Consecutive Sessions Research Articles

Abstract 4113405: The Role of Cardiac Power Output and Stroke Work Index in Balloon Pulmonary Angioplasty Therapy for Chronic Thromboembolic Pulmonary Hypertension

Background: Right ventricular (RV) and left ventricular (LV) measures of cardiac power output (CPO) and stroke work index (SWI) are existing markers of cardiac function and clinical outcomes. These metrics have not been used to evaluate the effects of balloon pulmonary angioplasty (BPA) therapy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: CTEPH patients who underwent at least six BPA sessions and were included in the UC San Diego BPA registry were included for analysis. Left and right ventricular CPO and SWI during each session were recorded. Cardiac output was measured using the thermodilution technique. Differences in continuous variable measurements before versus after BPA therapy were evaluated using the Student T-test. P-value <0.05 was significant. Results: A total of 66 subjects underwent six consecutive BPA sessions (55.5% female, BMI 28.3±6.10kg/m 2 ,16.7% prior pulmonary thromboendarterectomy surgery) and were included for analysis. Measurements of RV function, including RVCPO (Pre-BPA 0.38±0.14 vs Post-BPA 0.30±0.13 W, p=0.001)(Figure 1) and RVSWI (Pre-BPA 16.52±5.09 vs Post-BPA 14.14±4.00 g*m/beat/m 2 , p=0.004) significantly decreased after BPA therapy. Measurements of LV function, including LVCPO (Pre-BPA 1.00±0.32 vs Post-BPA 1.04±0.31 W, p=0.523) (Figure 2) and LVSWI (Pre-BPA 37.13±10.14 vs Post-BPA 39.73±9.37 g*m/beat/m 2 , p=0.152) did not change significantly after BPA therapy. The ratio of LVCPO/RVCPO increased in stepwise fashion from baseline to the last BPA session (2.82± 0.95 vs. 3.54±1.31 W, p<0.001)(Figure 3). Conclusions: Hemodynamic work expended by the RV decreased after BPA therapy, while work expended by the LV remained unchanged during BPA therapy. The ratio of LV-to-RV work increased in a stepwise manner during consecutive BPA sessions. These measurements may be useful parameters to monitor clinical response to BPA therapy.

Improving Reproductive Success in Captive Marmosets Through Active Female Choice.

The recent upsurge in the use of common marmosets (Callithrix jacchus) as a desirable model for high-priority biomedical research has challenged local and global suppliers struggling to provide sufficient numbers of marmosets for large-scale projects. In laboratories, random male-female pairings are often unsuccessful, with intervals of several months before attempting alternate pairings. Here we address this challenge through a behavioral task that promotes self-directed female selection of potential mates to increase the efficiency of breeding in captive marmosets. We created a partner preference test in which nulliparous females (n = 12) had the opportunity to select between two eligible males (n = 23) at a time, in a forced choice test. In this test, both males and females displayed sexual solicitations. However, the females displayed a clear preference for one male by directing affiliative behaviors toward him including proceptive tongue-flicking, approach, and grooming. Her preference remained consistent across three consecutive test sessions. This method resulted in a 2.5-fold improvement in breeding success within 90 days compared to random pairings. This cost-effective and straightforward pairing practice can be used to enhance breeding efficiency in both small and large marmoset colonies.

Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice

BackgroundSudden gains are large symptom improvements between consecutive therapy sessions. They have been shown to occur in randomised controlled trials of internet-delivered psychological interventions, but little is known about their occurrence when such treatments are delivered in routine clinical practice. ObjectiveThis study examined the occurrence of sudden gains in a therapist-guided internet-delivered Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in the UK NHS talking therapies for anxiety and depression (formerly known as IAPT services). It aimed to assess whether sudden gains were associated with better therapy outcomes, and examine changes in process variables around the period of sudden gains. MethodsThe study examined sudden gains based on the Liebowitz Social Anxiety Scale. Of 193 treated patients, 146 provided sufficient data to permit analysis. Linear mixed effects models were used to examine the impact of sudden gains on clinical outcomes, and examine changes in negative social cognitions, self-focused attention, and depressed mood. ResultsSeventy sudden gains were found among 57 participants. The occurrence rate of sudden gains was 39 %. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas changes in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints. ConclusionsApproximately 2 in 5 patients experienced a sudden gain whilst accessing the iCT-SAD intervention in routine practice. They were associated with better clinical outcomes following treatment compared to those who did not experience a sudden gain.

Breast cancer imaging-clinical experience with two-dimensional-shear wave elastography: A retrospective study.

Breast cancer morbidity has been increasing worldwide, but treatments are improving. The therapeutic response depends on the stage at which the disease is diagnosed. Therefore, early diagnosis has never been more essential for successful treatment and a reduction in mortality rates. Radiology plays a pivotal role in cancer detection, and advances in ultrasound (US) palpation have shown promising results for breast cancer imaging. The addition of two-dimensional-shear wave elastography (2D-SWE) US in the routine breast imaging exam can increase early cancer detection and promote better surveillance. To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities. The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions. All patients underwent mammography, bright mode (B-mode) US, and 2D-SWE followed by US-guided biopsy in two consecutive sessions. Combining B-mode and shear wave US imaging with X-ray mammography revealed 100% of the suspicious lesions, resulting in greater sensitivity, specificity, and negative predictive value. The result improves compared to either B-mode or 2D-SWE alone (P = 0.02). Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection. Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Effect of transcranial direct current stimulation on tinnitus modulation: A randomized, double-blind, and placebo-controlled clinical trial: Effect of tDCS on tinnitus modulation: A clinical trial

ObjectivesTo evaluate the short and long-term effects of anodal tDCS (a-tDCS) targeting the left temporoparietal area (LTA) on tinnitus severity, annoyance, and loudness. MethodsThis is a double-blind, randomized, sham-controlled, and parallel-group clinical trial. A total of 42 individuals with tinnitus were randomized to a-tDCS (n = 24) or sham tDCS (n = 18). The a-tDCS group received tDCS over the LTA during five consecutive day sessions (2 mA, 20 min). The sham group received a placebo current with the same characteristics as the a-tDCS group. Participants were assessed at baseline, after the fifth session, and at the 30-day follow-up, using hearing assessments and symptom questionnaires. ResultsThere was no effect of comparison between groups or interaction effect (time x group) in all hearing assessments and symptom questionnaires. There was only a main effect of time for Tinnitus Handicap Inventory - THI [F(1.642, 45.988) = 5.128; p = 0.014; η2 = 0.155]. Bonferroni post hoc showed that there was a significant difference in THI in the sham group between pre and post-treatment [CI (0.107, 14.643; p = 0.046)]. However, there was no difference between pre-treatment and follow-up THI, or between post-treatment and follow-up THI. There was no treatment effect on tinnitus severity (assessed by Tinnitus Functional Inventory - TFI), tinnitus annoyance or loudness (assessed by Visual Analogue Scale - VAS), or tinnitus pitch, loudness or minimum masking level (assessed by tinnitometry). ConclusionFive consecutive sessions of a-tDCS targeting LTA do not improve tinnitus severity, annoyance, and loudness. Future studies should investigate if other tDCS protocols are effective or a combination of tDCS with other forms of treatment.

Perception and Effectiveness of Online Anatomy Lab Exercise on Undergraduate Students of BPKIHS During COVID-19 Pandemic

Introduction: Online mode of teaching learning activities were started for medical students of Nepal to reduce the risk of spreading virus during COVID-19 pandemic. BPKIHS started the modified online lab exercise (LABEX) for the undergraduate students after six months of pandemic. Objective: The main objective of study was to evaluate the student’s perception and effectiveness of modified online LABEX (prior content video uploading) during pandemic. Methods: The mixed method cross-sectional study design using semi-structured questionnaire was conducted. The questionnaire had sub-sections such as questions regarding students’ means of study, students’ perception on modified online lab exercise during pandemic and reflective writing. We collected the responses from 129 students after institutional ethical clearance and informed consent. Student’s paired test for analysis of effectiveness of modified online LABEX was done by using pre-test/post-test score. Thematic analysis was performed for reflective writing. A p<0.05 was considered as statistically significant. Results: The mean age was calculated as 20.84 year. The modified online LABEX increase the scoring of students for three consecutive sessions with an average score of 1.71; 1.55 & 1.09 respectively (p<0.001). We formulated 15 codes and 3 themes from reflective writing such as strength, weakness and recommendation of modified online LABEX. We found that “Accessibility of recorded Labex” (n=54) was major strength and “less efficient of online LABEX” (n=57) was major weakness. Conclusions: Although physical form of anatomy education is best way of learning but modified online LABEX can be used as alternative during pandemic like situations in future

Impedance Spectroscopy Measures of Whole and Segmental Skeletal Muscle Quantity Associated With Strength and Power in Collegiate Ice Hockey Players.

Otremba, JR, Heesch, AJ, Morgan, RM, Poolman, MA, Schindler, GD, and Fitzgerald, JS. Bioelectrical impedance spectroscopy measures of whole and segmental skeletal muscle quantity associated with strength and power in collegiate ice hockey players. J Strength Cond Res XX(X): 000-000, 2024-Bioelectrical impedance spectroscopy (BIS) is a promising monitoring tool for body water compartment assessment, particularly intracellular water (ICW), in which acute decreases are associated with increased muscle damage and reduced function, and chronic changes are associated with muscle quantity. Because little is known about the predictive utility of BIS-derived measures in athletes, this study aimed to assess the association between whole-body and segmental compartment water measured by BIS and maximal-intensity exercise performance in athletes. Twenty-five National Collegiate Athletic Association Division I collegiate hockey players completed 2 consecutive testing sessions. Body water and composition were assessed using a SOZO BIS device. Strength and explosive strength were measured on a force platform during the isometric belt squat and squat jump, respectively. Peak power was assessed using the 6-Second Test on a Wattbike. Pearson's r and partial correlation were used to assess relationships. Select body water and composition BIS variables were strong correlates of strength ( r = 0.51-0.63, p < 0.05), moderate correlates of power ( r = 0.41-0.44, p < 0.05), and lacked association with explosive strength. Segmental leg variables tended to be the strongest correlates of strength and power. Body water and traditional lean mass variables expressed similar predictive utility. Intracellular water/extracellular water lacked associated with exercise performance in bivariate and adjusted models. We provide evidence of the criterion validity of whole-body (i.e., ICW, fat-free mass, skeletal muscle mass [SMM]) and segmental (i.e., leg ICW, leg SMM) BIS variables, related to the quantity of SMM, to predict body-size dependent maximal-intensity exercise performance. Practitioners can use this information to determine which variables to track for performance readiness monitoring.

Pulmonary Congestion and Anemia in Hemodialysis: The Potential Link to Inflammation

Pulmonary congestion (PC) is common in hemodialysis (HD) patients. We explored the association of anemia and pulmonary congestion in HD patients. A prospective pilot observational study included 18 patients on maintenance HD. Individual B-lines scores (BLS; 8-sites method) were obtained by lung ultrasound, before and after the first two consecutive HD sessions of the week (HD1-HD2), with different inter-dialytic intervals (68 vs. 44 h). Bioimpedance spectroscopy body composition (BIS) was performed before each HD session. Hemoglobin (Hb) levels, in addition to circulating markers of chronic inflammation (soluble urokinase Plasminogen Activator Receptor [suPAR], soluble Suppression of Tumorigenicity 2 [sST2]) were obtained. Mean (±SD) BLS values were quite elevated at all time points: Pre-HD1 (16 ± 5.53), post-HD1 (15.3 ± 6.63), pre-HD2 (16.3 ± 5.26) and post-HD2 (13.6 ± 5.83), respectively. No direct significant correlation was found between inflammation markers levels and BLS. However, mean levels (±SD, ng/mL) of suPAR pre-HD1 (7.88 ± 3.07) and pre-HD2 (7.78 ± 3.02) remained significantly above the normal range (&lt;4 ng/mL), and sST2 levels reached 2-fold the upper normal value in most patients (27.4 ± 17.8). Pulmonary congestion reflected by BLS was negatively correlated to Hb levels pre-HD1 (R² = 0.439, p = 0.003), and pre-HD2 (R² = 0.301, p = 0.018). In addition, Hb levels were negatively correlated to global volume status estimated by BIS (R² = 0.351, p = 0.009). Hemoglobin levels were negatively correlated to pulmonary congestion and to the global volume status evaluated by BIS. Chronic inflammation markers were increased in HD patients, suggesting a complex volume- and non-volume-dependent pathophysiology of pulmonary congestion in HD patients.

Identifying group metacognition associated with medical students’ teamwork satisfaction in an online small group tutorial context

BackgroundCollaborative learning is an essential pedagogy in medical education, within which small group learning constitutes an integral component. Online small group teaching has been widely applied and blended with in-person sessions in the aftermath of the Covid-19 pandemic. This study examined whether group metacognition was associated with teamwork satisfaction in an online small group teaching curriculum for medical students.MethodsWe enrolled medical students of the 2nd and 4th years during the 2021 fall semester after they participated in 3 consecutive sessions of online small group tutorials (SGTs), which have been implemented in our medical school for more than 20 years. The students completed a group metacognitive scale (GMS) and a teamwork satisfaction scale (TSS) after the sessions. We analyzed whether group metacognition in 4 dimensions (knowledge of cognition, planning, evaluating, and monitoring) could be connected with medical students’ teamwork satisfaction using partial least squares-structural equation modeling (PLS-SEM).ResultsA total of 263 medical students participated in this study. Both GMS and TSS exhibited good reliability and validity. Three of the 4 dimensions of group metacognition (cognition, planning, and evaluating) positively correlated with teamwork satisfaction (path coefficients 0.311, 0.279, and 0.21; p = 0.002, 0.002, and 0.043, respectively) following the online SGT curriculum, whereas the monitoring dimension did not (path coefficient 0.087; p = 0.357). The model achieved an adjusted R square of 0.683.ConclusionWe discovered that group metacognition correlated positively with better teamwork satisfaction, supporting the importance of group metacognitive competency for online collaborative learning.

Interrater agreement and reliability of the Bosniak classification for cystic renal masses version 2019

BackgroundThe Bosniak classification for cystic renal masses has undergone refinements since its inception. The 2019 version provides more objective criteria to enhance interrater agreement but needs validation. This study compares the interrater agreement of the 2005 and 2019 Bosniak classifications for cystic renal masses. MethodsForty cystic renal masses identified on computed tomography scans were selected, distributed equally among the five classes of the 2005 Bosniak classification. Eight radiology residents participated in 2 consecutive rating sessions using the 2005 and 2019 versions, respectively, with a 1-month wash-out period in between. Interrater reliability was assessed using Fleiss' κ, and changes in cyst classes between the versions were assessed using the Wilcoxon signed-rank test. ResultsFleiss' κ values for interrater reliability were 0.354 (0.286–0.431) for 2005 and 0.373 (0.292–0.487) for 2019, indicating fair to moderate agreement. A significant decrease in cyst grades was noted using the 2019 version (Z = 3.49, r = 0.55, P < 0.001) among all cysts assessed by residents and only in complex cysts assessed by consultants (Z = 1.907, r = 0.275, P = 0.048). ConclusionInterrater agreement was similar for both classifications, ranging from fair to moderate. The 2019 version increased the proportion of masses downgraded to lower classes. Comprehensive training may enhance reliability and accuracy.

Effect of trunk and upper limb retention on the motor function after stroke: Randomized clinical-trial pilot study

Objective. Trunk compensations do not allow the upper limb to use its full potential to perform functional activities. Therefore, the objective of this study was analyzing the effects of movement retention and induction therapy (TRIM) with trunk and upper limb stabilization in hemiparetic patients following a stroke. Method. This was a clinical pilot study with 18 individuals with sequelae from a stroke were randomly assigned to one of three groups: a control group (CG), an experimental TRIM group without trunk restriction (GET), and an experimental TRIM group with trunk restriction (GETT). The GET and GETT groups underwent TRIM therapy based on the Shaping protocol for ten consecutive sessions, lasting 1h each, over 2 weeks. Fugl-Meyer Sensory-Motor Function Assessment Scale (FAS), the Upper Extremity Activity Inventory (MAL), surface electromyography (EMG) of the elbow flexors, extensors, and superficial wrist flexors, as well as goniometric measurements of the upper limb were utilized for evaluation. Results. Significant differences were observed over time in the GET and GETT groups for the total scores on the FAS and MAL scales, as well as in the range of motion for shoulder flexion (p&lt;0.05). No significant differences were found for the EMG variables. Conclusion. TRIM combined with trunk stabilization did not exhibit any significant effects on functional, sensorimotor activities, or EMG and range of motion variables when comparing different groups.

Immersive visualization of movement in patients with hemophilic ankle arthropathy. Multicenter, single-blind, randomized clinical trial.

To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy. Multicentre, single-blind, randomized clinical trial. 48 patients with haemophilia. Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion-extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks' follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia). There were intergroup differences in pain intensity (F = 37.14; p < 0.001), conditioned pain modulation (F = 5.40; p = 0.006), and dorsal (F = 19.17; p < 0.001) and plantar (F = 9.27; p<0.001) ankle flexion. More than 50% of experimental group patients exhibited changes exceeding the minimum detectable change in pain intensity (MDC = 0.43), and the pressure pain threshold in the extensor carpi radialis longus muscle (MDC = 1.34) and malleolus (MDC = 4.93). 180º immersive video-based visualization of movement can improve the intensity of pain, conditioned pain modulation, and ankle range of motion in patients with haemophilic ankle arthropathy.

Intra-rater and test-retest reliability of videography observation method to check diversion time in Fukuda step test among college going students.

The Fukuda step test is a valuable tool for identifying vestibular dysfunction in humans. This study evaluated the intra-rater and test-retest reliabilities of videograph observations to determine the diversion time while performing the Fukuda test. This study aimed to determine the use of videographic observation as a beneficial tool for recording real-time assessment procedures in clinical settings. Fifty college students who were selected based on the inclusion criteria performed three consecutive sessions of the Fukuda step test. Intra-rater and test-retest reliabilities of the videograph observations were identified using the intraclass correlation coefficient (ICC). We noted both, good intra-rater (ICC= 0.78) and moderate-to-good test-retest reliabilities (ICC= 0.69) of the videograph observations. Videographic observation can be used in clinical settings to identify diversion times while performing the Fukuda step test.

Interpeduncular GABAergic neuron function controls threat processing and innate defensive adaptive learning.

The selection of appropriate defensive behaviors in the face of potential threat is fundamental to survival. However, after repeated exposures to threatening stimuli that did not signal real danger, an animal must learn to adjust and optimize defensive behaviors. Despite extensive research on innate threat processing, little is known how individuals change their defensive behaviors when presented with recurrent threat exposures without evidence of a real risk. Insight into this process is critical as its dysregulation may contribute to neuropsychiatric conditions, such as anxiety disorders. Here, we used the visual looming stimulus (VLS) paradigm in mice to investigate innate threat processing and adaptive defensive learning. Repeated exposure to VLS over consecutive sessions reduced immediate freezing responses and time spent inside a sheltered area upon VLS events, leading to an increase in foraging behaviors. Fiber photometry recordings and optogenetic manipulations revealed that VLS innate adaptive defensive learning is associated with reduced recruitment of the midbrain interpeduncular nucleus (IPN), a structure associated with fear and anxiety-related behaviors. Functional circuit-mapping identified a role for select IPN projections to the laterodorsal tegmental nucleus in gating defensive learning. Finally, we uncovered a subpopulation of IPN neurons that express the neuropeptide somatostatin and encode safety- and avoidance signals in response to VLS. These results identify critical behavioral signatures of innate defensive responses and a circuit that regulates the essential features of threat processing.

Different delayed consequences of attaining a plateau phase in practicing a simple (finger-tapping sequence learning) and a complex (Tower of Hanoi puzzle) task.

In practicing a new task, the initial performance gains, across consecutive trials, decrease; in the following phase, performance tends to plateau. However, after a long delay additional performance improvements may emerge (delayed/ "offline" gains). It has been suggested that the attainment of the plateau phase is a necessary condition for the triggering of skill consolidation processes that lead to the expression of delayed gains. Here we compared the effect of a long-delay (24-48h) interval following each of the two within-session phases, on performance in a simple motor task, the finger-tapping sequence learning (FTSL), and in a conceptually complex task, the Tower of Hanoi puzzle (TOHP). In Experiment 1 we determined the amount of practice leading to the plateau phase within a single practice session (long practice), in each task. Experiment 2 consisted of three consecutive sessions with long-delay intervals in between; in the first session, participants underwent a short practice without attaining the plateau phase, but in the next two sessions, participants received long practice, attaining the plateau phase. In the FTSL, short practice resulted in no delayed gains after the long delay, but after 24-48h following long practice, task performance was further improved. In contrast, no delayed gains evolved in the TOHP during the 24- to 48-h delay following long practice. We propose that the attainment of a plateau phase can indicate either the attainment of a comprehensive task solution routine (achievable for simple tasks) or a preservation of work-in-progress task solution routine (complex tasks); performance after a long post-practice interval can differentiate these two states.

Acupuncture-assisted therapy for prolonged disorders of consciousness: study protocol for a randomized, conventional-controlled, assessor-and-statistician-blinded trial.

Acupuncture is a promising non-pharmaceutical complementary therapy in treating prolonged Disorders of consciousness (pDOC), but solid evidence to support its effectiveness and safety is still lacking. Thus, the purpose of this study is to investigate the efficacy and safety of acupuncture-assisted therapy for pDOC patients. A single-center, prospective, randomized, conventional-controlled, assessor-and-statistician-blinded trial has been designed and is being conducted at West China Hospital of Sichuan University. A total of 110 participants will be randomly assigned to the experimental group and the control group in a 1:1 allocation ratio and evaluated using Coma Recovery Scale-Revised (CRS-R) at 8 a.m., 12 p.m., and 4 p.m. on 2 consecutive days before enrollment to determine the consciousness level. The experimental group will receive acupuncture combined with conventional treatment, while the control group will receive only conventional treatment during the trial observation period. The treatment duration of both groups will be 20 days. Among them, the frequency of acupuncture-assisted therapy is once a day, with 10 consecutive sessions followed by a day's rest for a total of 24 days. Data will be collected separately during baseline and after the final treatment. For data analysis, both Full Analysis Set (FAS) and Per Protocol Set (PPS) principles will be performed together by applying SPSS 27.0 software. The primary outcome measures are the changes of CRS-R before and after treatment, while the secondary outcome measures are the changes of Full Outline of Unresponsiveness Scale (FOUR), the changes of Nociception Coma Scale-Revised (NCS-R), the changes of Disability Rating Scale (DRS), the changes of Mismatch Negativity (MMN) and P300 before and after treatment, respectively. This trial aims to rationally assess the consciousness level from multiple 2 perspectives through subjective evaluation and objective detection by selecting several standardized clinical scales combined with Event-Related Potential (ERP) detection technology. In this way, we will be able to reduce the subjectivity of consciousness assessment and objectively evaluate the clinical efficacy of acupuncture-assisted therapy for pDOC. The study, if proven to be effective and safe enough, will provide a favorable evidence to guide medical decision-making choices and future researches. https://www.chictr.org.cn/, identifier ChiCTR2300076180.

Impact of Extracorporeal Shock Wave Lithotripsy (ESWL) on Kidney Length and Corticomedullary Differentiation in Patients With Renal Stones: A Case-Control Study.

Background The effect of extracorporeal shock wave lithotripsy (ESWL) on kidney morphology was evaluated sonographically in patients with renal stones. This study aimed to investigate the effects of ESWL on the kidneys after consecutive sessions. Methods This case-control study included adult participants from December 2018 to August 2022 in three major centers of ESWL treatment. Data were collected from 392 patients (336 treated with ESWL and 56 in the control group). Data were analyzed using SPSS Statistics (IBM Corp., Armonk, USA). Both binary logistic regression and generalized linear regression were applied to determine the factors that predicted the effect of ESWL on kidney length (KL) and cortico-medullary differentiation (CMD). Results The overall effect of ESWL treatment on patients with renal stones was observed in 19.9% disturbed CMD, and 11.6% decreased parenchymal thickness. KL was significantly decreased in patients exposed to ESWL compared to controls (9.103 vs.10.291 cm, p-value < .001). KL decreased significantly as the number of ESWL sessions increased (r = -.209, p-value < .001). After adjustment, the frequencies of ESWL and hydronephrosis were significantly associated with CMD distortion. Patients who were exposed to more than one ESWL session had 2.64 increased odds of distorted CMD as compared to controls (AOR=2.64, 95% CI = 1.040-6.683), and those with hydronephrosis had 1.70 increased odds of distorted CMD as compared to controls (AOR=1.70, 95% CI = 1.188-2.434). Conclusion ESWL significantly affected the renal length and CMD in patients with renal stones. The frequency of ESWL sessions significantly decreased KL and disturbed CMD in patients with renal stones. The outcome was not affected by the number of stones.

Psychobiological responses to choir singing and creative arts activities in children and adolescents with mental disorders: results of apilot study.

Children and adolescents living with mental health problems often experience stress and poor mood states, which may influence their quality of life and well-being. Arts interventions may improve mood and well-being and reduce physiological stress in this vulnerable population. Acohort of patients in child and adolescent psychiatry (N = 42; age range: 12-18years) participated in one of four arts activities including choir singing (n = 11), textile design (n = 9), drama (n = 16), and clownery (n = 6). They were led by professional artists and delivered through five consecutive 90-min daily afternoon sessions over the course of 1week. Questionnaires of mood and saliva samples before and after each session served to assess short-term psychobiological changes. In addition, patients reported their quality of life and well-being at the beginning and at the end of the 1‑week program. Results showed that alertness was significantly enhanced after textile design (∆post-pre = 4.08, 95% CI [0.77, 7.39]) and after singing (∆post-pre = 2.20, 95% CI [-0.55, 4.94]). Moreover, mood tended to be positively affected by textile design (∆post-pre = 2.89, 95% CI [-0.39, 6.18]). Quality of life increased significantly after singing (∆post-pre = 5.49, 95% CI [1.05, 9.92]). Arts participation except singing was associated with significant reductions in salivary cortisol (sCort) (textile design ∆post-pre = -0.81 ng/mL, 95% CI [-1.48, -0.14]; drama ∆post-pre = -0.76 ng/mL, 95% CI [-1.28, -0.24]; clownery ∆post-pre = -0.74 ng/mL, 95% CI [-1.47, -0.01]). No significant changes were observed for well-being over the whole program and salivary immunoglobulinA (sIgA) after any of the arts activities. These results suggest that arts participation can improve mood state and reduce stress in young people with mental disorders, but there is aneed for further studies.

Depth-Sensing-Based Algorithm for Chest Morphology Assessment in Children with Cerebral Palsy.

This study introduced a depth-sensing-based approach with robust algorithms for tracking relative morphological changes in the chests of patients undergoing physical therapy. The problem that was addressed was the periodic change in morphological parameters induced by breathing, and since the recording was continuous, the parameters were extracted for the moments of maximum and minimum volumes of the chest (inspiration and expiration moments), and analyzed. The parameters were derived from morphological transverse cross-sections (CSs), which were extracted for the moments of maximal and minimal depth variations, and the reliability of the results was expressed through the coefficient of variation (CV) of the resulting curves. Across all subjects and levels of observed anatomy, the mean CV for CS depth values was smaller than 2%, and the mean CV of the CS area was smaller than 1%. To prove the reproducibility of measurements (extraction of morphological parameters), 10 subjects were recorded in two consecutive sessions with a short interval (2 weeks) where no changes in the monitored parameters were expected and statistical methods show that there was no statistically significant difference between the sessions, which confirms the reproducibility hypothesis. Additionally, based on the representative CSs for inspiration and expirations moments, chest mobility in quiet breathing was examined, and the statistical test showed no difference between the two sessions. The findings justify the proposed algorithm as a valuable tool for evaluating the impact of rehabilitation exercises on chest morphology.

A genetic algorithm-based method to modulate the difficulty of serious games along consecutive robot-assisted therapy sessions

Background and Objective:One of the biggest challenges during neurorehabilitation therapies is finding an appropriate level of therapy intensity for each patient to ensure the recovery of movement of the affected limbs while maintaining motivation. Different studies have proposed adapting the difficulty of exercises based on psychophysiological state, based on success rate, or by modeling the user’s skills. However, all studies propose solutions for a single session, requiring a calibration process before using it in each session. We propose a dynamic adaptation method that can be used during different rehabilitation sessions, without the need for recalibration between sessions. Methods:The adaptation architecture is based on a genetic algorithm that aims to maintain a certain score level and to motivate the user to move. The method has been evaluated with two serious games for five sessions using a rehabilitation robot. A common initial evaluation was made for all the users involved in the study, and the game parameters that best suited each user from the previous session were introduced as the starting point of the next session. In addition, the desired score rate was lowered between sessions to increase the difficulty level. The psychophysiological state of the users was measured based on the Self-Assessment Manikin test, as well as different cardiorespiratory and galvanic skin response signals were analyzed. Results:The adaptation architecture proposed can find those game parameters that maximize the user movement for both games. In one of the games, the score rate set for each session is followed with high fidelity. The degree of personalization in the games increases between sessions as the dispersion of the game parameters grows. The Self-Assessment Manikin test and the physiological signals results would indicate that the psychophysiological state remains equal between sessions despite an increase in game difficulty. Conclusions:The genetic algorithm-based game adaptation has proven efficacy in maximizing the therapy performance through the sessions without needing recalibration. It also can be concluded that the design of the game influences the adaptation performance. Additionally, adaptive game design facilitated by our method does not significantly impact players’ emotional or physiological states.