Differences In Scores Research Articles

Effect of clustered nursing on liver function indexes, nutrition, and emotional status of patients with severe liver failure.

Liver failure is a metabolic disorder caused by a variety of mixed factors. For such diseases, adopting cluster care can effectively improve the relevant symptoms of patients. To explore the nursing effect of nutritional nursing combined with clustered nursing for patients with severe liver failure. A total of 129 patients with severe liver failure were selected as retrospective study subjects. Nine cases were due to an end event, such as death. The other patients were divided into control group and observation group according to different nursing methods. Among them, the control group adopted nutrition nursing, and the observation group implemented cluster nursing on this basis. The differences of liver function, anxiety and depression score, gastrointestinal recovery, nutritional status, and sleep quality were compared between the 2 groups before and after nursing. After nursing, the total bilirubin, albumin, and aspartate aminotransferase of the observation group were significantly higher than those of the control group (P < .05). The nursing staff used Self-Rating Anxiety Scale and Self-Rating Depression Scale of the observation group, which were slightly lower than those of the control group. The difference was statistically significant after testing (P < .05). After nursing, the observation group's upper arm circumference, brachial tri-scalp fold thickness, and hemoglobin were better than those of the control group. Statistics showed that the difference was statistically significant (P < .05). The depth of sleep, time to fall asleep, number of awakenings, time to fall asleep after awakening, overall sleep quality, and intensive care unit environmental noise intensity in the Richards-Campbell Sleep Questionnaire sleep scale after nursing in the 2 groups were significantly higher than those before nursing, and the scores of the observation group were significantly lower than those in the observation group. In the control group, this difference was statistically significant (P < .05). Nutritional nursing combined with clustered nursing can effectively promote the recovery of gastrointestinal function in patients with severe liver failure.

Increasing digital equity to promote online smoking cessation program engagement among rural adults: a randomized controlled pilot trial

BackgroundCigarette smoking prevalence is higher for rural than urban adults, yet digital access to cessation programming is reduced. We aim to investigate digital access interventions to promote engagement with an online evidence-based cessation treatment (EBCT) program among rural adults.MethodsThis pilot trial used a pragmatic, three-arm, randomized, parallel-group design (ClinicalTrials.gov: NCT05209451). Inclusion criteria included being aged ≥18, Mayo Clinic Midwest patient, rural residency, and currently smokes cigarettes. All participants received an online, 12-week EBCT program and were randomized to receive one of three digital access interventions: print materials (control, n = 30); print materials + loaner iPad device with data plan coverage (n = 30); or print materials + loaner device + up to six, 15–20-minute motivational interviewing-based coaching calls to support technology needs (n = 30). A composite score of trial engagement (primary outcome) and self-reported smoking abstinence and use of EBCT resources (secondary outcomes) were assessed online at 4 and 12 weeks. Qualitative interviews were used to assess patient experience. Neither participants nor outcome assessors were blinded to group assignment.ResultsResults are reported for all 30 participants in each group. The average age of participants is 51.0 years and 61% are women. We show no significant arm differences for the trial engagement composite score (p = 0.30). We also find coaching support is significantly (p < 0.05) associated with enhanced smoking-related treatment response, including cigarette abstinence and use of EBCT resources, and participants reported positive experiences with the intervention.ConclusionsThe coaching intervention to support technology needs is acceptable and shows preliminary evidence of its efficacy in smoking-related treatment response. Further studies could refine and implement the coaching intervention for trial engagement and long-term cessation.

Investigating the Minimal Clinically Important Difference for AzBio and CNC Speech Recognition Scores.

To assess the minimal clinically important difference (MCID) values for cochlear implant-related speech recognition scores, which have not been previously reported. Retrospective cohort. Tertiary referral center. Eight hundred sixty-three adult patients who underwent cochlear implantation between 2009 and 2022. MCID values for consonant-nucleus-consonant (CNC) word scores and AzBio sentences in quiet and noise scores using distribution-based methods (half-standard deviation, standard error of measurement, Cohen's d, and minimum detectable change). In this cohort, the mean preoperative CNC word score was 13.9% (SD, 15.6). The mean preoperative AzBio sentences in quiet score was 19.1% (SD, 22.1), and the mean preoperative AzBio sentences in noise score was 13.0% (SD, 12.0). The average MCID values of several distribution-based methods for CNC, AzBio in quiet, and AzBio in noise were 7.4%, 9.0%, and 4.9%, respectively. Anchor-based approaches with the Speech, Spatial, and Qualities of hearing patient-reported measure did not have strong classification accuracy across CNC or AzBio in quiet and noise scores (ROC areas under-the-curve ≤0.69), highlighting weak associations between improvements in speech recognition scores and subjective hearing-related abilities. Our estimation of MCID values for CNC and AzBio in quiet and noise allows for enhanced patient counseling and clinical interpretation of past, current, and future research studies assessing cochlear implant outcomes.

Photobiomodulation Therapy in the Management of Oral Lichen Planus: A Systematic Review and Meta-Analysis.

Photobiomodulation therapy (PBMT) is a non-invasive and the latest form of therapy used in the treatment of non oncological diseases as well as cancers of various types and locations. The aim of this study was to systematically review and assess the efficacy of PBMT in managing oral lichen planus (OLP) compared to the interventions. A systematic review and meta-analysis were implemented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search using PubMed, Scopus, and Cochrane was conducted to retrieve relevant studies published until June 2023. The outcomes evaluated included the reduction in pain score and clinical severity scores (Prospero No CRD42023428626). A total of eight studies were identified for qualitative synthesis. The pooled analysis incorporating six studies revealed that there are no significant differences for both mean pain score (mean difference [MD] = 0.21, 95% confidence interval [CI] = -0.51, 0.93) as well as clinical score (MD = -0.08, 95% CI = -0.4, 0.25) between PBMT and comparison groups. Subgroup analysis based on corticosteroids as controls showed that there was no significant difference in mean reduction in pain score between PBMT and topical steroids (MD = 0.38, 95% CI = -0.54, 1.31). PBMT is as effective as other interventions in the treatment of OLP, though not superior, and can be a promising alternative treatment for cases resistant to steroids or when steroids are contraindicated. Further studies are recommended to standardize the optimal settings for the treatment of OLP.

Does Integration of Graded Motor Imagery Training Augment the Efficacy of a Multimodal Physiotherapy Program for Patients With Frozen Shoulder? A Randomized Controlled Trial.

Despite the availability of numerous treatment modalities for frozen shoulder, spanning from nonsurgical approaches to surgical interventions, a consensus regarding the most effective treatment remains elusive. Current studies emphasize that pain in frozen shoulder affects central nervous system activity and leads to changes in cortical structures, which are responsible for processing sensory information (like pain) and controlling motor functions (like movement). These cortical changes highlight the importance of including the central nervous system in the management of frozen shoulder. It is therefore recommended that treatment should provide more effective management by focusing not only on the shoulder region but also on the cortical areas thought to be affected. Among patients treated nonsurgically for frozen shoulder, is graded motor imagery added to a multimodal physical therapy program more effective than multimodal physical therapy alone in terms of (1) Shoulder Pain and Disability Index (SPADI) scores, (2) pain with activities and QuickDASH (Q-DASH) scores, and (3) ROM after 8 weeks of treatment? In this randomized clinical trial, we considered the following as eligible for inclusion: (1) ROM < 50% compared with the unaffected shoulder, (2) clinically and radiologically confirmed primary frozen shoulder, and (3) 30% loss of joint ROM in at least two planes compared with the unaffected shoulder. Diagnosis of patients was based on patient history, symptoms, clinical examination, and exclusion of other conditions. A total of 38 patients with frozen shoulder were randomly assigned to either the graded motor imagery group (n = 19) or the multimodal physiotherapy group (n = 19). The groups did not differ in age, height, weight, gender, and dominant and affected side. In both groups, there were no losses to follow-up during the study period, and there was no crossover between groups. The multimodal physiotherapy program encompassed a variety of treatments, including stretching exercises, ROM exercises, joint-oriented mobilization techniques, scapular mobilization, strengthening exercises, and the application of cold agents. The graded motor imagery program, as an addition to the multimodal physiotherapy program, included the following steps: (1) left-right discrimination (identifying left and right body parts), (2) motor imagery (mentally visualizing movements), and (3) mirror therapy training (using mirrors to trick the brain into thinking the affected part is moving). Both groups of patients participated in a program of 12 sessions, each lasting approximately 45 minutes, twice a week for 6 weeks. Participants were assessed at baseline, after 6 weeks, and at 8 weeks. The primary outcome was the SPADI score, which ranges from 0 to 100, with higher values denoting greater disability. The minimum clinically important difference (MCID) for SPADI scores is reported to be 13.2 points. Secondary outcomes were shoulder ROM, Numeric Pain Rating Scale activity score (scored from 0 points, indicating "no pain," to 10 points, indicating "worst pain imaginable"), and Q-DASH score (ranging from 0 to 100 points, with a higher score indicating higher functional disability). Repeated-measures analysis of variance was used to compare means between one or more variables based on repeated observations. After 8 weeks of treatment, patients treated with graded motor imagery plus multimodal physical therapy experienced greater mean ± SD improvement from baseline in terms of SPADI scores than did the multimodal physical therapy group (65 ± 9 versus 55 ± 12, mean difference 10 points [95% confidence interval 4 to 17 points]; p = 0.01). Graded motor imagery when added to standard therapy did not produce a clinically important difference in pain scores with activity compared with physical therapy alone (7.0 ± 1.3 versus 5.9 ± 1.4, mean difference 1 point [95% CI 0.2 to 2.0 points], which was below our prespecified MCID; p = 0.04). However, improvements in Q-DASH score at 8 weeks were superior in the graded motor imagery group by a clinically important margin (58 ± 6 versus 50 ± 10, mean difference 9 points [95% CI 3 to 14 points], which was below our prespecified MCID; p = 0.01). ROM was generally better in the group that received the program augmented by graded motor imagery, but the differences were generally small. Adding graded motor imagery to a multimodal physiotherapy program was clinically superior to multimodal physiotherapy alone in improving function in patients with frozen shoulder. However, no clinically superior scores were achieved in ROM or activity-related pain. Additionally, the follow-up period was short, considering the tendency of frozen shoulder to recur. Although adding graded motor imagery provides superiority in many scores and does not require high-budget equipment, the disadvantages such as the difference in some scores being sub-MCID and the need for expertise and experience should not be ignored. Consequently, while graded motor imagery shows promise, further research with longer follow-up periods is recommended to fully understand its benefits and limitations in the treatment of frozen shoulder. Level I, therapeutic study.

Health-Related Quality of Life with Six Domains: A Comparison of Healthcare Providers without Chronic Diseases and Participants with Chronic Diseases.

Background/Objectives: This study aims to compare the health-related quality of life (HRQOL) between healthcare providers without chronic diseases and participants with chronic diseases presenting with one of the four different primary diagnoses on the health-related quality of life with six domains (HRQ-6D) scale. Methods: This is a cross-sectional study to compare the HRQOL between healthcare providers without chronic diseases and participants with chronic diseases. Data collection was performed from May 2022 to May 2023. Data for the comparison group were taken from healthcare providers without chronic diseases, and for the participant group with chronic diseases, the data were collected from actual patients with one of four types of primary diagnoses who were recruited from specialist cardiology, oncology, psychiatry, and nephrology clinics. All the participants of this study filled in the HRQ-6D. Results: There were 238 (58.6%) healthcare providers without chronic diseases who participated in this study, as well as 41 (10.1%) patients with end-stage renal disease (ESRD), 48 (11.8%) patients with cancer, and 40 (9.9%) patients who were depressed, and the remaining patients had heart disease. The means (SD) of HRQ-6D scores among healthcare providers without chronic diseases for pain, physical strength, emotion, mobility, self-care, perception of future health, and overall HRQ-6D score were 75.3% (19.8), 74.5% (21.1), 85.6% (18.4%), 93.0% (12.3), 91.6% (13.9), 74.2% (23.3), and 82.4% (13.6), respectively. In comparisons between healthcare providers without chronic diseases and participants with chronic diseases, all mean differences of the overall HRQ-6D score and its domains and dimensions were statistically significant (p < 0.001). Conclusions: The overall score of the HRQ-6D, as well as its domains and dimensions are sensitive in detecting the study participants with chronic diseases from among those without chronic diseases. Therefore, the HRQ-6D is a reliable and valid scale to measure HRQOL. Future studies may use this scale for interventional, observational, and cost-effectiveness studies.

Association of cannabis use with patient-reported pain measures among adults with chronic pain in US states with medical cannabis programs

IntroductionMost Americans live in a state that has legalized cannabis as a medical treatment for pain, but it is unclear how chronic pain intensity relates to cannabis use. Our objective...

Socioeconomic disparities based on shooting intent in pediatric firearm injury.

Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases. A linked integrated database of pediatric fatal and nonfatal firearm injuries was developed from trauma center and medical examiner records in Harris County, Texas (2018-2020). Geospatial analysis was utilized to map victim residence locations, stratified by shooting intent. Area Deprivation Index (ADI), a composite measure of neighborhood socioeconomic disadvantage at the census tract level was linked to shooting intent. Differences in high ADI (more deprived) versus low ADI among the shooting intents were assessed. Unadjusted and adjusted regression models assessed differences in ADI scores across shooting intent, adjusted models controlled for age, gender, and race/ethnicity. Of 324 pediatric firearm injuries, 28% were fatal; 77% were classified as interpersonal violence, 15% unintentional, and 8% self-harm. Differences were noted among shooting intent across the ADI quartiles; with increases in ADI score, the odds of interpersonal violence injuries compared with self-harm injuries significantly increased by 5%; however, when adjusting for individual-level variables of age, gender, and race and ethnicity, no significant differences in ADI were noted. Our results suggest that children living in disadvantaged neighborhoods are more likely to be affected by interpersonal firearm violence compared with self-harm; however, when differences in race/ethnicity are considered, the differences attributable to neighborhood-level disadvantage disappeared. Resources should be dedicated to improving structural aspects of neighborhood disadvantage, which disproportionately impact racial/ethnic minoritized populations. Furthermore, firearm self-harm injuries occurred among children living in the less disadvantaged neighborhoods. Understanding the associations among individual and neighborhood-level factors are important for developing streamlined injury prevention interventions by shooting intent. Prognostic and Epidemiological; Level IV.

Treatment of thoracolumbar tuberculosis with robot-assisted and minimally invasive access via transforaminal expansion approach

To investigate the feasibility and effectiveness of robot-assisted posterior minimally invasive access in treatment of thoracolumbar tuberculosis via transforaminal expansion approach. A clinical data of 40 patients with thoracolumbar tuberculosis admitted between January 2017 and May 2022 and met the selection criteria was retrospectively analyzed. Among them, 15 cases were treated with robot-assisted and minimally invasive access via transforaminal expansion approach for lesion removal, bone graft, and internal fixation (robotic group), and 25 cases were treated with traditional transforaminal posterior approach for lesion removal and intervertebral bone grafting (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05) in terms of gender, age, lesion segment, and preoperative American Spinal Injury Association (ASIA) grading, Cobb angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). The outcome indicators were recorded and compared between the two groups, including operation time, intraoperative bleeding volume, hospital stay, postoperative bedtime, complications, ESR and CRP before operation and at 1 week after operation, the level of serum albumin at 3 days after operation, VAS score and ASIA grading of neurological function before operation and at 6 months after operation, the implant fusion, fusion time, Cobb angle of the lesion, and the loss of Cobb angle observed by X-ray films and CT. The differences of ESR, CRP, and VAS score (change values) between pre- and post-operation were calculated and compared. Compared with the traditional group, the operation time and intraoperative bleeding volume in the robotic group were significantly lower and the serum albumin level at 3 days after operation was significantly higher ( P<0.05); the postoperative bedtime and the length of hospital stay were also shorter, but the difference was not significant ( P>0.05). There were 2 cases of poor incision healing in the traditional group, but no complication occurred in the robotic group, and the difference in the incidence of complication between the two groups was not significant ( P>0.05). There were significant differences in the change values of ESR and CRP between the two groups ( P<0.05). All Patients were followed up, and the follow-up time was 12-18 months (mean, 13.0 months) in the traditional group and 12-16 months (mean, 13.0 months) in the robotic group. Imaging review showed that all bone grafts fused, and the difference in fusion time between the two groups was not significant ( P>0.05). The difference in Cobb angle between the pre- and post-operation in the two groups was significant ( P<0.05); and the Cobb angle loss was significant more in the traditional group than in the robotic group ( P<0.05). The VAS scores of the two groups significantly decreased at 6 months after operation when compared with those before operation ( P<0.05); the difference in the change values of VAS scores between the two groups was not significant ( P>0.05). There was no occurrence or aggravation of spinal cord neurological impairment in the two groups after operation. There was a significant difference in ASIA grading between the two groups at 6 months after operation compared to that before operation ( P<0.05), while there was no significant difference between the two groups ( P>0.05). Compared with traditional posterior open operation, the use of robot-assisted minimally invasive access via transforaminal approach for lesion removal and bone grafting internal fixation in the treatment of thoracolumbar tuberculosis can reduce the operation time and intraoperative bleeding, minimizes surgical trauma, and obtain definite effectiveness.

Shift schedule effects on firefighter health and fitness.

Firefighter health is of utmost importance both to first responders and the individuals they serve daily. The impact of shift schedule on firefighter health remains poorly understood. The purpose of this study was to examine differences in health and performance outcomes in firefighters across two different shift schedules. Firefighter (N = 1995) body composition, muscular strength, endurance, flexibility, and cardiorespiratory endurance were assessed and described. A Mann-Whitney U test was conducted to compare differences between shift schedules (48/96 and 4's and 6's). There was a statistically significant difference in BMI (U = 70115, z=-1.988, p = .047), BF% (U = 67341, z=-2.779, p = .005), and trunk flexion score (U = 81362, z = 1.979, p = .048) favoring the 48/96 shift schedule. Firefighters following a 48/96 shift schedule exhibited improved body composition and fitness performance in comparison to peers who followed a 4's and 6's shift schedule. Findings may guide regional firefighter scheduling to optimize health and performance.

AB011. A propensity-score matched prospective study on the impact of tumour treating fields (TTF) on overall survival and quality of life in newly diagnosed WHO grade 4 astrocytoma patients.

World Health Organization (WHO) grade 4 astrocytoma is a high-grade brain tumour in adults. Tumour treating fields (TTF) has been shown to improve overall survival (OS). Few studies have explored quality-of-life (QoL) in these patients. This study aims to assess the QoL of TTF patients and OS. This was a prospective multicenter study of adult patients diagnosed with WHO grade 4 astrocytoma from 2018 to 2023 receiving TTF for >1 month after completing standard therapy. A propensity-score matched comparison with a 1:2 ratio with historical control was performed for OS analysis. The patients completed European Organisation for Research and Treatment of Cancer (EORTC) QLQ-30/BN20 questionnaires before TTF and at 3-month interval. Primary outcomes included OS, and secondary outcomes included QoL and TTF-associated adverse effects at 3 months. A total of 141 patients were reviewed, with TTF patients (n=47, 33%) and propensity-score matched controls (n=94). The mean duration of TTF use was 10±8 months. The mean age of the TTF group was 54±13 years, and for the control group 52±13 years. Sixty percent (n=28) were male, similar to the control group with 71% (n=67) (P=0.16). Seventy-two percent of TTF patients had preoperative Karnofsky Performance Scale (KPS) score ≥80, while controls had 70% (P=0.79). Five (11%) TTF patients and 8 (9%) controls were IDH1 mutant (P=0.70). Twenty (43%) TTF patients and 42 (45%) controls were O6-methylguanine-DNA methyltransferase promoter (pMGMT) methylated (P=0.81). Twenty-one (45%) of TTF patients and 55 (59%) of controls had gross total resection (P=0.72). After adjusting for independent predictors for OS, the median OS of the TTF group was 22.4 months [interquartile range (IQR): 18.6-26.5 months], significantly longer than the control group (17.2 months; IQR: 12.1-22.3 months) (log-rank test: P=0.01). Forty-seven TTF patients and 40 control patients completed EORTC questionnaires. There was no difference for EORTC functional and symptom scores between the TTF and control group [P=0.45, analysis of variance (ANOVA)] at 3 months. Thirty-two (67%) of TTF patients reported associated RTOG grade I scalp dermatitis. TTF for WHO grade 4 astrocytoma patients is an independent predictor for OS. QoL between the groups was similar, and overall QoL over time for TTF patients was not affected. TTF is a novel and effective outpatient treatment with minimal adverse effects.

Arthroscopic Autologous Iliac Crest Grafting with an Adjustable Loop Suspensory Device Yields Favorable Outcomes for Anterior Shoulder Instability with Glenoid Defects.

This study aims to evaluate the clinical and radiological outcomes of the arthroscopic autologous iliac crest grafting (AICG) procedure with an adjustable-loop suspensory fixation device in the treatment of anterior shoulder instability (ASI) with glenoid bone defects. A retrospective review was conducted on the patients who underwent arthroscopic AICG with an adjustable-loop suspensory fixation device from January 2017 to December 2020. Patients with traumatic ASI, significant glenoid bone defects, and a minimum follow-up of 24 months were included. Patient-reported outcomes (PROs), including the Oxford Shoulder Instability Score (OSIS), the Rowe score, the Walch-Duplay score, the Constant score, and the Visual Analogue Score (VAS), were compared preoperatively and postoperatively. Radiological assessments using computed tomography (CT) were performed before and after the procedure. Additional data on active range of motion, recurrence events, and complications were recorded. A total of 42 patients were included in the study, with a mean follow-up time of 35.2 months ranging from 25.1 to 55.9 months. Mean preoperative OSIS, Rowe score, Walch-Duplay score, and Constant score significantly improved from 24.4±7.2, 25.0±9.0, 25.2±9.8, 87.5±7.1 to 42.4±4.9, 92.4±8.1, 87.9±8.3, 93.6±4.5 at the last follow-up, respectively. All patients exceeded the minimal clinically important difference (MCID) for OSIS, Rowe, and Walch-Duplay scores. The graft union rate was 100%, and the glenoid area increased significantly from 82.5% preoperatively to 100.1% at the final follow-up. No patient experienced a recurrence of instability. Two recorded complications included one case of dysesthesia around the donor site and one case of postoperative shoulder stiffness. The outcomes of the arthroscopic AICG procedure, which utilizes an adjustable-loop suspensory fixation device, demonstrated stable bone graft fixation, high rates of graft integration, favorable clinical results, and a low incidence of complications. Moreover, the remodeling of the graft during the follow-up period significantly restored the width and concavity of the inferior glenoid, contributing to the overall recovery. Level IV, retrospective case series.

Worse postoperative outcomes and higher reoperation in smokers compared to nonsmokers for arthroscopic rotator cuff repair

Background This study aimed to determine if smokers at the time of arthroscopic rotator cuff repair met the minimally clinical important difference and substantial clinical benefit for Patient-Reported Outcomes Measurement Information System Upper Extremity, Depression, and Pain Interference scores in comparison to nonsmoking patients in a retrospective review. Methods Clinical outcomes and Patient-Reported Outcomes Measurement Information System scores were compared between a cohort of nonsmokers and current or former smokers (smokers). Further sub-analysis compared a cohort of nonsmokers propensity-matched 1:1 to a cohort of current/former smokers via age, body mass index, and tear size. Results A total of 182 patients, 80 smokers and 102 nonsmokers, were included. Smokers had statistically different-sized tears with more rated massive ( P = 0.02) and more reoperations ( P = 0.02). Smokers met substantial clinical benefit thresholds at a lower rate than nonsmokers for Patient-Reported Outcomes Measurement Information System Upper Extremity ( P = 0.03). In the sub-analysis, 74 smokers were matched to 74 nonsmokers. Smokers had a lower change in Patient-Reported Outcomes Measurement Information System Upper Extremity ( P = 0.007) and Patient-Reported Outcomes Measurement Information System Pain Interference ( P = 0.03) postoperatively. Fewer smokers met minimally clinical important difference for Patient-Reported Outcomes Measurement Information System Upper Extremity postoperatively ( P = 0.003) and more had reoperations ( P = 0.02). Discussion Overall, smokers demonstrated smaller improvements in function, and pain, and were less likely to meet minimally clinical important differences and substantial clinical benefits for Patient-Reported Outcomes Measurement Information System Upper Extremity at 6 months follow-up when compared to nonsmokers after rotator cuff repair.

Prognostic analysis of anoikis-related genes in bladder cancer: An observational study.

Anoikis is proved to play a crucial role in the development of cancers. However, the impact of anoikis on the prognosis of bladder cancer (BLCA) is currently unknown. Thus, this study aimed to find potential effect of anoikis in BLCA. The Cancer Genome Atlas (TCGA)-BLCA and GSE13507 cohorts were downloaded from TCGA and the Gene Expression Omnibus (GEO) databases, respectively. Differentially expressed genes (DEGs) were screened between BLCA and normal groups, which intersected with anoikis-related genes to yield anoikis-related DEGs (AR DEGs). Univariate COX, rbsurv, and multivariate COX analyses were adopted in order to build a prognostic risk model. The differences of risk score in the different clinical subgroups and the relevance between survival rate and clinical characteristics were explored as well. Finally, chemotherapy drug sensitivity in different risk groups was analyzed. In total, 78 AR DEGs were acquired and a prognostic signature was build based on the 6 characteristic genes (CALR, FASN, CSPG4, HGF, INHBB, SATB1), where the patients of low-risk group had longer survival time. The survival rate of BLCA patients was significantly differential in different groups of age, stage, smoking history, pathologic-T, and pathologic-N. The IC50 of 56 drugs showed significant differences between 2 risk groups, such as imatinib, docetaxel, and dasatinib. At last, the results of real time quantitative-polymerase chain reaction (RT-qPCR) demonstrated that the expression trend of CALR, HGF, and INHBB was consistent with the result obtained previously based on public databases. Taken together, this study identified 6 anoikis-related characteristic genes (CALR, FASN, CSPG4, HGF, INHBB, SATB1) for the prognosis of BLCA patients, providing a scientific reference for further research on BLCA.

Obesity Does Not Negatively Affect Patient-perceived Outcomes After Cervical Disc Replacement for Disc Herniation.

Retrospective review. To assess the impact of Body Mass Index (BMI) on patient-reported outcome measures (PROMs) after cervical disc replacement (CDR). BMI may affect PROMs after spine surgery. Primary CDR recipients for herniated disc(s) with BMI <40 were retrospectively selected from a single-surgeon registry. Cohorts were divided into non-obese (BMI <30) and obese (BMI ≥30). Intercohort in-hospital complication rates were compared through independent samples t tests. Pre/postoperative PROMs were compared between cohorts through multivariable regression accounting for demographic differences. Final follow-up dates between patients averaged 11.8 ± 9.3 months. PROMs assessed included Patient-reported Outcomes Measurement Information System-Physical Function, Neck Disability Index, Visual Analog Scale-Neck, Visual Analog Scale-Arm, and the 9-item Patient Health Questionnaire. Improvements in PROMs were evaluated and compared at each follow-up within cohorts through paired t tests. The magnitude of improvement in PROMs from preoperative baseline at 6-week follow-up (∆PROM-6W) and final follow-up (∆PROM-FF) along with achievement rates of minimum clinically important differences were compared between cohorts through multivariable regression accounting for demographic differences. Of 153 patients, 53 patients were noted as obese. Demographic differences included age, prevalence of hypertension and diabetes, and comorbidity burden scores ( P ≤ 0.011, all). No significant variations in in-hospital complications were found. The non-obese cohort demonstrated improvements in all PROMs at 6 weeks and final follow-up periods ( P ≤ 0.005, all). The obese cohort demonstrated improvements in all postoperative PROMs besides 9-item Patient Health Questionnaire at 6 weeks ( P ≤ 0.015, all). After accounting for age and comorbidity variations, there were no significant intercohort differences in raw PROM scores, ∆PROM-6W, ∆PROM-FF, or minimum clinically important difference achievement rates. Regardless of BMI, patients experience significant improvements in physical function, disability, pain, and mental health after CDR for disc herniation. Patients with obesity do not suffer inferior patient-perceived outcomes after CDR. These findings may help surgeons counsel patients in the preoperative period.

Testing for differences in polygenic scores in the presence of confounding.

Polygenic scores have become an important tool in human genetics, enabling the prediction of individuals' phenotypes from their genotypes. Understanding how the pattern of differences in polygenic score predictions across individuals intersects with variation in ancestry can provide insights into the evolutionary forces acting on the trait in question, and is important for understanding health disparities. However, because most polygenic scores are computed using effect estimates from population samples, they are susceptible to confounding by both genetic and environmental effects that are correlated with ancestry. The extent to which this confounding drives patterns in the distribution of polygenic scores depends on patterns of population structure in both the original estimation panel and in the prediction/test panel. Here, we use theory from population and statistical genetics, together with simulations, to study the procedure of testing for an association between polygenic scores and axes of ancestry variation in the presence of confounding. We use a general model of genetic relatedness to describe how confounding in the estimation panel biases the distribution of polygenic scores in a way that depends on the degree of overlap in population structure between panels. We then show how this confounding can bias tests for associations between polygenic scores and important axes of ancestry variation in the test panel. Specifically, for any given test, there exists a single axis of population structure in the GWAS panel that needs to be controlled for in order to protect the test. Based on this result, we propose a new approach for directly estimating this axis of population structure in the GWAS panel. We then use simulations to compare the performance of this approach to the standard approach in which the principal components of the GWAS panel genotypes are used to control for stratification.

The Effect of Benson Relaxation Technique on Stress, Anxiety, and Depression in Pregnant Women.

Relaxation programs can be effective in establishing psychological tranquility for maternal and fetal health. This study was conducted to evaluate the effect of this low-cost, effective, easy method on the stress, anxiety, and depression in pregnant women. This randomized clinical trial study was conducted from July 2015 to July 2016. Seventy pregnant women in the third trimester of pregnancy were included in this study. Participants were randomly assigned to 2 groups of 35 subjects using a random number table. Participants in group 1 received relaxation training and group 2 received routine care. A demographic questionnaire and Depression, Anxiety, and Stress Scale (DASS-21) were completed before and 1 and 2 months after the intervention. The SPSS software version 18 was used for data analysis. There were significant differences in the mean difference of the total DASS score (14; 95% confidence interval [CI]: 4 to 32) as well as the scores of stress (4; 95% CI : 1 to 10), anxiety (6; 95% CI: 2 to 10), and depression (6; 95% CI: 2 to 12) 2 months after the intervention between the 2 groups. The Benson relaxation technique decreased DASS-21 scores in the intervention group.

Patient-reported outcomes after minimally invasive sacro-iliac joint surgery: a cohort study based on the Swedish Spine Registry.

There is conflicting evidence regarding treatment outcomes after minimally invasive sacroiliac joint fusion for long-lasting severe sacroiliac joint pain. The primary aim of our cohort study was to investigate change in patient-reported outcome measures (PROMs) after minimally invasive sacroiliac joint surgery in daily practice in the Swedish Spine Registry. Secondary aims were to explore the proportion of patients reaching a patient acceptable symptom score (PASS) and the minimal clinically important difference (MCID) for pain scores, physical function, and health-related quality of life outcomes; furthermore, to evaluate self-reported satisfaction, walking distance, and changes in proportions of patients on full sick leave/disability leave and report complications and reoperations. Data from the Swedish Spine Registry was collected for patients with first-time sacroiliac joint fusion, aged 21 to 70 years, with PROMs available preoperatively, at 1 or 2 years after last surgery. PROMs included Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) for low back pain (LBP) and leg pain, and EQ-VAS, in addition to demographic variables. We calculated mean change from pre- to postoperative and the proportion of patients achieving MCID and PASS. 68 patients had available pre- and postoperative data, with a mean age of 45 years (range 25-70) and 59 (87%) were female. At follow-up the mean reduction was 2.3 NRS points (95% confidence interval [CI] 1.6-2.9; P < 0.001) for LBP and 14.8 points (CI 10.6-18.9; P < 0.001) for ODI. EQ-VAS improved by 22 points (CI 15.4-30.3, P < 0.001) at follow-up. Approximately half of the patients achieved MCID and PASS for pain (MCID NRS LBP: 38/65 [59%] and PASS NRS LBP: 32/66 [49%]) and physical function (MCID ODI: 27/67 [40%] and PASS ODI: 24/67 [36%]). The odds for increasing the patient's walking distance to over 1 km at follow-up were 3.5 (CI 1.8-7.0; P < 0.0001), and of getting off full sick leave or full disability leave was 0.57 (CI 0.4-0.8; P = 0.001). In the first 3 months after surgery 3 complications were reported, and in the follow-up period 2 reoperations. We found moderate treatment outcomes after minimally invasive sacroiliac joint fusion when applied in daily practice with moderate pain relief and small improvements in physical function.

Health-related outcomes 6 months after integrated care of older people with stroke in 2 different primary care settings.

Integrated care has been proven to be effective among stroke survivors. However, in China, these services mainly focus on connecting the healthcare system (acute, primary medical, and skilled) at the individual level. Closer health and social care integration is a new concept. This study aimed to compare health-related outcomes 6 months after the implementation of the 2 integrated care models. It was a 6-month follow-up of an open, prospectively study comparing the outcomes of a model of integrated health and social care (IHSC) versus a usual integrated healthcare (IHC) model. Outcomes were measured by Short-Form Health Survey-36 (SF-36), Modified Barthel Index (MBI), and Caregiver Strain Index (CSI) at 3 and 6 months, respectively. There were no statistically significant differences in MBI scores between patients in the 2 models either after 3 months or at the end of intervention. The same trend was not seen in Physical Components Summary, an integral component of SF-36. Patients in IHSC model scored statistically significant higher points in Mental Components Summary, another integral part of SF-36 than patients in IHC model after 6 months. Average scores of CSI were statistically significant lower for IHSC model than for IHC model after 6 months. The findings suggest the need to improve the scales of integration and recognize the vital role played by social care services when designing or improving an integrated care for older people with stroke.

Longitudinal evaluation of cervical length and shear wave elastography in women with spontaneous preterm birth.

To evaluate longitudinal changes in cervical length (CL) and mean cervical shear wave elastography (CSWE) score in women with a singleton or twin pregnancy who undergo spontaneous preterm birth (sPTB) compared with those who deliver at term. This was a prospective longitudinal study of unselected women with a singleton or twin pregnancy attending a dedicated research clinic for screening for sPTB at four timepoints during pregnancy: 11 + 0 to 15 + 6 weeks, 16 + 0 to 20 + 6 weeks, 21 + 0 to 24 + 6 weeks and 28 + 0 to 32 + 6 weeks. At each visit, a transvaginal ultrasound scan was conducted to measure the CL and the CSWE scores in six regions of interest (ROI) (inner, middle and external parts of anterior and posterior cervical lips). The mean CSWE score from the six ROIs was calculated for analysis. Log10 transformation was applied to data to produce a Gaussian distribution prior to statistical analysis. A multilevel mixed-effects analysis was performed to compare longitudinally CL and CSWE between the sPTB and term-delivery groups. The final cohort consisted of 1264 women, including 1143 singleton pregnancies, of which 57 (5.0%) were complicated by sPTB, and 121 twin pregnancies, of which 33 (27.3%) were complicated by sPTB. Compared to those who delivered at term, women with sPTB had a lower CL across gestation when controlling for history of cervical surgery, number of fetuses, gestational age (GA) at cervical assessment and the interaction between GA at cervical assessment and sPTB (P < 0.001). Specifically, CL in the sPTB group was significantly lower at 21 + 0 to 24 + 6 weeks (P = 0.039) and 28 + 0 to 32 + 6 weeks (P < 0.001). Twin pregnancies had significantly greater CL throughout pregnancy compared with singleton pregnancies (regression coefficient, 0.01864; P < 0.001). After adjusting for maternal age, weight, height, body mass index and GA at cervical assessment, CSWE score in the sPTB group was significantly lower compared with that in the term-delivery group across gestation (P = 0.013). However, on analysis of individual visits, CSWE score in the sPTB group was significantly lower than that in the term-delivery group only at 11 + 0 to 15 + 6 weeks (P = 0.036). There was no difference in CSWE score between singleton and twin pregnancies throughout gestation (regression coefficient, -0.00128; P = 0.937). Women with sPTB have a shorter and softer cervix across gestation compared with those who deliver at term. A shorter cervix in the sPTB group is observed from the late second trimester onwards, while lower cervical stiffness in the sPTB group is observed primarily in the first trimester. CL is significantly lower in singleton pregnancies compared with twin pregnancies, while cervical stiffness does not differ between the two. Our findings indicate that the cervix tends to undergo a softening process prior to shortening in sPTB cases. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.