BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher ...BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher accuracy in young,slender,healthy volunteers than the classical“Cyriax technique”.AIM To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.METHODS We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone,lidocaine,and air.After the injection,the shoulder was moved to determine whether a squishing sound could be produced.The squishing sound was interpreted as an accurate injection.The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.RESULTS Squishing was heard after 87%of the injections.This was 13%(10%points)more than the 77%in the previous study(P=0.004).CONCLUSION The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis.We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.展开更多
BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain d...BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain during IAHIs and the role of preinjection local anesthesia in pain modulation remains unclear.AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.METHODS This prospective study enrolled 60 patients undergoing IAHI,30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia.Pain levels were assessed using numeric rating scales.RESULTS Patients significantly overestimated anticipated pain compared to experienced pain(6.43±2.48 vs 3.68±2.37,P<0.001).Pre-injection local anesthesia did not significantly reduce experienced pain(3.19±2.38 vs 4.20±2.29,P=0.130).CONCLUSION Patients overestimate anticipated pain during IAHIs.Pre-injection local anesthesia does not reduce experienced pain.展开更多
BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).Howeve...BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.展开更多
BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the ef...BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.展开更多
文摘BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher accuracy in young,slender,healthy volunteers than the classical“Cyriax technique”.AIM To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.METHODS We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone,lidocaine,and air.After the injection,the shoulder was moved to determine whether a squishing sound could be produced.The squishing sound was interpreted as an accurate injection.The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.RESULTS Squishing was heard after 87%of the injections.This was 13%(10%points)more than the 77%in the previous study(P=0.004).CONCLUSION The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis.We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.
基金approved by the Medical Ethics Committee of the Tel Aviv Sourasky Medical Center Institutional Review Board,approval No.TLV-0674-21.
文摘BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain during IAHIs and the role of preinjection local anesthesia in pain modulation remains unclear.AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.METHODS This prospective study enrolled 60 patients undergoing IAHI,30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia.Pain levels were assessed using numeric rating scales.RESULTS Patients significantly overestimated anticipated pain compared to experienced pain(6.43±2.48 vs 3.68±2.37,P<0.001).Pre-injection local anesthesia did not significantly reduce experienced pain(3.19±2.38 vs 4.20±2.29,P=0.130).CONCLUSION Patients overestimate anticipated pain during IAHIs.Pre-injection local anesthesia does not reduce experienced pain.
基金Supported by the National Key R and D Program of China,No.2021YFC2501700 and No.2021YFC2501705and the National Natural Science Foundation of China,No.82171580 and No.81672646.
文摘BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.
文摘BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.
