Is there any advantage between using continuous passive motion and conventional physical therapy in patients with primary adhesive capsulitis?: A systematic review and meta-analysis

BACKGROUND

We are unsure if continuous passive motion (CPM) has any role in the nonoperative management of the Primary Stiff Shoulder (frozen shoulder). We hypothesized that there is no difference in pain improvement, range of motion, and function with or without CPM in patients with a primary stiff shoulder.

METHOD

We searched the databases for clinical trials comparing CPM versus no-CPM physiotherapy. In the final step, we reviewed five randomized clinical trials. We collected the data of Constant Shoulder Score (CSS), the visual analog scale of pain, shoulder pain and disability index (SPADI), and range of motion (flexion, abduction, external and internal rotation). We used a random-effects model to analyze the data.

RESULTS

Five studies with a total of 224 patients were included. There were 113 patients in the CPM arm and 111 in the control arm. Both the CPM and control groups showed significant improvements in all measured parameters compared to the first visit after 8-24 weeks. Meta-analysis of pooled data showed significant differences in pain improvement, forward flexion, and CSS favoring the CPM. Still, there was no significant difference in abduction, external and internal rotation, and SPADI.

DISCUSSION

The CPM seems to be slightly effective in improving pain and motion in the short term, but its long-term efficacy is still under question. The extra cost and time must be considered when offering the CPM.

Cancer-associated fibroblasts in colorectal cancer

Colorectal cancer (CRC) is one of the leading causes of mortality among cancers. Many aspects of this cancer are under investigation to find established markers of diagnosis, prognosis, and also potential drug targets. In this review article, we are going to discuss the possible solution to all these aims by investigating the literature about cancer-associated fibroblasts (CAFs) involved in CRC. Moreover, we are going to review their interaction with the tumor microenvironment (TME) and vitamin D and their role in tumorigenesis and metastasis. Moreover, we are going to expand more on some markers produced by them or related to them including FAP, a-SMA, CXCL12, TGF- β, POSTN, and β1-Integrin. Some signaling pathways related to CAFs are as follows: FAK, AKT, activin A, and YAP/TAZ. Some genes related to the CAFs which are found to be possible therapeutic targets include COL3A1, JAM3, AEBP1 and, CAF-derived TGFB3, WNT2, and WNT54.

O-139 Complete removal of uterine septum tissue as a wedge, an alternative method for patients suffering from recurrent pregnancy loss or infertility, a retrospective cohort study

Study question

Is hysteroscopic wedge septectomy (HWS) an effective and safe method for reducing the risk of miscarriage and improving the reproductive outcome in patients with recurrent pregnancy loss or infertility history?

Summary answer

HWS is a safe and effective method for RPL and infertility cases with statistically significant improvement in pregnancy chances and reproductive outcomes.

What is known already

With regard to the persisting uncertainty around the effectiveness of septum resection in recurrent miscarriage and infertility cases, there may be alternative methods to better address the pathophysiology of septum. There are different explanations for the poor reproductive performance with uterine septum: poor vascularisation of a highly fibrous implantation site, low sensitivity of endometrial receptors covering the septa, its “myoma-like” composition, and finally higher uterine vascular resistance. Complete removal of this abnormal tissue rather than just incising it may not only enhance challenging the pathogenesis but also expand the endometrial volume, an objective parameter by which to predict endometrial receptivity.

Study design, size, duration

In this retrospective cohort study, 214 consecutive patients, aged 33.3±4.8, diagnosed with a septate uterus based on ESHRE classification who had been under HWS between April 2017 and January 2020 due to recurrent miscarriage or at least one failed embryo transfer, met the enrollment criteria. With 11 to 36 months follow up, gathering of follow up data was managed between August till the end of Nov 2020, when the last new information was included.

Participants/materials, setting, methods

Patients with a history of RPL or at least one failed ET who were diagnosed as septate uterus by 2D, 3D, or hysteroscopy have been under HWS in a tertiary infertility and recurrent abortion treatment/educational setting. Those with BMI≥32, day 3 FSH≥13 mIU/mL, acquired or hereditary thrombophilia, thyroid disease, and myomatous uterus were excluded. HWS’s goal was to remove the septum as a wedge, cutting with 7Fr scissors, in its entirety as much as possible.

Main results and the role of chance

39 patients who experienced 1 to 8 failed ET and 175 with 2 to 10 miscarriages, were enrolled in the study. The average septum size based on the depth of the removed wedge was 1.73±0.86 cm. There was an increase of 1.68±0.9 cm in uterine depth and 2.28±0.6 ml in uterine capacity measured by uterine sound and inflation of 8F Folley catheter balloon inside the cavity, respectively. The procedure took 35.75±8.7 minutes. Intraoperative, postoperative, or late complications during the next pregnancies were not reported. 7 patients (17.9%) in failed ET group, conceived spontaneously, before another embryo transfer attempt. Embryo transfer in the remaining 32 cases resulted in 25 (78.1%) clinical pregnancies. 2 miscarried (6.2%), 5(15.6%) are ongoing after 20 weeks of gestation and 25 (78.1%) have resulted in live births. Among 126 clinical pregnancies in RPL group, 16 patients (12.6%) experienced another miscarriage; 6%, 11.3%, and 25% in patients with a previous history of 2, 3, and 4 or more miscarriages, respectively. There was a significant drop in odds of post-procedure miscarriage from 22.7% to 6% (p:0.005) and from 27.8% to 11.3% (p:0.27) with 2 and 3 miscarriage history, respectively. This reduction was not significant with more than 3 losses.

Limitations, reasons for caution

We acknowledge the inherent limitations of this retrospective observational study, confining direct inferences. Our goal is to encourage future prospective studies to compare the effectiveness of different methods of hysteroscopy with or without involving the removal of septal tissue. An RCT comparing metroplasty vs expectant management seems infeasible, though.

Wider implications of the findings

Our findings suggest that timely removal of the uterine septal tissue with hysteroscopy will result in favorable reproductive outcomes in patients with RPL and/or infertility. Also, a history of a normal term pregnancy before subsequent successive losses does not rule out the uterine septum and calls for a thorough assessment.

Trial registration number

not applicable

Oxford Shoulder Score: A Cross-Cultural Adaptation and Validation Study of the Persian Version in Iran

BACKGROUND

Oxford shoulder score is a specific 12-item patient-reported tool for evaluation of patients with inflammatory and degenerative disorders of the shoulder. Since its introduction, it has been translated and culturally adapted in some Western and Eastern countries. The aim of this study was to translate the Oxford Shoulder Score (OSS) in Persian and to test its validity and reliability in Persian speaking population in Iran.

METHODS

One hundred patients with degenerative or inflammatory shoulder problem participated in the survey in 2012. All patients completed the Persian version of OSS, Persian DASH and the SF-36 for testing validity. Randomly, 37 patients filled out the Persian OSS again three days after the initial visit to assess the reliability of the questionnaire.

RESULTS

Cronbach's alpha coefficient was 0.93. The intraclass correlation coefficient was 0.93. In terms of validity, there was a significant correlation between the Persian OSS and DASH and SF-36 scores (P < 0.001).

CONCLUSION

The Persian version of the OSS proved to be a valid, reliable, and reproducible tool as demonstrated by high Cronbach's alpha and Pearson's correlation coefficients. The Persian transcript of OSS is administrable to Persian speaking patients with shoulder condition and it is understandable by them.

Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2): A Cross-Cultural Adaptation and Validation Study of the Persian Version in Patients with Knee Osteoarthritis

BACKGROUND

We aimed to develop and validate the Persian version of Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) in patients with knee osteoarthritis.

METHODS

Translation and back translation was performed using Beaton's guideline. After a consensus has achieved on the Persian version of SF-MPQ-2, it was administered to 30 patients with knee osteoarthritis in a pilot study. Then, we enrolled 100 patients with knee osteoarthritis to fill the final SF-MPQ-2 as well as SF-36 and WOMAC questionnaires. Forty-three patients returned 3 days after the initial visit to fill the Persian SF-MPQ-2 for the second time. Construct validity was tested by Pearson's correlation coefficient between subscales of SF-MPQ-2 and subscales of SF-36 and WOMAC. Internal consistency for total and subscales was calculated by Cronbach's alpha and reliability between test retest was performed using Intraclass correlation coefficient (ICC).

RESULTS

ICC for subscales of SF-MPQ-2 ranged from 0.73 to 0.90. The ICC for total SF-MPQ-2 was 0.90. Cronbach's alpha for subscales was 0.65-0.74 at the first visit and 0.58-0.81 at the second visit. Cronbach's alpha for the total questionnaire was 0.88 and 0.91 at the first and second visit, respectively. Pearson's correlation coefficient was highly significant when comparing subscales specifically with WOMAC (r=-0.47 to -0.61; P<0.001). Interscale correlation between subscales of SF-MPQ-2 was significant as well (r: 0.43-0.88, P<0.001).

CONCLUSIONS

Persian SF-MPQ-2 showed excellent reliability and good to excellent internal consistency throughout the questionnaire. It is a valid and reliable instrument for measuring the pain intensity and applicable in osteoarthritic pain assessment.

Disabilities and activities of daily living among veterans with old hip disarticulation and transpelvic amputation

Background:

The Iran-Iraq imposed war lasted eight years and was one of the longest wars of the last century. Twenty-three years have passed since the war ended, but little has been discussed about the long-term results of war amputations in the literature.

Objectives:

In this long-term study, we have evaluated the activities of daily living among veterans with hip or hemipelvis amputations.

Patients and Methods:

A cross-sectional study was performed on Iran-Iraq war veterans with hip or hemipelvis amputations in Iran. Eighty-four (96.5%) veterans out of 87 registered veterans with hip or hemipelvis amputations participated in the study. The degree of independence for activities of daily living (ADL) was assessed by the Barthel index. The degree of independence for instrumental activities of daily living (IADL) was assessed by the Lawton-Brody scale.

Results:

The average follow-up time was 26.6 ± 3.7 years. The average age of veterans was 44.1±7 years old. Of 84 amputees, 57 (67.85%) had limitations in at least one domain of the ADL. The most common single item that affected the patients was ascending and descending stairs seen in 45 (78.9%) veterans, followed by eating seen in 4 (7.01%) veterans. In addition, 70 (83.33%) had limitations in at least one domain of the IADL. The most common single item that affected the veterans was shopping seen in 56 (80%), followed by responsibility for own medications seen in 13 (18.57%) veterans. Spearman correlation coefficient of the sum scores of ADL and IADL showed an intermediate to strong correlation (r = 0.58).

Conclusions:

Increasing dependency in ADL is accompanied by increasing dependency in IADL. In the past, the duty of health care providers was saving the life of veterans due to injuries while at present, because these injuries occurred in young and healthy individuals, the need for increased function is being highlighted.

Influencing factors on the functional level of haemophilic patients assessed by FISH

Joint destruction in early adulthood brings the patients to the orthopaedic clinics. If a haemophilic patient becomes disabled, it shows a number of factors such as timely diagnosis, availability of appropriate treatment depending on the country, access and affordability to treatments and equally importantly the responsibility of the patient in managing self care by remaining compliant by prescribed treatment regimen. We assessed the functional level by functional independence score in haemophilia (FISH). Overall, 104 patients with haemophilia A and 29 with haemophilia B were evaluated. We assessed the function of the patients by FISH. We divided the sum scores into weak (FISH score 8-16), moderate (17-24), and good (25-32). For evaluating the level of functional deficit in a 2 × 2 table, we categorized the weak and moderate levels into Disordered Group and the good level into Not-Disordered Group. The average age was 26.9 ± 14.24. Each 1 year increase in age can increase 1.07 fold the possibility of being placed in Disordered Function Group. Severe haemophilia can increase 7.34 fold, presence of inhibitor can increase 9.75 fold and home self-care increases 3.89 fold the possibility of being placed in Disordered Function Group. To decrease the burden of the cost on patient, family and the government, education plays the most important role. We suggest that we send a trained team of physician and nurses to the deprived villages and cities instead of waiting for the patient to refer to our Care Center.

Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies

Background

Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate.

Objectives

This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia.

Patients and Methods

In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered.

Results

The mean follow-up time was 9.33 ± 1.87 month. The average age was 45.13 ± 7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery.

Conclusions

The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies.

Long-term clinical outcomes of war-related hip disarticulation and transpelvic amputation

BACKGROUND

The Iran-Iraq war (1980 to 1988) was one of the longest wars of the twentieth century. Few studies are available in the current literature evaluating the long-term results of proximal lower-extremity war-related amputations. The purpose of the present cross-sectional study was to evaluate the current health-related quality of life and clinical musculoskeletal function of Iranian veterans with hip or hemipelvic amputation.

METHODS

Seventy-six patients from a cohort of eighty-four veterans with hip disarticulation and transpelvic amputation participated in this study. A Persian version of Medical Outcomes Study Short Form-36 (SF-36) was completed for all of the veterans.

RESULTS

The average duration of follow-up was 26.6 ± 3.7 years. The average age (and standard deviation) of the veterans was 44.1 ± 7.0 years. The average scores for the physical and mental health dimensions of the SF-36 were 45.85 ± 21.56 and 57.98 ± 25.19, respectively. These data indicate that the amputees were doing better in the mental domain than in the physical domain. Forty-five patients with a primary amputation (97.8%) and ten with a secondary amputation (33.3%) complained of pain in the amputation stump.

CONCLUSIONS

Veterans with proximal lower-extremity amputation will need life-long care. Supervision starts with stump management and the application of appropriate surgical techniques at the time of the injury and continues with periodic examination throughout life.

High performances III-Nitride Quantum Dot infrared photodetector operating at room temperature

In this paper we present a novel long wave length infrared quantum dot photodetector. A cubic shaped 6nm GaN quantum dot (QD) within a large 18 nm Al(0.2)Ga(0.8)N QD (capping layer) embedded in Al(0.8)Ga(0.2)N has been considered as the unit cell of the active layer of the device. Single band effective mass approximation has been applied in order to calculate the QD electronic structure. The temperature dependent behavior of the responsivity and dark current were presented and discussed for different applied electric fields. The capping layer has been proposed to improve upon the dark current of the detector. The proposed device has demonstrated exceptionally low dark current, therefore low noise, and high detectivity. Excellent specific detectivity (D*) up to approximately 3 x 10(8)CmHz(1/ 2)/W is achieved at room temperature.

A Y/15 translocation in a 45,X male with Prader-Willi syndrome

We report a male neonate with a 45 X karyotype; the long arm of a chromosome 15 was translocated onto the proximal long arm of the Y chromosome. Breakpoints were identified by in situ fluorescence hybridization (FISH) on the proximal 15q13 and Yq11.2. The derivative chromosome has no primary centromere. Clinical features were compatible with Prader-Willi syndrome. This is the first report case ofmonosomy 15q and Yq deletion with Prader-Willi syndrome.

Epidemiology of current treatment for sexual dysfunction in spinal cord injured men in the USA model spinal cord injury centers

This study is a prospective multicenter cooperative survey of the evaluation and treatment of erectile dysfunction in men with spinal cord injury (SCI). Uniform database questionnaires were completed prospectively by patients seeking therapy for erectile dysfunction. Eighty-five SCI men aged 17-68 years (mean age = 26 +/- 17) were enrolled. Mean duration of traumatic SCI was 3 +/- 3.2 years (Range = 0.3-18 years). The level of injury was cervical in 20 patients, thoracic in 31, lumbar in 29 and sacral in five. Patients were fully evaluated and then counseled as to their therapeutic options. Twenty-eight chose to use a vacuum erection device (VED), 26 preferred pharmacological penile injection and five used both intracorporeal therapy and VED. The remainder were managed with marriage and sexual counseling in 10 patients, three underwent penile prosthesis placement and two used topical pharmacotherapy. Four patients used other forms of treatment and in nine no therapy was recommended. Of the patients that used pharmacologic injection only, 74 percent used papaverine as a single agent, 20 percent used papaverine with phentolamine, five percent used prostaglandin E (PGE1) alone and one percent used a mixture. Patients using injection therapy report sexual intercourse a mean of 3 +/- 3.4 times per month as compared with 5 +/- 3.2 times per month in those using VED. Five intracorporeal injection patients developed priapism while two patients using the VED developed subcutaneous bleeding and one developed penile ischemia. We conclude that although a spectrum of erectile dysfunction treatment is present among SCI centers, VED and pharmacological penile injection are by far the two most popular methods of treatment and papaverine is the most common drug. The incidence of complications is small in the model centers.

Management of sphincter dyssynergia using the sphincter stent prosthesis in chronically catheterized SCI men

This effort represents a subset analysis of the long-term Multicenter North American Trial of the UroLume sphincter stent prosthesis to determine the effect of the sphincter stent prosthesis in SCI men afflicted with detrusor-external sphincter dyssynergia (DESD) and chronically managed with an indwelling urinary catheter. Forty-one of 153 male patients in this study were evaluated urodynamically before and after placement of the sphincter stent prosthesis. Of the 41 patients, 34 (81 percent) suffered cervical-level injury while 10 patients (25 percent) had been treated previously with external sphincterotomy. Forty patients (98 percent) were troubled with recurrent urinary tract infections (UTI), with a mean of 4.6 +/- 3 episodes of UTI per year. Seven patients (17 percent) demonstrated hydronephrosis prior to stent placement. Follow-up ranged from six to 44 months. Voiding pressures decreased from a mean of 77 +/- 23 cmH2O preoperatively to 35 +/- 18 cmH2O at 12 months (n = 34) and 33 +/- 20 cmH2O at 24 months (n = 22) after stent insertion (p = 0.001). Post-void residual urinary volume decreased from 202 +/- 187 ml preinsertion to 64 +/- 69 ml at 24 months (p = 0.001) postinsertion. Maximum cystometric capacity remained constant at 201 +/- 144 ml preinsertion to 203 +/- 79 ml at 24 months (p = 0.75) postinsertion. No significant changes in any of the urodynamic parameters occurred after 24 months of follow-up between patients with (n = 10) and without (n = 31) previous external sphincterotomy. Neither hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth, stent encrustation or stone formation, nor soft tissue erosion occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)