Changes In Scale Scores Research Articles

The Dipeptidyl Peptidase-4 Inhibitor Saxagliptin as a Candidate Treatment for Disorders of Consciousness: A Deep Learning and Retrospective Clinical Analysis.

Despite advancements in the neuroscience of consciousness, no new medications for disorders of consciousness (DOC) have been discovered in more than a decade. Repurposing existing US Food and Drug Administration (FDA)-approved drugs for DOC is crucial for improving clinical management and patient outcomes. To identify potential new treatments among existing FDA-approved drugs, we used a deep learning-based drug screening model to predict the efficacy of drugs as awakening agents based on their three-dimensional molecular structure. A retrospective cohort study from March 2012 to October 2024 tested the model's predictions, focusing on changes in Glasgow Coma Scale (GCS) scores in 4047 patients in a coma from traumatic, vascular, or anoxic brain injury. Our deep learning drug screens identified saxagliptin, a dipeptidyl peptidase-4 inhibitor, as a promising awakening drug for both acute and prolonged DOC. The retrospective clinical analysis showed that saxagliptin was associated with the highest recovery rate from acute coma among diabetes medications. After matching patients by age, sex, initial GCS score, coma etiology, and glycemic status, brain-injured patients with diabetes on incretin-based therapies, including dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 analogues, recovered from coma at significantly higher rates compared to both brain-injured patients with diabetes on non-incretin-based diabetes medications (95% confidence interval of 1.8-14.1% higher recovery rate, P = 0.0331) and brain-injured patients without diabetes (95% confidence interval of 2-21% higher recovery rate, P = 0.0272). Post matching, brain-injured patients with diabetes on incretin-based therapies also recovered at a significantly higher rate than patients treated with amantadine (95% confidence interval for the difference 2.4-25.1.0%, P = 0.0364). A review of preclinical studies identified several pathways through which saxagliptin and other incretin-based medications may aid awakening from both acute and chronic DOC: restoring monoaminergic and GABAergic neurotransmission, reducing brain inflammation and oxidative damage, clearing hyperphosphorylated tau and amyloid-β, normalizing thalamocortical glucose metabolism, increasing neural plasticity, and mitigating excitotoxic brain damage. Our findings suggest incretin-based medications in general, and saxagliptin in particular, as potential novel therapeutic agents for DOC. Further prospective clinical trials are needed to confirm their efficacy and safety in DOC.

Effectiveness and safety of transcutaneous auricular vagus nerve stimulation for depression in patients with epilepsy.

Our study aimed to evaluate the effectiveness and safety of transcutaneous auricular vagus nerve stimulation (taVNS) for treating mild to moderate depression in patients with epilepsy (PWE). A single-arm, prospective, multi-center, pre-post controlled study was conducted in Eastern China. After a four-week baseline period, PWE with mild to moderate depression began treatment with taVNS, administered for 30min, three times daily, over a 12-week period. The primary outcome measure was the change in 24-item Hamilton Depression Rating Scale (HAMD) scores from baseline to week 12. Secondary outcomes included the response and remission rates for depression at week 12, as well as changes in the 14-item Hamilton Anxiety Rating Scale (HAMA), the Pittsburgh Sleep Quality Index (PSQI), and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) scores, and seizure frequency at weeks 4 and 12 compared to baseline. Adverse events (AEs) were recorded to assess the safety of taVNS. Both modified Intention-To-Treat (mITT) and Per-Protocol (PP) analyses were employed. Sixty-nine participants were enrolled in this study. Of these, 61 (88.4%) completed the 4-week treatment phase, and 50 (72.5%) finished the 12-week treatment phase. In the mITT analysis, HAMD scores significantly decreased by 4.54±7.44 (p<0.001) from baseline to week 12, with clinical response in 16 (26.2%) and remission in 15 (24.6%) patients. HAMA scores also decreased significantly by week 4 (3.23±5.18, p<0.001) and week 12 (4.95±6.78, p<0.001). PSQI scores and seizure frequency showed non-significant changes at week 4, but seizure frequency decreased significantly by week 12 (0.03±10.47, p=0.038). In the PP analysis, similar improvements were observed. After 12weeks of taVNS compared to baseline, HAMD scores decreased significantly by 5.32±8.98 (p<0.001), with 32% of patients achieving a clinical response and 24% achieving clinical remission. And HAMA scores also decreased by 5.66±7.54 (p<0.001), seizure frequency by 0.14±11.03 (p=0.018), and PSQI scores by 1.06±4.14 (p=0.076).There was a significant increase in QOLIE-31 scores by 5.17±14.71 (p=0.020). Ten (14.5%) patients experienced non-serious adverse events, the most common of which was ear pain (n=4); one patient withdrew due to tinnitus enhancement; all resolved after reducing the stimulation intensity or stopping the treatment. Our study suggests that taVNS may effectively improve depressive symptoms in PWE. This may be an efficacious and safe treatment for mild to moderate depression in PWE.

Xanomeline-Trospium for Adults with Schizophrenia Experiencing Acute Psychosis: A Systematic Review and Meta-analysis of Safety and Tolerability Outcomes.

The United States Food and Drug Administration approved the xanomeline-trospium combination in September 2024 for treating schizophrenia, based in part on three double-blind, randomized placebo-controlled trials in adults with schizophrenia experiencing acute psychosis. This random-effects model pairwise meta-analysis of those three trials found that xanomeline-trospium was comparable to placebo in terms of all-cause discontinuation, discontinuation rate due to adverse events, Simpson-Angus Scale score change, Barnes Akathisia Rating Scale score change, body weight change, body mass index change, blood pressure change, serum total cholesterol change, blood glucose change, QTc interval changes, and the incidence of headache, somnolence, insomnia, dizziness, akathisia, agitation, tachycardia, gastroesophageal reflux disease, diarrhea, increased weight, and decreased appetite. However, xanomeline-trospium was associated with a higher incidence of at least one adverse event, dry mouth, hypertension, nausea, vomiting, dyspepsia, and constipation, and increased serum triglyceride compared with placebo. Notably, xanomeline-trospium demonstrated superior efficacy than placebo in improving the Positive and Negative Syndrome Scale (PANSS) total score, PANSS positive subscale score, and PANSS negative subscale score.

Changes in Recovery Assessment Scale Scores During a Treatment Episode Among Patients in a Large Behavioral Health Care System.

The authors utilized patient-reported outcomes from a large U.S. behavioral health care system to evaluate the strength of improvements in patients' self-perceived recovery during mental health treatment. This was a cohort study conducted with electronic health records from 2021-2022 Discovery Behavioral Health patients. Patients were grouped according to their 41-item Recovery Assessment Scale (RAS) scores at admission. Linear regression models accounting for patient characteristics were used to estimate RAS score changes from admission to discharge and RAS score at discharge. Of 9,441 patients, those belonging to groups with lower RAS scores at admission showed substantial score improvements, although their scores at discharge were still much lower compared with those of patients with higher admission scores. Results were consistent across secondary analyses. Substantial improvements in recovery were evident during treatment, especially for patients with lower RAS scores at admission. The findings underline the importance of research into enhanced personalized treatment approaches to optimize recovery.

Effect of cognitive behavioral intervention on physical symptoms, B-type natriuretic peptide, red cell distribution width, C-reactive protein in elderly heart failure patients

ObjectiveTo observe how cognitive behavioral intervention affects physical symptoms, B-type Natriuretic Peptide (BNP), Red Cell Distribution Width (RDW), and C-reactive Protein (CRP) in elderly patients with heart failure.MethodsConvenient sampling method was used to select 98 elderly heart failure patients who visited our hospital from January 2022 to December 2020. Patients were divided into a control group and an observation group using the red and blue ball method, with 49 cases in each group. Control group received routine intervention, while observation group received cognitive behavioral intervention on the basis of control group. The changes in the somatosensory scale scores of patients with heart failure before and after routine treatment were recorded. The changes in blood BNP, RDW, and CRP levels were measured before and within 4 weeks, 8 weeks after intervention.ResultsAfter intervention, the dimensions and total scores of DHFq scale in observation group were lower than control group’s during the same period (P < 0.05). The total DHFq scale score in observation group improved faster (P < 0.05). Both groups of patients showed a decrease in BNP after intervention compared to before (P < 0.05). The levels of DNP, RDW, and CRP in observation group after intervention were lower than control group’s (P < 0.05).ConclusionCognitive behavioral intervention for elderly patients with heart failure can alleviate their physical symptoms, promote the improvement of vascular function indicators BNP and RDW, and reduce inflammatory factor CRP in the body, reducing the burden on the healthcare system.

Intermittent theta burst stimulation for negative symptoms in schizophrenia patients with mild cognitive impairment: a randomized controlled trail.

This study aims to evaluate the intervention effect of intermittent Theta burst stimulation (iTBS) on bilateral dorsomedial prefrontal cortex (DMPFC) for negative symptoms in schizophrenia using functional near-infrared spectroscopy (fNIRS) to confirm the therapeutic significance of DMPFC in treating negative symptoms and provide new evidence for schizophrenia treatment and research. Thirty-nine schizophrenia patients with negative symptoms and mild cognitive impairment were randomly divided into a treatment group (n=20) and a control group (n=19). The treatment group received iTBS in bilateral DMPFC. The control group received the sham treatment. Negative symptoms, cognitive function, emotional state, and social function were assessed at pre-treatment, post-treatment, 4-, 8-, and 12-week follow-ups. Brain activation in regions of interest (ROIs) was evaluated through verbal fluency tasks. Changes in scale scores were analyzed by repeated measures ANOVA. After 20 sessions of iTBS, the Scale for the Assessment of Negative Symptoms (SANS) total and sub-scale scores significantly improved in the treatment group, with statistically significant differences. SANS scores differed significantly between pre- and post-treatment in both groups, with post-treatment scores markedly lower than pre-treatment and better efficacy in the treatment group. However, there was no significant difference in cognitive function, emotional state, and social function. ROIs did not differ significantly between groups before intervention. After treatment, prefrontal cortex activation was significantly higher in the treatment group than in controls, with a statistically significant difference. Regarding functional connectivity, the small-world properties Sigma and Gamma were enhanced. iTBS on bilateral DMPFC can effectively alleviate negative symptoms and enhance prefrontal cortex activation and the small-world properties in patients of schizophrenia.

Comparative clinical efficacy of acupuncture combined with manipulation and other non-pharmacological interventions in the treatment of lumbar disc herniation: a prospective, multi-arm, randomized, open-label, blinded endpoint trial.

To compare the clinical efficacy and safety of four intervention methods-traditional Chinese manipulation combined with acupuncture, acupuncture alone, manipulation alone, and traction-for the treatment of lumbar disc herniation (LDH). A prospective, multi-arm, randomized, parallel-controlled clinical trial was conducted between July 2021 and June 2024. A total of 240 eligible LDH patients were randomized into four groups (60 patients per group) in a 1:1:1:1 ratio: manipulation combined with acupuncture group, manipulation group, acupuncture group, and traction group. Each treatment lasted for 3 weeks. Changes in Visual Analog Scale (VAS) and Japanese Orthopedic Association (JOA) scores were recorded before treatment, at 1 and 3 weeks during treatment, and at 1 and 3 months post-treatment. Adverse events were also monitored. A total of 210 patients completed the follow-up. At the 3-week (day 21) and 3-month (day 111) follow-ups, the acupuncture + manipulation group showed the most significant improvements, with VAS scores decreasing by 63.34% and 68.30% and JOA scores increasing by 55.17% and 58.33%. The acupuncture group showed VAS score reductions of 55.04% and 59.29% and JOA score increases of 44.52% and 48.29%. The manipulation group reported VAS score reductions of 51.73% and 55.02% and JOA score increases of 41.16% and 45.27%. The traction group demonstrated the least improvement, with VAS scores decreasing by 43.25% and 45.73% and JOA scores increasing by 30.55% and 33.97%. Statistical analysis indicated that the acupuncture + manipulation group had significantly better improvements in VAS and JOA scores than the other three groups during treatment and follow-up periods (P < 0.05). There were no significant differences between the acupuncture and manipulation groups (P > 0.05), while the traction group showed significantly less improvement compared to the other groups (P < 0.05). This study demonstrates that acupuncture combined with spinal manipulation significantly reduces pain and improves lumbar function in LDH patients compared to other tested interventions. The symptom relief rate was significantly higher in the acupuncture + manipulation group compared to the acupuncture, manipulation, and traction groups. https://www.chictr.org.cn/index.aspx, identifier ChiCTR2200058598.

Efficacy and tolerability of antidepressants monotherapy for behavioral and psychological symptoms of dementia: A meta-analysis of randomized controlled trials

Behavioral and psychological symptoms of dementia (BPSD) are common and difficult to manage. Although experimental data suggest that antidepressants may reduce BPSD, the results are inconclusive. To evaluate the efficacy and tolerability of antidepressants monotherapy for treating BPSD. We searched 10 cross-disciplinary electronic databases from inception to October 2023.Randomized controlled trials (RCTs) comparing antidepressants versus placebo for treating BPSD were included. The primary outcome was change in total neuropsychiatric symptom scale scores. Secondary outcomes included changes on agitation and psychosis subscale scores, change in total score of Mini-mental State Examination (MMSE). Tolerability outcomes included incidences and discontinuations due to adverse events. Finally, 8 RCTs including 676 patients were identified. We found a small beneficial effect of antidepressants on overall BPSD However, when trials with potential high-dose citalopram were excluded, no improvement was observed. No significant effects were detected on agitation and cognition. Currently there is no clear evidence of a beneficial effect of currently available antidepressants on overall BPSD and in particular agitation. Notably, clinician should be cautious of the potential risk of arrhythmias, dizziness and diarrhea when prescribing an antidepressant.

Presentation, Treatment and Outcomes of Acute Basilar Artery Occlusion: A Retrospective Analysis

IntroductionWe aim to assess the clinical presentation, treatment, and outcomes in patients with acute basilar artery occlusion (BAO) after receiving medical management (MM) (including IV thrombolysis, antiplatelet, anticoagulation) and endovascular therapy (EVT) (including intra-arterial thrombolysis, stent placement, mechanical thrombectomy). MethodsThis is a retrospective cohort study including all adult patients treated at three Mayo Clinic stroke centers with acute BAO from 2008 to 2021. Chart review was conducted to extract details of presentation, treatment, and outcome. Comparisons of treatment outcomes between patients treated with MM and EVT were analyzed and include changes of modified Rankin Scale (mRS) and NIHSS score change from admission to discharge. ResultsA total of 182 patients were included in our final analysis: 95 in the MM group and 87 in the EVT group. There was a statistically significant difference in favorable functional outcome at discharge (mRS 0-3) favoring the MM group compared to EVT group (56.0% vs 34.9%; OR 0.42, p=0.005) and the difference remained significant in multivariate analysis (OR 0.38, p=0.048). There were significantly increased odds of having NIHSS improvement of more than 5 points (OR 3.94 p<0.001), and 10 points (OR 3.92 p<0.001) in patients treated with EVT compared to MM. ConclusionOur data demonstrates that although in general patients who received EVT had lower odds of having favorable outcomes at discharge, they were also more likely to have NIHSS score improvement of more than 5 and 10 points from presentation to discharge compared to MM, suggesting EVT could be beneficial in some patients.

Comparison of Efficacy of Duloxetine Versus Amitriptyline in Fibromyalgia Patients

ABSTRACTObjective: To compare the outcomes of Duloxetine and Amitriptyline therapy in fibromyalgia patients regarding change in Symptom Severity Scale (SSS) score and Widespread Pain Index (WPI) from baseline after three months of treatment.Methodology: This quasi-experimental study was done in the Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, from November 2022 to April 2023. One hundred fifty-six fibromyalgia patients of either gender between the ages of 25-70 years were included in the study. They were erratically assigned into two groups. Group A patients were given Duloxetine, while group B patients were given Amitriptyline for 12 weeks with main outcome of change in WPI and SSS scores three months after the therapy.Results: There were 2.6% (n=2/78) males and 97.4% (n=76/78) females in group A and 1.3% (n=1/78) males and 98.7% (n=77/78) females in group B (P=0.560). At baseline, the mean WPI score in group A was 15.8 ± 1.3 SD, and it was 16.1 ± 1.4 SD in group B (P=0.286), and the mean SSS score was 6.6 ± 1.6 SD in group A, and it was 6.8 ± 1.5 SD in group B (P=0.467). At 12 weeks, the mean WPI score in group A was 11.2 ± 2.2 SD, and it was 8.9 ± 3.1 SD in group B (P=0.001), and the mean SSS score was 4.5 ± 1.7 SD in group A, and it was 3.6 ± 1.3 SD in group B (P=0.001).Conclusions: Outcomes were better with Amitriptyline compared to those patients taking Duloxetine in diagnosed cases of fibromyalgia.

Optical coherence tomography in secondary progressive multiple sclerosis: cross-sectional and longitudinal exploratory analysis from the MS-SMART randomised controlled trial

BackgroundOptical coherence tomography (OCT) inner retinal metrics reflect neurodegeneration in multiple sclerosis (MS). We explored OCT measures as biomarkers of disease severity in secondary progressive MS (SPMS).MethodsWe investigated people with...

Prospective Randomized Study on Switching Triple Inhaler Therapy in COPD from Multiple Inhaler Devices to a Single Inhaler Device in a Chinese Population.

Triple therapy with inhaled corticosteroids and dual bronchodilator was recommended in chronic obstructive pulmonary disease (COPD) patients who had exacerbations and eosinophilia. It can be administered by single inhaler (SITT) or multiple inhaler (MITT). There was lack of evidence of the benefits of SITT over MITT in Chinese population, especially on switching from existing MITT to SITT. 70 Chinese patients with COPD was recruited in this open-label double-arm clinical trial to investigate the number of critical errors, mMRC dyspnoea scale, MARS-A score and satisfaction score upon switching from MITT to SITT. The mean number of critical errors were 0.4 ± 1.0 in SITT group and 1.1 ± 1.8 in MITT group, p = 0.038 at first visit; 0.2 ± 0.6 in SITT group and 0.8 ± 1.1 in MITT group, p = 0.007 at second visit. The mean change in MARS-A from baseline to first visit was +3.76 ± 7.48 in SITT group and -1.27 ± 7.76 in MITT group, p-value 0.008. 22 (59.5%) and 8 (24.2%) of the patients in SITT and MITT group had an increase in MARS-A score from baseline to first visit respectively, with adjusted OR (aOR) of 6.23 (95% CI = 1.63 - 23.77, p = 0.007), favoring SITT. There was no significant difference in the change in mMRC dyspnea scale and satisfaction score in the two groups. Switching from MITT to SITT in Chinese COPD patients may have the benefits of having fewer critical error numbers and higher MARS-A score.

Dual antiplatelet versus alteplase in anterior and posterior circulation minor stroke

ObjectiveThe Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy (DAPT) to alteplase in minor non-disabling stroke. This prespecified secondary analysis aimed...

A preliminary study on the short-term effectiveness and safety of sublingual immunotherapy-spray for patients with respiratory allergy

To investigate the short-term effectiveness and safety of sublingual allergen immunotherapy with allergen sprays (SLIT-sprays) in Chinese patients with allergic rhinitis (AR) with or without asthma using real-world data. The retrospective cohort study included 100 patients who received SLIT-sprays in the ENT departments in Hainan Shulan (Boao) Hospital and Boao Super Hospital between October 2023 and August 2024. A questionnaire survey was conducted to collect clinical data on the effectiveness and safety of SLIT-sprays, examining the types and incidence of adverse events (AEs) during treatment, treatments after the occurrence of AEs, and changes in Visual Analog Scale (VAS) scores before and after SLIT-sprays. Self-reports from 100 patients were collected. The results showed that the average treatment duration for the 100 patients was (90.7±58.9) days, median 78.5 days. Using changes in VAS scores as the effectiveness assessment, the average VAS score increased by 4.2 (95%CI: 4.06-4.34). The incidence of AEs during the SLIT-sprays was 17.0% (17/100), all of which were mild to moderate local reactions, with no serious AEs reported. There were no significant differences in AE incidence among patients with different diseases (AR or AR with asthma and asthma alone) (χ2=1.831,P>0.05), different age group (χ2=1.477,P>0.05), different types of allergen extracts (χ2=1.613,P>0.05), or the number of allergen extracts used (patients using one or two allergen extracts) (Fisher's exact test,P>0.05). In conclusion, Chinese patients showed good safety and tolerability to SLIT-sprays, with all AEs being mild to moderate local reactions and no serious or systemic AEs occurring. Patients reported positive subjective evaluations of the early treatment effects.

Effectiveness of unilateral lower-limb exoskeleton robot on balance and gait recovery and neuroplasticity in patients with subacute stroke: a randomized controlled trial

BackgroundImpaired balance and gait in stroke survivors are associated with decreased functional independence. This study aimed to evaluate the effectiveness of unilateral lower-limb exoskeleton robot-assisted overground gait training compared with conventional treatment and to explore the relationship between neuroplastic changes and motor function recovery in subacute stroke patients.MethodsIn this randomized, single-blind clinical trial, 40 patients with subacute stroke were recruited and randomly assigned to either a robot-assisted training (RT) group or a conventional training (CT) group. All outcome measures were assessed at the enrollment baseline (T0), 2nd week (T1) and 4th week (T2) of the treatment. The primary outcome was the between-group difference in the change in the Berg balance scale (BBS) score from baseline to T2. The secondary measures included longitudinal changes in the Fugl-Meyer assessment of the lower limb (FMA-LE), modified Barthel index (mBI), functional ambulation category (FAC), and locomotion assessment with gait analysis. In addition, the cortical activation pattern related to robot-assisted training was measured before and after intervention via functional near-infrared spectroscopy.ResultsA total of 30 patients with complete data were included in this study. Clinical outcomes improved after 4 weeks of training in both groups, with significantly better BBS (F = 6.341, p = 0.018, partial η2 = 0.185), FMA-LE (F = 5.979, p = 0.021, partial η2 = 0.176), FAC (F = 7.692, p = 0.010, partial η2 = 0.216), and mBI scores (F = 7.255, p = 0.042, partial η2 = 0.140) in the RT group than in the CT group. Both groups showed significant improvement in gait speed and stride cadence on the locomotion assessment. Only the RT group presented a significantly increased stride length (F = 4.913, p = 0.015, partial η2 = 0.267), support phase (F = 5.335, p = 0.011, partial η2 = 0.283), and toe-off angle (F = 3.829, p = 0.035, partial η2 = 0.228) on the affected side after the intervention. The RT group also showed increased neural activity response over the ipsilesional motor area and bilateral prefrontal cortex during robot-assisted weight-shift and gait training following 4 weeks of treatment.ConclusionsOverground gait training with a unilateral exoskeleton robot showed improvements in balance and gait functions, resulting in better gait patterns and increased gait stability for stroke patients. The increased cortical response related to the ipsilesional motor areas and their related functional network is crucial in the rehabilitation of lower limb gait in post-stroke patients.

Effectiveness of acupuncture as an adjunct to cardiac rehabilitation after coronary artery bypass grafting.

Considering the importance of cardiac rehabilitation after coronary artery bypass grafting (CABG) and the development of acupuncture over the past few decades, the aim of this study was to evaluate the effects of acupuncture on patients' exercise tolerance, heart rate and blood pressure after CABG. Thirty-four patients with a history of recent CABG were recruited between 2019 and 2020 for this clinical trial and randomly divided into two groups receiving acupuncture plus cardiac rehabilitation (group A) and cardiac rehabilitation alone (group B). In both groups, exercise-based rehabilitation exercise was performed. Group A additionally received acupuncture at PC6, PC4, HT7 and GB20 bilaterally. Changes in blood pressure, heart rate and Borg scale score were evaluated before, during and after the course of the treatment. Heart rate was significantly lower in group A compared to group B after completion of the course of the treatment (P = 0.022). However, there were no statistically significant differences between the two groups in systolic or diastolic blood pressure or Borg scale scores (P > 0.05). Nevertheless, the Borg scale scores showed a significant decrease within each group over time (P < 0.001), reflecting an improvement in the patients' ability to tolerate activity after cardiac rehabilitation with or without acupuncture. Acupuncture in combination with exercise-based cardiac rehabilitation was more effective at decreasing heart rate than cardiac rehabilitation alone after CABG. Both approaches appeared to be similarly effective at improving exercise tolerance. In this study, the addition of acupuncture at the aforementioned traditional acupuncture point locations to exercise-based cardiac rehabilitation did not affect blood pressure. IRCT20171208037793N1 (Iranian Registry of Clinical Trials).

Efficacy and safety of acupuncture for pain relief: a systematic review and meta-analysis.

This study aims to evaluate the efficacy and safety of traditional acupuncture for pain relief based on rigorously designed RCTs with double-blind. The findings seek to provide valuable insights for clinical practice and inform future research. A literature search was conducted in PubMed, Web of Science, Cochrane Library, and Embase databases for randomized controlled trials on traditional acupuncture for pain management using a double-blind design, published from database inception to November 22, 2023. The Risk of Bias 2 (RoB2) tool was used to assess potential biases in the included studies, followed by a comprehensive analysis to evaluate efficacy and safety. The findings show a significant positive effect on pain improvement, evidenced by changes in visual analog scale scores (mean difference 0.97 [95% confidence interval (CI) 0.66-1.27]). Safety analysis showed no significant differences in adverse reactions between the acupuncture and control groups (relative risk 1.40 [95% CI 0.52-3.74]), with no serious adverse effects reported. Traditional acupuncture is effective and safe in pain management. This suggests that acupuncture can be a valuable approach in clinical practice. Future studies should explore optimal treatment durations and frequency, using larger sample sizes for more comprehensive insights.

Causes and treatment of secondary sphenoid sinus infection post-endoscopic transsphenoidal approach.

This study analyzed the causes of sphenoid sinus (SS) infection (SSI) following endoscopic transsphenoidal skull base surgery and determined appropriate treatment methods. This study included 31 cases of secondary SSI following the endoscopic transsphenoidal approach (ETSA; SSI group) and 246 cases without SSI (non-SSI group). Data collected included post-ETSA pathological results, types of artificial skull base reconstruction materials, and SS patency. For the SSI group, data included time from ETSA to symptom onset, endoscopic and imaging findings, intraoperative conditions during the second surgery, and changes in visual analog scale (VAS) scores. The incidence of secondary SSI was 11.19%. In the SSI group, 26 patients (83.87%) reported headaches, and 24 (77.42%) had stenosis or closure of the SS ostium (SSO). The non-SSI group reported no symptoms, and 236 patients (95.93%) had well-opened SSOs. Centripetal hyperosteogeny (CHO) in the SS walls was observed in 20 patients (64.5%) in the SSI group. Absorbable materials were used in five cases (16.13%) and 215 cases (87.40%) in the SSI and non-SSI groups, respectively, while non-absorbable materials were used in 24 cases (77.42%) and 20 cases (8.13%), respectively. SSI risk was 9.42 times higher with non-absorbable synthetic materials. VAS scores for SSI symptoms and Lund-Kennedy scores significantly decreased at 3 and 12 months post-second surgery. Secondary SSI after ETSA can cause persistent symptoms. Non-absorbable synthetic repair materials should be avoided to prevent secondary SSI. Extended sphenoidectomy and removal of artificial materials can lead to rapid resolution of SSI symptoms. 4.

Potential Disease-Modifying Effects of Ganglioside GM1 Pulse Treatment on Spinocerebellar Ataxia Type 3, a Parallel-Group, Double-Blind, Randomized, Controlled Trial.

Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant inherited neurodegenerative disorder for which there is currently no cure, nor effective treatment strategy. Our aim was to investigate the safety and efficacy of high-dose ganglioside GM1 (ganglioside-monosialic acid) pulse treatment in patients with SCA3. Patients were randomly allocated to receive either high-dose GM1 (400 mg on the first day followed by 200 mg/day), low-dose GM1 (40 mg/day), or placebo (normal saline) for 4 weeks. The primary outcome, assessed by measuring the change in the Scale for the Assessment and Rating of Ataxia (SARA) scores from baseline to 12 weeks post-treatment, is central to evaluating treatment efficacy. Secondary outcomesincluded changes in the International Cooperative Ataxia Rating Scale (ICARS) score, Barthel Index of Activities of Daily Living (ADL), and plasma and cerebrospinal fluid (CSF) GABA levels. Safety was assessed in all treated patients. A total of 48 patients with SCA3 were enrolled in this study. After 12 weeks, data from 43 patients were included in the efficacy analysis (intention-to-treat analysis). The least-squares mean change in the SARA score from baseline to 12 weeks post-treatment was -3.80 (standard error [SE], 0.39; 95% confidence interval [CI], -4.58 to -3.02) in the high-dose GM1 group, 0.34 (SE, 0.40; 95% CI, -0.46 to 1.13) in the low-dose GM1 group, and 0.73 (SE, 0.40; 95% CI, -0.07 to 1.52) in the placebo group, respectively. Secondary outcomes showed improvements in the ICARS score, Barthel Index of ADL, and plasma and CSF GABA levels in the high-dose GM1 group compared to the low-dose GM1 and placebo groups. All treatments were well-tolerated and safe. High-dose GM1 treatment significantly ameliorated ataxic symptoms in patients with SCA3. © 2024 International Parkinson and Movement Disorder Society.

Evaluating the Efficacy and Cost-Effectiveness of Plasmapheresis and Intravenous Immunoglobulin in Acute Guillain-Barre Syndrome Management in Emergency Departments.

Guillain-Barre Syndrome (GBS) is a severe autoimmune neuropathy that has to be treated quickly and efficiently in emergency situations, when both cost and effectiveness are vital. To compare the clinical outcomes and cost-effectiveness of plasmapheresis and intravenous immunoglobulin (IVIG) in managing acute GBS in emergency departments. A prospective observational study conducted from January to December 2023 evaluated the treatment of adults with acute GBSusing IVIG or plasmapheresis. Cost analysis was done in conjunction with clinical outcomes assessment, such as improvement in motor function, length of recovery, and length of hospital stay. Each therapy group consisted of 39 individuals, and data were gathered via patient evaluations and medical records. Through statistical analysis, the two regimens' costs and results were compared. Plasmapheresis proved significantly more cost-effective than IVIG, with an average treatment cost of 295,000 Pakistani rupees (PKR) per patient versus 587,000 PKR for IVIG. Plasmapheresis showed a greater mean improvement in motor function (Glasgow Coma Scale (GCS) score change of 5.93 ± 2.17) compared to IVIG (4.98 ± 2.34), though the difference was not statistically significant (p=0.091). Recovery time was slightly shorter with plasmapheresis, averaging 8.26 ± 1.53 weeks versus 8.74 ± 1.87 weeks for IVIG (p=0.282). Hospital length of stay was marginally reduced with plasmapheresis (12.16 ± 3.28 days) compared to IVIG (12.95 ± 3.64 days, p=0.302). The time to reach maximum improvement was also shorter with plasmapheresis (6.51 ± 1.24 weeks) compared to IVIG (7.08 ± 1.32 weeks, p=0.260). Additionally, plasmapheresis had a lower complication rate, with 4 out of 39 patients (10.25%) experiencing complications, compared to 8 out of 39 patients (20.51%) with IVIG. Plasmapheresis is more cost-effective than IVIG for acute GBS management in emergency departments, offering similar or potentially superior clinical outcomes at a lower cost.