Visual Analogue Scale Research Articles

Effectiveness of Low-Volume Versus High-Volume Ropivacaine for Ultrasound-Guided Maxillary Nerve Block in Double-Jaw Surgery: A Randomized Non-inferiority Trial

Abstract Background Ultrasound-guided maxillary nerve block (UGMNB) is applied in oral and maxillofacial surgery to improve perioperative analgesia, decrease the risk of postoperative nausea and vomiting, and enhance recovery. However, the optimum volume of ropivacaine used for UGMNB is undetermined. Thus, it was hypothesized that in patients undergoing double-jaw surgery, low- and high-volume ropivacaine reduces perioperative pain with similar efficacy. Methods Adults undergoing double-jaw surgery were enrolled in a randomized non-inferiority trial to receive a bilateral single-injection UGMNB with 2 mL (low-volume [LV] group) or 5 mL (high-volume [HV] group) of 0.375% ropivacaine on each side. A visual analog scale (VAS) score for maxillary pain at 2 h postoperatively was taken as the primary outcome. VAS score for maxillary and mandibular pain at 2, 4, 6, 8, 12, 24, and 48 h postoperatively, hemodynamic changes intraoperatively, consumption of intraoperative opioids and sedatives, vasoactive medication use, extubation time, postoperative rescue analgesia, time to the first analgesia, postoperative nausea and vomiting and UGMNB-related complications within 48 h post-surgery were assessed as the secondary outcomes. Results Sixty-four adults were included. The maxillary pain score in the LV group was not inferior to that in the HV group at 2 h postoperatively, with a non-inferiority margin of 1 (mean difference − 0.1; 95% confidence interval [CI] − 0.6 to 0.8, P = 0.414 for non-inferiority). Maxillary and mandibular pain demonstrated no difference in the measured times between groups. The incidence of postoperative nausea was significantly higher in the LV group than that in the HV group at 6–24 h (12 (37.5%) vs. 5 (15.6%), P = 0.048). Moreover, no differences in intraoperative hemodynamic parameters, medications during anesthesia, time to extubation, rescue analgesia, time to the first analgesia, and postoperative vomiting were observed. Only one patient in the LV group was observed to have maxillary nerve block-related complications. Conclusions To conclude, the efficacy of UGMNB with 2 mL of 0.375% ropivacaine has the same efficacy as the 5 mL drug in reducing perioperative pain in patients undergoing double-jaw surgery. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Evaluation of Clinical Outcomes in Sport Participants Undergoing Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the most common musculoskeletal injuries. Evaluating the clinical outcomes of the ACL reconstruction (ACLR) procedure is essential to provide information regarding the benefits of this procedure. This study aimed to assess the clinical outcomes of patients who underwent ACLR at Prof. Dr. R. D. Kandou Hospital Manado. This was a retrospective study. Secondary data were collected from all athlete patients who underwent ACLR. The ACLR procedure was performed by a single operator following the standard arthroscopic procedure. All grafts used Hamstring grafts (gracilis and semitendinosus). Suspense fixation was done using a button, while tibial fixation was done with interference fixation (bioabsorbable screw). Patients were evaluated over a short period, specifically at three months, six months, and nine months. Outcome parameters were assessed using the Visual Analog Scale (VAS), Range of Motion (ROM), Lachman test, Anterior Drawer test, and Knee Functional Score (KFS). Any complications that arose were documented. The results showed that among 21 patients at Prof. Dr. R. D. Kandou Hospital Manado, it was found that ACL injuries were more common in physically active men, especially in the age group of 26-30 years. Most patients who underwent ACLR had serious injuries that required immediate treatment. Hamstring graft was the most common choice (85.7%). Knee stiffness was the most common complication and required special attention during the rehabilitation program. Based on KFS, most patients successfully achieved good knee function recovery. There was a decrease in the VAS score reflecting the effectiveness of the procedure in reducing postoperative pain. There was an increase in the KSS reflecting the success of ACLR in restoring knee stability and function to almost normal levels. In conclusion, anterior cruciate ligament reconstruction in sport participants showed significant improvements in knee mobility and pain reduction, with low complications. Keywords: anterior cruciate ligament injury; anterior cruciate ligament reconstruction; graft fixation

Pain Decrement Using Radiofrequency Therapy After Knee Platelet-Rich Plasma Injections Within First 72 h in Active Populations with Patellar Chondropathy

Objective: To determine whether 448 kHz capacitive-resistive monopolar radiofrequency (CRMR) after platelet-rich-plasma (PRP) injections can further reduce pain sensation within the first 72 h in an active population with patellar chondropathy. Methods: One-hundred fifty-three active patients with patellar chondropathy grade II-III were followed for three days after PRP injections with and without CRMR under a control–placebo study. They were clinically evaluated for pain sensation using a visual analog scale ranging from zero (no pain sensation) to ten (highest pain sensation). Pain sensation was described using medians and analyzed through the Friedman and Conover test for within-group comparison (pre-intervention, and 24, 48, and 72 h post-intervention) and the Mann–Whitney test for between-group comparisons (Intervention vs. Placebo) with α = 5% and 1−β = 80%. Results: The placebo group showed statistical significance between pre-intervention and 24 h (Δ = −2.0 pts, p < 0.001), baseline and 48 h (Δ = −2.0 pts, p < 0.001), baseline and 72 h (Δ = −3.0 pts, p < 0.001), 24 h and 48 h (Δ = 0.0 pts, p < 0.016), and 24 h and 72 h (Δ = −1.0 pts, p < 0.001). The radiofrequency group showed statistical significance between baseline and 24 h (Δ = −7.0 pts, p < 0.001), baseline and 48 h (Δ = −7.0 pts, p < 0.001), baseline and 72 h (Δ = −8.0 pts, p < 0.001), 24 h and 72 h (Δ = −1.0 pts, p < 0.001), and 48 h and 72 h (Δ = −1.0 pts, p < 0.001). The placebo and radiofrequency groups were significantly different at 24 h (Δ = 4.0 pts, p < 0.001), 48 h (Δ = 4.0 pts, p < 0.001), and 72 h (Δ = 4.0 pts, p < 0.001). Conclusions: CRMR therapy administered after knee intra-articular injections of PRP within the first 72 h in active populations with patellar chondropathy reduces pain sensation with a median difference of 8.0 pts compared to baseline and 4.0 pts compared to placebo group.

Rating of overall childbirth experience: A qualitative study of a quantitative measurement

AbstractIntroductionOverall childbirth experience scores are used both in research and in clinical settings. Since it is still not fully understood what assessment of childbirth experience on a single‐item numeric rating scale or visual analog scale represents, the aim of this study was to explore women's reasoning and thoughts when rating overall childbirth experience numerically.Material and MethodsA qualitative interview study of 26 women was conducted using a think‐aloud technique at a university referral hospital in Sweden. A manifest qualitative content analysis was performed to generate categories and sub‐categories representing how women decided which single value should represent their experience of giving birth.ResultsTwo main categories emerged from the analysis. The first, Strategies for choosing a number, reflects variations in how the women approached the rating scale itself and includes five sub‐categories, each relating to a different strategy: (1) Comparison, (2) Start from the maximum value, (3) Start from the middle, (4) Weigh certain experiences more heavily, and (5) A means to an end. The second category, Specific factors considered in the rating, includes four sub‐categories, representing groups of factors contributing to the final childbirth experience score: (1) The time period, (2) Events linked to strong emotions, (3) Perceived support, and (4) Previous expectations. What the women included in their overall childbirth experience was hence translated into a number, using strategies from the first category and factors from the second category.ConclusionsThe considerable variations in how women approach the rating scale, and what they include in the assessment of overall childbirth experience, suggest that not only the childbirth experience itself but also the reasoning when evaluating it, is multifaceted. A standardized phrasing of the question and a clear purpose for the evaluation is warranted to strengthen the validity of the measurement. When used clinically for identifying women in need of support after childbirth, the rating should be followed by a conversation about the experience of giving birth, independent of the value chosen.

Home-use agents in the treatment of dentin hypersensitivity: clinical effectiveness evaluation with different measurement methods

ObjectivesThis study aimed to evaluate the effectiveness of home-use desensitizing agents over an 8-week period by comparing them using different measurement methods.MethodsA randomized, controlled clinical trial was conducted with 180 individuals aged between 18 and 70 who clinically diagnosed dentin hypersensitivity (DH) in two or more non-adjacent teeth. Subjects who met the inclusion criteria (n = 164) were randomly allocated into five test groups—using Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), Arginine, Novamin, Propolis, and Potassium nitrate—and a control group using standard fluoride toothpaste. The status of DH was assessed at week 4 and week 8 by the same independent examiner. Changes from baseline in Dentine Hypersensitivity Experience Questionnaire-15 (DHEQ-15), Schiff Sensitivity Scale (SSS) and Visual Analog Scale (VAS) were analysed using ANOVA and Kruskall-Wallis tests.ResultsAll test groups showed statistically significant improvements in DH at weeks 4 and 8 compared to baseline in the DHEQ-15, VAS, and SSS assessments (p < 0.005). In the control group, significant improvements were observed only in the VAS and SSS measurements from baseline to weeks 8 (p < 0.005). The CPP-ACP group demonstrated the greatest reduction in scores by the end of week 8 compared to baseline, with DHEQ-15 (56.68 ± 17.87), VAS (6.52 ± 1.48), and SSS (2.32 ± 0.56).ConclusionsAmong the tested agents, the CPP-ACP group demonstrated the most notable reduction in DH symptoms by week 8, highlighting its potential as an effective method for alleviating DH symptoms in a home-use agents.Clinical relevanceHome-use desensitizing agents are effective in the treatment of DH, improving the daily activities of patients who cannot access clinical care and ensuring the relief of DH before clinical invasive procedures.Trial registrationClinicalTrials.gov Identifier: NCT06216262.

Correlation between serum levels of fibroblast growth factor-21 and the severity of migraine headache in patients undergoing sodium valproate treatment

Background: Mitochondrial metabolism disruption increases neuron excitability and reduces migraine attack threshold. This study investigates whether serum fibroblast growth factor-21 (FGF-21) levels in chronic migraine relate to headache severity and response to sodium valproate treatment. Methods: This pilot study involved 30 patients with chronic migraine treated with sodium valproate. Serum FGF-21 levels were assessed at baseline and after 12 weeks of treatment. Pain severity and disability were evaluated using visual analogue scale (VAS) and Migraine Disability Assessment (MIDAS). Paired t-test was used for the quantitative variables. The qualitative variables were evaluated using Pearson’s chi-square test and Fisher’s exact test. Moreover, correlation coefficients were calculated. A P &lt; 0.05 was considered statistically significant. Results: Mean age of the patients was 42.9 ± 11.3 years. There was a significant reduction in headache severity between baseline and the end of the study regarding VAS scores (8.50 ± 1.50 vs. 5.30 ± 2.20, P &lt; 0.001). The same reduction was observed in MIDAS during the study (61.20 ± 33.20 vs. 20.31 ± 17.07, P &lt; 0.001). However, there was no significant changes in serum levels of FGF-21 over three months (299.53 ± 479.80 vs. 491.33 ± 456.64, P = 0.810), nor any relationship between these levels and headache severity scores (MIDAS: P = 0.658, VAS: P = 0.708). Conclusion: The results of this study did not show a significant correlation between FGF-21 serum levels and changes in VAS and MIDAS throughout the study. Further research on various mitochondrial pathways can provide valuable insights into the migraine pathophysiology and help identify more effective biomarkers for monitoring therapeutic regimens.

Multimodal ultrasound assessment of the injection therapy in lateral epicondylitis: a retrospective observational study

BackgroundAt present, there is a dearth of objective methodologies for assessing the effectiveness of treatments for Lateral Epicondylitis (LE). This study examined 73 patients suffering from tennis elbow using a multimodal ultrasound approach and investigated the correlation between pertinent indicators and clinical scores.Methods73 patients diagnosed with unilateral tennis elbow by interventional ultrasound at Zhejiang Rongjun Hospital were included in the study. Ultrasound data of the extensor tendon, as well as VAS (Visual Analog Scale) and MEPS (Mayo Elbow Performance Score) for the affected elbow, were collected before and after a two-week treatment period. The study aimed to compare the alterations in gray-scale ultrasound features, hemodynamic parameters, and elastography scores pre- and post-treatment, and to analyze the correlation between the changes in ultrasound parameters and pain scores.ResultsFollowing treatment, the effective group exhibited a reduction in both the blood flow grade and elastic score of the extensor tendon. Additionally, the extensor tendon thickness in the effective group diminished to a greater extent than in the ineffective group. The effective group also experienced a higher rate of decrease in blood flow grade and a more pronounced increase in Resistive Index (RI) compared to the ineffective group. The reduction in tendon thickness, the increase in RI, and the improvement in elastic score were all positively correlated with the reduction in VAS scores. Notably, the increase in RI demonstrated the strongest correlation with the decrease in VAS scores.ConclusionsMultimodal ultrasound plays a significant role in the clinical assessment of treatment outcomes for Lateral Epicondylitis.

Intralesional steroid injection in keloid ear — a prospective observational study

BackgroundKeloid is a fibro-proliferative dermal benign growth affecting the Asian population. In India, ear keloids are common, often resulting from ear piercing, a prevalent cultural practice. The resultant ear keloids pose aesthetic concerns, leading to significant psychological distress, and necessitating effective treatment. While various treatment options are available, their outcomes and recurrence rates vary, highlighting the need for individualized and optimal management strategies. Our study aimed to observe the combined effect of intralesional triamcinolone with hyaluronidase on keloid regression.MethodsThis prospective observational study was conducted at our tertiary care institute over 1 and a half years. Fifty patients who met the inclusion criteria were enrolled and received intralesional triamcinolone injection with hyaluronidase. Keloid regression was assessed using the Vancouver Scar Scale (VSS), while the visual analogue score (VAS) and patient satisfaction score (PSS) provided subjective evaluations of symptom relief. All patients underwent compression therapy. Patients were evaluated at every visit and then at 1 year for symptom relief, keloid regression, and complications if any.ResultsDemographic data of all patients were recorded. Ear keloids were predominantly observed in females, with a male-to-female ratio of 18:32. The most common etiology was trauma following ear piercing, accounting for 46% of cases. All patients showed improvement in VSS, VAS, and PSS scores in the follow-up visits. A total of 98% of patients demonstrated a complete treatment response, with only a single instance of recurrence.ConclusionIntralesional triamcinolone with hyaluronidase provides satisfactory symptomatic relief and has lower recurrence rates. All patients showed improvement in the Vancouver Scar Scale and had enhanced VAS and PSS scores.

Long COVID-19–related and non-COVID-19 postviral olfactory dysfunction a comparative MRI study focusing on the olfactory cleft and bulbs

ObjectiveTo compare the magnetic resonance imaging (MRI) features of the olfactory cleft (OC) and olfactory bulbs (OBs) in patients with long COVID-19-related (LCOD) and non-COVID-19 postviral olfactory dysfunction (NCPVOD) to explore mechanisms underlying persistent olfactory dysfunction.MethodsThis retrospective analysis included patients diagnosed with LCOD or NCPVOD at the China–Japan Friendship Hospital between February 2023 and July 2024. All patients underwent olfactory psychophysical testing (Sniffin’ Sticks), a visual analogue scale (VAS) for olfactory function, and high-resolution MRI scans of the olfactory pathway. MRI features, including OC opacity, OB morphology, OB volume, and olfactory sulcus depth, were compared between groups. Correlations between MRI findings and olfactory test scores were assessed.ResultsSeventy patients were included (35 LCOD, 35 NCPVOD). LCOD patients had significantly higher OC opacity scores than NCPVOD patients (p &amp;lt; 0.001). No significant differences were found in OB morphology, abnormal OB signals, OB volume reduction, or distances between OBs and surrounding structures (p &amp;gt; 0.05). LCOD patients had significantly greater right olfactory sulcus depth than NCPVOD patients (p = 0.026), with negative correlation to age (r = −0.25, p = 0.04). OB volumes positively correlated with TDI and VAS scores.ConclusionLCOD patients exhibited greater OC opacity than NCPVOD patients, suggesting OC inflammation may contribute to persistent olfactory dysfunction. Treating inflammation in the OC could improve long-term olfactory outcomes. OB volume reduction was common in both groups.

Comparison of clinical efficacy of different internal fixation methods in older adult patients with osteoporotic fractures of proximal humerus

ObjectiveTo compare the efficacy of three treatment methods for older adult patients with osteoporotic proximal humerus fractures: proximal humerus locking plate (PHILOS) combined with calcium sulfate injection, PHILOS plate alone, and artificial hemi-shoulder joint replacement.MethodsThe clinical data of 48 older adult patients with osteoporotic proximal humerus fractures admitted to the Shoulder and Elbow Surgery Department of Zhongshan Hospital Affiliated with Dalian University from February 2018–August 2021 were retrospectively analyzed. The patients comprised 18 males and 30 females, with a mean age of (68.6 ± 5.8) years. The 48 patients were divided into three groups based on their treatment methods: Group A: 16 patients treated with PHILOS plate combined with calcium sulfate injection. Group B: 16 patients treated with the PHILOS plate alone. Group C: 16 patients treated with artificial hemi-shoulder joint replacement. Key parameters such as operation time, blood loss, incision length, operation cost, and shoulder joint motion at the final follow-up were recorded and compared. Shoulder joint function was evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS) for pain, University of California Shoulder Joint Score (UCLA), and Brief Shoulder Function Test (SST).ResultsThere were no statistically significant differences in the preoperative general data between the three groups (P &amp;gt; 0.05), indicating comparability. There was no significant difference in operation time, blood loss, and incision length among Groups A, B, and C (P &amp;gt; 0.05). However, Group C had significantly higher operation costs compared to the other two groups (P &amp;lt; 0.05). At the final follow-up, there were no significant differences in shoulder flexion and rotation among the three groups (P &amp;gt; 0.05). However, a statistically significant difference in abduction was observed between Group A and Group C (P &amp;lt; 0.05). No significant differences were found in ASES, VAS, UCLA, and SST scores among the three groups at the last follow-up (P &amp;gt; 0.05).Complications occurred in 1 patient (Group A), 3 patients (Group B), and 4 patients (Group C), showing a statistically significant difference among the groups (P &amp;lt; 0.05).ConclusionAll three surgical methods are effective in treating older adult osteoporotic proximal humerus fractures, as they significantly alleviate pain and restore joint function. However, the use of a PHILOS plate combined with calcium sulfate injection (Group A) is particularly effective, demonstrating reliable clinical efficacy with fewer complications.

Enhancing heart and circulatory well-being through optimized radial artery techniques: a meta-analysis of hemostasis and patient comfort

ObjectiveThis meta-analysis elucidates the efficacy of the Transradial Band Device (TR Band) in minimizing complications like radial artery occlusion and hematoma, preserving heart health, and enhancing blood flow post-transradial catheterization.MethodsA comprehensive literature search across databases including PubMed, Cochrane, and Embase examined the impact of radial artery compression techniques and decompression times on complications. Data from 13 studies were analyzed using R 4.1.2 with fixed-effects and random-effects models. The Newcastle-Ottawa Scale assessed the risk of bias in observational cohort studies.ResultsIn our meta-analysis, we evaluated data from various studies encompassing different air volumes in transradial band devices across several outcomes including bleeding, hematoma, radial artery occlusion (RAO), Visual Analog Scale (VAS) scores, and compression time. The collective analysis integrated findings from 11 studies, totaling 4,679 patients. No significant difference in bleeding risk (OR 1.04, 95% CI 0.60–1.82, p &amp;gt; 0.05, I2 = 78%), hematoma incidence (OR 0.96, 95% CI 0.78–1.19, p &amp;gt; 0.05, I2 = 0%), or RAO incidence (OR 0.96, 95% CI 0.78–1.19, p &amp;gt; 0.05, I2 = 0%) was observed between the “Less air” and “15 ml air” groups. However, the “Less air” group reported significantly higher VAS scores indicating increased pain or discomfort (Mean Difference 0.25, 95% CI 0.09–0.41, p &amp;lt; 0.05, I2 = 0%). Compression time analyses showed no significant difference between groups (Mean Difference −17.73, 95% CI −54.65–19.20, p &amp;gt; 0.05, I2 = 99%). Sensitivity analyses confirmed the stability of these findings, and Egger's test indicated no significant publication bias across the outcomes. This synthesis highlights the nuanced impact of air volume adjustments in transradial bands on patient outcomes, emphasizing the necessity for further research and standardized protocols to optimize patient safety and comfort post-intervention.ConclusionThe TR Band, when utilized with optimized air volume/pressure, maintains an essential balance between ensuring hemostasis and enhancing patient comfort without elevating the risk of radial artery complications. These findings support the careful selection of TR Band settings to optimize clinical outcomes in patients undergoing transradial cardiac procedures. Further research is warranted to establish standardized guidelines for the most effective use of TR Band in various clinical scenarios.

Sedative effects of roasted green tea aroma on autonomic nervous activity, central nervous activity, and subjective mood state in healthy adults

Introduction: To clarify the physiological and psychological effects of roasted green tea aroma, this study examined the effects of roasted green tea extract and its major aromatic components on autonomic nervous activity, central nervous activity, and subjective mood state. Methods: Twenty healthy adults who were not averse to the aroma of green tea, did not smoke, did not display any flu symptoms, and were not receiving drug treatment participated in this study. The study samples comprised a roasted green tea extract from Shizuoka first-growth green tea (Test I) and three pyrazines, which are the main aromatic components of roasted green tea (Test III). The pupil miosis rate, peripheral skin temperature, and cerebral blood flow were measured after 2 min of inhalation of the study samples as physiological evaluations. Subjective mood state was investigated using a questionnaire for psychological evaluation. Results: The results showed that inhalation of roasted green tea aroma significantly increased the pupillary miosis rate and peripheral skin temperature, similar to the effects observed with hot water. Furthermore, inhalation of roasted green tea aroma reduced the amount of oxygenated hemoglobin in the prefrontal cortex, suggesting that it also has a sedative effect on the central nervous system. In the psychological evaluation using the Visual Analog Scale, roasted green tea aroma inhalation reduced the scores for “tension”, and “anxiety” while increasing those for “mood” and “comfort” relative to those observed with hot water. In addition, the evaluation of the main aromatic components of roasted green tea, specifically three different pyrazines, demonstrated physiological effects similar to those of roasted green tea even at room temperature when tested at concentrations derived from the results of the analysis. Conclusion: The aroma of roasted green tea has both physiological and psychological sedative effects that differ from those of hot water and suggest that these pyrazines play a role in producing these effects, with 2,3,5-trimethylpyrazine being the most important aromatic component. Furthermore, the findings suggest that roasted green tea aroma exerts a sedative effect on the autonomic nervous system by suppressing sympathetic nerve activity while increasing parasympathetic nerve activity.

Robotically Assisted vs. Manual Total Hip Arthroplasty in Developmental Hip Dysplasia: A Comparative Analysis of Radiological and Functional Outcomes

Background/Objectives: Developmental dysplasia of the hip (DDH), defined by the malalignment of the femoral head and acetabulum, is a major precursor to coxarthrosis, posing substantial challenges during total hip arthroplasty (THA). Patients with coxarthrosis secondary to DDH often exhibit acetabular bone insufficiency, which makes challenging surgical reconstruction difficult. This study aimed to compare the radiologic and functional outcomes of robotically assisted and conventional manual THA techniques in patients with coxarthrosis secondary to Crowe type III–IV DDH. Methods: This prospective study included 40 patients divided into robotically assisted (n = 20) and conventional manual (n = 20) THA groups. Evaluations encompassed hip pain (Visual Analogue Scale, VAS), function (Harris hip score and University of California, Los Angeles, activity scale), quality of life (Short Form-12), and prosthesis sensation (Forgotten Joint Score-12). Radiologic outcomes included acetabular inclination and anteversion angles. Femoral shortening, operative duration, and follow-up times were also analyzed. Results: Demographic characteristics did not differ between groups (p &gt; 0.05). Robotically assisted THA exhibited a significantly longer operative time (171.40 ± 11.96 vs. 150.30 ± 14.67 min; p = 0.001) but a shorter follow-up (29.3 ± 8.51 vs. 52.95 ± 18.96 months; p = 0.001), without a difference in the amount of femoral shortening (p = 0.947). Despite the extended surgical duration, the two techniques achieved comparable radiologic outcomes, with no significant differences in acetabular inclination or anteversion angles (p &gt; 0.05). Functional assessments, including Harris hip scores (73.85 vs. 73.95; p = 0.978), UCLA activity scores, and VAS, indicated similar efficacy between groups. SF-12 physical and mental quality of life and Forgotten Joint Score-12 prosthesis sensation did not differ between groups (p &gt; 0.05). Conclusions: This study concludes that robotically assisted and conventional manual THA present similar radiologic and functional outcomes in patients with coxarthrosis secondary to Crowe type III–IV DDH, as displayed by comparable acetabular anteversion and inclination alignment, femoral shortening, hip function, pain, quality of life, and prosthesis sensation scores. While robotically assisted THA requires a longer operative time, its precision in implant placement may hold potential advantages for long-term outcomes, demanding further investigation in extended follow-up studies.

Dapagliflozin combined with metformin improves blood glucose, bone metabolism and bone mineral density in elderly patients with type 2 diabetes mellitus complicated with osteoporosis.

The incidence of type 2 diabetes mellitus (T2DM) complicated with osteoporosis (OP) (T2DM-OP) is growing. Dapagliflozin and metformin are commonly prescribed to manage glycemic levels in T2DM patients. We investigated the clinical efficacy of combining dapagliflozin with metformin in elderly patients with T2DM-OP. Totally 144 T2DM-OP patients were prospectively enrolled and allocated into two groups: the Metformin and Dapagliflozin + Metformin groups. Each group received treatment for 12 months. Fasting peripheral blood samples were collected before and after 12 months of treatment. Glycemic parameters and bone metabolic parameters were measured using oral glucose tolerance test, automatic biochemical analyzers, or liquid chromatography. Bone mineral density (BMD) changes at lumbar vertebrae (L1-4), femoral neck (FN) and total hip (TH) were assessed using dual-energy X-ray bone mineral densitometry. Pain severity was evaluated using the visual analog scale (VAS). The total effective rate, fracture incidence, and adverse reaction rate were also evaluated. After 12 months, both groups showed improvements in glycemic parameters, bone metabolic parameters, and BMD at L1-4, FN, and TH, and reductions in VAS scores. The Dapagliflozin + Metformin group exhibited more significant improvements. The overall effective rate was higher and fracture incidence, was lower in Dapagliflozin + Metformin group, with comparable rates of adverse reactions and safety profiles between the two groups. Taken together, treatment with a combination of dapagliflozin and metformin led to improvements in blood glucose levels, bone metabolism, and BMD in elderly patients with T2DM-OP, demonstrating superior efficacy and safety compared to metformin monotherapy.

Robot‐Assisted Positioning for Percutaneous Endoscopic Interlaminar Discectomy

ABSTRACTObjectiveDuring percutaneous endoscopic interlaminar discectomy (PEID), a range of technologies including medical robotics, visual navigation, and spatial registration have been proposed to expand the application scope and success rate of minimally invasive surgery. The use of robotic technology in surgery is conducive to improving accuracy and reducing risk. This study aims to introduce a precise and efficient targeting method tailored for robot‐assisted positioning under C‐arm fluoroscopy inPEID.MethodsThis study conducted a retrospective analysis of 107 patients with lumbar disc herniation (LDH) who underwent surgical treatment at our hospital from February 2023 to February 2024 (average age: 43.3 ± 13.3 years; 61 males and 43 females). The method entails constructing a specialized end‐effector capable of simultaneous fluoroscopy calibration and robot‐to‐image‐space registration. The average time of the surgical procedure and the average number of fluoroscopy exposures were collected. Preoperative and postoperative follow‐up data were collected, including assessment scores from the Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS). Paired t‐tests were employed to compare differences in each clinical outcome between the preoperative and follow‐up time.ResultsThese techniques effectively reduce both radiation exposure and operation time. Clinical data reveals that the average time for robot‐assisted positioning stands at 2.5 ± 0.7 min, with anteroposterior and lateral radiographs demonstrating accuracies of 2.4 ± 2.8 mm and 3.1 ± 3.7 mm, respectively, during robot‐assisted positioning. Postoperative VAS scores for back pain and leg pain were significantly lower than preoperative scores (1.2 ± 1.8 vs. 4.1 ± 2.3, 0.9 ± 2.0 vs. 5.9 ± 1.8; p &lt; 0.05, p &lt; 0.05, respectively). Postoperative JOA scores were significantly higher than preoperative scores (26.1 ± 3.5 vs. 14.5 ± 4.9; p &lt; 0.05).ConclusionsThrough the evaluation of the system in robot‐assisted positioning during PEID, this study substantiates the accuracy and reliability of the proposed method in clinical applications.

Tibial tubercle transfer SurgeRy and physiothErapy Versus physIotherapy only for chronic paTellofemorAL paIn: study protocol for a randomiSed controllEd trial (REVITALISE)

BackgroundPatellofemoral pain (PFP) is a common musculoskeletal disorder resulting in anterior knee pain. Physiotherapy is the current standard treatment, while surgical intervention (tibial tubercle transfer [TTT]) is reserved for chronic cases when nonoperative treatment has failed. TTT can result in clinically meaningful improvement in patients with patellofemoral maltracking without instability. However, to date, no randomised controlled trials (RCT) have compared TTT combined with a physiotherapy (PT) programme to PT alone as the initial treatment for PFP.MethodsA single-centre nonblinded RCT in 40 patients with chronic PFP (> 1 year) and tibial tubercle-trochlear groove (TT-TG) > 15 mm will be randomised to either TTT followed by PT or to PT alone in a 1:1 ratio in a concealed manner. The primary outcome is knee pain at 18 weeks for the TTT group (6 weeks splint phase + 12 weeks PT) and at 12 weeks for the PT group, measured by the visual analog scale (VAS). Secondary outcomes include Patient-Reported Outcome Measures (PROMs) using the Kujala score, International Knee Documentation Committee (IKDC) ‘Subjective Knee Form’, Tegner Activity score and EuroQol 5D-5 L for quality of life. Range of motion (ROM) is measured using the decline step-down test (DSDT). Between-group differences will be analysed using multivariable linear regression analysis, while longitudinal differences will be assessed with linear mixed models for repeated measures. The difference in direct medical costs will also be assessed.DiscussionThe REVITALISE study is the first randomised study to compare surgical intervention (TTT) followed by PT to PT alone in patients with chronic PFP. This study will generate level-1 evidence on the most effective treatment for chronic PFP, which can be integrated into the national guideline to aid orthopaedic surgeons and physiotherapists in their decision-making and ultimately improve our care for patients with chronic PFP.Trial registrationStudy Identifier NCT06227806, registered on 26 Jan 2024 on ClinicalTrials.gov. The study underwent independent peer review and received approval from the ethical review board (number NL80956.091.22).

Long-Term Effectiveness of Dupilumab in Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: A Multicenter Retrospective Study

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex immunological disease associated with significant morbidity and reduced health-related quality of life. Dupilumab is an anti-T2-inflammatory biological drug registered for chronic rhinosinusitis with nasal polyps, indicated by integrated care pathways when optimal medico-surgical treatment yields insufficient control of sinonasal symptoms. Objective The purpose of this study was to confirm the long-term efficacy of dupilumab in the treatment of severe uncontrolled CRSwNP. Methods Multicentric data collection of patients with severe uncontrolled CRSwNP treated with Dupilumab was retrospectively performed. Mixed Model Anova test was used to evaluate the effect of the biological therapy in the improvement of nasal polyp score and quality of life measured with Sinonasal Outcome Test-22 (SNOT-22) and visual analog scale (VAS) scores. Results The study showed a statistically significant and progressive improvement in the Nasal Polyp Score with a decrease from a median baseline value of 6 (IQR 5-6) to 0 (IQR 0-2) at 24 months. Furtherly, optimal results were found for SNOT-22 scores from baseline (62 ± 19) to 6 months (15± 11), with further variations on each successive timepoint remaining below the minimal clinically important difference. VAS scores of nasal obstruction, rhinorrhea, sleep disorders, and craniofacial pain, demonstrated consistent and significant improvements over time until one year of treatment, confirming substantial relief for the most pertinent symptoms of the condition Conclusions The results of this study show high therapeutic efficacy and safety of dupilumab for severe CRswNP particularly in the first 6-12 months, with sustained benefits up to 24 months.

Comparative Outcomes Between Three Different Techniques in the Fixation of Ulnar Styloid Fractures

Abstract Purpose This study aims to compare the clinical and radiological outcomes of three different techniques used in the surgical treatment of ulnar styloid fractures. Material and Method Ulnar styloid fractures treated surgically between 2012 and 2022 were evaluated retrospectively. There were three groups in the study: Group I (Kirschner wire, N= 19), Group II (tension band, N= 27) and Group III (headless compression screw, N= 25). The Gaulke classification was applied to categorise the fractures. After a follow-up period of at least one year, range of motion, Modified Mayo Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH), Visual Analogue Scale (VAS) and grip strength were measured. In addition, radiological union, bone resorption and dorsal subluxation of the DRUJ were evaluated. Results There was no difference between the three groups in terms of demographic data. Gaulke type 2 A was more frequently observed in all three groups (47.4%, 74.1%, 64%, respectively). Range of motion (flexion, extension, supination, pronation) was similar in all three groups (p&gt;0.05). QDASH and MMWS were similar in all three groups. Grip strength was significantly lower in Group I than in Group II (p=0.039). Radiological outcomes (nonunion, dorsal subluxation, bone resorption) were similar in all three groups. Implant irritation was significantly higher in Group II (p=0.026). Conclusion K-wires, tension band wiring and headless compression screws yield similar clinical and radiological outcomes in the surgical treatment of unstable ulnar styloid fractures. However, the need for secondary surgery is more frequent when a tension band is used. Level of Evidence: Level IV.

A comparative study of two full-endoscopic foraminoplasty techniques for lumbar disc herniation.

This study aimed to compare the use of the endoscopic drill (ED) with the extra-endoscopic trephine (EET) in treating lumbar disc herniations with regard to efficiency, safety, and clinical outcomes. From January 2022 and June 2023, 136 patients who had the single-level LDH and received the transforaminal endoscopic surgery were divided into two groups according to the foraminoplasty technique: the EET group (n = 69) and the ED group (n = 67). Surgery-related parameters, complications, Visual Analogue Scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among two groups. The mean operation time and the foraminoplasty time of the EET group was significantly shorter than that of the ED group (P < 0.05). Patients in ED group reported less back pain on the VAS during foraminoplasty than EET group. Although the total complication rate was similar between two groups, the incidence of neural irritation in ED group was significantly lower than that in the EET group. There were no significant differences in VAS or ODI scores at each follow-up visit between two groups. The application of EET and ED were both effective for full-endoscopic foraminoplasty, and have achieved good clinical outcomes. Although the efficiency of EET is higher than that of ED, it faces some problems during use, such as a high risk of neural irritation, intense intraoperative pain, and the trephine displacement. The ED technique is safe and controllable, which can be used as an ideal method for supplementary foraminoplasty.

Pain control and analgesic requirements following laparoscopy-assisted transversus abdominus plane (TAP) block compared to port site infiltration post-paediatric laparoscopic appendicectomy. A Randomised controlled trial.

Appendicectomy is a common procedure in children. Regional anaesthesia helps reduce requirements for opioids and hospital stay and enhances recovery. Laparoscopic-assisted Transversus Abdominus Plane block (L-TAP) was shown to be efficient and potentially superior to port site infiltration (PSI); however, this was not previously studied in paediatric appendicitis. This study aimed to evaluate the effectiveness of L-TAP compared to PSI in children undergoing laparoscopic appendicectomy (LA). A single-blinded RCT was performed to compare L-TAP to PSI with 0.25% plain bupivacaine at the end of an LA. Patients aged 6-16 years diagnosed with uncomplicated acute appendicitis (AAST grade 1) were randomised to either group in a 1:1 fashion. Complicated appendicitis, open or Lap-converted to open appendicectomies, were excluded. Outcome measures included the total amount and number of doses of opiates and clonidine required, length of stay (LOS), and visual analogue score (VAS) of pain. 49 patients in the PSI group and 41 in the L-TAP group were included; the mean age was 11.3 ± 2.4 years. There was no significant difference in age and weight between the groups. One patient in each group required opioid-based patient-controlled analgesia (PCA) in the theatre recovery room; however, on retrospective review, this was not clinically warranted. Seven patients in each group required morphine while in recovery (p = 0.4). There was no significant difference in total morphine (PSI 0.12 vs L-TAP 0.04 mg/kg body weight, p = 0.1) and clonidine (PSI 0.57 vs L-TAP 0.59 micro gm/kg body weight, p = 0.5) requirement during the hospital stay. Patients in the L-TAP group had two hours shorter LOS than the PSI group (38.0 ± 3.9 vs 39.7 ± 4.1, p = 0.38). There was no significant difference in VAS scores. There was no difference between L-TAP and PSI. L-TAP was feasible, easy to earn, and safe. We recommend that it be considered in clinical protocols and local guidelines as part of the peri-operative analgesia regimen, especially when ultra-sound guided blocks are unavailable. Overall, patients with uncomplicated appendicitis who undergo LA have low VAS scores and require mostly simple analgesia.