Search

Oclacitinib is a novel Janus kinase (JAK) inhibitor that potently inhibits JAK1‐dependent cytokines involved in allergy, inflammation, and pruritus (IL‐2, IL‐4, IL‐6, IL‐13, and IL‐31). Oclacitinib (Apoquel®, Zoetis Inc, Parsippany, NJ) is approved for the treatment/control of pruritus associated with allergic dermatitis and treatment/control of clinical manifestations of atopic dermatitis in dogs at least 12 months of age. To evaluate the effectiveness of oclacitinib in dogs with flea allergy dermatitis, the JAK1 selective inhibitor was tested in a placebo‐controlled, masked, single‐dose (0.4 mg/kg) or repeat‐dose (0.4 mg/kg, twice daily for 2 weeks) study. Pruritic behaviors were quantitated by video recording, and erythema and skin lesions were assessed using a 10‐cm visual analog scale (VAS). Results showed that oclacitinib reduced pruritus by 61% as early as 1.5 h after a single oral dose compared to placebo, with an average reduction (compared to placebo) of 85% 1–5 h after dosing (0.4 mg/kg; p <.0001). Oclacitinib also significantly reduced erythema (p <.0001) and skin lesion (p <.0005) VAS scores on Day 14 compared to placebo in a repeat dose study. No adverse events were noted during the conduct of these studies. IL‐31 concentrations were elevated in the majority of dogs after flea infestation, suggesting JAK1‐dependent cytokines may drive clinical signs of flea allergy dermatitis. These findings show that oclacitinib, an inhibitor of JAK1‐dependent cytokines involved in allergy and inflammation can rapidly reduce clinical signs associated with flea allergic dermatitis in dogs. [ABSTRACT FROM AUTHOR]

Background/Objectives: Bowel endometriosis (BE) is characterized by the presence of endometrial-like tissue within the muscular layer of the bowel wall. When BE does not result in the severe obstruction to fecal transit and in the absence of (sub)occlusive symptoms, the decision to perform surgery can be challenging, as intestinal procedures are associated with higher complication rates and long-term bowel dysfunction. This cross-sectional study aims to evaluate the quality of life (QoL) in patients with BE who avoided surgery, as well as to investigate the impact of the characteristics of BE nodules on the QoL and intestinal function. Methods: A retrospective cross-sectional analysis was conducted involving 580 patients with BE who did not undergo surgery but were treated conservatively with medical therapy or expectant management between January 2017 and August 2022. The diagnosis of BE was established through transvaginal ultrasound and confirmed via double contrast barium enema. After at least one year of follow-up, the QoL and intestinal function were assessed using the Endometriosis Health Profile-5 (EHP-5) questionnaire and the Bowel Endometriosis Symptom (BENS) score, while pain symptoms were quantified with the Visual Analog Scale (VAS 0–10). Statistical analyses were performed to explore potential associations between the QoL and the characteristics of BE nodules (size, location, and evidence of stenosis), as well as the type and duration of medical therapy. Results: Patients with BE reported a satisfactory overall QoL, with a mean EHP-5 score of 105.42 ± 99.98 points and a VAS score below three across all pain domains. They did not demonstrate significant impairment in bowel function, as indicated by a mean BENS score of 4.89 ± 5.28 points. Notably, patients receiving medical therapy exhibited a better QoL compared to those not receiving treatment (p < 0.05), with the exception of postmenopausal patients, who reported the highest QoL overall (p < 0.05). Among the characteristics of BE, nodule location significantly impacted the QoL and symptom intensity, with low (rectal or rectosigmoid) nodules less tolerated compared to sigmoid nodules, particularly regarding non-menstrual pelvic pain (NMPP), dyschezia, and psychological impact on daily life (p < 0.05). Conclusions: Women can effectively manage BE conservatively in the absence of (sub)occlusive symptoms, even when large nodules are present, causing significant radiological stenosis. The characteristics of BE nodules do not significantly affect the QoL or symptom intensity; however, the location of BE nodules is a crucial factor negatively influencing these outcomes. Medical therapy may confer a beneficial impact on patients of reproductive age with BE, but its use should be carefully considered for those approaching menopause, weighing the risks and benefits. [ABSTRACT FROM AUTHOR]

Background/Objectives: There are many aspects that may influence clinical outcomes in a total hip arthroplasty (THA). The influence of femoral stem on the clinical outcome of THA is probably underestimated in the literature. Our work aims to analyze how uncemented stem geometry (straight or anatomical) in THA might affect outcomes in clinical and radiographic terms. Methods: Over a period of 36 months, in a prospective-observational manner, we collected the results of THA secondary to osteoarthritis (OA) that met the inclusion criteria with the only variable being the straight or anatomical stem design in a single manufacturer. A total of 84 patients were selected and divided into two groups: group A, treated with straight stem (44 patients), and group B, treated with anatomical stem (40 patients). The assessment clinical tools were Harris Hip Score (HHS), Visual Analogue Scale (VAS), and Short Form Health Survey-36 (SF-36). Follow-up controls were at 6 months (T0), 12 months (T1), 24 months (T2), and 36 months (T3). Results: No statistically significant differences emerged between the two groups under analysis with VAS, SF-36, and HHS. At follow-up controls, eight patients (group A) and four patients (group B) showed anterior thigh pain. At T1, there were radiographic signs of aseptic loosening in two cases (group A) and one case (group B). In group A there were two cases of iatrogenic fracture, two cases of dislocation, one case of infection, and two cases of heterotopic ossification. Conclusions: The anatomical stem compared to the straight stem showed lower complication rates outcomes; the anatomical uncemented stem could be considered as a preferred first choice in THA compared to the straight stem. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Chronic lateral epicondylitis (LE), normally known as tennis elbow, is often managed by conservative treatments. Extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) are among the most commonly used conservative treatments. However, the comparison between these two interventions remains controversial. This study aimed to compare the effectiveness and safety of ESWT and LCI for chronic LE. A systematic review and meta‐analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until April 20, 2024. Meta‐analyses were conducted using Manager V.5.4.1. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR), with 95% confidence intervals (CIs). A total of six randomized controlled trials (RCTs) were included. Compared with LCI, ESWT had inferior change in visual analogue scale (Δ VAS) (WMD, 1.14; 95% CI, 0.80 to 1.48; I2 = 20%; p < 0.001), Δ grip strength (WMD, −4.01; 95% CI, −5.57 to −2.44; I2 = 36%; p < 0.001), change in patient‐rated tennis elbow evaluation (Δ PRTEE) score (WMD, 8.64; 95% CI, 4.70 to 12.58; I2 = 0%; p < 0.001) at 1‐month follow‐up, but superior Δ VAS (WMD, −1.15; 95% CI, −1.51 to −0.80; I2 = 6%; p < 0.001), Δ grip strength (WMD, 2.04; 95% CI, 0.90 to 3.18; I2 = 3%; p = 0.0005), Δ PRTEE score (WMD, −9.50; 95% CI, −14.05 to −4.95; I2 = 58%; p < 0.001) at 3‐month follow‐up, and superior Δ VAS (WMD, −1.81; 95% CI, −2.52 to −1.10; I2 = 33%; p < 0.001), Δ grip strength (WMD, 3.06; 95% CI, 0.90 to 5.21; I2 = 0%; p = 0.005) at 6‐month follow‐up. The two groups had a similarly low rate of adverse events (OR, 0.69; 95% CI, 0.05 to 8.60; I2 = 67%; p = 0.77), all of which were mild. Both ESWT and LCI are effective and safe in treating chronic LE. Compared with LCI, ESWT showed inferior short‐term (1‐month) but superior long‐term (3‐month and 6‐month) outcomes regarding pain relief and function recovery, with a similar rate of mild adverse events. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective clinical study. Objective: The purpose of this study was to establish a novel classification of migrated lumbar disk herniation (LDH) based on magnetic resonance imaging and provide appropriate treatment strategies for each type through algorithms. Summary of Background Data: Full‐endoscopic lumbar discectomy is a surgical technique that has been developed rapidly in recent years. For migrated LDH, few surgeons currently classify it with multiplanar positioning, and there is no consensus on the choice of treatment strategy. Therefore, we established a new multiplanar classification criteria that can localize the lesions more accurately than previous studies. Methods: A total of 263 eligible patients from March 2017 to March 2022 were included. Protrusions for each patient were located based on our classification and the surgical approach was selected according to our algorithms. The clinical symptoms of all patients before surgery, and at 1 day, 1 month, 3 months, 6 months, and 12 months after surgery were collected. Evaluations were performed using visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. We used the chi‐squared test, one‐way analysis of variance (ANOVA), and t‐test to compare perioperative results and postoperative 3‐month, 6‐month, and 12‐month follow‐up results. Results: VAS (low back pain) scores were reduced from 5.33 ± 2.67 to 0.73 ± 0.77 (p < 0.001), and VAS (leg pain) scores were reduced from 7.44 ± 2.21 to 0.37 ± 0.51 (p < 0.001). ODI scores improved from 58.46 ± 8.04 to 12.57 ± 2.51 (p < 0.001). According to the modified MacNab criteria, the excellent and good rate reached 92.78% at the 12‐month follow‐up. Twenty‐six patients developed complications, all of which improved after treatment. Recurrence occurred in 13 patients, and four of them underwent secondary surgery. Conclusions: This is an innovative classification method using multi‐plane positioning, and the algorithm used with it can help surgeons make appropriate choices when using endoscopic technology to treat migrated LDH. Statistical analysis of follow‐up data confirmed that this is a safe and effective strategy. [ABSTRACT FROM AUTHOR]

Objective: When implanting the Zero‐P device, the screws of Zero‐P form a bone wedge with a 40 ± 5° cranial and caudal angle (CCA). However, no study has been performed in the optimal CCA of the Zero‐P implant. To investigate whether the cranial/caudal angles (CCA) of the screws affect the clinical and radiological outcomes in patients undergoing ACDF with the Zero‐P implant. Methods: From January 2016 to December 2023, we retrospectively analyzed 186 patients who underwent 1‐level ACDF with the Zero‐P device. The patients were divided into four groups: group A (cranial angle ≤40°, caudal angle ≤40°); group B (cranial angle ≤40°, caudal angle >40°); group C (cranial angle >40°, caudal angle ≤40°); and group D (cranial angle >40°, caudal angle >40°). The clinical outcomes, including Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS) scores, the radiological parameters, including cervical lordosis (CL), cervical lordosis of operated segments (OPCL), intervertebral space height (ISH) and fusion rate (FR), and the complications, were evaluated and compared. Parametric tests, non‐parametric tests, and chi‐square tests were conducted to analyze the data. Results: The OPCL of group A was significantly less than that of the other groups at the final follow‐up (p < 0.05). The ISH of group D was significantly less than that of group A at the final follow‐up (p < 0.05). The subsidence rate of group A was significantly less than that of group D at the final follow‐up (p < 0.05). At the final follow‐up, the upper adjacent‐level degeneration (ASD) of group D was significantly less severe than that of groups A and B (p < 0.05). The clinical outcomes do not differ among groups (p > 0.05). Conclusion: A larger CCA of the screws (cranial angle >40°, caudal angle >40°) was better for maintaining OPCL and reducing the incidence of ASD. A smaller CCA of the screws (cranial angle ≤40°, caudal angle ≤40°) was better for maintaining ISH and reducing the rate of subsidence. [ABSTRACT FROM AUTHOR]

Objectives: Cervical spondylosis may lead to changes in the sagittal parameters of the neck and trigger compensatory alterations in systemic sagittal parameters. However, there is currently a dearth of comparative research on the changes and compensatory alterations to sagittal parameters resulting from different types of cervical spondylosis. This study compared the preoperative sagittal alignment sequences among patients with cervical spondylotic radiculopathy (CSR), ossification of the posterior longitudinal ligament (OPLL), and cervical spondylotic myelopathy (CSM) caused by factors resulting from non‐OPLL factors. Materials and Methods: Full length lateral X‐ray of the spine and cervical computed tomography (CT) of 256 patients (134 men, 122 women; mean age, 56.9 ± 9.5 years) were analyzed retrospectively. A total of 4096 radiomics features were measured through the lateral X‐ray by two spinal surgeons with extensive experience. The clinical symptoms measures were the Japanese Orthopaedic Association (JOA) score, number of hand actions in 10 s, hand‐grip strength, visual analog scale (VAS) score. Normally distributed data was compared using one‐way analysis of variance (ANOVA) for parametric variables and χ2 test were used to analyze the categorical data. Results: In the OPLL group, the C2‐C7 Cobb angle was greater than in the CSR and CSM groups (19.8 ± 10.4°, 13.3 ± 10.3°, and 13.9 ± 9.9°, respectively, p < 0.001). Additionally, the C7‐S1 SVA measure was found to be situated in the anterior portion with regards to the CSM and CSR groups (19.7 ± 58.4°, −6.3 ± 34.3° and −26.3 ± 32.9°, p < 0.001). Moreover, the number of individuals with C7‐S1 SVA >50 mm was significantly larger than the CSM group (26/69, 11/83, p < 0.001). In the CSR group, the TPA demonstrated smaller values compared to the OPLL group (8.8 ± 8.5°, 12.7 ± 10.2°, p < 0.001). Furthermore, the SSA was comparatively smaller as opposed to both the OPLL and CSM groups (49.6 ± 11.2°, 54.2 ± 10.8° and 54.3 ± 9.3°, p < 0.05). Conclusion: Patients with OPLL exhibit greater cervical lordosis than those with CSR and CSM. However, OPLL is more likely to result in spinal imbalance when compared to the CSM group. Furthermore, OPLL and CSM patients exhibit anterior trunk inclination and worse global spine sagittal parameters in comparison to CSR patients. [ABSTRACT FROM AUTHOR]

Objective: Diffuse‐type tenosynovial giant cell tumors (Dt‐TGCTs) commonly occur in the knee joint and tend to recur postoperatively. However, limited clinical data are available on ankle joint involvement especially associated multiportal arthroscopic treatment outcomes. The purpose of this study was to report the clinical results of multiportal arthroscopy‐assisted resection of Dt‐TGCTs of the ankle. Methods: We retrospectively reviewed the clinical data of 33 patients with Dt‐TGCT of the ankle who underwent multiportal arthroscopic treatment between August 2011 and December 2020. Clinical follow‐up included the visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, Kofoed score, and recurrence rate to assess surgical outcomes. The number of patients who achieved the patient acceptable symptom state (PASS) based on the AOFAS score was also examined. Additionally, the patients were categorized into two groups based on the final surgical approach: Group A who underwent multiportal arthroscopic synovectomy and Group AO who underwent combined arthroscopic and open surgical excision. Intergroup comparisons were conducted. Intraoperative characteristics, such as the number of patients with involvement of the tarsal tunnel and fibularis tendon and the Outerbridge grading of cartilage damage, were recorded to assess the selection of surgical procedures. Results: Among the 33 patients, 15 were assigned to Group A, and 18 were in Group AO. The median follow‐up duration for the 33 patients was 77 months (range, 28–142 months). The median VAS score was 1 (range, 0–4), the AOFAS score was 96 (range, 65–100), and the Kofoed score was 96 (range, 67–100). A total of 27 patients (82%) achieved PASS based on AOFAS scores, while five patients (15%) had recurrence. No statistically significant difference was observed between the two groups in recurrence rate, follow‐up VAS score, AOFAS score, Kofoed score, or number of patients who reached the PASS (p > 0.05). In the AO group, 16 cases of Dt‐TGCT involved the tarsal tunnel, and 11 cases involved the fibularis tendon. All these patients exhibited extension beyond the joint. In contrast, only one patient in Group A had involvement of the tarsal tunnel. Statistically significant differences were observed between the groups (p < 0.001). Conclusion: This study demonstrated that, with the assistance of a multiportal arthroscopic approach, surgical excision of Dt‐TGCT in the ankle resulted in favorable clinical outcomes with a relatively low recurrence rate. Additionally, patients with extra‐articular involvement were more likely to require concomitant open surgery. [ABSTRACT FROM AUTHOR]

Objective: As the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure. Methods: A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36‐Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line–C7 plumbline [CSVL–C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow‐up were compared to their preoperative results. Results: Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL–C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow‐up (p < 0.001). There was no significant change in PI at either the postoperative or follow‐up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF‐36 scores improved considerably at postoperative and final follow‐up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL–C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow‐up (p < 0.001). PI showed no significant change at either the postoperative or follow‐up timepoints. Conclusion: Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules. Purpose: To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA. Hypothesis: That leukocytes could influence results both in terms of adverse events and clinical outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This double-blind randomized controlled trial included 132 patients with Kellgren-Lawrence grade 1-3 knee OA who were randomized to a 3-injection cycle of either LR-PRP or LP-PRP. Patients were prospectively assessed at baseline and at 2, 6, and 12 months with subjective evaluations comprising the International Knee Documentation Committee (IKDC) subjective score, the KOOS (Knee injury and Osteoarthritis Outcome Score), the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the visual analog scale for pain, the EuroQol–visual analog scale, the EuroQol–5 dimensions, and the Tegner activity scale. Objective evaluations consisted of the IKDC objective score, active/passive range of motion, and circumference of the index and contralateral knees. Patient judgment of the treatment was recorded as well as adverse reactions and failures. Results: An overall improvement in subjective and objective outcomes was documented, with no differences between the 2 groups, except for the improvement in the IKDC subjective score at 2 months, which was greater for the LR-PRP group compared with the LP-PRP group (14.8 ± 14.8 vs 8.6 ± 13.3, respectively; P =.046), as well as for active (P =.021) and passive (P =.040) ROM of the index knee at 6 months, showing statistically significant higher values in the LP-PRP group; and for quadriceps circumference of the index (P =.042) and contralateral (P =.045) knees at 12 months, which were significantly greater in the LR-PRP group. The IKDC subjective score improved from 42.5 ± 17.6 at baseline to 55.6 ± 21.4 at 12 months for the LR-PRP group (P <.0005) and from 45.7 ± 16.4 to 55.3 ± 20.4 for the LP-PRP group (P =.001). No differences in terms of patient treatment judgment were observed at all follow-up time points. No severe adverse events related to the treatment were reported, but some mild adverse events related to the treatment were observed: 16 in the LR-PRP group and 17 in the LP-PRP group. Treatment failed in 5 patients in the LR-PRP group and 2 in the LP-PRP group. Conclusion: This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, without showing differences in subjective and objective outcomes or in adverse events and treatment failures. Registration: NCT04187183 (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

Introduction A rise in tinea cruris among Thai Naval Cadets has been observed. Clotrimazole powder has been shown to be effective as an adjunct treatment for tinea cruris; however, its efficacy as a monotherapy is limited. Objectives The aim is to determine the efficacy of 1% clotrimazole cream versus 1% clotrimazole powder in treating tinea cruris. Material and Methods A randomized trial was conducted at the Thai Naval Rating School, Chonburi, Thailand. Naval rating cadets with suspected tinea cruris were randomly assigned to one of two groups: 1% clotrimazole cream or 1% clotrimazole powder, and they were instructed to apply the related medication to the affected lesion twice daily for 4 weeks. Clinical and symptomatic evaluations were carried out at 4 and 8 weeks. Results All 17 and 14 participants who received 1% clotrimazole cream and powder, respectively, were included. After 4 weeks, the clinical cure rates were 76.5% in the cream group and 85.7% in the powder group (P  = .664). All participants were clinically cured within 8 weeks. The self-evaluation of itch severity using a visual analog scale (VAS) revealed no significant difference between the two groups (P  = .343). The dermatology quality of life index decreased as clinical improvement was achieved in both the clotrimazole cream and powder groups (6.0 vs. 7.5 score reductions, respectively; P  = .765). The score for sweat reduction was higher in the 1% clotrimazole powder group compared to the cream group (5.0 vs. 4.0, respectively; P  = .006). Conclusion Monotherapy with 1% clotrimazole powder showed comparable efficacy to 1% clotrimazole cream. Furthermore, the powder treatment reduced sweat more effectively compared to the cream. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of 24-week cyclic administration of estetrol (E4) (15 mg)/drospirenone (DRSP) (3 mg) in Japanese patients with endometriosis. A 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Twenty-five study centers in Japan. A total of 162 Japanese women diagnosed with endometriosis. Participants were randomly allocated to the E4/DRSP group or the placebo group. In the E4/DRSP group, participants were orally administered one tablet containing E4 (15 mg) and DRSP (3 mg) daily for 24 days, followed by one placebo tablet for 4 days for a hormone-free interval, constituting a 1-cycle regimen. One placebo tablet was administered once daily for 28 days to participants in the placebo group. The treatments were continued for six cycles (24 weeks) throughout the confirmatory period. Changes in visual analogue scale (VAS) scores for the most severe pelvic pain (lower abdominal and back pain) from baseline to six treatment cycles at the end of the confirmatory study period. Estetrol/drospirenone showed changes in the mean VAS scores for the most severe pelvic pain (−33.2 mm) from baseline to the end of the 6-cycle treatment. The between-group difference was significant (−8.5 mm; 2-sided 95% confidence interval, −16.1 to −0.9 mm), showing superiority to placebo. The responder rates, ≥30% and ≥50% reductions in the VAS scores from baseline, were higher in the E4/DRSP group than in the placebo group: 53.2% vs. 29.6% and 36.4% vs. 12.3%. Objective gynecological findings (induration of the cul-de-sac, pelvic tenderness, and limited uterine mobility) were significantly improved by E4/DRSP treatment, and the proportions of stable and worsened participants were significantly lower than in the placebo group. Estetrol/drospirenone decreased the size of endometriomas and improved quality of life, on the basis of quality of life–related questionnaires and global impression scores. No safety concerns were observed with E4/DRSP treatment. Few differences were observed in the proportion of participants with hemostasis parameters outside the reference range between the E4/DRSP and placebo groups. Estetrol/drospirenone effectively treats endometriosis-associated pain and improves gynecological findings. Estetrol/drospirenone may be a safe, new option for endometriosis treatment with a potentially decreased risk of thromboembolic events. jRCT2011210027. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility and acceptability of an emotional support programme for newly diagnosed people with multiple sclerosis. Design: Three-arm, mixed methods, randomised controlled trial comparing usual care, versus usual care plus nurse-specialist support, versus usual care plus nurse-specialist support plus peer support. Participants: Community-dwelling adults within two years of diagnosis or undergoing diagnosis. Interventions: PrEliMS involves information provision, emotional support, and strategies and techniques based on psychoeducation, Acceptance and Commitment Therapy principles, supportive listening. One version of the intervention was provided by nurse-specialists alone and the other was provided by nurse-specialists plus peer support. Main measures: The main outcome of interest was the feasibility of proceeding to a definitive trial, exploring recruitment rate, acceptability, completion of outcome measures (perceived stress, mood, self-efficacy, psychological impact, and service use), and signal of efficacy. Results: Of 40 participants randomised (mean age 36.2 years (SD = 14.8); 54% women; 85% with relapsing-remitting MS), 36 and 38 returned 3- and 6-month questionnaires, respectively. Participant interviews suggested the trial was largely feasible, and the intervention acceptable, with some amendments to trial procedures and intervention delivery noted. There were, however, no statistically significant differences between groups at followup for any measures, and effect-size estimates were small. Conclusion: A definitive trial combining nurse-specialist and peer support adjustment to diagnosis intervention is warranted, but more work exploring the delivery and fidelity of the intervention is needed before this is pursued [ABSTRACT FROM AUTHOR]

Objectives ANA-associated rheumatic and musculoskeletal (MSK) diseases (RMDs) [SLE, primary SS (pSS), scleroderma, inflammatory myositis, MCTD and UCTD] make up a disease spectrum with overlapping clinical and immunological features. MSK inflammation is common and impactful across ANA-associated RMDs. The objectives of this study were to evaluate MSK inflammation (ANA-associated arthritis) prevalence in a multidisease ANA-associated RMD study, assess its clinical impact across ANA-associated RMD diagnoses, propose new basket groupings of patients, and evaluate immunological profiles in legacy and new basket contexts. Methods An observational study enrolled patients with ANA-associated RMDs. Demographic variables, comorbidities, therapies, disease activity instruments [BILAG, SLEDAI, the EULAR SS disease activity index (ESSDAI), physician visual analogue scale (VAS)], patient-reported outcomes [SF36, FACIT-Fatigue, EQ5D, ICECAP-A, Work Productivity and Activity impairment (WPAI), patient VAS] and the biomarker profile (six-gene expression scores, flow cytometry, autoantibody profile) were analysed. Reclustering utilized Gaussian mixture modelling (GMM). The clinical and immune features of new and legacy clusters were compared. Results Inflammatory MSK symptoms were prevalent across ANA-associated RMDs, in 213/294 patients. In ANA-associated arthritis patients, most variables did not differ between diagnoses, with the exception of the EQ5D-5L index and mobility domains (lower in MCTD/pSS, both P  < 0.05). FM and OA prevalence were similar across diagnoses. Therapy use differed significantly, the use of biologics being greatest in SLE (P  < 0.05). GMM yielded two multidisease clusters: High MSK disease activity (n  = 89) and low MSK disease activity (n  = 124). The high MSK disease activity cluster included all patients with active joint swelling, and they had significantly higher prednisolone usage, physician global assessment (PGA), Sm/RNP/SmRNP/chromatin positivity, Tetherin mean fluorescence intensity (MFI), and IFN Score-A activity, along with numerically lower FM and OA prevalence. Conclusion We defined ANA-associated arthritis, a more clinically and immunologically homogeneous population than existing RMD populations for trials, and a more prevalent population for therapies in the clinic. [ABSTRACT FROM AUTHOR]

Purpose: Brachial plexus birth injuries (BPBI) can have lifelong effects on the development and functional use of the upper extremity. Currently there is no agreement with regards to what patient-reported outcome (PRO) measures should be used. Therefore, the ability to compare the effects of treatment between individuals and institutions is challenging. This study aimed to achieve consensus among clinicians on the use of PRO measures within this patient group to allow for improved comparison of treatments and outcomes in the future. Materials and Methods: Online, a 3 round Delphi survey was completed by 35 international multi-disciplinary specialist centers. Results: All respondents (100%) agreed that PRO measures are useful for clinical evaluation and patient treatment. None of the outcome measures scored >75% agreement for ability to assess responsiveness and current state in children with BPBI as most outcome measures were judged as not specific for BPBI. Additionally, participant centers were asked their perspective on the best available PRO option for each of the 3 categories: functional use of the upper limb, quality of life and pain. This resulted in endorsement by the participant centers of the Brachial Plexus Outcome Measure – Self-Evaluation, the Pediatric Quality of Life Inventory, and Visual Analogue Scale/Brief Pain Inventory respectively. Conclusion: International specialists in BPBI agree that PRO measures are important to use both clinically and in research in children aged 5 years and above. IMPLICATIONS FOR REHABILITATION: Patient-reported outcome measures were judged as useful both in clinic and in research for brachial plexus birth injury (BPBI), according to a panel of specialized centers. Currently available outcome measures were judged as not specific for BPBI. The panel endorsed the following measures as best available: the Brachial Plexus Outcome Measure – Self-Evaluation scale for functional evaluation, the Pediatric Quality of Life Inventory for disease-related quality of life and the Faces Pain Scale - Revised/Visual Analogue Scale/Brief Pain Inventory for pain [ABSTRACT FROM AUTHOR]

Objective: Measuring patient motivation for voice therapy is an important component of determining prognosis and estimating compliance. Voice stimulability testing is assumed to influence the patient’s motivation by improving their perception of the sound and/or feel of the voice. The purpose of this study was to validate a Voice Therapy Motivation and Voice Perception Inventory and to determine whether stimulability testing elicits improvements in motivation and patient-perceived voice status. Method: Seventy-five patients who underwent initial voice therapy evaluation completed a four-item inventory that queried their commitment to voice therapy, confidence that they could change their voice through voice therapy, perception of their voice severity, and ratings of their vocal effort. Inventories were completed shortly before and after stimulability testing. A psychometric analysis of the survey was conducted, including the internal consistency of each construct of the inventory along with content, predictive, and concurrent validity. Pairedsamples statistical analyses were conducted to determine differences before and after stimulability testing, and Spearman correlations between voice and motivation ratings were conducted to determine relationships between the patient’s perception of their voice and their motivation for voice therapy. Results: Internal consistency reliability was acceptable to good for each construct, particularly after stimulability testing. Motivation scales were predictive of returning for voice therapy sessions, subjective improvement of voice by the first therapy session, and likelihood of the patient practicing the home practice program. Patient ratings of voice severity and effort were positively correlated with clinician ratings of overall severity. Motivation and voice impairment perception improved following stimulability testing. Reduction in vocal effort was related to improved motivation, but change in voice severity was not. Conclusions: Voice stimulability testing can influence patient motivation for voice therapy and patient-perceived voice improvements. It should be considered a critical part of the voice evaluation. [ABSTRACT FROM AUTHOR]

Purpose: In symptomatic mid‐sized focal chondral defects, autologous matrix‐induced chondrogenesis (AMIC) and minced cartilage implantation (MCI) offer two versatile treatment options. This study aimed to conduct a matched‐patient analysis of patient‐reported outcome measures to compare these two surgical treatment methods for focal chondral defects. Methods: At the first centre, patients underwent a single‐stage procedure in which autologous cartilage was hand‐minced, implanted into the defect and fixed with fibrin glue. At the second centre, patients underwent AMIC, which was fixed in place with fibrin glue. All patients were seen 2–4 years postoperatively. Postoperative outcomes were assessed using the visual analogue scale for pain (VAS), the Lysholm score and the five domains of the knee osteoarthritis outcome score (KOOS). Patients from each surgical centre were matched by age, sex, defect size and defect localisation. Results: In total, 48 patients from two surgical centres (24 from each site) were matched for sex, age (MCI 30.3 ± 14.9 years vs. AMIC 30.8 ± 13.7 years) and defect size (MCI 2.49 ± 1.5 cm2 vs. AMIC 2.65 ± 1.1 cm2). Significantly better scores in the AMIC cohort were noted for VAS (p = 0.004), Lysholm (p = 0.043) and the KOOS subscales for pain (p = 0.016) and quality of life (p = 0.036). There was a significantly greater proportion of positive responders for Lysholm in the AMIC group (92%) compared with the MCI group (64%). Conclusions: The AMIC procedure delivers superior patient outcomes compared with hand‐minced autologous cartilage implantation. These are mid‐term outcomes, with follow‐up between 2 and 4 years. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: Autologous matrix‐induced chondrogenesis (AMIC) showed promising short‐term results comparable to microfracture. This study aims to assess the 19‐year outcomes of AMIC, addressing the lack of long‐term data. Methods: Retrospective cohort of 34 knees treated with AMIC underwent a 19‐year follow‐up. The primary outcome was AMIC survival, considering total knee arthroplasty as a failure event. Survival analysis for factors that were associated with longer survival of the AMIC was also performed. Clinical and radiological outcome scores were analysed for the AMIC group. Results: Twenty‐three knees were available for follow‐up analysis. Of these, 14 (61%) underwent revision surgery for total knee arthroplasty (TKA). The mean time was 13.3 ± 2.5 years (range: 9–17 years). Secondary outcomes showed that increased age at surgery (hazard ratio [HR]: 1.05; p = 0.021) and larger defect size (HR: 1.95; p = 0.018) were risk factors for failure. Concomitant proximal tibial osteotomy (HR: 0.22; p = 0.019) was associated with longer survival. The remaining nine knees (39%) were analysed as a single group. The mean clinical score at follow‐up of 18.6 ± 0.9 SD years was 79.5 ± 19.7 SD for the Lysholm score, 1.8 ± 1.5 SD for the visual analog scale score, 74.2 ± 22.4 SD for the KOOS score and a median of 3 (range: 3–4) for the Tegner activity scale. Conclusions: The mean survival time of 13.3 years indicates the durability of AMIC in properly aligned knees. Nonetheless, despite a 61% conversion to TKA, the knees that persisted until the 19‐year follow‐up remained stable, underscoring the procedure's longevity and consistent clinical outcomes. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: This study addresses the gap in the current literature by evaluating the combined treatment of autologous bone grafting and autologous chondrocyte implantation (ABCI) for osteochondral defects of the knee. It aims to evaluate clinical outcomes against methodological quality and to summarize histological results and surgical techniques. Methods: A thorough search was conducted across Pubmed, Cochrane and Embase databases. Studies reporting clinical outcomes of ABCI for osteochondral defects of the knee were included. Patient‐reported outcome measures (PROMs), failure rates, methodological quality and potential conflicts of interest were evaluated. Histological results and surgical techniques were summarized. Results: Eighteen studies with 344 analyzed patients met the eligibility criteria for inclusion. All studies showed a significant improvement (p < 0.05) across different PROMs (subjective International Knee Documentation Committee score, Cincinnati Knee Rating System, Visual Analogue Scale, Lysholm Score, Tegner Activity Scale, Knee injury and Osteoarthritis Outcome Score and Knee Society Score) compared to the preoperative status. Failure rates ranged from 0% to 17.6%, with a mean follow‐up of 73.2 months (range: 9.0–143.6 months). Methodological quality was low to medium, including only one comparative study. Six studies reviewed reported a potential conflict of interest. The histological assessment showed effective bonding between autologous chondrocytes and bone graft. A large degree of variability was observed in the operative technique used. Conclusion: The current literature suggests that ABCI yields good clinical outcomes at mid‐ to long‐term follow‐up with favourable histological results for osteochondral defects of the knee. However, future research should focus on high‐quality comparative studies to better guide treatment choices. Introducing ABCI as the standard abbreviation may enhance clarity in future research. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT). Methods: The clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow‐up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volume and depth of the lesions. Then, the talus nine‐compartment partitioning method was used to partition the injury site. Preoperative and final follow‐up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for pain and 36‐item Short‐Form Health Survey (SF‐36) to evaluate treatment efficacy and analyze prognostic factors. Results: Of the 31 patients with single cystic OLT with a complete set of follow‐up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow‐up time of 30.1 ± 14.0 months and a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow‐up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow‐up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS) score and mental component summary (MCS) score on the SF‐36 scale showed significant improvement at the final postoperative follow‐up when compared to preoperative scores (p < 0.001). No other complications were observed during follow‐up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight‐bearing or re‐sprained ankle after surgery. There was no significant correlation between the duration of illness, gender and the location, depth, surface area and volume of the OLT and the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF‐36 PCS and MCS scores. Conclusion: Autologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the postoperative outcomes of the all‐inside technique in arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods: Patients who underwent ACLR using the all‐inside technique between 2018 and 2021 were retrospectively assessed. All patients were followed up for at least 2 years. Functional recovery and pain relief were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). Instrumented laxity was assessed via side‐to‐side difference using the Kneelax3 arthrometer. Graft maturity was estimated using the signal‐to‐noise quotient value based on magnetic resonance imaging (MRI). Adverse events during and after the surgery were recorded. Results: A total of 78 patients were included in this study, with a mean age of 28.1 ± 7.6 years. The IKDC (p < 0.001), Lysholm (p < 0.001) and KOOS (p < 0.001 for all subgroups) scores at the final follow‐up were significantly higher than those before the surgery. The VAS scores (p < 0.05) were significantly lower than those before surgery. The side‐to‐side difference results indicated that 50 patients had a difference of less than 3 mm, indicating a tight graft, whereas only 1 patient had a difference of >5 mm, indicating a loose graft. The median signal‐to‐noise quotient of the graft on MRI was 1.4 (P25, P75: 1.0, 2.0). No intraoperative adverse events were observed. Postoperative adverse events included three cases of infection, three cases of graft rerupture, two cases of cyclops lesion and one case of surgical intervention for a meniscal tear. Conclusion: ACLR using the all‐inside technique offers promising results in patients with ACL rupture. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effectiveness and safety of separation surgery for Epidural Spinal Cord Compression (ESCC) graded ≥ 2 in patients with Multiple Myeloma (MM), analyze factors influencing surgical outcomes, and develop a preliminary treatment decision framework for these patients. Methods: A retrospective analysis was conducted on clinical data from 35 MM patients who underwent separation surgery for ESCC graded ≥ 2 between 2013 and 2018. Patient data, including baseline information, surgical details, complications, and pre-operative as well as one-month post-operative efficacy evaluation indicators were recorded. Statistical analysis was performed on pre-operative and post-operative efficacy indicators to determine if there were significant improvements (p < 0.05). Ordered logistic regression was utilized to assess factors associated with an unfavorable post-operative quality of life outcome. Results: Compared to pre-operative values, at one-month post-surgery, patients showed significant improvements in Frankel Score Classification (4 vs 5, p < 0.05), Karnofsky Performance Score (30 vs 70, p < 0.05), and Visual Analogue Scale (8 vs 3, p < 0.05). Complications occurred in 7 cases (20%). The number of segments with ESCC (OR = 0.171, p < 0.05) and pre-operative chemotherapy (OR = 5.202, p = 0.05) were identified as independent factors influencing patient outcomes. Patients with more than two vertebral segments with ESCC exhibited significantly worse post-operative conditions. Conclusions: Separation surgery effectively alleviates pain, improves neurological function, and enhances the quality of life in patients with ESCC graded ≥ 2 due to MM. [ABSTRACT FROM AUTHOR]

Background: While single-incision laparoscopic cholecystectomy (SILC) has gained more popularity in recent years, its application to elderly patients needs further evaluation. Few SILC studies regarded this rapidly growing vulnerable population, and single-incision laparoscopic common bile duct exploration (SILCBDE) was never mentioned. We conducted an observational study of 146 routine SILCBDE to address this issue. Methods: One hundred forty-six consecutive patients underwent SILCBDE with concomitant cholecystectomies during a period of 6 years (July 2012–June 2016 and July 2018–July 2020). Forty patients with an age of 65 years or older were the study target. Characteristics and operative outcomes were compared with the remaining 106 younger patients by retrospective chart review. The primary outcomes include complications and mortality, while the secondary outcomes contain intraoperative blood loss, operative time, procedural conversions, postoperative length of hospital stay, and bile duct stone recurrence. Results: There was no mortality. The bile duct stone clearance rate was 98.6%. The elderly group had higher American Society of Anesthesiologists (ASA) scores, higher comorbidity rate, higher acute cholangitis rate, lower completion intraoperative cholangiography (IOC) rate, longer operative time, more blood loss, longer postoperative hospital stay (p <.001), longer total hospital stay (p <.001), higher procedural conversion rate (p <.05), higher complication rate (p <.001), and the exclusive open conversion (2.5%). The difference in complications derived from Clavien–Dindo grade I. Conclusion: Routine SILCBDE with concomitant cholecystectomy by experienced surgeons is safe and efficacious for elderly patients as for younger patients. Randomized controlled trials are anticipated. [ABSTRACT FROM AUTHOR]

Background: This study introduces a new access method for one-anastomosis gastric bypass (OAGB) by placing ports at the bikini line. Objective: To describe our initial experience and assess the feasibility, safety, and effectiveness of this novel access. Setting: University Hospital. Methods: This prospective case–control study included 72 patients: 42 were allocated to the bikini line one-anastomosis gastric bypass (BLOGB) group, and 30 were assigned to the control group. Exclusion criteria included a history of major abdominal surgery, hiatal hernia, extensive lower abdominal adhesions, or a body mass index (BMI) exceeding 55 kg/m2. Results: The mean preoperative BMI of the study sample was 40.01 ± 2.84. Weight loss was satisfactory, with the highest percent excess weight loss (%EWL) observed at 12 months: 90.88 ± 7.90 and 91 ± 7.11 (p = 0.474) in both groups, respectively. Both groups showed no significant differences in operative complications, hospital stay, weight loss, or resolution of obesity-associated diseases. However, the BLOGB patients had a longer mean operative time of 110.71 ± 17.72 min compared to 98 ± 18.27 min in the control group (p = 0.002). Moreover, they experienced less postoperative pain and reported greater satisfaction with the appearance of their scars. Conclusion: BLOGB was found to be potentially feasible, safe, and effective, offering improved aesthetic outcomes and reduced postoperative pain. This approach may be suitable for a select group of patients concerned with scar appearance. However, large-scale studies are necessary to ensure that safety is not compromised in pursuit of aesthetic benefits. [ABSTRACT FROM AUTHOR]

Background: Stress while operating is an important contributor to surgeon health and burnout. Measuring stress is key to improving surgeon and patient outcomes, however biological responses to stress during surgery are variable and difficult to interpret. Participant reported measures of stress have been suggested as an alternative, but the most appropriate measure has not been defined. This study's primary aim was to assess measures of anxiety, stress, and workload before and after surgical simulation and characterize the relationship between these measures. Methods: Surgeons completed three laparoscopic exercises from the fundamentals of laparoscopy program (peg transfer, pattern cutting, intracorporeal suturing) in a neutral environment and "stressed" environment (ergonomic, noise, or time pressure). State trait anxiety and self-reported stress on a visual analogue scale were collected prior to simulation and again immediately afterwards. The NASA task load index (TLX) was also administered post-simulation. Results: Of the 26 participants from gynecological and general surgery specialties, state anxiety increased in 98/148 simulations (62%) with a significant mean increase during simulation (32.9 ± 7.9 vs 39.4 ± 10.2, p <.001). Self-reported stress increased in 107/148 simulations (72%), with a significant increase in mean scores during simulation (38.7 ± 22.5 vs 48.9 ± 23.7, p <.001). NASA-TLX scores immediately after simulation ranged from 40 to 118 (mean 60.5 ± 28.7). Greater anxiety and stress scores were reported in "stressed" simulations (43.6 ± 23.1 vs 54.2 ± 23.3; 68.7 ± 27.0 vs 52.4 ± 28.2 respectively) with a significant interaction effect of the "stressed" environment and type of exercise. Anxiety and stress were moderately positively correlated prior to simulation (r =.40) and strongly positively correlated post-simulation (r =.70), however only stress was strongly correlated to workload (r =.79). Conclusion: Stress and anxiety varied by type of laparoscopic exercise and simulation environment. Correlations between anxiety and stress are stronger post-simulation than prior to simulation. Stress, but not anxiety, is highly correlated with workload. [ABSTRACT FROM AUTHOR]

Introduction: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres. Methods: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP. Results: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively. Conclusions: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP. [ABSTRACT FROM AUTHOR]

Background: Pain is a common, severe symptom related to endometriosis. Despite this prominent feature, there is limited literature regarding its description and use of integrative treatment methods. Objective: We aimed to describe endometriosis-related pain characteristics, severity, and association with an integrative approach encompassing pharmacological and non-pharmacological methods. Methods: A cross-sectional descriptive correlational study was conducted using convenience sampling of adult women with endometriosis-related pain. Three questionnaires were utilized: a demographic and general health questionnaire, a visual analog pain scale (VAS), and the short-form McGill pain questionnaire (SF-MPQ). Results: Participants included 93 women with a mean general pain level of 6.2/10 (SD = 2.7) on the VAS. The total mean pain score on the SF-MPQ was 26.25/45 (SD = 10.1). Sixty-four women (68.8%) reported experiencing pain at the time of completion of the questionnaire (mean: 1.6/4, SD = 1.3). All participants utilized analgesia; those who used opioids reported a higher overall mean pain score of 2.3 (SD = 1.3) than patients who did not use opioids reported a mean of 1.4 (SD = 1.2; z = 9.59; P <.001). Present pain intensity was significantly higher for women using opioids than those not using opioids. In all, 77 women (82.8%) used integrative methods to alleviate the pain symptoms. Women who utilized nutritional therapy as part of the non-pharmacological method experienced lower mean (SD) overall pain (4.4 [2.5]) compared with patients who did not utilize nutritional therapy (6.75 [2.5]; P <.01). Conclusions: More studies are needed to find evidence-based treatment options for women for integrative pain relief for endometriosis-related pain. [ABSTRACT FROM AUTHOR]

Aim: To compare postoperative pain and recovery in patients undergoing oophorectomy with single‐port laparoscopic surgery (SPLS) versus vaginal natural orifice transluminal endoscopic surgery (vNOTES). Method: Patients who underwent salpingo‐oophorectomy with SPLS or vNOTES between 2016 and 2023 were analyzed retrospectively. Oophorectomy was performed based on the presence of an adnexal mass or breast cancer susceptibility gene mutation. Results: Fifty‐two patients underwent oophorectomy with SPLS and 35 underwent vNOTES. Although the mean mass size was slightly larger in the SPLS group than in the vNOTES group (8.0 ± 4.1 vs. 6.8 ± 3.3 cm), the difference was not significant. There was no difference in operating times between SPLS and vNOTES. The mean visual analog scale and faces pain scale scores 2 and 6 h postoperatively were lower in the vNOTES group. The mean quality of recovery‐40 (QoR‐40) score was higher in the vNOTES group (156 ± 14 vs. 148 ± 11; p = 0.009). This analysis identified vNOTES as an independent predictor of a high QoR‐40 score. Conclusion: The vNOTES group experienced less pain during the early postoperative period than the SPLS group. Although the operating and removal times were similar, the port setup time was longer for the vNOTES group. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the clinical management and effectiveness of metagenomic next-generation sequencing (mNGS) in patients with pyogenic spinal infections. Methods: We conducted a retrospective review of 17 patients diagnosed with pyogenic spinal infections and treated at our institution between October 2022 and February 2024. The cohort included 8 males and 9 females, with a mean age of 63.59 ± 10.18 years (range: 41–71 years). The infections comprised 9 epidural abscesses, 6 intervertebral space infections, and 2 deep abscesses. All patients underwent open surgical procedures and mNGS-based bacterial identification using intraoperative pus or tissue specimens, in addition to conventional blood bacterial cultures. Clinical outcomes were assessed using CRP, PCT, WBC inflammatory markers, and VAS scores postoperatively. Results: All 17 patients with pyogenic spinal infections underwent open surgery and mNGS bacterial detection at our institution. Among the 17 patients, mNGS yielded positive results in 14 cases (82.4%), significantly higher than the 5.9% positivity rate of conventional bacterial cultures (p < 0.001). The mNGS test time was notably shorter than conventional cultures (1.0 vs. 5.88 days, p < 0.001). Postoperative antibiotic therapy was adjusted based on mNGS findings. There were significant reductions in postoperative VAS, WBC, PCT, and CRP values compared to preoperative levels (p < 0.01). Conclusion: Metagenomic next-generation sequencing is effective in managing pyogenic spinal infections by facilitating rapid and sensitive detection of pathogens. This technique improves the timeliness and accuracy of diagnosis, highlighting its potential for broader clinical use. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin c can relieve the pain after other diseases, but there are no studies on whether vitamin C can relieve the pain after hip replacement. The purpose of this paper is to study whether vitamin C can relieve the pain after total hip replacement. Purpose: In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients receiving THA at our hospital were randomly assigned to vitamin c or control groups. During the operation, the vitamin C group will receive intravenous injection of 3 g vitamin C, and the control group will receive 3 g placebo. If the patient has postoperative pain, 10 ml subcutaneous injection of morphine will be required as a rescue analgesic. The primary outcome was the amount of postoperative injection of morphine as a rescue analgesic and expression of inflammatory factors, and the secondary outcome was postoperative pain and hip recovery as assessed by visual analog scale (VAS). Results: The dosage of subcutaneous injection of morphine was significantly reduced in vitamin C group. VAS pain scores at rest and exercise were lower in the vitamin C group 24 h after surgery, and hip motion was better 24 h after surgery, but there was no significant difference between the two groups 24 h after surgery.Nonetheless, the overall changes in morphine usage and VAS scores did not surpass the established minimal clinically important differences (10 mg for morphine consumption; 1.5 at rest and 1.8 during movement for VAS scores). Conclusion: Adding intravenous vitamin c to multimodal analgesia significantly improved morphine consumption, VAS pain score, and functional recovery. However, it is recommended that single intravenous administration of vitamin C during the perioperative period may achieve better pain relief for patients after THA. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects of oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) in the treatment of degenerative disc disease of the lumbar spine. Method: This was a retrospective study. The clinical data of 80 patients with lumbar disc degenerative disease who underwent surgery in Affiliated Hospital of Beihua University from May 2018 to May 2023 were selected. The patients were divided into LLIF group and OLIF group according to surgical methods. Compare the 36-Item Short- Form Health Survey(SF-36), Visual Analog Scale(VAS) scores, Oswesterly Disability Index(ODI), Japanese Orthopedic Association(JOA) scores, Cobb angle, and intervertebral height changes between two groups of patients pre- and posttreatment, and evaluate the differences in clinical efficacy and surgical complications. Result: Postsurgery, the SF-36 score, VAS score, ODI index, and JOA score of two groups were significantly better than presurgery(p<0.05); After three months of treatment, the improvement in OLIF group was better than LLIF group(p<0.05), while there was no statistically significant difference between the two groups at six months postsurgery(p>0.05). Six months postsurgery, the intervertebral space height and Cobb angle of the two groups were significantly improved compared to presurgery (p<0.05), but there was no significant difference between the groups(p>0.05). There was no difference in clinical efficacy and incidence between the two groups(p>0.05). Conclusion: LLIF and OLIF may be both safe and effective minimally invasive surgical methods for the treatment of degenerative disc disease of the lumbar spine. [ABSTRACT FROM AUTHOR]

Objective: Acetaminophen (Paracetamol) is the most widely used analgesic. We aimed to determine its efficacy in labour with varying pain intensity, to make labour less painful for women. Methods: This randomized controlled trial was conducted on primigravida's in their active phase of first stage of labour at Pharmacology department of Army Medical College, National University of Medical Sciences in collaboration with Gynecology department of Pak Emirates Military hospital, Rawalpindi. It was a registered trial with trial number of IRCT20220308054220N1. Duration of study was from May 2022 to October 2022. Patients were divided into two groups, Group-I received two doses of I/V 100 ml normal saline whereas Group-II received I/V two doses of 1000 mg acetaminophen in 100 ml normal saline. Calculated sample size was 130, 65 in each group. Visual analogue scale was used as a tool for data measurement. Data was analysed using split plot anova test. Results: Mean VAS in acetaminophen infusion group was found to be less than placebo for 1st dose, but this effect was apparent only one hour after 2nd dose intervention. The difference in means between groups was statistically significant only for 1st dose with p-value of 0.003 (for second dose p-value 0.21). In acetaminophen infusion group, for both doses mean VAS decreased as an immediate effect of drug, but then it increased with time. The difference in VAS between intervals had p-value of <0.001 for 1st dose and 0.005 for 2nd dose. Conclusion: Acetaminophen is an effective non opioid labour analgesic in active phase of first stage of labour. [ABSTRACT FROM AUTHOR]

Background: Pain is one of the common postoperative issues that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. It leads to prolonged recovery and sleep disturbances in patients. Aim: This study was conducted to examine the effect of eye mask use on sleep quality and pain in patients undergoing CABG surgery. Study Design: A double‐blind randomized trial design was employed. The study included 60 patients undergoing CABG surgery. They were divided into intervention and control groups through block randomization. Data were collected using a 'Demographic Characteristics Form', the 'Richards‐Campbell Sleep Questionnaire (RCSQ)' and a 'Visual Analogue Scale' (VAS) through face‐to‐face interviews. While patients in the control group received standard care throughout the night, patients in the intervention group received standard care and used eye mask. All patients were followed up for three nights. The CONSORT was used to report the study. Results: The main outcome of the study, the RCSQ score, was higher in the intervention group at baseline. The intervention group had higher RCSQ scores than the control group at time 1 and time 2. There were no differences between the groups in the secondary outcome, pain levels. The control group had higher pain scores at time 1 and time 2 than the intervention group. Conclusion: The use of an eye mask after CABG surgery is an effective, safe and simple nursing intervention to improve sleep quality and control pain. Relevance to Clinical Practice: Because the use of an eye mask is an independent and unique nursing intervention, nurses should be supported and allowed to practise it. [ABSTRACT FROM AUTHOR]

Background: For over 50 years, music therapy and breathing exercises have been widely utilized as interventions to help individuals cope with fatigue, stress and pain globally. Aim: To analyse the effects of music and breathing exercises on anxiety and pain in patients undergoing coronary angiography. Study Design: This is a single‐blind, randomized controlled trial. The sample comprised 165 patients: 55 in the control group, 55 in the breathing exercise group and 55 in the music therapy group. Patients in the music group listened to music during angiography, those in the breathing exercise group practised exercises 30 min before the procedure and the control group received standard treatment. Anxiety levels were assessed before and after the procedure, and pain levels were measured post‐procedure. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized trials was used to guide reporting. Results: Anxiety scores rose significantly in the control group from 33.9 ± 4.2 pre‐angiography to 37.7 ± 4.9 post‐angiography. Conversely, the breathing group's anxiety scores decreased from 34.3 ± 3.5 before angiography to 31.7 ± 1.5 after angiography, and the music group exhibited a reduction from 32.3 ± 3.6 to 30.8 ± 1.6. Post‐angiography, the control group reported a mean pain score of 64 ± 0.8 mm, while the breathing and music groups had significantly lower scores of 35 ± 0.6 and 29 ± 0.8 mm, respectively. Statistical analysis showed a highly significant difference in pain scores between the intervention and control groups. Conclusions: This study provides support for the beneficial effects of employing breathing exercises and music in alleviating pain and anxiety during coronary angiography procedures. Relevance to Clinical Practice: Integrating these findings into clinical practice could be significant for improving patients' pain experiences and anxiety, enhancing the tolerance of invasive medical procedures. [ABSTRACT FROM AUTHOR]

Extreme lateral interbody fusion (XLIF) has been established as an effective treatment for degenerative disorders of the lumbar spine. Nevertheless, there is a potential risk of lumbar plexus damage associated with XLIF, especially during surgeries at the L4–5 segment. Diffusion tensor imaging (DTI) evaluates the directional diffusion of water molecules in tissue, providing a more intricate depiction of internal tissue microstructure compared to conventional MRI techniques. The capability of DTI sequences to elucidate the 3-dimensional interplay between lumbar nerve pathways and adjacent musculoskeletal structures, potentially reducing the incidence of nerve injury complications related to XLIF, remains to be established. This study evaluates the effectiveness of preoperative DTI in reducing neurological complications after XLIF surgeries at the L4-5 level, focusing on the interaction between lumbar nerves and the psoas major muscle. Retrospective case-control study. The study included 128 patients undergoing XLIF surgery for degenerative disorders at the L4-5 segment: 68 in the traditional group and 62 in the DTI group. The study assessed Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores, along with complication rates. It also documented psoas major muscle morphology and its correlation with nerve pathways. A retrospective analysis of 128 patients undergoing XLIF surgery for degenerative disorders at the L4–5 segment between February 2020 and August 2022 was conducted. The cohort was divided into a traditional group (68 patients) receiving presurgery MRI scans to identify surgical entry points at the intervertebral space midpoint (Zones II–III junction) and a DTI group (62 patients) who additionally underwent preoperative DTI to customize entry points. The study evaluated VAS and ODI scores, complication rates, psoas major muscle morphology, and its interaction with nerve pathways. The traditional group uniformly chose the Zone II–III junction for entry. In contrast, the DTI group's entry points varied. Postoperative follow-up revealed significant improvements in VAS and ODI scores in both groups. However, the DTI group experienced fewer immediate postoperative complications such as thigh pain, numbness, and motor disturbances. The study also noted a ventral shift in nerve positioning in patients with elevated psoas muscles. Preoperative DTI effectively maps the relationship between the psoas major muscle and lumbar nerves. Tailoring surgical entry points based on DTI results significantly reduces the risk of nerve damage in XLIF surgeries. The study underscores the importance of recognizing variability in lumbar nerve pathways due to differing psoas muscle morphologies, highlighting a higher risk of nerve injury in patients with elevated psoas muscles during XLIF procedures. [ABSTRACT FROM AUTHOR]

Previous research has identified a specific subtype known as failure of pelvic compensation (FPC) in patients with adult spinal deformity (ASD). However, the criteria for assessing FPC remain inconsistent, and its impacts on spinal sagittal alignment and health-related quality-of-life (HRQoL) scores remain unclear. To propose a novel criterion for identifying FPC based on variations in spinopelvic alignment during the transition from the supine to upright position and to evaluate the effects of FPC on patients' spinal sagittal alignment and HRQoL scores. Retrospective cross-sectional study. Patients with ASD from a monocenter database. Radiographic measures, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt, pelvic incidence (PI), and sagittal vertical axis (SVA), were measured on lateral whole-spine radiographs. LL and SS were also measured on reconstructed lumbar computed tomography images in the sagittal view taken in the supine position. The relative functional cross-sectional area (rFCSA) of paraspinal muscles was evaluated via lumbar magnetic resonance imaging. HRQoL measures, encompassing visual analog scale for back pain (VAS-BP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22R (SRS-22R), were collected. A total of 154 patients were enrolled. Based on the calculated minimum detectable change of SS, FPC was defined as the change in SS of less than 3.4° between supine and upright positions. Patients were divided into 3 groups: sagittal balance with pelvic compensation (SI-PC), sagittal imbalance with pelvic compensation (SI-PC), and sagittal imbalance with failure of pelvic compensation (SI-FPC). Radiographic parameters and HRQoL scores were compared among the groups. Thirty-six patients were categorized into the SB-PC group, 87 into the SI-PC group, and 31 into the SI-FPC group. Patients with low PI and small paraspinal muscles rFCSA were more prone to experiencing FPC accompanied by severe sagittal imbalance. The SI-FPC group exhibited less TK and a larger SS than the SI-PC group exhibited and had a similar SVA as that of the SI-PC group. Additionally, they displayed worse VAS-BP, ODI, SRS-function, and SRS-22 total scores than the SB-PC group displayed. In patients with ASD, an inherently low pelvic compensatory reserve and a high fatty infiltration in paraspinal muscles are pivotal factors contributing to FPC. Compared with SI-PC patients, SI-FPC patients demonstrate a thoracic-dominant compensatory pattern for sagittal malalignment. In addition, these patients experienced more severe pain and functional decline than the SB-PC patients experienced. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the benefits of combining omalizumab with specific immunotherapy (SCIT) in the treatment of children with bronchial asthma. Methods: In this study, 83 children with asthma were treated at the Allergy Department of Qingdao University from January 2019 to February 2020. Participants were divided into three groups: SCIT, combination (omalizumab + SCIT), and control (standard asthma medications). We assessed Asthma Control Questionnaire (ACQ) scores, Visual Analogue Scale (VAS) scores, and lung function at baseline, 24 wk, and 48 wk. Additionally, asthma medication scores were compared at 24 and 48 wk. Adverse reactions were monitored in both the SCIT and combination groups. Results: The combination group demonstrated lower ACQ scores at both 24 and 48 wk, and improved VAS scores at 48 wk compared to the other groups. Additionally, lung function parameters (FEV1 and FEF50) showed significant improvement in the combination group. Reduced asthma medication scores were noted in the combination group at 24 and 48 wk. Local adverse reactions were fewer in the combination group, and no systemic adverse reactions were reported. Conclusion: Combining omalizumab with SCIT provides quicker asthma control, lowers medication requirements, and enhances lung function with fewer adverse effects, making it a safe and effective treatment for children with bronchial asthma. [ABSTRACT FROM AUTHOR]

Purpose: To estimate long-term prognosis of chemosensory dysfunctions among patients recovering from COVID-19 disease. Methods: Between April 2020 and July 2022, we conducted a prospective, observational study enrolling 48 patients who experienced smell and/or taste dysfunction during the acute-phase of COVID-19. Patients were evaluated for chemosensory function up to 24 months after disease onset. Results: During the acute-phase of COVID-19, 80% of patients reported anosmia, 15% hyposmia, 63% ageusia, and 33% hypogeusia. At two years' follow-up, 53% still experienced smell impairment, and 42% suffered from taste impairment. Moreover, 63% of patients who reported parosmia remained with olfactory disturbance. Interestingly, we found a negative correlation between visual analogue scale scores for smell and taste impairments during the acute-phase of COVID-19 and the likelihood of long-term recovery. Conclusion: Our study sheds light on the natural history and long-term follow-up of chemosensory dysfunction in patients recovering from COVID-19 disease. Most patients who initially suffered from smell and/or taste disturbance did not reach full recovery after 2 years follow-up. The severity of impairment may serve as a prognostic indicator for full recovery. [ABSTRACT FROM AUTHOR]

Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed. Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons' Intermacs registry were studied. Cox proportional hazard multivariable analyses incorporating AEs as time-varying covariates for mortality out to 180 days was used to generate the INtermacs Short term composITE quality score (INSITE score derivation), reflecting the adjusted hazard ratio (HR) for mortality contributed by each AE, applying the global ranking methodology. In those alive and on support at 6 months, multivariable logistic regression (odds ratio) was used to examine the impact of AEs on health-related quality of life (QOL) at 180 days, captured through the INSITE-QOL score. Failure to achieve ≥1 point increase in visual analog scale from baseline was the event. Of 13,148 patients, 4,389 (33.4%) suffered at least 1 AE or death through 180 days. Stroke (survival: HR 13.1; QOL: HR 1.7), dialysis (survival: HR 31.4; QOL: HR 4.2), prolonged respiratory failure (survival: HR 5.7; QOL: HR 2.3), reoperation (survival: HR 3.4; QOL: HR 1.6), and right heart failure (survival: 5.0; QOL: HR 1.4), contributed to both mortality and failure to improve QOL at 180 days (all p < 0.05). The median INSITE and INSITE-QOL scores were 0.0 [0.0, 1.6] and 0.0 [0.0, 0.0], respectively. At 9.4% (n = 17) of centers, a high INSITE score (≥13) was present in 15% of patients, while the top 25% of centers had perfect INSITE-QOL scores in at least 75% of patients. AEs after LVAD confer differential impact on mortality and QOL, enabling the development of global rank outcome scores. Given the high mortality hazard conferred by 180-day AEs, center-specific quality interventions aimed at reducing early complications provide the greatest opportunity to improve long-term survival and QOL. [Display omitted] [ABSTRACT FROM AUTHOR]

The article discusses the use of cryoinflation with liquid nitrogen as an alternative treatment for fistulas in hidradenitis suppurativa (HS). The study evaluated the efficacy and tolerability of cryoinflation in HS tunnels, showing promising results in terms of clinical improvement and ultrasound parameters. The procedure was well-tolerated by patients and demonstrated potential as a non-invasive therapy for HS tunnels, warranting further research to confirm its effectiveness. [Extracted from the article]

Objective: A recent study was designed to ascertain the impact of extracorporeal shock wave therapy on upper trapezius trigger points in cervicogenic headaches patients. Design: A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20–40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (4 wks). Results: There was a significant difference of headache disability index, visual analog scale scores, and upper trapezius electromyographic characteristics with P value <0.05 in both groups, in favor of the shock wave group. Conclusions: Extracorporeal shock wave therapy could be used for clinical and research concerns because its positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients. [ABSTRACT FROM AUTHOR]

Objective: To provide a strong foundation for the use of high-intensity laser therapy in carpel tunnel syndrome, we conducted a systematic review and meta-analysis to investigate the outcomes of short- and long-term follow-up studies. Design: This is a systematic review and meta-analysis. Results: Sample sizes of included studies ranged from 16 to 98 patients (N = 308). Overall, a significant difference between the treatment and control groups were found across majority of the measures. Studies using a 4-wk follow-up period, however, only found significantly greater benefits for high-intensity laser therapy in visual analog scale compared with placebo (P = 0.0191), transcutaneous electrical nerve stimulation (P = 0.0026), and low-intensity laser therapy 20 J/cm2 (P < 0.0002), and exercise (P < 0.0001). For improvement in visual analog scale score over a long treatment period, high-intensity laser therapy was also preferred over control group (P < 0.0071). Insufficient evidence exists to determine effect of high-intensity laser therapy on nerve conduction examinations. The only statistically significant differences observed in examinations were in relation to sensory nerve action potential (P = 0.0083) and sensory nerve conduction velocity (P = 0.0468). Conclusions: Moderate evidence exists regarding efficacy of high-intensity laser therapy compared with placebo, high-intensity laser therapy + wrist splint, and exercise in a short period of follow-up time but evidence on long-term follow-up is limited. [ABSTRACT FROM AUTHOR]

Purpose: There have been no adequate comparisons of the efficacy, safety, and efficiency of analgesia after laparoscopic colorectal resection (LAC), with and without epidural anesthesia (EDA). Methods: This was a multicenter prospective observational study of patients undergoing LAC. The primary end point was the mean visual analog scale (VAS) score on postoperative days (PODs) 1–7. The secondary end points were the highest VAS, complication rate, days to first ambulation and fatigue, length of hospital stay, and time to commencement of surgery. Results: We compared an EDA group (Group E, n = 48) and a no-EDA group (Group O, n = 48) after matching. The mean VAS was not significantly different between the groups (28.7 vs. 30.1, p = 0.288). On assessing the secondary end points, the highest VAS was not significantly different between the groups. In fact, the VAS was lower in Group E only on POD 2. There was no difference in the incidence of complications, the time to first postoperative evacuation was shorter in Group E, and postoperative hospitalization was similar. The time to surgery was shorter in Group O. Conclusion: These results suggest that LAC without EDA is a feasible option, but with the early and regular use of adjunctive measures to provide more stable analgesia. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the predictive value of illness and treatment beliefs for patient satisfaction and health-related quality of life (HRQOL) in adolescents receiving inpatient rehabilitation treatment. In addition, we examined the relationship between fulfilled rehabilitation-related treatment expectations and patient satisfaction. Method: In this longitudinal study (recruitment between April 2019 and March 2020), 170 participants (M = 14.3 years [SD = 1.6]) answered self-report questionnaires before and at the end of rehabilitation (6 weeks later). We applied multiple hierarchical regression analyses, controlling for sociodemographic and diagnoses variables. Results: The results showed fulfilled expectations of treatment success and sustainability to be a significant predictor of patient satisfaction (p <.01). The illness belief dimension of emotional representation predicted HRQOL (p <.01). Rehabilitation-related treatment beliefs were not predictive of any outcome. Conclusion: This study provides a first insight into the relationships between these constructs in the context of inpatient pediatric rehabilitation. However, future research is needed to further examine illness and treatment beliefs in this specific treatment setting. Practical implications concern the incorporation of children's and adolescents' beliefs into treatment management to optimize rehabilitation outcomes. Impact and Implications: This is the first study that examines the impact of illness beliefs, treatment beliefs, and fulfilled treatment expectations on patient satisfaction and health-related quality of life in adolescents with chronic diseases. While pediatric treatment beliefs have primarily been studied in relation to medication treatment, we captured adolescents' treatment beliefs regarding inpatient rehabilitation treatment with a multidimensional approach. Possible practical implications include the exploration of pediatric patients' treatment expectations at the beginning of rehabilitation, the provision of appropriate information and (if necessary) the correction of unrealistic expectations, as well as interventions addressing children's and adolescents' emotional representations about their illness. [ABSTRACT FROM AUTHOR]

Background Pemphigus is a rare autoimmune blistering disease with potentially life-threatening consequences. Establishing minimal clinically important differences (MCIDs) for disease severity scores like the Pemphigus Disease Area Index (PDAI) is crucial for assessing treatment efficacy. Objectives To calculate MCIDs for both improvement and deterioration in PDAI scores in patients with pemphigus vulgaris (PV) and pemphigus foliaceus (PF), using the anchor-based method. Methods A total of 41 patients with pemphigus were recruited, with 35 meeting the MCID analysis criteria. The anchor-based method was used to calculate MCIDs for PDAI scores against the 15-point Likert scale and the Physician Global Assessment visual analogue scale (PGA-VAS) anchors. Receiver operating characteristic curves were employed to determine optimal MCID cutpoints with the highest Youden Index (J). The 15-point Likert scale scores the change in disease severity spanning from –7 to +7, designed to quantify the extent of disease improvement/deterioration since the preceding visit. Results The MCID for improvement in PDAI activity scores was 2.65 points using the 15-point Likert scale (78.7% correct classification; sensitivity 75.9%; specificity 73.5%) and 2.5 points using the PGA-VAS as the anchor (78.0% correct classification; sensitivity 84.4%; specificity 68.2%). Given the slightly higher correct classification rate using the 15-point Likert scale anchor, the MCID of 2.65 points was selected for PDAI activity score improvement. In contrast, the MCID for deterioration consistently remained at 2.5 points for the 15-point Likert scale anchor (81.0% correct classification; sensitivity 72.7%; specificity 81.0%) and 2.5 points for the PGA-VAS anchor (70.9% correct classification; sensitivity 69.6%; specificity 76.9%). Conclusions This study marks the inaugural attempt at MCID determination for PDAI scores in pemphigus, filling a critical knowledge gap. The study's calculated MCIDs provide essential benchmarks for clinical trials, treatment evaluation and research design optimization. Future studies should explore international collaborations, to examine potential cross-cultural variations in MCIDs. [ABSTRACT FROM AUTHOR]

Background: Hyperkeratotic hand and foot dermatitis significantly affects quality of life. Some patients respond suboptimally to topical corticosteroids and have multiple recurrences. Objective: Our aim was to compare the efficacy and safety profile of apremilast and topical corticosteroid versus corticosteroid alone in hyperkeratotic hand and foot dermatitis. Methods: This randomized controlled study involved 77 patients treated for 3 months. Group A (39 patients) received mometasone furoate 0.1% cream with oral apremilast 30 mg twice daily, and Group B (38 patients) received mometasone alone. They were assessed monthly using the Hand Eczema Clinical Severity Index (HECSI) and Visual Analogue Scale (VAS) scores for pruritus. Investigator Global Assessment (IGA) and Quality of Life in Hand Eczema Questionnaire (QOLHEQ) were conducted at the end of 3 months. Results: The HECSI, VAS score, and QOLHEQ showed a significant decrease in both groups from baseline to the third month. Intergroup comparisons of HECSI failed to reach the significance level. When compared, patients receiving apremilast had significantly better improvement in the third month according to the Patient Global Assessment (PGA) and Investigator Global Assessment (IGA). They also had a smaller number of flares. Conclusion: Adding apremilast to topical corticosteroid leads to better patient and physician‐perceived improvement and reduces the number of flares in hyperkeratotic hand eczema. [ABSTRACT FROM AUTHOR]

Objective: The impact of a transversus abdominis plane (TAP) block in patients undergoing cesarean section requires further evaluation. The aim of this study was to compare postoperative pain scores and opioid use in cesarean surgery patients undergoing either a TAP block and scheduled multimodal pain management (SMPM) or SMPM alone. Methods: In this retrospective, dual cohort study, cesarean surgery patients underwent neuraxial anesthesia and a TAP block (SMPM/TAP) or SMPM; the TAP block incorporated ropivacaine (20–30 mL) administered bilaterally. The group analyses involved a comparison of postoperative pain scores using the visual analog scale and opioid consumption at 24 and 24–48 h. Results: There were 94 (52.8%) patients in the SMPM/TAP group and 84 (47.2%) subjects in the SMPM alone group. At 24 h postoperatively, the SMPM/TAP group exhibited significantly lower pain scores (4.07 vs 4.54) than the SMPM group (P < 0.001) and reduced opioid consumption (2.29 vs 3.28 mg; P < 0.001). However, at 24–48 h, the SMPM group demonstrated lower pain scores (5.46 vs 5.98) compared to the SMPM/TAP group (P < 0.001) and reduced opioid consumption (8.75 vs 10.21 mg; P < 0.001); overall opioid consumption was higher (12.50 vs 12.02 mg) in the SMPM/TAP group (P < 0.001). Conclusion: The TAP block improved cesarean surgery patients' pain scores and reduced opioid consumption at 24 h postoperatively but the effect of the TAP block was ephemeral as the SMPM/TAP group exhibited inferior pain scores and greater opioid consumption compared to the SMPM group at 24–48 h postoperatively. Synopsis: A TAP block is potentially an effective adjunct to neuraxial anesthesia in endeavoring to reduce postoperative pain and opioid consumption for patients undergoing cesarean section. [ABSTRACT FROM AUTHOR]

Purpose: Arthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV. Methods: A retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed. Result: A total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%. Conclusions: MPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions. Level of evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Purpose: Hip arthroscopy is effective in treating bordline developmental dysplasia of the hip (BDDH), but there are only a few clinical reports in China, and its postoperative failure rate is still a problem that cannot be ignored. The aim of this study was to analyze the clinical effect of hip arthroscopy in BDDH treatment in China and to explore the risk factors influencing the efficacy of hip arthroscopy in BDDH treatment. Methods: All of 22 cases of BDDH treated with arthroscopy in our hospital from November March 2017 to February 2022 were analyzed retrospectively, including ten males and 12 females, with an average age of 34.7 ± 9.5 years (19–53 years). All patients underwent arthroscopic treatment with acetabular plasty, labral repair, femoral osteoplasty, and capsular plication. Visual Analogue Scale (VAS), modified Harris Hip Scores (mHHS), Hip Outcome Score—activities of Daily Living (HOS-ADL) and International Hip Outcome Tool-12 (iHOT-12) were measured before operation and at the follow-up, and statistical analysis was performed. The Minimum clinically significant difference (MCID) and Patient Acceptable Symptom State (PASS) were also obtained. Results: 22 patients were followed up, and the follow-up time was ≥ one year, with an average of 21.4 ± 8.2 months. The VAS score decreased from 5.27 ± 1.58 points before surgery to 1.96 ± 0.92 points at the follow-up, and the difference was statistically significant (t = 9.05,P < 0.001). The mHHS score increased from 64.84 ± 13.58 points before surgery to 90.4 ± 10.11 points at the follow-up, and the difference was statistically significant (t=-7.07, P < 0.001). The HOS-ADL score increased from 68.92 ± 11.76 points before surgery to 88.91 ± 9.51 points at the follow-up, and the difference was statistically significant (t=-8.15,P < 0.001). The iHOT-12 score increased from 49.32 ± 12.01 points before surgery to 79.61 ± 15.89 points at the follow-up, and the difference was statistically significant (t=-7.66,P < 0.001). The MCID (mHHS) and MCID (HOS-ADL) were 81.8% and 77.3% respectively, and the PASS (mHHS) and PASS (HOS-ADL) were 86.4% and 72.7% respectively at the follow-up. Conclusion: Hip arthroscopy can achieve good short-term outcomes in the treatment of BDDH. Level of evidence: IV Therapeutic Study. [ABSTRACT FROM AUTHOR]