Long-term Effective Research Articles

Mechanical wrist traction as a non-invasive treatment for carpal tunnel syndrome: a randomized controlled trial

BackgroundCarpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain. Carpal tunnel release surgery is the only known long-term effective treatment. However, surgery is invasive and up to 30% of patients report recurrence or persistence of symptoms or suffer from post-surgical complications. A promising non-surgical treatment for CTS is mechanical wrist traction. The purpose of this study was to evaluate clinical outcomes following mechanical traction in patients with CTS compared to care as usual.MethodsAdult patients (N = 181, mean age 58.1 (13.0) years, 67% women) with electrodiagnostically confirmed CTS were recruited from an outpatient neurology clinic in the Netherlands between October 2013 and April 2015. After baseline assessments, patients were randomized to either the intervention group (12 treatments with mechanical traction, twice a week for a period of 6 weeks) or “care as usual”. The main clinical outcome measure was surgery during 6 months’ follow-up. In addition, symptom severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline, 3, and 6 months’ follow-up. Baseline characteristics and severity of CTS symptoms at follow-up were compared between the intervention and care-as-usual groups using a t test and χ2 tests. Time to event (surgery) between the groups was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards analysis.ResultsThe intervention group had fewer surgeries (28%) compared to the care-as-usual group (43%) during follow-up (χ21 = 4.40, p = .036). Analyses of the survival curves revealed a statistically significant difference between the groups over time (log-rank test χ21 = 6.94, p = .008). At 6 months’ follow-up, symptom severity and functional status scores had significantly decreased from baseline in both groups (p < .001) and the improvements did not differ between the two groups.ConclusionsMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months’ follow-up was similar in both groups. The long-term effects of mechanical traction require further evaluation.Trial registrationClinicalTrials.gov, ID: NL44692.008.13. Registered on 19 September 2013.

Clinical research of mild and moderate lumbar disc herniation of blood stagnation syndrome treated with qi-conducting needling technique at the governor vessel acupoints combined with electroacupuncture

To compare the difference in the clinical therapeutic effects on mild and moderate lumbar disc herniation (LDH) of blood stagnation syndrome between qi-conducting needling technique at the governor vessel acupoints combined with electroacupuncture (EA) and conventional EA. Two hundred and one patients of LDH at the mild and moderate stage, differentiated as blood stagnation syndrome were randomized into an observation group (101 cases) and a control group (100 cases). In the observation group, the qi-conducting needling technique at the governor vessel acupoints and EA were used. The acupoints were Yaoyangguan (GV 3), Shiqizhui (EX-B 8), Huantiao (GB 30) and Yanglingquan (GB 34). After qi arrival, the qi-conducting needling technique was used at Yaoyangguan (GV 3) and Shiqizhui (EX-B 8); the EA was at Huantiao (GB 30) and Yanglingquan (GB 34). The treatment was given once every two days, 3 times a week. The treatment for 12 times was as one session. The observation lasted for 1 session. In the control group, the acupoints were the same as the observation group and stimulated with EA. The EA parameters, treatment frequency and duration were all the same as the observation group. The lumbar back pain score of Japanese Orthopedics Association (JOA) score before treatment, after treatment and in 3-month follow-up visit in the two groups, the infrared thermogram temperature in lumbar region and the relaxation area under curve (RAUC) before and after treatment as well as the short-term and the long-term therapeutic effects were compared between the two groups. The total short-term effective rate was 89.11% (90/101) and the total long-term effective rate was 91.11% (82/90) in the observation group, and those were 86.00% (86/100) and 89.53% (77/86) in the control group respectively, without significant differences between the groups (both P>0.05). The short-term clinical curative rate was 52.48% (53/101) and the long-term clinical curative rate was 55.56% (50/90) in the observation group, better than 36.00% (36/100) and 34.88% (30/86) in the control group (both P<0.05). Compared with those before treatment, JOA scores were all improved after treatment and in follow-up visit in the two groups (all P<0.01), without statistical significance at each time point between the two groups (all P>0.05). The infrared thermogram temperature was improved after treatment in the two groups (both P<0.01). The increasing amplitude in the observation group was higher than that in the control group (P<0.01). The lumbar RAUC after treatment was increased apparently as compared with that before treatment in the observation group (P<0.01) and larger than that in the control group (P<0.01). The qi-conducting needling technique at the governor vessel acupoints combined with EA achieve the better clinical therapeutic effects than regular EA in the treatment of mild and moderate LDH of blood stagnation sydrome.

Long-Term Efficacy of Infliximab for Treatment of Severe Behcet’s Uveitis

Introduction: Behcet’s uveitis is a serious sight-threatening condition that may lead to blindness if not appropriately managed. The aim of the present study is to evaluate long-term effectiveness of infliximab in resistant Behcet’s uveitis. Methods: Medical records of 32 patients (56 eyes) were retrospectively analysed. Primary outcomes included ocular inflammatory activity, frequency of uveitis attacks and steroidsparing effect. Results: Mean follow-up was 33,2 months while mean age of patients at disease onset was 33,3 years. Ocular inflammation was bilateral in 75% of cases and consisted in panuveitis in 46,4 % of affected eyes. All patients received intravenous infusions of infliximab (5mg/kg) at weeks 0, 2, 4, 6 and every 6-8 weeks thereafter. Clinical remission was observed in 26 out 32 patients (81,2%). Mean number of uveitis attacks decreased from 2,56 to 0,65 during infliximab therapy (p<0.001) while systemic corticosteroids were tapered in 17 patients and suspended in 10 (31,2%). Conclusions: Our study suggested that infliximab is long-term effective in resistant Behcet uveitis, improving visual prognosis and stabilising clinical course of disease in a large cohort of patients with various pattern of BD including neuro-behcet forms.

Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-Year follow-up of a randomized trial

Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment.We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34–1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time.

The use of botulinum toxin type A in masseteric muscle hypertrophy: Long-term effects and lasting improvement

In this study, we aimed to evaluate the long-term efficacy of botulinum toxin A injection in reducing the masseter muscle thickness. Between 2007 and June 2008, we retrospectively analyzed the data from 28 patients (21 females, 7 males; mean age: 25.5±4.5 years; range 20 to 46 years) with benign masseter hypertrophy treated with botulinum toxin A injections. All patients were diagnosed by the morphometric analysis of the masseter muscle. The injections were repeated intermittently every six months and totally for six times. The patients were recalled and the last measurement was performed at a mean follow-up of 13.2 months. The values obtained following consecutive injections were compared and a statistically significant reduction in thickness of masseter muscle thickness after every single injection was found (p<0.001). The final measurement following treatment discontinuation revealed that this reduction was long-lasting. Botulinum toxin A injection is a safe and long-term effective therapy for the masseter muscle hypertrophy.

Long-term effect on radiofrequency heat-coagulation endometrial ablation in the treatment of anovulatory dysfunctional uterine bleeding

To investigate long-term effect on radiofrequency heat-coagulation (RF) endometrial ablation in treatment of anovulatory dysfunctional uterine bleeding (DUB). From Jul. 2001 to Nov. 2009, 1196 patients with DUB who were failed by medical treatment (including 127 patients with dysmenorrheal) were enrolled into this study in Jinan Millitary General Hospital. Those patients were divided into two groups according to age: 427 patients at age of or more than 45 years (average age 48 years) in Group A who were treated by RF procedure for amenorrhea;769 patients at age of less than 45 years old (average 37 years) in group B were treated by RF for controlling excessive menstrual bleeding. All the patients had the results of menstrual score (pictorial blood loss assessment chart, PBAC), hemoglobin (Hb), endometrial curettage pathology and hysteroscopy examination immediately after RF procedure; Some patients still had another endometrial curettage pathology and clinical results in 6 months after RF. The mean follow-up time was 72 months (range: 6 to 100 months). The evaluation criterion for RF treatment was to use optimal and significant effect measurements. For group A, the optimal treatment effect (cure) was defined as bleeding cessation and achieving amenorrhea that continued for more than 12 months after treatment. For group B, the optimal treatment effect(cure) was also defined as bleeding cessation and resuming normal menstruation which continued for more than 12 months after treatment. Significant treatment effect was defined as irregular, minor bleeding, but PBAC score less than 100 within 12 months. If patient symptoms and PBAC scores did not change compared with those before treatment, the treatment was defined as failure. For dysmenorrhea, the optimal treatment effect was disappearance for more than 12 months, the significant treatment effect was remission, and treatment failure was not changed from the pre-treatment baseline. The effective rate was the sum of that of the optimal and significant effect. One hundred and twenty-five patients with DUB treated by agents at the same time were chosen as control group. (1) The recent and long-term effective rates for bleeding cessation by RF:the total recent effective rates within 1 months were 94.82% (1134/1196), including 96.5% (412/427) in group A and 93.9% (722/769) in group B. The total curative rates for dysmenorrheal were 82.7% (105/127), including 86.4% (38/44) in group A and 80.7% (67/83) in group B. Pathology examination after hysteroscopy immediately after RF showed a completely and whole destroyed endometrium in group A, and a little rested endometrium in group B. The long-term effect rates for bleeding cessation by RF after 12, 24 and 36 months were 92.55% (969/1047), 93.9% (866/922) and 93.7% (609/650), respectively. PBAC and Hb in group A and group B within 12, 24, 36 and more than 36 months were improved significantly (P < 0.05). (2) COMPLICATIONS: the major complication was irregular minor bleeding in 1 to 2 months after treatment, the rate was 8.03% (96/1196). The second one was menorrhea in 3 months after RF, the rate was 5.18% (62/1196). This condition was corrected by the second RF. No hysterectomy was performed on those patients. RF is the safe, efficient and minimal invasive procedure in treatment for DUB. The mechanism of keeping long-term curative effect and preventing recurrence is due to endometrium inactivation and fibrosis by thermocoagulation.

Long-Term Effect to Avoid Cerebral Embolism after Ablation of Atrial Fibrillation by the Use of Radiofrequency Hot Balloon Catheter

Background: Non-uniform heating of the tissue due to direct resistive heating by radiofrequency current under regional cooling was changed blood flow or irrigation, resulting in thrombus formation. To avoid non-uniform heating, we have developed a radiofrequency hot balloon catheter system (RFHBS). Methods and Results: We treated 446 patients with atrial fibrillation (AF) (paroxysmal AF (PAF), n=269; persistent AF (Per-AF), n=78; long persistent AF (Long-AF), n=99) by pulmonary vein (PV) antral isolation or box isolation using RFHBS and performed MRI of brains after procedure. There were no complications such as cardiac tamponade, cerebral embolism, atrio-esophageal fistula, symptomatic PV stenosis or phrenic palsy, associated with the ablation procedure. During 12 months follow up, no AF episodes were detected without anti-arrhythmic drugs in 346 patients (PAF, n=230 (86%); Per-AF, n=53 (68%); Long-AF, n=55 (56%)). During 3.6±1.2 years follow-up period, no AF episodes were detected without anti-arrhythmic drugs in 279 patients (PAF, n=188 (70%); Per-AF, n=43 (55%); Long-AF, n=48 (48%)). Conclusion: PV antral isolation or box isolation using a RFHBS could be performed without serious complication and long-term effective for the patients with AF.

Long-Term Immunovirogical Effect and Tolerability of a Maraviroc- Containing Regimen in Routine Clinical Practice

to analyze the long-term immunovirological effect and tolerability of a maraviroc-containing antiretroviral therapy in viraemic and pretreated HIV-infected patients with a high prevalence of hepatitis C virus (HCV) coinfection. forty-six R5 HIV-infected patients (48% HCV-coinfected) started a maraviroc-containing antiretroviral regimen, including patients with multidrug resistant virus and patients after first virologic failure. A retrospective study was performed, analysing percentage of patients with undetectable viral load, mean CD4+ gain, liver enzymes, clinical events and treatment modification up to week 48. Raltegravir plus a boosted protease inhibitor was combined with maraviroc in 65.2% of the patients (mainly patients with multidrug resistant virus), while the coformulation lamivudine/abacavir was combined with maraviroc in 26.1% (all of them patients after first virologic failure). After 48 weeks on maraviroc-containing regimen, 96.3% of the patients had achieved undetectability and a mean CD4+ count increase of 151 cells/mm3 was observed. Liver enzymes did not increase along the follow up. One patient died after 24 weeks follow up due to heroin overdose. One patient developed a non-Hodgkin lymphoma after 36 weeks follow up, despite undetectable viral load and significant CD4+ increase was achieved (the only AIDS-defining event observed). Treatment modification was performed in 19.6% of the patients: 77.7% of them experienced a treatment simplification and only 1/46 suspended maraviroc. maraviroc-containing regimen is long-term effective and well tolerated in HIV-infected patients in routine clinical practice and in different clinical scenarios.

Deep brain stimulation for hyperkinetics disorders: dystonia, tardive dyskinesia, and tics

This review focuses on new insights in deep brain stimulation (DBS) for patients with hyperkinetic movement disorders: dystonia, tardive dyskinesia and Gille de la Tourette's syndrome, during the last 18 months. The recent literature confirms the efficacy of high-frequency stimulation of the globus pallidus internus (GPi) for primary dystonia, generalized or not, with a stable effect over time. The benefit of DBS in other forms of localized dystonia remains to be demonstrated in larger studies. Some clinical and radiological predictive factors have been determined with a predominant influence of the disease duration. Tardive dystonia and myoclonus-dystonia are also improved by GPi stimulation. Encouraging results obtained in cerebral palsy may pave the way for the application of DBS in other secondary dystonia. In Gilles de la Tourette's syndrome, both stimulation of the centre-median/parafascicular nucleus of the thalamus and GPi stimulation (ventromedial) have demonstrated efficacy with stable long-term effect. Thalamic stimulation failed to improve obsessions and compulsions in some patients. Stimulation of the nucleus accumbens has been tested in few cases with contradictory efficacy. In both diseases, complications are rare with no major side effects. The few controlled studies showed that bilateral GPi stimulation is a well tolerated and a long-term effective treatment for hyperkinetic disorders. However, recent published data of DBS applied in different targets or patients (especially secondary dystonia) are mainly uncontrolled case reports, precluding the clear determination of the efficacy of this procedure and the choice of the 'good' target for the 'good' patient.

Comparative Study of Two Root Coverage Procedures: A 24‐Month Follow‐Up Multicenter Study

Treatment alternatives to cover exposed root surfaces include free grafts, pedicle flaps, and barrier membranes. This 24-month follow-up study clinically evaluated the long-term effect of a coronally advanced flap procedure with the additional use of enamel matrix derivative (EMD) to treat gingival recession versus the subpedicle connective tissue graft (CTG) procedure. Miller Class I or II buccal recession-type defects in the anterior teeth or premolars in 65 patients (28 in EMD and 37 in CTG groups) were treated in several centers. At baseline and 12 and 24 months post-treatment, vertical recession defect (VRD), height of keratinized tissue (HKT), and probing depth (PD) were recorded, and the percentage of root coverage (PRC) of the original defect was calculated. Student t test, analysis of variance, and analysis of covariance were used for statistical analyses. At 12- and 24-month evaluations, PRC was 73.2% (SD=15.58%) and 76.9% (SD=16.77%) in the EMD group and 86.8% (SD=12.48%) and 84.3% (SD=13.32%) in the CTG group, respectively (P<0.001). Differences between groups were statistically significant (P=0.002). Baseline HKT was 1.07 mm (SD=0.66 mm) in the EMD group and 1.65 mm (SD=0.92 mm) in the CTG group. At 12 and 24 months, values were 1.75 mm (SD=0.59 mm) and 2.25 mm (SD=0.52 mm) in the EMD group and 4.24 mm (SD=0.89 mm) and 4.05 mm (SD=0.94 mm) in the CTG group, respectively. Differences in HKT were statistically significant within (EMD: P<0.001; CTG: P=0.017) and between (P<0.001) groups. Both treatments proved clinically successful. CTG treatment showed a higher percentage of root coverage and HKT increase. EMD is a valuable, long-term effective treatment alternative to achieve root coverage together with an increase in HKT.

Sugar malabsorption in functional abdominal bloating: A pilot study on the long-term effect of dietary treatment

Functional abdominal bloating is a functional bowel disorder dominated by a feeling of abdominal fullness without sufficient criteria for another functional gastrointestinal disorder. Gas-related complaints (i.e., passage of flatus), which are present in a subgroup of these patients, might be associated with carbohydrate malabsorption. To evaluate the presence of lactose and/or fructose plus sorbitol malabsorption, and the long-term efficacy of malabsorbed sugar-free diets, in patients with Rome II criteria of functional abdominal bloating and gas-related symptoms. Thirty-six consecutive patients (age, 51+/-3.1 years; sex, 12 M, 24 W) with Rome II criteria of functional abdominal bloating and gas-related symptoms were included in a pilot study. In all cases, the presence of malabsorption of both lactose (20 g) and fructose plus sorbitol (20+3.5 g) was assessed by means of hydrogen breath test. Patients with sugar malabsorption were put on a malabsorbed sugar-free diet. Follow-up visits were scheduled at both 1 and 12 months after starting the diet. Global rating scales of change as compared to the beginning of the study were used to assess symptom changes. Twenty-six of 36 patients (72.2%) presented sugar malabsorption (six lactose, 12 fructose plus sorbitol, and eight both). Seventeen of the 26 (65%) patients with malabsorption had symptoms of sugar intolerance during the 3-h breath testing period. All 26 were put on malabsorbed sugar-free diets. Eighty-one per cent of patients referred clinical improvement at 1-month visit, which was maintained at 12 months in 67% of them (complete improvement in 50% and partial improvement in 16.7%). Sugar malabsorption and intolerance seem to be frequent in patients with functional abdominal bloating and gas-related complaints. A malabsorbed sugar-free diet might be a long-term effective therapy in a high percentage of patients. Further controlled clinical trials are warranted.

Is primary endoscopic puncture of ureterocele a long-term effective procedure?

Background/Purpose: For more than a decade, endoscopic puncture of ureterocele has been recommended as an initial and, in the majority of the patients, as a definitive procedure. This study evaluates the long-term effectiveness of primary endoscopic puncture of ureterocele. Methods: Over the last 18 years (1984 through 2001), 52 patients (median age 3 months) underwent primary endoscopic puncture of ureterocele. The median follow-up was 9 years (6 months to 18 years). Antenatal ultrasound scan detected hydronephrosis and led to the postnatal diagnosis of ureterocele in 12 (23%) children, whereas in the remaining 40 (77%) children the diagnosis was made on investigation for urinary tract infection (UTI). The ureterocele presented as a part of renal duplication in 48 (92%) patients and a single system in 4 (8%). Forty-four (92%) of the patients with duplication presented with non- or poorly functioning upper poles. Vesicoureteric reflux (VUR) was seen in the lower moiety of the ipsilateral kidney in 31 and in 18 of the contralateral kidney comprising 49 renal refluxing units (RRU). Results: Complete decompression of the ureterocele was achieved in 48 (92%) patients after the first endoscopic puncture. Four (8%) patients required a second puncture of ureterocele. Nine (17%) of the 52 patients underwent nephrectomy for a nonfunctioning kidney. Ten (19%) patients required upper pole partial nephrectomy owing to nonfunctioning upper pole. Twenty-nine (59%) of the 49 RRU showed spontaneous resolution of VUR. Sixteen (33%) RRU underwent endoscopic correction of VUR. One required ureteric reimplantation. The remaining 4 (8%) are maintained on prophylactic antibiotics. Five (10%) patients had VUR in the upper pole moieties after ureterocele puncture. Conclusions: Our data suggest that primary endoscopic puncture of ureteroceles is a simple, long-term, effective, and safe procedure avoiding complete reconstruction in the majority of the patients. J Pediatr Surg 38:116-119. Copyright 2003, Elsevier Science (USA). All rights reserved.

Clinical study on treatment of reinforcing kidney and activating blood circulation principle in treating chronic pyelonephritis

To study the effect and mechanism of the treatment for reinforcing Kidney and activating blood circulation (RKAB) in treating chronic pyelonephritis. Using RKAB combined with western drugs to treat 41 patients with chronic pyelonephritis and controlled with 30 patients treated with western drugs only. Changes of kidney morphology, renal function were observed, and the long-term efficacy of treatment was pursued. The short-term effective rate in the treated group and the control group was 90. 24% (37/41) and 86. 67% (26/30) respectively, with no significant difference between them (P>0. 05). The long-term effective rate in the two groups was 70.73% (29/41) and 30.00% (9/30) respectively with significant difference (P<0. 01). Moreover, the occurrence of morphological change of kidney and renal dysfunction in the treated group was later than that in the control group (P<0. 01). RKAB treatment could raise the long-term effect in treating chronic pyelonephritis, alleviate/ block the morphological change of kidney and retard the progressing of renal dysfunction.

NIMH collaborative multimodal treatment study of children with ADHD (MTA): Design, methodology, and protocol evolution

The steering committee of the collaborative six-site Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (the MTA) had to develop a common protocol consistent with public health goals and with scientific and clinical state of the art. With the aid of statistical, educational, and public health consultation, the steering committee balanced the stated objectives of the RFA against budgetary, clinical, ethical, and logistical practicalities. Two primary questions will be addressed: (1) What is the relative long-term effectiveness of excellent medication vs. excellent behavioral treatment vs. the combination? (2) What is the relative long-term effective ness of each of these state-of-the art intense treatments vs. routine community care? In a parallel-group design, 576 children (96 at each site) age 7-9 in grades 1-4 are thoroughly assessed in multiple domains from multiple informants and randomized to 4 treatment conditions: a medication-alone strategy, a psychosocial-treatment-alone strategy, a combination strategy, and community comparison (assessment and referral). The first three groups are treated for 14 months and all are re-assessed periodically for 24 months. Each treatment strategy is multi-component, with compromises between clinical flexibility and cross-site uniformity supported by a multi-tiered supervisory/fidelity structure, including 10 manuals, weekly teleconference panels, site visits, circuit-riding consultants, and feedback loops from therapists and supervisors to the steering committee about clinical realities. The resulting data should not only answer the primary questions above, but also support secondary data analyses about the effect of comorbidity, sex, SES, and other subject characteristics on treatment outcome. The MTA should both provide conclusions useful to the practicing clinician and define questions for the next generation of investigations.