Complete Evaluation Research Articles

B - 15 Symptom Presentation on the Neurobehavioral Symptom Inventory and Post Traumatic Stress Disorder Checklist for DSM-5 in a Cohort of Explosive Ordnance Disposal Veterans

Abstract Objective This preliminary research examined symptom differences on the Neurobehavioral Symptom Inventory (NSI) and Post Traumatic Stress Disorder Checklist DSM-5 (PCL-5) for Explosive Ordnance Disposal (EOD) and Non-EOD Veterans receiving care at the Washington DC-War Related Illness and Injury Study Center (DC-WRIISC) Veterans Administration Medical Center. EOD Veterans have extensive repetitive blast-exposure histories, exposure to environmental toxins, and operated under high-stress/allostatic load throughout their careers. Therefore, we aim to understand how these unique occupational exposures influence long-term health outcomes for EOD Veterans. Method Eligible participants (N = 39, Mage = 51 years (SD = 9.5 years); EOD, n = 21) completed comprehensive interdisciplinary evaluations, self-report questionnaires, were combat deployed, and experienced traumatic brain injury. Total and component scores for the NSI (affective, cognitive, somatic, vestibular, and validity-10) and PCL-5 (criterion B-E symptom clusters), and total score for the Holmes-Rahe Life Stress Inventory, (HRLSI) were included. Results Regression analysis revealed overall NSI severity was positively correlated to PCL-5 total scores for both groups (EOD: F(1,19) = 25.30, p < 0.001); (Non-EOD: F(1,16) = 25.48, p < 0.001). However, significant differences in symptom presentation were noted between groups. NSI Cognitive scores were positively correlated with PCL-5 component scores for Criterion B for EOD (F(3,17) = 8.40, p < 0.001) and Criterion E for Non-EOD (F(3,14) = 24.32, p < 0.001). Post-hoc analysis suggested stress/resiliency may further contribute to group differences (HRLSI; Non-EOD, F(2,12) = 33.96, p < 0.001). Conclusion DC-WRIISC Veterans often present with cognitive concerns and complex medical presentations. Our findings suggest the presence of unique symptom presentations that may improve diagnostic formulation, treatment planning, and engagement. These findings highlight the need for continued research examining the influence occupational exposures have on Veteran health.

Internal Nasal Valve Collapse Treatment by Endonasal Hyaluronic Acid Injection.

Internal nasal valve collapse (IVC) is a common functional complication of rhinoplasty and injecting hyaluronic acid is one of the treatment options available, but its effectiveness has never been evaluated. The objective of this study was to assess the evolution of IVC after injection of hyaluronic acid using objective and subjective measures of nasal obstruction. A prospective interventional study was conducted. Adult patients consulting for nasal obstruction after (septo)rhinoplasty and diagnosed with IVC were included. Patients underwent 4-phase rhinomanometry, completed nasal obstruction symptoms evaluation (NOSE) and visual analog scale (VAS) questionnaires and received hyaluronic acid injections. Measurements were repeated immediately, one month and one year later. The primary outcome measure was the proportion of patients below the rhinomanometric diagnostic threshold for IVC at one month. Among the 22 patients included, 20 (91%) had rhinomanometry measurements below the diagnostic threshold for IVC one month after injection. It decreased to 53% (8/15 patients) at one year post injection. The mean NOSE score decreased from 74.5 (± 18.0) before injection to 35.2 (± 23.3) after injection (p < 0.0001). The mean VAS score decreased from 7.0 (± 1.4) before injection to 3.4 (± 1.9) after injection (p < 0.0001). In these patients with post-(septo)rhinoplasty IVC, hyaluronic acid injection into the internal nasal valve substantially improved subjective and objective measures of nasal obstruction. These results suggest hyaluronic acid injection (performed as described) is an effective treatment for IVC and is an excellent alternative to surgical treatment. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

A Rare Case of Primary Ovarian Mucinous Carcinoma with Signet-Ring Cells and Literature Review.

The presence of signet-ring cells in the ovary is almost always associated with metastatic mucinous carcinomas known as Krukenberg tumors. Here we report a primary ovarian mucinous carcinoma with signet-ring cells, which is scarcely encountered, and a review of the literature to summarize the clinical and morphological features of these tumors. The patient was a 26-year-old female who had a large multicystic lesion in the right ovary. Macroscopic examination of the cyst revealed a 30 cm-sized multicystic lesion filled with mucinous material. The capsule was intact, and there was no surface involvement. Microscopically, a multicystic mucinous tumor with a predominantly borderline background and three well-demarcated nodules composed of signet ring cells without desmoplastic stroma were noted in the cyst wall. There was only one invasive focus seen. Immunohistochemically, conventional mucinous areas were diffusely positive for Keratin 7 and Keratin 20, and focally positive for PAX8, while negative for CDX2. Signet ring cells were positive for Keratin 20, CDX2, and Keratin 7, while negative for PAX8. In the systemic examinations, no potential primary site was found. The patient has not received any adjuvant treatment and has been followed for six years without disease, which is the longest follow-up time among previously reported cases. Signet ring cells can be present in primary ovarian mucinous carcinomas. The distinction from the more frequently seen metastatic carcinomas needs a complete evaluation of clinicopathological findings. Early-stage primary mucinous carcinomas having localized signet-ring cell nodules seem to have favorable prognosis without adjuvant treatment.

WP8.10 - Ultrasound Cannulation Training Programme: Quality Improvement Project

Abstract Aim Familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts and preserves venous access. In our District General Hospital (DGH), no teaching on ultrasound-guided venous access was available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors. Methods Discussions were held with the medical education team at our DGH to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation, and usefulness of the session (out of 5). Results Of the 49 participants, only 65% (n=32) filled in the course forms. Data was only analysed from these individuals. 47% (n=15) had previous experience using an ultrasound machine. Of the 32 participants analysed, 87.5% (n=28) felt the session was very useful and the other 12.5% (n=4) found the session to be useful. 100% (n=32) felt more confident performing ultrasound-guided access after the session. The average confidence score pre vs post-session was 1.59/5 vs 3.88/5, respectively. Conclusions This programme can improve confidence in procedural skills amongst junior doctors, whilst also minimising stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results obtained will be critical in continuing this programme in our hospital and hopefully roll out to a wider audience.

Efficacy and Durability of Faricimab in Naïve Eyes with Neovascular Age-Related Macular Degeneration

Introduction: The aim of the study was to evaluate functional and anatomical changes in patients with neovascular age-related macular degeneration (nAMD) treated with a loading dose of faricimab intravitreal injections (IVIs). Methods: Eighteen eyes of 18 patients with active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University G. D’Annunzio, Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI as per label. Enrolled patients underwent complete ophthalmic evaluation, including optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All measurements were evaluated at baseline (T0) and then monthly up to week 20 (T4). Main outcome measures were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachments (PEDs) presence and maximum height (PED-MH), intraretinal fluid (IRF) presence, subfoveal subretinal fluid (SSRF) presence and thickness. Results: BCVA improved and CMT reduced significantly during follow-up (p < 0.001). In addition, SFCT decreased significantly (p = 0.031). Between T0 and T4, SSRF presence reduced from 55.6 to 16.7% (p = 0.045); IRF presence changed from 50 to 22.2%, respectively (p = 0.074). PED-MH was reduced in 58.8% of patients at T4. At week 20, 72.3% of patients were in the q12/q16 interval. Conclusion: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of anatomical and functional parameters and a treatment interval after the loading phase equal or greater than 12 weeks in the majority of patients.

Chromosome-level genome assembly of Oriental chestnut gall wasp (Dryocosmus kuriphilus)

Dryocosmus kuriphilus, commonly known as the chestnut gall wasp, belongs to the family Cynipidae and is native to China. It is a highly invasive insect species causing serious damage to chestnut trees and has rapidly spread to various continents, including Europe, North America, and Oceania. The D. kuriphilus has become one of the important pests of chestnut plants in the world and is listed as a quarantine object by the European and Mediterranean Plant Protection Organization (EPPO). In this study, we used PacBio long reads, Illumina short reads, and Hi-C sequencing data to construct a chromosome-level assembly of the D. kuriphilus genome. The assembled genome includes 14,729 contigs with a total length of 2.28 Gb and a contig N50 of 0.8 Mb. With Hi-C technology, 2.17 Gb (95.02%) of contigs were anchored and oriented into the 10 pseudochromosomes with the scaffold N50 of 198.8 Mb and the scaffold N90 of 158.8 Mb. In total, 24,086 protein-coding genes were predicted in the assembled D. kuriphilus genome as the reference gene set. A total of 1.82 Gb repeats (occupying 79.7% of the genome), including 1.42 Gb of transposable elements and 0.40 Gb of tandem repeats, were identified in D. kuriphilus genome. In the evaluation of completeness, the BUSCO analysis determined a level of 98.1% completeness for the assembled genome sequences based on the Insecta database (OrthoDB version 10). The high-quality genome assembly of D. kuriphilus will not only provide a valuable reference for the study of its evolutionary history and genetic structure but also facilitate the research of host-pest interactions and invasiveness. Moreover, this genome assembly will promote in the development of effective management strategies to mitigate the economic and ecological impacts of this invasive pest on chestnut trees and ecosystems.

Temporoorbital pulse rate can be obtained in ball pythons (Python regius) of any size and age and agrees with heart rate.

Currently, a standardised technique to obtain pulse rate in reptiles is lacking. We evaluated the feasibility of obtaining a temporoorbital pulse rate in ball pythons of various ages and sizes and whether it agreed with the heart rate. Heart rate and pulse rate were recorded in 40 ball pythons (Python regius) weighing between 0.05 and 2.2 kg using a standard veterinary ultrasonic Doppler flow detector. The temporoorbital pulse rate was obtained on the dorsal aspect of the head at the level of the temporoorbital artery. Each measurement was performed in a randomised fashion by two operators, who were blinded to each other's results. Pulse rate and heart rate were successfully obtained for all snakes. The median heart rate was 60beats per minute (bpm)(range 48‒88 bpm), and the median pulse rate was 60bpm (range 48‒88 bpm). The mean difference between the pulse rate and heart rate was 1.2 beats (95% limits of agreement: ‒10.6 to 13.0). When pulse rate and heart rate were measured at the same time, they were synchronous. Only healthy snakes were included. Temporoorbital pulse rates can be easily obtained in ball pythons of any size. This novel method to assess peripheral pulse allows for a more complete cardiovascular evaluation in this species.

Predictors of white matter hyperintensities in the elderly Congolese population.

White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer's disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults. In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMH volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMH and potential predictors (neurological status, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMH and variables retained in the final model (neurological status, sex, and age). Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMH was significantly associated with dementia (expβ1=1.75, 95% CI=1.14 - 2.71, p-value=0.01) though it had a weak association with age (expβ1=1.03, 95% CI=1.00 - 1.05, p-value=0.05) and sex (male) (expβ1=0.66, 95% CI=0.43 - 1.01, p-value=0.05). In multiple linear regression models, WMH was statistically significantly associated with dementia (expβ1=1.97, 95% CI=1.31 - 2.95, p-value =0.001), male sex (expβ2=0.54, 95% CI=0.36 - 0.80, p-value=0.003), and age (expβ3=1.03, 95% CI=1.00 - 1.06, p-value=0.03). However, WMH was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels. WMH is significantly associated with neurological status, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.

Validity of the Addiction-like Eating Behavior Scale among Patients with Compulsive Eating.

Food addiction (FA) and binge eating disorder (BED) co-occur and share compulsive eating symptoms. When using an FA measure, it is important to evaluate its performance in a population presenting compulsive eating. The study aims to validate the Addiction-like Eating Behavior Scale (AEBS) among a clinical sample characterized by compulsive eating and overweight/obesity and to evaluate its incremental validity over the Yale Food Addiction Scale 2.0 (YFAS). Patients seeking help for compulsive eating (n = 220), between January 2020 and July 2023, completed online questionnaires, including FA, compulsive eating, and BMI evaluations. The factor structure, internal consistency, and convergent, divergent, and incremental validity were tested. The sample had a mean age of 44.4 years old (SD = 12.7) and a mean BMI of 38.2 (SD = 8.0). The two-factor structure provided a good fit for the data, with factor loadings from 0.55 to 0.82 (except for item 15) and the internal consistency was high (ω = 0.84-0.89). The AEBS was positively correlated with the YFAS (r = 0.66), binge eating (r = 0.67), grazing (r = 0.47), craving (r = 0.74), and BMI (r = 0.26), and negatively correlated with dietary restraint (r = -0.37), supporting good convergent and divergent validity. For each measure of compulsive eating, linear regression showed that the AEBS "appetite drive" subscale had a unique contribution over the YFAS. This study provided evidence that the AEBS is a valid measure among a clinical sample of patients with compulsive eating and overweight/obesity. However, questions remain as to whether the AEBS is a measure of FA or compulsive eating.

A penicillin allergy stewardship team to address unconfirmed pediatric penicillin allergies in Houston, Texas

BackgroundPenicillin (PCN) allergy labels are the most common drug allergy label and limit use of first-line antibiotics for many pediatric bacterial infections. Improving access to PCN allergy evaluations is a priority for allergy and immunology (A&I) and infectious diseases (ID) programs. ObjectiveTo increase the number of completed PCN allergy evaluations from 6 to 24 per month from January 2022 to December 2023. MethodsA collaborative PCN allergy stewardship team was established in the A&I and ID divisions at Texas Children's Hospital. Telemedicine evaluations and, when clinically indicated, in-person PCN allergy evaluations were conducted from January 2022 to December 2023. Plan-do-study-act cycles were conducted to increase awareness about the clinics. The primary outcome measure was the average number of monthly completed PCN allergy evaluations. ResultsThe average number of completed PCN allergy evaluations increased from 6 to 19 per month. Children were seen rapidly in the ID telemedicine clinic (20 vs 62 days, P < .001), and 428 of 627 (68%) children who required in-person challenge were scheduled for their in-person evaluation. Among the 211 children delabeled, 71 (33.6%) were subsequently diagnosed with a bacterial infection requiring PCN during the study period. ConclusionA collaborative PCN allergy stewardship team consisting of ID and A&I specialists increased the number of completed PCN allergy evaluations 3-fold. ID telemedicine services allowed prompt access to care, and most children were delabeled and subsequently able to receive PCN antibiotics for bacterial respiratory tract infections. Future work should explore ways to minimize barriers to PCN allergy evaluations and further expand testing services in other settings.

Choosing the optimal combination of lungs lobe evaluation during focused pulmonary ultrasonography in calves

Bovine respiratory disease (BRD) poses significant challenges on beef and dairy farms, impacting mortality rates, animal welfare, and production efficiency. Although pulmonary ultrasonography is highly sensitive and specific for monitoring lung lesions and diagnosing BRD, its practical application could be optimized by focusing on the most commonly affected lung lobes. This study first evaluated the efficacy of focused lung ultrasonography for diagnosing BRD in calves, examining individual lung lobes and their associations versus the extensive lung scanning under various disease prevalence scenarios. Then, the relationship between individual and combined clinical respiratory signs vs lung consolidation was analyzed. In a combined analysis, 193 Holstein calves from a longitudinal study and 112 Angus calves from a cross-sectional study underwent a total of 1265 complete bilateral thoracic ultrasonographic evaluations from 1 to 6 mo of age. Then, it was assessed the agreement and sensitivity of specific lung lobe combinations compared with the findings from total lung ultrasonography. The Classification and Regression Tree (CART) algorithm was used to suggest an optimal examination sequence, and logistic regression was applied to associate specific clinical signs with the presence of lung consolidation adjusting for breed and calf age. Findings reveal that the most sensitive areas are cranial (K: 0.867; Se: 84.7%) and the caudal (K: 0.433; Se: 40.3%) portions of the right cranial lobe, the caudal portion (K: 0.235; Se: 20.6%) of the left cranial lobe, and the middle lobe (K: 0.25; Se: 22%). The optimal lobe combinations for focused lung ultrasonography were identified as the right cranial lobe paired with either the left cranial lobe or the middle lobe. Focused techniques achieved sensitivity over 94% and maintained good agreement. Using these focused techniques were relatively robust to various true lung consolidation scenarios. CART analysis recommended initiating examinations with the right cranial lobe, proceeding to the left cranial lobe, and concluding with the middle lobe. While spontaneous cough was linked to pneumonia presence, reliance on a single clinical sign is not advised due to low sensitivity (26.8%) and high specificity (85.4%); it should merely prompt further ultrasound assessment. In conclusion, focused lung ultrasonography, especially utilizing the right cranial lobe in conjunction with the left cranial lobe or the middle lobe, emerged as effective strategies for focused pulmonary ultrasonography, preserving the accuracy of the results.

Regarding the establishment of the anti-burn «Fenix-MS» bed conformity with the requirements of quality and safety standards

The standards that anti-burn beds must meet are given. The design of the domestically produced anti-burn «Phoenix-MS» bed, which has improved design and technological indicators, is briefly described. The main test results of this bed, obtained in the process of independent conformity assessment, are presented. Their analysis showed that the product meets quality standards and ensures the safety of patients and medical personnel during its operation in medical institutions. It is noted that the manufacturer needs to carry out a more complete clinical evaluation of the product, taking into account the strengthening of this requirement in the new EU Regulation 2017/745 on medical devices.

Comparable Outcomes Between Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation in the Setting of Patellar Realignment

PurposeThe purpose of this study was to determine clinical and functional outcomes in patients treated with autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation for chondral defects secondary to patellar instability with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) for patellar realignment. MethodsA retrospective review identified patients who underwent ACI or OCA transplantation with concomitant MPFL reconstruction and TTO . Patients were excluded if they did not have concomitant MPFL reconstruction and TTO, had the presence of other intra-articular pathologies, or failed to complete postoperative subjective outcome evaluations at a minimum of 2 years following surgery. Subjective outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and Short Form Health Survey (SF-12) physical scores, collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined. ResultsEighteen total patients were included in this study. The ACI cohort included 11 patients with 13 total defects that were treated with ACI. The OCA cohort included 7 patients with 10 total defects that were treated with OCA. This was due to a number of patients in either group having multiple cartilage defects. Twenty-three total chondral defects were compared to analyze clinical and functional outcomes following surgical correction (ACI: n=13, OCA: n=10). Five defects were noted on the femoral condyle and 18 on the patellar facets/central ridge. Defects were comparable between groups including, size measured during index-arthroscopy (ACI = 3.34 cm2, 95% CI [2.3 cm2 - 4.4 cm2] vs OCA = 4.03 cm2, 95% CI [3.1 cm2 - 5.0 cm2]; P=.351), Outerbridge classification (ACI = 54.8% grade 4 vs OCA = 60.0% grade 4; P=1.000), and AMADEUS score (ACI = 47.1 vs OCA = 58.6; P=.298). Postoperative outcomes were comparable including revision rate (ACI = 15.4% vs OCA = 10.0%; P=1.000) and 2-year IKDC scores (ACI = 74.2, 95% CI [65.2 - 83.2] vs OCA = 51.2, 95% CI [30.3 - 72.1]; P=.077). ACI did have significantly higher 2-year KOOS JR (85.1, 95% CI [76.9 - 93.3] vs 63.7, 95% CI [49.1 - 78.3]; P=.031) and SF-12 scores (54.1, 95% CI [52.0 - 56.2] vs 42.6, 95% CI [35.8 - 49.4]; P=.007) compared to OCA. ConclusionACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. Level of EvidenceRetrospective Case Series Study (Level 3)

Sleep disorder syndromes of post-acute sequelae of SARS-CoV-2 (PASC) / Long Covid

IntroductionCOVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or “Long COVID”. PASC is a heterogeneous disease with a high prevalence of sleep disturbances, varying from an insomnia disorder to excessive daytime sleepiness. MethodsPatients seen in the Covid Survivorship Program at the Beth Israel Deaconess Medical Center Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19-Sleep clinic, followed by diagnostic sleep testing and treatment. This report summarizes patients who completed an American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses. ResultsIn 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients met criteria for idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity. ConclusionsSpecific sleep symptoms/syndromes are reported in this select group of patients with PASC/Long Covid. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection.

Clinical correlates of obstructive sleep apnoea in idiopathic normal pressure hydrocephalus.

The pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) remains controversial. Limited studies have indicated a high prevalence of obstructive sleep apnoea (OSA) amongst iNPH patients. The aim was to investigate the clinical correlates of OSA in iNPH patients. In this cross-sectional observational study, consecutive iNPH patients were prospectively enrolled. Evaluations included the iNPH Rating Scale, the Movement Disorder Society Unified Parkinson's Disease Rating Scale part III, the time and number of steps to walk 10 m, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, a complete neuropsychological evaluation, 3-T brain MRI, full-night video-polysomnography, tap test and cerebrospinal fluid (CSF) neurodegeneration biomarkers. Fifty-one patients were screened, of whom 38 met the inclusion criteria. Amongst the recruited patients, 19/38 (50%) exhibited OSA, with 12/19 (63.2%) presenting moderate to severe disorder. OSA+ iNPH patients required more time (p = 0.02) and more steps (p = 0.04) to complete the 10-m walking test, had lower scores on the gait subitem of the iNPH Rating Scale (p = 0.04) and demonstrated poorer performance on specific neuropsychological tests (Rey Auditory Verbal Learning Test immediate recall, p = 0.03, and Rey-Osterrieth Complex Figure, p = 0.01). Additionally, OSA+ iNPH patients had higher levels of total tau (p = 0.02) and phospho-tau (p = 0.03) in their CSF but no statistically significant differences in beta-amyloid (1-42) levels compared to OSA- iNPH patients. Obstructive sleep apnoea is highly prevalent in iNPH patients, particularly at moderate to severe levels. OSA is associated with worse motor and cognitive performance in iNPH. The CSF neurodegeneration biomarker profile observed in OSA+ iNPH patients may reflect OSA-induced impairment of cerebral fluid dynamics.

Safety and potential effects of intrathecal injection of allogeneic human umbilical cord mesenchymal stem cell-derived exosomes in complete subacute spinal cord injury: a first-in-human, single-arm, open-label, phase I clinical trial

ObjectiveNeurological and functional impairments are commonly observed in individuals with spinal cord injury (SCI) due to insufficient regeneration of damaged axons. Exosomes play a crucial role in the paracrine effects of mesenchymal stem cells (MSCs) and have emerged as a promising therapeutic approach for SCI. Thus, this study aimed to evaluate the safety and potential effects of intrathecal administration of allogeneic exosomes derived from human umbilical cord MSCs (HUC-MSCs) in patients with complete subacute SCI.MethodsThis study was a single-arm, open-label, phase I clinical trial with a 12-month follow-up period. HUC-MSCs were extracted from human umbilical cord tissue, and exosomes were isolated via ultracentrifugation. After intrathecal injection, each participant a underwent complete evaluation, including neurological assessment using the American Spinal Injury Association (ASIA) scale, functional assessment using the Spinal Cord Independence Measure (SCIM-III), neurogenic bowel dysfunction (NBD) assessment using the NBD score, modified Ashworth scale (MAS), and lower urinary tract function questionnaire.ResultsNine patients with complete subacute SCI were recruited. The intrathecal injection of allogeneic HUC-MSCs-exosomes was safe and well tolerated. No early or late adverse event (AE) attributable to the study intervention was observed. Significant improvements in ASIA pinprick (P-value = 0.039) and light touch (P-value = 0.038) scores, SCIM III total score (P-value = 0.027), and NBD score (P-value = 0.042) were also observed at 12-month after the injection compared with baseline.ConclusionsThis study demonstrated that intrathecal administration of allogeneic HUC-MSCs-exosomes is safe in patients with subacute SCI. Moreover, it seems that this therapy might be associated with potential clinical and functional improvements in these patients. In this regard, future larger phase II/III clinical trials with adequate power are highly required.Trial registrationIranian Registry of Clinical Trials, IRCT20200502047277N1. Registered 2 October 2020, https://en.irct.ir/trial/48765.

Maintaining fidelity to the treatment court model through evaluation: The racial and ethnic disparities (RED) program assessment tool

ABSTRACT Treatment courts have played a key role in criminal justice reform by offering an alternative to incarceration for individuals who have substance use and mental health disorders. The treatment court model requires programs to complete evaluations, as well as measure potential racial and ethnic disparities in outcomes. This study contributes to literature by using the Racial and Ethnic Disparities (RED) Program Assessment Tool to see if treatment courts (n = 151) have fidelity to the model by completing regular evaluation and to assess for racial and ethnic disparities in graduation rates. Treatment courts in this study, for the most part, were not faithful to the model by completing regular evaluation. Specifically, only 34% of the programs regularly examined graduation outcomes by race and ethnicity. Additionally, racial and ethnic disparities did exist where white participants were more likely than African American and Hispanic participants to graduate treatment court. Implications for policy advocacy, treatment court practice, and future research are discussed.

Evaluation of Spare Parts Support Capacity of Civil Aircrafts Based on Type-2 Hesitant Pythagorean Fuzzy Sets and Improved Technique for Order Preference by Similarity to Ideal Solution

To improve the spare parts support capacity of civil aircrafts and given the actual lack of evaluation methods at present, the evaluation problem of spare parts support capacity was solved in this study by proposing a multi-attribute decision method based on Type-2 hesitant Pythagorean fuzzy sets and an improved Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). First, the basic definitions of Type-2 hesitant Pythagorean fuzzy sets were given, which were further promoted to Type-n hesitant Pythagorean fuzzy sets, and the basic order relation criterion of Type-2 hesitant Pythagorean fuzzy sets was introduced. Second, a complete evaluation system for spare parts supply support capacity was established with the spare parts of civil aircrafts as the study objects, and each evaluation indicator was introduced in detail. Then, the spare parts support solutions were preferentially sorted using the correlation coefficient formula of Type-2 hesitant Pythagorean fuzzy sets and improved TOPSIS. Finally, the reliability and reasonability of the proposed method were verified through an example calculation and comparative analysis. The experimental results indicate that the proposed method can acquire the evaluation results of spare parts support capacity more scientifically and can be referenced by relevant studies.

Molecular Diagnostic Yield and Safety Profile of Ultrasound-Guided Lung Biopsies: A Cross-Sectional Study.

The recent advances in precision oncology for lung cancer treatment has focused attention on the importance of obtaining appropriate specimens for tissue diagnosis as well as comprehensive molecular profiling. CT scan-guided biopsies and bronchoscopy are currently the main procedures employed for tissue sampling. However, growing evidence suggests that ultrasound-guided biopsies may represent an effective as well as safe approach in this diagnostic area. This study explores the safety and the diagnostic yield for cancer molecular profiling in ultrasound-guided percutaneous lung lesion biopsies (US-PLLB). One hundred consecutive patients with suspected lung cancer, between January 2021 and May 2024, who had ultrasound-guided lung biopsies have been retrospectively analyzed. Molecular profiling was conducted with next-generation sequencing Genexus using Oncomine precision assay or polymerase chain reaction according to specimen quality. Qualitative immunohistochemical assay of programmed death ligand 1 (PD-L1) expression was evaluated by the Dako PD-L1 immunohistochemistry 22C3 pharmDx assay. The co-primary endpoints were the molecular diagnostic yield and the safety profile of US-guided lung biopsies. From January 2021 to May 2024, 100 US-guided lung biopsies were carried out and 95 were considered for inclusion in the study. US-PLLB provided informative tissue for a histological evaluation in 93 of 95 patients with an overall diagnostic accuracy of 96.84% [Sensitivity: 92.63%; Specificity: 96.84%; PPV: 100%; NPV: 100%]. Sixty-Six patients were diagnosed with NSCLC (69.47%) and were considered for molecular diagnostic yield evaluation and PD-L1 testing. Four patients had malignant lymphoid lesions. US-PLLB was not adequate to achieve a final diagnosis in three patients (3.16%). Complete molecular profiling and PD-L1 evaluation were achieved in all patients with adenocarcinoma (molecular diagnostic yield: 100%). PD-L1 evaluation was achieved in 28 of 29 patients (96.55%) with either SCC or NOS lung cancer. The overall complication rate was 9.47% (n = 9). Six patients (6.31%) developed pneumothorax, while three patients (3.16%) suffered mild haemoptysis without desaturation. According to our findings, US-guided lung biopsy is a safe, minimally invasive procedure in patients with suspected lung malignancies, providing an excellent diagnostic yield for both comprehensive molecular profiling and PD-L1 testing. In addition, our results suggest that US-guided biopsy may also be an effective diagnostic approach in patients with suspected lung lymphoma.

Performance Management Decision-Making Model: Case Study on Foreign Language Learning Curriculums

Foreign language learning courses can be regarded as a service operation system, and a complete foreign language learning course performance evaluation model can help improve the effectiveness of student learning. The performance evaluation matrix (PEM) is an excellent tool for evaluation and resource management decision making, and the administrator uses the satisfaction and the importance indices to establish evaluation coordinate points based on the rules of statistical testing. The coordinate points of all service items are plotted into the PEM to grasp the full picture and to make decisions on what to improve or to consider resource transfers so as to elevate the overall satisfaction of the entire service. However, plotting all the coordinate points on the PEM can only be performed by programming, which will lead to limitations in practice. Therefore, instead of the above evaluation rules, this article uses the confidence intervals of decision-making indicators to form a validity evaluation table, to decide which teaching service items should be improved, maintained, or transferred to improve the satisfaction of the entire service system. This form of performance evaluation can be completed using any commonly used word-processing software, so it is easy to apply and promote. Finally, this article provides an applied example to illustrate the proposed method.