6-month Follow-up Research Articles

Improvements of depression, anxiety, stress, and social support through a telerehabilitation system in discharged COVID-19 patients: a randomized controlled pilot study

ABSTRACT Introduction Post-acute COVID-19 patients who were discharged from hospitals during the epidemic faced significant challenges, not only physical sequelae, but also psychological distress, anxiety, and depression. It is already known that continued exercise improves psychosocial components, but few studies have explored the impact of multimodal rehabilitation programs, including therapeutic education, in this type of patient. There are no studies that explore the application of these programs through asynchronous telerehabilitation, which would open up new therapeutic windows. Methods This pilot single-blinded randomized controlled trial included 35 post-discharge COVID-19 patients allocated to two intervention arms: an asynchronous telerehabilitation group (ATG) and a booklet-based rehabilitation group (BRG). The aim was to analyze the preliminary changes in depression, anxiety, stress, and social support comparing both groups. Results The ATG exhibited statistically significant reductions in depression (p = 0.048) and stress (p = 0.033) compared to the BRG after intervention. While both groups showed improvements in psychosocial variables, the ATG demonstrated consistent lower depression levels at 3- and 6-month follow-ups (p = 0.010, p = 0.036 respectively) and notably higher social support at 3- and 6-month follow-ups (p = 0.038, p = 0.028 respectively). Discussion This pilot study suggests that a multimodal rehabilitation program using asynchronous telerehabilitation provides substantial benefits in terms of alleviating psychological distress and improving social support in discharged COVID-19 patients. These data will enable for larger studies to confirm these results.

Radiofrequency Ablation for Solitary Autonomously Functioning Thyroid Nodules: Multicenter Study from Latin America.

Background: Autonomously functioning thyroid nodules (AFTNs) represent ∼5% of all thyroid nodules and often necessitate definitive treatments such as surgery or radioiodine (131I), both of which have inherent risks. Radiofrequency ablation (RFA) has emerged as an effective and safe therapeutic option for managing AFTNs. This study aims to assess the effectiveness and safety of RFA for solitary AFTNs in various countries across Latin America. Methods: This retrospective, observational, multicenter cohort study included patients with a solitary AFTN that was histologically confirmed as benign and treated with a single session of RFA. The study included an analysis of patient demographics, sonographic characteristics of the nodules, thyroid profile assessment at each follow-up visit, evaluation of clinical symptoms to determine the achievement of a euthyroid state, and the measurement of nodule volume reduction. In addition, a bivariate analysis was conducted to identify associations between these variables and the resolution of hyperthyroidism. Results: Our study enrolled 81 patients with a solitary, benign AFTN. The volume reduction ratio (VRR) consistently increased over the follow-up period, with medians of -50%, -74.9%, -78.4%, and -90.2% at 1, 3, 6, and 12 months, respectively. The rate of resolution of hyperthyroidism was 93.8% (76/81). Following the RFA procedure, 58.02% of patients (47/81) normalized their thyrotropin levels within 1 month of follow-up, and by 3 months, an additional 33.3% had achieved normalization (27/81). Notably, a baseline volume ≥10, 20, or 30 mL did not affect the achievement of clinical success. In bivariate analyses, a VRR ≥50% at the 6-month follow-up was associated with the resolution of hyperthyroidism. Overall complications occurred in 6.2% of patients (5/81), including 1.2% (1/81) of a major complication (transient Horner syndrome), 3.7% cases of transient dysphonia (3/81), and 1.2% (1/81) of hypothyroidism requiring low-dose levothyroxine replacement. Conclusions: The results of this multicenter study suggest that RFA is a promising treatment option for patients with solitary AFTN, regardless of their baseline characteristics, including volume, age, or composition. The clinical success of the intervention may be related to the VRR at 6 months.

Comparative analysis of MRI-based VBQ and EBQ score for predicting cage subsidence in PILF surgery

Background contextAs lumbar degenerative diseases become more prevalent in an aging population, there is an increasing demand for surgical interventions, such as posterior lumbar interbody fusion (PLIF). However, cage subsidence (CS), observed in 23.9–54% of cases postoperatively, remains a significant complication. Several factors, including age, bone quality, and endplate damage, contribute to the risk of CS, with bone quality being among the most critical determinants. Although DEXA and QCT are widely employed to assess bone density, their routine use in preoperative evaluations is restricted by cost considerations and radiation exposure. Recent studies suggest that MRI-based vertebral body quality (VBQ) and endplate bone quality (EBQ) score offer a viable, non-invasive alternative for evaluating bone quality; however, there is limited research comparing their predictive value for CS.MethodsIn this retrospective study, 165 patients undergoing single-level PLIF surgery were included. MRI-based VBQ and EBQ score were calculated using T1-weighted images, and preoperative QCT was employed as a clinical standard. Cage subsidence was assessed based on postoperative imaging at 12-month follow-up. Statistical analyses, including t-tests, chi-square tests, and ROC curve analyses, were used to evaluate the predictive accuracy of VBQ and EBQ for CS.ResultsThe study’s findings demonstrated that both VBQ and EBQ scores were significantly correlated with QCT measurements, thereby validating their utility as indicators of bone quality. ROC analysis revealed that VBQ had superior predictive value for CS (AUC = 0.814) compared to EBQ (AUC = 0.719), with both scores demonstrating significant clinical utility in identifying patients at risk for CS. Notably, VBQ exhibited a stronger correlation with preoperative clinical outcomes compared to EBQ, underscoring its greater reliability as a predictor.ConclusionsThis study highlights the effectiveness of MRI-based VBQ and EBQ score as practical, non-invasive tools for assessing bone quality preoperatively, with VBQ demonstrating superior predictive performance for CS risk. The findings underscore the potential of integrating these MRI-based assessments into routine preoperative planning to improve patient outcomes and minimize complications associated with PLIF surgery.

Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study

ObjectivesTo explore the short- and long-term effects of glycemic management—through glycemic treatment and blood glucose monitoring (BGM)—on stroke recurrence and mortality specifically in patients experiencing a first-ever ischemic stroke (FIS) with hyperglycemia (FISHG) who have not previously been diagnosed with diabetes mellitus (DM).MethodsWe gathered data on patients who were registered on Taiwan’s National Health Insurance Research Database from 2000 to 2015. We one-fold propensity-score-matched (by sex, age, and index date) 207,054 patients into 3 cohorts: those with FIS (1) without hyperglycemia, (2) hyperglycemia without glycemic treatment, and (3) hyperglycemia with glycemic treatment. We used Cox proportional hazard regression to evaluate the short- (within 1 year after FIS) and long-term (9.3 ± 8.6 years after FIS) prognostic effects of glycemic management on stroke recurrence and mortality of FISHG.ResultsStroke recurrence and mortality were significantly more likely in the patients with FISHG than their counterparts without hyperglycemia (p < 0.05). Under glycemic treatment, patients with FISHG demonstrated lower risk of mortality at every follow-up than those without (p < 0.001) but were not less likely to have stroke recurrence (p > 0.05). Integrating BGM with glycemic treatment in the FISHG cohort significantly reduced the risk of stroke recurrence compared to patients receiving only glycemic treatment at 1-month, 3-month, 6-month, and 1-year post-stroke follow-ups (adjusted hazard ratios = 0.84, 0.90, 0.88, and 0.92, respectively); additionally, this approach significantly decreased mortality risk at each post-stroke follow-up period (p < 0.05).ConclusionsBGM combined with glycemic treatment significantly improves prognosis in patients with FISHG who have not been previously diagnosed with DM, reducing the risks of stroke recurrence and mortality.

Radiation Myelitis Risk After Hypofractionated Spine Stereotactic Body Radiation Therapy.

Stereotactic body radiation therapy (SBRT) for spinal metastases improves symptomatic outcomes and local control compared to conventional radiotherapy. Treatment failure most often occurs within the epidural space, where dose is constrained by the risk of radiation myelitis (RM). Current constraints designed to prevent RM after spine SBRT are derived from limited data. To characterize the risk of RM after spine SBRT and to update the dosimetric constraints for preventing it. This cohort study was conducted in a single tertiary cancer care center with patients treated for spinal metastases from 2014 to 2023. All included participants had undergone spine SBRT, had a minimum of 1-month follow-up with magnetic resonance imaging (MRI), a maximal cord dose to a voxel (Dmax) greater than 0 Gy, and no overlapping prior radiotherapy. In all, 2051 patients received SBRT to 2835 spinal metastases (levels C1-L2) during the study period. Three-fraction spine SBRT to a prescription dose of 27 to 36 Gy. RM defined as radiographic evidence of spinal cord injury in the treatment field, classified as grade (G) 1 to G4 or G3 to G4 per the Common Terminology Criteria for Adverse Events, version 5.0. Multiple dosimetric parameters of the true spinal cord structure were assessed for an association with risk of RM to determine the important covariates associated with this toxicity. The analysis included 1423 patients (mean [SD] age, 61.6 [12.9] years; 695 [48.8%] females and 728 [51.1%] males) who received SBRT for 1904 spinal metastases. Among them, 30 cases of RM were identified, 19 of which were classified as G3 to G4. Two years after SBRT, the rate of G1 to G4 RM was 1.8% (95% CI, 1.2%-2.5%) and the rate of G3 to G4 RM was 1.1% (95% CI, 0.7%-1.7%). The minimum dose to the 0.1 cm3 of spinal cord receiving the greatest dose (D0.1cc) was the most important covariate on univariable cause-specific hazards regression for RM (for G3 to G4: hazard ratio, 2.14; 95% CI, 1.68-2.72; P < .001). A true cord D0.1cc of 19.1 Gy and Dmax of 20.8 Gy estimated a 1.0% risk (95% CI, 0.3%-1.6% and 0.4%-1.6%, respectively) of G3 to G4 RM 2 years after SBRT. The findings of this cohort study indicate that a cord (myelogram or MRI-derived) D0.1cc constraint of 19.1 Gy and a Dmax constraint of 20.8 Gy correspond with a 1.0% risk of G3 to G4 RM at 2 years.

The effect of pressing needle therapy on depression, anxiety, and sleep for patients in convalescence from COVID-19

ObjectiveTo evaluate the effect of pressing needle therapy on depression, anxiety, and sleep in patients recovering from COVID-19, and to provide a more effective and convenient treatment for the sequelae of COVID-19.MethodsA total of 136 patients recovering from COVID-19 were randomized into a treatment group (68 cases) and a control group (68 cases, with one case dropping out). The treatment group received pressing needle therapy, while the control group received sham pressing needle therapy, three times a week for 4 weeks. The Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Insomnia Severity Index (ISI) were used to evaluate patients’ emotional states and sleep quality. These scales were assessed before, after, and at a 1-month follow-up.ResultsCompared to before treatment, the treatment group showed a significant decrease in PHQ-9 scores (p &amp;lt; 0.05, Cohen’s d = 1.26), GAD-7 scores (p &amp;lt; 0.05, Cohen’s d = 1.10), and ISI scores (p &amp;lt; 0.05, Cohen’s d = 0.94) after treatment. Similarly, at the 1-month follow-up, significant decreases were observed in PHQ-9 scores (p &amp;lt; 0.05, Cohen’s d = 1.11), GAD-7 scores (p &amp;lt; 0.05, Cohen’s d = 0.88), and ISI scores (p &amp;lt; 0.05, Cohen’s d = 0.94). In contrast, the control group demonstrated no statistically significant differences in PHQ-9, GAD-7, or ISI scores after treatment or at the 1-month follow-up (p &amp;gt; 0.05). Between the two groups, statistically significant improvements (p &amp;lt; 0.05) were observed in PHQ-9 scores (Cohen’s d = 1.47), GAD-7 scores (Cohen’s d = 1.61), and ISI scores (Cohen’s d = 1.06) after treatment. At the 1-month follow-up, statistically significant differences (p &amp;lt; 0.05) between the two groups were also noted in PHQ-9 scores (Cohen’s d = 1.10), GAD-7 scores (Cohen’s d = 0.87), and ISI scores (Cohen’s d = 0.92).ConclusionPressing needle therapy significantly improves the mental health and sleep quality of patients recovering from COVID-19. It enhances their quality of life, promotes early recovery, and is simple and easy to administer, making it a treatment worthy of clinical application.Clinical trial registrationhttps://www.chictr.org.cn/.

Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study.

Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Feasibility was demonstrated, with almost 70% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required.

Changes in Healthcare Professionals' Practice Behaviors Through an Educational Intervention Targeting Weight Bias.

Weight bias is pervasive in healthcare and leads to worse patient outcomes. A uniquely designed 4-h continuing medical education (CME) intervention was assessed for changing healthcare professionals' (HCPs') weight biases and clinical practice behaviors. The intervention used a (1) pre/post design examining CME attendees' self-reported weight bias at baseline, after, and 4- and 12-month follow-up, and (2) post/post design examiningobesity practice behaviors 12months after intervention in attendees and non-attendees. Single medical center service area within Kaiser Permanente Southern California. All HCPs (n = 472) from the target service area were eligible to attend. Analyses were done with 218 HCPs who attended and 89 who did not. The intervention contained theory-based elements of changing attributions of responsibility of obesity, increasing empathy, creating self-awareness of weight bias, and creating a bias-free culture. For pre/post analyses, the primary outcome was self-reported weight bias. For comparative analyses of CME attendees and non-attendees, the outcomes were electronic medical record-confirmed rates of obesity diagnosis and referrals to evidence-based obesity treatments in the 12months following the CME intervention. Self-reported negative obesity stereotypes were significantly reduced compared to baseline while self-reported empathy and confidence in caring for patients with obesity were significantly increased immediately post intervention and were maintained at 4- and 12-month follow-up. After adjusting for years in practice, race/ethnicity, gender, profession type, practice type, and panel size, HCPs who attended the CME intervention had significantly increased odds (range 60-212%) of diagnosis and obesity-related referrals in the 12months following the CME intervention when compared to HCPs who did not attend. This intervention has promise to be a scalable program that goes beyond impacting HCP's self-reported weight bias and also changes HCPs' clinical practice behaviors related to obesity treatment.

Serial Examination of Platelet Function Tests Might Predict Prognosis of Patients with Acute Ischemic Stroke—A Cohort Study

Background: This study investigated whether point-of-care platelet function measurements could predict favorable outcomes in patients with acute ischemic stroke (AIS). Antiplatelet agents, such as aspirin, are known to reduce the risk of recurrent stroke by 20–30%. However, identifying nonresponders to therapy remains a clinical challenge. The study aimed to assess the prognostic value of serial Platelet Function Analyzer (PFA)-100 measurements and hematological ratios in AIS patients. Methods: A prospective cohort study was conducted on 212 AIS patients in Taiwan. Platelet function was assessed at baseline, week 2, and week 4 using PFA-100. The primary outcome was functional recovery, defined by a modified Rankin Scale (mRS) score of 0–3, at 1-month and 1-year. Subgroup analyses compared outcomes between pre- and post-aspirin administrations. Statistical analyses examined the association between changes in platelet function and clinical outcomes. Results: Difference in collagen and epinephrine (CEPI) measurements between baseline and week 2 was associated with favorable mRS scores (p &lt; 0.001). A difference in CEPI closure time greater than 99 seconds was most predictive of a favorable outcome with an adjusted odds ratio of 11.859 (95% CI 2.318–60.669) at 1-month follow-up. Subgroup analyses revealed predictive value in pre-aspirin measurements at 1-month follow-up (p = 0.007). Conclusions: Serial PFA-100 measurements and hematological biomarkers, specifically changes in on-treatment CEPI closure times, may help predict favorable clinical outcome in AIS patients. These findings suggest that dynamic platelet function assessment could play a role in optimizing antiplatelet therapy in AIS management.

Mental health in children admitted with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): a follow-up study at 6 months of the Swissped-RECOVERY trial

BackgroundPIMS-TS presents with features considered to pose a risk for the development of unfavourable long-term mental health outcomes which haven’t been prospectively investigated. These include neurological symptoms (headache, confusion, and delirium), systemic inflammation, and critical illness requiring PICU support. Therefore, we set out to investigate mental health at 6-month follow-up in patients recruited into Swissped-RECOVERY trial.MethodsThis is a pre-planned analysis of the Swissped-RECOVERY trial (clinicaltrial.gov, NCT 04826588) investigating intravenous immunoglobulins versus intravenous methylprednisolone in patients with PIMS-TS. Mental health was assessed 6 months after hospital discharge using the Strength and Difficulties Questionnaire (SDQ), leading to a score concerning mental well-being (total score scale 0–40 points, subdomains 0–10 points). At population level it is expected that 80% of children belong to the normal, 10% to the borderline, and 10% to the abnormal band of the SDQ scores.FindingsSeventy-five patients were included, 66 (88%) parent-reported and 26 (78.8%) self-reported SDQs were returned. The median total difficulty score was 7.0 [4.0, 11.8] for parent-reported and 11.0 [7.0, 14.8] for self-reported SDQ. The total difficulty score was borderline or abnormal in 12/58 (20.7%) of parent-reported and 7/26 (26.9%) of self-reported SDQs. Emotional problems were reported borderline or abnormal in 19% and 27% of the parent- and self-reported SDQ, respectively, and for hyperactivity/inattention 21% and 27%, respectively.ConclusionEmotional problems and hyperactivity/inattention appeared to be the pressing concerns. Potential interference with daily activities such as home life, friendship, etc., makes early identification important to ensure adequate support.Trail registrationClinicalTrials.gov, ID NCT04826588, https://clinicaltrials.gov/study/NCT04826588.

Closed trans-intersphincteric fistulotomy: a new modified sphincter-sparing technique for high transsphincteric anal fistula

BackgroundThe main goals of surgery for fistula-in-ano are to completely resolve the condition and maintain optimal anal function. Effective management of the internal opening during and proper postoperative drainage of the intersphincter plane are crucial for achieving successful outcomes. This study evaluated the clinical efficacy of a novel sphincter-sparing technique for treating high transsphincteric anal fistula (HTAF).MethodsThis prospective study included 55 patients with HTAF who underwent closed trans-intersphincteric fistulotomy (CTiF) between July 2021 and April 2022 at our institution. Preoperative anorectal magnetic resonance imaging was performed for all patients. The primary outcome measures assessed the rate of fistula healing while the secondary outcome measures evaluated healing time, Cleveland Clinic Florida fecal incontinence score (CCF-FIS), 11-point visual analog scale (VAS) pain score and postoperative complications.ResultsWe included 55 patients with HTAF in this study. During a mean follow-up period of 9.3 months, CTiF achieved a healing rate of 90.91% (50/55). The mean time to recovery was 7.09 ± 1.94 weeks. Four (7.27%) patients developed postoperative urinary retention. At the 6-month follow-up, the CCF-FIS and VAS score were 0 [(0,0) range, 0–3] and 0 [(0,1); range, 0–4], respectively. Two patients with recurrent HTAF recovered after treatment with a transanal opening of intersphincteric space procedure, and three recovered after seton placement.ConclusionsCTiF is a promising and effective sphincter-sparing technique for treating HTAF. To confirm long-term outcomes, larger sample size prospective randomized controlled trials are required.

Effect of High-Intensity Focused Electromagnetic Technology in the Treatment of Female Stress Urinary Incontinence

Background: The aim of the study was to assess the effect of high-intensity focused electromagnetic (HIFEM) technology in the treatment of female stress urinary incontinence (SUI). Materials and Methods: 20 women with SUI were delivered a treatment course with HIFEM technology. Patients attended 6 therapies scheduled twice a week. Validated questionnaires were assessed, including the overactive bladder symptoms score (OABSS), urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), international consultation on incontinence questionnaire (ICIQ), and valued living questionnaire (VLQ). Some urodynamic parameters, such as maximum flow rate (Qmax), residual urine (RU), and bladder volume at first sensation to void (Vfst). Bladder neck mobility in ultrasound topography was also collected pre- and post-treatment at 1- and 6-month follow-up visits. Results: HIFEM treatment significantly improved SUI symptoms on pad tests from 4.2 ± 5.5 to 0.6 ± 1.3 and patients’ self-assessment in the 6-month follow-up. Additionally, the data from urinary-related questionnaires, including OABSS (5.3 ± 3.9 to 3.9 ± 3.6), UDI-6 (35.7 ± 22.3 to 15.2 ± 10.6), IIQ-7 (33.1 ± 28.7 to 14.3 ± 17.2), and ICIQ (9.4 ± 5.0 to 5.4 ± 3.6), all showed a significant reduction. Then, the analysis of the urodynamic study revealed that only maximum urethral closure pressure (MUCP) (46.4 ± 25.2 to 58.1 ± 21.2) and urethral closure angle (UCA) (705.3 ± 302.3 to 990.0 ± 439.6) significantly increased after the six sessions of HIFEM treatment. The urethral and vaginal topography were performed and found that HIFEM mainly worked on pelvic floor muscles (PFM) and enhanced their function and integrity. Conclusions: The results suggest that HIFEM technology is an efficacious therapy for the treatment of SUI.

Selective dorsal rhizotomy outcomes in mixed spasticity and dystonia cases.

This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia. A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale. Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved. SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.

Pulsed-field ablation of atrial fibrillation with a pentaspline catheter across National Health Service England centres

IntroductionPulsed-field ablation (PFA) is a novel modality for pulmonary vein isolation in patients with atrial fibrillation (AF). We describe the initial uptake and experience of PFA using a pentaspline catheter...

Transophthalmic Artery Embolization of Anterior Skull Base Meningiomas: Technical Case Series.

Preoperative embolization of anterior skull base meningiomas can facilitate surgical resection by reducing tumor vascularity. However, transophthalmic artery embolization carries risks of visual complications. This study aimed to evaluate the safety and efficacy of this technique using modern endovascular tools. This retrospective study included patients with anterior skull base meningiomas who underwent preoperative transophthalmic artery embolization followed by surgical resection between January 2022 and April 2024. Patient demographics, tumor characteristics, embolization details, surgical outcomes, and complications were analyzed. Seven patients (median age 57 years; 6 male) underwent embolization for tumors located primarily at the planum sphenoidale (58%). Unilateral embolization was performed in most cases, with one bilateral transophthalmic approach. Commonly embolized branches included the anterior and posterior ethmoidal arteries. Polyvinyl alcohol particles were the primary embolic agent (71%). Angiographic devascularization was achieved in all cases without complications. Gross total resection was achieved in 71%, with a median blood loss of 427 cc. At a 9-month follow-up, the median modified Rankin Scale score was 1. With careful patient selection, advanced microcatheter technology, and meticulous technique, preoperative transophthalmic artery embolization can be safely performed to facilitate resection of anterior skull base meningiomas. These results suggest it is a viable option for well-selected patients at experienced centers, though larger prospective studies are needed. Fr = French (unit of measurement for catheter diameter); IQR = Interquartile range; IRB = Institutional Review Board; PVA = Polyvinyl alcohol; TOAE = Transophthalmic artery embolization; WHO = World Health Organization.

Trypsinized suction blister

Suction blister epidermal grafting (SBEG) is a standard technique for treating vitiligo on challenging areas like fingertips and lips but often results in pigment halos and difficulties with small, curved surfaces. We propose a modified SBEG technique, utilizing trypsinization of one blister graft to improve melanocyte spread and reduce peri-graft halo. Trypsin ethylenediaminetetraacetic acid (EDTA) solution is introduced into a selected blister, creating a cell suspension applied to dermabraded gaps and peripheries, including eyelid margins. At 5-month follow-up, complete re-pigmentation with no halo effect was achieved, indicating this modified approach’s potential in enhancing SBEG outcomes for complex sites.

Evaluating artesunate monotherapy and dihydroartemisinin-piperaquine as potential antimalarial options for prevaccination radical cures during future malaria vaccine field efficacy trials

BackgroundIn malaria vaccine clinical trials, immune responses after vaccination may be compromised due to immunosuppression caused by concurrent Plasmodium falciparum infection. This has a direct effect on the protective efficacy of the vaccine being evaluated. Therefore, parasite clearance prior to vaccination is being considered. Drugs with good safety and efficacy profiles and a short posttreatment prophylaxis period should be used. Two antimalarial drugs, artesunate (AS) as monotherapy and dihydroartemisinin-piperaquine (DHAPQ), have been evaluated in order to identify the most suitable option for use in future trials.MethodsA cohort of children aged 1.5–12 years living in the Banfora Health District area was recruited. They were randomly assigned to receive supervised curative doses of AS monotherapy for 7 days or DHAPQ for 3 days. A polymerase chain reaction (PCR) was performed 21 days after treatment to confirm clearance of infection, and only those with a negative PCR were included in the study cohort for a 6-month longitudinal follow-up. Cohort children were actively visited fortnightly to collect blood samples for P. falciparum detection via microscopy and PCR. Passive surveillance was also conducted at the local health facility to record incident malaria episodes that occurred between two active visits.ResultsA total of 513 children were treated. Among these patients, 458 (89.3%) were free of P. falciparum malaria infection on day 21: 87.3% (226/259) in the AS group vs 91.3% (232/254) in the DHAPQ group (p = 0.053). The mean time to first malaria infection by microscopy was 154.9 (2.9) days in the DHAPQ arm and 129.0 (3.9) days in the AS arm (p < 0.01). The incidence rates of clinical malaria episodes during the follow-up period were 0.507 (0.369–0.645) and 0.293 (0.190–0.397) in the AS and DHAPQ arms, respectively (p < 0.05).ConclusionsThese findings suggest that although both drugs are effective in clearing P. falciparum infections, AS is likely to cause no more than minimal interference with the evaluation of vaccine efficacy endpoints and could, therefore, be considered for use.Trial registration: NCT04601714.

Surgical technique for mitral valve repair in dogs using a novel method to anchor artificial chordae tendineae with emphasis on key intraoperative decision points

ObjectivesSurgical options for mitral valve repair in dogs are unstandardized and influenced by various factors. This study describes a four-point surgical technique (MI-4) to reduce mitral regurgitation and provides data from a study of dogs with 12 months of follow up.MethodsTwenty-five dogs with stages C or D mitral insufficiency were treated by one of two surgeons using the MI-4 procedure at Ueno no Mori Animal Hospital between October 2021 and May 2023. The surgical technique comprised: (I) determination of the valve annulus dimensions by measuring between the trigones, (II) triad-anchored chordae tendinea reconstruction, (III) determination of the appropriate position and number of chordae tendineae on the leaflets, and (IV) appropriate height determination. The regurgitation percentage was measured using B-mode color Doppler flow in the atrium in the four-chamber left long-axis view.ResultsThere were no intraoperative complications, and 23, 23, and 18 dogs were successfully re-evaluated at 1, 6, and 12 months, respectively (5 dogs have not yet reached the 12-month follow-up point). The regurgitation percentage decreased from 73.0% (interquartile range, 58.1–81.5%) preoperatively to 2.1% (0.0–8.8%), 4.6% (0.1–10.8), and 1.3% (0.0–7.1) at 1, 6, and 12 months postoperatively, respectively. All surviving dogs improved clinically.ConclusionThe MI-4 surgical technique was performed in dogs with mitral valve insufficiency with no significant complications. The surgery reduced the regurgitation percentage postoperatively, with benefits seen at least 12 months after surgery.

Prognostic value of macular neovascularisation characteristics for photoreceptor integrity in nAMD: a prospective observational study

PurposeTo explore the relationship between characteristics of macular neovascularisation (MNV) and photoreceptor integrity in patients with neovascular age-related macular degeneration (nAMD).MethodsThis prospective study enrolled treatment-naïve nAMD eyes and conducted a...

A comparative analysis of platelet-rich plasma alone versus combined with extracorporeal shockwave therapy in athletes with patellar tendinopathy and knee pain: a randomized controlled trial

BackgroundPatellar tendinopathy, also known as jumper’s knee, can significantly impact the quality of daily life for patients due to the associated pain. A randomized controlled trial was investigated the clinical, sonographic, and serum cytokine markers in patellar tendinopathy of athletes following platelet-rich plasma (PRP) or PRP with extracorporeal shockwave therapy (ESWT) treatments. Our aims to investigate and compare therapeutic effects of PRP versus a combination of PRP with ESWT for treating patellar tendinopathy.MethodsA total of 33 athletes with patellar tendinopathy were randomized into two groups. PRP + Sham (PS) group received intraarticular injection of autologous PRP (5 mL) once and sham ESWT. PRP + ESWT (PE) group received intraarticular injection of autologous PRP once and after 1 week ESWT (0.2 mJ/mm2 energy flux density, 1350 impulses, 4 Hz) once. All patients were followed up for 1 year.ResultsAutologous PRP injection and its combination with ESWT are both effective treatments for chronic patellar tendinopathy in athletes. PRP combined with ESWT resulted in faster reduction of knee pain than PRP alone at the 1-month follow-up. Serum IL-33 showed no significant difference at the 12-month follow-up. Levels of interleukin (IL)-6, IL-15, and IL-17 increased at the 12-month follow-up, potentially due to the additional training. However, the athletes did not report any discomfort or injuries, and no abnormalities were detected by ultrasonography after study. We demonstrated improvements in pain and functional scores, as well as knee injury protection in athletes, following 12 months of PRP and PRP with ESWT treatments.ConclusionsThe study analyzed the therapeutic effect of PRP injection alone and combining PRP injection with ESWT for chronic patellar tendinopathy. Our results showed that combined treatment can facilitate the pain relief early than PRP alone and is a safety treatment modality. No adverse effect was noted in our study.Trial registration Research registry and the registration number is researchregistry9518. Registered 14 September 2023. https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650263e4f549fd00282a338c/. The level of evidence is level II.