Treatment Study

治疗研究
  • 文章类型: Journal Article
    抗药性癫痫是狗的常见主诉,影响多达30%的特发性癫痫犬。实验数据表明,靶向环加氧酶-2(COX-2)介导的信号传导可能会限制过度的兴奋性并防止发生。此外,已经描述了COX-2信号在癫痫发作相关的P-糖蛋白诱导中的作用。因此,靶向这一途径可能会改善癫痫发作的控制,这主要是基于疾病的改善作用,以及增强脑通路和共同给药的抗癫痫药物的疗效.目前的开放标签非对照试点研究调查了COX-2抑制剂(firocoxib)附加疗法在转化自然发生的慢性癫痫动物模型(客户拥有的狗患有苯巴比妥抗性特发性癫痫)中的疗效和耐受性。尽管有足够的苯巴比妥治疗,但该研究队列的特征是频繁的强直阵挛性癫痫发作和集束性癫痫发作。登记的狗(n=17)接受费罗昔布附加疗法6个月。在研究期间(6个月)的基线(6个月)分析了强直阵挛性癫痫发作和集群性癫痫发作频率。反应者的定义是强直阵挛性癫痫发作和集束性癫痫发作频率的显着降低(≥50%)。总的来说,11只狗完成了研究,并考虑进行统计分析。两只狗(18%,2/11)根据癫痫发作频率的变化将其分类为响应者。有趣的是,这两只狗的基线癫痫发作频率最高。总体耐受性良好。然而,鉴于响应者的比例较低,目前的数据不支持COX-2抑制剂附加疗法在克服犬中自然发生的苯巴比妥耐药癫痫方面的总体疗效相当.仅应在基线癫痫发作密度非常高的犬科患者中考虑进一步的转化评估。
    Drug-resistant epilepsy is a common complaint in dogs and affects up to 30% of dogs with idiopathic epilepsy. Experimental data suggest that targeting cyclooxygenase-2 (COX-2) mediated signaling might limit excessive excitability and prevent ictogenesis. Moreover, the role of COX-2 signaling in the seizure-associated induction of P-glycoprotein has been described. Thus, targeting this pathway may improve seizure control based on disease-modifying effects as well as enhancement of brain access and efficacy of the co-administered antiseizure medication. The present open-label non-controlled pilot study investigated the efficacy and tolerability of a COX-2 inhibitor (firocoxib) add-on therapy in a translational natural occurring chronic epilepsy animal model (client-owned dogs with phenobarbital-resistant idiopathic epilepsy). The study cohort was characterized by frequent tonic-clonic seizures and cluster seizures despite adequate phenobarbital treatment. Enrolled dogs (n = 17) received a firocoxib add-on therapy for 6 months. Tonic-clonic seizure and cluster seizure frequencies were analyzed at baseline (6 months) months during the study (6 months). The responders were defined by a substantial reduction of tonic-clonic seizure and cluster seizure frequency (≥50%). In total, eleven dogs completed the study and were considered for the statistical analysis. Two dogs (18%, 2/11) were classified as responders based on their change in seizure frequency. Interestingly, those two dogs had the highest baseline seizure frequency. The overall tolerability was good. However, given the low percentage of responders, the present data do not support an overall considerable efficacy of COX-2 inhibitor add-on therapy to overcome naturally occurring phenobarbital-resistant epilepsy in dogs. Further translational evaluation should only be considered in the canine patients with a very high baseline seizure density.
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  • 文章类型: Journal Article
    背景:用于治疗锁骨远端第三骨折的两种流行方法是传统的钩钢板和解剖学轮廓锁定钢板。对于一种方法是否比另一种方法更有效,没有共识。因此,这项研究的目的是比较传统的钩钢板和解剖轮廓锁定钢板在锁骨远端第三骨折治疗中的疗效。
    方法:注册患者被随机分配到钩板组(n=13)或锁定板组(n=17)。术后6个月和12个月进行随访评估(临床和放射学)。
    结果:在两组中,91%的病例在6个月和100%的病例在12个月时实现了结合。手臂的残疾没有差异,在12个月时,钩板和锁定板组之间记录了肩和手(DASH)和Constant-Murley肩评分。从6到12个月,钩板组DASH评分改善(P=.007),Constant-Murley肩评分趋于改善(P=.075)。锁定钢板组手术时间长于钩钢板组(P<0.001)。
    结论:两组在术后12个月时获得了相似的功能结果和愈合率。然而,钩钢板组的DASH评分从6个月到12个月改善,这表明使用解剖轮廓锁定钢板治疗的患者比使用钩钢板治疗的患者恢复更快.
    BACKGROUND: Two popular methods used to treat distal-third clavicle fractures are the traditional hook plate and the anatomically contoured locking plate. No consensus exists on whether one method is more effective than the other. Therefore, the aim of this study was to compare the efficacy of a traditional hook plate with that of an anatomically contoured locking plate augmented with coracoclavicular fixation in the treatment of distal-third clavicle fractures.
    METHODS: Enrolled patients were randomly assigned to either the hook plate group (n = 13) or the locking plate group (n = 17). Follow-up assessments (clinical and radiologic) were performed at 6 and 12 months postoperatively.
    RESULTS: In both groups, union was achieved in 91% of cases at 6 months and 100% at 12 months. No differences in Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley shoulder scores were noted between the hook plate and locking plate groups at 12 months. From 6 to 12 months, DASH scores improved in the hook plate group (P = .007) and Constant-Murley shoulder scores tended to improve (P = .075). Surgical time was longer in the locking plate group than in the hook plate group (P < .001).
    CONCLUSIONS: Similar functional outcomes and union rates were achieved in both groups at 12 months postoperatively. However, the improvement in DASH scores in the hook plate group from 6 to 12 months suggests that patients treated with an anatomically contoured locking plate make a quicker recovery than patients treated with a hook plate.
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  • 文章类型: Editorial
    OBJECTIVE: Hoarding disorder (HD) was recognized as a psychiatric disorder in 2013. Existing literature suggests room for improvement in its treatment. The current pilot study aimed to provide an initial evaluation on the potential of compassion-focused therapy (CFT) as an intervention for HD, with the primary aim being assessing its feasibility and acceptability, and the secondary being evaluating its effects.
    METHODS: Both CFT and a second round of the current standard of treatment and cognitive behavioural therapy (CBT) were investigated in the current study as follow-up treatment options for individuals who had completed CBT but were still significantly symptomatic.
    METHODS: Forty eligible individuals were enrolled (20 in each treatment). Treatment feasibility and acceptability were assessed by quantitative and qualitative measures. To explore treatment effects, HD symptom severity, HD-related dysfunctions, and their underlying mechanisms were assessed pre-treatment and post-treatment.
    RESULTS: Retention rates were 72% for CFT and 37% for CBT. All participants and 79% of the participants rated CFT and CBT, respectively, as good or excellent. After receiving CFT as a follow-up treatment, HD symptom severity dropped below the cut-off point for clinically significant HD for 77% of the treatment completers, and 62% achieved clinically significant reduction in symptom severity. In contrast, after completing a second course of CBT, 23% had HD symptom severity dropped below the cut-off threshold, and 29% achieved clinically significant symptom reduction.
    CONCLUSIONS: The current study showed satisfactory feasibility and acceptability of CFT. Moreover, it also found promising effects of CFT in addressing hoarding-related mechanisms that may not have been sufficiently addressed by CBT. The results suggest promising potential of CFT as a treatment for HD. Further investigation on this intervention is needed.
    UNASSIGNED: CFT may be a promising treatment option, particularly for those who do not respond well to CBT. Improving emotion regulation and negative self-perception by applying CFT interventions may help relieve hoarding symptoms. Generalization of the findings should be applied with caution given the small convenience sample of the current study. Statistical comparison on treatment effect measures between CFT and CBT as follow-up treatments was not available due to small sample size. Therefore, the comparative conclusions based on this pilot study should be made with caution.
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  • 文章类型: Journal Article
    BACKGROUND: The posterior elbow is prone to soft tissue loss that may require reconstructive methods for wound healing to be achieved. The flexor carpi ulnaris (FCU) muscle has been described for coverage in case reports and small series. Previous studies give conflicting anatomic findings about the dominant vascular pedicle for the FCU.
    METHODS: Twenty-five cadaveric specimens were dissected. Pedicle location, number, and distance from the medial epicondyle were recorded along with the extent of posterior elbow coverage. Chart review was conducted during a 4-year period. Eight patients who underwent FCU rotational flap coverage were identified. Those flaps relied entirely on a single proximal pedicle.
    RESULTS: The vascular pedicles from the ulnar artery or recurrent ulnar artery were identified in 24 of 25 specimens. The average distance from the tip of the medial epicondyle to the first pedicle was 5.7 cm (range, 3 to 10 cm). The length of muscle coverage proximal to the olecranon tip averaged 9.3 cm. The clinical follow-up of 7 patients requiring FCU rotational flaps for coverage of the posterior elbow showed that all flaps survived and provided adequate coverage for the defect.
    CONCLUSIONS: The FCU rotational pedicle flap provides predictable coverage of small to medium-sized defects about the posterior elbow. Although it is relatively consistent, the proximal vascular pedicle does demonstrate some variability, which should be considered in planning surgery. The consistent distal extent of the FCU muscle belly provides wider proximal coverage of defects.
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  • 文章类型: Journal Article
    OBJECTIVE: We hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) in a standardized, modified protocol is technically feasible and results in a higher vascularization response and watertight healing rate during early healing.
    METHODS: Twenty patients with chronic rotator cuff tears were randomly assigned to 2 treatment groups. In the test group (N = 10), L-PRF was added in between the tendon and the bone during arthroscopic rotator cuff repair. The second group served as control (N = 10). They received the same arthroscopic treatment without the use of L-PRF. We used a double-row tension band technique. Clinical examinations including subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores and measurement of the vascularization with power Doppler ultrasonography were made at 6 and 12 weeks.
    RESULTS: There have been no postoperative complications. At 6 and 12 weeks, there was no significant difference in the clinical scores between the test and the control groups. The mean vascularization index of the surgical tendon-to-bone insertions was always significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P = .0001). Whereas the L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P = .001), there was no difference after 12 weeks of follow-up (P = .889). Watertight healing was obtained in 89% of the repaired cuffs.
    CONCLUSIONS: Arthroscopic rotator cuff repair with the application of L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose to an increased and earlier cellular response and an increased healing rate.
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  • 文章类型: Journal Article
    BACKGROUND: Complex fracture-dislocations of the proximal ulna and radius represent a challenge even for expert orthopaedic surgeons. A new comprehensive classification, the proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS), was recently proposed. The aim of this study was to analyze the clinical usefulness of this classification in a large series of patients.
    METHODS: We studied 38 patients (39 elbows) with a mean age of 56 years. All patients were classified with the PURCCS by use of standard radiography, computed tomography, and intraoperative fluoroscopy. Surgical treatment was performed according to the PURCCS therapeutic algorithm. Patients were followed up for a mean of 23 months. The clinical evaluation was performed with the Mayo Elbow Performance Score and Index (MEPS and MEPI); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and the modified American Shoulder and Elbow Surgeons (m-ASES) score.
    RESULTS: Each pattern of fracture-dislocation in our series finds its position within the PURCCS. At the last follow-up, the mean MEPS, DASH score, and m-ASES score were 91.2, 14.9, and 83.9, respectively. The mean extension, flexion, pronation, and supination were 19°, 136°, 81°, and 79°, respectively. According to the MEPI, 72%, 20%, and 8% of cases were rated excellent, good, and fair, respectively. Two patients with elbow stiffness underwent a reoperation, with final satisfactory results.
    CONCLUSIONS: The PURCCS helps identify the main lesions of each injury pattern; the associated therapeutic algorithm helps select correct surgical strategies. This study showed that the clinical results were satisfactory in the majority of cases, with few major complications and reinterventions. The PURCCS is a comprehensive classification that may contribute to the surgical management of these difficult fracture-dislocations.
    METHODS: Level IV, case series, treatment study.
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  • 文章类型: Comparative Study
    BACKGROUND: The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear.
    METHODS: We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test.
    RESULTS: Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024).
    CONCLUSIONS: Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair.
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  • 文章类型: Journal Article
    背景:确定基于射频的等离子微肌腱切开术在治疗肩袖肌腱畸形的肩关节撞击综合征中是否具有积极的疗效。
    方法:本研究纳入了80例经关节镜治疗的撞击综合征和袖带肌腱病患者。患者被随机分配接受关节镜下肩峰下减压术(ASD组,n=40)或关节镜下肩峰下减压联合射频(RF)等离子微张力切开术(RF组,n=40)。临床结果数据,包括VAS疼痛评分,肩部运动范围(ROM),ASES,加州大学洛杉矶分校,Constant-Murley,术前和术后3周记录SST评分,6周,3个月,6个月,术后1年。
    结果:80例患者中有65例(81.3%)可在术后1年进行最后随访。ASD组32例,RF组33例。两组患者术后3周疼痛均显著减轻(ASD组P=0.031vsRF组P=0.017)。两组患者术后3个月功能评分均有明显改善。两个治疗组术后1年的屈曲抬高(FE)和外旋转(ER)以及术后6个月的内旋转(IR)显着改善。在术后任何时间点的任何结果测量中,两组之间均未发现显着差异。
    结论:关节镜下肩峰下减压术是治疗难治性撞击综合征的可靠方法。额外的基于射频的等离子微肌腱切开术未显示任何关于疼痛缓解的显著积极效果。ROM,或功能恢复。
    BACKGROUND: To determine whether radiofrequency based plasma microtenotomy has a positive effective in the treatment of shoulder impingement syndrome with cuff tendinosis.
    METHODS: Eighty patients with impingement syndrome and cuff tendinosis that were treated arthroscopically were enrolled in the study. The patients were randomly assigned to receive either arthroscopic subacromial decompression (ASD) alone (ASD group, n = 40) or arthroscopic subacromial decompression combined with radiofrequency (RF) based plasma microtenotomy (RF group, n = 40). Clinical outcome data including VAS pain score, shoulder range of motion (ROM), ASES, UCLA, Constant-Murley, and SST score were recorded preoperatively and at 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively.
    RESULTS: Sixty-five out of eighty patients (81.3%) were available for the final follow-up at 1 year postoperation. There were 32 patients in the ASD group and 33 in the RF group. Both treatment groups showed significantly (P = .031 in the ASD group vs P = .017 in the RF group) reduced pain 3 weeks postoperatively. Both treatment groups showed significantly improved functional scores 3 months postoperatively. Both treatment groups showed significantly improved flexion elevation (FE) and external rotation (ER) 1 year postoperatively and internal rotation (IR) 6 months postoperatively. No significant difference between the 2 groups was found in any of the outcome measurements at any time point postoperatively.
    CONCLUSIONS: Arthroscopic subacromial decompression is a reliable treatment for refractory impingement syndrome. The additional radiofrequency based plasma microtenotomy did not show any significant positive effects regarding pain relief, ROM, or functional recovery.
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  • 文章类型: Comparative Study
    BACKGROUND: Devastating neurologic ischemic episodes, such as stroke and deafness, have occurred in patients undergoing shoulder surgery in the beach chair position. We hypothesized that awake patients would be able to avoid significant cerebral deoxygenation events (CDEs) compared with anesthetized patients when procedures were performed in the beach chair position.
    METHODS: Sixty patients underwent elective shoulder surgery in the beach chair position. Thirty patients underwent an interscalene block and monitored sedation (awake group); 30 patients underwent general anesthesia (asleep group). Cerebral oxygenation saturation (Scto2) was measured during the procedure. Scto2 values below critical thresholds were defined as CDEs and treated.
    RESULTS: Baseline mean arterial pressure and Scto2 values were lower in the asleep group during the operation (P < .0001). A higher incidence of CDEs was seen in the asleep group (56.7% vs 0% awake group), and more CDEs were seen per patient (2.97 in asleep vs 0 awake, P < .0001). Scto2 below a threshold value of 55% was seen in 23.3% in the asleep group vs 3.3% in the awake group. A total of 89 combined desaturation events were documented in the asleep vs 1 in the awake group (P < .0001).
    CONCLUSIONS: Patients in the beach chair position treated with regional anesthesia and sedation had almost no cerebral desaturation events, unlike patients who had general anesthesia. Avoidance of general anesthesia in the beach chair position may reduce the risk of ischemic neurologic injury.
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  • 文章类型: Journal Article
    OBJECTIVE: To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospective cohort study design.
    METHODS: Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments (Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits, patients could choose 1 of 3 courses: (1) cured (no formal follow-up scheduled), (2) improved (continue therapy with scheduled reassessment in 6 weeks), or (3) no better (surgery offered). Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6-week, and 12-week outcome scores.
    RESULTS: The cohort consists of 452 patients. Patient-reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months.
    CONCLUSIONS: Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years.
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