Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain

BackgroundAcute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.ObjectivesTo investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.MethodsProspective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected.ResultsWe studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1–9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD 0.17 and 0.50 nmol/L, SD 0.15, respectively; p = 0.005). The areas under the receiver-operating characteristic curves were 0.66 (95% CI, 0.59–0.72) for pro-ADM, 0.70 (95% CI, 0.63–0.76) for C-reactive protein (CRP), 0.84 (95% CI, 0.79–0.89) for neutrophils, and 0.84 (95% CI, 0.79–0.89) for total leukocytes. The most reliable combination to rule out AA was CRP ≤1.25 mg/dL and pro-ADM ≤0.35 nmol/L with a sensitivity of 96% and a negative predictive value of 93%.ConclusionChildren with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA.     

Alterations in energy consumption and plantar pressure distribution during walking in young adults with patellofemoral pain syndrome

Objective

The aim of this study was to determine the alterations of walking energy expenditure and plantar pressure distribution in young adults with patellofemoral pain syndrome (PFPS).

Intraoral Somatosensory Alterations Impact Pulp Sensibility Testing in Patients with Symptomatic Irreversible Pulpitis

IntroductionThis case-control study aimed to compare trigeminal somatosensory sensitivity between patients with a clinical diagnosis of symptomatic irreversible pulpitis (n = 33) and healthy participants (n = 33) and to evaluate the impact of somatosensory stratification of symptomatic irreversible pulpitis on pulp sensibility testing.MethodsA standardized battery of qualitative sensory assessment measured intra- and extraoral sensitivity to touch, cold, and pinprick stimuli. Dental pain intensity (0–100, numeric rating scale) and duration (seconds) evoked by cold stimuli (refrigerant spray) were applied to, respectively, the nonaffected and affected tooth (cases) and the upper right and left premolars (controls); z score transformation, analysis of variance (ANOVA), and chi-square tests were applied to the data (P = .050).ResultsPatients with irreversible pulpitis reported intraoral hypersensitivity more frequently than healthy participants (58% and 33%, respectively; P < .05). In addition, patients with irreversible pulpitis reported higher z scores of pain intensity (ANOVA main effects, F = 37.10, P < .05, partial η² = 0.37) and duration (ANOVA main effects F = 23.3, P < .05, partial η² = 0.27) after the pulp sensibility test compared with healthy participants. Nevertheless, subgroup analysis taking into account the presence of intraoral hypersensitivity indicated that the pain lingered most for patients with symptomatic irreversible pulpitis who also presented intraoral hypersensitivity (Tukey test, P < .05) but with no differences between patients with irreversible pulpitis without intraoral hypersensitivity and healthy participants (Tukey test, P > .05).ConclusionsQualST is able to detect intraoral alterations in patients with symptomatic irreversible pulpitis that seem useful to stratify the patients into distinct subgroups. Therefore, somatosensory assessment of the adjacent tissues may provide diagnostic fine-tuning of dental pulp diseases.     

不同直腿抬高扳腿法对推拿治疗腰椎间盘突出症临床疗效的影响

目的探讨不同直腿抬高扳腿法对推拿治疗腰椎间盘突出症临床疗效的影响。方法选择2018年5月—2019年1月在广西中医药大学第一附属医院推拿科治疗的腰椎间盘突出症患者100例,随机分为对照组与观察组各50例。2组均采用相同的松解类推拿手法治疗,治疗过程中观察组采用改进的直腿抬高扳腿法,对照组采用常规的直腿抬高扳腿法。2组均以治疗6次为1个疗程,疗程之间间隔1 d,共治疗4个疗程。观察2组治疗效果及治疗前后患侧直腿抬高角度、疼痛视觉模拟评分(VAS评分)、日本骨科学会腰椎功能量表评分(JOA评分)变化和治疗过程中可能发生的不良反应。结果观察组与对照组愈显率分别为74%(37/50)、54%(27/50),总有效率分别为96%(48/50)、94%(47/50),观察组愈显率明显高于对照组(P<0.05),2组总有效率比较差异无统计学意义(P>0.05)。与治疗前比较,治疗后2组患者患侧直腿抬高角度均显著增大(P均<0.05),VAS评分均显著降低(P均<0.05),JOA评分均显著升高(P均<0.05);治疗后2组比较,观察组患侧直腿抬高角度显著大于对照组(P<0.05),VAS评分显著低于对照组(P<0.05),JOA评分显著高于对照组(P<0.05)。观察组患者均未出现疼痛症状加重等手法反应,对照组有7例患者出现不同程度的腰臀疼痛症状加重。结论在采用推拿手法治疗腰椎间盘突出症时,改进的直腿抬高扳腿法较常规的直腿抬高扳腿法疗效更为显著,可能发生的不良反应更少。