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Background: Currently, there remains a high percentage of complications after lumbar discectomy, while there is no uniform tactic to prevent their development. Purpose of the study was to compare the clinical efficacy and return to work rate (RWR) after total disk replacement (TDR) and microsurgical lumbar discectomy (MLD) in railway workers with lumbar disk herniation (LDH)., Methods: We randomly assigned 75 patients out of a total of 81 patients, between 25 and 35 years of age who had one level LDH to undergo single-level TDR surgery (group I, n=37) or MLD surgery (group II, n=38) in the L4-L5 or L5-S1 segments. The functional state was assessed using the Oswestry Disability Index (ODI), pain severity was analyzed using the Visual Analogue Scale (VAS) for back pain and leg pain, quality of life was assessed according to SF-36 preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. The X-ray assessment was used to assess the efficacy of the respective surgical methods pre-operatively and last follow-up of 1-year. Workload intensity criterions were used to analyze return to work 1 year after surgery. Clinical and radiographic observers were blinded for the assigned treatment during the 12-month follow-up., Results: As expected, the MLD group had statistically significantly lower duration of surgery and less bleeding than TDR group. At a 1-year follow-up period, the TDR group had significantly better ODI, VAS and SF-36 than the MLD group. The postoperative X-ray revealed a statistically significant difference of the range of motion (ROM) and global lumbar lordosis in TDR group compared to the MLD group. After TDR procedure in light-moderate and heavy-very heavy workload patients groups had a statistically significantly higher RWR compared with MLD. The analysis revealed a comparable number of symptomatic complications in both groups (P=0.47), with a greater frequency of reoperations in the follow-up period in MLD group in comparison TDR group (P=0.04)., Conclusions: The use of single-level TDR in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of reoperations, restore of segmental mobility at operation level, preserve of global lumbar lordosis and RWR compared to MLD., Trial Registration: Russian Clinical Trial Registry 622011400059-4., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-24-63/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

The Flash Technique of Eye Movement Desensitization and Reprocessing (EMDR) is widely recognized for its effectiveness in reducing the effects of emotional responses associated with traumatic memories. Using a randomized-controlled trial methodology, this study attempts to establish the efficacy of the EMDR Flash Technique. This study's sample includes volunteers who were involved in traffic accidents and were given the randomized EMDR Flash Technique and Improving Mental Health Training for Primary Care Residents (mhGAP) Stress management module. The participants were given a socio-demographic data form, the Depression-Anxiety-Stress 21 scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the WHOQOL Quality of Life scale. Participants were evaluated using measurements taken before and after the application, as well as a one-month follow-up. The mean age of the participants was 36.20 (11.41) years and 82.1% (n = 32) were female. The DASS-21 Anxiety (η 2 = 0.085), IES-R Intrusion (η 2 = 0.101), Avoidance (η 2 = 0.124), Total (η 2 = 0.147), and WHOQOL-BREF Psychological (η 2 = 0.106) score improvements of the EMDR Flash Technique group were shown to be statistically significant when compared to the mhGAP group. However, no statistically significant difference in the DASS-21 Depression, Stress, Impact of Event Scale-Revised Hyperarousal WHOQOL-BREF General Health, Physical, Social Relationships, and Environment component scores was reported between the two groups. The present study's findings clearly demonstrate that the EMDR Flash technique, when applied to persons involved in traffic accidents, is successful in improving anxiety, intrusion, avoidance, total traumatic stress, and mental quality of life symptoms for at least 1 month. We believe that these findings will improve the reliability and applicability of the EMDR Flash Technique, which was tested for the first time in a clinical randomized-controlled trial (RCT). [ABSTRACT FROM AUTHOR]

The Flash Technique of Eye Movement Desensitization and Reprocessing (EMDR) is widely recognized for its effectiveness in reducing the effects of emotional responses associated with traumatic memories. Using a randomized-controlled trial methodology, this study attempts to establish the efficacy of the EMDR Flash Technique. This study’s sample includes volunteers who were involved in traffic accidents and were given the randomized EMDR Flash Technique and Improving Mental Health Training for Primary Care Residents (mhGAP) Stress management module. The participants were given a socio-demographic data form, the Depression-Anxiety-Stress 21 scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the WHOQOL Quality of Life scale. Participants were evaluated using measurements taken before and after the application, as well as a one-month follow-up. The mean age of the participants was 36.20 (11.41) years and 82.1% (n = 32) were female. The DASS-21 Anxiety (η2 = 0.085), IES-R Intrusion (η2 = 0.101), Avoidance (η2 = 0.124), Total (η2 = 0.147), and WHOQOL-BREF Psychological (η2 = 0.106) score improvements of the EMDR Flash Technique group were shown to be statistically significant when compared to the mhGAP group. However, no statistically significant difference in the DASS-21 Depression, Stress, Impact of Event Scale-Revised Hyperarousal WHOQOL-BREF General Health, Physical, Social Relationships, and Environment component scores was reported between the two groups. The present study’s findings clearly demonstrate that the EMDR Flash technique, when applied to persons involved in traffic accidents, is successful in improving anxiety, intrusion, avoidance, total traumatic stress, and mental quality of life symptoms for at least 1 month. We believe that these findings will improve the reliability and applicability of the EMDR Flash Technique, which was tested for the first time in a clinical randomized-controlled trial (RCT).

Mindfulness is enfolded in therapies addressing mental health conditions and is informed by secular and Buddhist models. However, mindfulness interventions can be rooted in other theoretical and spiritual frameworks including Christianity, which parallels Buddhist-based mindfulness practices. This study evaluates a mindfulness-based intervention drawing from Christian spiritual practices and discusses its practical implications. The researcher explored whether a Moving Picture Experts Group-3 (MP3)-based Christian mindfulness intervention would improve mindfulness states and decrease stress, measured by the Mindful Attention and Awareness Scale (MAAS) and Perceived Stress Scale (PSS), respectively. An analysis of covariance (ANCOVA) resulted in significant differences between pre- and post-test scores in experimental versus control groups on the MAAS and PSS after a 6-8-week intervention of a student sample (n = 80) from two private, religiously-affiliated universities. Higher MAAS scores reflected improved mindfulness states, F(1,80) = 11.947, p = .01 with a partial η2 = .134. Lower PSS scores reflect lowered perceived stress, F(1,80) = 3.849, p = .053 with a partial η2 = .047. [ABSTRACT FROM AUTHOR]

Background: Protamine administration post-cardiopulmonary bypass (CPB) can potentially cause hemodynamic instability. Histamine released from mast cells is believed to be responsible for hypotension after protamine administration. The aim of this study was to examine the effects of pretreatment with H1 and H2 antihistamines on changes in systemic arterial pressure following protamine administration., Methods: This study was a randomized, triple-blinded, placebo-controlled study, conducted at a university hospital. Forty adult patients undergoing elective coronary artery bypass grafting (CABG) or single valve surgery were included. The patients were randomly allocated (20 patients in each group) to receive a single dose of combined chlorpheniramine 10 mg and ranitidine 50 mg or normal saline intravenously immediately after separation from CPB prior to protamine administration. Trajectory changes in systolic blood pressure (SBP), mean arterial pressure (MAP), and vasoactive-inotropic score (VIS) from baseline until 35 minutes following protamine administration (24-time points) were compared between the two groups. Serial serum tryptase levels were also obtained at baseline, 30 and 60 minutes after protamine was given., Results: Forty patients were included in the analysis. Demographic and baseline blood pressure were similar between the two groups. At 30 minutes after protamine administration, there were no significant differences in both crude SBP [mean difference: -7.1 mmHg, 95% confidence interval (CI), -1.1 to 15.3 mmHg, P=0.09] and SBP after adjustment for the European System for Cardiac Operative Risk Evaluation (EuroSCORE II), CPB time, and VIS (mean difference: -3.9 mmHg, 95% CI, -11.9 to 4.0 mmHg, P=0.33). There were also no significant differences in crude MAP (mean difference: -2.1 mmHg, 95% CI, -6.9 to 2.7 mmHg, P=0.39) and adjusted MAP (mean difference: -0.7 mmHg, -5.9 to 4.4 mmHg, P=0.78) between the two groups. None of the patients in both groups had a significant increase in serum tryptase from baseline. No differences in median serum tryptase levels at baseline, 30 and 60 minutes were demonstrated between the two groups., Conclusions: Pretreatment with H1 and H2 antihistamines does not attenuate blood pressure responses to protamine administration in patients after CPB. Mechanisms other than histamine release from mast cells might be responsible for protamine-induced cardiovascular changes., Trial Registration: ClinicalTrials.gov NCT03583567.

Gastroesophageal reflux (GER) with laryngopharyngeal reflux plays a significant role in voice disorders. A significant proportion of patients attending ear, nose, and throat clinics with voice disorders may have gastresophageal reflux disease (GERD). There is no controlled study of the effect of voice therapy on GERD. We assessed the effect of voice therapy in patients with dysphonia and GERD. Thirty-two patients with dysphonia and GERD underwent indirect laryngoscopy and voice analysis. Esophageal and laryngeal symptoms were assessed using the reflux symptom index (RSI). At endoscopy, esophagitis was graded according to Los Angeles classification. Patients were randomized to receive either voice therapy and omeprazole (20 mg bid) (n = 16, mean [SD] age 36.1 [9.6] y; 5 men; Gp A) or omeprazole alone (n = 16, age 31.8 [11.7] y; 9 men; Gp B). During voice analysis, jitter, shimmer, harmonic-to-noise ratio (HNR) and normalized noise energy (NNE) were assessed using the Dr. Speech software (version 4 1998; Tigers DRS, Inc). Hoarseness and breathiness of voice were assessed using a perceptual rating scale of 0–3. Parameters were reassessed after 6 weeks, and analyzed using parametric or nonparametric tests as applicable. In Group A, 9 patients had Grade A, 3 had Grade B, and 1 had Grade C esophagitis; 3 had normal study. In Group B, 8 patients had Grade A, 2 had Grade B esophagitis, and 6 had normal study. Baseline findings: median RSI scores were comparable (Group A 20.0 [range 14–27], Group B 19.0 [15–24]). Median rating was 2.0 for hoarseness and breathiness for both groups. Values in Groups A and B for jitter 0.5 (0.6) versus 0.5 (0.8), shimmer 3.1 (2.5) versus 2.8 (2.0), HNR 23.0 (5.6) versus 23.1 (4.2), and NNE −7.3 (3.2) versus −7.2 (3.4) were similar. Post-therapy values for Groups A and B: RSI scores were 9.0 (5–13; P < 0.01 as compared with baseline) and 13.0 (10–17; P < 0.01), respectively. Ratings for hoarseness and breathiness were 0.5 ( P < 0.01) and 1.0 ( P < 0.01) and 2.0. Values for jitter were 0.2 (0.0; P = 0.02) versus 0.4 (0.7), shimmer 1.3 (0.7; P < 0.01) versus 2.3 (1.2), HNR 26.7 (2.3; P < 0.01) versus 23.7 (3.2), and NNE −12.3 (3.0, P < 0.01) versus −9.2 (3.4; P < 0.01). Improvement in the voice therapy group was significantly better than in patients who received omeprazole alone. Dysphonia is a significant problem in GER. Treatment for GER improves dysphonia, but in addition, voice therapy enhances the improvement. [ABSTRACT FROM AUTHOR]

This study investigated the effect of stabilization splint (SS) and palatal splint (PS), which had the same design as SS except for the elimination of the occlusal coverage, on sleep bruxism (SB) using a portable electromyographic (EMG) recording system. Sixteen bruxers participated in this study. The EMG activities of the right masseter muscle during sleep were recorded for three nights each in the following five recording periods: before, immediately after, and 2, 4 and 6 weeks after the insertion of the splint. The crossover design, in which each splint was applied to each subject for 6 weeks with an interval of 2 months for a washout period, was employed in this randomized-controlled study. The number of SB events, duration and total activities of SB were analysed. The number of SB events before the insertion of splints (baseline) was 2·98 ± 1·61 times h−1. Both splints significantly reduced SB immediately after the insertion of devices ( P < 0·05, one-way repeated-measuresanova followed by Dunnett); however, no reduction was observed in 2, 4 or 6 weeks ( P > 0·05). There was no statistical difference in the effect on SB between the SS and PS ( P > 0·05, two-way repeated-measuresanova). Both splints reduced the masseter EMG activities associated with SB; however, the effect was transient. [ABSTRACT FROM AUTHOR]

PASSMAN, R.S., et al.: Radiofrequency Ablation of Atrial Flutter: A Randomized Controlled Trial of Two Anatomic Approaches. Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the “septal” or “posterior” approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 ± 30.3 versus 70.8 ± 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice. (PACE 2004; 27:83–88) [ABSTRACT FROM AUTHOR]

To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling (DN) of local myofascial trigger points and sham laser acupuncture (Sham). Outcome measures were motion-related pain intensity (visual analogue scale, 0–100 mm) and range of motion (ROM). In addition, patients scored changes of general complaints using an 11-point verbal rating scale. Patients were assessed immediately before and after each treatment by an independent (blinded) investigator. Multivariate analysis was used to assess the effects of true acupuncture and needle site independently. For motion-related pain, use of acupuncture at non-local points reduced pain scores by about a third (11.2 mm; 95% CI 5.7, 16.7; P=0.00006) compared to DN and sham. DN led to an estimated reduction in pain of 1.0 mm (95% CI −4.5, 6.5; P=0.7). Use of DN slightly improved ROM by 1.7° (95% CI 0.2, 3.2; P=0.032) with use of non-local points improving ROM by an additional 1.9° (95% CI 0.3, 3.4; P=0.016). For patient assessment of change, non-local acupuncture was significantly superior both to Sham (1.7 points; 95% CI 1.0, 2.5; P=0.0001) and DN (1.5 points; 95% CI 0.4, 2.6; P=0.008) but there was no difference between DN and Sham (0.1 point; 95% CI −1.0, 1.2; P=0.8). Acupuncture is superior to Sham in improving motion-related pain and ROM following a single session of treatment in chronic neck pain patients. Acupuncture at distant points improves ROM more than DN; DN was ineffective for motion-related pain. [Copyright &y& Elsevier]