Evaluation of the versatility of perforators-enhanced rhomboid flap technique for ischial sores reconstruction

Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management,are available. In flap surgery for pressure sores, a variety of flap types may be used;each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforatorenhanced rhomboid flap technique for ischial sore construction.Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital.The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap.Postoperative follow-ups and evaluations were performed.Results: The mean age of the study group was 43.7 ± 13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases.The mean surface area of sores was 24.8 ± 6.3 cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ± 0.98 cm and required around 6.8 ± 1.9 weeks to heal.Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Treatment of 73 Cases of Bed Sores with Warming Moxibustion

Seventy-three patients with bed sores were treated by warming moxibustion. Of the 73 cases, 58 cases were cured, 12 cases improved and 3 cases ineffective, with an effective rate of 95.9%.

Studying pressure sores through illuminant invariant assessment of digital color images

Methods for pressure sore monitoring remain both a clinical and research challenge.Improved methodologies could assist physicians in developing prompt and effective pressure sore interventions.In this paper a technique is introduced for the assessment of pressure sores in guinea pigs,using captured color images.Sores were artificially induced,utilizing a system particularly developed for this purpose.Digital images were obtained from the suspicious region in days 3 and 7 post-pressure sore generation.Different segments of the color images were divided and labeled into three classes,based on their severity status.For quantitative analysis,a color based texture model,which is invariant against monotonic changes in illumination,is proposed.The texture model has been developed based on the local binary pattern operator.Tissue segments were classified,using the texture model and its features as inputs to a combination of neural networks.Our method is capable of discriminating tissue segments in different stages of pressure sore generation,and therefore can be a feasible tool for the early assessment of pressure sores.

Local Application of Combined Drugs of Natural Essential Oils for the Prevention of Acute Pharyngitis

Objective: Viral pharyngitis, commonly known as a sore throat, is a widespread condition affecting people of all ages globally. This study aimed to assess the effectiveness of a medical device containing the combined drugs of natural essential oils (CDNEO) formulation in managing throat pain in patients with acute viral pharyngitis. With the growing resistance to traditional antibacterial treatments, essential oils have attracted interest for their potential analgesic, anti-inflammatory, and antibacterial properties. Results: The study involved 81 patients randomly divided into two groups: those taking a medical device containing combined drugs of natural essential oils (CDNEO) and those taking a placebo. A questionnaire was used to assess throat pain among the participants, with 45 receiving the CDNEO and 36 the placebo. The CDNEO group experienced a significant reduction in throat pain, with the average VAS score decreasing from 5.36 to 1.09, compared to the placebo group, which saw a decrease from 4.97 to 2.19. This difference, with p Conclusion: By using a double-blind research method, it was possible to evaluate the effectiveness of the oils more objectively, since there was also a control placebo group. The study shows that CDNEO significantly reduces throat pain and decreases the need for additional pain relief medication in patients with acute viral pharyngitis. The findings suggest that natural essential oils could serve as an alternative treatment for pharyngitis, particularly in efforts to minimize NSAID use and combat antibiotic resistance.

Occipital pressure sores in two neonates

The preference for a specific head shape can be influenced by people's culture,religious beliefs and race.Modern Chinese people prefer a"talented"head shape,which is rounded and has a long profile.To obtain their preferred head shape,some parents try to change their neonates'sleeping position.Due to these forced sleeping positions,positional skull deformities,such as plagiocephaly,may be present during the first few months of life.In this article,we report two neonatal cases,of Hui nationality and Dongxiang nationality,with occipital pressure sores that were caused by using hard objects as pillows with the intention of obtaining a flattened occiput.The pressure sores were deep to the occipital bone and needed surgical management.These pressure sores caused wounds that were repaired by local skin flaps,after debridement,and the use of external constraints from a dense sponge-made head frame for approximately two weeks.One case recovered with primary healing after surgical operation.The other case suffered from a disruption of the sutured wound,and a secondary operation was performed to cover the wound.These occipital pressure sores are avoidable by providing guidance to the parents in ethnic minorities'area regarding the prevention,diagnosis and management of positional skull deformity.

Validation of LPD Scale for the Assessment of Pressure Ulcer at Home

Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home;and to compare LPD to the Braden scale for internal validity. Method: This multicenter, cross-sectional study was conducted in the domestic environment of subjects cared for Home Care services from North to South of Italy. Data collection lasted 8 months, between June 2018 and September 2020, and consisted of the simultaneous compilation of the new LPD, and the Braden scale. Home Care Expert nurses could interface with the recruited subjects and/or caregivers. The parameters considered to validate the new scale were sensitivity (Se), specificity (Sp), positive predictive values (PPV), odds ratio (OR), and the area under the receiver operating characteristic (ROC) curve. Results: Of the 679 recruited subjects, 63.2% were women, and more than 50% did not have a pressure ulcer. 48.2% of the sample aged over 85 years old;69% was affected by multiple disease, and 76.6% took a lot of drugs. 91.6% of the subjects were affected by a partial or total functional dependency. Around 50% of subjects presented double incontinence, and 43% were conscious and collaborated. 85.4% of subjects lived in a healthy environment. The predictive validity parameters showed: Se 77.25%, Sp 84.04%, PPV 91.37%, and the area under the curve (AUC) 0.88% with a confidence interval (CI) 95%. These values mean a moderately accuracy of the test. Conclusions: The new LPD scale has demonstrated a good capacity for identifying the subjects at risk of pressure ulcer and had a better discriminatory power rather than Braden scale.

Sandwich Rolling over Method in Patients with Prone Position Ventilation

Background: Prone positioning is nowadays considered as one of the most effective strategies for patients with severe acute respiratory distress syndrome (ARDS). Prone position ventilation can lead to some severe complications. Effectively implement prone ventilation and reduce the incidence of complications become an important problem for clinical medical staff. Aims: To investigate whether the Sandwich rolling over method was convenient for clinical implementation and can reduce complications. Design: This is a single-center, retrospective, observational study. Results: The mean pronation cycles per patient were 6.11 ± 4.40. The mean time spent in prone position for each cycle was 10.05 ± 4.42 hours. Two patients developed a pressure sore and the positions were cheek, auricle and chest. The mean time it took from preparation to cover the patient with the quilt was 10.56 ± 4.35 minutes. Conclusions: This retrospective study has shown that under the close cooperation and supervision of the team, the implementation efficiency of prone position ventilation can be improved and the occurrence of complications can be reduced.

Assessment of Knowledge,Attitude and Practices(KAPS)of Anthrax among Pastoralists in Wajir,Isiolo and Marsabit Counties,Kenya

Anthrax is an important zoonotic disease in Kenya causing high morbidity and mortality in both human and livestock.It is endemic in the country.The objective of this study was to assess the knowledge,attitude and practices(KAPS)of anthrax among pastoralists in Wajir,Isiolo and Marsabit.The study was cross-sectional whereby various areas of anthrax outbreaks were identified through the veterinary departments in the three study counties of Wajir,Isiolo and Marsabit.These areas were visited and using systematic sampling methods,a total of 400 households were visited.Data were collected through questionnaires administered via personal interviews.Information collected included demographic characteristics of the households,knowledge on anthrax,attitude and practices on the disease.Pastoralists had adequate knowledge on anthrax.They correctly pointed out the clinical signs of anthrax in livestock such as sudden death,bleeding from body orifices and cutanous sores.The indigenous knowledge was uniform in all the three counties.Despite that knowledge,they reportedly engaged in dangerous practices that would expose them to infection by anthrax.These practices included consumption of meat from suspect anthrax cases,opening of carcasses of dead animals and throwing of anthrax suspect carcasses in bushes.Anthrax is a well known disease in this pastoral setting.There is a need for education programmes to be designed for this community especially with regard to proper handling of suspect anthrax cases.Continuous anthrax efforts should be initiated through vaccination of livestock.

Subacute Thyroiditis as Seen Initially in ENT Department—— A Reportof30 Cases

To assess the pharyngeal presentations and the diagnostic value of thyroid SPECT and thyroid fine needle aspiratory biopsy (FNAB) in subacute thyroiditis (SAT) as seen initially in ENT department, 30 patients, during the course of SAT, were examined for pharyngeal symptoms and tested for serum T 3, T 4 level. The thyroid SPECT imaging or thyroid FNAB were performed. Our results showed that, of the 30 patients, 21 had sore throat of various degrees, and 9 had abnormal sensation of throat. Six were diagnosed as having SAT by only SPECT, in the remaining 24, the final diagnoses was established by SPECT combined with FNAB. Two of them were finally diagnosed as having SAT by trial treatment with oral prednisone. It is concluded that sore throat and abnormal sensation of pharynx are the important presentations of SAT, and thyroid SPECT imaging and thyroid FNAB are valuable in diagnosing SAT.

Intracuff alkalinized lidocaine to prevent postoperative airway complications:A meta-analysis

BACKGROUND Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia,which can lead to potentially dangerous complications.In this meta-analysis,we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period.AIM To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.METHODS PubMed,Embase,Cochrane,and Web of Science were searched for randomized controlled trials(RCTs)that compared intracuff alkalinized lidocaine to placebo.We used risk-of-bias assessment to assess the RCTs,and the quality of evidence was assessed using the grading of recommendations,assessment,development,and evaluations.RESULTS Twelve randomized trials(1175 patients)were analyzed.Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo[risk ratio(RR):0.38;95%confidence interval(CI):0.23-0.63].Similarly,intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h(RR:0.19;95%CI:0.09-0.41)and postoperative hoarseness(RR:0.38;95%CI:0.21-0.69).CONCLUSION Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications,such as coughing,hoarseness,and sore throat.

Comparison of postoperative sore throat following laryngoscopy conducted by Miller and Macintosh laryngoscope blades

BACKGROUND: Post operative sore throat (PST) is one of the most common complaints after tracheal intubation. In this study we compared the effects of curved and straight laryngoscope blades on severity and incidence of PST. METHOD: In this prospective randomized clinical trial we evaluated incidence and severity of PST in 147 ASA physical status I–II, aged 18 – 62 y (group Miller, n = 71), (group Macintosh, n = 76) following intubation with Miller and Macintosh laryngoscope blades by using Visual Analog Scale (VAS). RESULTS: The overall incidence of PST in our study was 35.4% (Macintosh group = 39.5% and in Miller group = 31% and P = 0.829). The incidence of PST was not statistically different between two kinds of laryngoscope blades and the mean rank of pain score was not statistically different in recovery room and up to 48 hours after surgery. CONCLUSIONS: Our study showed these types of laryngoscope blade had not association with incidence and severity of PST. .

Comparison of Postoperative Throat and Neck Complaints after the Use of the i-Gel versus the Traditional Laryngeal Mask

Introduction: One of the most important jobs of an anesthesiology is to preserve an adequate gaseous exchange. With the coming in the 80’s of the laryngeal mask airway, a less invasive technique was introduced for this end. There are a lot of variants of these supraglotic issues, being the i-gel a no inflate mask;witch principle is to provide a perilaryngel stamp that reduced the incidence of sore throat, cervical pain compared with the traditional laryngeal mask. Method: A group of 121 ASA I-II patients with general anesthesia administration, where divided in two groups, one of 60 patients where a traditional laryngeal mask airway was used, and a second group of 61 patients where an i-gel mask was used. In both groups the presence of postoperative sore throat, cervical pain and dysphonia;number of attempts and pressure in the airway tract was measured. Results: The group of patients where the i-gel was used present lower incidence of sore throat (11% vs 27%) and cervical pain (3% vs 9%) and lower values of pressure on the airway tract compared with the group in which the conventional laryngeal mask was used. On the other hand there was no difference in the presence of dysphonia, trauma or number of attempts used to insert the mask. Conclusions: The i-gel larygeal mask demonstrated to be a safe issue, with low incidence of morbidity to administrated general anesthesia.

Meta-analysis and systematic evaluation of the curative effect and analgesic effect of acupuncture on herpes zoster

Objective:To systematically evaluate the clinical efficacy and analgesic effect of acupuncture and moxibustion in the treatment of herpes zoster by comparing western medicine.Methods:Randomized controlled trials on acupuncture and western medicine for herpes zoster were searched from CNKI,Wanfang Database,VIP,CMB,PubMed,Embase and Cochrane library databases,and the retrieval time was from January 2010 to July 2020.RevMan5.3 software was used for Meta analysis.Results:A total of 30 randomized controlled studies were included,involving a total of 4292 patients.Subgroup analysis was conducted according to different intervention measures in the experimental group.The results showed that:(1)The total effective rate of the subgroup analysis showed that the combined effect of acupuncture treatment alone RR=1.10,95%CI[1.05,1.15],P<0.0001.Results:RR=1.16,95%CI[0.86,1.57],P=0.33.It suggests that the therapeutic effect of acupuncture and moxibustion on herpes zoster is superior to that of western medicine,but acupuncture and western medicine treatment cannot improve the clinical efficacy of western medicine.However,due to the unstable meta-analysis of acupuncture and western medicine treatment in the subgroup,the results need to be treated with caution and further clinical verification is still needed.(2)VAS score improvement analysis showed that the combined effect of acupuncture alone RR=2.20,95%CI[1.53,2.87],P<0.00001.RR=1.12,95%CI[0.39,1.85],P=0.002,suggesting that acupuncture is significantly better than western medicine in improving the pain of shingles,and western medicine combined with acupuncture can improve the analgesic effect.(3)The subgroup analysis of sequelae incidence showed that the combined effect amount of acupuncture alone on sequelae incidence at 30 days was RR=0.34,95%CI[0.25,0.48],P<0.00001,and the combined effect amount of acupuncture combined with western medicine was RR=0.18,95%CI[0.05,0.69],P=0.01.Incidence of sequelae at 60 days RR=0.38,95%CI[0.23,0.62],P=0.0001;The incidence of post-herpetic neuralgia treated with acupuncture alone at 90 days RR=0.39,95%CI[0.20,0.74],P=0.004,suggesting that the incidence of post-herpetic neuralgia treated with acupuncture is significantly lower than that treated with western medicine,and western medicine combined with acupuncture can reduce the incidence of post-herpetic neuralgia.(4)The time analysis of the onset of pain relief showed that the combined effect of acupuncture alone RR=-2.32,95%CI[-2.48,-2.17],P<0.00001.RR=-2.39,95%CI[-2.70,-2.09],P<0.00001,suggesting that the onset time of acupuncture and moxibustion was shorter than that of western medicine,and western medicine combined with acupuncture and moxibustion could accelerate the onset time of analgesia.(5)The time analysis of pain relief showed that the combined effect of acupuncture alone RR=-10.80,95%CI[-12.49,-9.01],P<0.00001.RR=-5.98,95%CI[-11.55,-0.41],P=0.04,suggesting that acupuncture treatment of herpes zoster can significantly reduce the pain time,combined with western medicine can shorten the pain time.Conclusion:Acupuncture and moxibustion treatment of herpes zoster in the total effective rate,pain relief and the incidence of post-neurosis is significantly better than western medicine;Acupuncture and moxibustion combined with western medicine can improve the analgesic effect and reduce the incidence of post-neurosis.In view of the low overall quality of the literature included in this study,further clinical validation is needed for this conclusion.

Correlation between Vulvar Symptoms Stratification and Vulvar Cancer Detection: Prospective Cohort Observational Study

Background: The incidence of cancer vulva is increasing. 50% of cases are occurring at younger age especially the type related to Human Papilloma Virus infection. Cancer vulva can be prevented. Awareness of cancer vulva is deficient among women and healthcare providers. In this study we looked for a correlation between the most significant vulval symptoms to be associated with cancer vulva in order to educate women and to provide guidance for the health care providers. Methods: 569 women were enrolled in this observational cohort study. The patients were stratified according to their symptoms into 5 groups. Biopsy from the vulva, unless the lesion is obviously benign. Results: Vulvar lesion, as a symptom (mass-ulcer), was significantly associated with detection of vulvar cancer (P ≤ 0.001). 100% of those women presented with vulvar lesions (mass or ulcer) had cancer. Positive predictive value (PPV) of vulvar lesion alone was 1.25% but the probability of detection of a cancer dramatically increased when the lesion was accompanied with bleeding 35.2% or pain 26.9% respectively. Conclusion: Presenting symptoms other than a lesion in the vulva as for example, soreness, irritation or bleeding was rarely associated with detection of cancer.

Design, Development and Phytochemical Evaluation of a Poly Herbal Formulation Linkus Syrup

The present work has been carried out on polyherbal formulation named as Linkus Syrup. The herbal formulation consists of Glycyrrhiza glabra, Hyssopus officinalis, Piper longum and Alpinia galangal. The Linkus syrup physico-chemical evaluation such as pH, density, identification of polysaccharide, tanning agents, ascorbic acid and shelf life was complied. The TLC and quantitative determination of alkaloid were quantified. Determination of biomarker has been validated for the analysis of vasicine. The study result revealed that Linkus syrup formulation was well standardized at different levels such as physic-chemical consistency and assay of bio marker compound.

Effects of L-carnitine and Branched-Chain Amino Acids on Energy Metabolism,Body Composition,and Delayed-Onset Muscle Soreness after Exercise in Healthy Subjects

Background Specific nutrients combined with exercise may prevent a loss of lean body mass and consequently prevent sarcopenia.We examined the effects of 2 weeks of supplementation with L-carnitine and a single dose of branched-chain amino acids(BCAAs)on energy metabolism and body composition before and after exercise and on post-exercise muscle soreness in healthy subjects.Methods A total of 12 young,untrained,healthy women were randomly assigned to two groups who received either 2 weeks of supplementation with L-carnitine(1000 mg/day)and a single dose of BCAAs plus 200 kcal energy(LCAR+BCAA group,n=6)or 200 kcal energy alone(control group,n=6)before 60 min of exercise.Energy substrate metabolism and body composition by bio-impedance were examined before and after exercise.Delayed-onset muscle soreness(DOMS)was evaluated by using a visual analogue scale for 3 days after exercise.Results Serum concentrations of free and acyl-L-carnitine in the LCAR+BCAA group were not significantly different from those in the control group.There were no significant differences in body composition before or after exercise between the two groups.Although serum free fatty acid levels 120 min after the oral ingestion of BCAAs were significantly lower in the LCAR+BCAA group than in the control group,there were no significant differences in serum free fatty acid levels immediately after and 60 min after exercise.DOMS for 3 days after exercise was lower in the LCAR+BCAA group than in the control group,but this difference was not significant.Conclusion Continuous supplementation with L-carnitine combined with a dose of BCAAs in young,untrained,healthy subjects caused a blunted response of stimulated lipolysis after exercise.

The modified bilobed flap for reconstructing sacral decubitus ulcers

Background:Sacral pressure ulcers are associated with high morbidity and,in some cases,result in mortality from severe sepsis.Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers.An ideal flap should be simple to design,have a reliable vascular supply and minimal donor site morbidity.Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer.Case presentation:We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019.A description of our management,operative protocol,outcome and complications is outlined.Seven paraplegic patients(6 male,1 female;average age 53.1 years)with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery.The average size of the pressure ulcers was 7×5 cm(range 6.2×4.5 cm to 11×10 cm).All 7 flaps survived.The patients were followed up for 12 months without significant complications,such as flap necrosis or recurrence.Conclusions:The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap.The superior cluneal nerve can be included in the design.The technique is simple and reliable.It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.

Strategies of the acupuncture treatment for delayed-onset muscle soreness based on pathophysiology

Based on the pathophysiological analysis of delayed-onset muscle soreness,the key points of its treatment was summarized in this paper:promoting the repair of injury,improving the metabolic state,and effectively relieving pain.Its key objectives and order of treatment are made clear:first to promote repair,second to improve metabolism,and then to relieve pain.And through the analysis of the key points of the treatment,the law of acupuncture and moxibustion treatment is put forward as follows:puncture those acupoints with the overall regulation function to adjust the secretion of endogenous analgesic substances in the body,at the same time,the special respiratory movement is adopted to improve the metabolic state,and the proper exercises are combined to promote the tissue repair.

Effects of Zingiber cassumunar(Plai cream) in the treatment of delayed onset muscle soreness

OBJECTIVE： To evaluate the effects of Zingiber cassumunar（Plai cream） in either 7% or 14% concentration on delayed onset muscle soreness（DOMS）.METHODS： Seventy-five untrained healthy volunteers（28 males and 47 females）, performed 4 sets of 25 eccentric repetitions of the dominant quadriceps muscle on an isokinetic dynamometry machine. Participants were then randomized into 3 groups： 14% Plai cream, 7% Plai cream and placebo cream. Two grams of the cream（strips of 5-cm long） were gently rubbed into the quadriceps muscles for 5 min immediately following the exercise and every 8 h thereafter for 7 d in all groups. Muscle soreness, muscle strength, jump height, thigh circumference and creatine kinase were measured before and after eccentric exercise.RESULTS： Compared to the placebo cream the 14% Plai cream substantially reduced muscle soreness over the 7 d by –82%（95% CI = –155% to –6%, P = 0.03）, but had similar muscle soreness effects to 7% Plai cream（–34%, –96% to 27%, P = 0.2）. Compared to the placebo cream the 7% Plai cream resulted in a small non-significant reduction in muscle soreness levels over the following 7 d（–40%, –116% to 36%, P = 0.3）. Compared to placebo cream there was little effect of Plai cream（7% or 14%） on muscle strength, jump height, thigh circumference or creatine kinase concentration. CONCLUSION： Using 14% Plai cream over a 7-day period substantially reduced muscle soreness symptoms compared to 7% Plai cream or a placebo cream. The authors suggest that the administration of 14% Plai cream is a useful alternative in the management of DOMS.TRIAL REGISTRATION： Thai Clinical Trial Registry TCTR20140215001.