Functional Disorders Research Articles

Breastfeeding Duration Reduces the Risk of Childhood Leukemia and Modifies the Risk of Developing Functional Gastrointestinal Disorders.

Objective: The aim of this study was to test the hypothesis that the duration of breastfeeding in infancy reduces the risk of childhood leukemia or lymphoma, and modifies the risk of developing functional gastrointestinal disorders (FGIDs). Subjects and Methods: This case-control study involved the recruitment of children with lymphoid malignancy and functional gastrointestinal symptoms with healthy children as controls. Focused questionnaires were used to collect data on breastfeeding history and other key risk factors. Univariate and multivariate analyses were undertaken. Results: Of the 334 children with lymphoid malignancy, 65% were male. The control group included 334 age- and sex-matched participants. Most (n = 189; 56.6%) of the children with leukemia were <10 years of age. Differences between cases and controls included the duration of breastfeeding (p < 0.0001), mean birthweight (p < 0.001), maternal age (p < 0.001), paternal age (p < 0.001), birth order (p < 0.001), mean number of children (p < 0.001), BMI percentile (p = 0.042), and maternal smoking (p = 0.012). Breastfeeding duration of up to 6 months' duration, when compared with feeding of longer than 6 months, was associated with increased odds ratios (OR) for acute lymphoblastic leukemia (OR = 3.43, 95% confidence interval [CI] 2.37-4.98; p < 0.001), Hodgkin's lymphoma (OR = 1.58, 95% CI: 0.88-2.84, p = 0.120), Non-Hodgkin's lymphoma (OR = 2.14, 95% CI: 1.25-3.65, p = 0.005), and overall (OR = 1.95, 95% CI: 1.40-2.71, p < 0.001). Cases also differed from controls with regard to FGIDs, such as stomach ache (p < 0.001), dyspepsia (p < 0.001), early satiety (p = 0.017), bowel satisfaction (p < 0.001), bloating (p < 0.001), nausea (p = 0.005), vomiting (p = 0.039), constipation (p = 0.003), diarrhea (p = 0.010), gastrointestinal canal congestion (p =0.039), muscle aches pains (p = 0.008), fecal incontinence (p = 0.021), and indigestion (p = 0.003). A multivariate stepwise regression analysis revealed that maternal smoking (p < 0.001), formula feeding (p < 0.001), duration of breastfeeding (p < 0.001), birth order (p = 0.002), mother's age (p = 0.004) and the child's birthweight (p = 0.009) were predictors for leukemia. Further analysis showed that dyspepsia (p < 0.001), gastrointestinal tract canal congestion (p < 0.001), constipation (p = 0.009), diarrhea (p = 0.013), bowel satisfaction (p = 0.021), bloating (p = 0.022), duration of breastfeeding (p < 0.001), and stomach ache (p = 0.025) were significant predictors for developing FGID symptoms after adjusting for age, gender, and other confounding variables. Conclusion: This study confirmed that breastfeeding has some effect on reducing possible risk of childhood lymphoma and leukemia and FGID symptoms compared with healthy control children.

Experimental Modeling of Cranial Injury and Defect Reconstruction Using Superconstructive Polymers (PEEK).

Experimental model of resection craniotomy with subsequent reconstruction of the defect with a polymer implant enables comprehensive assessment of functional and ultrastructural changes during replacement of the damaged tissue. Reconstruction of a skull defect was accompanied by transient motor disturbance in the acute period and did not cause functional disorders and neurological deficits in a delayed period. Histological examination of osteal and brain tissue revealed no pathological reactions that could be associated with the response to the chemical components of the implant.

Validation of Rome IV Criteria in Diagnosis of IBS as a Part of Functional Gastrointestinal Disorders among Children

Abstract Background There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome IV criteria in diagnosis of IBS as a part of functional gastrointestinal disorders among children (FGIDs). These revisions are expected to improve clinical care in children with FGIDs. We hypothesize that red flags may appear after the initial diagnosis leading to categorization of patients to organic illness rather than functional. Aim of the Work The aim of this study is to validate the Rome IV criteria in diagnosis of IBS as a part of functional gastrointestinal disorders among children. Patients and Methods Enrollment was targeted at children(4-16yrs) with chronic abdominal pain for 3 months or more and any patient with red flags were excluded from the study. The resulting sample included 200 patients. They were then followed up for 3 months then re-classification of the patients according to Rome 4 criteria. Comparison between the initially diagnosed patients as functional Gastrointestinal disorders with the final diagnosis after the 3 months follow in order to pick up any red flags which might appear. Results Diagnosis and follow up of patients using Rome IV is efficient in excluding organic diseases and diagnosing IBS as one of the FGIDs in children however there was interchangeable results between sub-types of IBS after the follow up of patients. None of our patients developed red flags of organic illness. Conclusion Rome criteria is helpful in diagnosing IBS and its subtypes and avoiding the need for further investigations.

Quality of Life in Pediatric Iritable Bowel Syndrome among a Sample of Egyptian Children at Ain Shams University Hospitals

Abstract Background Iritable bowel syndrome (IBS) is one of the pediatric functional gastrointestinal disorder with upper and lower gastrointestinal symptoms.IBS afects the child’s daily activities and quality of life (QoL) negatively, and can often persist into adulthood. Objectives To measure the dimensions of QoL of children with IBS among a sample of Egyptian pediatric patients at Ain Shams University Hospitals. Methods A cross-sectional study was conducted on 80 children aged 5-15 years old, who were diagnosed as IBS, according to Rome IV criteria Pediatric quality of life Inventory Generic Core (PedsQL generic core scale was used to measure QoL of the patients,where 100 is the maximum quality score. Results A total of 80 children participated in the study ; 48 (60%) males and 32 (40%) females with mean age 10.6 (SD2.7) years. Physical functioningscorewascalculatedtobe96.04(SD5.5), socialfunctioning score was 99.37 (SD3.95), emotional functioning score was 90.37 (SD8.85), and school functioning score was 73.25 (SD27.34).The school functioning scale was higher among male participants (P-value0.31), also the emotional scale was higher among male participants with no statistical significant diference (P-value0.70). Conclusion IBS afects the school functioning dimension of OoL among the pediatric age group rather than other dimensions.

Diagnostic Outcome of Rome IV Criteria in Infant Regurgitation

Abstract Background Infant regurgitation is the most prevalent functional gastrointestinal disorder (FGID) occurring in the first year of life. In 2016 Rome IV criteria was launched with criteria for diagnosis of infantile FGIDs including regurgitation. Objectives The aim of this study is to follow up cases of infant regurgitation diagnosed by applying Rome IV criteria among neonates and toddlers and reevaluate them to uncover any organic causes among them. Methods A prospective cohort study was conducted at the general outpatients’clinic, Children’s Hospital, Ain-Shams University included 280 cases fulfillingRome IV criteria with 3 months for recruitment of patients followed by 3 months follow of each case. Full history and clinical examination were performed with special focus on anthropometric measurements. Results from 280 cases 42.9% totally cured (stopped regurgitation), 49.6% partially improved (decreased number of regurgitation episodes per day) and 7.5% didn’t improve (still have the same number of regurgitations per day) with proper weight gain. However, only 3 cases showed failure to thrive which is not related to regurgitation. Conclusion None of our cases diagnosed as infant regurgitation by Rome IVcriteria developed any organic diseases during period of follow up indicating the accuracy of Rome IV criteria in excluding organic diseases.

Assessment of Interleukin 10 (IL-10) Single Nucleotide Polymorphism (SNP) in Irritable Bowel Syndrome (IBS) Patients

Abstract Background Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder characterized by the presence of abdominal pain, bloating and altered bowel habits. The pathophysiological mechanisms underlying IBS are unclear. The abnormalities of motility, visceral hypersensitivity, gut microbial alteration and psychological stress contribute to the clinical symptoms of IBS. The associations of IBS and its risk gene polymorphisms have been ascertained by many researchers. Single nucleotide polymorphisms (SNPs) represent the most widespread type of sequence variations in genomes. It is known to be valuable genetic markers, because it may reveal the evolutionary history and common genetic polymorphisms that explain the hereditary risks for common diseases. Cytokines are involved in the pathogenesis of IBS. To date, only a few studies concerned the association of interleukin-10 (IL-10) gene polymorphism (rs1800871) -819 position to IBS. Objective We assessed interleukin 10 (IL-10) single nucleotide polymorphism rs1800871 (-819 C/T) in IBS patients. Method This was comparative case - control study for 40 participants, 20 cases and 20 controls, IL-10 rs1800871 (−819 T/C) single nucleotide polymorphism (SNP) was done via real time polymerase chain reaction for both study groups to assess its relation with IBS. Results The studied participants were divided into two groups according to ROME IV _criteria. For the case group (n = 20), the mean age was 41.05 ± 17.45 years, with 50% being male and 50% being female. In the control group (n = 20), mean age was 39.80 ± 14.84 years, with 25% being male and 75% being female Compared to the controls subjects, the frequencies of the IL-10 -819 T/T genotype and T allele were observed to be overrepresented in patients with IBS (60%; odds ratio [OR] = 1.143; 95% confidence interval [CI]: (0.152 – 8.593) for the TT genotype; P = 0.897) and (72.5%; OR: 1.582; 95% CI: (0.615 – 4.066)for the T allele; P = 0.341, respectively). The results demonstrated that T/T genotype was the most common genotype in the case group (60%). T allele was the most prevalent in case group (72.5%), while the C allele was the least prevalent (27.5%). However, T/T polymorphism in cases was greater than in control with non- statistical significance (p = 0.157). Conclusion IL-10 polymorphism (rs-1800871) has no association with IBS, However, T/T genotype was shown frequently in cases, with strong association with IBS. Abbreviations: IBS (irritable bowel syndrome), IL-10 (Interleukin-10 cytokine), SNP (single nucleotide polymorphism)

Motor improvement in Parkinson’s disease patients receiving caffeine adjuvants: A double-blind randomized controlled trial in Indonesia

Parkinson's disease (PD) manifests as a movement and brain function disorder characterized by symptoms such as resting tremors, rigidity, bradykinesia, and postural instability, leading to disability among patients. The use of psychostimulants such as caffeine has been associated with the improvement of motor symptoms in PD patients; however, studies regarding the effect of caffeine adjuvant therapy on motor function among PD patients in the Indonesian population are lacking. The aim of this study was to evaluate motor improvement as measured by the change in scores of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) among PD patients receiving caffeine adjuvant. A double-blind randomized controlled trial (RCT) was conducted among PD patients at Dr. Soetomo General Academic Hospital and Universitas Airlangga Hospital, Surabaya, Indonesia, from April to August 2023. A total of 27 patients were enrolled and randomly assigned to an intervention (receiving caffeine adjuvant, n=15) and control group (receiving placebo, n=12). Motor improvement was measured using the UPDRS III score prior to intervention and three weeks after. The Chi-squared test was used to analyze the difference in UPDRS III scores between the two groups. Motor improvement, as demonstrated by a reduction in the UPDRS III score, was observed in patients receiving caffeine adjuvant compared to those receiving placebo (80.0% vs 16.7%; p=0.004). Regarding the safety profile, only four out of 15 (26.6%) patients treated with caffeine reported minor adverse events. These conditions improved over time during the intervention. None of the 12 patients in the placebo reported adverse events. This study provides valuable insights into the initial dosage of caffeine that improves motor function in PD patients with minimum adverse effects.

Neurocognitive performance in functional neurological disorder: A systematic review and meta-analysis.

Cognitive complaints are common in functional neurological disorder (FND), but it is unclear whether objective neurocognitive deficits are present. This systematic review summarized validated/standardized cognitive test performance in FND samples across cognitive domains. Embase, PsycInfo and MEDLINE were searched from inception to 15 May 2023, combining terms for FND and cognitive domains (e.g., attention, memory, executive functioning). Studies included a range of FND phenotypes (seizures, motor, cognitive disorder, mixed), compared to healthy or clinical controls. Risk of bias was assessed with the modified Newcastle-Ottawa Scale and a qualitative synthesis/narrative review of cognitive performance in FND was conducted. Test performance scores were extracted, and random effects meta-analyses were run where appropriate. This review was registered on PROSPERO, CRD42023423139. Fifty-six studies including 2260 individuals with FND were eligible. Although evidence for some impairments emerged across domains of executive functioning, attention, memory and psychomotor/processing speed, this was inconsistent across studies and FND phenotypes. Common confounds included group differences in demographics, medication and intellectual functioning. Only 24% of studies objectively assessed performance validity. Meta-analyses revealed higher scores on tests of naming (g = 0.67, 95% confidence interval [CI] 0.50, 0.84) and long-term memory (g = 0.43, 95% CI 0.13, 0.74) in functional seizures versus epilepsy, but no significant differences in working (g = -0.08, 95% CI -0.44, 0.29) or immediate (g = 0.25, 95% CI -0.02, 0.53) memory and cognitive flexibility (g = -0.01, 95% CI -0.29, 0.28). There is mixed evidence for objective cognitive deficits in FND. Future research should control for confounds, include tests of performance validity, and assess relationships between objective and subjective neurocognitive functioning.

Exploring Gut–Brain Interaction Disorders: Mechanisms and Translational Therapies Crossing Neurology to Gastroenterology

The bidirectional communication network between the gut and the brain, known as the gut–brain axis, plays a crucial role in health and disease. This review explores the mechanisms underlying gut–brain interaction disorders and highlights translational therapies bridging neurology and gastroenterology. Mechanisms encompass anatomical, endocrine, humoral, metabolic, and immune pathways, with the gut microbiota exerting profound influence. Clinical evidence links gut microbiota fluctuations to mood disorders, GI disruptions, and neurodevelopmental conditions, emphasizing the microbiome’s pivotal role in shaping brain–gut interactions. Pharmacological therapies such as amitriptyline and selective serotonin reuptake inhibitors modulate neurotransmitter activity, offering relief in functional gastrointestinal disorders like irritable bowel syndrome (IBS). Non-pharmacological interventions like cognitive–behavioral therapy and hypnotherapy address maladaptive thoughts and induce relaxation, alleviating gastrointestinal symptoms exacerbated by stress. Emerging therapies include gut microbiota modulation, dietary interventions, vagus nerve stimulation, and intestinal barrier modulation, offering novel approaches to manage neurological disorders via the gastrointestinal tract. Understanding and harnessing the gut–brain axis holds promise for personalized therapeutic strategies in neurogastroenterology.

THE EFFECTIVENESS OF THE AUTHOR'S TECHNOLOGY AIMED AT THE DEVELOPMENT OF STATIC AND DYNAMIC BODY BALANCE OF PRIMARY SCHOOL CHILDREN WITH HEARING DEPRIVATION

The relevance of the research topic. Numerous studies have stated that abnormal child development is always accompanied by motor function disorders and deficits in motor activity. The combination of sensory and motor deprivation causes extraordinary difficulties in the perception, assimilation, retention and reproduction of educational material, and also significantly complicates the life of a child with a disability. The purpose of the article is to determine the effectiveness of the author's technology aimed at the development of static and dynamic body balance of primary school children with hearing deprivation in the process of adaptive physical education. Matherial and Methods. The study involved 8 boys and 11 girls with hearing impairment aged 8 years, who were randomly divided into main groups (GG1, GG2) and control groups (CG1, CG2). The following research methods were used to accomplish the tasks: analysis of scientific literature, pedagogical experiment, stabilography. Mathematical and statistical processing and analysis of data were carried out using the computational and graphical capabilities of the application software packages "Statistica" (StatSoft, version 10.0) and Microsoft Excel 2010. Results. The results obtained during the formative experiment prove the positive influence of the means and methods of the author's technology on the indicators of steady- state body balance (in the Romberg test with open eyes) in girls of 8 years old with hearing impairment GG2the amplitude of oscillations of the total body mass centre (TBC) in the frontal plane of girls of GG2 statistically significantly improved (Т=0; Z=2.20; p=0.028); the amplitude of oscillations of TBC in the sagittal plane of girls of GG2 statistically significantly decreased (Т=0; Z=2.02; p=0.043); there was a statistically significant improvement in the length of the trajectory of the TBC in the frontal and sagittal planes (Т=0; Z=2.20; p=0.028); statistically significant increase in the assessment of the speed of TBC movement of the examined girls (Т=0; Z=2.20; p=0.028); also revealed a statistically significant difference in the indicators of the area of oscillations of the TBC after the experiment of girls of CG2 (T=0; Z=2.02; p=0.043) and girls of GG2 (T=0; Z=2.20; p=0.028); among boys with hearing impairment (GG1) there was a tendency to improve the indicators of steady-state body balance. Calculations were performed by applying the nonparametric Wilcoxon signed rank test for dependent samples.

IMMUNOLOGICAL CRITERIA OF THE EFFECTIVENESS OF IMMUNOPREVENTIVE OF THE NON-SPECIFIC IMMUNOMODULATOR BIVEL AMONG CONTACTED CHILDREN

The aim of the study - to study the feasibility of using the natural immunomodulator BIVEL (conditionally called BI-V) as a nonspecific immunoprevention of tuberculosis (TB) among contacted children from the focies of chemodrug-resistant tuberculosis infection on the basis of clinical and immunological researches. Research metods. The object of study was 120 contacted from multidrug-resistant tuberculosis infection (FsMDR-TBI) including 75 children and 45 adolescents. The first contact group included 95 children/adolescents who did not receive BI-V and the second one ‒ 25 infected children/adolescents who received BI-V. Immunological studies determining the state of the phagocytic reactivity of immunity (phagocytic number and index, testes redox activity of neutrophils and non-enzymatic cationic lysosomal proteins of granulocytic leukocytes; cellular (CD3+, CD56+, CD3+HLA-DR+, CD4+, CD8+, CD4+/CD8+, CD4+45RA, CD16/56+) and humoral (CD19+, IgA, IgM, IgG, CIC) immunity; interleukins (TNF-α, IL-6, IL-10) and specific immunity (tuberculin diagnostics, Quantiferon test). Statistical analysis of the results obtained based on the software package Excel Results and discussion. On the background of non-specific preventive with the BI-V immunomodulator among contact infected children, normalization of blood phagocytic activity indicators was noted in the form of an increase in phagocytic number, phagocytic index, non-enzymatic cationic lysosomal proteins of granulocytic leukocytes and a decrease in HST test compared to children who had not yet received preventive BI-V. In infected children/adolescents from FsMDR-TBI, while maintaining normal values of CD3+, CD3+CD4+, CD3+CD8+, insignificant functional disorders of the cell response were revealed at the level of immunoregulatory processes due to the dominance of suppressor-cytotoxic reactions were revealed (decrease by 1.3 times IRI CD3+CD4+/CD3+CD8+, p&lt;0.05, relative to donors), balance shift in the regulatory system of pro- and anti-inflammatory cytokines towards pro-inflammatory cytokines (increase by 2.0 times TNF-α/IL-10, p&lt;0.01, relative to normal). The existing deviations in the regulatory system and the cellular response system disappeared after the completion of the autumn-spring BI-V course. Among the children from FsMDR-TBI who took a BI-V preventive course 8% people fell ill with various forms of primary pulmonary TB, among the children who BI-V was not prescribed ‒ 22.1%, p&lt;0.05 during the 4-year observation. The maximum TB level occurred in the first two years of observation in both groups. Conclusions. The results of the appointment of a non-specific immunomodulator BI-V confirmed the feasibility of using this immunomodulator for contacted children and adolescents from FsMDR-TBI.

Comorbidity and sex differences in functional disorders and internalizing disorders

ObjectiveIn the current exploratory study we estimate comorbidity rates between FDs [fibromyalgia (FM), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and irritable bowel syndrome (IBS)]—and IDs—[major depressive disorder (MDD) and generalized anxiety disorder (GAD)] by using self-reported diagnostic criteria. MethodWe analyzed data from 107,849 participants (mean age = 49.3 (SD = 13.0), 58.6% women) of the Lifelines Cohort Study. Lifelines is a prospective population-based cohort study in the northeast of the Netherlands. Current IDs were assessed using the Mini-International Neuropsychiatric Interview. Current FM, ME/CFS, and IBS were assessed according to the 2010 American College of Rheumatology criteria, the 1994 Centers for Disease Control and Prevention criteria and the ROME IV criteria, respectively. We estimated tetrachoric correlations between diagnoses and tested for sex differences. Additionally, we estimated the ratio of observed-to-expected frequency for combinations of diagnoses. ResultsFDs and IDs are highly comorbid (odds ratios: 3.2–12.6) with associations stronger among men. Participants with at least three disorders/diagnoses were more prevalent than expected by chance. ConclusionStudies that aim to explain sex differences and the comorbidity of specific combinations of IDs and FDs will be an important contribution to understanding the etiology of these conditions.

Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study

BackgroundFunctional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for...

Evaluation of a psychoeducation group for children presenting with functional tic-like behaviours.

We describe the implementation and evaluation of an online psychoeducation group for young people experiencing functional tic-like behaviours (FTLBs) - a type of functional neurological disorder (FND). Across six groups, 50 participants completed pre- and post-group goal-based outcomes (GBOs) and 36 participants completed service-user feedback, which gathered qualitative and quantitative data about participants experiences of the group. Young people and their parents reported significant improvement in their GBOs following the group and increased knowledge and confidence in managing FTLBs. The findings highlight that virtual psychoeducation group intervention is an acceptable and effective first step in treatment of young people with FTLBs. We discuss implications for future intervention development.

Application of artificial intelligence-based magnetic resonance imaging in diagnosis of cerebral small vessel disease.

Cerebral small vessel disease (CSVD) is an important cause of stroke, cognitive impairment, and other diseases, and its early quantitative evaluation can significantly improve patient prognosis. Magnetic resonance imaging (MRI) is an important method to evaluate the occurrence, development, and severity of CSVD. However, the diagnostic process lacks quantitative evaluation criteria and is limited by experience, which may easily lead to missed diagnoses and misdiagnoses. With the development of artificial intelligence technology based on deep learning, the extraction of high-dimensional features in imaging can assist doctors in clinical decision-making, and it has been widely used in brain function and mental disorders, and cardiovascular and cerebrovascular diseases. This paper summarizes the global research results in recent years and briefly describes the application of deep learning in evaluating CSVD signs in MRI imaging, including recent small subcortical infarcts, lacunes of presumed vascular origin, vascular white matter hyperintensity, enlarged perivascular spaces, cerebral microbleeds, brain atrophy, cortical superficial siderosis, and cortical cerebral microinfarct.

Brain functional networks and psychiatric disorders.

Brain functional networks and psychiatric disorders.

Metagenomic analysis of the gut virome in patients with irritable bowel syndrome.

Irritable bowel syndrome (IBS), a chronic functional gastrointestinal disorder, is recognized for its association with alterations in the gut microbiome and metabolome. This study delves into the largely unexplored domain of the gut virome in IBS patients. We conducted a comprehensive analysis of the fecal metagenomic data set from 277 IBS patients and 84 healthy controls to characterize the gut viral community. Our findings revealed a distinct gut virome in IBS patients compared to healthy individuals, marked by significant variances in between-sample diversity and altered abundances of 127 viral operational taxonomic units (vOTUs). Specifically, 111 vOTUs, predominantly belonging to crAss-like, Siphoviridae, Myoviridae, and Quimbyviridae families, were more abundant in IBS patients, whereas the healthy control group exhibited enrichment of 16 vOTUs from multiple families. We also investigated the interplay between the gut virome and bacteriome, identifying a correlation between IBS-enriched bacteria like Klebsiella pneumoniae, Fusobacterium varium, and Ruminococcus gnavus, and the IBS-associated vOTUs. Furthermore, we assessed the potential of gut viral signatures in predicting IBS, achieving a notable area under the receiver operator characteristic curve (AUC) of 0.834. These findings highlight significant shifts in the viral diversity, taxonomic distribution, and functional composition of the gut virome in IBS patients, suggesting the potential role of the gut virome in IBS pathogenesis and opening new avenues for diagnostic and therapeutic strategies targeting the gut virome in IBS management.

The Effect of Music Therapy on the Sleep Quality of Patients with Heart Failure: The Miracle of Nature Music

Abstract Background: Patients with heart failure experience poor sleep quality due to the nature of disease they suffer from. The aim of this study was to investigate the effect of music on the sleep quality of patients with heart failure. Materials and Methods: The present study is a randomized clinical trial, which was performed on 76 patients with heart failure, hospitalized in the cardiac ward of an educational hospital. These patients had obtained a score of 5 or higher on Pittsburgh’s sleep quality index. The block randomization method was used to generate the allocation sequence. Thus, the number of subjects in each block was determined to be 4 people in 18 blocks. Intervention was collection of nature music played through headphones for 30 minutes over three nights, and at the end of the third night, the Pittsburgh’s index was completed again by both groups. Data were analyzed using descriptive and inferential statistics. Results: After the intervention, the mean scores of mental quality of sleep (p = 0.007) and daily function disorders improved significantly in the intervention group (p = 0.025). Significant differences were seen between the mean scores of mental quality of sleep (p &lt; 0.001), daily function disorders (p = 0.002), delay in falling asleep (p = 0.01), sleep disorders (p &lt; 0.001), and use of sleeping pills (p &lt; 0.001) before and after the intervention in the intervention group. Conclusions: Playing relaxing music like nature sounds and spending time in nature after discharge can improve the sleep quality and sense of relaxation in patients with heart failure. The implementation of such affordable and amusing interventions can be proposed by nurses in heart failure patients.

Modelling of the early stage of retinal neurodegeneration via a topical injection of dopaminergic neurotoxin

Purpose: to develop a model of the early stage of retinal neurodegeneration via an intravitreal injection of the dopaminergic neurotoxin. Material and methods. The experiment was carried out on 20 Chinchilla rabbits. The experimental groups received intravitreal injection of 0.1 ml of 6-hydroxydopamine (6-OHDA) in NaCl 0.9 % with 0.5 % ascorbate, containing 0.25 or 0.5 mg 6-OHDA. The control group received injections of 0.1 ml of NaCl-ascorbate solution without neurotoxin. On the 7th and the 14th days after the injection, intraocular pressure (IOP), pupillary light reaction and ocular blood flow were estimated and the fundus was examined. On the 7th day after an injection of 0.25 mg 6-OHDA, we used ELISA to measure dopamine concentration in retinal homogenates, while on the 14th day after an injection of 0.5 mg 6-OHDA, the concentrations of dopamine, norepinephrine, TNF-a and endothelin-1 were measured by the same method. Results. On the 7th day after a 0,25 mg injection of neurotoxine, we revealed a decrease of dopamine in the retina (0.043 ± 0.130 pg/mg protein compared with 0.10 ± 0,03 pg/mg protein in the controls, р &lt; 0.01). On the 14th day, dopamine and norepinephrine levels showed a fourfold increase (р &lt; 0.05). An injection of 0.5 mg of 6-OHDA caused a threefold increase of dopamine (р &lt; 0.05) and a fivefold increase of norepinephrine (р &lt; 0.01) concentration in comparison with the controls. On the 14th day, endotheline-1 level was 65 % higher than in the controls after a 0.25 mg 6-OHDA injection (р &lt; 0.01) and 45 % higher after a 0,5 mg injection (р&lt;0.05). At the same time, TNF-α levels increased by 43 % (р &lt; 0.05) and 20 % (р &lt; 0.05) respectively. We also revealed a dose-dependent change of IOP, a disturbance of pupillary light reaction and decreased ocular blood flow after an injection of neurotoxin. Conclusion. A single intravitreal injection of dopaminergic neurotoxin 6-OHDA in the amount of 0.25 or 0.5 mg per eye leads to a neuroinflammation and vascular disorders, which are the main pathogenetic pathways of neurodegeneration. To model its early phase, the 0.25 mg dose is preferable as it causes less dramatic functional disorders. The latter model can be useful for the investigation of retinal neurodegeneration pathogenesis, the search for early diagnostic and prognostic markers thereof and the estimation of therapy effectiveness.

Risk prediction of kalaemia disturbance and acute kidney injury after total knee arthroplasty: use of a machine learning algorithm

IntroductionTotal knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty. HypothesisA predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty. Material and methodsThis single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K+ A). Two groups were formed of K+ A and non-K+ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity. ResultsOf the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate.Overall performance was good with an area under the curve of 0.979 [CI95% 0.938 - 1.02], sensitivity was 90.3% [CI95% 86.2 - 94.4] and specificity 89.7% [CI95% 85.5 - 93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injuryafter TKA is available on https://arthrorisk.com. ConclusionThe risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model. Level of evidenceIV; retrospective study of case series.