Ultrasound-Guided Sciatic Nerve Hydrodissection Can Improve the Clinical Outcomes of Patients with Deep Gluteal Syndrome: A Case-Series Study.

Deep gluteal syndrome (DGS) is caused by sciatic nerve entrapment. Because fascial entrapment neuropathies may occur in multiple locations, ultrasound-guided nerve hydrodissection is a key component of DGS treatment. In this study, we examined the clinical outcomes of patients with DGS undergoing ultrasound-guided sciatic nerve hydrodissection. A 10 mL mixture consisting of 5% dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve hydrodissection. Clinical outcomes were evaluated using Numeric Rating Scale (NRS) scores of pain, the proportion of patients with favorable outcomes (reduction of ≥50% in pain), the duration for which patients exhibited favorable outcomes (percentage of follow-up duration), and the occurrence of major complications and minor side effects. A total of 53 patients were consecutively included and followed up for 3 to 19 months. After the initial injection, the NRS scores significantly improved at 1 week, 1 month, 3 months, and the final follow-up. Specifically, 73.6%, 71.7%, 64.2%, and 62.3% of the patients exhibited favorable outcomes at 1 week, 1 month, 3 months, and the final follow-up, respectively. The median duration for which the patients exhibited favorable outcomes was 84.7% of the follow-up period. Three patients (5.7%) experienced transient dizziness and vomiting, which resolved without further treatment. No vessel or nerve puncture was observed. Overall, ultrasound-guided sciatic nerve hydrodissection is a safe procedure that mitigates the pain associated with DGS. To achieve favorable outcomes, three consecutive injections 3 weeks apart are required.

Ultrasound-guided nerve hydrodissection of cervical nerve roots for cervical radicular pain in patients with mild and moderate to severe stenosis: a retrospective cohort study.

Because fascial entrapment neuropathy can occur in multiple locations, ultrasound-guided nerve hydrodissection has become a key component of the treatment of cervical radicular pain. In this paper, we propose a combination of injectates used for nerve hydrodissection of the cervical nerve roots and compare the clinical outcomes of this treatment among patients with different severities of stenosis. This is a retrospective cohort study designed to compare outcomes between patients with mild stenosis and moderate to severe stenosis. Forty-four patients with mild cervical stenosis and 30 patients with moderate to severe cervical stenosis were consecutively enrolled into two groups. A 10-mL mixture in a single level consisting of 5% in Dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve roots hydrodissection. The two groups were compared with regard to their numeric rating scales (NRS) of pain, proportion of patients who exhibited a favorable outcome (a reduction of pain ≥ 50%), duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects. The follow-up period ranged from 3 to 20 months. The NRS of both groups improved significantly by 1 week, 1 month, 3 months, and final follow-up after the initial injection. Differences in the groups' NRS, proportion of patients who exhibited a favorable outcome, duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects were nonsignificant. There were 4 patients (5.4%) experienced dizziness in that resolved without further treatment. Ultrasound-guided nerve hydrodissection of cervical nerve roots is a safe procedure that reduces pain associated with cervical radicular pain, even in patients with moderate to severe stenosis.

Cerebral Oxygenation during Exercise in Patients with Cardiopulmonary Diseases: A Prospective Observational Study.

BACKGROUND: The relationship between exercise and cerebral oxygenation has gained increasing attention. However, few studies have investigated the correlation between exercise and cerebral oxygenation in patients with cardiopulmonary diseases. OBJECTIVES: To investigate the correlation between exercise and cerebral oxygenation in patients with cardiopulmonary diseases. METHODS: Thirty eligible patients with cardiopulmonary diseases underwent incremental cardiopulmonary exercising test (CPET) and near-infrared spectroscopy with both right and left sensors placed at the mid forehead to detect oxygen saturation of cerebral tissue (STO2). Parameters of cerebral oxygenation and exercise intensity were collected and analyzed. RESULTS: The average age of the patients was 51.17 ± 10.21 years and included 23 males and 7 females. The average maximal STO2 of the left and right brain during CPET were 51.850 ± 1.57% and 51.755 ± 1.90%, respectively. Meanwhile, mean oxygen consumption (VO2) while reaching maximal STO2 was 4.42 ± 1.05 metabolic equivalents (METs) over the left brain and 4.34 ± 1.17 METs over the right brain. The exercise intensity upon reaching maximal STO2 was 84.91 ± 11.70% over the left brain and 83.16 ± 14.64% over the right brain. Peak VO2 was significantly correlated to VO2 upon reaching maximal STO2 over the left and right brain (R = 0.805, p < 0.001 and R = 0.739, p < 0.001, respectively). Age was significantly negatively correlated to VO2 upon maximal STO2 over the left and right brain (R = -0.378, p = 0.039 and R = -0.513, p = 0.004, respectively). CONCLUSIONS: Cerebral oxygenation increases with higher exercise intensity, and it reaches a maximal STO2 between respiratory compensation point and peak exercise. The higher the peak VO2, the better the VO2 upon reaching maximal STO2.

Isocapnic buffering phase: a useful indicator of exercise endurance in patients with coronary artery disease.

OBJECTIVES: The significance of the isocapnic buffering (IB) phase - the period between the first ventilatory threshold (1st VT) and respiratory compensation point (RCP) - has not been adequately established in patients. This study aimed to determine the clinical significance of the IB phase in patients with coronary artery disease (CAD). METHODS: This retrospective study included data of sixty-two CAD patients after coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) performed in a single medical center between 2010 - 2014. According to their physical conditions, the patients performed incremental cardiopulmonary exercise test (CPET) using a cycle ergometer by the ramp of 5-20 W/min. Correlations between the corrected IB phase duration and age, body mass index (BMI), left ventricular ejection fraction (LVEF), and CPET parameters were evaluated using Pearson correlation coefficients. Variables predicting peak oxygen consumption (VO2) were evaluated using multiple regression. RESULTS: Peak VO2 (p < 0.001), VO2 at RCP (p < 0.001), ∆O2/∆WR slope (p < 0.001), maximal partial pressure of end tidal CO2 (PetCO2) (p = 0.0012), VE/VCO2 slope (p = 0.010), BMI (p = 0.012), and age (p = 0.017) were significantly correlated, whereas LVEF (p = 0.246) and VO2 at 1st VT (p = 0.179) were not significantly correlated with the corrected IB phase duration. In multiple regression analysis, the corrected IB phase duration, VO2 at 1st VT, and ∆O2/∆WR slope were significantly associated with peak VO2. CONCLUSION: The findings indicate that the IB phase duration is a useful indicator of peripheral cardiopulmonary function and endurance performance in CAD patients. These findings could assist the exercise prescription of cardiac rehabilitation for patients with CAD.

Selecting score types for longitudinal evaluations: the responsiveness of the Comprehensive Developmental Inventory for Infants and Toddlers in children with developmental disabilities.

OBJECTIVE: The objective of this study was to examine the responsiveness of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) in children with developmental disabilities (DD). METHODS: The responsiveness of a measure is its ability to detect change over time, and it is fundamental to an outcome measure for detecting changes over time. We compared the responsiveness of four types of scores (ie, raw scores, developmental ages [DAs], percentile ranks [PRs], and developmental quotients [DQs]) in the five subtests of the CDIIT. The CDIIT was administrated three times at intervals of 3 months on 32 children with DD aged between 5 months and 64 months (mean =30.6, standard deviation [SD] =17.8). The CDIIT is a pediatric norm-referenced assessment commonly used for clinical diagnosis of developmental delays in five developmental areas: cognition, language, motor, social, and self-care skills. The responsiveness was analyzed using three methods: effect size, standardized response mean, and paired t-test. RESULTS: The effect size results showed that at the 3-month and 6-month follow-ups, responsiveness was small or moderate in the raw scores and DAs of most of the subtest scores of the CDIIT, but the level of responsiveness varied in the PRs and DQs. The standardized response mean results of the 3-month and 6-month follow-ups showed that most of the subtest scores of the CDIIT had respectively moderate and large responsiveness in raw scores and DAs, but the responsiveness varied (from no to large) in PRs and DQs. CONCLUSION: The findings generally support the use of the CDIIT as an outcome measure. We also suggest using the raw scores and DAs when using a norm-referenced pediatric developmental assessment to evaluate developmental changes and program effectiveness in children with DD.