Visual Scale Assessment Research Articles

A comparative study of the sexual functioning of women with primary headache in India.

Introduction:Female Sexual dysfunction is an important health concern caused by several factors. This study aimed to compare the sexual function of women who have primary headaches in order to investigate the relationship between sexual dysfunction and the features of headaches.Materials and Methods:95 consecutive patients aged 18 to 65 years with a history of headache for at least 1 month and sexually active in the last 6 months presenting to Psychiatry OPD of a tertiary care hospital in New Delhi giving informed consent were taken. The diagnosis of headache type was confirmed according to the 2nd edition of International Headache Society (IHS) International Classification of Headache Disorders (ICHD-II) in 2004. The Female Sexual Function Index (FSFI), visual analog scale (VAS) score and Migraine disability assessment scale score (MIDAS) were applied.Results:Those with migraines reported a greater intensity of pain than those with tension headaches. Individuals with tension headaches reported more frequent headaches. The mean MIDAS score in the migraine group was 14.64 (±2.59); 30% of the migraine group fell into the most severe category in MIDAS. Women with headaches had lower scores (indicating impaired sexual functioning) on all FSFI subscales, as well as on the total score when the prescribed cutoffs were applied as compared to controls (66.3% vs. 30% in controls).Conclusion:The present study showed that patients with either type of primary headache experience problems in several aspects of sexuality compared with controls.

Collagen Augmentation Improves the Quality of Cartilage Repair After Microfracture in Patients Undergoing High Tibial Osteotomy: A Randomized Controlled Trial

Background: The quality of cartilage repair after marrow stimulation is unpredictable. To overcome the shortcomings of the microfracture technique, various augmentation techniques have been developed. However, their efficacies remain unclear. Hypothesis: The quality of cartilage repair and clinical outcomes would be superior in patients undergoing high tibial osteotomy (HTO) with microfracture and collagen augmentation compared to those undergoing HTO with microfracture alone without collagen augmentation for the treatment of medial compartment osteoarthritis (OA) of the knee. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Twenty-eight patients undergoing HTO were randomized into 2 groups: microfracture alone (group 1, n = 14) or microfracture with collagen augmentation (group 2, n = 14). At 1 year postoperatively, second-look arthroscopic surgery and biopsy of repaired cartilage were performed at the time of HTO plate removal. Biopsy specimens were graded using the International Cartilage Repair Society Visual Assessment Scale II (ICRS II). In addition, imaging outcomes in terms of the magnetic resonance observation of cartilage repair tissue (MOCART) score were assessed based on magnetic resonance imaging (MRI). Finally, clinical outcomes in terms of the visual analog scale (VAS) for pain score, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Tegner activity scale score were evaluated. Results: The mean ICRS II score in group 2 was significantly higher than that in group 1 (1053.2 vs 885.4, respectively; P = .002). Group 2 showed greater improvement in tissue morphology, cell morphology, surface architecture, middle/deep zone assessment, and overall assessment compared with group 1 (P < .050 for all comparisons). Imaging outcomes based on the MOCART score were superior in group 2 compared to those in group 1 on MRI at 1 year postoperatively (64.6 vs 45.4, respectively; P = .001). The degree of defect repair was better in group 2 than in group 1 (P = .040). Clinical outcomes in terms of the VAS for pain score, KOOS, IKDC score, and Tegner activity scale score were improved in both groups without between-group differences (P > .100 for all comparisons). Conclusion: The quality of cartilage repair after microfracture with collagen augmentation was superior to that after microfracture alone in patients undergoing HTO. Clinical results after 1 year did not reflect this difference in tissue repair. Therefore, a longer follow-up of the cohort is needed to answer this question.

Comparison of Mechanical Versus Hand Administration of IV Contrast Agents for Pediatric Pulmonary CT Angiography.

The purpose of this study was to assess the difference between mechanical versus hand administration of IV contrast agents on the diagnostic quality of pediatric pulmonary CT angiography (CTA). A retrospective review of the medical records was performed to detect pediatric patients (≤ 18 years) with pulmonary CTA performed between September 2012 and March 2015. Patients were placed into two cohorts on the basis of the method of contrast administration (mechanical vs hand). Additional information obtained included IV size or gauge, IV site, amount and type of contrast agent administered, and rate of administration (mL/s). The quality of the CT images was independently evaluated by two pediatric radiologists using a qualitative 4-point visual assessment scale and quantitatively with attenuation (HU). An ANOVA controlling for age compared the contrast enhancement in the central pulmonary arteries between the cohorts. One hundred forty-eight consecutive pediatric patients (71 boys and 77 girls; mean age, 11.1 years; age range, 8 days-17.9 years) were identified between September 2012 and March 2015. Mechanical administration of contrast material was performed in 117 patients (79.1%; mean age [± SD], 13.7 ± 3.7 years), and hand administration of contrast material was performed in 31 patients (20.9%; mean age, 1.6 ± 1.8 years). After adjusting for age, the degree of enhancement within the pulmonary arteries was not statistically different between the two IV contrast administration methods at the main pulmonary artery (mechanical vs hand administration: mean attenuation, 310 ± 128 vs 338 ± 142 HU, respectively, p = 0.505), right pulmonary artery (305 ± 124 vs 329 ± 146 HU, p = 0.556), and left pulmonary artery (303 ± 125 vs 340 ± 151 HU, p = 0.349). It is possible to perform diagnostic-quality pulmonary CTA for the assessment of the central pulmonary arteries with hand administration of IV contrast material in pediatric patients with small-gauge IV catheters.

Pain Control of Medical Abortion with Misoprostol in the First Trimester of Pregnancy

Background: Abortion is the most common subjects of obstetric which has applied two methods including surgical and medical approaches. Pain is the most common complication of medical abortion and pain relief is one the most important items in these patients. Objectives: Evaluated the effect of three non-steroidal anti-inflammatory drugs in pain reduction of medical abortion in less than 14 weeks gestation with forensics declaration. Methods: This study was a retrospective cohort in 66 pregnant women with less than 14 weeks gestation referred to Yas hospital for medical abortion that were assigned to three groups based on sedative drugs: A) Mefenamic acid capsules 250 mg, B) Diclofenac tablets 100 mg and C) Ibuprofen tablets 400 mg. The standardized visual assessment scale was assessed before and after drug administration that presented in medical records of patients. Results: Comparison of visual assessment scale means before and after using of three non-steroidal antiinflammatory drugs demonstrated that all three drugs lead to pain relief after the abortion that was significant statistically (P value=0.001). There was a significant difference in termination time of pregnancy between three groups, (P value= 0.016). In the case of hemoglobin drop, diclofenac lead to the lowest hemoglobin drop (P value=0.004). The amount of receiving narcotic among three groups revealed the significant difference (P value= 0.000). There were not significant differences in pain relief (P value=0.327) and demographic data between three groups. Conclusion: It was indicated that the three NSAIDs drugs, had a significant effect on the management of pain, diclofenac expended less termination time of pregnancy, narcotic drug usage and also hemoglobin drop than other groups. What does this study add? Non-steroidal anti-inflammatory drugs are effective in pain management of medical abortion and some of them are preferred to others. Diclofenac can reduce abortion time and also hemoglobin drop after abortion and additional dose of other narcotics too.

The Effect of Ginger on Pain and Satisfaction of Patients with Knee Osteoarthritis

Background: Knee osteoarthritis is the most common type of arthritis and musculoskeletal disease. Due to low efficacy and significant side effects of synthetic drugs in the treatment of this disease, many researchers are looking for drugs that besides effectiveness have fewer side effects, and recently ginger has become one of the most popular herbal remedies in the treatment of this disease in controversial researches. Objectives: The aim of this study was to determine the effect of ginger on pain and satisfaction of patients with knee osteoarthritis. Methods: This study was a clinical trial. A total of 90 patients with knee osteoarthritis were randomly divided to ginger and control groups. In addition, treatment was prescribed by orthopedic specialists; the ginger group received two tablets of 500 mg/day for 12 weeks. The control group only received the treatment prescribed by the orthopedic specialist. Pain was measured using a linear visual assessment scale (VAS) and satisfaction using a researcher-made questionnaire at the beginning and end of the twelfth week. Results: There was no significant difference between pain scores of the two groups before the intervention, yet after the intervention, pain scores declined in both groups, but it was greater in the ginger group (P = 0.001). In terms of satisfaction with treatment, a statistically significant difference was shown between the two groups (P = 0.012), so that it was higher in the group receiving ginger. On the other hand, the incidence of side effects was not statistically significant between the two groups. Conclusions: The results of this study showed that ginger is effective in relieving pain in patients with knee osteoarthritis and it can be used as a safe method to improve pain in patients with knee osteoarthritis.

Does eating environment have an impact on the protein and energy intake in the hospitalised elderly?

This pilot study aimed to examine the difference in energy and protein intake of the midday meal in two different eating environments-the communal dining room and patient bedside-and to obtain feedback on patient preference at each location. Elderly patients in two rehabilitation wards were observed consuming the midday meal on two consecutive days: day 1 in the dining room and day 2 at the bedside. The patients' intake was recorded by a visual 5-point assessment scale and analysed for protein and energy content using the hospital food services nutrient analysis of the menu. Patients were also surveyed on preference of eating environment through a written survey. This study found that patients consumed 20% more energy and protein when dining in a communal environment (P = 0.006 and 0.01, respectively). Patients with a body mass index of less than 22 (P = 0.01 and 0.01, respectively) and those with significant cognitive impairment (P = 0.001 and 0.007, respectively) ate 30% more protein and energy in the dining room, and those identified at risk of malnutrition (Malnutrition Screening Tool (MST) ≥ 2) ate 42% more energy and 27% more protein in the dining room, although this was not statistically significant (P = 0.05 and 0.16). A total of 86% of surveyed patients favoured eating their midday meal in the dining room. This study supports the contention that a dining room environment can increase food intake, increase patients' opportunities to enjoy the social aspect of meal times, and potentially lead to weight gain and reduced malnutrition risk in the rehabilitation setting.

High Tibial Osteotomy in Combination With Chondrogenesis After Stem Cell Therapy: A Histologic Report of 8 Cases

To histologically evaluate the quality of articular cartilage regeneration from the medial compartment after arthroscopic subchondral drilling followed by postoperative intra-articular injections of autologous peripheral blood stem cells (PBSCs) and hyaluronic acid with concomitant medial open-wedge high tibial osteotomy (HTO) in patients with varus deformity of the knee joint. Eight patients with varus deformity of the knee joint underwent arthroscopic subchondral drilling of International Cartilage Repair Society (ICRS) grade 4 bone-on-bone lesions of the medial compartment with concomitant HTO. These patients were part of a larger pilot study in which 18 patients underwent the same procedure. PBSCs were harvested and cryopreserved preoperatively. At 1 week after surgery, 8 mL of PBSCs was mixed with 2 mL of hyaluronic acid and injected intra-articularly into the knee joint; this was repeated once a week for 5 consecutive weeks. Three additional intra-articular injections were administered weekly at intervals of 6, 12, and 18 months postoperatively. Informed consent was obtained at the time of hardware removal for opportunistic second-look arthroscopy and chondral biopsy. Biopsy specimens were stained with H&E, safranin O, and immunohistochemical staining for type I and II collagen. Specimens were graded using the 14 components of the ICRS Visual Assessment Scale II, and a total score was obtained. Second-look arthroscopy showed satisfactory healing of the regenerated cartilage. Histologic analysis showed significant amounts of proteoglycan and type II collagen. The total ICRS Visual Assessment Scale II histologic scores comparing the regenerated articular cartilage (mean, 1,274) with normal articular cartilage (mean, 1,340) indicated that the repair cartilage score approached 95% of the normal articular cartilage score. There were no infections, delayed unions, or nonunions. Chondrogenesis with stem cells in combination with medial open-wedge HTO for varus deformity correction of the knee joint regenerates cartilage that closely resembles the native articular cartilage. Level IV, therapeutic case series.

Use of radium-223 in heavily pretreated metastatic castrate resistant prostate cancer (mCRPC) patients.

275 Background: Ra 223 has been shown to improve overall survival in mCRPC patients with symptomatic bone metastases. Little is known about the utility of following PSA during Ra 223 therapy in heavily pretreated patients. Here we report our experience with Ra 223 in such a setting. Methods: We reviewed 26 heavily pretreated mCRPC patients who received Ra 223 at 3 institutions and evaluated the trend of PSA during treatment, the association of various demographic, clinical and biochemical variables with PSA trend, and the correlation of PSA trend with clinical outcomes. Patients received IV Ra 223 every 4 weeks with a planned total of 6 cycles. Results: Twenty six patients were treated between August 2013 and August 2014. Median age was 70 years (range 49-80); 77% (N=20) were European American (EA), 19% (N=5) were African Americans (AA), unknown for 1 patient. Prior therapy included docetaxel in 77% (N=20) of patients, cabazitaxel in 19% (N=5), enzalutamide in 65% (N=17), and abiraterone in 54% (N=14). 62% (N=16) received at least 3 prior therapies.35% (N=9) received all 6 cycles of Ra 223, while 18% (N=4) received only 1 cycle. Median alkaline phosphatase level increased from 126.0 U/L (54.0, 514.0) to 332.0 U/L (136.0, 566.0) at the end of Ra 223 therapy. Median pre-therapy PSA was 100.3 and median post-therapy PSA was 429.5. 54% (N=14) patients had &gt;50% rise in PSA. Higher pre-therapy PSA was strongly associated with higher post-therapy PSA (Pearson’s correlation coefficient = 0.84, p &lt;0.0001). Faster rate of rise in PSA was observed in patients with higher number of bone metastasis and those who have had prior therapy with docetaxel. The patients with &gt;50% PSA rise had reported overall higher pain scores by visual assessment scale. Ra 223 was discontinued in 15% (N=4) patients due to myelosuppression and in 8% (N=2) due to side effects. Conclusions: All heavily pretreated patients receiving Ra 223 therapy for mCRPC showed PSA progression and reasonable tolerability. Only 35% of patients were able to receive all 6 cycles of Ra 223.

Intra-Articular Injection of Synovium-Derived Mesenchymal Stem Cells with Hyaluronic Acid Can Repair Articular Cartilage Defects in a Canine Model

Objective: The purpose of this study was to evaluate effectiveness of intra-articular injection of synovium-derived mesenchymal stem cells (SMSCs) and hyaluronic acid (HA) for the treatment of articular cartilage defects in a canine model. Methods: Forty-eight knees of 24 beagle dogs were randomly assigned to 16 groups (n=3) according to both the number of injected SMSCs (0.5×105 cells, 5×106 cells, 5×107 cells) and the concentration of HA (0%, 0.01%, 0.1%, 0.5%). A partial-thickness cartilage defect was created in the medial femoral condyle under arthroscopy. After seven weeks, autologous SMSCs with or without 1 ml HA were percutaneously injected into the injured knee. In the control group, 1 ml saline was injected. Twelve weeks after the injection, evaluation was performed using the International Cartilage Repair Society (ICRS) visual assessment scale and the modified O’Driscoll histological score. Results: The mean ICRS visual assessment scale and the mean modified O’Driscoll histological score were 1.0 ± 0.00 and 11.0 ± 0.00 in the control group. On the other hand, the mean ICRS visual assessment scale and the mean modified O’Driscoll histological score were 7.3 ± 3.21 and 30.7 ± 7.23 in the group injected with 5×106 cells and 0.01% HA. Conclusion:Intra-articular injection of SMSCs with HA may be effective for stimulating articular cartilage repair. Our results suggest that there is an ideal combination of the number of SMSCs and the concentration of HA for promoting particular cartilage repair.

Improvement of Therapy Outcomes after Negative Pressure Wound Therapy in a Patient with Acne inversa.

Treatment of acne inversa (also known as hidradenitis suppurativa) is complicated and chronic. This debilitating, inflammatory disease of the follicular sacks affects mostly young adults and has a strong negative impact on their quality of life. We present a case of a 28 year old woman with a history of acneinversa of Hurley grade 2 for 6 years. Patient underwent surgical excision of the skin of the left inguinum followed by negative pressure therapy dressings for 2 and a half weeks (5 dressing changes). This allowed a full closure of the wound after 12 weeks and formation of a well accepted scar. Patient’s paindecreased from 4.5 to 1.5 according to visual assessment scale. We also noted a 28 point decrease in disease severity score according to Sartorius scale and a 19 point decrease in Dermatology Life Quality Index. Two years prior admission patient had undergone surgical treatment of her right inguinum with split thickness skin grafting, which healed for 26 weeks and yielded less satisfactory results. Comparison photographs of both treatment results are presented.

What Factors Impact Referral of Patients by Radiation Therapists at the Princess Margaret Cancer Centre to the Electronic Living Laboratory for Interdisciplinary Cancer Survivorship Research (ELLICSR) Kitchen?

based on a modified RTOG visual assessment scale. On day 1 of treatment, baseline photos are taken and patients complete a Quality of Life Questionnaire (QLQ). 7-10 days post-treatment, patients return for photos, STAT, 2 QLQ, and Global Questionnaire (GQ) completion. Preliminary Results: Currently, 19 patients have completed treatment (8/19 medial BF; 11/19 lateral BF); preliminary results are based on data collected from these cases. In the control arm, 8/19 patients had > grade (G) 1 dermatitis vs. 7/19 using BF (42% vs. 37%). In the control arm, 3/19 patients had G2 dermatitis vs. 4/19 using BF (16% vs. 21%). Of the 4 BF arm patients that experienced G2 scores, 3/4 of these reactions occurred in the lateral half of the breast. Of the 7 BF patients that had > G1, 5/7 of the reactions occurred laterally, suggesting an increased susceptibility/sensitivity of the lateral aspect of the intact breast. Of the 4 occurrences of G2, 3/4 occurred bilaterally; 1 case occurred unilaterally in the lateral BF arm. GQ responses indicate that patients would use the BF again and thought it made a meaningful difference to their skin care (67% would use again; 20% would not; 0.07% did not respond or were undecided. QLQ and pain/pruritus scores have not been analyzed at this point. Conclusion: BFs protect skin from external trauma and help maintain integrity while allowing skin to breathe. By protecting irradiated skin from excess friction trauma, the severity of radiation skin toxicity and/or pain/pruritus scores in post-lumpectomy breast cancer patients may be reduced, or the time of onset delayed. Though preliminary results are marginally suggestive of benefit, continuation of our current study will provide more definitive data.

Quality of Life and Health Care Use in Patients With Arthralgias Without Synovitis Compared With Patients Diagnosed With Early Rheumatoid Arthritis: Data From an Early Arthritis Cohort

To compare the burden of disease and its development over time in patients referred to an early arthritis cohort who were diagnosed either as having arthralgias without synovitis or as having rheumatoid arthritis (RA). Patients diagnosed as having arthralgias without synovitis or RA were selected from the Rotterdam Early Arthritis Cohort. Data on clinical and psychological characteristics, demographics, pain scores (Rheumatoid Arthritis Disease Activity Index), functional ability (Health Assessment Questionnaire), health-related quality of life (HRQOL; Short Form 36), fatigue (visual analog scale and Fatigue Assessment Scale), and health care utilization (HCU) were collected at baseline and at 6 and 12 months of followup. The burden of disease measures (pain, functional ability, fatigue, and HRQOL) and HCU levels were plotted over time for both groups. A Poisson regression model for repeated data was used to identify determinants of HCU for both groups. At baseline, 330 patients with arthralgias without synovitis (nonsynovitis [NS] group) and 244 RA patients (RA group) were included. Overall, the burden of disease measures and HCU levels were very similar between groups. Both groups showed improvement over time with respect to pain scores, functional ability, HRQOL, and HCU levels. Independent predictors of high HCU were identified as more pain, worse physical health, and external locus of control in the NS group and as shorter duration of symptoms, low chance locus of control, and worse physical functioning in the RA group. Despite the absence of an inflammatory diagnosis, patients with arthralgias without synovitis experienced a similar burden of disease compared with RA patients.

Implantation of tissue-engineered cartilage-like tissue for the treatment for full-thickness cartilage defects of the knee

The purposes of this study were to evaluate early- to midterm clinical results after implantation of tissue-engineered cartilage-like tissue for the treatment for full-thickness cartilage defects of the knee and to identify the factors affecting the final clinical results. Tissue-engineered cartilage-like tissue was prepared by culturing autologous chondrocytes in atelocollagen gel for 3-4 weeks. A total of 73 knees of 72 patients with full-thickness cartilage defects were implanted with this tissue-engineered cartilage-like tissue. The follow-up of these patients for >5 years (range 5-11 years, median 8.0 years) is reported. The patients were evaluated clinically using a rating scale, as well as arthroscopically, biomechanically, and histologically. A modified magnetic resonance observation of cartilage repair tissue (MOCART) system was used to quantify the magnetic resonance imaging (MRI) findings of the lesions. The patient or defect factors influencing the final clinical outcomes were also investigated. Clinical rating improved significantly after implantation of tissue-engineered cartilage-like tissue. Arthroscopic findings at 2 years after implantation were graded as normal or nearly normal according to the International Cartilage Repair Society (ICRS) scale in 64 of 73 knees (87.7%). Biomechanically, stiffness of the graft almost equalled the surrounding normal cartilage (87.9-102.5%) at 2 years after implantation. Histologically, overall assessment of the repaired tissue by ICRS Visual Assessment Scale II was 70.4 ± 20.8. The average MOCART score was 13.5 ± 11.3 (0-45) preoperatively, 66.6 ± 16.8 (10-90) at 1 year after implantation, 70.4 ± 16.1 (15-90) at 2 years after implantation, and 72.5 ± 17.4 (15-95) at the final follow-up, indicating that MRI results were maintained. Among the factors investigated, only arthroscopic grade of the repaired lesion at 2 years after implantation was significantly correlated with the final clinical scores. Implantation of tissue-engineered cartilage-like tissue for the cartilage defects of the knee was effective in short- to midterm post-operatively. This procedure can be proposed as one option for repairing full-thickness cartilage defect of the knee. IV.

Articular Cartilage Regeneration With Autologous Peripheral Blood Stem Cells Versus Hyaluronic Acid: A Randomized Controlled Trial

The purpose of this study was to compare histologic and magnetic resonance imaging (MRI) evaluation of articular cartilage regeneration in patients with chondral lesions treated by arthroscopic subchondral drilling followed by postoperative intra-articular injections of hyaluronic acid (HA) with and without peripheral blood stem cells (PBSC). Fifty patients aged 18 to 50 years with International Cartilage Repair Society (ICRS) grade 3 and 4 lesions of the knee joint underwent arthroscopic subchondral drilling; 25 patients each were randomized to the control (HA) and the intervention (PBSC+ HA) groups. Both groups received 5 weekly injections commencing 1 week after surgery. Three additional injections of either HA or PBSC+ HA were given at weekly intervals 6 months after surgery. Subjective IKDC scores and MRI scans were obtained preoperatively and postoperatively at serial visits. We performed second-look arthroscopy and biopsy at 18 months on 16 patients in each group. We graded biopsy specimens using 14 components of the International Cartilage Repair Society Visual Assessment Scale II (ICRS II) and a total score was obtained. MRI scans at 18 months were assessed with a morphologic scoring system. The total ICRS II histologic scores for the control group averaged 957 and they averaged 1,066 for the intervention group (P= .022). On evaluation of the MRI morphologic scores, the control group averaged 8.5 and the intervention group averaged 9.9 (P= .013). The mean 24-month IKDC scores for the control and intervention groups were 71.1 and 74.8, respectively (P= .844). One patient was lost to follow-up. There were no notable adverse events. After arthroscopic subchondral drilling into grade 3 and 4 chondral lesions, postoperative intra-articular injections of autologous PBSC in combination with HA resulted in an improvement of the quality of articular cartilage repair over the same treatment without PBSC, as shown by histologic and MRI evaluation. Level II, randomized controlled trial (RCT).

Diagnostic value of endoscopic ultrasound-guided directional eFLOW in solid pancreatic lesions.

Ultrasound using microbubble-based contrast agents is useful for vascular imaging. Directional eFLOW (D-eFLOW) is a novel technology for vascular assessment that provides high spatial and temporal resolution. The purpose of this study was to investigate the utility of endoscopic ultrasound (EUS)-guided D-eFlow before and after administration of an ultrasound contrast agent (USCA) for assessing the vascularity of solid pancreatic lesions. D-eFlow was compared to power Doppler EUS (PD-EUS) or color Doppler EUS (CD-EUS) before and after USCA injection. We also evaluated the Visual Vascular Assessment (ViVA) scale for the estimation of vascularity and investigated its reliability using the interclass correlation coefficient (ICC). From January 2007 to March 2007, 35 patients (mean age, 64.5years old; age range, 28-81years) underwent EUS followed by D-eFLOW EUS, PD-EUS, and CD-EUS before and after administration of USCA. The pancreatic parenchymal ViVA score, pancreatic vascular pattern, and ICC were evaluated for all lesions. Concerning the sensitivity for detection of the hypovascular pattern in pancreatic adenocarcinoma, D-eFLOW (before and after USCA) had similar sensitivity to PD-EUS (before and after USCA) and CD-EUS (before and after USCA). D-eFLOW after contrast showed the highest accuracy (82.3%) and negative predictive value (53.8%) among all the modalities investigated. There was a good correlation among the ViVA scores for D-eFLOW before contrast, those for D-eFLOW EUS, and those for PD-EUS and CD-EUS. The reliability of the ViVA scale was excellent with an ICC of 0.81. In conclusion, D-eFLOW EUS is a sensitive, reliable, and highly accurate method of assessment of pancreatic vascularity. D-eFLOW EUS with contrast was more sensitive than PD-EUS and CD-EUS for assessment of pancreatic vascularity.

The role of honey in healing of bedsores in cancer patients

Background:Honey was used to treat infected wounds as long as 2000 years before bacteria were discovered. It has been reported to have inhibitory action to around 50 species of bacteria and fungi (aspergillus, penicillium). Usually, Metronidazole powder is used in our palliative clinic for wound healing due to low cost & effectivity. Honey is cheap, easily available ingredient with high astringent activity.Objective:Objectives of the study were to find out the effectiveness of Honey in terms of rate of wound healing & pain control in bedsores of cancer patients.Materials and Methods:40 cancer patients with bedsore wounds were randomly assigned (1:1 ratio i.e. 20 in each arm) for Study Arm (Honey plus Metronidazole powder) and Control Arm (only Metronidazole powder), attending Palliative clinic of our department in between July 2010 to September 2011.Washing of the wound with normal saline done daily before application of above medicaments. Change of posture & soft bed were encouraged in both groups. A pre designed interview proforma, standardised Bates Jensen Wound Assessment Tool and Visual Analogue Pain assessment scale were used to collect and assess data.Results:There was significant difference in wound healing status (F value = 6.523; Critical Difference =14.03, P>0.05) from day 10 and pain reduction also (F value = 6.638 and Critical Difference = 1.667, P>0.05) from day 7 in study arm.Conclusion:Application of honey dressing provides a better wound healing, rapid pain relief in cancer patients with bedsores in palliative settings.

Microporous calcium phosphate ceramics as tissue engineering scaffolds for the repair of osteochondral defects: Biomechanical results

This work investigated the suitability of microporous β-tricalcium phosphate (TCP) scaffolds pre-seeded with autologous chondrocytes for treatment of osteochondral defects in a large animal model. Microporous β-TCP cylinders (Ø 7mm; length 25mm) were seeded with autologous chondrocytes and cultured for 4weeks in vitro. Only the upper end of the cylinder was seeded with chondrocytes. Chondrocytes formed a multilayer on the top. The implants were then implanted in defects (diameter 7mm) created in the left medial femoral condyle of ovine knees. The implants were covered with synovial membrane from the superior recess of the same joint. For the right knees, an empty defect with the same dimensions served as control. Twenty-eight sheep were split into 6-, 12-, 26- and 52week groups of seven animals. Indentation tests with a spherical (Ø 3mm) indenter were used to determine the biomechanical properties of regenerated tissue. A software-based limit switch was implemented to ensure a maximal penetration depth of 200μm and maximal load of 1.5N. The achieved load, the absorbed energy and the contact stiffness were measured. Newly formed cartilage was assessed with the International Cartilage Repair Society Visual Assessment Scale (ICRS score) and histomorphometric analysis. Results were analysed statistically using the t-test, Mann–Whitney U-test and Wilcoxon test. Statistical significance was set at p<0.05. After 6weeks of implantation, the transplanted area tolerated an indentation load of 0.05±0.20N. This value increased to 0.10±0.06N after 12weeks, to 0.27±0.18N after 26weeks, and 0.27±0.11N after 52weeks. The increase in the tolerated load was highly significant (p<0.0001), but the final value was not significantly different from that of intact cartilage (0.30±0.12N). Similarly, the increase in contact stiffness from 0.87±0.29Nmm−1 after 6weeks to 3.14±0.86Nmm−1 after 52weeks was highly significant (p<0.0001). The absorbed energy increased significantly (p=0.02) from 0.74×10−6±0.38×10−6Nm after 6weeks to 2.83×10−6±1.35×10−6Nm after 52weeks. At 52weeks, the International Cartilage Repair Society (ICRS) scores for the central area of the transplanted area and untreated defects were comparable. In contrast, the score for the area from the edge to the centre of the transplanted area was significantly higher (p=0.001) than the score for the unfilled defects. A biomechanically stable cartilage was built outside the centre of defect. After 52weeks, all but one empty control defect were covered by bone and a very thin layer of cartilage (ICRS 7 points). The empty hole could still be demonstrated beneath the bone. The histomorphometric evaluation revealed that 81.0±10.6% of TCP was resorbed after 52weeks. The increase in TCP resorption and replacement by spongy bone during the observation period was highly significant (p<0.0001). In this sheep trial, the mechanical properties of microporous TCP scaffolds seeded with transplanted autologous chondrocytes were similar to those of natural cartilage after 52weeks of implantation. However, the central area of the implants had a lower ICRS score than healthy cartilage. Microporous TCP was almost fully resorbed at 52weeks and replaced by bone.

Outcome instruments to assess scoliosis surgery.

To review and summarize the current knowledge regarding the outcome measures used to evaluate scoliosis surgery. Literature review. Outcome instruments should be tested to ensure that they have adequate metric characteristics: content and construct validity, reliability, and responsiveness. In the evaluation of scoliosis, generic instruments to assess health-related quality of life (HRQL) have been used, such as the SF-36 questionnaire and the EuroQol5D instrument. Nonetheless, it is preferable to use disease-specific instruments for this purpose, such as the SRS-22 Patient Questionnaire and the quality of life profile for spinal deformities (QLPSD). More recently, these generic and disease-specific instruments have been complemented with the use of super-specific instruments; i.e., those assessing a single aspect of the condition or specific populations with the condition. The patients' perception of their trunk deformity and body image has received particular attention, and several instruments are available to evaluate these aspects, such as the Walter-Reed Visual Assessment Scale (WRVAS), the Spinal Appearance Questionnaire (SAQ), and the Trunk Appearance Perception Scale (TAPS). The impacts of brace use can also be measured with specific scales, including the Bad Sobernheim Stress Questionnaire (BSSQ) and the Brace Questionnaire (BrQ). The available instruments to evaluate the treatment for non-idiopathic scoliosis have not been sufficiently validated and analyzed. Evaluation of scoliosis treatment should include the patient's perspective, which can be obtained with the use of patient-reported outcome measures.

2140 ABDOMINAL COLPOPEXY: COMPARISON OF ENDOSCOPIC SURGICAL STRATEGIES

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122140 ABDOMINAL COLPOPEXY: COMPARISON OF ENDOSCOPIC SURGICAL STRATEGIES Jennifer Anger, Elizabeth Mueller, Chris Tarnay, Linda Brubaker, Amy Rosenman, Bridget Smith, Kevin Stroupe, Catherine Bresee, and Kimberly Kenton Jennifer AngerJennifer Anger Los Angeles, CA More articles by this author , Elizabeth MuellerElizabeth Mueller Maywood, IL More articles by this author , Chris TarnayChris Tarnay Los Angeles, CA More articles by this author , Linda BrubakerLinda Brubaker Maywood, IL More articles by this author , Amy RosenmanAmy Rosenman Los Angeles, CA More articles by this author , Bridget SmithBridget Smith Maywood, IL More articles by this author , Kevin StroupeKevin Stroupe Maywood, IL More articles by this author , Catherine BreseeCatherine Bresee Los Angeles, CA More articles by this author , and Kimberly KentonKimberly Kenton Maywood, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic (LASC) and robotic (RASC) sacrocolpopexy are widely used for the treatment of pelvic organ prolapse (POP). However, strong evidence comparing outcomes and costs for the procedures is lacking. METHODS Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS, NCT01124916) is a 2-center randomized comparative effectiveness trial conducted at UCLA/Cedars-Sinai and Loyola University Medical Centers. The primary aim compared costs of RASC and LASC. Following a clinical decision for ASC and research consent, participants with greater than or equal to symptomatic stage II POP including apical support loss to greater than 0.5 TVL were randomized to LASC or RASC on the day of surgery. Concomitant surgeries, including hysterectomy, posterior repair, and midurethral sling were allowed. Costs of care were based on each patient's billing record and equipment costs at each hospital. All costs associated with surgical procedure including costs for robot, initial hospitalization, and any re-hospitalization in the 1st 6 weeks were compared between groups. Secondary outcomes included postoperative pain, POP quantification, symptom severity and quality of life, and adverse events (AE). Power calculation determined that 32 women in each arm would provide > 99% power to detect $4800 difference in total charges, using a 2-sided t-test with significance level of 0.05. RESULTS 78 women with mean age of 59 years (range 26-79) were randomized: LASC (38) and RASC (40). Hospital costs for RASC were higher than for LASC ($20,459 vs $12,022, P<0.0001). Over 6 weeks, hospital costs remained higher for RASC ($24,870 vs $13,840, P=0.008). Excluding costs of robot, hospital costs of RASC vs LASC ($13,428 vs $12,022, P = 0.06) and hospital costs over 6 weeks ($17,839 vs $13,840, P=0.32) were not significantly different. Total operating room time for RASC was slightly longer (202 vs 179 minutes, P=0.03). Women with RASC reported higher pain scores by visual assessment scales 1-week after surgery; however, pain scores did not differ by 2-weeks. There were no differences in complications, symptom bother, or POP stage three months after surgery. CONCLUSIONS Costs of RASC are higher than LASC, while short-term outcomes and complications are similar. Primary cost differences resulted from robot maintenance and purchase costs. Variable LASC RASC P value Baseline 3 months Basline 3 months Mean UDI (SD) 99.0(60.6) 25.6(41.4) 110.7(59.4) 30.3(42.1) 0.50 POPDI (SD) 116.4(61.6) 27.5(27.8) 126.1(63.9) 32.7(45.4) 0.65 CRADI (SD) 100.6(34.3) 34.3(34.0) 87.9(71.5) 44.1(48.3) 0.12 POPQ Point Ba (SD) 2.5(1.8) −2.4(1.2) 2.6(2.0) −2.6(0.7) 0.74 POPQ Point C (SD) 0.7(3.6) −7.7(4.8) 0.2(4.0) −7.9(5.1) 0.98 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e864 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Anger Los Angeles, CA More articles by this author Elizabeth Mueller Maywood, IL More articles by this author Chris Tarnay Los Angeles, CA More articles by this author Linda Brubaker Maywood, IL More articles by this author Amy Rosenman Los Angeles, CA More articles by this author Bridget Smith Maywood, IL More articles by this author Kevin Stroupe Maywood, IL More articles by this author Catherine Bresee Los Angeles, CA More articles by this author Kimberly Kenton Maywood, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The frost tolerance of Miscanthus at the juvenile stage: Differences between clones are influenced by leaf-stage and acclimation

Miscanthus, a perennial, C 4 grass, has numerous advantages for biomass production, notably its high yield per hectare and low input requirements. However, establishment of this crop may be affected in Europe by frost damage when stem emergence occurs early in the year. The principal aim of this study was to quantify the impact of frost on young miscanthus shoots at different leaf-stages, and to characterise inter-species variations in frost tolerance. Four clones belonging to two species were tested at three leaf stages in a climate-controlled chamber simulating acclimation conditions and frost treatments. Frost tolerance was scored using a 0–6 visual assessment scale and analysed with nonparametric tests. We were thus able to show that more developed plants (6 or 7-leaf stage) were less frost tolerant than those at the 3 or 5-leaf stage. Plants at the 6 or 7-leaf stage also displayed differences in tolerance between clones. The leaf-stage of the plant is linked to apex height, and this appeared to play a role in frost tolerance. M. sinensis displayed variable frost tolerance (tolerance score of between 3.6 and 4.9), although the three clones observed were always more frost tolerant than M. x giganteus (with a score of 3). Moreover, the differences in frost tolerance were negatively correlated ( r = −0.94) with the mean leaf surface area of clones at the time of frost exposure. Finally, we observed that acclimation at 12 °C under strong light intensity (600 μmol m −2 s −1) enabled an increase in the tolerance of young shoots in all the clones tested.