Search

Objective: To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH). Methods: Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M (IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16-18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ 2 test, corrected χ 2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results: In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR =3.88,95% CI :1.57 to 9.58, P =0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR =0.21,95% CI :0.05 to 0.80, P =0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P >0.05). Conclusion: The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective: To explore the quantitative value of the T2mapping sequence in evaluating the early glenohumeral joint cartilage injury. Methods: A total of 92 patients with shoulder joint pain who underwent routine sequence and T2mapping sequence scanning in General Hospital of Ningxia Medical University from March 2023 to March 2024 were retrospectively collected as a case group. The patients were classified into tendinitis group, partial tear group and full tear group according to the degree of tendon injury. Another 25 healthy subjects of the same age were selected as the control group. Two physicians divided articular cartilage into upper, middle, and lower subregions in the T2mapping sequence and measured T2 values in each subregion. The intra-observer correlation coefficient (ICC) was employed to evaluate the inter-observer and intra-observer consistency. Independent sample t test was utilized to compare the T2 values of different subregions between the two groups. One-way analysis of variance was used to compare the T2 values of different subregions among the groups, and pairwise comparison was conducted using the Bonferroni test. Spearman correlation analysis was conducted to analyze the correlation between the T2 values in different subregions of the articular cartilage and the injury degree of the supraspinatus tendon. Results: There were 44 males and 48 females in the case group, with an age range of 38 to 60 (51.4±5.8) years; there were 32 cases in the tendonitis group, 33 cases in the partial tear group, and 27 cases in the full tear group. There were 11 males and 14 females in the control group, with an age range of 40 to 54 (49.1±3.9) years. The T2 values of the upper, middle, and lower subregions of the glenohumeral articular cartilage in the case group were (37.8±4.9) ms, (39.1±5.9) ms, and (42.1±5.1) ms, respectively, all of which were significantly higher than those in the control group [(29.4±3.3) ms, (31.7±5.0) ms, and (36.3±6.2) ms, respectively] (all P <0.001). Within the supraspinatus tendon full tear group, the T2 values were (40.2±5.7) ms, (41.2±5.4) ms, and (43.4±4.1) ms, respectively, all of which exceeded those in the partial tear group [(38.2±4.3) ms, (38.9±6.5) ms, (43.1±5.1) ms, respectively], which were also higher than those in the tendonitis group [(35.0±3.2) ms, (37.7±5.0) ms, (40.1±4.5) ms, respectively] and the control group [(29.4±3.3) ms, (31.7±5.0) ms, (36.3±6.2) ms, respectively] (all P <0.001). Statistically significant differences in T2 values were observed between different subregions of articular cartilage in both the tendonitis and partial tear groups (all P <0.05); however, no significant differences were found among the upper, middle, and lower subregions in the full tear group ( P =0.140). Furthermore, the T2 values in the upper, middle, and lower subregions of articular cartilage exhibited a positive correlation with the degree of supraspinatus muscle injury ( r =0.693, 0.515, and 0.449, respectively, all P <0.001). Conclusions: The T2mapping sequence can quantitatively assess the degree of articular cartilage damage, and the degree of supraspinatus tendon damage and glenohumeral joint cartilage damage is positively correlated.