Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebo-control trial

The aim of the study was to investigate the effect of high-intensity laser therapy (HILT) in treatment of patients with chronic neck pain (CNP) on cervical range of motion (ROM), pain, and functional activity. Sixty male patients participated in this study with mean (SD) age of 35.47 (4.18) years. Patients were randomly assigned into two groups and treated with HILT plus exercise (HILT?+?EX) and placebo laser plus exercise (PL?+?EX) in groups 1 and 2, respectively. The outcomes measured were cervical ROM, pain level by visual analog scale (VAS), and functional activity by neck disability index (NDI) score. Statistical analyses were performed to compare the differences between baseline and post-treatment. The level of statistical significance was set as p?<?0.05. Cervical ROM significantly increased after 6 weeks of treatment in all groups. VAS and NDI results showed significant decrease post-treatment in both groups. HILT?+?EX effectively increased cervical ROM and decreased VAS and NDI scores after 6 weeks of treatment compared to PL?+?EX. HILT?+?EX is an effective physical therapy modality for patients with CNP compared to PL?+?EX therapy. The combination of HILT?+?EX effectively increased cervical ROM, functional activity, and reduced pain after 6 weeks of treatment.     

Exercise during energy restriction mitigates bone loss but not alterations in estrogen status or metabolic hormones

Summary

Energy restriction causes bone loss, increasing stress fracture risk. The impact of exercise during energy restriction on bone and endocrine factors is examined. Exercise with energy restriction did not influence endocrine factors, but did mitigate some bone loss seen with energy restriction in sedentary rats.

Introduction

Chronic dietary energy restriction (ER) leads to bone loss and increased fracture risk. Strictly controlled trials of long-term ER with and without vigorous exercise are required to determine whether exercise loading can counterbalance ER-induced bone loss. The aim of this current project is to elucidate the impact of exercise and ER on bone mass, estrogen status, and metabolic hormones.

Methods

Twenty-four virgin female Sprague-Dawley rats (n?=?8/group) were divided into three groups—ad libitum fed?+?exercise (Adlib?+?EX), 40 % energy restricted?+?exercise (ER?+?EX), and 40 % energy restricted?+?sedentary (ER?+?SED). Energy availability between ER groups was equal. Treadmill running was performed 4 days/week at 70 % VO_2max for 12 weeks.

Results

Fat and lean mass and areal bone mineral density (aBMD) were lower after 12 weeks (p?<?0.05) for ER?+?EX vs Adlib?+?EX, but ER?+?EX aBMD was higher than ER?+?SED (p?<?0.0001). Serum leptin and a urinary estrogen metabolite, estrone-1-glucuronide (E1G), were lower at week 12 (p?=?0.0002) with ER, with no impact of exercise. Serum insulin-like growth factor I (IGF-I) declined (p?=?0.02) from baseline to week 12 in both ER groups. ER?+?EX exhibited higher cortical volumetric bone mineral density (vBMD) at the midshaft tibia (p?=?0.006) vs ER?+?SED.

Conclusion

Exercise during ER mitigated some, but not all, of the bone loss observed in sedentary ER rats, but had little impact on changes in urinary E1G and serum IGF-I and leptin. These data highlight the importance of both adequate energy intake and the mechanical loading of exercise in maintaining bone mass.

     

Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period

Background

Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves.

Materials and methods

A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The initial 60 consecutive patients received ACB?+?IPACK (Group 1, n?=?60), and the subsequent 60 patients received ACB alone (Group 2, n?=?60). All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance.

Results

VAS score showed significantly (p?<?0.005) better values in ACB?+?IPACK group compared to the ACB group. The mean ROM of knee and ambulation distance also showed significantly better values in ACB?+?IPACK group compared to the ACB group.

Conclusion

ACB?+?IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.

     

Efficacy of pulsed Nd:YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial

The purpose of this study was to investigate the effects of pulsed Nd:YAG laser plus glucosamine/chondroitin sulfate (GCS) in patients with knee osteoarthritis (KOA) by examining changes in pain and knee function, as well as synovial thickness (ST) and femoral cartilage thickness (FCT). Sixty-seven male patients participated, with a mean (SD) age of 53.85 (4.39) years, weight of 84.01 (4.70) kg, height of 171.51 (3.96) cm, and BMI of 28.56 (1.22). Group 1 was treated with high-intensity laser therapy (HILT), GCS, and exercises (HILT?+?GCS?+?EX). Group 2 was treated with GCS plus exercises (GCS?+?EX), and group 3 received placebo laser plus exercises (PL?+?EX). The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. ST and FCT were measured by ultrasound examination. Statistical analyses were performed to compare differences between baseline and after 6 weeks of treatment and then after 3 months of follow-up. Statistical significance was set at p?<?0.05. VAS and WOMAC were significantly decreased in all groups after 6 weeks, with nonsignificant differences between 6 weeks and 3 months of follow-up. ST was significantly decreased in the HILT?+?GCS?+?EX group posttreatment, with nonsignificant decreases in the GCS?+?EX and PL?+?EX groups, as well as nonsignificant differences to FCT in all groups. Overall, pulsed Nd:YAG laser combined with GCS and exercises was more effective than GCS?+?EX and exercises alone in the treatment of KOA patients.     

Low-level laser therapy in the management of plantar fasciitis: a randomized controlled trial

This study aimed at estimating the extent to which a combination therapy of low-level laser therapy (LLLT) with exercise and orthotic support (usual care) affects functional ability in the patient with plantar fasciitis (PF) when compared to usual care alone. Participants with PF were randomly allocated into two groups: LLLT (n?=?27) and control (n?=?22). All the participants received home exercise program with orthotic support. In addition, the LLLT group received a gallium-aluminum-arsenide laser with a 850-nm wavelength for ten sessions, three times a week. Functional outcomes were measured by function subscale of American Orthopedic Foot and Ankle Society Score (AOFAS-F) and 12-min walking test including walking speed, cadence, and activity-related pain using visual analog scale (VAS).The scores were recorded at baseline, third week, and third month after the treatment. Analysis was performed using repeated measures ANOVA and an intention to treat approach using multiple imputations. There was a significant improvement in AOFAS-F total score at 3 weeks in both groups (LLLT, p?<?0.001; control, p?=?0.002), but the improvements were seen only for the LLLT group for AOFAS-F total score (p?=?0.04) and two individual items of AOFAS-F (walking distance (p?<?0.001) and walking surface (p?=?0.01)) at 3 months. The groups were comparable with each other for both walking speed and cadence at all assessment times (p?>?0.05). Both groups showed significant reduction in pain over 3 months (LLLT, p?<?0.001; control, p?=?0.01); however, the LLLT group had lower pain than the control group at 3 months (p?=?0.03). The combination therapy of LLLT with usual care is more effective to improve functional outcomes and activity-related pain when compared to usual care alone.     

Long term effects of high intensity laser therapy in lateral epicondylitis patients

The objective of this study is to investigate short- and long-term effects of high-intensity laser therapy (HILT) in lateral epicondylitis (LE) patients. Thirty patients with LE diagnosis (23 unilateral and 7 bilateral in total 37 elbows) were treated using HILT. LE patients were evaluated before, right after, and 6 months following HILT intervention post-treatment using visual analogue scale for pain (VAS) during activity and resting. Disabilities of the Arm, Shoulder, and Hand (DASH) Score and hand grip strength test (HGST) were used. The participants of the present study were also evaluated using Short-Form 36 (SF-36) before and 6 months after the treatment. Out of the 30 patients, 8 were male and 22 female with a mean age of 47.2?±?9.7. The activity and resting VAS, DASH, and HGST scores revealed statistically significant improvement (p?=?0.001) following treatment. Whereas VAS activity, DASH, and HGST scores increased after treatment until post-treatment 6 months significantly (p?=?0.001), VAS resting scores remained stable (p?=?0.476). A statistically significant improvement was also evident in the physical and mental components of SF-36 scores following treatment until post-treatment 6 months compared to pre-treatment scores (p?=?0.001). In conclusion, the results of the present study suggest that HILT is a reliable, safe, and effective treatment option in LE patients in the short and long term considering pain, functional status, and quality of life.     

Nonsurgical periodontal therapy with/without diode laser modulates metabolic control of type 2 diabetics with periodontitis: a randomized clinical trial

In order to evaluate whether nonsurgical periodontal treatment with/without diode laser (DL) decontamination improves clinical parameters, the levels of IL-1β, IL-6, IL-8, intercellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM) in gingival crevicular fluid and metabolic control (HbA1c) in chronic periodontitis (CP) patients with diabetes mellitus type 2 (DM2). Sixty patients with DM2 and CP were randomly assigned into two groups to receive scaling and root planing (SRP, n?=?30) or SRP followed by diode laser application (SRP?+?DL, n?=?30). Clinical periodontal and gingival crevicular fluid (GCF) parameters were assessed at baseline, 1, and 3 months after periodontal treatment. HbA1c levels were evaluated at baseline and 3 months post-therapy. Total amounts of cytokines and molecules were analyzed by ELISA. Nonsurgical periodontal treatment with/without DL appeared to improve clinical, biochemical parameters, and glycemic control in DM2 patients (BMI?<?25 kg/m²) with CP. The SRP?+?DL group provided better reductions in probing depth (PD) and clinical attachment level (CAL) parameters compared to the SRP group (P?<?0.05). Significant reductions were found in the total amounts of GCF levels of IL-1, IL-6, IL-8, ICAM, and VCAM after treatment (P?<?0.05). HbA1c levels decreased significantly at 3 months after treatment (P?<?0.05). SRP?+?DL reduced HbA1c levels more significantly compared to SRP alone (0.41 vs. 0.22 %, P?<?0.05). SRP, especially in combination with DL, shows improvement of glycemic control for DM2 patients with CP.     

Effects of different photobiomodulation dosimetries on temporomandibular dysfunction: a randomized,double-blind,placebo-controlled clinical trial

Changes involving temporomandibular joint, masticatory musculature, and associated structures characterize temporomandibular dysfunction (TMD). The analgesic and anti-inflammatory effect produced by photobiomodulation has contributed to pain relief and functional improvement. However, the parameters to be used have not yet been well established. The aim of this study is to compare the efficacy of three different photobiomodulation dosimetries in the treatment of patients with TMD. A randomized, double-blind, placebo-controlled clinical trial with 44 subjects divided into the groups 8 J/cm² (n?=?11), 60 J/cm² (n?=?11), 105 J/cm² (n?=?11), and control (n?=?11). Pain, symptom severity, and joint mobility were evaluated before and after a ten-session protocol of photobiomodulation with AlGaAs laser (830 nm), at a power density of 30 mW/cm². The mouth opening increased in the 8-J/cm² group from 10.49?±?4.68 to 15.40?±?6.43 degrees, and in the right protrusion from 9.80?±?4.2 to 12.56?±?5.40 degrees after the intervention protocol (p?<?0.05). All groups significantly decreased pain (p?<?0.05). 830-nm laser photobiomodulation was effective in reducing TMD pain and symptoms at all doses tested. Only the doses of 8 J/cm² were effective regarding maximal opening and protrusion of the mandible.     

IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind,Prospective, Randomized Trial in a Single Accredited Bariatric Center

Background

Postoperative pain control in bariatric surgery is challenging, despite use of intravenous (IV) narcotics. IV acetaminophen is one pain control alternative.

Objective

The aim of this study was to investigate the economic impact of IV acetaminophen in bariatric surgery and its effect on patients’ pain, satisfaction, and hospital length of stay.

Methods

In a randomized controlled trial, Group 1 (treatment) received IV acetaminophen plus IV narcotics 30 min before surgery, then medication plus IV narcotics/PO narcotics for the remaining 18 h. Group 2 (control) received IV normal saline plus IV/PO narcotics. Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (SG). Primary outcomes included direct hospital costs, length of stay, postoperative pain, and patient satisfaction. Secondary outcomes included indirect costs, rescue narcotics dosage, and 30-day outcomes.

Results

Mean direct hospital cost in the treatment group (n?=?50) was $3089.18 versus $2991.62 for the control group (n?=?50) (p?>?0.05). Pain scores did not differ significantly (p?=?0.61). After adjusting for surgery type, there was no significant difference in length of stay (p?=?0.95). Significantly more control group patients incurred surgery-related indirect costs (10 versus 2 %, p?<?0.05), with greater presentation to the emergency department (ED) for abdominal pain (5/50 versus 1/50), yielding higher total indirect costs ($39,293 versus $13,185).

Conclusions

Using IV acetaminophen for postoperative pain management produced notable indirect cost savings and reduced ED visits in the first 30 days postoperatively, with good safety and tolerance. Decreased statistical power may have accounted for certain non-significant findings.

     

A Prospective Randomized Controlled Trial of the Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition

Purpose

To compare the effects of the sleeve gastrectomy with transit bipartition (SG?+?TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D).

Methods

This is a prospective, randomized, controlled trial. Twenty male adults, ≤?65 years old, with T2D, body mass index (BMI)?>?28 kg/m² and <?35 kg/m², and HbA1c level?>?8% were randomized to SG?+?TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months.

Results

At 24 months, SG?+?TB group showed a significant decrease in HbaA1c values (9.3?±?2.1 versus 5.5?±?1.1%, P?=?<?0.05) whereas SMT group maintained similar levels from baseline (8.0?±?1.5 versus 8.3?±?1.1%, P?=?NS). BMI values were lower in the SG?+?TB group (25.3?±?2.8 kg/m² versus 30.9?±?2.5 kg/m²; P?=?<?0.001). At 24 months, none patient in SG?+?TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG?+?TB group (33?±?8 to 45?±?15 mg/dL, P?<?0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG?+?TB group and the AUC of the GIP concentrations was lower in the SG?+?TB group than in the SMT. At 3 months, SG?+?TB group showed a marked increase in FGF19 levels (74.1?±?45.8 to 237.3?±?234 pg/mL; P?=?0.001).

Conclusions

SG?+?TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.

     

Radiological and biochemical effects (CTX-II,MMP-3, 8, and 13) of low-level laser therapy (LLLT) in chronic osteoarthritis in Al-Kharj,Saudi Arabia

Inflammation of synovial membrane and degeneration of articular cartilage in osteoarthritis (OA) lead to major changes in joint space width (JSW) and biochemical components such as collagen-II telopeptide (CTX-II) and matrix metallo protineases (MMP-3, 8, and 13). Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as biomodulatory effect on microcirculation and cartilage regeneration in animal studies. The objective of this study was to examine the analgesic and biochemical effect of LLLT in patients with knee osteoarthritis. Subjects (n?=?34) who fulfilled the selection criteria were randomly divided into active group (n?=?17) and placebo group. Subjects in active group were irradiated laser with the frequency of 3 days per week for 4 weeks with the specific parameters on 8 different points on the joint at 1.5 J per point for 60 s for 8 points for a total dose of 12 J in a skin contact method. The placebo group was treated with the same probe with minimum emission of energy. Visual analog scale for pain intensity, joint space width, collagen-II telopeptide, and matrix metallo protinease-3, 8, and 13 was measured before treatment and at 4 and 8 weeks following treatment. Data are analyzed with mean values and standard deviation with p?<?0.05. Baseline values of all outcome measures show insignificant difference (p?>?0.05) in both groups which shows homogeneity. After 4- and 8-week treatment, active laser group shows more significant difference (p?<?0.001) in all the parameters than the placebo laser group (p?>?0.05). Our results show that low-level laser therapy was more efficient in reducing pain and improving cartilage thickness through biochemical changes.     

Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon’s 10 years of experience

Objectives

Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008.

Methods

Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7?±?4.8 (3–38) years. Over an 8 years’ experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on “compression test”. Early follow-up was on postoperative day 15 and 30.

Results

The mean operative time was 42.1?±?16.9 min. The mean hospital stay was 4.2?±?0.9 days. Postoperative complications included pneumothorax (n?=?2, 1.9%), wound infection (n?=?2, 1.9%), skin perforation (n?=?2, 1.9%), intolerable pain (n?=?1, 0.9%), skin hyperpigmentation (n?=?1, 0.9%), and overcorrection (n?=?1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8?±?4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results.

Conclusions

MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.

     

The investigation of the survival time after recurrence in patients with pancreatic ductal adenocarcinoma for individualization of adjuvant chemotherapy

Purpose

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease; however, the frequency of recurrence can be reduced if curative surgery following adjuvant chemotherapy is applied. At present, adjuvant chemotherapy is uniformly performed in all patients, as it is unclear which tumor types are controlled best or worst. We investigated patients with recurrence to establish the optimum treatment strategy.

Methods

Of 138 patients who underwent curative surgery for PDAC, 85 developed recurrence. Comprehensive clinicopathological factors were investigated for their association with the survival time after recurrence (SAR).

Results

The median SAR was 12.6 months. Treatments for recurrence included best supportive care, GEM-based therapy and S-1. The performance status [hazard ratio (HR) 0.12, P?<?0.001], histological invasion of lymph vessels (HR 0.27, P?<?0.001), kind of treatment for recurrence (HR 5.0, P?<?0.001) and initial recurrence site (HR 2.9, P?<?0.001) were independent significant risk factors for the SAR. The initial recurrence sites were the liver (n?=?21, median SAR 8.8 months), lung (n?=?10, 14.9 months), peritoneum (n?=?6, 1.7 months), lymph nodes (n?=?6, 14.7 months), local site (n?=?17, 13.9 months) and multiple sites (n?=?25, 10.1 months). A shorter recurrence-free survival (<?1 year) and higher postoperative CA19-9 level were significantly associated with critical recurrence (peritoneal/liver).

Conclusions

Several risk factors for SAR were detected in this study. Further investigations are needed to individualize the adjuvant chemotherapy for each patient with PDAC.

     

Diversity of the midstream urine microbiome in adults with chronic kidney disease

Purpose

To examine the characteristics of the midstream urine microbiome in adults with stage 3–5 non-dialysis-dependent chronic kidney disease (CKD).

Methods

Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate [eGFR]?<?60 ml/min/1.73 m²) and diuretic use were recruited from outpatient nephrology clinics. Midstream voided urine specimens were collected using the clean-catch method. The bacterial composition was determined by sequencing the hypervariable (V4) region of the bacterial 16S ribosomal RNA gene. Extraction negative controls (no urine) were included to assess the contribution of extraneous DNA from possible sources of contamination. Midstream urine microbiome diversity was assessed with the inverse Simpson, Chao and Shannon indices. The diversity measures were further examined by demographic characteristics and by comorbidities.

Results

The cohort of 41 women and 36 men with detectable bacterial DNA in their urine samples had a mean age of 71.5 years (standard deviation [SD] 7.9) years (range 60–91 years). The majority were white (68.0%) and a substantial minority were African-American (29.3%) The mean eGFR was 27.2 (SD 13.6) ml/min/1.73 m². Most men (72.2%) were circumcised and 16.6% reported a remote history of prostate cancer. Many midstream voided urine specimens were dominated (>?50% reads) by the genera Corynebacterium (n?=?11), Staphylococcus (n?=?9), Streptococcus (n?=?7), Lactobacillus (n?=?7), Gardnerella (n?=?7), Prevotella (n?=?4), Escherichia_Shigella (n?=?3), and Enterobacteriaceae (n?=?2); the rest lacked a dominant genus. The samples had high levels of diversity, as measured by the inverse Simpson [7.24 (95% CI 6.76, 7.81)], Chao [558.24 (95% CI 381.70, 879.35)], and Shannon indices [2.60 (95% CI 2.51, 2.69)]. Diversity measures were generally higher in participants with urgency urinary incontinence and higher estimated glomerular filtration rate (eGFR). After controlling for demographics and diabetes status, microbiome diversity was significantly associated with estimated eGFR (P?<?0.05).

Conclusions

The midstream voided urine microbiome of older adults with stage 3–5 non-dialysis-dependent CKD is diverse. Greater microbiome diversity is associated with higher eGFR.

     

LBP rs2232618 polymorphism contributes to risk of sepsis after trauma

Background

Previous study revealed that rs2232618 polymorphism (Phe436Leu) within LBP gene is a functional variant and associated with susceptibility of sepsis in traumatic patients. Our aim was to confirm the reported association by enlarging the population sample size and perform a meta-analysis to find additional evidence.

Methods

Traumatic patients from Southwest (n?=?1296) and Southeast (n?=?445) of China were enrolled in our study. After genotyping, the relationship between rs2232618 and the risk of sepsis was analyzed. Furthermore, we proceeded with a comprehensive literature search and meta-analysis to determine whether the rs2232618 polymorphism conferred susceptibility to sepsis.

Results

Significance correlation was observed between rs2232618 and risk of sepsis in Southwest patients (P?=?0.002 for the dominant model, P?=?0.006 for the recessive model). The association was confirmed in Southeast cohort (P?=?0.005 for the dominant model) and overall combined cohorts (P =?4.5?×?10^?4, P?=?0.041 for the dominant and recessive model). Multiple logistical regression analyses suggested that rs2232618 polymorphism was related to higher risk of sepsis (OR?=?1.77, 95% CI?=?1.26–2.48, P?=?0.001 in Southwest patients; OR?=?2.11, 95% CI?=?1.24–3.58, P?=?0.006 in Southeast cohort; OR?=?1.54, 95% CI?=?1.34–2.08, P?=?0.006 in overall cohort). Furthermore, meta-analysis of four studies (including the present study) confirmed that rs2232618 within LBP increased the risk of sepsis (OR?=?1.75, P?<?0.001 for the dominant model; OR?=?6.08, P?=?0.003 for the recessive model; OR?=?2.72, P?<?0.001 for the allelic model).

Conclusions

The results from our replication study and meta-analysis provided firm evidence that rs2232618T allele significantly increased the risk of sepsis.

     

Translation and validation of ICIQ-FLUTS for Tamil-speaking women

Aims

Research in to lower urinary tract symptoms (LUTS) in women in South Asia is hampered by lack of validated tools. Our aim was to validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) from English to Tamil.

Method

After translation to Tamil, a validation study was carried out among women attending the gynecology clinic at District General Hospital-Mannar.

Results

Content validity assessed by the level of missing data was <2%. Construct validity was assessed by the ability of the questionnaire to identify patients with incontinence (n?=?45) from controls (n?=?93) using the incontinence score [patients?=?7.7 standard deviation (SD)?=?4.7, controls?=?1.4 SD?=?2.2, p?<?0.001] and those with symptomatic anterior wall prolapse (n?=?16) from controls (n?=?93) using voiding symptoms score (patients?=?4.8 SD?=?2.3, controls?=?0.3 SD?=?0.8, p?<?0.001). Internal consistency was assessed using Cronbach’s coefficient alpha score [0.80 (0.77–0.81)]. Test–retest reliability assessed by weighted kappa (κ) ranged from 0.73 to 0.87. Patients with incontinence (n?=?30, pretreatment incontinence score?=?7.9, SD?=?4.9 versus posttreatment incontinence score?=?3.3, SD?=?3.1) and symptomatic anterior wall prolapse (n?=?14, preoperative voiding symptoms score?=?4.9 SD?=?2.5 versus postoperative voiding symptoms score?=?0.9 SD?=?1.5) showed an improvement with treatment (Wilcoxon matched-–pairs signed-rank test p?<?0.001 and p?<?0.01, respectively). An incontinence score?≥?3 (sensitivity?=?86.7%, specificity?=?78.4%) and a voiding symptoms score?≥?3 (sensitivity?=?87.5%, specificity?=?96.2%) detected any form of incontinence and symptomatic anterior wall prolapse, respectively.

Conclusion

Tamil translation of ICIQ-FLUTS retained the psychometric properties of the original English questionnaire and will be an invaluable tool to detect LUTS among Tamil-speaking women.

     

Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention

Gastrobronchial fistula (GBF) is a serious complication following bariatric surgery, whose treatment by thoracotomy and/or laparotomy involves a high morbidity rate. We present the outcomes of endoscopic management for GBF as a helpful technique for its healing process. This is a multicenter retrospective study of 15 patients who underwent gastric bypass (n?=?10) and sleeve gastrectomy (n?=?5) and presented GBF postoperatively (mean of 6.7 months). Ten patients developed lung abscess and were treated by antibiotic therapy (n?=?10) and thoracotomy (n?=?3). Abdominal reoperation was performed in nine patients for abscess drainage (n?=?9) and/or ring removal (n?=?4) and/or nutritional access (n?=?6). The source of the GBF was at the angle of His (n?=?14). Furthermore, 14 patients presented a narrowing of the gastric pouch treated by 20 or 30 mm aggressive balloon dilation (n?=?11), stricturotomy or septoplasty (n?=?10) and/or stent (n?=?7). Fibrin glue was used in one patient. We performed, on average, 4.5 endoscopic sessions per patient. Endotherapy led to a 93.3% (14 out of 15) success rate in GBF closure with an average healing time of 4.4 months (range, 1–10 months), being shorter in the stent group (2.5?×?9.5 months). There was no recurrence during the average 27.3-month follow-up. A patient persisted with GBF, despite the fibrin glue application, and decided to discontinue it. GBF is a highly morbid complication, which usually arises late in the postoperative period. Endotherapy through different strategies is a highly effective therapeutic option and should be implemented early in order to shorten leakage healing time.     

Effect of anesthesia type on perioperative outcomes with a midurethral sling

Introduction and hypothesis

There is no consensus on the most appropriate type of anesthesia for placement of a midurethral sling. Our objective was to compare intra- and perioperative outcomes for this procedure performed under general anesthesia versus monitored anesthesia care.

Methods

Retrospective cohort analysis of women undergoing outpatient placement of synthetic retropubic midurethral sling under general anesthesia (n?=?141) or monitored anesthesia care (n?=?84). Patients undergoing concomitant procedures were excluded. Primary outcome was operating room time. Secondary outcomes included surgical and recovery times, cost, discharge home with a catheter, and postoperative pain and/or nausea.

Results

In the general anesthesia group, both operating room time (mean?±?SD, 67.6?±?13.3 min vs 56.9?±?11.8 min, p?<?0.001) and recovery room time (240.0?±?69.8 min vs 190.1?±?78.3 min, p?<?0.001) were longer, whereas there was no difference in surgical time (30.0?±?8.9 min vs 29.0?±?9.7 min, p?=?0.43). Cost was significantly higher in the general anesthesia group ($4,095?±?715 vs $3,877?±?777, p?=?0.03). There was no difference in rates of bladder perforation (6.4 % vs 11.9 %, p?=?0.33). Patients who underwent general anesthesia had higher rates of discharge with a catheter (27.0 % vs 15.8 %, p?=?0.04).

Conclusion

Monitored anesthesia care may offer significant benefits over general anesthesia in women undergoing retropubic midurethral sling, including shorter operating room and recovery times, lower costs, and less voiding dysfunction in the immediate postoperative period.

     

Are there any metastases to the chest in non-muscle-invasive bladder cancer patients on follow-up computed tomography?

Purpose

The purpose of the study was to retrospectively determine whether there are metastases to the chest in patients with primary non-muscle-invasive urothelial carcinoma in the bladder on the follow-up computed tomography (CT).

Methods

We analyzed 328 patients with follow-up chest CT for urothelial carcinoma of the bladder diagnosed between January 2004 and September 2013. We divided patients into four groups: Ta (n?=?74), T1 (n?=?78), carcinoma in situ (CIS, n?=?25), and ≥?T2 (n?=?151). We used the chest CT to determine whether there were positive findings of metastasis. Univariate and multivariate analyses were achieved using categories of T stage, histological grade, multifocal lesions, and recurrence.

Results

On univariate analysis, there were significant differences on T stage (p?<?0.001) and histological grade (p?=?0.001), and there was no significant difference on multifocal lesions (p?=?0.11) and recurrence (p?=?0.34). Positive findings of metastases were observed in 1.4% (1/74) of the Ta patients, 0% (0/78) of the T1 patients, 8.0% (2/25) of the patients with carcinoma in situ (CIS), and 27.2% (41/151) of the ≥?T2 patients (p?<?0.001). On multivariate analysis, T staging was independent variable for positive findings of metastasis (Odds ratio; 2.84, 95% Confidence Interval; 1.65–4.89). In contrast, histological grade, multifocal lesions, and recurrence were not independent variables.

Conclusions

T stage would affect to metastasis to the chest. It might be appropriate to omit chest CT in patients with Ta or T1 without upstaging in the course of follow-up. We may suggest that the follow-up chest CT in patients with CIS.

     

A Prospective,Randomized, Phase III Study to Evaluate the Efficacy and Safety of Fibrin Sealant Grifols as an Adjunct to Hemostasis as Compared to Cellulose Sheets in Hepatic Surgery Resections

Background

Local hemostatic agents have a role in limiting bleeding complications associated with liver resection.

Methods

In this randomized, phase III study, we compared the efficacy and safety of Fibrin Sealant Grifols (FS Grifols) with oxidized cellulose sheets (Surgicel®) as adjuncts to hemostasis during hepatic resections. The primary efficacy endpoint was the proportion of patients achieving hemostasis at target bleeding sites (TBS) within 4 min (T₄) of treatment application. Secondary efficacy variables were time to hemostasis (TTH) at a later time point if re-bleeding occurs and cumulative proportion of patients achieving hemostasis by time points T₂, T₃, T₅, T₇, and T₁₀.

Results

The rate of hemostasis by T₄ was 92.8% in the FS Grifols group (n?=?163) and 80.5% in the Surgicel® group (n?=?162) (p?=?0.01). The mean TTH was significantly shorter (p?<?0.001) in the FS Grifols group (2.8?±?0.14 vs. 3.8?±?0.24 min). The rate of hemostasis by T₂, T₅, and T₇ was higher and statistically superior in the FS Grifols group compared to Surgicel®. No substantial differences in adverse events (AE) were noted between treatment groups. The most common AEs were procedural pain (36.2 vs. 37.7%), nausea (20.9 vs. 23.5%), and hypotension (14.1 vs 6.2%).

Conclusions

FS Grifols was safe and well tolerated as a local hemostatic agent during liver resection surgeries. Overall, data demonstrate that the hemostatic efficacy of FS Grifols is superior to Surgicel® and support the use of FS Grifols as an effective local hemostatic agent in these surgical procedures.