Effectiveness and safety of motion-style acupuncture treatment using traction for inpatients with acute low back pain caused by a traffic accident: A randomized controlled trial.

BACKGROUND: Musculoskeletal symptoms, such as neck pain and low back pain (LBP) are common after a traffic accident (TA). While motion-style acupuncture treatment (MSAT) is effective in relieving pain, MSAT using traction (T-MSAT) has rarely been studied, and evidence for its efficacy and safety is lacking. To address this gap, this study aimed to assess the effectiveness and safety of T-MSAT for pain and functional disturbances in patients with acute LBP caused by a TA. METHODS: This two-armed, parallel, assessor blinded randomized controlled trial, conducted at Jaseng Hospital of Korean Medicine, included 100 patients with acute LBP occurring within 1 week of a TA. The participants were randomly allocated (1:1 ratio) to receive either combined T-MSAT and integrative Korean medicine treatment (IKMT) or only conventional IKMT, applied for 3 consecutive days after admission. The primary outcome was the difference between numerical rating scale (NRS) scores for LBP at baseline and after treatment completion on day 4 after admission. RESULTS: At the primary endpoint, the difference in NRS scores for LBP between the T-MSAT and control groups was 0.94 (95% confidence interval [CI] 0.40-1.48). The T-MSAT group showed a significantly lower NRS score for LBP than the control group. Differences in visual analogue scale (VAS) scores between the T-MSAT and control groups were significant at baseline and discharge. The area under the curve of the VAS score showed a significant difference (-46.86 [95% CI -85.13 to -8.59]), indicating faster pain reduction in the T-MSAT group than in the control group. Recovery (30% pain reduction) was achieved more rapidly in the T-MSAT group than in the control group (log-rank test P = .005). Meanwhile, the NRS, VAS, Oswestry disability index, and quality of life scores at discharge or at the 12-week follow-up showed no significant difference. The rates of mild adverse events (AEs) were comparable between the groups. No severe AEs were reported, and none of the AEs were associated with the clinical trial. CONCLUSIONS: T-MSAT combined with IKMT is a safe treatment that can effectively and quickly reduce initial pain in patients with LBP.

Analysis of Healthcare Utilization for Primary Dysmenorrhea in Korea: A Retrospective, Cross-Sectional Study.

Purpose: This study is a retrospective, cross-sectional study aiming to present basic data on the treatment modalities and cost of care for primary dysmenorrhea (PD) by analyzing healthcare utilization and patient distributions using the 2010 to 2018 Health Insurance Review and Assessment Service (HIRA) data. Patients and Methods: We used the HIRA-National Patient Sample (NPS) data to analyze medical service utilization for PD (ICD-10 code: N94.4, N94.6) in Western medicine (WM) or Korean medicine (KM) care between January 2010 and December 2018. Results: There were 41,139 patients diagnosed with PD who utilized Western medicine (WM) or Korean medicine (KM) care at least once during the study period. The number of claims and patients steadily rose over the years from 7430 claims for 3989 patients in 2010 to 11,523 claims for 6226 patients in 2018. The predominant age group was 15 to 24 years. Regarding the frequency of service categories for PD in the claims, consultation was the most common and costly service category in WM (72,120 cases, 47.89%; 631,912 USD, 69.74%), while injection and analogous treatments was the most common and costly service category in KM (97,157 cases, 72.41%; 314,696 USD, 55.86%). Regarding the drug prescriptions, nonsteroidal anti-inflammatory drugs (NSAIDs) (26,617 cases, 40.47%) were the most frequently prescribed drug for PD in pharmacies and hospitals. Conclusion: The result shows an annual increase in healthcare utilization for PD with the fastest rate in individuals aged 15 to 24 years. This study provides data on the current utilization of WM and KM care for PD for policymakers. Furthermore, we analyzed the frequency and cost of common treatment modalities in WM and KM, which would be useful data for clinicians and researchers.

The Effectiveness and safety of T-MSAT on inpatients with acute low back pain caused by traffic accidents: A protocol for randomized controlled trial.

BACKGROUND: Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA. METHODS: This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12). DISCUSSION: This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.

Novel amides and esters prodrugs of olmesartan: Synthesis, bioconversion, and pharmacokinetic evaluation.

Synthesis of novel amides and esters prodrugs of olmesartan is described. Their in vitro stability in rat plasma was tested. The results showed that the ester derivative IIa with n-octyl substituted dioxolone moiety was rapidly converted into olmesartan within 30 min. The pharmacokinetic parameters of IIa were studied and compared with those of olmesartan medoxomil. Compound IIa is proposed to be a promising prodrug of olmesartan.

Synthesis of pyrrolo[2,3-d]pyrimidine derivatives and their antiproliferative activity against melanoma cell line.

Synthesis of a new series of diarylureas and amides having pyrrolo[2,3-d]pyrimidine scaffold is described. Their in vitro antiproliferative activities against A375 human melanoma cell line and HS 27 fibroblast cell line were tested and the effect of substituents on pyrrolo[2,3-d]pyrimidine was investigated. The newly synthesized compounds, except N-acetyl derivatives (Id, Ie, and Im), generally showed superior or similar activity against A375 to Sorafenib. Among all of these derivatives, compounds Iq and Ir having imidazole and morpholine moieties, respectively, showed the most potent antiproliferative activity against A375.

Clinical Outcomes and Radiologic Changes After Microsurgical Bilateral Decompression by a Unilateral Approach in Patients With Lumbar Spinal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-Year Follow-Up.

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the clinical outcomes and radiologic changes after microsurgical bilateral decompression via a unilateral approach in patients with lumbar spinal stenosis (LSS) and degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Satisfactory short-term results have been observed after minimally invasive decompressive procedures, but intermediate-term and long-term outcomes have not been assessed. It is not yet clear whether decompressive laminectomy with concomitant fusion is the optimal surgical treatment for spinal stenosis combined with mild DS. We, therefore, evaluated minimum 3-year clinical outcomes and radiologic changes in patients with LSS and grade 1 DS, who underwent microsurgical bilateral decompression via a unilateral approach, without fusion. METHODS: We assessed 21 consecutive patients who underwent surgery conducted by a single surgeon of our hospital, between 2005 and 2007. The Oswestry Disability Index was determined preoperatively, just before discharge, and at last follow-up. Plain dynamic x-rays were used to determine slip percentages. RESULTS: Average patient age and clinical and radiologic follow-up periods were 67 years, 49.3 months, and 18 months, respectively. Preoperative, immediate postoperative, and last follow-up average Oswestry Disability Indices were 59.52±9.00, 50.19±7.23, and 26.19±12.42, respectively. However, 1 patient experienced aggravated symptoms and later underwent a fusion procedure. Of the 22 levels with spondylolisthesis, 15 had no sagittal motion as the difference in slip percentage on dynamic x-rays, but 7 showed sagittal motion. Average slip percentages increased from 13.90±5.41% to 14.60±5.78% for levels without sagittal motion on dynamic x-ray, and from 13.12±3.48% to 18.58±4.55% for levels with sagittal motion. CONCLUSIONS: Despite small case series with retrospective design and the absence of a control group, our study suggests that bilateral decompression via a unilateral approach in patients with LSS and grade 1 DS showed good mid-term clinical outcomes, despite an increase in slip percentage.However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray, than in patients without sagittal motion. Therefore, bilateral decompression via a unilateral approach can aggravate symptoms related to instability in patients with preoperative sagittal motion on dynamic x-ray, and needs a longer term follow-up than in our study.

Does plate profile affect postoperative dysphagia following anterior cervical spine surgery?

Dysphagia following anterior cervical spine surgery is a significant problem. The risk factors for such dysphagia have not been established. We examined whether plate profile affected the incidence of dysphagia. This study enrolled 50 consecutive patients undergoing one-level corpectomy or one- or two-level discectomies with plate fixation performed by the same surgeon from 2004 to 2009. The anterior cervical plates used were either the Codman (Johnson and Johnson Professional Inc., Raynham, MA, USA; width 17.58 mm, thickness 2.69 mm; 27 patients) or the Zephir (Medtronic Sofamor Danek Inc., Memphis, TN, USA; width 15 mm, thickness 1.6 mm; 23 patients). Dysphagia was assessed via telephone interviews, and was classified as short-term (occurring within 6 months postoperatively) or persistent (persisting beyond 6 months postoperatively). The overall short-term and persistent dysphagia rates were 20% and 14%, respectively. The short-term and persistent dysphagia rates were 26% and 13% for the Zephir plate, and 14.8% and 14.8% for the Codman plate, and analysis showed that the rates were similar for both types of plate. Age and sex were not found to correlate with dysphagia. In patients undergoing anterior cervical spine surgery with plate fixation, we found that postoperative dysphagia did not correlate with plate profile up to a plate size of 17.58 mm wide and 2.69 mm thick. Dysphagia occurred at the same incidence in patients with a smaller plate that was 15 mm wide and 1.6 mm thick.

New imidazo[2,1-b]thiazole derivatives: synthesis, in vitro anticancer evaluation, and in silico studies.

A series of 18 new imidazo[2,1-b]thiazole derivatives was synthesized. Their in vitro antiproliferative activities against A375P human melanoma cell line and NCI-60 cell line panel were tested. Compounds 15, 16, 18, 22, 26-28, and 31 showed superior potency against A375P to sorafenib. In addition, compounds 26 and 27 showed selectivity toward melanoma cell lines than for other cancer types. Both compounds exerted sub-micromolar IC(50) values over 7 (including A375P) and 6 melanoma cell lines, respectively. In silico studies are also reported. ADME profiling, in silico toxicity, drug-likeness, and drug-score data of compounds 26 and 27 are promising.