12 weeks after treatment. ResultsFor the VAS there was a significant time-group interaction, showing that the behavior of two groups differed regarding changes of VAS in favor of the RTMS group (df = 1.73, F = 4.80, p = <0.016). Time-group interaction effect on DASS-21 and FIQR was not significant. 66.6% of patients in rTMS group and 26.6% of patients in tDCS group experienced at least a 30% reduction of VAS from baseline to last follow-up (p = 0.028). DiscussionWith the methodology used in this study, both rTMS and tDCS were safe modalities and three sessions of rTMS over DLPFC had greater and longer lasting analgesic effects compared to tDCS in patients with FM. However, considering the limitations of this study, further studies are needed to explore the most effective modality.

Perineural Therapy in Treatment of Chronic DegenerativeLumbosacral Lesions

AbstractBackground: Low Back Pain (LBP) is the most frequenttype of musculoskeletal pain. “It is often recurrent and oftenhas important socio-economic consequences.Aim of Study: The aim of this study is to evaluate efficacy of perineural injection in treatment of chronic low back pain due to degenerative lumbosacral lesions among sample of Egyptian population.Patients and Methods: A prospective randomized casecontrolled study was performed on forty patients with subacuteand chronic low back pain; they were diagnosed clinicallyand radiologically as having degenerative disc lesion. Thepatients were randomly divided in two groups. In group 1,twenty patients received PNI sessions, the injection was doneonce weekly for 8 sessions with dextrose 5% (500ml) bufferedwith 2.4ml sodium bicarbonate (8.4% concentration). In eachsession; 5-10ml was injected subcutaneously with insulinsyringe with angle of introduction 30-40 degrees which targets:Pain located in thoraco-dorsal fascia, the fascia of the erectorspinae muscles along T10 to L2 dorsal rami, interspinoustenderness from medial branches of dorsal rami, superiorcluneal nerve at 7-8 cm from middle line cross the iliac crest& T10 cross over iliac crest at a distance 8-10cm. In group2, twenty patients received physical rehabilitation programTranscutaneous Electrical Nerve Stimulation (TENS), Ultra-sound (US), infrared light (IR) and massage if needed+ homeexercise) 3 days per week 1 day apart for 4 weeks.Results: Our forty cases were 17 males and 23 females;their mean age was 36.8±4.7. Significant improvement inROM post-treatment in the group 1 compared to group 2. Ahighly statistically significant difference in VAS (VisualAnalogue Scale) and Oswestry Disability Index (ODI) scorespost-treatment in group 1 compared to the group 2. PNI wassignificantly associated with higher improvements measuredby VAS, ROM and ODI when compared with group 2. Signif-icant positive correlation between age and disease durationin the 1st group. Significant positive correlations betweenROM & VAS. ODI change showed significant positive corre-lation with age and VAS change in group 1. In the 1st group;VAS change showed significant positive correlations witheach of flexion tips to floor change and lateral flexion. In the 2nd group; VAS change showed positive correlations withflexion change, flexion tips to floor change and lateral flexion.Group 1 showed more positive correlations regarding ROMdue to improvement of pain score.Conclusion: PNI with Dextrose 5% achieved short termimprovement in pain and functional abilities in patients withlow back pain secondary to degenerative lumbosacral disclesions at least for a short-term. The degree of improvementof pain and functional abilities was higher in the group thatreceived PNI compared to the group that received physicalrehabilitation program.