Total Score In Group Research Articles

Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the Treatment of Category III Chronic Prostatitis: A Randomized Sham Controlled Study

Abstract Background Chronic non-bacterial prostatitis (CNBP) is a common disease associated with pain, urinary and sexual symptoms. Diagnosis and treatment of CNBP is usually difficult and requires multiple approaches and usually with unsatisfactory outcomes. Aim and Objectives to assess the effectiveness of the intraprostatic Botulinum toxin type A (BONT-A) in the treatment of refractory CNBP in a randomized sham-controlled trial. Subject and Methods 70 patients with refractory CNBP were equally randomized into two groups. Patients in treatment group (group 1) received transurethral intraprostatic BONT-A injection, whereas patients in sham group (group 2) received transurethral intraprostatic saline injection. Baseline national institute of health chronic prostatitis symptom index (NIHCPSI) was evaluated before intervention and reassessed after 1, 3 and 6 months following treatment. Result Age, prostate size, duration of symptoms as well as baseline total NIHCPSI were not statistically significantly different between both groups before intervention (30.29 vs. 29.8 for group 1 vs. group 2 respectively, p = 0.583). We found statistically significantly reduction of NIHCPSI total score in group 1 compared to group 2 at all intervals of follow up (27.21 vs. 29.03, p = 0.037, 24.97 vs. 28.59, p < 0.001 and 21.76 vs. 27.27, p < 0.001, at 1, 3 and 6 months respectively). Mean pain subscale scores statistically significantly decreased in group 1 compared to group 2 from baseline (14.77 and 14.06 for group 1 and group 2 respectively, p = 0.127) to 12.52 and 13.79, p = 0.010, 11.53 and. 13.25 p < 0.001 and 10 and 13.33, p < 0.001 after 1, 3 and 6 months respectively. Similarly, mean quality of life score statistically significantly improved in group 1 compared to group 2 from baseline (7.74 and. 8.40 for group 1 and. group 2 respectively, p = 0.038), then after 1, 3 and 6 months (6.09 vs. 7.88, p < 0.001, 5.56 vs. 7.81, p < 0.001 and 4.74 vs. 7.39, p < 0.001 respectively). Mean urinary symptoms scores statistically significantly decreased in group 1 compared to group 2 at all follow up intervals from baseline (7.77 and. 7.34 for group 1 and group 2 respectively, p = 0.136), to 6.15 vs. 7.06, p < 0.001, 5.75 vs. 6.97, p < 0.001, 4.91 vs. 6.58 p < 0.001 after 1, 3 and 6 months respectively. Maximal effect of treatment with BONT-A was at 6 months. Mild dysuria and hematuria were the only two postoperative complications encountered after intervention in both groups. Conclusion Transurethral intraprostatic injection of BONT-A is a safe and effective treatment for refractory CNBP.

Evaluation of comparative efficacy of Hijama bila shart (dry cupping) and Bukhoor (steam application) in the management of low back pain

IntroductionLow back pain is an important cause of disability. The aim of treatment is to reduce the pain and minimize its consequences. Management includes counseling and reassurance, use of analgesics, non-pharmacological therapies, and regular review. MethodAn open-label, randomized, and parallel-group clinical trial was conducted in which Group A patients received Hijama bila Shart (dry cupping) while group B patients received Bukhoor (medicated steam application); both therapies were given for 5 min in 3 sittings (day 1, 4 and 8). ResultOswestry LBP Total Scores in Group A decreased from 20.70 ± 0.49 to 6.77 ± 0.37, while in Group B it decreased from 20.07 ± 3.63 to 5.83 ± 2.36. The pain intensity also decreased from 3.10 ± 0.55 to 1.57 ± 0.57 in group A, while from 2.97 ± 0.61 to 1.30 ± 0.75 in group B. Improvement in disability was also found statistically significant. On comparing the improvement in disability between the group, the difference was significant (p < 0.05), and improvement in group A was a little better as compared to group B. DiscussionThe effect of dry cupping may be due to increased blood circulation; lymphatic channelization and dispersion of inflammatory chemicals from the site of pain. The effect of medicated steam application may be due to the anti-inflammatory and muscle relaxing effects of steam and heat of the steam itself; the drugs used for steam application are reported to reduce inflammation on local application. ConclusionDry cupping and Medicated Steam application both are beneficial, safe, and cost effective treatment modalities for the Low back pain.

Development of a Semiquantitative Whole-Body MRI Scoring System for Multiple Myeloma.

Background In patients with multiple myeloma (MM), the serum marker β2-microglobulin does not always accurately reflect tumor load. In contrast, whole-body (WB) MRI has shown high sensitivity for detecting bone lesions. Purpose To develop and validate a semiquantitative WB MRI scoring system for newly diagnosed MM and to compare it with the International Staging System (ISS) and Revised ISS (R-ISS). Materials and Methods This study included two retrospective groups (group 1, July 2015 to September 2021; group 2, February 2020 to September 2021) and one prospective group (group 3, October 2021 to February 2022) of patients with newly diagnosed MM. A new scoring system for MM was developed using spine MRI scans in group 1 and WB MRI scans in group 2 that integrated three features: (a) background marrow pattern, (b) number of focal bone lesions, and (c) presence of extramedullary or paramedullary lesions. The summed total score ranged from zero to nine. The interobserver agreement for each feature was assessed using Fleiss or Cohen weighted κ. WB MRI total scores in group 3 were compared across ISS and R-ISS stages using two-way analysis of variance. Results Groups 1, 2, and 3 included 103 patients (mean age, 62.1 years ± 9.1 [SD]; 60 men), 36 patients (mean age 65.4 years ± 11.3 [SD]; 19 women), and 39 participants (mean age, 62.0 years ± 11.7 [SD]; 20 men), respectively. The interobserver agreements for the three features composing the scoring system were substantial (κ range, 0.69-0.80). WB MRI total score increased with increasing ISS stage (mean score for ISS 1, 2, and 3 was 2.2, 4.2, and 5.8, respectively; P = .009) and R-ISS stage (mean score for R-ISS 1, 2, and 3 was 2.1, 3.8, and 5.9, respectively; P = .005). Conclusion The developed WB MRI scoring system for MM demonstrated substantial observer agreement and corresponded well with ISS and R-ISS stages. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Dragan and Messiou in this issue.

Comparative analysis of the clinical, functional and radiological outcomes of proximal femoral nail alone verses proximal femoral nail along with lateral wall plating in management of unstable intertrochanteric femur fracture, AO/OTA, type 31A2 fractures with deficient lateral wall

Background: The objective of the study was to compare the effectiveness in terms of clinical, functional and radiological outcomes of management of unstable intertrochanteric femur fracture, AO/OTA type 31A2 intertrochanteric fractures with deficient lateral wall with proximal femoral nail (PFN) alone verses PFN along with lateral wall plating. Methods: In our study 52 patients with intertrochanteric femur fractures, AO/OTA type 31A2 which met the selection criteria were divided into two groups, group A (PFN) with lateral wall plating and group B (PFN) alone by randomization and were analysed prospectively with no significant difference in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The intraoperative time and blood loss, time to full weight-bearing and radiological union, varus collapse, functional outcome and postoperative complications were recorded and compared. Results: Comparatively, no significant difference was observed between both groups for the time for full weight bearing. However significant difference was observed between both the groups for HHS at 9 months, neck shaft angle and time for radiological union (in weeks). Statistically significant difference was observed between both the groups for neck shaft angle and HHS at 9 months. The incidence of complications was 30.77% in group B. The incidence of complications was around 26.92% in group A; with no significant difference. At 9 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B. Conclusions: For unstable intertrochanteric femur fracture with incomplete lateral wall, the incidence of varus collapse after augmentation of PFN fixation with lateral wall plating was lower, the time for radiological union was earlier and functional outcome was better.

Simulation-Based Learning Combined with Case and Problem-Based Learning in the Clinical Education of Joint Surgery

Traditional education of clinical training mainly relies on a single mode of lecture-based learning (LBL), in which the teacher lectures and the students listen, and the teaching effect is often unsatisfactory. This study aims to explore the effect of simulation-based learning (SBL) combined with case and problem-based learning (CPBL) teaching mode in the clinical education of joint surgery. Through objective evaluation of joint surgery students' theoretical knowledge and clinical skills, and subjective evaluation of teaching quality by anonymous questionnaire, the teaching effects of LBL teaching mode, CPBL teaching mode and SBL combined with CPBL teaching mode in clinical teaching of joint surgery were compared. Sixty students who participated in the standardized training of residents in the Center for Joint Surgery, Southwest Hospital, Army University, China from March 2020 to September 2021 were selected and randomly divided into groups A, B, and C, with 20 students in each group. Group A adopted traditional LBL mode, group B adopted CPBL mode, and group C adopted SBL combined with CPBL mode. The scores of theoretical knowledge, clinical skills and total score of group C were (86.40 ± 9.76), (92.15 ± 4.49), (88.70 ± 5.75) points respectively, which were significantly higher than (78.80 ± 10.50), (86.60 ± 8.79), (81.92 ± 6.97) points in group B, and (80.50 ± 6.64), (85.35 ± 7.99), (82.44 ± 5.97) points in group A, the difference was statistically significant (p < 0.05). The scores of 5 self-evaluation items, i.e., learning interest, self-learning ability, problem-solving ability, clinical skills and comprehensive competency were (18.90 ± 1.22), (18.85 ± 1.01), (18.75 ± 1.13), (18.90 ± 1.22), (18.50 ± 1.02), (18.80 ± 0.81) points in group C, which were higher than (15.90 ± 1.41), (14.30 ± 2.47), (13.95 ± 2.01), (14.50 ± 1.63), (14.70 ± 1.38) points in group B, and (11.65 ± 2.90), (10.05 ± 1.69), (9.75 ± 1.67), (14.35 ± 1.90), (12.75 ± 2.12) points in group A, the difference was statistically significant (p <0.05). The satisfaction of students in group C (95.00%) was significantly better than that in group B (80.00%) and group A (65.00%), and the difference was statistically significant (p < 0.05). SBL combined with CPBL teaching mode can effectively improve the theoretical knowledge and clinical skills of the students, which could improve self-assessment and teaching satisfaction rate, and is worthy of application and promotion in the clinical teaching of joint surgery.

Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases.

To evaluate the safety and complications of hydrogel spacer implantation. This single-center historical cohort study retrospectively analyzed cases of hydrogel spacer implantation between October 2018 and March 2022. The survey items were the rates of possible hydrogel injection implementation, the success rate of hydrogel implantation including asymmetry, higher position, rectal wall infiltration, subcapsular injection, and other adverse events, and width created by the spacer. To investigate the learning curve, 1, 2, and 3 points were assigned to adverse event grades G1, G2, and G3, respectively. Spacer effectiveness obstruction, such as asymmetry was assigned 3 points. A Mann-Whitney U test was performed to assess statistically significant differences. The study included a total of 200 patients with a median (range) age of 70 (44-85) years. In 10 (5%) patients, hydrogel injection implementation was not possible. Of 190 patients who underwent hydrogel spacer placement, 168 (88%) received a satisfactory placement. The median (range) width of hydrogel spacers was 13.1 (4.4-18.7) mm. Spacer asymmetry, higher position, rectal wall infiltration, and prostate subcapsular infiltration occurred in 7 (3.7%), 5 (2.6%), 12 (6.3%), and 1 (0.5%) patients, respectively. G1 and G3 adverse events occurred in 13 (7%) and 4 (2%) patients, respectively. Practitioner #1 who performed the highest number of procedures had significantly (p=0.04) lower total scores in group B. Spacer implantation yielded favorable outcomes with a high percentage of appropriate spacer implantation, and few major complications.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ НЕСТАБИЛЬНЫХ НЕОСЛОЖНЁННЫХ ПЕРЕЛОМОВ ПОЗВОНОЧНИКА

Objective: To perform a comparative analysis of the results of treatment of unstable uncomplicated spinal fractures (UUSF) Methods: Six hundred fifty-nine patients aged 18-74 years (mean age 45.4±2.3 years) with a UUSF were enrolled; 63.7% of them were males. The patients were categorized into three groups: Group I (35.9%) patients underwent posterior transpedicular fixation, Group II (20.6%) – posterior fusion using various plates, and Group III (43.4%) patients were treated conservatively, as they refused surgery. The results of treatment were evaluated using a newly developed scale, and the quality of life was assessed using the Oswestry scale. Results: In Group I, good results were achieved in 59.9% of cases, whereas 1.1% of patients showed unsatisfactory results. In Group II satisfactory results (62.6%) were predominant, while in Group III most common were unsatisfactory results (55.6%). When studying the quality of life using the Oswestry scale, the best results were achieved in Group I. The total score in Group I was 3.2±0.03; in Group II – 15.8±2.3 and in Group III – 24.9±3.4, while the Oswestry index score was 7.1±1.6; 35.1±3.8; and 55.3±4.6 respectively. Conclusion: The results of the study demonstrated a highly significant correlation between the long-term results of UUSF treatment and the chosen treatment tactics. Transpedicular fixation allowed us to achieve positive results in 98.9% of patients Keywords: Uncomplicated spine fractures, unstable spine fractures, transpedicular fixation, posterior fusion, long-term results, conservative treatment.

Validation of the Mandarin Chinese Translation of the "Meaning of Life" in Patients with Hearing Loss or Tinnitus.

There is an increasing need to evaluate the quality of life of individuals who are hearing impaired. However, most of the generic "quality of life" questionnaires do not include communication-related questions. Recently, a new "Meaning of Life" (MOL) questionnaire was developed to measure quality of life based on everyday issues, enabling a comprehensive evaluation of tinnitus patients and cochlear implant users. A Mandarin Chinese version of this questionnaire for the Mandarin-speaking population is needed. Many of the existing Mandarin Chinese questionnaires currently in use are not effectively assessing hearing-related conditions. We aimed to translate and validate the MOL questionnaire into Mandarin Chinese to make it applicable as a tool for measuring quality of life in patients with hearing loss or tinnitus. For this study, the original version of the MOL questionnaire was translated into the Mandarin Chinese language. A prospective cohort study was then performed on adults with hearing loss or tinnitus to preliminarily examine the reliability and validity of the Mandarin Chinese version. A total of 206 Mandarin-speaking subjects with hearing loss or tinnitus were included in the study and divided into three groups according to their chief complaints: group B included patients suffering from both hearing loss and tinnitus (N = 113), group T contained patients with tinnitus alone (N = 49), and group H was composed of patients with hearing loss alone (N = 44). The Mandarin version of the MOL (C-MOL) was administered to the participants. The reliability of the C-MOL was evaluated using Cronbach's α and item total correlation coefficients. Exploratory factor analysis was performed to examine the relationships among the questions. Correlations between the patient characteristics and total scores were tested. The Cronbach's α coefficient of C-MOL was 0.921. Four factors were identified by exploratory factor analysis: (1) mental state and positive outlook; (2) friendship; (3) physical health; and (4) hearing and negative experience. The total scores of groups B, T, and H were 76.4 (standard deviation [SD] = 13.5), 81.3 (SD = 10.6), and 82.4 (SD = 12.5), respectively. The total score was correlated with the affected ears (r = 0.179, p < 0.05), age (r = 0.179, p < 0.05), hearing of the better ear (r = 0.188, p < 0.01), and educational background (r = 0.181, p < 0.01). The Mandarin Chinese version of the MOL questionnaire showed good reliability. It can be used to quantify the quality of life of patients with hearing loss or tinnitus.

Effect of Physical Therapy and Yoga on Quality of Life in Children with Duchenne Muscular Dystrophy – A Randomised Comparative Study

Background and Objectives Quality of life QOL of the individuals suffering from Duchenne Muscular Dystrophy DMD was found to be reduced due to the chronicity and progressive nature of the illness and the intensity of disability. We intended to identify whether physical therapy and yoga intervention has an effect on the QOL in patients with DMD.Methods Patients diagnosed with DMD in the age group of five to ten years were randomly allocated to two groups. Group 1 was managed with two sessions of physical therapy whereas group 2 received one session of yoga and physical therapy. Quality of life status was measured using Pediatric quality of life PedsQL neuromuscular module. Intervention was continued for a period of one year as a home based program with assessments done during the first visit and at every three months till one year.Results Homogeneity was maintained between the groups with regard to the age p0.578 and duration of the disease p0.312. There was a significant time effect in group I for lsquoMy neuromuscular diseasersquo sub-score and the total score whereas group II demonstrated significant time effect for lsquoMy neuromuscular diseasersquo subscore alone p lt0.05. A reduction in scores was observed for communication family resources and total score in group II demonstrating a negative effect.Conclusion Two physiotherapy sessions in a day are beneficial in improving the quality of life status in patients with DMD. Yoga was also an acceptable way of treatment in children with DMD as the caretakers participated in the sessions along with them.nbsp

Influence of Physical Therapy and Cholinergic Medication on the Life Quality Parameters in Post-Stroke with the arm Motor Dysfunction

Motor dysfunction makes the greatest contribution to the patient’s functional independence and has a significant impact on the quality of life (QOL) of post-stroke patients.&#x0D; The objective of the research was to evaluate the impact of different physical therapy approaches and choline alphoscerate on the functional independence and quality of life in patients in 1 year after ischemic stroke.&#x0D; Materials and methods. There were 104 patients examined in 1-year period after first anterior circulation ischemic stroke. Neurological status, functional independence and QOL were assessed according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Functional Independence Measurement (FIM) and Stroke Specific Quality of Life Scale (SS-QOL). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for hand motility improvement for 2 months; patients in Group 3 received choline alphoscerate 400 mg twice a day for 2 months in addition to the abovementioned physical therapy.&#x0D; Results. 2 months of physical therapy in Group 1 resulted in increase of “Transfer” and subtotal motor scores. A significant increase in the “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in the patients in Group 2 and Group 3; the motor subtotal and total scores in Group 3 were 11.4% and 11.6 % higher than the same indices in Group 1, respectively.&#x0D; The most significant improvement of QOL parameters was observed in patients in Group 3, whose total score increased by 36.8% from the baseline (p&lt;0.05), and exceeded the same index of Group 1 by 17.1% (p&lt;0.05).&#x0D; Conclusions. Adding of hand exercise into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore functional independence. Stimulation of cholinergic neurotransmission with the choline alphoscerate may also increase the efficacy of physical therapy and contribute to patients’ general mobility, upper extremity function and QOL.

Effectiveness of Short Form-36 Health Status Questionnaire Versus WOMAC Arthritis Index Questionnaire on Chronic Knee Osteoarthritis Patients

Introduction: Osteoarthritis is a common disease of aged population and one of the leading causes of disability. Key causes include obesity or overweight along with aging. Knee osteoarthritis can cause significant pain and functional loss. As the disease progresses, it can cause chronic knee joint pain, muscle weakness, joint deformity and functional deficiency which leads to decreased quality of life. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) is a 24-item questionnaire with 3 sub-scales measuring pain (5 items), stiffness (2 items) and physical function (17 items). Health related quality of life is measured using Short Form-36, used to examine health status in following eight domains: Bodily pain, physical function, role limitations due to social problems, physical problems, general health, vitality, social function, mental health, role limitation due to physical problems. Aim: To find the effect of Short Form-36 Health Status Questionnaire versus WOMAC Arthritis Index Questionnaire to measure the pain, Range of Motion (ROM) and disability in subjects with chronic knee osteoarthritis patients treated with Contrast Bath and Knee Exercises. Materials and Methods: This study was a pre and post longitudinal cohort study. A total of 90 patients were divided into two groups of 45 each. Each patient was given treatment for four weeks. Each patient was treated with Contrast bath and Knee Exercises. Group A patients were instructed to fill the Short Form-36 Health Status Questionnaire and Group B patients were instructed to fill the WOMAC Arthritis Index Questionnaire and outcome measures were collected on day 1, at the end of 2nd week and at the end of 4th week. Data from study were analysed using the statistical package SPSS 19.0 (SPSS Inc., Chicago, IL) and level of significance was set at p&lt;0.05. Results: Group B shows a mean of the total score of WOMAC Arthritis Index Questionnaire which was 74.66 (SD 10.01) on Day 1; mean of 49.02 (SD 12.08) at the end of the 2nd week and a mean of 20.68 (SD 12.23) at the end of 4th week. The p-value was found to be 0.0001. The percentage disability evaluated by the WOMAC Arthritis Index Questionnaire shows a mean of 78 (SD 10) on Day 1; mean of 51 (SD 12) at the end of 2nd week and a mean of 22 (SD 13) at the end of 4th week. On day 1 Short Form-36 Questionnaire, total score of group A was 88.24 (SD 6.72) and at the end of 2nd week and 4th week the mean score was 94.06 (SD 5.10) and 98.72 (SD 4.55), respectively with statistically significant difference p-value (0.0001). Conclusion: The present study showed that the WOMAC Arthritis Index Questionnaire had superior sensitivity in reducing pain and increasing range of motion and thus by decreasing the disability.

Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis

To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation ( P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ 2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ 2=5.13, P=0.03; χ 2=7.53, P=0.01). Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

Effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy

Objective: To investigate the effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy. Methods: One hundred patients undergoing radical laparoscopic nephrectomy in Affiliated Cancer Hospital of Zhengzhou University from September 2018 to February 2020 were divided into two groups (n=50) using a random number table: butorphanol patient-controlled intravenous analgesia group (group A) and sufentanil patient-controlled intravenous analgesia group (group B). Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery. The formulation of group A was butorphanol (0.15 mg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. The formulation of group B was sufentanil (1.5 μg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. At the time points of 4, 8, 24, 48 h after operation (T(1), T(2), T(3), T(4)), VAS scores at rest and cough were recorded. The incidence of remedial analgesia, the number of pressings during 48 h after the operation, the postoperative anal exhaust recovery time of the patients were recorded. Quality of recovery-40(QoR-40) scores were recorded at T(3) and T(4). Adverse reactions were recorded. Results: There was no significant difference in VAS scores at rest and cough at T(1), T(2), T(3) and T(4) between two groups (all P>0.05). There was no significant difference in the incidence of remedial analgesia and the number of pressings during 48 h after the operation between two groups (all P>0.05). The postoperative anal exhaust recovery time of the patients in group A was (32±6) h, which was lower than that in group B with statistically significant difference [(40±5) h, t=7.937, P<0.01]. The QoR-40 total scores in group A were higher than those in group B at T(3) and T(4), which were (185.8±2.5) vs (170.7±2.7), (194.8±1.9) vs (183.6±2.6), and the differences were statistically significant (t=28.878, 25.025, all P<0.01). The incidence of nausea, retching/vomiting, respiratory depression and itch during 48 h after the operation in group A were 10%, 6%, 2%, 2%, which were lower than that in group B (32%, 20%, 14%, 18%), with statistically significant difference (χ(2)=7.294, 4.322, 4.891, 5.983, all P<0.05). Conclusion: PCIA with butorphanol or sufentanil can provide satisfactory analgesia for patients undergoing radical laparoscopic nephrectomy, but butorphanol can promote postoperative rehabilitation with fewer adverse reactions.

Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall

To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall. The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated. The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B ( P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups ( P<0.05), and there was also no significant difference in TAD values between the postoperative time points ( P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups ( χ 2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B ( P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant ( χ 2=3.881, P=0.049). For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.

Application of 3D-Printed Orthopedic Cast for the Treatment of Forearm Fractures: Finite Element Analysis and Comparative Clinical Assessment.

Objective This pilot study is aimed at investigating the mechanical characteristics of a cast-wrapped fractured forearm and performing a clinical comparative study of our own developed 3D-printed orthopedic cast. Methods An integrated finite element (FE) model including a forearm and a 3D-printed cast wrapping the forearm was created. The distal radial ulna in this model was cut through to mimic the bone fracture. A 400 N force and 1 Nm rotation moment, which were much larger than the loading conditions encountered in daily life for a human being, were applied on the palm. We conducted a comparative clinical study by using statistical assessment. 60 patients with forearm fractures were selected and treated with manual reduction and external fixation cast. All patients were divided into three groups with equal members (20): (a) 3D-printed external cast group, (b) traditional plaster external fixation group, and (c) splint external fixation group. The clinical efficacy, wrist function, and patient satisfaction were scored and compared. Results In the condition of 400 N loading, the fracture displacements in anterior-posterior (AP), posterior-anterior (PA), medial to lateral (ML), and lateral to medial (LM) compression directions were 1.2648, 1.3253, 0.8503, and 0.8957 (mm), respectively, and the corresponding fracture stresses were 4.5986, 3.9129, and 5.0334, 7.9197 (MPa), respectively. In the inward (IR) and outward (OR) rotations, the fracture displacements were both 0.02628 (mm), and the corresponding fracture surface stresses were 0.1733 and 0.1723 (MPa), respectively. In the clinical efficacy, wrist function, and patient comfort evaluation, the total scores of group A were both higher than those in groups B and C (P < 0.05). Conclusion A 3D-printed orthopedic cast was capable of exerting appropriate mechanical correction loads on specific areas to maintain optimal alignment of a fractured forearm and thus could achieve the favorable clinical efficacy and patient comfort.

Nursing intervention in prevention of phlebothrombosis of lower limbs after renal tumor resection

Objective To observe the effect of nursing intervention based on analytic hierarchy process in prevention of phlebothrombosis of lower limbs after renal tumor resection. Methods Clinical materials of 80 patients with renal tumor resection from October 2017 to October 2019 were analyzed retrospectively. According to the application time of nursing intervention based on analytic hierarchy process, the patients treated with routine nursing intervention from October 2017 to September 2018 were selected as control group(n=34), and the patients treated with nursing intervention based on analytic hierarchy process from October 2018 to October 2019 were selected as study group(n=46). Rehabilitation related indexes, coagulation and fibrinolysis indexes after intervention, quality of life, incidence of complications and excellent rate of nursing were compared between the two groups. Results The time to anal exhaustion, infusion time, time to first activity and hospitalization time of the study group were significantly shorter than those of the control group, and the hospitalization expense was signifiantly less than that of the control group(P<0.05). After the intervention, prothrombin time(PT), D-dimer, partial thromboplastin time(APTT), plasma tissue plasminogen activator antigen(TPA-Ag)in the study group were significantly lower than those in the control group, and the tissue-type plasminogen activator inhibitor(PAI)was significantly higher than that in the control group(P<0.05). After intervention, the scores of environment, physiology, independence, psychological state, mental support, social relationship and total score in both groups increased significantly, and the - scores of environment, physiological condition, independent state, psychological state, mental support, social relationship score and total score in the study group were significantly higher than those in the control group(P<0.05). The incidence rates of lower limbs swelling or pain, venous thrombosis of lower limbs, pulmonary embolism and other complications in the study group were significantly lower than those in the control group(P<0.05). The excellent rate of nursing in the study group was 97.83%, which was significantly higher than 67.65% in the control group(P<0.05). Conclusion Nursing intervention based on analytic hierarchy process can effectively shorten the recovery time of patients with renal tumor resection, improve the quality of life of patients, and prevent phlebothrombosis of lower limbs.

Effects of phased discharge process for ICU patients on separation anxiety of their family members

Objective To explore the effects of phased discharge process for ICU patients on separation anxiety of their family members. Methods From October 2018 to December 2018, we selected 136 family members of patients discharged from ICU at Xinxiang Central Hospital by convenience sampling as subjects. Family members were randomly divided into group of routine discharge (n=66) and group of phased discharge (n=70) . Group of routine discharge carried routine discharge process. Group of phased discharge process implemented phased discharge process which divided discharge process into four stages including after condition stabilizing, 24 hours before discharge, on the discharge day and 24 hours after discharge and provided different nursing keys. The separation experience and depression as well as anxiety were evaluated with the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) and Hospital Anxiety and Depression Scale (HADS) before and after intervention. Results After intervention, the scores of PDEQ of two groups decreased compared with those before intervention (t=-11.763, -27.172) ; besides, the score of PDEQ in group of phased discharge was lower than that in group of routine discharge (t=-28.441) ; the ratios of family members with the scores of PDEQ<1.20 and ranged from 1.20 to 2.00 in group of phased discharge were higher than those in group of routine discharge respectively. After intervention, the scores of HAD-A and HAD-D and total score in HADS between two groups all decreased compared with those before intervention; the dimension scores and total score of group of phased discharge were lower than those of group of routine discharge (t=-6.881, -8.806, -9.111) . The differences were all significantly statistical (P<0.05) . Conclusions Phased discharge process can relieve separation experience in family members of ICU discharged patients, lower their anxiety and depression and improve their care ability. Key words: Intensive care units; Phased discharge; Anxiety, separation; Family members

Clinical observation of selective posterior rhizotomy for improving spasticity and gross movement in patients with cerebral palsy

To explore the effect of selective lumbosacral posterior rhizotomy(SPR) on lower limb spasticity and gross motor function in patients with cerebral palsy. From January 2018 to October 2018, 47 patients with cerebral palsy were treated with rehabilitation alone and SPR combined with rehabilitation. According to whether SPR was performed, the patients were divided into group A and group B. Group A was treated with rehabilitation combined with SPR at lumbosacral level, and group B was treated with rehabilitation alone. There were 23 cases in group A, including 15 males and 8 females, with an average age of (7.30±3.25) years old; 24 cases in group B, 13 males and 11 females, with an average age of (7.00±3.09) years old. Forty-seven patients were assessed with modified Ashworth(MAS) and Gross Motor Function Scale(GMFM-88 items) before and after treatment. The changes of MAS and GMFM-88 scores before and after treatment were compared to evaluate the degree of spasm and the improvement of gross motor function in the two groups. All 47 patients were followed up. At 6 months after treatment, the MAS classification of the two groups was significantly improved(P<0.05), and the improvement of group A was more obvious than that of group B(P<0.05). Six months after treatment, the D, E and total scores of GMFM-88 between two groups were significantly improved compared with those before operation(P<0.05). The improvement of D and total scores in group A was more obvious than that in group B. There was no significant difference in the improvement of area E between two groups. Selective posterior rhizotomy combined with rehabilitation can significantly improve the spastic state and gross motor function of lower limbs in children with cerebral palsy, and can effectively promote the reconstruction and recovery of motor function of lower limbs in children with cerebral palsy.

Comparison of the effects of atorvastatin, hyaluronic acid and oxidized cellulose (Interceed) on reducing intestinal adhesions postoperative after open abdominal surgery in animal models

Background: Abdominal adhesions are considered as an important problem in abdominal surgery. In this study we compared the effectiveness of atorvastatin, hyaluronic acid and interceed (oxidized cellulose) in prevention of postoperative intestinal adhesions. Material and Methods: A total of 40 Wistar-albino rats were randomly divided into 5 groups: Group 1 (Sham); Group 2 (Control or Adhesion induction); Group 3 (Adhesion induction + hyaluronic acid); Group 4 (Adhesion induction + oxidized cellulose); and Group 5 (Adhesion induction + atorvastatin). A same experimental method of cecal abrasion and ligature was used to produce adhesions in all rats. Fourteen days after adhesions formation, animals were killed and adhesions were scored according to macromorphological characteristics and adhesion-carrying tissues under standard histologic examination. Inflammation, vascularization and fibrosis in granulation sites were graded in all samples. Results: Adhesion scores in all experimental groups were slightly lower than control group. Group 3 had the lowest mean adhesions score (1.18 ± 1.24) based on surgeon observation. The mean of adhesion score in Group 3 (1.18 ± 1.24) was significantly lower than that in Group 4 (3.43 ± 0.53) (p=0.004). Group 5 showed the lowest mean adhesions score on pathological examination (5.62 ± 3.73). The mean of adhesion total score in Group 3 was slightly lower than that in other groups; however, this difference was not significant. Conclusion: Hyaluronic acid, oxidized cellulose, and atorvastatin are effective in treatment and prevention of intestinal adhesions during open abdominal surgery. Although hyaluronic acid was slightly more effective, further studies are needed to evaluate the effect of combination therapy with these agents.

Oral health-related quality of life in different clinical forms of oral lichen planus.

The aim of the study was to determine the prevalence of clinical forms in a group of oral lichen planus (OLP) patients and to investigate whether the oral health-related quality of life (OHRQoL) of patients with common clinical OLP forms differs significantly from that of other clinical forms of OLP and healthy patients, respectively. OHRQoL was assessed using the Romanian version of the short form of the Oral Health Impact Profile (OHIP-14). OLP patients rated the pain they were currently experiencing on a visual analog scale (VAS). Statistics was performed using parametric and non-parametric tests and multiple linear regression. Eighty OLP patients and 80 healthy controls were enrolled. The most prevalent OLP clinical form was keratotic form (n = 39, 48.75%, group 1), followed by atrophic (31.25%), erosive-ulcerative (17.5%), and bullous (2.5%) forms, which were included in group 2 (n = 41). The OHRQoL did not differ significantly between group 1 and the other two groups. A negative social impact was reported on psychological discomfort domain for both OLP groups, as compared with healthy controls. VAS scores were significantly associated with OHIP total scores in group 1 (rho = 0.41, n = 39, p = 0.009, Spearman's correlation coefficient). Within the same group, significantly higher OHIP total scores were recorded in patients lacking academic education (p = 0.0086, Mann-Whitney U test). Overall, the most common clinical OLP form did not impact significantly the OHRQoL of OLP patients. Psychological therapy and meeting the educational needs might improve the OHRQoL of patients with common clinical forms of OLP.