Short Form Health Survey Scores Research Articles

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment - A prospective randomized and multicenter study.

BackgroundThe objective of this study was to compare the radiologic and clinical outcomes of HURWA robotic-assisted total knee arthroplasty (TKA) to those of conventional TKA.MethodsA total of 150 patients were randomized into two groups – 73 and 77 patients underwent robotic-assisted TKA and conventional TKA, respectively. Preoperative and postoperative Western Ontario McMaster University Osteoarthritis Index (WOMAC) score, Hospital for Special Surgery (HSS) score, 36-item Short Form Health Survey (SF-36) score, Knee Society Score (KSS) and range of motion (ROM) were obtained and compared between these two groups. The preoperative and postoperative hip-knee-ankle (HKA) angle and the rate of HKA≤3° in the two groups were also compared.ResultsThe postoperative mean HKA angle was 1.801° ​± ​1.608° of varus for the robotic-assisted TKA group and 3.017° ​± ​2.735° of varus for the conventional TKA group; these values were significantly different. The alignment rate for mechanical axis lower than 3° in the robotic-assisted TKA group and the conventional TKA group were 81.2% and 63.5%, respectively. Patients undergone robotic-assisted TKA or conventional TKA had similarly improved knee flexion and functional recovery reflected by WOMAC score, HSS score, SF-36 score and KSS.ConclusionHURWA robotic-assisted TKA is a safe and effective, resulting in better alignment for mechanical axis than conventional TKA. The improvement in knee flexion and functional recovery after HURWA robotic-assisted TKA were similar to those after conventional TKA. However, longer follow-up is needed to determine whether the improved alignment of mechanical axis will produce better long-term clinical outcomes.The translational potential of this articleRecently, the robotic-assisted TKA system has been introduced to clinical practice for TKA. Several robotic-assisted TKA systems, including CASPAR, Tsolution, ROSA, ROBODOC and Mako, have been implemented into clinical application.However, the clinical application of these robotic systems was limited due to their technical complexity, insufficient versatility and increased operative time. Until now, there are still no robotic-assisted TKA systems approved by the National Medical Products Administration of China. Therefore, more robotic-assisted TKA systems need to be designed and improved, particularly in China. Through our randomized, multicenter, single blind and parallel controlled trial, we showed that HURWA robot-assisted TKA system is a safe and effective system for TKA, which had improved knee flexion.

Comparison of Two Different Pulsed Radiofrequency Modes for Prevention of Postherpetic Neuralgia in Elderly Patients With Acute/Subacute Trigeminal Herpes Zoster

ObjectiveTrigeminal postherpetic neuralgia (PHN) is often refractory to treatment. Pulsed radiofrequency (PRF) neuromodulation can help in preventing PHN after herpes zoster. This study aimed to compare the efficacy and safety of two different PRF modes on gasserian ganglion neuromodulation in elderly patients with acute/subacute trigeminal herpes zoster. Materials and MethodsA total of 120 elderly patients with acute or subacute (within past three months) trigeminal herpes zoster were randomized to receive either a single cycle of high-voltage, long-duration PRF (HL-PRF group; N = 60) or three cycles of standard PRF (S-PRF group; N = 60). Patients were followed up for six months after treatment. Visual analog scale (VAS) pain score, 36-Item Short Form Health Survey (SF-36) score, and pregabalin at baseline and at different time points during follow-up were recorded. ResultsVAS and SF-36 scores declined significantly from baseline levels in both groups (p < 0.001). The scores were significantly lower in the HL-PRF group than in the S-PRF group at some time points (p < 0.05). The mean dose of pregabalin was significantly lower in the HL-PRF group than in the S-PRF group on days 3, 14, and 28 after treatment (p < 0.05). No serious adverse events occurred in either group. ConclusionHL-PRF neuromodulation of the gasserian ganglion appears to be more effective than S-PRF for preventing PHN in the elderly. Clinical Trial RegistrationChiCTR2000038775.

P286 Sustained improvement in health-related quality of life outcomes in patients with Ulcerative Colitis with long-term tofacitinib treatment in the open-label extension study, OCTAVE Open

Abstract Background Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Tofacitinib induction and maintenance therapy has previously been shown to improve health-related quality of life (HRQoL) outcomes. Here, we present HRQoL data from patients (pts) with UC who received tofacitinib 5 or 10 mg twice daily (BID) in the Phase 3 open-label, long-term extension (OLE) study (OCTAVE Open; NCT01470612), up to Month (M)72. Methods Proportions of pts with an Inflammatory Bowel Disease Questionnaire (IBDQ) total score ≥170, and EuroQol-5D (EQ-5D) and Short Form-36 Health Survey (SF-36) scores were analysed up to M72 in 4 subpopulations in the OLE study: ‘maintenance remitters’ completed OCTAVE Sustain in remission and received tofacitinib 5 mg BID in the OLE study; in contrast, ‘maintenance treatment failures’ (induction responders who experienced treatment failure), ‘maintenance non-remitters’ and ‘induction non-responders (IndNR)’ received tofacitinib 10 mg BID in the OLE study (Figure 1). Data were analysed for each subpopulation overall and stratified by prior tumour necrosis factor inhibitor (TNFi) failure, prior immunosuppressant failure and baseline corticosteroid use. Results Baseline demographics and clinical characteristics for each subpopulation are shown in Table 1. Among the 163 maintenance remitters, HRQoL outcomes were maintained up to M72: 80.0% of pts had an IBDQ total score ≥170 (Figure 1); changes from baseline in EQ-5D scores up to M72 and SF-36 scores up to M33 were minimal (eg M72 EQ-5D utility score -0.07 [standard deviation 0.10]; M33 SF-36 physical functioning score -1.3 [8.3]). Among pts continuing long-term tofacitinib treatment, improvement in IBDQ total score was maintained/achieved by M2 (first post-baseline assessment), and was stable up to M72, with maintenance treatment failures and IndNR subpopulations experiencing the largest improvements from baseline (Figure 1). Similar trends were observed for improvement in EQ-5D and SF-36 scores. Improvements in HRQoL outcomes were independent of prior TNFi failure, prior immunosuppressant failure or baseline corticosteroid use, eg in maintenance remitters with prior TNFi failure, 90.9% of pts had IBDQ total score ≥170 at M60 vs 88.9% of pts without prior TNFi failure. Conclusion Sustained beneficial effects in HRQoL were observed among pts continuing long-term tofacitinib treatment in OCTAVE Open. In maintenance remitters, improvements in all HRQoL outcomes were maintained with tofacitinib therapy. In pts who entered the OLE study not in remission and received tofacitinib 10 mg BID, HRQoL improvements were observed within the first 2 months, and were maintained up to M72, regardless of treatment history including prior TNFi failure.

Incidence and clinical results of tendinous injuries in calcaneus and pilon fractures.

The aims of this study were: (1) to define the incidence of tendinous injuries in calcaneus and pilon fractures with different fracture severity and (2) to determine the clinical impact of such injuries. CT-scans of 121 patients with calcaneus and pilon fractures were retrospectively analyzed over a 4-year period. The tendinous injuries were identified and correlated with the type of fracture (location and classification). Clinical analysis was performed using the American Orthopedic Foot and Ankle Society (AOFAS) and SF-36 (Short Form-36 Health Survey) scores. Tendinous injuries were observed in 36% of all CT-scans analyzed, with the most common injury being incarceration (n = 20) and dislocation (n = 24). Calcaneus fractures sanders type 3/4 were 9 times more prone to tendon injury (p < 0.001; OR 8.67; 95% CI 2.49-30.24). Pilon fractures Ruedi-Allgower type 2/3 were 8 times more prone to tendon injury (p = 0.005; OR 7.5; 95% CI 1.72-32.80). No significant differences (p > 0.05) were found in AOFAS and SF-36 scores between patients with/without tendon injuries for fractures with the same severity. The incidence of tendon injuries in calcaneus/pilon fractures is high and may be underreported. Calcaneus fractures are prone to peroneal tendon injury. In pilon fractures, it is important to look for tibialis posterior tendon injury, especially entrapment. The presence of tendinous injuries does not affect function and pain for the same type of calcaneus and pilon fractures at the long term. Level 3 retrospective study.

Novel Bipolar High-Voltage Pulsed Radiofrequency Targeting the Cervical Sympathetic Chain for Treating Acute Herpetic Neuralgia

IntroductionPostherpetic neuralgia (PHN) in the oral, maxillofacial, neck, and upper limb regions is a refractory neuropathic pain and severely affects the quality of life of patients. Because of the absence of ideal treatments for this condition, relieving pain in the acute stage and preventing the occurrence of PHN are of great clinical significance. However, the optimal intervention for this acute herpetic neuralgia remains obscure. ObjectivesThis study aimed to investigate whether bipolar high-voltage pulsed radiofrequency (PRF) targeting the cervical sympathetic chain could effectively treat acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions and reduce the incidence of PHN. Materials and MethodsA total of 60 patients with acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions were enrolled. The radiofrequency group (n = 30) received bipolar high-voltage PRF under ultrasound guidance at the level of the transverse processes of C6 and C7 to modulate the cervical sympathetic chain. In the sham group (n = 30), the electrodes were simply placed at the same position as in the radiofrequency group, but no radiofrequency energy was applied. The same treatment was repeated in each group after 72 hours. If patients were reported to have a visual analog scale (VAS) score ≥4, they would receive oral tramadol and gabapentin as rescue analgesics. The VAS score, Pittsburgh Sleep Quality Index (PSQI), 36-Item Short Form Health Survey (SF-36) score, use of tramadol and gabapentin, incidence of PHN, and adverse reactions were recorded to assess the effect and safety of therapy during three months of follow-up. ResultsDecreased VAS scores, PSQI scores, and improved SF-36 scores were detected in the two groups at different time points after treatment (all p < 0.05). The VAS scores, PSQI scores, use of tramadol and gabapentin, and incidence of PHN were significantly lower, whereas the SF-36 scores were significantly higher in the radiofrequency group than in the Sham group (all p < 0.05). No serious adverseness related to the treatment was detected in either group. ConclusionsBipolar high-voltage PRF treatment targeting the cervical sympathetic chain could effectively relieve acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions and reduce PHN incidence. The efficacy and safety of this novel treatment make it worthy of recommendation for clinical application.

Clinical Efficacy of Atorvastatin Combined with Ezetimibe in Preventing Restenosis after Coronary Artery Bypass Grafting

To investigate the clinical efficacy of atorvastatin combined with ezetimibe in preventing restenosis after coronary artery bypass grafting. Total 100 patients in Tangshan Workers’ Hospital were randomly divided into observation group and control group. The control group received 100 mg aspirin, 75 mg clopidogrel and atorvastatin 20 mg once a day. The observation group was given 10 mg ezetimibe once a day in addition to the above drugs. The venous diameter, blood lipid level changes, inflammatory response, quality of life, adverse reactions and treatment effects were assessed. After treatment for 6 mo, hypersensitive C-reactive protein and interleukin-6 levels were lower in observation group than control group. Total cholesterol, triglyceride and low-density lipoprotein cholesterol levels were lower and high-density lipoprotein cholesterol level was higher in observation group than control group. The observation group exhibited higher rates of vein garft stenosis improvement, lower rates of disease progression, lower incidence of major adverse cardiovascular events and higher 36-Item Short-Form Health survey scores than control group. The efficacy of ezetimibe combined with atorvastatin in treating restenosis after coronary artery bypass grafting is good, which also controls blood lipids with low incidence of adverse reactions.

Change in Patient-Reported Outcome Measures as Predictors of Revision Lumbar Decompression Procedures.

ObjectiveTo assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD). MethodsPatients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD. ResultsThe study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024). ConclusionLD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.

Efficacy of a Lateral Mass Fusion Device Combined with a Three-Dimensional–Printed Model in the Treatment of Craniovertebral Junction Abnormalities

To investigate the efficacy of a lateral mass fusion device combined with a three-dimensional-printed model in treatment of craniovertebral junction abnormalities. This retrospective study comprised 56 patients with irreducible atlantoaxial dislocation who underwent posterior fixation between January 2016 and December 2019. Patients were divided into 2 groups according to whether or not cages were used-cage group and autograft group. Visual analog scale score, Japanese Orthopaedic Association score, health-related quality of life, American Spinal Injury Association spinal cord injury grade, atlas-dens interval, space available for the cord, cervicomedullary angle, and fusion rate were compared between groups. Medical follow-up was >1 year. There was no statistical difference between groups in preoperative visual analog scale score, Japanese Orthopaedic Association score, 12-Item Short Form Health Survey score, American Spinal Injury Association grade, atlas-dens interval, space available for the cord, and cervicomedullary angle, and these indexes significantly improved after surgery (P < 0.05). Visual analog scale score and atlas-dens interval were lower in the cage group than in the autograft group (P < 0.05). Japanese Orthopaedic Association score, 12-Item Short Form Health Survey score, space available for the cord, and cervicomedullary angle were significantly higher in the cage group than in the autograft group (P < 0.05). Fusion rate of the cage group 4-6 months after surgery was higher than that of the autograft group (P= 0.068). American Spinal Injury Association grade was significantly higher in the cage group than in the autograft group (P < 0.05). During 1-year follow-up, neurological function improvement and atlantoaxial joint reduction were satisfactory. The lateral mass fusion device combined with a three-dimensional printed model may be a clinically useful technique.

The Rhinoconjunctivitis Quality of Life Questionnaire and its modified short version validation in adults and children with allergic rhinitis.

This study aimed to develop the Greek versions of the Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire for adult and pediatric populations, discuss their differences and detect the impact of age and gender on quality of life questionnaire results. Ninety-eight patients with allergic rhinitis participated. Quality of Life evaluation was made by two generic (Short Form-36 and Beck Depression Inventory) and two disease-specific questionnaires (Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire). Symptom evaluation was made by the Total 5 Symptoms Score assessment. Internal consistency and test-retest reliability of both questionnaires was high. Convergent validity showed statistically significant negative correlations of total Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire with overall Short Form-36 Health Survey score and positive correlations with Beck Depression Inventory and Total 5 Symptoms Score. Discriminative validity demonstrated statistically significant improvement for all instruments and all domains after treatment. Females presented highly significant increased scores. Patient age was positively correlated with total scores of Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire. The clinically significant improvement after treatment was higher among females than males, while it was independent of patient age. Rhinoconjunctivitis Quality of Life Questionnaire and Mini-Rhinoconjunctivitis Quality of Life Questionnaire proved to be valid and reliable methods of assessment of allergic rhinitis-related quality of life in children, adolescents and adults.

Clinical Outcome Comparison between Staged -Bilateral Versus Simultaneous Bilateral Total Knee Replacements.

This retrospective study aimed to compare the clinical outcomes of patients with staged and simultaneous bilateral total knee arthroplasty (TKA). The present study included 100 patients with a mean age of 62±3.72 years from 2014 to 2017. Among them, 51 and 49 patients underwent simultaneous and staged bilateral TKA, respectively. The two groups were compared regarding the range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster UniversitiesOsteoarthritis Index (WOMAC) improvement, and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores. The mean follow-up duration was 24 months (range: 12-36 months). According to the results obtained from the SF-36 questionnaire (possessing eight different factors of quality of life), there was no significant difference between the two groups. Furthermore, the OKSs were 39.98±1.52 and 38.68±2.55 in the simultaneous and staged groups, respectively. Moreover, the WOMAC improvement scores were obtained at 84.15±2.2 and 83.26±2.6 in the simultaneous and staged groups, respectively. The final knee ROM was acceptable without a significant difference between the two groups. Substantial controversy about the complications, functional, and clinical outcomes has negatively affected the decision of the surgeons on conducting bilateral sequential TKA. This clinical assessment revealed that all determinants, including OKS, WOMAC, SF-36, ROM, postoperative bleeding, and hospitalization duration exhibited almost the same improvement in both groups. According to this study, no statistically significant difference exists in both procedures.

Effects of incorporating multidomain interventions into integrated primary care on quality of life: a randomised controlled trial

Integrating primary prevention into care pathways for older adults is a core strategy of healthy ageing, but evidence remains limited. We aimed to determine whether incorporating a multidomain intervention into primary health care could improve standard value-based health outcomes and quality of life. For this Taiwan Integrated Geriatric Care (TIGER) study, a pragmatic randomised controlled trial, we recruited community-dwelling outpatients aged 65 years or older with at least three chronic medical conditions. We excluded people with malignancies undergoing chemotherapy, people with a life expectancy of less than 12 months, or people who were insufficiently able to communicate with study staff. Participants were randomly assigned (1:1) to usual care or to the integrated multidomain intervention using block randomisation. The integrated multidomain intervention entailed 16 2-h sessions per year, comprising communal physical exercise, cognitive training, nutrition and disease education, plus individualised treatment by specialists in integrated geriatric care. The primary outcome was changes from baseline quality of life, based on 36-item Short Form Health Survey (SF-36) scores, at 3, 6, 9, and 12 months. Intervention effects were analysed per protocol using a generalised linear mixed model. This trial is registered with ClinicalTrials.gov, NCT03528005. Between June 25, 2018, and Feb 15, 2019, 628 participants were screened, of whom 398 were assigned to the integrated multidomain intervention (n=199) or to usual care (n=199). 335 (84%) participants completed the 12-month follow-up. Compared with the usual care group, the integrated multidomain intervention group had significantly higher mean SF-36 physical component scores across all timepoints (overall difference 0·8, 95% CI 0·2-1·5; p=0·010), but differences at 3, 6, 9, and 12 months did not reach statistical significance. The SF-36 mental component scores did not differ significantly overall, but were significantly higher in the integrated multidomain intervention group at the 12-month follow-up (55·3 [SD 7·6] vs 57·2 [7·0]; p=0·019). No serious adverse events occurred. Incorporating multidomain interventions into integrated health care improved quality of life. Our standardised protocol is amenable to inclusion in policies to promote value-based care and healthy ageing. National Health Research Institutes, Taiwan, and Ministry of Science and Technology, Taiwan.

Effective Treatment of Postherpetic Neuralgia at the First Branch of the Trigeminal Nerve by High-Voltage Pulsed Radiofrequency.

Background: Postherpetic neuralgia (PHN) is one of the most common and serious complications of herpes zoster. PHN of the first branch of the trigeminal nerve is painful and difficult to treat, as no definitive effective treatment is available. The aim of this retrospective study was to observe the efficacy and safety of treatment of PHN of the first branch of the trigeminal nerve with high-voltage pulsed radiofrequency (PRF) of the supraorbital nerve.Methods: Fifty-two patients diagnosed with the PHN of the first branch of the trigeminal nerve at the Department of Pain Management, Shengjing Hospital, China Medical University, between April 2017 and October 2020 were selected. The PRF treatment of the supraorbital nerve was used. The patients were divided into two groups according to the treatment received: group C, conventional PRF group; and group H, high-voltage PRF group. The basic conditions, pain scores, and SF-36 scores of patients before treatment were recorded. Also, intraoperative and postoperative adverse events, visual analog scale (VAS) scores, 36-Item Short Form Health Survey (SF-36) scores at 1 week, 1 month, 3 months, and 6 months of follow-up were recorded. Furthermore, treatment efficiency was followed up at 6 months after treatment.Results: The VAS scores of patients in both groups were significantly lower at all time points after treatment compared with presurgery. VAS scores in group H were lower than those in group C 1, 3, and 6 months after treatment. SF36 scores of patients in group H were better than those in group C 1, 3, and 6 months after treatment. The treatment efficiency at 6 months after treatment was higher in group H than in group C. No serious adverse events occurred in both groups.Conclusion: The efficacy of the high-voltage PRF of the supraorbital nerve in treating the PHN of the first branch of the trigeminal nerve was superior to that of conventional PRF. It was a safe and effective treatment method.

The Reliability and Validity of the Turkish Version of the Mental Fatigue Scale In Healthy Individuals

Objectives: The aim of the study was to investigate the reliability and validity of the Turkish version of the Mental Fatigue Scale (MFS) in healthy Turkish population.&#x0D; Methods: This study was held in Hacettepe University, Faculty of Physical Therapy and Rehabilitation between April and August 2019. A total of one hundred thirty-two healthy participants aged between 18-50 years were recruited. Reliability was investigated using test-retest reliability. The internal consistency of MFS was calculated using Cronbach's alpha coefficient. The validity of the MFS was assessed by comparing the MFS score with the 36-item Short Form Health Survey (SF-36) and Checklist Individual Strength Questionnaire (CIS-T) scores. Pearson correlation coefficient was used to evaluate validity.&#x0D; Results: The test–retest reliability of the MFS were excellent in healthy Turkish population (ICC: 0.91, with a 95% confidence interval of 0.88–0.94). The scale had high internal consistency (Cronbach’s α 0.86). For the validity, the correlations between the MFS and the total/subscales of CIS-T scores and SF-36 scores were good (p

Application Value of Information-Based Health Education and Continuity of Care in Patients With Peptic Ulcer.

Objective: This study is to assess the application value of information-based health education and continuity of care in patients with PU (peptic ulcer).Methods: Patients (116) with PU who have been treated in the hospital between January 2019 and October 2020 were taken as research objects and equally assigned to a control group and an observation group in a random manner. In contrast to the routine care applied to the control group, the observation group received information-based health education and continuity of care intervention. The clinical efficacy, the mastery of health knowledge, self-care ability, medication compliance, quality of life, mental state, and nursing satisfaction of the two groups were compared.Results: After the intervention, the total effective rate, health knowledge adequate rate, Exercise of Self-Care Agency (ESCA) scores of all dimensions, the MOS 36-item short-form health survey (SF-36) scores of all dimensions, medication compliance rate, and total nursing satisfaction of the observation group all notably exceeded those of the control group, with a p < 0.05. Patients of the group with continuity of care intervention showed lower Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, as compared to the group with conventional care (p < 0.05).Conclusion: Information-based health education and continuity of care elevates the medication adherence and nursing satisfaction of patients with PU, enhances disease-related knowledge of patients and their self-care ability, and eventually ameliorates the quality of life and psychological state. It is worthy of clinical application.

Catheter ablation vs. antiarrhythmic drugs as 'first-line' initial therapy for atrial fibrillation: a pooled analysis of randomized data.

Catheter ablation (CA) is recommended for patients with atrial fibrillation (AF) after failure of antiarrhythmic drugs (AADs). The role of CA as 'initial therapy' for AF is to be determined. Following PRISMA guideline an up-to-date pooled analysis of randomized data comparing ablation vs. AADs as first-line therapy for symptomatic AF was performed. The primary outcome was recurrence of atrial tachyarrhythmia. The secondary outcomes were improvement in quality-of-life (QoL) and major adverse events. A total of 997 patients from five randomized trials were enrolled (mean age 57.4 years, 68.6% male patients, 98% paroxysmal AF, mean follow-up 1.4 years). The baseline characteristics were similar between the ablation and AADs group. Overall pooled analysis showed that, as compared with AADs, CA as first-line therapy was associated with significantly higher freedom from arrhythmia recurrence (69% vs. 48%, odds ratio: 0.36, 95% confidence interval: 0.27-0.48, P < 0.001). This significance was maintained in subgroup analyses of 1- and 2-year follow-up (P < 0.001). Catheter ablation was associated with significantly greater improvement in QoL regarding AFEQT score and 36-Item Short-Form Health Survey score. The incidence of serious adverse events between ablation and AADs group (5.6% vs. 4.9%, P = 0.62) was similar. Catheter ablation as 'initial therapy' was superior to AADs in maintenance of sinus rhythm and improving QoL for patients with symptomatic paroxysmal AF, without increasing risk of serious adverse events.

Comparison of total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures: a 10\u201320-year follow-up study

BackgroundThe purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures.MethodsBetween January 1987 and December 2003, this retrospective study included a total of 35 patients (mean age, 51.4±16.8 years) with a minimum of 10 years follow-up period, comprising 29 males and 6 females, who were divided into the total patellectomy group (17 patients) or the open reduction and internal fixation (ORIF) group (18 patients) in the Third Affiliated Hospital of Hebei Medical University. We retrospectively collected patient demographics and data on the type of trauma, fracture type, and postoperative complications. Clinical outcomes including knee range of motion (ROM), 36-Item Short-Form Health Survey (SF-36) score [including physical component score (PCS) and mental component score (MCS)], Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score were evaluated and compared between the two groups. Biodex System dynamometer was used to quantitatively evaluate quadriceps femoris muscle power following measurement of peak torque.ResultsThe mean follow-up periods of the total patellectomy group and the ORIF group were 17.2±5.6 and 16.8±4.9 years, respectively. There were no significant differences between the two groups of patient demographics in terms of the number of patients, age, sex, injury side, time to surgery, type of trauma, and fracture classification (p>0.05). Total patellectomy was comparable to osteosynthesis with tension band wiring in terms of ROM [injured knee: 120.4±3.1° vs 118.6±3.3°; uninjured knee: 126.5±2.8° vs 127.3±1.7°; both p>0.05], peak torque [Injured knee: 96.2±2.3 vs 97.3±2.6, N· m; Uninjured knee: 107.6±2.1 vs 106.3±1.8, N· m; both p>0.05], SF-36 score [PCS: 64.1±18.0 vs 61.5±17.9; MCS: 55.1±13.8 vs 54.3±12.4; both p>0.05], KOOS score [76.3±12.1 vs 73.4±11.7; p>0.05], and Kujala score [67.6±11.8 vs 70.8±11.9; p>0.05] at the final follow-up, while total patellectomy had significantly shorter operation time than ORIF group (47.5±12.1 vs 68.8±22.3, min, p<0.05). In the total patellectomy group, complications occurred in 6 of 17 cases (35.3%), and all occurred with calcification. In the ORIF group, complications occurred in 12 of 18 cases (66.7%), including 2 cases of infection (11.1%), 1 case of non-union (5.6%), 2 cases of implant failure (11.1%), 2 cases of soft tissue irritation (11.1%), and 5 cases of patellofemoral arthritis (27.8%).ConclusionsTotal patellectomy technique was a safe and reliable alternative treatment for treating patients with highly comminuted patella fractures when anatomically reduction and rigid fixation were difficult, although it caused relatively higher rates of calcification.

Oligoarticular vs Polyarticular Psoriatic Arthritis: A Longitudinal Study Showing Similar Characteristics.

The objectives of this study were to determine whether patients with oligoarticular presentation differ from those with polyarticular presentation and to identify potential predictors for evolution of oligoarthritis to polyarthritis in patients with psoriatic arthritis (PsA). Patients who entered the University of Toronto PsA clinic between 1978 and 2018 within 12 months of diagnosis were identified. Only patients with ≥ 2 clinic visits were included. Patients were followed at 6- to 12-month intervals according to standard protocol, which included demographics, clinical history, detailed clinical examination, laboratory information, and patient questionnaires. Radiographs were done at 2-year intervals. Oligoarthritiswas defined by the presence of ≤ 4 inflamed joints and progressionas an increase to ≥ 5 joints. Statistical analyses included logistic regression models as well as Weibull regression models, adjusted for age, disease duration, and sex. Of 407 patients, 192 (47%) presented with oligoarthritis. Whereas demographic features were similar to those with polyarthritis, more patients with polyarthritis presented with dactylitis and enthesitis. Similar joint distribution was observed, with small joints of the hands and feet being most commonly affected. Patients with polyarthritis had higher Health Assessment Questionnaire and lower 36-item Short Form Health Survey (SF-36) scores. Of the 192 oligoarticular patients, 117 (61%) remained oligoarticular and 75 (39%) progressed to polyarthritis. A lower SF-36 mental component summary (MCS) score was the predictor for progressing to polyarthritis. Oligoarticular PsA occurs in 47% of patients with PsA and is similar to polyarticular disease, with most patients having small joint involvement. The only predictor for progression to polyarthritis was lower SF-36 MCS.

Staged surgical management of sinus tarsi syndrome: our experience of 273 cases.

The sinus tarsi syndrome (STS) is a common foot and ankle disease with controversial pathogenesis and treatment procedures. This long-term study aimed to analyze the effect of a staged surgical strategy for STS. Clinical data were retrospectively analyzed in 273 STS patients [129 men and 144 women; mean age: 36 years (10-60 years)] treated between 2006 and 2016. The 89 patients underwent different surgeries, including sinus tarsal debridement, subtalar joint stabilization, sinus tarsal denervation, tarsal coalition resection, or subtalar arthrodesis. The patients' American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, visual analogue scale (VAS) scores for pain during daily activities, and 36-item short-form health survey (SF-36) scores at the first visit and latest follow-up were assessed by paired T-test. The 89 patients who failed conservative treatments first underwent tarsal sinus soft tissue debridement, with 52 patients remaining in remission after 2 years. The other 37 patients with relapse underwent further surgeries. Five of the 19 patients with subtalar instability were cured following ligament reconstruction surgery. Two of the four patients with severe neurological signs recovered after nerve release surgery. Five of the 10 patients with tarsal coalition were cured by resection of the talocalcaneal bridge. A total of 21 patients failed their second operations due to peroneal spasm, and were eventually successfully treated by subtalar arthrodesis. In addition, subtalar arthrodesis was directly performed in the remaining four patients with peroneal spastic flatfoot. After the final operations, all patients achieved satisfactory results. The AOFAS ankle-hindfoot scores increased from 34.83±12.21 preoperatively to 85.52±7.07 postoperatively (t=-24.62, P<0.01), the VAS scores decreased from 8.14±1.52 to 2.14±1.00 (t=24.65, P<0.01), and the SF-36 scores increased from 36.58±11.36 to 86.22±9.17 (t=-28.13, P<0.01). In this study, we observed that 67% (184/273) of patients with STS need a staged surgical management. According to the etiology, symptoms, and severity, soft tissue surgery is the first choice. However, simple soft tissue surgeries may fail to achieve long-term results. Once the symptoms recur and become difficult to cure, the staged surgical strategy for STS we proposed can be the best choice to achieve long-term results.

Clinical observation of refined moxibustion for sequelae of pelvic inflammatory disease with qi stagnation and blood stasis

To compare the curative effect of refined moxibustion, traditional moxa box moxibustion and Chinese patent medicine on the sequelae of pelvic inflammatory disease with qi stagnation and blood stasis. A total of 150 patients with sequelae of pelvic inflammatory disease with qi stagnation and blood stasis were randomized into a refined moxibustion group (50 cases), a box-moxibustion group (50 cases) and a Chinese medication group (50 cases, 2 cases dropped off). The patients in the refined moxibustion group were treated with refined moxibustion at Qihai (CV 6), Guanyuan (CV 4), Zigong (EX-CA 1) and Shuidao (ST 28), 2 moxa-cones for each acupoint. The patients in the box-moxibustion group were treated with box-moxibustion on the lower abdomen and Shenque (CV 8), and the patients in the Chinese medication group were treated with penyanqing capsules orally. All groups started treatment after menstruation, moxibustion was applied once every 4 days, twice a week, and medication was taken 3 times a day for a total of 2 menstrual cycles. The TCM symptoms and body signs scores of each group were observed before and after treatment. The short form health survey (SF-36) scores of each group were observed before and after treatment and during follow-up 12 weeks after treatment. After treatment, the TCM symptoms, body signs and comprehensive scores of each group were lower than those before treatment (P<0.05), and those in the refined moxibustion group were lower than the box-moxibustion group and the Chinese medication group (P<0.05). The SF-36 scores of each group after treatment and during follow-up were higher than before treatment (P<0.05); during follow-up, the SF-36 scores of the box-moxibustion group and the Chinese medication group were lower than after treatment (P<0.05), while that in the refined moxibustion group was higher than after treatment (P<0.05); the SF-36 scores after treatment and during follow-up in the refined moxibustion group were higher than the box-moxibustion group and the Chinese medication group (P<0.05, P<0.01). Compared with traditional moxa box moxibustion and Chinese patent medicine treatment, refined moxibustion can better improve the symptoms, body signs and quality of life in patients with the sequelae of pelvic inflammatory disease of qi stagnation and blood stasis, and the effect is longer.

Efficacy of Transcutaneous Electrical Nerve Stimulation in the Management of Neurogenic Overactive Bladder: A Randomized Controlled Trial.

The aim of the study was to investigate the therapeutic effect of transcutaneous electrical nerve stimulation on neurogenic overactive bladder that is refractory to pharmacotherapy. This randomized trial recruited 83 participants with neurogenic overactive bladder that were nonresponsive to 3-mo first-line anticholinergic drug treatment. Participants were randomized into treatment and control groups. Transcutaneous electrical nerve stimulation current consisting of biphasic square wave with pulse durations of 150 μs and pulse frequency set at 20 Hz were applied to for 30 mins once a day for 90 days. Stimulation was provided over the lateral aspect of the sacrum bilaterally of the electrodes. Patients in the transcutaneous electrical nerve stimulation group stopped taking the anticholinergic drugs. The control group continued to receive anticholinergic drugs for 90 days. The participants' Overactive Bladder Symptom Score, the Medical Outcomes Study 36-Item Short-Form Health Survey scores, urodynamic values, and voiding diary data were assessed before and after the therapy. The transcutaneous electrical nerve stimulation treatment group had significantly decreased Overactive Bladder Symptom scores compared with the control group (P < 0.001); in addition, half of the Medical Outcomes Study 36-Item Short-Form Health Survey scores were significantly improved in the transcutaneous electrical nerve stimulation group (P < 0.05). The patients treated with transcutaneous electrical nerve stimulation improved significantly voiding diary parameters at P < 0.05. Similarly, urodynamic values at P < 0.05 favored the experimental group over the control group. Applying daily transcutaneous electrical nerve stimulation over the sacral region for 90 days to patient with neurogenic overactive bladder improved overactive bladder symptoms of patients whose response to anticholinergic drugs is far inferior. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Determine the therapeutic effect of transcutaneous electrical nerve stimulation (TENS) on neurogenic overactive bladder (NOAB); (2) Demonstrate the effectiveness of reflex suppression of the bladder using the TENS applied over the sacral region as a stimulation location; and (3) Confirm the TENS method using biphasic square waves with pulse durations of 150 μs and pulse frequencies of 20 Hz as applied is shown to be superior to anticholinergic drugs in managing NOAB. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.