Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.

Objective: To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. Methods: Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). Results: Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). Conclusion Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

Objective: To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. Methods: Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). Results: Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). Conclusion Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

Objective: : Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a T2 hyperintense signal that extends beyond the hyperostotic bone. In this study we try to investigate the perimeter of tumour cells outside the visible nidus of hyperostotic bone and to what extent they are present outside this nidus. This would serve as an initial step for setting guidelines on dealing with hyperostosis in meningioma surgery. Methods: : This is a prospective case series that included 14 patients with convexity meningiomas and hyperostosis during the period from March 2017 to August 2018 in two university hospitals. Patients demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed. In all cases, all visible abnormal bone was excised bearing in mind to also include the hyperintense diploe in magnetic resonance imaging (MRI) T2 weighted images after careful preoperative assessment. To examine bony tumour invasion, five marked bone biopsies were taken from the craniotomy flap for histopathological examinations. These include one from the centre of hyperostotic nidus and the other four from the corners at a 2-cm distance from the margin of the nidus. Results: : Our study included five males (35.7%) and nine females (64.3%) with a mean age of 43.75 years (33-55). Tumor site was parietal in seven cases (50%), fronto-parietal in three cases (21.4%), parieto-occipital in two cases (14.2%), frontal region in one case and bicoronal (midline) in one case. Tumour pathology revealed a World Health Organization (WHO) grade I in seven cases (50%), atypical meningioma (WHO II) in five cases (35.7%) and anaplastic meningioma (WHO III) in two cases (14.2%). In all grade I and II meningiomas, bone biopsies harvested from the nidus revealed infiltration with tumour cells while all other bone biopsies from the four corners (2 cm from nidus) were free. In cases of anaplastic meningiomas, all five biopsies were positive for tumour cells. Conclusion : Removal of the gross epicentre of hyperostotic bone with the surrounding 2 cm is adequate to ensure radical excision and free bone margins in grade I and II meningiomas. Hyperintense signal change in MRI T2 weighted images, even beyond visible hypersototic areas, doesn’t necessarily represent tumour invasion.

PURPOSE: We evaluated oral metronomic capecitabine (MC) compared to intravenous doxorubicin in patients with advanced or metastatic hepatocellular carcinoma (HCC).METHODS: From January 2013 to December 2015, patients with Child-Pugh class A or early B were randomized either to MC group (500 mg twice daily continuously) or doxorubicin group (60 mg/m² every 21 days).RESULTS: Forty patients were included in each group. The baseline clinical characteristics of the enrolled patients were well balanced between the two groups. No complete response (CR) was reported in either group. In MC group, 2 patients (5%) had partial response (PR), 25 patients (62.5%) stable disease (SD) and 27 patients (67.5%) had disease control. In doxorubicin group, 4 patients (10%) achieved PR, 24 patients (60%) SD and 28 patients (70%) had disease control. The 6 months overall survival (OS) was 77.5% for MC and 75% for doxorubicin. The one year OS was 47.5% for MC and 42.5% for doxorubicin (P=0.521). The median OS survival was 10.2 months for MC and 9.6 months for doxorubicin (95% confidence interval, 3.2–6.5). The 6 month progression-free survival (PFS) was 45% for MC and 50% for doxorubicin. The one year PFS was 12.5% for MC and 7.5% for doxorubicin (P=0.289). The median time to progression was 3.4 months for MC and 3.1 months for doxorubicin. On multivariate analysis no significant impact for tumor stage, previous transhepatic arterial chemoembolization, portal vein thrombosis or median baseline alpha fetoprotein on OS.CONCLUSION: MC showed response rate and survival outcome comparable to doxorubicin in advanced HCC but with a more favorable toxicity profile.
alpha-Fetoproteins ; Capecitabine ; Carcinoma, Hepatocellular ; Disease-Free Survival ; Doxorubicin ; Humans ; Multivariate Analysis ; Venous Thrombosis

Objective: This study was conducted to investigate the relationship of semen parameters in samples used for intracytoplasmic sperm injection (ICSI) with fertilization and pregnancy rates in infertile couples. Methods: In this prospective study of Infertile couples with male factor infertility that had undergone ICSI, fractions of the same semen samples obtained for microinjection (to ensure the best predictability) were evaluated to determine the semen parameters and sperm DNA fragmentation index (DFI) on the day of oocyte recovery. Results: In total, 120 couples completed the study and were subdivided into fertilized (n=87) and non-fertilized couples (n=33). The fertilized couples were further classified into pregnant (n=48) and non-pregnant (n=39) couples. Compared to non-fertilized and non-pregnant couples, fertilized and pregnant couples showed statistically significantly higher sperm viability and percentage of normal sperm morphology, as well as significantly lower sperm DFI values. A receiver operating characteristic curve analysis of data from the 120 ICSI cycles showed that sperm viability, normal sperm morphology percentages, and sperm DFI were significant prognostic indicators of fertilization at cutoff values of 40%, 7%, and 46%, respectively. A sperm DFI of 46% showed sensitivity and specificity of 95% and 90%, respectively, for predicting fertilization, and no clinical pregnancies occurred in couples with a sperm DFI above 46%. Conclusion Semen parameters from the ICSI day sample, especially sperm viability, normal morphology, and DFI, had an impact on fertilization and pregnancy outcomes in ICSI cycles.