Relief Rate Research Articles

Clinical efficacy of Kuanxiong aerosol for patients with prehospital chest pain: A randomized controlled trial

BackgroundKuanxiong Aerosol (KXA)(CardioVent®), consisting of Asarum sieboldii Miq. oil, Santalum album L. oil, Alpinia officinarum Hance oil, Piper longum L. oil and borneol, seems to relieve the symptoms of chest pain and serve as a supplementary treatment for prehospital chest pain in emergency department. Style of the studyThis randomized controlled trial aimed to determine the clinical effect and safety of KXA for patients with prehospital chest pain. MethodsA total of 200 patients were recruited from Guangdong Provincial Hospital of Chinese Medicine and randomly divided into KXA group (n = 100) and Nitroglycerin Aerosol (NA) group (n = 100) by SAS 9.2 software. All patients were treated with standardized Western medicine according to the pre-hospital procedure. The experimental group and NA group was additionally treated with KXA and NA respectively. The primary outcome was the relieving time of prehospital chest pain (presented as relief rate) after first-time treatment. The secondary outcomes included the evaluation of chest pain (NRS scores, degree of chest pain, frequency of chest pain after first-time treatment), efficacy in follow-up time (the frequency of average aerosol use, emergency department visits, 120 calls, medical observations and hospitalization at 4 weeks, 8 weeks, 12 weeks), alleviation of chest pain (Seattle angina questionnaire, chest pain occurrence, and degree of chest pain at 12-weeks treatment) and the change of TCM symptoms before and after 12-weeks treatment. In addition, the safety of KXA was also assessed by the occurrence of adverse events. The database was created using Epidata software, and statistical analysis was conducted by SPSS 23.0 software. ResultsA total of 194 participants finally completed the trial, the results showed that after first-time treatment, KXA had a higher relief rate (72.2%) of chest pain within 30 min than that of NA group (59.4%, p = 0.038), KXA group had a lower degree of chest pain (p = 0.005), lower NRS score (p = 0.011) and higher reduction of NRS score (p = 0.005) than the NA. In the follow-up period, KXA group decreased the frequency of 120 call better than that of NA group at 4 weeks (p = 0.040), but KXA had a similar efficacy as NA in the improvement on the of frequency of chest pain, aerosol use, emergency department visits, 120 call, medical observation and hospitalization at 4 weeks, 8 weeks and 12 weeks (p>0.05). There also had no difference between the two groups on the occurrence of chest pain, degree of chest pain, physical limitation, angina stability, treatment satisfaction, and disease perception between the two groups at 12 weeks (p>0.05). In addition, KXA and NA both improved the patient's chest pain, but not the TCM symptoms. In terms of safety, KXA showed similar safety as NA in this study. ConclusionsKXA relieved prehospital chest pain faster than NA and had a better remission effect on the prehospital chest pain than that of the NA group in short-period. In long-period, KXA showed similar efficacy on the improvement of prehospital chest pain as NA. KXA may be a safe and reliable therapy for prehospital chest pain.

The use of virtual reality during extra-amniotic balloon insertion for pain and anxiety relief—a randomized controlled trial

Background: Induction of labor with extra-amniotic balloon (EAB) catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. Objective(s): We aimed to investigate the distractive effect of virtual reality (VR) technology on pain and anxiety- in pregnant patients who undergo Induction of labor with EAB.Study design: In this randomized controlled trial, pregnant patients intended for Induction of labor with EAB at term, for various obstetric indications, were recruited and randomized in a 1:1 ratio into two groups. Patients in the VR group were exposed to a VR technology clip (using SootheVR All-In-One VR care system for pain and anxiety) during the entire EAB insertion while patients in the control group received the institutional standard care for EAB insertion. Pain scores expressed by Visual Analog Scale (VAS) and maternal hemodynamic parameters, were obtained before, during, and after EAB insertion. Anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) before and after the procedure. Maternal satisfaction from the VR technology was also recorded. The primary outcome was the change in VAS score before and during EAB insertion. Among the secondary outcomes was the change in Anxiety levels before and after EAB insertion. The study was powered to detect a 25% decrease in the primary outcome.Results: A total of 132 pregnant patients were recruited (66 in each group). There were no differences between groups in terms of age, BMI, gestational age at enrollment, indication for Induction of labor, and pre-procedural VAS score and anxiety levels. The change in VAS score (maximal VAS score during the procedure subtract the initial VAS score before the procedure, i.e the primary outcome) was significantly lower in the VR group compared to the control group (2.78±3.0 vs 4.09±2.99, p=0.01). In addition, the VR group benefited a higher rate of anxiety relief expressed by the difference between pre-procedure and post-procedure STAI score, (-6.46 ± 9.6 vs -2.01 ± 9.11, P=0.007). Patients in the VR group reported an overall very high (94%) satisfaction score.Conclusions: In this randomized controlled trial, we demonstrated that the use of VR technology in patients undergoing Induction of labor with EAB was associated with lower VAS scores during the procedure and significant anxiety reduction compared to patients who received standard care. There was also a very high satisfaction rate from the use of VR technology.

NCMP-19. OUTCOMES FOLLOWING PALLIATIVE CEREBROSPINAL FLUID DIVERSION FOR NEOPLASTIC LEPTOMENINGEAL DISEASE: A SYSTEMATIC REVIEW

Abstract BACKGROUND Leptomeningeal disease (LMD)—cancer involvement of meninges or disseminated through the cerebrospinal fluid (CSF) system—indicates widespread or advanced cancer. LMD leads to symptomatic hydrocephalus, for which palliative CSF diversion may be indicated. We conducted a systematic review exploring published literature on outcomes of permanent CSF diversion for hydrocephalus among pediatric and adult patients with LMD from primary brain tumor or systemic cancers. METHODS We searched PubMed, Embase, and Web of Science from database inception until 8/20/2022, using search terms including but not limited to ‘cancer’, ‘hydrocephalus’, and ‘shunt’. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Inclusion criteria were English-language, quantitative studies of patients with LMD and hydrocephalus, with at least five subjects. RESULTS We screened 2440 abstracts and 152 full-text articles to yield a final cohort of 23 articles. The retrospective studies reported outcomes for 2895 patients, among which 995 patients (34.3%) specifically had LMD on presentation. Fourteen studies reported proportions of patients with LMD and hydrocephalus who underwent surgery for permanent CSF diversion (range: 9.9-100%), including endoscopic third ventriculostomy, ventriculoperitoneal or lumboperitoneal shunts. Postoperative complication rates were 0-37.7% with no cases of extraneural metastases via shunt. Rates of symptomatic relief following CSF diversion ranged from 50-100% in studies that reported data. In 14 studies, median overall survival ranged from 2.1-17.1 months. Three studies reported median survival after shunt surgery for LMD (2-3.3 months). CONCLUSION A rare entity with dismal prognosis, LMD and disseminated tumor can present as symptomatic hydrocephalus in patients with cancer. Symptom relief can be achieved with palliative surgery for permanent CSF diversion with relatively low complication rates. Prospective studies are needed to further assess outcomes and needs of this patient population.

Systematic review and Meta-analysis of efficacy and safety of Shufeng Jiedu Capsules in treatment of influenza

This study aims to systematically review the efficacy and safety of Shufeng Jiedu Capsules in the treatment of influenza. The randomized controlled trial(RCT) of Shufeng Jiedu Capsules alone or in combination with conventional western medicine for treating influenza were retrieved from PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP, Wanfang, and ClinicalTrails.gov. The data analysis was performed in RevMan 5.4.1. The Cochrane risk of bias assessment tool was used to evaluate the quality of the involved RCT, and GRADEpro GDT to assess the quality of the evidence. A total of 11 RCTs involving 1 836 patients were included in this study. Compared with conventional western medicine, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.09, 95%CI[1.03, 1.15], P=0.002), shortened the time to relief of cough, and increased the 3-day sore throat relief rate, whereas there was no significant difference in the time to fever abatement, the time to relief of sore throat, 3-day cough relief rate, or 3-day runny nose relief rate. Subgroup-analysis showed that Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.11, 95%CI[1.08, 1.15], P<0.000 01), shortened the time to relief of cough, and increased the 3-day relief rate of symptoms(cough, sore throat, and runny nose) compared with conventional western medicine alone, while there was no significant difference in the time to fever abatement or the time to relief of sore throat. Shufeng Jiedu Capsules alone could not improve the response rate(RR=0.97, 95%CI[0.93, 1.02], P=0.19). In addition, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine vs conventional western medicine were no significant difference in adverse reactions(RR=0.98, 95%CI[0.57, 1.69], P=0.95). The available evidence suggests that Shufeng Jiedu Capsules is effective and safe in the treatment of influenza, and the combination of Shufeng Jiedu Capsules with conventional western medicine can accelerate the relief of symptoms. However, since the number and quality of the included studies were low, the above findings remained to be further verified by multicenter RCT with large sample sizes.

Meta-analysis of the traditional Chinese medicine care model in relieving postoperative pain in patients with anorectal diseases

ObjectiveTo explore the effect of traditional Chinese medicine (TCM) nursing on relieving postoperative pain in patients with anorectal diseases. MethodThree English and three Chinese databases (PubMed, Embase, the Cochrane Library, the China National Knowledge Internet, Wanfang Data and the China Science and Technology Journal Database) were systematically searched for case-controlled or prospective studies evaluating the impact of TCM nursing on postoperative pain in patients with anorectal diseases from the date of library construction until June 20, 2022. The Newcastle–Ottawa Scale was adopted to evaluate the quality of the observational studies. The effect of TCM care on pain based on the Visual Analogue Scale (VAS), the effective pain relief rate, the wound healing time and the length of hospital stay were systematically analysed. ResultAfter a systematic search and screening, a total of 15 documents were included in this study. The systematic evaluation showed that TCM care reduced the VAS score (mean difference (MD): 1.15（95 % Confidence Interval (CI): 1.96, −1.06; P < 0.00001) compared with conventional postoperative care methods. As TCM nursing time increased, there was a trend towards decreased VAS scores. Furthermore, TCM care was effective in providing pain relief (OR: 4.78; 95 % CI: 2.93,7.79; P < 0.00001) and reducing wound healing time (MD: 4.44; 95 % CI: 5.60, −3.27; P < 0.00001) and length of hospital stay (MD: 4.87; 95 % CI: 5.93, −3.82; P < 0.00001). ConclusionTraditional Chinese medicine nursing has a positive effect on the postoperative clinical results of patients with anorectal diseases, especially in relieving postoperative pain. The effect of traditional Chinese medicine nursing in relieving short-term postoperative pain in patients with anorectal diseases is obvious. However, there is no uniform standard for TCM nursing projects, which may lead to heterogeneity.

SHORT SEGMENT VERSUS LONG SEGMENT PEDICLE SCREW FIXATION IN MANAGEMENT OF THORACOLUMBAR BURST FRACTURES: A META-ANALYSIS

This comprehensive meta-analysis evaluates the comparative effectiveness of short-segment pedicle screw fixation (SSF) and long-segment pedicle screw fixation (LSF) in treating thoracolumbar burst fractures. Our study examines various outcomes, including fusion rates, pain relief, functional recovery, and complication rates. Data from studies conducted between January 2018 and January 2022 were reviewed, involving a collective patient cohort of 100 individuals diagnosed with thoracolumbar burst fractures. We conducted an extensive review of the literature, including six investigations, with a total sample size of 100 patients, drawn from studies by Smith et al. (2018), Johnson et al. (2019), Brown et al. (2020), White et al. (2021), Davis et al. (2022), and Wilson et al. (2022). Fusion rates were 90% for SSF and 91% for LSF. The risk difference (RD) between SSF and LSF was -1%, indicating a marginal advantage favoring LSF (RD M-H = -0.95, 95% CI: -4.02 to 2.11). Analysis of postoperative pain scores showed that SSF patients had a mean pain level of 2.4, while LSF patients reported 2.3. With low heterogeneity (T = 12%) and a Z-score of 3.42, our findings demonstrated no statistically significant difference in postoperative pain levels between SSF and LSF. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and Short Form 36, revealing an RD of -1% in favor of LSF. However, this difference was insignificant (RD M-H = -0.82, 95% CI: -3.80 to 2.16). The complication rate for SSF was 12%, and for LSF, it was 11%, with an RD of 1%, suggesting a slightly higher complication rate for SSF, although this difference was not statistically significant (RD M-H = 1.05, 95% CI: -1.38 to 3.48).Our meta-analysis found no statistically significant differences in fusion rates, postoperative pain scores, or complication rates between SSF and LSF in the context of thoracolumbar burst fractures. The choice between SSF and LSF for treating thoracolumbar burst fractures is a pivotal consideration. Our findings indicate that SSF and LSF yield comparable outcomes in fusion, postoperative pain relief, functional recovery, and complication rates. The marginal advantages associated with LSF are of negligible clinical significance. This study underscores the importance of individualized decision-making, emphasizing patient-specific criteria and surgeon expertise in selecting the most appropriate fixation strategy for thoracolumbar burst fracture management. Personalized treatment plans are paramount in optimizing patient outcomes in this clinical scenario.

Percutaneous radiofrequency thermocoagulation and microvascular decompression for treating glossopharyngeal neuralgia: a retrospective clinical study

ObjectivesThis study aimed to investigate the differences in the effectiveness of percutaneous radiofrequency thermocoagulation (PRT) and microvascular decompression (MVD) in treating glossopharyngeal neuralgia (GPN).MethodsMedical records of patients were reviewed to investigate their baseline characteristics and immediate postoperative prognosis. Long-term outcomes of these patients were obtained through telephone interviews. Visual analog scale (VAS) and Pittsburgh sleep quality index (PSQI) scores at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were compared between the MVD and PRT groups, in addition to complete pain relief rate, effective rate, adverse reactions, length of hospital stay, and economic indicators.ResultsThe VAS and PSQI scores of the two groups at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were significantly lower (P < 0.05) than those before surgery. At 48 weeks, the complete remission rate was significantly higher (P < 0.05) in the MVD group than in PRT group. No significant difference in adverse reactions was observed between the two groups. The length of hospital stay, operative time, and cost were significantly higher (P < 0.05) in the MVD group than in the PRT group.ConclusionsBoth PRT and MVD can significantly reduce patients’ degree of pain and improve their sleep quality. In the medium term, MVD is better than PRT in terms of the complete curative effect. In young patients with GPN, MVD is more often recommended than PRT; however, MVD is costlier than PRT.

Outcomes of Endoscopic Endonasal Dacryocystorhinostomy in Glaucoma Patients

Purpose: Glaucoma has been investigated on producing fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. The aim of the study was to assess whether these effects may impair the effectiveness of dacryocystorhinostomy (DCR) in patients affected by both glaucoma and nasolacrimal duct obstructions (NLDO). Methods: Single-center observational retrospective study on endoscopic endonasal-DCR (EE-DCR) via posterior approach. Consecutive patients were enrolled in 2020–2023 and evaluated with proper questionnaires; resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). Results: 17 patients (29 operated sides) were enrolled. Preoperatively, 92.1% (n = 27/29) presented severe (Munk 3-4) epiphora and 69.0% (n = 20/29) recurrent dacryocystitis. At T1, 51.72% (n = 15/29) referred residual epiphora (Munk  1) and 17.20% (n = 5/29) dacryocystitis. At T2, 34.5% (n = 10/29) still complained epiphora (Munk  1) and 6.9% (n = 2/29) symptoms of dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted statistically significant (p&lt;0.05). At T2, 20 (69.0%) complete, 7 (24.2%) anatomical successes and 2 surgical failures (6.8%) were observed. Conclusion: EE-DCR in patients affected by both glaucoma and NLDO guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis, appearing as a reasonable therapeutical strategy to improve disease-related quality of life.

Transcutaneous Auricular Vagal Nerve Stimulation Is Effective for the Treatment of Functional Dyspepsia: A Multicenter, Randomized Controlled Study.

Vagal nerve stimulation (VNS) can be used to modulate gastrointestinal motility, inflammation, and nociception. However, it remains unclear whether VNS is effective in adult patients with functional dyspepsia (FD). We investigated the effectiveness of transcutaneous auricular VNS (taVNS) in patients with FD. Consecutive patients with FD meeting Rome IV criteria with modified FD Symptom Diary score ≥10 were enrolled. Patients were randomly allocated to 10-Hz taVNS (V10 group), 25-Hz taVNS (V25 group), or sham group, with 30 minutes of treatment twice a day for 4 weeks. The primary outcome was the response rate at week 4, defined as the proportion of patients whose modified FD Symptom Diary score was reduced ≥5 when compared with the baseline. Secondary outcomes included adequate relief rate and adverse events. A total of 300 patients were randomized to V10 (n = 101), V25 (n = 99), and sham groups (n = 100). After 4 weeks of treatment, V10 and V25 groups had a higher response rate (81.2% vs 75.9% vs 47%, both P < 0.001) and adequate relief rate (85.1% vs 80.8% vs 67%, both P < 0.05) compared with the sham group. There was no significant difference between V10 and V25 in response rate and adequate relief rate (both P > 0.05). The efficacy of taVNS (both 10 and 25 Hz) lasted at week 8 and week 12 during follow-up period. Adverse events were all mild and comparable among the 3 groups (1%-3%). Our study firstly showed that 4-week taVNS (both 10 and 25 Hz) was effective and safe for the treatment of adult FD ( clinicaltrials.gov number: NCT04668534).

Efficacy and safety of different thermal ablative therapies for desmoid-type fibromatosis: a systematic review and meta-analysis.

Desmoid-type fibromatosis (DF) is a locally aggressive tumor characterized by peripheral infiltration of neoplastic cells and remote metastasis disability. This systematic review examined the efficacy and safety of thermal ablative therapy for DF tumors. A literature search was conducted using PubMed, Web of Science, Cochrane Library, and Embase from January 1, 2000, to November 12, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide literature selection. The inclusion criteria were the following: (I) the patients were diagnosed with aggressive fibromatosis pathologically, (II) the patients were treated by thermal ablations, and (III) a focus on treatment efficacy and safety. Meanwhile, the exclusion criteria were the following: (I) cohorts of patients with hypertrophic scar, Gardner fibroma, or nodular fasciitis; (II) conference abstracts, reviews, case reports, letters to editors, comments, or editorials; (III) number of patients <5; (IV) in vitro or animal experiments; and (V) non-English language articles. The inverse variance method with a random effects model was used to obtain the pooled data. Subgroup analyses were performed to identify treatment factors. Egger test was conducted to assess the risk of publication bias. After literature selection, 694 DF tumors were identified in 23 studies. In terms of modality, 13 studies used cryoablation, 9 studies used high-intensity focused ultrasound (HIFU), and 1 study used microwave ablation (MWA). The pooled symptom relief rate was 90% [95% confidence interval (CI): 80-97%], with that for HIFU being 100% (95% CI: 85-100%), that for cryoablation being 87% (95% CI: 74-97%), and that MWA being 89% (95% CI). The pooled major complication rate was 3% (95% CI: 1-7%), and that for each modality was as follows: HIFU =2% (95% CI: 0-6%), cryoablation =4% (95% CI: 1-8%), MWA =11%, ultrasound =6% (95% CI: 1-13%), computed tomography (CT) =2% (95% CI: 0-7%), and magnetic resonance imaging (MRI) =3% (95% CI: 0-14%). The pooled nonperfused volume rate (NPVR) was 76% (95% CI: 71-81%), and that for each modality was as follows: HIFU =77% (95% CI: 71-85%), cryoablation =74% (95% CI: 69-79%), ultrasound =75% (95% CI: 67-83%), CT =76% (95% CI: 67-87%), and MRI =78% (95% CI: 70-87%). The pooled local control rate was 88% (95% CI: 79-94%) and that for each modality was as follows: HIFU =99% (95% CI: 96-100%), cryoablation =80% (95% CI: 68-90%), and MWA =78%. The differences in major complication rate (P=0.77) and NPVR between imaging-guided modalities (P=0.40) were not significant, nor were the differences in symptom relief rate (P=0.32) and major complication rate (P=0.61) between ablative techniques; however, the differences in local control rate (P=0.01) were significant between ablative techniques. Imaging-guided thermal ablative therapies contribute to symptom relief with a duration of more than 6 months and a low major complication rate of DF tumors.

Stereotactic Radiosurgery for Trigeminal Neuralgia: A Comparison of Proximal and Distal Isocenter Outcomes

Trigeminal neuralgia is a chronic pain condition of the trigeminal nerve affecting 12 per 100,000 people. Stereotactic radiosurgery (SRS) delivered by both a non-invasive stereotactic radiosurgery instrument and linear accelerators (LINAC) is a non-invasive alternative to surgical approaches. Although SRS in this setting is commonly performed, there lacks a consensus and comparative data on the optimal anatomical target with the two most common targets being the dorsal root entry zone (proximal) and retrogasserian zone (distal). This study aims to evaluate treatment outcomes in patients based on these two target locations. This multi-center, retrospective analysis included patients treated for trigeminal neuralgia between 2017 and 2021 with GK and LINAC-based SRS who were followed for at least 1 year. All patients received a dose of 85 Gy prescribed to the isocenter, set at the dorsal root entry zone (proximal) or the retrogasserian zone (distal). Isocenter location was based on the preference of the radiation oncologist and neurosurgeon. Patient reported clinical pain relief was recorded as full, partial, or no pain relief after SRS. Among patients with full and partial pain relief duration of pain relief was recorded. Ability to achieve full or partial medication de-escalation was also recorded. Outcomes of patients in the proximal and distal target cohort were compared using time based univariate analyses using log rank hazards model. We identified 86 eligible patients, of whom 54 patients (63%; median age 63, 72% female) were treated using a proximal target, and 32 (37%; median age 66, 71% female) were prescribed to a distal target. In the proximal and distal cohorts, patients experienced pain relief (either partial or full relief) at a rate of 74% and 90% and full pain relief at a rate of 46% and 31%, respectively (p = 0.011). The duration of pain relief was not significantly different amongst the two groups (p = 0.18). Partial medication de-escalation was more frequent in the distal target (75%) vs proximal (33%), while full medication de-escalation was more frequent with proximal (39%) vs distal (13%), p = 0.001. This study contributes to the limited data evaluating the differences in outcomes between proximal and distal targeting for treatment of trigeminal neuralgia with stereotactic radiosurgery. Overall, this study confirms that both approaches achieve a high rate of response in a difficult to control disease process. Our study suggests that a distal isocenter may be associated with higher rates of any type of pain improvement while a proximal isocenter may be associated with higher rates of complete pain relief. This data is hypothesis-generating and warrants further investigation into the effectiveness/toxicity differences of two approaches.

Efficacy of probiotics, prebiotics and synbiotics in irritable bowel syndrome: a systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials.

Introduction. Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects the quality of life of numerous people worldwide.Gap statement. The therapeutic role of gut microbiota modulation in IBS remains controversial.Aim. We aimed to assess the efficacy of probiotics, prebiotics or synbiotics in patients with IBS.Methodology. We searched MEDLINE and EMBASE up to 1 August 2023, to identify the randomized, double-blind, placebo-controlled trials investigating the effectiveness of probiotics, prebiotics or synbiotics among patients with IBS. Pooled analyses of the effects of probiotics in relieving IBS symptoms were calculated using a random-effects model. Further subgroup analyses were performed by different genera, doses and duration of treatment.Results. Our final analysis included 52 trials involving 6289 IBS patients. Probiotics significantly increased the overall response rate (RR:1.64; P<0.00001), subjective relief rate (RR:1.50; P=0.0002) and abdominal pain relief rate (RR:1.69; P<0.00001). As for specific genera, mixed probiotics (RR:1.41; P=0.0001), Bifidobacterium (RR:1.76; P<0.00001), Lactobacillus (RR:1.97; P=0.0004) and Saccharomyces (RR:1.31; P=0.0004) markedly relieved IBS symptoms. Mixed probiotics (RR:1.31; P=0.005), Lactobacillus (RR:2.22; P=0.04) and Bifidobacterium (RR:1.62; P<0.0001) elevated patients' subjective relief rate. Besides, probiotics effectively relieved the abdominal pain in IBS patients (RR:1.69; P<0.00001). Probiotics appeared to show a remarkable beneficial role at a dose of 109 c.f.u./day or above (RR:1.662; P<0.0001) and started to work at 4 weeks (RR 1.72; P<0.00001). Efficacy of prebiotics and synbiotics in IBS remained uncertain, due to the deficiency of available RCTs.Conclusions. Probiotics have a therapeutic role in IBS. However, the effect of different probiotics varies. The minimal effective dose of probiotics may be 109 c.f.u./day. With appropriate probiotic formula, the therapeutic effect can occur at 4 weeks. These data provide a basis for further research on the optimal probiotic therapy in IBS.

Classification of Patients with Painful Tumors to Predict the Response to Palliative Radiotherapy

Palliative radiotherapy is an effective and commonly used treatment for pain relief in metastatic cancer patients. This study aimed to classify the patients to predict their response to palliative radiotherapy. This study used the data from our single-center, prospective observational study (UMIN000044984), which included all patients undergoing palliative radiotherapy for the painful tumor, except for postoperative setting or brain metastases. The eligibility criteria were as follows: (1) numerical rating scale (NRS) was two or more before treatment, and (2) underwent palliative radiotherapy between August 2021 and September 2022. Questionnaires for pain site, NRS, and presence/dose of opioids were obtained before, on the last day of treatment, two weeks later, one month later, three months later, and every three months after that. Patients with severe performance status (PS) were contacted by telephone. Pain response was defined to reduce NRS 2 or more at the treated site without an analgesic increase. The primary outcome was the response rate within three months of the treatment. We used multivariable logistic regression to find the independent prognostic factors for the response based on the following covariates: age, sex, PS, body mass index, NRS, history of radiotherapy, treated site, radiographic features (lytic/sclerotic/mixed), metastatic complication, presence/dose of opioids, bone-modifying agents, radiation dose, type of primary tumor, radiosensitivity, number of metastases, and days from diagnosis to treatment. A classification model was created using significant factors, and response rates were calculated for each class. Statistical significance was defined as P<0.05. Among 488 targets of 300 patients registered, 366 targets of 261 patients met the criteria. The median age was 65 years, 44% were female, and PS (0/1/2/3/4) was 6/63/18/9/4%. The major type of tumor was gastrointestinal (32%), lung (19%), and breast (12%). Bone metastases were 75% at treated sites. Opioids were used by 72%, BMA was 27%, and chemotherapy was 50%. Re-irradiation rate was 22%. With a median follow-up of 5.8 months, 113 patients were alive, 129 had died, and 20 were lost follow-up. The average NRS was reduced from 6.1 to 3.1 from pretreatment to 3 months later per evaluable 232 targets, resulting in a pain relief rate of 60%. Opioids use (P<0.001) and re-irradiation (P<0.001) were significant factors of poor response in multivariate analysis. In our classification model, 89 targets were classified as class 1 (no opioids & no irradiation history), 211 were class 2 (other than class 1 and 3), and 66 were class 3 (opioids & re-irradiation), were 75/61/36% (P<0.001) of response rate. The 6-month cumulative pain progression rate was 12/22/32% (P<0.001), respectively. Palliative radiotherapy is highly effective for patients with painful tumors especially for those without previous irradiation history or use of opioids.

Importance of Sacrotuberous Ligament in Transgluteal Approach for Sciatic Nerve Entrapment in the Greater Sciatic Notch (Piriformis Syndrome).

The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch.

Effectiveness and safety of Xingbei Zhike granules in patients with postinfectious cough: A multicenter, randomized, double-blinded, placebo-controlled trial

BackgroundPostinfectious cough (PIC) is a common symptom following a respiratory tract infection. Xingbei Zhike (XBZK) granules, a Chinese patent medicine, has been widely used for PIC in clinics. However, there is a lack of evidence on the effectiveness. PurposeTo investigate whether treatment with XBZK granules is effective for PIC. Study designA multicenter, randomized, double-blinded, placebo-controlled trial. MethodsEligible participants from fourteen hospitals were randomly assigned in 3:1 ratio to receive either XBZK granules or placebo for 14 days. The primary outcome was the area under the curve (AUC) of a visual analogue scale (VAS) for cough symptoms. Secondary outcomes included cough symptom score (CSS), time and probability of recovery from cough, traditional Chinese medicine (TCM) syndrome score, relief rates of individual symptoms, Leicester Cough Questionnaire (LCQ) score, and the use of reliever drug. ResultsA total of 235 patients (176 in XBZK and 59 in placebo groups) were included in the analysis. The AUC for cough VAS scores was lower in the XBZK than placebo group (−8.10, 95 % CI -14.12 to −2.07, p = 0.009), indicating superiority. XBZK decreased CSS (−0.68 points, 95 % CI −1.13 to −0.22, p = 0.01), shortened time to cough recovery (−2 days, hazard ratio [HR] 1.48, 95 % CI 1.03 to 2.13, p = 0.02), enhanced the probability of cough recovery (risk ratio [RR] 1.66, 95 % CI 1.07 to 2.58, p = 0.03), lowered TCM syndrome score (−0.99 points, 95 % CI −1.58 to −0.40, p = 0.004), increased the rate of daytime (RR 1.84, 95 % CI 1.07 to 3.15, p = 0.02) and nighttime (RR 2.07, 95 % CI 1.29 to 3.35, p = 0.004) cough recovery, and reduced the viscosity of sputum (RR 2.92, 95 % CI 1.66 to 5.13, p < 0.001) compared to placebo. There were no significant differences in LCQ scores and taking reliever drugs between groups. No severe adverse events were reported in either group. ConclusionsXBZK granules are a promising therapy against PIC, effective in lowering the overall severity of cough, shortening the time to cough recovery, and reducing the viscosity of sputum.

A Prospective Study To Evaluate Medical Management Vs Surgical Intervention In Pain Relief And Healing Of Anal Fissure

Introduction: Anal fissure is a commonly encountered problem for surgeons. It is a longitudinal tear in distal anal canal with or without an ulcer. It causes significant changes in quality of life. This study was done to compare the efficacy of medical management and surgical intervention in cases of anal fissures. Methods: 50 patients were divided into two groups of 25 each. Group A patients were treated with topical application of 2% diltiazem gel and Group B patients were treated with Lateral sphincterotomy. Both groups were examined weekly for 4 weeks for pain using VAS score and at 12 weeks for healing. Results: 21(84%) patients were pain free after 4 weeks under Group A, 24 (96%) patients were pain free after 4 weeks under Group B. 22(88%) patients were completely healed at 12 weeks under Group A, 25(100%) patients were completely healed at 12 weeks under Group B. Conclusion: Lateral sphincterotomy can be advocated as treatment of choice for anal fissures. It has better pain relief and healing rates compared to topical application of 2% diltiazem gel. Medical Management can be used in patients refusing surgery or unfit for surgery

Clinical efficacy and safety of folic acid and vitamin B12 for the adjuvant treatment of schizophrenia: a systematic review and meta-analysis.

Given the different effects of folate and vitamin B12 on the ad-juvant treatment of schizophrenia (SCH), their efficacy and safety as adjuvant therapies for SCH were systematically evaluated by evidence-based medicine. Publication retrieval was performed using authoritative databases such as the Cochrane Library, PubMed, and Web of Science to screen randomized con-trolled trials (RCTs). After the quality evaluation and data extraction of includ-ed studies, eligible RCTs were systematically reviewed using Review Manager 5.2 software. In total, 14 RCTs were included. The results of the meta-analysis revealed that as the adjuvant therapy for SCH, vitamin B12 differed significantly from folate in terms of anxiety relief rate [odds ratio (OR)=1.28, 95% con-fidence interval (CI) (1.02, 1.61), p=0.03, I2 =0%, Z=2.13]. However, there were no significant differences in the incidence rate of mania [OR=1.13, 95% CI (0.78,1.65), p=0.65, I2=36%, Z=0.65], total efficacy [OR=1.06, 95% CI (0.72, 1.56), p=0.77, I2=0%, Z=0.30] and incidence rate of adverse reactions [OR=1.15, 95% CI (0.88, 1.49), p=0.31, I2=0%, Z=1.03]. Although folate and vitamin B12 exhibit no significant differences in the adjuvant treatment of SCH, vitamin B12 exerts markedly fewer side effects than folate drugs, and it is of de-terminant significance for the clinical adjuvant medication of SCH.

Individual Differences in Vulnerability Factors for Anxiety Disorders: A Study on the Acquisition, Extinction, and Renewal of Avoidance, and the Concomitant Dynamics of Relief

We conducted an experiment to assess the role of trait anxiety (TA) and prospective intolerance of uncertainty (P-IU) in the extinction and renewal of avoidance and distress. In this experiment, we used an extinction procedure in which making the avoidance response did not prevent participants from noticing that the US did not follow warning stimuli. Renewal was assessed through a re-extinction phase conducted in a context different from that used in the acquisition and extinction phases. Our dependent measures included participants’ scores on P-IU and TA, the frequency of avoidance responses per trial, and participants’ post-trial relief ratings (used to infer the degree of distress suffered during the previous trial). We found that higher P-IU scores were associated with heightened relief ratings to a safety signal that had never been followed by the US in the avoidance acquisition phase, and with an overall less steep reduction in relief ratings during the re-extinction phase. Increased TA was associated with heightened avoidance frequency in safety-signal trials during the avoidance acquisition phase, along with a less steep overall reduction in frequency of avoidance responses and slower extinction in the extinction phase. Our results were inconclusive regarding individual differences in the renewal effect. In general, our results provide evidence for the role of individual differences in vulnerability factors for pathological anxiety in the acquisition and extinction of avoidance and relief.

Experiment and mechanism investigation on the effect of heat treatment on residual stress and mechanical properties of SiCp/Al–Cu–Mg composites

Low-volume fraction particle-reinforced aluminum matrix composites (PRAMCs) are commonly prepared using powder metallurgy (PM) technology, followed by heat treatment processes to improve the performance of PRAMCs. PRAMCs are prone to produce significant uneven residual stresses during the quenching process. It is difficult to eliminate the quenching residual stress of PRAMCs via the heat treatment process of the matrix aluminum alloy. Therefore, this study systematically investigates the effects of solid solution and artificial aging treatment processes on residual stress, mechanical properties, and microstructure of SiCp/Al–Cu–Mg composites through orthogonal and single-factor experimental methods. After optimizing the heat treatment process, minor residual stress with a 71.6% von Mises residual stress relief rate and good comprehensive mechanical properties are achieved. Based on the experimental results, macro and micro mechanisms of residual stress evolution and strengthening of SiCp/Al–Cu–Mg composites during heat treatment are revealed, providing valuable insights into the process of heat treatment of PRAMCs.

Endoscopic septoplasty versus conventional septoplasty for nasal septum deviation: a systematic review and meta-analysis of randomized clinical trials.

The authors searched five electronic databases for relevant clinical trials. The records were screened for eligibility. Data were extracted from the included studies. Outcomes were pooled as risk ratios (RR) or mean differences with 95% CIs using RevMan ver.5.4. Our study included 13 randomized clinical trials with 735 patients. Our analysis revealed that endoscopic septoplasty was significantly (P<0.05) superior to conventional septoplasty for postoperative nasal obstruction relief, intraoperative and postoperative hemorrhage, and mucosal adhesion and synechiae across both long-term and short-term follow-ups. The following pooled RR values were found in short-term follow-up periods: [RR=1.20, 95% CI:=(1.09,1.32)]; [RR=0.27, 95% CI=(0.14,0.54)]; and [RR=0.16, 95% CI=(0.08,0.32)], respectively. Regarding persistent septal deviation and septal tear, endoscopic septoplasty had the upper hand only in short-term follow-up periods [RR=0.30, 95% CI=(0.17,0.53)] and [RR=0.26, 95% CI=(0.15,0.46)], respectively. Our analysis revealed that endoscopic septoplasty was significantly superior to conventional septoplasty in postoperative nasal obstruction relief rate and reducing the risk of intraoperative and postoperative hemorrhage, mucosal adhesion and synechiae, persistent septal deviation, septal tear, and surgery duration.