Effectiveness of Radiofrequency Ablation of the Genicular Nerves of the Knee for the Management of Intractable Pain from Knee Osteoarthritis.

BACKGROUND: The knee joint is one of the most common diseases in elderly individuals. This is a progressive and debilitating condition. The purpose of knee osteoarthritis treatment is to manage pain, increase mobility, and improve the quality of life. OBJECTIVES: This study evaluated the therapeutic effect of radiofrequency thermocoagulation (RFTC) on the genicular nerves in patients with intractable pain due to knee osteoarthritis, as well as its effects on pain severity and magnetic resonance imaging (MRI) findings. STUDY DESIGN: A prospective outcome study. SETTING: The outpatient clinic of a single academic medical center. METHODS: We conducted a prospective study. Fifty consecutive patients with intractable knee pain due to osteoarthritis were enrolled and underwent ultrasound (US)-guided RFTC of the genicular nerves (medial superior genicular nerve, medial inferior genicular nerve, and lateral superior genicular nerve). Pain severity was measured using the Numeric Rating Scale (NRS), and knee osteoarthritis-associated symptoms were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at pretreatment and one, 3, and 6 months after RFTC treatment. We also analyzed the relationship between therapeutic outcomes and pain severity based on pre-treatment and knee MRI findings. RESULTS: No dropouts were observed. The most significant reduction in knee symptoms associated with knee osteoarthritis was observed after one month of treatment; however, at 3 and 6 months, there was a rebound effect, leading to a decrease in therapeutic efficacy. Nonetheless, there was still a noticeable decrease in symptoms due to knee osteoarthritis compared to those prior to RFTC treatment. The effect of RFTC treatment was better when pre-treatment pain was relatively less severe, knee effusion was not severe, there were no meniscal tears in the middle or posterior zones, no bone marrow edema in the middle and posterior zones of the femur and tibia, and no severe cartilage defects in the posterior femur and middle and posterior tibia. LIMITATIONS: We conducted our study without a control or a placebo group. CONCLUSION: RFTC of the genicular nerve is a good therapeutic option for controlling intractable pain following knee osteoarthritis. In addition, we found that a lower level of pain prior to treatment, along with the absence or lesser degree of knee joint effusion, as well as an absence or less severe middle or posterior knee pathologies associated with knee osteoarthritis, can predict a more favorable therapeutic outcome.

Mobile monitoring system detects the disease activity pattern and shows the association with clinical outcomes in patients with newly diagnosed Crohn's disease.

We aimed to determine whether Crohn's disease (CD) activity patterns assessed via a web-based symptom diary can help predict clinical outcomes in patients with newly diagnosed CD. Patients diagnosed with CD within the preceding 3 months were prospectively enrolled at four tertiary centers. All patients recorded their symptoms on a website using a smartphone at least once a week. The index outcomes were disease-related admission and surgery during follow-up. The disease activity from enrollment to outcome or last follow-up was reviewed for pattern analysis. Cox regression analysis was used to identify the predictors of disease outcomes. A total of 102 patients were enrolled. During a median follow-up period of 42 months, 25 (24.5%) and 6 (5.9%) patients required admission and surgery, respectively. Poor activity pattern was an independent predictor of disease-related hospitalization (adjusted hazard ratio [aHR], 3.96; 95% confidence interval [CI] 1.5-10.45; p = 0.005). A poor activity pattern (aHR, 19.48; 95% CI 1.86-203.95; p = 0.013) and female sex (aHR, 11.28; 95% CI 1.49-85.01; p = 0.018) were found to be independent predictors of bowel resection. CD disease activity patterns monitored through the mobile monitoring system may help predict clinical outcomes, such as disease-related hospitalization and surgery, in patients with newly diagnosed CD.

Effect of Comprehensive and Integrative Medical Services on Patients with Degenerative Lumbar Spinal Stenosis: A Pilot Study.

Background and Objectives: Two types of medicinal systems are available in Korea: Western and oriental. These exist as separate services that independently provide medical care to patients. We determined the utility and benefits of compressive and integrated medical services (CIMS) comprising 12 sessions of acupuncture and healing programs over 6 weeks. Methods and Methods: In this two-group parallel single-center randomized controlled assessor-blinded trial, 25 participants were assigned to either the experimental (conventional medical treatment plus CIMS, n = 12) or control (conventional medical treatment, n = 13) group. Spinal nerve root block was performed on the compressed spinal nerve root (identified using magnetic resonance imaging) when no improvement was observed after the initial treatment. The experimental group received 12 cycles of acupuncture and manual therapy for 6 weeks; the control group received conventional medical treatment alone. Results: The average age of participants in the experimental and control groups was 70.73 ± 5.95 and 67.33 ± 8.89 years, respectively. There were no significant differences between the groups in terms of age, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs, sex, and current medical history. We found high compliance for both programs (acupuncture and healing). On exclusion of between-group effects, the visual analog scale (VAS) score improved significantly over time (p = 0.045). Further, comparison of the groups after excluding the effects of visits revealed significantly lower VAS scores in the experimental group than in the control group (p = 0.000). Conclusions: Patients with degenerative lumbar spinal stenosis who mainly complain of radiating pain in the lower leg may benefit from CIMS after spinal nerve root block for ≤3 months after treatment. Our study findings suggest that this treatment improves spinal function and Oswestry Disability Index score. However, CIMS did not improve QoL.

Effects of intraoperative or postoperative administration of intravenous iron supplements on hemoglobin recovery in patients with total knee arthroplasty: A systematic review and meta-analysis.

BACKGROUND: The objectives of the researchers are as follows: First, to investigate whether intraoperative or postoperative administration of Intravenous (IV) iron supplements in patients undergoing primary total knee arthroplasty (TKA) can contribute to the hemoglobin recovery during the postoperative period (between 4 and 8 weeks after surgery). Second, to examine whether the administration of IV iron supplements during or immediately after TKA in patients undergoing primary TKA can reduce the need for allogenic blood transfusion during hospitalization. METHODS: Articles published between January 1, 1990, and June 30, 2023 were searched in PubMed, Cochrane, and Embase. The population, intervention, comparison, and outcome of this study are as follows; Population: Patients undergoing primary total knee arthroplasty; Intervention: Administration of IV iron supplements during or immediately after surgery; Comparison: Non-administration of IV iron supplements; Outcome: Degree of hemoglobin recovery (between 4 and 8 weeks after surgery) and the need for blood transfusion during hospitalization. RESULTS: There was a statistically significant difference in the amount of change in hemoglobin between iron supplementation group and non-iron supplementation group. The effect size were -0.44 (95% confidence interval: -0.69 to -0.19, P value < .001) in all patients. This means that the amount of change in hemoglobin were significantly reduced in the iron supplementation group than in the non-iron supplementation group. There was a statistically significant difference for post-operative transfusion rate between 2 groups. The effect size were 0.28 (95% confidence interval: 0.10-0.81, P value = .02) in all patients. This means that the post-operative transfusion rate was significantly less in the iron supplementation group than in the non-iron supplementation group. CONCLUSION: The administration of IV iron supplements during or after TKA surgery increases hemoglobin recovery between 4 and 8 weeks after surgery and reduces the need for allogeneic blood transfusion during hospitalization.

The effect of preexisting heart failure and coronary artery disease on motor function recovery in cerebral infarct patients: A retrospective observational study.

Less is known about the impact of heart failure (HF) and coronary artery disease (CAD) on motor recovery after cerebral infarction although previous studies have reported that preexisting HF and CAD were associated with increased mortality in stroke patients as well as unfavorable functional outcomes. In this study, we aimed to accurately evaluate the impact of HF and CAD on motor recovery after cerebral infarction by including only patients with corona radiata using diffusion tensor tractography. A total of 110 patients were recruited, and diffusion tensor tractography was performed within 7 to 30 days of infarct onset. Motor function on the affected side was evaluated for each patient using the upper myocardial infarction (MI), lower MI, modified Brunnstrom classification, and the functional ambulation category at the onset of stroke and 6 months after the onset of stroke. The influence of preexisting HF and CAD on the recovery of motor function were analyzed, adjusting for critical factors for motor recovery after stroke, namely the corticospinal tract condition, lesion location, age, and upper and lower MIs at the onset of stroke. No significant difference was found in motor outcomes according to the presence of HF, while poorer outcomes in motor function of the lower extremities and gait ability were observed in patients with CAD compared to patients without CAD. Motor function of the lower extremities and gait ability in cerebral infarct patients with CAD is more impaired than those without CAD.

Content Analysis of YouTube Videos on the Effect of Vitamin C on Common Cold.

BACKGROUND: With the growth of the Internet, social media platforms have emerged as major sources of medical information. We assessed the reliability, quality, and accuracy of the most-viewed YouTube videos containing information on the effect of vitamin C on the common cold. METHODS: The YouTube videos were searched on August 1, 2022, using the keywords: ("ascorbic acid" OR "vitamin C" OR "Sodium Ascorbate" OR "L-ascorbic") AND "common cold". The 30 most-viewed videos were included in our study. The reliability and quality of the videos were analyzed using modified DISCERN and Global Quality Scales, respectively. When the videos included at least one correct or inaccurate scientific statement about the effect of vitamin C on the common cold, they were classified as accurate or misleading videos, respectively; those without any pertinent information were considered neither accurate nor misleading. If a video contained both accurate and inaccurate statements, it was classified as misleading. RESULTS: Of the 30 most-viewed videos, 73% were unreliable, and 67% contained misleading information and were of a poor quality. Of these 30 videos, 14 videos were produced and posted by customers who were not specialized in medicine or nutrition. Moreover, these videos were of significantly lower reliability, quality, and accuracy than those produced by nutrition or fitness channels or by medical or nutrition professionals. CONCLUSION: The reliability, quality, and accuracy of videos uploaded by non-professionals were low. Therefore, video creators should upload reliable, high-quality videos to ensure the dissemination of accurate medical information.

Exposure to perfluoroalkyl and polyfluoroalkyl substances and risk of stroke in adults: a meta-analysis.

INTRODUCTION: Evidence of the adverse metabolic health effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) is increasing. However, the impact of PFAS on cardiovascular diseases remains controversial. This meta-analysis aimed to analyze the impact of PFAS on the stroke risk. CONTENT: Databases were searched for studies published up to November 1, 2022, which report the association between stroke and exposure to at least one of four main PFAS (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS], perfluorononanoic acid [PFNA], and perfluorohexane sulfonic acid [PFHxS]). Data extraction and quality assessment were performed according to the Newcastle-Ottawa scale. SUMMARY AND OUTLOOK: Four studies were included in this systematic review. Multivariate adjusted odds ratios (ORs) for incident stroke per 1-log unit increment in each serum PFAS were combined in the meta-analysis. The risk of development of stroke was not significantly associated with PFOA, PFOS, or PFNA exposure (PFOA: pooled odds ratio [OR]=1.001, 95 % confidence interval [CI]=0.975-1.028, p=0.934; PFOS: pooled OR=0.994, 95 % CI=0.972-1.017, p=0.601; PFNA: pooled OR=1.016, 95 % CI=0.920-1.123, p=0.752), whereas a moderately lower risk was associated with PFHxS exposure without statistical significance (pooled OR=0.953, 95 % CI=0.908-1.001, p=0.054). PFOA, PFOS, and PFNA exposure showed a neutral association, while PFHxS showed a possible inverse association with the risk of stroke. Therefore, this finding should be interpreted with caution. Further prospective observational studies with PFAS mixture analyses are warranted.

The effectiveness of acupuncture as an adjunctive therapy to oral pharmacological medication in patient with knee osteoarthritis: A systematic review and meta-analysis.

BACKGROUND: We aimed to find out whether the combined treatment of acupuncture and oral medication is more effective than sole oral medication in reducing pain and improving knee function at the end of treatment and after short-term period (4-6 weeks after treatment). Second, if it is effective, we investigated whether the effect surpasses the minimal clinically important difference. METHODS: Articles published between January 1, 1992, and August 31, 2022, were searched in PubMed, Cochrane, and Embase. The PICO (population, intervention, comparison, and outcome) of this study are as follows: Population: knee osteoarthritis patients; Intervention: acupuncture (non-sham acupuncture) + oral medication (analgesic or non-steroidal anti-inflammatory drugs); Comparison: oral medication (analgesic or non-steroidal anti-inflammatory drugs); Outcome: visual analog scale (VAS) or Western Ontario and McMaster University (WOMAC) osteoarthritis index. RESULTS: The combined treatment of oral medication and adjuvant acupuncture showed statistically significant improvement in VAS and WOMAC scores at the end of acupuncture treatment and short-term follow-up time (between 4 and 6 weeks after acupuncture). In addition, the degree of improvement of VAS and WOMAC index showed effects beyond minimal clinically important differences compared to pretreatment at both the end of acupuncture treatment and the short-term follow-up of acupuncture treatment. CONCLUSION: The existing evidence suggests that adjuvant acupuncture may play a role in the treatment of knee osteoarthritis. However, physicians should be aware of adverse effects such as hematoma in adjuvant acupuncture treatment.

The Results of Femorofemoral Bypass Using a Saphenous Vein Graft as an Alternative to PTFE Grafts.

Purpose: This study aimed to report the results of femorofemoral bypass (FFB) using a great saphenous vein (GSV) graft as an alternative to polytetrafluoroethylene (PTFE) grafts. Materials and Methods: From January 2012 to December 2021, 168 patients who underwent FFB (PTFE, 143; GSV, 25) were included. The patients' demographic features and surgical intervention results were retrospectively reviewed. Results: There were no intergroup differences in patients' demographic features. In GSV vs. PTFE grafts, the superficial femoral artery provided statistically significant inflow and outflow (P<0.001 for both), and redo bypass was more common (P=0.021). The mean follow-up duration was 24.7±2.3 months. The primary patency rates at 3 and 5 years were 84% and 74% for PTFE grafts and 82% and 70% for GSV grafts, respectively. There was no significant intergroup difference in primary patency (P=0.661) or clinically driven target lesion revascularization (CD-TLR)-free survival (P=0.758). Clinical characteristics, disease details, and procedures were analyzed as risk factors for graft occlusion. Multivariate analysis revealed that none of the factors was associated with an increased risk of FFB graft occlusion. Conclusion: FFB using PTFE or GSV grafts is a useful method with an approximately 70% 5-year primary patency rate. The GSV and PTFE grafts showed no difference in primary patency or CD-TLR-free survival during follow-up; however, FFB using GSV may be an option in selective situations.

Effectiveness of Transforaminal, Interlaminar, and Caudal Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Network Meta-analysis.

BACKGROUND: Epidural injection (EI) has been used to manage lower back and radicular leg pain caused by a herniated lumbar disc. There are 3 types of EI techniques currently being used: transforaminal (TFEI), interlaminar (ILEI), and caudal epidural injections (CEI). OBJECTIVES: To evaluate the comparative effectiveness of TFEI, ILEI, and CEI in reducing pain and improving function in patients with HLD. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The PubMed, Embase, Cochrane Library, and Scopus databases were searched from the earliest records up to August 2022 for randomized controlled trials (RCTs) and non-RCTs. The standard mean differences (SMDs) in the changes in the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were calculated from one week through one month posttreatment (short-term) and from 4 months through 6 months posttreatment (long-term). RESULTS: In total, 11 studies comprising 1,050 patients were included. Network meta-analysis showed that the improvement in the VAS scores was better with TFEI than with CEI (SMD = -1.16, 95% CI = -2.10 to -0.23). Ranking probability analysis showed that TFEI had the highest probability of being the best treatment for reducing pain and improving function in the short- and long-term evaluation periods. LIMITATIONS: Only a small number of previous studies were included in our analysis. Also, subgroup analysis according to the injection volume, material type, or pain onset could not be conducted. CONCLUSIONS: TFEI had the best potential of the 3 EI techniques to reduce pain and improve function in patients with a herniated lumbar disc. Further qualified trials comparing the effects of these 3 techniques are warranted to derive definitive conclusions.

Effectiveness of Extracorporeal Shockwave Therapy on Controlling Spasticity in Cerebral Palsy Patients: A Meta-Analysis of Timing of Outcome Measurement.

Extracorporeal shockwave therapy (ESWT) has been suggested as an alternative treatment for reducing spasticity in patients with cerebral palsy (CP). However, the duration of its effect was rarely known. A meta-analysis was performed to investigate the effectiveness of ESWT at controlling spasticity in patients with CP according to the follow-up period. We included studies in which ESWT was used to manage spasticity in patients with CP, and the effect was compared with that in a control group. Finally, three studies were included. In the meta-analysis, spasticity, measured using the modified Ashworth scale (MAS), was significantly reduced after ESWT compared with that in the control group; however, it was sustained for only 1 month. After ESWT, significant increases in passive ankle range of motion (ROM) and plantar surface area in the standing position were observed compared with those in the control group and sustained for up to 3 months. Although spasticity measured using MAS was significantly reduced for only 1 month, improvement in spasticity-associated symptoms, such as ankle ROM and plantar surface area contacting the ground, persisted for over 3 months. ESWT appears to be a useful and effective therapeutic option for managing spasticity in patients with CP.

Clinical and electrophysiological characteristics of respiratory onset amyotrophic lateral sclerosis: a single-centre study.

BACKGROUND: We compared the clinical characteristics of patients with respiratory, bulbar and limb onset amyotrophic lateral sclerosis (ALS) who visited a single tertiary centre for 8 years. METHODS: Total of 115 ALS patients with respiratory, bulbar and limb onset ALS, including sex, body mass index (BMI), presence of lung disease, age at diagnosis, disease duration after initial symptoms, ALS Functional Rating Scale (ALSFRS-R) and progression rate (Delta-FS), pulmonary function, amplitude and distal latency (DL) of the phrenic nerves and blood creatine kinase (CK) and uric acid levels were collected. RESULTS: The prevalence of respiratory, bulbar and limb onset ALS were 5.2%, 28.7% and 66.1%, respectively. The mean age at diagnosis and ALSFRS-R were 67.8 ± 5.5, 63.8 ± 10.1 and 59.2 ± 11.7 in the descending order. The mean amplitude (0.18 ± 0.10 mV) and DL (9.5 ± 1.7 ms) of the phrenic nerves were significantly decreased and prolonged in respiratory onset ALS compared with other types of ALS patients. Patients with respiratory onset ALS had normal creatine kinase (CK) levels, whereas patients with other types of ALS had increased CK levels. CONCLUSIONS: Although rare, respiratory onset ALS may occur and should be considered during the initial differential diagnosis. In this study, patients with respiratory onset ALS were characterised by male predominance, with a higher baseline ALSFRS-R, lower BMI and phrenic nerve study well discriminated respiratory onset ALS from bulbar or limb onset ALS patients.

Five to ten-year prognosis of whiplash injury-related chronic neck pain: A brief report.

BACKGROUND: Whiplash injury-related neck pain frequently hinders daily life activities, resulting in poor quality of life. Recovery time is prolonged in many patients. Long-term outcomes of refractory whiplash injury-related neck pain remain poorly understood. OBJECTIVE: This study aimed to evaluate the long-term prognosis of chronic whiplash injury-related neck pain. METHODS: We evaluated the prognosis of 38 patients with whiplash injury-induced neck pain via phone interviews. We investigated the data on current presence and degree of neck pain, current pain medication, physical modality or injection procedures, and difficulty performing daily life activities or occupational duties. RESULTS: At least 5 years after the whiplash injury, 34 patients (89.5%) experienced whiplash injury-related neck pain. The average numeric rating scale (NRS) score on the initial visit to our spine center was 5.3 ± 1.7 and that at the follow-up interview was 4.3 ± 2.6. Twenty-six (68.4%) patients had pain scores ⩾ 3 on the NRS. Additionally, 26 (68.4%) patients were receiving at least one of the following pain-management treatments: oral pain medications, physical modality, and injection procedures. Twenty-eight (73.7%) patients encountered difficulty performing daily life activities and occupational duties. CONCLUSIONS: The long-term prognosis of patients with whiplash injury-related neck pain was found to be poor.

A Novel App for Assessing the Caregivers' Physical Activity: A Pilot/Feasibility Study.

This study sought to determine the feasibility and clinical value of using a novel mobile application (app) to record the muscle/physical activity (PA) of caregivers. In all, 23 caregivers were enrolled and they were trained to use the app and a wearable device that automatically recorded their care activities and PA/burden. Data were collected for 42 days. Muscle activity was measured for 3 weeks during maximum voluntary isometric contraction (MVIC) and PA. Approximately 80% of the caregivers agreed that they conveniently used the wearable device through the mobile app. The most active %MVIC was noted for the back muscles during feeding assistance. As regard subjective pain evaluation, back pain was the most prevalent and pain level in the left knee was the highest. Incorporating mobile apps with wearable devices to record every activity of the caregivers may be feasible and can provide valuable clinical data for optimizing their pain management.

Influence of meteorological factors on development of spontaneous pneumothorax.

This study investigated the correlation between spontaneous pneumothorax (SP) and meteorological factors during different seasons. Patients who visited emergency rooms (ERs) in large cities in Korea and were discharged with SP from 2014 to 2016 were included in this study. Data on temperature, air pressure, and wind speed for each region were collected to obtain each factor's daily maximum, minimum, average, and changes. Days with more than 1 case of SP per million were referred to as pneumothorax days (PD) and those with less than 1 case of SP per million were referred to as non-pneumothorax days (NPD). The environmental factors were assessed on the same day (Day 0), 1 day prior (Day-1), and 2 days prior (Day-2) to PD and NPD per season. A total of 17,846 patients were included in this study. During winter, 4080 patients with SP visited the ERs of large cities with low population densities. The maximum temperature (0.16°C vs 0.76°C, 0.04°C vs 0.87°C, and 0.09°C vs 0.91°C), change in temperature (0.24°C vs 0.90°C, 0.38°C vs 0.81°C, and 0.41°C vs 0.83°C), average atmospheric pressure (0.16 vs 0.52 hPa, 0.25 vs 0.42 hPa, 0.34 vs 0.40 hPa), and maximum atmospheric pressure (0.15 vs 0.53 hPa, 0.28 vs 0.49 hPa, 0.33 vs 0.71 hPa) were greater for Day 0, Day-1, and Day-2, respectively, in PD than in NPD. Meanwhile, the average (0.31 vs 0.48 m/s, 0.28 vs 0.46 m/s, 0.20 vs 0.40 m/s), minimum (0.20 vs 0.31 m/s, 0.18 vs 0.25 m/s, 0.16 vs 0.25 m/s), and maximum (0.44 vs 0.67 m/s, 0.36 vs 0.71 m/s, 0.26 vs 0.58 m/s) wind speeds were slower, and the changes in wind speed (0.44 vs 0.67 m/s, 0.36 vs 0.71 m/s, 0.16 vs 0.25 m/s) were lower for all 3 days in PD than in NPD. High average and change in temperature, slow and unchanging wind speed, and high average and maximum atmospheric pressure were associated with SP. Since many findings of this study were contradictory to previous studies, it is assumed that the interaction of various factors affects SP.

Effectiveness of Mobiderm® bandages in the treatment of cancer-related secondary lymphedema: A pilot study.

Secondary lymphedema is a clinically incurable disease that commonly occurs following surgical cancer treatment and/or radiation. One of the most common forms of lymphedema treatment is complete decongestive therapy (CDT). This study aimed to investigate the clinical effects of new compression bandages (Mobiderm® bandages) in patients with secondary lymphedema after cancer treatment. This study included 17 patients with ipsilateral limb lymphedema after cancer treatment (one male and 16 female patients; age, 45-80 years). Patients were divided into the Mobiderm® bandage group (n = 9) and classical bandage group (n = 8). The International Society of Lymphology (ISL) stage was also evaluated. Limb circumference was measured at 5 to 6 sites per limb to identify the maximal circumference difference (MCD) between the affected and unaffected limbs. Pre-and posttreatment MCD were analyzed. After intensive CDT, both the Mobiderm® bandage group (1.2 ± 0.56 cm) and classical bandage group (0.85 ± 0.40 cm) had a significant decrease in MCD compared to pretreatment (P < .05). However, in patients with ISL stage 2, the mean MCD decrease rate was greater in the Mobiderm® bandage group (22.82 ± 10.92 %) than in the classical bandage group (12.18 ± 8.1 1%)(P = .045). Both new bandages (Mobiderm® bandages and classical bandages) reduced the circumference of limb edema in patients with secondary lymphedema after cancer treatment. This study findings suggest that Mobiderm® bandages as an alternative modality for controlling ISL stage 2 lymphedema.

Integrative medicine in patients with degenerative arthritis of the knee: A pilot randomized control study.

BACKGROUND: We aimed to comparatively analyze the effect of integrative medicine treatments (lifestyle change education, use of anti-inflammatory drugs, acupuncture, manual therapy-type massage) and conventional medical treatments (lifestyle change education and use of anti-inflammatory drugs) on pain control, knee function improvement, and quality of life improvement in patients with degenerative knee arthritis. METHODS: In this study, 30 patients were randomly divided into the control group (n = 15) and the experimental group (n = 15). Both groups were prescribed anti-inflammatory drugs and lifestyle change education for 12 weeks. The experimental group underwent acupuncture including electroacupuncture, moxibustion, and manual therapy-type massage 12 times during the first 6 weeks. Evaluations were performed at 3 visits: visit 1 (before treatment), visit 2 (6 weeks after initial treatment), and visit 3 (12 weeks after initial treatment). The effect of each treatment was measured using Visual Analog Scale (VAS, 0-10), Western Ontario and McMaster Universities index (WOMAC), and SF-36. RESULTS: From visit 1 to visit 2, the mean value of VAS decreased by 0.72 and 3.17 in the control and experimental groups, respectively. From visit 2 to visit 3, the mean VAS value decreased by 0.25 in the control group but increased by 0.87 in the experimental group. Among the sub-area of SF-36, the physical role restriction area and mental health area showed significant differences between the 2 groups over time (P = .024, P = .006). CONCLUSION: Integrative medicine treatment has superior effects in pain control over conventional medical treatment. In integrative medicine treatment, pain control tends to decrease with time, but still superior over conventional medical treatment up to 6 weeks after treatment (12 weeks after initial treatment).

Comparing the therapeutic effects of pregabalin and gabapentin after transforaminal epidural nerve block in lumbar radiculopathy.

Lumbar radiculopathy can be presented as low back pain and radiating pain. Transforaminal epidural steroid injection (TFESI) has been used to treat radicular pain, and after the injection, additional medications such as gabapentinoids including pregabalin (PGB) and gabapentin (GBP) can be administered to relieve remnant pain. However, little is known about the effectiveness of gabapentinoids in relieving pain after transforaminal epidural steroid injection. This study was conducted to compare the effect of pregabalin and gabapentin in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection. One hundred seven patients who received TFESI and had taken PGB or GBP after the intervention at Daegu Catholic University Medical Center from January 2013 to August 2021 were included in this study. Visual Analogue Scale (VAS) was evaluated in all patients. Among 107 patients, 57 (53.3%) patients took PGB and 50 (46.7%) patients took GBP after TFESI. The PGB and GBP groups showed reduced VAS scores according to visit (P < .001). However, no statistically significant differences in VAS scores according to the types of medication (P = .811) and change aspects according to visit were observed between the PGB and GBP groups (P = .947). The study findings suggest that both pregabalin and gabapentin can be equally used to reduce pain in lumbar radiculopathy patients who underwent TFESI. Further studies with larger sample size are needed to generalize the findings of this study.

Decline of Lung Function in Knee and Spine Osteoarthritis in the Korean Population: Cross-Sectional Analysis of Data from the Korea National Health and Nutrition Examination Survey.

Background: Evidence on the close association between osteoarthritis (OA) and lung diseases is supported by the shared pathogenesis of the two diseases. We assessed the association between knee and spine OA and chronic obstructive pulmonary disease (COPD) in the Korean population. Methods: Using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012, a total of 2006 subjects who underwent both plain radiography for assessment of knee and lumbar spine and spirometry analysis for lung function were analyzed. Radiographic severity grade for OA was assessed using the Kellgren−Lawrence (K-L) grading scale. COPD was defined as a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) less than 0.7. Results: Subjects with spine OA had higher prevalence of COPD than controls (p < 0.001), but not knee OA (p = 0.990). FVC (L), FEV1 (L), and FVC/FEV1 (%) were significantly decreased in spine OA compared to in controls (p = 0.003, p < 0.001, and p < 0.001, respectively). FVC (L), FVC (%), FEV1 (L), and FEV1 (%) were significantly different between knee OA and controls. Univariate regression analysis showed that spine OA was significantly associated with COPD (OR 1.581, 95% CI 1.204−2.076, p = 0.001), but not knee OA. Multivariate analysis revealed that spine OA lost statistical significance for COPD. Conclusion: This study found that subjects with knee OA and spine OA had a decline of lung function compared to subjects without OA, although OA was not associated with COPD.

Short-term Effect of Repetitive Transcranial Magnetic Stimulation on Diabetic Peripheral Neuropathic Pain.

BACKGROUND: Approximately half of the patients with long-standing diabetes are known to have diabetic peripheral neuropathy (DPN). Pain from DPN deteriorates quality of life and hinders activities of daily living. OBJECTIVES: This study aimed to evaluate the short-term effect of high-frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) on the left primary motor cortex (M1) for neuropathic pain in the lower extremities due to DPN. STUDY DESIGN: A randomized controlled trial. SETTING: The outpatient clinic of a single academic medical center. METHODS: In this randomized trial, 22 patients with DPN were randomly assigned to the rTMS group (10 Hz stimulation, 5 sessions) or the sham group. A numeric rating scale (NRS) was used to measure pain intensity before treatment and after one day and one week of treatment. Physical and mental health status were evaluated using the Short Form 36-Item Health Survey (SF-36), comprising 2 subscales (physical and mental component scores [PCSs and MCSs]), at one-week posttreatment. Of the 22 included patients, 20 (10 patients in each group) completed the study. RESULTS: In the rTMS group, the NRS score at one day and one week posttreatment was significantly lower than that at pretreatment. The SF-36 PCS and SF-36 MCS were significantly increased one week after the rTMS sessions. However, in the sham group, the NRS score, SF-36 PCS, and SF-36 MCS did not significantly change after the rTMS sessions. LIMITATIONS: The small number of included patients and no long-term follow-up. CONCLUSION: High-frequency rTMS on the left M1 may be useful for managing pain in the lower extremities due to DPN and may improve a patient's the quality of life.