Improvement In Visual Analog Scale Research Articles

Effects of upper thoracic Mulligan mobilization on pain, range of motion and function in patients with mechanical neck pain: A randomized placebo-controlled trial.

This study aimed to assess the impact of Mulligan Reverse Natural Apophyseal Glides (RNAGS) applied to the upper thoracic region on pain, movement limitation, and function in individuals with mechanical neck pain. Conducted between January 2021 and May 2021, the study involved 69 participants randomly assigned to a sham group, physiotherapy group, and Mulligan group. A two-week, 11-session treatment program was administered with shared physiotherapy interventions and stretching exercises to all groups. The Mulligan group received additional mobilization with the Mulligan RNAGS technique. The sham group received sub-standard Mulligan mobilization. Outcome measures included Range of Motion (ROM), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). No baseline differences were found in measurements among the groups. After the intervention, all groups showed increased ROM and decreased VAS and NDI scores (p<0.001). The Mulligan group exhibited significantly greater improvement in VAS, ROM, and NDI compared to other groups (p<0.001). The sham group demonstrated greater improvement in NDI and extension ROM compared to the physiotherapy group (p<0.001). Mulligan RNAGS technique in the upper thoracic region proved beneficial for pain relief, range of motion, and functionality in mechanical neck pain. Long-term effects warrant further exploration through population-based studies.

Focal Versus Combined Focal Plus Radial Extracorporeal Shockwave Therapy in Lateral Elbow Tendinopathy: A Retrospective Study.

Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal shockwave therapy (F-ESWT) alone versus a combination of focal and radial pressure waves (F-ESWT+R-PW) in treating chronic lateral epicondylitis. Methods: This retrospective observational study included 45 patients diagnosed with chronic lateral epicondylitis divided into two groups based on the treatment received: group A (F-ESWT, n = 23) and group B (F-ESWT+R-PW, n = 22). Both groups underwent three weekly sessions of their respective treatments. Patients were also given a home exercise protocol. Primary outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for pain and functional impairment at baseline (T0), 4 weeks (T1), 12 weeks (T2), and 24 weeks (T3) post-treatment. Secondary outcomes included grip strength and ultrasonographic measurements of common extensor tendon (CET) thickness and vascularization. Results: Significant improvements in VAS and PRTEE scores were observed in both groups at all follow-up points. Group B showed greater pain reduction at T1 (VAS: 3.0 ± 1.6 vs. 4.43 ± 1.47; p < 0.005) and T2 (VAS: p < 0.030) compared to group A. Functional outcomes (PRTEE) also favored group B at T1 (p < 0.030) and in the pain section at T2 (p < 0.020). Grip strength improved similarly in both groups. CET thickness showed no significant differences at T3. Vascularization decreased significantly in both groups, with a non-significant trend favoring group B. Conclusions: The combined F-ESWT+R-PW therapy proved more effective than F-ESWT alone in the short- to mid-term management of chronic lateral epicondylitis, significantly enhancing pain reduction and functional outcomes. The combination of focal and radial pressure waves offers a superior therapeutic approach, leveraging the distinct mechanisms of each modality for better clinical results. Further research is needed to confirm these findings and establish long-term efficacy.

Arthroscopic treatment for femoroacetabular impingement yields favourable patient-reported outcomes and method survivorship at 10-year follow-up.

To compare the outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) preoperatively and at minimum 10-year follow-up using patient-reported outcome measures (PROMs). A total of 128 patients with FAIS were prospectively included. The patients underwent arthroscopic surgery for FAIS between 2011 and 2013 and had a minimum of 10-year follow-up. The International Hip Outcome Tool short version (iHOT-12) was the primary outcome. Secondary outcomes were the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the European Quality visual analogue scale (EQ VAS), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analogue Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. The Wilcoxon signed rank test was used to compare pre- and postoperative PROMs. There was a significant improvement (p < 0.001) of iHOT-12, HAGOS subscales, EQ-5D, EQ VAS and VAS for overall hip function. A total of 83% of the patients were satisfied with their surgery. The survivorship of hip arthroscopy, defined as nonconversion to total hip arthroplasty (THA), at the end of the follow-up period was 77%. Patients undergoing arthroscopic treatment for FAIS reported statistically significant and clinically relevant improved outcomes at 10-year follow-up. Case series, level IV.

Comparative efficacy of unilateral biportal endoscopic and full-endoscopic posterior cervical foraminotomy in the treatment of cervical spondylotic radiculopathy: a retrospective analysis.

The aim of this study was to compare the clinical efficacy of the full-endoscopic posterior cervical foraminotomy (FE-PCF) and the unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) in the treatment of cervical spondylotic radiculopathy (CSR). Patients who underwent posterior cervical spine surgery in our hospital from January 2020 to December 2022 were retrospectively analyzed. According to the surgical method, the patients were divided into two groups: FE-PCF group and UBE-PCF group. Perioperative data included operation time, Intraoperative blood loss and postoperative hospital stay were collected. The Visual Analog Scale (VAS)-arm, VAS-neck, and Neck Diability Index (NDI) was used to evaluate the clinical outcomes at preoperative, postoperative 1 week and Last follow-up. Serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were recorded to evaluate surgical invasiveness. A total of 160 patients were included, including 89 cases of FE-PCF and 71 cases of UBE-PCF. The demographic and preoperative data showed no significant differences between the two groups (P > 0.05). The mean operating time was significantly shorter in the UBE-PCF group compared to FE-PCF group (P < 0.05). Serum CRP and CPK levels of the two groups both exhibited a pattern of rising and then falling, peaking one day following surgery and decreasing to near normal values three days after the operation. Compared with preoperative, both groups showed significant improvement in postoperative VAS and NDI scores, with a statistically significant difference (P < 0.05). However, the differences in results between the groups were not significant. Both UBE-PCF and FE-PCF are secure and efficient methods for treating CSR by continuous visualization. UBE-PCF offers predictable and adequate decompression within a reduced surgical duration, facilitated by its separate observation and operation channels.

Evaluation of the Efficacy and Safety of FFX Facet Cages Compared With Pedicle Screw Fixation in Patients With Lumbar Spinal Stenosis: A Long-Term Study.

Hybrid retrospective/prospective study. The study evaluated the long-term safety and efficacy of the FFX facet cage versus pedicle screw (PS) fixation in patients with lumbar spinal stenosis (LSS). A previous single-arm study reported on the safety, fusion rate, and patient outcomes associated with the use of the FFX facet cage in patients with lumbar spinal stenosis. There are no long-term studies reporting outcomes with this device compared with the use of pedicle screw fixation. Following a medical records review, subjects meeting the inclusion and exclusion criteria were consented to and enrolled in the prospective arm of the study. CT scans and dynamic X-rays were performed to assess fusion rates, range of motion, and translation. Adverse events during the 2-year post-index procedure were also analyzed. Preoperative and 2+ year Visual Analogue Scale (VAS) back and leg scores and Oswestry Disability Index (ODI) were also obtained. A total of 112 subjects were enrolled with 56 patients included in the PS and FFX groups. Mean age was 63.1±11.2 and 67.1±10.9 years and the mean number of levels operated was 1.8±0.8 and 2.3±1.0, respectively, for the PS and FFX groups. There was no difference between the 2 groups for the primary composite fusion endpoint assessed with the FFX group achieving a 91% bony facet fusion rate. There was also no difference in postoperative complications or adverse events during the 2-year follow-up period. A higher percentage of patients in the PS group (10.7%) required reoperation compared with the FFX group (3.6%). Although both groups experienced significant improvements in VAS and ODI scores versus preoperative assessment, there was no difference between the 2 groups. The present study documents the long-term safety and efficacy of the FFX device in patients with LSS with a reduction in reoperation rate when compared with PS fixation. Level III.

Percutaneous Mesh-Container-Plasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Compression Fractures with Up-Endplate Injury: A Retrospective Study

Percutaneous mesh-container-plasty(PMCP), a modified traditional percutaneous kyphoplasty(PKP)technique, is increasingly being used to treat osteoporotic vertebral compression fractures(OVCF) with up-endplate injury. This retrospective study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of this disease. We retrospectively analyzed the medical records of patients with osteoporotic compression fractures and upper endplate injuries treated at our hospital between January 2019 and December 2021. A total of 192 patients who met the inclusion and exclusion criteria were enrolled. Of these, 103 underwent PKP and 89 underwent PMCP. Key outcome measures included surgical safety, clinical efficacy, and radiological results. Both the PKP and PMCP groups showed significant improvements in VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) scores postoperatively. Additionally, anterior vertebral body height ratio (AVBHr) and Cobb's angle improved in both groups, though no statistically significant difference was observed between them. The hospital stay duration was similar between the two cohorts. Notably, the PMCP group required a larger volume of bone cement injection, yet exhibited a significantly lower incidence of cement leakage and adjacent vertebral fractures (9/89 and 2/89, respectively) compared to the PKP group (24/103 and 11/103, respectively) (p < 0.05). Moreover, the PMCP group had shorter operation times (34.64 ± 9.88 minutes) and reduced fluoroscopy frequency (35.43 ± 5.46 instances) compared to the PKP group (27.23 ± 8.54 minutes and 23.87 ± 5.59 instances, respectively) (p < 0.05). PMCP provided superior clinical outcomes for the management of osteoporotic compression fractures with upper endplate injuries. It was associated with reduced operation and fluoroscopy times, as well as lower risks of adjacent vertebral fractures and cement leakage, compared to PKP.

Patients With Graft Tears Leaving the Tuberosity Covered Have Similar Functional Outcomes to Those With an Intact Graft After Superior Capsular Reconstruction.

Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group. The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered. Cohort study; Level of evidence, 3. Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity. A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex (P = .72), previous surgery (P = .06), preoperative acromiohumeral distance (P = .57), and preoperative Goutallier stage of the supraspinatus (P = .16). Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.

To validate and correlate radiologic grading of central and foraminal stenosis post-surgical decompression on degenerative lumbar canal stenosis

Background: Lumbar canal stenosis (LCS) is characterized as a narrowing of the canal diameter with age, which can lead to degenerative bone and soft-tissue changes. Aims and Objectives: The aim of the study is to validate the radiologic grading of central and foraminal through correlation with outcome after surgical decompression in degenerative LCS. Materials and Methods: A total of 23 patients with degenerative LCS who satisfied inclusion criteria and consented to participate in the study were selected and their Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain were recorded and their magnetic resonance imaging (MRI) was graded. Results: LCS is the reduction in the dimension of the central or lateral lumbar canal that occurs most frequently as a result of chronic degenerative changes at the lumbar motion segments. In our study, ODI has comparable improvement in all groups and it does not correlate with the severity of stenosis. However, VAS for leg pain has a greater prevalence in the shorter durations group (&lt;60 months) which had an average of 8.0. If VAS for leg pain was more preoperatively, a better outcome was seen postoperatively. Conclusion: Decompression surgery for degenerative LCS shows significant improvement in ODI and VAS for back pain and leg pain irrespective of the severity of the stenosis by MRI grading or the severity of symptoms as assessed by VAS or ODI.

Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Linked with Posterior Ring Apophysis Separation: A Retrospective Study

ObjectivesPosterior ring apophysis separation (PRAS) associated with lumbar disc herniation (LDH) is a relatively rare form of disc herniation. This study aims to evaluate the clinical effectiveness of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of PRAS with LDH. MethodsWe enrolled 41 patients who met the inclusion criteria to undergo either unilateral biportal endoscopic discectomy (UBE) (15 cases) or percutaneous endoscopic lumbar discectomy (PELD) (26 cases) between October 2022 and October 2023. Perioperative evaluation parameters included mean operative time, hemoglobin (Hb) loss, length of stay (LOS), and postoperative complications. Outcomes were assessed at admission, as well as at 1, 3, and 6 months post-surgery using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Additionally, we evaluated the results according to the modified MacNab criteria. ResultsBoth groups demonstrated improvements in postoperative VAS and ODI scores. However, there were no significant differences between the two groups in VAS and ODI scores before surgery, or at 1, 3, and 6 months post-surgery. Additionally, no notable differences were observed in the modified MacNab criteria. The UBE group experienced greater hemoglobin (Hb) loss, longer mean operative time, and increased length of stay (LOS) compared to the PELD group. Furthermore, two patients in the PELD group reported recurrence, while one patient in the UBE group experienced a dural tear. ConclusionsUBE and PELD possess strong clinical effectiveness for treating PRAS with LDH. Although the UBE group had a longer mean operative time and LOS, with more Hb loss, the UBE group had a lower recurrence rate. Therefore, UBE remains safe and innovative for the treatment of PRAS with LDH.

Clinical Outcomes of the Arthroscopic Capsular Suture-Lifting Technique in the Treatment of Femoroacetabular Impingement in Patients With Borderline Developmental Dysplasia of the Hip

Background: Patients with femoroacetabular impingement (FAI) are likely to present with borderline developmental dysplasia of the hip (BDDH). Considering the prolonged risk of negative prognosis in these patients, the need for surgical management of the capsule has been emphasized. Although previous studies have advocated different techniques of capsular closure during surgery, no consensus has been achieved. Therefore, the aim of this study was to evaluate the clinical outcomes of a new arthroscopic capsular suture-lifting technique for the treatment of FAI combined with BDDH. Hypothesis: The arthroscopic capsular suture-lifting technique would achieve better anterior stability and show better clinical outcomes compared with routine capsular closure. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients diagnosed with FAI and BDDH and who underwent hip arthroscopy in our hospital between September 1, 2017, and April 30, 2021, were evaluated. Data were collected prospectively and analyzed retrospectively. Patients were divided into 2 groups according to the capsule closure methods used: capsular suture-lifting technique (lifting group) and routine capsular closure (control group). Anteroposterior hip radiography, Dunn view radiography, and computed tomography imaging were carried out for all patients preoperatively and postoperatively. Patient-reported outcomes, including the modified Harris Hip Score (mHHS) and visual analog scale (VAS) for pain, were collected preoperatively and at least 1 year after surgery and compared between the 2 groups. The Wilcoxon signed-rank test was used to evaluate changes in preoperative to postoperative mHHS scores and VAS. Mann-Whitney U test was used to evaluate significant differences in postoperative mHHS and VAS scores in the 2 groups. Results: In all, 144 patients were included in this study, of whom 77 (53.5%) underwent the arthroscopic capsular suture-lifting technique and 67 (46.5%) underwent routine arthroscopic surgery. The patients in both groups had significant improvement in postoperative mHHS and VAS compared with the preoperative assessment ( P &lt; .05). The postoperative VAS score of patients in the suture-lifting group was significantly lower (2.6 vs 3.8; P &lt; .05) and the mHHS score was significantly higher (75.2 vs 68.5; P &lt; .05) than those of patients in the control group. Of the 77 patients in the suture-lifting group, 68 (88.3%) surpassed the minimal clinically important difference (MCID) and 49 (63.6%) achieved the Patient Acceptable Symptom State (PASS). Of the 67 patients in the control group, 26 (38.8%) surpassed MCID and 32 (47.8%) achieved PASS. The percentage of patients achieving MCID and PASS in the suture-lifting group was significantly greater than that in the control group ( P = .007 for MCID; P = .03 for PASS). Conclusion: The study demonstrated that the arthroscopic capsular suture-lifting technique provided good clinical outcomes in the treatment of patients with FAI combined with BDDH. This technique showed better improvement of postoperative clinical outcomes than routine capsular closure.

Comparative study of dorsiflexion closing wedge osteotomy of the metatarsal head and osteochondral autologous transplantation for Freiberg disease treatment: A multicenter analysis

Freiberg disease (FD) is a condition characterized by osteochondrosis affecting the metatarsal heads, with the second metatarsal head being the most commonly affected. Dorsiflexion Closing Wedge Osteotomy of the Metatarsal Head (DCWMO) has been conventionally employed, whereas Osteochondral Autologous Transplantation (OAT) represents a more recent technique with restricted comparative research. This study aimed to compare the outcomes of DCWMO and OAT for treating Freiberg disease (FD). Groups were established among two institutions. Institution-1 has made the treatment with OAT (8 patients) and Institution-2 has made the treatment with DCWMO (8 patients). The primary outcomes collected, including complications, range of motion, length of the metatarsal, American-Orthopaedic-Foot-and-Ankle-Society–lesser MTP-interphalangeal (AOFAS-LMI) score, visual-analog-scale (VAS), Foot-and-Ankle-Disability (FADI) score, and Short-Form-12 (SF-12), were all compared. The Sport-FADI and activity-FADI scores at final follow-up were significantly greater in the OAT group than in the DCWMO group (94.04 vs 84.75 and 97 vs 92, P = 0.021 and P = 0.04, respectively), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (43.13 vs 6.88 degrees, P < 0.001). The AOFAS-LMI score at final follow-up was significantly greater in the DCWMO group than in the OAT group (86.75 vs 75.38, P = 0.013). In conclusion, this study highlights the effectiveness of both OAT and DCWMO in treating Freiberg's disease, as evidenced by significant postoperative improvements in various functional scores, including AOFAS-LMI, VAS and FADI. Notably, OAT demonstrated favorable outcomes in SFADI and AFADI and plantarflexion ROM, while DCWMO led to improved the AOFAS-LMI score.Level of Evidence: Level 3

An Underrated Performer in Repair of Rotator Cuff Tears: Single-row Suture Anchor Technique

Abstract Background: Single-row suture anchor technique is a well-established, economical, and relatively easier method of arthroscopic rotator cuff repair that has been recently tripped over by double-row technique which is proven to be biomechanically superior. However, this advantage is not reflected in the functional outcome scores which are reported to be identical with both single- and double-row techniques. Materials and Methods: A prospective cohort study was performed on 67 patients with degenerative rotator cuff tear, diagnosis was confirmed on radiological magnetic resonance imaging, treated surgically by single-row suture anchor method, and evaluated for functional outcome at minimum 1-year follow-up. Pre- and postoperative Visual Analog Scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores were calculated at initial evaluation and the end of 1-year follow-up. Results: Eighty-six percentage of the patients showed a clinically significant improvement in VAS and ASES scores. Conclusion: Consistent acceptable success rates in terms of outcome functional scores, including patient reported outcomes, depict single-row suture anchor technique as a reliable option for the management of degenerative rotator cuff tears 3 cm or less.

Clinical effect of posterior-only approach debridement, intervertebral fusion, and internal fixation for upper thoracic tuberculosis.

This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.

Inhalation of Hydrogen-rich Gas before Acute Exercise Alleviates Exercise Fatigue: A Randomized Crossover Study.

Hydrogen, as an antioxidant, may have the potential to mitigate fatigue and improve selected oxidative stress markers induced by strenuous exercise. This study focused on a previously unexplored approach involving pre-exercise inhalation of hydrogen-rich gas (HRG). Twenty-four healthy adult men first completed pre-laboratories to determine maximum cycling power (Wmax) and maximum cycling time (Tmax). Then they were subjected to ride Tmax at 80% Wmax and 60-70 rpm on cycle ergometers after inhaled HRG or placebo gas (air) for 60-minute in a double-blind, counterbalanced, randomized, and crossover design. The cycling frequency in the fatigue modeling process and the rating of perceived exertion (RPE) at the beginning and end of the ride were recorded. Before gas inhalation and after fatigue modeling, visual analog scale (VAS) for fatigue and counter-movement jump (CMJ) were tested, and blood samples were obtained. The results showed that compared to a placebo, HRG inhalation induced significant improvement in VAS, RPE, the cycling frequency during the last 30 seconds in the fatigue modeling process, the ability to inhibit hydroxyl radicals, and serum lactate after exercise (p<0.028), but not in CMJ height and glutathione peroxidase activity. The cycling frequency during the last 30 seconds of all other segments in the fatigue modeling process was within the range of 60-70 rpm. In conclusion, HRG inhalation prior to acute exercise can alleviate exercise-induced fatigue, maintain functional performance, and improve hydroxyl radical and lactate levels.

Characteristics and treatment outcomes of musical tinnitus: a prospective study

PurposeTinnitus, the perception of sound without an external source, affects millions worldwide. Although its origin may be organic or psychological, musical tinnitus (hearing music in the absence of external stimuli) presents a distinct challenge. This study investigated musical tinnitus, focusing on its clinical profile, treatment outcomes, and associated psychiatric symptoms.MethodsThe demographics, auditory perceptions, psychiatric history, and treatment response of 20 patients with musical tinnitus were prospectively evaluated. Sound therapy using hearing aids and tinnitus counselling were administered. Data were collected using the Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS) for tinnitus loudness and distress, Self-Rating Depression Scale (SDS), and the State-Trait Anxiety Inventory (STAI).ResultsOf the 20 patients who underwent these tests every year until the 2-year follow-up, 15 were able to follow a sound therapy treatment regimen with hearing aids for > 2 years. The results revealed the prevalence of musical tinnitus in older women with hearing loss, emphasising its association with aging and the female sex. Patients reported varied musical content, predominantly nursery rhymes and melodies originating from the ear or head. No significant psychiatric symptoms were observed; this contrasts with previous reports linking musical hallucinations and psychiatric disorders. Sound therapy using hearing aids and counselling led to significant improvements in THI, VAS, and STAI-state scores at 1-year and 2-year follow-ups, suggesting the efficacy of this approach. However, no significant changes were noted in SDS or STAI-trait scores, indicating a lack of prominent depressive tendencies and stable anxiety traits.ConclusionsMusical tinnitus primarily affects older women with hearing loss and responds favourably to sound therapy. Understanding its clinical characteristics and treatment outcomes is crucial for optimising patient care and enhancing quality of life.

Evaluation of the therapeutic efficacy of high-intensity focused ultrasound ablation combined with different drugs in the treatment of adenomyosis

Objectives To observe the therapeutic efficacy of high-intensity focused ultrasound (HIFU) combined with different pharmacological treatments for adenomyosis. Materials and methods A total of 126 patients with adenomyosis who underwent HIFU combined with pharmacological treatment were retrospectively reviewed. Patients were treated with either dienogest (DNG) (Group A, N = 38) or GnRH-a (Group B, N = 88) for three months after HIFU, and received levonorgestrel-releasing intrauterine systems (LNG-IUS) at the end of the third month. Visual Analog Scale (VAS) and Pictorial Blood Loss Assessment Chart (PBAC) scores were used for evaluating symptom improvement. Results After propensity score matching (1:2), 38 patients were included in Group A and 76 in Group B. All patients showed significant improvement in VAS and PBAC scores after HIFU, but the PBAC score of Group A was significantly higher than that of patients in Group B at 18 months [11.50 (1.00, 29.50) vs. 0.00 (0.00, 16.50), p < 0.01] and 24 months [4.00 (0.25, 27.75) vs. 0.00 (0.00, 12.75), p = 0.04] after HIFU. Furthermore, patients in Group B had a greater uterine volume reduction at 24 months after HIFU than that of patients in Group A [51.00 (27.00, 62.00) vs. 30.00 (17.00, 42.75, p = 0.02)]. However, the adverse effects in Group A were lower than those in Group B [7 (15.79) vs. 35 (46.05), p < 0.01]. No significant difference was observed in the recurrence rate between the two groups. Conclusions HIFU combined with DNG and LNG-IUS is a safe and effective treatment for patients with adenomyosis.

Clinical, sonographic and molecular changes in calcific tendinitis of the shoulder following extracorporeal shockwave therapy: a prospective case-control study.

Extracorporeal shockwave therapy (ESWT) is the primary treatment for calcific tendinitis of the shoulders, but what are the effects of clinical, sonographic, and molecular markers following ESWT in treating calcific tendinitis of the shoulder? Twenty-eight patients were categorized into radiodense and radiolucent subgroups. In addition, clinical assessments included the visual analogue scale (VAS), Constant-Murley (CM) score, American Shoulder and Elbow Surgeon (ASES) score, sonographic evaluation, and serum enzyme-linked immunosorbent assay (ELISA). The participants completed a one-year follow-up. All data were collected before and after treatment. After one year of follow-up, all patients showed notable improvement in VAS, CM, and ASES scores, with no significant clinical variations among the subgroups. However, the radiolucent group showed significant complete resorption and size reduction at the final follow-up. Sonographic evaluation revealed improved tissue perfusion and reduced calcification from 3 to 12 months in all patients, including those in the radiolucent group, but complete resorption of calcific deposits did not occur. The percentage of tissue perfusion was improved at 1 and 3 months after ESWT. There were no significant differences in the levels of the molecular markers interleukin-1 beta (IL-1 β) or IL-33, but the level of insulin-like growth factor 1 (IGF-1) was notably increased at 1 and 3 months post-ESWT. The BMP7 level was increased at 3 months and was then decreased significantly at 6 and 12 months. ESWT improved symptoms, reduced calcification, enhanced tissue perfusion, and promoted angiogenesis and BMP7 activity. In particular, it benefited radiolucent type patients with better calcification resorption. Partial resorption led to improvements in transparency, and a second ESWT session at 3 months was recommended for optimal results.

Effect of Topical Hemp (Cannabis sativa L.) Seed Oil on Knee Osteoarthritis: A Randomized Double-Blind Controlled Trial

Purpose, and DesignKnee osteoarthritis (OA) is one of the most common and debilitating diseases, especially in the elderly. Hemp seed oil is a plant product that has been used as a food or drug since ancient times because of its anti-inflammatory and analgesic properties. MethodsA double-blind, active, placebo-controlled trial was done to assess the efficacy of hemp seed oil on knee OA. Ninety patients were randomly allocated to three groups; hemp seed oil, diclofenac gel, and placebo via a blocked randomization method, and were asked to apply the topical treatment daily for 2 months. The study participant underwent assessments before, and four and 8 weeks after the intervention. Evaluation included measurements of the heel-to-thigh distance, utilization of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and application of visual analog scale (VAS). Data analysis was performed using SPSS.24 and the significance level was considered as p < .05. ResultsAll parameters, except heel-to-thigh distance, improved significantly in the hemp seed oil group compared to placebo group. Improvements in VAS and WOMAC parameters were not different comparing the hemp seed oil and diclofenac gel groups. Heel-to-thigh distance decreased significantly within all groups during the study. There were no significant differences in improvements in heel-to-thigh distance comparing the three groups. Conclusion, and Clinical ImplicationsHemp seed oil led to greater improvements in VAS pain score and WOMAC parameters, but not knee flexion range, compared to placebo. There were no differences in measured outcomes comparing hemp seed oil and diclofenac gel.

A retrospective cohort review of BMI on SI joint fusion outcomes: examining the evidence to improve insurance guidelines.

The demand for SIJ fusion among obese patients has grown substantially. However, the clinical relevance of obesity in the context of SI joint fusion has not been well investigated specifically, whether there is a BMI cutoff above which the benefit-risk ratio is low. Adult patients ≥ 21 years of age who underwent minimally invasive SIJ fusion between 2020 and 2023. Participants were classified using the National Institutes for Health body mass index (BMI). Patients with a BMI of 30 to 39 with no significant comorbidity are considered obese, patients with a BMI of 35 to 39 with a significant comorbidity or a BMI of 40 or greater are considered morbidly obese. All subjects completed the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline and 12 months. One-way analysis of variance was used to examine the impact of BMI category on score changes. Overall, mean VAS improved at 12 months by 2.5 points (p < .006). Over the 12-month follow-up period, BMI category did not impact mean improvement in VAS (ANOVA p = .08). Mean ODI at 12 months improved by 23.2 points (p < .001). BMI category did impact mean improvement in ODI (ANOVA p = .03). This study demonstrates similar benefits across all BMI categories. This data suggests that obese patients do benefit from minimally invasive SIJ fusion, specifically the 35-40 BMI cohort of patients, and should not be denied this procedure based on arbitrary healthcare organizations BMI criteria.

Impact of Teriparatide and Denosumab on Clinical and Radiographic Outcomes in Osteoporotic Vertebral Compression Fractures.

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly, often leading to significant pain, morbidity, and mortality. Effective management of underlying osteoporosis is essential to prevent subsequent fractures. This study aimed to compare the clinical and radiographic outcomes of teriparatide and denosumab treatments in patients with OVCFs to determine their relative effectiveness in improving patient outcomes. Materials and Methods: This retrospective study included 78 patients diagnosed with an acute thoracolumbar OVCF who received either teriparatide (35 patients) or denosumab (43 patients) within three months of a fracture. Clinical outcomes were assessed using the visual analog scale (VAS) for back pain, Oswestry disability index (ODI), and EQ-5D quality of life scores at baseline, 6 months, and 12 months. Bone mineral density (BMD) and radiographic outcomes were evaluated initially and at 12 months post-treatment. Results: Both treatment groups demonstrated significant improvements in VAS, ODI, and EQ-5D scores over 12 months. No significant differences were observed between the teriparatide and denosumab groups in terms of clinical outcomes or radiographic measurements at any time point. Fracture union and BMD improvements were similarly observed in both groups. The teriparatide group had a lower baseline BMD, but this did not affect the overall outcomes. Conclusions: Both teriparatide and denosumab are effective in improving clinical and radiographic outcomes in patients with OVCFs. Despite concerns about denosumab's potential to hinder fracture healing, our study found no significant differences between the two treatments. These findings support the use of denosumab for early treatment of OVCFs to prevent subsequent fractures without compromising fracture healing. Further prospective studies are needed to confirm these results.