Mean Visual Analog Scale Score Research Articles

Prospective observational study comparing the perioperative outcomes of laparoscopic colectomy with or without epidural anesthesia: the Kanagawa Yokohama Colorectal Cancer Study Group (KYCC) 1806.

There have been no adequate comparisons of the efficacy, safety, and efficiency of analgesia after laparoscopic colorectal resection (LAC), with and without epidural anesthesia (EDA). This was a multicenter prospective observational study of patients undergoing LAC. The primary end point was the mean visual analog scale (VAS) score on postoperative days (PODs) 1-7. The secondary end points were the highest VAS, complication rate, days to first ambulation and fatigue, length of hospital stay, and time to commencement of surgery. We compared an EDA group (Group E, n = 48) and a no-EDA group (Group O, n = 48) after matching. The mean VAS was not significantly different between the groups (28.7 vs. 30.1, p = 0.288). On assessing the secondary end points, the highest VAS was not significantly different between the groups. In fact, the VAS was lower in Group E only on POD 2. There was no difference in the incidence of complications, the time to first postoperative evacuation was shorter in Group E, and postoperative hospitalization was similar. The time to surgery was shorter in Group O. These results suggest that LAC without EDA is a feasible option, but with the early and regular use of adjunctive measures to provide more stable analgesia.

Analgesic Efficacy of Thoracolumbar Interfascial Plane Block versus Standard Care in Patients Undergoing Lumbar Spinal Surgeries—A Randomized Controlled Trial

Abstract Background Patients who undergo spine surgery often experience severe pain postoperatively. Multimodal analgesia inclusive of a regional block provides optimal pain relief. Thoracolumbar interfascial plane (TLIP) block may provide promising analgesia in these patients. Materials Fifty consenting adults aged between 18 and 60 years undergoing elective lumbar spinal surgeries under balanced general anesthesia were divided into two equal groups (group T: received bilateral TLIP block, and group C: received conventional opioid analgesia). All the patients were taken care of by an independent anesthesiologist unaware of the study protocol in the postanesthesia care unit. The postoperative pain was assessed by visual analog scale (VAS). Time to first rescue analgesia, total morphine consumption, complications, and patient satisfaction were also recorded. Results Postoperative mean VAS scores till 12 hours were significantly higher in the control group. The mean time to the first analgesic requirement among group T and group C patients was 404.4 ± 25.1 and 150.2 ± 12.4 minutes, respectively (p < 0.001). Morphine consumptions in 24 hours were also significantly higher in group C (3.36 ± 1.04 vs. 7.84 ± 1.43; p < 0.001). Mean intraoperative fentanyl consumption was significantly more in group C (122.4 ± 16.4 µg and 140.4 ± 21.7 µg; p = 0.001). Complications were similar in both groups. However, patient satisfaction was significantly higher in group T (p < 0.001). Conclusion TLIP block provided superior analgesia, decreased opioid consumption, and improved patient satisfaction as compared with patients receiving standard general anesthesia with opioid analgesics. Hence, TLIP block could be a component of multimodal analgesia in patients undergoing lumbar spine surgeries.CTRI No.: CTRI/2021/03/031682

Modified Suture Button Latarjet Procedure With Coracoacromial Ligament And Pectoralis Minor Preservation Achieves Good Clinical Outcomes at 2-Year Follow-up: Case Series of Latarjet Technique

To evaluate if the modified suture button Latarjet procedure with coracoacromial ligament (CAL) and pectoralis minor (PM) preservation could achieve excellent outcomes at the 2-year follow-up. During January 2019 to January 2021, data of patients who underwent the modified suture button Latarjet with CAL and PM preservation in our department was collected. The glenoid bone loss of these patients were above 20% or over 10% with high demands for exercise. Partial coracoid osteotomy was based on the results of the preoperative 3-dimensional computed tomography (3D CT) evaluation of the glenoid defect area (GDA) and corresponding coracoid process morphology. The preoperative and postoperative clinical results were assessed. The minimal clinically important difference (MCID) was utilized to compare improvement in clinical outcomes. Graft-glenoid union and remodeling were assessed using postoperative 3D CT, and magnetic resonance imaging (MRI) was performed to confirm the integrity of the CAL and PM postoperatively. 35 patients were included in this study; the mean follow-up time was 26.9 ± 1.9 months. No case of recurrent dislocation or sublaxity. Significant improvements were observed in mean visual analog scale (VAS) scores for pain during motion, American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and Walch-Duplay score (P < .001). The percentage of patients achieving at least an MCID improvement in clinical outcomes was: VAS 85.71%; ASES 97.14%; Rowe 100%; Walch-Duplay 97.14%. 33 patients (94.3% of all cases) were able to return to their preoperative sport levels, 34 grafts (97.1%) achieved bone union (1 soft union) in 6.3±2.2 months, and the coracoid grafts restored 97.1±4.0% of the perfect fitting circle (PFC) at the last follow-up. Postoperative CT scan showed that 31 grafts (88.6%) were placed ideally in vertical view. In the axial view, 25 grafts (82.9%) were flushed to the glenoid, whereas 1 and 5 grafts were fixed medially and laterally, respectively. The CAL and PM were visualized postoperatively. No arthropathy was observed in any patient at the last follow-up. The modified suture button Latarjet procedure with CAL and PM preservation obtained good clinical and radiological results without recurrence or complications. A substantial majority of patients (>85%) achieved the MCID for the VAS, ASES, ROWE, and Walch-Duplay scores. Additionally, the malpositioned graft (17.1%) did not cause arthropathy of the joints at 2-year follow-up.

Bedside critical care training: A quasi-experimental study in the paediatric emergency department of a referral hospital in Nigeria

Background. There is a need for critical care services outside intensive care units (ICUs), especially in emergency departments (EDs). However, there is a paucity of skilled manpower for ED critical care or emergency critical care (ECC) in resource-limited settings. Objective. To evaluate the impact of bedside training on emergency critical care practices of clinical staff. Methods. This was a quasi-experimental study using a pretest - post-test design in a paediatric ED. The intervention was a six-week structured bedside training on bubble continuous positive airway pressure (CPAP) high-flow nasal cannula (HFNC) and mechanical ventilation. Participants’ actual ECC practices pre and post training were evaluated, including their perceived proficiency on an uncalibrated 100 mm visual analogue scale (VAS). Descriptive and inferential analyses were done; p&lt;0.05 was considered significant. Results. A total of 35 clinical staff participated in the training, comprising 9 (24.3%) paediatric registrars, 12 (32.5%) senior registrars, 10 (27.0%) nurses, 4 (10.8%) house officers and 2 (5.4%) paediatric consultants. The male:female ratio of the participants was 1:1.6, and their mean (SD) age was 33.24 (6.30 years. Participants’ understanding of testing the CPAP circuit, connecting the patient and weaning significantly improved following training (p=0.004). Their capacity to select appropriate HFNC parameters improved (p=0.013). They performed more endotracheal intubations in the post-training period (p=0.001). Their pretest-post-test proficiency in mechanical ventilation increased on VAS (mean scores 45.26+31.99 v. 63.26+22.26; p=0.038). Also, there was a significant increase in their perceived proficiency in paediatric analgesia/sedation (30.83+29.86 v. 49.83+23.90; p=0.029). Conclusion. Short-term bedside critical care training enhanced the self-reported competency of paediatric ED staff. There is a need for on-the-job ECC training and retraining of clinical staff in our setting.

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study

BackgroundSelf-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass–ceramic veneers made by either pressing (PG) or milling (MG) process.MethodsFifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.ResultsA total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).ConclusionSZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Efficacy and safety of fractional micro-needling radiofrequency for the treatment of enlarged pores on the cheeks of a chinese cohort: a retrospective study.

To explore the efficacy and safety of fractional micro-needling radiofrequency (FMRF) in the treatment of enlarged pores on the cheek in a Chinese cohort. Patients with enlarged facial pores who underwent FMRF between January 2020 and December 2022 were included in this study. Blinded clinical assessments were performed by two independent dermatologists using a six-grade photographic enlarged pore scale and a quartile grading scale. Patients were asked to rate the degree of pain related to treatment on a visual analog scale (VAS), with scores ranging from 0 (no pain) to 10 (worst pain ever). A paired t-test was used to analyze the six-grade photographic enlarged pore scores. A total of 22 patients received three consecutive sessions of FMRF treatment, with intervals of 1-3 months, and underwent follow-up as scheduled. The mean six-grade photographic enlarged score was 3.55 ± 0.96 at baseline, while the score decreased significantly to 2.59 ± 0.59 after three treatment sessions (P < 0.05). The improvement score of the patients, assessed by two independent dermatologists, was 2.31 ± 0.71, according to the quartile grading scale. The mean VAS score was 6.42 ± 1.44. FMRF is effective and safe for the treatment of enlarged facial pores after three sessions.

A Comparative Study to Evaluate the Efficacy of Topical and Infiltrative Anesthesia for Dermatosurgery Through a Subject-Oriented Approach.

Introduction The skin, along with its subcutaneous tissue, constitutes one of the major organ systems of the human body. Dermatosurgery is the branch dealing with skin conditions that operate at the level of skin, without disturbing the milieu intérieur of the human organ system. Materials and methods A cross-sectional study was undertaken, which included 100 patients comprised of 50 patients in each group. For group A, the topical anesthetic agent used was a eutectic mixture of topical 2.5% lignocaine and 2.5% prilocaine cream (EMLA); for group B, infiltration anesthesia with 2% lignocaine injection. Patients satisfying the inclusion and exclusion criteria were recruited for the study. All the participants were requested to rate the pain at the time of drug administration, during the dermatosurgical procedure, and post-procedurally with a visual analogue scale (VAS) separately. Results In this study, 50% of the participants were of the age group of 21-40 years. Males constituted 57.8% whereas females constituted 42.2%. The common procedures performed in the study were electrocautery at 37%, intralesional platelet-rich plasma (PRP) at 16%, and intralesional steroid at 7%. In group A, the VAS score during drug administration was 0. In the group B, 70% had a VAS score of 4-6, and 30% had a VAS score of 1-3 pre-procedurally. The mean VAS score during procedure was 3.06 for group A and 1.03 for group B. Conclusion The study inferred that topical anesthesia is a better choice in superficial dermatosurgical procedures for providing adequate anesthesia and improved compliance when compared to infiltrative anesthesia.

Low back pain and kinesiophobia in pregnant women.

During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations. To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy. The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia. The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n= 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2, and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p= 0.49), gestational week (p= 0.75), and gravida (p= 0.81) were similar. BMI (p= 0.038) and ODI scores (p< 0.001) were higher in the group with LBP. LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend.

Surgical management of lower limb radiculopathy following acute singe-level osteoporotic vertebral fracture of lower lumbar spine in geriatric patient: a retrospective study

BackgroundRadiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision.MethodsWe retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated.ResultsFrom September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P < 0.05). The total satisfaction rate at the last follow-up was 90.9% per the Macnab criterion.ConclusionPatients with OVFs in the IEP are predisposed to suffer from radiculopathy of the lower limb. PKP alone or in combination with other minimally invasive surgical strategies is safe and effective in treating stable fractures. Additionally, aggressive surgical intervention should be considered in patients with unstable fractures or severe foraminal encroachment.

Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures

BackgroundTension band wiring and plate fixation are common internal fixation methods used for olecranon fractures, but complications and reoperations are common. The purpose of this study is to investigate the clinical outcomes of displaced olecranon fractures treated with olecranon sled internal fixation. MethodsThe data of 39 patients with olecranon fractures treated with olecranon sledin the Department of Traumatology of Beijing Jishuitan Hospital between May 2018 and April 2020 were retrospectively analyzed. There were 17 males and 22 females; the mean age was 44.0 ± 15.8 (range, 18–68 years). Preoperative olecranon fractures were classified according to the Mayo classification: 24 cases were type IIA and 15 cases were type IIB. Elbow range of motion (extension and flexion) and forearm rotation (protonation and supination) were observed at the last follow-up. The Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) scores were used to evaluate elbow function and pain, and complications were also recorded. ResultsThirty-nine patients were followed up for 33.6 ± 8.3 months (range, 25–51 months) after the operation. At the last follow-up, the mean flexion-extension arc was 137° ± 15° (range, 60°–160°), and the mean pronation-supination arc was 178° ± 4° (range, 160°–180°). The mean MEPS was 94.9 ± 9.9 (range, 50.0–100.0). The mean DASH score was 5.4 ± 4.3 (range, 0–18.3). The mean VAS score was 0.4 ± 0.8 (range, 0–3). Seven patients developed olecranon skin irritation, and 3 of them had the internal fixation device removed. Two patients developed heterotopic ossification, of whom 1 patient suffered elbow stiffness. ConclusionOlecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.

Evaluation of the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain: A randomized controlled trial.

The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months. This was a randomized controlled trial. Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control. The mean pain scores were statistically analyzed using one-way analysis of variance and posthoc test. The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain. TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain.

Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring.

To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases. A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period. Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4-10) and 137.2 ± 38.7 (40-200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (all P < 0.001). ODI scores significantly decreased (P < 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging. MWA combined with PVP can significantly relieve pain and improve patients' quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.

Impact of Midfoot Charcot Arthropathy (Brodsky Type 1) on Patient Reported Outcome Scores

Introduction/Purpose: Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning, but they have not been reported in the setting of Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation. Methods: A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship- trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS- 8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases. Results: Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8. Conclusion: Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.

EQ-5D-5L Population Norms for China Derived From a National Health Survey

ObjectivesTo develop the EQ-5D-5L (5L) population norms for China and to assess the relationship between various factors and 5L data. MethodsThis study used data derived from the Psychology and Behavior Investigation of Chinese Residents, a national sample survey of 21 909 representative participants aged 12 years and above. Participants’ health-related quality of life (HRQoL) was measured by the 5L. Their socioeconomic characteristics, behavioral factors, and health conditions were also obtained from the survey. Norm scores were generated and compared for different socioeconomic variables. Multiple linear and logistic regressions were used to assess the relationships of the 3 kinds of variables with the 5L utility, visual analog scale (VAS) scores and 5L health problems. ResultsThe mean (SD) age of participants was 39.4 (18.9) years, and 50.0% of the participants were female. The mean (SD) utility and VAS scores were 0.940 (0.138) and 73.4 (21.6), respectively. Participants reported considerably more problems in anxiety/depression (26.2%) and pain/discomfort (22.2%) dimensions. The gender difference in HRQoL is attenuated. The participants older than 75 years suffered from a sharp decline in HRQoL; the participants in Shanghai and Tibet provinces reported lower utility and VAS scores and more health problems. Those who were younger, with better socioeconomic status and healthier lifestyles, and without diseases tended to report higher utility and VAS scores and fewer health problems. ConclusionsThis study derived the 5L population norms for China based on a representative population sample.

Robot-assisted Percutaneous Radiofrequency Ablation for the Treatment of Osteoid Osteomas.

Percutaneous CT-guided radiofrequency ablation (CT-RFA) is a widely accepted procedure for treatment of osteoid osteomas. However, the application of CT-RFA was restricted as a result of some drawbacks, such as radiation exposure, and inconvenience in general anesthesia. The primary aim of this study is to evaluate the safety and efficacy of intra-operative TiRobot-assisted percutaneous RFA of osteoid osteomas. We retrospectively reviewed 21 medical files of patients who were treated with percutaneous RFA of osteoid osteomas guided by the TiRobot system in our institution between March 2021 and April 2022. The three-dimensional images obtained by a 3D C-arm intra-operatively were sent to the TiRobot system. The puncture point and trajectory were designed. Then the guide pin was positioned to the lesion with the assistance of TiRobot and the biopsy sheath was inserted into the lesion through the guide pin. The tumor was biopsied for pathological examination. Then the RFA needle was inserted into the nidus through the biopsy sheath for thermal ablation. Data were extracted on the associated complications, the reduction in pain at 1 month and 1 year postoperatively assessed by the visual analogue scale (VAS). A paired t-test was used to compare the pre-operative and post-operative VAS scores. The patients included 17 males and four females with a mean age of 19.5 ± 10.4 years (range 3-45 years). Lesions were located on the femur in nine cases, on the tibia in nine cases, on the humerus in one case, on the calcaneus in one case, and on the acetabulum in one case. TiRobot-assisted percutaneous RFA was successfully performed on all 21 patients. There was no intra-operative or post-operative complications observed. Pathological diagnosis of osteoid osteoma was obtained in 11 patients, but the other 10 cases were not pathologically diagnosed. The mean follow-up time was 18.8 months (range: 12-26 months).Post-operative VAS scores were reduced significantly in all cases. The mean VAS score decreased from 6.5 pre-operatively to 0.5 at 1 month post-operatively and to 0.1 at 1 year post-operatively. As a reliable technique for localizing and resection of nidus, TiRobot-assisted percutaneous RFA is a safe and effective option for the treatment of osteoid osteomas.

Genicular artery embolization for the treatment of knee pain secondary to mild to severe knee osteoarthritis: One year clinical outcomes

ObjectiveTo evaluate the safety and efficacy of genicular artery embolization (GAE) in patients with mild-to-severe knee osteoarthritis up to 12 months after GAE. Materials & methodsThis prospective single-center study included patients who had knee osteoarthritis for >1 year with moderate-to-severe pain after failed conservative treatment for >6 months. Baseline imaging features were evaluated to determine Kellgren-Lawrence (KL) grade and magnetic resonance imaging (MOAKS) scores. GAE was performed using 150–350 μm embolic polyvinyl alcohol particles. The visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used to evaluate knee pain, stiffness, and function at baseline and follow-up. The primary endpoints were changes in VAS and WOMAC scores at 12 months. ResultsThirty-three patients (n = 37 knees) aged 66.6 ± 8.7 years were enrolled. The patients were categorized into two groups: mild-to-moderate osteoarthritis (n = 28, KL grades 2–3) and severe osteoarthritis (n = 9, KL grade 4). GAE was successfully performed in all patients, with no major adverse events. Three to six branches of the genicular artery were embolized. The mean VAS and WOMAC scores in the mild-to-moderate group significantly decreased (6.6 at baseline vs. 3.0 at 12 months and 49.4 vs. 27.4, respectively, all P < 0.001). The mean VAS and WOMAC scores in the severe group significantly decreased at 12 months (7.3 vs. 4.4 and 58.1 vs. 40.6, respectively, all P < 0.001). ConclusionGAE is a well-tolerated and effective treatment that significantly improves pain symptoms and function in patients with mild-to-severe knee osteoarthritis.

Botulinum Toxin Injection Technique for Reducing the Masseter Size and Enhancing the Jawline.

The injection of botulinum toxin into the masseter muscle is an important method used to improve hypertrophy. However, some patients may experience adverse reactions, such as sagging of the lower jaw. Therefore, we proposed a method of injecting botulinum toxin into the masseter and platysma muscles that would reduce masseter size and enhance the jawline. Reducing the masseter size while enhancing the jawline. Twenty patients received botulinum toxin injections into the masseter and platysma muscles. Pain levels were evaluated using the visual analog scale. All patients were photographed before and 6 months after treatment. Evaluations were performed based on standardized criteria. The lift index, reduction index, and symmetry index were used to assess the degree of jawline elevation, masseter size reduction, and jawline symmetry before and after treatment, respectively. The mean visual analog scale score of the 20 patients was 2.80 (±1.24). The mean lift index score decreased from 4.93 (±0.34) to 4.53 (±0.37), P<0.05. The mean reduction index score decreased from 3.13 (±0.27) to 2.74 (±0.27), P<0.05. The mean symmetry index score changed from 0.0393 (±0.0296) to 0.0257 (±0.0246), P<0.05. Botulinum toxin injections into the masseter and platysma muscles through nerve block reduced the masseter size, elevated the jawline, and improved symmetry.

The Safety and Efficacy of Dorsal Root Entry Zone Lesioning for Pain Management in Patients With Brachial Plexus Avulsion: A Systematic Review and Meta-Analysis.

Persistent neuropathic pain after brachial plexus avulsion (BPA) is common and generally nonresponsive to medical management. Dorsal root entry zone (DREZ) lesioning is the last resort for pain management in patients with BPA. This study aims to investigate and compare the outcomes and complications of DREZ procedures. A systematic literature search was conducted to identify all related studies. Comparisons were based on the number of patients with preoperative pain vs postoperative pain, with the effect size calculated using the risk ratio. Mean visual analog scale (VAS) scores were extracted and analyzed between interventions. A meta-regression analysis was performed to identify risk factors for final outcomes. The rates of complications were also assessed and analyzed between interventions. A total of 30 studies with 917 patients (90.0% male and 10.0% female, mean age: 42.9 ± 16.6) were included in this systematic review. Of the 917 patients who underwent surgery, 655 (71.4%) patients had significant pain reduction at the last follow-up (P < .05). The weighted mean preoperative VAS score was 8.3 ± 1.3, compared with postoperative VAS scores (1.9 ± 2.2); a significant improvement was observed (P < .05). The subgroup analysis showed that microsurgical DREZotomy (MDT) is associated with better outcomes in terms of VAS score improvements compared with radiofrequency (RF)-assisted DREZ lesioning (P < .05). Meta-analysis showed that the relative risk of motor deficits was significantly lower in the MDT group, compared with the RF-assisted group (P < .05). Meta-regression showed that older age is correlated with an elevated risk of postoperative motor deficits compared with the incidence of sensory loss. DREZ lesioning is effective for intractable pain alleviation after BPA. Compared with RF-assisted DREZ lesioning, MDT is associated with better VAS score improvements and a lower rate of postoperative motor weakness.

Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients.

Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 patients, specifically 194 women (69.3%) and 86 men (30.7%), were enrolled. We used the AO spine fractures classification and the Yeom classification to determine the subtype of cement leakage. Only single-level VCFs of the thoracic or lumbar spine were included. Visual analogue scale (VAS) was assessed preoperatively and regularly after the surgery. Vertebral compression ratio (VBCR) was used to determine postoperative vertebral body collapse. Results: We recorded 54 cases (19.3%) of cement leakage. There was a significant decrease in mean VAS scores (6.82-0.76 in PVPs, 7.15-0.81 in PKPs). The decrease in VBCR was greater in the VP group (4.39%; 84.21-79.82) compared to the KP group (1.95%; 74.36-72.41). Conclusions: No significant difference in the risk of cement leakage when comparing KPs and VPs was found. VPs and KPs provide rapid and significant pain relief in patients with VCFs. Clinically relevant complications of VPs and KPs are rare. Kyphoplasties prevent further vertebral body collapse more effectively compared to vertebroplasties.

Determining the predictors associated with the difficulty of adaptation to ageing of hospitalized older adults. Difficulty of older adult to aging.

To determine the predictors associated with the difficulty of adaptation to ageing of hospitalized older adults. This descriptive cross-sectional study was carried out in a university hospital between October 2019 and March 2020. The sample consisted of 247 older adults. Research data were collected using a Visual Analogue Scale (VAS), the Falls Efficacy Scale (FES) International, Hospital Anxiety and Depression Scale, and Assessment Scale of Adaptation Difficulty for the Elderly (ASADE). The average age of the patients was 73.90 ± 7.38 years, 22.3% of the patients had a fall history in the last year, and 74.5% had a high fear of falling. The mean FES score of the older adult patients was 35.60 ± 11.09, and the mean VAS score was 1.40 ± 1.36. The mean scores for anxiety was 9.30 ± 2.32 and depression was 10.08 ± 1.96. The mean ASADE total score was 16.56 ± 10.7, role and the self-actualization mode score was 9.05 ± 4.66, interdependence mode score was 2.02 ± 1.02, physiological mode score was 3.00 ± 2.03 and self-concept score was 2.47 ± 2.07. The findings revealed that using walking aids, being single, pain, fear of falling, and anxiety affect adaptation difficulties to aging. Anxiety was found to have an effect on all sub-dimensions of adaptation difficulty to aging. There is a need for further studies to determine the correlation between anxiety and the adaptation difficulties experienced by older adults.