Patient Discomfort Research Articles

Efficient urinary stone type prediction: a novel approach based on self-distillation

Urolithiasis is a leading urological disorder where accurate preoperative identification of stone types is critical for effective treatment. Deep learning has shown promise in classifying urolithiasis from CT images, yet faces challenges with model size and computational efficiency in real clinical settings. To address these challenges, we developed a non-invasive prediction approach for determining urinary stone types based on CT images. Through the refinement and improvement of the self-distillation architecture, coupled with the incorporation of feature fusion and the Coordinate Attention Module (CAM), we facilitated a more effective and thorough knowledge transfer. This method circumvents the extra computational expenses and performance reduction linked with model compression and removes the reliance on external teacher models, markedly enhancing the efficacy of lightweight models. achieved a classification accuracy of 74.96% on a proprietary dataset, outperforming current techniques. Furthermore, our method demonstrated superior performance and generalizability on two public datasets. This not only validates the effectiveness of our approach in classifying urinary stones but also showcases its potential in other medical image processing tasks. These results further reinforce the feasibility of our model for actual clinical deployment, potentially assisting healthcare professionals in devising more precise treatment plans and reducing patient discomfort.

Comparisons of the Clinical Outcomes of Mandible Contouring Surgery With or Without the Use of Intraoral Drains.

Mandible contouring surgery is a common cosmetic procedure aimed at reducing the width of the lower face or correcting chin-related issues by contouring the mandible. Typically, an intraoral drain is placed during procedures involving the reduction of the mandible angle portion to mitigate seroma or hematoma formation. Despite this standard practice, anecdotal evidence suggests that the omission of drains does not significantly impact complication rates or surgical outcomes. A retrospective study was conducted to compare surgical outcomes and complication rates between patients who received intraoral drains (n = 338) and those who did not (n = 132) during mandible contouring surgery. The primary outcomes measured included the incidence of seroma, hematoma, and infection by counting the number of post-operative interventions required to address these complications. Statistical analysis was performed using chi-square tests for categorical variables. A p-value of < 0.05 was considered statistically significant. The incidence of post-operative surgical interventions for bleeding control or hematoma evacuation in the drain group was 0.59% compared to 0% in the no-drain group (p = 0.922). Minimally invasive interventions were required in 2.37% of patients with drains and 3.03% without drains (p = 0.933). Infection rates were 1.18% in the drain group versus 0.76% in the no-drain group (p = 1.0). The study demonstrates no statistically significant difference in complication rates between mandible contouring surgeries performed with or without intraoral drains. These findings suggest that the routine use of drains may be unnecessary, potentially simplifying post-operative care and reducing patient discomfort. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The physiological determinants of symptom burden in cirrhosis with ascites.

Paracentesis is commonly used to manage patient discomfort due to ascites. The relationship between ascites pressure, ascites volume, and patient discomfort has not been elucidated. We prospectively enrolled adult patients with non-malignant ascites undergoing outpatient therapeutic paracenteses from 2021 to 2024 at a tertiary care hospital. Patients completed a validated symptom questionnaire (ASI-7, maximum score 35) before, immediately after, and 1week after paracentesis. An open-ended manometer was used to measure ascites pressure at the beginning and end of paracentesis. Mixed effect linear regression was performed to evaluate the relationships between patient characteristics, pressure, volume, and symptoms. One hundred and fifty paracentesis procedures among 48 unique patients with an average Model for End Stage Liver Disease-Sodium 3.0 of 16.7 were included. An average of 6.5L was drained, which reduced abdominal pressure from a mean of 13.7 to 6.0cm H2O (10.1 to 4.4mmHg, p<0.001) and mean symptom score from 22.6 to 6.5 (p<0.001). Regression models identified that symptoms and abdominal pressure linearly correlated above a pressure of 6cm H2O or ASI-7 score of 16 (p<0.01). Taller patients required about 670ml additional drainage per inch above the cohort mean height (5'8″) to achieve the same symptom relief. Pressure measured at the bedside can be used to explore changes in abdominal pressure during paracentesis. Pressure, volume, and patient level factors such as height contribute to patient symptoms but cannot fully explain discomfort associated with ascites and relief after paracentesis.

Whole-brain T2 mapping with radial sampling and retrospective motion correction at 3T.

Several barriers prevent the use of whole-brain T2 mapping in routine use despite increasing interest in this parameter. One of the main barriers is the long scan time resulting in patient discomfort and motion corrupted data. To address this challenge, a method for accurate whole-brain T2 mapping with a limited acquisition time and motion correction capabilities is investigated. A 3D radial multi-echo spin-echo sequence was implemented with optimized sampling trajectory enabling the estimation of intra-scan motion, subsequently used to correct the raw data. Motion corrected echo images are then reconstructed with linear subspace constrained reconstruction. Experiments were carried out on phantom and volunteers at 3T to evaluate the accuracy of the T2 estimation, the sensitivity to lesions and the efficiency of the correction on motion corrupted data. Whole-brain T2 mapping acquired in less than 7 min enabled the depiction of lesions in the white matter with longer T2. Data retrospectively corrupted with typical motion traces of pediatric patients highly benefited from the motion correction by reducing the error in T2 estimates within the lesions. All datasets acquired on seven volunteers, with deliberate motion, also showed that motion corrupted T2 maps could be improved with the retrospective motion correction both at the voxel level and the structure level. A whole-brain T2 mapping sequence with retrospective intra-scan motion correction and reasonable acquisition time is proposed. The method necessitates advanced iterative reconstruction strategies but no additional navigator, external device, or increased scan time is required.

Comfortable sound design based on auditory masking with chord progression and melody generations using automatic composition

Unpleasant noise is a crucial problem, that we often face in daily life. One of such a problem is in the case of dental treatment. A dental instrumental noise that includes peaky components in the high-frequency band makes doctors and patients discomfort. To reduce discomfort, we proposed a method to mask unpleasant noise with a comfortable sound. The proposed method was automatically generating a comfortable cord progression. In previous subjective test results, it shows that degree of discomfort reduces. The remaining problem is that degree of comfort improves. This is due to the fact that the previous method utilizes the musical element of chord, but does not introduce the musical elements of melody and rhythm. Therefore, in this paper, we propose a new method to introduce the melody generation with automatic composition (AI composition) into the previous method based on the automatic generation of the chord progression. The proposed method automatically generates a chord progression to follow the peak frequency of dental treatment sounds and to add a melody following the chord progression with AI composition assistance tool to improve comfort and to design comfortable sound.

Cat scratch colon and cecal barotrauma perforation during colonoscopy with CO2 insufflation.

Cecal perforation from barotrauma is a rare complication of colonoscopy, even with the use of CO₂ insufflation, which is generally preferred over room air due to its rapid absorption and reduced patient discomfort. A 64-year-old woman with hypertension and dyslipidemia underwent a routine colonoscopy with CO₂ insufflation. Multiple diverticula were noted, and upon reaching the cecum, several parallel linear lesions with spontaneous bleeding, consistent with "cat scratch" colon, were observed. Hemostasis was achieved with 10 endoscopic clips. A subsequent CT scan revealed pneumoperitoneum and the clips in the cecum. The patient was managed conservatively with bowel rest and intravenous antibiotics, showing a favorable clinical course and was discharged on the fifth day. This case highlights the potential for cecal perforation due to barotrauma even with CO₂ insufflation during colonoscopy, emphasizing the need for awareness and prompt management of such complications.

Analgesic Use of Virtual Reality for Burn Dressing Changes in Low- and Middle-income Countries: A Feasibility Study.

The paucity of pain management options in resource-limited settings is a significant and systemically unaddressed problem. To improve global health equity, it is important to bridge this gap in care without introducing the peril of opioid dependence. We present a proof-of-concept case series wherein virtual reality (VR) was successfully used to manage discomfort in patients undergoing burn dressing changes in sub-Saharan Africa. Nine patients presenting with burn injuries of variable severity underwent routine stabilization and dressing as part of standard-of-care treatment. During dressing changes, a VR intervention consisting of the Dream Flight interactive game displayed on an Oculus Quest 2 headset was offered to patients. Patient mood scores were collected before VR initiation and at the conclusion of the dressing change by a translator using the Youth Feelings Scale. There were no adverse events associated with use of the VR headset and no patients elected to terminate the VR during their procedure. Patients and physicians subjectively reported satisfaction with the device's utility in the procedure. Before VR initiation, the 95% confidence interval for patient mood score was 4.89 ± 1.725. After VR initiation, the 95% confidence interval for patient mood score was 8.78 ± 1.40. Our results of this proof-of-concept case series to suggest both feasibility of use and positive influence on patient discomfort and periprocedural satisfaction. We propose that VR should be explored as an analgesic alternative and/or adjunct to narcotics in resource-limited countries, particularly for high-pain, low-duration procedures.

The Efficacy of Blood Flow Restriction Training to Improve Quadriceps Muscle Function after ACL Reconstruction.

Blood flow restriction training (BFRT) is a popular rehabilitation intervention after anterior cruciate ligament reconstruction (ACLR). However, there are a lack of clinical trials establishing the efficacy of using BFRT during rehabilitation to improve quadriceps muscle function. To evaluate the efficacy of blood flow restriction training to improve quadriceps muscle strength, morphology, and physiology, and knee biomechanics in individuals after ACLR in a double-blind, randomized, placebo-controlled clinical trial (NCT03364647). 48 athletes (20 females/28 males) were randomly assigned to low-load strength training with active BFRT or standard of care strength training with a sham unit. Treatment occurred for 1-month pre-surgery and 4-5 months post-surgery with both groups following the same standard rehabilitation protocol. Outcome variables were measured at baseline and 4-5 months post-surgery. Quadriceps muscle strength (isometric and isokinetic peak torque and rate of torque development) was measured on an isokinetic dynamometer. Quadriceps muscle morphology (physiological cross-sectional area, fibrosis) was determined using magnetic resonance imaging. Quadriceps muscle physiology (fiber type, fiber cross-sectional area, satellite cell abundance, collagen content, fibro-/adipo-genic progenitor cells) was evaluated with muscle biopsies of the vastus lateralis. Knee extensor moment and knee flexion angle were measured via three-dimensional gait analysis. Change scores were calculated as: post-intervention-baseline. Two sample t-tests were then used to assess between-group differences for each outcome variable. No significant between-group differences were found for any outcome variable. The addition of BFRT to a rehabilitation program for athletes pre- and post- ACLR was no more effective than standard rehabilitation for improving quadriceps muscle function. Clinicians should consider the value of BFRT relative to the cost, time, and discomfort for patients in light of these results.

Thoracic MRI in pleural infection – a feasibility study from patients’ and radiographers’ perspectives

BackgroundPleural infections present significant clinical challenges, particularly in elderly or immunosuppressed patients, leading to prolonged hospital stay, high morbidity and high mortality. While CT and X-ray are standard imaging modalities, MRI's potential remain unexplored due to historical limitations in scan duration and patient discomfort. Advances in MRI technology, however, may enable its broader use in thoracic imaging. The study aimed to explore the feasibility of thoracic MRI from the radiographers’ and patients’ perspectives. MethodsA prospective feasibility study was conducted involving thirteen patients with pleural infections who underwent thoracic MRI as an add-on within 48 hours of the conventional contrast-enhanced chest CT. Feasibility was assessed on technical success, and scan duration. Patients and radiographers experiences were evaluated through questionnaires and qualitative comments. ResultsTechnical success was high as all thirteen patients completed the scans. The mean in-room time was 30.7±5.5 minutes and the mean scan time was 23±5.4 minutes. Radiographers reported the MRI scans as feasible with few patients requiring breaks or assistance. Most patients found the MRI experience manageable though two reported difficulties with breath-hold instructions. No patients were challenged by lying in supine position and no patients felt very anxious. No significant movement- or breathing artefacts were identified on MRI. ConclusionThoracic MRI is feasible with high technical success, acceptable scan time, and good patient experience in patients with pleural infections offering potential as a radiation-free imaging modality. Furthermore, compared to CT, the use of MRI showed potential advantages in identifying pleural effusion septations.

Quality Control Circle Practices to Reduce Specimen Rejection Rates.

Quality assurance in laboratory testing significantly impacts patient care. The pre-analytical phase is particularly error-prone, contributing to around 70% of laboratory errors. High specimen rejection rates can delay diagnosis and treatment, cause patient discomfort, and increase healthcare costs. Quality Control Circles (QCC) have been introduced to medical institutions to improve process efficiency and reduce errors. This study aims to evaluate the effectiveness of QCC practices in reducing specimen rejection rates in a hospital clinical laboratory. A QCC initiative was implemented in the clinical laboratory from July 2021 to August 2022. The QCC comprised members from the clinical laboratory, nursing department, and administration. The initiative followed the PDCA (Plan-Do-Check-Act) cycle and involved multiple quality control methods, including flowchart analysis, Pareto analysis, and Fishbone diagrams. The effectiveness of the initiative was evaluated using statistical analyses of specimen rejection rates before and after implementation. The QCC initiative led to a significant reduction in specimen rejection rates. The monthly specimen rejection rate decreased from an average of 1.13% before the intervention to 0.27% after the intervention. The most significant factors contributing to specimen rejection were identified as lack of sample collection information and blood clotting. Targeted interventions, such as appointing specimen collection liaisons, establishing a quality control team, and providing training on blood collection procedures, were implemented. These measures resulted in a notable decrease in the proportion of rejected specimens due to the identified factors. The implementation of QCC practices effectively reduced specimen rejection rates in the hospital laboratory. The study highlights the importance of systematic quality control methods and targeted interventions in improving laboratory processes. The success of the QCC initiative demonstrates its potential for broader application in other healthcare settings to enhance quality and efficiency.

Machine learning model predicting factors for incisional infection following right hemicolectomy for colon cancer

Background and aimColorectal cancer is a prevalent malignancy worldwide, and right hemicolectomy is a common surgical procedure for its treatment. However, postoperative incisional infections remain a significant complication, leading to prolonged hospital stays, increased healthcare costs, and patient discomfort. Therefore, this study aims to utilize machine learning models, including random forest, support vector machine, deep learning models, and traditional logistic regression, to predict factors associated with incisional infection following right hemicolectomy for colon cancer.MethodsClinical data were collected from 322 patients undergoing right hemicolectomy for colon cancer, including demographic information, preoperative chemotherapy status, body mass index (BMI), operative time, and other relevant variables. These data are divided into training and testing sets in a ratio of 7:3. Machine learning models, including random forest, support vector machine, and deep learning, were trained using the training set and evaluated using the testing set.ResultsThe deep learning model exhibited the highest performance in predicting incisional infection, followed by random forest and logistic regression models. Specifically, the deep learning model demonstrated higher area under the receiver operating characteristic curve (ROC-AUC) and F1 score compared to other models. These findings suggest the efficacy of machine learning models in predicting risk factors for incisional infection following right hemicolectomy for colon cancer.ConclusionsMachine learning models, particularly deep learning models, offer a promising approach for predicting the risk of incisional infection following right hemicolectomy for colon cancer. These models can provide valuable decision support for clinicians, facilitating personalized treatment strategies and improving patient outcomes.

Eco-logistical comparison of non-radioactive seeds and the wire-guided localization for intraoperative detection of breast lesions

BackgroundThe current standard for the preoperative marking of non-palpable breast lesions is wire guided localization (WGL) which is associated with logistical efforts and patient discomfort. Non-radioactive seeds (NRS) recently challenged the use of WGL; but do they provide a better alternative from a logistical and environmental perspective? MethodsWGL standard was compared with NRS available in Germany: Magseed®, Pintuition®, SAVI SCOUT ® and LOCalizer™ on a logistical and carbon-footprinting basis. In the logistical analysis the number of patient contacts with the healthcare system for lesion localization/removal and the number of breast punctures were evaluated in two different clinical scenarios (primary surgery and secondary surgery after neoadjuvant treatment). The carbon footprints of WGL and NRS (with exception of LOCalizer) were assessed based on their material compositions and operating energy in a streamlined approach. ResultsApplication of NRS reduces the number of contacts by 33.3 % (2 vs. 3) in primary, by 50 % (2 vs. 4) in secondary surgery, and the number of breast punctures by 33.3 % (2 vs.3). Annual Germany-wide material- and energy-based carbon footprints of NRS (1.6 to 3.2 tons CO2eq) are significantly lower in comparison to WGL (10.3 tons CO2eq). The implementation of NRS would lead to a CO2eq reduction by around 79 % compared to WGL. ConclusionsThe use of NRS for the localization of non palpable breast lesions is more favorable from the environmental and logistical perspective, when compared to WGL with possible benefits for patients, healthcare providers and the environment.

Navigation of video-assisted thoracoscopic surgery using electromagnetic versus CT-guided localization (NOVEL): a study protocol for comparing procedural success and complication rates in a prospective, multicenter, randomized controlled, non-inferiority phase III trial.

The rise of low-dose computed tomography (LDCT) has increased the detection of small pulmonary nodules, demanding more effective localization techniques for their resection. Minimally invasive resection utilizing video-assisted thoracoscopic surgery (VATS) is a critical method for treating these nodules. However, traditional computed tomography (CT)-guided localization has limitations such as invasiveness and patient discomfort. The current gap in knowledge relates to the potential advantages of electromagnetic navigation bronchoscopy (ENB) in reducing complications and improving procedural efficiency. The NOVEL trial evaluates the non-inferiority of ENB-guided labeling against CT-guided puncture for lung nodule localization. This multicenter, randomized, controlled, non-inferiority phase III trial includes 156 participants across four Chinese hospitals, randomized to undergo either ENB-guided or CT-guided localization prior to VATS sub-lobar resection. Randomization is performed using sealed opaque envelopes to ensure allocation concealment. Primary outcomes are the procedural success rates and complication rates of both techniques, with secondary outcomes including procedure times and lesion margins. The NOVEL trial aims to provide a detailed comparison of ENB-guided versus CT-guided localization for small pulmonary nodules. Establishing the safety and efficacy of the ENB method could significantly influence clinical practices and improve patient outcomes. This trial was registered with the Medical Research Registration Platform (https://www.medicalresearch.org.cn), registration number MR-31-24-018575.

Clinical Observations of Soft Tissue Dimensions Around Teeth and Implants After Free Gingival Graft

Introduction and aimsThe histological and morphological differences in soft tissue between natural teeth and peri-implant may result in different clinical effectiveness to free gingival graft (FGG). This research aims to investigate the different efficacy of FGG in augmenting keratinized tissue width (KTW) between tooth and implant sites while evaluating its medium-term stability over a 2- to 5-year follow-up. MethodsIn this study, 29 patients underwent FGG to address insufficient clinical scenarios when KTW <2 mm at the buccal aspect, including 37 implant sites and 33 natural teeth sites both in posterior regions were included. The KTW and gingival margin position (GMP) of these sites was assessed by measuring the intra-oral photographs which were taken at 0 days (T0), 3-month (T1), 6-month (T2), 12-month post-surgery (T3), and 2 to 5 years follow-up (T4). ResultsThe results revealed that KTW increased significantly in both groups. However, the natural teeth group showed significantly less graft shrinkage (GS) than the implants group. (Teeth: 2.05 ± 0.51 mm and 25.42% ± 6.45%; Implants: 3.18 ± 0.65 mm and 38.92% ± 5.39%, P <.01). From T1 to T4. The gingival margin coronally advanced by 0.47 ± 0.51 mm and 0.18 ± 0.43 mm for the natural teeth and implants group, respectively (P<.05). ConclusionsA greater KTW reduction after FGG was observed at implants versus natural teeth. And, the graft surrounding implants after crown restoration was stable for up to 2 to 5 years. Clinical relevanceBy comparing the changes in KTW around natural teeth and implants following FGG to investigate whether there are differences between them and the degree of differences. Additionally, this allows us to explore whether the restorations impact the effect of FGG. This research can assist clinicians in selecting an appropriate amount of soft tissue during surgery to achieve treatment goals, reduce postoperative discomfort for patients, and enhance predictability in clinicians' ability to increase keratinized tissue. Furthermore, by observing changes in the position of GMP around natural teeth and implants, the effectiveness of FGG in root coverage can be understood, thus improving the predictability of FGG for root coverage.

Digital prosthodontics in near future: Awareness among the dental students on intraoral scanners and its probability of replacement over conventional method in the near future of prosthodontics: A cross-sectional survey

Aims: The aim of the study is to analyse the awareness and knowledge about IOSs among the dental students of Tamil Nadu. Settings and Design: A cross sectional survey – questionnaire study. Materials and Methods: A descriptive, cross-sectional survey was carried out to assess the knowledge, awareness, and practice of IOSs among dental students through a questionnaire of five domains, with five questions in each domain. This is sent to various dental students of Tamil Nadu through mail and othersocial media platforms. Statistical Analysis Used: It was performed using a statistical package for the social sciences’ [SPSS] software version 22. Descriptive statistics were performed for demographic variables. Chi square test was performed for all the qualitative data. Results: Most of the answers were statistically significant with P &lt; 0.05 and few results were not significant indicating less knowledge and awareness about digital prosthodontics among the dental students. Conclusions: Thus, the addition of digital dentistry in the curriculum of dental students and giving them more knowledge helps in the flourishment of the future prosthodontic field with much accuracy of treatment and with less patient discomfort replacing the conventional methods.

.

Background: Gallstones are a common gastrointestinal disorder often requiring cholecystectomy. Laparoscopic cholecystectomy, the gold standard for gallbladder removal, involves pneumoperitoneum (PNP) using carbon dioxide (CO2) for better visibility and access. However, postoperative shoulder pain remains a frequent complication, largely attributed to CO2 insufflation. This study compares the incidence and severity of postoperative shoulder pain between low-pressure pneumoperitoneum (LPP) and standard-pressure pneumoperitoneum (SPP) during laparoscopic cholecystectomy. Materials and Methods: A prospective interventional study was conducted at SMS Hospital, Jaipur, including 80 patients with gallstone disease undergoing elective laparoscopic cholecystectomy. Patients were divided into two groups: LPP (8–10 mm Hg) and SPP (12–14 mm Hg), each comprising 40 patients. Pain was assessed using the Verbal Rating Scale (VRS) at 2, 6, 12, 24, and 48 hours postoperatively. Data were analyzed using the unpaired two-tailed t-test, with a P value &lt; 0.05 considered statistically significant. Results: The incidence of shoulder pain was significantly lower in the LPP group (10%) compared to the SPP group (40%) (P = 0.00). Mean VAS scores at 2, 6,12,24, and 48 hours post-surgery were consistently lower in the LPP group, with significant differences noted at each time point. At 12 hours, the LPP group had a mean VAS score of 0.62 ± 0.34 compared to 2.92 ± 1.4 in the SPP group (P = 0.00). By 48 hours, no LPP patients reported shoulder pain, whereas the SPP group still reported a mean VAS score of 0.62 ± 0.21 (P = 0.00). Conclusion: LPP is associated with significantly lower incidence and severity of postoperative shoulder pain compared to SPP in laparoscopic cholecystectomy. These findings suggest that LPP could be a better option for reducing patient discomfort and improving postoperative outcomes

A customized nasal dilator and breather for patient with deviated nasal septum

Nasal obstruction due to deviated nasal septum (DNS) is commonly defined as patient discomfort manifested as a sensation of insufficient airflow through the nose. The definitive treatment for a DNS is septoplasty, this customized nasal device can be used as an adjunct to treatment. And can be used as a breather until The patient receives or underwent definitive treatment. This device contains a nasopharyngeal airway tube and a customized nasal dilator, the nasopharyngeal airway tube is made of soft and elastic medical plastics, with good biocompatibility, without skin damage and allergy, which will be inserted inside. which will be inserted inside the affected nostril and it fits accurately between the septum and the lateral endonasal tissue, the nasal dilator which is composed of heat-cure acrylic resin helps to keep the nasopharyngeal airway in position withoutdislodging. The device also has an elastic band on both sides which can be worn like a mask by the patient. The nasopharyngeal tube of this device has a stopper that prevents the nasopharyngeal tube to go inside the nostril accidentally and the said tube is sterilizable and easily replaceable (even by the patient).

Optimizing peripheral I.V. access outcomes - Part 2.

Peripheral I.V. access failure is a source of patient discomfort and dissatisfaction with a significant financial impact on healthcare. This article reviews the benefits and the risks of peripheral I.V. catheter (PIVC) utilization, infusate characteristics and their impact on peripheral vasculature, PIVC site assessment and management, and PIVC research priorities. Part 1 of this series was published in Nursing's September 2024 issue.

Enhanced Anti-Inflammatory Activity of Kaempferia galanga Extract by Solid Self-Nanoemulsifying Drug Delivery System and Its Development in Fast Disintegrating Tablet

The increasing global incidence of osteoarthritis (OA) emphasizes the need for effective treatments, particularly for the elderly. Conventional OA treatments pose administration challenges, leading to patient discomfort due to difficulties in administration. Herbal formulations offer an alternative to mitigate these issues. Kaempferia galanga (KG) contains ethyl p-methoxycinnamate, a compound displaying anti-inflammatory properties that hold promise for OA treatment. This study explores the formulation of a solid self-nanoemulsifying drug delivery system (S-SNEDDS) of Kaempferia galanga extract (KGE) and evaluates its anti inflammatory efficacy, subsequently developing it into a fast disintegrating tablet (FDT) dosage form. Initially, a liquid SNEDDS (L-SNEDDS) was prepared with varying surfactant and co surfactant concentrations. The optimal formula of L-SNEDDS (FL2) using tween 80: cremophor RH 40: PEG 400 in a ratio of 1:1:2 demonstrated favorable characteristics, including transmittance of 86.93 ± 1.16%, emulsification time of 28 ± 2.65 s, particle size of 27.79 ± 2.00 nm, PDI of 0.21 ± 0.014, and zeta potential of -12.57 mV. FL2 was solidified using aerosil 200 to produce S-SNEDDS and tested for anti-inflammatory efficacy in vivo using a carrageenan induced rat model. Results showed enhanced anti-inflammatory efficacy of KGE via S-SNEDDS, marked by reduced edema volume. Afterward, FDT S-SNEDDS were prepared using the direct compression method by comparing different types of superdisintegrants. The formulation using the combination of crospovidone and croscarmellose sodium (FT2) demonstrated excellent flow properties, tablet disintegration time of 63 s, wetting time of 34.01 ± 7.87 s, friability of 0.19%, and hardness of 3.53 ± 6.16 kg/cm2. The dissolution test indicated a better dissolution profile for FT2 compared to other formulations. In conclusion, this research presents the potential of FDT S-SNEDDS as a promising drug delivery system for enhancing the therapeutic effects of Kaempferia galanga extract in treating inflammatory conditions such as osteoarthritis.

Different Sodium Concentrations of Noncancerous and Cancerous Prostate Tissue Seen on MRI Using an External Coil

Abstract Background Sodium (23Na) MRI of prostate cancer (PCa) is a novel but under-documented technique conventionally acquired using an endorectal coil. These endorectal coils are associated with challenges (e.g., a non-uniform sensitivity profile, limited prostate coverage, patient discomfort) that could be mitigated with an external 23Na MRI coil. Purpose To quantify tissue sodium concentration (TSC) differences within the prostate of participants with PCa and healthy volunteers using an external 23Na MRI radiofrequency coil at 3 Tesla. Materials and Methods A prospective study was conducted from January 2022 to June 2024 in healthy volunteers and participants with biopsy-proven PCa. Prostate 23Na MRI was acquired on a 3 Tesla PET/MRI scanner using a custom-built two-loop (diameter, 18 cm) butterfly surface coil tuned for the 23Na frequency (32.6 MHz). The percent difference in TSC (ΔTSC) between prostate cancer lesions and surrounding noncancerous prostate tissue of the peripheral zone (PZ) and transition zone (TZ) was evaluated using a one-sample t-test. TSC was compared to apparent diffusion coefficient (ADC) measurements as a clinical reference. Results 6 healthy volunteers (mean age, 54.5 years ± 12.7) and 20 participants with PCa (mean age, 70.7 years ± 8.3) were evaluated. A total of 31 lesions were detected (21 PZ, 10 TZ) across PCa participants. Compared to noncancerous prostate tissue, prostate cancer lesions had significantly lower TSC (ΔTSC, -14.1% ± 18.2, p = 0.0002) and ADC (ΔADC, -26.6% ± 18.7, p &amp;lt; 0.0001). Conclusion We used an external 23Na MRI coil for whole-gland comparison of TSC in PCa and noncancerous prostate tissue at 3 Tesla. PCa lesions presented with lower TSC compared to surrounding noncancerous PZ and TZ tissue. These findings demonstrate the feasibility of an external 23Na MRI coil to quantify TSC in the prostate and offer a promising, non-invasive approach to prostate cancer diagnosis and management.