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A retrospective study of the effects of anesthesia methods on post-operative delirium in geriatric patients having orthopedic surgery: Anesthesia methods on post-operative delirium 麻醉方法对老年骨科术后谵妄影响的回顾性研究:麻醉方法对术后谵妄的影响
Pub Date : 2023-05-18 DOI: 10.28982/josam.7710
L. Delen, Z. Korkmaz Disli
Background/Aim: Post-operative delirium, which usually develops in geriatric patients, also causes an increase in mortality and morbidity for various reasons, such as difficulty in compliance with treatment. Estimating the effects of the anesthesia method on delirium contributes to the prevention of possible complications. In this study, effects due to use of different anesthesia methods on the post-operative delirium development in geriatric patients who underwent orthopedic surgery were investigated.Methods: In our retrospective cohort study, scanning of the patient files was performed for 276 patients who were older than 65 years and who had undergone surgery for lower extremity fractures in Malatya education and research hospital, orthopedics department between May 1, 2022 and October 15, 2022. Demographic data, comorbid conditions, anesthesia type, lengths of surgery, and level of delirium development were recorded for each scanned patient.Results: In our study, 201 patients were included. The mean age of the patients was 74.1 (7.3) (min–max: 65–98); 133 (66.2%) were female, and 68 (33.8%) were male. It was noticed that patients who had undergone regional anesthesia developed a significantly smaller rate of delirium development (8.1%) compared to those who had received general anesthesia (20.6%; P=0.012). Ages (P<0.001), lengths of surgery (P<0.001), and lengths of hospitalization stays (P<0.001) were significantly higher in patients with delirium compared to those without.Conclusion: Based on the data obtained in this study, it was concluded that to reduce the risk of delirium development after orthopedic surgery, regional rather than general anesthesia should be selected, and the time of hospitalization stay should be minimized.
背景/目的:术后谵妄通常发生在老年患者中,由于各种原因,如难以依从治疗,也会导致死亡率和发病率的增加。评估麻醉方法对谵妄的影响有助于预防可能的并发症。本研究探讨不同麻醉方式对老年骨科手术患者术后谵妄发展的影响。方法:在回顾性队列研究中,对2022年5月1日至2022年10月15日期间在马拉提亚教研院骨科行下肢骨折手术的276例65岁以上患者进行患者档案扫描。记录每位扫描患者的人口统计数据、合并症、麻醉类型、手术时间和谵妄发展水平。结果:本研究共纳入201例患者。患者平均年龄74.1岁(7.3岁)(最小-最大:65-98岁);其中女性133例(66.2%),男性68例(33.8%)。值得注意的是,接受区域麻醉的患者谵妄发展率(8.1%)明显低于接受全身麻醉的患者(20.6%;P = 0.012)。谵妄患者的年龄(P<0.001)、手术时间(P<0.001)和住院时间(P<0.001)明显高于无谵妄患者。结论:根据本研究资料,为降低骨科术后谵妄发生的风险,应选择局部麻醉而非全身麻醉,并尽量减少住院时间。
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引用次数: 0
The effect of a single dose of intravenous tranexamic acid on visual clarity in knee arthroscopic meniscectomy without a tourniquet 单剂量静脉注射氨甲环酸对无止血带膝关节镜半月板切除术中视力清晰度的影响
Pub Date : 2023-05-18 DOI: 10.28982/josam.1127788
Aziz Çataltape, K. Öznam
Background/Aim: Tranexamic acid (TXA) is known to reduce intra-articular bleeding during arthroscopic procedures, which can improve visibility and reduce postoperative pain and knee joint swelling from hemarthrosis. However, insufficient data supports the routine use of TXA in arthroscopic meniscectomy. This study aimed to evaluate the effect of a single dose of intravenous (IV) TXA on visual clarity in arthroscopic meniscectomy without a tourniquet. Methods: A randomized, double-blind, controlled trial was conducted to assess the use of TXA for visibility in routine arthroscopic meniscectomy without a tourniquet. Between January 2021 and February 2022, 53 patients undergoing arthroscopic meniscectomy were randomly assigned to either the TXA group (n=27), who received 1 g IV-TXA, or the control group (n=26), who received 100 ml of normal saline. Visual clarity was evaluated using a Numeric Rating Scale (NRS). Patients were also assessed for the need for a tourniquet, tourniquet time, total operative time, volume of irrigation fluid, postoperative pain, hemarthrosis, and knee function on postoperative day 3 and weeks 1, 2, and 4, using the Lysholm knee scoring scale. Results: There was no significant difference in intra-operative arthroscopic visibility between the TXA and control groups (P=0.394). Tourniquet was required in three cases in the TXA group and four cases in the control group (P=0.646). There was no significant difference between the two groups regarding postoperative pain, grade of postoperative hemarthrosis, knee motion, or the Lysholm Knee Score after the operation. Conclusion: The administration of IV-TXA in arthroscopic meniscectomy without a tourniquet did not provide any benefits such as enhanced surgical visualization, reduction in the need to inflate the tourniquet due to obstructed visibility, or decrease in hemarthrosis, VAS pain score, or improved range of motion of the knee in the postoperative period when compared to the control group.
背景/目的:已知氨甲环酸(TXA)可减少关节镜手术期间的关节内出血,从而提高能见度,减轻术后疼痛和膝关节血肿。然而,没有足够的数据支持在关节镜半月板切除术中常规使用TXA。本研究旨在评估单剂量静脉注射(IV) TXA对关节镜半月板切除术中无止血带视觉清晰度的影响。方法:一项随机,双盲,对照试验进行评估使用TXA在常规关节镜半月板切除术的能见度无止血带。在2021年1月至2022年2月期间,53名接受关节镜半月板切除术的患者被随机分配到TXA组(n=27),接受1g IV-TXA,或对照组(n=26),接受100ml生理盐水。使用数字评定量表(NRS)评估视觉清晰度。在术后第3天和第1、2、4周,使用Lysholm膝关节评分量表评估患者是否需要止血带、止血带时间、总手术时间、冲洗液量、术后疼痛、关节出血和膝关节功能。结果:TXA组与对照组术中关节镜能见度差异无统计学意义(P=0.394)。TXA组3例需要止血带,对照组4例需要止血带(P=0.646)。两组在术后疼痛、术后关节积血程度、膝关节运动或Lysholm膝关节评分方面无显著差异。结论:与对照组相比,在无止血带的关节镜半月板切除术中给予IV-TXA并没有提供任何好处,如增强手术可视性,减少因可视性障碍而需要充气止血带,或减少关节出血,VAS疼痛评分,或术后膝关节活动范围的改善。
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引用次数: 0
Inflammation-based biomarkers for the prediction of nephritis in systemic lupus erythematosus 基于炎症的生物标志物预测系统性红斑狼疮肾炎
Pub Date : 2023-05-15 DOI: 10.28982/josam.7674
N. Oruçoğlu
Background/Aim: Inflammation is a crucial component in the pathophysiology of systemic lupus erythematosus (SLE) nephritis. Immune-based scores, such as the neutrophil-lymphocyte and the platelet-lymphocyte ratios (NLR and PLR, respectively) have been suggested as predictors of inflammation and prognosis in SLE. This study aimed to investigate the value of the systemic immune-inflammation index (SII), inflammatory prognostic index (IPI), and systemic inflammatory response index (SIRI) in SLE and lupus nephritis (LN).Methods: This case-control study consisted of 108 newly diagnosed SLE patients (separated into two subgroups, which included 34 patients with biopsy-proven LN and 74 without nephritis) and 108 age- and gender-matched healthy controls who presented to our outpatient clinic between October 2015 and June 2020. Patients with malignancy, lymphoproliferative and hematologic disorders, active infection, and autoimmune diseases other than SLE were excluded. Inflammation-based biomarkers were calculated at the first presentation of the disease and before any medication was administered. SII was calculated as Neutrophil/Lymphocyte x Platelet, SIRI as Neutrophil x Monocyte/Lymphocyte, and IPI as CRP x NLR/serum albumin. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was used to measure disease activity. The capability of SII, SIRI, NLR, PLR, and IPI to distinguish between SLE patients with or without nephritis was assessed using receiver operating characteristic (ROC) curves. Correlations of inflammation-based scores (SII, SIRI, IPI, NLR) with disease activity and laboratory data of SLE patients were analyzed.Results: SII, SIRI, and IPI were significantly higher in SLE patients than in healthy controls (P=0.003, P=0.019, and P<0.001, respectively) and also significantly higher in patients with nephritis than in those without (P<0.001, P=0.009, and P=0.007, respectively). The area under the curve (AUC) for SII, SIRI, and IPI in terms of differentiating SLE patients with or without nephritis was 0.748, 0.690, and 0.663, respectively. The cut-off value of SII, SIRI, and IPI to predict LN was 552.25 (sensitivity: 64.7%; specificity: 64.9%; P<0.001), 1.08 (sensitivity: 61.8%; specificity: 62.2%; P=0.002), and 4.48 (sensitivity: 61.8%; specificity, 62.2%; P=0.007), respectively.Conclusion: SII, SIRI, and IPI may be valuable and promising inflammation-based biomarkers in SLE and for the presence of nephritis in SLE patients. SII was found to be the most reliable predictor of SLE among the inflammation-based biomarkers in our study.
背景/目的:炎症是系统性红斑狼疮(SLE)肾炎病理生理的重要组成部分。基于免疫的评分,如中性粒细胞淋巴细胞和血小板淋巴细胞比率(分别为NLR和PLR)已被认为是SLE炎症和预后的预测因子。本研究旨在探讨系统性免疫炎症指数(SII)、炎症预后指数(IPI)和系统性炎症反应指数(SIRI)在SLE和狼疮性肾炎(LN)中的价值。方法:本病例对照研究包括108名新诊断的SLE患者(分为两个亚组,其中34名活检证实的LN患者和74名无肾炎的患者)和108名年龄和性别匹配的健康对照组,这些患者于2015年10月至2020年6月在我们的门诊就诊。排除恶性肿瘤、淋巴增生性和血液病、活动性感染和SLE以外的自身免疫性疾病患者。基于炎症的生物标志物在疾病首次出现时和任何药物治疗前计算。SII为中性粒细胞/淋巴细胞×血小板,SIRI为中性粒细胞×单核细胞/淋巴细胞,IPI为CRP × NLR/血清白蛋白。采用系统性红斑狼疮疾病活动性指数2000 (SLEDAI-2K)来衡量疾病活动性。采用受试者工作特征(ROC)曲线评估SII、SIRI、NLR、PLR和IPI区分SLE患者有无肾炎的能力。分析基于炎症的评分(SII、SIRI、IPI、NLR)与SLE患者疾病活动性和实验室数据的相关性。结果:SLE患者SII、SIRI、IPI明显高于健康对照组(P=0.003、P=0.019、P<0.001),合并肾炎患者SII、SIRI、IPI明显高于未合并肾炎患者(P<0.001、P=0.009、P=0.007)。SII、SIRI、IPI鉴别SLE有无肾炎的曲线下面积(AUC)分别为0.748、0.690、0.663。SII、SIRI和IPI预测LN的临界值为552.25(灵敏度:64.7%;特异性:64.9%;P<0.001), 1.08(敏感性:61.8%;特异性:62.2%;P=0.002), 4.48(敏感性:61.8%;特异性,62.2%;分别P = 0.007)。结论:SII, SIRI和IPI可能是SLE和SLE患者肾炎存在的有价值和有前途的炎症生物标志物。在我们的研究中,SII被发现是基于炎症的生物标志物中最可靠的SLE预测因子。
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引用次数: 0
The efficiency of volumetric apparent diffusion coefficient histogram analysis in breast papillary neoplasms 体积表观扩散系数直方图分析在乳腺乳头状肿瘤中的有效性
Pub Date : 2023-05-15 DOI: 10.28982/josam.7715
M. O. Nalbant, A. Gemici, M. Karadağ, E. Inci
Background/Aim: Papillary neoplasia encompasses both malignant and benign lesions, and core needle biopsy (CNB) is crucial in their diagnosis. Histological findings determine their management. Here we compare volumetric apparent diffusion coefficient (ADC) histogram analysis of carcinomas and benign pathologies identified by histopathology from excisional biopsies.Methods: This retrospective study included 524 patients who underwent breast magnetic resonance imaging (MRI) for a suspicious breast mass from January 2018 to October 2022. Patients with benign lesions, incompatible ultrasound-guided CNB results with papillary neoplasia, and those with MRI exams insufficient for diagnosis due to motion artifacts were excluded. After applying the exclusion criteria, the study included 48 patients (average aged 61.5 (14.8) years; range, 31 to 72 years). After excisional biopsies, 30 benign lesions and 18 carcinomas were identified. MRI was acquired at 1.5 T (Verio; Siemens Medical Solutions, Erlangen, Germany), and the b-values for diffusion-weighted imaging were calculated at 1000 s/mm2. Histogram parameters were computed. Receiver operating characteristic (ROC) curve analysis was performed to investigate diagnostic accuracy, evaluate histogram analysis performance, and determine threshold values.Results: The ADCmin, ADCmean, ADCmax, and all ADC value percentiles were significantly lower in the carcinoma group than in the benign group (P<0.001). The variance, skewness, and kurtosis were higher in the carcinoma group. ADCmax had the highest area under the curve (AUC: 0.985; cut-off 1.247 × 10-3 mm2/s; sensitivity 86%, and specificity 92%), followed by ADCmean (AUC: 0.950; cut-off 0.903 × 10-3 mm2/s; sensitivity 94%, and specificity 96%).Conclusion: Volumetric ADC histogram analysis of papillary neoplasia at higher b-values can be an imaging marker to detect carcinoma and quantitatively reveal the lesions’ diffusion characteristics.
背景/目的:乳头状瘤变包括恶性和良性病变,核心穿刺活检(CNB)在诊断中至关重要。组织学结果决定了其处理方法。在这里,我们比较体积表观扩散系数(ADC)直方图分析癌和良性病理组织病理从切除活检。方法:本回顾性研究纳入了2018年1月至2022年10月期间因可疑乳房肿块接受乳房磁共振成像(MRI)检查的524例患者。排除良性病变、超声引导下CNB结果不一致伴乳头状瘤变、MRI检查因运动伪影不足以诊断的患者。应用排除标准后,纳入48例患者,平均年龄61.5(14.8)岁;范围:31至72年)。经切除活检,发现30个良性病变和18个癌。在1.5 T (Verio;Siemens Medical Solutions, Erlangen, Germany),在1000 s/mm2下计算弥散加权成像的b值。计算直方图参数。进行受试者工作特征(ROC)曲线分析,以调查诊断准确性,评估直方图分析性能,并确定阈值。结果:癌组的ADCmin、ADCmean、ADCmax及所有ADC值百分位数均显著低于良性组(P<0.001)。癌组的方差、偏度和峰度较高。ADCmax曲线下面积最高(AUC: 0.985;截止时间1.247 × 10-3 mm2/s;灵敏度86%,特异性92%),其次是ADCmean (AUC: 0.950;截止时间0.903 × 10-3 mm2/s;灵敏度94%,特异性96%)。结论:高b值的体积ADC直方图分析可作为检测肿瘤的影像学标记,定量揭示病变的扩散特征。
{"title":"The efficiency of volumetric apparent diffusion coefficient histogram analysis in breast papillary neoplasms","authors":"M. O. Nalbant, A. Gemici, M. Karadağ, E. Inci","doi":"10.28982/josam.7715","DOIUrl":"https://doi.org/10.28982/josam.7715","url":null,"abstract":"Background/Aim: Papillary neoplasia encompasses both malignant and benign lesions, and core needle biopsy (CNB) is crucial in their diagnosis. Histological findings determine their management. Here we compare volumetric apparent diffusion coefficient (ADC) histogram analysis of carcinomas and benign pathologies identified by histopathology from excisional biopsies.\u0000Methods: This retrospective study included 524 patients who underwent breast magnetic resonance imaging (MRI) for a suspicious breast mass from January 2018 to October 2022. Patients with benign lesions, incompatible ultrasound-guided CNB results with papillary neoplasia, and those with MRI exams insufficient for diagnosis due to motion artifacts were excluded. After applying the exclusion criteria, the study included 48 patients (average aged 61.5 (14.8) years; range, 31 to 72 years). After excisional biopsies, 30 benign lesions and 18 carcinomas were identified. MRI was acquired at 1.5 T (Verio; Siemens Medical Solutions, Erlangen, Germany), and the b-values for diffusion-weighted imaging were calculated at 1000 s/mm2. Histogram parameters were computed. Receiver operating characteristic (ROC) curve analysis was performed to investigate diagnostic accuracy, evaluate histogram analysis performance, and determine threshold values.\u0000Results: The ADCmin, ADCmean, ADCmax, and all ADC value percentiles were significantly lower in the carcinoma group than in the benign group (P<0.001). The variance, skewness, and kurtosis were higher in the carcinoma group. ADCmax had the highest area under the curve (AUC: 0.985; cut-off 1.247 × 10-3 mm2/s; sensitivity 86%, and specificity 92%), followed by ADCmean (AUC: 0.950; cut-off 0.903 × 10-3 mm2/s; sensitivity 94%, and specificity 96%).\u0000Conclusion: Volumetric ADC histogram analysis of papillary neoplasia at higher b-values can be an imaging marker to detect carcinoma and quantitatively reveal the lesions’ diffusion characteristics.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82499084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Investigation of the effects of inflammatory and metabolic factors on fracture union in head trauma and long bone fractures 炎症和代谢因素对头部创伤和长骨骨折骨折愈合影响的研究
Pub Date : 2023-05-05 DOI: 10.28982/josam.1084466
Abdulkadir Sarı, B. Erdal, A. Çelikkol, M. Ü. Çetin
Background/Aim: Fractures are the most common form of trauma in current orthopedic practice. Although studies have shed light on the relationship between the factors affecting the healing process after fracture, this process is still not fully understood. In this study, we aimed to investigate the changes in serum biomediator levels and fracture healing in different trauma patterns, such as head trauma (HT), long bone fracture (LBF), a combination of HT + LBF injury (CI), and in different time points of the healing period. Methods: Forty Wistar rats were included in the study and divided into five groups. Group 1, the donor group, included rats with HT; Group 2 included rats with LBFs who were administered the serum taken from rats in Group 1; Group 3 included the rats with isolated LBFs; and Group 4 the rats with CI. Group 5 comprised the control rats. An experimental closed HT and fracture model was applied to rats. The rats in Groups 2, 3 and 4 were sacrificed on the 10th, 20th, and 30th days. The biomediator levels in the serum taken after sacrification were studied, while closed femoral fracture models were examined radiologically. Results: Statistically significant differences were found among the groups regarding radiological scores on the 10th, 20th, and 30th days. On Day 10, Group 2a had significantly higher scores than Group 3a (P=0.03), and Group 3a had lower scores than Group 4a (P=0.01). On Day 20, Group 2b had significantly higher scores than Group 3b (P=0.004) but lower than Group 4b (P=0.03). On Day 30, Group 2c had significantly higher scores than Group 3c but lower than Group 4c (P=0.001). The mean Ca, TGF beta 1, beta-catenin, IL-10, IL-17A, TNF alpha, CRP, Wnt-16, ALP, GH, PTH, IL-1 beta, IL-6, and IL-22 levels were significantly different among the groups (P<0.05). No significant difference was observed in the biomediator levels among the groups at different time points of the healing period. Conclusion: We concluded that inflammatory cytokines (IL-1 beta, IL-6, IL-17A, IL-17F, IL-23, and TNF alpha) were elevated in the early period in individuals with isolated head trauma and that this effect could be transferred to other individuals by serum transfer. On the other hand, the negative relationship between the IL-10 level, which is a negative modulator in fracture union, and callus thickness was significant. Our study contributes by providing a molecular description of the positive union effect transferred between individuals by serum. We believe our findings will play a significant role in developing new therapeutic agents for fracture healing.
背景/目的:骨折是目前骨科实践中最常见的创伤形式。虽然研究已经揭示了影响骨折愈合过程的因素之间的关系,但这一过程仍未完全了解。在本研究中,我们旨在探讨不同创伤模式,如头部创伤(HT)、长骨骨折(LBF)、长骨骨折+长骨骨折(CI),以及愈合期不同时间点的血清生物介质水平和骨折愈合的变化。方法:选用Wistar大鼠40只,分为5组。1组,供体组,包括HT大鼠;第2组为LBFs大鼠,给予第1组大鼠血清;第3组为离体LBFs大鼠;第四组为CI大鼠。第5组为对照大鼠。建立大鼠闭式HT骨折模型。第2、3、4组大鼠于第10、20、30天处死。研究牺牲后血清中的生物介质水平,同时对闭合性股骨骨折模型进行放射学检查。结果:两组患者第10、20、30天放射学评分差异有统计学意义。第10天,2a组评分显著高于3a组(P=0.03), 3a组评分低于4a组(P=0.01)。第20天,2b组评分显著高于3b组(P=0.004),低于4b组(P=0.03)。第30天,2c组得分显著高于3c组,但低于4c组(P=0.001)。各组Ca、TGF β 1、β -catenin、IL-10、IL-17A、TNF α、CRP、Wnt-16、ALP、GH、PTH、IL-1 β、IL-6、IL-22的平均水平差异均有统计学意义(P<0.05)。各组愈合不同时间点生物介质水平差异无统计学意义。结论:我们得出结论,炎性细胞因子(IL-1 β、IL-6、IL-17A、IL-17F、IL-23和TNF α)在孤立性头部创伤患者的早期升高,并且这种影响可以通过血清转移到其他个体。另一方面,作为骨折愈合负调节因子的IL-10水平与愈伤组织厚度呈显著负相关。我们的研究提供了通过血清在个体之间传递的正结合效应的分子描述。我们相信我们的发现将在开发新的骨折愈合治疗药物方面发挥重要作用。
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引用次数: 0
Graded motor imagery in orthopedic and neurological rehabilitation: A systematic review of clinical studies 分级运动意象在骨科和神经康复:临床研究的系统回顾
Pub Date : 2023-05-01 DOI: 10.28982/josam.7669
Busra Candiri, Burcu Talu, G. Karabıcak
Background/Aim: Graded motor imagery is an increasingly popular motion representation technique. However, treatment protocols for graded motor imagery vary depending on various diseases. This study aims to summarize the cases in which graded motor imagery therapy is used, study protocols, and outcome measures in studies.Methods: The literature search was done with Web of Science, Pubmed, Scopus, and PEDro databases. The last search was carried out on September 13, 2022. A series-specific bias risk assessment tool was used with randomized, non-randomized, and case reports. All clinical studies that performed graded motor imagery, available in full text, describing their methods and findings, were included. The gender of the participants was not significant. The intervention was graded motor imagery. Outcome measures were mainly pain severity, other pain-related measures (e.g., pressure pain threshold, pain catastrophe), range of motion, strength, reaction time, kinesiophobia, neurophysiological measures, depression, function, or quality of life measures.Results: Complex regional pain syndrome, distal radius fracture, phantom limb pain, stroke, cancer, pathological pain (phantom pain after amputation, pain after brachial plexus avulsion), elbow stiffness, frozen shoulder, chronic shoulder pain, and osteoarthritis conditions were included. The intervention duration in the studies varies from 2 to 8 weeks. A common outcome measure could not be determined among studies. The pain was assessed in 15 studies, although different rating scales were used. Graded motor imagery resulted in a reduction in pain in 14 of the 15 studies.Conclusions: Due to the heterogeneity of the studies, a general conclusion regarding the effect of the disease-specific intervention was not possible. Based on pain outcome, graded motor imagery effectively decreased pain severity in various painful conditions.
背景/目的:分级运动意象是一种日益流行的运动表征技术。然而,分级运动意象的治疗方案因不同疾病而异。本研究旨在总结使用分级运动意象疗法的病例、研究方案和研究结果。方法:采用Web of Science、Pubmed、Scopus、PEDro数据库进行文献检索。最后一次搜寻是在2022年9月13日。随机、非随机和病例报告采用系列特异性偏倚风险评估工具。所有进行分级运动意象的临床研究均包含在全文中,描述了他们的方法和发现。参与者的性别差异不显著。干预被分级为运动意象。结果测量主要是疼痛严重程度、其他疼痛相关测量(如压痛阈值、疼痛突变)、活动范围、力量、反应时间、运动恐惧症、神经生理测量、抑郁、功能或生活质量测量。结果:包括复杂区域疼痛综合征、桡骨远端骨折、幻肢痛、中风、癌症、病理性疼痛(截肢后幻肢痛、臂丛撕脱痛)、肘关节僵硬、肩周炎、慢性肩周痛和骨关节炎。研究中的干预时间从2周到8周不等。在研究中无法确定共同的结果测量。15项研究对疼痛进行了评估,尽管使用了不同的评分标准。在15项研究中,有14项的运动意象分级导致疼痛减轻。结论:由于研究的异质性,无法得出针对特定疾病的干预效果的一般性结论。基于疼痛结果,分级运动意象有效地降低了各种疼痛状况下的疼痛严重程度。
{"title":"Graded motor imagery in orthopedic and neurological rehabilitation: A systematic review of clinical studies","authors":"Busra Candiri, Burcu Talu, G. Karabıcak","doi":"10.28982/josam.7669","DOIUrl":"https://doi.org/10.28982/josam.7669","url":null,"abstract":"Background/Aim: Graded motor imagery is an increasingly popular motion representation technique. However, treatment protocols for graded motor imagery vary depending on various diseases. This study aims to summarize the cases in which graded motor imagery therapy is used, study protocols, and outcome measures in studies.\u0000Methods: The literature search was done with Web of Science, Pubmed, Scopus, and PEDro databases. The last search was carried out on September 13, 2022. A series-specific bias risk assessment tool was used with randomized, non-randomized, and case reports. All clinical studies that performed graded motor imagery, available in full text, describing their methods and findings, were included. The gender of the participants was not significant. The intervention was graded motor imagery. Outcome measures were mainly pain severity, other pain-related measures (e.g., pressure pain threshold, pain catastrophe), range of motion, strength, reaction time, kinesiophobia, neurophysiological measures, depression, function, or quality of life measures.\u0000Results: Complex regional pain syndrome, distal radius fracture, phantom limb pain, stroke, cancer, pathological pain (phantom pain after amputation, pain after brachial plexus avulsion), elbow stiffness, frozen shoulder, chronic shoulder pain, and osteoarthritis conditions were included. The intervention duration in the studies varies from 2 to 8 weeks. A common outcome measure could not be determined among studies. The pain was assessed in 15 studies, although different rating scales were used. Graded motor imagery resulted in a reduction in pain in 14 of the 15 studies.\u0000Conclusions: Due to the heterogeneity of the studies, a general conclusion regarding the effect of the disease-specific intervention was not possible. Based on pain outcome, graded motor imagery effectively decreased pain severity in various painful conditions.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72998838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Primary pancreatic lymphoma and metastatic lymphoma cases diagnosed with ultrasonography guided tru-cut needle biopsy; Two case reports 超声引导下原位穿刺活检诊断原发性胰腺淋巴瘤及转移性淋巴瘤两例报告
Pub Date : 2023-04-29 DOI: 10.28982/josam.1122921
Işıl Bağcı, N. Şeker
Secondary pancreatic involvement can be seen up to 30% of advance staged non-Hodgkin’s lymphoma cases, but primary pancreatic lymphomas constitute only 1% of extranodal lymphomas. Furthermore, 0.2% of the pancreatic space-occupying lesions are primary pancreatic lymphomas, which usually present as a mass in the head of the pancreas with nonspecific symptoms. Therefore, primary pancreatic lymphomas should be considered as differential diagnosis of pancreatic solid lesions. Herein, we report two cases with different clinical presentation and different course of disease resulting in the diagnosis of primary and metastatic pancreatic lymphoma.
在晚期非霍奇金淋巴瘤病例中,继发性胰腺受累可达30%,但原发性胰腺淋巴瘤仅占结外淋巴瘤的1%。此外,0.2%的胰腺占位性病变为原发性胰腺淋巴瘤,通常表现为胰腺头部肿块,无特异性症状。因此,原发性胰腺淋巴瘤应作为胰腺实性病变的鉴别诊断。在此,我们报告两例不同的临床表现和不同的病程导致原发性和转移性胰腺淋巴瘤的诊断。
{"title":"Primary pancreatic lymphoma and metastatic lymphoma cases diagnosed with ultrasonography guided tru-cut needle biopsy; Two case reports","authors":"Işıl Bağcı, N. Şeker","doi":"10.28982/josam.1122921","DOIUrl":"https://doi.org/10.28982/josam.1122921","url":null,"abstract":"Secondary pancreatic involvement can be seen up to 30% of advance staged non-Hodgkin’s lymphoma cases, but primary pancreatic lymphomas constitute only 1% of extranodal lymphomas. Furthermore, 0.2% of the pancreatic space-occupying lesions are primary pancreatic lymphomas, which usually present as a mass in the head of the pancreas with nonspecific symptoms. Therefore, primary pancreatic lymphomas should be considered as differential diagnosis of pancreatic solid lesions. Herein, we report two cases with different clinical presentation and different course of disease resulting in the diagnosis of primary and metastatic pancreatic lymphoma.","PeriodicalId":30878,"journal":{"name":"International Journal of Surgery and Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89649926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reasons for requesting an interferon gamma release test from internal medicine and rheumatology clinics and evaluation of the results 要求内科和风湿病诊所进行干扰素释放试验的原因及结果评估
Pub Date : 2023-04-25 DOI: 10.28982/josam.7759
Alper Sarı, Adem Ertürk, Petek Şarlak Konya
Background/Aim: Tuberculosis is a disease involving many systems, such as the lung, gastrointestinal system, genitourinary system, etc. Detecting this disease in its latency significantly reduces the morbidity and mortality associated with tuberculosis. One of the tests used in latent TB screening is the interferon gamma release test. In rheumatology practices, it is routinely used to screen for latent tuberculosis infections before treatment with biological agents and Janus kinase (JAK) inhibitors, and it can also be used to exclude tuberculosis infection in clinical practice. In our study, we aimed to evaluate the reasons for requesting interferon gamma release tests and the results of this test in patients who requested it. Methods: Patients admitted to internal medicine and rheumatology outpatient clinics were retrospectively screened within the retrospective cohort study. In total, 364 patients who requested interferon gamma release testing were included in the study. Nine patients with unclear test results were excluded. Laboratory results, demographic data, reasons for requesting the interferon gamma release test, and results were evaluated. Results: The interferon gamma release test was requested by 355 patients. Of these, 266 patients (74.9%) asked for latent tuberculosis screening before treatment with biological agents and JAK inhibitors. This was followed by patients with peripheral lymphadenopathy-lung nodules, patients with unexplained elevated acute phase reactants, and patients with constitutional symptoms, respectively. Ten out of 107 patients (9.3%) had an active tuberculosis infection, while six out of ten patients (60%) had pulmonary tuberculosis, and four (40%) had extrapulmonary tuberculosis. Conclusion: The most common reason for requesting the interferon gamma release test in internal medicine and rheumatology clinics was screening for latent tuberculosis before treatment with biologic agents and JAK inhibitors. In internal medicine, it has been observed that this test can also be requested by patients with constitutional symptoms, unexplained elevated acute phase reactants, and a preliminary diagnosis of tuberculosis in order to rule out or strengthen the preliminary diagnosis.
背景/目的:结核病是一种累及肺、胃肠、泌尿生殖系统等多系统的疾病。在潜伏期发现这种疾病可显著降低与结核病相关的发病率和死亡率。在潜伏性结核筛查中使用的试验之一是干扰素γ释放试验。在风湿病学实践中,在使用生物制剂和Janus激酶(JAK)抑制剂治疗前,常规用于筛查潜伏性结核感染,并且在临床实践中也可用于排除结核感染。在我们的研究中,我们旨在评估要求进行干扰素γ释放试验的原因以及要求进行该试验的患者的结果。方法:在回顾性队列研究中对内科和风湿病门诊收治的患者进行回顾性筛选。总共有364名要求进行干扰素释放测试的患者被纳入研究。排除9例检测结果不明确的患者。对实验室结果、人口统计数据、要求进行干扰素释放试验的原因和结果进行了评估。结果:355例患者要求进行干扰素释放试验。其中,266例(74.9%)患者要求在使用生物制剂和JAK抑制剂治疗前进行潜伏性结核病筛查。其次分别是外周淋巴结病变-肺结节患者、不明原因急性期反应物升高患者和有体质症状的患者。107例患者中有10例(9.3%)有活动性结核感染,10例患者中有6例(60%)有肺结核,4例(40%)有肺外结核。结论:内科和风湿病诊所要求进行干扰素γ释放试验的最常见原因是在使用生物制剂和JAK抑制剂治疗前筛查潜伏性结核病。在内科中,观察到有体质症状、不明原因的急性期反应物升高、初步诊断为结核病的患者也可以要求进行这项检查,以排除或加强初步诊断。
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引用次数: 0
A case of spontaneous ovarian malignant neoplasm rupture and life-threatening massive intra-abdominal bleeding 卵巢恶性肿瘤自发性破裂并发危及生命的腹腔大出血1例
Pub Date : 2023-04-25 DOI: 10.28982/josam.1059670
İsa Kaplan
Although ovarian cancer is the second most common gynecological cancer, it is the most common gynecological malignancy that causes death. Approximately 75% of the patients are diagnosed at an advanced stage, and high-grade serous-type ovarian cancer is detected in most of these patients. The final pathology result in our case was high-grade serous ovarian carcinoma. Our patient, 39 years old, applied to our emergency department with complaints of inability to urinate for three days and new onset abdominal pain. We were consulted because of detection of an 11 cm solid mass and globe vesicle in the pelvic region detected on the computed tomography (CT) taken in the emergency department. The patient's initial hemoglobin value was 11.2 g/dL and the beta-human chorionic gonadotropin (ß-HCG) value was negative. During the follow-up, the patient’s hemoglobin values were 9.2 and then decreased to 8.6, 8.1, and 6.5 g/dL after which hypotensive shock developed in the patient. The patient was taken for an emergency laparotomy. Intra-operatively, 1500 mL of intra-abdominal hemorrhagic fluid and diffuse tumor fragments were observed. In the right adnexal area, approximately 11 cm of ruptured tumor tissue, which may originate from the ovary or uterus, was observed. It was observed that the Douglas pouch and uterine, internal iliac , and some parts of the external iliac arteries were extensively invaded by the tumor and active bleeding occurred. Total Abdominal Hysterectomy + Bilateral Salpingo-Oopherectomy (TAH+BSO) was performed on the patient. Additional surgical intervention could not be performed because the patient had extensive vascular tumor invasion, heavy bleeding, and was in hypotensive shock. Six anti-bleeding sponges were placed on intra-abdominal bleeding areas. In addition, packing was applied to the patient by placing four sterile compresses and soft drains inside the abdomen. Tranexamic acid was administered to the patient, and six units of red blood cell suspension and four units of fresh frozen plasma were transfused. The patient was transferred by ambulance to a higher institution, which is a gynecological oncology center, for follow-up, treatment, and complementary surgery. In this case, we aimed to draw attention to a rare case of ovarian malignancy rupture and hypotensive shock.
虽然卵巢癌是第二常见的妇科癌症,但它是最常见的导致死亡的妇科恶性肿瘤。大约75%的患者被诊断为晚期,其中大多数患者可检出高级别浆液型卵巢癌。本病例最终病理结果为高级别浆液性卵巢癌。我们的病人,39岁,以无法排尿三天及新发腹痛来急诊科就诊。我们咨询的原因是在急诊科的计算机断层扫描(CT)上发现盆腔区域有一个11厘米的固体肿块和球形囊泡。患者初始血红蛋白值为11.2 g/dL, β -人绒毛膜促性腺激素(ß-HCG)值为阴性。随访期间,患者血红蛋白值为9.2,随后分别降至8.6、8.1、6.5 g/dL,发生低血压休克。病人被紧急送去做剖腹手术。术中观察腹腔内出血1500ml及弥漫性肿瘤碎片。在右侧附件区,观察到约11厘米的破裂肿瘤组织,可能起源于卵巢或子宫。观察肿瘤广泛侵犯道格拉斯袋及子宫、髂内动脉及部分髂外动脉,出现活动性出血。行全腹子宫切除术+双侧输卵管卵巢切除术(TAH+BSO)。由于患者有广泛的血管肿瘤侵犯,大量出血,并处于低血压休克,因此无法进行额外的手术干预。在腹内出血区放置6块止血海绵。此外,对患者进行了填塞,在腹部内放置了4个无菌纱布和软引流管。患者给予氨甲环酸,并输注6单位红细胞悬液和4单位新鲜冷冻血浆。患者被救护车转至一所高等妇科肿瘤中心进行随访、治疗和补充手术。在这种情况下,我们的目的是提请注意一个罕见的卵巢恶性肿瘤破裂和低血压休克。
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引用次数: 0
Immunohistochemical study of CD147 and matrix metalloproteases in meningiomas 脑膜瘤中CD147和基质金属蛋白酶的免疫组化研究
Pub Date : 2023-04-24 DOI: 10.28982/josam.7618
Ilkay Cinar, F. Karagöz
Background/Aim: Expression of extracellular matrix proteins and metalloproteases (MMPs) has been implicated in neoplasm recurrence. Some recent studies have suggested a correlation between matrix modifier proteins and recurrence or invasion of meningiomas. Based on previous data, the aim of this study was to find a correlation between the immunohistochemical (IHC) expression patterns of a group of matrix modifier proteins, including CD147, Matrix Metalloprotease 2 and 9 (MMP2 and 9, respectively), Epithelial Cadherin (ECAD), and Galectin-3 (GAL3) with World Health Organization (WHO)-defined grade, brain invasion, recurrence, and other clinicopathological features.Methods: This study was a cohort study. All patients with meningioma who underwent resection over a 10-year period were identified from the electronic pathology archives. Tissue microarrays (TMAs) were created for IHC studies, and IHC staining was performed using standard methodology.Results: A total of 231 cases fulfilled the study criteria. Histological review identified 198 grade 1 tumors (85.3%), 28 grade 2 tumors (12.6%), and five grade 3 tumors (2.2%). CD147 was determined to be positively correlated with WHO-defined grade (P=0.009). ECAD, MMP2, MMP9, GAL3 were not found to be correlated with brain invasion, recurrence, or WHO grade.Conclusion: The study results demonstrated that CD147 could be a target for diagnosis, prognosis, and treatment of meningiomas.
背景/目的:细胞外基质蛋白和金属蛋白酶(MMPs)的表达与肿瘤复发有关。最近的一些研究表明基质修饰蛋白与脑膜瘤的复发或侵袭有关。基于先前的数据,本研究的目的是发现一组基质修饰蛋白,包括CD147、基质金属蛋白酶2和9(分别为MMP2和9)、上皮钙粘蛋白(ECAD)和半凝集素-3 (GAL3)的免疫组织化学(IHC)表达模式与世界卫生组织(WHO)定义的分级、脑侵袭、复发和其他临床病理特征之间的相关性。方法:本研究为队列研究。所有在10年内切除脑膜瘤的患者都是从电子病理档案中确定的。组织微阵列(tma)用于免疫组化研究,免疫组化染色采用标准方法进行。结果:231例患者符合研究标准。组织学检查发现198例1级肿瘤(85.3%),28例2级肿瘤(12.6%),5例3级肿瘤(2.2%)。CD147与who定义的分级呈正相关(P=0.009)。未发现ECAD、MMP2、MMP9、GAL3与脑侵犯、复发或WHO分级相关。结论:CD147可作为脑膜瘤诊断、预后和治疗的靶点。
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引用次数: 0
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International Journal of Surgery and Medicine
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