CSS Score Research Articles

Nursing intervention and quality feedback guided by stress system theory in neurological function recovery and post-traumatic growth of patients with acute primary cerebral hemorrhage

Objective To explore the effect of nursing intervention and quality feedback guided by stress system theory on neurological function recovery and post-traumatic growth in patients with cerebral hemorrhage. Methods 120 patients with cerebral hemorrhage admitted to our hospital from October 2022 to November 2023 were selected, 47 patients in the control group received routine medical care, and 73 patients in the observation group were added nursing intervention measures under the guidance of stress system theory on this basis. The effects of the intervention were evaluated by Posttraumatic Growth Inventory (PTGI), self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), Barthel index (BI) and Chinese scale of clinical neurological impairment in stroke patients (CSS). Results After intervention, the PTGI score in the observation group was significantly higher than that in the control group (p < 0.05). The SAS and SDS scores were significantly lower than those of the control group (p < 0.001), indicating that the nursing intervention effectively alleviated the anxiety and depression of patients. At the same time, the BI index of the observation group was significantly increased, and the CSS score was significantly decreased (p < 0.001), indicating that the patients’ self-care ability of daily life and the recovery level of neurological function were significantly improved. Conclusion Nursing intervention and quality feedback strategy under the guidance of stress system theory can effectively improve the neurological recovery ability and post-traumatic growth level of patients with cerebral hemorrhage, and has a significant effect on improving the psychological state and quality of life of patients.

Efficacy and safety of standardized Ginkgo biloba extract as adjuvant therapy for intracerebral hemorrhage in China: A systematic review and meta-analysis

ObjectiveThe aim of this study was to systematically review the clinical efficacy and safety of standardized Ginkgo biloba extract (GBE) in the adjuvant treatment of intracerebral hemorrhage (ICH). MethodsRelevant RCTs on GBE as adjuvant therapy for ICH were searched in seven Chinese and English databases. Data extraction of the included literature was performed after duplicate checking and screening, and Stata 15.1 software was applied for data analysis. ResultsWith a total of 19 RCTs, the meta-analysis results showed that: Compared with conventional treatment alone, GBE combined with conventional treatment had a higher effective rate; NIHSS score and CSS score were lower; The residual hematoma was less. The volume of cerebral edema was smaller. ADL score was higher. MoCA score was higher. The serum levels of hs-CRP, TNF-α and IL-6 were lower; No significant difference was observed in the incidence of adverse reactions between conventional treatment alone and GBE combined with conventional treatment. ConclusionThis study suggests that GBE as adjuvant therapy for ICH has better efficacy and is relatively safe compared with conventional treatment alone. However, due to the quality and quantity of included studies, further validation by more methodologically rigorous and multi-center studies with larger sample sizes is needed.

Burnout syndrome among employees in a clinical center in Montenegro during COVID-19.

Burnout syndrome occurs as a result of the influence of stressors in the workplace. The chronic disproportion between the demands placed on the worker and the resources available to fulfill the demands makes a significant contribution to the development of this syndrome. The occurrence of burnout syndrome has been shown to occur in a wide range of jobs, and it is taking on epidemic proportions among healthcare workers. So far, there have been no large-scale studies dealing with burnout syndrome in healthcare workers in Montenegro. The research was conducted as a cross-sectional study. All full-time employees of the Clinical Center of Montenegro who participated in the treatment of patients with COVID-19 during 2020 and 2021 were included in the research. Questionnaires used in the research were: a general questionnaire for collecting socio-demographic data, a questionnaire for the assessment of burnout syndrome at work - Maslach Burnout Inventory and a COVID-19 stress scale. The prevalence of burnout syndrome was 16.8% among employees who were engaged around COVID-19 patients. Predictors of burnout syndrome identified were occupation (nurses/technicians have a 2.8 times higher chance of burnout syndrome than doctors as a reference category), confirmed COVID-19 infection (subjects with confirmed COVID-19 infection have more than 2 times higher chance for burnout syndrome), higher CSS scores (subjects with high CSS score have a 3% higher chance of developing burnout syndrome). In order to reduce losses due to reduced productivity of employees and prevent long-term detrimental consequences on the mental health of employees, evidence-based preventive measures are needed.

Is fixation of both clavicle and scapula better than clavicle alone in surgical treatment of floating shoulder injury? A retrospective study

Background & objectiveLittle research was available to explore which surgical fixation was better between fixation of both clavicle and scapula and clavicle alone in management of floating shoulder injury.MethodsTotal 69 patients with floating shoulder injury receiving surgery from February 2005 to July 2020 participated in the study. 49 patients underwent fixation of the clavicle alone (Group C) while 20 patients underwent fixation of both clavicle and scapula (Group C + S). They were further divided into subgroups according to age: Group C1, Group C + S1 (age ≤ 55 years old) and Group C2, Group C + S2 (age>55 years old). The radiological parameter (glenopolar angle (GPA)) and clinical outcomes (Herscovici score, Constant-Murley shoulder outcome score (CSS score), and Visual Analogue Scale score (VAS score)) were collected and compared between these groups. The correlation between age and radiological parameter and clinical outcomes was calculated by the Spearman correlation analysis.ResultsAll people were followed up for at least 1 year. The degree of change in GPA before and after surgery in Group C + S is significantly better than that in Group C. The Herscovici and CSS score in Group C + S2 were significantly higher than those in Group C2 at 1 month, 3 months and 1 year after surgery. However, no significant difference in Herscovici and CSS score was found at final follow-up (1 year after surgery) between Group C + S1 and Group C1. The VAS score in Group C + S2 at final follow-up was significantly lower than that in Group C2. No significant difference in VAS score at final follow-up was found between Group C + S1 and Group C1. In addition, the VAS score was negatively correlated with Herscovici and CSS score. No correlation was found between VAS score and GPA.ConclusionsBoth types of surgical fixation are effective in management of floating shoulder injury. For young people with floating shoulder injury, both types of surgical fixation are equally effective. However, for older people with floating shoulder injury, fixation of both clavicle and scapula is better in prognosis than fixation of clavicle alone.

SERUM FERRITIN AS PROGNOSTIC MARKER IN ACUTE ISCHEMIC STROKE-AN OBSERVATIONAL STUDY

Background: Stroke is dened as "rapidly developing clinical evidence of focal (or global) impairment of brain function, with symptoms lasting 24 hours or more or leading to death, with no evident cause other than vascular origin," according to the World Health Organization. Many studies have suggested that serum ferritin may have a role in predicting iron-mediated free radical harm in the etiology of cerebrovascular disorders. A high serum ferritin level upon admission was linked to a poor prognosis in acute stroke patients (within 24-48 hours after start). The primary goal of this study is to evaluate the role of serum ferritin in patients with acute ischemic stroke. Settings and Design: It is observational study carried out in 50 cases with ischemic stroke. Severity of stroke was determined using CSS score. Laboratory investigations were done to estimate serum ferritin. Results: We found that the mean serum ferritin levels were signicantly increased among “more severe stroke” and deteriorated stroke patients than compared to “less severe stroke” and not-deteriorated stroke patients (p&lt;0.05). We found signicant negative correlation with spearman's rho of -0.7 between serum ferritin and CSS score. Conclusions:Serum ferritin plays a major role in predicting the severity and prognostic outcome of acute ischemic stroke.

Characterisation of the clinical phenotype in Phelan-McDermid syndrome

BackgroundPhelan-McDermid syndrome (PMS) is a rare genetic disorder compromising the 22q13 terminal region and affecting SHANK3, a gene crucial to the neurobehavioural phenotype and strongly linked to autism (ASD) and intellectual disability (ID). The condition is characterised by global developmental delay, ID, speech impairments, hypotonia and autistic behaviours, although its presentation and symptom severity vary widely. In this study, we provide a thorough description of the behavioural profile in PMS and explore differences related to deletion size and language ability.MethodsWe used standard clinical assessment instruments to measure altered behaviour, adaptive skills and autistic symptomatology in sixty participants with PMS (30 females, median age 8.5 years, SD=7.1). We recorded background information and other clinical manifestations and explored associations with deletion size. We performed descriptive and inferential analyses for group comparison.ResultsWe found delayed gross and fine motor development, delayed and impaired language (~70% of participants non or minimally verbal), ID of different degrees and adaptive functioning ranging from severe to borderline impairment. Approximately 40% of participants experienced developmental regression, and half of those regained skills. Autistic symptoms were frequent and variable in severity, with a median ADOS-2 CSS score of 6 for every domain. Sensory processing anomalies, hyperactivity, attentional problems and medical comorbidities were commonplace. The degree of language and motor development appeared to be associated with deletion size.ConclusionsThis study adds to previous research on the clinical descriptions of PMS and supports results suggesting wide variability of symptom severity and its association with deletion size. It makes the case for suitable psychotherapeutic and pharmacological approaches, for longitudinal studies to strengthen our understanding of possible clinical courses and for more precise genomic analysis.

The Relationship Between Gensini Score and Erectile Dysfunction in Patients with Chronic Coronary Syndrome.

IntroductionIn previous studies, the relationship between atherosclerosis and erectile dysfunction (ED) was examined, but the relationship and correlation between Gensini score which evaluates the extent and severity of chronic coronary syndrome (CCS), and ED severity were not investigated.AimTo evaluate the relationship between Gensini score and ED in patients with CCS.MethodsWe included 142 consecutive male patients with the diagnosed CCS and underwent an elective coronary angiography between January 2019 and March 2020.Main Outcome MeasureCorrelation analysis demonstrated that Gensini score significantly negatively correlated with the International Index Erectile Function - 5 (IIEF-5) score (r = -0.417, P < .001).ResultsSevere ED was present in 48 (33.8%) patients, moderate ED in 31 (21.8%) patients, and mild ED in 22 (15.5%) patients. 41(28.9%) patients did not have ED. Both the No ED and Mild ED groups were statistically significantly lower than the Severe ED group in terms of the Gensini score (P < .05). When the recommended optimal cut-off point and accuracy measurements were made for the Gensini score, the area under curve (AUC) value in predicting ED was 0.806 (95% CI: 0.732-0.880, P < .001). Multivariate logistic regression analysis demonstrated that independent predictors for ED were Gensini score and age (P < .001, and P = .026, respectively). Every 1 unit increase in Gensini score resulted in a 6% increase in the occurrence of ED (OR = 1.06, CI:1.03-1.10, P < .001).ConclusionED can be caused by endothelial dysfunction. Patients with severe CSS and high Gensini score should be evaluted for ED. ED may be a sign of severe CCS and a high Gensini score. It is also necessary to evaluate cardiological in patients with ED.Deger M, Ozmen C, Akdogan N, et al. The Relationship Between Gensini Score and Erectile Dysfunction in Patients with Chronic Coronary Syndrome. Sex Med 2021;9:100376.

Metastatic pheochromocytoma and paraganglioma: signs and symptoms related to catecholamine secretion

BackgroundThe presence or future development of metastatic pheochromocytomas or paragangliomas (mPPGLs) can be difficult to diagnose or predict at initial presentation. Since production of catecholamines from mPPGLs is different from non-metastatic tumors (non-mPPGLs), this study aimed to clarify whether presenting catecholamine-related signs and symptoms (cSS) might also differ.MethodsThe study included 249 patients, 43 with mPPGL and 206 with non-mPPGL. Clinical data at the time of biochemical diagnosis (i.e. at entry into the study) were used to generate a cumulative score of cSS for each patient.ResultsPatients with mPPGL were significantly younger (43.3 ± 14 vs. 48.9 ± 16.1 years) and included a lower proportion of females (39.5% vs. 60.7%) than patients with non-mPPGLs. Frequencies of signs and symptoms did not differ between the two groups. Patients with mPPGLs had lower (P < 0.001) urinary excretion of epinephrine (3.5 (IQR, 1.9—6.5) µg/day) than those with non-mPPGLs (19.1 (IQR, 4.3—70.2) µg/day). There was no difference in urinary excretion of norepinephrine. In patients with mPPGLs a high cSS score was associated with high urinary excretion of norepinephrine and normetanephrine. In contrast, in patients with non-mPPGLs, a high cSS was associated with high urinary excretion of epinephrine and metanephrine.ConclusionAlthough presenting signs and symptoms were associated with production of norepinephrine in patients with mPPGLs and of epinephrine in patients with non-mPPGLs, there were no differences in signs and symptoms between the two groups. Therefore, consideration of signs and symptoms does not appear helpful for distinguishing patients with and without mPPGLs.

Utility of logistic clinical SYNTAX score in prediction of in-hospital mortality in ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery.

The logistic clinical SYNTAX score (log CSS) is a combined risk scoring system including clinical and anatomic parameters; it has been found to be effective for the prediction of mortality in patients with ST-elevation myocardial infarction (STEMI). Coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction is still debated. In the present study, we aimed to evaluate the utility of log CSS to stratify the risk of in-hospital mortality in acute STEMI patients undergoing emergent CABG for primary revascularization. In total, 88 consecutive patients with acute STEMI, who did not qualify for primary percutaneous coronary intervention and required emergent CABG were included in our study. Nine of 88 patients died during hospitalization. The study population was divided into two groups as in-hospital survivors and non-survivors. Log CSS and SYNTAX score (SS) were calculated for both groups and two groups were compared in terms of demographics, preoperative, intraoperative, postoperative characteristics, SS and log CSS. Log CSS was found to be an independent predictor of in-hospital mortality, log CSS > 10.5 had 89% sensitivity, 81% specificity (area under the curve: 0.927; 95% confidence interval: 0.855-0.993). Moreover, peak troponin level was an independent predictor of in-hospital mortality. Glucose level, cardiopulmonary resuscitation before operation, glomerular filtration rate, left ventricular ejection fraction, and Killip class were significantly associated with in-hospital mortality. Log CSS may improve the accuracy of risk assessment in patients who are undergoing emergent CABG for primary revascularization of STEMI.

Effect of Huatan Quyu Decoction on Patients with Cerebral Infarction

The objective is to explore the clinical methods and effects of applying Huatan Quyu Decoction in the treatment of patients with cerebral infarction. The research work was carried out in our hospital, and the research was carried out from November 2019 to November 2020. Patients with cerebral infarction were selected as the research object, and the number of patients was 80. They were randomly divided into two groups and one group was given conventional rehabilitation therapy as the control group, the other group was given Huatan Quyu Decoction as the experimental group, and the effects of different treatments on patients were compared and analyzed. Before treatment intervention, there was no significant difference in the scores of neurological impairment, limb motor ability and ability of daily living between the two groups of patients, P&gt;0.05. After treatment intervention, the CSS score of the experimental group decreased and the BI score increased, which has significant differences compared with the control group, and the experimental group has higher scores for sensory and motor function. In addition, the effective rate of treatment in the experimental group was 95.00%, which was significantly higher than the 77.50% in the control group. The difference between the two groups was significant and meaningful. The treatment effect was better in the experimental group.The application of Huatan Quyu Decoction in the process of treating patients with cerebral infarction can effectively promote the recovery of patients and improve the quality of life of patients. The clinical application is significant.

Increased preoperative greater tuberosity angle does not affect patient-reported outcomes postarthroscopic rotator cuff repair.

BackgroundThe greater tuberosity angle (GTA) is a newly described radiological parameter identified in a 2018 study by Cunningham et al that sought to investigate the effect of GT morphology on cuff tears. Increased GTA has been conceptualized to affect rotator cuff pathology through both extrinsic and intrinsic mechanisms. GTA > 70° was highly predictive of a degenerative rotator cuff tear. This study seeks to examine if increased GTA predicts for worse functional outcomes 2 years postoperatively after arthroscopic rotator cuff repair.MethodsBetween May 2010 and December 2016, 169 patients who underwent arthroscopic rotator cuff repair with subacromial decompression were included in this study. GTA was measured on preoperative radiographs. These patients were evaluated preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Outcomes were assessed with the Visual Analog Scale Pain score, Constant Shoulder Score, and the Oxford Shoulder Score. Power analysis was performed based on the minimal clinically important difference of the Constant Shoulder Score. Statistical analysis was performed by dividing patients into two groups based on GTA: 1) ≤ 70 (control GTA); and 2) >70 (increased GTA) and comparisons were made between the 2 groups.ResultsThe patients’ demographics were comparable between both groups. All 169 patients had statistically significant improvements in all functional scores at 2 years postoperatively. There were no statistically significant differences between the two groups of patients in Visual Analog Scale and functional scores at 3 months, 6 months, 1 year, and 2 year postoperatively. The changes in functional scores from their preoperative baseline were also tabulated, and there were no statistically significant differences between the 2 groups. Finally, there was no significant correlation between GTA with CSS or Oxford Shoulder Score at 2 years follow-up.ConclusionThis study represents the largest single series available investigating the influence of GTA on midterm functional outcomes after arthroscopic rotator cuff repair. Although GTA remains a reliable radiographic predictor of rotator cuff tears, the authors conclude that increased GTA does not negatively influence midterm functional outcomes. As there is also no statistical significance between increased GTA vs. control in relative functional gain 2 years postoperatively, corrective tuberoplasty may not be mandatory during arthroscopic repair of cuff tears. Standard arthroscopic double-row rotator cuff repair with subacromial decompression can still be offered as a suitable treatment option.

Novel mutation points to a hot spot in CDKN1C causing Silver\u2013Russell syndrome

BackgroundPathogenic CDKN1C gain-of-function variants on the maternal allele were initially reported as a cause of IMAGe syndrome characterized by intrauterine growth retardation, metaphyseal dysplasia, primary adrenal insufficiency and genital anomalies. Recently, a maternally inherited CDKN1C missense mutation (p.Arg279Leu) was identified in several members of a single family clinically diagnosed with Silver–Russell syndrome (SRS) but without adrenal insufficiency. Thereafter, two half siblings from UK with familial SRS were described who carried the same mutation. This specific amino acid change is located within a narrow functional region containing the mutations previously associated with IMAGe syndrome.ResultsHere, we describe a third familial case with maternally inherited SRS due to a missense variant affecting the same amino acid position 279 but leading to a different amino acid substitution (p. (Arg279Ser)). The two affected family members (mother and son) presented with the complete SRS phenotype (both Netchine–Harbison CSS score 5 of 6) but without body asymmetry or adrenal insufficiency.ConclusionsIn comparison with loss-of-function genomic IGF2 mutations, CDKN1C gain-of-function mutations are a less frequent cause of SRS and seem to affect a cluster of few amino acids.

Constipation in nursing students and factors affecting

Aim: The aim of this study was to determine the constipation problems of nursing students and the variables that affect it.Material and Methods: The research was conducted on the first, second, third and fourth year students of Batman University School of Nursing in 2018-2019 academic year. The sample of the study consisted of 218 nursing students who accepted to participate voluntarily. In the collection of data, a “Student Information Form” and the “Constipation Severity Scale” (CSS) were used. Results: The average age of the students included in the study was 21.14±2.34 (17-39 years), 55.5% of the students were female, 33% were in their senior year, 55% were living at home with their parents, 85.6% did not smoke, 93.6% had no chronic disease and 76.6% performed regular exercise. It was found that 56.9% of the students ate three times a day and 38.5% twice a day; 67.9% of the students consumed pulpy or fibrous foods occasionally; the daily average of water consumed by the students was 7.69±4.16 cups and 3.83±2.44 cups of coffee were consumed. The mean total CSS score of the students was 27.83±7.85 and the mean scores of the sub-scales were calculated as “Intestinal Obstruction”12.53±3.48, “Lazy Bowels” 11.56±3.84 and “Pain” 2.29±2.62. It was determined that there were differences between the variables of gender, exercise status, consumption of pulpy or fibrous foods and the daily consumption of tea or coffee and the mean score of CSS.Conclusion: It was observed that there were the incidence of constipation was not very high in nursing students and that this problem was experienced more by students who did not perform exercise, who consumed less pulpy or fibrous food, and who were female.Keywords: Constipation; health status; nursing students.

Antithyroid drug treatment for Graves' disease: baseline predictive models of relapse after treatment for a patient-tailored management.

Antithyroid drugs (ATDs) are first-line treatment for Graves' hyperthyroidism worldwide, but relapses are frequent. The reliability of individual risk factors to predict at baseline subsequent relapse is poor. Predictive scores grouping single risk factors might help to select the best treatment (pharmacological vs. ablative). To assess the predictivity of a recently developed score (Clinical Severity Score, CSS) and to compare it with another score (GREAT score). A retrospective observational, single-center study was conducted of 387 consecutive, newly diagnosed Graves' patients, who completed an 18-24months ATD course and were followed for at least 2years. Hyperthyroidism relapsed in 185 patients (48%). At diagnosis and before treatment, the relapse group had higher serum TSH-receptor antibody and free thyroxine levels and larger goiters than the remission group, with no differences in Graves' orbitopathy prevalence and severity. In the multivariate analyses, only large goiter size was significantly associated with an increased recurrence hazard ratio. Using CSS, the risk of relapse increased from 36% in the mild category and 49% in the moderate category to 59% in the severe category, with quite a good area under the curve (AUC) (0.60; 95% CI: 0.55; 0.66). GREAT score showed an increase in relapse from 34% for class I (mild) and 49% for class II (moderate) to 64% for class III (severe) (AUC, 0.63; CI: 0.58; 0.68). Both CSS and GREAT score are useful, although imperfect, tools to predict at baseline relapse of hyperthyroidism after treatment. In real life they may help the clinician to tailor a treatment for newly diagnosed Graves' hyperthyroidism.

Application of group health education on the prevention of disuse atrophy of muscle in patients with craniocerebral trauma

Objective To explore the effect of group health education on the prevention of disuse atrophy of muscle in patients with craniocerebral trauma. Methods From June 2014 to May 2016 at the root of craniocerebral injury patients in the treatment of 148 cases of our hospital as the research object, according to the order of admission number, were randomly divided into observation group and control group, 74 cases in each. The patients of control group were given routine health education, and the patients of observation group were given the group health education. At admission and intervention for 3 months were determined in patients with neurological function, motor function and muscle strength. Results 3 months after the intervention, the CSS score of the observation group (16.45±4.65) was significantly lower than that of the control group, the difference was statistically significant (t=2.646, P<0.01) . The score of upper limb motor function (53.58±10.31) and the score of lower extremity motor function (28.46±4.75) of the observation group were significantly higher than those in the control group, the difference was statistically significant (t=3.015, 2.699; P<0.01) . The total effective rate of muscle recovery in observation group was 84.38%, and the total effective rate of muscle recovery in control group was 53.97%, there was significant difference between two groups (χ2=6.783, P<0.01) . Conclusions Comparing with conventional health education, group health education can improve the recovery of limb motor function and muscle strength in patients with craniocerebral trauma. Meanwhile, it can effectively prevent the disuse atrophy of muscle so as to improve the quality of life of patients. Key words: Health education; Craniocerebral trauma; Disuse atrophy of muscle

Correlation of quantitative MR imaging findings with symptoms in patients with incidentally detected inflammatory sinonasal disease.

To assess the relationships between mucosal thickness, T1-weighted, T2-weighted signals and restricted diffusion on magnetic resonance imaging (MRI) with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease. Conventional and diffusion-weighted MRI of 100 patients with incidental sinonasal mucosal thickening were prospectively evaluated. There were 53 men and 47 women, with a mean age of 44.6 years±15.17 (SD) (range: 18-81 years). Correlations between quantitative values (T1-signal, T2-signal and apparent diffusion coefficient [ADC]) and three different quality of life questionnaires (chronic sinusitis survey, sinonasal outcomes test-22 and nasal obstruction and septoplasty effectiveness scale [NOSE]) were searched using the Spearman correlation test. The mean SNOT-22 score was 35.81±20.36 (SD) (range: 0-83), CSS score was 4.64±3.42 (SD) (range: 0-14), and NOSE score was 5.91±4.84 (range: 0-18). All patients (100%) had maxillary sinus involvement. Ethmoidal sinus involvement was present in 57% of patients, frontal sinus involvement in 33% and sphenoidal sinus involvement in 27%. Morphologically, 40 patients (40%) had septal deviation, 41 (41%) had maxillary sinus retention cyst and 78 (78%) had hypertrophy of the conchae. No correlations were found between morphological abnormalities, quantitative values and patient scores in none of the questionnaires. Incidental morphological abnormalities or restricted diffusion of the paranasal sinuses on MRI do not correlate with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease.

Development of a clinical spasticity scale for evaluation of dogs with chronic thoracolumbar spinal cord injury.

OBJECTIVE To develop a spasticity scale for dogs with chronic deficits following severe spinal cord injury (SCI) for use in clinical assessment and outcome measurement in clinical trials. ANIMALS 20 chronically paralyzed dogs with a persistent lack of hind limb pain perception caused by an acute SCI at least 3 months previously. PROCEDURES Spasticity was assessed in both hind limbs via tests of muscle tone, clonus, and flexor and extensor spasms adapted from human scales. Measurement of patellar clonus duration and flexor spasm duration and degree was feasible. These components were used to create a canine spasticity scale (CSS; overall score range, 0 to 18). Temporal variation for individual dogs and interrater reliability were evaluated. Gait was quantified with published gait scales, and CSS scores were compared with gait scores and clinical variables. Owners were questioned regarding spasticity observed at home. RESULTS 20 dogs were enrolled: 18 with no apparent hind limb pain perception and 2 with blunted responses; 5 were ambulatory. Testing was well tolerated, and scores were repeatable between raters. Median overall CSS score was 7 (range, 3 to 11), and flexor spasms were the most prominent finding. Overall CSS score was not associated with age, SCI duration, lesion location, or owner-reported spasticity. Overall CSS score and flexor spasm duration were associated with gait scores. CONCLUSIONS AND CLINICAL RELEVANCE The CSS could be used to quantify hind limb spasticity in dogs with chronic thoracolumbar SCI and might be a useful outcome measure. Flexor spasms may represent an integral part of stepping in dogs with severe SCI.

Long-term Results, Functional Outcomes and Complications after Open Reduction and Internal Fixation of Neglected and Displaced Greater Tuberosity of Humerus Fractures.

Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes of open reduction and internal fixation (ORIF) of neglected GT fractures. We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder. Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (P value<0.0001). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: 6.5 to 1.3, Mean CSS: 29.83 to 86, Mean ADL: 6.6 to 27.1,: Mean ASES: 28.6 to 88.9) (P value<0.0001). ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture.

High prevalence of constipation and reduced quality of life in opioid-dependent patients treated with opioid substitution treatments

ABSTRACTObjectives To evaluate prevalence and severity of constipation and quality of life (QoL) in a cohort of opioid-addicted patients treated with opioid substitution treatments (OST).Methods: A total of 1057 heroin-dependent patients treated with methadone or buprenorphine were enrolled in a multicenter observational study. Constipation was assessed by Wexner Constipation Scoring System (Wexner CSS), QoL by General Health Questionnaire (GHQ-12).Results: 38.5% patients reported mild constipation, 33.3% reported moderate constipation, 14.8% severe constipation and 5.1% very severe constipation. Mean Wexner CSS score was 6.6 ± 4.8. 44.9% patients showed a GHQ-12 score ≥14; of these 18.3% patients showed a GHQ-12 score ≥20. Mean GHQ score was 13.8 ± 6.5. Mean Wexner CSS score was significantly higher in methadone patients (p = 0.004), in those taking psychoactive drugs (p = 0.0001) and in female (p < 0.0001) with respect to counterparts. Similarly, GHQ-12 mean scores were higher methadone group (p = 0.003), in those taking psychoactive drugs (p < 0.0001), and in female (p = 0.039) with respect to counterparts. ANOVA and ANCOVA showed a significant influence of methadone and female gender on Wexner CSS score while psychoactive drugs significantly influenced both tests.Conclusions: The present study shows that patients affected by opioid-dependence in OST with methadone and buprenorphine have a high prevalence of constipation and reduced QoL.

Correlation analysis of operation timing, mode and curative effects of patients with severe hypertensive cerebral hemorrhage

Objective To study the correlation of operation timing,mode and curative effects of patients with severe hypertensive cerebral hemorrhage.Methods 90 patients with hypertensive cerebral hemorrhage were collected and divided into super early treatment group (32 cases),early treatment group (29 cases),delayed treatment group (29 cases) and big bone flap craniotomy treatment group (41 cases),small bone window craniotomy operation removal group(49 cases).The therapeutic effect,neural function and mental state were observed.Results The total effective rate (93.32％,93.56％),MMSE score [(22.22 ± 2.33) points,(31.55 ± 3.68) points] of super early group and small bone window craniotomy group were significantly higher than other groups (F =6.672,5.325,all P ＜ 0.05.x2 =6.852,7.372,all P ＜ 0.05),CSS score [(17.92 ± 1.84) points,(17.41 ± 1.97) points],NIHSS score [(22.22 ±2.33) points,(22.53 ± 2.48) points] were significantly lower than other groups(F =5.624,6.621,all P ＜ 0.05.F =5.458,6.171,all P ＜ 0.05).The operation timing was positively correlated with CSS and NIHSS score,while negatively correlated with MMSE.The operation mode was negatively correlated with CSS and NIHSS score,while positively correlated with MMSE.Conclusion Early small bone window craniotomy operation therapy has the positive clinical value,it can improve the treatment efficacy and neurological function. Key words: Intracranial hemorrhage, hypertensive ; Craniotomy; Microsurgery