EVALUATION OF INTRAOPERATIVE PAIN OCCURRENCE AND NEED FOR SUPPLEMENTAL ANESTHESIA DURING EMERGENCY DENTAL CARE

Aims: This study aimed to evaluate the intraoperative pain (IOP) occurrence in situations of symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP). Materials and Methods: Patients who sought emergency care presenting a diagnosis of SIP or SAP were included. IOP was measured with a Visual Analogue Scale (VAS) after five minutes of local anesthesia, during access to the pulp chamber, root canal exploration and at the end of procedures. In cases where pain was reported during treatment, supplementary anesthesia was performed. Pain scores were recorded and analyzed using a generalized estimating equation model with posthoc comparisons. Results: 56 patients were included. 35 had a diagnosis of SIP; and 21 a diagnosis of SAP. Mean preoperative pain scores for SAP and SIP were 6.69 (±1.54) and 6.39 (±1.48), respectively (p>0.05). In patients with SIP, significant differences were observed between: preoperative scores and other time points; scores after five minutes of local anesthesia and other time points; scores during pulp chamber access and at the end of procedures; and scores during root canal exploration and at the end of procedures (p<0.05). In patients with SAP, significant differences were observed between preoperative pain scores with all other time points (p<0.05). Chi-square test indicated an association between diagnosis and the need for supplementary anesthesia (p<0.05). Conclusions: In conclusion, there is a strong relationship between reduction of moderate/severe pain after application of local anesthesia. The need for supplemental anesthesia is significantly associated to the diagnosis of symptomatic irreversible pulpitis.

Surveying Colombian Speech-Language Pathologists on their Reported Training & Practices of Auditory-Perceptual Evaluation of Voice

Objective: To explore the training and use of auditory perceptual evaluation of the voice reported by Colombian speech-language pathologists. Study Design: Cross-sectional observational research with a quantitative approach. Methods: A digital questionnaire was designed and distributed to gather information regarding professionals' training process and implementation of auditory-perceptual evaluation procedures. Descriptive statistics were applied, and several generalized linear models were adjusted to determine the influence of certain variables on others. Results: The survey received responses from 40 speech-language pathologists, revealing that the most used scales for training and evaluating vocal quality within this group are direct magnitude estimations (82.5% and 77.5%). Similarly, in this group, the tasks most frequently used to train and use as an evaluation strategy are vowel assessments (38%) followed by spontaneous speech (30%). Practitioners of this group were mostly trained using a conceptual framework involving multiple exposures to rating (42.5%). The use of direct magnitude estimation in training with a normal voice showed significance (p = 0.015), as did the use of the vowel /i/ in training with an equal-appearing interval (p = 0.013). The statistical models relating the scale used to the scale on which participants were trained were also significant (p < 0.05). Conclusions: The GRBAS scale is the training tool most used by the group of speech-language pathologists of the study group in Colombia. Future efforts should focus on improving training practices for auditory-perceptual evaluation, exploring alternative conceptual frameworks, and incorporating external references to enhance validity and reliability.

Objetivo: Explorar los reportes de fonoaudiólogos colombianos acerca del entrenamiento y uso de la evaluación perceptual auditiva de la voz. Diseño de estudio: Se eligió un diseño de investigación observacional transversal con un enfoque cuantitativo. Metodología: Se diseñó y distribuyó un cuestionario digital para recopilar información sobre el proceso de formación de los profesionales y la implementación de procedimientos de evaluación perceptual auditiva. Se aplicaron estadísticas descriptivas y se ajustaron varios modelos lineales generalizados para determinar la influencia de ciertas variables en otras. Resultados: La encuesta recibió respuestas de 40 fonoaudiólogos, revelando que las escalas más utilizadas para la formación y la evaluación de la calidad vocal en el grupo son las estimaciones de magnitud directa (82.5% y 77.5%). Del mismo modo, en este grupo las tareas más frecuentemente utilizadas para la formación y el uso como estrategia de evaluación son las vocales (38%), seguidas por el habla espontánea (30%). La mayoría de los profesionales del grupo fueron formados utilizando un marco conceptual que involucra múltiples exposiciones a la calificación (42.5%). El uso de la estimación de magnitud directa en la formación con una voz normal mostró significancia (p = 0.015), al igual que el uso de la vocal /i/ en la formación con intervalos de igual apariencia (p = 0.013). Los modelos estadísticos que relacionan la escala utilizada con la escala en la que los participantes fueron entrenados también fueron significativos (p < 0.05). Conclusiones: La escala GRBAS es la herramienta de formación más utilizada por el grupo de fonoaudiólogos del estudio. Los esfuerzos futuros deberían centrarse en mejorar las prácticas de formación para la evaluación perceptual auditiva, explorar marcos conceptuales alternativos e incorporar referencias externas para mejorar la validez y la confiabilidad.

Complicaciones y mortalidad en pacientes neurocríticos / Complications and mortality in neurocritic patients

Objetivo: Relacionar las complicaciones y el riesgo de muerte en pacientes neurocríticos admitidos en la unidad de cuidados intensivos (UCI) del Hospital Universitario de Caracas durante un período de 5 meses. Métodos: investigación observacional, prospectiva, descriptiva. La muestra estuvo conformada por 65 pacientes neurocríticos, ≥ 18 años, con patologías médicas o quirúrgicas, ingresados en la UCI. El análisis estadístico incluyó la determinación de frecuencias, promedios, porcentajes y medias para descripción de variables y el T de Student. Resultados: La edad promedio fue 50,98 ± 16,66 años; la población masculinarepresentó el 50,76%. Entre las complicaciones, la mayor incidencia correspondió a las no infecciosas (70,77 %) y los trastornos ácido-básicos de tipo metabólico, la anemia y las alteraciones electrolíticas fueron las más frecuentes; el 29,23% de los pacientes presentaron complicaciones infecciosas, y la neumonía asociada a ventilación mecánica fue la más frecuente (73,91 %). La comorbilidad con mayor incidencia fue hipertensión arterial sistémica (53,84%). El 90.70% requirió ventilación mecánica y el tiempo en VM fue 4.29 ± 6.43 días. La estancia en UCI fue 5.96 ± 7.72 días. El 29,23% presentó un puntaje en la escala APACHE II entre 5-9; el SAPS II presentó mayor incidencia entre los 6-21 y 22-37 puntos con (66,70%); el SOFA al ingreso se reportó < 15 puntos en 98,46% y > 15 en 1,53%. La mortalidad del grupo fue 23,08 % (n=15). Conclusiones: Las complicaciones no infecciosas predominaron sobre las infecciosas las primeras íntimamente relacionadas con la mortalida(AU)

Objective: To relate complications and the risk of death in neurocritical patients admitted to the intensive care unit (ICU) of the University Hospital of Caracas during a period of 5 months. Methods: observational, prospective, descriptive research. The sample was made up of 65 neurocritical patients, ≥ 18 years old, with medical or surgical pathologies, admitted to the ICU.The statistical analysis included the determination of frequencies, averages, percentages and meansfor description of variables and Student's T.Results: The average age was 50.98 ± 16.66 years; the male population represented 50.76%. Among the complications, the highest incidence corresponded to non-infectious complications (70.77%) and metabolic acid-base disorders, anemia and electrolyte alterations were the most frequent; 29.23% of patients presented infectious complications, and pneumonia associated with mechanical ventilation was the most frequent (73.91%). The comorbidity with the highest incidence was systemic arterial hypertension (53.84%), 90.70% required mechanical ventilation and the time on MV was 4.29 ± 6.43 days. The ICU stay was 5.96 ± 7.72 days. 29.23% had a score on the APACHE II scale between 5-9; SAPS II presented the highest incidence between 6-21 and 22-37 points with (66.70%); The SOFA upon admission was reported to be < 15 points in 98.46% and > 15 in 1.53%. The mortality of the group was 23.08% (n=15). Conclusions: Non-infectious complications predominated over infectious complications, the former being closely related to mortalit(AU)

Relación entre índice cintura cadera, índice cintura talla y la Escala FINDRISC en adultos de Guatemala / Relationship between waist-hip index, waist-height index and the FINDRISC Scale in adults from Guatemala

La diabetes mellitus tipo 2 (DM2) es una amenaza para la salud por las complicaciones derivadas de un diagnóstico tardío, donde la identificación oportuna es primordial. Con el objetivo de establecer la relación entre índice cintura talla (ICT), índice cintura cadera (ICC) y puntaje de la escala FINDRISC (Finnish Diabetes Risk Score) como determinantes del riesgo de padecer DM2 a largo plazo, se realizó este estudio predictivo transversal con adultos de 18 y 60 años atendidos en el Centro de Salud Primero de Julio del municipio de Mixco, Guatemala. Participaron 80 adultos, seleccionados por un muestreo aleatorio simple. El instrumento de recolección de datos estuvo conformado por tres secciones: información general de la persona, parámetros antropométricos y la encuesta de FINDRISC. Se generaron modelos lineales generalizados para identificar relaciones entre índice cintura talla (ICT), índice cintura cadera (ICC) y puntaje de la escala FINDRISC (Finnish Diabetes Risk Score). El 36.2% presentó riesgo de desarrollar DM2 a largo plazo; encontrándose un 21.2% en el nivel de riesgo alto y muy alto. Se comprobó que únicamente existe relación significativa entre el ICT y el puntaje de la escala de FINDRISC como determinante del riesgo de padecer DM2 a largo plazo. Se concluye que la implementación de la medición del ICT constituye una herramienta útil para identificar personas con riesgo de desarrollar DM2, siendo su aplicación sencilla, no invasiva, económica y de fácil acceso en los servicios de salud.

Type 2 diabetes mellitus (T2DM) is a health threat due to the complications derived from a late diagnosis, where timely identification is essential. This study aimed to establish the relationship between waist-height index (WHR), waist-hip index (WHR) and the FINDRISC (Finnish Diabetes Risk Score)scale as determinants of the risk of suffering from T2DM in the long term. A cross-sectional predictive study was carried out with a simple random sample of 80 adults between 18 and 60 years old treated at the Primero de Julio Health Center in Mixco, Guatemala. The data collection instrument was structured into three sections: general information, anthropometric parameters and the FINDRISC survey. Generalized linear models were generated to identify relationships between waist-height ratio (WHR), waist-hip ratio (WHR) and the FINDRISC scale score (Finish Diabetes Risk Score). The results shows that 36.2% of the participants were at risk of developing T2DM in the long term; 21.2% being at the high and very high risk level. It was found that there is only a significant relationship between the WHR and the FINDRISC scale score as a determinant of the risk of suffering from T2DM in the long term. The implementation of the waist height index measurement constitutes a useful tool to identify people at risk of developing T2DM, its application being simple, non-invasive, economical and easily accessible in health services.

Evaluación del riesgo de caídas en adultos mayores con Diabetes Mellitus tipo 2 / Evaluation of fall risk assessmentin in older adults with Type 2 Diabetes Mellitus / Avaliação do risco de quedas em idosos com Diabetes Mellitus tipo 2

Introducción: La diabetes mellitus 2 es una enfermedad frecuente en adultos mayores, con múltiples complicaciones que pueden llegar a afectar el equilibrio y la marcha e incrementar el riesgo de caída. Objetivo: Determinar el riesgo de caídas en dos grupos de adultos mayores, uno con padecimiento de DM2 y otro sin este padecimiento. Metodología: Estudio de enfoque cuantitativo, alcance descriptivo, diseño observacional, y de cohorte transversal; muestra poblacional de 120 adultos mayores en la ciudad de Guayaquil divididos en dos grupos: grupo A con 60 adultos mayores que no padecían DM2 y grupo B con 60 adultos mayores con DM2; que cumplen con los criterios de inclusión y a quienes se evalúan mediante las técnicas: observación, evaluación y entrevista; y los instrumentos: Escala de Berg, Mini-BESTest y formulario estándar. Se utilizó la prueba estadística Chi cuadrado para la comparación de los resultados obtenidos. Resultados: Los resultados indican que, en la determinación del riesgo de caídas, se encontraron diferencias estadísticamente significativas (p0.05). El estudio además encontró que los resultados obtenidos, en las dos pruebas de riesgo de caídas, difieren entre sí. Conclusiones: Los adultos mayores diabéticos presentan un mayor riesgo de caída a comparación de adultos mayores no diabéticos.

Introduction: Diabetes mellitus 2 is a common disease in older adults, with multiple complications that can affect balance and gait and increase the risk of falling. Objective: To determine the risk of falls in two groups of older adults, one with and the other without DM2. Methodology: Quantitative approach study, descriptive scope, observational design, and cross-sectional cohort; population sample of 120 older adults in the city of Guayaquil divided into two groups: group A with 60 older adults who did not suffer from DM2 and group B with 60 older adults with DM2; who meet the inclusion criteria and who are evaluated by means of the techniques: observation, evaluation and interview; and the instruments: Berg scale, Mini-BESTestest and standard form. The Chi-square statistical test was used to compare the results obtained. Results: The results indicate that, in the determination of the risk of falls, statistically significant differences (p0.05) were found. The study further found that the results obtained, in the two fall risk tests, differed from each other. Conclusions: Diabetic older adults present a higher risk of falling compared to non-diabetic older adults.

Introdução: O diabetes mellitus tipo 2 é uma doença comum em idosos, com múltiplas complicações que podem afetar o equilíbrio e a marcha e aumentar o risco de quedas. Objetivo: Determinar o risco de quedas em dois grupos de idosos, um com DM2 e outro sem essa condição. Metodologia: Estudo com abordagem quantitativa, escopo descritivo, desenho observacional e coorte transversal; amostra populacional de 120 idosos da cidade de Guayaquil dividida em dois grupos: grupo A com 60 idosos que não sofriam de DM2 e grupo B com 60 idosos com DM2; que atendam aos critérios de inclusão e que sejam avaliados pelas técnicas: observação, avaliação e entrevista; e os instrumentos: Escala de Berg, Mini-BESTest e formulário padrão. O teste estatístico Qui-quadrado foi utilizado para comparação dos resultados obtidos. Resultados: Os resultados indicam que, na determinação do risco de quedas, foram encontradas diferenças estatisticamente significativas (p0,05). O estudo também constatou que os resultados obtidos nos dois testes de risco de queda diferem entre si. Conclusões: Idosos diabéticos apresentam maior risco de queda em comparação aos idosos não diabéticos.

Cobertura de MRS e indicación de terapia hormonal en Pedro Aguirre Cerda, septiembre de 2019 / MRS coverage and hormone replacement therapy indication at Pedro Aguirre Cerda, September 2019

Introducción: El envejecimiento de la población en todo el mundo es un fenómeno progresivo y Chile no se queda atrás frente a esto. Actualmente existe un subprograma de climaterio mujeres entre los 45 a 64 años, que presenta diversas acciones y propósitos. Objetivo: Describir la cobertura de la aplicación de la Menopause Rating Scale (MRS) e indicación de terapia de reemplazo hormonal en mujeres inscritas en los CESFAM de la comuna de Pedro Aguirre Cerda. Método: Descriptivo transversal. Resultados: La cobertura de aplicación de MRS en mujeres entre 45-64 años fue de un 62,6%. Un 34,3% de mujeres presentaron un puntaje MRS alterado, indicándose terapia hormonal en un 37,8% de los casos, en las indicaciones un 21,8% eran usuarias candidatas acorde a criterios médicos y un 78,2% no lo eran. Conclusiones: Se debe aumentar la cobertura de MRS y recursos para exámenes de laboratorio, de imágenes y capacitaciones, esto para mejorar la entrega de las prestaciones en el subprograma climaterio.

Introduction: The aging of the population worldwide is a progressive phenomenon and Chile is not lagging behind in this. Currently, there is a climacteric subprogram for women between 45 and 64 years of age, which has various actions and purposes. Objective: To describe the coverage of the application of the Menopause Rating Scale (MRS) and indication of hormone replacement therapy in women enrolled in the CESFAM of the commune of Pedro Aguirre Cerda. Method: Cross-sectional descriptive study. Results: The coverage of the MRS application in women between 45-64 years old was 62.6%. A 34.3% of women presented an altered MRS score, indicating hormone therapy in 37.8% of the cases, 21.8% of the indications were candidates according to medical criteria and 78.2% were not. Conclusions: There is a lack of labs and images tests in the climacteric controls, resulting in a mayor number of women no candidates to the hormonal therapy according to medical criteria.

Study advances in analgesic management in severe patients after neurosurgery / 重庆医学

Analgesia is an important link in the treatment of severe patients after neurosurgery and plays a vital role in improving the prognosis of the patients.Understanding the status quo and influencing fac-tors of pain in severe patients after neurosurgery helps to predict the occurrence of pain,which is crucial for determining the new pain assessment methods and auxiliary analgesic methods and developing novel analgesic drugs.This paper reviews the pain status,pain evaluation and analgesic methods of severe patients after neuro-surgery in recent years so as to understand the pain management current status of the patients with severe neurological conditions and provide reference for the medical staff to implement the analgesic programs.

Exploration of correlation between multiple subjective and objective evaluation indicators in early stage with recovery time in combination of acupuncture and medication for treating facial neuritis / 重庆医学

Objective To analyze the correlation between the multiple evaluation indicators in the early stage and the cure time(needed time from treatment to cure)of the patients with facial neuritis treated by ac-upuncture combined with medication,and to optimize the subjective and objective indicators enable predicting the cure time of facial neuritis in early stage.Methods All patients were treated by acupuncture and medica-tion combination.The research subjects were 64 patients with facial neuritis from the outpatient of cupuncture and moxibustion department of this hospital.The correlation between the grade of facial nerve paralysis,sur-face electromyography related data,scores of self-made symptom scoring scale,Sunnybrook Facial Grading System(SFGS)score,Facial Disability Index-Physical(FDIP)score,Facial Disability Index-Social(FDIS)score on 7 d of onset with the cure time was analyzed.Results The cure time was positively correlated with the grade of facial nerve paralysis and FDIS score on 7 d of onset(P＜0.01),amd negatively correlated with the scores of self-made symptom scoring scale,FDIP score,SFGS score and the affected side to healthy ratio of CMAP amplitude of buccal temporal branch of facial nerve(P＜0.01 or P＜0.05);the cure time had no sig-nificant correlation with the ratio of affected side and healthy side of CMAP amplitude in zygomatic branch of facial nerve,the ratio of affected side and healthy side of CMAP latent period of temporal branch,buccal branch and zygomatic branch of facial nerve and F wave output rate(P＞0.05).Conclusion In the early stage subjective indicators of the acupuncture combined with medication for treating facial neuritis,grade of facial nerve paralysis,self-made symptom scoring scale,scores of self-made symptom scoring scale,FDIP and FDIS scores and the ratio of affected side to healthy side of CMAP amplitude of the buccal branch,temporal branch of the facial nerve in sEMG in the objective indicators could be used to predict the cure time,better guide the treatment and have more effective and accurate comunication with the patients.

Study on the ratio of TNF-α to ADP in patients with depression / 重庆医学

Objective To investigate the changes and clinical significance of serum tumor necrosis fac-tor-α(TNF-α),adiponectin(ADP)and their ratio in patients with depression.Methods A total of 40 patients with depression admitted to Shandong Daizhuang Hospital from January to December 2020 were selected as the observation group,and 26 healthy volunteers were selected as the control group.The observation group was treated with oral antidepressants for four weeks,and the severity of depressive symptoms was assessed by Hamilton depression scale(HAMD).The levels of serum TNF-α and ADP in the observation group before and after treatment and the control group were detected by ELISA,and the change of TNF-α/ADP was ana-lyzed.Results HAMD scores of the observation group were 25.5(21.0,30.0)before treatment and 2.0(1.0,4.0)after treatment,the difference was statistically significant(P<0.05).The levels of TNF-α and TNF-α/ADP in the observation group before treatment were higher than those in the control group,which af-ter treatment were also higher than those before treatment(P<0.05).The level of ADP in the observation group after treatment was lower than that before treatment and in the control group,the differences were sta-tistically significant(P<0.05).Conclusion The level of TNF-α/ADP in patients with depression is more ob-vious than TNF-α.

Clinical Observation on the Abdominal Acupuncture Combined with Acupuncture Method of Zuosheng Youjiang Qi-Regulaton Microneedling in the Treatment of Depression / 广州中医药大学学报

Objective To observe the clinical efficacy of abdominal acupuncture with acupuncture method of Zuosheng Youjiang(left ascending and right descending)Qi-Regulation Microneedling in the treatment of depression.Methods Sixty cases of depression were randomly divided into observation group and control group,30 cases in each group.The observation group was given Zuosheng Youjiang Qi-Regulation Microneedling therapy,and the control group was given oral use of Sertraline Hydrochloride Tablets.A total of 6 weeks of treatment was given.After 6 weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes in Hamilton Depression Scale(HAMD)scores and Self-rating Anxiety Scale of Depression(SAS)scores of the two groups were observed before and after treatment.The safety and the occurrence of adverse reactions in the two groups were evaluated.Results(1)After treatment,the HAMD scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the HAMD scores,and the differences were statistically significant(P＜0.05).The difference between the HAMD scores of patients in the two groups was statistically significant before and after treatment(P＜0.05).(2)After treatment,the SDS scores of the two groups of patients were significantly improved,and the observation group was significantly superior to the control group in improving the SDS scores,and the difference was statistically significant(P＜0.05).The difference between the pre-treatment and post-treatment differences in the SDS scores of the two groups of patients was statistically significant(P＜0.05).(3)The total effective rate of the observation group was 100.00%(30/30),and the control group was 83.33%(25/30).The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(4)There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P＞0.05).Conclusion Abdominal acupuncture combined with Zuosheng Youjiang Qi-Regulation Microneedling for the treatment of depression can significantly improve the clinical symptoms of the patients,and the therapeutic effect is remarkable.

Factor analysis of pain after arthroscopic rotator cuff suture bridge / 解剖学报

Objective To analyze the factors associated with pain after arthroscopic rotator cuff bridge suture.Methods According to the inclusion and exclusion criteria,the data of 112 patients with unilateral rotator cuff injury who received arthroscopic bridge suture in our department were collected and were investigated in the form of telephone follow-up.In this study,SPSS 23.0 was used to input data and conduct statistical analysis.Logistic regression analysis was used to analyze the correlation between the above influencing factors and postoperative pain.Results A total of 112 patients were included for statistical analysis,single factor analysis revealed,including course of disease,smoking history,preoperative University of California,Los Angeles(UCLA)score,Constant score,numeric rating scale(NRS),size of rotator cuff tear,whether it was full-thickness tear and degree of tendon retraction might be related to postoperative pain(P<0.05).The age,gender,body mass index(BMI),drinking history,diabetes and hypertension were not related to postoperative pain(P>0.05).Multiple linear regression analysis concluded that there were four factors related to postoperative pain,and the correlation degree was preoperative NRS,preoperative UCLA score,tear size and smoking history.Conclusion The causes of postoperative pain after arthroscopic rotator cauff repair are complex and diverse.Analyzing the cause of postoperative pain can effectively reduce the pain of patients and promote the recovery of shoulder joint function.

Establishment and assessment of a postoperative delirium risk scale for elderly patients undergoing hip and knee replacement / 临床麻醉学杂志

Objective To construct a risk assessment scale for postoperative delirium(POD)in elderly patients undergoing hip and knee joint replacement and evaluate the effect.Methods A total of 474 elderly patients undergoing hip and knee arthroplasty from March 2021 to May 2022 were collected as the training set,and a total of 153 the homogeneous patients from January 2022 to May 2022 were collected as the validation set.The patients were divided into two groups based on whether or not POD occurred:non-POD group and POD group.Risk factors of POD in the training set were analyzed by univariate analysis and multifactorial logistic regression.The consistency of the model was evaluated by Homser-Lemeshow goodness of fit test.The postoperative delirium risk assessment scale was established after the selected variables as-signed value according to OR value,and the predictive efficacy of the scale was evaluated by receiver oper-ating characteristic(ROC)curve.The patients in the training set and the validation set were divided into two groups according to the cut-off value:high-risk and low-risk.The incidence rate of POD with different risk stratification was calculated and the applicability of the risk assessment scale was evaluated.Results Fifty-eight patients(12.2%)with POD in the training set,and nineteen patients(12.4%)with POD in the validation set.Multifactor logistic regression showed that age≥85 years,ASA physical status Ⅲ or Ⅳ,the mini-mental state examination(MMSE)score≤24 points,preoperative sleep disorder,comorbid neu-rological disorders,use of general anesthesia,and non-use of dexmedetomidine were independent risk factors of POD.The POD risk assessment scale was then published based the seven risk factors.The ROC curve showed that the area under the curve(AUC)for this scale to predict the risk of POD was 0.956(95%CI 0.937-0.975),and the risk stratification was performed with a cut-off value of 44.5 points,which divided the patients into low-risk and high-risk.Compared with low-risk,the incidence rate of POD in high-risk patients group was significantly increased(P＜0.001).Conclusion A risk assessment scale based on the seven risk factors:age≥85 years,ASA physical status Ⅲ or Ⅳ,MMSE score≤24 points,preoperative sleep disorder,combined neurological disease,use of general anesthetic modality,and non-use of dexmedetomidine,can effectively identify elderly patients undergoing hip and knee replacement who are at high risk of developing POD.

Abnormal changes of white matter structure in temporal lobe epilepsy patients with sleep disorders based on diffusion kurtosis imaging / 实用放射学杂志

Objective To investigate the microstructural changes of temporal lobe epilepsy(TLE)in patients with sleep disorders based on diffusion kurtosis imaging(DKI).Methods This research prospectively included 38 TLE patients(case group)and 20 healthy controls(HC)(HC group).Participants used sleep questionnaires to evaluate their sleep status.All TLE patients were divided into groups with and without sleep disorders according to the diagnostic criteria and scale scores of sleep disorders.The mean kurtosis(MK),mean diffusivity(MD),and fractional anisotropy(FA)of the relevant region of interest(ROI)were measured by DKI sequence.The differences of sleep quality scores and DKI parameters between groups were further compared via independent samples t-test and one-way analysis of variance.Results The Epworth sleepiness scale(ESS),Athens insomnia scale(AIS),and Pittsburgh sleep qual-ity index(PSQI)scores of TLE patients with sleep disorders were significantly higher than those of HC group(P＜0.05).The FA and MK values in TLE patients were significantly lower than those in HC group,while the MD value of TLE patients were substan-tially higher than that of HC group(P＜0.05).The values of MK and FA in left TLE patients with sleep disorders were significantly lower than those of without sleep disorders(P＜0.05),while there was no significant difference in MD value between the two groups(P＞0.05).MK value of right TLE patients with sleep disor-ders was significantly lower than that of without sleep disorders(P＜0.05),however,there were no significant differences in MD and FA values between the two groups(P＞0.05).Conclusion Quantitative DKI analysis revealed differences in DKI parameters in TLE patients combined with sleep disorders,inferring a specific white matter fiber damage in this group and providing imaging data to support the personalized treatment and prognostic assessment of these patients.

Diagnostic value of T2WI gray scale ratio for incidental Hashimoto's thyroiditis / 实用放射学杂志

Objective To investigate the diagnostic value of the T2WI gray scale ratio for Hashimoto's thyroiditis(HT).Methods The T2WI-iterative decomposition of water and fat with echo asymmetry and least square estimation(IDEAL)quantitation sequence water images of 22 HT cases were analyzed retrospectively.The gray scale ratio of the thyroid,sternocleidomastoid muscle,trachea cavity,and subcutaneous fat at the same layer were measured on the picture archiving and communication systems(PACS).The gray scale ratios of thyroid/sternocleidomastoid muscle(T/M),thyroid/trachea cavity(T/Tr),and thyroid/lipid(T/L)were calculated.The intraclass correlation coefficient(ICC)was used to evaluate the consistency among the measurements,and the optimal threshold for distinguishing HT from non-HT was determined via the receiver operating characteristic(ROC)curve.The Spearman correlation analysis was used to analyze the correlation between T/M,T/Tr,T/L ratios,and titers of thyroid peroxidase antibody(TPO-Ab)and thyroglobulin antibody(Tg-Ab),respectively.Results On the T2WI-IDEAL quantitation sequence water images,the(x)±s of T/M,T/Tr,T/L ratios for HT and non-HT were 2.17±0.47 and 1.62±0.21(t=14.90,P<0.001),9.40±3.24 and 4.87±2.93(t=11.42,P<0.001),1.66±0.32 and 1.21±0.31(t=7.51,P<0.001),respectively.The area under the curve(AUC)of T/M,T/Tr,and T/L ratios for diagnosing HT were 0.89,0.86,and 0.85,respectively;the optimal thresholds were 1.90,3.50,and 1.36,and the sensitivity and specificity were 72.7%and 100%,100%and 40.5%,95.5%and 29.7%,respectively.The T/M ratio had a moderate correlation with TPO-Ab(r=0.513,P<0.05),and T/Tr,T/L ratios had a mild correlation with TPO-Ab,respectively.Conclusion The T/M ratio in the T2WI gray scale ratio can quantitatively and objectively distinguish HT from non-HT to some extent and is correlated with TPO-Ab.It has extremely high specificity and holds promise as a non-invasive imaging method for the diagnosis of incidental HT.

Diagnostic and predictive value of CT perfusion imaging in patient with traumatic brain injury / 实用放射学杂志

Objective To investigate the application value of CT perfusion imaging in patient with traumatic brain injury(TBI).Methods Thirty-seven patients with TBI were included retrospectively and divided into mild,moderate,and severe groups according to Glasgow coma scale(GCS)score.Perfusion parameters of the cerebral hemispheres on the injured side and the contralateral side of the level of basal ganglia were compared.After three months,the correlations between perfusion parameters and GCS score at baseline and Glasgow outcome scale-extended(GOSE)score at follow-up were further analyzed,respectively.Results The injured side of TBI patients showed hypo-perfusion compared with that of the contralateral side.The abnormal perfusion volumes of time to maximum of the residual function(Tmax)>10 s was significantly negatively correlated with GOSE score(ρ=-0.55,P=0.01),and could distinguish the good prognosis group from the poor prognosis group with GOSE score[area under the curve(AUC)=0.82,P= 0.01].In the group of patients undergoing decompressive craniectomy,the abnormal perfusion volumes of Tmax>4 s and Tmax>6 s were significantly associated with GCS score(ρ=0.61,P=0.01;ρ=0.53,P=0.03).Conclusion CT perfusion imaging may be useful in assessing the hemodynamics and severity of TBI,and in predicting the clinical prognosis.

Development and reliability and validity test of the Scale of Pain-Relevant Responses from Spouse for Chronic Pain Patients / 中国实用护理杂志

Objective:To develop the Scale of Pain-Relevant Responses from Spouse for Chronic Pain Patients and to test its reliability and validity, so as to provide a reliable tool for the scientific assessment of the pain-relevant responses from spouses for chronic pain patients.Methods:Based on the interpersonal process model of intimacy, the first draft of the scale was formed through literature analysis, semi-structured interview, Delphi expert consultation and pre-investigation. A questionnaire survey was conducted on 388 patients with chronic pain who visited the Second Affiliated Hospital of Air Force Military Medical University from April 2022 to April 2023 using convenience sampling method to test the reliability and validity of the scale.Results:The Scale of Pain-Relevant Responses from Spouse for Chronic Pain Patients included 21 items in 4 dimensions: emotional support pain-relevant responses, behavioral support pain-relevant responses, distractive pain-relevant responses and negative pain-relevant responses. The range of I-CVI was 0.850-1.000. The results of structural validity analysis showed that four qualified common factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 71.173%. The confirmatory factor analysis model fit indicators were within the acceptable range. The correlation validity coefficient was 0.692 ( P<0.01). The Cronbach α coefficient of the total table was 0.894, the half reliability was 0.906, and the retest reliability was 0.927. Conclusions:The Scale of Pain-Relevant Responses from Spouse for Chronic Pain Patients has good reliability and validity, and is suitable for the evaluation of pain-relevant responses from spouse of chronic pain patients.

Effects of Cochlear Implantation on Ipsilateral Tinnitus in Post-lingual Adault Recipients / 听力学及言语疾病杂志

Objective To study the changes of tinnitus after cochlear implantation in post-lingual adault recip-ients and analyze the factors that affect tinnitus.Methods A total of 47 postilingually-deafened adult subjects with tinnitus who underwent cochlear implantation at the Department of Otology,the first affiliated hospital of Zheng-zhou University,from January 2017 to December 2021.The subjects were evaluated using tinnitus handicap invento-ry(THI)and visual analogue scale(VAS)before cochlear implantation and 6 months after cochlear implant surger-y.Results Among 47 subjects who were eligible for this study,the THI scores were 36.94±13.337,14.48± 12.726,respectively,before CI and 6 months after cochlear implantation.The VAS scores were 5.13±1.676 be-fore and 2.34±1.903 after cochlear tmplantation.Statistical analysis showed significant differences in THI and VAS scores before and after cochlear implantation(P＜0.05).A total of 18 patients experienced complete tinnitus suppression,14 patients experienced alleviation of tinnitus,tinnitus remained unchanged in 13 patients,tinnitus worsened in 2 patients,and the overall efficiency was 66.0％(31/47).The tinnitus alleviation rate was signifant higher in the patients with tinnitus history of ≤5 years than the patients with tinnitus history of＞5 years(P＜0.05).There was a statistically significant difference in tinnitus alleviation between the patients with mild tinnitus and the patients with more than mild tinnitus before surgery(P＜0.001).Conclusion Cochlear implantation has an inhibitory effect on tinnitus in adults.Patients with shorter duration of the tinnitus and higher tinnitus handicap are more likely to experience tinnitus improvement after cochlear implantation.

Effect of diabetes mellitus on perioperative blood loss and pain after primary total knee arthroplasty / 中国组织工程研究

BACKGROUND:Total knee arthroplasty is the main therapeutic regimen for end-stage osteoarthritis.However,diabetes mellitus can affect the treatment effect and prognosis. OBJECTIVE:To explore the effect of diabetes mellitus on perioperative blood loss and postoperative pain in patients undergoing primary total knee arthroplasty. METHODS:A retrospective study was conducted on 154 patients who underwent primary total knee arthroplasty and met the inclusion criteria in the Osteonecrosis and Joint Reconstruction Ward of Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University from January to April 2021.Patients were divided into a non-diabetic group and a diabetic group according to their diagnosis,with 32 cases in the diabetic group,9 males and 23 females,aged 55 to 80(66.58±7.16)years and 122 cases in the non-diabetic group,34 males and 88 females,aged 44 to 83(66.69±6.63)years.Perioperative blood loss(including total blood loss,hidden blood loss,the falling value of hemoglobin and hematocrit)was calculated for both groups.Visual analog scale scores,hospital for special surgery knee score,and Caprini scores were recorded preoperatively and postoperatively. RESULTS AND CONCLUSION:(1)Total blood loss was significantly lower in the non-diabetic group(729.93±233.83 mL)than that in the diabetic group(853.69±184.91 mL)(P<0.05).Latent hidden blood loss was also significantly lower in the non-diabetic group(624.40±233.19 mL)than that in the diabetic group(749.08±179.49 mL)(P<0.05).(2)In the non-diabetic group,the visual analog scale scores preoperatively and 1 month postoperatively were significantly lower than those in the diabetic group(P<0.05).The differences in visual analog scale scores at 3 days and 3 months postoperatively between the non-diabetic group and the diabetic group were not statistically significant(P>0.05).(3)The hospital for special surgery knee score at 1 month postoperatively was significantly higher in the non-diabetic group than that in the diabetic group(P<0.05).There was no significant difference in hospital for special surgery knee score between the two groups at 3 months postoperatively(P>0.05).(4)There was no statistically significant difference in preoperative and postoperative Caprini scores between the two groups(P>0.05).(5)It is concluded that having diabetes increases total and occult hidden blood loss in primary total knee arthroplasty.In the short term after total knee arthroplasty,diabetes increases the patient's pain and affects the recovery of joint function,but the negative effects fade with time.

Mid-and long-term state after total hip arthroplasty versus hemiarthroplasty for femoral neck fractures in the elderly:evaluation using propensity score matching method / 中国组织工程研究

BACKGROUND:Arthroplasty is the primary treatment for displaced femoral neck fractures in the elderly,and the choice of total hip arthroplasty versus hemiarthroplasty is currently the subject of considerable debate. OBJECTIVE:To compare the mid-and long-term survival status of total hip arthroplasty versus hemiarthroplasty under a direct anterior approach for displaced femoral neck fractures in the elderly based on the propensity score matching method. METHODS:One hundred and forty-seven elderly patients(≥65 years of age)with displaced femoral neck fractures were admitted from January 2016 to January 2021,of whom 88 had total hip arthroplasty(total hip arthroplasty group)and 59 had artificial femoral head replacement(hemiarthroplasty group).For the patients'preoperative comorbidities,the age-corrected Charlson Comorbidity Scale was used to quantify the scores and calculate patient frailty.The propensity score matching method was used to match the two groups 1:1 and to compare the operation time,bleeding,postoperative hospitalization time,hospitalization cost,nutritional index,postoperative complications,and mortality between the two groups after matching.Postoperative survival time was determined by Kaplan-Meier Survival analysis. RESULTS AND CONCLUSION:(1)After propensity score matching,a total of 42 matched pairs were successful in both groups,and the preoperative data of patients in both groups were balanced and comparable after matching(P>0.05).(2)Compared with the hemiarthroplasty group,operation time(79.71 minutes vs.59.07 minutes,P<0.001),bleeding volume(839.64 mL vs.597.83 mL,P=0.001),and hospitalization cost(56 508.15 yuan vs.41 702.85 yuan,P<0.001)were significantly higher in the total hip arthroplasty group.However,the mortality rate was lower in the total hip arthroplasty group than in the hemiarthroplasty group(36%vs.57%,HR=0.44,95%CI:0.23-0.87,P=0.018),and the mean survival time was longer in the total hip arthroplasty group than in the hemiarthroplasty group(59.4 months vs.43.7 months,P=0.024).(3)There were no statistically significant differences in postoperative hospitalization time,preoperative and postoperative nutritional indicators,and overall postoperative complication rate between the two groups(P>0.05).However,in terms of postoperative pain,the incidence of pain was significantly higher in the hemiarthroplasty group than that in the total hip arthroplasty group(24%vs.7%,P=0.035).(4)Overall,total hip arthroplasty has a better prognosis for survival,while hemiarthroplasty is more appropriate for patients with poor physical fitness.At the same time,postoperative pain may largely affect the quality and survival time of patients after hip arthroplasty.

Effect of balance training on chronic ankle instability:a meta-analysis / 中国组织工程研究

OBJECTIVE:Chronic ankle instability is mainly characterized by symptoms such as muscle weakness,intermittent pain,and repeated sprains,which seriously affect exercise and daily life.Loss of proprioception,prolongation of fibular reaction time,and weakening of valgus force may be the main symptoms of chronic ankle instability,so exercise intervention can effectively improve the symptoms related to ankle instability.Meta-analysis was used to quantitatively evaluate the effect of balance training on the rehabilitation intervention of chronic ankle instability,providing a reliable theoretical basis and practical basis for chronic ankle instability patients to scientifically formulate exercise prescriptions. METHODS:The randomized controlled trial of balance training on symptom rehabilitation and dynamic equilibrium of patients with chronic ankle instability was retrieved on CNKI,VIP,Web of Science,and PubMed.The literature was published from the inception to November 23,2022.Two reviewers were included to evaluate the quality of the included literature based on the physical therapy evidence scale.The primary outcome measure is the Self Functional Rating Scale,and the secondary outcome measure is the Star Shift Balance Test,both of which are continuous variables.Forest mapping,meta-regression,subgroup analysis,sensitivity analysis,and publication bias evaluation were performed on the included literature using RevMan 5.3 and Stata-SE 15 software. RESULTS:(1)A total of 18 articles of randomized controlled trials were screened and 641 patients with chronic ankle instability were included in the study.Overall,the methodological quality of the literature was relatively high.(2)Meta-analysis results showed that balance training improved the functional rehabilitation effect of chronic ankle instability patients(SMD=0.82,95%CI:0.41-1.23,P<0.000 1).Meta-regression exhibited that intervention time might be the main reason for heterogeneity(P=0.008).(3)The subgroup analysis results revealed that 6 weeks of intervention(SMD=0.98,95%CI:0.31-1.65,P=0.03),more than 3 interventions per week(SMD=0.87,95%CI:0.30-1.44,P=0.003),and each intervention time less than 20 minutes(SMD=0.89,95%CI:0.61-1.66,P<0.000 1)were the best rehabilitation plans to improve the functional rehabilitation effect of chronic ankle instability patients.(4)Meta-analysis results also showed that balance training improved the stretching degree of the anterior side(SMD=0.56,95%CI:0.31-0.80,P<0.05),posterior inner side(SMD=0.88,95%CI:0.45-1.32,P<0.05),and posterior outer side(SMD=0.84,95%CI:0.22-1.46,P<0.05)of the star shift balance test. CONCLUSION:Current clinical evidence shows that balance training can improve ankle instability symptoms and elevate dynamic equilibrium ability in chronic ankle instability patients.It is recommended to intervene more than 3 times a week,with each intervention lasting less than 20 minutes,to achieve better rehabilitation effects.