Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report

Abstract

Therapeutic neuroscience education (TNE) has been shown to be effective in the treatment of mainly chronic musculoskeletal pain conditions. This case study aims to describe the changes in brain activation on functional magnetic resonance imaging (fMRI) scanning, before and after the application of a newly-designed preoperative TNE program. A 30-year-old female with a current acute episode of low back pain (LBP) and radiculopathy participated in a single preoperative TNE session. She completed pre- and post-education measures including visual analog scale (VAS) for LBP and leg pain; Oswestry Disability Index (ODI); Fear Avoidance Beliefs Questionnaire (FABQ); Pain Catastrophizing Scale (PCS) and a series of Likert-scale questions regarding beliefs and attitudes to lumbar surgery (LS). After a 30-minute TNE session, ODI decreased by 10%, PCS decreased by 10 points and her beliefs and attitudes shifted positively regarding LS. Immediately following TNE straight leg raise increased by 7° and forward flexion by 8?cm. fMRI testing following TNE revealed 3 marked differences compared to pre-education scanning: (1) deactivation of the periaqueductal gray area; (2) deactivation of the cerebellum; and (3) increased activation of the motor cortex. The immediate positive fMRI, psychometric and physical movement changes may indicate a cortical mechanism of TNE for patients scheduled for LS.     

正常产后48h母婴出院联合家庭访视的可行性研究

目的:评价经选择的母婴正常产后48 h出院联合家庭访视的可行性。方法:选择在深圳妇幼保健院正常产并接受产后家庭访视的10 172例产妇和9 297例新生儿为研究A组,同期拆线后出院的正常产产妇5 286例和新生儿4 604例为对照A组,比较两组产妇会阴伤口愈合不良发生率和婴儿再入院率。产后42天对1 000例产妇进行有关母乳喂养和产褥期母婴情况的问卷调查,按照是否曾接受产后访视将调查对象分为研究B组和对照B组,比较两组母乳喂养成功率和产褥期抑郁症的发生率。结果:通过产后家庭访视,平均缩短住院时间(1.76±0.44)天,研究A组产妇会阴伤口愈合不良发生率明显低于对照A组(P<0.05);研究A组婴儿再入院率和对照A组相比,差异无统计学意义(P>0.05);研究B组母乳喂养成功率明显高于对照组(P<0.05);研究B组产褥期抑郁症的发生率明显低于对照B组(P<0.05)。结论:对于经过选择的低风险产妇和婴儿,正常产后48 h出院联合家庭访视安全、经济、有效。     

The Cancer Series: An Introduction

A 77-year-old man presented to the emergency department with chest pain. Severe pain had occurred while he was walking, persisted for ten minutes, and was relieved when he took two nitroglycerine tablets. He had experienced intermittent chest pain for the past 11 days, mostly on exertion. The patient had hypertension, an elevated serum cholesterol level, and was a former smoker. His medications included aspirin, pravastatin, isosorbide dinitrate, metoprolol, and nitroglycerine.

The patient was in no apparent distress and without chest pain when he was examined. His blood pressure was 154/88 mm Hg; pulse, 70 bpm; respirations, 18 per min; temperature, 36.8° C; and oxygen saturation, 97% by pulse oximetry. The physical examination was unremarkable. The ECG is shown.     

青年颅内动静脉畸形患者术前焦虑状况及其护理

目的探讨青年颅内动静脉畸形患者术前焦虑状况,并总结其护理干预措施。方法回顾性分析2015年1月至2016年4月新疆医科大学第一附属医院神经外科收治的颅内动静脉畸形青年患者84例的临床资料。所有患者均在全身麻醉下实施动静脉畸形切除术,术前均详细记录其术前焦虑水平,并在常规护理的基础上实施心理护理及健康宣教。结果84例患者在术前均发生不同程度的焦虑(轻、中、重度焦虑分别为39例、32例、13例)。经心理护理后,患者均有不同程度的好转,均能顺利完成手术,手术时间为185~250min,平均(156±21.4)min。所有患者均未发生并发症,住院时间8~12d,平均(7.5±11.5)d。患者术后随访3~12个月,随访期间有1例患者复发;1例患者发生再出血。结论早期对患者进行良好的心理指导和健康宣教,可明显降低青年颅内动静脉畸形患者术前焦虑,有利于患者疾病康复。     

Prognostic factors of single‐visit endodontic and restorative treatment under general anaesthesia for special needs patients

The aim of this study was to evaluate the longevity of teeth with single‐visit endodontic and restorative treatment under general anaesthesia (GA) for special needs patients and to investigate factors associated with survival and success. Data were collected from 381 teeth in 203 patients [mean (s.d.) age = 27·0 (14·1)]. All endodontic and restorative procedures were performed during a single GA session except for cementation of crowns in the cases requiring crown restoration (38%). A total of 267 teeth (70·6%) were followed‐up for 6–81 months [mean (s.d.): 32·7 (20·0)]. Patients and teeth with and without follow‐up were compared. Kaplan–Meier analysis with generalised Wilcoxon test was used to compare the mean survival and success period. Cox proportion hazard regression model was applied for multivariate analysis. At the end of the observation period, 10 teeth had a crown fracture (5‐year survival rate = 89·8%), and an additional 10 teeth had primary or secondary caries (5‐year success rate = 86·4%). Risk factors associated with survival were age (>40), non‐parental caregiver, cooperation level and periodontal disease. A soft diet was an additional risk factor against the success of teeth. Single‐visit endodontic and restorative treatment under GA showed favourable outcomes, suggesting a promising treatment option for special needs patients. Patient‐ and dental‐specific circumstances need to be carefully considered to enhance the longevity of reconstructed teeth.     

“Choke” vessels between vascular territories of the abdominal wall: Literature review and rare case of Leriche's syndrome

We undertook a review of the anatomical changes of “choke” vessels between the internal thoracic artery (ITA) and deep inferior epigastric artery (DIEA), as highlighted by a case of aortoiliac occlusive disease (Leriche's syndrome), and discuss the physiological concepts observed with regard to surgical delay procedures within the abdominal wall performed prior to abdominal cutaneous free flaps and coronary artery bypass grafting. Computed tomographic angiography (CTA) was undertaken on a patient with a rare case of Leriche's syndrome and a literature review of over 200 references on the anatomy, physiology and clinical uses of choke vessels in the abdominal wall was undertaken. The CTA demonstrated that in patients with Leriche's syndrome, there is a marked dilatation of all ITA‐DIEA pathways and increased flow through choke vessels. If these changes can be surgically replicated in the form of a delay procedure for patients seeking to undergo autologous breast construction, this could improve the outcomes of abdominal cutaneous free flaps and coronary artery bypass grafting. We accordingly propose three surgical methods for augmenting blood flow to the abdominal wall: a) ligation of the DIEA; b) ligation of the distal ITA; and c) creation of an arterio‐venous fistulae in the DIEA. Our review of the literature confirmed the viability of these propositions. The dilatation of choke vessels in response to increased haemodynamic stress may thus be utilised to enhance blood supply to tissues prior to transfer and can be achieved through simple and minimally invasive methods. Clin. Anat. 25:998–1004, 2012. © 2012 Wiley Periodicals, Inc.     

Examining the accuracy of caregivers' assessments of young children's oral health status

BackgroundCaregivers' perceptions of their young children's oral health status (OHS) are a strong determinant of whether the children visit a dentist. Our aims were to quantify the correlation between caregivers' assessments and their children's clinically determined restorative treatment needs, while investigating factors related to this association.MethodsOne hundred eight caregivers assessed their children's OHS by answering a question on the self-reported National Health and Nutrition Examination Survey III instrument. Children underwent clinical oral examinations at one of two study sites of the Carolina Oral Health Literacy Project: a dental school–based clinic and a community-based health clinic. Examiners recorded the children's clinical treatment needs by using a modification of the caries severity index. The authors quantified concordance between the two measures with use of the Spearman rank correlation (ρ) and Kendall τ rank correlation, whereas they assessed differences in sociodemographic factors and oral health literacy (OHL) levels by using a homogeneity χ² test (P < .2 criterion).ResultsThe concordance between caregivers' assessments and clinically determined OHS was lower for younger children (< 2 years, ρ = 0.29 versus = 2 years, ρ = 0.63 [homogeneity P = .03]), a pattern that was evident in the community clinic but not in the university clinic. Caregivers' age, education and OHL did not influence the accuracy of self-reports.ConclusionsFor children younger than 2 years, caregivers' assessments correlated poorly with clinical needs, which routinely were underestimated.Practice ImplicationsThese findings underscore the importance of preventive dental visits at a young age and the early establishment of a dental home.