Symptom Severity Scale Score Research Articles

Clinical Characteristics of Predominantly Unilateral Oral Cenesthopathy With and Without Neurovascular Contact.

Oral cenesthopathy (OC) is characterized by unusual oral discomfort without corresponding evidence, and it has often been categorized as “delusional disorder, somatic type”. Regarding possible causative factors of OC, involvement of neurovascular contact (NVC) of the trigeminal nerve, which transmits not only pain but also thermal, tactile, and pressure sensations, has never been observed yet. This study aimed to investigate the relationship between clinical characteristics of unilateral OC and the presence of trigeminal nerve NVC. This is a retrospective comparative study that involved 48 patients having predominantly unilateral OC who visited the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between April 2016 and February 2019. Magnetic resonance imaging was performed to assess NVC presence. The Oral Dysesthesia Rating Scale (Oral DRS) was used to assess the various oral sensations and functional impairments besides psychometric questionnaires. Clinical characteristics were retrospectively obtained from the patients' medical charts. NVC was present in 45.8% (22/48) of the patients. There was no significant difference in sex, age, psychiatric history, oral psychosomatic comorbidity, and psychometric questionnaire scores between patients with and without NVC. However, compared to the patients with NVC, the patients without NVC had significantly higher scores for overall subjective severity of OC symptoms (p = 0.008). Moreover, patients having predominantly unilateral OC without NVC showed significantly higher scores in symptom severity and functional impairment of the following parameters: movement (p = 0.030), work (p = 0.004), and social activities (p = 0.010). In addition, compared with the patients with NVC, the patients without NVC showed significantly higher averages of the total symptom severity scale (SSS) and functional impairment scale (FIS) scores in the Oral DRS (p = 0.015 and p = 0.031, respectively). Furthermore, compared with the patients with NVC, the patients without NVC had significantly higher numbers of corresponding symptoms in both the SSS and FIS (p = 0.041 and p = 0.007, respectively). While NVC may be involved in the indescribable subtle OC symptoms, more complex mechanisms may also exist in OC patients without NVC, which yield varying and more unbearable oral symptoms.

Fibromyalgia influences health-related quality of life and disease activity in psoriatic arthritis.

Fibromyalgia syndrome (FMS) is common in patients of psoriatic arthritis (PsA), but the magnitude of its impact is uncertain. Thiscross-sectional study evaluated the impact of FMS on health-related quality of life (HRQoL) and disease activity in PsA. Adults classified with PsA (CASPAR criteria) at the rheumatology and dermatology outpatient clinics of PGIMER, Chandigarh, India between January 2014 and June 2015were recruited. All patients were assessed for FMS using the 2010 ACR criteria. Health-related quality of life was assessed using PROMIS-HAQ, HAQ-pain, HAQ-health and revised fibromyalgia impact questionnaire (FIQR). Disease activity measures (SJC, TJC, BASDAI, enthesitis, dactylitis, PASI) and PROMIS-HAQ were correlated with measures of FMS [FIQR, symptom severity scale (SSS) score and widespread pain index (WPI)]. Multivariate regression analyses were used to identify predictors of PROMIS-HAQ and FMS. Out of 106 PsA patients screened, 102 [50 (49%) females; mean age 43.8 (12.4) years] were included. 19 (18.3%) had FMS. Patients of PsA with FMS had significantly (p < 0.05) higher TJC (14vs7), SJC (10vs5), BASDAI (6.1vs4.1) and enthesitis (53 vs 33%), but no difference in dactylitis, severity of skin disease and disease duration. A significant positive correlation of measures of FMS (FIQR, SSS and WPI) with SJC, TJC and BASDAI was noted. PROMIS-HAQ, HAQ-pain and HAQ-health were significantly worse (p < 0.001) in patients of PsA with coexisting FMS. Presence of FMS was found to be an independent predictor of worse PROMIS-HAQ. Female gender and higher TJC independently predicted presence of FMS.To conclude, FMS is an important contributor towards poor HRQoL in patients of PsA and is associated with higher values of joint disease activity measures.

Sleep disorders and relationship with comorbid anxiety and depression in carpal tunnel syndrome

Objectives: In this study, it was aimed to assess relationship of disease severity with sleep quality, depression and anxiety in patients with carpal tunnel syndrome (CTS) and to compare findings with healthy controls. Methods: The study included 35 patients diagnosed as CTS and 20 healthy individuals. In CTS patients, symptom severity and functional disorders were assessed using Boston Carpal Tunnel Questionnaire (BTCQ). The sleep quality was assessed using Pittsburg Sleep Quality Index (PSQI) in CTS patients and healthy controls. The Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used to evaluate depression and anxiety accompanying to CTS and sleep disorder. Results: In the assessment of general sleep quality, it was found that PSQI scores were significantly higher in CTS group when compared to healthy controls (p &amp;lt; 0.0001). Again, the BDI and BAI scores were also significantly higher in CTS group than control group (p &amp;lt; 0.0001 and p &amp;lt; 0.003, respectively). There was a strong, positive correlation between BTCQ symptom severity scale (SSS) and PSQI (r = 0.774; p &amp;lt; 0.0001). A significant, positive correlation was observed between Boston SSS and BDI scores (r = 0.666; p &amp;lt; 0.001). When assessed correlation between anxiety scores and Boston SSS and functional state scale (FSS), it was found that anxiety was increased by increasing severity of CTS, indicating a positive, moderate correlation (r=0.469, p &amp;lt; 0.0001 and r=0.464, p &amp;lt; 0.0001). Conclusions: The pain in patients with CTS can impair sleep quality, which, in turn, may increase risk for depression and anxiety. Thus, comorbid psychiatric symptoms and signs should be considered in the treatment of patients with CTS.

The Association of Current Tobacco Status With Pain and Symptom Severity in Fibromyalgia Patients.

ObjectiveTo describe current tobacco use among patients with newly confirmed fibromyalgia and evaluate the association between tobacco use status and severity of reported pain and other fibromyalgia symptoms.Patients and MethodsParticipants in this study were adult patients (N=1068) with fibromyalgia who met American College of Rheumatology 2010/2011 clinical criteria for fibromyalgia at the time of initial presentation to a Midwest fibromyalgia clinic (June 1, 2018, through May 31, 2019). Multiple linear regression analyses were performed to assess the association of tobacco use status with the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) scores. Covariates included in these analyses included age, sex, body mass index, depression, opioid medication use, and use of fibromyalgia-specific pharmacotherapy.ResultsThe patients were largely women (87.0%; n=929), white (87.9%; n=939), and with an average ± SD age of 46.6±13.9 years. The WPI and SSS scores were significantly greater in current tobacco users compared with never tobacco users (WPI effect estimate [EE] = 1.03; 95% CI, 0.30 to 1.76; type III P=.020; SSS EE = 0.47; 95% CI, 0.11 to 0.84; type III P=.036). The WPI score was negatively associated with age (EE = −0.02 per year; 95% CI, −0.03 to −0.001 per year; P=.037) and no use of opioid medication (EE = −1.08; 95% CI, −1.59 to −0.57; P<.001) while positively associated with higher body mass index (EE = 0.03 per 1 kg/m2; 95% CI, 0.001 to 0.06 per kg/m2; P=.04) and higher Patient Health Questionnaire-9 score (EE = 0.12; 95% CI, 0.08 to 0.16; P<.001).ConclusionThe results of our study suggest that tobacco use is associated with greater pain and other symptom severity in patients with fibromyalgia. These findings have important clinical and research implications for patients with fibromyalgia who use tobacco and who may benefit from early identification and timely implementation of tobacco cessation treatment to decrease pain and improve overall quality of life.

The evaluation of nailfold capillaroscopy pattern in patients with fibromyalgia.

Objectives This study aims to evaluate nailfold capillaroscopic pattern in patents with fibromyalgia and to assess the relation of capillaroscopic parameters with clinical variables and disease-related measures.Patients and methods This cross-sectional, case-control study included 60 participants (4 males, 56 females; mean age: 44.0±8.2 years; range, 26 to 64 years) between August 2019 and November 2019. All participants were divided into two groups as the primary fibromyalgia group (n=30) who met the 2016 modified American College of Rheumatology Diagnostic Criteria for Fibromyalgia and the control group (n=30) consisting of age- and sex-matched healthy individuals. Nailfold capillaroscopy was performed by a digital microscope under a magnification of 200X. Capillary density, capillary loop diameter, number of dilated, giant and neoangiogenic capillaries, capillary shape, number of avascular areas, micro-aneurysms and micro-hemorrhages were evaluated by an assessor who was blind to the group allocation. In the fibromyalgia group, Widespread Pain Index, Symptom Severity Scale scores, and Fibromyalgia Severity scores were calculated. Health status and presence of benign joint hypermobility syndrome (BJHS) were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) and revised Brighton criteria, respectively.Results Of the capillaroscopic parameters, the mean capillary loop diameter, number of micro-aneurysms, avascular areas, and neoangiogenic capillaries were significantly higher in the patient group compared to the controls (p<0.001, p=0.016, p=0.038, and p=0.04, respectively). Nailfold capillaroscopic findings did not significantly differ between the patients with (n=16) and without concomitant BJHS (n=14). Of the disease-related measures, only FIQ score showed a weak correlation with the number of dilated capillaries (p=0.324).Conclusion Patients with fibromyalgia have distinct capillaroscopic patterns than healthy population. Capillaroscopic features, in general, are not related to clinical variables and disease-related measures.

Tiaoshen acupuncture method combined with electroacupuncture for diarrhea-type irritable bowel syndrome : a randomized controlled trial

To compare the clinical effect between Tiaoshen acupuncture method combined with electroacupuncture (EA) and EA alone in the treatment of diarrhea-type irritable bowel syndrome (IBS-D). A total of 76 patients of IBS-D were randomly divided into a Tiaoshen group (38 cases, 2 cases dropped off ) and an EA group (38 cases, 1 case dropped off). The EA group was treated with acupuncture at Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25), Dachangshu (BL 25), Zusanli (ST 36), Shangjuxu (ST 37), etc. for 30 min. The bilateral Tianshu (ST 25) and the same side of Zusanli (ST 36) and Shangjuxu (ST 37) were connected EA (discontinuous wave, 1 Hz in frequency, 4-6 mA in current intensity). In the Tiaoshen group, the Tiaoshen acupuncture method was added on the basis of the EA group. The acupoints were Baihui (GV 20), Shenting (GV 24) and Benshen (GB 13), and the needles were retained for 30 min. Both groups were treated once a day, 6 days as a course of treatment, with an interval of 1 d between treatment courses, and a total of 4 courses of treatment were required. The IBS symptom severity scale (IBS-SSS) score, IBS quality of life scale (IBS-QOL) score and Hamilton depression scale (HAMD) score were observed before and after treatment in the two groups, and the clinical effect was evaluated. After treatment, the total effective rate in the Tiaoshen group was 94.4% (34/36), which was higher than 78.4% (29/37) in the EA group (P<0.05). The IBS-SSS and HAMD scores of both groups after treatment were lower than before treatment (P<0.05), while IBS-QOL scores were higher than before treatment (P<0.05). Moreover, the changes of above scores in the Tiaoshen group were higher than those in the EA group (P<0.05). The Tiaoshen acupuncture method combined with EA have a significant effect in treatment of IBS-D, can significantly reduce the symptoms of abdominal pain, abdominal distension and diarrhea in patients, effectively improve patients' quality of life and depression condition, the effect is better than the simple EA treatment.

Intrinsic brain abnormalities of irritable bowel syndrome with diarrhea: a preliminary resting-state functional magnetic resonance imaging study

BackgroundThe aim of the present study was to explore the brain active characteristics of patients with irritable bowel syndrome with diarrhea (IBS-D) using resting-state functional magnetic resonance imaging technology.MethodsThirteen IBS-D patients and fourteen healthy controls (HC) were enrolled. All subjects underwent head MRI examination during resting state. A voxel-based analysis of fractional amplitude of low frequency fluctuation (fALFF) maps between IBS-D and HC was performed using a two-sample t-test. The relationship between the fALFF values in abnormal brain regions and the scores of Symptom Severity Scale (IBS-SSS) were analyzed using Pearson correlation analysis.ResultsCompared with HC, IBS-D patients had lower fALFF values in the left medial superior frontal gyrus and higher fALFF values in the left hippocampus and right precuneus. There was a positive correlation between the duration scores of IBS-SSS and fALFF values in the right precuneus.ConclusionThe altered fALFF values in the medial superior frontal gyri, left hippocampus and right precuneus revealed changes of intrinsic neuronal activity, further revealing the abnormality of gut-brain axis of IBS-D.

Value of Boston Questionnaire in Carpal Tunnel Syndrome

Objectives: The Boston Carpal Tunnel Questionnaire (BCTQ) is a patient-based outcome measure that has been developed for patients with Carpal tunnel syndrome (CTS). The purpose of this study was to investigate the association between BCTQ scores and electrophysiological findings in patients with CTS. Subjects and Methods: This study included 174 individuals (control group [n = 68] and patient group [n = 106]) admitted to Erciyes University Hospital Department of Neurology between August 2019 and November 2019 with complaints of pain, numbness, and paresthesia in the unilateral or bilateral median nerve trace and diagnosed with idiopathic CTS or normal after electrophysiological testing. The Turkish version of the BCTQ was applied to these patients. Results: The mean age of the participants was 46.6 (standard deviation ± 11.9). One hundred and fifty-seven (90.2%) of all the participants were female. Among patients, 29.9% (n = 52) had mild, 21.8% (n = 38) had moderate, and 9.2% (n = 16) had severe CTS. Both the Symptom Severity Scale (SSS) and functional status scale (FSS) scores were evaluated between the groups, and there was a significant difference between the groups (P &lt; 0.001 and P = 0.001, respectively). Although there was a significant difference between the groups, the huge overlap in the distribution of the scores indicated that discrimination of an individual according to FSS/SSS scores is unrealistic in the clinical setting. Conclusion: The BCTQ will not be sufficient and objective in the diagnosis and management of CTS. Today, electrophysiological tests are still the gold standard for the diagnosis of CTS, and referring the patient to the electromyography EMG laboratory is necessary for early diagnosis and determining the effective treatment method.

Karpal Tünel Sendromu Tanılı Erkek Olguların Klinik ve Elektrofizyolojik Bulgularının Meslek Hastalığı, Obezite ve Sigara Kullanımıyla İlişkisinin Değerlendirilmesi

Amaç: Bu çalışmada elektrofizyolojik olarak karpal tünel sendromu (KTS) tanısı almış erkek olgularda sigara kullanımı, obezite, yaş, meslek ve meslek süreleri ile KTS ilişkisinin araştırılmasını amaçladık. Materyal ve Metot: Çalışmaya KTS tanısı konulan 50 erkek olgu dahil edildi. Hastaların yaşı, semptom süreleri, el dominansları, meslekleri ve meslek süreleri, sigara kullanımları ve vücut kitle indeksi (VKİ) kaydedildi. Semptom şiddeti Boston semptom şiddet skalası (BSŞS) ve fonksiyonel kapasite skorları (FKS) ile değerlendirildi. Elektrofizyolojik değerlendirmede bilateral ulnar median duysal ve motor sinir ileti incelemeleri çalışıldı. Bulgular: Hastaların yaş ortalaması 48,40±9,61 yıldı. Mesleki dağılımları büyük oranda inşaat, tekstil, ayakkabı işçileri ve aşçılardan oluşturmaktaydı. BSŞS ortalaması 22,88±8,385 ve FKS 11,40±4,527 idi. VKİ &amp;lt;25 ile &amp;gt;25 üzeri olan KTS’lı hastaların yaş, semptom süresi, semptom şiddet ve FKS arasında istatistiksel olarak anlamlı fark saptanmadı. Meslek süreleri ve sigara kullanımıyla hastalık şiddeti arasında bir ilişki saptanmadı. Sonuç: Erkek KTS özellikle tekstil, inşaat işçileri,ayakkabı üreticileri ve aşçılar gibi işçi sınıfında yüksek oranda görülür. Obezite dereceleri ve sigara kullanımıyla hastalık şiddeti arasında anlamlı ilişki saptamamakla birlikte daha büyük vaka serileri üzerinde çalışmak gereklidir. Çalışanların KTS ile ilgili bilinçlenmesi ve meslek hastalığı farkındalığının oluşturulması önemlidir.

A Comparison of Open Carpal Tunnel Release Outcomes Between Procedure Room and Operating Room Settings

PurposeCarpal tunnel release (CTR) surgical costs are minimized when performed in the procedure room (PR) setting, compared with the operating room. However, it remains unclear whether outcomes differ between surgical settings. Our purpose was to compare outcomes at 1 year or greater follow-up after open CTR between patients treated in PR versus operating room settings using the Boston Carpal Tunnel Questionnaire (BCTQ).MethodsA change in clinical care protocols at our institution occurred in 2014. Before this, all CTRs were performed in the operating room; thereafter, these were transitioned to the PR. Adult patients who underwent isolated unilateral or bilateral open CTR in either surgical setting were considered for inclusion, in which procedures were conducted between January 2014 and October 2018 for the PR group and January 2009 and March 2014 for the operating room group. The Functional Status Scale (FSS) and the Symptom Severity Scale (SSS) components of the BCTQ were collected for all eligible patients at a minimum of 1 year after surgery. We used univariate and multivariable linear regression to determine whether postoperative BCTQ scores were equivalent between PR and operating room groups within a threshold of one-fourth of the lowest estimates of the minimal clinically important difference.ResultsNo differences in demographics, comorbidities, or insurance type were observed between the 104 PR and 112 operating room patients. Survey response rate was 25% and 25% for the PR and operating room patients, respectively. At a mean follow-up of 3 ± 1 years, FSS and SSS scores were equivalent between PR and operating room groups on bivariate analysis. The multivariable equivalence test also demonstrated equivalent FSS and SSS scores between PR and operating room groups within a one-fourth minimal clinically important difference threshold while controlling for age, sex, presence of diabetes or thyroid disease, unilateral versus bilateral CTR, and surgeon.ConclusionsClinical outcomes did not differ between PR and operating room settings after open CTR.Type of study/level of evidenceTherapeutic III.

Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults.

BACKGROUNDAlthough nonpharmacological interventions (NPI) for irritable bowel syndrome (IBS) have been applied clinically, their relative efficacy and safety are poorly understood.AIMTo compare and rank different NPI in the treatment of IBS.METHODSFive electronic databases were searched from their inception to January 12, 2020. Data of included publications were analyzed using network meta-analysis (NMA). Quality of endpoints were assessed by tools of the Cochrane Handbook and the GRADEpro software. Pooled relative risk or standardized mean difference with their corresponding 95% confidence intervals were used for statistical analysis. Surface under the cumulative ranking curve (SUCRA) probability value was conducted to rank the examined interventions. Sensitivity analysis was performed to verify the robustness of results and test the source of heterogeneity.RESULTSForty randomized controlled trials with 4196 participants were included in this NMA. Compared with routine pharmacotherapies and placebo, acupuncture and cognitive behavioral therapy (CBT) had better efficacy in relieving IBS symptoms. Based on the SUCRA values, acupuncture ranked first in improving overall clinical efficacy and avoiding adverse effects. CBT ranked first in lowering the scores of IBS symptom severity scale, self-rating anxiety scale and self-rating depression scale.CONCLUSIONThis study confirmed the efficacy and safety of NPI for improving IBS symptoms, which to some extent recommended several interventions for clinical practice.

Evaluation of Duruöz Hand Index in diagnosis and staging of Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients’ demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r: 0.306, p < 0.001) and Boston functional status scale (FSS) (r: 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR: 2.36, p: 0.01), Phalen positivity (OR: 2.22, p: 0.02), Boston symptom severity scale (SSS) scores (OR: 1.76, p: 0.024), increasing age (OR: 1.06, p < 0.001) and increased BMI (OR: 1.07, p: 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.

Association between vitamin D serum levels and fibromyalgia disease activity

Fibromyalgia (FM) is a chronic musculoskeletal disorder characterized by widespread, long-term pain and multiple tender points revealed in physical examination. Previous studies about the relationship between serum vitamin D level and FM have reported paradoxical results. This cross-sectional study aimed to evaluate levels of vitamin D and its relationship with the severity of FM. Based on the American College of Rheumatology (ACS) criteria, 100 female patients with FM were enrolled in this study, and their serum vitamin D levels were screened. Vitamin D deficiency is defined as a level less than 12 ng/mL; insufficiency is defined as a level between 12–29 ng/mL, and sufficiency is a level equal to or greater than 30 ng/mL. Disease severity was evaluated by symptom severity scale (SSS) score and documented using designed questionnaires. Among the 100 female FM patients enrolled in this study, the mean patient age was 35.60 years; 47% of them had vitamin D deficiency, 36% had vitamin D insufficiency, and only 17% had normal vitamin D serum levels. Vitamin D deficiency was reported among 50% of patients with an SSS score between 9 and 12, 49% of patients with an SSS score between 5 and 8, and 14.3% of patients with an SSS score between 1 and 4. There was no significant correlation between patient age and vitamin D level (p-value=0.12). Moreover, no significant correlation was found between patient age and SSS score (p-value=0.36). The current study demonstrated that there was no statistically significant relationship between FM disease activity and vitamin Dserum level.

Online gambling: A treatment for sports betting addiction

Background: online gambling (bets, casino games, poker, etc.) is an activity that is spreading worldwide, even in countries where it is not yet legalized. Although the situation in Latin America is very heterogeneous, it is possible that, as online gambling is developed and promoted, addiction problems arise. This has already happened in Spain since the legalization of online gambling in 2011. Thus, psychology should be developing intervention programs to face this new scenario. Goal: this paper describes the treatment protocol for a young man with sports betting addiction. Method: the treatment proposal consisted in a cognitive behavioral therapy which focused on deconditioning of gambling situations; training of skills needed to prevent relapses and overcome risky situations; information on gambling risks; change of attitude towards gambling; and promotion of a healthy lifestyle incompatible with gambling addiction. Results: both the treatment phases and the theoretical basis of the intervention proposal are described. The patient, diagnosed with a severe gambling disorder, showed improvements in the gambling disorder criteria and the Symptom Severity Scale Score. Conclusions: a treatment protocol for online gambling addiction, which is based on the principles of motivation and learning, has been developed. This protocol has demonstrated to be effective in reducing gambling behavior and promoting a new healthy lifestyle.

Is Boston questionnaire an alternative to electromyography for evaluation of the surgical outcome for carpal tunnel syndrome?

Objectives This study aims to identify the optimal follow-up method for evaluation of the surgical outcome for carpal tunnel syndrome (CTS).Patients and methods Between January 2006 and December 2010, 61 hands of a total of 46 patients (7 males, 39 females; mean age 56.0±10.4 years; range, 20 to 71 years) with a diagnosis of CTS were retrospectively analyzed. All operations were performed by a single surgeon with a mini-incision distal to the transverse carpal ligament. At a mean follow-up of seven years after surgery, electromyography (EMG) was repeated for all patients. The Boston Carpal Tunnel Questionnaire (BCTQ), Boston Symptom Severity Scale, Boston Functional Status Scale, palmar pinch strength, grip strength, and EMG of the patients were compared before and after surgery.Results The mean follow-up was 84±10 (range, 72 to 104) months. There were significant improvements in the Boston Symptom and Functional Scale scores postoperatively, as well as in the grip and pinch strength. After surgery, EMG findings improved in 83.6% of the patients. However, there was no significant correlation between pre- and postoperative Boston Symptom Severity Scale scores, functional status, pinch and grip strengths, and pre- and postoperative EMG results.ConclusionOur study results demonstrate that the symptom severity and functional status scores of the BCTQ are favorable, and this tool is reliable and easy-to-apply for the diagnosis and follow-up of CTS surgeries.

Characterization of kynurenine pathway in patients with diarrhea-predominant irritable bowel syndrome.

Our objectives are to demonstrate whether the kynurenine pathway is activated in diarrhea-type irritable bowel syndrome (IBS-D) patients, and whether the neurotoxic metabolite quinolinic acid (QUIN) is out of balance with the neuroprotective metabolite kynurenic acid (KYNA), and further explore whether this can lead to increased expression of N-methyl D-aspartate receptor 2B (NMDAR2B) in the enteric nervous system and in turn leads to intestinal symptoms and mood disorders. All enrolled healthy controls and patients accepted IBS Symptom Severity Scale (IBS-SSS) score, Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) anxiety and depression scores, and also underwent colonoscopy to collect ileum and colonic mucosa specimens. The expression of NMDAR2B in intestinal mucosa was detected by immunofluorescence, and fasting serum was collected to detect the tryptophan, kynurenine (KYN), KYNA and QUIN by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Our results showed that the KYN pathway of IBS-D patients was activated. The production of QUIN and KYNA was imbalanced and resulting in an increased NMDAR2B for patients with IBS-D, which may be involved in intestinal symptoms and mood disorders of IBS-D.

Relugolix Combination Improves Quality of Life in Phase 3 Studies of Symptomatic Uterine Fibroids [OP04-4D

INTRODUCTION: In the two phase 3 LIBERTY Institutional Review Board-approved studies, relugolix combination therapy (Relugolix-CT; once-daily relugolix 40 mg, estradiol 1.0 mg, and norethindrone acetate 0.5 mg) significantly improved heavy menstrual bleeding (HMB) and pain associated with uterine fibroids (UF). Impact of Relugolix-CT treatment on quality of life (QoL) was assessed using the validated Uterine Fibroid Symptom (UFS)-QoL questionnaire. METHODS: Changes from baseline to Week 24 in UFS-QoL symptom severity (SS) and health-related (HR) QoL scale scores (range 0 to 100), and HR-QoL subscale scores were assessed. Higher SS scores reflect more severe symptoms; conversely, higher HR-QoL scores indicate better QoL. Least-squares mean changes in SS and HR-QoL were compared between Relugolix-CT and placebo, by LIBERTY study, using a mixed-effects model, with treatment, visit, region, baseline menstrual blood loss volume, and treatment by visit interaction as fixed effects. RESULTS: At Week 24, SS improved significantly from baseline (both studies: nominal P&lt;.0001) with Relugolix-CT vs placebo (decreases were, respectively, from 55.1 to 23.4 and from 60.3 to 49.2 [LIBERTY-1]; from 59.1 to 21.7 and from 59.2 to 45.1 [LIBERTY-2]). HR-QoL improved significantly from baseline (both studies: nominal P&lt;.0001) with Relugolix-CT vs placebo (increases were from 37.2 to 74.0 and from 33.5 to 44.9 [LIBERTY-1]; from 38.9 to 78.7 and from 37.3 to 51.0 [LIBERTY-2]). Similar results were observed between groups in all HR-QoL subscales. CONCLUSION: Over 24 weeks, Relugolix-CT significantly improved HMB and pain associated with UF, with corresponding significant improvements in patient-reported SS, and HR-QoL total and subscale scores.

Characterization of Acute Prescription Migraine Medication Use: Results From the CaMEO Study

ObjectiveTo characterize self-reported use of acute prescription medication for migraine in a sample representing the US population. Patients and MethodsData were obtained from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. The CaMEO Study is an Internet-based cross-sectional longitudinal survey administered between September 17, 2012, and November 19, 2013. Demographic characteristics, migraine-related disability, symptom severity, quality of life, and psychiatric comorbidity profiles were evaluated. ResultsData from 13,624 respondents were analyzed, including 3121 (22.9%) self-reported current users of acute prescription medication for migraine, 1719 (12.6%) previous/discontinued users, and 8784 (64.5%) who had never used acute prescription medication for migraine. Mean ± SD monthly headache frequency was 7.3±7.1 days for current users, 5.6±6.6 days for those who discontinued, and 3.9±4.9 days for respondents who never used acute prescription medication for migraine. Current users experienced the highest degree of migraine-related disability based on Migraine Disability Assessment scores and the highest levels of migraine symptom severity based on Migraine Symptom Severity Scale scores. Current users also had the highest scores on the depression and anxiety questionnaires. The most commonly reported prescription medications used or “kept on hand” by current users were triptans (47.2%; 1474 of 3121), opioids (37.3%; 1164 of 3121), nonsteroidal anti-inflammatory drugs (31.9%; 997 of 3121), and barbiturates (12.8%; 399 of 3121), with many people reporting more than 1 medication. ConclusionDespite reporting moderate to severe migraine-related disability and impairment, many people with migraine have never used acute prescription migraine medication. The burden related to migraine is great, especially among individuals currently using acute prescription medication for migraine.

Features of the Ulnar Nerve Predicting Postoperative Prognosis in Idiopathic Cubital Tunnel Syndrome: Three Distinct Features of the Ulnar Nerve.

This retrospective case-control study was performed to determine the relationships between features of the ulnar nerve and postoperative outcomes following in situ decompression in idiopathic cubital tunnel syndrome (CuTS). The study population consisted of 86 patients who had undergone surgery for CuTS. We evaluated demographic factors, hand dominance, symptom onset time, time from diagnosis to surgery, findings of electrodiagnosis (nerve conduction velocity/electromyography), and preoperative clinical status. Intraoperatively, the ulnar nerve was defined as a definitively compressed, abnormally enlarged, or inflammatory lesion. Clinical improvements were evaluated at least 2 years after surgery. Fifty-four patients showed improvement after surgery in terms of the modified McGowan grade and were designated as group 1. Meanwhile, 32 patients with unchanged or aggravated status were classified as group 2. Preoperative status, as determined by the modified McGowan grade, Boston Symptom Severity Scale score, severity of electrodiagnosis, and predominant symptoms were similar between the groups (all, P > 0.05). On regression analysis, only the classification of nerve lesions and the time from diagnosis to surgery had an impact on postoperative outcome (all, P < 0.05). Especially, enlarged ulnar lesion predicted poor prognosis (P = 0.003). Ulnar nerve enlargement, grossly detected intraoperatively, and long interval between diagnosis and surgery were independently associated with poor prognosis of CuTS. Among the anatomic structures involved in the generation of CuTS, the medial epicondyle showed a strong association with enlarged nerve lesions.

Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 Improve Abdominal Pain Severity and Symptomology in Irritable Bowel Syndrome: Randomized Controlled Trial.

This randomized, double-blind, placebo-controlled, multi-center study investigated the clinical efficacy of two probiotic strains on abdominal pain severity and symptomology in irritable bowel syndrome (IBS). Three hundred and thirty adults, aged 18 to 70 years, with IBS according to Rome IV criteria were allocated (1:1:1) to receive placebo, Lactobacillus acidophilus DDS-1 (1 × 1010 CFU/day) or Bifidobacterium animalis subsp. lactis UABla-12 (1 × 1010 CFU/day) over six weeks. The primary outcome was the change in Abdominal Pain Severity - Numeric Rating Scale (APS-NRS). Over the intervention period, APS-NRS was significantly improved in both probiotic groups vs. placebo in absolute terms (DDS-1: −2.59 ± 2.07, p = 0.001; UABla-12: −1.56 ± 1.83, p = 0.001) and in percentage of significant responders (DDS-1: 52.3%, p < 0.001); UABla-12 (28.2%, p = 0.031). Significant amelioration vs. placebo was observed in IBS Symptom Severity Scale (IBS-SSS) scores for L. acidophilus DDS-1 (−133.4 ± 95.19, p < 0.001) and B. lactis UABla-12 (−104.5 ± 96.08, p < 0.001) groups, including sub-scores related to abdominal pain, abdominal distension, bowel habits and quality of life. Additionally, a significant normalization was observed in stool consistency in both probiotic groups over time and as compared to placebo. In conclusion, L. acidophilus DDS-1 and B. lactis UABla-12 improved abdominal pain and symptom severity scores with a corresponding normalization of bowel habits in adults with IBS.