Health Survey Scores Research Articles

Efficacy of Laminoplasty in Improving Sensory Disturbances in Patients with Cervical Spondylotic Myelopathy: A Prospective Study

Upper extremity sensory disturbances are primary symptoms that affect the quality of life (QOL) of patients with cervical spondylotic myelopathy. Although laminoplasty is 1 of the surgical options, its effects on sensory disturbances have remained unclear. We aimed to determine whether surgical intervention would improve the sensory disturbances of patients with cervical spondylotic myelopathy. We conducted a prospective clinical trial of 101 patients who had undergone open door laminoplasty. For an objective sensory assessment, we measured the current perception thresholds (CPTs) in the patients' forearms and palms using PainVision PS-2100. For a subjective sensory assessment, numbness in the upper extremities was rated using a visual analog scale (VAS). Using the VAS scores, the patients were divided into those with improvement and without improvement. Their self-reported 36-item short-form health survey and Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire scores were compared. The postoperative CPTs in relationship to the preoperative CPTs at 3, 6, and 12 months was 99.3%, 98.1%, and 93.8% in the forearm and 93.6%, 90.6%, and 87.8% in the palm, respectively. The corresponding postoperative numbness VAS scores were 63.8%, 50.5%, and 48.0%. At 12 months postoperatively, the 36-item short-form health survey physical and role component summary scores, cervical spine function effectiveness rates, upper and lower extremity function, and QOL items in the Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire were significantly higher in the improvement group. Our findings have indicated that improvement in postoperative subjective sensory disturbances will occur relatively earlier and will be significantly greater than the improvement in objective sensory disturbances. Furthermore, improvement in the subjective sensory disturbances contributes to functional spinal cord recovery and patients' health-related QOL.

Cost-Effectiveness of Jingshu Granules Compared to Placebo for the Treatment of Patients with Cervical Radiculopathy in China: A Decision-Tree Model Based on Randomized Controlled Trial.

Objective: Traditional Chinese Medicines (TCMs), as well as physiotherapy and chemical drugs, are recommended for the treatment of cervical spondylosis by Chinese guidelines for cervical spondylosis diagnosis and treatment. The aim of this study was to evaluate whether TCM Jingshu Granules are cost-effective in patients with cervical radiculopathy in China. Methods: A multicenter, double-blinded, randomized placebo-controlled trial was performed. A total of 480 patients were recruited from 14 tertiary hospitals in China and were randomly divided into an experimental group (Jingshu Granules) or control group (placebo) at a 3:1 ratio. All patients received 4 weeks of treatment. Clinical outcomes and cost data were collected during the trial, including the neck disability index (NDI), visual analog scale (VAS) of pain, VAS of numbness, 36-Item Short Form Health Survey (SF-36) score, willingness to pay (WTP) for VAS of pain, direct medical costs, and transport costs. From a social perspective, a decision-tree model and cost-effectiveness analysis were conducted. Results: The treatment group has a significant advantage in reducing NDI (9.41 ± 10.51 vs. 4.83 ± 8.43, p < 0.05), VAS of pain (22.72 ± 15.08 vs. 12.86 ± 13.45, p < 0.05), and VAS of numbness (16.96 ± 17.53 vs. 11.64 ± 16.54, p < 0.05), respectively, while there was no significant difference in the improvement of quality of life (QoL; SF-36 score, p > 0.05). The expected mean cost of the experimental group was 1144.34 yuan, and the effective rates were 57.9% for NDI and 72.9% for VAS of pain. The expected mean cost of the control group was 767.41 yuan, and the effective rates were 33.3% for NDI and 51.6% for VAS of pain. For the primary indicators (VAS of pain and NDI), the incremental cost-effectiveness ratio was 17.69 and 15.32, respectively. The WTP per efficacy for pain resolution of patients was 19.10 yuan. Setting the WTP as threshold, Jingshu Granules were found to be a cost-effectiveness strategy, and sensitivity analysis showed that the effective rates and inspection fees of both groups had a greater impact on the results of both groups. Conclusions: Jingshu Granules were shown to be effective for treating patients with cervical radiculopathy. This treatment was found to be cost-effective when considering VAS of pain and NDI as clinical outcome indicators compared to no treatment (placebo). A clinical study with longer duration or real world study is needed to determine the impact on QoL of patients in the future.

One-Stage Sequential Bilateral Total Knee Arthroplasty: An Effective Treatment for Advanced Bilateral Knee Osteoarthritis Providing High Patient Satisfaction

BackgroundThe mortality and risks of bilateral total knee arthroplasty (BTKA) have been reported to be far greater than in unilateral total knee arthroplasty (UTKA). This study aimed to determine whether this remains the case using contemporary anesthetic and surgical techniques for one-stage single anesthetic sequential BTKA. MethodsTwo cohorts of 394 patients were created by propensity matching for gender, age, body mass index, American Society of Anesthesiologists grade, and Veterans Rand-12 health survey scores. Primary outcome was morbidity and mortality, with satisfaction measures using patient-reported outcome measures. ResultsThe mortality rate was low with one case after BTKA. Major complications were also low; however, a pulmonary embolism rate of 2% in BTKA patients was significantly higher than 0.3% after UTKA (P < .05), and associated with an American Society of Anesthesiologists grade ≥3. The rate of minor complications between the 2 cohorts was comparable (P = .95). Blood transfusions were uncommon and not significantly different between cohorts (2.5% vs 1.3%, P = .3). BTKA patients stayed in hospital a mean 1.3 days longer with greater rehabilitation requirements. At final follow-up, patient satisfaction was high with all patient-reported outcome measures significantly improved and comparable between cohorts. ConclusionBTKA is safe and effective in the majority of patients. Transfusion rates were far lower than historically reported and major complications were rare after both UTKA and BTKA. A significant increase in the rate of pulmonary embolism after BTKA was observed, especially in high risk patients. At minimum 1-year postoperatively, cohorts had the same significant clinical improvement and high level of satisfaction.

Short-Term Outcomes for the Biologic Treatment of Bone Marrow Edema of the Knee Using Bone Marrow Aspirate Concentrate and Injectable Demineralized Bone Matrix

PurposeTo evaluate short-term outcomes for the biologic treatment of bone marrow edema (BME) of the knee using bone marrow aspirate concentrate (BMAC) and injectable demineralized bone matrix (iDBM).MethodsWe performed a review of prospectively collected data from patients who underwent treatment for bone marrow lesions (BMLs) of the knee using BMAC and iDBM (IntraOsseous BioPlasty; Arthrex, Naples, FL) between May 2017 and December 2018. Inclusion criteria included patients aged 18 to 65 years with the presence of BME on T2-weighted magnetic resonance imaging in the subchondral weightbearing region of the tibia or femoral condyle, with pain corresponding to the same compartment. The International Knee Documentation Committee (IKDC), pain visual analog scale (VAS), and 12-Item Short Form Health Survey (SF-12) scores were used to evaluate clinical outcomes.ResultsWe evaluated 20 patients who were treated at a single academic medical institution over a mean 14.5-month follow-up (median, 14 months; range, 6-25 months). The average patient age was 51.7 years (range 38-62 years). Compared with preoperative values, the visual analog scale decreased from 7.0 to 1.3 (P = .008). The mean International Knee Documentation Committee scores improved from 29.2 to 66.1 (P = .063). Both the Physical and Mental Component Scores of the 12-Item Short Form Health Survey also showed improvement (Physical Component Score, P = .438; Mental Component Score, P = .563). Based on postoperative magnetic resonance imaging, 75% (3 of 4) of the BMLs demonstrated complete healing. The survival rate was 93% at 1-year follow-up.ConclusionBiologic treatment of BME of the knee using BMAC and iDBM is an effective adjunct to arthroscopy that provides short-term pain relief for BMLs associated with degenerative conditions of the knee. This procedure is associated with clinically significant improvements in knee pain and function at a short-term follow-up.Level of EvidenceLevel IV, therapeutic case series.

Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road.

Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4-L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

Patients with Chronic Musculoskeletal Pain of 3-6-Month Duration Already Have Low Levels of Health-Related Quality of Life and Physical Activity.

To determine the level of physical activity and health-related quality of life in patients with chronic musculoskeletal pain of 3-6-month duration who have not been diagnosed or treated before. Low levels of quality of life and physical activity have been reported for patients with musculoskeletal pain with a duration of longer than 6months. This study assessed the levels of quality of life and physical activity at the beginning stage of chronic musculuskeletal pain. Prospective cross-sectional study carried out at a musculoskeletal and sports medicine clinic. Eighty-five consecutive patients with muskuloskeletal (i.e., spine, peripheral joint, muscle, tendon) pain of 3-6-month duration, not diagnosed before, age 14 and older, and from either gender were recruited. Short Form-36 Health Survey and International Physical Activity Questionnaire long were administered during assessments. Scores on subscales of Short Form-36 Health Survey and total scores of International Physical Activity Questionnaire were used as outcome measures. A total of 85 patients with an age range of 15-86 (51.22 ± 15.99) were enrolled. There were 23 male (27.06%) and 62 (72.94%) female subjects. Forty-six (54.11%) patients had three or less painful regions; 39 (45.88%) had more than three painful regions. Majority of the patients had low scores on both Short Form-36 Health Survey subscales and International Physical Activity Questionnaire. Forty-nine patients had low, 32 patients had moderate, and 4 patients had high level of physical activity. Overall, females had lower level of physical activity in all age groups. All patients had less than optimal scores on all subscales of Physical Health and Mental Health scales of the Short Form-36. The female patients had lower scores in role physical and bodily pain subscales of physical health. Patients with musculoskeletal pain duration of 3-6months have low levels of physical activity and health-related quality of life at the time of their first evaluation.

Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors.

BACKGROUNDThe treatment of heart failure not only needs to relieve the clinical symptoms and improve the quality of life for patients but also needs to select scientific and reasonable ways to prevent or delay the progression of the disease, thus reducing the mortality and hospitalization rate. Although the previous regimen can effectively relieve symptoms in the early stage of treatment, long-term use may cause adverse events, such as arrhythmia, and even increase mortality. Therefore, conventional treatment cannot meet the actual health needs of patients, and scientific nursing intervention is very necessary.AIMTo investigate the application of self-care based on full-course individualized health education (FCIHE) and its influencing factors in patients with chronic heart failure (CHF).METHODSWe enrolled CHF patients who were admitted to our center between September 2015 and June 2016 and divided them into an intervention group (n = 50) and control group (n = 50) using a random number table. Routine nursing care was applied to the control group, and FCIHE was offered to the intervention group. The self-care behavior, 6-min walking distance (6MWD), and 36-item short form health survey (SF-36) scores were compared between the two groups. The influencing factors of the self-care were also analyzed.RESULTSThe 6MWD was not significantly different between the two groups at admission (P > 0.05); however, at 3 and 6 mo after discharge, 6MWD was significantly increased, and it was significantly longer in the intervention group (P < 0.05). The scores for self-care behavior showed no significant difference at admission between the two groups (P > 0.05); however, at 3 and 6 mo after discharge, the total scores for self-care maintenance, management, confidence, and behavior of the intervention group were significantly higher than those of the control group (P < 0.05). There were no significant differences in the SF-36 scores at admission (P > 0.05); however, at 3 mo and 6 mo after discharge, the scores for all eight subscales, including physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health, were significantly higher in the intervention group (P < 0.05). As shown by logistic regression analysis, the influencing factors of self-care mainly included age, cardiac function class, and education background (odds ratio > 1; all P < 0.05).CONCLUSIONFCIHE improved self-care behavior and cardiac function in CHF patients. Age, cardiac function, and education level affected the implementation of self-care among CHF patients.

A prospective randomised controlled trial of operative versus non-operative management of fractures of the humeral diaphysis: the HUmeral Shaft Fracture FIXation (HU-FIX) Study\xa0protocol

BackgroundHumeral shaft fractures constitute around 1% of adult fractures in the UK, with an annual incidence of approximately 13 per 100,000 population. Historically, these injuries have been primarily managed non-operatively, with operative fixation reserved for specific indications. Although some recent retrospective studies have suggested there are potential benefits of operative fixation over humeral bracing, there is a deficiency in level 1 evidence to support operative management as the primary treatment for humeral shaft fractures.Methods/designThis single-centre prospective randomised controlled trial aims to recruit 70 adult patients with an isolated closed fracture of the humeral diaphysis into one of two treatment arms: operative (n = 35) or non-operative (n = 35). The operative arm will undergo open reduction and internal fixation (ORIF) of the fracture using a standard fixation technique (plate and screws). The non-operative arm will be fitted with a prefabricated humeral brace until fracture union. All patients will be followed up for 1 year post-intervention. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH) score at 3 months post-intervention. Secondary outcome measures will include pain, treatment complications, return to work or sporting activities, shoulder and elbow range of motion, radiographic assessment, EuroQol (EQ-5D) Health Outcome score and 12-item Short Form (SF-12) Health Survey score. A health economic analysis will be performed to compare the cost implications of each treatment strategy.DiscussionThis randomised controlled trial will provide level 1 evidence comparing a standard ORIF technique against functional bracing for isolated closed humeral shaft fractures. The investigators hope that the study results will assist surgeons in their decision-making when managing patients with these injuries.Trial registrationClinicalTrials.gov, NCT03689335. Registered on 28 September 2018 (retrospectively).

Routine fixation of displaced midshaft clavicle fractures is not cost-effective: a cost analysis from a randomized controlled trial.

The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) versus early plate fixation (n = 86) of displaced midshaft clavicular fractures. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). The Six-Dimension Short-Form Health Survey (SF-6D) score was used as the preference-based health index to calculate the cost per QALY at 12 months after the injury. The mean 12-month SF-6D was 0.9522 (95% confidence interval (CI) 0.9355 to 0.9689) following conservative management and 0.9607 (95% CI 0.9447 to 0.9767) following fixation, giving an advantage for fixation of 0.0085, which was not statistically significant (p = 0.46). The mean cost per patient was £1322.69 for conservative management and £5405.32 for early fixation. This gave an ICER of £480 309.41 per QALY. For a threshold of £20 000 per QALY, the benefit of fixation would need to be present for 24 years to be cost-effective compared with conservative treatment. Linear regression analysis identified nonunion as the only factor to adversely influence the SF-6D at 12 months (p < 0.001). Routine plate fixation of displaced midshaft clavicular fractures is not cost-effective. Nonunion following conservative management has an increased morbidity with comparable expense to early fixation. This may suggest that a targeted approach of fixation in patients who are at higher risk of nonunion would be more cost-effective than the routine fixation of all displaced fractures. Cite this article: Bone Joint J 2019;101-B:995-1001.

Efficacy and Safety of Acupuncture for Chronic Discogenic Sciatica, a Randomized Controlled Sham Acupuncture Trial.

To evaluate the efficacy and safety of acupuncture for discogenic sciatica. Single-center, parallel, randomized controlled sham acupuncture trial. Twelve sessions of acupuncture or sham acupuncture at the same traditional acupoints over four weeks. The primary outcome was change from baseline in weekly mean leg pain, measured by the visual analog scale (VAS) over the four-week treatment period. The secondary outcomes were determined by the change from baseline in mean VAS scores for leg pain, VAS scores for low back pain, Oswestry Disability Index (ODI) scores, and 36-Item Short Form Health Survey (SF-36) scores. Patients were followed for 28 weeks. Forty-six patients were enrolled in this study between June 2017 and January 2018, of which 23 were in the acupuncture group and 23 were in the sham acupuncture group. The between-group difference in weekly mean leg pain measured by the VAS over the four-week treatment period was -7.28 mm (95% confidence interval = -13.76 to -0.80, P = 0.029), which is larger than the minimum clinically important difference of 5 mm. The between-group differences in mean VAS scores for low back pain, ODI scores, and SF-36 scores were not significant in the study period (P > 0.05 for all). The proportion of acupuncture-related adverse events was 4.3%, and all adverse events were mild and transient. Twelve sessions of acupuncture showed short-term clinical benefits in relieving the symptoms of leg pain for patients with chronic discogenic sciatica compared with sham acupuncture. Acupuncture is safe in treating chronic discogenic sciatica. Further studies with larger sample sizes, a longer treatment period, and long-term follow-up should be conducted to verify these results.

“Tube in tube” interlaminar endoscopic decompression for the treatment of lumbar spinal stenosis

To describe the Tube in Tube interlaminar endoscopic decompression method and investigate its efficacy and safety in treating lumbar spinal stenosis (LSS).Utilizing the advantages of the micro-endoscopic decompression (MED) operation channel tube, we used a water-medium spinal endoscopy to perform trans-interlaminar canal decompression, that is, the “Tube in Tube” technique. A retrospective study was performed on 35 patients with LSS who were treated with the Tube in Tube technique. All patients were followed up to 12 months postoperatively. Visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were collected preoperatively and at 3, 6, and 12 months postoperatively. Short-form (36) health survey (SF-36) score was used to examine the general health-related quality of life (HRQoL) of patients preoperatively and at 3 and 12 months postoperatively. Modified Macnab criteria were used to examine the clinical outcomes at 3 and 12 months post-surgery.The clinical outcomes were satisfactory, with an improvement in all scoring systems. The VAS, JOA, and ODI scores improved from 6.46 ± 1.85, 12.03 ± 4.96, and 42.17 ± 12.22 preoperatively to 2.20 ± 1.14, 21.40 ± 5.86, and 13.14 ± 7.52 at 12 months postoperatively, respectively (P < .001). The Macnab excellent or good rates reached 65.7% and 77.1% at the 3 and 12 months follow-ups. No severe complications occurred.The Tube in Tube technique had a positive clinical outcome in LSS patients and is safe, reliable, and efficacious. However, a larger number of cases and a multi-center research design will be needed further develop the technique.Level of Evidence: IV.

Quantification of Cognitive Dysfunction in Dizzy Patients Using the Neuropsychological Vertigo Inventory.

Currently available patient reported outcomes questionnaires for dizzy patients give limited insight into the cognitive dysfunction patients often report. Using the newly developed English version of the neuropsychological vertigo inventory (NVI), we aimed to quantify the cognitive impairment of dizzy patients. Prospective cohort study. Tertiary neurotology clinic. Adults with vestibular diagnoses seen between June 2018 and October 2018. Patients with neurologic disorders affecting cognition were excluded. None. NVI score. Secondary measures: dizziness handicap inventory (DHI) score, cognitive failure questionnaire (CFQ) score, 20-item short form health survey scores (SF20). Of 67 subjects, 13 had BPPV, 11 had Menière's disease (MD), and 20 had vestibular migraine (VM). VM patients were significantly younger (43.5 versus 61.1 yrs, p = 0.016), and had significantly higher NVI (67.5 versus 51.0, p = 0.040) scores than BPPV patients. MD patients had significantly higher CFQ scores (44.8 versus 23.4, p = 0.015) than BPPV patients. NVI scores were similar between MD (67.3) and VM (67.5) patients (p = 1.000). DHI scores were similar for all patients (p = 0.102). NVI scores were highly correlated to CFQ scores (r = 0.864, p < 0.001). VM patients have levels of cognitive dysfunction similar to MD patients, but greater than BPPV patients. A lack of difference in DHI scores among these patients reflects its limitation in assessing the cognitive domain.

Kidney donor outcomes ≥ 50 years after donation

Many living kidney donors (LDs) are young at donation; yet there are little data on long-term LD follow-up. We report on 66 LDs who donated ≥50years ago: 22 (33.3%) are still alive (current age, 78.5±7.25years); 39 (59%) died (mean age at death, 74.2±12.3years); and 5 are lost to follow-up (mean age at last contact, 68.7±4.6years). Those who died were older at donation (P<.001). Causes of death included 12 (30.8% of deaths) cardiovascular diseases, 9 (23.0%) respiratory failures, 5 (12.8%) malignancies and 4 (10.3%) infections, and 9 (23%) were unknown or miscellaneous. Forty-nine living donors (74%) developed hypertension at a mean age of 59.9±14.0years; 12 (18%) developed diabetes at a mean age of 62±19.4years; and 11 (16.7%) developed proteinuria at a mean age of 60.6±18.2years-each at a similar incidence as seen in the age-matched general population. At last follow-up, the eGFR by CKD-EPI (mean±SD) for donors currently alive was 60.2±13.4mL/min/1.73m2 ; for those that died, 54.0±21.5mL/min/1.73m2 ; for those lost to follow-up, 55.6±7.5mL/min/1.73m2 . ESRD developed in 2 (3.3%). SF-36 quality of life health survey scores (n=21) weresimilar to the age-matched general population.

Internal carotid artery occlusion may affect long-term quality of life in patients with high-flow carotid cavernous fistulas

To investigate the mid- and long-term effects of parent artery occlusion on the carotid cavernous fistula and on the quality of life of patients. One hundred and twenty-six patients with high-flow direct carotid cavernous fistulas were enrolled. The modified Rankin scale scores, the headache impact test and the short form health survey scores were used to evaluate the patients' clinical status. Fifty-two patients had parent artery occlusion, while the rest of the 74 patients had embolization of carotid cavernous fistulas with parent artery preservation. No periprocedural complications occurred. Eighteen patients in the parent artery occlusion group had low perfusion symptoms within two weeks following embolization, and three patients had Horner's syndrome on the ipsilateral side. At two months' follow-up, the patients with parent artery occlusion had a significantly (P < 0.05) greater proportion of headache than patients with parent artery preservation. At 12 months, no significant (P > 0.05) difference existed in the headache impact test scores in both groups. At 36 months' follow-up, the patients with parent artery occlusion had decreased SF-30 scores in all the eight health domains compared with patients treated with parent artery preservation, with a significant (P < 0.05) lower score in general health, vitality and bodily pain in the parent artery occlusion compared with the parent artery preservation group. No recurrence was shown in patients with parent artery occlusion, but nine (12.2%) patients were recurrent in patients with parent artery preservation. Parent artery occlusion may affect the quality of life of patients with carotid cavernous fistulas despite being an effective treatment option for high-flow direct fistulas.

Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study

ObjectiveTo compare quality of life (QoL), anxiety and depressive symptoms, alcohol consumption and other correlates between patients with psoriasis and controls; and to identify features of psoriasis associated with lower levels of QoL. MethodCase-control study including 70 subjects with moderate-severe psoriasis and 140 controls without psoriasis. All participants answered the Short Form Health Survey (SF-36), with physical and mental component scores of quality of life, and the Hospital Anxiety and Depression Scale (HADS). Among subjects with psoriasis, the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were used, respectively, to measure the severity of psoriasis and the impact of psoriasis on the specific quality of life. ResultsCompared to controls, patients with psoriasis showed higher HADS depression score and alcohol consumption, and lower QoL. Among subjects with psoriasis, multivariate analysis showed: 1) poorer physical QoL was associated with older age, articular lesions and anxious symptoms, whereas poorer mental QoL was associated with younger age, female sex, genital lesions and depressive symptoms; 2) the higher the severity of psoriasis, the lower the level of QoL and the higher the levels of anxious or depressive symptoms; and 3) female sex and articular or genital location of lesions are linked with higher HADS scores. ConclusionHigher scores in anxiety and depression and lower QoL is common in psoriasis, especially among women and those with genital or articular lesions. Dermatologists should give special attention to this subgroup of persons with psoriasis in order to prevent future psychopathology.

Acupuncture and moxibustion for the elderly patients with depression: A randomized controlled trial

ObjectiveTo identify the effects of acupuncture and moxibustion therapy by soothing liver and regulating mind on the quality of life among the elders with depression. MethodsThis was a single-blind, randomized, controlled trial of 75 elders with depression conducted in Guangdong Province, China, in January to December 2010. Eligible patients were randomly divided into three treatment groups. 22 patients received acupuncture and moxibustion treatment of soothing liver and regulating mind [group A, in acupuncture procedure: Hégǔ (合谷 LI4), Tàichōng (太冲 LR3), Bǎihuì (百会 GV20) and Yìntáng (印堂 GV29) were selected, in moxibustion procedure, bilateral Géshū(膈俞 BL17) and Dǎnshū (胆俞 BL19) were selected, the moxibustion cones was placed on the acupoints, five cones were given to each point. In intradermal needling procedure, Xīnshū(心俞 BL15), and Gānshū (肝俞 BL18) were selected]. 28 patients received acupoint shallow puncturing treatment (group B, patients received the same acupoints as in the group A, with a 2–3 mm needling depth and no needle sensation was required. A shorter duration of moxibustion and only 1–2 mm of needle body was inserted into the points when intradermal needling). 25 patients received non-acupoint shallow puncturing treatment (group C, patients received non-acupoint shallow puncturing at points 10 mm lateral to LI4 and LR3, 10 mm left side of GV20 and GV29 in acupuncture procedure; 10 mm lateral to BL17 and BL19 in moxibustion procedure; 10 mm lateral to BL15 and BL18 in intradermal needling procedure, with the same manipulation method as that in the group B). In all three groups, the treatment was given twice a week for 12 weeks. The Short Form (36) Health Survey(SF36) and TCM Symptom Scale Score as clinical efficacy and quality of life were used to quantitatively assess patients' outcomes before and after treatment. ResultsThe TCM Symptom Scale scores showed significant differences between the group A and C, and between group B and C (both P < 0.05), while there was no significant difference between group A and B (P > 0.05). An item-by-item analysis of the SF36 showed the elders in group A obtained the highest scores at each time point after treatment (all P < 0.05). Among the results, mental health and report health transition items showed no significant differences between the group A and group B at time point of after treatment (all P > 0.05). Vitality and social functioning items at a month after treatment time point, social functioning and report health transition items at 3 months after treatment time point, role emotional item at after treatment time point showed no significant differences between the group B and group C (all P > 0.05). ConclusionsThe therapeutic effect of acupuncture and moxibustion by soothing liver and regulating mind can obviously improve the quality of life of depression elders.

Comparison of Clinical Outcomes in the Treatment of Patellofemoral Chondral Defects: Autologous Chondrocyte Implantation versus Fresh Osteochondral Allografts

Objectives: The complex environment and the extreme stresses of the patellofemoral joint make chondral defects a challenge to treat. Autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) have been reported as case series in the patellofemoral joint with mixed results. This study compared the clinical outcomes for ACI and OCA treatments for patellofemoral chondral defects at our institution. Methods: We reviewed all consecutive patients undergoing ACI and OCA at a single institution for the treatment of isolated patellofemoral cartilage defects. Treatment type was based on surgeon preference. Medical records were examined for patient demographic, lesion specific data, complications, re-operations and failures (graft delamination requiring surgery, revision cartilage repair or conversion to arthroplasty). Clinical outcomes included International Knee Documentation Committee (IKDC) and Short Form 12 health survey (SF-12) scores. Mean follow up was 5.2 years (range, 3.1-7.5 years). Results: There were 30 patients: 19 in the ACI group and 11 in the OCA group with a mean age of 33 (15-48) and 25.5 (16-55) respectively (p=0.12). Etiology in the ACI group was 63%(n=12) patellar instability, 21%(n=4) post-traumatic osteoarthritis, 10%(n=2) primary osteoarthritis and 5%(n=1) osteochondritis dissecans, whereas it was more evenly distributed in the OCA group (27%, 27%, 19% and 27% respectively). Lesions in the ACI group were either Fulkerson type III (84% (n=16), medial patellar facet) or type IV (16%(n=3), pan-patellar). In the OCA group, lesions varied between type 1 (9%(n=1)), type II (27%(n=3)), type III (9%(n=1)) and type IV (54%(n=6)). The mean lesion size was similar between the two groups (OCA 3.1 cm2 ±1.1 vs. ACI 3.4 cm2 ±2.4, p=0.7) with more bipolar lesions in the OCA group (45%(n=5) vs.11%(n=2), p=0.038). Failures (requiring revision or replacement surgery), were significantly more common in OCA at 36% (n=4) compared to 5.3% (n=1) in ACI patients (p=0.04), one of which was bipolar in the former group. Re-operation was performed in 27%(n=3) OCA patients (each for adhesiolysis) and in 21%(n=4) ACI patients (2 manipulation under anesthesia, 1 adhesiolysis and 1 graft debridement for overgrowth) (p=0.3). There were no significant differences between the OCA and ACI groups in IKDC (60.7 vs. 74, p=0.08) and SF-12 scores (43.5 vs 43.7, p=0.43). Conclusion: Compared to ACI, OCA had significantly more failures for patellofemoral chondral defects at short to mid-term follow-up. This may relate to differences in the etiology and lesion locations between the two groups. Despite these findings, both groups had similar complication rates and functional outcome scores.

Effects of totally extraperitoneal and lichtenstein hernia repair on men's sexual function and quality of life.

In the literature, there have been scant studies that compare the effects of totally extraperitoneal (TEP) and Lichtenstein hernia (LH) repairs on men's sexual function and quality of life. Our aim in this study was to study the sexual function of men after TEP and LH repair according to SF 36 (Health Survey Scoring Demonstration) and IIEF (The International Index of Erectile Function). A total of 176 men with unilateral inguinal hernia were randomized into two groups. Group T (n = 88) received TEP hernia repair, and Group L (n:88) received LH repair. Patients' demographics and perioperative findings were recorded. For all patients, the preoperative as well as postoperative 7th, 30th and 90th day SF 36 and IIEF were recorded. A total of 176 operations consisting of 88 TEP and 88 LH repairs were evaluated. There were no differences in demographics, hernia type, and complications except for body mass index (BMI). The operative time was higher in Group T (29.6 ± 5.8 vs. 43.5 ± 5.7min; p = 0.001). The averages of the SF 36-Vitality and Social Function for Postoperative (PO) 30thday scores were higher in Group T. The averages of the SF 36-Bodily Pain, General Health, Physical Role, Emotional Role for PO 7-30thdays SF36- Mental Health for PO 7th day and SF 36 Physical Function for PO 30-90thdays scores were statistically higher in Group T. The averages of the IIEF- Erectile Function for PO 30thday, IIEF- Orgasmic Function, Sexual Desire, Intercourse Satisfaction, and Intercourse Satisfaction for PO 7th and 30th days scores were higher in Group T. TEP and LH repairs have similar results for recurrence, complications, and hospital stay; otherwise, TEP repair yields better results than the LH repair in the postoperative course at the 7th and 30th day evaluation, concerning sexual function and quality of life, but this benefit is no longer apparent at the 90th day. Although the short-term differences were statistically significant, they were moderate and might have a limited impact from the clinical point of view.

The HINTEGRA total ankle arthroplasty

The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated. There were significant improvements in all functional outcome categories between the preoperative and final follow-up assessments (p < 0.001). Patients showed marked improvement in clinical outcomes in terms of pain, function, and quality of life. The overall implant survivorship was 91.7% at a mean follow-up of 6.4 years. In all, 33 major complications were identified with a 15.7% rate, resulting in 12 prosthesis failures (5.7%). Periprosthetic osteolysis (19 cases; 9.0%) was the most frequent complication. Mobile-bearing TAA resulted in improved functional outcomes, a low major complication rate, and excellent implant survivorship at a mean follow-up of 6.4 years. Cite this article: Bone Joint J 2019;101-B:695-701.

Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients.

Study Design:Retrospective case series.Objectives:Both the rate and complexity of spine surgeries in elderly patients has increased. This study reports the outcomes of multilevel spine fusion in elderly patients and provides evidence on the appropriateness of complex surgery in elderly patients.Methods:We identified 101 patients older than70 years who had ≥5 levels of fusion. Demographic, medical, and surgical data, and change between preoperative and >500 days postoperative health survey scores were collected. Health surveys were visual analogue scale (VAS), EuroQoL 5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-30), and Short Form health survey (SF-12) (physical composite score [PCS] and mental composite score [MCS]). Minimal clinically important differences (MCIDs) were defined for each survey.Results:Complications included dural tears (19%), intensive care unit admission (48%), revision surgery within 2 to 5 years (24%), and death within 2 to 5 years (16%). The percentage of patients who reported an improvement in health-related quality of life (HRQOL) of at least an MCID was: VAS Back 69%; EQ-5D 41%; ODI 58%; SRS-30 45%; SF-12 PCS 44%; and SF-12 MCS 48%. Improvement after a primary surgery, as compared with a revision, was on average 13 points higher in ODI (P = .007). Patients who developed a surgical complication averaged an improvement 11 points lower on ODI (P = .042). Patients were more likely to find improvement in their health if they had a lower American Society of Anesthesiologists or Charlson Comorbidity Index score or a higher metabolic equivalent score.Conclusions:In multilevel surgery in patients older than 70 years, complications are common, and on average 77% of patients attain some improvement, with 51% reaching an MCID. Physiological status is a stronger predictor of outcomes than chronological age.