Conservative Treatment Group Research Articles

Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment.

Despite the available classifications, diagnostics and treatment of acute acromioclavicular joint (ACJ) injuries are still vague and challenging for trauma and shoulder surgeons. This study aimed to evaluate the dynamic radiographic as well as clinical outcome of operatively and conservatively treated Rockwood (RW) type III and IV ACJ dislocations. All patients with RW type III and IV ACJ dislocations between 2009 and 2016 (n = 226) were included in this retrospective data analysis with a prospective follow-up examination. According to their injury classification, patients were subdivided in an operative and conservative treatment group. Examiner blinded clinical evaluation including the constant score (CS), American shoulder and elbow surgery (ASES) score, the acromioclavicular joint instability (ACJI) score, visual analog scale (VAS), bilateral force measurements, and posttraumatic/postsurgical sequelae were assessed. Fluoroscopic evaluations including dynamic stability assessment with functional axillary views were performed for every patient. For follow-up examination (mean 4.8years ± 0.3 SEM) 56 patients (29 RW type III, 27 RW type IV) were available. In patients with RW type III ACJ dislocations [operative (n = 10); conservative (n = 19)] prolonged duration of treatment was seen in operatively treated patients (p < 0.05). Clear improvement could be shown for the ACJI score (p < 0.05) and coracoclavicular (CC) and acromioclavicular (AC) distance (p < 0.05) in the operative group. In patients with RW type IV ACJ dislocations [operative (n = 18); conservative (n = 9)] superior clinical results were found in operated patients with highly significant differences for the ACJI score (p < 0.001). Radiographic dynamic horizontal analysis showed nearly normalized anteroposterior translation in operated patients (p < 0.05). No differences were found regarding arthroscopic or open procedures. Accurate diagnostics including sufficient dynamic stability assessment with functional axillary views are strongly advised for patients with ACJ dislocations. Conservative treatment should be recommended for patients with RW type III ACJ dislocations, due to shorter duration of treatment with good clinical results but lacking operative risks. In patients with RW type IV ACJ dislocations, surgical treatment is recommended because of superior clinical and radiological results. Level III.

Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial

It remains unclear whether urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy improves the outcome of patients with gallstone pancreatitis without concomitant cholangitis. We did a randomised trial to compare urgent ERCP with sphincterotomy versus conservative treatment in patients with predicted severe acute gallstone pancreatitis. In this multicentre, parallel-group, assessor-masked, randomised controlled superiority trial, patients with predicted severe (Acute Physiology and Chronic Health Evaluation II score ≥8, Imrie score ≥3, or C-reactive protein concentration >150 mg/L) gallstone pancreatitis without cholangitis were assessed for eligibility in 26 hospitals in the Netherlands. Patients were randomly assigned (1:1) by a web-based randomisation module with randomly varying block sizes to urgent ERCP with sphincterotomy (within 24 h after hospital presentation) or conservative treatment. The primary endpoint was a composite of mortality or major complications (new-onset persistent organ failure, cholangitis, bacteraemia, pneumonia, pancreatic necrosis, or pancreatic insufficiency) within 6 months of randomisation. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, ISRCTN97372133. Between Feb 28, 2013, and March 1, 2017, 232 patients were randomly assigned to urgent ERCP with sphincterotomy (n=118) or conservative treatment (n=114). One patient from each group was excluded from the final analysis because of cholangitis (urgent ERCP group) and chronic pancreatitis (conservative treatment group) at admission. The primary endpoint occurred in 45 (38%) of 117 patients in the urgent ERCP group and in 50 (44%) of 113 patients in the conservative treatment group (risk ratio [RR] 0·87, 95% CI 0·64-1·18; p=0·37). No relevant differences in the individual components of the primary endpoint were recorded between groups, apart from the occurrence of cholangitis (two [2%] of 117 in the urgent ERCP group vs 11 [10%] of 113 in the conservative treatment group; RR 0·18, 95% CI 0·04-0·78; p=0·010). Adverse events were reported in 87 (74%) of 118 patients in the urgent ERCP group versus 91 (80%) of 114 patients in the conservative treatment group. In patients with predicted severe gallstone pancreatitis but without cholangitis, urgent ERCP with sphincterotomy did not reduce the composite endpoint of major complications or mortality, compared with conservative treatment. Our findings support a conservative strategy in patients with predicted severe acute gallstone pancreatitis with an ERCP indicated only in patients with cholangitis or persistent cholestasis. The Netherlands Organization for Health Research and Development, Fonds NutsOhra, and the Dutch Patient Organization for Pancreatic Diseases.

Comparison of minimally invasive surgery for non-flail chest rib fractures: a prospective cohort study.

BackgroundTo evaluate therapeutic efficacy of minimally invasive and small incision surgery [minimally invasive surgery (MIS)] in patients with non-flail chest rib fractures through a prospective cohort study.MethodsThis study included 98 patients with non-flail chest rib fractures (≥3 displaced fractures) and 66 patients undergoing MIS served as the experimental group and 32 patients receiving conservative treatment served as the matched control group. Pain index and indicators of pulmonary function [vital capacity (VC); forced expiratory volume in one second (FEV1); peak expiratory flow (PEF)] for the two groups were assessed and compared at the time of admission and before discharge. In addition, duration of pain, time required for the patient to regain the ability to perform daily self-care, mental labor, and moderate-to-severe physical labor, and duration of chest discomfort were measured during long-term follow-up and compared between the two groups.ResultsThere were also no significant differences (P>0.05) in pain index (8 vs. 8) or indicators of pulmonary function (VC: 31.0% vs. 26.5%; FEV1: 29.9% vs. 26.7%; PEF: 15.2% vs. 12.0%) were found between the MIS and conservative treatment groups at the time of admission; while pain index (3 vs. 6), VC (42.1% vs. 35.3%), and FEV1 (44.2% vs. 35.9%) were significantly different between the two groups (P<0.05) but not in PEF (21.2% vs. 19.6%) before discharge. Long-term follow-up showed that duration of pain, time required for the patient to regain the ability to engage in daily self-care, mental labor, and moderate-to-severe physical labor, and duration of chest discomfort in the MIS group were significantly more improved than in the conservative treatment group (P<0.05).ConclusionsMIS was a simple and safe treatment that significantly relieved chest pain and rapidly restored pulmonary function and improved the long-term quality of life of patients with non-flail chest rib fractures of ≥3 ribs with displacement.

Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome.

BACKGROUNDTreatments for hepatic sinusoidal obstruction syndrome (HSOS) are limited.AIMTo evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS).METHODSThis retrospective analysis included patients with PA-HSOS admitted to the First Affiliated Hospital of the University of Science and Technology of China (June 2015 to January 2019). Baseline clinical characteristics and follow-up data were extracted from the medical records. All patients included in this study experienced failure of initial therapy. Patients were divided into the TIPS and conservative treatment groups according to the therapy they received. Liver function, maximal ascites depth, imaging characteristics, pathology findings, and survival were compared between groups.RESULTSThe TIPS group included 37 patients (28 males), and the conservative treatment group included 17 patients (11 males). Baseline characteristics were similar between groups. There were two deaths in the TIPS group and seven deaths in the conservative treatment group during follow-up (3-48 mo). The 3-, 6-, 12- and 24-mo survival rates were 94.6%, 94.6%, 94.6% and 94.6%, respectively, in the TIPS group and 70.6%, 57.8%, 57.8% and 57.8%, respectively, in the conservative treatment group. Kaplan-Meier analysis revealed significantly longer survival for the TIPS group than for the conservative treatment group (P = 0.001). Compared with the pre-treatment value, maximal ascites depth was significantly lower at 1 wk, 2 wk, 1 mo, and 3 mo for the TIPS group (all P < 0.05) but not in the conservative treatment group. Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS. Pathology showed that liver congestion and hepatocyte swelling improved with time after TIPS placement.CONCLUSIONTIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.

Percutaneous coronary intervention in the very elderly with NSTE-ACS: the randomized 80+ study

Objective: The treatment strategy in the very elderly with NSTE-ACS is debated, as they are often under-represented in clinical trials. The aim of this multicenter randomized controlled trial was to compare invasive and conservative strategies in the very elderly with NSTE-ACS.Methods: We randomly assigned patients ≥ 80 years of age with NSTE-ACS to an invasive strategy with coronary angiography and optimal medical treatment or a conservative strategy with only optimal medical treatment. The primary outcome was the combined endpoint of major adverse cardiac and cerebrovascular events (MACCE). Sample size was powered for a 50% reduction of event rate in MACCE with an invasive strategy. We used intention-to-treat analysis.Results: Altogether, 186 patients were included between 2009 and 2017. The study was terminated prematurely due to slow enrollment. At 12-month follow-up, the primary outcome occurred in 31 (33.3%) of the invasive treatment group and 34 (36.6%) of the conservative treatment group, with a hazard ratio (HR) of 0.90 (95% CI 0.55‒1.46; p = 0.66) for the invasive group relative to the conservative group. The corresponding HR value for urgent revascularization was 0.29 (95% CI 0.10‒0.85; p = 0.02), 0.56 (95% CI 0.27‒1.18; p = 0.13) for myocardial infarction, 0.70 (95% CI 0.31‒1.58; p = 0.40) for all-cause mortality, 1.35 (95% CI 0.23‒7.98; p = 0.74) for stroke, and 1.62 (95% CI 0.67‒3.90; p = 0.28) for recurrent hospitalization for cardiac reasons.Conclusion: In the very elderly with NSTE-ACS, we did not find any significant difference in MACCE between invasive and conservative treatment groups at 12-month follow-up, possibly due to small sample size. ClinicalTrials.gov: NCT02126202

Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice.

ObjectiveTo compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice.DesignRetrospective comparative study.Patients and MethodsMedical records and retinal images of 62 patients with non-resolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed.ResultsThere was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (p=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups (p < 0.001), final BCVA was improved significantly in only the spironolactone group (p < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone.ConclusionOral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.

Diagnosis and treatment of pure arterial malformation

Rationale:The incidence of pure arterial malformations is relatively low, and few cases have been reported. Only 2 cases with pure arterial malformation have been reported to receive surgery or endovascular treatment.Patient concerns:We report 3 cases and review the relevant literatures. The head examinations of the patients suggested the presence of high-density shadows in front of the pons and midbrain, the dilation of the supraclinoid segment of the right internal carotid artery, and moyamoya in the left brain with an aneurysm-like expansion located on the left posterior communicating artery respectively. After admission, head digital subtraction angiography (DSA) was performed.Diagnoses:Digital subtraction angiography (DSA) for these 3 patients showed that the left posterior communicating artery, the supraclinoid segment of the right internal carotid artery, and the left posterior communicating artery appeared dilated, tortuous, and spirally elongated. In addition, the lesions in the latter 2 patients were accompanied with local aneurysmal changes.Interventions:Two patients were given conservative treatment, and another patient was given endovascular treatment. A head DSA was reviewed 6 months after therapy.Outcomes:The prognosis status of the 3 patients was good. Two patients in the conservative treatment group showed no changes in the lesions on head DSA examination. The DSA examination of the third patient indicated that the vascular remodeling of the diseased vessels was good, the blood vessels were unobstructed, and the aneurysms had disappeared.Lessons:Pure arterial malformations mostly occur in young women and may involve any blood vessels in the brain. It can be accompanied with local aneurysms and calcification. The patients are often given conservative treatment but need to be reviewed regularly. However, it is beneficial to give endovascular treatment to the patients with local aneurysms.

Conservative vs Surgical Treatment of Impacted Femoral Neck Fracture in Patients 75 Years and Older

To evaluate the safety and effectiveness of conservative treatment (CST), internal fixation (IF), and hemiarthroplasty (HA) in treating patients older than 75 years with impacted femoral neck fracture (IFNF). A randomized clinical trial to compare clinical outcomes of CST, IF, and HA in IFNF patients older than 75 years with a 1:1:1 ratio. Nanjing First Hospital, Nanjing Medical University, Nanjing, China. A total of 154 patients with IFNF aged between 75 and 97 years. Patients with IFNF were allocated to CST, IF, and HA. They all received a 36-month follow-up. All patients were evaluated by Harris hip score (HHS) (primary outcome) for hip function, European Quality of Life-5 Dimensions (EQ-5D) index scores for health-related quality of life, and visual analogue scale score for hip pain. Operation duration, blood loss, mortality, union rate, complications, and reoperation were also recorded. Assessors were blind to the type of treatment. The baseline parameters of the three groups were similar. IF group had much lower blood loss than HA group (P < .05), while no significant difference in operative duration was found between the two groups (P > .05). HHS in HA group was significantly higher at 1, 3, and 6 months (P < .05), but no significant difference in HHS was found between CST and IF groups at any of the time points during the overall follow-up (P > .05). EQ-5D index score was higher in HA group at each follow-up within 1 year (P < .05), but the difference was not significant at 2- and 3-year follow-up (P > .05). There was no significant difference in mortality among the three groups at each follow-up point (P > .05). The nonunion rate was 11.76% (6/51) in CST group and 9.80% (5/51) in IF group and showed no significant difference (P > .05). CST may be a feasible way for IFNF in the older patients. ClinicalTrials.gov Identifier: NCT04219943. J Am Geriatr Soc 68:2214-2221, 2020.

BMI Patient Injury Anterior Cruciate Ligament (ACL) Post Operative And Conservative Action

Body Mass Index (BMI) is on of most risk factors for ACL injury. Operative treatment and conservative treatment are the exact solution for handling ACL injuries. The aim of this study is to determine the difference of mean Body Mass Index (BMI) in patients with ACL injury post operative and conservative treatments. Type of this research was observational with post test only design and used a cross-sectional approach. Fifteen operative patients and fifteen conservative patients were selected based on inclusion and exclusion criteria, divided into OT (Operative Treatment) and KT(Conservative Treatment) groups. Body weight and body height measurements were carried out to obtain Body Mass Index (BMI). The results obtained by means and p value are OT group 24,59 ± 5,00 Kg/m² &gt; KT group 23,49 ± 2,60 Kg/m² (p= 0,256 &gt; 0,05). The results can be concluded that there is no significant difference BMI between OT and KT group

Revisiting Arthroscopic Partial Meniscectomy for Degenerative Tears in Knees With Mild or No Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The purpose of this systematic review and meta-analysis was to evaluate the efficacy of arthroscopic partial meniscectomy (APM) for symptomatic degenerative meniscal tear (DMT) in knees with mild or no osteoarthritis. A systematic review and meta-analysis. MEDLINE, EMBASE, and Cochrane databases were systematically searched. The inclusion criteria were as follows: (1) English language; (2) randomized controlled trial (RCT); (3) comparison between APM and other treatment modalities as a primary objective; and (4) complete DMT in knees with mild or no osteoarthritis. Mild or no arthritis was defined as Kellgren-Lawrence grade 0 to 2 or Ahlbäck 0 to 1 on radiography. Statistical analysis of functional activity and pain after APM and conservative treatment or sham operation was performed using R version 3.3.1. Five articles were included in the final analysis, and they were all RCTs. Four studies compared clinical results of APM with those for physical therapy, and one study compared APM with sham operation. The functional activity was not better in the APM group (296 cases) than in the conservative treatment or sham operation group (284 cases) (I: 0%, small level of heterogeneity). Pain was not reduced significantly in the APM group compared with that in the conservative treatment or sham operation group (I: 0∼90%, high level of heterogeneity). This systematic review and meta-analysis of high-quality literature provides relatively strong evidence that APM did not improve functional activity or reduce pain compared with the results with conservative treatment or sham operation in knees with mild or no osteoarthritis.

The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit.

In the present study, we aimed to compare clinical results of conservative and surgical stabilization approaches and to investigate the effect of early reduction in patients with a flail chest. Between March 2013 and December 2017, 34 patients (23 males, 11 females; mean age 43.7±12.1 years; range, 20 to 74 years) with a flail chest who underwent early rib fixation were included in the surgical group and 29 patients with a flail chest (19 males, 10 females; mean age: 45.7±15.8 years; range, 24 to 74 years) who were followed with the conservative approach were included in the conservative treatment group between February 2012 and December 2017. We applied early rib reduction on the first or the next day (within 24 to 36 h) of trauma. The length of hospitalization, the presence of pneumonia and septic complications in the postoperative period, mortality, mechanical ventilation duration, tracheostomy rate, respiratory function test results, and pain scores were recorded and compared between the groups. The length of stay in the hospital and intensive care unit, and duration of mechanical ventilation were statistically significantly higher in the conservative treatment group than the surgery group (p<0.001, p<0.001, and p<0.001, respectively). None of the patients required tracheostomy in the surgical group, while five patients required tracheostomy in the conservative treatment group (p=0.004). Mortality rates were 2.94% and 20.69% in the surgery and conservative treatment groups, respectively (p=0.027). Pain scores were statistically significantly different in favor of the surgical group compared to the conservative treatment group (p=0.0038 and p=0.044, respectively). The results of our study show that early fixation and weaning reduce the need for mechanical ventilation, length of hospitalization, the need for tracheostomy, and mortality rates. This approach also provides a significant improvement in the long-term pain complaints and pulmonary function tests of patients with a flail chest.

Extravasation and fluid collection on computed tomography imaging in patients with colonic diverticular bleeding.

We evaluated the characteristics of patients with diverticular bleeding in whom emergency endoscopy should be proactively performed and those in whom it is unnecessary for spontaneous hemostasis following conservative treatment. This study involved 132 patients in whom diverticular bleeding was diagnosed on lower gastrointestinal endoscopy. We evaluated the rate of identification of the bleeding diverticulum during endoscopy and the rate of spontaneous hemostasis following conservative treatment. In 26 patients (20%), bleeding diverticulum was identified during endoscopy. Extravasation or fluid collection on CT imaging was an important factor of successful identification of the bleeding source on endoscopy. Of the 104 patients in the conservative treatment group, 91 (87%) were able to be discharged after spontaneous hemostasis. Univariate analysis revealed a high rate of spontaneous hemostasis in patients without extravasation and fluid collection on CT imaging, those without adhesion of blood during endoscopy, those without diabetes, and those with a hemoglobin level ≥10 g/dL. In patients with colonic diverticular bleeding, extravasation or fluid collection on CT is an important factor related to the identification of the bleeding diverticulum. Patients without characteristic CT findings had a high rate of spontaneous hemostasis after conservative treatment. Diverticular bleeding is the most frequent cause of lower gastrointestinal bleeding accounting for 20%-40% of all cases in Japan and 20%-48% of all those in the Western countries[1, 2]. The prevalence of colonic diverticula tends to increase with age; thus, the overall prevalence of diverticular bleeding is expected to increase in the future. In Japan, the Japanese Gastroenterological Association published guidelines on colonic diverticulitis in 2017; these guidelines recommend the performance of lower gastrointestinal endoscopic examination within 24 h in patients with lower gastrointestinal bleeding suspected to be diverticular bleeding[3]. It has been reported that, for patients with lower gastrointestinal bleeding, urgent endoscopy helps avoid embolotherapy, colectomy, massive blood transfusion, and repeat bleeding[1, 4, 5]. However, it is often difficult to identify the bleeding point [6]; further, there are many challenging cases wherein it is difficult to decide whether urgent endoscopy should be performed in situations where there is insufficient medical staff, such as during nighttime and on holidays. Bleeding is reported to stop spontaneously with conservative treatment alone in 70% of diverticular bleeding cases[7, 8]. In particular, when determining the treatment policy for diverticular bleeding and in the case of patients at high risk of complications following endoscopy, such as older patients, those with poor performance status or cardiovascular disease, and those in whom spontaneous hemostasis can be expected, urgent endoscopy should be avoided, and elective endoscopy should be selected. Therefore, the type of cases wherein urgent endoscopy is effective and the type wherein it is unnecessary need to be clarified. Thus far, there have been very few reports of the characteristics of patients with diverticular bleeding in whom spontaneous hemostasis was achieved. We aimed to assess the characteristics of patients in whom emergency endoscopy should be proactively performed and those for whom it is unnecessary. Thus, we retrospectively analyzed the identification rate for the responsible diverticulum in patients with diverticular bleeding and the rate of spontaneous hemostasis following conservative treatment.

STUDY ON SERUM FGF-23 CONCENTRATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: To determine the serum FGF-23 levels in patients with chronic kidney disease (CKD) receiving conservative treatment and hemodialysis. Method: Cross-sectional study, describing serum FGF-23 concentration and some other biochemical parameters of 149 patients with chronic kidney disease at Hue Central Hospital, compared with a control group of 64 people who were not affected by CKD. Results: The concentration of FGF-23 in the control group, conservative treatment and hemodialysis group were 32.53 ± 9.803 pg/ml, 333.01 ± 243.02717 pg/ml, 717.66 ± 357.360 pg/ml, respectively, there were statistically significant differences (p &lt; 0.05). The concentration of FGF-23, PTH, total Calcium, phosphorus, Calcium x phosphorus accumulation increased with increasing renal failure (p &lt; 0.05). The concentration of Vitamin D and calcium ion decrease when renal failure level increases (p &lt; 0.05). FGF-23 had a better predictive value of the increasing total blood calcium level than PTH. FGF-23, PTH levels were all predictive of increasing blood phosphorus level, but FGF-23 was more valuable. Concentrations of FGF-23 and PTH had predictive values of the increasing Calcium x phosphorus accumulation, but FGF-23 was more valuable. The concentration of FGF-23 had predictive value of the increasing PTH concentration with the area under the curve by 0.765 (p &lt; 0.05). Conclusion: The concentration of FGF-23 significantly increased in patients with chronic kidney disease, and is worth predicting changes in factors related to mineral metabolism such as Calcium, Phosphorus, PTH Key words: hronic kidney disease, Fibroblast growth factor 23, Parathyroid hormone, Renal osteodystrophy, Calcium phosphate product

The Influence of Mechanic Factors in Disc Degeneration Disease as a Determinant for Surgical Indication

ObjectiveLow back pain is the most common reason for physician visit in Western population. It’s one of the factors that affect health-related quality of life. Intervertebral disc degeneration is one of the leading factors for low back pain and disc degeneration needs serious attention. In this article, we try to summarize biomechanical factors on the degenerative process. MethodsPatients with low back pain in Neurosurgery Department between January 2012 and June 2019 are searched for this study. The patients were gathered under 2 groups; surgical intervention and conservative treatment groups. Intervertebral disc degeneration was assessed by Pfirrmann grading system. All spinopelvic parameters were measured by using standardized lateral plain standing lumbar radiographs. ResultsThere were 165 patients in the surgical group (60 females, 105 males) and 84 patients in the conservative group (57 females, 27 males) after randomization. One hundred fifty patients had microdiscectomy and 15 patients had spinal instrumentation with transforaminal lumbar interbody fusion. There was not a statistically significant difference between surgical intervention and conservative treatment groups when comparing disc degeneration status. There was a statistically significant difference in parameters lumbar lordosis (LL), L4–S1, and pelvic incidence-LL (PI–LL) between the 2 treatment groups. In the surgical group when we further analyze the spinopelvic parameters in between the 2 different surgical techniques; L4–S1, pelvic tilt, and PI–LL showed a statistically significant difference. ConclusionDegenerative disc disease is related with multiple factors which can be detailed under the mechanic components and the genetic components. Of these factors, spinopelvic parameters seem highly penetrating to patients’ surgery needs with degenerative disc disease independently.

Factors Predicting the Need for Early Surgical Intervention for Small Bowel Obstruction.

Purpose Small bowel obstruction (SBO) is a common disease that requires hospitalization. The most common cause of SBO is postoperative adhesion. Delayed timing of operations in patients who need surgical intervention results in mortality or morbidity. A number of studies on SBO have established criteria for emergency surgery. However, few objective clinical parameters are available for screening patients who need a delayed operation. Therefore, we analyzed factors that affect the clinical course of SBO to select appropriate therapeutic plans for reducing the risk of complications in these patients.Methods We investigated the clinical characteristics of patients admitted to the surgery department of our hospital between January 1, 2015, and December 31, 2016, who were diagnosed with SBO. Patients were divided into an operative treatment group (n = 12) and a conservative treatment group (n = 96). We compared clinical characteristics between the 2 groups.Results The operative treatment group underwent more operations before SBO than the conservative treatment group (P = 0.007). Initial leukocyte counts (P = 0.004) and C-reactive protein (CRP) levels (P = 0.028) were elevated in the operative group. Body mass index (BMI) was lower in the operative group (P = 0.013).Conclusion The number of operations before SBO, leukocyte counts, CRP levels, and BMI were useful parameters for selecting patients who needed an urgent operation for SBO.

Acute Traumatic Intracranial Hematoma Index and its Significance for Objectifying Indications for Their Surgical Treatment

THE AIM OF THE STUDY. was an index creation for both single and multiple acute traumatic intracranial hematomas (ATIH) for objectification of the surgical treatment indications and using multispiral computed tomography (MSCT) and based on up-to-date clinical recommendations.MATERIAL AND METHODS. We performed a retrospective study of 3 groups of patients with ATIH. Group 1 included 19 patients who were treated conservatively and discharged from the hospital without complications (group of conservative treatment). Group 2 included 9 patients who were observed after hospitalization and were treated in a delayed manner surgically due to growth of the intracranial hematoma volume or the patient condition deterioration (group of observation). Group 3 included 18 patients who were operated due urgent indications (group of surgical treatment). For each patient, the acute traumatic hematoma index (ATHI) was calculated by our original formula. It took the ATIH location, volume in milliliters according to the first MSCT, and risk factors significant for poor outcomes into account. After a preliminary assessment of the significance of differences between the studied characters of groups, a discriminant analysis was carried out with determination of the ATHI values in each group.RESULTS AND CONCLUSIONS. The suggested ATHI index has been shown to be effective in assessing single and multiple ATIHs of any location in accordance with current recommendations. The index is an objective (digital) and easy-to-use for determining ATIH surgical treatment indications and statistical treatment. If ATHI is less than 3 points, there are no indications for surgery and the repeated MSCT of the brain is indicated at least 12 hours after the first checkup or if the suspicious clinical sings appear; if ATHI is 3–4, the indications for surgery are relative and the repeated MSCT of the brain is required 6 hours later even if the patient condition is unaltered; the surgery is indicated if ATHI is more than 4 points.Authors declare lack of the conflicts of interests.

Sleep Disturbance in Patients With Lumbar Spinal Stenosis: Association With Disability and Quality of Life.

This was a cross-sectional cohort study. The objective of this study was to identify the prevalence of sleep disturbance in patients with symptomatic lumbar spinal stenosis (LSS) and to establish the relationship between sleep disturbance and both functional disability and health-related quality of life in patients with symptomatic LSS. Despite the possible association between LSS and poor sleep quality, there has been no study regarding the relationship between LSS and sleep disturbance. A total of 148 patients with LSS were divided into the poor sleeper and nonpoor sleeper groups according to Global Pittsburgh Sleep Quality Index (PSQI) score. Demographic data, Visual Analog Scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5-dimension questionnaire (EQ-5D) were compared between both groups. Multiple regression analysis was performed with ODI or ODI without sleep component as the dependent variable and age, sex, PSQI, VAS for back pain, VAS for leg pain as independent variables. Of the 148 patients who participated in this study, 54 (36.5%) and 94 (63.5%) patients were classified into nonpoor sleeper and poor sleeper groups. Although there were no differences in demographic data or VAS for back or leg pain between the nonpoor sleeper and poor sleeper groups, poor sleepers demonstrated significantly higher ODI scores, and lower EQ-5D than nonpoor sleepers (P=0.003 and 0.004, respectively). There were significant correlations between the global PSQI score and both the ODI score and EQ-5D. Although the surgical treatment group showed significantly higher VAS for back pain, VAS for leg pain, ODI scores, and lower EQ-5D than the conservative treatment group, the ratio of poor to nonpoor sleepers was not different between both groups (P=0.733). In the surgical treatment group, the percent of poor sleeper decreased from 65.1% to 47.6% 6 months after surgery (P<0.001). The present study demonstrated that 'poor sleep quality' is a prevalent condition (63.5%) in patients with symptomatic LSS. Poor sleep quality has an adverse effect on functional disability and health-related quality of life in symptomatic LSS patients.

Prenatal ultrasonographic diagnosis and prognosis of fetal meconium peritonitis

Objective To investigate the maternal and neonatal outcomes of fetal meconium peritonitis (FMP) cases with different ultrasonic manifestations. Methods The clinical data of 31 pregnant women with FMP diagnosed by prenatal ultrasound and confirmed by postnatal imaging examination in Guangzhou Women and Children's Medical Center from January 2011 to December 2018 were analyzed retrospectively. According to the last prenatal ultrasonographic findings, the 31 cases were classified into the following grades: grade 0 (three cases), grade 1 (20 cases, grade 1A: nine cases, grade 1B: three cases, grade 1C: eight cases), grade 2 (seven cases) and grade 3 (one case). All neonates were also divided into two groups: the operation group (19 cases) and conservative treatment group (12 cases) based on whether or not underwent surgery. Statistical methods were independent sample t-test and Chi-square test. Results (1) The gestational ages at the first diagnosis of FMP and birth of the operation group were both lower than those of the conservative treatment group [(29.9±4.5) vs (38.2±1.0) weeks, t=-6.202; (36.2±2.7) vs (38.2± 1.0) weeks, t=-2.426; both P<0.05]. (2) The operation rates in cases of grade 0, 1, 2 and 3 groups were 0/3, 55%(11/20), 7/7 and 1/1, respectively (χ2=10.136, P=0.017). However, the operation rates in grade 1A, 1B and 1C groups were 7/9, 1/3 and 3/8, respectively (χ2=3.446, P=0.179). Conclusions The rate of operation of FMP newborn was related to the gestational age of the first prenatal ultrasound diagnosis of FMP and the ultrasonic grade. The different grades of prenatal ultrasound in FMP cases can provide important information for guiding perinatal treatment. Key words: Peritonitis; Meconium; Ultrasonography, prenatal; Fetal diseases

A comparative study between effects of aerobic exercises and conventional treatment on selected outcomes of heart failure clients

Heart failure (HF) is now a major public health issue with a current prevalence of over 23 million worldwide. Physical exercise is now mandatory for HF management to improve a sense of wellbeing. The purpose of the study was to compare the effect of aerobic exercises with the conventional treatment methods with selected patient outcomes among heart failure patients. A quantitative experimental research approach with a post-test-only control group design was adopted. A total of 40 HF patients were taken as study sample, and they were randomly divided into two groups. One group was given conservative treatment, whereas the other was trained with aerobic exercise. Aerobic exercise training was given to the training group for 30 days, and physical, physiological, and psychological changes were assessed by standardized rating scales. A difference of post-test scores of the exercise training group and conservative treatment group were examined using t-tests and Chi-square tests. Out of 40 patients (45% above 60yrs of age, 62.5% male), two groups exhibited an extremely significant difference in terms of HF symptoms, pain, and anxiety (p &lt; 0.00001). HF symptoms, chest pain, anxiety exhibited a significant association with age, edema showed significant association with occupation and oxygen uptake showed a significant association with age and occupation. This study concluded that aerobic exercises are highly effective to improve the activity tolerance of the body and can significantly reduce pain, edema, and anxiety levels in heart failure patients receiving conservative treatment.

Application of Damage Control Neurosurgery and Corresponding Nursing Strategy in Patients with Bilateral Frontal Lobe Contusion and Laceration

Objective: To investigate the key points and effect of damage control neurosurgery (DCNS) and nursing strategy of patients with neurosurgery in bilateral frontal contusion. Methods: According to the principle of damage control nursing strategy of neurosurgery, 33 cases of bilateral frontal contusion from September 2017 to January 2019 were treated by adjusting the internal environment disorder after trauma, increasing plasma osmotic pressure and maintaining blood oxygen saturation, craniotomy and decompression operations when patients grew worse. Patients were followed up for 6 months with the corresponding nursing practice given to the patients out of hospital. Results: Among the 33 cases, 25 of them received successful conservative treatment, 8 were converted to surgery. The operation rate was 24.2%. Six months after treatment, there were 27 cases with GOS ≥ 4, including 22 cases GOS ≥ 4 in the conservative treatment group and 5 cases GOS ≥ 4 in the surgery transfer group. Conclusion: The application of DCNS in the treatment of bilateral frontal contusion and take appropriate nursing strategy intervention can reduce the operation rate, prevent complications and promote patient’s recovery.