Improvement In Visual Analog Scale Scores Research Articles

Association Between Opioid Use and Patient-Reported Outcomes in a Randomized Trial Evaluating Basivertebral Nerve Ablation for the Relief of Chronic Low Back Pain

Chronic low back pain (CLBP) is a primary indication for opioid therapy. To evaluate the hypothesis that CLBP patients reporting reduced opioid use have superior functional outcomes following basivertebral nerve (BVN) radiofrequency ablation. This post hoc analysis from a sham-controlled trial examined short-acting opioid use from baseline through 1 yr. Opioid use was stratified into 3 groups by two blinded external reviewers. Two-sample t-tests were used to compare Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) measurements between those patients who increased or decreased their opioid usage compared to baseline. Actively treated patients with decreased opioid use at 12 mo had a mean ODI improvement of 24.9±16.0 (n=27) compared to 7.3±9.8 (n=18) for patients reporting increased opioid use (P<.001). In the sham arm, the improvements in ODI were 17.4±16.1 (n=19) and 1.2±14.3 (n=5; P=.053) for the patients reporting decreased vs increased opioid usage, respectively. Actively treated patients reporting decreased opioid use had a mean improvement in VAS of 3.3±2.5 (n=27) compared to 0.6±1.8 (n=18) for patients reporting increased opioid use (P<.001). In the sham arm, the improvements in VAS were 2.5±2.6 (n=19) and 1.4±1.9 (n=5; P=.374) for patients reporting decreased vs increased opioid use, respectively. Subjects undergoing BVN ablation who decreased opioid use had greater improvement in ODI and VAS scores compared with those reporting increased opioid usage. There is an association between functional benefit from BVN ablation and reduced opioid use.

Effect of time to first ambulation on recurrence after PELD

Study designRetrospective cohort study.ObjectiveTo evaluate the effect of time to first ambulation on recurrence after percutaneous endoscopic lumbar discectomy (PELD).MethodsFrom July 2017 to August 2018, 90 patients with lumbar intervertebral disc herniation underwent PELD surgery. According to the initial walking time, i.e., the time until the patient could walk after the operation, the operations were divided into three groups: early stage, middle stage, and late stage. The follow-up period was 3 months, and complete follow-up data were obtained. The visual analog scale (VAS) and Oswestry disability index (ODI) scores before the operation, at first ambulation, 1 month after the operation, and 3 months after the operation and the recurrence and incidence rates of high magnetic resonance imaging (MRI) signal in the vertebral endplate area were recorded after the operation.ResultsThe success rate was 100% for these 90 cases. The VAS and ODI scores at the first ambulation after the operation significantly improved compared with those before the operation, and the difference was statistically significant. The improvements in the lumbar VAS and ODI scores of the middle- and late-stage groups were better than that of the early-stage group at 1 and 3 months after the operation, and the differences were statistically significant; however, there was no significant difference between the middle- and late-stage groups. The postoperative recurrence rate and rate of high MRI signal in the vertebral endplate area were significantly higher in the early-stage group than in the other two groups, and the difference was statistically significant.ConclusionThe time to first ambulation after PELD is an important factor affecting the curative effect of the operation. Early ambulation may be one of the factors affecting recurrence after PELD.

Total Temporomandibular Joint Replacement: Stick to Stock or Optimization by Customization?

This article aims to compare the difference in postoperative results in patients treated with either a patient-specific (PSI) or a stock temporomandibular total joint replacement system. The investigators performed a systematic review concerning postoperative results after placement of either a stock total joint replacement system or a PSI. PubMed Central, Web of Science, Cochrane Library Plus, Wiley Online Library, and EMBASE were used to conduct this search. All articles up to August 15, 2018, were scrutinized. All included articles were nonrandomized cohort studies. Maximal mouth opening (MMO) and Visual Analog Scale (VAS) scores for pain and diet before and after surgery were evaluated. The Methodological Index for NonRandomized Studies scale was used for quality assessment. Weighted mean difference was calculated and pooled by meta-analysis using random-effect models. The search identified 1581 articles, of which 15 were included. The average risk of bias was low. Both systems achieved significant increases in MMO and decreased VAS pain scores at 1, 2, and 3 years after surgery. No significant difference was found between the system types. Both achieved significant improvements in dietary VAS scores, with a more significant improvement for stock implants. Due to the lack of detailed diagnostic evaluation tools allowing proper start-point categorization, there is a significant risk for selection bias in the pooled data. The PSI is more frequently chosen for cases with more significant joint degeneration, skewing postoperative results. A patient-fitted implant can provide significant operative and patient-centered advantages over a stock implant, which will likely be confirmed when observational cohort studies have included indications like the ones for stock prostheses. Furthermore, while current US Food and Drug Administration-approved stock implants contain cobalt -chromium -molybdenum, the newly manufactured PSI are made of titanium alloy, diminishing the risks of morbidity and implant failure.

Midterm outcomes of arthroscopic rotator cuff repair in patients aged 75 years and older

Full-thickness rotator cuff tears remain a significant cause of pain and dysfunction in the elderly. Substantial improvement in pain and functional outcomes with arthroscopic cuff repair is possible. Recent data has shown that patients older than 70-75 years still have clinical improvement with operative rotator cuff repair. This is a retrospective study of patients aged ≥75 years undergoing arthroscopic rotator cuff repair at a minimum of 24 months after surgery. Outcome measurements included range of motion (ROM), visual analog scale (VAS) pain scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, Single Assessment Numeric Evaluation (SANE) scores, and Short Form Health Survey (SF-12) scores. Reoperation and rates of conversion to reverse shoulder arthroplasty (RSA) were determined. Eighty-three patients were included with an average follow-up of 56.9 ± 25.9 months (range 24-127 months). Six (7.2%) patients had additional surgery, including 3 revision rotator cuff repairs for retear, 2 conversion to RSA, and 1 capsular release and loose anchor removal. There were statistically significant improvements in shoulder ROM, ASES, SANE, VAS, and SF-12 scores postoperatively. Rotator cuff repair in select patients aged ≥75 yearsresults in reliable improvements in pain and function. There was a low reoperation rate or conversion to RSA (7.2%) at midterm follow-up. This study indicates a role for rotator cuff repair in an elderly population and argues against the routine use of reverse arthroplasty for repairable rotator cuff tears in this population.

Effects of Short Wave Diathermy Added on Dextrose Prolotherapy Injections in Osteoarthritis of the Knee.

Objective: To show the effects of short wave diathermy (SWD) added on prolotherapy injections in osteoarthritis (OA) of the knee on pain, physical functioning, and quality of life. Design: This is a single-blinded randomized controlled study. Setting: Physical Medicine and Rehabilitation Department of a university hospital. Subjects: Sixty-three patients with OA of the knee with Kellgren-Lawrence class 2 or 3 were included in the study. Methods: Patients were randomized into two groups, first being dextrose prolotherapy+SWD and the second being dextrose prolotherapy with sham SWD. Patients were injected with dextrose prolotherapy solutions in the beginning, third, and sixth week of the study, for a total of three times, and took 20 min of SWD after injection (true or sham). Outcome measures: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, and Short Form Health Survey (SF-36) were applied before, after (sixth week), and at the third month of treatment. Results: Both groups showed improvements in VAS, WOMAC, and SF-36 scores (p < 0.05). Between-group analyses showed no significant differences (p > 0.05). Conclusions: This study shows that prolotherapy is effective for pain, functionality, and quality of life in patients with OA of the knee. The effects of additional SWD require more evidence. More studies of higher quality are required to make a statement.

Human umbilical cord blood-derived mesenchymal stem cell implantation for osteoarthritis of the knee.

This study aimed to investigate the clinical outcomes after human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) implantation for medial compartment (MC) osteoarthritis of the knee. Inclusion criteria were patients older than 60years, with a kissing lesion of the MC, a full-thickness chondral defect ≥ 4cm2 of the medial femoral condyle (MFC), and a varus deformity ≥ 3° on a long cassette scanogram. The mean age was 64.9 ± 4.4years and the mean chondral defect of the MFC was 7.2 ± 1.9cm2. A mixture of sodium hyaluronate and hUCB-MSC was implanted into the chondral defect and a high tibial osteotomy was performed in all patients. International Knee Documentation Committee (IKDC), visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and 1year and 2years postoperatively. Cartilage regeneration was evaluated in 14 (56%) patients by second-look arthroscopy at 1year postoperatively. Twenty-five patients underwent hUBC-MSC implantation. IKDC, VAS, and WOMAC scores at 1year and 2years improved significantly compared to preoperative scores. These scores at 1year and 2years were not significantly different between the body mass index (BMI) < 25 group and BMI ≥ 25 group. However, the < 65-year-old group showed superior IKDC scores at 1year and 2years and VAS score at 2years than the ≥ 65-year-old group. Younger age and larger size of the chondral defect were associated with a significantly greater improvement in IKDC, VAS and WOMAC scores at 2years. Second-look arthroscopy demonstrated International Cartilage Repair Society-Cartilage Repair Assessment grade I in six (42.9%) patients and grade II in eight (57.1%). hUCB-MSC implantation regenerated cartilage satisfactorily and showed satisfactory clinical outcomes in patients older than 60years who had MC osteoarthritis.

Minimally invasive spinal fusion and decompression for thoracolumbar spondylodiscitis.

Objective:The objective was to study the results of the treatment of thoracolumbar spondylodiscitis (SD) through minimally invasive fusion and decompression technique.Materials and Methods:All the patients were evaluated clinically and radiologically (X-ray, magnetic resonance imaging, and computed tomography scan) along with necessary laboratory investigations. They underwent the minimally invasive spinal (MIS) decompression and fusion procedure using tubular retractor system and percutaneous transpedicular fixation done under fluoroscopy guidance. They were assessed using pre- and postoperative Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Kirkaldy-Willis functional outcome criteria. Postoperative radiological assessment of fusion was done. Operating time and fluoroscopy duration were also studied.Results:There were a total of 12 patients, with an equal sex ratio of 1:1 with 8 and 4 patients having the involvement of the lumbar and dorsal spine, respectively. The fixation was done in the involved vertebrae in 8 patients and adjacent normal vertebrae in 4 patients. There was an improvement in VAS score from 7.8 to 2.1 and ODI from 64.3 to 16.4. 4 patients had excellent, 7 had good, and 1 had fair outcome in Kirkaldy-Willis functional outcome criteria. There was Grade 2 and 3 fusion in 4 cases each, and 2 patients had Grade 4 fusion. The laboratory studies were found positive for tuberculosis in 3 cases with 7 having necrotizing granulomatous inflammation, and 2 patients had negative results.Conclusion:The MIS procedure is a safe and effective method of the management of SD in the thoracolumbar spine.

Proximal fibular osteotomy: Alternative approach with medial compartment osteoarthritis knee - Indian context.

Context:Osteoarthritis knee is a common degenerative disorder for which various treatment modalities are available. Our aim was to evaluate the functional outcome and effectiveness of proximal fibular osteotomy (PFO) in patients who are unwilling to undergo total knee arthroplasty or high tibial osteotomy (HTO).Aims:To evaluate functional outcome of medial compartment osteoarthritis managed with PFO, clinically as well as radiologically in Indian study settings.Settings and Design:Study was done at the Department of Joint Replacement and Orthopedics, Tata Main Hospital, Interventional prospective cohort study.Subjects and Methods:Consecutive samples fulfilling study criteria were evaluated preoperatively with visual analogue scale (VAS) and preoperative functional status was assessed. The functional outcome was measured by pre- and postoperative VAS, Tegner Lysholm Knee score; X rays were used to measure pre- and postoperative “Medial joint space” and “Femoro-tibial angle (FTA).”Statistical Analysis:All the data were tabulated, and then analyzed with appropriate statistical tools “MedCalc. Chi-square test, test of significance and student paired and unpaired T-test were used.Results:There was a significant improvement in VAS score, Tegner Lysholm score postoperatively as compared to the pre-perative scores. FTA and medial joint space were also increased postoperatively.Conclusions:PFO is a good surgical alternative for medial compartmental osteoarthritis of the knee with an excellent functional outcome. A simple surgical procedure, non-requirement of specialized instruments, and low cost of surgery are some of the advantages for patients who do not want to undergo HTO or total knee replacement (TKR).

Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: Surgery versus conservative treatment.

This study aims to compare clinical and radiographic outcomes of surgical treatment and conservative treatment with bracing in neurologically intact patients with score 4 of TLICS thoracolumbar vertebra fractures. Patients with traumatic thoracolumbar junction fractures (T11-L2), the score of TLICS 4, and minimum 24-month follow-up were included in this study. Patients were divided into surgery and bracing groups. The groups were compared concerning clinical and demographical features, local kyphotic angles (LKA), vertebra height loss percentage (VHL), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and time to return to work. There were 74 patients (71 males, 3 females) in the surgery group and 76 patients (58 males, 18 females) in the bracing group. Although the surgery group showed better improvement in VAS scores within six months postoperatively, no significant difference was observed at the 24th-month evaluation (p<0.001 and p=0.270, respectively). ODI, LKA and VHL were significantly lower in the surgery group (p<0.001, p<0.001 and p<0.001, respectively). In addition, return to work was significantly earlier in the surgery group (p<0.001). The findings obtained in this study suggest that the surgical treatment for TLICS 4 patients with thoracolumbar fractures has better clinical and radiographic outcomes than the bracing. Moreover, returning time to the work of patients is shortened with surgical treatment. The surgical treatment seems to be the first and the appropriate choice in the management of TLICS 4 thoracolumbar vertebral fractures.

The effect of distal fusion level on functional and radiographic parameters following long posterior instrumentation and fusion

To investigate the effect of distal fusion level on radiographic parameters and functional outcome in patients with degenerative spine disease who undergo long posterior fusion with instrumentation. This study included 78 adult patients aged > 60 years who underwent long posterior fusion ( > 6 levels) for spinal deformity with a minimum 2-year follow-up. The patients were divided into two groups based on distal fusion level (L5 group and iliac group). Spinopelvic parameters, including lumbar lordosis (LL) and sagittal vertical axis (SVA), were evaluated. Functional outcome was evaluated with the pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire. Correlations between clinical and radiographic parameters were calculated statistically. In the L5 group, the mean SVA and LL significantly improved after surgery (p=0.025 and 0.008, respectively). Similarly, the SVA and LL also improved significantly in the iliac group (p=0.002 and 0.001, respectively). In both groups, lumbar VAS, leg VAS and ODI scores significantly improved (p < 0.001). The change in ODI score was significantly greater in the iliac group than the L5 group (p=0.013). Although patients did not achieve the desired optimal spinal saggital balance, both L5 and iliac groups showed significant improvement in VAS and ODI scores. The iliac group showed slightly better improvement in ODI score.

How effective is cryotherapy applied to the nail fold in ingrown toenails?

There are only two publications in Pubmed on the effectiveness of cryotherapy in ingrown toenails, and they present conflicting results. We aimed to clarify the clinical effectiveness of cryotherapy in onychocryptosis. This study retrospectively examined the visual analogue scale (VAS), dermatological life quality index (DLQI), other medical records, and photographs taken before each cryotherapy session and 6-month follow-up in 59 adult patients with ingrown toenails that underwent cryotherapy with a 3-week interval. Cryotherapy effectiveness was assessed by the clinicians' decisions, improvements in VAS and DLQI scores, and granulation tissue. Other factors related to effectiveness and recurrence were also investigated. After excluding approximately 20% of patients, for whom the treatment was not effective, this study revealed that recurrence rates in unilateral and bilateral onychocryptosis were 34.2% and 88.9%, respectively, 6 months after treatment. In patients that responded to the treatment, about 75 to 80% had excellent symptomatic responses. Excellent symptomatic responses were maintained in about 80% of patients in remission. We found that foot or toe deformity was associated with treatment ineffectiveness (p = 0.019). Age younger than 20 years and bilateral ingrown toenails were also related to recurrence (p = 0.042 and 0.003, respectively). Cryotherapy can be used to greatly and consistently improve the DLQI in suitable ingrown toenails.

Effect of upper back brace with auditory feedback for forward head rounded shoulder posture among office workers with chronic neck pain – A pre-post single group study

Background: Forward head and rounded shoulder posture (FHRSP) is a poor habitual neck posture among office workers. The posture results in muscle tension and pain around the neck and shoulders and nerve root symptoms in the upper extremities. Objectives: The aim of this study was to investigate the effect of upper back brace with auditory feedback on posture among office workers with neck pain and forward head posture. Study Design: The study design involves prospective, experimental, pre–post single group. Methods: The office workers (males and females aged 25–60 years) were screened on shoulder girdle flexibility test (fingertips > 2 inches [5 cm] apart). Ten subjects (out of 50 screened subjects) meeting the eligibility criteria were selected for the study. The subjects wore the upper back brace with auditory feedback for 6 h in a day (minimum 30 min in continuation) for 2 weeks. Pre- and post-assessments of the neck disability index (NDI), visual analog scale (VAS), craniovertebral angle (CVA), and scapular index (SI) were carried out at the baseline and after 2 weeks, respectively. Results: Postintervention, significant reduction was found in NDI score (P < 0.05, 95% confidence interval (CI) of mean difference (CI): 2.33–8.72 and VAS score (P < 0.05, 95% CI: 0.70–2.89) and significant improvement was found in CVA score (P < 0.05, 95% CI: 0.60–6.59) and SI score (P < 0.05, 95% CI: 0.70–10.01). Conclusion: The results indicate that the upper back brace with auditory feedback improves the FHRSP and reduces neck pain and related disability among office workers.

Comparison of intra articular autologous platelet-rich plasma with steroids in osteoarthritis knee: Experience from a North Indian tertiary care center

Background: Intra-articular (IA) platelet-rich plasma (PRP) is a promising treatment option for knee osteoarthritis (OA). It accelerates the process of healing, ligament repair, cartilage regeneration, and bone formation when given in supraphysiological doses. The aim of this study was to compare the efficacy of IA PRP versus IA methylprednisolone acetate (MPA) in patients with knee OA. Methods: Open labeled prospective observational study was conducted on 60 patients with Kellgren-Lawrence Grade 2 and 3 OA knee, who fulfilled the ACR classification criteria for knee OA. Thirty patients were given IA PRP (6 ml) and 30 received IA methyl prednisolone (80 mg) at baseline line, which was repeated at 12 weeks. The primary endpoint was an improvement in Western Ontario and McMaster Universities Index (WOMAC) and 100 mm Visual Analog Scale (VAS) pain at 24 weeks postinjections. Results: The mean change in VAS pain and total WOMAC score from baseline to 24 weeks was 32.9 ± 12.1, 31.8 ± 14.7 for PRP group, and 12.9 ± 5.9, 7.5 ± 5.5 for MPA group, which was statistically significant (P Conclusions: Treatment with IA PRP showed sustained improvements in WOMAC and VAS scores compared to IA steroids. PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis.

Functional outcome of intraarticular platelet rich plasma in early osteoarthritis of knee joint: A prospective study

Aims: The effectiveness of Platelet rich plasma (PRP) is still controversial in osteoarthritis. We investigated the effect of PRP injection in patients with knee osteoarthritis based on improving function and decreasing pain. Our aim and objective is to assess the functional outcome of PRP in patients with early osteoarthritis, Kellgren-Lawrence Grade-1, 2 and to evaluate PRP as a treatment option for early osteoarthritis of knee joint. Materials and Methods: This is a prospective study included 50 cases of osteoarthritis of knee of either sex fitting inclusion criteria which was conducted between November 2017 to June 2019. Patients underwent detailed history, clinical and radiological evaluation on first visit and were later followed up for a minimum period of 6 months. Autologous PRP extract prepared in Haematalogy lab and Intraarticular injections injected at 3 weeks interval at 3 sittings each. The outcome was assessed using International Knee Documentation Committee (IKDC) and Visual Analogue Scale (VAS) scores recorded prior to injections and at 2 and 6 months after the injection course. Results: The mean age in our study is 52.48.The mean IKDC score increased from baseline of 38.63 to 59.68 at 6 month follow up, which is statistically significant (p value < 0.0001). The mean VAS score increased from 7.20 to 3.72 which is statistically significant (p value = 0.0001). After 2 month of follow up, there was significant improvement of VAS and IKDC score. The VAS and IKDC score showed improvement in all four age groups. Minor complications were reported. Conclusion: Autologous PRP injections based on current evidence have effective pain reduction than other preparations with additional significant functional improvement in early osteoarthritis. More large studies with longer follow up are needed to confirm these early results and to test PRP injection as a part of management in osteoarthritis of knee.

Posterior Fixation Combined with Vertebroplasty or Vertebral Column Resection for the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft Complicated by Neurological Deficits.

Purpose The aim of the current study was to evaluate the relative benefits of posterior fixation combined with vertebroplasty (PFVP) or vertebral column resection (PVCR) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) complicated by neurological deficits. Methods From June 2010 to January 2015, 45 consecutive patients suffering OVCFs with IVC and spinal cord injuries were treated with PFVP or PVCR in our department. The visual analogue scale (VAS) score, anterior vertebral height (AVH), posterior vertebral height (PVH), local kyphotic angle (LKA), and neurologic function were evaluated and compared, and the operative duration, blood loss, and complications were also recorded. Results They all achieved excellent pain relief, vertebral height recovery, and kyphosis correction one month after surgery, and no significant differences existed between the two groups. No significant differences were observed between the 1-month postoperative and final follow-up VAS, AVH, and LKA values in the PVCR group (P > 0.05), while AVH and LKA worsened in the PFVP group at the final follow-up (P < 0.05). Similarly, the initial improvements in VAS scores decreased over time (P < 0.05). Neurologic function improved in both groups, and no significant differences were observed between the 2 groups either preoperatively or postoperatively (P > 0.05). The blood loss and operative duration were significantly lower in the PFVP group than those in the PVCR group (P < 0.05). Conclusion Compared with PVCR, PFVP had equivalent short-term clinical outcomes with less blood loss and operative duration which can be very beneficial for treating elderly patients with extreme comorbidities in this condition. However, based on the long-term efficacy of pain relief, vertebral height maintenance, and deformity correction, PVCR is a more reasonable choice.

Outcomes of reverse shoulder arthroplasty using a short stem through a superolateral approach

Reverse shoulder arthroplasties have progressed in recent decades to become the most popular type of arthroplasty. Short stems with metaphyseal fixation have been developed to preserve bone stock and facilitate possible revision. Accurate positioning of these implants can be challenging using the superolateral approach. This study aimed to evaluate the clinical and radiologic results of reverse short-stem arthroplasties using a superolateral approach with a minimum of 2 years' follow-up. Between January 2015 and December 2016, a total of 76 patients underwent reverse shoulder arthroplasty surgery (79 shoulders) using a short uncemented humeral stem for shoulder arthritis with irreparable rotator cuff tear. Arthroplasties for post-traumatic osteoarthritis were excluded. Functional outcomes were assessed using Constant Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and range of motion. Radiographic analysis was used to evaluate component loosening, implant position, and implant filling ratio. The mean age was 70.8 years. At a mean of 38.8-monthfollow-up, there were significant improvements in Constant score (44.2 to 87.9, P < .001), ASES score (36.2 to 84.3, P < .001), and VAS score (6.8 to 0.4, P < .001). Forward flexion improved from 89°to 131°(P < .001), and external rotation improved from 25° to 36°(P < .001). No evidence of periprosthetic loosening was visible. Mean varus of the humeral stem was 1°(±6°). The mean glenoidal inclination was 98°(±7°), which corresponds to a lower tilt of 8°. The average filling ratio was between 50% and 60% in both the metaphysis and the diaphysis. The clinical results obtained in this study were satisfying, with a significantly low complication rate. Hence, short-stem reverse shoulder arthroplasty using a superolateral approach, while taking particular care to protect the deltoid, remains our method of choice.

Efficacy of a Quail Eggs-Based Dietary Supplement for Allergic Rhinitis: Results of a Single-Arm Trial

Previous data suggested the potential treatment effect of a proprietary quail eggs-based blend on allergic rhinitis (AR) symptoms, induced by allergen challenge. We herein aimed to investigate the efficacy and safety of a similar dietary supplement, comprising the bioactive ingredients of quail eggs and the zinc mineral, in the setting of active AR. Adult patients (n = 77), aged 18- 60 years, with mild, intermittent AR were enrolled in this single-arm, open-label trial. Patients’ responses were assessed based on peak nasal inspiratory flow (PNIF) measurements at two visits (Day 1/Visit 1 and Day 7/Visit 2) and self-rating of AR-associated symptoms on a Visual Analog Scale (VAS) throughout the entire 7-day study period. PNIF values at 15, 30, 60, 90 and 120 min (Visit 1) following administration of an oral dose of the study product were the primary efficacy endpoint. PNIF values (Visit 1) gradually increased from baseline (pre-treatment), with statistical significance first reached 30 min later (p = 0.002). VAS scores (Visit 1) for all AR symptoms gradually decreased with statistical significance first reached at 15 min (rhinorrhea, p = 0.042; itchy nose, p = 0.001; sneezing p < 0.001), 30 min (nasal congestion, p < 0.001; itchy eyes, p = 0.003) or 60 min (watery eyes, p = 0.04). PNIF improvement and decline of VAS scores were significantly more apparent at Visit one vs. Visit 2. Treatment-emergent adverse events were limited to cough and muscle strain (one patient each). Our results support the efficacy, rapid mode of action and tolerability of the investigated product for symptomatic treatment of mild intermittent AR.

Hydraulic Distension with Pumping Technique for Treating Frozen Shoulder: A CaseControlled, Retrospective, Comparative Study with 6-Month Follow-Up

Background: We have applied a new method called “the pumping technique” to the capsulepreserving hydraulic distension for frozen shoulder. With this technique, the stretching effect can be directly applied to the joint capsule of the affected shoulder. Objectives: We attempted to evaluate the effect of capsule-preserving hydraulic distension using the pumping technique by comparing capsule-preserving hydraulic distension without it. Study Design: A case-controlled, retrospective, comparative study. Setting: Outpatient clinic of department of rehabilitation medicine in a single university hospital. Methods: Patients (n = 47) with frozen shoulder who were treated with hydraulic distension were assigned into the pumping group (n = 24) and the nonpumping group (n = 23). Range of motion (ROM), Shoulder Pain and Disability Index (SPADI), and Visual Analog Scale (VAS) scores were assessed. Results: Significant improvement of VAS, ROM, and SPADI scores was observed after the second injection in each group (P &lt; 0.05). There were significant differences in total passive ROM, abduction, and flexion after the fifth injection between the 2 groups (P &lt; 0.05). There was a significant difference in the disability domain of SPADI after the second injection between the 2 groups (P &lt; 0.05). However, there was no significant interaction between time and group with respect to VAS scores. There were no serious complications after procedures. Limitations: This was a retrospective study. There might be some limitations in gathering comprehensive records of outcome measurements. In addition, because the objective of this study was to determine the effect of the new pumping technique, included patients range was very narrow. This study only included patients who were treated 5 times with capsule-preserving hydraulic distensions with or without the pumping technique. Conclusions: Although the effect on pain was excellent in both groups, the superiority of the new pumping technique was demonstrated by reduction of SPADI disability subscale score and improvement of ROM of the shoulder compared with the nonpumping technique.

Clinical effectiveness of ultrasound guided subacromial-subdeltoid bursa injection of botulinum toxin type A in hemiplegic shoulder pain: A retrospective cohort study.

Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, causes considerable distress and worsens outcomes in rehabilitation. Although they have received the treatments such as anti-inflammatory drugs or physical therapy, many of the individuals remain suffering from shoulder pain 6 months after acute stroke event. In this retrospective study, we evaluated the effectiveness of ultrasound guided subacromial-subdeltoid (SASD) bursa injections with botulinum toxin type A (BoNT/A) compared to steroids for refractory HSP.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. In total, 38 patients who received ultrasound guided SASD bursa injection (BoNT/A group, n = 18; corticosteroid group, n = 20) were included. The pain visual analog scale (VAS) score at rest and during arm passive abduction, Fugl-Meyer score of upper limbs (F-M score) were evaluated before, 2, 4, 8, and 12 weeks after injection.Both 2 groups obtained a significant improvement of VAS score at rest or during arms passive abduction compared to baseline score (within group compare, P < .05). There were no significant differences of pain score improvement between two groups at week 2, 4, 8, and 12 after injection either at rest or during passive arm abduction (between 2 groups compare, P > .05). There were also no differences in results of the post treatment F-M score between 2 groups (between 2 groups compare, P > .05). Similarly, during the follow-up period no collateral effects were reported after BoNT/A injection.SASD bursa BoNT/A injection can substantially reduce the pain as corticosteroid in patients with HSP. BoNT/A injection could be a useful strategy for replacing steroids as a treatment for refractory HSP especially in the patients who cannot tolerate the steroids injection.

Long-term clinical outcome of two revision strategies for failed total disc replacements

PurposeTo compare the long-term clinical results and complications of two revision strategies for patients with failed total disc replacements (TDRs).MethodsIn 19 patients, the TDR was removed and the intervertebral defect was filled with a femoral head bone strut graft. In addition, instrumented posterolateral fusion was performed (removal group). In 36 patients, only a posterolateral instrumented fusion was performed (fusion group). Visual Analogue Scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed.ResultsThe median follow-up was 12.3 years (range 5.3–24.3). In both the removal and fusion groups, a similar (p = 0.515 and p = 0419, respectively) but significant decrease in VAS (p = 0.001 and p = 0.001, respectively) and ODI score (p = 0.033 and p = 0.013, respectively) at post-revision surgery compared to pre-revision surgery was seen. A clinically relevant improvement in VAS and ODI score was found in 62.5% and 43.8% in the removal group and in 43.5% and 39.1% in the fusion group (p = 0.242 and p = 0.773, respectively). Removal of the TDR was associated with substantial intra-operative complications such as major vessel bleeding and ureter lesion. The percentage of late re-operations for complications such as pseudarthrosis were comparable for both revision strategies.ConclusionsRevision of a failed TDR is clinically beneficial in about half of the patients. No clear benefits for additional TDR removal as compared to posterolateral instrumented fusion alone could be identified. In particular, when considering the substantial risks and complications, great caution is warranted with removal of the TDR.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.