Traditional Conservative Treatment Research Articles

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial

PurposeThis study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. MethodsIn this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. ResultsAt all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). ConclusionUltrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

The efficacy of robot-assisted surgery on minor basal ganglia cerebral hemorrhage with neurological dysfunction.

This study aims to compare the outcomes of robot-assisted drainage and conservative treatment in minor basal ganglia hemorrhage (10ml< hemorrhage volume ≤ 30ml) patients with neurological dysfunction, and analyze patients treated with robot-assisted drainage in order to optimize this treatment strategy. In a retrospective study conducted in December 2021 to December 2023, minor basal ganglia cerebral hemorrhage patients with neurological dysfunction were enrolled from the Department of Neurosurgery, Shanghai Ninth People's Hospital. The patients included both the surgical (robot-assisted drainage) and conservative groups. The efficacy of robot-assisted drainage compared with conservative treatment in patients with minor cerebral hemorrhage and neurological dysfunction was evaluated by modified Rankin Scale (mRS) score after 3 months, muscle strength (grade 1 to 5) and cost of hospitalization. Of the patients included, 23 received robot-assisted drainage and 20 received conservative treatment. There were no significant differences in gender, age, history of hypertension and diabetes, muscle strength and mRS score at admission. Female patients accounted for 32.6%, and male patients accounted for 67.4%. About 90% of the patients enrolled had a pre-existing hypertension history. The mRS score after 3 months indicated that prognosis of the patients was significantly better in the surgical treatment group than the conservative treatment group (favorable prognosis 69.57% VS. 35%, P = 0.034) while the patients underwent surgery paid higher hospital bills than patients treated conservatively. Compared with traditional conservative treatment, robot-assisted drainage surgery is more helpful to improve the prognosis of patients with minor basal ganglia hemorrhage (volume ≤ 30mL) accompanied by neurological dysfunction. Robot assisted surgery can safely and effectively remove the hematoma of minor basal ganglia hemorrhage, and there were 69.6% of surgery group patients had a good prognosis in this study.

Frequency and management of rod fractures following minimally invasive bipolar fusionless surgery in neuromuscular scoliosis patients

IntroductionNeuromuscular scoliosis (NMS) is associated with an abnormal muscle tone. Traditional conservative treatments, with the historical practice of early posterior fusion, have proven ineffective. Recently, growth-sparing techniques have gained traction owing to their ability to maximize trunk height. However, these techniques have a substantial risk of complications, particularly rod breakage, with reported incidence rates ranging from 15 % to 42 %. The objective of this study was to conduct a descriptive analysis of NMS patients who experienced rod breakage following the minimally invasive fusionless surgery (MIFS) technique. MethodsThis was a single-center, retrospective study that included all NMS patients who underwent surgery between January 2015 and January 2021 and subsequently presented with rod breakage after MIFS. The MIFS technique is based on proximal fixation with double hook claws made of pedicular and -sus laminar hooks and pelvic fixation with iliosacral screws. ResultsThe mean follow-up was 5.2 ± 2.2 years. The mean dominant etiology of NMS was cerebral palsy (67 %). Of the 217 patients who underwent surgery, 15 (6.9 %) developed rod breakage. Rod breakage occurred 2.7 ± 1.3 years after the initial surgery. Four cases of rod fracture recurrence were reported in ambulatory patients with dystonia or hyperactivity. ConclusionCompared with other fusionless techniques, the minimally invasive bipolar technique appears promising for patients with NMS, with a lower rate of rod breakage. We recommend the use of a four-rod construct for ambulatory patients or for those with dystonia or hyperactivity.

The Role of Platelet-Rich Plasma Injection for Muscle Strains in Athletes.

Muscle tears/strains are among the most common musculoskeletal injuries, posing a serious challenge for sports medicine. Aiming to reduce the time to return to play and the rate of reinjuries, apart from the traditional conservative treatments and rehabilitation protocols, new and innovative therapeutic options have emerged, particularly platelet-rich plasma (PRP). This study aims to present the available evidence regarding PRP injection for the treatment of muscle strains in athletes. Two databases were searched for articles published between January 2012 and December 2022 in Portuguese or English. The query used for the PubMed database was ("Muscles/injuries"[Mesh]) AND ("Athletes"[Mesh] OR "Athletic Injuries"[Mesh]) AND "Platelet-Rich Plasma"[Mesh], while for the Web of Science database the search was performed for "Platelet-rich plasma" AND "Muscle injuries" AND ("Athletes" OR "Athletic injuries"). Eleven studies involving athletes diagnosed with muscle injuries who received treatment with PRP injection alone, or in combination with traditional conservative treatment, compared to a control group, were included. Four randomized controlled trials, four systematic reviews/meta-analyses, two retrospective studies, and one comparative study were included. Current evidence from the highest-quality studies does not support the hypothesis of reduction of time to return to play and the rate of reinjuries after PRP injection, even though some studies reported positive results. However, the available evidence suggests that PRP might have a beneficial effect on the pain perceived by athletes following an acute muscle strain. It is challenging to arrive at definitive conclusions and translate these findings into a clinical context for treating muscle strains in athletes. The existing trials present several inconsistencies and limitations, with a heterogeneous set of patients and injuries, as well as the use of different and inconsistent methods for preparing, administering, and measuring the effects of PRP. To achieve consistent outcomes, standardizing PRP administration procedures is essential.

Electroacupuncture improves apoptosis of nucleus pulposus cells via the IL-22/JAK2-STAT3 signaling pathway in a rat model of cervical intervertebral disk degeneration.

Cervical spondylosis (CS) is a prevalent disorder that can have a major negative impact on quality of life. Traditional conservative treatment has limited efficacy, and electroacupuncture (EA) is a novel treatment option. We investigated the application and molecular mechanism of EA treatment in a rat model of cervical intervertebral disk degeneration (CIDD). The CIDD rat model was established, following which rats in the electroacupuncture (EA) group received EA. For overexpression of IL-22 or inhibition of JAK2-STAT3 signaling, the rats were injected intraperitoneally with recombinant IL-22 protein (p-IL-22) or the JAK2-STAT3 (Janus kinase 2-signal transducer and activator of transcription protein 3) inhibitor AG490 after model establishment. Rat nucleus pulposus (NP) cells were isolated and cultured. Cell counting kit-8 and flow cytometry were used to analyze the viability and apoptosis of the NP cells. Expression of IL-22, JAK2 and STAT3 was determined using RT-qPCR. Expression of IL-22/JAK2-STAT3 pathway and apoptosis related proteins was detected by Western blotting (WB). EA protected the NP tissues of CIDD rats by regulating the IL-22/JAK2-STAT3 pathway. Overexpression of IL-22 significantly promoted the expression of tumor necrosis factor (TNF)-α, IL-6, IL-1β, matrix metalloproteinase (MMP)3 and MMP13 compared with the EA group. WB demonstrated that the expression of IL-22, p-JAK2, p-STAT3, caspase-3 and Bax in NP cells of the EA group was significantly reduced and Bcl-2 elevated compared with the model group. EA regulated cytokines and MMP through activation of IL-22/JAK2-STAT3 signaling in CIDD rat NP cells. We demonstrated that EA affected apoptosis by regulating the IL-22/JAK2-STAT3 pathway in NP cells and reducing inflammatory factors in the CIDD rat model. The results extend our knowledge of the mechanisms of action underlying the effects of EA as a potential treatment approach for CS in clinical practice.

Capacitive biophysical stimulation improves the healing of vertebral fragility fractures: a prospective multicentre randomized controlled trial

BackgroundCapacitively coupling electric fields (CCEF) is a method of non-invasive biophysical stimulation that enhances fracture repair and spinal fusion. This multicentre randomized controlled trial aimed to further examine the roles of CCEF in (1) the resolution of vertebral bone marrow oedema (VBME) using a follow-up MRI study and (2) pain relief, analgesic drug consumption and quality of life improvement in stimulated patients who were referred with acute vertebral fragility fractures (VFFs) compared to non-stimulated patients.MethodsBetween September 2016 and December 2019, patients who were referred to the spine centres that participated in this multicentre randomized clinical study with acute VFFs of type OF1 or OF2 were included in the present study. All the VFFs were conservatively managed according to Good Clinical Practice. Moreover, the patients were randomized into two groups: the CCEF group received, as an adjunct to the clinical study protocol, biophysical stimulation with a CCEF device (Osteospine, IGEA) for 8 h per day for 60 days, whereas the control group was treated according to the clinical study protocol. At baseline (T0), the 30-day follow-up (T1), the 60-day follow-up (T2), and the 6-month follow-up (T3), each patient underwent clinical evaluation using the Visual Analogue Scale (VAS) for Pain and the Oswestry Disability Index (ODI). Analgesic therapy with paracetamol 1000 mg tablets for 7 days—or longer, depending on the pain intensity—was performed; patients were required to report their paracetamol consumption on a specific sheet between study day 8 to 180 days of follow-up. MRI studies of the thoracolumbar spine were performed at 0 (T0), 30 (T1) and 60 days of follow-up (T2) using a 1.5-T MRI system in all of the centres that took part in the study. For each VBME area examined via MRI, the vertebral body geometry (i.e. anterior wall height/posterior wall height and vertebral kyphosis) were assessed.ResultsA total of 66 patients (male: 9, 13.63%; mean age: 73.15 years old) with 69 VFFs were included in the present study and randomized as follows: 33 patients were included in the control group and the remaining 33 patients were randomized into the CCEF group. In the CCEF group, good compliance with CCEF therapy was observed (adherence = 94%), and no adverse effects were recorded. In the stimulated patients, faster VBME resolution and significantly less vertebral body collapse during follow-up were observed compared to the control patients. Moreover, in the active group, faster pain reduction and improvement in the ODI mean score were observed. Stimulated patients also reported a significantly lower paracetamol consumption rate from the third follow-up after treatment until the 6-month follow-up. In terms of sex-related differences, in the CCEF group, VBME showed a faster resolution in male patients compared with females.ConclusionBiophysical stimulation with CCEF, as an adjunct to traditional conservative treatment, is a useful tool to hasten the VBME resolution process and prevent vertebral body deformation. These MRI findings also correlate with faster back pain resolution and quality of life improvement. From the third follow-up after treatment untilthe 6-month follow-up, stimulated patients reported a significantly lower paracetamol consumption than control patients, even though back pain and quality of life showed no significant differences between the two groups.Level of evidenceII.Trial Registration Register: ClinicalTrials.gov, number: NCT05803681.

The effect of complex treatment including osteopathic correction on pain intensity and quality of life in patients with chronic tonsillitis

Introduction. The relevance of the problem of chronic tonsillitis is due to the wide spread of the disease and the occurrence of complications associated with it, which, in turn, contributes to the appearance of pain and a decrease in the quality of life. Available information about the role of the palatine tonsils as an important organ of the immune system makes conservative treatment methods more preferable. Conventional conservative treatment is reduced to episodic implementation of individual techniques and remains insufficiently effective. Obtaining in-depth knowledge about the mechanisms of development of chronic tonsillitis necessitates the search for an integrated approach to treatment including non-drug methods. Often, questions about the severity of pain in patients that affect the level of quality of life are not given due attention.The aim is to study the effect of complex treatment including osteopathic correction on the quality of life and intensity of pain in patients with chronic tonsillitis.Materials and methods. In a prospective controlled randomized study conducted at the Department of Osteopathy and the Department of Otorhinolaryngology of the North-Western State Medical University named after I. I. Mechnikov of the Ministry of Health of Russia in the period from 06.2022 to 06.2023, 60 patients with a diagnosis of chronic tonsillitis were included. All patients, depending on the treatment, were divided using the randomization envelope method into two groups — main (n=30) and control (n=30). Patients in both groupsreceived otorhinolaryngological treatment in the form of lavage of the palatine tonsils (five rinsing procedures using an antiseptic solution, the interval between procedures was 2 days). Patients in the main group additionally received osteopathic correction (three procedures with an interval of 14 days). In all patients, before and after completion of treatment, the intensity of pain was assessed using a visual analogue scale (VAS) and quality of life using the SF-36 questionnaire.Results. In patients of both the main and control groups, there was a statistically significant decrease in the intensity of sore throat (p&lt;0,05) after treatment. The increase in the level of quality of life in terms of both physical and psychological components of health was statistically significant (p&lt;0,001) in patients of the main group. The level of quality of life in patients in the control group increased only due to the psychological component (p&lt;0,001) of health, and the indicators of the physical component did not change (p=0,092).Conclusion. The inclusion of osteopathic correction in the complex therapy of patients with chronic tonsillitis in the inter-relapse period helps to reduce the pain and improve the physical component of quality of life compared to traditional conservative treatment alone. The study should be continued with a larger sample.

Curettage combined with bone cavity opening reduces recurrence of the mandibular conventional ameloblastoma and effectively preserves the mandible: a retrospective study

BackgroundPatients with mandibular conventional ameloblastoma undergoing radical surgical treatment experience greater trauma and often find it challenging to accept, whereas conservative therapy is associated with a higher recurrence rate. In this study, we have improved traditional conservative treatment for mandibular conventional ameloblastoma by curettage combined with bone cavity opening (Cur/BCO). This retrospective study aimed to evaluate the effectiveness of the Cur/BCO treatment by comparing its recurrence rate and bone mineral density (BMD) growth rate with the traditional conservative treatment approach.MethodsA total of 40 patients, meeting the study’s inclusion and exclusion criteria from 2012 to 2020, were screened, with 20 in the modified group and 20 in the traditional group. ImageJ (RRID: SCR_003070) software was employed for measuring image indices. All data were analyzed using T-test, Chi-square test and Fisher exact test in SPSS 26.0 (p = 0.05).ResultsThe incidence of recurrence was significantly lower in the modified group, at only 5%, compared to 35% in the traditional group (p < 0.05). Regarding bone mineral density (BMD) growth rate, the average value in the modified group was 0.0862 ± 0.2302 (/month), significantly higher than the average value of 0.0608 ± 0.2474 (/month) in the traditional group (p < 0.05).ConclusionsIn this study, it was found that the recurrence rate of the modified conservative treatment (Cur/BCO) was lower than that of the traditional conservative treatment for managing mandibular conventional ameloblastoma. Furthermore, the BMD growth rate was quicker in the modified group. Thus, Cur/BCO could be considered as a viable option for the conservative treatment of mandibular conventional ameloblastoma.

Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures.

With an aging population, the osteoporotic vertebral compression fracture (OVCF) has become a constant concern for its physical and neurological complications, such asspinal kyphosis and refractory pains. Compared with traditional conservative treatments, the open surgery is more superior in some ways because of its direct decompression and correction. Various operation methods applying to different indications have been developed to deal with different fracture situations, including anterior, posterior, and combined surgery. In this review, we have concluded the latest developments of the surgery treating OVCF and the internal fixation as references for spinal surgeons of the choice of suitable treatments.

УСОВЕРШЕНСТВОВАНИЕ КОМПЛЕКСНОЙ ТЕРАПИИ ГИПЕРТРОФИЧЕСКОГО ГИНГИВИТА У ПАЦИЕНТОВ С ПАТОЛОГИЕЙ ПРИКУСА

The prevalence of inflammatory periodontal diseases, and in particular hypertrophic gingivitis, among adolescents ranges from 50 - 99%, which is often combined with malocclusion and this combination is about 70% of cases, which is an urgent and unresolved problem of modern periodontology and orthodontics. Therefore, the study of the issues of correlation between the severity of morphological, functional and aesthetic disorders of the masticatory-speech apparatus and the severity of the inflammatory process in the tissues of the periodontal complex is important and necessary for the development of modern complexes for the treatment of adolescents with hypertrophic gingivitis and malocclusion class 1 according to Angle during the hormonal period. perestroika. The purpose of the study: to optimize the complex treatment of malocclusion in adolescents with hypertrophic gingivitis. 32 patients aged 14 to 17 years with E.H. class I malocclusion. ANGLE and mild edematous hypertrophic gingivitis were included in this study. All patients underwent orthodontic treatment using non-removable orthodontic equipment (brackets), but for periodontal treatment, patients were divided into 2 groups of 16 people, one group underwent traditional conservative periodontal treatment, and the other group of patients underwent removal of dental biofilm using GBT therapy on apparatus "PROPHYLAXIS MASTER". Before treatment, after 6 months and after the removal of orthodontic equipment, an index assessment of the state of periodontal tissues was carried out and a comparison of the average statistical data of teleradiography to study changes in the size of the facial part of the skull before and after orthodontic treatment, as well as a study of the correlation between the studied parameters was carried out for all patients. According to the results of the study, it was found that during orthodontic treatment of adolescents with malocclusion class I according to E.H. ANGLE and GBT-periodontal therapy increases the effectiveness of complex treatment for this category of patients by 40% compared to traditional therapy for inflammatory periodontal diseases at the stages of orthodontic treatment.

MODERN ASPECTS OF THE TREATMENT OF PATIENTS WITH AUTOIMMUNE THYROIDITIS

The relevance of the problem is due to the continuous increase in morbidity and the lack of effectiveness of existing treatment methods. The aim of the study is to improve the treatment results of patients with autoimmune thyroiditis by introducing modern laser technology. The study was conducted retrospectively from 2008 to 2021 and is based on data from the examination and treatment of 481 patients with autoimmune thyroiditis. The patients were divided into groups according to the applied treatment methods: the first group - 129 (29,19%) patients, the second group - 106 (23,98%) patients, and the third group - 207 (46,83%) patients. The concentrations of thyroid hormones, pituitary gland and antibodies to thyroid tissues in the blood serum of patients before and after treatment were studied and compared. Long-term treatment results were studied in 340 (70,7%) patients (t=8,8, p≤0,001). Photodynamic therapy, in combination with sessions of intravenous laser blood irradiation with lowintensity laser radiation, contributed to the normalization of thyroid hormone levels (TSH, FT4 and FT3) of the thyroid gland on the 15th day of treatment. Combining conservative treatment of patients with autoimmune thyroiditis with photodynamic therapy allows to obtain good and satisfactory results in 77,5% of cases, which gives reason to recommend photodynamic therapy in combination with sessions of intravenous laser blood irradiation with low-intensity laser radiation as an effective way to complement traditional conservative treatment

Autologous micro-fragmented adipose tissue injection provides significant and prolonged clinical improvement in patients with knee osteoarthritis: a case-series study

PurposeAmong the conservative strategies to manage patients with symptomatic knee osteoarthritis (OA), an innovative approach exploiting the regenerative capability of adipose tissue and its resident MSCs (Mesenchymal Stem Cells or Medicinal Signalling Cells) has been proposed with encouraging results. This study aims to demonstrate the benefits of autologous micro-fragmented adipose tissue (MAT) injection in the conservative treatment of knee osteoarthritis and whether any variables may affect the outcome. This is a case series single-centre study in which patients underwent intraarticular MAT injection without any associated procedures.MethodsBased on inclusion and exclusion criteria, 49 patients (67 Knees) were included and retrospectively analysed with a mean follow-up of 34.04 ± 13.62 months (minimum 11 – maximum 59). Patients were assessed through the WOMAC and KOOS questionnaires at baseline (pre-treatment) and 1-, 3-, 6-, 12-, 24- and 36-month follow-up. A minimal clinically important difference (MCID) of at least 7.5 points for the WOMAC pain scale and 7.2 for the WOMAC function scale compared to the baseline value was used.ResultsWOMAC and KOOS scores improved after treatment compared to baseline at all follow-ups with p < 0.001. Male gender and Kellgren-Lawrence (KL) grade 2 were associated with smaller improvement in WOMAC and KOOS scores (with respect to females and to KL grade 1, respectively) up to 24 months. The percentage of patients who reach the MCID for WOMAC pain is generally lower than that of patients who reach the MCID for WOMAC function (around 80% at all time points), but it increases significantly over time. Moreover, the baseline score of the WOMAC pain and function influence the outcome. Patients with worse symptoms are more likely to reach the MCID.ConclusionsIntra-articular knee injection of MAT for the treatment of knee osteoarthritis (KOA), recalcitrant to traditional conservative treatments, proved to be effective in a high percentage of cases. The positive association between a worse pre-operative score and a better clinical response to the treatment would support the idea that intra-articular administration of MAT could be considered in patients with very symptomatic KOA in which joint-replacement surgeries are not indicated (or accepted).Level of EvidenceIV, case series.

The potential therapeutic effect of platelet-rich plasma in the treatment of post-COVID-19 parosmia

BackgroundCOVID-19-related olfactory dysfunction is an emerging problem with a significant impact on the quality of life of affected individuals. Different lines of treatment have been used with varying results. This study aimed to assess the potential therapeutic effect of PRP in the treatment of post-COVID olfactory dysfunction. This work aimed to assess the potential therapeutic effect of platelet-rich plasma (PRP) in treating post-COVID-19 parosmia. A pilot study was conducted on 60 patients with post-COVID parosmia without responding to a 3-month course of olfactory training, topical corticosteroids, omega-three, vitamin B12, and zinc supplementation. The patients were distributed randomly and equally among 2 groups. The case group was subjected to three PRP injections in the olfactory cleft at 3 weeks intervals. The control group continued the pre-study treatment protocol for 6 weeks. The degree of parosmia was assessed before and after treatment subjectively using a visual analog scale (VAS) from 0 to 10. Reaching 0–1 on the visual analog scale was a complete improvement. The primary outcome was assessing the post-treatment score for parosmia 1 month after the third injection in the case group. The second outcome was the comparison between both groups regarding the degree of improvement 1 month after cessation of treatment.ResultsThere was a highly significant improvement in VAS for parosmia (p < 0.00001) in the case group and a significant improvement in VAS for parosmia in the control group (p = P = 0.00148). There was a significant difference between both groups regarding the degree of improvement favoring the case group (p = 0.002).ConclusionPlatelet-rich plasma injection in the olfactory cleft offers a therapeutic option for treating patients with post-COVID-19 olfactory parosmia who failed to respond to traditional conservative treatment.

Comprehensive treatment of patients with autoimmune thyroiditis using laser technologies

Background. The frequency of autoimmune thyroiditis reaches up to 40% among all thyroid gland diseases and ranks second among endocrinological diseases.&#x0D; Aim. Carrying out a comparative evaluation of the effectiveness of laser photodynamic therapy and traditional conservative treatment in diffuse form of autoimmune thyroiditis.&#x0D; Material and methods. The work is based on the examination and treatment data of 235 patients hospitalized in the Scientific Center of Surgery named after M.A. Topchubashov for the period from 2008 to 2021. Patients were divided into two groups based on the applied methods of treatment. Patients of the main group (106 people, 45.1%) received sessions of laser photodynamic therapy in combination with intravenous laser blood irradiation with low-intensity laser radiation. Patients in the control group (129 people, 54.9%) received a course of conservative therapy in combination with sessions of intravenous laser blood irradiation with low-intensity laser radiation. To test the statistical significance of differences in the concentrations of thyroid hormones, pituitary gland and antibodies to thyroid tissues in the blood serum of patients before and on the 15th day after treatment, Pearson's 2 test was used. In each group, the mean values of the analyzed clinical parameters, their mean error (m), 95% confidence interval, and the significance of intergroup differences were calculated according to Pearson's 2, MannWhitney U, and Student's t criteria. Differences were considered statistically significant at p 0.050.&#x0D; Results. In the main group on the 5th day of treatment, normalization of the main indicators of the inflammatory response occurred in 26 (24.5%) patients, in the control group in 16 (12.4%) patients (2=5.9, p=0.010). In patients of the main group, the levels of antibodies to thyroperoxidase on the 15th day after treatment, compared with their values before treatment, decreased by 5.65 times (t=8.4, p 0.001), the content of thyroid-stimulating hormone decreased by 2.18 times (t=6.9, p 0.001), free thyroxine increased 2 times (t=3.4, p 0.01), free triiodothyronine increased 1.71 times (t=1.4, p 0.05). The average values of antibodies to thyroperoxidase in the main group after treatment were within the normal range (31.575.75 IU/ml).&#x0D; Conclusion. The use of laser photodynamic therapy provides the best results in the treatment of patients with diffuse autoimmune thyroiditis.

Flowable placental connective tissue matrices for tendon repair: A review

Tendon injuries are associated with considerable pain and disability. Owing to the hypovascularity and hypocellularity of the tissue, natural tendon healing is slow and ineffective. Traditional conservative and surgical treatment options fail to address the underlying pathology. As a result, the healed tendon is mechanically incompetent and prone to degeneration and rupture. Therefore, new biological methods have been suggested to enhance tendon repair and regeneration. Flowable Placental Connective Tissue Matrices (FP-CTMs) represent a promising means to promote tendon healing. Like non-flowable placental scaffolds, FP-CTMs possess the innate healing properties of the placenta and provide structural and biochemical extracellular matrix components. Unlike their non-flowable counterparts, FP-CTMs have the added benefits of minimal invasiveness and the capacity to fill irregular spaces. FP-CTMs can enhance tendon repair by providing a three-dimensional extracellular matrix for cellular attachment and proliferation while decreasing inflammation and limiting adhesion formation. The present report reviews tendon biology, pathology, healing, and current treatment modalities, followed by a comprehensive literature review, evaluating the clinical application of FP-CTMs for tendon repair. Recent research suggests that the use of FP-CTMs in tendon repair is safe and efficacious and further indicates that FP-CTMs can modulate the tendon repair environment and improve clinical outcomes. However, the existing clinical evidence is limited to retrospective case series with no control group. Therefore, additional work must be performed to better understand the clinical applications and therapeutic benefits of FP-CTM in tendon repair compared with conventional treatments.

Disorder of sound conduction function in patients with COVID-19

Topicality: Recently, due to the pandemic of the new virus COVID-19, a significant number of patients have been observed in almost all countries of the world, presenting various clinical manifestations of the disease. The auditory system can also suffer when infected with COVID-19. In the publications of several authors, observation of concomitant cochleovestibular manifestations in COVID-19 is presented. In addition, there are reports of sensorineural hearing loss, tinnitus, vertigo, otitis, and ear pain. However, there is still not enough information on auditory system lesions in patients with COVID-19 in the literature; so far, there are no thorough studies in this direction. Aim: to investigate the state of auditory function in patients with COVID-19 with sound conduction disorders. Materials and methods: An analysis of the clinical and instrumental examination results of 47 patients with COVID-19 with auditory function disorders was carried out. The results of the questionnaire, otolaryngological examination, subjective audiometry, and acoustic impedance measurement were analyzed. The investigation was carried out using audiometers АС-40 ("Interacoustics," Denmark), and MA 31 (Germany), impedance audiometers АТ-235, Ad 229e, ("Interacoustics," Denmark), and MAICO (Germany). In addition, an endoscopic examination of the nasal cavity was carried out using the workplace of an otorhinolaryngologist with the Mega Medical NET-1100 endovideo complex. Results and their discussion: The analysis of the survey of 147 patients revealed that damage to the auditory system mainly occurred after a particular time after suffering from the disease due to COVID-19. Some patients (15.6%) had a progression of pre-existing SNS; in them, the first signs of deterioration of auditory function were usually noted a few days after the onset of the disease. In total, among 147 interviewed patients, 51 people (34.7%) indicated certain disorders of the auditory system. At the same time, the patients noted such symptoms as tinnitus, decreased hearing acuity, impaired speech intelligibility, poor tolerance to loud sounds, blocked ears, and unpleasant sensations in the ears (feeling of pressure, tingling, dull pain). During the instrumental examination of 47 patients with COVID-19 with complaints from the auditory system, we mainly observed sensorineural disorders of auditory function. In 23.4% of cases, there was a conductive component. In the majority of such patients after COVID-19, they do not immediately notice symptoms in the auditory system. Instead, they have an unexpressed character and appear over time after the disease. Such hearing disorders are often accompanied by secretory otitis, tubootitis, and auditory tube patency disorder. It should be noted that in patients (19.1%) with a conductive component, there were changes in the anatomical structures of the nose and nasopharynx in the form of curvature of the nasal foramen, hypertrophy of the nasal shells, tubular rollers, etc. Conservative therapy with vasoconstrictor, anti-inflammatory, and hormonal drugs is not always effective in such cases. In most cases, according to our observations, minimally invasive surgical intervention in the form of tympanopuncture was required. Therefore, the disease of COVID-19 is often (34.7%) accompanied, in addition to other symptoms, by a decrease in hearing function. Lesions of the auditory system manifest in the form of perceptual disorders with a pronounced conductive component (23.4%).On the other hand, when presenting patients with persistent but vague hearing impairments, it should be borne in mind that this may be related to a previous illness of COVID-19. Elucidation of this circumstance is vital for prescribing adequate treatment and preventive measures. Conclusions: 1. The disease with COVID-19 is often (34.7%) accompanied, in addition to other symptoms, by hearing impairment due to damage to the auditory system, both perceptual and conductive. Mainly, such manifestations occur after a particular time after the disease. 2. Hearing disorders with COVID-19 often have a conductive component (23.4% of cases). Such disorders can be observed directly during the disease and, in some patients, persist for a long time after recovery. Conductive disorders of auditory function can also develop somewhat delayed from the onset of the disease, have an indistinct protracted nature, and the manifestations can intensify even after the end of the active phase of the disease. 3. Conductive disorders of auditory function in COVID-19 are poorly amenable to traditional conservative treatment methods and require more active measures, including minimally invasive surgical intervention in the form of tympanopuncture. 4. For patients with COVID-19 who have complaints of hearing impairment, it is advisable to undergo an instrumental audiological examination.

Radial head arthroplasty vs. open reduction and internal fixation for the treatment of terrible triad injury of the elbow: A systematic review and meta-analysis update.

Terrible triad injury of the elbow (TTIE) is a severe high-energy injury to the elbow, mainly including elbow dislocation, coronoid fracture and radial head fracture. It is difficult to maintain the stability of the elbow joint using traditional conservative treatment, and there is a high risk of redislocation and various complications. Therefore, surgical treatment is currently advocated, mainly for repairing damaged ligaments and reconstructing bony structures, but there is still controversy about the treatment plan for the radial head. The current meta-analysis was conducted to compare the differences in efficacy of radial head arthroplasty (RHA) and open reduction internal fixation (ORIF) in the treatment of TTIE. Published literature related to the treatment (either ORIF or RHA) of TTIE was searched for in Embase, PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical Literature Database. According to the search strategy, a total of 1,928 related publications were retrieved. The patient must have been diagnosed with TTIE and required surgery on the radial head. The interventions were RHA and ORIF. Non-case-control studies, case reports, review articles, letters, duplicate reports and literature without sufficient relevant data were excluded. The quality of the literature was evaluated according to the Cochrane systematic review methodology and the Jadad scale. After data extraction, meta-analysis was performed using ReviewManager 5.4 software (Cochrane). A total of 15 studies involving 455 patients (189 who underwent RHA and 266 who underwent ORIF) were included. Range of motion (ROM) of the forearm (pronation-supination arc) after surgery in the RHA group [95% CI (0.28, 9.59); P=0.04] was found to be significantly superior to the ORIF group, with a lower incidence of complications [95% CI (0.22, 0.84); P=0.01]. However, there was no statistically significant difference for the Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand Score nor for ROM of the elbow (flexion-extension arc). Overall, compared with the ORIF group, the RHA group had better forearm rotational ROM and fewer complications after surgery. Therefore, RHA was found to be superior to ORIF in the treatment of TTIE.

A Randomized Controlled Trial Evaluating the Levels of the Biomarkers hs-CRP, IL-6, and IL-8 in Patients with Temporomandibular Disorder Treated with LLLT, Traditional Conservative Treatment, and a Combination of Both.

Temporomandibular disorders (TMDs) are a type of idiopathic orofacial pain. Inflammation, particularly elevated circulating levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), has been linked to pain symptoms. The purpose of this study was to compare hs-CRP, IL-6, and IL-8 biomarkers and pain intensity with different treatment strategies (LLLT, standard conservative treatment, and combination) for TMD patients. Methods: A total of 32 participants were randomly included in the study and divided into three groups (Group I, Group II, and Group III) referred from the Dental Clinic, School of Dental Science, HUSM. Patients received LLLT (Groups II and III) in five sessions for the duration of 10 days. Patients in Groups I and III received standard conservative TMD treatment (diet and stress counseling, jaw exercises, physical therapy, which was a hot towel application) by the principal investigator. All blood samples for biomarkers were performed before starting treatments and directly after finishing the treatment protocols, where all results were recorded. Results: The result showed a significant difference in the mean IL-8 (p = 0.001) between the three intervention groups (LLLT, standard treatment, and combined treatment). IL-6 showed an increase in the mean of IL-6 levels from baseline to post-treatment with a better mean in the LLLT treatment group without any significant differences. Additionally, there were no significant mean differences found between the groups and in the group for the hs-CRP biomarker. Conclusions: A statistically non-significant difference was found in hs-CRP and IL-6 before and after LLLT, conservative, and combined treatment strategies of TMD. A statistically significant difference was observed in the mean levels of IL-8 between the LLLT intervention group and the combined treatment group. Although there was no statistically significant correlation between pain intensity and biomarkers, a statistically significant difference was found in pain intensity before and after LLLT, conservative, and combined treatment strategies. TMJ degeneration could be exacerbated by elevated IL-8 levels. Thus, this can be an important biomarker to mark or identify the painful condition of TMJ.

Fibular Glide Mobilization With Movement for the Treatment of Acute Lateral Ankle Sprains: A Critically Appraised Topic

What are the effects of the Mulligan Concept™ posterior fibular mobilization with movement (MWM) on clinical outcomes in patients who sustain an acute lateral ankle sprain (LAS)? The evidence reviewed was level C–Recommendation based on “consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention or screening.” In the studies examined, patients who received Mulligan Concept™ posterior fibular mobilizations in combination with other treatments significantly improved (Minimal Clinically Important Difference met) on the Numeric Rating Scale (NRS) and Disablement of Physically Active (DPA) scale. All patients in the studies were discharged within 2-18 days. However, due to the low level of evidence and the use of traditional conservative treatments in conjunction with mobilization, it is difficult to ascertain whether the Mulligan LAS treatment aided recovery more than traditional methods of treating acute LAS. Therefore, Mulligan Concept™ posterior fibular MWM may be useful clinically in conjunction with traditional conservative treatments for reduction of pain, disability and discharge time for patients with acute LAS, but future research must be conducted to determine if MWMs offer any benefits above and beyond traditional methods of treatment.

Comparative efficacy of traditional conservative treatment and CT-guided local chemotherapy for mild spinal tuberculosis

BackgroundThere are considerable differences in the treatment strategy for spinal tuberculosis, including conservative or surgical procedures. Conservative treatment is always suitable for most patients. This study aimed to compare the clinical efficacy of traditional conservative treatment with CT-guided local chemotherapy strategy of mild spinal tuberculosis.MethodsThis research retrospectively analysed 120 patients with spinal tuberculosis between January 2005 and January 2016 according to the diagnostic criteria of mild spinal tuberculosis. In total, 89 patients underwent traditional conservative treatment, 31 underwent CT-guided local chemotherapy. Clinical outcome, laboratory indexes, and radiological results were analysed to provide a clinical basis for the choice of mild spinal tuberculosis treatment.ResultsAll cases achieved a clinical cure with 24 to 50 months followed up. Cobb angle of the two groups spinal tuberculosis segments was 6.25 ± 3.1100B0, 5.69 ± 2.5800B0 before treatment and 12.36 ± 6.3100B0, 14.87 ± 7.2600B0 after treatment, respectively. The VAS scores were significantly decreased post-treatment. At the 1 month follow-up, the VAS scores and erythrocyte sedimentation rate (ESR) were significantly differences between the two groups. The efficacy in the CT-guided local chemotherapy (Group B) was better than the traditional conservative treatment (Group A). But from the 3 months follow-up to the last follow-up, the VAS scores and ESR was no significant differences between the two groups and the average ESR decreased to normal. There was no evident kyphosis, symptoms or neurological deficits at the final follow-up. The paravertebral abscesses had disappeared, with no significant progression of local kyphosis, significant absorption and clear lesion edges, pain relief and normal ESR in the two groups.ConclusionsFor mild spinal tuberculosis, traditional conservative treatment can achieve satisfactory results. The strategy combined with CT-guided local chemotherapy treatment is minimally invasive, beneficial for the drainage of paravertebral abscesses and pain relief.