Partial Thickness Research Articles

Fabrication and evaluation of four combinations of pullulan-based biopolymeric, microporous scaffolds impregnated with peppermint oil for management of partial thickness burn wounds and accelerated tissue regeneration

Burn injuries are common in both civilian and military settings and cause severe morbidity and mortality. The present study aimed to develop microporous bioactive scaffolds from the natural polysaccharide, pullulan, combined individually with Gelatin (Gel)/ Alginate (Alg)/ Chitosan (Ch)/ Carboxy-methyl cellulose (CMC), and crosslinked with glutaraldehyde to form a polymeric network. The objective was to evaluate and compare their efficacy in healing second degree partial-thickness burn wounds. The scaffolds were also impregnated with peppermint oil (PEO) to provide potential analgesic and cooling effects. Scaffolds were characterized using FTIR, TGA and SEM analysis to understand the intra-and intermolecular interactions and morphological characteristics. In vitro parameters like fluid uptake ability, biodegradation and hemolytic index were also assessed. Biocompatibility studies, including cell adhesion, migration and proliferation, were conducted using L929 mouse fibroblast cell lines. The in vivo efficacy was evaluated in Sprague Dawley rats inflicted with second degree burns to assess and compare wound retraction across different experimental groups. Histology, immunohistochemistry along with gram and picrosirius staining studies were also performed. The average pore size of all biopolymeric scaffold combinations ranged between 25.6-298μm. All four test combinations were non-hemolytic, with hemolytic indices between 0.3-2.9. Wound retraction studies in rats clearly indicated that among the four test combinations studied, Pu/Gel/PEO scaffold not only reduced local inflammation faster but also accelerated dermal regeneration in comparison to positive control as well as other test combinations (viz., Pu/Alg/PEO, Pu/Ch/PEO, and Pu/CMC/PEO). Immunohistochemistry results corroborated animal efficacy findings and demonstrated enhanced expression level of epidermal growth factor and fibroblast growth factor-2 in Pu/Gel/PEO scaffold treated group. Picrosirius staining also revealed enhanced collagen deposition in Pu/Gel/PEO scaffold treated group. The study findings suggest that biopolymeric scaffolds made from pullulan combined with gelatin and PEO (Pu/Gel/PEO) could serve as a promising substrate for skin regeneration template for second degree burns.

Treatment of Partial-Thickness Rotator Cuff Tears with Bio-Inductive Collagen Implant for Paraplegic Tennis Player: A Case Report

In patient with lower limb disability, rotator cuff disorders are prevalent, with partial thickness tears occurring at nearly twice the rate of full thickness tears. For those with acromion spurs unresponsive to conservative treatment, rotator cuff repair via the take-down method poses a retear risk and requires extensive rehabilitation. Conversely, surgery utilizing bio-inductive collagen implants shows a lower retear risk and enables faster recovery, making it an appealing option for wheelchair athletes. Thus, the authors aim to present favorable outcomes from isolated bio-inductive collagen implant repair in a 45-year-old female wheelchair tennis player with a bursal side partial thickness tear, alongside a literature review.

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

Suprathel Versus Hypafix in the Management of Split-Thickness Donor Site Wounds in the Elderly: A Randomised Controlled Trial

(1) Background: Effective wound management aims for expedited healing, improved functional and scar outcomes, and reduced complications including infection. Delayed wound healing remains a prevalent problem in the elderly. Suprathel is a synthetic absorbable skin substitute and an attractive option in partial thickness wounds. The objective of this randomised controlled study was to assess the effect of skin substitute dressings on elderly split-skin graft (STSG) donor sites, evaluating time to heal, pain, itch and scar outcome. (2) Methods: 40 patients over 65 undergoing split-thickness skin grafting for non-melanoma skin cancer excision were randomised to STSG donor site dressings with either Suprathel or Hypafix. Patients were followed up weekly until healed and at 13 weeks post-procedure. (3) Results: There was no significant difference in time to healing, pain, itch, or scar outcome at 13 weeks between the two groups. The mean time to healing was 31.7 days for the skin substitute group and 27.3 days for the adhesive tape control group (p = 0.182). (4) Conclusions: Both dressings are appropriate for STSG donor sites. Hypafix remains a cost-effective dressing of choice for donor sites. Benefits demonstrated in other studies using skin substitutes have not translated into the elderly population. There remains scope in developing dressings that reduce elderly donor site morbidity.

Comparative Efficacy of Silver Sulfadiazine and Aquacel Ag in Superficial Partial Thickness Burn Treatment: A Retrospective Analysis

Comparative Efficacy of Silver Sulfadiazine and Aquacel Ag in Superficial Partial Thickness Burn Treatment: A Retrospective Analysis

Disparities in Rotator Cuff Tear Progression Definitions and Rates: A Systematic Review.

While rotator cuff tears are prevalent in the general population, the natural history of this disease is unclear. Understanding rotator cuff tear progression is crucial for refining surgical indications and evaluating the necessity of early interventions. This study presents an in-depth analysis of the existing literature on the definitions and progression rates of rotator cuff tears, aiming to enhance clinical decision making and patient outcomes. A systematic literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using Medline (PubMed), Embase (Elsevier), and Web of Science databases on January 12, 2023. Articles were identified as relevant to the natural history and progression of asymptomatic and symptomatic partial-thickness (PT) and full-thickness (FT) rotator cuff tears. Those written in English reporting rotator cuff progression rates of tears in adults, based on magnetic resonance imaging (MRI) or ultrasound, were included. After reviewing the articles, the data on the rates of tear progression and associated risk factors were extracted, compiled, and analyzed. The risk of bias was determined using the Newcastle-Ottawa Scale. Twenty-one articles met the inclusion criteria, with 1,831 tears included. The progression rate for all partial thickness tears was 26.7% ± 12.8% at an average follow-up of 2.2 ± 0.9 years, with 5 definitions for tear progression. For FT tears, the progression rate was 54.9% ± 18.6% at a follow-up time of 3.0 ± 2.0 years, with 8 definitions for tear enlargement. A significant difference (p < 0.0001) was found between the progression rates of PT and FT tears. Patients who were initially asymptomatic and became symptomatic had higher progression rates (33%-63%) than those who remained asymptomatic (4%-38%). Further research would benefit by identifying a clinically relevant and standardized definition of rotator cuff tear progression, to describe the natural history of rotator cuff disease, making results more comparable and optimizing treatment planning. Level II. See Instructions for Authors for a complete description of levels of evidence.

Including the bowel within the iceball during cryoablation: a retrospective single-center review of adverse events

To evaluate the safety of including bowel in the ice-ball during cryoablation. 43 patients who underwent 50 cryoablations between 1/1/2012 and 2/1/2023 were retrospectively reviewed and compared to a control cohort of those undergoing cryoablation without bowel involvement (n=86). Adverse events (AEs) were stratified by the Society of Interventional Radiology Adverse Events classification system, 2017 (1). Adverse events occurring within 12 months and factors that may affect the AE rate, such as degree of bowel involvement and portion of bowel involved, were reviewed. Fourteen AEs occurred in 13 patients (13/43, 30.2%). This included 7 grade 1 AEs (7/43,16.3%), 3 grade 2 (3/43,7.0%) and 4 grade 3 (4/43,9.3%). Of them 1 grade 3 AE was judged to be related to bowel involvement (1/43,2.3%). When comparing AEs by degree of bowel wall involvement, there were more injuries with the full thickness bowel wall cases (6/9,66.7%), compared with partial thickness, but the findings were not statistically significant (p=0.140). When looking at AEs by portion of the intestine involved, it was found that 7 (7/14,50%), 10 (10/17,58.8%), and 4 (4/19, 21.1%,p=0.055) were found when stomach, small bowel or large bowel was involved respectively. No significant difference in AEs (13/43,30.2% vs 31/86,36%,p=0.511) or severe AEs (4/43, 9.3% vs 9/86, 10.5%, p=0.836) was found between the study and control cohorts. Findings from this single center retrospective experience suggest that bowel wall involvement by the ice ball during cryoablation resulted in a lower-than-expected rate of adverse events for bowel-related injuries.

Topical application of anti-inflammatory agents on burn wounds and their effect on healing

Advancements in the treatment of burns have considerably improved overall survival rates, but they have also highlighted several long-term sequelae related to the injury. Hypertrophic scars can impair function, reduce quality of life, and require multiple procedures as well as physical therapy. The purpose of this study was to investigate the effects of topical application of anti-inflammatory drugs in the treatment of burns. Up to 15 deep-partial thickness burns were created on the dorsum of four anesthetized swine. Subsequently, the burn wounds were randomized to receive amiloride, celecoxib, dexamethasone or minocycline mixed in a hydrogel. Silver sulfadiazine cream and blank hydrogel acted as controls. The animals were followed for 90 days and the wounds were assessed on days 3, 7, 14, 28 and 90 post-burn. Assessments were performed using photographs (macroscopic healing, contraction), laser-speckle imaging (blood perfusion), 3D camera (scarring, pigmentation), and histology (inflammation, burn depth, epidermal maturation). Inflammation was present in all burn wound histology specimens and peaked on day 7 in all groups. Regardless of the treatment the burns progressed and were deeper on day 7 in comparison to day 3. The burns were 50 – 80 % healed by day 14, but no significant differences were observed. No differences in epidermal thickness, rete ridges, contraction, hypopigmentation, or scar elevation were seen on day 90. Topical anti-inflammatories did not significantly decrease inflammation or mitigate burn wound progression in deep partial thickness burns in pigs. Also, no significant differences in wound healing or quality of healing were observed.

Wireless Micro Current Stimulation (WMCS) therapy to enhance burn wound healing: A randomized clinical trial

BackgroundPediatric burn injuries are often associated with significant morbidity, and require specialized care. The primary advantage of Wireless Micro Current Stimulation (WMCS) is the ability to deliver electric current without direct contact with the wound, which is particularly advantages in the pediatric population, wounds over multiple areas, and over sensitive regions. MethodsA prospective, randomized trial was performed. Patients with partial thickness burns were recruited into the study over a 5-year period, and randomly assigned to one of two groups – Conventional dressings group and WMCS therapy group. Time to wound healing, adverse effects and risk of burn wound conversion were evaluated. ResultsAverage percentage of total body surface area (TBSA%) of burn injuries for patients in both groups were 1.39% and 2.78% respectively.Median time to healing was 2 days faster in WMCS group (6 days vs 8 days; p=0.0057). 1 burn (5.9%) from WMCS group and 5 (20.8%) from conventional dressings group progressed to deeper injuries (p=0.261). Most common symptoms reported during therapy in both groups were pain and itch. ConclusionOur study shows statistically significant improvement in healing time with WMCS therapy. This is despite two times higher average TBSA% noted in the WMCS group.

Novel multi-spectral short-wave infrared imaging for assessment of human burn wound depth.

Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non-biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi-spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth.

Research progress in Oxford unicompartmental knee arthroplasty for partial thickness cartilage loss in medial compartment of knee joint

To summarize the research progress of Oxford unicompartmental knee arthroplasty (UKA) in treating partial thickness cartilage loss (PTCL) in the medial compartment of the knee joint, aiming to further clarify the indications and optimize the effectiveness of Oxford UKA. A comprehensive review of recent domestic and international literature on Oxford UKA for PTCL in the medial compartment of the knee joint was conducted to summarize its application and research advancements. Based on current researches, the main indication for Oxford UKA is full thinckness cartilage loss in the medial compartment of the knee joint. Although it has shown certain effectiveness in treating PTCL in the medial compartment of the knee joint, there are also reports of opposite conclusions. Therefore, there is still controversy over whether Oxford UKA can be chosen for PTCL, and the large-sample and multi-center studies are needed to further clarify the controversy. Studies indicate that accurate preoperative assessment of cartilage damage severity is crucial for selecting appropriate candidates for Oxford UKA to optimize postoperative effectiveness. Oxford UKA may represent an effective treatment for patients with PTCL in the medial compartment of the knee joint. However, strict patient selection and precise preoperative evaluation are essential to ensure surgical success and long-term effectiveness.

FP7.20 - Peri-orbital burns: A 5-Year Review of the Epidemiological Characteristics and Outcomes at a Regional Burns Centre in the UK 2019 – 2023

Abstract Background Burn injuries are a major cause of global morbidity. Despite being infrequent, peri-orbital and ocular burns can have significant implications on a patient’s vision and overall quality of life. In Northern Ireland, the current epidemiological landscape of peri-orbital burns is not clear. This study aimed at assessing the incidence of peri-orbital and ocular burns and the management outcomes of patients admitted at the regional burns unit in Northern Ireland 2019-2023. Methods Patients admitted to the regional burns unit in Northern Ireland between January 2019 and September 2023 with periorbital burns were identified from the burns unit electronic records, the burns unit database and hospital image database. Results Over 5 years, 100 patients with facial burns were treated, including 60 patients with eyelid burns. 71% were males and 29% were females with a mean age of 47 years. The mean burn size was 14% total body surface area. The burn depth varied; 55% superficial partial thickness, 22% mixed, 17% full thickness and 6% deep dermal. Majority of burns were flame burns 64%. In total, 7 patients sustained corneal burns, one patient responded to steroids, one underwent amniotic membrane grafting, one lost complete vision in both eyes, one had physical debridement and topical antimicrobials and three patients required periorbital reconstruction to maintain eye closure. Conclusion 60% of Facial burns were associated with eyelid burns, the majority of which were caused by flame burns and were managed conservatively with wound cleaning, physical debridement, and application of topical antimicrobials. Despite being rare, complete loss of vision was associated with mortality among our patients.

Enhancing Gingival Aesthetics: A Case Report on Gingival Depigmentation

Abstract The beauty of a smile is not solely defined by the teeth’s shape, position and colour, but also by the condition of the gingival tissues. While melanin pigmentation of the gingiva poses no medical risk, complaints about ‘black gums’ are common, particularly amongst individuals with a high smile line. Consequently, treatment approaches in periodontal aesthetics aim to establish a harmonious balance between the pink hues of the gums and the white of the teeth, a crucial aspect of all dental procedures. Various methods for gingival depigmentation have been documented, including bur abrasion, scraping, partial thickness flap surgery, cryotherapy, electrosurgery and laser treatment. In this case report, scraping, electrosurgery and diode laser techniques were employed for depigmentation, chosen for their simplicity, effectiveness and ability to deliver satisfactory results, thereby ensuring patient contentment.

CASE STUDY OF DM GANGRENE WOUNDS WITH SKIN INTEGRITY DISORDERS

According to the World Health Organization (WHO), Indonesia is ranked 7th among the 10 countries with the highest number of sufferers, namely 10.7 million people. Complications from diabetes mellitus with diabetic gangrene rate in Indonesia is around 15%, and the amputation rate is 30%. In diabetes mellitus patients there are many nursing problems, one of which is impaired skin/tissue integrity. Diabetes mellitus is a disease caused by metabolic disorders as a result of the pancreas being unable to produce enough insulin needed by the body. A complication that often occurs in diabetes mellitus sufferers is gangrenous wounds where tissue deformity occurs either partially (Partial Thickness) or completely (Full Thickness). This study used a qualitative research design with a case study approach. The sample was 2 (two) Diabetes Mellitus patients with Gangrene Wounds with nursing problems of Skin/Tissue Integrity Disorders. The case study was carried out at Karawang District Hospital. Data collection techniques were carried out by: interviews, observation, physical examination and documentation studies. The data was analyzed narratively based on a comparison of 2 (two) patients who were processed based on the stages of the nursing process. Based on the assessment, it was found that patient 1 and patient 2 had gangreen wounds which is one of the complications that occurs in diabetes mellitus sufferers. The nursing problem that occurred was disruption of skin/tissue integrity and the implementation carried out for these two patients was wound care. The nursing problem of skin/tissue integrity disorders in both patients showed that the problem was not resolved and the intervention was continued by the nurse who was on duty in the room. Further research with another intervention and larger sample size needed to find out the best intervention for gangrene. Keywords: Diabetes Mellitus,gangrene, skin integrity

Comparison of MRI Osteoarthritis Knee Score with Clinico-Radiological Grading

Abstract Background Knee joint osteoarthritis (OA) is among the most prevalent degenerative diseases of the joints in the body. Various scoring system exists for grading OA, such as (1) magnetic resonance imaging (MRI) Osteoarthritis Knee Score (MOAKS), (2) clinical grading by Western Ontario and McMaster Universities Arthritis Index (WOMAC), and (3) X-ray grading of the Kellgren–Lawrence grading system (K-L). Objectives To study MRI findings and MOAKS scoring of knee OA and correlation with WOMAC and K-L scoring. Setting and Design Cross-sectional study in hospital population. Methods and Material A total 40 knee OA cases underwent an MRI of the knee. MOAKS scoring was done and compared with K-L grading and WOMAC scores. Statistical Analysis Collected data were compiled systematically and interpreted using IBM SPSS statistics software 25.0. A p-value of less than 0.05 was considered significant. Results The mean total WOMAC score was 9. K-L grade 2 was the most prevalent X-ray grade. Bone marrow lesion (BML) and cartilage loss in MOAKS score were greater in the medial femorotibial region. A moderate positive correlation was noted between the WOMAC score and K-L grade; full-thickness articular cartilage loss score at the medial femorotibial joint (MFTJ) and WOMAC score; partial-thickness articular cartilage loss score at lateral femorotibial joint (LFTJ) and WOMAC total pain score. No correlation was found between BML and pain severity score. Conclusion Higher WOMAC scores were associated with higher grades of K-L scoring and score of cartilage loss (partial and full thickness) of the MOAKS scoring system. The rest of the features of the MOAKS score (BML score, osteophyte, and synovitis) had no significant association with pain severity and K-L grading.

Peculiarities of Early Surgical Treatment of Patients With Deep Burns Using Biological Dressings

Background: Early necrosectomy with immediate or delayed skin grafting is the gold standard in treatment of burn injuries. Despite all advances in active surgical treatment of burn patients, the optimal time of necrosectomy as well as methods and timing of skin grafting remain the subject of debate among burn surgeons. Reliability and practicality of methods to determine the viability of affected skin tissues act as a limiting factor to advances in surgical strategies for early treatment of burn injuries.Objective: To improve methods of early surgical treatment of patients with deep burns using biological dressings.Materials and methods: Our study analyzed treatment outcomes of 34 patients (age, 18 to 60 years) diagnosed with third-degree burn wounds of different localizations involving 5%-20% of body surface area (according to ICD-10). Group 1 included 18 (53%) patients who underwent skin grafting right after surgical removal of necroses; biological dressings (Chitopran) were applied. Group 2 comprised 16 (47%) patients who also underwent early surgical treatment (autografting), but autografts were covered with synthetic dressings (Voskopran).Results: We found that in group 1 the average time to engraftment after skin grafting followed by Chitopran application was 5.0 (5.0-6.0) days. In group 2, the average time to engraftment after skin grafting followed by Voskopran application was 6.0 (6.0-6.3) days. The statistical data demonstrated that biological dressings had an advantage over synthetic ones in terms of time to engraftment.Conclusions: We can conclude that biological dressings have an advantage over synthetic ones in surgical treatment of partial thickness and deep burn wounds.

Review of Hard Palate Lipoma and Retrospective Clinicopathological Analysis of Patients With Oral Lipomas.

Lipomas occurring in the hard palate are extremely rare, and treating lipomas in this area presents challenges due to the thinness of soft tissue and the risk of postoperative bony surface exposure. We present a case of hard palate lipoma that was successfully removed using the partial thickness flap dissection technique. In addition, we reviewed the clinicopathological features of 20 reported cases of hard palate lipomas worldwide and retrospectively analyzed the clinical characteristics and pathological types of 68 oral lipomas in China. The use of a partial thickness flap demonstrates potential effectiveness in excising benign masses located in the hard palate. Regarding 68 patients with oral lipomas, the most commonly affected sites were the buccal region, tongue, and floor of the mouth. Histologically, simple lipomas and fibrolipomas were the predominant types observed.

Effects of uneven wall thickness of steel pipes on magnetic permeability perturbation testing for internal defects

ABSTRACT Magnetic Permeability Perturbation testing (MPPT) has the advantage of high sensitivity for deeply buried defects in steel pipes. However, in complex working conditions, variations in the partial wall thickness of the pipe can affect the defect detection results. The paper discusses the influence mechanism of uneven wall thickness on the MPPT of internal defects on steel pipes and analyzes the magnetic field distribution caused by uneven wall thickness which influences on the magnetic permeability perturbation (MPP) of internal defects. The MPP is enhanced at the thinning wall and weakened at the thickening wall. The effect of uneven wall thickness on MPPT signals is confirmed through simulation and experiment. The signal of defects in thinning wall is enhanced, while the signal of defects in thickening wall is weakened. The greater the wall thickness variation, the degree of signal distortion is more significant. Experimental results show that uneven wall thickness has an effect on the detection of the defects with different depths. Finally, a method using deep saturation magnetisation is proposed to mitigate the inconsistent signals caused by uneven wall thickness. The findings will contribute to quantitative evaluation of defects in MPPT.

Physiotherapist-supervised exercises versus physiotherapist-prescribed home exercises for treating partial thickness rotator cuff tears: a randomized controlled trial

BackgroundPartial thickness rotator cuff tears significantly affect physical and psychosocial well-being This study aimed to compare the efficacy of physiotherapist-supervised exercise and physiotherapist-prescribed home exercise programs on physical and psychosocial health measures in partial thickness rotator cuff tears. MethodsSeventy patients with partial thickness rotator cuff tears (44 female; mean age, 50.1 ± 5.2 years) were divided into two groups. Both the physiotherapist-supervised exercise group (Group 1, n=35) and physiotherapist-prescribed home exercise group (Group 2, n=35) received a program consisting of glenohumeral joint range-of-motion, stretching, and strengthening exercises (twice a week for eight weeks). The primary outcome measures were the modified Constant-Murley Score (mCMS) and the Hospital Depression and Anxiety Scale (HADS). Secondary outcome measures were the visual analog scale (VAS), active range of motion (AROM), Pain Catastrophizing Scale (PCS), Pittsburg Sleep Quality Index (PSQI), Short Form-12 (SF-12), and Global Rating of Change Scale (GRC). Patients were assessed at baseline and the end of the treatment. The significance level was adjusted to 0.025 after the Bonferroni correction. ResultsBoth groups showed significant improvements in all measures after treatment. There were no statistically significant group-by-time interactions for the mCMS (F=12.47, p=0.03) and the HADS (F=0.89, p=0.14 for depression; F=0.73, p=0.44 for anxiety). However, the improvement in the mCMS was clinically meaningful in both groups. The overall group-by-time interaction was significant for the VAS activity (p=0.004), shoulder flexion (p=0.01) and abduction (p=0.02) AROM, and PCS (p=0.005) in favor of Group 1. ConclusionExercise effectively improves physical and psychosocial health measures in partial thickness rotator cuff tears when delivered in the clinic or at home. However, exercise is more effective for activity pain, AROM, and pain catastrophizing when delivered in the clinic, highlighting the effectiveness of the physiotherapist-supervised exercise program.

The Diagnostic Pathway of Hirschsprung's Disease in Paediatric Patients: A Single-Centre Experience.

The presenting symptoms of patients with Hirschsprung's disease (HD) are a failure to pass meconium, abdominal distension, and bilious vomiting. The gold standard diagnosis is a rectal biopsy to confirm aganglionosis. The aim of our study was to describe the diagnostic pathway of Hirschsprung's disease at our institution and document the indication for a rectal biopsy. We have performed a prospective collection of all patients who underwent a rectal biopsy to exclude HD from December 2022 until September 2023 including. The following data were collected: patient's age, presenting symptoms, type of biopsy, failure rate, complications, and histopathological results. We identified 33 patients who underwent 34 rectal biopsies at 0.6 years of age. A total of 17 patients had a rectal suction biopsy (RSB), and 17 patients underwent a partial thickness under general anaesthesia (GA). 1/17 (6%) patients had an inconclusive RSB and subsequently underwent a biopsy under GA. Constipation and chronic abdominal distension plus vomiting were the most common presenting symptoms throughout all ages. Five patients (15%) had a rectal biopsy that was positive for HD. A protocolised approach to the assessment of infants and children with suspected HD ensures the appropriate utilisation of invasive procedures such as biopsy.