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Journal of Pain Research 2023Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. is an emerging minimally... (Review)
Review
BACKGROUND
Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. is an emerging minimally invasive treatment for LSS. It is an image-guided percutaneous procedure designed to debulk hypertrophied ligamentum flavum. However, the exact short- and long-term efficacy, safety profile, indication criteria, and certain procedure details reported in medical literature vary.
OBJECTIVE
This narrative review was to elucidate efficacy, safety profile, certain procedure details, advantages, and limitations of
STUDY DESIGN
This is a narrative review.
SETTING
All included articles are clinic trials including analytic studies and descriptive studies.
METHODS
PubMed, Cochrane Library, and Scopus were searched. Only clinical trials of procedure were included. Information of indications, contraindications, VAS scores, ODI scores, effective rate, efficacy durations, and certain procedure details was focused on.
RESULTS
According to the literature, for the procedure, the VAS score could be reduced from a pre-treatment level of 6.3-9.6 to a post-treatment level of 2.3-5.8. The ODI score could be reduced from a pre-treatment level of 38.8-55.3 to a post-treatment level of 27.4-39.8. The effective rate of the procedure was reported to be 57.1%-88%. A 2-year postoperative stability of efficacy was also supported. One RCT study testified superior efficacy of over epidural steroid injection.
LIMITATIONS
There is few high-quality literature in the review. Moreover, the long-term efficacy of cannot be revealed according to the current literature.
CONCLUSION
Based on the reviewed literature, is an effective and safe procedure. can reduce pain intensity and improve functional status significantly. Therefore, it is a preferable option for LSS patients who failed conservative treatments, but not for those who require immediate invasive decompression surgery.
PubMed: 37954472
DOI: 10.2147/JPR.S428112 -
Current Opinion in Neurology Dec 2018When describing clinical or experimental traumatic brain injury (TBI), the adjectives 'mild,' 'moderate' and 'severe' are misleading. 'Mild' clinical TBI frequently... (Review)
Review
PURPOSE OF REVIEW
When describing clinical or experimental traumatic brain injury (TBI), the adjectives 'mild,' 'moderate' and 'severe' are misleading. 'Mild' clinical TBI frequently results in long-term disability. 'Severe' rodent TBI actually resembles mild or complicated mild clinical TBI.
RECENT FINDINGS
Many mild TBI patients appear to have recovered completely but have postconcussive symptoms, deficits in cognitive and executive function and reduced cerebral blood flow. After moderate TBI, 31.8% of patients died or were discharged to skilled nursing or hospice. Among survivors of moderate and severe TBI, 44% were unable to return to work. On MRI, 88% of mild TBI patients have evidence of white matter damage, based on measurements of fractional anisotropy and mean diffusivity/apparent diffusion coefficient. After sports concussion, clinically recovered patients have abnormalities in functional connectivity on functional MRI. Methylphenidate improved fatigue and cognitive impairment and, combined with cognitive rehabilitation, improved memory and executive functioning. In comparison to clinical TB, because the entire spectrum of experimental rodent TBI, although defined as moderate or severe, more closely resembles mild or complicated mild clinical TBI.
SUMMARY
Many patients after mild or moderate TBI suffer long-term sequelae and should be considered a major target for translational research. Treatments that improve outcome in rodent TBI, even when the experimental injuries are defined as severe, might be most applicable to mild or moderate TBI.
Topics: Animals; Brain Injuries, Traumatic; Cognition Disorders; Diffusion Magnetic Resonance Imaging; Disease Models, Animal; Humans; Terminology as Topic
PubMed: 30379702
DOI: 10.1097/WCO.0000000000000624 -
Chest Jan 2022Asthma is a common chronic airways disease with significant impact on patients, caregivers, and the health care system. Although most research and novel interventions... (Review)
Review
Asthma is a common chronic airways disease with significant impact on patients, caregivers, and the health care system. Although most research and novel interventions mainly have focused on patients with uncontrolled severe asthma, most patients with asthma have mild disease. Epidemiologic studies suggest that many patients with mild asthma report frequent exacerbations of the disease and uncontrolled symptoms. However, despite its impact, mild asthma does not have either a uniformly agreed on definition for or a consensus on its clinical and pathophysiologic progression. More recently, the approach to treatment of patients with mild asthma has undergone significant changes primarily based on emerging evidence that airway inflammation in this population is important. This led to clinical research studies that explored the efficacy of as-needed inhaled corticosteroids along with the rescue medications that traditionally have been the mainstay of treatment. Despite some advancement in the field in recent years, many controversies and unmet needs remain. In this review, we examine the current understanding of the pathophysiologic features and management of mild asthma. In addition, we outline unmet needs for future research. We conclude that mild asthma contributes significantly to the morbidity and mortality of asthma and should be the focus of future research.
Topics: Administration, Inhalation; Airway Remodeling; Asthma; Bronchodilator Agents; Clinical Decision-Making; Disease Management; Disease Progression; Fractional Exhaled Nitric Oxide Testing; Glucocorticoids; Humans; Inflammation; Needs Assessment; Severity of Illness Index
PubMed: 34543667
DOI: 10.1016/j.chest.2021.09.004 -
PM & R : the Journal of Injury,... Sep 2019Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential... (Review)
Review
Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.
Topics: Disability Evaluation; Humans; Recovery of Function; Severity of Illness Index; Stroke; Stroke Rehabilitation
PubMed: 30746896
DOI: 10.1002/pmrj.12142 -
The American Journal of Medicine Apr 2021With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on... (Review)
Review
With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.
Topics: Cognitive Behavioral Therapy; Cognitive Dysfunction; Humans; Mindfulness
PubMed: 33385339
DOI: 10.1016/j.amjmed.2020.10.041 -
Expert Opinion on Pharmacotherapy Jun 2015The important question whether 'mild' hypertension should or should not be treated by drugs is difficult to answer, because the only randomized controlled trials (RCTs)...
The important question whether 'mild' hypertension should or should not be treated by drugs is difficult to answer, because the only randomized controlled trials (RCTs) investigating this question were conducted when the definition of 'mild' hypertension was based on diastolic blood pressure only, whereas the present definition of grade 1 hypertension includes both systolic and diastolic values (SBP/DBP), and the concept of 'mild' hypertension also includes that of low-moderate cardiovascular risk (< 5% cardiovascular death rate in 5 years). Due to the lack of evidence from specific RCTs, guidelines recommend drug treatment of mild hypertension only on the basis of expert opinion. However, recent meta-analyses have provided some support to drug treatment intervention in low-moderate risk grade 1 hypertensives and have shown that, when treatment is deferred until organ damage or cardiovascular disease occur, absolute residual risk (events occurring despite treatment) markedly increases. Although evidence favoring therapeutic intervention in mild hypertension is nowadays stronger than expert opinion, meta-analyses are not substitutes for specific RCTs, and the wide BP spans defining grade 1 hypertension as well as the span defining low-moderate risk leave a wide space for individualized or personalized decisions.
Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Diastole; Humans; Hypertension; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Risk; Systole
PubMed: 25912082
DOI: 10.1517/14656566.2015.1040761 -
Turk Psikiyatri Dergisi = Turkish... 2022In this review, it is aimed to discuss neuropsychiatric symptoms as prodromal symptoms of dementia syndromes, to define the concept of 'Mild Behavioral Impairment', and... (Review)
Review
In this review, it is aimed to discuss neuropsychiatric symptoms as prodromal symptoms of dementia syndromes, to define the concept of 'Mild Behavioral Impairment', and to introduce the 'Mild Behavioral Impairment Checklist'. Neuropsychiatric symptoms (NPS) represent non-cognitive symptoms and behaviors in dementia patients. The frequency of NPS accompanying dementia increases as the disease progresses. Studies reveal that NPS are seen in patients with dementia as well as in the elderly without cognitive complaints, individuals with subjective cognitive complaints, and individuals diagnosed with mild cognitive impairment. Based on these findings, identifying and detecting these symptoms were thought to be useful in predicting the development of dementia in cases where cognitive symptoms have not yet appeared. 'Mild Behavioral Impairment' was first defined by Taragano and Allegri, and it was introduced as a concept that includes neurobehavioral symptoms seen in elderly people for at least 6 months and that do not meet the diagnostic criteria of any other psychiatric syndrome. Mild Behavioral Impairment Checklist (MBI-C) has been developed recently which consists of 34 questions including apathy, mood, impulse dyscontrol, social inappropriateness, abnormal thinking, and perception. Studies on the neurobiological basis of these sub-domains and their relationship with biomarkers gained momentum with the definition of the concept and the development of MBI-C. However, the concept is still very new and it is possible for people to be over-diagnosed and to face the risk of stigmatization during the evaluation. Therefore, studies with large samples are needed. Demonstrating the validity of this concept will also serve the purpose of identifying the subjects with a neurodegenerative disease without any cognitive complaints yet at a very early stage in clinical studies. Keywords: Mild behavioral impairment, neuropsychiatric symptoms, prodromal dementia.
Topics: Humans; Aged; Dementia; Prodromal Symptoms; Neurodegenerative Diseases; Neuropsychological Tests; Cognitive Dysfunction
PubMed: 36592107
DOI: 10.5080/u26980 -
Journal of the Endocrine Society Sep 2018Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the... (Review)
Review
Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.
PubMed: 30187015
DOI: 10.1210/js.2017-00471 -
Neural Regeneration Research Feb 2022There is increasing evidence that infants with mild neonatal encephalopathy (NE) have significant risks of mortality, brain injury and adverse neurodevelopmental... (Review)
Review
There is increasing evidence that infants with mild neonatal encephalopathy (NE) have significant risks of mortality, brain injury and adverse neurodevelopmental outcomes. In the era of therapeutic hypothermia, infants need to be diagnosed within 6 hours of birth, corresponding with the window of opportunity for treatment of moderate to severe NE, compared to the retrospective grading over 2 to 3 days, typically with imaging and formal electroencephalographic assessment in the pre-hypothermia era. This shift in diagnosis may have increased the apparent prevalence of brain damage and poor neurological outcomes seen in infants with mild NE in the era of hypothermia. Abnormal short term outcomes observed in infants with mild NE include seizures, abnormal neurologic examination at discharge, abnormal brain magnetic resonance imaging and difficulty feeding. At 2 to 3 years of age, mild NE has been associated with an increased risk of autism, language and cognitive deficits. There are no approved treatment strategies for these infants as they were not included in the initial randomized controlled trials for therapeutic hypothermia. However, there is already therapeutic creep, with many centers treating infants with mild NE despite the limited evidence for its safety and efficacy. The optimal duration of treatment and therapeutic window of opportunity for effective treatment need to be specifically established for mild NE as the evolution of injury is likely to be slower, based on preclinical data. Randomized controlled trials of therapeutic hypothermia for infants with mild NE are urgently required to establish the safety and efficacy of treatment. This review will examine the evidence for adverse outcomes after mild NE and dissect some of the challenges in developing therapeutic strategies for mild NE, before analyzing the evidence for therapeutic hypothermia and other strategies for treatment of these infants.
PubMed: 34269188
DOI: 10.4103/1673-5374.317963 -
Fertility and Sterility Oct 2017It has been proven that the use of high gonadotropin dose does not necessarily improve the final outcome of IVF. Mild ovarian stimulation is based on the principle of... (Review)
Review
It has been proven that the use of high gonadotropin dose does not necessarily improve the final outcome of IVF. Mild ovarian stimulation is based on the principle of optimal utilization of competent oocytes/embryos and endometrial receptivity. There is growing evidence that the pregnancy or live birth rates with mild-stimulation protocols are comparable to those with conventional IVF; the cumulative pregnancy outcome has been shown to be no different, despite having fewer numbers of oocytes or embryos available with milder ovarian stimulation. Although equally effective, mild-stimulation IVF is associated with a greater safety profile, in terms of the incidence of ovarian hyperstimulation syndrome and venous thromboembolism. It is also found to be better tolerated by patients and less expensive. Emerging research evidence may lead to widespread acceptance of mild IVF, by both patients and IVF providers, and make IVF more accessible to women and couples worldwide.
Topics: Birth Weight; Female; Fertilization in Vitro; Humans; Infant, Newborn; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Rate
PubMed: 28965549
DOI: 10.1016/j.fertnstert.2017.08.022