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OBJECTIVES Adductor canal block (ACB) could provide effective postoperative pain control for patients following total knee arthroplasty (TKA). However, some authors pointed out that the ACB as originally described may be more similar to a femoral triangle block (FTB). Recent neuroanatomical evidences made us to conjecture that the “true” ACB would provide superior analgesia compared to FTB. Therefore, the study was designed to determine the hypothesis that postoperative analgesia following TKA could be improved by a “true” ACB compared to FTB. METHODS Subjects undergoing unilateral, primary TKA were randomized into ACB group or FTB group. The primary outcome was postoperative pain during active flexion at 8 hours after surgery measured by visual analogue scale (VAS). In addition, pain scores at other time points, quadriceps strength, morphine consumption, satisfactions of patient and side effects of morphine were also evaluated. RESULTS Sixty subjects completed the research. The VAS scores were lower in the ACB group than the FTB group at 8 and 24 hours at rest (P0.05). DISCUSSION ACB can provide superior analgesia and preserve more quadriceps strength than FTB. ACB facilitates functional recovery in the early stages and is compatible with the highly-recognized concept of rapid rehabilitation, which should be promoted in the clinic.More systematic breast biomechanics research and better translation of the research outcomes are necessary to inform sports bra designs and develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.Blood lactate concentrations have traditionally been utilized as an index of exercise intensity or clinical hyperlactatemia. However, more recent data suggests that fasting plasma lactate can also be indicative of the risk for subsequent metabolic disease. The hypothesis presented is that fasting blood lactate accumulation reflects impaired mitochondrial substrate utilization, which in turn influences metabolic disease risk.BACKGROUND Picosecond lasers appear to be effective and safe in treating pigmentation and photoaging disorders through laser-induced optical breakdown. OBJECTIVE To analyze the feasibility of photorejuvenation using picosecond lasers with diffractive lens array (DLA) in patients with melasma. METHODS Ten Asian (N = 10) women with melasma and Fitzpatrick skin Type IV were enrolled and treated using 755-nm picosecond alexandrite lasers with DLA. All individuals were assessed before treatment, and at 12, 20 weeks, and 1 year by post-hoc test on melasma area and severity index (MASI) and with VISIA Complexion Analysis System using percentile rank for measurement. RESULTS The median participant age was 46.5 years. The average MASI continually and significantly (p less then .05) decreased until the 1-year follow-up, with the photoaging characteristics, such as wrinkles and red areas improving simultaneously (p less then .05). see more Spots, texture, pores, ultraviolet (UV) spots, brown spots, and porphyrins exhibited alleviation, but this improvement relapsed by the 1-year follow-up. No postinflammatory hyperpigmentation or hypopigmentation occurred. CONCLUSION In patients with melasma, picosecond laser treatment with DLA may alleviate pigmentation disorder and the related photoaging characteristics (e.g., wrinkled skin and increased vascularity), and the effects may be maintained for a long time. Nevertheless, post-treatment clinical visits every 3 to 6 months are recommended.BACKGROUND Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck. OBJECTIVE The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2000-2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed. RESULTS Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56-1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12-6.47), nor overall mortality (HR 1.10, 95% CI 0.82-1.48) between MMS versus LE. CONCLUSION There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities.BACKGROUND Lateralization of the glenosphere in reverse shoulder arthroplasty likely mitigates scapular notching; however, there is a paucity of data evaluating the effect of heterotopic ossification (HO) at the inferior aspect of the glenoid neck. METHODS We retrospectively reviewed 107 consecutive reverse shoulder arthroplasty patients between April 2013 and April 2016. During the study period, the surgeon switched from a 2.5-mm lateral center of rotation and a 155° neck-shaft angle (NSA) to a 6- or 10-mm lateralized design with a 135° NSA. Preoperative and minimum 2-year postoperative patient-reported outcomes and range of motion were collected. Two-year postoperative radiographs were evaluated for scapular notching and HO. RESULTS The lateralized center of rotation implant was 72% less likely to develop HO and 85% less likely to produce scapular notching than the medialized prosthesis. CONCLUSION Implants with laterally offset glenospheres and 135° NSA may decrease postoperative HO and scapular notching. LEVEL OF EVIDENCE Level III, retrospective cohort study.STUDY DESIGN This study was a meta-analysis of published randomized controlled trials (RCTs). OBJECTIVE We investigated the mid-term to long-term outcomes of cervical disk arthroplasty (CDA) versus anterior cervical diskectomy and fusion (ACDF) for the surgical treatment of symptomatic cervical disk degenerative disease. SUMMARY OF BACKGROUND DATA ACDF has been widely performed for the surgical treatment of symptomatic cervical disk degenerative disease. However, the loss of motion at the operated level has been hypothesized to accelerate adjacent-level disk degeneration. CDA was designed to preserve motion segments and decrease the risk/rate of adjacent segment degeneration. However, it is still uncertain whether mid-term to long-term outcomes after CDA is more effective and safer than those observed after ACDF. METHODS Two independent reviewers conducted a search of PubMed, Embase, and the Cochrane Library databases for RCTs with a minimum of 48 months of follow-up. For dichotomous variables, the risk ratio and 95% confidence intervals were calculated.