Visual Analog Scale Scores Research Articles

Assessment of Low Level Laser Therapy on Periodontal Inflammation and Healing after Scaling and Root Planing in Chronic Periodontitis Patients – A Clinico Biochemical Study

ABSTRACT Aim: The aim of this study was to determine how Low-level laser therapy (LLLT) post- Scaling and root planning (SRP) affected the inflammatory periodontal tissue caused by chronic periodontitis. Methodology: The study involved 56 sites in 28 patients with almost bilaterally symmetrical moderate pocket depths. The sites were split into two groups at random. SRP was administered alone to Group I, while SRP with LLLT were administered to Group II. In addition to recording the clinical parameters [plaque index (PI), sulcus bleeding index (SBI), and probing pocket depth (PPD)], GCF sample was taken at baseline, 3 to 4 weeks, and 6 to 7 weeks from baseline. The visual analogue scale (VAS) was scored for both groups on the final day of LLLT, which was 7 days following SRP. All GCF samples were then sent for TGF-β1 and PGE2 biochemical analysis. Results: This study demonstrated a significant reduction in PI, SBI, PPD, VAS score, PGE2 and TGF- β1 level in GCF in group I after SRP. Similarly in group II, which received LLLT with SRP, showed a significant decrease in all clinical and biochemical parameters. Intergroup comparison showed no significant difference in PI, SBI, TGF-β1 levels in the GCF. However, there was a significant difference in PPD, VAS score, and PGE2 level results. Conclusion: Our study concluded that LLLT may be effective in reducing inflammation when used as an adjunct to SRP.

The impact of ERAS-based nursing interventions on postoperative complication management and prognosis in early gastrointestinal tumor endoscopic resection: a prospective randomized controlled study.

This study aimed to evaluate the effectiveness of Enhanced Recovery After Surgery (ERAS)-based nursing interventions in improving postoperative recovery, reducing complications, and enhancing patient satisfaction and quality of life in patients undergoing endoscopic resection for early gastrointestinal tumors. A single-center, randomized, single-blind controlled trial was conducted from October 2023 to October 2024 at a tertiary hospital. A total of 120 patients with early-stage gastrointestinal tumors scheduled for endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) were randomly assigned to the ERAS group (n = 60) or the control group (NC, n = 60). Data collection included Comprehensive Complication Index (CCI), Visual Analog Scale (VAS), Six-Minute Walk Test (6MWT), EORTC QLQ-C30, SF-36, patient satisfaction, and length of hospital stay. Statistical analyses included repeated measures ANOVA and chi-square tests, with a significance threshold of P < 0.05. Compared to the NC group, the ERAS group demonstrated significantly lower CCI scores and fewer Clavien-Dindo ≥ III complications at 3days, 2weeks, and 3months postoperatively (P < 0.05). The ERAS group also reported shorter hospital stays (4.8 ± 1.5 vs. 6.3 ± 1.8days, P < 0.001). VAS scores in the ERAS group were significantly lower at 24h and 3days postoperatively (P < 0.001), with differences diminishing over time. Functional recovery, measured by 6MWT, was significantly better in the ERAS group at all time points except 12months. HRQoL scores in the ERAS group were significantly higher at 3months, particularly in functional and symptom dimensions (P < 0.05), and have higher patient satisfaction rates across all follow-up time points (P < 0.05). ERAS-based nursing interventions significantly improved postoperative recovery, reduced complications, shortened hospital stays, and enhanced patient satisfaction and quality of life in patients undergoing minimally invasive endoscopic resection for early gastrointestinal tumors. These findings support the integration of ERAS principles into nursing care protocols to optimize surgical outcomes.

Is operative revision associated with favourable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? A retrospective, single-centre data analysis of forty two cases.

There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA. This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55. Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4kg vs. 78.7kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55. Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.

Fissurectomy with or without anoplasty for chronic anal fissures is a valid alternative to lateral internal sphincterotomy: a retrospective cohort study of 475 patients.

After the failure of conservative therapy, the most effective surgical treatment for chronic anal fissures (CAFs) is lateral internal sphincterotomy. However, the choice of the procedure must be always evaluated carefully due to the risk of long-term anal continence impairment. The aim of the present study is to report the outcomes of fissurectomy with or without associated anoplasty. This study is a single-center retrospective study including patients with CAFs in whom conservative medical and non-medical treatments failed and who underwent fissurectomy with or without anoplasty from January 2015 to June 2023. Fecal continence, pain, and complications were assessed using specific questionnaires and scores. Overall, 475 patients [280 males (58.9%)] with CAF underwent fissurectomy, with (n = 392; 82.5%) or without (n = 83; 17.5%) anoplasty. The majority of them (n = 379; 79.8%) had a posterior fissure. The mean follow-up was 49.9 months ± 26.13 months, with a minimum of 1 year, showing no intraoperative complications and a 4.2% postoperative complication rate. Missed healing occurred in 7.15% of patients at 6 months of follow-up, with higher recurrence and sphincterotomy rates in posterior fissures (p = 0.04). Cleveland Clinic Incontinence Scores were higher in patients who underwent anoplasty (p = 0.002). Interestingly, anoplasty led to a significant decrease in visual analogue scale (VAS) scores (p < 0.001), compared with those who did not undergo the procedure, with a consequent faster recovery. Our study showed that fissurectomy, whether performed with or without anoplasty, was a highly effective surgical option for treating CAFs, achieving an overall success rate of 92.8% without significant impairment of continence and with a low complication rate. Further randomized prospective trials are needed to confirm this finding. Interestingly, fissurectomy with anoplasty seems to allow for better short-term outcomes in terms of postoperative pain and recovery time compared with fissurectomy alone.

The Potential Role of Bio Extra Virgin Olive Oil (BEVOO) in Recovery from HPV 16-Induced Tonsil Cancer: An Exploratory Case Study

The human papillomavirus type 16 (HPV 16) is a high-risk human papillomavirus strain commonly associated with oropharyngeal cancers, including lymph node involvement. The treatment for HPV 16-related tonsil cancer, commonly involving surgery, radiation, and chemotherapy, presents significant challenges. Complications such as oral mucositis, xerostomia, dysphagia, dysgeusia, hypogeusia, impaired gustatory function, and significant weight loss frequently arise, leading to reduced nutritional intake, impaired healing, and recovery progression. These challenges underscore the need for supportive interventions to enhance rehabilitation and the post-recovery period, improve treatment tolerance, and maintain quality of life. Objective: This single-subject study examines a 67-year-old male patient diagnosed with a T1N3b (small primary tumor with advanced lump node involvement) associated with HPV 16 positivity, indicating a virus-associated oncogenesis. Methods: The patient underwent radiation therapy and chemotherapy, leading to treatment-associated side effects. After having dietary drinks for daily nourishment, the patient routinely incorporated oral bio extra virgin olive oil (BEVOO) to cope with indicated challenges. Results: Body composition and metabolic parameters showed treatment-induced declines, followed by substantial but not complete recovery during follow-up examination. Visual Analog Scale (VAS) scores reflected gradual improvements in dysphagia, xerostomia, mucositis, and subtle but ongoing enhancement of the dysgeusia, gustatory perception, and oral palatability. The BEVOO supplementation and mindfulness were associated with positive recovery trends. Additional variables could have impacted the outcomes, preceding and throughout treatment, including the patient’s cognitive and somatic health, environmental conditions, dietary habits, individual attitudes toward recovery, physical activity, and patient way of life. Conclusions: These results emphasize the need for additional research employing a comprehensive, multi-factorial framework that accounts for the complex interplay of physiological, psycho-social, and environmental contributors. More extensive, more diverse studies are essential to confirm these observations and substantiate the role of BEVOO as a supportive intervention in cancer recovery.

Effectiveness of oral vs intravenous acetaminophen on pain management following total joint arthroplasty: A systematic review and meta-analysis

BACKGROUND In the management of postoperative pain following total joint arthroplasty (TJA), the use of nonsteroidal anti-inflammatory drugs, including acetaminophen, plays a key role in alleviating pain. However, the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial. AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA. METHODS PubMed, Embase and the Cochrane Library were comprehensively searched to identify cohort studies. The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials. PRISMA guidelines were followed. The effectiveness of the administration routes was compared based on visual analogue scale (VAS) scores at 24 and 48 h, total morphine usage within 24 h, and total duration of hospital stay. RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups. The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h (P = 0.76 and 0.08, respectively). The difference in total morphine use between the two groups was not significant (P = 0.22). However, the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups (P = 0.0005), showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time. CONCLUSION After TJA surgery, intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia, Oral administration has become the preferred choice for mild cases due to its convenience and economy, providing a basis for clinical drug selection.

Blood biomarkers for brain injury in chronic subdural hematomas: postoperative dynamics and relation to long-term outcome.

The aim of this study was to investigate whether the biomarkers neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau (total [t] and brain-derived [BD]) are elevated in plasma preoperatively; if there is a dynamic biomarker response to surgery; and if the biomarker levels are related to long-term outcome in chronic subdural hematomas (CSDHs). Eighty-five CSDH patients surgically treated between 2022 and 2023 at Uppsala University Hospital, Uppsala, Sweden, were included in this prospective, observational study. NSE, GFAP, NfL, t-tau, and BD-tau were evaluated in plasma pre- and postoperatively (6-24 hours after surgery) and in the CSDH fluid. Health-related quality of life was evaluated using the 5-level EQ-5D (EQ-5D-5L) at 6 months postoperatively. GFAP, NfL, and tau levels decreased after CSDH surgery (p < 0.02). NSE and BD-tau levels also decreased, but not significantly. Older age and larger CSDH volume were associated with higher preoperative GFAP, NfL, and BD-tau levels (p < 0.05). Higher preoperative values and greater dynamics (Δ [postoperative value - preoperative value]) of GFAP, NfL, and BD-tau correlated significantly with worse levels of several EQ-5D-5L domains (p < 0.05). A higher preoperative NfL level in plasma was independently associated with a lower EQ-5D-5L visual analog scale score (p < 0.001). Surgical CSDH patients exhibit ongoing central nervous system cellular injury, demonstrated via increased fluid biomarkers for brain injury preoperatively, which immediately improved after surgery and was strongly related to long-term outcome. The extent of preoperative biomarker elevation could aid in the decision-making for surgical indication and urgency.

Ultrasound-Guided Erector Spinae Plane Block for Breakthrough Cancer Pain in the Emergency Department: A Case Series.

Objectives: Patients with cancer often experience severe pain, leading to emergency department (ED) visits and hospitalization. The erector spinae plane block (ESPB) has a multimodal mechanism that may treat cancer pain exacerbations. Methods: Data were collected via chart review for three patients with intra-abdominal cancer presenting to the ED for cancer-related abdominal pain and received a bilateral ESPB. Visual analog scale scores were collected pre- and post-procedurally. Results: The patient with colon cancer was pain-free postprocedurally and was discharged the following day. The patient with rectal cancer had a 75% reduction in pain and was discharged from the ED. The patient with pancreatic cancer had a 66% reduction in pain and was discharged the following day. Conclusion: Our findings suggest that the ESPB effectively treats cancer pain exacerbations and may expedite the bridge to home pain regimens. Furthermore, the ESPB may reduce the length of hospitalization and facilitate discharge.

Comparative outcomes of hysterectomy using single-port umbilical laparoscopy versus vaginal natural orifice transluminal endoscopic surgery

Background This study compared two minimally invasive hysterectomy techniques—single-port umbilical laparoscopy (SPLS) and vaginal natural orifice transluminal endoscopic surgery (vNOTES)—in terms of operating time, blood loss, postoperative pain, and hospitalization duration. Methods We retrospectively analyzed patients who underwent hysterectomy via SPLS or vNOTES. Inclusion criteria were patients who had a hysterectomy with bilateral salpingectomy, with additional procedures such as salpingo-oophorectomy or sentinel lymph node dissection as indicated. Results Among the 121 patients studied, 63 underwent SPLS and 58 underwent vNOTES. The mean operative time was 67.3 ± 15.9 min for vNOTES and 75.7 ± 12.1 min for SPLS. Six patients (9.5%) in the SPLS group and four (6.9%) in the vNOTES group underwent sentinel lymph node biopsies for endometrial cancer. Pain assessment at six, 12, and 24 h after surgery indicated lower visual analog scale (VAS) scores in the vNOTES group. Notably, patients in that group reported reduced shoulder and umbilical pain at 24 h postoperatively. Those patients also showed improved sexual function index scores and reduced dyspareunia, although the differences were not statistically significant. Conclusions The vNOTES approach to hysterectomy is a viable alternative, characterized by shorter operative times and decreased postoperative pain without increasing complication rates.

Early functional training is not superior to routine rehabilitation in improving walking distance and multifidus atrophy after lumbar fusion: a randomized controlled trial with 6-month follow-up.

To investigate the effects of early functional training within a 12-week rehabilitation program on walking distance and lumbar multifidus atrophy following lumbar fusion surgery. A total of 52 patients who underwent lumbar fusion surgery were randomly assigned to either the early functional training group (n = 26) or the routine rehabilitation group (n = 26). The early functional training group (FT group) began a progressive functional training program within the first 12weeks post-surgery, while the routine rehabilitation group (RH group) started the same training program 12weeks after surgery. The primary outcome was the walking distance, measured as the 6-minute walk distance (6MWD) at the 3-month, and 6-month follow-up. Secondary outcomes included the cross-sectional area (CSA) of the multifidus muscles, the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI) score, the Short Form 36 Health Survey (SF-36) subscales, including the Physical Component Summary (PCS) and Mental Component Summary (MCS),and the incidence of adverse events. The primary aim was evaluated using a 2-way mixed-model analysis of covariance (ANCOVA), with treatment group as the between-subjects factor and time as the within-subjects factor, after adjusting for baseline measures. Among the total patients, 38 (73.1%) left with at least one follow-up result, and 29 (55.8%) completed all treatment sessions and obtained an MRI assessment. The mixed-model ANCOVA revealed a significant group-by-time interaction for the 6MWD (F = 6.214, p = 0.003). Patients in the FT group demonstrated superior 6MWD compared to the GH group at 3months (95% CI: 32.51 to 101.88, p < 0.001). No significant differences were found between the two groups at the 6-month follow-up (95% CI: -15.34 to 54.03, p = 0.271). Regarding secondary outcomes, no significant group-by-time effects were found for ODI (F = 1.221, p = 0.299), PCS (F = 0.166, p = 0.847), or MCS (F = 0.282, p = 0.755). No significant differences were found in the CSA of multifidus muscles between the groups. Nine patients (17.3%) experienced adverse events. Early functional training after lumbar fusion was not superior to routine rehabilitation in improving walking distance, multifidus atrophy, pain, physical function, and quality of life during the 6-month follow-up. Trial registration number (TRN): ChiCTR2300068296.

Standardization of Beef, Pork, Chicken, and Soy Protein Extracts for Patch Testing and Their Accuracy in Diagnosing Adverse Food Reactions in Dogs with Chronic Pruritus

(1): Background: This study aimed to evaluate the concentrations of four proteins for allergic patch testing (APT) in dogs, assessing sensitivity (SE), specificity (SP), negative predictive value (NPV), positive predictive value (PPV), reactions to adhesives/containers, and the safety of APT with food proteins in dogs. (2) Methods: For evaluation, 43 dogs were screened and divided into two groups: Group 1 consisted of 20 healthy dogs, and Group 2 included 23 dogs with canine atopic dermatitis (AD). Group 1 underwent allergic patch testing (APT) with beef, pork, chicken, and soy proteins at four different concentrations (100 mg, 250 mg, 500 mg, 1000 mg/0.2 mL). Of the 23 dogs included in Group 2, four did not undergo the elimination diet and were excluded, leaving 17 dogs in the study. They underwent an elimination diet (ED) and were evaluated using the pruritus visual analog scale (pVAS) and lesion scores (CADESI-4) before and after the ED (days 0 and 45). After the ED, Group 2 was subjected to APT (using the same proteins and concentrations as Group 1) and an oral provocation test (OPT) with the proteins used in the APT. The results of the OPT were used to assess the accuracy of the APT. (3) Results: In Group 1, one dog reacted to the APT. In Group 2, after 45 days of ED, of the 17 dogs included, 13 showed a reduction in pVAS and CADESI-4 scores (p &lt; 0.05) and nine an improvement considered good to excellent. Of these, two showed irritant contact reactions to the APT chambers and were excluded, leaving 11 dogs that were reactive to APT, and the OPT increased pruritus (p &lt; 0.05). Accuracy: Beef and chicken proteins at concentrations of 500 and 1000 mg/0.2 mL, and soy protein at 1000 mg/0.2 mL, achieved 100% SE, SP, PPV, and NPV. Pork protein at 1000 mg/0.2 mL achieved 100% SE, 83% SP, 83% PPV, and 100% NPV. (4) Conclusions: APT with beef and chicken proteins at 500 mg and 1000 mg/0.2 mL and soy protein at 1000 mg/0.2 mL, based on the results of this study, can be recommended for diagnosing adverse food reactions in dogs with AD.

Effect of mini-open rotator cuff repair combined with intraoperative cocktail therapy in the treatment of rotator cuff injury: a prospective comparative study between the cocktail therapy and the control group.

To investigate the clinical effect of mini-open rotator cuff repair combined with intraoperative cocktail therapy in the treatment of rotator cuff injury. A prospective comparative study of 78 patients with rotator cuff injury who underwent mini-open rotator cuff repair in our hospital from January 2020 to January 2022 and used block randomization to divide patients into 2 groups in this trial: The cocktail group received 150mg ropivacaine, 40mg of methylprednisolone succinate, 0.3mg of epinephrine, and saline solution to a total of 100 mL, whereas the control group received 100mL of saline solution. The drug mixtures were injected into the glenohumeral joint, subacromial bursa, and anterior, middle, and posterior parts of the deltoid muscle. The patients' visual analog scale (VAS) scores preoperatively were recorded at 6, 12, 24, and 48h postoperatively. We also recorded the Constant-Murley function scores and passive abduction angles of the operation shoulder at two weeks, one, three and six months postoperatively. We also compared the number of patients using postoperative celecoxib capsules and receiving parecoxib sodium injections; the number of patients experiencing nausea; the patients with infection; the course of disease and the tear size. The cocktail group constituted 39 shoulders (50.0%), with 16 men (41.0%) and 23 women (59.0%); the mean age was 58.71 ± 6.39 years; the mean BMI was 24.25 ± 4.50kg/m 2. The control group constituted 39 shoulders (50.0%), with 18 men (46.2%) and 21 women (53.8%); the mean age was 59.71 ± 10.78 years; the mean BMI was 23.25 ± 3.73kg/m 2. We found no significant difference in sex, age and BMI between the 2 groups (P = 0.647, P = 0.620, P = 0.289). The VAS scores at 6, 12, 24 and 48h postoperatively were significantly lower in the cocktail group (P = 0.023, P = 0.036, P = 0.014, P = 0.017). The number of patients receiving celecoxib capsules and parecoxib sodium injections tended to be lower in the cocktail group, and the difference was significant (P = 0.001, P = 0.001). There was no significant difference in the incidence of nausea(P = 0.617), infection, the course of disease(P = 0.182) and the tear size (P = 0.649)between the two groups. The Constant-Murley functional score and passive abduction angle of the operation shoulder were significantly improved in all patients after surgery, and there was no statistical difference in the functional score and active abduction angle of the operation shoulder between the two groups preoperatively (P = 0.430, P = 0.183) and at three(P = 0.468, P = 0.832) and six months postoperatively(P = 0.110, P = 0.381). However, at two weeks (P = 0.001, P = 0.001) and one month postoperatively (P = 0.001, P = 0.001), the Constant-Murley functional score and the passive abduction angle of the operation shoulder in the cocktail group were significantly higher than those in the control group. The mini-open rotator cuff repair has satisfactory curative effect in the treatment of rotator cuff injury, and intraoperative cocktail therapy can alleviate postoperative pain and speed up postoperative functional rehabilitation and improvement of joint range of motion. Level III, therapeutic study.

Minimally Invasive Surgery For Posterior Temporary Fixation Through Intermuscular Approach in the Treatment of Odontoid Fractures: A Retrospective Cohort Study.

Retrospective study. This study aims to evaluate the effectiveness of temporary fixation through intermuscular approach in reducing intraoperative blood loss, postoperative pain, and preserving suboccipital musculature. Odontoid fractures pose significant treatment challenges, particularly regarding the preservation of cervical range of motion and minimizing disruption to the occipitocervical muscles. Conventional posterior open approaches are associated with a high incidence of postoperative occipitocervical pain, dysfunction, and substantial perioperative blood loss. We hypothesized that minimally invasive posterior temporary fixation through an intermuscular approach, which avoids significant disruption of the suboccipital musculature, would offer advantages over the standard open approach. This study included patients aged less than 65 years old and without osteoporosis who underwent posterior temporary fixation for odontoid fractures between 2015 and 2023. Outcomes measured included fracture healing rate, surgery duration, blood loss, Visual Analog Scale (VAS) scores, narcotic use, postoperative complications, hospital stay duration, and changes in muscle cross-sectional area (CSA). 45 patients were included (26 in the intermuscular group and 19 in the open group). No significant differences were found in fracture healing time or postoperative complications between the groups. The intermuscular group showed significantly lower intraoperative blood loss, shorter hospital stays, reduced postoperative VAS scores, and a decreased need for supplementary narcotics. Additionally, the intermuscular approach better preserved key occipitocervical muscles, with less CSA reduction compared to the open approach. No failures of internal fixation were observed in either group. Minimally invasive posterior temporary fixation through the intermuscular approach offers substantial benefits over traditional open surgery for odontoid fractures. These include reduced blood loss, lower postoperative pain, shorter recovery time, and better preservation of suboccipital musculature, all without compromising fracture healing. This technique provides an effective, muscle-sparing alternative for open temporary fixation in the treatment of odontoid fractures.

Inflammation and patient satisfaction in micropulse versus continuous wave transscleral cyclophotocoagulation

Background/aimsThis work aims to clarify whether micropulse transscleral cyclophotocoagulation (MPCPC) is gentler in terms of postoperative inflammation and is better tolerated compared with continuous wave cyclophotocoagulation (CWCPC).MethodsProspective, randomised controlled, interventional,...

Breastfeeding in women with juvenile idiopathic arthritis: results from a Norwegian quality register

BackgroundLimited research exists on the challenges women diagnosed with juvenile idiopathic arthritis (JIA) can face during pregnancy and breastfeeding, and if breastfeeding affects disease related factors.Aims and objectivesThis study aimed to explore the proportion of women with JIA breastfeeding at six weeks, six months, and 12 months postpartum, as well as examining demographic and disease related factors and the use of medications, comparing the breastfeeding and the non-breastfeeding groups.MethodsData on women with JIA regarding pregnancy and breastfeeding were collected prospectively from the Norwegian nationwide quality register RevNatus in this observational study. The data included demographics, disease activity, self-reported health status, medication, obstetric and neonatal outcome, and were collected from clinical documentation and self-reported material during visits at the outpatient clinic between January 2016 and July 2023. In this study, we used data from the inclusion visit and from the follow-up at six weeks, six months and 12 months postpartum.ResultsAmongst 304 births in 227 women, 86% of the patients were breastfeeding at six weeks, 70% at six months and 39% at 12 months postpartum. Breastfeeding women differed from non-breastfeeding women in several aspects. At six weeks postpartum, 79% of breastfeeding women had a higher education level compared to 49% of non-breastfeeding women (p-value < 0.001). Additionally, breastfeeding women experienced longer pregnancy duration (40 weeks versus 38 weeks, p-value 0.004), had a lower prevalence of cesarean section (CS) (21% versus 45%, p-value 0.007) and premature birth (5% versus 22%, p-value < 0.001), and gave birth to newborns with a mean higher birth weight (3512 g versus 3175 g, p-value 0.011). In terms of health status, the breastfeeding women had lower Visual Analog Scale (VAS) scores for pain (24 compared to 38 mm, p-value 0.002), fatigue (25 compared to 40 mm, p-value 0.030) and total (29 compared to 38 mm, p-value 0.023) six weeks postpartum. At all registrations, a larger proportion of non-breastfeeding women used conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (at six weeks: 29% compared to 21%, p-value 0.021; at six months: 30% compared to 27%, p-value 0.002; at twelve months: 38% compared to 30%, p-value < 0.001).ConclusionIn the present study, we observed a high proportion of women with JIA breastfeeding at six weeks and six months postpartum. Based on our findings, health professionals should encourage women with JIA to breastfeed when taking compatible medications.

Quantitative assessment of platelet-rich plasma in enhancing bone regeneration and healing in osteoporotic fractures

Osteoporotic fractures pose a significant clinical challenge due to impaired bone healing and an increased risk of nonunion. Platelet-rich plasma (PRP) has emerged as a promising therapeutic intervention due to its high concentration of bioactive molecules that stimulate bone regeneration. This randomized controlled trial aimed to evaluate the efficacy of PRP in enhancing fracture healing in elderly patients with osteoporosis. Fifty patients diagnosed with osteoporotic fractures were randomly assigned to either the PRP group (n=25), receiving a single injection of PRP at the fracture site, or the standard guideline therapy group (n=25), receiving the usual standard treatment for such fractures. Fracture healing outcomes were assessed over six months through radiographic imaging, bone mineral density (BMD) measurement, pain assessment using the Visual Analog Scale (VAS), and functional recovery evaluated by the Timed Up and Go (TUG) test. Additionally, serum biomarkers of bone formation, including osteocalcin and alkaline phosphatase, were analyzed. The results demonstrated that the PRP group exhibited significantly higher radiographic union scores (7.8 ± 1.1 vs. 5.8 ± 1.7, p = 0.0001), greater improvement in BMD (3.3 ± 1.9% vs. 1.8 ± 2.9%, p = 0.02), lower VAS scores (2.4 ± 1.8 vs. 4.1 ± 2.1, p = 0.001), and shorter TUG test completion times (14.5 ± 3.1s vs. 18.6 ± 3.5s, p = 0.0001) compared to the standard guideline therapy group. Biochemical analysis revealed significantly elevated osteocalcin (33.5 ± 7.3 ng/mL vs. 23.9 ± 5.5 ng/mL, p = 0.0001) and alkaline phosphatase levels (119.4 ± 23.1 U/L vs. 102.3 ± 20.4 U/L, p = 0.01) in the PRP group, suggesting enhanced osteoblastic activity. These findings indicate that PRP significantly improves fracture healing, enhances bone regeneration, reduces pain, and accelerates functional recovery in osteoporotic patients. Further research is needed to optimize PRP protocols and establish long-term efficacy in clinical applications.

Mediating role of pain sensitization in preoperative and postoperative pain in knee osteoarthritis patients

ObjectiveThis study aims to explore the relationship between preoperative and postoperative pain in patients with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKR), and to assess the mediating roles of central and peripheral sensitization.MethodsThis prospective cohort study enrolled a total of 105 eligible KOA patients. The Visual Analog Scale (VAS) was used to assess preoperative and postoperative pain levels. Multivariate linear regression analysis and Bootstrap mediation analysis were conducted to investigate the impact of preoperative pain intensity on postoperative pain.ResultsThis study revealed a significant positive correlation between preoperative VAS scores during movement and pain scores 3 days postoperatively (β = 0.4018, p = 0.0017), as well as a significant correlation with pain scores 6 months postoperatively (β = 0.735, p = 0.004). Central sensitization (β = 0.0446, p < 0.0001) and peripheral sensitization (β = 0.0333, p = 0.0015) exhibited significant mediation effects between preoperative and postoperative pain. Additionally, preoperative VAS scores (B = 1.107, p = 0.014, OR = 3.027), age (B = 0.207, p = 0.036, OR = 1.229), and duration of arthritis (B = 0.190, p = 0.013, OR = 1.210) were significant predictors of postoperative analgesic demand.ConclusionThis study demonstrates that preoperative pain intensity is closely related to postoperative pain in KOA patients undergoing TKA and UKR, with central and peripheral sensitization playing significant mediating roles in this process. In particular, preoperative pain management is crucial for alleviating postoperative pain and improving patients' quality of life. Therefore, when formulating individualized pain management strategies, the central and peripheral sensitivity of patients should be comprehensively considered. Future research is necessary to develop and evaluate innovative pain control methods integrating central and peripheral mechanisms to optimize postoperative rehabilitation and long-term health outcomes.

Nasal Mucosa Regeneration After Reboot Surgery: Electron Microscopy and Histology Insights in CRSwNP.

Chronic rhinosinusitis with nasal polyps (CRSwNP) often requires multiple treatments. When topical steroids prove insufficient, endoscopic sinus surgery (ESS) is the primary intervention. Among surgical options, reboot surgery is an innovative approach that offers the potential for prolonged disease control in rapidly recurring cases, delaying the need for monoclonal antibody (mAb) therapy. Our study investigates the histological and ultrastructural aspects of mucosal regeneration post-reboot surgery, providing evidence beyond clinical observations. Five adult patients with recurrent CRSwNP, having undergone previous ESS, were enrolled in our study along with one control patient. All underwent partial reboot surgery, and biopsies were taken at pretreatment, 3-, 12-, and 24-months post-op. Analysis included clinical history, demographics, nasal polyps score, CT scans, and ACCESS score. All biopsies were analyzed using light (LM) and electron microscopy (both in transmission and scanning mode [TEM and SEM], respectively). Clinical response was assessed with Sinonasal Outcome Test-22 (SNOT-22) and Visual Analog Scale (VAS). Difference of means of SNOT-22 and VAS scores, pre versus at 24 months, were statistically significant (69.8 vs. 18.6, p = 0.043; 9.2 vs. 1.2, p = 0.038, respectively). The histological and ultrastructural analysis revealed significant changes in mucosal morphology, collagen composition, vascularity, and cell adhesion, with gradual restoration of normal epithelium and ciliary structure over time. Evidence of mucosal regeneration was provided at LM and electron microscopy. Reboot surgery is an innovative procedure that may be considered a valid alternative to mAbs, especially in younger patients, considering costs of medication and long-term safety. Level 4.

The effect of bilateral rectus sheath and oblique subcostal transversus abdominis plane blocks on mechanical power in patients undergoing laparoscopic cholecystectomy surgery: a randomized controlled trial

BackgroundIn this study, we aimed to investigate the effects of bilateral rectus sheath blocks (RSBs) and oblique subcostal transversus abdominis plane (OSTAP) blocks on mechanical power (MP) in patients receiving laparoscopic cholecystectomy under general anesthesia. Additionally, we sought to evaluate the impact of these blocks on postoperative pain and quality of patient recovery.MethodsIn this prospective, double-blind study, 66 patients who underwent laparoscopic cholecystectomy were randomized into two groups: Group C (control), which received a standard analgesic intravenous regimen; and Group B (block), which received bilateral RSB and OSTAP blocks. Intraoperative mechanical power was measured for all patients. Postoperative pain was assessed using visual analog scale (VAS) scores, and recovery quality was measured using the 15-item quality of recovery (QoR-15) questionnaire.ResultsThe mechanical power values for patients in Group C were consistently greater at all measured times: baseline, before bridion, and after bridion. Although the difference at baseline was not statistically significant, significant differences were observed before and after bridion (p values = 0.112, 0.021, and 0.003, respectively). Patients in Group B exhibited significantly lower VAS scores at all time points (30 min, 2 h, 8 h, and 24 h) (p < 0.05). Additionally, essential variations were noted in the administration of rescue analgesia between the groups (p < 0.001). Regarding tramadol consumption, Group C patients had significantly greater values [84 (74–156) vs. 0 (0–75), median (25–75th percentiles)] (p < 0.001). For the QoR-15 scores, Group C also had significantly greater values [129 (124–133) vs. 122 (115–125), median (25–75th percentiles)] (p < 0.001).ConclusionsBilateral RSB and OSTAP blocks significantly reduce mechanical power during surgery. Moreover, they significantly decrease postoperative pain and analgesic consumption and increase patient recovery scores.Trial registrationThe study protocol was registered in the international database ClinicalTrials.gov (registration no. NCT06202040). This study was conducted between December 2023 and January 2024 at the Department of Anesthesiology and Reanimation of Konya City Hospital.

Comparison of Surgical Time and Clinical Outcomes for Intravenous Regional Anesthesia (IVRA) versus Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Open Carpal Tunnel Release Surgery: A Comparative Study

Abstract Background This study aimed to compare the efficacy and safety of two anesthetic techniques in patients undergoing carpal tunnel release surgery: intravenous regional anesthesia (IVRA) and the wide-awake local anesthesia no tourniquet (WALANT) technique. Materials and Methods A retrospective observational dual-center study was conducted, including 102 patients diagnosed with moderate-to-severe carpal tunnel syndrome (CTS) unresponsive to conservative treatment. Outcomes were assessed using the visual analog scale (VAS) for pain and the Duruoz Hand Index (DHI) for hand functionality. Comparisons were made based on age, gender, preoperative VAS scores, incision length, and surgical procedure duration. Results The outcomes of the WALANT (n = 51) and IVRA (n = 51) techniques in CTS surgery were compared. The IVRA group had a shorter operation time (2.49 ± 0.50 minutes) and faster return to daily activities (10.13 ± 9.50 days) compared with the WALANT group (operation time: 7.27 ± 1.35 minute, return to daily activities: 17.64 ± 2.52 days) (p &lt; 0.05). Additionally, postoperative analgesic requirements were significantly lower in the IVRA group (8/51; 15.6%) than in the WALANT group (37/51; 72.5%) (p &lt; 0.05). Both groups showed significant postoperative improvements in VAS and DHI scores (p &lt; 0.05), with the IVRA group demonstrating a greater improvement in DHI scores (14.76 ± 0.43) compared with the WALANT group (12.76 ± 0.45) (p &lt; 0.05). Conclusion IVRA with small incisions demonstrated superior outcomes in CTS surgery compared with WALANT, including shorter operation times, faster recovery, and reduced postoperative analgesic requirements. These findings suggest that IVRA may be a more favorable option for both patients and surgeons in carpal tunnel release surgery.