BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane...BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.展开更多
AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated ...AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.展开更多
To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center(SYSUCC) launched the Good Pain Management(GPM) Ward Program, which has been recognized by the Chinese Ministry...To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center(SYSUCC) launched the Good Pain Management(GPM) Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index(PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients(244 in the control group and 231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group(62.8% vs. 37.7%, P < 0.001). The PMI of the GPM group was significantly higher than that of the control group(0.083 vs.-0.261, P < 0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.展开更多
AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of ...AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman's coefficient of rank correlation was used for statistical analysis,with significance set at P < 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients' disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.展开更多
AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were rec...AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.展开更多
基金Supported by Key Research and Development(R&D)Projects of Shanxi Province,China,No.201803D31135.
文摘BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.
文摘AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.
文摘To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center(SYSUCC) launched the Good Pain Management(GPM) Ward Program, which has been recognized by the Chinese Ministry of Health and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of the GPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index(PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients(244 in the control group and 231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group(62.8% vs. 37.7%, P < 0.001). The PMI of the GPM group was significantly higher than that of the control group(0.083 vs.-0.261, P < 0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.
文摘AIM:To investigate the correlation of facet joint osteoarthritis(FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS:The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years.The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner(Magnetom Avanto,Siemens AG,Erlangen,Germany) using a dedicated receive only spine coil.After initial blinding,each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging.In total 2364 facet joints were graded.Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI.The index is scored from 0 to 100 and interpreted as follows:0%-20%,minimaldisability; 20%-40%,moderate disability; 40%-60%,severe disability; 60%-80%,crippled; 80%-100%,patients are bedbound.Spearman's coefficient of rank correlation was used for statistical analysis,with significance set at P < 0.05.RESULTS:In total 2364 facet joints at lumbar levels L4/5 and L5/S1 were analysed in 591 individuals.FJOA was present in 97%(L4/L5) and 98%(L5/S1).At level L4/5(left/right) 17/15(2.9%/2.5%) were described as grade 0,146/147(24.7%/24.9%) as grade 1,290/302(49.1%/51.1%) as grade 2 and 138/127(23.4%/21.5%) as grade 3.At level L5/S1(left/right) 10/11(1.7%/1.9%) were described as grade 0,136/136(23.0%/23.0%) as grade 1,318/325(53.8%/55.0%) as grade 2 and 127/119(21.5%/20.1%) as grade 3.Regarding the ODI scores,patients' disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%.The majority of patients(48.39%) had moderate functional disability(21%-40%).There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1.A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1.CONCLUSION:The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain.Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.
文摘AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.
