The Effects of Extracorporeal Shock Wave Therapy in Patients with Coccydynia: A Randomized Controlled Trial

<div><p>Coccydynia is pain in the coccygeal region, and usually treated conservatively. Extracorporeal shock wave therapy (ESWT) was incorporated as non-invasive treatment of many musculoskeletal conditions. However, the effects of ESWT on coccydynia are less discussed. The purpose of this study is to evaluate the effects of ESWT on the outcomes of coccydynia. Patients were allocated to ESWT (n = 20) or physical modality (SIT) group (n = 21) randomly, and received total treatment duration of 4 weeks. The visual analog scale (VAS), Oswestry disability index (ODI), and self-reported satisfaction score were used to assess treatment effects. The VAS and ODI scores were significantly decreased after treatment in both groups, and the decrease in the VAS score was significantly greater in the ESWT group. The mean proportional changes in the ODI scores were greater in the ESWT group than in the SIT group, but the between-group difference was not statistically significant. The patients in the ESWT group had significantly higher subjective satisfaction scores than SIT group. We concluded that ESWT is more effective and satisfactory in reducing discomfort and disability caused by coccydynia than the use of physical modalities. Thus, ESWT is recommended as an alternative treatment option for patients with coccydynia.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/study/NCT02313324?term=NCT02313324&rank=1" target="_blank">NCT02313324</a></p></div

Association of bacterial genotypes and epidemiological features with treatment failure in hemodialysis patients with methicillin-resistant <i>Staphylococcus aureus</i> bacteremia

<div><p>Objectives</p><p>Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections in the hemodialysis (HD) population are epidemiologically classified as healthcare-associated infections. The data about the clinical impact and bacterial characteristics of hospital-onset (HO)- and community-onset (CO)-MRSA in HD patients are scarce. The current study analyzed the difference in the clinical and molecular characteristics of HO-MRSA and CO-MRSA.</p><p>Methods</p><p>We performed a retrospective review and molecular analysis of clinical isolates from 106 HD patients with MRSA bacteremia from 2009 to 2014. CA genotypes were defined as isolates carrying the SCC<i>mec</i> type IV or V, and HA genotypes were defined as isolates harboring SCC<i>mec</i> type I, II, or III.</p><p>Results</p><p>CO-MRSA infections occurred in 76 patients, and 30 patients had HO-MRSA infections. There was no significant difference in the treatment failure rates between patients with CO-MRSA infections and those with HO-MRSA infections. CA genotypes were associated with less treatment failure (odds ratio [OR]: 0.18; 95% confidence interval [95% CI], 0.07–0.49; <i>p</i> = 0.001). For isolates with a vancomycin minimum inhibitory concentration (MIC) < 1.5 mg/L, the multivariate analysis revealed that HA genotypes and cuffed tunneled catheter use were associated with treatment failure. For isolates with a vancomycin MIC ≥1.5 mg/L, the only risk factor for treatment failure was a higher Pitt score (OR: 1.76; 95% CI, 1.02–3.05; <i>p</i> = 0.043).</p><p>Conclusion</p><p>CA genotypes, but not the epidemiological classification of CO-MRSA, impacted the clinical outcome of MRSA bacteremia in the HD population.</p></div

Incidence and hazard ratios for postherpetic neuralgia during the follow-up period for herpes zoster patients with traumatic brain injury (TBI) versus without TBI with a Charlson comorbidity index = 0 or ≥ 1.

<p>PHN, postherpetic neuralgia; CI, confidence interval; HR, hazard ratio; CCI, Charlson comorbidity index; HZ, herpes zoster; TBI, traumatic brain injury; HRs with a 95% CI and their P values were calculated using a Cox proportional-hazards regression model.</p><p>Incidence and hazard ratios for postherpetic neuralgia during the follow-up period for herpes zoster patients with traumatic brain injury (TBI) versus without TBI with a Charlson comorbidity index = 0 or ≥ 1.</p

Univariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.

<p>Univariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.</p

Incidence and hazard ratios for herpes zoster and postherpetic neuralgia during the follow-up period for surgical versus nonsurgical traumatic brain injury patients.

<p>CI, confidence interval; HR, hazard ratio; TBI, traumatic brain injury; HRs with a 95% CI and their P values were calculated using a Cox proportional-hazards regression model.</p><p>Incidence and hazard ratios for herpes zoster and postherpetic neuralgia during the follow-up period for surgical versus nonsurgical traumatic brain injury patients.</p

Incidence and hazard ratios for post-herpetic neuralgia during the follow-up period for adult patients with traumatic brain injury among herpes zoster patients.

<p>PHN, postherpetic neuralgia; CI, confidence interval; HR, hazard ratio; HZ, herpes zoster; TBI, traumatic brain injury; Adjusted HRs with 95% CI and their P values were adjusted for age, sex and Charlson comorbidity index using a Cox proportional-hazards regression model.</p><p>Incidence and hazard ratios for post-herpetic neuralgia during the follow-up period for adult patients with traumatic brain injury among herpes zoster patients.</p

Multivariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.

<p>Multivariate analyses of the association between potential predictor variables and treatment failure in patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia.</p

The Oswestry disability index (ODI) at baseline, 5^th week, and 8^th week.

<p>SD: standard deviation; ESWT: extracorporeal shock wave therapy; SIT: physical modality.</p><p>The Oswestry disability index (ODI) at baseline, 5^th week, and 8^th week.</p

Incidence and hazard ratios for herpes zoster during the follow-up period for adult patients with traumatic brain injury versus control cohorts.

<p>HZ, herpes zoster; CI, confidence interval; HR, hazard ratio; TBI, traumatic brain injury.</p><p>^aAdjusted HRs with 95% CI and their P values. The results were adjusted for age and Charlson comorbidity index using a Cox proportional-hazards regression model.</p><p>^bAdjusted HRs with 95% CI and their P values. The results were adjusted for age, sex and Charlson comorbidity index using a Cox proportional-hazards regression model.</p><p>P for interaction: a Cox proportional-hazards regression model including a gender x TBI interaction was applied</p><p>Incidence and hazard ratios for herpes zoster during the follow-up period for adult patients with traumatic brain injury versus control cohorts.</p

Patient satisfaction score.

<p>The subjective satisfaction score was higher in the ESWT group (*p < 0.01). Differences between the ESWT and SIT groups in the subjective satisfaction score at the 8^th week follow-up were analyzed by <i>t</i>-test / Wilcoxon rank-sum test. ESWT: mean±SD = 3.95±0.76 versus SIT group: mean±SD = 3.24±0.76, <i>t</i>-test p = 0.003/Wilcoxon rank-sum test p = 0.007.</p