Alternative Interventions Research Articles

Transcutaneous auricular vagal nerve stimulation modulates blood glucose in ZDF rats via intestinal melatonin receptors and melatonin secretion

BackgroundMelatonin (MLT) and its receptor deficiency have been shown to be associated with type 2 diabetes mellitus (T2DM). Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive alternative intervention for patients suffering from hyperglycemia. Here, we aimed to investigate the role of taVNS on blood glucose modulation via intestinal melatonin receptors (MRs) and MLT secretion in hyperglycemia.MethodsAdult male Zucker diabetes fatty (ZDF) rats and Zucker lean (ZL) littermates were used. Forty ZDF rats were randomized into ZDF, taVNS, Px + taVNS and Lu + Px + taVNS groups (Px: pinealectomy, Lu: Luzindole). ZL rats served as a control group for comparison with ZDF rats without involvement in the taVNS intervention. Thirty min-taVNS interventions (2/15 Hz, 2 mA, 30 min/days) were administered once daily under anesthesia for 3 consecutive weeks in taVNS, Px + taVNS and Lu + Px + taVNS groups. Body weight and fasting blood glucose (FBG) were measured weekly in all rats, and real-time blood glucose was tested in the ZL and ZDF groups before, during and after the taVNS intervention. Plasma MLT concentration and the expression of MRs in the duodenum, jejunum and ileum were measured by the end of experiments.ResultsCompared with the ZL group, the level of FBG and body weight increased (all p < 0.01), plasma MLT secretion and the expression of MRs in duodenum, jejunum and ileum of ZDF rats decreased obviously (all p < 0.05), respectively. TaVNS can significantly reverse the hyperglycemia by regulating the non-pineal-derived MLT and MRs system in Px + taVNS group. Compared with the ZDF group, the expression of different intestinal MRs in the taVNS group was increased and more compactly arranged (both p < 0.05), the level of plasma MLT secretion was up-regulated (p < 0.01), and FBG and body weight were decreased (both p < 0.01). Meanwhile, after taVNS intervention in rats in the Px + taVNS group, we observed an increase in MLT secretion and the number of intestinal MRs compared with the taVNS group (all p > 0.05). In contrast, ZDF rats in which the pineal gland was excised by taVNS intervention and injected with the MRs antagonist Luzindole did not show these changes.ConclusionThe glucose reduction effect of taVNS may be related to regulating MLT levels and expressing intestinal MRs.

Sump syndrome: Diagnosis dilemmas and therapeutic approaches-A case series.

It is important to consider the diagnosis of Sump syndrome in patients with a history of open cholecystectomy, particularly in those who migrate from developing countries where alternative biliary interventions may be limited. The presentation may range from acute severe, mimicking acute ascending cholangitis, to chronic recurrent abdominal pain without evidence of inflammation. Management is a case-by-case decision, with principal management aims to decompress the biliary tract and address any underlying sepsis. Sump syndrome is a rare and often long-term complication of choledochoduodenostomy (CDD). The presentation and severity are variable, and management should be tailored to each patient based on several factors. Herein, we report three cases of sump syndrome, each demonstrating unique diagnostic dilemmas and therapeutic modalities. Case I describes a woman presenting with acute cholangitis, managed with percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). Case II illustrates a similar presentation complicated by myocardial infarction, necessitating urgent biliary decompression via PTC and subsequent unsuccessful endoscopic stenting. Case III highlights the diagnostic difficulty in a stable patient with inconclusive diagnostic imaging. This case series emphasizes the importance of considering sump syndrome diagnosis in patients with a history of CDD or open cholecystectomy, especially in elderly patients and those who come from regions where alternative biliary interventions may be limited.

Prognostic significance of oxygen saturation/fraction of inspired oxygen 3 days after initiation of tocilizumab treatment in patients with COVID-19

BackgroundTocilizumab is effective in treating severe coronavirus disease 2019 (COVID-19). However, the specific time point it acts as a valid indicator of treatment efficacy remains unclear. This study aimed to determine the optimal day for assessing the prognostic value of the oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) and ratio of respiratory rate-oxygenation (ROX) index in patients receiving tocilizumab for COVID-19. MethodsAll patients admitted to our hospital from March 2020 to July 2021 who received tocilizumab for COVID-19 were retrospectively identified from hospital charts. Biodata, medical history, and laboratory tests results were obtained from medical records. The prognostic values of the SpO2/FiO2 and ROX index for predicting mortality were assessed. Cox proportional hazard and receiver operating characteristic curve models were utilized. ResultsOf the 84 included patients, 34 died within 7 days after discharge. The patients who recovered had a mean age of 65 years and were younger than those who died. The multivariate analysis indicated that multiple comorbidities, cancer history, CURB-65 score, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and lactate dehydrogenase levels were higher in those who died compared with those who survived. No significant differences were found in dyspnea or total bilirubin levels between the two groups. The SpO2/FiO2 at 3 days post-tocilizumab initiation was strongly associated with survival. ConclusionsThe SpO2/FiO2 on day 3 post-tocilizumab initiation was a predictor of COVID-19 prognosis, which could be employed in determining clinical decisions. Prompt alternative interventions should be considered when this ratio does not improve.

Usability and engagement of web application on parental behaviors for child obesity intervention

Background: Childhood obesity is a growing global health issue, with increasing prevalence in Asian countries, including Malaysia. Web applications such as JEJAK BMI offer an alternative intervention to address this concern by targeting parental behaviors that could influence their children’s weight. The usability and engagement of the app used are important elements that could influence the intervention outcome. Objective: To assess the engagement and usability of JEJAK BMI apps that could affect parental use of apps in child obesity interventions. Methods: To evaluate the app’s usability, three criteria were evaluated which were ease of use, visual appeal and functionality, post-intervention questionnaires were completed by the parents. Results: The study found that most parents considered the app practical, easy to use, visually engaging and functional. However, the impact on children's BMI over the short term was inconclusive. Conclusion: The JEJAK BMI web application demonstrated strong usability and positive effects on parental behaviors. Nonetheless, significant changes in children's BMI may require longer-term interventions and additional strategies.

COMPLICAÇÕES CRÔNICAS DO DIABETES MELLITUS TIPO 2

Diabetes mellitus is defined as a chronic non-communicable disease (NCD), being a syndrome characterized by persistent hyperglycemia, resulting from metabolic disorders, which may occur due to the destruction of insulin-producing beta cells or resistance to insulin action. The increase in plasma glucose occurs due to defects in the secretion and/or action of insulin produced by the pancreas, and can be subdivided into three main types: Type 1 Diabetes mellitus (autoimmune), Type 2 Diabetes mellitus (insulin resistant) and Diabetes gestational mellitus. Diabetes is characterized by multiple complications, acute and chronic (divided into microvascular and macrovascular), which constitute an important cause of early mortality. Chronic microvascular complications are associated with specific injuries caused by difficulty in passing blood to the endothelium. This obstruction occurs due to chronic hyperglycemia that triggers endothelial inflammation, resulting in the production of advanced glycolysis products, leading to oxidative stress, inflammation and the appearance of microthrombi, making this passage difficult. Macrovascular complications, in addition to hyperglycemia, are also related to problems such as dyslipidemia, systemic arterial hypertension and smoking. Such factors can lead to stroke, acute myocardial infarction and peripheral arterial obstructive disease. This work proposes a critical review of the existing literature on the chronic complications of Type 2 Diabetes mellitus, highlighting screening, prevention and treatment measures. It is concluded that technical and clinical knowledge about the pathophysiology and alternative interventions is essential for the immediate and comprehensive care of patients with Type 2 Diabetes mellitus, as well as the prevention of its chronic complications.

Prevalence, mechanisms and prognostic impact of dynamic mitral regurgitation unmasked by handgrip exercise in patients with hypokinetic non-dilated and dilated cardiomyopathy

Abstract Background Recent studies suggest that mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the hemodynamic relevance of MR and is recommended by current guidelines. Handgrip exercise may serve as alternative exercise intervention to bicycle exercise, as it is easy to perform even bedside. However, there are no data yet, on the prevalence, mechanisms and prognostic impact of dynamic MR in patients with dilated cardiomyopathy using isometric exercise testing. Aims We aimed to assess the prevalence, hemodynamic consequences, and prognostic impact of exercise-induced changes in MR in patients with hypokinetic non-dilated and dilated cardiomyopathy. Methods Patients with hypokinetic non-dilated and dilated cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled.Patients were followed-up for one year to assess clinical outcomes. We assessed all-cause mortality, HF-associated hospitalizations, MV surgery, transcatheter edge-to-edge repair (TEER), left ventricular assist device implantation and heart transplantation during follow-up. Results Fifty-eight patients were included (mean age 70±15 years; 41% female; mean LVEF 37±10%). At rest, 28 patients (48%) presented with mild MR, and 30 patients (52%) had moderate MR. Fifteen patients (26%) with non-severe MR at rest, developed dynamic severe MR during handgrip exercise. Patients with dynamic severe MR had advanced MR at rest, larger left atrial dimensions, and increased mitral annulus diameter (all p<0.01). During exercise, LVEDVi, LVESVi and parameters of local left ventricular remodeling (tenting height, tenting area) were increased in patients with dynamic severe MR compared to those with non-severe MR (all p<0.05). During one-year follow-up, there was no difference regarding all-cause mortality and HF hospitalizations in patients with dynamic severe MR and non-severe MR (Log-rank test Chi2 0.262; p=0.609)(Figure 1). However, patients with dynamic severe MR more often underwent mitral valve surgery/intervention than patients with non-severe MR (Log-rank test Chi2 29.41; p<0.001)(Figure 1). Conclusion Our results demonstrate that the evaluation of non-ischemic MR only at rest underestimates the full severity of the lesion. Handgrip exercise unmasks severe MR in every fourth patient with non-severe MR at rest. These data may have implications for therapeutic decision-making in symptomatic patients with hypokinetic non-dilated and dilated cardiomyopathy and non-severe MR at rest. TEER might present an effective treatment option to improve clinical outcomes in patients with non-ischemic cardiomyopathy and non-severe MR at rest but dynamic severe MR during exercise.Figure 1

Proactive control for conflict resolution is intact in subclinical obsessive-compulsive individuals.

BackgroundObsessive-compulsive (OC) traits (i.e., tendency to implement stereotyped behaviors to avoid negative consequences) are transversally observed in psychiatric disorders largely differing in terms of clinical manifestations and etiopathogenesis. Interestingly, OC traits were also extensively found in the prodromal phases of the full-blown psychopathology and in healthy relatives of affected individuals. Moreover, OC traits were found to be associated—and possibly underlain by—cognitive control impairments. Nonetheless, the role of such interplay in the onset of OC disorders is yet to be understood. We hypothesized that OC traits are associated with abnormalities in proactively implement cognitive control for solving conflict.MethodsWe administered healthy individuals (n = 104) with the perifoveal spatial Stroop task to measure their ability of solving conflict in a proactive fashion, and with Obsessive-Compulsive Inventory (OCI) to stratify population according to the severity of OC traits.ResultsAnalysis of response times by means of Linear Mixed-effect models revealed that proactive control performance was not associated with and the severity of OC traits. Furthermore, an equivalence test (Two One-Sided Test) revealed that the association between OCI scores and task performance was equivalent to zero.ConclusionThese results suggest that the interplay between OC traits and proactive control abnormalities might not contribute to the development of OC-related disorders. Therefore, the role of other cognitive endophenotypes should be scrutinized for exploiting alternative prevention and intervention strategies.

Systems modelling and simulation to guide targeted investments to reduce youth suicide and mental health problems in a low–middle-income country

BackgroundDespite suicide’s public health significance and global mental health awareness, current suicide prevention efforts show limited impact, posing a challenge for low- and middle-income countries. This study aimed to develop a dynamic simulation model that could be used to examine the potential effectiveness of alternative interventions for reducing youth mental health problems and suicidal behavior in Bogotá, Colombia.MethodsA system dynamics model was designed using a participatory approach involving three workshops conducted in 2021 and 2022. These workshops engaged 78 stakeholders from various health and social sectors to map key mental health outcomes and influential factors affecting them. A model was subsequently developed, tested, and presented to the participants for interactive feedback, guided by a moderator. Simulation analyses were conducted to compare projected mental health outcomes for a range of intervention scenarios with projections for a reference scenario corresponding to business-as-usual.ResultsA total of 6670 suicide attempts and 347 suicides are projected among 7 − 17-year-olds from January 1, 2023, to early 2031 under the business-as-usual scenario. Mental health issues among 12 − 17-year-olds are projected to increase from 18.9% (2023) to 27.8% (2031), and substance use issues from 2.29 to 2.49% over the same period. School-based suicide prevention and gatekeeper training are the most effective strategies, reducing total numbers of suicide attempts and suicides by more than 20% (i.e., compared to business-as-usual). However, discontinuous funding significantly hinders these effective suicide prevention efforts.ConclusionsSystems modelling is an important tool for understanding where the best strategic financial and political investments lie for improving youth mental health in resource-constrained settings.

A review of exercise interventions for reducing anxiety symptoms: Insights and implications.

Generalized anxiety disorder (GAD) is a prevalent mental health condition affecting a significant proportion of the adult population. Despite the availability of pharmacological treatments, their long-term efficacy and potential side effects necessitate exploring alternative interventions. Aerobic exercise has emerged as a promising non-pharmacological approach for managing anxiety symptoms in individuals with GAD. This narrative review examines the efficacy of aerobic exercise interventions in alleviating symptoms of anxiety disorders, drawing on a comprehensive analysis of relevant literature. The review synthesizes findings from studies investigating various forms of aerobic exercise, including high-intensity interval training, resistance training, Pilates, and walking. The results indicate that aerobic exercise interventions demonstrate efficacy in reducing anxiety symptoms and improving overall well-being across diverse populations, including primary care patients, individuals with coronary heart disease, and older adults with cancer undergoing chemotherapy. The review discusses the neurobiological and psychological mechanisms underlying the anxiolytic effects of aerobic exercise. It highlights the implications of these findings for clinical practice, public health initiatives, and future research directions. Despite the promising evidence, limitations in study methodologies and heterogeneity across interventions warrant a cautious interpretation of the results. Further research is needed to elucidate optimal exercise modalities, dosages, and long-term effects on anxiety outcomes.

Botulinum toxin for the management of bruxism: an overview of reviews protocol

IntroductionBruxism is characterised by a repetitive activity in the masticatory muscles that involves teeth clenching or grinding and/or forceful mandibular movements. Its management is typically initiated when individuals start experiencing...

Is endoscopic decompression for Morton's neuroma a safe technique?

IntroductionMorton's neuroma is predominantly attributed to chronic nerve entrapment within third space adjacent metatarsals, the deep transverse metatarsal ligament (DTML), and the plantar skin. While conservative treatments are of election, failures require alternative interventions such as ultrasound-guided injections and various surgical procedures, including minimally invasive neurectomy and DTML release. This study aimed to anatomically assess the risks associated with the endoscopic dorsal surgical decompression of Morton's neuroma. Materials and methodsTwenty feet from ten fresh-frozen cadaveric specimens underwent a dorsal percutaneous approach for endoscopic access. Surgical procedures were monitored by three foot and ankle surgeons. Post-surgical anatomical dissections were conducted to evaluate potential risks to surrounding structures. ResultsThe endoscopic technique successfully sectioned the DMTL in all specimens (100%) without iatrogenic injury of tendons, nerves, or arteries, while lumbricals may be at risk. ConclusionEndoscopic dorsal decompression of Morton's neuroma presents as an accessible minimally invasive surgical option with low risk of collateral associated injuries.

Assessing investment priorities for inclusive agricultural transformation in Tanzania

AbstractMotivationPolicy‐makers dealing with conflicting development goals and constrained budgets must comprehend the relative cost effectiveness of agricultural and rural development initiatives.PurposeWe assess the impact of alternative interventions on development outcomes—economic growth, job creation, poverty reduction, and diet quality—to inform decision‐making and resource allocation in Tanzania's agriculture. We analyse trade‐offs among development objectives and explore budget reallocation to enhance the efficiency of public spending.Approach and methodsWe used a computable general equilibrium (CGE) model linked top‐down with microsimulation modules to simulate the impact of public investment options.FindingsNo single option emerges as the most effective across all development objectives. Investments in improved inputs and extension for horticulture and cash crops stand out for diet quality and employment creation. Livestock services show consistently high rankings across multiple objectives. Investments to boost cereals and root crops promote growth and reduce poverty but do little to increase employment and diet quality.Budget reallocation towards more cost‐effective interventions can significantly enhance the development effectiveness of Tanzania's agricultural expenditures and would substantially increase cumulative gross domestic product growth between 2019 and 2028.Policy implicationsPolicy‐makers can use the findings to design and prioritize agricultural interventions that better align with broader development objectives. Tanzania can achieve higher benefits and contribute to overall development goals by reallocating resources towards more cost‐effective expenditure options.

Positive Effects of Two Interventions to Reduce Stress in Students of Different Courses of Study

Abstract: Background: Students report high levels of stress. Aim: Investigation of the effectiveness of cognitive-behavioral and meditation interventions to reduce stress in students of psychology and dentistry. Method: In longitudinal control group comparisons, 262 students were divided into five groups: cognitive-behavioral training (IGcogPsy: n = 59 psychology; IGcogDent: n = 41 dentistry), mindfulness-based meditation (IGmedPsy: n = 63 psychology), measurement controls (CGPsy: n = 57 psychology; CGDent: n = 42 dentistry). 126 psychology students (IGcogPsy: n = 43; IGmedPsy: n = 47; CGPsy: n = 36) took follow-up tests 6 months after training. Results: ANCOVAs with repeated measurement factor (interactions group/time t1 to t2; co-variates: terms studied, gender, the stress in addition to studies) and contrasts over pairwise differences (alpha-error accumulation correction applied) showed stronger improvements for all IGs compared to CGs in coping strategies, self-efficacy, and learning strategies. IGcogPsy also improved more in test anxiety, and IGcogDent in test anxiety, trait and state anxiety. IGcogPsy and IGmedPsy reduced stress symptoms. At follow-up (simultaneous ANCOVAs t1, t2, t3; contrasts), more favorable development in test anxiety and some learning strategies resulted in both IGcogPsy and IGmedPsy compared to CGPsy. Limitations: Controls received feedback on concentration development but no alternative intervention. Confounding by self-selection cannot be ruled out. Conclusion: Cognitive-behavioral intervention had comprehensive impacts on all areas under investigation for both psychology and dental students; meditation was effective primarily in areas not directly related to action. Both interventions evoked some long-term effects.

Socio-Communicative Behaviors Involving Minimally Speaking Autistic Preschoolers and Their Typically Developing Peers: Effects of an Augmentative and Alternative Communication Intervention Package.

The purpose of this study was to examine the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided AAC modeling with speech-output technology on the acquisition, maintenance, and generalization of socio-communicative behaviors in four minimally speaking, preschool-aged, autistic children. A multiple-probe design across behaviors (i.e., initiating a request for a turn, answering questions, and commenting) replicated across participants was implemented to evaluate the effects of the intervention package on socio-communicative behaviors. Furthermore, a pretreatment and posttreatment multiple-generalization-probe design was used to assess generalization across typically developing peers who were not a part of the intervention. Maintenance data were collected 3 weeks post intervention. Visual analysis, corroborated by nonoverlapping of all pairs statistics, established a strong functional relationship between the AAC intervention package and all targeted socio-communicative outcomes for two participants. For the other two participants, inconsistent intervention effects were observed. In terms of generalization from interacting with the researcher to typically developing peers, a functional relationship between the intervention and generalization outcomes for all targeted behaviors was established for only one participant (i.e., Aiden). The outcomes of this study suggest that aided AAC modeling and systematic instruction using a speech-output technology may lead to gains in socio-communicative behaviors in some minimally speaking, preschool-aged, autistic children. https://doi.org/10.23641/asha.27091879.

Evaluation of a novel biplex rapid diagnostic test for antibody responses to Loa loa and Onchocerca volvulus infections.

Endemic to Central Africa, loiasis, caused by the vector-borne worm Loa loa, affects approximately 10 million individuals. Clinical manifestations include transient angioedema (Calabar swellings), migration of the adult worm under the eye conjunctiva (eye worm) and less specific general symptoms. Loiasis presents a significant public health challenge because L. loa-infected individuals can develop serious adverse events after taking ivermectin, the drug used to combat onchocerciasis. In this context, alternative interventions and rigorous diagnostic approaches are needed. Diagnosing loiasis is challenging because its main clinical manifestations are sporadic and non-specific. The definitive diagnosis relies on identifying adult worms migrating beneath the conjunctiva, or microfilariae (pre-larvae) in blood smears. However, "occult loiasis" (infection without blood microfilariae) is frequent. Serological rapid antibody diagnostic tests (ARTs) can provide an alternative diagnostic method. We compared a novel ART simultaneously targeting onchocerciasis (IgG4 to Ov-16 and OvOC3261, test line 1) and loiasis (IgG4 to L1-SXP-1, test line 2), called IgG4-SXP-1 biplex test) to the already established Loa-ART (all IgG isotypes to Ll-SXP-1, called pan-IgG-SXP-1 test). Blood samples underwent both ARTs, read qualitatively and semi-quantitatively. Additionally, blood smears, skin snips, Kato-Katz method for soil-transmitted helminthiases identification and eosinophilia measurements were performed. Questionnaires gathered demographic details and loiasis-related signs. ARTs performance was compared using specific loiasis-related signs and microfilaremia as references. Discordances between the two ARTs were investigated using logistic regression models. Out of 971 participants, 35.4% had L. loa microfilaremia, 71.9% had already experienced loiasis-related signs, 85.1% were positive in the pan-IgG-SXP-1 test and 79.4% were positive in the IgG4-SXP-1 biplex test. In the microfilariae-positive population, the sensitivity of the rapid tests was 87.4% for the pan-IgG-SXP-1 test and 88.6% for the prototype IgG4-SXP-1 biplex test. Sensitivity was similar for both ARTs when using eye worm or Calabar swelling as references, but diagnostic performance varied based on microfilaremia levels and occult loiasis. Overall, IgG4-SXP-1 biplex test demonstrated a sensitivity of 84.1% and specificity of 47.6% for loiasis compared to the pan-IgG-SXP-1 test, leading to a Kappa coefficient estimated at 0.27 ± 0.03 for the qualitative results of the 2 ARTs. In the group that tested positive with the Pan-IgG test but negative with the IgG4-specific test, there was a lower prevalence of STH infection (p = 0.008) and elevated eosinophilia (p<0.001) compared to the general tested population. The sensitivity of each test was good (84-85%) but the diagnostic agreement between the two ARTs was poor, suggesting that IgG and IgG4 antibody responses should be interpreted differently. The assessment of the innovative rapid diagnostic IgG4-SXP-1 biplex test, designed for onchocerciasis and loiasis, shows encouraging sensitivity but underlines the necessity for further in vitro assessment.

Identification of two repurposed drugs targeting GSDMD oligomerization interface I to block pyroptosis.

As an executor of pyroptosis, gasdermin D (GSDMD) plays a critical role in inflammatory diseases and cancer. Thus, GSDMD is currently being widely explored as a drug target. Existing inhibitors targeting GSDMD, such as necrosulfonamide, disulfiram, and fumarate, primarily prevent pyroptosis by modifying human/mouse C191/C192 in the N-terminal fragment of GSDMD. However, cysteine modification can prevent the function of important proteins or enzymes, thereby leading to adverse reactions. Here, we chose an alternative key intervention site for GSDMD activation, which is located at the oligomerization interface I of its pore-forming structure. Through high-throughput virtual and experimental screening and in combination with efficacy and pharmacological validation, we have identified two safe, specific "repurposed drugs" that potently suppress GSDMD-mediated pyroptosis. Moreover, the candidates exhibited synergistic therapeutic effects of "1+ 1>2" in murine sepsis and tumorigenesis models. These recently identified GSDMD inhibitors hold great promise for clinical translation in the development of anti-inflammatory and anti-cancer immunotherapies.

Remote delivered cognitive rehabilitation programs in Acquired Brain Injury: a systematic review of methods and outcomes

AbstractRemote delivered cognitive rehabilitation programs (r-CRP) are increasingly recognized as alternative and complementary intervention approaches to traditional cognitive rehabilitation (CR) in the context of several neurological conditions, including acquired brain injuries (ABI). This systematic review examines the methodological characteristics of currently available r-CRP for ABI patients and investigates their impact on cognitive and noncognitive outcomes. A systematic search was performed on EBSCOhost, PubMed, and Web of Science, complemented by a manual search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration Guidelines were followed. Out of 1624 studies, a total of 19 studies were included. The results demonstrate that most r-CRP were administered to middle-aged community-dwelling chronic stroke survivors and that there was no consensus regarding assessment and intervention protocols. Moreover, most r-CRP were delivered through information and communication technologies (ICTs), primarily relying on cognitive training (CT) interventions addressing multiple cognitive domains (e.g., attention, memory). These ICT-based CT programs included tasks with low ecological validity, i.e., tasks with limited real-world application (e.g., cancelation tasks with artificial stimuli), and were asynchronous, meaning that participants performed the sessions at their own pace, without real-time monitoring from a therapist. In terms of the impact of r-CRP, class I studies reported mixed and inconsistent results regarding the effect of this mode of delivery on cognitive and noncognitive outcomes of ABI patients while supporting its high feasibility and acceptability among patients. Specific recommendations for future research are provided to improve the methodological quality of clinical studies and establish the evidence base for r-CRP.

Dermatologic Procedures for the Treatment of Seborrheic Dermatitis.

This paper examines alternative procedural interventions for Seborrheic Dermatitis (SD), aiming to offer clinicians more treatment options and encourage further research. A search was conducted on PubMed using specific search terms related to SD and various dermatological procedures. Studies in English, focusing on SD in human patients, and in-office treatments were included. Data were analyzed for procedure type, effectiveness, and side effects. Nine studies were reviewed, covering phototherapy, indole-3-acetic acid photodynamic therapy (IAA-PDT), Picosecond Nd:YAG laser, botulinum toxin (BoNT) injections, triamcinolone injections, hair growth factor therapy, and precision cryotherapy. Most showed significant efficacy in small cohorts with high patient satisfaction. Hair growth factor therapy had long-term benefits, while narrow-band ultraviolet B phototherapy showed relapse within one month. Intense pulsed light with supramolecular salicylic acid, IAA-PDT, and laser therapy reduced sebum output and Malassezia furfur. Triamcinolone injections were effective against SD's immunological aspects. Hair growth factor therapy and precision cryotherapy have been successfully used to treat scalp SD. The role of BoNT in SD is still being explored; however, current evidence does not support its use. Limited data reveal the need for further research on dermatological procedures for SD. These methods show promise for better patient compliance but face challenges such as cost, variable effectiveness, and unknown long-term safety. Future research should focus on protocol standardization and comprehensive evaluation of long-term outcomes. J Drugs Dermatol. 2024;23(10):819-824. doi:10.36849/JDD.8116.

Combining low-technology augmentative and alternative communication with regular aphasia treatment: interim findings of a hospital-based RCT in post-stroke patients

ABSTRACT Background Previous research indicates that low-technology (low-tech) augmentative and alternative communication interventions (AACT) can enhance communication skills in individuals with post-stroke aphasia in China. However, there is limited evidence for low-tech AACT in inpatient settings. Aim This study aims to evaluate the impact of low-tech AACT combined with speech-language therapy (SLT) on communication skills related to basic needs, quality of life, and spoken language function among individuals with post-stroke aphasia in an inpatient setting. Methods & Procedures Twelve participants with aphasia having difficulty in daily communication were randomly assigned to an experimental group, receiving 30 minutes of SLT and 30 minutes of low-tech AACT per session (AACT + SLT), or a control group, receiving 60 minutes of SLT per session (SLT), over ten sessions in two weeks. Primary outcomes were measured using the basic needs (CBN) domain of the functional assessment of communication skills for adults (FACS). Secondary outcomes included scores from the Chinese version of the stroke-specific quality of life scale (SS-QOL) and subtests of spoken language production and comprehension from the aphasia battery of Chinese (ABC). The study was registered in the Chinese clinical trial registry (ChiCTR2000028870). Results The results indicated a significant improvement in the CBN domain of FACS in the AACT + SLT group, with larger clinically significant changes compared to the SLT group. The AACT+ SLT group also showed significantly higher overall scores on the SS-QOL and more significant improvements in the content of spontaneous speech than the SLT group after intervention. Comparable improvements were observed in other subtests of the ABC between the two groups. Conclusions Incorporating low-tech AACT into regular SLT in inpatient settings can improve communication for basic needs in an in-patient setting, facilitate language recovery, and potentially support the overall quality of life, compared to SLT alone, for people with post-stroke aphasia. This combined approach demonstrates preliminary feasibility in hospital settings, suggesting the value of low-tech AACT in aphasia rehabilitation.

Vaccine-based therapeutic interventions in lung cancer management: A recent perspective.

The incidence of lung cancer continues to grow globally, contributing to an ever-increasing load on healthcare systems. Emerging evidence has indicated lowered efficacy of conventional treatment strategies, such as chemotherapy, surgical interventions and radiotherapy, prompting the need for exploring alternative interventions. A growing focus on immunotherapy and the development of personalized medicine has paved the way for vaccine-based delivery in lung cancer. With various prominent targets such as CD8+T cells and PD-L1, immune-targeted, anti-cancer vaccines have been evaluated in both, pre-clinical and clinical settings, to improve therapeutic outcomes. However, there are a number of challenges that must be addressed, including the scalability of such delivery systems, heterogeneity of lung cancers, and long-term safety as well as efficacy. In addition to this, natural compounds, in combination with immunotherapy, have gained considerable research interest in recent times. This makes it necessary to explore their role in synergism with immune-targeted agents. The authors of this review aim to offer an overview of recent advances in our understanding of lung cancer pathogenesis, detection and management strategies, and the emergence of immunotherapy with a special focus on vaccine delivery. This finding is supported with evidence from testing in non-human and human models, showcasing promising results. Prospects for phytotherapy have also been discussed, in order to combat some pitfalls and limitations. Finally, the future perspectives of vaccine usage in lung cancer management have also been discussed, to offer a holistic perspective to readers, and to prompt further research in the domain.