Mean Visual Analog Scale Score Research Articles

Factors Affecting Appearance after Thumb Polydactyly Reconstruction - A Caregiver's Perspective in an Asian Population.

Background: Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction. Methods: Patients who underwent thumb polydactyly reconstruction were recalled for assessment. Objective measurements of both the reconstructed and unaffected thumbs were taken. Surgical scars were evaluated by measuring their length and using the Vancouver Scar Scale (VSS). To assess the appearance of the reconstructed thumbs, we used the Visual Analogue Scale (VAS) through surveys completed by the primary caregiver of each patient. Caregivers also provided reasons for any unsatisfactory appearance outcomes and we correlated these with objective factors. Results: This study included 26 paediatric patients with 29 reconstructed thumbs. The mean VAS score for overall thumb appearance was 7.8 ± 2.2. While surgical treatment achieved symmetry in most anthropometric measures, reconstructed thumbs had smaller nail plates and greater joint angulation. Caregiver assessment of thumb width was closely related to the objective interphalangeal joint (IPJ) girth measurements, and perceived excessive angulation was related to the IPJ angle. Symmetry was not associated with nail fold width or scar location. However, perceived scar prominence was linked to VSS score and scar location. Conclusions: Thumb polydactyly reconstruction achieves symmetry in size, length and girth, but nail plate size and joint angulation remain significant challenges. Despite this, caregivers are generally satisfied with the overall appearance. Attention should be focussed on improving thumb IPJ girth, IPJ angulation and scar location to enhance overall aesthetic outcomes. Level of Evidence: Level IV (Therapeutic).

Modified double-row suture bridge technique for anterior colliculus fractures combined with deltoid ligament injury: a retrospective study.

The management of anterior colliculus fractures in combination with deltoid ligament injuries is a topic of debate, and there is a need to improve surgical outcomes. The purpose of the present study was to describe the application of a modified double-row suture bridge technique and evaluate its early clinical outcomes in the management of anterior colliculus fracture combined with deltoid ligament injury. From 2020 to 2022, 12 patients with anterior colliculus fracture combined with deltoid ligament injury were treated using a modified double-row suture bridge technique. For clinical outcome evaluation, objective data are presented through clinical examination findings; radiographic assessments, including X-rays and computed tomography (CT); and follow-up analysis utilizing American Orthopaedic Foot & Ankle Society ankle‒hindfoot (AOFAS) scores, Olerud Molander Ankle Scores (OMAS), and visual analogue scale (VAS) scores. Preoperative and follow-up scores were compared with Student's t test. (p < .05). The mean age of the patients was 52.67 ± 9.42 years (range: 39-74). The mean duration of follow-up was 14.42 ± 1.51 months (range: 12-17). At the final follow-up, the mean AOFAS score (P < 0.001) improved to 91.50 ± 2.65 points (range: 87-96), the mean OMAS (P < 0.001) improved to 77.08 ± 3.97 points (range: 70-85), and the mean VAS score (P < 0.001) improved to 0.25 ± 0.45 points (range: 0-1). Nine patients achieved excellent outcomes, and three achieved good outcomes according to the AOFAS score. Follow-up imaging evaluation indicated satisfactory alignment of the fracture and complete healing. Clinical examination suggested good mobility of the ankle. At the last follow-up, ankle dorsiflexion mobility was 14-18 degrees, plantar flexion mobility was 42-45 degrees, inversion mobility was 27-32 degrees, and eversion mobility was 22-25 degrees. The modified double-row suture bridge technique is effective for achieving anatomic reduction of anterior colliculus fractures, and the technique also provides substantial benefit to the injured deltoid ligament. With this technique, the clinical outcomes can be significant and encouraging, indicating a new stage in its application and development.

Ultrasound combined with DSA-guided pulsed radiofrequency for perineal herpes zoster pain management: clinical outcomes and complications

BackgroundHerpes zoster (HZ) in the perineal area is a rare disease. There are limited treatment options for this disease. This study aimed to assess the efficacy of ultrasound combined with digital subtraction angiography (DSA)-guided pulsed radiofrequency (PRF) for perineal herpes zoster-related pain.MethodsTwo hundred and twelve patients with perineal HZ were enrolled at the pain department. From January 1, 2018 to December 30, 2019, patients with HZ in the perineal area were treated with PRF under DSA guidance, and from January 1, 2020 to October 30, 2023, patients with HZ in the perineal area were treated with PRF under ultrasound combined with DSA guidance. The included patients were divided into two groups: DSA group and ultrasound + DSA group. The visual analog scale (VAS), central sensitization inventory (CSI), sleep quality scores (SQS), the 36-Item Short Form Health Survey questionnaire (SF-36) at baseline and after the PRF treatment were analyzed to evaluate clinical efficacy.ResultsThe mean VAS scores, CSI scores, SQS, and SF-36 scores were statistically significantly lower after treatment compared to baseline (p &amp;lt; 0.001). There was no significant change in VAS scores, CSI scores, SQS, and SF-36 scores between the DSA group and the ultrasound + DSA group (p &amp;gt; 0.05). The time it took from the start of the puncture to the successful puncture was significantly shorter in the ultrasound + DSA group compared to the DSA group (41.2 ± 21.2 vs. 48.1 ± 20.3, p = 0.035). The ultrasound + DSA group had a higher percentage of satisfaction with the procedure than the DSA group (90/99, 90.9% vs. 62/78, 79.5%, p = 0.030). A total of 27 postoperative complications occurred. The incidence of puncture site hematoma was significantly higher in the DSA group (10/78, 12.8%) than that in the ultrasound + DSA group (4/99, 4.0%) (p = 0.032).ConclusionPRF can reduce pain from HZ in the perineal region, alleviate central sensitization, enhance sleep quality, and improve overall quality of life. When PRF is performed under ultrasound guidance combined with DSA, it shortens the puncture time and reduces the risk of hematoma formation at the puncture site, making it the recommended method for clinical use.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Application of disposable digital hysteroscope for outpatient hysteroscopy in women undergoing artificial assisted reproductive procedures: a clinical research

BackgroundHysteroscopy is the preferred method for the diagnosis and treatment of uterine diseases. With the increasing demand for outpatient hysteroscopy, disposable digital hysteroscopy has emerged, which can meet the requirements of diagnosis and treatment integration, and greatly reduce the labour and storage costs.MethodsA total of 108 outpatients who underwent hysteroscopy using disposable digital hysteroscope were divided into two groups: the non-porous group (group A, n=49) and the married with child group (group B, n=59). The patients’ general information and clinical data were recorded and statistical analysis was performed.ResultsNo differences were found between the age, weight, body mass index, menopausal status and indication for hysteroscopy of the two groups. The most common indication was embryo transfer failure. The surgical success rate of 108 patients was 100%, the concordance rate between hysteroscopic diagnosis of chronic endometritis and pathological diagnosis was 94.44% (68/72), while the false positive rate stood at 38.89% (14/36). Additionally, incidental findings rate for endometrial polyps was 92.00% (23/25) with a low false positive rate of only 6% (5/83). The mean visual analogue scale score of group A was 2.285±0.180, which was not significantly different from group B (p=0.483, 95% CI(−0.60-0.44)). The pregnancy rate among patients who received assisted reproductive technology and were followed up for 1 year after surgery was 66.67% (40/60), while the abortion rate stood at 5.00% (3/60).ConclusionsThe disposable digital hysteroscope is a valuable and effective tool for outpatient hysteroscopy.

Failed radial head arthroplasty treated by removal of the implant.

In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow. A total of 11 patients in whom removal of a RHA without reimplantation was undertaken as a revision procedure were reviewed at a mean follow-up of 8.4 years (6 to 11). The range of motion (ROM) and stability of the elbow were recorded. Pain was assessed using a visual analogue scale (VAS). The functional outcome was assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiological examination included the assessment of heterotopic ossification (HO), implant loosening, capitellar erosion, overlengthening, and osteoarthritis. Complications and the rate of further surgery were also recorded. The indications for removal of the implant were stiffness in five patients, aseptic loosening in five, and pain attributed to the RHA in three. The mean time interval between RHA for trauma to removal was ten months (7 to 21). Preoperatively, three patients had overlengthening of the implant, three had capitellar erosion, six had HO, and four had radiological evidence of loosening. At the final follow-up, the mean the flexion-extension arc improved significantly by 38.2° (95% CI 20 to 59; p = 0.002) and the mean arc of prono-supination improved significantly by 20° (95% CI 0 to 72.5; p = 0.035). The mean pain VAS score improved significantly by 3.5 (95% CI 2 to 5.5; p = 0.004). The mean MEPS improved significantly by 27.5 (95% CI 17.5 to 42.5; p = 0.002). The mean OES improved significantly by 9 (95% CI 2.5 to 14; p = 0.012), and the mean DASH score improved significantly by 23.5 (95% CI 7.5 to 31.6; p = 0.012). Ten patients (91%) had HO and osteoarthritis. Two patients underwent further surgery due to stiffness and pain, respectively. Simple removal of the implant at revision surgery following a failed RHA introduced following trauma provides satisfactory mid-term results with an acceptable risk of complications. Osteoarthritis, instability, and radioulnar impingement were not problems in this series.

A Clinical Study on the Efficacy and Safety of Poly-Herbal Formulation in Managing Functional Dyspepsia

IntroductionFunctional dyspepsia is a common condition that affects millions of people worldwide. It is characterized by symptoms such as abdominal discomfort, bloating, and nausea, which can significantly impact a person's quality of life. While there are several pharmaceutical treatments available, many individuals are turning to herbal remedies as a safer and more natural alternative. This clinical study aimed to evaluate the efficacy and safety of poly-herbal formulation (PHF), marketed under brand names like Dizester® Herbal, Great Day®, etc. in patients suffering from functional dyspepsia compared to Pantoprazole, a commonly used pharmaceutical treatment. Materials & MethodsThe study included 80 patients, with 40 patients in each treatment arm. The primary objective was to assess the improvement in symptoms using various questionnaires at All India Institute of Medical Science Bhubaneswar, including the Reflux Disease Questionnaire, Short-Form Leeds Dyspepsia Questionnaire, GERD-Health Related Quality of Life Questionnaire, visual analogue scale (VAS) for pain, and Investigator's Symptomatic Assessment. The secondary objective was to evaluate the safety of PHF by assessing liver and renal function parameters and hemogram. Results & discussionThe results showed significant improvement in symptoms of GERD in the PHF group, which was comparable to the Pantoprazole group. The burning feeling behind the breastbone, pain behind the breastbone, burning feeling in the center of the upper stomach, acid taste in the mouth, and unpleasant movement of material upwards towards the mouth improved significantly from the beginning of the study to the follow-up visits. The mean VAS score reduced by 71.5% in the PHF arm and 67.85% in the Pantoprazole arm. Additionally, the study found no abnormal elevations in liver and renal function parameters in blood or any abnormal changes in hemogram, indicating the safety for use in patients with functional dyspepsia. Since the synthetic anti-dyspeptic drugs like proton pump inhibitors are known to have adverse effects, this natural alternative PHF shows promising results in a safer way. ConclusionIn conclusion, this study provides evidence for the efficacy and safety of PHF in improving symptoms of functional dyspepsia. The use of synthetic anti-dyspeptic medications has been associated with the occurrence of undesirable effects. In light of this, PHF has demonstrated encouraging outcomes in a manner that is considered safer.

Examination of the effect of different techniques (demonstration, telesimulation and game-based training) in teaching the management of shoulder dystocia: A randomized controlled trial

BackgroundThis study evaluated the effect of demonstration, telesimulation and game-based training in teaching SD management for midwifery students. MethodsThis randomized controlled trial was completed with 123 participants. To collect data, the ‘Introductory Information Form’, ‘Self-efficacy Visual Analog Scale (VAS)’, ‘Shoulder Dystocia Skill Checklist’, and ‘Instructional Materials Motivation Survey (IMMS) were used. ResultsAfter the training, mean VAS scores of self-efficacy in diagnosing and intervening SD were higher in the telesimulation and demonstration groups, and mean VAS scores of self-efficacy in evaluating the postpartum mother and infant were higher in all intervention groups than in the control group (p < .001). There is a difference between the control group and all intervention groups in terms of total skill score in SD management (p < .001). Demonstration group's mean total score of MMS of students is higher than kahoot and control groups (p < .005). ConclusionIt was seen that all three methods were more effective than theoretical training in gaining SD management skills, but telesimulation was more effective than other methods.

Effectiveness of Transforaminal Epidural Steroid Injection and Lumbar Traction in Lumbar Radiculopathy Due to Intervertebral Disc Herniation: A Comparative Study

Background: Lumbar radiculopathy, commonly caused by intervertebral disc herniation, leads to severe pain and disability. Various non-surgical treatments, including Transforaminal Epidural Steroid Injection (TESI) and lumbar traction, are employed to alleviate pain and improve functionality. Objective: The study aimed to compare the effectiveness of TESI and lumbar traction in managing lumbar radiculopathy. Methods: This study was designed as a prospective, randomized, comparative trial conducted over 12 months at a tertiary care center, involving 100 patients diagnosed with lumbar radiculopathy due to intervertebral disc herniation (IDH). Eligible patients, aged 18 to 65 years with MRI-confirmed disc herniation causing radiculopathy, were randomly assigned to either the TESI group (n=50) or the lumbar traction group (n=50). Exclusion criteria included patients with prior lumbar surgery, spinal infections, or tumors. The TESI group received a single transforaminal epidural steroid injection under fluoroscopic guidance, while the lumbar traction group underwent mechanical traction therapy for 30 minutes per session, three times a week for six weeks. Outcome measures included pain intensity, assessed using the Visual Analog Scale (VAS) at baseline, two weeks, and six months post-intervention, functional outcome using the Oswestry Disability Index (ODI) at the same time points, and patient satisfaction using a five-point Likert scale at six months. Statistical analyses were conducted using SPSS software, with significance set at p-values &lt;0.05. Results: The results of this study demonstrated that both the TESI and lumbar traction groups experienced significant improvements in pain and functional outcomes; however, the TESI group showed more pronounced results. In terms of pain reduction, the TESI group’s mean VAS score decreased from 7.5 at baseline to 3.2 at two weeks and 2.8 at six months, while the lumbar traction group saw a decrease from 7.6 to 5.1 at two ........

THE EFFECT OF YOGA SLEEP (YOGA NIDRA) ON PAIN, MOBILIZATION, FIRST WALKING DISTANCE AND CARE SATISFACTION AFTER CESAREAN SECTION: A RANDOMIZED CONTROLLED TRIAL

Aim: This study aims to investigate the effect of yoga nidra on pain, mobilization, first walking distance, and care satisfaction. Methods: This is a randomized controlled trial. Data were collected between 01 October–28 December 2023. Sample of the study consisted of 128 women (yoga nidra: 64, control: 64) who gave birth by cesarean section. Women were randomly assigned to the groups as 1:1. The yoga nidra group received a 30-minute yoga nidra session before the first mobilization after cesarean section. Yoga nidra was not applied to the control group. The primary outcomes of the study were the mean scores of the Visual Analogue Scale (VAS) for pain, Patient Mobility Scale (PMS), Observer Mobility Scale (OMS), and walking distance for mobilization, and Newcastle Satisfaction with Nursing Care Scale (NSNCS) for satisfaction. Results: It was determined that the mean VAS score for pain decreased; the mean scores of PMS, OMS, and sub-dimensions decreased and the mobilization process was positively affected; the mean first walking distance increased; and the nursing care satisfaction increased more in the yoga nidra group compared to the control group (p

Does antenatal exercise shape labor and delivery outcomes?

Incorporating regular physical activity into the lifestyle of a pregnant woman offers numerous health benefits and prepares her effectively for labor. This study was conducted to determine the impact of antenatal exercise on labor, delivery and perinatal outcome. An interventional study was conducted including 200 women attending the antenatal clinic of Obstetrics and Gynaecology department of PGIMS Rohtak, India. The study subjects were randomly divided into two groups-exercise group and control group. The demographic profile of both the groups was similar. A higher proportion of patients in control group required labor induction compared to exercise group (33% vs 16%, P = 0.002). The rate of vaginal delivery was significantly higher in exercise group than in control group (71% vs 56%, P = 0.027). Additionally, women in exercise group had fewer assisted vaginal deliveries than control group (7% vs 20%, P = 0.007). Rates of cesarean section were comparable between both groups (P = 0.736). The mean duration of labor was significantly shorter in exercise group compared to control group (428.69 ± 131.242min vs 516.91 ± 143.105min, P < 0.0001). Mean Visual Analog Scale (VAS) score for pain was 6.38 ± 1.94 in exercise group compared to 7.89 ± 1.49 in control group (P < 0.0001). No significant difference was observed between the groups in birth weight and APGAR score of neonates. A structured exercise program, practiced regularly during the antenatal period reduced the need for labor induction, shortened labor duration, increased the incidence of vaginal deliveries, and decreased pain perception during labor and delivery.

C1 root decompression as a therapeutic target in non-suboccipital non-Valsalva related headache associated with Chiari I malformation

Headache is the most common symptom impacting the quality of life of patients with Chiari I malformation. While headaches typically present in the occipital or suboccipital regions, and induced by Valsalva maneuver, complex migraine-like headaches referring to frontal or orbital regions also occur. Our study explores the therapeutic potential of C1 nerve root decompression in addition to increasing intracranial compliance in patients with Chiari I malformation. We retrospectively analyzed cases operated on for Chiari I malformation, focusing on patients with non-suboccipital, non-Valsalva induced headaches. Preoperative and postoperative visual analog scale (VAS) scores and headache frequency were recorded. Surgical technique involved suboccipital craniectomy, C1 laminectomy, cerebellar tonsil reduction, and C1 root decompression. Twelve patients (10 females, 2 males) aged 22-52 were included. Preoperative mean VAS score was 8, which improved to 2 or less in 11 patients postoperatively. The mean headache frequency decreased significantly. Our findings suggest that C1 root compression contributes to atypical headaches in Chiari I malformation and that C1 root decompression may improve surgical outcomes.

Designing a Nasal Lining-Framework Complex for Reconstructing Total Nasal Defects.

To validate the feasibility of an innovative nasal lining-framework complex (NLFC) for reconstructing total nasal defects. Retrospective cohort study. This NLFC is composed of forearm flap and support framework. Twenty-four patients were followed up for a minimum of 17 months in 5 centers. Patients' medical history data were retrospectively analyzed. Visual Analog Scale (VAS) of surgeons and patients was used to evaluate the aesthetic effects and self-satisfaction. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and Rhinoplasty Outcome Evaluation (ROE) questionnaire were used for functional assessment. Reconstruction surgeries were all successfully completed. The flaps healed well in all patients, and there were no signs of ischemic necrosis. The healing time of the wound was 10 to 14 days, except for 1 case with infection. The nasal lining was reconstructed and no significant contracture was observed. The average VAS of surgeons was 4.29 ± 0.69 (range 3-5). The mean VAS score of patients was 3.75 ± 0.79 (range 2-5). There was a significant positive correlation between patients' and surgeons' VAS scores (P = .007, r = .5355). The results of the NOSE questionnaire showed that all patients had no obvious ventilation restriction, and only 3 patients mildly felt that the nasal inspirations were slightly insufficient during exercise or exertion. The mean ROE of the patients was 21 ± 1.96 (range 18-25). This NLFC is suitable for total nasal reconstruction, which can provide effective support to prevent flap collapse and retraction and ensure good nasal ventilation. Level IV, therapeutic study.

The association between ultrasonographic findings and pain, physical function, and symptoms in patients with shoulder pain.

Shoulder ultrasonography (US) is commonly employed to differentiate the causes of shoulder pain. However, the correlation between ultrasonographic findings and the individual's functional disability and daily activities remains unexplored. To investigate the relationship between shoulder US findings and physical function, disability, and pain. The study investigated patients with shoulder pain. Tendons of supraspinatus, infraspinatus, subscapularis, and long head of biceps brachii, acromiohumeral distance, and acromioclavicular joint (ACJ) degeneration were evaluated using US. The QuickDASH questionnaire was employed to evaluate physical function, symptoms, and disability, while the visual analog scale (VAS) was utilized to assess pain levels. The study included 84 patients (69 [82.1%] women, mean age = 55.7 ± 11.9 years). Ultrasonographic examination revealed ACJ degeneration in 61 (21.4%) patients and biceps tendinitis in 21 (25%) patients. In addition, supraspinatus tendinosis was identified in 51 (61%) patients, while 28 (33%) exhibited a supraspinatus tear. The patients demonstrated a mean VAS score of 7.03 ± 1.49 and mean QuickDASH score of 45.6 ± 15.3. Individuals with a supraspinatus tear exhibited higher VAS (P = 0.008) and QuickDASH (P = 0.016) scores. Patients presenting with ACJ degeneration demonstrated increased VAS scores (P = 0.014), whereas those with biceps tendinopathy showed higher QuickDASH scores (P = 0.035). The results obtained from our research demonstrate significant correlations between ultrasonographic data and pain, disability, and physical manifestations. The findings of this study indicate that shoulder US provides valuable information regarding the difficulties individuals face in their daily tasks and the degree of pain they endure.

Total Arthroscopic Resection of the Talocalcaneal Coalition in Adults: Key Points of Surgical Technique.

Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC. A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16-57 years). The mean follow-up period was 38.93 ± 15.69 months (range, 11-59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale scores were evaluated pre- and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases. The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini-incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle-hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study. Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini-incisions were necessitated in complex situations.

The efficacy of a food supplement in the treatment of tinnitus with comorbid headache: A Statistical and Machine Learning analysis with a literature review.

Introduction Tinnitus, the perception of sound without an external auditory stimulus, affects approximately 10% to 15% of the population and is often associated with significant comorbidities such as headaches. These conditions can severely impact the quality of life. The aim of this study was to evaluate the efficacy of a food supplement in reducing the symptoms of both tinnitus and headache in patients experiencing these conditions concurrently. Methods This prospective study included 32 patients (21 males and 11 females) aged between 23 and 68 years (mean age 49.38 years) who were experiencing both tinnitus and headache. The study assessed the impact of a food supplement on tinnitus and headache over a 90-day treatment period using three main instruments: the Tinnitus Handicap Inventory (THI), the Headache Impact Test (HIT-6), and a Visual Analog Scale (VAS) for discomfort. Statistical analyses, including paired t-tests, were conducted to compare pre- and post-treatment scores. In the same dataset, Ridge Regression, a linear regression model with L2 regularization, was used to predict post-treatment scores (THI90, HIT90, VAS90). Results The results indicated a statistically significant reduction in all three measures after 90 days of treatment. The mean THI score decreased from 29.81 to 27.06 (p = 0.011), the mean HIT-6 score decreased from 50.41 to 48.75 (p = 0.019), and the mean VAS score for discomfort decreased from 7.63 to 7.13 (p = 0.033). The optimal Ridge Regression model was found with an `alpha` value of approximately 3.73. The performance metrics on the test set were as follows: Mean Squared Error (MSE) of 13.91 and an R-squared score of 0.61, indicating that the model explains approximately 61% of the variance in the post-treatment scores. These results indicate that pre-treatment scores are significant predictors of post-treatment outcomes, and gender plays a notable role in predicting HIT and VAS scores post-treatment. Conclusion This study demonstrates that a food supplement is effective in reducing the symptoms of tinnitus and headache in patients suffering from both conditions. The significant improvements in THI, HIT-6, and VAS scores indicate a positive impact on patient quality of life. Further research with larger sample sizes and more detailed subgroup analyses is recommended to fully understand the differential impacts of treatment across various demographics.

A Prospective Nonrandomized Comparison of Wet Needling Versus Prolotherapy in Myofascial Pain.

The objective was to analyze the difference between prolotherapy and wet needling (WN) for myofascial trigger points (MTrPs) for the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Clinical Global Impression (CGI), and MTrPcount. Patients with myofascial pain for 1.5 years were included based on convenience sampling after a pilot study for sample size calculation. The WNgroup received an injection of bupivacaine 0.5% into the trigger points with WN. Participants in thedextrose prolotherapy (DPT) group received dextrose (25%) plus bupivacaine (0.5%) (1:1) into the same. Outcome measures were recorded at baseline immediatepost-injection, one month, three months, and 24 months. Among the 200 participants, there was no significant difference in the baseline VAS score between the two groups nor for immediate post-VAS. At three months of follow-up, the mean VAS was 6.34 ± 1.44 in the WN group and 1.99 ± 0.89 in the DPT group (p= 0.03). The mean VAS score significantly changed in both groups but favored the DPT group (p= 0.001)and again at 24 months (p= 0.001). The ODI showed a similar trend favoring the DPT group at all intervals. On correlating the VAS score with the ODI score, a statistically significant correlation was seen at one month, favoring the WN group, and at the end of the third month, favoring the DPT group. Both modalities are effective at one month. At three and 24 months, the DPT was significantly more effective in improving the VAS and ODI.

Reduced Injection Site Pain with Altered pH in 24-h Reconstituted Botulinum Toxin: Findings from a Randomized Controlled Study on Cosmetic Applications.

Botulinum toxin (BTX) injections are widely recognized for many cosmetic applications, but still commonly encounter a challenge: injection site pain (ISP). This discomfort can impact the overall patient experience and satisfaction, highlighting a need for innovative solutions to this problem. This randomized controlled study aimed to determine whether adjusting the pH levels in a 24-h reconstituted botulinum toxin can serve as a strategy to mitigate ISP. A controlled trial involving 24 volunteers was executed. Participants received incobotulinum toxin A. One side of each participant's face was treated with fresh toxin, while the other received a 24-h reconstituted version. Pain perceptions post-injection were assessed using the visual analogue scale (VAS). pH values of the fresh toxin were more acidic (6.17) than the 24-h reconstituted toxin (7.17). Out of 24 patients, 13 reported reduced ISP with the 24-h reconstituted toxin. The mean VAS score for the fresh toxin was 5.92, in contrast to 4.17 for the reconstituted toxin, indicating a significant difference (p<0.01). Limitations include the use of a VAS and a relatively small sample size. Altering the pH of BTX demonstrates potential in ISP reduction. However, broader, large-scale investigations are important for comprehensive validation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy of Outside-In Hip Arthroscopy without Traction in the Treatment of Hip Synovial Osteochondromatosis.

Arthroscopic treatments of hip synovial osteochondromatosis are mostly performed under traction, resulting in neurovascular injury or iatrogenic damage to the labrum or cartilage. This study aimed to assess the effectiveness of outside-in hip arthroscopy without traction in treating hip synovial osteochondromatosis. This retrospective study was conducted on a series of patients with hip synovial osteochondromatosis treated using outside-in hip arthroscopy without traction in our hospital between 2018 and 2020. Plain radiography and magnetic resonance imaging (MRI) scans were obtained. The Harris hip score (HHS), hip range of motion (ROM), and visual analog scale (VAS) scores were analyzed. The preoperative scores and last follow-up scores were compared with a paired-sample t test. The complications and recurrence postsurgery were recorded. This study included five patients (three male and two female) with an average age of 41 years (range 28-54 years). The mean follow-up time was 25.2 months (range 18-36 months). All patients experienced groin pain relief and improved ROM. The mean VAS score was significantly lower postoperatively (0.4 ± 0.5) than preoperatively (3.2 ± 0.8) (p < 0.001). The mean HHS improved from 58.6 ± 12.7 (range 43-73) to 89.8 ± 5.26 (range 81-95) (p < 0.001). No major complications, including infection, perineal numbness and swelling, neurotrosis, thromboembolism, or severe persistent pain, were reported. Synovial osteochondromatosis recurred in one patient after 2 years of follow-up without any obvious symptoms such as hip pain or joint locking. Therefore, no further treatment was necessary. This study showed that outside-in hip arthroscopy without traction might be a viable option for treating hip synovial osteochondromatosis, effectively and safely relieving symptoms with minimal complications, especially in patients without lesions in the central compartment.

The effect of femoral strapping on hip internal rotation and pain response in females with patellofemoral pain

BackgroundHip internal rotation has been reported to affect patellofemoral joint mechanics and contribute to patellofemoral pain (PFP). The SERF (Stability through External Rotation of the Femur) strap was designed to provide hip stability by pulling the thigh into external rotation during weight-bearing activities. Research questionWhat are the effects of the SERF strap on hip internal rotation and pain response in females with PFP who present with hip internal rotation during weight-bearing activities? MethodsNineteen females between the ages of 18 and 45 with a diagnosis of PFP participated. Lower extremity kinematics were obtained during three tasks (drop-jump, unilateral step-down, over-ground running) under strap and no-strap conditions. A 10-cm visual analog scale (VAS) was used to assess pain response during each task and strap condition. Participants who exhibited at least 5 degrees of hip internal rotation during at least one of the 3 tasks were included in the final analysis. Peak hip internal rotation and mean VAS score were compared separately between strap conditions across tasks using 2 ×3 (strap condition x task) repeated-measures ANOVAs. ResultsEighteen of the 19 females with PFP met the criteria for the presence of hip internal rotation. There was a significant reduction in peak hip internal rotation across tasks when wearing the SERF strap (mean ± sd = 7.4 ± 2.3, p<0.001). Additionally, the change in mean VAS pain score was significantly lower across tasks when wearing the SERF strap (1.0 ± 1.0, p=0.03). SignificanceThe SERF strap was effective in reducing hip internal rotation and PFP during dynamic weight-bearing activities in symptomatic females. The SERF strap may be a useful treatment adjunct for persons with PFP who present with poor transverse plane control of the hip.