Uncomfortable Sensations Research Articles

A Cluster Randomized Controlled Trial of the Dental Sealants Quality in Rural Schoolchildren Using Innovative Suction without Dental Assistance.

This study examined whether the moisture control innovation (tongue and cheek retractors and saliva contamination (SS-suction)) used without dental assistance could improve the quality of dental sealant in rural Thai school children compared to a standard treatment, i.e., high power suction with dental assistance. A single blind, cluster randomized controlled trial was conducted. Participants were 15 dental nurses working in sub-district health promoting hospitals and 482 children. All dental nurses attended workshops of SS-suction and revised dental sealant procedures. Children with sound lower first permanent molar teeth were simple-randomly assigned to either an intervention or control group. The children in the intervention group were sealed with SS-suction, and the children in the control group were sealed with high power suction and dental assistance. There were 244 children in the intervention group and 238 children in the control group. Dental nurses' satisfaction on SS-suction was record by visual analogue scale (VAS) for each tooth during treatment. After 15-18 months, caries on sealed surfaces were examined. The results showed that the median satisfaction score of SS-suction was 9 out of 10, and 17-18% children experienced uncomfortable sensation during insertion or removal. The uncomfortable feeling disappeared once the suction was in place. Caries on sealed surfaces did not differ significantly between the intervention and control groups. Caries on the occlusal surface was present in 26.7% and 27.5%, and caries on the buccal surface was present in 35.2% and 36.4% of cases in the intervention and control groups, respectively. In conclusion, dental nurses were satisfied with SS-suction in terms of both function and safety. The effectiveness of SS-suction was compatible with the standard procedure after 15-18 months.

Excitatory Projections from the Prefrontal Cortex to Nucleus Accumbens Core D1-MSNs and κ Opioid Receptor Modulate Itch-Related Scratching Behaviors.

Itch is an uncomfortable and complex sensation that elicits the desire to scratch. The nucleus accumbens (NAc) activity is important in driving sensation, motivation, and emotion. Excitatory afferents from the medial prefrontal cortex (mPFC), amygdala, and hippocampus are crucial in tuning the activity of dopamine receptor D1-expressing and D2-expressing medium spiny neurons (Drd1-MSN and Drd2-MSN) in the NAc. However, a cell-type and neural circuity-based mechanism of the NAc underlying acute itch remains unclear. We found that acute itch induced by compound 48/80 (C48/80) decreased the intrinsic membrane excitability in Drd1-MSNs, but not in Drd2-MSNs, in the NAc core of male mice. Chemogenetic activation of Drd1-MSNs alleviated C48/80-induced scratching behaviors but not itch-related anxiety-like behaviors. In addition, C48/80 enhanced the frequency of spontaneous EPSCs (sEPSCs) and reduced the paired-pulse ratio (PPR) of electrical stimulation-evoked EPSCs in Drd1-MSNs. Furthermore, C48/80 increased excitatory synaptic afferents to Drd1-MSNs from the mPFC, not from the basolateral amygdala (BLA) or ventral hippocampus (vHipp). Consistently, the intrinsic excitability of mPFC-NAc projecting pyramidal neurons was increased after C48/80 treatment. Chemogenetic inhibition of mPFC-NAc excitatory synaptic afferents relieved the scratching behaviors. Moreover, pharmacological activation of κ opioid receptor (KOR) in the NAc core suppressed C48/80-induced scratching behaviors, and the modulation of KOR activity in the NAc resulted in the changes of presynaptic excitatory inputs to Drd1-MSNs in C48/80-treated mice. Together, these results reveal the neural plasticity in synapses of NAc Drd1-MSNs from the mPFC underlying acute itch and indicate the modulatory role of the KOR in itch-related scratching behaviors.SIGNIFICANCE STATEMENT Itch stimuli cause strongly scratching desire and anxiety in patients. However, the related neural mechanisms remain largely unclear. In the present study, we demonstrated that the pruritogen compound 48/80 (C48/80) shapes the excitability of dopamine receptor D1-expressing medium spiny neurons (Drd1-MSNs) in the nucleus accumbens (NAc) core and the glutamatergic synaptic afferents from medial prefrontal cortex (mPFC) to these neurons. Chemogenetic activation of Drd1-MSNs or inhibition of mPFC-NAc excitatory synaptic afferents relieves the scratching behaviors. In addition, pharmacological activation of κ opioid receptor (KOR) in the NAc core alleviates C48/80-induced itch. Thus, targeting mPFC-NAc Drd1-MSNs or KOR may provide effective treatments for itch.

Characterization of four thermogelled egg yolk varieties based on moisture and protein content

There are obvious differences between egg yolks of different varieties. Additionally, boiled eggs, which are widely liked and consumed globally, are nutrient rich. However, they absorb water in the esophagus during swallowing, and this result in an uncomfortable sensation. Here, we determined the moisture content and distribution as well as the protein contents and properties of 4 varieties of thermogelled egg yolks. Among the varieties, Green Shelled thermogelled egg yolk showed the highest protein content and solubility. Additionally, the ionic, hydrogen, and disulfide bonds corresponding to Rhode Island Red thermogelled egg yolk samples were the weakest, while the hydrophobic interaction force corresponding to the Hetian Dahei (HD) egg yolk samples was the weakest. Further, the distribution of the moisture contents of the 4 varieties was significantly different (P < 0.05). HD egg yolk showed the highest moisture content, and its bound and immobile moisture contents were significantly higher than those of the other 3 varieties. Egg yolk moisture content also affected free amino acid content, which was the highest for HD egg yolk. Therefore, owing to its high moisture content, HD egg yolk was conducive for chewing and swallowing and given its high free amino acid content, it also had a more suitable taste and flavor. The results of this study provide a theoretical basis for the application of egg yolks in food processing.

Pain Is An Uncomfortable Sensation

Pain is an uncomfortable sensation that indicates that the body is damaged or threatened with injury. Pain starts at special pain receptors that are found all over the body. These pain receptors transmit messages as electrical impulses along nerves to the spinal cord and then upward to the brain. Sometimes the signal when it reaches the spinal cord elicits a reflex response. When this happens, the signal is immediately sent back by the motor nerve to the site of pain, encouraging the muscles to tighten. An example of a reflex reaction is an immediate withdrawal reaction after something very hot is inadvertently touched. The pain signal is also transmitted to the brain. Only when the brain processes the signal and perceives it as pain does the person become aware of it. Pain felt in some areas of the body does not have to indicate exactly where the problem is, because the pain can be transferred to another area. Transmitted pain occurs because signals from several areas of the body often go to the spinal cord and brain through the same nerve pathways. The ability to endure pain varies with mood, personality, and conditions. Pain can change greatly with age. As people get older, they complain less about pain, perhaps because changes in the body reduce the sensation of pain. On the other hand, older people may simply be more stoic than younger people.

A Study to Assess the Effectiveness of the Inspiratory Muscle Training Program on level of Dyspnea among Heart Failure Patients Attending Cardiac Tertiary Care Centers, Maharashtra

Background of the study: Dyspnea is defined as an uncomfortable sensation in breathing, it is a cardinal symptom for cardiorespiratory diseases. As heart failure progresses, dyspnea becomes increasingly troublesome for these patients and frequently worsens their quality of life.Dyspnea is more closed associated with cardiac mortality rate than angina.1Inspiratory muscle weakness can occur in 30% to 50% of the heart failure patients, which is associated with the reduction in functional capacity and reduction in the quality of life and poor prognosis of these individuals. Inspiratory Muscle training is an effective therapeutic approach to reduce the dyspnea and muscle fatigue of heart failure patients, promoting their sense of independence and psychosocial health.2 Problem Statement: A study to assess the effectiveness of the inspiratory muscle training program on level of dyspnea among heart failure patients attending cardiac tertiary care centers, Maharashtra. Objectives: The outcome of this study was to assess the level of dyspnea and to assess the effectiveness of inspiratory muscle training on level of dyspnea among heart failure patients.Result: The study results showed that, before the level of dyspnea in experimental group was 36.94% with mean and standard deviation of 4.33±1.25, whereas the level of dyspnea in control group was 36.06% followed by 4.4 mean and ±1.25 standard deviation. Then the effectiveness of inspiratory muscle training was found using paired t-test, the calculated t value was 15.05 with the degree of freedom 29 which shows the significant difference in the pretest and posttest level of dyspnea. Conclusion: This study concluded that, the inspiratory muscle training program as an alternative approach, which was effective in reduction of level of dyspnea among heart failure patients

Anemia in patients with inflammatory bowel disease as a risk factor for restless legs syndrome. Literature review

Restless legs syndrome (RLS) is a neurological, sensorimotor disorder. It is characterized by the uncomfortable and unpleasant sensations in the legs which begin or worsen during periods of rest, primarily in the evening or night, and are relieved by movement. Central iron deficiency plays a vital role in the pathogenesis of RLS. There is evidence that chronic inflammation is an additional risk factor for RLS. Anemia is the most common complication and extraintestinal manifestation of inflammatory bowel disease, therefore the prevalence of RLS in these patients is a problem of great interest. In addition, inflammatory bowel disease patients’ sleep disturbances directly influence the disease’s clinical course and can be the preclinical marker of exacerbation. It is essential for clinicians to be aware of RLS as a possible reason for sleep disturbance and as a factor that negatively affects the quality of life in inflammatory bowel disease patients.

Periosteal graft and conjunctival pedicle flap for re‐exposed glaucoma drainage device tube

AbstractPurpose: To report the management of exposed glaucoma drainage device (GDD) tube using periosteal graft.Methods: A case report of patient from ophthalmology outpatient clinic in Dr. Saiful Anwar general Hospital.Results: A 26‐year‐old male with history of steroid induced glaucoma came to ophthalmology clinic. Patient already underwent several procedures to control his intraocular pressure (IOP), including trabeculectomy and implantation of GDD. Implantation of GDD is widely used to control IOP in glaucoma patients. One month after implantation, patient experienced exposed GDD tube. Exposed GDD tube is one of the most common complications. The incidence is about 12% and tend to happen in eyes that already underwent many surgeries previously. This condition needs a further operative procedure such as adding patch graft on exposed area, in this case patient underwent conjunctival and pericardial graft. One month after additional patch graft procedure, patient felt uncomfortable sensation and redness on his right eye, even though IOP was 12 mmHg. During anterior segment examination, tube expose was found again. Patient underwent periosteal graft from his right tibial bone and conjunctival pedicle flap. After 2 months of evaluation, the graft is attached and IOP controlled at 14 mmHg.Conclusions: Periosteal graft and conjunctival pedicle flap could be one of the appropriate choices to cover re‐exposed GDD tube.

The thermal state of body when using personal protective equipment against biological factors

Introduction. The article presents the study results of the effect of personal protective equipment (PPE) from biological factors on the functional state of the medical workers’ body and thermoregulatory reactions when working in the “biohazard zone” of the infectious department. Materials and methods. The study involved twenty five volunteers (doctors and paramedical staff of the infectious diseases department) performing official duties for 5 hours in the “biohazard zone” with an air temperature of 23.9 ± 1.6 ○C and a relative humidity of 39.2 ± 11.8%. Measurements were carried out before the work shift start, during and within 30 minutes after leaving the “biohazard zone” in a room with a comfortable climatic conditions. Recorded indicators were skin temperature, heat, and moisture sensations on 11 areas of the body surface, body temperature (measured in the armpit), heart rate. Based on the obtained data, there were calculated the following parameters including body surface area, average skin, and body temperature, the change in the body’s heat content for each hour of work, moisture loss, and energy consumption. Results. The use of PPE from biological factors leads to a heat and moisture exchange disorder of the human body with the environment, which is expressed in an increase in “shell” and “core” temperature, moisture loss, energy consumption, and, consequently, overheating, the appearance of uncomfortable sensations, as well as working capacity decrease. Limitations. When studying the thermal state of the body of 25 medical workers, the tension of thermoregulatory mechanisms when using biological PPE was established, depending on the type of work performed, and the severity of the labour process, gender, age, and weight. Conclusion. The obtained results showed the greatest impact on the thermal state during work duties in a comfortable climatic conditions to be exerted by the design and thermophysical properties of PPE from biological factors made of vapour resistant and airtight fabrics, as well as a long stay in the “biohazard zone” along with a high degree of psychological stress of their occupational activities.

Three-dimensional High-definition Exoscope in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study.

The operative microscope (OM) has revolutionized the field of modern spine surgery, however, it remains limited by several drawbacks. Recently, the exoscope (EX) system has been designed to assistant spine surgery. It provides a three-dimensional (3D) high-definition (HD) operative experience and becomes an alternative to the OM. The aim of the study was to evaluate the clinical outcomes, advantages and limitations of EX-assisted minimally invasive transforaminal lumbar interbody fusion (EMIS-TLIF) and OM-assisted MIS-TLIF (OMIS-TLIF). The clinical outcomes were assessed in 47 patients with lumbar degenerative diseases (LDD) who underwent MIS-TLIF assisted with the OM or EX between January 2019 and September 2020. A total of 22 were treated with EMIS-TLIF, and 25 received OMIS-TLIF. Perioperative parameters (including sex, age, number of fusion levels and body mass index), perioperative parameters (operation time, intraoperative blood loss, postoperative drainage, postoperative hospitalization stay, and duration of follow-up), visual analogue scale (VAS) of back pain, VAS of leg pain, Oswestry disability index (ODI) scores and clinical outcomes were assessed and compared. Image quality, handling of equipment, ergonomics, 3D glasses and educational usefulness were scored according to a questionnaire. Operation time in the OMIS-TLIF group (121.92 ± 16.92 min) was significantly increased compared with that in the EMIS-TLIF group (111.00 ± 19.87 min) (P < 0.05). The VAS of the back pain and ODI scores in the EMIS-TLIF group were significantly lower compared with the OMIS-TLIF group at 1 week postoperatively (P < 0.05). The good-excellent outcomes rate was 90.91% in the EMIS-TLIF group and 88.00% in the OMIS-TLIF group, and there was no significant difference. A total of 44 visits completed the questionnaire. The results of the questionnaire showed that the EX has exhibited advantages regarding handing of equipment, ergonomics and educational usefulness, and comparable image quality as compared with the OM, however, operating surgeons complained uncomfortable sensation when wearing 3D glasses. The EMIS-TLIF was a safe and effective procedure in the management of LDD as compared with the OMIS-LIF. Meanwhile, EMIS-TLIF might resulted in a short operation time.

Analysis of brain signal change response in amygdala evoked by skin pressure stimulus.

It was well known that the human body would produce an uncomfortable sensation when the fabric exerted a certain amount of pressure irritation on the skin. The amygdala had long been thought to be the source of negative emotion perception. However, up to now, the brain signal changes in the amygdala evoked by skin exposure pressure had not been known. In this work, a series of gradually increasing contact pressure stimulus from boneless corsets was repeatedly applied to the body's waist and abdomen, and the technology of functional magnetic resonance imaging (fMRI) was adopted to detect the brain response synchronously. The results shown that both subjective comfort score and percent signal changes (PSCs) of amygdala decreased with the increase of skin contact pressure. When the skin pressure applied to the waist and abdomen of the human body exceeded about 1kPa, blood oxygen level dependent signal in the amygdala was negatively activated. Besides, the degree of response of PSCs was intense than subjective evaluation, and the standard deviations of PSCs between individuals were much smaller than subjective evaluations. It was suggested that skin contact pressure stimulus caused the attention of the amygdala brain area. The greater the stimulus, the higher the attention, but such attention was caused by negative activation of the amygdala induced by skin discomfort. In addition, skin comfort representation based on brain perception was superior to subjective representation due to its higher response sensitivity and antipsychological interference ability.

Gaping for relief? Rein tension at onset and end of oral behaviors and head movements in unridden horses

Pressure from the bit in the horse's mouth, rein tension, likely feels unpleasant to the horse due to sensitive oral tissues. Through trial and error, the horse may learn how to adjust their behavior in order to avoid, diminish or cease uncomfortable sensations from the bit. We hypothesized that oral behaviors and head movements in response to rein tension have the function to avoid or escape the rein tension. The study objective was to assess in what way oral behaviors and head movements affect rein tension and determine the magnitude of rein tension at the onset and end of these behaviors. Twenty Warmblood horses were fitted with a bitted bridle and subjected to 8 trials of backing up in response to a rein tension signal with the handler standing next to the horse's withers. The rein tension signal was gradually increased and then immediately released when the horse stepped back. A rein tension meter and video recordings were used for data collection. Linear mixed models were used for the statistical analysis. There was a decrease in mean rein tension (sum of left and right rein) from onset to end for open mouth (P < 0.001, from 19 to 11 Newtons (N), biting on the bit (P = 0.004, from 11 to 5 N), and head upward (P = 0.024, from 16 to 12 N), while there was an increase in rein tension associated with head forward (P = 0.015, from 27 to 37 N) and head downward (P < 0.001, from 17 to 46 N). Our results suggest that horses will open their mouth, or bite on the bit, to alleviate the oral tissues from pressure; move the head upward to avoid rein tension and move the head forward or downward to increase rein tension, likely in a presumed attempt to break free from the pressure applied. The horse's oral behaviors and head movements during training can be used to gain a greater understanding of how the horse perceives the magnitude of rein tension.

Reliability of submaximal stimulation for the train-of-four test using acceleromyography and electromyography with individualized stimulation currents.

The supramaximal stimulation (SMS) of the TOF test causes uncomfortable sensations in patients. We aimed to determine whether the submaximal stimulation would be reliable in TOF tests with reduced painful sensation. The accelomyography (AMG) and electromyography (EMG) monitor was applied at each arm and general anesthesia was induced and maintained by total intravenous anesthesia. At extubation, we conducted TOF test three times at each of four different currents: SMS, 70% SMS, 50% SMS, and 30% SMS. The same procedure was performed in the postanesthesia care unit (PACU) only with EMG, and the pain scores on the numerical rating scale (NRS) during the tests were recorded. A total of 36 patients were enrolled. At extubation, TOF ratios with SMS in AMG and EMG were 112.0 ± 13.1% and 93.7 ± 8.9%, respectively. There were no significant differences in TOF ratios between the SMS and lower stimulation intensities. However, 30% and 50% SMS showed significantly higher rates of the unmeasurable results of tests in the PACU. In terms of the stimulation pain, NRS showed a downward pattern as the current decreased and was significantly lower at 50% and 30% SMS than the NRS at SMS. The TOF test with submaximal stimulation is still reliable and can reduce stimulation pain. Considering the importance of the TOF results in determining extubation, the authors suggest the minimal current for the TOF test as 70% SMS.

PO116 / #1052 A PROSPECTIVE RANDOMIZED DOUBLE-BLINDED CROSSOVER TRIAL TO COMPARE CONVENTIONAL, BURST AND HIGH FREQUENCY SCS ON PAIN RELIEF IN PSPS-T2 PATIENTS: E-POSTER VIEWING

Studies have clearly demonstrated the efficacy of Spinal Cord Stimulation (SCS) to manage pain in Persistent Spinal Pain Syndrome after spinal surgery (PSPS-T2) patients (1,2). Tonic Conventional Stimulation (TCS) is the most used technique. However, studies showed that TCS does not appear to relieve pain for more than 30-55% of PSPS-T2 patients and provokes paresthesia that can be perceived as an uncomfortable sensation for the patients (3). To address these difficulties, new sub-paresthesia stimulation modalities were investigated such as BURST and High Frequency (HF) stimulation waveforms (4). Recent clinical trials reported evidence of their efficacy (5-12). Our study is the first randomized controlled trial to assess the efficacy of TCS, BURST and HF stimulation waveforms on pain relief.

Autistic children and adolescents with frequent restricted interest and repetitive behavior showed more difficulty in social cognition during mask-wearing during the COVID-19 pandemic: a multisite survey

BackgroundThe public health measures enacted in order to control the coronavirus disease (COVID-19) pandemic have caused considerable changes to daily life. For autistic children and adolescents, adapting to the “new normal,” including mask-wearing, may be difficult because of their restricted interest and repetitive behavior (RRB) characteristics. We aimed to examine the relationships between RRB characteristics and the impact of mask-wearing on their social communications during the pandemic.MethodsWe recruited participants with a clinical diagnosis of autism spectrum disorder based on DSM-5 diagnostic criteria from two outpatient clinics in Tokyo, Japan, between November 2020 and April 2021 using a convenience sampling methodology. As a result, the participants consisted of 102 children and adolescents (mean (SD) age = 11.6 (5.3)). We collected data on RRB characteristics frequency before and during the pandemic using the CoRonavIruS Health Impact Survey (CRISIS) – Adapted for Autism and Related Neurodevelopmental conditions (AFAR). We then conducted factor analyses to compute the RRB severity composite scores, which are divided into lower- (e.g., sensory seeking), and higher-order (e.g., restricted interest). We also investigated mask-wearing culture using a bespoke questionnaire, and using Spearman’s rank correlation analyses, we examined the relationships between before pandemic RRB characteristics, and the impact of mask-wearing on social communications during the pandemic.ResultsWe found that children and adolescents who exhibited lower-order RRB before the pandemic had difficulties in going-out with mask-wearing (rho = -0.25, q = .031), more challenges with mask-wearing (rho = − 0.34, q = .0018), and difficulty in referring to others’ emotions while wearing masks (rho = − 0.36, q = .0016). We also found an association between higher-order RRB before the pandemic and an uncomfortable sensation (rho = − 0.42, q = .0002) and difficulties in referring to other’s emotions while wearing masks (rho = − 0.25, q = .031).ConclusionsWe revealed that various behaviors, such as sensory seeking, repetitive motor mannerisms and movements, and rituals and routines, undertaken before the pandemic could be important predictors of difficulties with mask-wearing and social communication for autistic children and adolescents during the pandemic. Caregivers and teachers wearing masks may need to provide extra support for social communication to autistic children and adolescents showing RRB characteristics frequently.

Bioflavonoid exerts analgesic and anti-inflammatory effects via transient receptor potential 1 channel in a rat model.

Pain is an uncomfortable sensation in the body. Kaempferol is a flavonoid with antinociceptive effects. Transient receptor potential (TRP) channels have been characterized in the sensory system. This study evaluated the central antinociceptive effect of Kaempferol and possible mechanisms of action of transient receptor potential cation channel subfamily V member 1 (TRPV1). Capsaicin as a TRPV agonist (5 μg/μL, intracerebroventricular [ICV]) and capsazepine as its antagonist (10 μg/μL, icv) were used to test the analgesic effect of kaempferol (1.5 mg, ICV). Morphine (10 μg, ICV) was used as a positive control. The other groups were treated with a combination of kaempferol and capsaicin, kaempferol and capsazepine, and capsaicin and capsazepine. The cannula was implanted in the cerebroventricular area. The tail-flick, acetic acid, and formalin tests were used to assess analgesic activity. For evaluation of antiinflammatory effect, the formalin-induced rat paw edema was used. Kaempferol significantly decreased pain in the acute pain models, including the tail-flick and the first phase of the formalin test. In the late phase of the formalin test, as a valid model of nociception, capsazepine inhibited the antinociceptive effect of kaempferol. Kaempferol has an analgesic effect in the acute pain model and can affect inflammatory pain. Also, the TRPV1 channel plays a role in the antinociceptive activity of kaempferol.

Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome.

Restless legs syndrome (RLS) is a sleep-related disorder defined by an urgency to move the legs, usually combined with uncomfortable or unpleasant sensations, which occurs or worsens during rest, usually in the evening or at night, and disappears with the movement of the legs. RLS can be classified as idiopathic or primary, and secondary to comorbid conditions (eg, renal disease, polyneuropathy). The pathophysiology of RLS is still unclear. This article provides an updated practical guide for the treatment of primary RLS in adults.

Restless Legs Syndrome and the Use of Antipsychotic Medication: An Updated Literature Review.

Restless legs syndrome or Willis-Ekbom disease (RLS/WED) is a sleep-related movement disorder characterized by an urge to move the legs. This impulse is usually accompanied by an uncomfortable and unpleasant sensation in the legs, which worsens at night and during periods of inactivity and is relieved by movement. Several studies in the literature reported the association between RLS and different antipsychotic medications. with Olanzapine, Quetiapine, and Clozapine identified as the most common causes. The literature suggests that the development of RLS in antipsychotic users may be attributed to the inhibition of dopaminergic neurotransmission or the impact of antipsychotics on iron metabolism. Diagnosing antipsychotic-induced RLS remains a substantial challenge in clinical practice, with challenges in the management of this condition also being widely reported in the current literature. In this article, we will review the evidence suggesting the association between RLS and the use of antipsychotic medications, differentiate between RLS and other movement disorders, and give a brief review of the pathophysiology, diagnosis, and management of RLS and its challenges among psychotic patients.

Modified acupuncture therapy, long-term acupoint stimulation versus sham control for weight control: a multicenter, randomized controlled trial.

ObjectiveLong-term acupoint stimulation (LAS), also called embedding acupuncture, is a modified acupuncture technique. The preliminary results have demonstrated its efficacy in body-weight control. However, the low quality of available trials limited its application. This study aimed to evaluate the efficacy and safety of LAS in body-weight control by using a randomized, parallel, sham-controlled clinical trial design.MethodsThis was a randomized, single-blind, sham-controlled clinical trial including 84 adult participants (18–60 years) with a body mass index (BMI) of ≥ 24 kg/m2 conducted in three general hospitals in Shanghai, China. Participants were equally assigned to receive LAS or sham LAS (SLAS) once per 10 days, eight times in total. After completion, an additional intervention with a 3-month follow-up period was set to examine the continued effect of LAS. The primary outcome was the change in body weight from baseline to treatment endpoint within the intention-to-treat (ITT) analysis. Secondary outcomes contained changes in waist-to-hip ratio (WHR), lipid metabolism, and visceral and subcutaneous adipose tissues.ResultsFrom 14 May 2018 to 03 November 2019, 84 participants out of 201 screened individuals met the eligibility criteria, were randomized, and were analyzed (42 participants in each group). From baseline to treatment endpoint, the body-weight reduction in the LAS group was significantly larger than in the sham control (net difference: 1.57 kg, 95% CI: 0.29–2.86, p = 0.012). The superior weight reduction effect persisted in the follow-up period (net difference: 3.20 kg, 95% CI: 1.17–5.21, p = 0.001). LAS therapy also showed improvement in triglyceride and subcutaneous adipose tissue (SAT) compared with sham control. One participant in the LAS group reported a slightly uncomfortable and tingling sensation after the additional intervention. No other adverse events (AEs) were documented.ConclusionLAS, a modified acupuncture technique, is safe and effective in body-weight control. It could be used as an alternative choice to classical acupuncture for obesity management.Clinical Trial Registration[www.chictr.org.cn], identifier [ChiCTR1800015498].

Multiple drill hole osteotomy and Herbert screw for correcting a-2 years ring finger phalanx media malunion: A case report.

Introduction and importanceThe rotational deformity is formed due to the instability of the fixation device used before in a spiral or oblique fracture pattern, and will create uncomfortable sensation also disturb daily activities. This condition usually treated with several methods of osteotomies and implants, that involving large wound and longer period of healing.Case presentationA 27-year-old male with chief complaint of discomfort sensation when the ring finger flexed and it was disturbing the daily activities. Two years ago, the patient was diagnosed with minimally displace closed fracture of the ring finger phalanx media and treated with buddy tapping for six months and become a malunion until now. Multiple drill hole osteotomy were made to correct the rotational position and fixed with Herbert screws. Three months follow up, the wound healed nicely and able to perform his daily activity.Clinical discussionMalunion that was formed from previous inadequate treatment could make uncomfortable sensation and disturbing daily activities usually treated with large osteotomies. Multiple drill hole (MDH) usage in combination with the Herbert screw to fix the new fracture line had several advantages compared to standard methods that were previously performed.ConclusionThe combination of multiple drill hole and Herbert screws could be an alternative procedure with minimal surgical wounds. Without implant removal in the future, the patient can proceed to rehabilitation and return to his daily activities.

Prevalence and Predictors of Restless Leg Syndrome in Adolescents and Young Adults of Bengaluru City, India: A Cross-Sectional Study

Introduction: Restless leg syndrome (RLS) is a sensorimotor disease characterized by an urge to move the legs, often caused by uncomfortable and unpleasant sensations in the legs. It affects the quality of sleep which in turn affects scholastic performance in children and predisposes them to cardiovascular diseases in the long run. Hence, the primary aim of this study was to assess the prevalence and predictors of RLS, poor sleep quality, and excessive daytime sleepiness (EDS). Methods: This was a cross-sectional observational study conducted between September 2017 and March 2020 in Bengaluru, India, including all consenting PreUniversity College, Degree College, and Higher Secondary school students. After parental consent and assent (if applicable) was obtained, a semi-structured standardized pilot-tested questionnaire consisting of the RLS diagnostic criteria, Pittsburgh Sleep Quality Index (PSQI), Epworth sleepiness scale, and questions on sleep hygiene was administered. The prevalence was expressed as proportions and 95% confidence intervals (95% CI). Regression analysis was done to determine the predictors. Results: The overall prevalence (95% CI; frequency) of students with RLS, poor sleep quality, and EDS in our study population was 8.36% (7.54, 9.24; n = 1,544/4,211), 36.67% (35.21, 38.14; n = 1,544/4,211), and 39.87% (38.39, 41.37; n = 1,679/4,211), respectively. PSQI and Epworth score were the significant predictors of RLS. Age, Epworth score, knowledge score, and the number of unacceptable sleep habits were the significant predictors of sleep quality. Female gender, PSQI, RLS, knowledge score, and the number of unacceptable sleep habits were the significant predictors of EDS. Conclusions: The prevalence of RLS, those with poor sleep quality and EDS among adolescents and young adults was higher when compared to the historical data of general population in the same city.