Difficulty Score Research Articles

Does difficulty adapting to old age impact the social vulnerability of older adults

ABSTRACT The study was conducted to evaluate the effect of the difficulty of adapting to old age on the social vulnerability of individuals over the age of 65. The study was in cross-sectional design and the sample consisted of 200 people. The data were collected with the scale of social vulnerability and difficulty in adapting to old age. In the study, it was determined that the total score of social vulnerability was moderate (29.54 ± 10.28), and the total score of difficulty in adapting to old age was at a good level (1.15 ± .57). Social vulnerability in the elderly explained 32.6% of the total variance in the difficulty of adapting to old age. In the study, the elderly’s adaptation to old age was found to be at a good level and their Social vulnerability was found to be at a moderate level. It has been found that elderly people with low education levels and single elderly people have lower adaptation to old age. Creating adaptation to old age; It was determined that there was a moderate relationship between role and self-actualization, mutual attachment, physiological state, self-style parameters and Social vulnerability. As the level of adaptation to old age increased, Social vulnerability decreased.

Association of preschool children behavior and emotional problems with the parenting behavior of both parents.

Parental behaviors are key in shaping children's psychological and behavioral development, crucial for early identification and prevention of mental health issues, reducing psychological trauma in childhood. To investigate the relationship between parenting behaviors and behavioral and emotional issues in preschool children. From October 2017 to May 2018, 7 kindergartens in Ma'anshan City were selected to conduct a parent self-filled questionnaire - Health Development Survey of Preschool Children. Children's Strength and Difficulties Questionnaire (Parent Version) was applied to measures the children's behavioral and emotional performance. Parenting behavior was evaluated using the Parental Behavior Inventory. Binomial logistic regression model was used to analyze the association between the detection rate of preschool children's behavior and emotional problems and their parenting behaviors. High level of parental support/participation was negatively correlated with conduct problems, abnormal hyperactivity, abnormal total difficulty scores and abnormal prosocial behavior problems. High level of maternal support/participation was negatively correlated with abnormal emotional symptoms and abnormal peer interaction in children. High level of parental hostility/coercion was positively correlated with abnormal emotional symptoms, abnormal conduct problems, abnormal hyperactivity, abnormal peer interaction, and abnormal total difficulty scores in children (all P < 0.05). Moreover, paternal parenting behaviors had similarly effects on behavior and emotional problems of preschool children compared with maternal parenting behaviors (all P > 0.05), after calculating ratio of odds ratio values. Our study found that parenting behaviors are associated with behavioral and emotional issues in preschool children. Overall, the more supportive or involved the parents are, the fewer behavioral and emotional problems the children experience; conversely, the more hostile or controlling the parents are, the more behavioral and emotional problems the children face. Moreover, the impact of fathers' parenting behaviors on preschool children's behavior and emotions is no less significant than that of mothers' parenting behaviors.

The validation of a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q)

ObjectiveThis study aimed to develop a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q) and investigate its validity and reliability.MethodsAfter translating the NFOG-Q according to a standardised protocol, 56 patients with Parkinson’s disease (PD) were administered it. Additionally, the MDS-UPDRS parts II and III, Hoehn and Yahr (H&Y) stage, and number of falls over 1 month were evaluated. Spearman’s correlation coefficients (rho) were used to determine construct validity, and Cronbach’s alpha (α) was used to examine reliability.ResultsThe interquartile range of the NFOG-Q scores was 10.0–25.3 (range 0–29). The NFOG-Q scores were strongly correlated with the MDS-UPDRS part II, items 2.12 (walking and balance), 2.13 (freezing), 3.11 (freezing of gait), and 3.12 (postural stability) and the postural instability and gait difficulty score (rho = 0.515–0.669), but only moderately related to the MDS-UPDRS item 3.10 (gait), number of falls, disease duration, H&Y stage, and time of the Timed Up-and-Go test (rho = 0.319–0.434). No significant correlations were observed between age and the time of the 10-m walk test. The internal consistency was excellent (α = 0.96).ConclusionsThe Japanese version of the NFOG-Q is a valid and reliable tool for assessing the severity of freezing in patients with PD.

The impact of the Covid-19 pandemic on mental health in Danish school children in 5th to 7th grade.

We wanted to examine the impact of the Covid-19 pandemic on mental health in Danish school children in 5th to 7th grade (11 to 15 years), and whether the impact differed across age and sex. We included 793 and 391 school children from winter 2020 and winter 2021, respectively. Mental health was measured using the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), Strengths and Difficulties Questionnaire (SDQ), and Brief Resilience Scale (BRS). Data were analyzed by sex using linear regression models adjusting for grade (age), cohabitation, geographical region, employment status of parents, and schools as clusters. Girls in 5th grade and boys in 6th grade during Covid-19 had statistically significant lower well-being (SWEMWBS) compared with before Covid-19. Girls in 5th and 6th grade during Covid-19 had non-statistically significant lower scores on all subscales of SDQ compared with girls before Covid-19. Girls in 7th grade during Covid-19 had statistically significant lower total difficulty score (SDQ) and fewer conduct problems (SDQ) compared with girls before Covid-19. Boys in 5th grade during Covid-19 had statistically significant fewer conduct problems (SDQ) compared with boys before Covid-19. This study indicates that the Covid-19 pandemic impacted Danish school children differently across sex and grade (age). During Covid-19, mental health tended to be better among the oldest girls and worse among the youngest girls compared with girls before Covid-19. Boys in 6th grade had poorer mental well-being, and boys in 5th grade had fewer conduct problems during Covid-19 compared with before Covid-19.

Tampa Difficulty Score: a novel scoring system for difficulty of robotic hepatectomy

BACKGROUNDDifficulty scoring systems (DSS) have been established for laparoscopic hepatectomy and serve as useful tools to predict difficulty and guide preoperative planning. Despite increased adoption of robotics and its unique technical characteristics compared with laparoscopy, no DSS currently exists for robotic hepatectomy. We aim to introduce a new DSS for robotic hepatectomy. METHODS328 patients undergoing a robotic hepatectomy were identified. After removing the first 24 major and 30 minor hepatectomies using CUSUM analysis, 274 patients were included in this study. Relevant clinical variables underwent linear regression using operative time and/or estimated blood loss (EBL) as markers for operative difficulty. Score distribution was analyzed to develop a difficulty-level grouping system. RESULTSOf the 274 patients, neoadjuvant chemotherapy, tumor location, size, type, extent of parenchymal resection, need for portal lymphadenectomy, and need for biliary resection with hepaticojejunostomy were significantly associated with operative time and/or EBL. They were utilized to develop the difficulty scores from 1-49. Grouping system results were: Group 1 (Less Demanding/Beginner): 1-8 (n=39), Group 2 (Intermediate): 9-24 (n=208), Group 3 (More Demanding/Advanced): 25-32 (n=17), and Group 4 (Most Demanding/Expert): 33-49 (n=10). When stratified by group, age, prior abdominal operation, Child-Pugh score, operative duration, estimated blood loss, major resection, 30-day mortality, 90-day mortality, and length of stay were significantly different among the groups. CONCLUSIONSIn addition to established variables in laparoscopic systems, new factors such as the need for portal lymphadenectomy and biliary resection specific to the robotic approach have been identified in this new robotic DSS. Internal and external validation are the next steps in maturing this robotic DSS.

Morphology-Based Risk Analysis of Catheter-related Thrombus After Pediatric Cardiac Surgery

BackgroundUnderstanding the development of central venous catheter-related thrombus (CVCRT) is vital for the prevention of adverse events caused by thrombi after cardiac surgery in children. However, the risks associated with CVCRT remain controversial. This study analyzed the risk factors of CVCRT based on a detailed evaluation of its morphometric features and severity. MethodsPatients aged <15 years who underwent catheter insertion into the internal jugular vein for cardiac surgery were included, and those receiving extracorporeal membrane oxygenation were excluded. The clinical data of the eligible patients, including the ultrasound CVCRT images and the ratio of the catheter occupying the internal jugular vein area (C/V ratio) by reassuming the images, were consistently collected. Logistic regression analysis using clinical factors was performed for the 2 groups divided according to morphologic severity. ResultsForty-seven patients were included in the study. CVCRT developed in 38 patients. Five graded types, ranging from wall-localized small thrombi to complete occlusion of the vein, were detected, and those who developed sheath-like thrombus were classified in to the severe group. Patients in the severe group were significantly younger and had higher C/V ratios. There were no significant differences in the surgical procedure, its difficulty, or postoperative severity score. Logistic regression analysis revealed the C/V ratio as the sole significant risk factor (odds ratio, 1.120; 95% CI, 1.01-1.24; P = .036). ConclusionsOur findings show the clinical implications of thrombus evaluation and morphologic classification to properly assess the risk factors of CVCRT in children with heart disease.

A203 PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR COMPLEX ACHALASIA AND THE POEM DIFFICULTY SCORE: AN UPDATE

Abstract Background POEM for achalasia can be challenging in patients with complex achalasia (CA) (i.e., type III achalasia, multiple prior treatments, prior myotomy, and sigmoid type). The POEM difficulty score (PDS) identifies factors that contribute to challenging POEM procedures. (Figure 1) Here, we present an update on the PDS in a series of patients with non-CA and CAs. Aims Our aim was to determine whether, with the introduction of the TT-J knife with waterjet functionality, the PDS still maintains a strong correlation with procedural efficiency and technical difficulty. Methods We retrospectively reviewed patients who underwent POEM for achalasia between May 2018 to July 2023 at the Kingston Health Sciences Center. 139 consecutive POEMs were performed, with 74 CAs. Primary outcomes include correlation of procedural efficiency with the PDS. Secondary outcomes include clinical success at the last followup and adverse events. Demographics and procedural variables were compared with descriptive statistics (mean ± SD; median, min-max range) and the Mann-Whitney U-test. Pre and post-POEM Echkhardt scores were compared using the Wilcoxon signed-rank test. Results 74 (56.7% male) complex and 65 (55.4% male) non-complex POEM procedures were carried out. The mean age is 56.7 ± 16.5 years and 47.3 ± 20.2 years in CA and non-CA respectively. PDS correlates moderately with procedural efficiency with a correlation coefficient of 0.595 (Spearman’s Pampersand:003C0.001). A subanalysis is available in Table 1. The mean efficiency for non-CA was 3.3min/cm±1.2. The median PDS for non-CA was 1 (0-5). In comparison, the mean efficiency for CA were 3.3min/cm ± 1.3 (type III), 5.3min/cm ± 2.3 (prior myotomy), 4.0min/cm ± 1.7 (≥4 prior procedures), and 5.2min/cm ± 2.4 (sigmoid type). The median PDS for CA was 3 (0-6) (type III), 4 (0-8) (prior myotomy), 3 (0-8) (≥4 prior procedures), and 3 (0-6) (sigmoid type). CA and non-CA POEM procedures were completed with 97% and 98% clinical success, respectively. Conclusions PDS continues to moderately correlate with procedural efficiency using the TT-J knife. However, the presence of spastic contractions correlated poorly with procedural efficiency. Thus, it may be omitted with the use of the TT-J knife. The order of increasing difficulty of POEM in CA appears to be type III, prior myotomy, sigmoid type, and ≥4 prior procedures. Multi-center prospective studies are needed to validate PDS in different clinical settings. Table 1: Sub-analysis of individual PDS factors and procedural velocity Figure 1: Peroral Endoscopic Myotomy (POEM) difficulty score (PDS): "FOODS" Funding Agencies None

A144 ZENKER’S PERORAL ENDOSCOPIC MYOTOMY (Z-POEM) OUTCOMES IN TREATMENT OF ZENKER’S DIVERTICULUM: A RETROSPECTIVE CASE SERIES

Abstract Background Zenker’s diverticulum (ZD) is an outpouching of tissue in an area of the posterior hypopharynx called the Killian triangle. ZD is associated with dysphagia, regurgitation, cough and recurrent aspirations. Open surgical repair has been the traditional treatment approach but has high morbidity (0-40%) and mortality (0-9.5%). Endoscopic intervention with septotomy is a less invasive approach with lower complications and shorter recovery times. However, technical success rates range between 56.4-100%, and recurrences occur in 0-32% of patients. Recent studies have shown promising results for peroral endoscopic myotomy treatment of ZD (Z-POEM), although data is limited. Aims In this first Canadian case series, we assess the safety and efficacy of Z-POEM, a novel approach for managing ZD. Methods This is a retrospective case series of all patients who underwent Z-POEM for ZD at Kingston Health Sciences center between July 2021-2023. Data collected included patient demographics, symptoms [Kothari Haber Score (KHS)] pre and post Z-POEM, ZD size and prior treatments. Technical outcomes were also analyzed including the procedure time and the Z-POEM Difficulty Score (ZPDS), which ranges from 0-3 based on maneuverability, fibrosis, and oozing. Clinical success was defined as complete or near-complete resolution of symptoms (i.e. KHS ampersand:003C2), and recurrence was defined as KHS of 3 or more. Lastly, we recorded adverse events and hospital length of stay. Results This case series included 9 patients (6 males and 3 females). The mean age ± standard deviation (SD) was 66.1 ± 10.64 years. One patient had two separate Z-POEM procedures and those were analyzed separately (total sample size = 10). The mean duration of symptoms before the procedure was 31.2 ± 10.12 months and the mean size of ZD was 2.25 ± 1.10 cm. Two patients had prior treatments before their Z-POEM procedure. The median preprocedural KHS was 6 (range 3-10) with dysphagia being the most commonly reported symptom in 80% of patients. In terms of technical outcomes, the mean procedural time was 32.3 ± 13.21 mins, and the median ZPDS score was 2. Most patients required 4-6 clips, with one patient requiring 11 clips for closure. No adverse events or periprocedural complications were reported. 9/10 patients (90%) were discharged one day after the procedure, and one patient required a longer stay (4 days) for observation. Clinical success was achieved in 8/10 patients (80%) of patients with a KHS score of 0 at mean 12 months follow-up. The remaining two patients (20%) had a KHS score of 3 at follow-up suggesting some persistent symptoms. Conclusions Z-POEM is safe and effective in management of ZD with high technical and clinical success rates in the short-term. Larger-scale studies are required to determine the long-term clinical efficacy of Z-POEM in treatment of ZD. Funding Agencies None

Concomitant training in robotic and laparoscopic liver resections of low-to-intermediate difficulty score: a retrospective analysis of the learning curve

In the setting of minimally invasive liver surgery (MILS), training in robotic liver resections (RLR) usually follows previous experience in laparoscopic liver resections (LLR). The aim of our study was to assess the learning curve of RLR in case of concomitant training with LLR. We analyzed consecutive RLRs and LLRs by a surgeon trained simultaneously in both techniques (Surg1); while a second surgeon trained only in LLRs was used as control (Surg2). A regression model was used to adjust for confounders and a Cumulative Sum (CUSUM) analysis was carried out to assess the learning phases according to operative time and difficulty of the procedures (IWATE score). Two-hundred-forty-five procedures were identified (RobSurg1, n = 75, LapSurg1, n = 102, LapSurg2, n = 68). Mean IWATE was 4.0, 4.3 and 5.8 (p < 0.001) in each group. The CUSUM analysis of the adjusted operative times estimated the learning phase in 40 cases (RobSurg1), 40 cases (LapSurg1), 48 cases (LapSurg2); for IWATE score it was 38 cases (RobSurg1), 33 cases (LapSurg1), 38 cases (LapSurg2) respectively. Our preliminary experience showed a similar learning curve of 40 cases for low and intermediate difficulty RLR and LLR. Concomitant training in both techniques was safe and may be a practical option for starting a MILS program.

Patient-reported difficulty in activities of daily living and corresponding muscle weakness in elderly patients undergoing haemodialysis.

Patients undergoing haemodialysis have reduced muscle strength and impaired activities of daily living (ADL). We examined possible relationship between difficult ADL and corresponding muscle weakness in elderly haemodialysis patients. This was a single-centre, cross-sectional study. Patient-reported ADL difficulty was examined using a questionnaire in six ADL using upper limbs (eating, grooming and dressing) and lower limbs (bathing, toileting and locomotion). We measured six muscle strengths by dynamometers of shoulder flexion, shoulder abduction, elbow flexion, handgrip, hip abduction and knee extension. The muscle strength with the lowest Z-score was considered as the weakest muscle strength for the patient. The six scores of ADL difficulty were all inversely associated with the six muscle strengths in the 81 total participants of whom 71 individuals (87.7%) had any ADL difficulty. Among the six measurements of muscle strength, handgrip strength showed the highest associations with all ADL difficulties. In 25 patients who perceived that the most difficult ADL was an activity using upper limbs, the common weakest muscle strengths were the hip abduction, handgrip and elbow flexion. In 44 patients who perceived that the most difficult ADL was an activity using lower limbs, knee extension was the most prevalent weakest muscle strength. This study suggested preferential relationship between the most difficult ADL and corresponding muscle weakness in elderly haemodialysis patients. This finding may be useful in prevention and treatment.

Symmetric bimanual coordination discrepancy and activities of daily living in individuals with autism spectrum disorder

Impairments in bimanual coordination are commonly observed in individuals with autism spectrum disorder (ASD). Bimanual coordination is essential for the performance of activities of daily living (ADLs). However, it remains unclear whether bimanual coordination impairment is associated with performing ADLs in adults with ASD. This study examined the relationship between bimanual tasks and subjective ADL difficulty in adults with ASD. Nineteen adults with ASD (41.95 ± 10.89) and 20 aged-matched (41.70 ± 11.07) controls completed a bimanual thumb–index finger opposition task and a questionnaire on subjective difficulty in ADL performance, which was evaluated using a visual analogue scale. The bimanual thumb–index finger opposition task was evaluated using a motion capture system, which quantified the coefficient of variation (COV) between bilateral finger movements. The subjective ADL difficulty scores were significantly higher in adults with ASD than in controls (p = 0.003). The COV in adults with ASD was also higher than in controls (p = 0.025). A moderate correlation was found between bimanual task COVs and subjective ADL difficulty scores in adults with ASD (r = 0.56, p = 0.013). Thus, a discrepancy in bimanual coordination may increase the effort required to perform ADLs in adults with ASD.

Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study.

This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). It was a prospective case-series study. The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. We included 73 CI candidates performed via the PT approach. The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. We correlated this score with the intraoperative difficulty and surgical duration. The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.

Results of robotic liver surgery in association with IWATE criteria — the first 100 cases

BackgroundAim of the current study was to present the results of the implementation phase of a robotic liver surgery program and to assess the validity of the IWATE difficulty score in predicting difficulty and postoperative complications in robotic liver surgery.MethodsBased on the prospective database of the Interdisciplinary Robotic Center of Ulm University Hospital, the first 100 robotic liver surgeries were identified and analyzed. Perioperative parameters (duration of surgery and blood loss) and postoperative parameters including morbidity, mortality, and length of hospital stay were assessed and the results were compared between different IWATE difficulty categories.ResultsFrom November 2020 until January 2023, 100 robotic liver surgeries were performed (41 female, 59 male; median age 60.6 years, median BMI 25.9 kg/m2). Median duration of surgery was 180 min (IQR: 128.7), and median blood loss was 300 ml (IQR: 550). Ninety-day mortality was 2%, and overall morbidity was 21%, with major complications occurring in 13% of patients (≥ grade 3 according to Clavien/Dindo). A clinically relevant postoperative biliary leakage was observed in 3 patients. Posthepatectomy liver failure occurred in 7% (4 Grade A, 3 Grade B). Duration of surgery (p < 0.001), blood loss (p < 0.001), CCI (p = 0.004), overall morbidity (p = 0.004), and length of hospital stay (p < 0.001) were significantly increased in the IWATE ‘expert’ category compared to lower categories.DiscussionRobotic surgery offers a minimally invasive approach for liver surgery with favorable clinical outcomes, even in the implementation phase. In the current study the IWATE difficulty score had the ability to predict both difficulty of surgery as well as postoperative outcomes when assessing the complexity of robotic liver surgery. Therefore, the role of the IWATE score in predicting these outcomes highlights its importance as a tool in surgical planning and decision-making.

Adherence to the Singapore Integrated 24-Hour Activity Guidelines by Infants and Toddlers and Its Association With Well-Being.

This study estimated the prevalence of Singapore infants and toddlers who met the new Singapore Integrated 24-Hour Activity Guidelines for Early Childhood and examined its association with well-being. A total of 267 parents of children aged between 0 and 2years completed an online questionnaire that consists of the Singaporean Children Lifestyle Questionnaire and either the Pediatric Quality of Life (PedsQL) Inventory Infant Scale or the Strength and Difficulties Questionnaire. Well-being of infants was measured through parent responses to PedsQL and that of toddlers was measured through Strength and Difficulties Questionnaire. Data were benchmarked against age-specific guidelines for physical activity, screen time, and sleep in the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood. A higher percentage of infants (37.3%) than toddlers (20.6%) had met 3 guidelines. In contrast, a lower percentage of infants than toddlers met at least one or did not meet any guidelines (3.8% and 0% for infants vs 22.4% and 1.8% for toddlers, respectively). Infants who met more guidelines had significantly higher parent-reported PedsQL total scale score than infants who met fewer guidelines (P < .05). However, the present study found that the number of guidelines met was not associated to infants' PedsQL scale score and toddlers' total difficulty score (P > .05). Adherence to this set of local guidelines should be widely publicized, so parents will have greater awareness and knowledge on cultivating good physical activity, screen time, and sleep habits for their child from a young age.

The relationship of sexual dysfunction and quality of life in patients with type 2 diabetes

Objective: Diabetes, along with being able to play a role in the formation of many health problems such as psychological, psychosocial, and sexual dysfunction, also indirectly affects the duration and quality of life. This research was conducted as a descriptive, cross-sectional research model to determine the relationship between sexual dysfunction and the quality of life of patients diagnosed with type 2 diabetes.&#x0D; Methods: The research sample consisted of 485 individuals diagnosed with type 2 diabetes. The data were collected through the General Information Form, the Female Sexual Function Index, the Erection Function International Assessment Form, and the Quality of Life Scale (SF-36).&#x0D; Results: It was found that 91% of women have sexual dysfunction and are experiencing sexual desire (92.2%), orgasmic function, arousal (92.9%), and pain, satisfaction, and lubrication (92.5%), respectively. This rate was found to be 91.3% in men, and the degree of erectile dysfunction was found to be moderate (55%), mild (21.6%) and severe (14.7%), respectively. It was found that the problems experienced in the areas of sexual dysfunction were in the sub-dimensions of general satisfaction 20.6%, orgasmic function 49.5%, and sexual desire 50.9%. And relationship satisfaction is 72.5%. In the study, it was found that sexual dysfunction affects the quality of life in both sexes, and the scale sub-dimensions have a statistically significant difference (p &lt; 0.05). It was found that the physical role difficulty, physical function, emotional role, mental health, and social function sub-dimension score had a statistically significant difference in men and women with sexual dysfunction, and the pain and vitality sub-dimension scores in men were significantly lower compared to those without sexual dysfunction (p &lt; 0.05).&#x0D; Conclusion: As a result, sexual dysfunction is common in men and women with Type 2 Diabetes Mellitus, and in parallel, the quality of life is low.

Perfluorobutane application value in microwave ablation of small hepatocellular carcinoma (

No studies have been retrieved comparing perfluorobutane with sulfur hexafluoride for microwave ablation (MWA) in small hepatocellular carcinoma(sHCC). To retrospective investigate the value of perfluorobutane ultrasonography contrast agent in ultrasonography (US)-guided MWA of sHCC. We conducted a retrospective clinical controlled study about US-guided percutaneous MWA in patients with sHCC, and in patients undergoing intra-operative treatment with perfluorobutane or sulfur hexafluoride. In both groups, a contrast agent was injected to clear the tumor and then a needle was inserted. A 5-point needle prick difficulty score was developed to compare needle prick difficulty in the two groups of cases. A total of 67 patients were included: 25 patients in group perfluorobutane, aged 41-82 (60.64±9.46), tumor size 1.1-2.8 (1.78±0.45) cm. 42 patients in group sulfur hexafluoride, aged 38-78 (62.26±9.27), with tumor size of 1.1-3.0 (1.89±0.49) cm. There was no significant difference in age or tumor size in both groups (P > 0.05). Puncture difficulty score (5-point): 2.0-2.7 (2.28±0.29) in group perfluorobutane, and 2.0-4.7 (2.95±0.85) in group sulfur hexafluoride, and the difference between the two groups was statistically significant (P < 0.05). Enhanced imaging results within 3 months after surgery: complete ablation rate was 100% (25/25) in the group perfluorobutane, 95.2% (40/42 in the group sulfur hexafluoride), with no significant difference between the two groups (P > 0.05). Perfluorobutane kupffer phase can make the operator accurately deploy the ablation needle and reduce the difficulty of operation.

Relationship Between Airway Examination with LEMON Criteria and Difficulty of Tracheal Intubation with IDS Criteria.

Tracheal intubation is a common technique used to secure a patient's airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient's airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway's appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems. This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared. In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152). The LEMON score is associated with difficult intubation in adult patients requiring intubation.

The association between chronotype profile and temporomandibular disorders among college students.

Temporomandibular joint disorders (TMDs) are common in young adults, and the link between chronotype profile and TMDs is unclear. This study examined TMD prevalence and chronotype distribution and explored the relationship between chronotype and TMDs in young adults. A total of 663 students from Sichuan University completed questionnaires. Chronotype profiles were assessed using the Morningness-Eveningness Questionnaire, and TMDs were screened using the Fonseca Memory Index. To validate the findings, 68 TMD patients and 136 controls were enrolled. The prevalence of TMDs was 69.7%, with significant differences among chronotype profiles. The intermediate profile was the most common chronotype. Eveningness profile was associated with higher TMDs prevalence and severity. Muscle pain and side movement difficulty scores were higher in eveningness and intermediate profiles. Female gender (OR 2.345; 95% CI 1.668-3.297) was a TMD risk factor, while morningness profile (OR 0.537; 95% CI 0.297-0.970) was protective. Validation with TMD patients and controls supported these findings, showing higher eveningness profile prevalence in the TMD groups. TMDs have a high prevalence in college students, chronotype profiles shown to be associated with TMDs. Morningness is the protection factor in TMDs and PT, eveningness is a risk factor for IT.

Social skills training with a tabletop role-playing game, before and during the pandemic of 2020: in-person and online group sessions.

The area of social skills is broad, in theory and in practice. For social skills training, various clinical practices have been applied in group sessions, as have motivational resources such as role-playing games (RPGs). In recent years, the need arose to assess the clinical impact of the pandemic. The objective of this study was to determine the impact that the pandemic has had on in-person and online social skills training. We evaluated six subjects with autism spectrum disorder, with or without another, similar disorder, each of whom attended a total of 12 two-hour RPG sessions over a 12-month period. The original (Portuguese-language) version of the Social Skills Inventory for Adolescents was applied at three different time points (pre-, mid-, and post-intervention). After six in-person tabletop RPG sessions, there was an increase in the mean frequency scores and a decrease in the mean difficulty scores. However, during the pandemic, the remaining six sessions were conducted online and the effect was the opposite. Our data indicate that there is a need for further studies assessing social skills training in online contexts.

Quality of life and its predictors among patients with metastatic cancer in Bangladesh: the APPROACH survey

BackgroundThis study aimed to assess the health-related quality of life (HRQOL) (physical, functional, emotional, social, spiritual) and psychological (anxiety and depression) well-being and their associations with patient characteristics among patients with metastatic cancer in Bangladesh.MethodsA convenience sample of 386 Bangladeshi patients with stage IV solid cancers was recruited from a palliative care outpatient department and an inpatient palliative center. Dependent variables included the physical, functional, emotional, social, and overall scores of the Functional Assessment of Cancer Therapy-General (FACT-G) scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale, the anxiety, depression, and overall scores of the Hospital Anxiety and Depression (HADS) scale. Linear regressions examined the association between dependent variables and patient characteristics.ResultsA substantial proportion of Bangladeshi patients reported anxiety (59% of outpatients and 55% of inpatients) and depression (60% of outpatients and 73% of inpatients) symptoms. Generally, greater financial difficulty and symptom burden scores were associated with worse health outcomes. Older patients reported poorer functional and spiritual well-being but better anxiety scores. Females reported worse anxiety and depressive symptoms and physical well-being but better spiritual outcomes.ConclusionsAdditional efforts must be directed at improving the HRQOL of patients with metastatic cancer in Bangladesh. Furthermore, assistance should be made more accessible to vulnerable groups, including women, the elderly, and those with financial difficulty.