Comorbidities are diseases that coexist with a disease of interest or an index disease, which can directly affect the prognosis of the disease of interest or indirectly affect the choice of treatment. The Charlson comorbidity index (CCI) is the most widely used comorbidity index. In this study, it was aimed to examine the predictive role of the CCI score on the mortality of patients with COVID-19.We have retrospectively analyzed COVID-19 patients whose diagnosis was confirmed by PCR and who were hospitalized in two centers between April 2020 and December 2020. The severity of comorbidity of the patients was categorized into five groups according to the CCI score: CCI score 0, CCI score 1–2, CCI score 3–4, CCI score 5–6, and CCI score ≥7. Factors affecting mortality and differences between groups classified by CCI were determined by logistic regression analysis and one-way analysis of variance.A total of 1,559 COVID-19 patients were included in the study and 70 (4.49%) patients had deceased. Half of the study population  had different comorbidities. The CCI score was 3.8±2.7 in deceased patients and 1.3±1.9 in surviving individuals. There was a positive correlation between CCI scores and mortality in COVID-19 patients, with each point increase in the CCI score increasing the risk of death by 2.5%. CCI score of 4 and above predicted mortality with 87.2% sensitivity and 97.9% negative predictive value. Five (0.6%) of 766 patients with CCI scores of 0, 16 (3.6%) of 439 patients with CCI scores of 1–2, 13 (6.9%) of 189 patients with CCI scores of 3–4, and a CCI score of 5, 13 (15.7%) of 83 patients with -6 and 23 (28.0%) of 82 patients with a CCI score of ≥7 died.CCI is a simple, easily applicable, and valid method for classifying comorbidities and estimating COVID-19 mortality. The close relationship between the CCI score and mortality reveals the reality of how important vaccination is, especially in this group of patients. Increasing awareness of potential comorbidities in COVID-19 patients can provide insight into the disease and to improve outcomes by identifying and treating patients earlier and more effectively. COVID-19 was declared as a pandemic by the World Health Organization shortly after its emergence. The infection has resulted in the death of millions of people as of December 2021. Despite the period of more than 2 years and all the technological possibilities at our disposal, its spread and lethality still continues. Newly emerged mutant strains also contribute to this spread and mortality [Advanced age and having comorbid factors cause more mortality in COVID-19, as in other infections . ComorbiCharlson comorbidity index (CCI) is one of the most commonly used methods to evaluate comorbid factors and predict mortality. In the calculation of CCI, which has been used since 1987, many underlying conditions such as age, kidney diseases, malignancies, cerebrovascular diseases, liver diseases, and human immunodeficiency virus positivity are taken into account . It can We have retrospectively analyzed COVID-19 patients whose diagnosis was confirmed by polymerase chain reaction (PCR) and who were hospitalized in two centers between April 2020 and December 2020. Demographic data of patients (gender and age), symptoms , respiratory rate per minute number, results of laboratory tests at admission (hemogram and blood biochemistry), hepatorenal function, coagulation function, D-dimer, C-reactive protein (CRP), procalcitonin, ferritin, arterial blood gas analysis, chest X-ray or computerized tomography (CT) imaging findings and CO-RADS score, comorbidities, and clinical outcomes  were recorded in the study form. The study has been approved by The Health Sciences University, Umraniye Research and Training Hospital Clinical Research Ethics Committee at 20.12.2021 protocol number 54132726 – 000 – 27327.Comorbidity categories were evaluated, including diabetes mellitus (DM), hypertension, heart failure, chronic heart disease, asthma, chronic obstructive pulmonary disease, chronic kidney disease, malignancy, chronic liver disease, connective tissue disease, and dementia, categorized into groups: CCI score 0, CCI score 1–2, CCI score 3–4, CCI score 5–6, and CCI score ≥7.•Advanced age and having comorbid factors cause more mortality in COVID-19, as in other infections.•CCI, which has the advantage of being able to be calculated quickly at the bedside without the need for any laboratory parameters, is one of the most frequently used methods for the evaluation of comorbid factors and predicting mortality.•CCI is a simple, easily applicable, and valid method for classifying comorbidities and estimating COVID-19 mortality.•Each point increase in the CCI score increases the risk of death by 2.5%, and a CCI score of 4 and above can predict mortality with 87.2% sensitivity and 97.9% negative predictive value.•The close relationship between CCI score and mortality reveals how important vaccination is in patients with comorbidities.Descriptive statistical analysis was performed for all variables investigated in the study. The data were analyzed by the Statistical Package for the Social Sciences . Concordance with the normal distribution of the data obtained by the measurement was made using the Kolmogorov–Smirnov test. Student’s t-test was used for data with normal distribution, and Mann–Whitney U-test was used for data without normal distribution. Chi-square test was used in the analysis of categorical variables. Data obtained by measurement were expressed as mean±standard deviation.The data obtained by counting were expressed as numbers (%). Pearson’s correlation test or Spearman’s correlation test was used for correlation analysis. Factors affecting mortality and differences between groups classified by CCI were determined by logistic regression analysis and one-way analysis of variance. The predictive value of CCI was determined by Receiver Operating Characteristic (ROC) analysis. P<0.05 was considered statistically significant.A total of 1559 COVID-19 patients positive for the real-time PCR were included in the study. The mean age was 47.1±17.5 years and 53.6% were male. Symptoms were present in 87.4% of the patients. The main symptoms were fever (48.6%), cough (61.5%), shortness of breath (30.3%), diarrhea (5.5%), sore throat (10.1%), smell-taste disorder (8.9%), myalgia (13.9%), fatigue (19.6%), and headache (7.6%) .Laboratory values of the patients were analyzed as follows: White blood cell (WBC) (6936±2485/μl), lymphocyte (1261±681/μl), platelet (183.4±58.9/μl), alanine aminotransferase (ALT) (53.4±76.2 U/L), aspartate aminotransferase (76.1±138.4 U/L), CRP (36.4±34.3 mg/L), lactate dehydrogenase (LDH) (481.5±132.6 U/L), D-Dimer (1026.5±1284 ng/mL), ferritin (481.6±478.9 ng/mL), and troponin (0.061±0.38μg/L).During the study period, 70 (4.49%) patients had deceased. Half of the study population  had different comorbidities. The CCI score was 3.8±2.7 in deceased patients and 1.3±1.9 in surviving patients (p<0.001). As CCI scores increased, mortality increased . For each point increase in CCI score, the risk of death increased by 2.5% ; . Five (0.6%) of 766 patients with CCI scores of 0, 16 (3.6%) of 439 patients with CCI scores of 1–2, 13 (6.9%) of 189 patients with CCI scores of 3–4, and a CCI score of 5, 13 (15.7%) of 83 patients with −6 and 23 (28.0%) of 82 patients with a CCI score of ≥7 died (p<0.001) .There was a positive correlation with CCI score and presence of symptoms , duration of symptoms , shortness of breath , WBC , CRP , LDH , D-dimer , ferritin , and troponin . There was a negative correlation between with CCI score and smell-taste disorder , sore throat , headache , lymphocyte count , and ALT .When the possibility of CCI score predicting mortality was evaluated by ROC analysis, the area under the curve (AUC) was determined as 0.805 (95% CI: 0.748–0.861) . The proIt is known that patients with comorbidities are more affected by COVID-19 and are associated with worse clinical outcomes. Therefore, it is crucial to have a comprehensive assessment of comorbidities to establish the risk stratification of patients with COVID-19 on admission to the hospital .During the pandemic, the severity and mortality of COVID-19 were generally related to age, gender, and the presence of comorbidities such as DM, cardiovascular, cerebrovascular, and respiratory diseases –7. AdvanIn a meta-analysis by Kuswardhan et al. , it was Various biomarkers, such as CRP, D-dimer, procalcitonin, and ferritin, were frequently elevated in severe cases of COVID-19, and evaluation of these parameters might be useful in predicting serious outcomes and complications during this type of pandemic . In our CCI is a simple, easily applicable, and valid method for classifying comorbidities and estimating COVID-19 mortality. The close relationship between CCI score and mortality reveals the reality of how important vaccination is in patients with comorbidities.Each point increase in CCI score increases the risk of death by 2.5%, and a CCI score of 4 and above can predict mortality with 87.2% sensitivity and 97.9% NPV. Increased awareness of potential comorbidities in COVID-19 patients can provide insight into the disease and improve outcomes by identifying and treating patients earlier and more effectively.


This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs , located in different regions of the city of Presidente Prudente, Brazil.2) was calculated using body mass and height values, both collected at the time of the interview. In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index  reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors . High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition. Low back pain has been found to be highly prevalent worldwide, for example in Germany (59%),Occurrences of low back pain are the second largest cause of medical consultations in the world,,A large part of the adult population suffers from this disorder (50.2%), of which 11.3% suffer from chronic low back pain.Primary healthcare units (PHUs) serve the majority of the Brazilian population. They form the main triage locations for primary care, in which the focus is prevention and avoidance of the need for patients to access other levels of healthcare. Public policies need to be based on scientific evidence, so as to effectively meet the requirements of the community.The aims of the present study were to determine the prevalence of chronic low back pain and to analyze the possible protective effect of physical exercise in different domains, among patients over 50 years of age who were attended at PHUs in Presidente Prudente, Brazil.This was an analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs , located in different regions of the city of Presidente Prudente, São Paulo, Brazil.This study was approved by the local Research Ethics Committee, at the Presidente Prudente campus of UNESP .The sample was composed of adults over 50 years old, of both sexes, who were attended at two PHUs , which are located in different regions of the city of Presidente Prudente. This age group was chosen because individuals of this age present greater incidence of chronic low back pain.The minimum sample size was calculated using the prevalence of chronic low back pain (14.7%) that was reported by Almeida et al.During the mornings of a 60-day period, all patients attended at these PHUs were invited to take part in the study, if they fulfilled all of the following inclusion criteria: i) registration at that PHU for at least one year, with at least one medical consultation attended over the previous six months; ii) age > 50 years; iii) resident in the city of Presidente Prudente for at least two years; iv) signing of an informed consent statement.At each of the two PHUs selected, an initial screening of the medical schedules of all patients who had visited the unit over the previous thirty days was performed. At each PHU, all patients seen over the previous 30 days who met the inclusion criteria were invited to participate.The patients thus selected were invited to attend the PHU for an evaluation and directed interview. The final sample consisted of 327 patients.,The questionnaire developed by Kuorinka et al.the presence of musculoskeletal disorders over the previous 12 months;impairment of daily activities over the previous 12 months, due to these disorders;consulting a healthcare professional because of these disorders; andfeeling the presence of these disorders in the week immediately prior to the interview. Positive responses to these four questions were considered to be indicative of chronic low back pain in the lumbar region.To determine the participants’ economic situation, a questionnaire developed by the Brazilian Association of Market Research Companies (2010) was used. In this, economic situation is subdivided from A (highest) to E (lowest). The sample was subsequently dichotomized into high economic situation (categories A and B) and low economic situation , as adopted by Fernandes et al.Body mass index (in kg/m²) was calculated using body mass and height values, which were both obtained at the time of the interview, in accordance with the protocol of Lohman et al.th percentile and above (highest quartile) were considered physically active. Cycling was also computed dichotomously (yes or no).Information regarding habitual physical activity practices was collected by means of an interview using the questionnaire developed by Baecke et al.,The following were considered to be confounding factors: education ; gender ; age (< 65 years or ≥ 65 years); ethnicity ; and current occupational activity (yes or no).2, with the Yates correction applied via 2 x 2 contingency tables). When significant differences were found, the values were inserted in a multivariate model (binary logistic regression) with hierarchical insertion. The magnitude of associations was expressed in terms of odds ratio (OR) values and their respective 95% confidence interval (CI). In our analysis model, associations between the dependent variable (chronic low back pain) and the independent variables were investigated, and the results were corrected for possible confounding variables . The statistical analyses were performed using specific software (BioEstat version 5.0) and, in all procedures, the significance level adopted was 5%.Numerical variables were presented as means and standard deviations, and the means were compared using Student’s t test. Categorical variables were expressed as absolute and percentage values, and univariate statistical tests were applied to these  and 98 males (30%). The mean body mass index was 29.1 ± 5.4 kg/m², the mean age was 62 ± 8.8 years and 83 patients (25.4%) had a current occupation. Low back pain was found to be present in 175 patients (53.5%), i.e. at least one episode of low back pain in the previous year. Among these patients with low back pain, 71 (21.7%) gave positive responses to the four questions about low back pain and were therefore classified as having chronic low back pain. Females had higher odds of developing chronic low back pain . The independent variables are presented in In the whole sample, 78 patients (23.9%) were considered physically active. The variables associated with chronic low back pain were inserted into the binary logistic regression, which resulted in the odds ratios presented in The variables that were associated with chronic low back pain, as shown in ,,,The prevalence of low back pain found in the present study (53.5%) is similar to that reported from another survey carried out in the same city (50.2%),In the models created, female sex was shown to be a risk factor for the development of chronic low back pain, independently of the other confounding factors . This greater occurrence may have been due to anatomical-functional differences, but may also have come from women’s double working day.Patients who reported that they were working also presented greater risk of developing chronic low back pain . This association lost significance when inserted into the multivariate model together with age and economic situation, perhaps because people in a higher economic situation have better information about healthy life habits and also do not need to work when they have reached this age group.,,It is known that workers in several types of occupation perform functions that contribute towards installation of this pathological condition. Moreover, chronic low back pain can cause decreased productivity and quality of life among the individuals affected, and this may lead to susceptibility to absences from work. It is therefore important to stress that management teams in public institutions and other employers need to make efforts to prevent and/or combat this important health problem.Encouragement to practice physical activity may be a strategy, through advertisements that incorporate healthy values and increase the level of physical activity. In Brazil, the example of the United States could be adopted, with a national road map to improve the quality of health through a physically active lifestyle, like the one developed by the American College of Sports Medicine, which involves four steps: awareness, education, partnerships and monitoring.The physical activity practices among PHU users seem to be a relevant problem, since only 24% of the interviewees were classified as sufficiently active. This is a low percentage and is similar to that reported by Turi et al.,Promotion of physical activity has greater efficacy among younger individuals. Moreover, if physical activity practices are insufficient during youth, this tends to continue into adulthood, since the characteristics of these practices tend to stabilize over time.,,,Lastly, the greatest contribution of the present study was to make a correlation between the level of physical activity and occurrences of chronic low back pain. Physically active people were found to have 65% less chance of developing chronic low back pain, independently of other factors. This differed from some previous studies, in which physical activity lost its association when inserted in the multivariate model.,The beneficial effects of regular physical activity on maintenance of good health have been recognized worldwide.,,There is evidence indicating that physically active people are less likely to develop poor sleep quality. Poorer sleep quality has been correlated with chronic low back pain.It is worth highlighting the methodological design of the present study. It used a sample of the population that was of significant size and demonstrated that physical activity was a protection factor in different domains of leisure and locomotion, in relation to chronic low back pain. Thus, public policies aimed towards increasing the level of physical activity should be encouraged, such as inclusion of physical educators and training infrastructure within PHUs.However, there were some limitations to the present study. The lack of a more sophisticated method for diagnosing low back pain, the reverse causality bias applied in this study and the data collection method used , which led to a large discrepancy in the numbers of men and women in the sample, should be considered to be the main limitations. These form directions for future studies.A high prevalence of low back pain was identified among PHU patients, while the practice of physical exercise during leisure time was a protective factor against this outcome.


This study aimed to investigate the clinical efficacy of a balloon compression day-surgery operation under the guidance of spiral computed tomography (CT) three-dimensional (3D) reconstruction for the treatment of trigeminal neuralgia.The clinical efficacy and related indexes of 380 patients with trigeminal neuralgia treated by a spiral CT-guided balloon compression day-surgery operation in the pain department of Beijing TianTan Hospital, from October 2017 to March 2021, were retrospectively analyzed.Five patients failed due to foramen ovale puncture or in placing the balloon; two patients had ineffective results after the operation and re-entered the hospital for secondary balloon compression. The initial effective rate of the operation in the 380 patients was 98.16%. All patients were discharged on the day of the operation, the average operation time was 26.46 ± 12.15 min, and the average interval from the completion of the operation to discharge was 2.67 ± 0.95 h. During the follow-up period (1–41 months), 12 patients had pain recurrence, and a Kaplan–Meier analysis revealed that the cumulative pain-free recurrence survival rate at 41 months after the operation was 80.64%. No complications related to foramen ovale puncture occurred.The spiral CT-guided balloon compression day-surgery operation is safe, effective, and worthy of clinical promotion. Trigeminal neuralgia is a common neuropathic severe pain in the facial trigeminal innervation area. The annual incidence of trigeminal neuralgia is ~0.03–0.05%. The incidence in the elderly population is high, as patients over 40 years old account for 70–80% of the total patients . The quaAccording to the International Classification of Headache Disorders 3rd Edition (ICHD-3), trigeminal neuralgia is divided into three types: classic, secondary, and idiopathic . BecauseWith the improvement of medical technology and management levels, day-surgery operations have developed rapidly . Day-surgery operations greatly shorten the hospitalization time of patients, reduce the hospital-acquired infection rate, speed up the turnover of beds, and improve the utilization rate of medical resources; all of these results , in turn, reduce medical costs. In 2017, the pain department of our hospital took the lead in performing day-surgery PMC for trigeminal neuralgia under general anesthesia and guided by spiral computed tomography (CT) three-dimensional (3D) reconstruction images at home and abroad. Our hospital preliminarily reported that 22 patients received day-surgery PMC in the early stage, all of whom achieved satisfactory treatment results . TherefoThe ethics committee of Beijing TianTan Hospital approved this study. In view of the retrospective nature of this study, informed consent of the patients was exempted. The data were collected and analyzed retrospectively from the medical records of Beijing TianTan Hospital and from the routine post-operative follow-up data of the patients in the pain department.(1) The age of the patient was >18 years old; (2) The patients met the diagnostic criteria of trigeminal neuralgia defined by the ICHD-3; (3) Patients underwent day-surgery PMC of the trigeminal semilunar ganglion guided by spiral CT 3D reconstruction under general anesthesia.Patients with incomplete perioperative clinical data or follow-up data.The pre-operative examinations were performed . For patients whose pre-operative examination results were abnormal and needed to delay the day-surgery operation, a new appointment was made for the operation after correcting the abnormal indexes. A pre-operative evaluation was conducted to determine whether the conditions of the patients with hypertension, diabetes, coronary heart disease, cerebrovascular disease, and other complications were stable. Patients with unstable complications were transferred to the corresponding specialty for treatment. After the complication became stable, the patients went to the pain department for reevaluation and rescheduling of the day-surgery operation.The patient lay on their back on the scanning table in the CT operating room, with their head in a natural median position. The patient's blood pressure, heart rate, ECG, and blood oxygen saturation were routinely monitored. A peripheral vein of the upper limbs was opened, and 0.01 mg/kg of atropine was given intravenously before the operation. Anesthesia was induced by sequential intravenous administration of 0.2 μg/kg of sufentanil, 1.5–2 mg/kg of propofol, and 0.1 mg/kg of Cisatracurium, and a suitable laryngeal mask was placed. Patients with poor alignment of the laryngeal mask received endotracheal intubation. Anesthesia was maintained by a continuous intravenous pumping of propofol at 4–6 mg/(kg h) and remifentanil at 0.05–0.1 μg/(kg min) with a micropump, and the drug dosage was adjusted according to the circulation of the patients during the operation.After routine disinfection, a surgical drape and towel were place. Local infiltration anesthesia was induced at the puncture site and along the puncture route by 0.5% lidocaine. Surgery using Hartel landmarks approach for the puncture. According to the clinical experience of the surgeon, a 14G blunt head puncture probe  was inserted and placed near the foramen ovale of the skull base. Thin-slice CT scanning of the skull base was performed . According to the relative spatial position relationship between the puncture probe and the foramen ovale in the spiral CT 3D reconstruction image , the operator adjusted the puncture probe until it successfully entered the foramen ovale . The neeAfter the operation, the laryngeal mask or endotracheal tube was removed from the patient, who returned to the post-anesthesia recovery room for observation until discharge. The discharge criteria of the patients after PMC included the following items: (1) The patient had stable vital signs, lucid mental state, and clear verbal expression; (2) No dizziness, nausea, and vomiting were present; (3) The patient's walking ability was restored to the same level as before the operation. If the discharge standard could not be met on the day of operation, the patient was transferred to the ward and discharge was delayed. After discharge, the patients received comprehensive post-operative nursing guidance through the Wechat platform of the pain department. If the patient's pain was not relieved 1 month after the operation, they went to the clinic. If the patient's ongoing pain was considered to be incomplete trigeminal nerve damage, another PMC operation was arranged.The pre-operative, intraoperative, and post-operative clinical data were collected from the inpatient medical records and the pain department follow-up database. The pre-operative data included the patient's gender, age, pre-operative course of disease, trigeminal neuralgia side, affected trigeminal nerve branches, pre-operative Barrow Neurological Institute (BNI) pain rating, and previous surgical treatment. The intraoperative data included the operation time, anesthesia time, volume of contrast medium injected into the balloon, time of balloon compression, and intraoperative trigeminal inhibitory reaction. The time from the completion of the operation to patient discharge was recorded. To improve the medical quality of care, the pain department followed up with every patient immediately after the PMC operation. Initial follow-up based on initial clinical efficacy evaluation took place 1 week after PMC treatment by the surgeons who performed the operation. Long-term follow-ups were carried out 1 month after the operation, local patients were followed up with an outpatient department, and foreign patients were followed up by telephone. Subsequently, all patients received intermittent telephone follow up every month for at least 1 year, every 3 months for the next 2 years, and thereafter every 12 months by specially trained investigators on schedule. Details of pain relief, recurrence, complications, and side effects were recorded in the database during each follow-up conversation. The BNI pain rating, complications, and side effects  were recorded.The patients' pain intensity was rated by the BNI scale . Pain relief in the immediate post-operative period is defined as a BNI pain rating of grade I or II after awakening from anesthesia. Preliminary post-operative pain relief is defined as a BNI pain rating of grade I or II 1 month after the PMC operation. The effective rate = (number of cases at BNI I + II)/total number of cases ×100%. The pain recurrence is defined as an increase in the post-operative BNI pain intensity rating from grade I or II to grade III or higher.t-test or an analysis of variance. The non-normally distributed data were expressed as the median and interquartile range (IQR) and were compared between the two groups using the Mann–Whitney U-test or the Kruskal–Wallis H-test. The categorical data were expressed as a frequency and a percentage and were compared between the two groups using a chi-square test. The Kaplan–Meier method was used to evaluate the pain-free recurrence survival rate of patients.The SPSS 20.0 statistical software was used for the statistical analysis of each collected variable. For the measurement data, if the variables were normally distributed, the mean and standard deviation were calculated, and an inter-group comparison was conducted using a A total of 380 patients with trigeminal neuralgia who underwent a spiral CT 3D reconstruction day-surgery PMC operation of the trigeminal semilunar ganglion in the pain department of Beijing TianTan Hospital, from October 2017 to March 2021, were included in this analysis. Among these 380 patients, 167 patients were men, and 213 patients were women. The age of these patients was 72.40 ± 8.28 years old, the course of the disease was 8.33 ± 7.21 years, 127 patients had left pains, and 253 had right pains. Eleven patients had pain in the first branch, 44 had pain in the second branch, 79 had pain in the third branch, 81 had pain in both the first and second branches, 121 had pain in both the second and third branches, five had pain in both the first and third branches, and 39 had pain in all of the branches . Nine patients had trigeminal neuralgia secondary to intracranial tumors, seven of which had undergone intracranial tumor resection. Thirty-eight patients had undergone craniotomy microvascular decompression or microvascular decompression combined with the partial transection of the trigeminal sensory root, 55 patients had undergone radiofrequency thermocoagulation, 48 patients had undergone γ knife treatment, and six patients had a previous PMC surgery.Among the 380 patients, 379 patients completed the operation under general anesthesia and laryngeal mask ventilation; one patient (0.3%) had poor alignment after the laryngeal mask placement and required endotracheal intubation ventilation.Failure to puncture the foramen ovale  occurred in one patient (0.3%). Success in puncturing the foramen ovale during the operation, but a failure in the balloon implantation, occurred in two patients (0.5%). Effective compression was not achieved in two patients (0.5%) because the balloon ruptured three times when they were injected with the contrast agent. A total of five patients (1.3%) did not complete the PMC surgery, and radiofrequency thermocoagulation was completed during the operation.The successful puncture of the foramen ovale occurred in 375 patients (98.7%), along with correct balloon position and shape (a pear shape) under the guidance of spiral CT 3D reconstruction image. Pain relief in the immediate post-operative period (BNI I or II) was reported by 368 patients (96.8%), and 373 patients (98.2%) had preliminary post-operative pain relief (1 month after operation). Two patients (0.5%) had no facial hypoesthesia and hypoalgesia at 1 month after the operation; however, after hospitalization, their pain was relieved after they underwent a secondary PMC with an appropriate increase of balloon volume and an extension of the compression time.The dosage of contrast agent injected into the balloon was 0.76 ± 0.12 ml, the time of the intraoperative balloon compression was 4.14 ± 1.01 min, the median time of the PMC operation was 25 min (IQR: 18–30 min), the median time of anesthesia was 35 min (IQR: 30–45 min), and the average interval from the completion of operation to patient discharge was 2.67 ± 0.95 h. All patients were smoothly discharged on the day of operation, and none of these patients delayed discharge or were transferred to the general ward.Of the 373 patients who achieved effective results after the PMC day-surgery operation, the follow-up time ranged from 1 month to 41 months, with a median of 14 months. Pain recurrence occurred in 12 patients; the Kaplan–Meier curve is shown in When patients wake up and back to Post-anesthesia care unit (PACU), 15 patients (3.95%) suffered from post-operative dizziness. Forty-five patients (11.84%) reported nausea and 21 of them (5.53%) suffered from vomiting after the PMC operatin. All these side effects mentioned above disappeared within 4 h after treatment. Three patients (0.79%) suffered from post-operative delirumin which disappeared 2 days later. Among the 375 patients who completed the foramen ovale puncture and balloon placement, no serious complications related to the foramen ovale puncture occurred. No severe cardiac arrest occurred in any patient, and 191 patients (50.9%) had different degrees of trigeminal inhibition during operation. After the operation, 362 patients (96.5%) had different degrees of facial numbness on the affected side, and 293 patients (78.1%) had masseter weakness on the affected side. After the operation, 243 patients (64.8%) developed ipsilateral facial herpes simplex that subsided after 1–3 weeks. Diplopia occurred in five patients (1.3%) and recovered 1–3 months after the operation, and keratitis occurred in 6 patients (1.6%), but it improved after symptomatic treatment. No serious complications  occurred in any patient.Since 2017, the pain department at our hospital successfully performed day-surgery PMC of trigeminal semilunar ganglion guided by spiral CT 3D reconstruction image under general anesthesia and laryngeal mask for the first time. This study reported, for the first time, the clinical effect of day-surgery PMC for 380 patients at home and abroad.p < 0.001) and for the whole operation (p < 0.001). In our study, puncture of foramen ovale under the guidance of spiral CT can reduce puncture damage and shorten puncture time to a certain extent. After the puncture is in place, the spiral CT 3D reconstruction images accurately determine the position and shape of the balloon from the coronal, sagittal, axial, and 3D images, ensuring the success of the balloon compression.First, this study revealed that, consistent with the success rate reported in previous routine inpatient surgeries , the sucThis study also reported that the total average operation time was only 39.23 min shorter than Lin et al. , and Aydvia prospective controlled research in the future.In this study, all the patients under general anesthesia, recovered and were discharged with no issues on the day of operation. No patients were transferred to the inpatient department due to serious post-operative complications, and after discharge, there were no patients with serious complications leading to readmission. In recent years, Chinese scholars have also proposed that , 18 PMC Third, this study revealed that PMC day-surgery operations ensured patient safety by improving the safety of the operation and by avoiding serious complications requiring hospitalization during and after the operation. These were necessary conditions to ensure that the patients were quickly discharged. In a survey conducted in Scotland, only 18% of trained neurosurgeons believed that they could independently complete the puncture and catheterization of the foramen ovale . Due to In recent years, clinical studies generally believe that microballoon compression, radiofrequency thermocoagulation, and microvascular decompression in the treatment of trigeminal neuralgia can achieve significant therapeutic effects in the short term. The operation of PMC is simple, avoids the risk of craniotomy, and is suitable for patients with underlying diseases, poor physical conditions, and unable to tolerate craniotomy . ClinicaOf course, consistent with the conclusions of other studies , 24, PMCThe spiral CT-guided balloon compression day surgery for trigeminal neuralgia has the advantages of short operation time, high safety, low incidence of post-operative serious complications and adverse reactions, and high pain relief rate, which is worthy of promotion.The present study does have some limitations. Because it was a retrospective study, the related indicators of the conventional c-arm X-ray guided surgery were not evaluated and compared . This study only collected the clinical data from October 2017 to March 2021, so there was a lack of long-term follow-up results. Due to the retrospective nature of this study, some valuable variables  were not obtained; therefore, a prospective randomized controlled study on the efficacy and safety of multi-parameter PMC in the treatment of trigeminal neuralgia should be performed. This study did not compare the health economic indicators of PMC day-surgery operations and inpatient surgery in the treatment of trigeminal neuralgia; this should be done in the future to clarify the value of day-surgery operations in reducing the economic burden of patients and the proportion of national medical insurance reimbursement.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by Beijing Tiantan Hospital, Capital Medical University. The patients/participants provided their written informed consent to participate in this study.BX, Z-pJ, and FL: conception and design of the research. Z-pJ, HR, BX, and RL: acquisition of data. LM, YS, FL, and TW: analysis and interpretation of the data. Z-pJ: statistical analysis. BX, Z-pJ, and RL: writing of the manuscript. FL and RL critical revisd of the manuscript for intellectual content. All authors read and approved the final draft.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Cordotomy has evolved since the first open procedure by Spiller and the first percutaneous radiofrequency cordotomy by Mullan in 1965. Today, the minimally invasive, CT-guided percutaneous radiofrequency cordotomy is mostly used for the palliative management of medically intractable somatic pain related to malignancy in well-selected patients. The risk of adverse events is minimized with the use of intraoperative stimulation monitoring. This video highlights the spinal cord anatomy at the level of C1–2, the approach to patient selection, the associated risks and benefits, and, finally, the procedural setup and key steps involved in this unique neurosurgical procedure.https://youtu.be/a-0ORqy0W2oThe video can be found here:  This video illustrates a CT-guided percutaneous radiofrequency electrode placement into the upper cervical spinal cord through the C1–2 interspace for ablation of the anterolateral spinothalamic tracts for the treatment of cancer-related pain.0:40 The spinothalamic tract transmits nociceptive signals, temperature, and nondiscriminative touch from the contralateral side of the body. There is a somatotopic organization of axons within the tract.0:55 Fibers entering from rostral and caudal segments are located in the medial and lateral parts of the tract, respectively.1:04 The spinothalamic tract terminates in the contralateral VPL and VPM nuclei, as well as the intralaminar or central lateral nucleus and posterior complex of the thalamus. The centrolateral nucleus is involved in the effective and motivational response to pain, while the lateral thalamic projections are more involved in the sensory and discriminative aspects of pain sensation.1:28 This procedure is most commonly utilized in those patients with severe, medically intractable cancer pain who have a life expectancy of 1 to 2 years. The procedure is best suited for patients with unilateral somatic-type pain below the level of C5. Midline pain is not responsive, typically, to this procedure.1:48 Malignancies most commonly treated include mesothelioma and Pancoast tumors, gastrointestinal carcinomas, and metastatic carcinoma. Rarely, it may be utilized for the treatment of noncancer pain. For example, cordotomy may be useful in the treatment of nociceptive pain related to a hip fracture in a patient who is receiving palliative care.2:11 Great caution should be exercised when performing a bilateral high cervical cordotomy due to the risk of Ondine’s curse. Outcomes for patients with complete deafferentation may also be worse due to centralization of the pain syndrome. Patients with large intracranial metastases are also at increased risk due to CSF egress through the C1–2 puncture. The ideal patient should have good pulmonary reserve. Though there are not reported complications in patients with impaired pulmonary function, pulmonary function tests in order to measure their FEV-1 and FVC may be considered [https://commons.wikimedia.org/wiki/File:Lungvolumes_Updated.png].2:49 The corticospinal tracts lie dorsal to the spinothalamic tracts, while the ventral spinal cerebellar tracks overlie them laterally. Lesions to the spinocerebellar or corticospinal tracts can lead to postoperative ataxia or weakness of the ipsilateral leg. If the lesion is too high , it is possible to cause contralateral leg weakness. Medially lies the autonomic pathways for vasomotor and genitourinary control found in the lateral horn of the gray matter. Lesions here can result in urinary incontinence and hypotension. The most important adjacent structure is the reticulospinal tract found anteriomedially to the spinothalamic tract. Damage here can result in sleep apnea and Ondine’s curse. This can also occur as the result of reticulospinal tract lesioning in the setting of impaired pulmonary function or if the only functioning lung is on the side being lesioned.3:45 It can also occur within the context of a bilateral cordotomy. Bilateral cordotomy is often reserved for bilateral lower-extremity pain and involves super-selective lesioning of the superficial and dorsal portion of the spinal cord. Dysesthesias can occur in up to 5% of patients with a neuropathic component to their pain and who are long-term survivors, as well as those who receive large lesions.4:11 One important, though rare, and difficult consequence of this procedure is what is called “mirror pain,” which can occur in up to 5% of patients. This is thought to be the result of bilateral pain that is unmasked as a result of the procedure, or transmission of the dorsal spinal nerve roots into bilateral spinothalamic tracts.4:32 To perform the procedure, you will need a CT scanner, a radiofrequency device, a 20-gauge needle, and a disposable percutaneous radiofrequency electrode.4:42 The procedure is done in the interventional CT suite. Thirty minutes prior to the procedure, a myelogram is performed via lumbar puncture. Afterwards, the patient is placed in the Trendelenburg position to aid in contrast distribution.4:56 This is done to better visualize the spinal cord. Alternatively, this can be done after placement of the cannula during the C1–2 puncture.5:05 The procedure is done under a local anesthetic with monitored anesthesia care. It is important to provide local anesthesia and light conscious sedation for the initial needle placement. The patient should be woken for test stimulation and lesioning. The patient is positioned supine. It is important that the head remain immobilized in a straight and neutral position within the CT gantry. The shoulders, if needed, should be pulled down to ensure access to the neck. The patient is draped and the area around the mastoid tip is prepped in a sterile fashion.5:37 CT image acquisition should be parallel and 0 gantry with 1- to 1.25-mm slices from the foramen magnum to the inferior portion of C2 with a wide field of vision so as to see the skin. The field of view should be narrowed to avoid dental artifact.5:56 Prior to insertion of needle, local anesthetic with 2% lidocaine is infiltrated into the entry point. A 20-gauge spinal needle is inserted into the skin and soft tissue just inferior to the mastoid tip, less than the distance to the dura. Serial CT scans are obtained to confirm appropriate trajectory and estimate additional distance. The trajectory is adjusted as needed as the needle is advanced into the subarachnoid space. Just prior to the puncture of the dura, 2 ml of 2% lidocaine may be injected to avoid pain secondary to the C2 ganglion and dura.6:34 Once CSF egress is confirmed, a repeat CT scan is obtained to confirm adequate needle placement in the anterolateral quadrant of the spinal cord contralateral to the painful side.6:46 Because of the somatotopic arrangement of the spinothalamic tract, the needle can be positioned more anteromedially, or 2 to 3 mm anterior to the dentate ligament, for more cervical, thoracic, and arm pain. Or, more posterolaterally, 1 mm anterior to the dentate ligament, for pain located in lumbar, sacral, or leg region.7:08 The RF electrode and hub is placed within the spinal needle. The radiofrequency electrode is slowly advanced while monitoring impedance. Entry into the spinal cord is signaled once there is a sudden increase to approximately 800 to 1000 ohms.7:24 Final needle position. At this time, the patient may experience a brief period of pain. It is not uncommon for the radiofrequency electrode to overshoot the intended target secondary to the movement of the spinal cord and the force required to penetrate the pia.7:37 The electrode depth may be retracted by adjusting the probe depth on the hub.7:43 There is a lot of variability in the location of spinal pathways, especially with anterior cortical spinal pathways, and it is therefore critical to utilize intraoperative monitoring to ensure patient safety and avoid complications.7:57 Stimulation. Sensory stimulation at 100 Hz at 0.1-msec pulse width at < 0.15 V is performed to confirm appropriate placement.8:09 This should give the patient a sense of warm or mild pain on the opposite half of the body in the region of pain. Usually sensory stimulation can be elicited at less than 0.2 V. However, in patients with the deafferentation, higher amplitudes may be needed up to 0.5 V. Occasionally, paresthesia cannot be elicited in the area of pain, but rather will be elicited in surrounding somatotopic areas. Adjustment of the RF electrode anteroposteriorly and mediolaterally is needed to confirm optimal electrode placement. If sensory stimulation is not elicited at less than 0.5 V, the RF electrode should be repositioned more anteromedially for cervicothoracic pain or posterolaterally for lumbosacral pain.8:58 Motor stimulation at 2 Hz and 0.1-msec pulse widths up to 1 V is performed, at which time there should be no motor response. Ipsilateral neck contractions are commonly seen due to current spread to the anterior horn cells and ventral rootlets. Ipsilateral motor responses at less than 1 V indicates the electrode is too close to the dorsal corticospinal tracts and warrants repositioning.9:25 Ablation. Once position is verified, a thermal ablation can be performed at 80°C for 60 seconds.9:32 During this portion of the procedure, the patient may elevate the leg ipsilateral to the stimulation, but contralateral to the painful side in order to detect subtle changes in motor strength throughout the process. The RF electrode may be adjusted either mediolaterally or anteroposteriorly to create a second lesion at 80°C for 60 seconds. Following lesioning, the patient should not be able to differentiate sharp or dull sensation.10:01 Conclusions. Percutaneous cordotomy is a minimally invasive option for the treatment of unilateral, intractable somatic cancer pain below the level of C5 in a patient with a 1- to 2-year life expectancy. It can be performed relatively easily in the awake patient and improves the quality of life in a well-selected patient.Primary surgeon: Viswanathan. Assistant surgeon: North. Editing and drafting the video and abstract: Larkin, North. Critically revising the work: all authors. Reviewed submitted version of the work: all authors. Approved the final version of the work on behalf of all authors: Larkin.


Purpose: The main purpose of this pilot study was to detect the positive effects of our self-made gargle containing honeysuckle and semen oroxyli on post-operative pain and complications after Uvulopalatopharyngoplasty (UPPP).Methods: Patients with obstructive sleep apnea (OSA) who had underwent elective UPPP during the period of April 2019 to January 2022 were randomly divided into treatment group and control group. The patients in the treatment group were instructed to gargle the solution containing honeysuckle and semen oroxyli (25 ml) four times a day for 2 weeks. The patients in the control group were instructed to gargle normal saline (25 ml) at the same schedule. The post-operative resting throat pain, swallowing throat pain and patient comfort level were evaluated at 12 h, 1 week and 2 weeks after UPPP. The post-operative complications were collected and analyzed.Results: During the study period, 218 patients completed all the post-operative assessments. For resting throat pain, the treatment group had much lower VAS scores at 1 week and 2 weeks after UPPP. For swallowing throat pain, treatment group had much lower VAS scores than control group at 2 weeks after surgery. And patients in the treatment group felt more comfortable comparing to those in control group at 1 week and 2 weeks after UPPP. Although the treatment group had less numbers of patients with post-operative wound infection or bleeding, the difference between the 2 groups was not statistically significant.Conclusion: The gargle containing honeysuckle and semen oroxyli could relieve both resting and swallowing throat pain and increase patient comfort after UPPP. Obstructive sleep apnea (OSA) is a common disease characterized by repetitive upper airway collapse during sleep . Over 4%via shortening the uvula and soft palate or in company with tonsillectomy  is the major treatment for OSA, which could relieve the obstruction of upper airway llectomy . The effllectomy . HoweverLonicera japonica Thunb) is a semi-evergreen vine shrub that grows in China, Japan and Korea (Oroxylum indicum (L.) Vent., which grows widely in the tropic regions in China  after UPPP. The main purpose of this pilot study was to detect the positive effects of our self-made gargle containing honeysuckle and semen oroxyli on post-operative pain and complications after UPPP.https://register.clinicaltrials.gov . We used a Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) to evaluate the methodological quality of the present study .This study was registered at Lonicera japonica Thunb), Semen oroxyli (Oroxylum indicum L), Prunella vulgaris (L), Wax gourd (Benincasa hispida) peel, Euchresta japonica (Sophora tonkinensis Gagnep.), Rehmannia glutinosa (Rehmannia glutinosa Libosch.) and Arnebiae Radix [Arnebia euchroma (Royle) Johnstn]. were obtained from Zhang Zhongjing Pharmacy . Honeysuckle (20 g), Semen oroxyli (15 g), Prunella vulgaris (30 g), Wax gourd (Benincasa hispida) peel (20 g), Euchresta japonica (6 g), Rehmannia glutinosa (10 g) and Arnebiae Radix (10 g) were ground into powder using a high-speed tissue crusher . 15 g of mixed medicinal powder was totally dissolved in 500 ml of hot water.Honeysuckle  as much as possible. The long and thick uvula tissue was partially ablated to fully stop bleeding.Close the palatoglossal arch and palatopharyngeal arch mucosa on both sides with 4-0 absorbable suture, and clear the dead space. Avoid eating hard, overheated and irritating food after operation.The patients in both groups were given first generation or second generation cephalosporins for 3–5 days after UPPP. Except for these drugs, patients in the treatment group were instructed to gargle the suspension solution containing honeysuckle and semen oroxyli (25 ml) for 5 min. The solution was given 4 times a day for 2 weeks. The patients in the control group were instructed to gargle normal saline (25 ml) at the same schedule. No NSAIDs were administered unless requested by the patient.The post-operative resting throat pain and swallowing throat pain were evaluated at 0 weeks (12 h after surgery), 1 week and 2 weeks after UPPP by the patients themselves using a visual analog scale (VAS) based on a linear scale from 0 to 10, where 0 represented an absence of pain and 10 represented maximal pain. Then, the changes of scores from week 0 to week 2 between the 2 groups were compared. The VAS scores related to patient comfort level were also evaluated by patients themselves, with 0 representing very much worse and 10 very much comfort. Furthermore, the researchers who were blinded to the therapeutic regimens evaluated the improvement in postoperative pain of patients within the 2-weeks postoperative period based on the clinical global impression of improvement (CGI-I score) questionnaire. In this questionnaire, the researchers used a seven-point scale from 1 (very much improved) to 7 (very much worse) to rate the improvement of body pain of the patients .The post-operative complications, such as wound infection and wound bleeding, were collected and analyzed. The baseline characteristics of the patients in 2 groups including age, gender, body mass index (BMI), OSA severity, American Society of Anesthesiologist (ASA) classification and pre-operative complications were also collected. The venous blood was collected at 12 h and 1 week after operation to detect the levels of hs-CRP, hemoglobin, neutrophil% and white blood cell count (WBC).p < 0.05 was considered as statistical significance.The data in this study were analyzed by the SPSS software (version 22.0). Normal distribution quantitative data were described as mean ± SD. The difference between groups were compared by the Student’s t test. Non-normal distribution quantitative data were described as median with range and compared with Mann-Whitney U test. Categorical data were described as numbers and percentages and compared using the Chi-square test or Fisher’s exact test. n = 116) and control group (n = 116). However, 6 patients in the treatment group and 8 patients in the control group were lost to follow-up. Finally, 218 patients completed all the post-operative assessments , the data of whom were included into the statistical analysis. The characteristics of the 2 groups are shown in During the study period, 240 patients with OSA were screened in this study . 8 of thp = 0.033 and p = 0.031, respectively, p = 0.465). For swallowing throat pain, treatment group had much lower VAS scores than control group at 2 weeks after surgery (p < 0.001). But the 2 groups had similar VAS scores for swallowing throat pain at 12 h and 1 week after surgery . In addition, the treatment group performed a lower GGI-I score than control group . Although the treatment group had less numbers of patients with post-operative wound infection or wound bleeding, the difference between the 2 groups was not statistically significant  and interleukin-6 (IL-6), can evoke pain iceptors . Honeysuiceptors . Lin et iceptors . FurtherAfter UPPP, oral flora may increase. It can cause infection and inflammation in the throat, resulting in more pain in advance of infection . And theThe present study has several limitations. First, this study was carried out in a single center with small sample size. A multi-center with a larger sample is needed to confirm the conclusions of this study. Second, the assessment of post-UPPP pain based on VAS was completely subjective. More objective methods should be considered in the further studies. Third, in this study, we used the theory behind the VAS to evaluate patient comfort. It is not a widely accepted method. Thus, more precise evaluation of patient comfort should be applied in future studies. Forth, clinical application needs to consider the individual differences of patients and the safety and effectiveness of drugs. Therefore, further research is still needed for the promotion of this homemade mouthwash. Finally, we did not detect the mechanisms why the gargle containing honeysuckle and semen oroxyli could relieve post-UPPP pain. The mechanisms should be investigated in our future studies.In conclusion, our results found the gargle containing honeysuckle and semen oroxyli could relieve both resting and swallowing throat pain and increase patient comfort after UPPP in patients with OSA.


To evaluate the analgesic efficacy of intraoperative dexmedetomidine (DEX) for acute postoperative pain in colorectal cancer patients undergoing laparoscopic surgery.We retrospectively analyzed data of 190 colorectal cancer patients who had undergone laparoscopic surgery between October 2020 and May 2021 at Samsung Medical Center, Seoul, Korea, with (n=74) or without intraoperative DEX (n=85) administration. The demographic, clinical, anesthetic, and postoperative data were compared.p<0.001) and heart rate (p<0.001) were lower in the DEX group at the end of surgery and after extubation . The minimum alveolar concentration of sevoflurane was lower in the DEX group during surgery. At the post-anesthesia care unit (PACU) admission and discharge, pain scores  and fentanyl consumption (p<0.001) were significantly lower in the DEX group. On postoperative days 1-3, pain scores and opioid consumption were not different between the groups. The incidence of postoperative complications was not different between the groups.In total, 159 patients were enrolled. Demographic and clinical data were not different between the groups. The mean arterial pressure (Continuous intraoperative DEX administration had an intraoperative analgesic effect as indicated by lower hemodynamic and fentanyl consumption. Furthermore, there was immediate postoperative analgesia as suspected by the lower pain scores and fentanyl dose during the PACU. However, pain scores and opioid consumption after the PACU remained unaffected. Despite remarkable developments in minimally invasive surgical techniques and understanding of pain mechanisms, postoperative pain remains a serious issue. Surgical tissue and neural damage activate nociceptive neurons, leading to peripheral and central sensitization. Acute postoperative pain mostly revolves within one week; however, in approximately 10% of all surgeries, acute postoperative pain persists beyond the usual tissue healing time and transits into persistent postoperative pain. The presence and intensity of intraoperative pain comprise the most important determinants of persistent postoperative pain. Therefore, multimodal analgesic management is needed to attenuate nociceptor sensitization and decrease postoperative pain. Opioids have been considered the gold standard of acute postoperative pain management for decades. They provide balanced anesthesia and analgesia by blunting the hemodynamic response to surgical stimuli. However, opioid monotherapy is limited due to adverse events . Therefore, opioid-sparing analgesia is a critical component of acute and chronic pain management to enhance analgesic efficacy and eliminate adverse effects. Large numbers of non-opioids, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or alpha-2 agonist, have improved analgesic properties. It has sedative, sympatholytic, and analgesic effect. Dexmedetomidine inhibits norepinephrine release from synaptic neurons via alpha-2 receptors in rostral pons and central pain modification by enhancing the inhibitory descending pain pathway. Reportedly, DEX diminishes the catecholamine levels by decreasing the sympathetic nervous system activity and provide hemodynamic stability during surgery. Dexmedetomidine has been used as a sub-anesthetic and anxiolytic agent; however, of late, DEX has been found to have an antinociceptive effect, thus broadening its usage in acute and chronic pain conditions. Perioperative administration of DEX has been shown to have superior analgesic and opioid-sparing effects in several surgeries. In laparoscopic hysterectomy, intraoperative DEX showed decreased postoperative pain and improved bowel function. In spinal fusion surgery, intraoperative DEX did not decrease postoperative pain and opioid consumption. Nonetheless, the analgesic efficacy of DEX is still unclear due to different surgical and pain characteristics. In laparoscopic colon surgery, the enhanced recovery after surgery (ERAS) guideline recommends multimodal analgesia using opioids and non-opioids (NSAIDs or paracetamol). Published studies regarding DEX in colorectal surgery focused on cognitive dysfunction, cardiovascular stability, or cerebral protection effect; however, these studies are insufficient to determine the analgesic efficacy of DEX. Therefore, the aim of this syudy was to evaluate the efficacy of intraoperative DEX on postoperative pain in colorectal cancer surgery.Dexmedetomidine (DEX), a highly selective and potent agonist of alpha-2 adrenoreceptors, acts on neuropathic pain modulation. The exclusion criteria were as follow: I) non-elective surgery; II) metastatic cancer surgery; III) open or conversion to open surgery; IV) insufficient follow-up data; V) intensive care unit discharge after surgery; VI) inability to express pain intensity; and VII) usage of any of the analgesics  during anesthesia. This study was carried out according to the guidelines of the Declaration of Helsinki. It was approved by the Institutional Review Board of Samsung Medical Center, Seoul, Korea, (SMC 2021-07-089) and registered with the Clinical Research Information Service of the Korea National Institute of Health, (ref: KCT0006382). Since this was a retrospective review of medical records, patient consent was waived.We retrospectively examined the electronic medical records of colorectal cancer patients who underwent laparoscopic surgery between October 2020 and May 2021 at Samsung Medical Center, Seoul, Korea. The patients were aged 27-87 years. The inclusion criteria were as follow: I) patients who were diagnosed with malignant tumors in the colon or rectum; and II) who have undergone elective laparoscopic colectomy or anterior resection.®, Hospira, Lake Forest, IL, USA) was administered without a bolus dose, and continued until the end of anesthesia. Endotracheal intubation was carried out after approximately 3-5 minutes of mask ventilation and loss of all 4 twitches by train-of-4 stimulation of the ulnar nerve. After endotracheal intubation, anesthesia was maintained with 1.5-2.0 vol% sevoflurane and a bolus injection of 0.5-1.0 μg/kg fentanyl to maintain hemodynamic parameters within 20% of baseline values and BIS at 30-60. The lungs were ventilated with 50% oxygen with air. This was adjusted to maintain an end-tidal CO2 level of 30-40 mmHg. Intraoperative fluid was managed considering blood pressure, heart rate, and hemoglobin level. The temperature was maintained within normal ranges using a warm blanket. All surgeries were carried out by specialized surgeons who followed standardized procedures for colorectal cancer. At the end of the surgery, patients received intravenous patient-controlled analgesia (PCA) pump , which delivered 10-20 μg/kg of fentanyl in normal saline (100 ml) at a basal infusion rate of 0.5 ml/hour and bolus of 1 ml. At the end of the anesthesia, the patients were administered 4 mg/kg of sugammadex or 0.03 mg/kg of pyridostigmine and 0.002 mg/kg of glycopyrrolate intravenously. After extubation, the patients were transferred to the post-anesthesia care unit (PACU). They received a further bolus of intravenous fentanyl at 0.5 μg/kg when the reported scores on a numeric rating scale (NRS: 0=no pain to 10=absolutely intolerable pain) were greater than 3. After discharge from the PACU, postoperative intravenous opioids  and oral opioids (oxycodone or tapentadol) were administered in the general ward according to the attending physician’s decision.The patients were not premedicated preoperatively. In the operating room, standard monitoring for anesthesia was carried out, including oxygen saturation, electrocardiography, end-tidal carbon dioxide (CO2), bispectral index (BIS), oxygen reserve index, and non-invasive blood pressure. Anesthesia was induced with 40 mg of 2% lidocaine, 2 mg/kg of 2% propofol, 0.5-1.0 μg/kg of fentanyl, 0.05 mg/kg of midazolam, and 0.6-0.8 mg/kg of rocuronium intravenously. At anesthetic induction, 0.5-1.0 μg/kg/hour of DEX  1, 2, and 3. Opioid consumption was recorded by conversion to fentanyl units throughout POD 1, 2, and 3.p-value of <0.05.All data were analyzed using SAS 9.4 . Data are described as mean ± standard deviation (SD) or number (n) and precentage (%), as appropriate. Demographic, clinical, and anesthetic data for the 2 groups were compared using a Chi-square test, T-test or Fisher’s exact test. We extracted the mean arterial pressure, heart rate, BIS, oxygen saturation, and oxygen reserve index before intubation (T0), at the start of surgery (T1), at the start of intra-abdominal CO2 insufflation (T2), at deflation of intra-abdominal CO2 (T3), at the end of surgery (T4), and after extubation (T5). The values of minimum alveolar concentration (MAC) of sevoflurane were extracted from T1-T4. These values were compared using a T-test or Wilcoxon rank sum test. In each group, differences in mean arterial pressure, heart rate, BIS, and MAC of sevoflurane values over time were compared using a generalized estimating equation (GEE) analysis. We analyzed the pain scores at PACU arrival and PACU discharge and on POD 1, 2, and 3 at rest and during movement. We analyzed opioid consumption throughout anesthesia, while admitted to the PACU, and on POD 1, 2, and 3, using the Wilcoxon rank sum test. We compared the incidence of postoperative complications using a Chi-square test. The level of statistical significance was set at p=0.008). Details regarding intraoperative hemodynamics are shown in p<0.001) and T5 (p=0.003) and the heart rate was significantly lower at T3 (p<0.001), T4 (p<0.001), and T5 (p=0.001). Moreover, the BIS (p=0.016) and oxygen reserve index (p=0.030) were significantly lower in the DEX group at T4; however, no between-group differences were observed at other time points. Oxygen saturation was not different between the groups. The MAC of sevoflurane was significantly lower in the DEX group at T2 (p=0.002) and T3 (p<0.001). The GEE analysis revealed significant between-group differences in the mean arterial pressure (p<0.001) and heart rate (p<0.001) over time (from T0-5). There were no significant differences in the BIS and MAC of sevoflurane over time between both groups. p<0.001) and discharge (p=0.027) were significantly lower in the DEX group; however, the NRS scores throughout POD 1-3 were not significantly different between the groups. p<0.001). From POD 1-3, the fentanyl dose was not different between the groups. Postoperatively, the discontinuation day of PCA, time to pass flatus, and length of hospital stay were not different between the groups. Of the enrolled 190 patients, 31 were ruled out due to exclusion criteria. Thus, data were evaluated for 159 patients. Patients were divided into 2 groups based on whether they received DEX infusion intraoperatively; patients who received DEX infusion during anesthesia comprised the DEX group (n=74) and those who did not receive DEX infusion comprised the non-DEX group (n=85). The demographic and clinical data are summarized in  Therefore, continuous multimodal analgesia is required to achieve prolonged analgesia after surgery. Furthermore, postoperative pain after colorectal surgery has a mixed character ; since the pelvic cavity is a limited space, there is an increased risk of damage to the pelvic nerve plexus during surgery. These multiple sources of pain may induce more severe pain compared to other laparoscopic surgeries; therefore, intraoperative DEX infusion induce postoperative analgesia not lasting over 24 hours.In this study, we aimed to evaluate the analgesic effectiveness of intraoperative DEX in colorectal cancer patients undergoing laparoscopic surgery. Dexmedetomidine had intraoperative analgesia as indicated by the lower mean arterial pressure, heart rate, and MAC of sevoflurane, as well as the reduced fentanyl consumption by 18.5%. Postoperatively, it induced analgesia based on lowered pain scores and a 43.8% reduction in fentanyl consumption during PACU admission. After PACU discharge, pain scores and opioid consumptions were not different on POD 1, 2, and 3 between both groups. Notably, the incidence of postoperative nausea/vomiting, dizziness, itching, and headache was not different between both groups. Continuous DEX infusion reduced intraoperative pain, but not postoperative pain. We hypothesize that although intraoperative DEX has an analgesic effect, the short half-time of DEX or dose of DEX is insufficient to sustain the analgesic effect for postoperative pain. However, the application of various analgesic protocols has shown different results regarding postoperative pain management. Dexmedetomidine has previously been administered intravenously for sedation and analgesia during critical illness and surgical procedures. It induces analgesia by releasing centrally acting enkephalin-like substance, inhibits the release of substance P at the level of the dorsal root neuron, and prevents norepinephrine release at nerve endings. Dexmedetomidine has anti-inflammatory properties indicated by the reduced secretion of inflammatory factors and decreased inhibition of immunity, leading to reduced opioid consumption. It was shown to have a rapid distribution corresponding to a half-time of 6 minutes, followed by a 2-hour terminal half-time and 4 hours context sensitive half-time after a prolonged 8 hours infusion. The adverse effects of DEX include hypotension, hypertension, nausea, bradycardia, atrial fibrillation, and hypoxia. When DEX is infused at a higher bolus dose, it triggers tachycardia and hypertension. Therefore, further studies are warranted to determine the optimal dose of DEX. Several studies have reported improved analgesia when DEX was used as an adjuvant to anesthetic agents via various routes . In laparoscopic colon cancer surgery, 0.5-1.5 μg/kg DEX was administered with ropivacaine for transversus abdominis plane block during anesthesia, and it showed improved postoperative pain compared with a placebo group. Intravenous DEX combined with sufentanil showed significantly decreased pain score until post-operative 48 hours after colon cancer surgery. Intravenous analgesic regimens of DEX administration for adults recommend 0.25-0.5 μg/kg for the loading bolus and 0.2-1.0 μg/kg/hour for continuous injection. A comparison of continuous injection of DEX with or without a loading dose showed no differences in 24 hours postoperative opioid consumption after abdominal surgery. In our study, we infused DEX corresponding to 0.5-1.0 μg/kg/hour continuously and stopped the infusion at the end of anesthesia; we observed that the analgesic effect was significant until PACU discharge. Considering the sedative effects of DEX and the importance of early ambulation after surgery, other analgesics or interventions are required to prolong analgesia postoperatively.The ERAS recommendations included the combined use of non-opioid analgesics with opioids.First, we did not enroll postoperatively prescribed non-opioid analgesics  into opioid equivalents due to conversion difficulties, even though this could have affected postoperative pain. Second, we did not measure the daily required dose of PCA, which may reflect daily pain intensity. Third, this retrospective study had a small sample size. Further studies with larger sample sizes are needed to investigate prolonged analgesia using other non-opioid analgesics for laparoscopic colorectal surgery.In conclusion, intraoperative continuous DEX administration showed analgesic effects intraoperatively and immediately after surgery but not during the postoperative period. Further prospective trials are needed to investigate analgesic prolongation with different doses or administration routes of DEX and with the combined use of other adjuvants or interventions.


Primary dysmenorrhea (PDM) is highly associated with mood symptoms. However, the neuropathology of these comorbidities is unclear. In the present study, we aimed to investigate the structural changes in the amygdala of patients with PDM during the pain-free phase using a surface-based shape analysis.Forty-three PDM patients and forty healthy controls were recruited in the study, and all participants underwent structural magnetic resonance imaging scans during their periovulatory phase. FMRIB’s Integrated Registration and Segmentation Tool (FIRST) was employed to assess the subcortical volumetric and surface alterations in patients with PDM. Moreover, correlation and mediation analyses were used to detect the clinical significance of the subcortical morphometry alteration.PDM patients showed hypertrophic alteration of the amygdala in the left superficial nuclei and right basolateral and superficial nuclei but not for the whole amygdala volume. The hypertrophic amygdala was associated with disease duration, pain severity and anxiety symptoms during the menstrual period. Furthermore, the hypertrophic left amygdala could mediate the association between disease duration and anxiety severity.The results of the current study demonstrated that the localized amygdala shape hypertrophy was present in PDM patients even in the pain-free phase. In addition, the mediator role of the hypertrophic amygdala indicates the potential target of amygdala for anxiety treatment in PDM treatment in the pain-free phase.The online version contains supplementary material available at 10.1007/s11682-022-00664-3. Primary dysmenorrhea (PDM) is characterized as painful, spasmodic cramping in the lower abdomen, without pelvic pathology, and is a common gynecological condition that affects most women throughout the menstrual years Coco, . DysmenoThe current knowledge on PDM pathogenesis is the overproduction of uterine prostaglandins, which causes the uterine hypercontractility, reduces uterine blood flow, and increases peripheral nerve hypersensitivity-induced pain Dawood, . As a geFMRIB’s Integrated Registration and Segmentation Tool (FIRST) is a new automated structural MRI analysis tool in the FMRIB Software Library (FSL) for the subcortical nuclei segment. FIRST can achieve an individual-level segmentation of the outer surface of the substructure nuclei  were recruited from local communities and university campuses through flyer and social media advertisements . The study was approved by the Institutional Review Board of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (No. 2013KL-033). All participants signed the informed consent. The inclusion criteria for PDM were as follows: The inclusion criteria for PDM is (1) a regular menstrual cycle (27–32 days); (2) Meeting the diagnostic criteria of primary dysmenorrhea under the Primary Dysmenorrhea Consensus Guideline  from “no pain at all” to “unbearable pain Larroy, . The Zun2) and prostaglandin F2α (PGF2α) serum levels were measured using the Enzyme-Linked Immunosorbent Assay (ELISA) method.Blood samples were collected in the morning on the first or next day of menstruation, and the serum levels of prostaglandin E2  during the patients’ periovulatory phase . Sagittal 3D T1-weighted images were acquired using a brain volume sequence with the following parameters: repetition time (TR) = 8.16 ms, echo time (TE) = 3.18 ms, flip angle (FA) = 7°, field of view (FOV) = 256 × 256 mmhttps://fsl.fmrib.ox.ac.uk/fsl; FMRIB Software Library, Oxford University, Oxford, UK)  was used to estimate the total intracranial volume (eTIV), white matter volume (WM), and gray matter volume (GM) for all subjects; Second, the subcortical structures were segmented by using the FMRIB’s Integrated Registration and Segmentation Tool . This approach calculated the group differences on a per-vertex basis, and controlled the effect of age and eTIV volume. The multiple comparison correction was used the Threshold-Free Cluster Enhancement (TFCE), a new method for finding significant “clusters” in the statistic image without having to define clusters in a binary way . Two-sample t-test was employed to conduct the group difference of demographic, clinical symptoms, experimental test and subcortical volumes between the PDM and HC groups. In addition, the relationships between clinical features were detected using bivariate Pearson correlation analysis.2 (PGF2α)) in the PDM group. The partial bivariate correlation analyses were then employed to detect the potential relationship between the altered amygdala and clinical features, adjusted for age and the eTIV. In addition, the significance level was set at P < 0.05, and false discovery rate (FDR) method was used for multiple comparison corrections.The mean shape value of the group differences on subcortical volumes was extracted for correlation analyses to further detect the potential associations between altered amygdala morphology and clinical experimental features  and catastrophizing (PCS score) were observed in PDM patients. The mediation analyses were then performed to examine whether the shape of the amygdala could serve as a potential mediator of these relationships. A simple mediation model from PROCESS Macro in SPSS was used for the mediation analysis (model 4) . Age and eTIV were set as covariates. The detail of the mediation analysis can be found in a previous study . SAS score, PCS score, and serum PGE2 were higher in patients with PDM compared to HC group (P < 0.05). The duration of disease was positively associated with anxiety symptoms , catastrophizing  in the PDM group. However, these relationships would not be significant after FDR correction. The anxiety symptom was positively associated with depressive symptoms , and the serum PGE2 level was positively associated with PGF2α in PDM patients . These relationships were also significant after FDR correction (Table S1).Table P > 0.05, Table S1).The eTIV, GM and WM volumes were not significantly different between the two groups. Moreover, no significant difference in volume between the PDM and HC groups was noted for the bilateral amygdala and hippocampus Table . The ParAs shown in Fig. R = 0.454, P = 0.002), the serum level of PGE2 was negatively correlated with the hypertrophic basolateral nuclei of the right amygdala , and the disease of duration and SAS score were positively associated with the hypertrophic superficial nuclei of the left amygdala  in the PDM group. The relationship between the basolateral nuclei of the right amygdala and VAS as well as the relationship between the superficial nuclei of the left amygdala and duration were also significant after FDR correction. No significant association was found between altered amygdala shape and clinical features.The potential clinical associations of the altered amygdala morphology in the PDM group were detected using partial correlation analysis. Figure R = 0.31, P = 0.04). The hypothesized mediation effect of the shape of the altered amygdala shape on the relationship between duration of disease and anxiety in PDM was then tested. Mediation analysis revealed a significant indirect effect of the superficial of left amygdala on the relationship between disease duration and anxiety in patients with PDM during the menstrual phase   in patients with PDM  was found in PDM group. The mediation analysis was also conducted to estimate the mediation effect of the shape of the altered amygdala shape on the relationship between duration of disease and anxiety in PDM. However, no significant indirect effect was found in the mediation analysis.This study is believed to be the first to explore the morphological alteration in the amygdala and its potential relationship with pain severity and mood symptoms in patients with PDM. Three main findings were presented in the study: (1) the hypertrophic changes were found in the bilateral amygdala in the pain-free phase in PDM, but not the whole volume of the amygdala. The left hypertrophic amygdala was located in the superficial nuclei, whereas the right hypertrophic amygdala was located in the superficial and basolateral nuclei in the patients with PDM; (2) the hypertrophic amygdala in the pain-free phase was associated with both disease duration, pain severity and anxiety symptoms in the menstrual phase in PDM; and (3) the hypertrophic superficial of the left amygdala could mediate the disease duration- associated anxiety severity in PDM. Taken together, the results indicated the regional hypertrophic amygdala in the pain-free phase in PDM. Moreover, the mediator of the hypertrophic amygdala in the association between duration and anxiety will help elucidate the neural mechanisms underlying the anxiety disorder in the PDM patients.Shape analysis of subcortical nuclei is a new approach to detect the potential structural alterations in neuropsychiatry diseases, rarely implemented in PDM research. The volumetric analysis did not show any significant group difference between the PDM and HC groups, and the results are similar to the finding of a previous structural study using voxel-based morphometry (VBM) analysis in the periovulatory phase of PDM (Yang et al., 2 serum level in PDM menstrual phase. Thus, the results of the current study indicated that the shape of the basolateral amygdala may contribute to pain information prediction before the pain input during the menstrual phase. In addition, the hypertrophic superficial amygdala was associated with disease duration and anxiety symptoms during menstruation in PDM. The superficial amygdala was thought to play a decisive role in social interaction, such as social hierarchy assessment and reproductive behavior in mammals and higher primates (Dulac & Torello, The analysis of the current study also confirmed the association between hypertrophic amygdala during the pain-free stage and disease duration as well as VAS during menstruation in PDM patients. The basolateral nuclei of the amygdala is a likely integrator of the preprocessed perceptual input, including visual, auditory and somatosensory information (Bzdok et al., The hypertrophic superficial amygdala could be interestingly a mediator in the disease duration-associated anxiety symptoms in PDM during the menstrual phase because the superficial amygdala is mainly involved in social information integration (Bzdok et al., Pain catastrophizing, which defined as an exaggerated negative response to imagined pain or actual pain, have been reported increased in patients with PDM, especially the first day of the menstrual cycle (Cosic et al., The present study has several limitations. First, this was a cross-sectional study, and how the hypertrophic amygdala mediates the duration associated anxiety symptoms in PDM over time is unclear. A longitudinal design study may help to resolve this question. Second, as PDM is a cyclic chronic pain, the present MRI scan is during the pain-free phase. Recently, Yang et al. have found the larger amygdala volume in patients with patients with PDM during the menstrual phase but not the periovulatory phase by using VBM analysis (Yang et al., The results of the current study demonstrated that localized amygdala shape hypertrophy was present in PDM patients even in the absence of pain. In addition, the mediator role of the hypertrophic amygdala in the disease duration-associated anxiety may indicate the potential target for PDM treatment before the menstrual phase.Below is the link to the electronic supplementary material.Supplementary Material 1Supplementary Material 2


The purpose of our study was to examine the impact that an increased body mass index (BMI) has on arthroscopic rotator cuff repair (aRCR) outcomes.We identified a sample of 313 patients who underwent aRCR at our institution from 2017 to 2020. Patients were classified into cohorts by BMI: normal BMI (<25), overweight (25-30), and obese (≥30). Patient-Reported Outcomes Measurement Information System (PROMIS) scores  and Clinical Global Impressions scale rating of pain and functional improvement after surgery were obtained at 1 year postoperatively. The significance of the BMI category as a predictor for outcomes was evaluated using multiple linear and multivariable logistic regressions. Receiver operating characteristic curve analysis with Youden’s J-statistic was used to determine optimal BMI cutoff for predicting likelihood of achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) on the Clinical Global Impressions scales.P = .04). However, BMI was not predictive of other preoperative-to-postoperative differences in outcome scores or the size and number of cuff tendons torn (P > .05). Optimal BMI cutoffs were determined for pain MCID (40.8), pain SCB (26.8), function MCID (27.4), and function SCB (26.8), but all cutoffs had low correct classification rates (≤13%).Obesity was a significant predictor of reduced preoperative-to-postoperative improvement in the PROMIS Upper Extremity score (Obesity was not found to be an independent risk factor for increased rotator cuff tear size or tendon involvement but was nonetheless associated with worse upper extremity function and pain after aRCR. This was a prospective study conducted on a sample of patients that was retrospectively identified utilizing CPT code 29827 between October 2017 and January 2020. Final follow-up data (Patient-Reported Outcomes Measurement Information System [PROMIS] scores and patient satisfaction) were collected prospectively through either phone calls or office visits if they met the following inclusion criteria: (1) age ≥18 years, (2) undergoing primary aRCR surgery with or without long head of biceps tendon (LHBT) or labral debridement and subacromial decompression, (3) minimum 1-year follow-up, (4) had completed the preoperative PROMIS Upper Extremity (UE), Pain Interference, and Pain Intensity surveys, and (5) were able to provide informed consent. Exclusion criteria included (1) patients who underwent open RCR procedures, (2) patients who underwent revision procedures, (3) patients who underwent arthroscopic shoulder procedures that did not repair any RC tendons , and (4) patients <18 years of age, and (5) non-English speakers.All RCT repairs were performed arthroscopically in the beach chair or lateral decubitus position under regional anesthesia. The kind of repair (single row vs. double row) was determined by the surgeon's preference and the extent of tear/number of tendons involved. The decision for subacromial decompression and biceps tenotomy vs. tenodesis was determined by the operating surgeon. Following surgery, patients’ arms were immobilized for 4-6 weeks (depending on the extent of the tendons involved) and supervised physical therapy was initiated at 4 weeks for small-sized tears and 6 weeks for medium- to large-sized tears.BMI at the time of surgery was abstracted from preoperative assessments from electronic medical records. Subjects were classified into three groups based on BMI: normal (BMI <25), overweight (BMI ≥25 and < 30), and obese (BMI ≥30).Preoperative imaging (magnetic resonance imaging scans) and intraoperative reports were used to identify the total number of RC tendons torn, specific tendons torn , and tears of the LHBT and glenoid labrum. RCTs included full-thickness and partial-thickness tears comprising more than 50% of the tendon footprint but excluded tendinitis or partial tears involving less than 50% of the tendon footprint. Tear sizes were classified as per the DeOrio and Cofield classification of partial, small, medium, large, and massive.Shoulder pain and functional outcomes were assessed using the PROMIS Pain Interference, Pain Intensity, and UE surveys. These surveys were administered during the preoperative time period and completed online or over the phone after a minimum of 1 year postoperatively. Patients also reported any perceived change in shoulder pain and functional status after surgery using the Clinical Global Impressions (CGI) scale, a 7-point scale with options ranging from “much worse” to “much better.”P values less than 0.05 were considered significant.Normality of continuous variables was assessed using the Shapiro-Wilk test. Baseline demographics, operative variables, and preoperative PROMIS scores were compared between the BMI groups using the Kruskal-Wallis test and Dwass-Steel-Critchlow-Fligner post hoc testing. BMI group, age, sex, smoking history (ever-smoker vs. never-smoker), and comorbidities  were entered into a multiple linear regression model for continuous outcomes (PROMIS and CGI scores) and a multivariable logistic regression model for binary outcomes . The cutoff BMI values that optimized the number of patients who achieved MCID and SCB for pain and function were determined using receiver operating characteristic (ROC) analysis with Youden’s J-statistic. ROC curves with the area under the curve (AUC) ≥ 0.7 were considered to have an adequate predictive value. For all analyses, P = .001) and a younger mean age than patients with lower BMI  had normal BMI, 127 (41%) were overweight, and 100 (32%) were obese . The cohP = .03; .Table IBP > .05). Multivariable logistic regression analysis (P > .05).RCT patterns were similar between the BMI groups . The majanalysis  found thP < .05), but these differences were lower than the MCID values for individual outcomes. In addition, the CGI scale for function showed lower perceived improvement in postoperative function among patients in the obese group vs. patients with normal BMI (P = .04).There were notable differences in postoperative PROMIS and CGI scores between the BMI groups . WithoutP < .05). Furthermore, obesity was predictive of reduced preoperative-to-postoperative improvement in the PROMIS UE score  compared with patients with normal BMI. However, BMI was not predictive of other preoperative-to-postoperative differences in PROMIS scores or of CGI scores for pain and functional improvement (P > .05).Multiple linear regression analysis  found obROC curves were generated for BMI as a predictor of patients achieving MCID and SCB for pain and function after aRCR . All modAs obesity rates are projected to continue to climb throughout the next decade, it is imperative that orthopedic surgeons understand its ramifications on aRCR outcomes.ROC analysis identified an obese BMI cutoff (40.8) for patients who achieved MCID for pain. However, the same analysis identified overweight BMI cutoffs (<30) for patients who achieved SCB for pain and MCID and SCB for function. This analysis reinforces the existing notion that obese patients experience more pain and have suboptimal functional outcomes after aRCR. It must be stated that these results should be interpreted with caution as the models used in our analysis had poor discrimination and did not attain an ideal predictive value based on the AUC (range: 0.55-0.60). Furthermore, each identified BMI cutoff had a low correct classification rate, with the highest being 12.9% for function SCB. A similar conclusion was reached by Rubenstein et al,P = .019), respectively. They also found that surgeries in obese patients were longer and required lengthier hospital stays. A study by Ateschrang et alP < .05). However, these results serve as a contrast to the findings of the studies by Kessler et alAs it stands, there are conflicting results in literature regarding the impact of obesity on outcomes after aRCR. A retrospective study of 149 patients by Warrender et alP > .05).,Similar to prior works, our overall readmission and complication rate was low with no differences between cohorts (Another important aspect of this study, in contrast to the work of Gumina et al,We acknowledge several limitations of our study. First, patient reported outcome measures are subject to variability by recent events and influenced by longitudinal changes in shoulder function over time.Obesity was not found to be an independent risk factor for increased RCT size or tendon involvement but was nonetheless associated with worse upper extremity function and pain after aRCR.Funding: No funding was disclosed by the authors.Conflicts of interest: The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.