Decline In Scores Research Articles

Perivascular Spaces, Diffusivity Along Perivascular Spaces, and Free Water in Cerebral Small Vessel Disease.

Previous studies have linked the MRI measures of perivascular spaces (PVSs), diffusivity along the perivascular spaces (DTI-ALPS), and free water (FW) to cerebral small vessel disease (SVD) and SVD-related cognitive impairments. However, studies on the longitudinal associations between the three MRI measures, SVD progression, and cognitive decline are lacking. This study aimed to explore how PVS, DTI-ALPS, and FW contribute to SVD progression and cognitive decline. This is a cohort study that included participants with SVD who underwent neuroimaging and cognitive assessment, specifically measuring Mini-Mental State Examination (MMSE), cognitive index, and processing speed, at 2 time points. Three MRI measures were quantified: PVS in basal ganglia (BG-PVS) volumes, FW fraction, and DTI-ALPS. We performed a latent change score model to test inter-relations between the 3 MRI measures and linear regression mixed models to test their longitudinal associations with the changes of other SVD MRI markers and cognitive performances. In baseline assessment, we included 289 participants with SVD, characterized by a median age of 67.0 years and 42.9% women. Of which, 220 participants underwent the follow-up assessment, with a median follow-up time of 3.4 years. Baseline DTI-ALPS was associated with changes in BG-PVS volumes (β = -0.09, p = 0.030), but not vice versa (β = -0.08, p = 0.110). Baseline BG-PVS volumes were associated with changes in white matter hyperintensity (WMH) volumes (β = 0.33, p-corrected < 0.001) and lacune numbers (β = 0.28, p-corrected < 0.001); FW fraction was associated with changes in WMH volumes (β = 0.30, p-corrected < 0.001), lacune numbers (β = 0.28, p-corrected < 0.001), and brain volumes (β = -0.45, p-corrected < 0.001); DTI-ALPS was associated with changes in WMH volumes (β = -0.20, p-corrected = 0.002) and brain volumes (β = 0.23, p-corrected < 0.001). Furthermore, baseline FW fraction was associated with decline in MMSE score (β = -0.17, p-corrected = 0.006); baseline FW fraction and DTI-ALPS were associated with changes in cognitive index (FW fraction: β = -0.25, p-corrected < 0.001; DTI-ALPS: β = 0.20, p-corrected = 0.001) and processing speed over time (FW fraction: β = -0.29, p-corrected < 0.001; DTI-ALPS: β = 0.21, p-corrected < 0.001). Our results showed that increased BG-PVS volumes, increased FW fraction, and decreased DTI-ALPS are related to progression of MRI markers of SVD, along with SVD-related cognitive decline over time. These findings may suggest that the glymphatic dysfunction is related to SVD progression, but further studies are needed.

Subjective hearing loss is not associated with an increased risk of Alzheimer's disease dementia

Hearing loss is a risk-factor for dementia but the reasons for this are unclear. Subjective hearing loss is related to increased future dementia risk, however, this metric has not been previously examined with cognitive, neuroimaging and biochemical measures that are relevant to Alzheimer's disease. We assessed Cognitively Normal and Mild Cognitively Impaired participants from the Alzheimer's Disease Neuroimaging Initiative with subjective hearing loss to examine if they had faster decline in episodic memory scores, hippocampal volume and greater pTau positivity. The likelihood of a dementia diagnosis in hearing impaired participants over a 5-year period was also assessed. There were no statistically significant differences between the hearing subgroups over a 5-year period nor were there in conversions to a dementia diagnosis. Objective hearing loss metrics may provide a more reliable link between hearing loss and dementia risk.

Laser interstitial thermal therapy for first-line treatment of insular glioma.

Insular gliomas pose a significant surgical challenge due to the complex surrounding functional and vascular anatomy. The authors report their experience using a novel framework for the treatment of insular gliomas with laser interstitial thermal therapy (LITT) and provide representative case examples emphasizing indications, rationale, and technical pearls. A prospectively gathered institutional database was used to identify patients with newly diagnosed insular gliomas who underwent LITT between 2015 and 2023. The proposed framework of insular glioma management is guided by tumor size and extent of extra-insular tumor involvement. Patients with tumors localized to the insula (insula-only) were treated with single-session or staged LITT. Patients with insular tumors with frontotemporal involvement (insular+) were treated with insular LITT and standard frontotemporal resection of extra-insular tumor. Clinical and volumetric lesional characteristics were analyzed, with particular emphasis on extent of cytoreductive treatment and safety. Of the 261 patients treated at the authors' institution with LITT between 2015 and 2023, 33 LITT procedures were identified involving 22 unique patients with treatment-naive insular gliomas. Of the 22 patients, 12 had insular-only tumors and were treated with LITT alone, while 10 patients had insular+ lesions and were treated with LITT and resection. The median tumor volume for insular-only tumors was 13.4 cm3 (IQR 10.6, 26.3 cm3), with a median extent of treatment of 100% (IQR 92.1%, 100%). Insular+ lesions were significantly larger, with a median volume of 81.2 cm3 (IQR 51.9, 97 cm3) and median extent of treatment of 96.6% (IQR 93.7%, 100%). All patients with insular-only tumors were discharged the day after ablation, while insular+ patients had significantly longer hospital stays, with 50% staying more than 3 days. Overall, 8% of insular-only patients had permanent neurological deficits compared with 33% of insular+ patients. Two patients' tumors progressed during follow-up: one patient with WHO grade 4 astrocytoma and the other with diffuse glioma not otherwise specified. Patients with grade 4 tumors had the highest rate of permanent neurological deficit (43%) and a larger decline in postoperative Karnofsky Performance Status score (p = 0.046). The authors present their experience using a novel insular glioma treatment paradigm that incorporates LITT into the broader framework of insular glioma surgery. Their findings suggest that insular LITT is feasible and may allow for high rates of cytoreduction while potentially ameliorating the risks of conventional insular glioma surgery.

Functional outcomes of femoral diaphyseal fractures using titanium elastic nail: A retrospective study

Background: Femoral Diaphyseal is common fracture in pediatrics. The Titanium Elastic Nail is designed to stabilized the long bone fracture in children where the implant flexibility is paramount and medullary canal is narrow. This study evaluates the functional outcome and complications of using elastic nail. Materials and Methods: This was a single centric, retrospective and clinical investigation study. The study was consisting of thirty-eight children (29 boys, 9 girls) aged group of 9-15 years who underwent femoral diaphyseal fracture treatment in Gautemala between March 2018 to June 2019 were recruited. The patient outcome was analyzed by physical examination, radiographs, VAS and ASA score by one year follow up. Results: The result showed better outcomes in all the patients with decline in the VAS score. All patients were available for the follow up of one year. The bone union was achieved in mean time of 7.1 weeks. The study reveal that no mechanical failure related to nail, bend or corrosion was seen in the patients. Finally, all the patient’s bone healed with time without any adverse effect and severe complications. Conclusion: The elastic nailing fixation is an efficient method for treating long bone fracture in children’s.

Contrast sensitivity assessment using the Mars letter contrast sensitivity test

Background: Contrast sensitivity (CS) represents an individual’s ability to detect differences in luminance between two areas and is an essential component of vision. Various studies have evaluated the relevance of different charts to assess CS in ophthalmology practice. We evaluated the CS of healthy individuals using the Mars letter CS chart. Methods: In this hospital-based cross-sectional study, we consecutively recruited healthy individuals older than 18 years with unremarkable ocular examinations who attended the general outpatient clinic at Benue State University Teaching Hospital, Makurdi, Nigeria, between March 2021 and July 2022. Each participant was allocated to one of five groups with 10-year age intervals and 1:1 male-to-female ratios. All participants underwent a detailed ophthalmic examination. We tested visual fields using the 24-2 program on a Humphrey visual field analyzer with appropriate refractive correction. Monocular testing of CS with appropriate spectacle correction was performed using a Mars letter CS chart. The tribe, age, and sex of each individual, along with the best-corrected visual acuity (BCVA), intraocular pressure, mesopic pupil size, cup-to-disc ratio (C/D ratio), and mean deviation (MD) of the visual field for each eye were recorded. Results: A total of 100 eyes of 50 patients with a mean (standard deviation [SD]) age of 44.6 (12.8) years and a 1:1 male-to-female ratio were enrolled. The mean (SD) CS score for the 100 included eyes was 1.67 (0.09) log units. The mean (SD) CS score was comparable between sex groups and tribes (both P &gt; 0.05) yet differed significantly between age groups (P &lt; 0.001). We found a significant good inverse correlation between CS score and age (r = - 0.60; P = 0.001), a low inverse correlation with BCVA (r = - 0.29; P &lt; 0.003), and a low direct correlation with C/D ratio (r = + 0.23; P = 0.023); however, we observed no significant correlation with tribe (r = + 0.07; P = 0.053), sex (r = + 0.16; P = 0.123), IOP (r = + 0.07; P = 0.481), mesopic pupil size (r = - 0.02; P = 0.861), and mean deviation of visual field (r = + 0.02; P = 0.873). Conclusions: We observed a progressive decline in the mean CS score in healthy eyes with each decade of increase in age. Our findings are similar to those of previous studies and could be used as reference values for the healthy population among various age groups. However, further studies with larger sample sizes are necessary to encourage clinicians to incorporate CS into routine examinations. Further studies must compare these normative values with those of disease conditions to further understand the clinical application of the CS test.

Retention of En Route Cricothyroidotomy Skills in Novice Providers Following a Simulation-Based Mastery Learning Curriculum.

Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment. This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist. There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38-31.07 seconds; 6 months: median 36.33, interquartile range 31.59-55.22 seconds; 12 months: median 49.50, interquartile range 41.75-60.75 seconds; 24 months: median 38.79, interquartile range 30.20-53.08 seconds; P < .0001, P < .0001, P = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50-10.00; 6 months: median 8.00/10, interquartile range 6.75-9.00; 12 months: median 8.00/10, interquartile range 6.75-9.25; P < .0001, P < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50-10.00; 24 months: 10.00/10, interquartile range 9.00-10.00; P= .125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria. This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency.

Comparing the efficacy and pregnancy outcome of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis in infertile women: a prospective, randomized, controlled trial study

Study objectiveTo evaluate the efficacy and pregnancy outcomes of intrauterine balloon and intrauterine contraceptive devices in the prevention of adhesion reformation following hysteroscopic adhesiolysis in infertile women with moderate to severe intrauterine adhesion.DesignA prospective, randomized, controlled trial study.SettingA tertiary university hospital.PatientsA total of 130 patients with moderate (American Fertility Society [AFS] score of 5–8) and severe (AFS score of 9–12) intrauterine adhesions were recruited.Interventions86 patients were evenly allocated to group treated with an IUD for 1 month and group treated with an IUD for 2 months. 44 patients were allocated to group treated with a Foley catheter balloon.(IUD: Yuangong IUD).Measurements and main resultsThe primary outcome measures were the AFS score, endometrial thickness, and pregnancy outcome. After hysteroscopy, the AFS score was significantly decreased(P<0.05), whereas endometrial thickness was significantly increased across the three groups(P<0.001). Notably, the decline in the AFS score in the balloon group was greater than that in the IUD-1-month group and IUD-2-month group(P<0.01), with no significant difference between the IUD groups(P = 0.298). Lastly, In addition, the extent of the increase in endometrial thickness(P = 0.502) and the pregnancy outcomes(P = 0.803) in the three groups were not significantly different.ConclusionInserting a balloon or placing an IUD for one or two months can effectively lower the risk of adhesion recurrence and restore the shape of the uterine cavity. While the therapeutic effect of the balloon was superior to that of the IUD, no significant differences were observed in the one-month and two-month IUD groups.Trial registrationThis research was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/enIndex.aspx); Clinical trial registry identification number: ChiCTR-IOR-17,011,943 (http://www.chictr.org.cn/showprojen.aspx?proj=17979). Date of trial registration: July 11, 2017.

Mediterranean diet related to 3-year incidence of cognitive decline: results from a cohort study in Chinese rural elders

ABSTRACT Objective This study aims to examine the effect of the Mediterranean diet (MeDi) on cognitive decline among the Chinese elderly with a 3-year follow-up. Methods This study is divided into two waves: wave-1 January 2019 to June 2019 (n = 2313); wave-2 January 2022 to March 2022 (n = 1648). MeDi scores were calculated from the Mediterranean Diet Adherence Screener (MEDAS), with the scoring of low compliance (0–6 points) and high compliance (7–14 points). The Mini-Mental State Examination (MMSE) was used to assess cognitive function. An MMSE score dropping ≥ 2 points from baseline was defined as cognitive decline. The relationships between MeDi score and cognitive decline were analyzed by linear regression models or Binary logistic regression. Results During the 3-year follow-up, 23.8% of patients exhibited cognitive decline. The study revealed a significant difference in MMSE score changes between low and high MeDi adherence groups (p < 0.001). MeDi score was negatively correlated with cognitive deterioration (β = −0.020, p = 0.026). MeDi score was only negatively associated with cognitive decline in the female subgroup aged ≥65 years (β = −0.034, p = 0.033). The food beans (OR = 0.65, 95%CI:0.51, 0.84), fish (OR = 0.72, 95%CI:0.54, 0.97), and cooked vegetables (OR = 0.68, 95%CI:0.53, 0.84) were protective factors for cognitive decline. Conclusions This study suggests that greater adherence to the MeDi is linked to a reduced risk of cognitive decline in elderly people. However, this is found only in women who are 65 years old or older. It also found long-term adherence to beans, fish, and vegetables are more effective in improving cognitive function.

Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos.

To evaluate whether hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are associated with cognitive decline later in life among U.S. Hispanic/Latina individuals. The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a prospective population-based study of Hispanic/Latino individuals aged 18-74 years from four U.S. communities. This analysis included parous individuals aged 45 years or older who participated in the HCHS/SOL clinic study visit 1 (2008-2011) neurocognitive assessment and subsequently completed a repeat neurocognitive assessment as part of the Study of Latinos-Investigation of Neurocognitive Aging ancillary study visit 2 (2015-2018). Hypertensive disorders of pregnancy were assessed retrospectively by self-report of any gestational hypertension, preeclampsia, or eclampsia. Cognitive functioning was measured at both study visits with the Brief Spanish-English Verbal Learning Test, Digit Symbol Substitution, and Word Fluency. A regression-based approach was used to define cognitive decline at visit 2 as a function of cognition at visit 1 after adjustment for age, education, and follow-up time. Linear regression models were used to determine whether hypertensive disorders of pregnancy or their component diagnoses were associated with standardized cognitive decline after adjustment for sociodemographic characteristics, clinical and behavioral risk factors, and follow-up time. Among 3,554 individuals included in analysis, the mean age was 56.2 years, and 467 of individuals (13.4%) reported at least one hypertensive disorder of pregnancy. Individuals with hypertensive disorders of pregnancy compared with those without were more likely to have higher mean systolic blood pressure, fasting glucose, and body mass index. After an average of 7 years of follow-up, in fully adjusted models, gestational hypertension was associated with a 0.17-SD relative decline in Digit Symbol Substitution scores (95% CI, -0.31 to -0.04) but not other cognitive domains (Brief Spanish-English Verbal Learning Test or Word Fluency). Neither preeclampsia nor eclampsia was associated with neurocognitive differences. The presence of preeclampsia or eclampsia was not associated with interval neurocognitive decline. In this cohort of U.S. Hispanic/Latina individuals, gestational hypertension alone was associated with decreased processing speed and executive functioning later in life.

The effectiveness of online teaching and learning compared to in-person instruction in science for junior secondary students: a case study in the Kurunegala education zone

Schools and Universities in Sri Lanka have been closed intermittently during the past three years due to COVID-19 and fuel shortages. During this period, in-person teaching became impossible, and online teaching was developed. However, schools have been reopened for in-person teaching and learning at present. In contrast, other countries adopted both methods, online and in-person. It was noticed that a decline in test scores among junior secondary students in some education zones during online learning. This study aimed to assess and compare the effectiveness of online and in-person teaching and learning science among junior secondary students in a selected school within the Kurunegala education zone. The study objectives were to 1). conduct both online and in-person science lessons for two groups separately and compare grade-eight students' performance in both settings; 2) compare teacher-student interaction, learning resources, peer group interaction, and motivation in both sittings; and 3) make suggestions for effective teaching and learning process. Two equally weighted courses were used to teach the two groups. Convenience sample of 72 Grade 8 students was used in the data collection with mixed methods approach. Pre-tests, post-tests, and questionnaires were used in the quantitative data collection. Qualitative data were collected via interviews with ten randomly selected students. The findings revealed that the performance scores of in-person group in Unit 4 (Properties of Matter) of grade-eight Science evaluation were slightly higher than that of online group. Both groups demonstrated similar performance levels in Unit 8 (Changes in Matter). However, in-person teaching exhibited significantly higher scores (p &lt; 0.05) than the online group for factors such as teacher-student interaction, peer group interaction, learning resources, and motivation. Students achieved high results in both settings but needed more resources, reliable internet facilities, and adequate technology skills for online teaching and learning. The study suggests adapting effective instructional methods, technology usage, resource availability, training, participation, peer interactions, and monitoring well-being for effective online science teaching.

A Retrospective Chart Review Evaluating the Changes in Depressive Symptoms in Adult Patients With Attention-Deficit/Hyperactivity Disorder (ADHD) With the Treatment of the Underlying ADHD.

Adult attention-deficit/hyperactivity disorder (ADHD) represents a significant public health burden. ADHD is often comorbid with many other psychiatric disorders, with a high co-occurrence with depression. However, there is a paucity in our understanding of the potential impact of treating patients' ADHD on their depressive symptoms. The primary objective of this study was to assess the effect of treating adult ADHD on comorbid depressive symptoms without directly administering treatment for depression in an integrated behavioral health clinic in the primary care setting. We performed a retrospective chart review between April 2021 and May 2022 on adult patients treated in the Primary Care Adult Integrated Behavioral Health Clinic at an urban family medicine residency clinic. For patients with ADHD, we administered the Adult ADHD Self-Report Scale (ASRS-v1.1) to serve as a marker of ADHD symptom burden and the nine-item Patient Health Questionnaire(PHQ-9) to serve as a marker of depressive symptom burden. We administered the questionnaires prior to initiating ADHD treatment and again at the three-month follow-up visit. The ADHD treatment included pharmacotherapy and brief psychological interventions targeted at ADHD. We compared the ASRS scores and PHQ-9 scores at baseline and after three months to determine whether ADHD treatment had any impact on PHQ-9 scores. At baseline, the average ASRS score was 11.3 and the average PHQ-9 score was 8.25. Comparing scores after three months of intervention to the initial scores, our preliminary results demonstrated a trend of improvement in both ASRS and PHQ-9 scores. A total of 75% (n=24/32) of the patients had an improvement in ASRS scores, and 56.7% (n=17/30) of the patients had an improvement in PHQ-9 scores at three months. At three months, there was a decline in PHQ-9 scores with a decrease in ASRS scores following treatment. Our preliminary results suggest that integrated behavioral health treatment of ADHD using a combination of pharmacological and non-pharmacological interventions may play a role in improving comorbid depressive symptoms.

Effectiveness of nirmatrelvir-ritonavir versus azvudine for adult inpatients with severe or critical COVID-19

BackgroundIn China, both nirmatrelvir-ritonavir (Paxlovid) and azvudine have been granted approval to treat adult SARS-CoV-2-infected patients with moderate symptoms. Information about the clinical effect of the two available agents among...

Associations of cognitive impairment and longitudinal change in cognitive function with the risk of fatal stroke in middle-aged to older Chinese

It is unclear whether cognitive impairment and the longitudinal change in cognition are associated with the risk of fatal stroke in aging populations. Based on the Guangzhou Biobank Cohort Study data a sum of 26,064 participants at baseline and all deaths caused by stroke in a mean follow-up of 14.3 years (standard deviation = 3.2) were included, and the Cox proportional hazard regression was used in this prospective cohort study. Cognitive impairment was respectively associated with an increased risk of fatal strokes (the adjusted hazard ratio (aHR) = 1.38, 95% CI1.16–1.64, P < 0.001) and fatal ischaemic stroke (aHR = 1.39, 95% CI1.10–1.77, P = 0.007), compared to median cognition; the Delayed Word Recall Test (DWRT) score was associated with a decreasing trend for the risk of fatal strokes in a restricted cubic spline analysis; the longitudinal DWRT score decline was associated with the increased risks of fatal strokes (aHR = 1.42, 95% CI 1.11–1.82, P = 0.006) and fatal haemorrhagic stroke (aHR = 1.75, 95% CI 1.10–2.78, P = 0.02), compared to the longitudinal DWRT score rise. In summary, cognitive impairment and the longitudinal decline in DWRT scores were associated with the increased risk of fatal strokes; early screening of cognitive function should be conducive to predictive intervention in fatal stroke among relatively healthy middle-aged to older populations.

An Observational Study of the Progression of Patients’ Mental Health Symptoms Six Weeks Following Discharge From the Hospital

IntroductionTransitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise.ObjectivesThe objective of this paper was to evaluate the progression of mental health symptoms in patients six weeks after their discharge from the hospital as the first phase of an ongoing innovative supportive program. In this study, factors that may contribute to the presence or absence of anxiety and depression symptoms, and the quality of life following a return to the community were examined. The results of this study provide evidence and baseline data for future phases of the project.MethodsAn observational design was used in this study. We collected sociodemographic and clinical data using REDCap at discharge and six weeks later. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5) respectively. Descriptive, Chi-square, independent T-test, and multivariate regression analyses were conducted.ResultsThe survey was completed by 88 participants out of 144 (61.1% response rate). A statistically non-significant reduction in anxiety and depression symptoms was found six weeks after returning to the community based on the Chi-squared/Fisher exact test and independent t-test. As well, the mean anxiety and depression scores showed a non-significant marginal reduction after discharge compared to baseline. In the period following discharge, a non-significant increase in participants experiencing low well-being symptoms was observed, as well as a decline in the mean well-being scores. Based on logistic regression models, only baseline symptoms were significant predictors of symptoms six weeks after inpatient discharge.Image:Image 2:Image 3:ConclusionsIn the short term following hospital discharge, no significant changes were observed in mental health conditions. A collaboration between researchers and policymakers is essential for the implementation and maintenance of effective interventions to support and maintain the mental health of patients following discharge.Disclosure of InterestNone Declared

Ejaculatory and erectile function outcomes following holmium laser enucleation of the prostate.

Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for benign prostatic hyperplasia (BPH). Many men develop retrograde ejaculation postprocedure, but there is conflicting evidence regarding sexual function outcomes post-HoLEP. We sought to examine significant variations in patient-reported erectile and ejaculatory function within 12 months post-HoLEP. We conducted a retrospective study for patients who underwent HoLEP between Nov 2018 and Feb 2022. Of the reviewed patients, 277 patients met inclusion criteria and completed pre and postoperative questionnaires, which included the Male Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EJD) and the International Index of Erectile Function/Sexual Health Inventory for Men (IIEF-5/SHIM). Surveys were provided to patients up to 12 months postprocedure. Demographics and comorbidities associated with sexual dysfunction were collected. Responses to each question were analyzed to detect sub-categorical variations in sexual function as the secondary objective. Data was analyzed by using a linear mixed model. There was a significant decline in total scores for the MSHQ-EJD (8.70 pre-HoLEP vs. 6.58 post HoLEP, p ≤ 0.001) including a significant decline (p < 0.005) in questions 1-3 which assess ejaculatory ability, strength, and volume. There was not a significant decline in question 4 which assesses bother (2.552 pre-HoLEP vs. 3.119 post-HoLEP, p = 0.526). There was not a significant decline in the IIEF-5/SHIM postoperatively (11.51 pre-HoLEP vs. 13.327 post-HoLEP, p = 0.498). Patients undergoing HoLEP do not experience a decline in erectile function. Patients do experience a decline in ejaculatory function but did not find this bothersome.

Prediction of cognitive decline in older breast cancer survivors: the Thinking and Living with Cancer study.

Cancer survivors commonly report cognitive declines after cancer therapy. Due to the complex etiology of cancer-related cognitive decline (CRCD), predicting who will be at risk of CRCD remains a clinical challenge. We developed a model to predict breast cancer survivors who would experience CRCD after systematic treatment. We used the Thinking and Living with Cancer study, a large ongoing multisite prospective study of older breast cancer survivors with complete assessments pre-systemic therapy, 12 months and 24 months after initiation of systemic therapy. Cognition was measured using neuropsychological testing of attention, processing speed, and executive function (APE). CRCD was defined as a 0.25 SD (of observed changes from baseline to 12 months in matched controls) decline or greater in APE score from baseline to 12 months (transient) or persistent as a decline 0.25 SD or greater sustained to 24 months. We used machine learning approaches to predict CRCD using baseline demographics, tumor characteristics and treatment, genotypes, comorbidity, and self-reported physical, psychosocial, and cognitive function. Thirty-two percent of survivors had transient cognitive decline, and 41% of these women experienced persistent decline. Prediction of CRCD was good: yielding an area under the curve of 0.75 and 0.79 for transient and persistent decline, respectively. Variables most informative in predicting CRCD included apolipoprotein E4 positivity, tumor HER2 positivity, obesity, cardiovascular comorbidities, more prescription medications, and higher baseline APE score. Our proof-of-concept tool demonstrates our prediction models are potentially useful to predict risk of CRCD. Future research is needed to validate this approach for predicting CRCD in routine practice settings.

Impact of Radiotherapy on Radiation-Induced Brain Injury in Patients with Nasopharyngeal Carcinoma Using Nano-Magnetic Resonance Imaging

This study investigate the changes of white matter injury induced by radiation after radiotherapy in patients with nasopharyngeal carcinoma (NPC) and its association with cognitive dysfunction using multiple MRI methods. A total of 42 patients with NPC who underwent radiotherapy at xxx Hospital between December 2018 and June 2021 were included. The patients were randomly divided into 4 groups based on the timing of radiotherapy. Superparamagnetic iron oxide nanoparticles were used as MRI contrast agents. DTI and MRS scans were conducted to measure FA, ADC, NAA/Cho, Cho/Cr, and NAA/Cr ratios in the hippocampus of both temporal lobes. A cognitive assessment was performed using the MoCA and MMSE scales. After radiotherapy, patients experienced a decline in cognitive scores, which stabilized after 6 months. White matter changes were observed in the hippocampus, with decreased FA and increased ADC values that gradually returned to normal levels. Cho value increased and NAA value decreased initially but eventually returned to pre-treatment levels. No significant changes occurred in the Cr value. Metabolite ratios decreased within 3 months post-radiotherapy but gradually increased thereafter, remaining lower than pre-treatment levels at 6 months. Higher radiation doses did not significantly affect FA and ADC values but decreased white matter metabolite ratios. In conclusion, we reveal that the dosage and duration of radiotherapy can influence the degree of brain injury in patients with NPC and highlights the cognitive decline, white matter changes, and changes in metabolite ratios after radiotherapy for NPC, providing insights into the effects of radiation on brain structure and function.

Cowhide gelatin peptide as a source of antioxidants for inhibiting the deterioration of pudding quality during storage

To investigate the effect of gelatin peptide on the inhibition of quality deterioration in stored pudding, gelatin peptide with antioxidant properties was added to pudding products. For this purpose, a pudding recipe containing gelatin peptides was created. The gelatin peptides were characterized based on their antioxidant activity and protein structure. It was found that gelatin peptides had better antioxidant properties, lower thermal stability and crystallinity, higher hydrophobic amino acid content, and greater surface hydrogen bond exposure than commercially available peptides. Properties such as the pH, colony growth, and sensory characteristics of the pudding were characterized at 4 °C and 25 °C. The results showed that the addition of 0.5–1.0 % gelatin peptide to pudding was capable of significantly (P< 0.05) slowing down the decline in pH and sensory scores of the pudding and significantly inhibiting colony growth. It could prolong its storage life by five days at 4 °C and three days at 25 °C.

The Effect of Psychological Resilience on Cognitive Decline in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study.

Chronic stress is associated with an increased risk of cognitive impairment and Alzheimer's disease. This study aimed to assess whether better coping with stress, as assessed using the Brief Resilience Scale (BRS), is associated with slower cognitive decline in community-dwelling older adults. This study used 2018/2019 data and 2-year follow-up data from the Korean Frailty and Aging Cohort Study. Of the 3,014 total participants, we included 1,826 participants (mean age, 77.6±3.7 years, 51.9% female) who completed BRS and Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Battery and the Korean version of the Frontal Assessment Battery (FAB). Higher BRS score at baseline was associated with a lesser decline in the Mini-Mental State Examination score over 2 years after adjusting for age, sex, years of education, smoking status, hypertension, diabetes, and depression (B, 0.175; 95% confidence interval, 0.025-0.325) for 2 years, which represents global cognitive function. Other cognitive function measurements (Word List Memory, Word List Recall, Word List Recognition, Digit Span, Trail Making Test-A, and FAB) did not change significantly with the BRS score at baseline. These findings suggest that better stress-coping ability, meaning faster termination of the stress response, may limit the decline in cognitive function.

The link between the early surgery-induced inflammatory response and postoperative cognitive dysfunction in older patients.

Postoperative cognitive dysfunction (POCD) is a common complication in older patients with cancer and is associated with decreased quality of life and increased disability and mortality rates. Systemic inflammation resulting in neuroinflammation is considered important in the pathogenesis of POCD. The aim of this study was to explore the association between the early surgery-induced inflammatory response and POCD within 3 months after surgery in older cancer patients. Patients ≥65 years in need of surgery for a solid tumor were included in a prospective cohort study. Plasma levels of C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL-10, and Neutrophil gelatinase-associated lipocalin (NGAL) were measured perioperatively. Cognitive performance was assessed preoperatively and 3 months after surgery. POCD was defined as a decline in cognitive test scores of ≥25% on ≥2 of five tests within the different cognitive domains of memory, executive functioning, and information processing speed. Logistic regression analysis was performed. POCD was observed in 44 (17.7%) of 248 included patients. Age >75, preoperative Mini-Mental State Examination (MMSE) score ≤26 and major surgery were independent significant predictors for POCD. In multivariate logistic regression analysis, no significant associations were shown between the early surgery-induced inflammatory response and either POCD or decline within the different cognitive domains. This study shows that one out of six older patients with cancer developed POCD within 3 months after surgery. The early surgery-induced inflammatory response was neither associated with POCD, nor with decline in the separate cognitive domains. Further research is necessary for better understanding of the complex etiology of POCD.