Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Validación del ClinESSDAI para Argentina / Validation of ClinESSDAI for Argentina

Introducción: recientemente, en Europa y en idioma inglés, se ha desarrollado el Clinical EULAR Sjögren's Syndrome Disease Activity Index (ClinESSDAI) para evaluar la actividad en pacientes con síndrome de Sjögren primario (SSp). Objetivos: validar el ClinESSDAI en pacientes con SSp en Argentina. Materiales y métodos: estudio de corte transversal. Se utilizó la versión en castellano del EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) validada en Argentina. Para evaluar la validez del constructo, se usó la escala visual análoga (EVA) desarrollada por un reumatólogo experto por dominio del ClinESSDAI y de la EVA global para el puntaje total del ClinESSDAI, mientras que otro profesional en la materia realizó el ESSDAI y ClinESSDAI. Para analizar la reproducibilidad, se estudió a un subgrupo de pacientes, sin mediar cambios en el tratamiento ni en la condición clínica, 10 días después de la evaluación basal. Todos los médicos examinaron a los pacientes desconociendo la evaluación de los demás colegas. Resultados: se incluyeron 47 pacientes con SSp. La correlación entre la EVA global y el ClinESSDAI fue muy buena (Rho 0,7), así como la correlación de la EVA y el ClinESSDAI de cada dominio. El coeficiente de correlación intraclase (CCI) entre el ESSDAI y el ClinESSDAI fue de 0,98. La reproducibilidad fue de 0,93. Conclusiones: el ClinESSDAI es una herramienta válida y reproducible en nuestra población, equiparable al ESSDAI.

Introduction: the Clinical EULAR Sjögren's Syndrome Disease Activity Index (ClinESSDAI) has recently been developed in Europe and in the English language to evaluate activity in patients with primary Sjögren's syndrome (pSS). Objectives: validate the ClinESSDAI in patients pSS in Argentina. Materials and methods: a cross-sectional study. The Spanish version of the ESSDAI, validated in Argentina, was used. To evaluate construct validity, the Visual Analog Scale (VAS) was used, performed by an expert rheumatologist per ClinESSDAI domain, and the global VAS was used for the total score of the ClinESSDAI, while another professional performed the ESSDAI and ClinESSDAI. To evaluate reproducibility, a subgroup of patients was evaluated without changes in treatment or clinical condition 10 days after the baseline evaluation. All physicians were blind to each other's evaluation. Results: 47 patients with pSS were included. The correlation between global VAS and ClinESSDAI was very good (Rho 0.7), as well as the correlation of the VAS and ClinESSDAI of each domain. The intraclass correlation coefficient (ICC) between ESSDAI and ClinESSDAI was 0.98. The reproducibility was 0.93. Conclusions: the ClinESSDAI is a valid and reproducible tool in our population, comparable to the ESSDAI.

Correlation between Bath Ankylosing Spondylitis Disease Activity Index Score and body mass index in the patients suffering with ankylosing spondylitis

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial spine that can manifest with various clinical signs and symptoms. Chronic back pain and progressive spinal stiffness are the most common features of this disease. It is an autoimmune disease which also leads to the involvement of skeletal, cardiac, nervous tissues, and other systemic organs. Aim and Objectives: This study was conducted to assess the correlation between the Bath AS Disease Activity Index (BASDAI) score/visual analog scale (VAS) and various age groups in the patients suffering with AS using standard questionnaire. Materials and Methods: Forty-eight AS patients having BASDAI scores of ?4 were included in this study. The height and weight were taken and responses to the standard questionnaire were recorded. BASDAI Score, body mass index (BMI), and VAS were computed. The patients with history of chronic diseases such as hyper/hypothyroidism, diabetes mellitus, and hypertension or the use of any medication such as ?/? blockers, calcium channel blockers, and antiepileptics were excluded from the study. Results: The patients were divided into six different age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years. The mean ± SEM values of the BASDAI score in various age groups were 6.8 ± 0.34, 6.3 ± 0.33, 6.2 ± 0.26, 7.1 ± 0.41, 6.5 ± 0.30, and 5.8 ± 0.48, respectively. The mean ± SEM values of VAS are shown in relation to the various age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years and the values were 6.88 ± 0.312, 6.58 ± 0.22, 6.55 ± 0.66, 6.00 ± 0.23, 6.72 ± 0.25, and 6.0 ± 0.50, respectively. Conclusion: This study indicates that in the young age group, patients BASDAI score is higher and BMI is lower, and in the older age group, patients BASDAI score is lower and BMI is higher than each other indicating higher disease activity in the younger patients than older patients. An inverse correlation between VAS and age further substantiates our previous finding.

Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study

Abstract Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures. Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes. Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables. Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53-- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores. Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.

Comparative study of atienuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Introduction: Needle prick pain is a distressing event for a pa?ent receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally trauma?zing for many pa?ents. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the prac?ce of giving injec?ons of local anaesthe?c or local applica?on of EMLA cream or patch at the site of spinal puncture beforehand for anaesthe?zing the skin and subcutaneous ?ssues. Methods: A prospec?ve cohort study was done. Those enrolled pa?ents were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed pa?ents either EMLA cream or regular standard lignocaine infiltra?on anaesthesia and labelled them as Group E and Group L respec?vely. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 pa?ents were enrolled in the study33 in Group E and 31 in Group L. Both groups had an almost similar number of pa?ents who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E pa?ents compared to that in Group L, p<0.001. The mul?variate analysis had similar findings a?er controlling confounding factors in mul?ple regression analysis. Conclusion: Local 2% lignocaine injec?on achieved significantly more pain reduc?on during spinal needle inser?on compared to the applica?on of an EMLA patch before spinal anaesthesia.

Postoperative Comfort Score after Septoplasty among Patients Undergoing Nasal Packing versus Suturing of the Septal Flap by Modified Technique without Packing : A Randomized Controlled Trial

Background : Septal surgery is one of the most common surgical procedures performed by an Otorhinolaryngeal surgeon since ancient times. Various modifications in the approach, changing concept of conserving septal cartilage, use of an endoscope and good antibiotics to control postoperative infection have played a key role in controlling the complication rates but still, one thing which is mostly practiced worldwide is nasal packing in the postoperative period which is a nightmare for many patients, as the pain threshold varies from patient to patient. It also causes dryness of mouth, throat irritation, facial heaviness, headache, excessive watering from eyes, aural fullness. There is a lack of proper evidence to prove whether nasal packing really decreases postoperative hemorrhage as the incision is properly approximated and sutured. The main reason for nasal packing was an approximation of nasal septal flap thereby reducing the chances of septal Haematoma and stabilization of septal flap in the midline. The present study has been taken to study and compare postoperative nasal packing and modified quilting suture of the septal flap without the nasal pack. Material and Methods : This one-year prospective comparative study was conducted on 149 patients who underwent septoplasty with 3 months follow-up. One group had Postoperative nasal packing and the other had only modified septal flap suturing without the nasal pack. Results : Out of the total of 149 patients, 88 underwent nasal packing in the postoperative period and 61 patients had undergone suture of the nasal septal flap without nasal packing. A statistically significant value of VAS score was found in the non-packing group of 61 patients, where the average postoperative VAS score was 1.46 against 3.7 among the packing group of 88 patients. An unpaired t-test was applied and a value of 15.431 was obtained with a pvalue less than 0.001. No cases presented with septal perforation in the postoperative period in patients without a nasal pack and there were 2 cases (2.2%) of septal perforation in the nasal packing group. There was no significant bleeding in the postoperative period in both groups of patients. Conclusion : Stabilization of the nasal septal flap by modified quilting technique is better option after septoplasty with good comfort score.

Analysis on Characteristics of Plantar Pressure and Balance in Patients with Chronic Nonspecific Low Back Pain / 医用生物力学

Objective To explore the difference of balance ability between patients with chronic nonspecific low back pain ( CNLBP) and healthy individuals, and the correlation between patients’ pain symptoms, lumbar flexibility, abdominal muscle endurance, overall function, quality of life and fear of avoidance with balance ability, so as to guide clinical rehabilitation evaluation. Methods A total of 34 patients with CNLBP were selected as the experimental group, and 34 healthy volunteers without history of low back pain were selected as control group. The plantar pressure measurement system was used to collect the ratio of forefoot to hindfoot pressure, pathlength ( L) of plantar center of pressure ( COP), displacement length in anteroposterior direction ( LAP ), displacement length in mediolateral direction (LML ), mean velocity (v), displacement velocity in anteroposterior direction (vAP ), displacement velocity in mediolateral direction (V-ML) and elliptical swing area (S). In addition,the experimental group was assessed by the visual analogue scale (VAS), the finger floor distance (FFD), the number of sit-ups in 1 minute, the Oswestry disability index (ODI), the 36-item short form survey (SF-36) and the fear avoidance beliefs questionnaire (FABQ), and correlated with plantar pressure parameters. Results All plantar pressure parameters were significantly different between the two groups ( P < 0. 05). The the ratio of forefoot to hindfoot pressure in experimental group was significantly lower than that in control group (P<0. 05), and the parameters L, LAP , LML , v, vAP , vML and S were significantly higher than those of control group (P<0. 05). With eyes open or closed, the VAS score of experimental group was positively correlated with L, LAP , LML(P<0. 05), and FFD and FABQ scores were positively correlated with L and LML , respectively (P< 0. 05). With eyes open, ODI was positively correlated with L, LAP and LML (P< 0. 05), and SF-36 score was negatively correlated with L and LML(P<0. 05). With eyes closed, the number of 1-min sit-ups was negatively correlated with LAP and S (P<0. 05), ODI was positively correlated with L and LML(P<0. 05), and the SF-36 score was negatively correlated with L (P<0. 05). Conclusions The static balance ability of patients with CNLBP is decreased, and it is correlated with pain symptoms, lumbar function, quality of life and psychological status. The result can provide references for the assessment of functional activities.

Transcutaneous electrical acupoint stimulation combined with electroacupuncture for rapid recovery after abdominal surgery: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with electroacupuncture (EA) on rehabilitation after abdominal surgery.@*METHODS@#A total of 320 patients undergoing abdominal surgery were randomly divided into a combination group (80 cases), a TEAS group (80 cases, 1 case discontinued), an EA group (80 cases, 1 case discontinued) and a control group (80 cases, 1 case discontinued). The patients in the control group received enhance recovery after surgery (ERAS) standardized perioperative management. On the basis of the treatment in the control group, the TEAS group was treated with TEAS at Liangmen (ST 21) and Daheng (SP 15); the EA group was treated with EA at Neiguan (PC 6), Hegu (LI 4), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39); the combination group was treated with TEAS combined with EA, with continuous wave, 2-5 Hz in frequency, and the intensity was tolerable to the patients, 30 min each time, once a day, from the first day after surgery, until the anus resumed spontaneous defecation and the oral intake of solid food was tolerated. The gastrointestinal-2 (GI-2) time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time, time of first get out of bed and hospital stay were observed in all the groups; the pain visual analogue scale (VAS) score and incidence rates of nausea and vomiting 1, 2, 3 days after surgery were compared in all the groups; after treatment, the acceptability of each treatment was evaluated by patients in each group.@*RESULTS@#Compared with the control group, the GI-2 time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time were shortened (P<0.05), the VAS scores 2, 3 days after surgery were decreased (P<0.05) in the combination group, the TEAS group and the EA group; those in the combination group were shorter and lower than the TEAS group and the EA group (P<0.05). Compared with the control group, the time of hospital stay in the combination group, the TEAS group and the EA group were shortened (P<0.05), and that in the combination group was shorter than the TEAS group (P<0.05).@*CONCLUSION@#TEAS combined with EA can accelerate the recovery of gastrointestinal function in patients after abdominal surgery, relieve postoperative pain, and shorten hospital stay.

Clinical efficacy of flexible ureteroscopic lithotripsy under local anesthesia and risk factors of perioperative pain / 现代泌尿外科杂志

【Objective】 To explore the efficacy of flexible ureteroscopic lithotripsy (FURL) under local anesthesia (LA) in the treatment of upper urinary tract calculi, and to analyze the risk factors of pain. 【Methods】 Clinical data of 255 patients treated during Apr.2022 and Sep.2022 were reviewed, including visual analogue score (VAS) of pain during ureteroscopy, sheath placement, holmium laser lithotripsy, 1 hour and 8 hours after operation. VAS ≥5 was defined as significant pain. Clinical and follow-up data of the significant pain group and non-significant pain group were analyzed with logistic regression to analyze the risk factors of pain in FURL under LA. 【Results】 Altogether 198 patients (77.6%) successfully completed the operation, and the stone-free rate (SFR) was 89.9% (178/198). The VAS of ureteroscopy was the highest (4.49±1.08), and 73 patients (28.6%) experienced significant pain. Univariate analysis showed that significant pain was associated with gender, previous surgical history, age, body mass index (BMI), education level, and ASA classification (P<0.05). Multivariate analysis showed that male (OR=2.896, 95%CI:1.413-5.933, P=0.040) and BMI≥28 (OR=7.776, 95%CI:2.268-26.657, P=0.001) were independent risk factors of significant pain, while age ≥65 years (OR=0.237, 95%CI:0.083-0.672, P=0.007) and previous surgical history (OR=0.156, 95%CI:0.032-0.754, P=0.021) were the protective factors. 【Conclusion】 It is feasible and effective to treat upper urinary tract calculi with FURL under LA. The presence of significant pain is associated with factors such as gender, age, BMI and previous surgical history.

Different operation sequences between acupuncture and cupping therapy for lumbar muscle strain with cold and dampness: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy on lumbar muscle strain with cold and dampness between the different operation sequences of acupuncture and cupping therapy.@*METHODS@#Seventy-six patients with lumbar muscle strain with cold and dampness were randomly divided into an acupuncture + cupping group (A + C group, 38 cases) and a cupping + acupuncture group (C + A group, 38 cases, 1 case dropped off). In the A + C group, cupping therapy was delivered 10 min after the end of treatment with acupuncture, while in the C + A group, acupuncture therapy was exerted 10 min after the end of treatment with cupping. Acupuncture was applied to Mingmen (GV 4), Yaoyangguan (GV 3), ashi point and bilateral Shenshu (BL 23), Dachangshu (BL 25), Weizhong (BL 40) and Yanglingquan (GB 34), and the needles were retained for 30 min in each intervention. Flash cupping was operated along the bilateral sides of the lumbar spine for 3 min, and the cups were retained for 10 min at bilateral Shenshu (BL 23), Dachangshu (BL 25) and ashi points. The intervention was delivered once every two days, 3 times weekly, for 3 weeks totally in each group. The scores of visual analogue scale (VAS) and Oswestry disability index (ODI), TCM syndrome score and the mean temperature of the lumbar region before and after treatment were compared between the two groups. The safety and the clinical efficacy were assessed for the interventions of the two groups.@*RESULTS@#Compared with the values before treatment, except for the sleep score of ODI, the VAS scores, ODI scores and TCM syndrome scores were decreased after treatment (P<0.01, P<0.05); while the mean temperature of the lumbar region was increased (P<0.01) in both groups. After treatment, the VAS score and the pain score of ODI in the C + A group were lower than those in the A + C group (P<0.05). The incidence rate of adverse reactions of the C + A group was lower than that of the A + C group (P<0.01). The effective rate in the A+C group was 92.1% (35/38), that in the C+A group was 94.6%(35/37), there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#Different operation sequences between acupuncture and cupping therapy obtain the similar efficacy on lumbar muscle strain with cold and dampness, but cupping therapy delivered prior to acupuncture has certain advantages in relieving pain and improving safety.

Effect of Two Different Meal Compositions on 1-hour Plasma Ghrelin Levels in Young Men

@#Introduction: Calorie restriction is the main strategy for loosing body weight in obese individuals. However, persistence to this strategy is a major challenge. Ghrelin, a hormone that influences an individual to consume food by modulating the feelings of hunger. This effect may be influenced by the % fat composition of a meal. Materials and Methods: Twelve young male participants with normal BMI, were administered in random order one of 2 isocaloric meals after an overnight fast. The 2 meals contained either 31 or 52% fat. After a 7 day gap, cross-over of the participants was carried out and they consumed the other meal similarly. Ghrelin levels were measured after fasting and 1 hour after diet consumption. An appetite rating on a visual analogue scale (VAS) was used to measure perceived hunger and satiety before and after the meal. Results: When compared to the baseline values, an average of 34% and 20% decrease in ghrelin levels were noted after the high-fat meal (p<0.025), and low-fat meal respectively. Analysis of the VAS showed that feelings of hunger decreased, while feelings of satiety increased after the meal, however there was no difference between the two meals. Conclusion: Thus, within this study group, though the feelings of hunger and satiety was comparable, consumption of isocaloric high fat caused ghrelin levels to decrease within one hour post meal. This shows that manipulation of % fat of the diet can achieve lower post-meal ghrelin levels.

The posture decoding technique can improve the pelvis carriage and lumbar motion of patients with lower crossed syndrome, relieving back pain and relaxing the back muscles / 中华物理医学与康复杂志

Objective:To observe the clinical effectiveness of manual therapy based on posture decoding for patients with lower crossed syndrome (LCS).Methods:Thirty-six LCS patients were randomly divided into an observation group and a control group, each of 18. The observation group received manual therapy based on posture decoding, while the control group was treated with proprioceptive neuromuscular facilitation (PNF), both in 20min sessions, once a week for 4 weeks. Before the experiment, after one, two and four weeks of treatment and followed-up 4 and 8 weeks later, both groups were evaluated using a visual analogue scale (VAS), the Oswestry Disability Index (ODI) and finger-floor distance (FFD). Anterior pelvic tilt angles (ASIS-PSISs), sacral slopes (SS), lumbar curve index (LCI) and surface EMG flexion-relaxation ratios (FRRs) were also recorded from both groups before and after the treatment.Results:After one and four weeks of the treatment, the average VAS, ODI, and FFD had decreased significantly in both groups, with all significantly lower in the observation group, on average. At the final follow-up, the average VAS and ODI scores of both groups were significantly lower than before the treatment, with those of the observation group significantly lower than the control group′s averages. After 4 weeks of treatment significant differences were observed also in the group′s average ASIS-PSISs, SSs and LCIs compared with before the treatment. And right after the treatment the left and right surface electromyography FRRs of the observation group were significantly higher than those of the control group.Conclusion:Manual therapy based on posture decoding can significantly improve the pelvis forward angle and lumbar motion of LCS patients, relieving back pain and relaxing back muscles.

Research progress on the nucleoside/nucleotide-loaded nanomedicines / 浙江大学学报·医学版

Nucleoside drugs play an essential role in treating major diseases such as tumor and viral infections, and have been widely applied in clinics. However, the effectiveness and application of nucleoside drugs are significantly limited by their intrinsic properties such as low bioavailability, lack of targeting ability, and inability to enter the cells. Nanocarriers can improve the physiological properties of nucleoside drugs by improving drug delivery efficiency and availability, maintaining drug efficacy and system stability, adjusting the binding ability of the carrier and drug molecules, as well as modifying specific molecules to achieve active targeting. Starting from the design strategy of nucleoside drug nanodelivery systems, the design and therapeutic effect of these nanomedicines are described in this review, and the future development directions of nucleoside/nucleotide-loaded nanomedicines are also discussed.

Correlation between vitamin D deficiency and benign paroxysmal positional vertigo

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo. Vitamin D3 is an indispensable part of bone mineralization and calcium homeostasis. Vitamin D3 also plays a role in BPPV and therefore may offer a therapeutic option. Aim and Objective: This study aims to evaluate the relationship of BPPV with Vitamin D deficiency. Materials and Methods: This observational case–control study was done on 80 subjects out of which 40 were confirmed cases of BPPV patients and 40 were controls. Ear, throat, and nose were examined in all patients. Measurement of Vitamin D3 was done in all subjects. Assessment of quality of life was done using Dizziness Handicap Inventory score (DHI) and Visual Vertigo Analog Scale (VVAS). Results: In our study among cases, 14 patients (35%) had normal Vitamin D levels, Vitamin D deficiency was seen in 15 cases (37.5%) and 11 patients (27.5%) had Vitamin D insufficiency. In control group, 22 patients (55%) had normal Vitamin D levels and 9 patients (22.5%) each had Vitamin D insufficiency and deficiency. Mean of Vitamin D concentration in the case group was 23.78 ± 10.43 and in the control group had 35.99 ± 15.99. The relationship between the two groups was significant (P = 0.001). The mean of body mass index in case and control group was 22.46 ± 2.48 and 23.43 ± 2.38, respectively, with P-value of 0.032 indicating significant relationship statistically. Furthermore, VVAS and DHI scores were higher in cases with deficiency and insufficiency of Vitamin D. Conclusion: The present study shows a significant relationship of reduced concentration of Vitamin D with idiopathic BPPV.

Outcome of Single Intra-Articular Injection of High- Molecular-Weight Hyaluronic Acid in Patients with Knee Osteoarthritis

Background: Osteoarthritis (OA) is the most common type of rheumatic disease and a leading cause of disability. Current treatments aim at alleviating these symptoms by several different methods: non-pharmacological and pharmacological treatments and invasive interventions. Among the regenerative methods, hyaluronic acid (HA) is popular now-a-days where differences exist in concentration, molecular weight, dosage, expected duration of effects and added formulations. Based on HA molecular weight, these products are classified in two groups (high and low). Due to cost effectiveness, low molecular weight HA is commonly used. To find out the outcome of single intra-articular injection of high-molecular- weight HA in patients with knee osteoarthritis.Material & Methods:This was a randomized clinical trial conducted among purposively selected 55 patients suffering from Knee OA attending at the Physical Medicine and Rehabilitation outpatient department, DMCH during July 2020 to June 2021. Patients were randomly allocated into two groups; group A received single dose of high molecular weight HA and designed exercise program and group B received same exercise program only. Pre-treatment and 3 weekly post treatment assessment were done up to 12 weeks in each group. In each follow up visit, pain, and functional status were measured in Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) respectively and compared between group A and group B where was considered as significant (p value <0.050.Results:The mean age of the participants in group A and group B were 56.8 (±9.8) and 53.3 (±7.4) years respectively where majority of the patients in both groups were female patients with overweight. In group A, VAS and WOMAC significantly decreased from base line to each follow up till 12th weeks after treatment with high-molecular-weight HA (P<0.001). In group B, VAS and WOMAC significantly decreased from base line to each follow up till 12th weeks after treatment with conservative management (P<0.001). After 6 weeks of intervention, the mean VAS scores of the patients became 4.9 ±1.1 and 6.0±1.0 in group A and group B respectively which showed significant statistical difference (P<0.001). At the end of 12 weeks, the VAS score was significantly decreased in group A (2.8±1.3) than group B (4.9±1.7) (P<0.001). After 3 weeks of intervention, the mean WOMAC scores of the patients became 71.2±6.6 and 75.0 ±4.9 in group A and group B respectively which showed significant statistical difference (P<0.001). At the end of 12 weeks, the WOMAC score was significantly decreased in group A (61.9±6.6) than group B (68.1±4.6) (P<0.001). Conclusion:Single intra-articular injection of high-molecular-weight Hyaluronic Acid is effective in patients with knee osteoarthritis in reducing pain and improving functional impairment. Long term and large scale research studies are needed to establish the effectiveness and safety of this procedure in patients with knee osteoarthritis.

Engineering Parameters Responses during Extrusion Processing of Noodles Analogue from Water Yam, Yellow Maize, and African Yam Bean Flour Mixture

This study investigated the effect of extrusion process on engineering properties of noodles analogue from water yam, yellow maize, and African yam bean. Flour blend from water yam, yellow maize, and African yam bean were produced using the standard method of dry milling and was used to extrude noodles analogue using a brabender single screw laboratory extruder (Duisburg DCE 330 model) fitted with 3.0mmdie nozzle diameter. A central composite rotatable design (CCRD) with three variables, namely barrel temperature, feed moisture content and screw speed and five level coded – a, -1, 0, +1,, +a, was used for the study and data was generated at (p<0.05). Results of result of the engineering properties of noodles analogue showed that toque ranged from 22.4 to 60.50Nm/s, mass flow rate ranged from 33.90 to 109g/min-1, specific mechanical energy ranged from 100.19 to 385.97kj/kg, and the residence time ranged from 22 to 55s in this study. The CCRD was effective in explaining the effect of the process conditions on noodles analogue as influenced by barrel temperature, feed moisture content, and screw speed of the extruder. The data obtained from the study could be used for control of product characteristics.It was generally observed that the changing of feed moisture content, barrel temperature, and screw speed influenced an acceptable torque, mass flow rate, and residence time during the extruder operation. The noodles analogue produced at this cheap machine operating conditions could be projected for commercial production.

Functional Properties of Noodles Analogue from Water Yam, Yellow Maize, and African Yam Bean Mixtures – A Response Surface Methodology

Response surface methodology was used to investigate the effect of extrusion process on proximate composition of noodles analogue from water yam, yellow maize, and African yam bean flour mixture. Flour blend from water yam, yellow maize, and African yam bean were produced and was used to extrude noodles analogue using a Brabender single screw laboratory extruder (Duisburg DCE 330 model) fitted with 3.0 mm die nozzle diameter. A central composite rotatable design (CCRD) with three variables, namely barrel temperature, feed moisture content and screw speed and five level coded – a, -1, 0, +1, +a, was used and data analyzed by regression analysis. Results showed that bulk density ranged from 0.41 to 0.09 g/cm water solubility index ranged from 4.41 to 6.36%; water absorption capacity ranged from 2.05 to 5.66% and expansion ratio ranged from 1.62 to 3.81respectively. The coefficients of determinations (R2) were high and ranged from 0.9039 to 0.9887 at 5% level. The response surface plots suggested that the models developed had a good fit and the CCRD was effective in explaining the effect of the process conditions on noodles analogue as influenced by barrel temperature, feed moisture content, and screw speed of the extruder. The data obtained from the study could be used for control of product characteristics. The study indicated that improved noodles analogue from available and cheap roots, cereal and legumes such as water yam, yellow maize, and African yam bean can be produced for possible projection for the commercial production of noodles analogue.

Mammary analogue secretory carcinoma of the parotid: An arduous maze to solve

Mammary analogue secretory carcinoma (MASC) is an unusual and rare salivary gland malignancy that recapitulates the genetic and microscopic features of secretory carcinoma of the breast (SCB) which is an equally rare entity. MASC and SCB express S-100 protein, vimentin, mammaglobin, and harbor a t (12; 15) (p13; q25) translocation which leads to ETV6-NTRK3 fusion product. The morphology of MASC is not specific and can overlap with many salivary gland tumors. S100 and mammaglobin抯 strong positivity confirm the diagnosis of MASC. The morphology along with immunohistochemical findings provides important clues for diagnosis. Recent advances in molecular pathology help in investigating both differential diagnosis and prognosis in salivary gland oncology. Molecular testing is recommended to arrive at a diagnosis of MASC. We report a case of MASC of the parotid gland in a 47-year-old male patient with his immunohistochemical profile.

Efficacy of port-site infiltration with ropivacaine alone versus ropivacaine with fentanyl for postoperative analgesia in patients undergoing laparoscopic procedures

Background and aims: Wound infiltration as a pre-emptive measure to relieve post-operative pain is a common practice following laparoscopic procedures. The addition of adjuvants like opioids to local anesthetics can facilitate the prolongation of postoperative analgesia. Our primary aim was to compare the analgesic efficacy of peri-portal infiltration of Ropivacaine alone versus Ropivacaine with Fentanyl in patients undergoing laparoscopic operations. Methods: The study was conducted on 80 ASA physical status I and II patients, aged 18 to 65 years, undergoing surgical procedures under general anesthesia. Group R was infiltrated with Ropivacaine (0.5%) (18ml+2ml saline) while in Group RF, Ropivacaine(18ml) with Fentanyl 2ml (100礸)] was infiltrated around ports, before wound closure. At the end of the surgery, one of our study drug solutions was infiltrated, to which the patient as well as the assessor were blinded. Postoperative pain was assessed by the VAS (visual analog scale) score. Injection Tramadol 100mg was given as a rescue analgesic if the VAS score was ? 3. Student抯 t-test and Fischer抯 exact test were applied for continuous and categorical variables; Kruskal Wallis and Mann Whitney U test for nonparametric data. The entire statistical analysis was done using STATA 13[ STATA CORP. TEXAS, USA] software. Results: The mean duration of analgesia was significantly longer in group RF, with a requirement of fewer doses of rescue analgesics, compared to group R. Conclusion: The addition of Fentanyl to Ropivacaine for periportal infiltration was found to be superior to Ropivacaine alone in providing effective postoperative analgesia as well as reducing the requirement of rescue analgesics.