Comparison Clinical Effects of Hypertonic Dextrose and Steroid Injections on Chronic Subacromial Bursitis: A Double-Blind Randomized Controlled Trial.

OBJECTIVE: The aim of the study is to determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy for chronic subacromial bursitis patients. DESIGN: Fifty-four patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder Pain and Disability Index and visual analog scale were the primary outcomes. RESULTS: The steroid group ( n = 26) exhibited significant visual analog scale score improvements comparing with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group ( n = 28) exhibited visual analog scale score improvements at weeks 6 and 12. The steroid group displayed significant Shoulder Pain and Disability Index score improvements compared with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group exhibited significant score decreases at weeks 2 and 6. Compared with the dextrose prolotherapy group, the steroid group demonstrated significantly greater decreases in visual analog scale scores at weeks 2 and 6; the steroid group showed significantly greater decreases in Shoulder Pain and Disability Index scores at weeks 2, 6, and 12. CONCLUSIONS: Both hypertonic dextrose prolotherapy and steroid injections can provide short-term improvements of pain and disability among chronic subacromial bursitis patients. Moreover, steroid injections showed better effectiveness than hypertonic dextrose prolotherapy in ameliorating pain and improving function.

Effects of conjugated linoleic acid and exercise on body composition and obesity: a systematic review and meta-analysis.

CONTEXT: Conjugated linoleic acid (CLA) has been reported to have anti-obesity and antidiabetic effects. However, the benefits of CLA combined with exercise remain unclear, and studies report conflicting results. OBJECTIVE: A systematic review and meta-analysis were performed to investigate the synergistic effect of CLA and exercise on body composition, exercise-related indices, insulin resistance, and lipid profiles; and of the safety of CLA supplements. DATA SOURCES: In October 2021, the PubMed, Embase, and Cochrane Library databases were searched for reports on clinical trials of the combined intervention of CLA and exercise. DATA EXTRACTION: A total of 18 randomized controlled trials and 2 crossover trials were included. The methodological quality assessment was performed using the revised Cochrane risk-of-bias tool. Pooled effect sizes were reported as standardized mean difference (SMD) for continuous data and risk ratio for dichotomous data with their corresponding 95% confidence intervals (CIs). Heterogeneity was tested using the I2 statistic. DATA ANALYSIS: The combination of CLA and exercise resulted in significantly decreased body fat (SMD, -0.42 [95%CI, -0.70, -0.14]; P = 0.003; I2 = 65) and insulin resistance (SMD, -0.25 [95%CI, -0.44, -0.06]; P = 0.01; I2 = 0) than did exercise alone. In subgroup analysis, the following factors were associated with significant outcomes: (1) body mass index ≥25 kg/m2; (2) female sex; (3) follow-up time >4 weeks; and (4) intervention duration >4 weeks. Nevertheless, supplementation with CLA during exercise programs was not effective for body-weight control, exercise performance enhancement, or lipid-profile improvement. CLA in combination with exercise did not result in a higher risk of adverse events (risk ratio, 1.32 [95%CI, 0.94-1.84]; P > 0.05; I2 = 0). CONCLUSION: CLA combined with exercise is generally safe and can lower body fat and insulin resistance but does not reduce body weight, enhance exercise performance, or improve lipid profiles.

Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy.

Background: Both corticosteroids and hypertonic dextrose injections are commonly used for chronic supraspinatus tendinopathy. Purpose: To compare the supraspinatus echogenicity and clinical effects of echo-guided hypertonic dextrose versus corticosteroid injection for treating chronic supraspinatus tendinopathy. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a secondary data analysis of a previous clinical trial including patients who received normal saline versus hypertonic dextrose injection; patients who received corticosteroid injection were recruited between August 2017 and July 2021. Baseline patient data were matched among these 3 groups at a 1:1:1 ratio. At baseline and 2, 6, and 12 weeks after the intervention, the authors compared morphological changes (supraspinatus thickness and echogenicity) and clinical parameters (visual analog scale [VAS] for pain, Shoulder Pain and Disability Index [SPADI], and range of motion [ROM]). Analysis of variance was used to compare mean changes from baseline among the groups. Results: A total of 75 patients (25 in each group) were included. At 2-week follow-up, both the dextrose and the steroid groups exhibited improvement in VAS scores (mean difference [MD] from baseline: -2.0 in dextrose group; -3.3 in steroid group (P < .001)), SPADI scores (MD from baseline: -10.6 in dextrose group; -24.6 in steroid group (P < .001)), and flexion ROM (MD from baseline: 13.6° in dextrose group; 21.1° in steroid group) (P =.001). At 6 weeks after injection, the hypertonic dextrose group exhibited more favorable echogenic improvement in supraspinatus tendon morphology compared with the other 2 groups (P < .001). However, the steroid group showed significantly more improvement in clinical parameters compared with the other 2 groups at both week 6 (MD from baseline: VAS, -3.2; SPADI, -26.6; flexion ROM, 21.5°) and week 12 (MD from baseline: VAS, -2.5; SPADI, -20.4; flexion ROM, 15.2°) (P < .001 for all). Conclusion: Hypertonic dextrose injection improved supraspinatus echogenicity after 6 weeks but provided short-term symptomatic relief in the patients with chronic supraspinatus tendinopathy when compared with corticosteroid or saline injections. Steroid injection exerted a more favorable clinical effect at weeks 6 and 12 but demonstrated a negative effect on the supraspinatus.

Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials.

OBJECTIVE: The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke. METHODS: Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected. RESULTS: Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs (n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51-0.84) and at follow-up (12 RCTs (n = 391): SMD = 0.66, 95% CI = 0.35-0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs (n = 411): SMD = 0.70, 95% CI = 0.39-1.02) and at follow-up (8 RCTs (n = 289): SMD = 0.93, 95% CI = 0.34-1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity. CONCLUSION: Electrical stimulation therapy can effectively improve the arm function in stroke patients.

A cross-sectional evaluation of meditation experience on electroencephalography data by artificial neural network and support vector machine classifiers.

To quantitate the meditation experience is a subjective and complex issue because it is confounded by many factors such as emotional state, method of meditation, and personal physical condition. In this study, we propose a strategy with a cross-sectional analysis to evaluate the meditation experience with 2 artificial intelligence techniques: artificial neural network and support vector machine. Within this analysis system, 3 features of the electroencephalography alpha spectrum and variant normalizing scaling are manipulated as the evaluating variables for the detection of accuracy. Thereafter, by modulating the sliding window (the period of the analyzed data) and shifting interval of the window (the time interval to shift the analyzed data), the effect of immediate analysis for the 2 methods is compared. This analysis system is performed on 3 meditation groups, categorizing their meditation experiences in 10-year intervals from novice to junior and to senior. After an exhausted calculation and cross-validation across all variables, the high accuracy rate >98% is achievable under the criterion of 0.5-minute sliding window and 2 seconds shifting interval for both methods. In a word, the minimum analyzable data length is 0.5 minute and the minimum recognizable temporal resolution is 2 seconds in the decision of meditative classification. Our proposed classifier of the meditation experience promotes a rapid evaluation system to distinguish meditation experience and a beneficial utilization of artificial techniques for the big-data analysis.

Improved emotional stability in experienced meditators with concentrative meditation based on electroencephalography and heart rate variability.

OBJECTIVE: To determine whether emotional stability distinguishes how experienced and novice meditators react to visual stimuli. DESIGN: PARTICIPANTS practiced concentrative meditation and then responded to visual stimuli while continuing to meditate. PARTICIPANTS: Ten experienced and 10 novice meditators responded to sequences of visual stimuli after concentrative meditation. RESULTS: As predicted, both groups had increased parasympathetic activities during concentrative meditation. Experienced meditators had increased low-frequency electroencephalography (EEG) rhythms in response to visual stimulation, whereas novices had increased high-frequency EEG rhythms. Correlational analyses revealed that novice meditators changed from a meditative state to a nonrelaxed state when the visual stimuli were presented, whereas experienced meditators maintained the meditative state. CONCLUSION: The study provides evidence that regular concentrative meditation can improve emotional stability and that recording physiologic responses to visual stimuli can be a good method for identifying the effects of long-term concentrative meditation practice.

Epidural anesthesia does not increase the incidences of urinary retention and hesitancy in micturition after ambulatory hemorrhoidectomy.

BACKGROUND: This randomized, prospective study was designed to evaluate the role of various anesthesias in postoperative urinary retention and hesitancy in micturition in patients receiving hemorrhoidectomy on ambulatory basis. METHODS: In a randomized order, 128 ambulatory patients, ASA physical status I or II, were divided into two groups to receive hemorrhoidectomy under epidural or local anesthesia. In all patients, the intraoperative intravenous fluid given was limited to 200 ml +/- 2 ml/kg/h of Ringer's lactate solution. Patients were requested to void urine voluntarily before discharge. The incidences of postoperative urinary retention and hesitancy in micturition were evaluated by telephone interview 24 hours after surgery. RESULTS: Neither the incidence of urinary retention, nor the incidence of hesitancy in micturition was significantly different between the two groups. Patients with age over 50 had a significantly higher incidence of hesitancy in micturition than younger patients. The incidence of hesitancy in micturition seemed higher in male patients (31.3%) than that in females (15.6%), but the difference was not statistically different (P = 0.0585). CONCLUSIONS: With judicious intraoperative fluid restriction and voluntary voiding before discharge, epidural anesthesia does not increase the incidence of postoperative urinary retention or hesitancy in micturition following ambulatory hemorrhoidectomy.