[Exploring the Experience of Dysmenorrhea and Life Adjustments of Women Undergoing Traditional Chinese Medicine Treatment].

BACKGROUND: Previous studies of women with dysmenorrhea have focused on menstrual attitudes, the characteristics of menstrual pain, and self-care behavior. Traditional Chinese Medicine (TCM) studies on dysmenorrhea, on the other hand, have focused on the efficacy and safety of TCM treatments. Few studies have investigated how women perceive their own TCM-treatment experience of dysmenorrhea. PURPOSE: The objective of this study was to explore the experience of dysmenorrhea and life adjustments of women undergoing TCM treatment. METHODS: A semi-structured interviewing guide was used to collect data. A total of 40 dysmenorrheal women participated in the study. Individual, in-depth interviews were conducted for about 60-90 minutes with each participant. Their speech tone, facial expressions, and gestures during the interview process were also observed and recorded. The findings were analyzed using content analysis via ATLAS. ti 5.2 software. RESULTS: The process that the participants used to adjust to dysmenorrhea were distinguished into four progressive stages: "tip of the iceberg", "ice-breaking", "tug-of-war", and "blending-in". Initially, the participants perceived the symptoms of dysmenorrhea as the "tip of the iceberg". They attempted to hide / ignore the initial pain until the problem gradually worsened to the point that the symptoms began to significantly affect various aspects of life. It was only then that the participants began to pay attention to the problem and to seek help from TCM practitioners, which we defined as the "ice-breaking" stage. If they encountered unexpected situations with regard to the treatment regimen, the participants entered the "tug-of-war" stage, during which they struggled over whether to continue with TCM treatments. Afterward, the participants gradually achieved a "blending-in" of new ideas, which allowed them to identify the strategies that best facilitated adjustment and rebalancing. Eventually, the participants achieved a new life balance. CONCLUSIONS: The outcomes of the present study may be referenced for nurse-patient communications that relate to dysmenorrhea and TCM treatment.

Comparative Analysis of ABM/P-15, Bone Morphogenic Protein and Demineralized Bone Matrix after Instrumented Lumbar Interbody Fusion.

OBJECTIVE: ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) is a commercially available synthetically manufactured P-15 collagen peptide fragment, that is adsorbed on ABM. This study was done to investigate the efficacy of ABM/ P-15 in achieving fusion in the lumbar spine and comparing it with that of recombinant bone morphogenic protein-2 (rhBMP-2) and demineralized bone matrix (DBM). METHODS: A retrospective observational study of prospectively collected data of 140 patients who underwent lumbar spinal fusion surgeries in a single specialty spine hospital between 2016 and 2020, with a minimum 6-month follow-up was conducted. Based on the material used for the augmentation of the bone graft at the fusion site, the patients were divided into three categories namely ABM/P-15, rhBMP-2, and DBM group. RESULTS: ABM/P-15, rhBMP-2, and DBM were used in 46, 44, and 50 patients, respectively. Patient characteristics like age, gender, bone mineral density, smoking history, and presence of diabetes mellitus were comparable amongst the three groups. Average follow-up was 16.0±5.2, 17.9±9.8, and 26.2±14.9 months, respectively in ABM/P-15, rhBMP-2, and DBM groups. The fusion was achieved in 97.9%, 93.2%, and 98% patients while the average time-to-union was 4.05±2.01, 10±4.28, and 9.44±3.49 months (p<0.001), respectively for ABM/P-15, rhBMP-2, and DBM groups. The average pre-operative Visual analogue scale score was 6.93±2.42, 7.14±1.97, 7.01±2.14 (p=0.900) for ABM/P-15, rhBMP-2 and DBM groups, respectively, which reduced to 1.02±0.80, 1.21±0.96, and 0.54±0.70 (p=0.112), respectively at the last follow up. Pre-operative Oswestry disability index scores were 52.7±18.02, 55.4±16.8, and 53.56±19.6 (p=0.751) in ABM/P-15, rhBMP-2, and DBM groups, which post-operatively reduced to 33.77±15.52, 39.42±16.47, and 38.3±15.89 (p=0.412) and further to 15.74±8.3, 17.41±10.45, and 16.76±9.81 (p=0.603), respectively at the last follow-up. CONCLUSION: ABM/P-15 appears to achieve union significantly earlier than rhBMP-2 and DBM in lumbar spinal fusion cases while maintaining a comparable clinical and complication profile.

Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk.

OBJECTIVE: The purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass. METHODS: Single-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA ≤ 4 cm, PT > 20°) and decompensated sagittal deformity (DSD) (SVA > 4 cm, PT > 20°) based on prewalk measurements. RESULTS: Initial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p < 0.01). After walking, significant deteriorations in SVA, PT-LL (p < 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e. , decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r = -0.412, p = 0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r = 0.477, p = 0.018). ΔSVA and ΔPT correlated with FI at L4 (r = 0.577, p = 0.003 and r = -0.407, p = 0.048, respectively). DSD group, had weak correlations (-0.3 < r < -0.1) between changes in sagittal and PSM parameters. CONCLUSION: PSM quality in adults with spinal deformity correlates with patients' ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.

The Likelihood of Reaching Substantial Clinical Benefit After an Interlaminar Dynamic Spacer for Chronic Low Back Pain: A Clinical and Radiologic Analysis of a Prospective Cohort.

OBJECTIVE: Chronic low back pain (CLBP) often causes disabling pain that impairs a patient's quality of life. Surgical treatment is recommended for patients who do not respond to conservative treatments lasting more than 6 months. The purpose of this study is to present results after the use of an interlaminar dynamic spacer for CLBP. METHODS: We enrolled consecutive patients with CLBP irresponsive to more than 6 months of conservative treatment into the present study. Included patients underwent an interlaminar dynamic spacer insertion without direct decompression. We assessed radiographic parameters and health-related quality of life (HRQoL) data included visual analog scale back/leg pain and Oswestry Disability Index scores. Substantial clinical benefit achievement was assessed. RESULTS: Thirty-five patients (average age, 47.8 years; 21 female) were included. The mean preoperative symptom duration was 29.6 months. Surgeries involved 1-level (n = 18) and 2-levels (n = 17) procedures. Operative levels included L4-5 (n = 8), L5-S1 (n = 10), L3-4-5 (n-2), and L4-5-S1 (n = 15). The average follow-up period was 16.6 months. After the procedure, all radiographic parameters (including disc height, segmental extension angle, and foraminal area) improved significantly. All preoperative HRQoL parameters improved significantly at the final follow-up. Substantial clinical benefit achievement was observed in 75.8% of the cases on the Oswestry Disability Index, and in 72.7% and 84.8% of the cases on the visual analog scale back and leg pain, respectively. CONCLUSIONS: An interlaminar dynamic spacer significantly improves HRQoL scores in patients with CLBP who do not respond to conservative treatment. Although encouraging, these results should be confirmed with studies assessing a larger cohort and a longer follow-up.

The effectiveness of the waffle-cone technique in treating complex intracranial aneurysms.

We report 13 consecutive cases of complex intracranial aneurysms treated by the waffle-cone technique and the midterm angiographic results and discuss the effectiveness and safety of this technique. We performed a retrospective review to evaluating the angiographic results and clinical effectiveness of 15 cases in which waffle-cone stenting for treating broad-necked complex intracranial aneurysms at our institution up to July 2008. Among these 15 patients, we enrolled 13 patients who had undergone at least one follow-up angiography. We collected patient data including age, sex, ruptured state, aneurysm size, neck size, complications, initial Hunt and Hess (HH) grade, modified Rankin Score (mRS) at the last angiographic follow-up, and initial and follow- up angiographic results.The mean size of the aneurysm was 10.6 mm (range, 4.0 to 20.4 mm) and the mean size of the aneurysm neck was 5.7 mm (range, 2.7 to 9.2 mm). The mean angiographic follow-up time was 13.6 months (range, six to 30 months). There were no procedure-related complications. However, there were two delayed complications. One complication was delayed focal embolic infarct and the other complication was delayed rebleeding. Angiographic improvement was achieved in two cases (15.4%), stable occlusion was achieved in seven cases (53.8%), and recanalization or compaction that needed retreatment occurred in four cases (30.8%). We think that the waffle-cone technique is an effective alternative in selected aneurysms unable to be "Y" stented or surgically clipped.