Conventional Conservative Treatment Research Articles

Application of prostate resectoscope in the treatment of massive rectal bleeding after transrectal prostate puncture

BACKGROUND Ultrasound-guided prostate biopsy is a reliable diagnostic procedure for prostate cancer diagnosis with minimal procedure-related trauma. However, complications, such as massive rectal bleeding may occur after the puncture. We hypothesized that using a transrectal resectoscope could help treat massive rectal bleeding after transrectal prostate punctures. AIM To identify a simple and effective treatment for massive rectal bleeding after transrectal prostate punctures. METHODS Patients requiring treatment for massive rectal bleeding after transrectal prostate punctures were included. A SIMAI resectoscope was inserted through the anus. Direct electrocoagulation was performed for superficial bleeding points. Part of the rectal mucosa or surface muscle layer was removed to expose deep bleeding points, followed by electrocoagulation. An electric cutting ring was used to compress and stop the bleeding for jet-like points before electrocoagulation. The fluid color in the drainage tube was monitored postoperatively for continuous bleeding. RESULTS Eight patients were included from 2012 to 2022. None of the patients with massive rectal bleeding after the transrectal prostate punctures improved with conventional conservative and blood transfusion treatments. Two patients had an inferior artery embolism, and digital subtraction angiography was ineffective. All patients received emergency transanal prostate resection, which immediately stopped the bleeding. Four days after the procedure, the patients had recovered and were discharged. CONCLUSION Using a transanal prostate resection instrument is a simple, safe, and effective method for treating massive rectal bleeding after transrectal prostate punctures.

The effect of complex treatment including osteopathic correction on pain intensity and quality of life in patients with chronic tonsillitis

Introduction. The relevance of the problem of chronic tonsillitis is due to the wide spread of the disease and the occurrence of complications associated with it, which, in turn, contributes to the appearance of pain and a decrease in the quality of life. Available information about the role of the palatine tonsils as an important organ of the immune system makes conservative treatment methods more preferable. Conventional conservative treatment is reduced to episodic implementation of individual techniques and remains insufficiently effective. Obtaining in-depth knowledge about the mechanisms of development of chronic tonsillitis necessitates the search for an integrated approach to treatment including non-drug methods. Often, questions about the severity of pain in patients that affect the level of quality of life are not given due attention.The aim is to study the effect of complex treatment including osteopathic correction on the quality of life and intensity of pain in patients with chronic tonsillitis.Materials and methods. In a prospective controlled randomized study conducted at the Department of Osteopathy and the Department of Otorhinolaryngology of the North-Western State Medical University named after I. I. Mechnikov of the Ministry of Health of Russia in the period from 06.2022 to 06.2023, 60 patients with a diagnosis of chronic tonsillitis were included. All patients, depending on the treatment, were divided using the randomization envelope method into two groups — main (n=30) and control (n=30). Patients in both groupsreceived otorhinolaryngological treatment in the form of lavage of the palatine tonsils (five rinsing procedures using an antiseptic solution, the interval between procedures was 2 days). Patients in the main group additionally received osteopathic correction (three procedures with an interval of 14 days). In all patients, before and after completion of treatment, the intensity of pain was assessed using a visual analogue scale (VAS) and quality of life using the SF-36 questionnaire.Results. In patients of both the main and control groups, there was a statistically significant decrease in the intensity of sore throat (p<0,05) after treatment. The increase in the level of quality of life in terms of both physical and psychological components of health was statistically significant (p<0,001) in patients of the main group. The level of quality of life in patients in the control group increased only due to the psychological component (p<0,001) of health, and the indicators of the physical component did not change (p=0,092).Conclusion. The inclusion of osteopathic correction in the complex therapy of patients with chronic tonsillitis in the inter-relapse period helps to reduce the pain and improve the physical component of quality of life compared to traditional conservative treatment alone. The study should be continued with a larger sample.

Optimal tactics for surgical revascularisation in diabetic angiopathy of the lower limbs.

Aim: This study aims to compare the efficacy of conservative treatment methods versus advanced surgical interventions, including revascularising automyelotransplantation and stem cell therapy, in improving vascular patency and the quality of life in patients with diabetic angiopathy. Materials and Methods: The research analyzed 68 patients with angiopathies under medical supervision from January 2007 to December 2017 at the National Scientific Center of Surgery named after A.N. Syzganov. Participants, aged 4 to 49, were divided into two groups based on angiographic blood flow characteristics: one with accelerated and another with delayed blood flow. A comprehensive participant selection process was implemented to ensure a representative sample. Sensitivity analysis was conducted to validate the findings' robustness. Results: The main group demonstrated notable success in limb salvage, with 90.9% avoiding high limb amputation post-revascularising automyelotransplantation. Moreover, 16.7% of patients experienced healing of trophic ulcers and toe necrosis. The use of stem cells from adipose tissue and fetal tissue progenitor cells showed promising results in reducing pain and increasing pain-free walking distance, alongside the formation of collateral vascular networks. Conclusions: The study concludes that advanced surgical interventions and stem cell therapies significantly enhance treatment outcomes in patients with diabetic angiopathy compared to conventional conservative treatments. These findings highlight the potential of personalized and innovative approaches in managing vascular complications associated with diabetes, offering new avenues for reducing disability and improving patient quality of life. Future research should focus on further refining these therapeutic strategies and exploring their integration into clinical practice.

A Randomized Controlled Trial of Vertebral Body Decompression Procedure Versus Conservative Treatment for Painful Vertebral Compression Fracture.

Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score (adjusted treatment effect: -0.1 and 2.0; 95% confidence interval [CI]: -7.5 to 7.3 and -5.6 to 9.6; p = 0.970 and p = 0.601, respectively). In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period (p = 0.917 and 0.704, respectively). Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment.

Efficacy of ultrasound‑guided platelet rich plasma injection for the management of de Quervain's tenosynovitis.

De Quervain's tenosynovitis (DQT) is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, which may be refractory to conservative treatments. The present study aimed to evaluate the efficacy of ultrasound (US)-guided platelet-rich plasma (PRP) injection for the management of DQT. For this purpose, from January, 2020 to February, 2021, 12 patients with DQT who received the US-guided PRP injection were studied prospectively. All patients were evaluated clinically for pain intensity using the visual analog scale and sonographically prior to treatment. The patients were followed-up at 1 and 3 months after the procedure to evaluate the efficacy of the treatment. In total, 12 hands of 12 female patients with DQT were analyzed in the present study. The post-treatment clinical evaluation revealed complete recovery in 4 (33.3%) of the patients, and 6 (50%) of them had recovered and returned to their daily activities. The sonographic evaluation revealed a significant reduction in the mean retinaculum thickness from 1.84 to 1.069 mm, and mean tendon sheath effusion from 2.06 to 1.25 mm, with only 58% of the cases having tendon sheath effusion at 3 months post-treatment. On the whole, the findings of the present study demonstrate that US-guided PRP injection with needle tenotomy can be used as an alternative non-surgical therapy for patients who do not respond to conventional conservative treatments, particularly in cases with sub-compartmentalization. The use of US may play a crucial role in the treatment of DQT, as improved clinical outcomes can be obtained with US-guided injections, particularly in cases with sub-compartmentalization.

Clinical and Immunological Efficacy of an Eucalyptus Leaf Preparation in Chronic Periodontitis Treatment: A Randomized Interventional Longitudinal Clinical Study

Background. The prevalence of inflammatory-destructive periodontal diseases remains to be a global problem. Long-term topical application of chlorhexidine bigluconate and metronidazole is known to involve various side effects, thereby requiring widening the spectrum of herbal preparations used for treating chronic periodontitis.Aim. To evaluate the efficacy of Chlorophyllipt in the treatment of chronic generalized periodontitis by studying cytokine concentration dynamics in the gingival fluid.Methods. A randomized controlled clinical study of outcomes achieved in 50 patients with chronic generalized periodontitis treated in Dental Polyclinic No. 3, Krasnodar Кrai, was carried out. The control group included 20 clinically healthy people. Patients diagnosed with chronic generalized periodontitis were divided into the main (n = 25) and comparison (n = 25) groups. The main group received basic therapy and conventional conservative treatment with the addition of Chlorophyllipt. The comparison group received basic therapy and conventional conservative treatment. The therapy efficacy was estimated based on clinical indicators and IL-1β, IL-1Ra, IL-8, and TNF-α cytokine levels in the gingival fluid before treatment and after 14 days, three days, and six months of treatment. Statistical analysis was performed using the SPSS version 15 software (USA).Results. All clinical parameters improved significantly in both chronic periodontitis groups after 14 days, three days, and six months of treatment in comparison with their levels before treatment (p < 0.001). At the same time, the conventional conservative treatment with the addition of Chlorophyllipt reduced inflammatory processes in periodontal tissues and gum bleeding at earlier stages. In the main group IL-1β, cytokine levels after 14 days of treatment were 19% lower than in the comparison group (p = 0.025), while IL-1Ra cytokine levels were 52% higher (p = 0.023). Six months after treatment, IL-1β and TNF-α cytokine levels were 14% and 32% lower than in the control group, respectively (p2 = 0.021 and p2 = 0.008), while IL-1Ra cytokine levels were 39% higher (p =0.019). All these results were statistically significant.Conclusion. Due to the established clinical and immunological efficacy, Chlorophyllipt can be included in the conventional conservative therapy of chronic generalized periodontitis. The determined levels of IL-1β, IL-1Ra, and TNF-α cytokines in chronic periodontitis patients can be used when assessing the response of periodontal tissues towards therapeutic interventions.

Predictors of improvement for patients with CNS vasculitis stenoses: A high-resolution vessel wall MRI follow-up study

PurposeTo investigate the predictors of the improvement for patients with isolated intracranial vasculitis stenoses using high-resolution vessel wall magnetic resonance imaging (HR VW-MRI). MethodsWe retrospectively reviewed data from consecutive patients with confirmed intracranial vasculitis under the same conventional conservative treatment based on a prospectively established HR VW-MRI database between December 2016 and December 2020. According to the changes between the degree of stenosis at baseline compared to follow-up MR angiography, the patients were divided into an improvement group and a non-improvement group. A multivariate analysis was performed to identify the predictive factors associated with the improvement of stenoses secondary to intracranial vasculitis. ResultsOverall, 41 patients (mean age 32.0 ± 10.1 years, 16 females) with isolated intracranial vasculitis stenoses were included (41.5 % [17/41] in the improvement group, and 58.5 % [24/41] were in the non-improvement group). The degree of wall enhancement on follow-up imaging was significantly reduced compared with that on the baseline imaging in the improvement group (P = 0.004). The multivariate analysis showed that the degree of enhancement (OR, 0.219, 95 % CI, 0.054 to 0.881; P = 0.033) at baseline was an independent predictive factor associated with the improvement in the intracranial vasculitis stenoses. ConclusionsIn patients with isolated intracranial vasculitis stenoses, the less enhancement the vessel wall was, the more likely the degree of stenosis would be reduced by conventional conservative therapy.

Comparative study between different approaches for the management of postdural puncture headache

Introduction The postdural puncture headache (PDPH) is one of the spinal and epidural anesthesia complications. It can be induced by using large gauge-cutting needles or performing numerous trials. Conservative treatment was the primary option for the management of PDPH, sphenopalatine ganglion block (SPGB) can be a suitable and safe option for the treatment of PDPH. Aim The aim was to verify the efficacy and safety of transnasal SPGB using either lidocaine 2% or bupivacaine 0.5% as a treatment line for PDPH versus the conventional conservative treatment. Patients and methods In total, 120 patients with PDPH following cesarean section under spinal anesthesia were assigned and divided into three groups. Group L (n=40) received transnasal SPGB (lidocaine 2%), group B (n=40) received transnasal SPGB (bupivacaine 0.5%), and group C (n=40) received conservative treatment for 24 h [intravenous (IV) paracetamol 1 g/8 h]. The headache severity was measured by the visual analog scale (VAS) at 0 min, 30 min, 6 h, 12 h, and 24 h post treatment. Results No significant difference in the VAS from the baseline between the groups L and B was observed. VAS values were significantly lower in both groups when compared with patients in group C (P<0.05). No significant differences from baseline mean blood pressure, heart rate, or other complications (such as bleeding), were observed between the three groups at any timepoint. Conclusion The headache severity in PDPH cases might be reduced more efficiently through SPGB using either lidocaine or bupivacaine, unlike other conservative treatments such as paracetamol.

Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Improves the Prognosis of Patients with Severe Acute Cholecystitis.

The aim of this study was to investigate the clinical efficacy of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) for the treatment of severe acute cholecystitis (AC). The data of 40 patients diagnosed with severe AC at our hospital between August 2020 and June 2021 were retrieved and classified into a PTGD group, open cholecystostomy (OC) group, laparoscopic cholecystectomy (LC) group, and conventional conservative treatment (CT) group. Before treatment and on days 1, 3, 5, and 7 after treatment, their serum levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), total bilirubin (TBIL), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), white blood cell count (WBC), IL-2, IL-4, IL-6, IL-8, and cancer antigen 19–9 (CA19-9) were measured. Additionally, clinical manifestations such as body temperature and pain score were monitored before treatment and at 24, 48, and 72 hours after treatment. The recovery time and complications/adverse reactions were statistically analyzed, and the Kaplan–Meier survival curve was plotted. After treatment, compared with the other three groups, the PTGD group had a significant reduction in serum indicators, including WBC and inflammatory factors, recovery time, pain score, and complications, and benefitted from better treatment efficacy and higher survival rate. Thus, ultrasound-guided PTGD was found to be more effective in treating severe AC patients and was associated with improved patient prognoses.

Observation on the Rehabilitation Effect of Athletes with Anterior Cruciate Ligament Injury of the Knee Based on Multidisciplinary Combined Nondrug Therapy.

This study analyzes the rehabilitation effects of athletes with anterior cruciate ligament injury of the knee based on multidisciplinary combined nondrug therapy. For this purpose, 70 athletes with anterior cruciate ligament injury of the knee admitted from September 2019 to December 2020, who were randomly selected, were the subjects of the study. According to the random number table method, they were divided into the control group and observation group, with 35 cases in each group. The control group was given conventional conservative treatment such as braces braking, local physiotherapy, and routine rehabilitation exercise after injury. For the observation group, multidisciplinary combined nondrug therapy was implemented on the basis of the control group. After receiving the intervention, the balance function score of the observation group was significantly higher than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). After receiving the intervention, the functional recovery scores of the knee joint of the observation group were significantly higher than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Before treatment, there was no significant difference in knee flexion extension, internal rotation, and external rotation between the two groups (P > 0.05). After treatment, flexion extension, internal rotation, and external rotation of the knee joint in the observation group were significantly higher than those in the control group (P < 0.05). There was no significant difference in VAS scores between the two groups before treatment (P > 0.05). After treatment, the VAS score of the observation group was significantly lower than that of the control group (P < 0.05). Multidisciplinary combined nondrug therapy has a good therapeutic effect in the treatment of anterior cruciate ligament injury of the knee for athletes. It can be used as a conservative treatment method to improve the score of balance function and recovery of lacquer joint function, enhance the range of motion of the knee joint, and reduce the VAS.

Successful Endovascular Therapy for Total Occlusion of the Distal Radial and Ulnar Artery with Palmar Artery Lesion in a Patient with Critical Hand Ischemia Associated with Systemic Sclerosis

Vasculopathy of systemic sclerosis (SSc) is known to lead to severe limb ischemia and is often associated with macrovascular diseases. Revascularization of proximal macrovascular lesions that cause limb ischemia in patients with SSc has been recommended; however, it has rarely been reported for lesions below-the-elbow (BTE) involving the palmar artery. A 66-year-old female patient with SSc experienced critical hand ischemia (CHI) with gangrene of the left third finger that failed to respond to conventional pharmacological treatment. Angiography revealed total occlusion of the distal radial and ulnar arteries with a palmar artery lesion. Balloon angioplasty was performed for bilateral occlusive lesions around the wrist, which improved antegrade flow to the digital artery. Endovascular therapy may be a feasible option for BTE lesions involving palmar artery disease, presenting with CHI in SSc, when conventional conservative treatments fail.

Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial.

BackgroundExtensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE.MethodsSixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments.ResultsOverall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]).ConclusionsPDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

Saving a Natural Tooth in the Implant Era: A Case Report on Noninvasive Surgical Root Amputation

This report highlights the use of a seldom-used treatment modality to save a diseased multirooted tooth, as an alternative to extraction and implant. Root-resection therapy is a simple surgical procedure performed by an endodontist or periodontist to save a multirooted tooth with furcation involvement and/or defective root. A 64-year-old female patient reported a strip perforation in the distobuccal (DB) root of the maxillary left first molar. The tooth had previously undergone endodontic treatment and had a well-fitted crown. After presenting the patient with treatment options and prognosis, a treatment plan of root amputation to save the tooth was formulated. A full mucoperiosteal flap was reflected. The DB root was amputated and GIC was placed to cover the root. Sutures were placed and the patient was given postoperative instructions. A follow-up was carried out with clinical examination, and periapical radiographs were taken at 10 months, 2 years, and 5 years after the procedure. The tooth was intact and functioning; no signs or symptoms were reported. Root resection has a deserved place in the modern clinical management of endodontic lesions or injuries. Conventional conservative treatment plans can succeed with proper treatment planning, diagnosis, case selection, maintenance of oral hygiene, and meticulous follow-up. This case emphasizes a viable treatment procedure to manage teeth with compromised radicular or restorative presentations. Root resection is a venerable treatment option that is often ignored in the era of implants even though it shows favorable prognosis and success rates.

Contemporary Review of Olfactory Dysfunction in COVID-19

The pandemic of coronavirus disease 2019 (COVID-19) is an extreme threat to international health care, resulting in more than two million deaths. Data reveal that olfactory disorder is a characteristic symptom of COVID-19 and has unique clinical manifestations. The olfactory dysfunction induced by COVID-19 has sudden onset, short duration, and rapid recovery, with anosmia often the only symptom. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) affects the human body by binding to angiotensin converting enzyme 2 (ACE2) of the olfactory epithelium. However, the etiology of COVID-19-induced olfactory dysfunction is unclear. In many countries, vaccines for COVID-19 in human are beginning to be administered. Conventional conservative treatments are common for olfactory disorders caused by COVID-19. Rhinologists should be aware of olfactory dysfunction to avoid delayed diagnosis of COVID-19. The article reviews the latest scientific evidence of anosmia in COVID-19.

Clinical value of emergency endovascular embolization in the interventional treatment for oral hemorrhage caused by carcinoma

To evaluate the clinical value of emergency endovascular embolization in the interventional treatment for oral hemorrhage caused by carcinoma, 32 patients with oral hemorrhage caused by carcinoma, who received emergency endovascular embolization due to unsatisfactory hemostatic effect of conventional conservative treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2019, were included in this study and their clinical data, laboratory data and imaging information were retrospectively analyzed. There were 16 males and 16 females, aged (60.6±13.6) years (34-88 years). Technical successful rate of emergency endovascular embolization, immediate successful rate of controlling hemorrhage, blood pressure before and after operation, hemoglobin before and after operation, postoperative complications and recurrence rate of oral hemorrhage were statistically analyzed. Results showed that technical successful rate of operation and immediate successful rate of controlling oral hemorrhage are both 100% (32/32). Recurrent oral hemorrhage occurred in 4 patients (13%). The hemorrhagic shock symptoms of all patients were significantly improved after interventional therapy. After operation, local swelling happened in 34% (11/32) patients and intermittent local pain happened in 22% (7/32) within 24 hours; the swelling and the pain gradually disappeared from 2nd to 5th days. Mild complications of transient fever happened in 9% (3/32) patients and disappeared spontaneously in the short term. No serious complications such as blindness, cerebrovascular accident or central nervous system disturbance occurred in all patients after operations. During the whole follow-up period (1 to 12 months), a total of 8 patients died. The causes of death were progression and metastasis of carcinoma (n=4), heart failure (n=2), severe pneumonia (n=1) and respiratory failure caused by recurrent oral hemorrhage (n=1). Owing to the remarkable short-term curative effect, repeatable operation, low recurrence rate of oral hemorrhage and low incidence of complications, emergency endovascular embolization can be used in the clinical therapy and application of oral hemorrhage caused by carcinoma.

Management of post-operative discitis following discectomy in a tertiary-level hospital.

To perform retrospective analysis of 75 post-operative disc space infections after open lumbar discectomy (OLD) and to assess the outcome of their medical and surgical management in a tertiary-level hospital. Records of 50 men and 25 women aged 26-65 (mean, 42.53) years who underwent treatment for post-operative discitis (POD) after single level OLD at L3-4 (n = 8), L4-5 (n = 42), L5-S1 (n = 25) level. The POD was diagnosed according to specific clinical signs, laboratory and radiographic investigations and all of them received initial intravenous antibiotics (IVA) for at least 4-6 weeks followed by oral ones. Successful responders (n = 55) were considered in Group-C and remainder [Group-S (n = 20)] were operated at least after 4 weeks of failure. Demographic data, clinical variables, hospital stay, duration of antibiotic treatment and post-treatment complications were collected from the hospital record and assessment before and after treatment were done by using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score. Comprehensive outcome was evaluated by modified criteria of Kirkaldy-Willis. The mean follows up was 36.38 months. Significant improvement of mean VAS and JOA score was achieved in both conservative (76.36% satisfactory) and operative (90% satisfactory) groups although the difference was statistically insignificant. Although insignificant, early surgical intervention provided better results (e.g. functional outcomes, length of hospital stay and duration of antibiotic treatment therapy) than conventional conservative treatment in post-operative discitis.

A retrospective controlled study protocol of transforaminal lumbar interbody fusion compared with posterior lumbar interbody fusion for spondylolisthesis.

Background:In the current literature, for adult lumbar spondylolisthesis, the direct comparison of clinical outcomes and perioperative complications between transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) is limited. Whether the therapeutic effect of TLIF is better than that of PLIF is still controversial. In this retrospective controlled study, our aim was to compare their clinical outcomes and radiological results of the above two stabilization approaches after 1-year follow-up period.Methods:This investigation was approved via the Institutional Review committee of China-Japan friendship hospital. This was a retrospective single-center analysis of subjects. We reviewed the patients with spondylolisthesis treated with TLIF or PLIF between July 2016 and February 2019 in our hospital. Patients with these conditions will be included: with the radiological evidence of degenerative lumbar spondylolismia with leg pain and/or low back pain, or the neurogenic claudication after failure of conventional conservative treatment for more than 6 months. The patients who received 3 levels or more intervertebral fusion levels were excluded. Patients without a completed medical history were excluded. Patients who had a history of lumbar spine surgery were also excluded. Clinical outcomes in our follow-up included functional outcomes, complications, and radiographic such as spondylolisthesis degree. The radiographs were obtained at 1, 3, 6, and 12 months during the outpatient follow-up.Results:This protocol will provide a solid theoretical basis for exploring which technique is better in treatment of spondylolisthesis.Trial registration:This study protocol was registered in Research Registry (number: researchregistry6032).

Clinical effect and economic benefit evaluation of minimally invasive surgery for drivers with lumbar disc herniation

Objective: To investigate the clinical effect of minimally invasive surgery in the treatment of professional drivers with lumbar disc herniation. Methods: 126 patients with lumbar disc herniation admitted to hospital from June 1, 2015 to December 30, 2018 were selected and divided into observation group (59 cases treated by percutaneous transforaminal endoscopy) and control group (67 cases treated with conventional conservative treatment) according to the treatment methods. The Visual Analogue Scale (VAS) and Japanese Orthopaedic Association Scores (JOA) before and after treatment were analyzed retrospectively. Length of stay, time out of bed, hospitalization expenses and recurrence rate were evaluated. The measurement data was expressed by x±s, the comparison between groups was performed by t test, and the count data were analyzed by descriptive analysis. Results: Before treatment, there was no significant difference in gender, age, VAS score and JOA score between the two groups (P>0.05) . After treatment, compared with the control group, the VAS score of the observation group was lower, the JOA score was higher, the time out of bed was shorter, the average hospitalization time was reduced, the average hospitalization cost was higher, and the recurrence rates after Six months and one year were lower in the observation group, the differences were statistically significant (P<0.05) . Conclusion: The clinical effect of percutaneous transforaminal endoscopic treatment is better than that of conventional conservative treatment for driver＇s lumbar disc herniation.

Effectiveness and safety of ablative fractional CO2 laser for the treatment of burn scars: A case-control study

BackgroundBurn scars are a major clinical challenge. The aim of this study was to determine the effectiveness and safety of one treatment with the ablative fractional CO2 laser (AFL-CO2) compared to standard burn scar treatment. MethodFrom December 2014 to October 2018 patients were prospectively recruited and treatment effects analyzed by assessing various outcome parameters from the date of first consultation and after treatment. A case control study was conducted looking at the impact of one AFL-CO2 treatment compared to a cohort subjected to conventional conservative treatment. Adverse effects were noted at follow up. Results187 patients were included, with 167 in the AFL-CO2, and 20 in the control cohort. Baseline demographics and scar characteristics showed no significant differences. Ultrasound measured scar thickness as well as the Vancouver Scar Scale (VSS) revealed a significant reduction in the treatment cohort, but no significant improvement in the control group. The POSAS-O was significantly improved in both cohorts. Subjective parameters (POSAS-P, DN4-Pain, and modified D4Pruritus scores) decreased significantly in the AFL-CO2 cohort but remained unchanged in the control group. The BSHS-B quality of life score increased significantly in the AFL-CO2 group, but worsened at the follow up of the untreated patients. Sub-domain analyses found the biggest differences in Affect, Body Image, Heat Sensitivity, Treatment and Work. Complications occurred in 5 patients (2.9%). ConclusionsThis study demonstrates that AFL-CO2 is an effective and safe treatment modality for burn scars improving thickness, symptoms and quality of life of burn survivors when compared to conventional scar treatment.

МАНУАЛЬНА ТЕРАПІЯ В ЛІКУВАННІ БОЛЬОВИХ РОЗЛАДІВ КРИЖОВО-КЛУБОВОГО СУГЛОБУ

Болі в структурах крижово-клубових суглобів і їх дисфункція становлять значну частину патологій попереково-крижового відділу хребта. Їх симптоматика різноманітна, бо вона пов’язана як із запальними процесами в самих суглобах, так і з нестабільністю суглобів та підтримуючих їх зв'язок. Всі складові цих структур можуть бути джерелом болю, тому й діагностувати та лікувати захворювання доволі складно. Лікування патологій крижово-клубових суглобів багатопланове. Дана публікація доводить, що мануальна терапія в поєднанні з ударно-хвильовою терапією дозволяє успішно надавати допомогу хворим із стійкими до лікування больовими синдромами та дисфункцією крижово-клубових суглобів, які не отримали бажаного результату при використанні традиційних методів консервативних та хірургічних втручань.