Reduction In Visual Analog Scale Research Articles

Efficacy of Combined vs. Monotherapy in Oral Lichen Planus: A Randomized Clinical Trial.

The aim of this study was to compare the topical therapeutic efficacy of triamcinolone acetonide (TA) (0.2%) plus hyaluronic acid (HA) (0.1%) versus monotherapy in patients with symptomatic oral lichen planus (OLP), as well as to investigate the oxidative stress of saliva under the different treatments. Sixty OLP patients were included in a randomized, double-blind, singlecenter study with a treatment duration of 28 days and 3-month follow-up period. Participants were randomized into three groups: Group I (TA + HA), Group II (TA), and Group III (HA). Treatment efficacy was assessed by means of Thongprasom scale, Oral Health Impact Profile-14 (OHIP-14), and visual analog scale (VAS). In addition, biochemical analyses were performed in order to determine the level of antioxidant biomarkers in saliva, including superoxide dismutase (SOD), glutathione (GSH), and total antioxidant capacity (TAC). All treatments seem to exhibit a significant effect in accordance with Thongprasom scale (p < 0.001), VAS reduction (p < 0.001), and OHIP14 (p < 0.05), which maintains over time. No significant changes in salivary oxidative stress in any of the three groups occurred. The results exhibited a significant improvement in the treated patients in all three groups. There were no significant changes in salivary stress biomarkers under treatment condition.

A keep-it-simple embolisation approach to treat pelvic congestion syndrome without compromising clinical effectiveness.

There are two approaches to treating pelvic congestion syndrome (PCS): (i) the keep-it-simple (KIS) approach, which involves embolising only the refluxing vein(s), typically the left ovarian vein (LOV) unless the right ovarian vein (ROV) or left/right internal iliac vein (IIV) tributaries are also refluxing; and (ii) the extensive (EXT) approach, which empirically embolises almost all of the LOV, ROV, and left and right IIV tributaries. The aim of this study is to determine whether the KIS approach can effectively treat PCS while minimising the number of treated veins and coils used, without the need for injecting sclerosing agents into pelvic veins or the use of occlusion balloons. This is a single-institution retrospective cohort study. Our records identified 154 women who underwent venograms for possible PCS, with the intent to proceed with embolisation. Refluxing veins were treated using the KIS approach, deploying minimal number of coils, 'sandwiching' sclerosing foam. Short-term follow-up was conducted at 6 weeks; long-term follow-ups (between 12 and 60 months) were conducted via an electronic survey consisting of 19 questions assessing pelvic pain/pressure, leg and back pain, fatigue, and bladder and menstrual symptoms. Fifteen women had negative venogram; 139 women had one or more refluxing veins on venogram. Most women (73%) required unilateral ovarian vein (OV) embolisation, 14% required bilateral OV embolisation, and 12% underwent pelvic vein embolisation. Most cases required only four pushable coils. Clinical success was 89% at 6 weeks and 84% at 1-5 years. A visual analogue scale reduction of 5.2 points (from 7.8 to 2.7) was achieved. There were no instances of coil dislodgement or other complications. The keep-it-simple approach, embolising only the refluxing ovarian and/or iliac veins, can achieve a successful clinical outcome for pelvic congestion syndrome. The extensive approach of empirically embolising all ovarian veins and internal iliac veins may not be necessary. This carries implications for potential savings in procedure time, cost and radiation dose.

An IoT-enabled EEG headphones with customized music for chronic tinnitus assessment and symptom management

Chronic tinnitus often affects elderly or hearing-impaired individuals, which can disturb their daily lives by disrupting concentration and limiting communication. Clinically, sound masking using external sounds like white noise (WN) aims to mask tinnitus and relieve secondary symptoms. Even when symptoms are relieved, tinnitus often requires long-term management, and for patients to visit healthcare professionals regularly. Generally, it could make maintaining symptom management challenging due to the time and effort required for consistent follow-ups. EEG is considered as one of the objective marker for assessing tinnitus symptoms. In this study, we designed IoT-enabled EEG sensing (IEES) headphones, an innovative IoT device that provided customized music (CM) and EEG measurement. The headphones employed a pitch-matching (PM) method to create CM tailored to each patient at specific frequencies for tinnitus patients. To collect EEG measurements, the device incorporated OpenBCI electrodes and a sensing chip to monitor brain waves and evaluate the outcomes.. After 30 days of experiment, participants showed significant reductions in both tinnitus handicap inventory (THI) scores and visual analog scale for annoyance (VAS-A) scores. In comparison, tinnitus frequency showed a slight reduction. EEG measurements demonstrated an increase in alpha band activity. In questionnaires, patients reported high satisfaction with their experiences. These findings highlight the potential of the proposed method for chronic tinnitus assessment and symptom management.

A study to determine the efficacy of intense pulse light in vascular mode for topical steroid damaged facies

Objectives: Misuse of topical corticosteroids on the face has gradually evolved over the years and has now reached phenomenal proportions on account of easy availability, widespread misinformation, and the fairness craze sweeping across the land. Topical steroid-damaged/dependent facies (TSDFs) may present with diffuse erythema, telangiectasia, papules, and atrophy. Current modalities used for the management of TSDF, such as topical tacrolimus and oral antibiotics, have shown a variable response. Intense pulsed light (IPL) systems are economical, have a higher safety margin, and are widely available. The goal of treating vascular lesions with IPL is to raise blood vessel temperature high enough to cause coagulation, leading to destruction and healing with fibrosis. In our study, we exploit these properties of IPL for the management of TSDF. Material and Methods: A total of 15 patients of TSDF were recruited and were treated with three sessions of IPL treatments (vascular mode) 3 weeks apart and were assessed based on a clinical score for TSDF, visual analog scale (VAS) for erythema assessed by the physician and patient at the end of 9 weeks. Results: There was a significant response with a reduction in clinical score of 5.4 points (P &gt; 0.001) and a reduction in physician and patient-assessed VAS for erythema of 3.47 and 3.73, respectively. Conclusion: There is a scarcity of data regarding the efficacy of various treatment modalities for TSDF. Our study establishes IPL (vascular mode) as an innovative emerging modality of treatment.

Effects of 3′-Sialyllactose on Symptom Improvement in Patients with Knee Osteoarthritis: A Randomized Pilot Study

Background/Objectives: 3′-Sialyllactose (3′-SL), a human milk oligosaccharide, has anti-inflammatory effects and is demonstrated to have protective effects against osteoarthritis (OA) in vitro and in vivo. However, this hypothesis remains to be investigated in a clinical setting. Herein, we investigated the effects of 3′-SL on pain and physical function in patients with knee OA. Methods: Sixty patients with knee OA with Kellgren and Lawrence grades (KL-grades) 1–4 and Korean Western Ontario and McMaster Universities Osteoarthritis Index (KWOMAC) scores ≥30 were randomly assigned to the placebo (n = 20), 3′-SL 200 mg (n = 20), and 3′-SL 600 mg (n = 20) groups. For 12 weeks, 3′-SL or placebo was administered to patients once a day. Clinical efficacy was evaluated using a visual analog scale (VAS) for pain and KWOMAC for physical function at baseline and at 6 and 12 weeks. Adverse effects were assessed for 12 weeks. Results: Significant reductions in VAS and KWOMAC scores were observed at 12 weeks compared with the baseline in the 3′-SL group. No severe adverse effects were observed over 12 weeks. Conclusions: 3′-SL reduced pain in patients with knee OA, improved daily life movements, and was safe, suggesting that 3′-SL might be an effective treatment for knee OA without severe side effects.

Patients With Graft Tears Leaving the Tuberosity Covered Have Similar Functional Outcomes to Those With an Intact Graft After Superior Capsular Reconstruction.

Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group. The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered. Cohort study; Level of evidence, 3. Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity. A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex (P = .72), previous surgery (P = .06), preoperative acromiohumeral distance (P = .57), and preoperative Goutallier stage of the supraspinatus (P = .16). Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.

Evaluation of the single and combined therapeutic effects of individually manufactured earplug therapy in patients with myogenous temporomandibular disorders: A randomized controlled clinical trial

ObjectiveTo evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD).MethodsOne-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey’s HSD, and chi-square tests (alpha = 0.05).ResultsAt T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05).ConclusionsThe short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month.Clinical RelevanceEarplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians.

Local Transplantation of Mesenchymal Stromal Cells Is Safe and Could Alleviate Kienböck Disease's Complications: A Clinical Trial Study.

Kienböck disease is a rare condition characterized by severe pain and restricted wrist movement. Various palliative methods have been proposed as therapeutic strategies for alleviating symptoms. Mesenchymal stromal cell transplantation has been suggested as an innovative and promising approach due to its potential for inducing regeneration and immunomodulation in the necrotic tissue. This study aims to evaluate the safety of autologous bone marrow derived mesenchymal stromal cells (BM-MSCs) transplantation after core decompression in Kienböck disease. In this phase I of an open-label clinical trial, three patients (one female and two males) with stage 2 Kienböck disease underwent autologous BM-MSCs transplantation following lunate core decompression. The patients were followed up for six months to assess safety as well as secondary clinical outcomes, including pain level, range of motion (ROM), and functional disability. Safety of BM-MSCs injection following the core decompression was evaluated by recording post-treatment complications during the six-month follow-up. No adverse events (AEs) or severe AEs (SAEs) were reported, indicating that BM-MSCs injection after core decompression is a safe intervention. All patients showed a remarkable reduction in visual analog scale (VAS) scores and "Disabilities of the Arm, Shoulder, and Hand" (DASH) questionnaire scores, suggesting the therapeutic potential of this intervention. Moreover, an increase in the ROM indicated that BM-MSCs transplantation can improve wrist functionality. Additionally, radiographic assessments before and after cell infusion demonstrated a reduction in lunate sclerosis after six months of follow-up. The transplantation of autologous BM-MSCs following lunate core decompression seems to be a safe clinical intervention and may lead to pain relief in patients with Kienböck disease. Furthermore, this procedure may help prevent disease progression during the follow-up period (registration number: NCT02646007).

Multimodal Analgesia Approach in Acute Low Back Pain Management: A Phase III Study of a Novel Analgesic Combination of Etoricoxib/Tramadol.

Pain and disability management are crucial for a speedy recovery. Combining analgesics with different mechanisms of action provides greater pain relief with lower doses, promoting efficient multimodal analgesia. This study evaluated the efficacy and safety between two fixed-dose combinations (FDC): etoricoxib/tramadol compared to paracetamol/tramadol for the management of acute low back pain (LBP) in a 7-day treatment. We conducted a phase IIIb, prospective, randomized, and multicenter study in patients with acute LBP treated with etoricoxib 90mg/tramadol 50mg (one packet of granules diluted in 100ml of water, once a day [QD], for 7 days) or paracetamol 975mg/tramadol 112.5mg (one tablet of 325mg/37.5mg, three times a day [TID], for 7 days) to assess the efficacy (in terms of pain and disability improvement) and safety. One hundred and twenty-four patients were randomized to receive either etoricoxib/tramadol QD (n = 61) or paracetamol/tramadol TID (n = 63). From the magnitude of change in pain evaluations, differences were observed between the treatment groups at 3 [p = 0.054, CI 95% -0.648 (-0.010 to 1.306)] and 5days (p = 0.041). The proportion of patients with a 30% reduction in Visual Analogue Scale (VAS) score was statistically significant when comparing the treatment groups on the third day of follow-up [p = 0.008, CI 95% 0.241 (0.061-0.421)]. An improvement in LBP's disability to perform activities of daily routine (Oswestry and Roland-Morris questionnaires) was observed in both treatment groups. A total of 79 adverse events (AEs) (38 [48.1%] with etoricoxib/tramadol and 41 [51.9%] with paracetamol/tramadol) were reported. The most frequent AEs were nausea (17.7%) and dizziness (16.4%). The results show the clinical benefits of etoricoxib/tramadol FDC, such as the sparing effect of tramadol dose per day, early therapeutic response rate compared with paracetamol/tramadol; which translates into faster pain relief, better adherence, less tramadol drug dependency, and a reduction of related AEs incidence. ClinicalTrials.gov identifier, NCT04968158.

Effect of hydrogen peroxide and hyaluronic acid in mouth rinse after third molar extraction: a triple-blind parallel randomized controlled clinical trial.

The study aimed to investigate the potential beneficial role of hydrogen peroxide (H2O2) and hyaluronic acid (HA) combination formulation in socket healing after third molar surgery. Biomaterials, including mouthwash formulations, were hypothesized to contribute to improved socket healing and reduced post-operative complications. A triple-blinded parallel randomized controlled clinical trial was conducted at a single-center dental hospital in Milan, Italy. The trial included 114 patients who underwent extraction of impacted, partially erupted, and completely erupted third molars. Patients were randomly assigned to three parallel groups: Group 1 (H2O2 and HA), Group 2 (placebo), and Group 3 (0.2% chlorhexidine). The trial was registered at ClinicalTrial.gov (registration number NCT04438434). The main outcome measures included various parameters related to socket healing, such as pain, inflammation, swelling, plaque index, bleeding index, granulation tissue, suppuration, re-epithelialization, bleeding upon palpation, odor, and taste alteration. Patients were followed up for 7 days. All 114 enrolled patients completed the study, with no dropouts or loss to follow-up. The mean age of patients in the three groups differed (H2O2 and HA: 30.9±14.9; placebo: 27.6±13.1; 0.2% chlorhexidine: 23.05±10.16). Significant reductions (p<0.001) in visual analog scale (VAS) pain levels and other outcome measures were observed in the H2O2 and HA group compared to the placebo group. These findings suggest a positive effect of the H2O2 and HA combination on socket healing after the third molar surgery. The study concludes that the combination of hydrogen peroxide and hyaluronic acid can be considered a potential mouthwash with beneficial effects on socket healing following third molar surgery. However, additional clinical trials are recommended to validate its effectiveness further and provide additional evidence supporting its use in clinical settings. gov: NCT04438434.

The Efficacy of Medical Treatment on Endometrioma: A Systematic Review and Meta-Analysis

Background: Ovarian endometriomas have been shown to have a negative effect on fertility. There is a dilemma on the timing for surgery either before or after the fertility treatment. By delaying surgical treatment for infertile patients with endometriomas, medical treatment has become an important choice for these patients. The objectives of this review were to compare the efficacy of medical treatment on endometrioma size and endometriosis-associated pelvic pain (EAPP). Methods: We performed a systematic review and meta-analysis examining women who have endometrioma and underwent medical therapy for endometrioma size reduction. The primary outcome measure was endometrioma size reduction. Secondary outcome measures EAPP. Results: We included 14 studies for the meta-analysis. We performed a systematic review and meta-analysis examining women with endometrioma who underwent medical therapy for endometrioma size reduction. The primary outcome measure was endometrioma size reduction. Secondary outcome measure is EAPP. The majority of the studies were non-randomized controlled trials (RCTs; 9/14), and five were RCTs. Women who received medical treatment have a significant endometrioma size reduction in diameter compared to women not receiving any medical treatment or placebo (MD −9.66[Formula: see text]mm; 95% CI [−13.85, −5.46], three studies, 467 women, [Formula: see text]%) and a reduction in visual analog scale (VAS) for EAPP (MD −2.64; 95% CI [−3.31, −1.97], two studies, 338 women, [Formula: see text]%). Women who received dienogest (DNG) treatment have a significant endometrioma size reduction in diameter (MD −4.61[Formula: see text]mm; 95% CI [−9.08, −0.15], three studies, 220 women, [Formula: see text]%). Compared to women receiving other medical treatments, women receiving DNG treatment had more VAS reduction of EAPP (MD −0.46; 95% CI [−0.62, −0.31], four studies, 451 women, [Formula: see text]%). Conclusions: The use of medical therapy is associated with endometrioma size reduction and a reduction in endometriosis-related pain when compared with no medical treatment given. With the availability of various medical options, surgery can thus be avoided to minimize the risk of damage to the ovarian reserves.

Impact of Centrifugation Parameters on Platelet-Rich Plasma Injection for Patella Tendinopathy: A Systematic Review and Meta-Analysis.

Patellar tendinopathy (PT) is a chronic, degenerative form of tendinitis commonly affecting young, active individuals. Numerous nonsurgical treatments exist, of which platelet-rich plasma (PRP) is a frontrunner. However, heterogeneity among various PRP preparation techniques results in a large variation in treatment efficacy. This review and meta-analysis aims to investigate the effect of PRP centrifugation factors, specifically centrifuge speed and duration, on functional outcomes in patients with PT. A systematic search of the literature was performed in April 2024 on Medline and Embase. Articles involving the use of PRP in the treatment of PT were included. The risk of bias was assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration, England, UK) and Risk of Bias in Non-randomised Studies of Intervention (ROBINS-I; the Cochrane Collaboration, England, UK) tools. Comparative meta-analysis between the different centrifugation speeds and the different centrifugation durations was performed on articles reporting Victorian Institute of Sports Assessment - Patellar tendon (VISA-P) and visual analogue scale (VAS) scores for PT. Seventeen studies consisting of 360 participants were included in the analysis. The mean follow-up duration was 13.2 months (95% CI: 8.81 to 17.7). The mean VAS reduction was 3.85 (95% CI: -4.63 to -3.08; P < 0.01). VISA-P scores improved by 32.03 (95% CI: 24.29 to 39.78; P < 0.01). There were no significant differences between centrifuge speeds for VAS (P = 0.17) and VISA-P (P = 0.18) and between centrifuge durations for VAS (P = 0.25) and VISA-P (P = 0.27). Centrifuge speed and duration and number of centrifuge cycles did not show any significant differences in patient outcomes. There were no significant differences observed in outcomes for the different preparations of PRP. There remains a need for further high-quality RCTs using standardized PRP preparations with long-term follow-up for the development of a consensus method of PRP preparation for the treatment of PT.

Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis.

To compare clinical outcomes following steroid injections using the anterior and posterior approaches. Systematic review with meta-analysis. Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. Patients with adhesive capsulitis. Glenohumeral steroid injections using either anterior or posterior approach. Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc

ObjectiveTo compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc.MethodsThis retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes.ResultsDuring the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B’s mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A’s mouth opening did not significantly improve. Regarding pain, Group A’s VAS score decreased by 0.463 ± 0.778 after one month, and Group B’s score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups.ConclusionCompared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

Robotic endoscopic transforaminal lumbar interbody fusion: A single institution case series

BackgroundRobotic-assisted, endoscopic transforaminal lumbar interbody fusion (RE-TLIF) is a promising, minimally invasive surgical option for degenerative lumbar spondylosis/spondylolisthesis; however, outcomes data and efficacy are limited, especially in multilevel disease. Here, we present the first reported series of patients that underwent either single or multilevel RE-TLIF. MethodsA retrospective review was performed on 23 consecutive patients who underwent a single level or multilevel RE-TLIF by a single surgeon. Variables included demographics, perioperative results, pain scores, and functional outcome scores. ResultsEighteen patients (78.3 %) underwent single level RE-TLIF and 5 patients (21.7 %) underwent multilevel RE-TLIF. The median reduction of visual analog scale (VAS) for low back pain (LBP) of all subjects was 6 (IQR = 4.5, 6.5) with no significant difference between single level and multilevel RE-TLIF (p = 0.565). The median reduction of VAS for leg pain of all subjects 7 (IQR = 6, 8) with no significant difference between single level and multilevel RE-TLIF (p = 0.702). Median blood loss was 25 cc (IQR = 25, 25) and 50 cc (IQR = 25, 100) for single and multilevel RE-TLIF, respectively (p = 0.025), whereas median length of stay was 1 (IQR = 1, 1; mean = 1.0 ± 00.18) days and 1 (IQR = 1, 2; mean = 1.4 ± 00.54) days, respectively (p = 0.042). One major complication was observed requiring reoperation for demineralized bone matrix migration resulting in an L5 radiculopathy. ConclusionsSingle and multi-level RE-TLIF appears to be a safe and efficacious approach with comparable outcomes to open and other minimally invasive approaches. Additionally, we observed favorable accuracy in robot-assisted pedicle screw, endoscope, and interbody device placement.

The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study

Aim: Patients with De Quervain's stenosing tenosynovitis (DQT) experience problems in daily living activities due to the chronic inflammatory process and tenderness around the wrist. This study aimed to compare the effects of prolotherapy and steroid injection on short-term functional outcomes in DQT patients. Methods: In this retrospective study between January 2022 and 2023, a cohort of 34 patients with complete demographic data and elbow pain and functional scores, which were recorded at pre-treatment, two weeks, and six weeks post-treatment, was divided into the steroid injection (n=17) and prolotherapy (n=17) groups. Demographic and clinical data of all patients were recorded. The outcomes of the Visual Analogue Scale (VAS) score for wrist pain, Quick Disability Assessment of Arm, Shoulder, and Hand Problems (QuickDASH), and the Health Assessment Questionnaire (HAQ) for wrist functions were examined. Results: Initial assessments did not reveal any differences between groups in terms of VAS (p=0.756), QuickDASH (p=0.168), and HAQ (p=0.615). In the second week post-treatment, there was a significant reduction in VAS, QuickDASH, and HAQ in steroid injection compared to the prolotherapy (p=0.001). This difference continued at sixth-week post-treatment; VAS (p=0.007), QuickDASH (p=0.003), and HAQ (p=0.011) were found to be significantly lower in steroid injection than in the prolotherapy. Conclusion:Our findings underscore the superior effectiveness of steroid injection compared to prolotherapy in reducing wrist pain and improving functional outcomes in patients with DQT. These findings benefit orthopedic settings in choosing treatment options logically, though further research is needed to understand long-term effects and mechanisms.

The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis.

Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients, lacking effective treatment options. A review was conducted utilizing EMBASE, MEDLINE, and all evidence-based medicine reviews to evaluate the effect of fat grafting as a treatment option for PMPS from database inception to 29 April 2023 (PROSPERO ID: CRD42023422627). Nine studies and 812 patients in total were included in the review. The overall mean change in visual analog scale (VAS) was -3.6 in 285 patients following fat grafting and 0.5 in 147 control group patients. There was a significant reduction in VAS from baseline in the fat grafting group compared to the control group, n = 395, mean difference = -2.17 (95% CI, -2.95 to -1.39). This significant improvement was also noted in patients who underwent mastectomy without reconstruction. Common complications related to fat grafting include capsular contracture, seroma, hematoma, and infection. Surgeons should consider fat grafting as a treatment option for PMPS. However, future research is needed to substantiate this evidence and to identify timing, volume of fat grafting, and which patient cohort will benefit the most.

Outcomes of combined treatment of patients with acute lumbodynia

Introduction. Acute dorsalgia is a common reason to seek outpatient medical care in Russia. The clinical picture usually includes muscular-tonic and pain syndromes. The most common form of dorsalgia by localization is acute lumbar pain (lumbodynia).Aim. To evaluate the effectiveness of Spascuprel®, Traumeel S in the complex treatment of patients with acute lumbar pain in real-world clinical practice.Materials and methods. We conducted a non-interventional, prospective, observational study of 110 outpatients aged 26 to 65 years. Patients received a standard on-demand therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, Group 1 received Spascuprel® and Traumeel® C, and Group 2 received centrally acting muscle relaxants. The effectiveness of treatment was assessed using the visual analogue scale (VAS) of pain intensity and the limitations of various activities in daily living were measured using the Roland – Morris questionnaire. Consideration was given to the exacerbation duration, the need for additional intake of NSAIDs, and the number of cases of pain exacerbation within 60 days from the start of participation in the observational study.Results. Under treatment, pain intensity showed statistically significant decreases in VAS scores (from 61.0 to 35.5 scores out of 100 according to VAS by Day 7 and to 19.5 scores by Day 14 of treatment in Group 1, from 61.2 to 41.1 and to 25.8 scores in Group 2, respectively (p &lt; 0.05)). A more rapid decrease was observed in VAS pain intensity score from baseline in Group 1. Over 2-month observation period, group 1 had less exacerbations (p &lt; 0.05) and fewer cases of need for additional intake of NSAIDs (p &lt; 0.05). The frequency and severity of adverse events did not differ between two groups.Conclusion. A more rapid decrease in VAS pain intensity scores and reduction in the need for NSAIDs were noted in the group of patients with acute dorsalgia who used Traumeel® C and Spascuprel® in addition to standard NSAID therapy.

Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients.

Laminectomy has long been a "gold standard" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT). A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman's correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted. The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient. FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.

A pilot study on Langerhans cells in keratoconus patients by in vivo confocal microscopy before and after corneal cross-linking and correlation with eye rubbing

PurposeThe aim of this study was to investigate the corneal microstructure and Langerhans cells using in vivo confocal microscopy in keratoconus patients before and after cross-linking, and to correlate the morphologic findings with clinical and patient-reported outcomes, including eye rubbing (ER) behavior. MethodsPatients with progressive keratoconus undergoing iontophoresis-assisted epithelium-on cross-linking (I-CXL) were consecutively enrolled. In vivo confocal microscopy was performed before and 6 months after treatment. Patients were asked to quantify their ER behavior on a Visual Analogue Scale (VAS) and completed the Keratoconus Outcomes Research Questionnaire and the Ocular Surface Disease Index questionnaires at the same time points. Visual acuity, tear osmolarity, topography, aberrometry, and pachymetry of both eyes were assessed. ResultsThirteen patients were included in this pilot study. Preoperatively, the mean Langerhans cells density was 35,615 cells per mm2, and the median morphology was 3. The mean ER VAS before treatment was 7,077 out of 10. The ER VAS showed significant positive correlations with both Langerhans cells density and morphology of the study eye. After treatment, a statistically significant reduction in ER VAS and in Langerhans cells variables was observed. The mean sub-basal plexus nerve density was comparable to pre-operative values 6 months after I-CXL. ConclusionsBased on this preliminary evidence, the presence of high density of mature Langerhans cells in the central cornea of keratoconus patients and its correlation with eye rubbing support the role of inflammation in keratoconus. The reduction in these markers after treatment may suggest a potential of CXL in moderating immune-related inflammation and eye rubbing in the medium term.