Early Intervention Group Research Articles

Comparative Efficacy of Family-Mediated Intervention Versus Early Intensive Behavioral Intervention on Developmental Domains in Children with Autism Spectrum Disorder: A Randomized Controlled Trial

Background: Autism spectrum disorder is a neurodevelopmental disorder of childhood in which there is a deficit in social and communicative skill, and the child shows restricted and repetitive behavior. For children diagnosed with autism spectrum disorder, family-mediated intervention and early intensive behavioral intervention are considered standard of care. The study aimed to compare their efficacy on social skills and other developmental domains in our cultural context. Methods: This study was a parallel-arm, open-label, randomized active-controlled clinical trial. Fifty children diagnosed with autism spectrum disorder were randomly assigned to either the family-mediated intervention or early intensive behavioral intervention groups. Communication DEALL Developmental Checklist was applied at 0, 12, and 24 weeks. Results: The difference in the mean value of Communication DEALL Developmental Checklist at the end of 24 weeks from the initial value was significantly better in the family-mediated intervention as compared to the early intensive behavioral intervention group in social (mean difference = −16.8, 95% CI = −27.18, −6.49, p = .002) as well as fine motor, cognitive, and overall development. In other developmental domains of Communication DEALL Developmental Checklist, the family-mediated intervention group performed better in comparison to the early intensive behavioral intervention group at different time periods although not statistically significant. Conclusion: The results of the study indicated that, throughout the course of 24 weeks of treatment, autism spectrum disorder children in family-mediated intervention showed a distinct improvement in major developmental domains. Family-mediated intervention can be advocated for autism spectrum disorder children in our cultural context in view of improved functioning in major developmental domains in the background of our study findings.

Macrophages overexpressing interleukin-10 target and prevent atherosclerosis: regression of plaque formation and reduction in necrotic core

Abstract Background Atherosclerosis, a slowly progressing inflammatory disease, is characterized by the presence of monocyte-derived macrophages. Interventions targeting the inflammatory characteristics of atherosclerosis hold promising potential. Although interleukin (IL)-10 is widely acknowledged for its anti-inflammatory effects, systemic administration of IL-10 has limitations due to its short half-life and significant systemic side effects. Purpose We aimed to investigate the effectiveness of an approach designed to overexpress IL-10 in macrophages and subsequently introduce these genetically modified cells into ApoE-/- mice to promote atherosclerosis regression. Methods We engineered RAW264.7 cells to overexpress IL-10 (referred to as IL-10M) using lentivirusvectors. The ApoE-/- mice were divided into two groups based on the timing of the intervention. The early intervention group (n = 45) received intravenous tail injections from the beginning of Western diet (WD) at six weeks old. The late intervention group (n = 45) started receiving injections at 16 weeks old, 2 months after being fed the WD. Both the early and late intervention group stopped receiving injections after 5 months of being fed the WD. Results The IL-10M exhibited robust IL-10 secretion, maintained phagocytic function, improved mitochondrial membrane potentials, reduced superoxide production and showed a tendency toward the M2 phenotype when exposed to inflammatory stimuli. IL-10M can selectively target plaques in ApoE-/- mice, and oil red staining of the entire aorta unequivocally demonstrated that intervention with IL-10M elicited a substantial reduction in plaque area. H&E staining revealed that mice treated with IL-10M in the early intervention group showed a significant reduction in the ratio of plaque area to lumen area. However, the late intervention group did not exhibit statistically significant differences. Notably, mice treated with IL-10M exhibited significantly smaller necrotic cores and reduction in matrix metalloproteinase 9 within the aortic plaques in both the early and late intervention groups. Additionally, the administration of IL-10M showed no obvious side effects. Conclusion We developed an anti-inflammatory protein delivery system based on engineered macrophages that can target atherosclerotic plaques and reduce the plaque area and necrotic core. This approach has a promising safety profile and has the potential to be a therapeutic strategy for the intervention of atherosclerosis.

Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis

Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis. To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia. Asymptomatic patients with severe aortic stenosis and myocardial fibrosis were included. The final date of follow-up was July 26, 2024. Early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management. The primary outcome was a composite of all-cause death or unplanned aortic stenosis-related hospitalization in a time-to-first-event intention-to-treat analysis. There were 9 secondary outcomes, including the components of the primary outcome and symptom status at 12 months. The trial enrolled 224 eligible patients (mean [SD] age, 73 [9] years; 63 women [28%]; mean [SD] aortic valve peak velocity of 4.3 [0.5] m/s) of the originally planned sample size of 356 patients. The primary end point occurred in 20 of 113 patients (18%) in the early intervention group and 25 of 111 patients (23%) in the guideline-directed conservative management group (hazard ratio, 0.79 [95% CI, 0.44-1.43]; P = .44; between-group difference, -4.82% [95% CI, -15.31% to 5.66%]). Of 9 prespecified secondary end points, 7 showed no significant difference. All-cause death occurred in 16 of 113 patients (14%) in the early intervention group and 14 of 111 (13%) in the guideline-directed group (hazard ratio, 1.22 [95% CI, 0.59-2.51]) and unplanned aortic stenosis hospitalization occurred in 7 of 113 patients (6%) and 19 of 111 patients (17%), respectively (hazard ratio, 0.37 [95% CI, 0.16-0.88]). Early intervention was associated with a lower 12-month rate of New York Heart Association class II-IV symptoms than guideline-directed conservative management (21 [19.7%] vs 39 [37.9%]; odds ratio, 0.37 [95% CI, 0.20-0.70]). In asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis-related hospitalization. The trial had a wide 95% CI around the primary end point, with further research needed to confirm these findings. ClinicalTrials.gov Identifier: NCT03094143.

EARLY SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION ON LEFT VENTRICULAR EJECTION FRACTION IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

Early intervention in patients with ST-elevation myocardial infarction (STEMI) is crucial for preserving left ventricular function and improving patient outcomes. Primary percutaneous coronary intervention (PPCI) has become the standard of care, and the timing of intervention significantly influences recovery and long-term prognosis. Objective: This study aimed to evaluate the impact of early successful primary percutaneous coronary intervention (PPCI) on left ventricular ejection fraction (LVEF) in patients presenting with STEMI. Methods: A prospective cohort study was conducted on 116 STEMI patients undergoing PPCI at a tertiary care hospital. The patients were categorized into two cohorts: early presenters (n=67) who received PPCI within 6 hours of symptom onset and late presenters (n=49) who received PPCI after 6 hours. Baseline characteristics, procedural outcomes, Thrombolysis in Myocardial Infarction (TIMI) flow grades, and LVEF measurements were assessed at presentation and two months post-PPCI using transthoracic echocardiography. The primary outcome was the change in LVEF from baseline to follow-up, and the secondary outcome was the distribution of TIMI flow grades achieved during PPCI. Statistical analysis was performed using appropriate tests to compare outcomes between the two groups. Results: Early presenters demonstrated significantly better outcomes compared to late presenters. At presentation, the mean LVEF in the early group was higher (45.67 ± 1.73%) compared to the late group (36.94 ± 1.25%) (p = 0.0001). At the two-month follow-up, the LVEF improved significantly in both groups, with early presenters achieving an LVEF of 56.24 ± 1.73%, which was notably higher than the LVEF of late presenters (45.12 ± 1.42%) (p = 0.0001). In terms of coronary reperfusion, 62.7% of early presenters achieved TIMI grade 3 flow compared to 26.5% of late presenters (p = 0.0001), indicating better coronary artery perfusion in the early intervention group. Conclusion: Early successful PPCI in STEMI patients is associated with superior recovery of left ventricular function and improved coronary reperfusion compared to delayed intervention. Patients who received PPCI within 6 hours of symptom onset demonstrated significantly higher LVEF at follow-up and achieved better TIMI flow grades, highlighting the critical importance of minimizing treatment delays in STEMI management.

Can early treatment of lisfranc injuries without planned re-intervention be safely performed

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 h from presentation and a second group being greater than 24 h. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 h and 41 patients who underwent fixation after more than 24 h. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries. Level of evidenceLevel 3 Therapeutic retrospective comparative study.

Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality.

Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus. To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States. A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality. A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06). Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.

Macrophages overexpressing interleukin‐10 target and prevent atherosclerosis: Regression of plaque formation and reduction in necrotic core

AbstractAtherosclerosis, a slowly progressing inflammatory disease, is characterized by the presence of monocyte‐derived macrophages. Interventions targeting the inflammatory characteristics of atherosclerosis hold promising potential. Although interleukin (IL)‐10 is widely acknowledged for its anti‐inflammatory effects, systemic administration of IL‐10 has limitations due to its short half‐life and significant systemic side effects. In this study, we aimed to investigate the effectiveness of an approach designed to overexpress IL‐10 in macrophages and subsequently introduce these genetically modified cells into ApoE−/− mice to promote atherosclerosis regression. We engineered RAW264.7 cells to overexpress IL‐10 (referred to as IL‐10M) using lentivirus vectors. The IL‐10M exhibited robust IL‐10 secretion, maintained phagocytic function, improved mitochondrial membrane potentials, reduced superoxide production and showed a tendency toward the M2 phenotype when exposed to inflammatory stimuli. IL‐10M can selectively target plaques in ApoE−/− mice and has the potential to reduce plaque area and necrotic core at both early and late stages of plaque progression. Moreover, there was a significant reduction in MMP9, a biomarker associated with plaque rupture, in IL‐10M‐treated plaques from both the early and late intervention groups. Additionally, the administration of IL‐10M showed no obvious side effects. This study serves as proof that cell therapy based on anti‐inflammatory macrophages might be a promising strategy for the intervention of atherosclerosis.

Effectiveness of a home-based, post-discharge early intervention program for very preterm infants in reducing parental stress: a randomized controlled trial

BackgroundThis study aims to evaluate the impact of a home-based, post-discharge early intervention (EI) program on reducing parental stress levels in families with preterm infants born between 28+ 0 and 31+ 6 weeks gestational age.MethodsA randomized controlled trial was conducted, with families randomly allocated to either the EI or standard care (SC) group. A term reference group was also recruited for comparison. The Parental Stress Index-Short Form was used to assess parental stress levels, yielding a total stress score and three subdomain scores. Assessment was performed at baseline, at the 60-day mark of the study, and when the infants reached six corrected months of age. Parents in the reference group were assessed only at six months of corrected age for infants. The intervention comprised three sections: intellectual, physical, and social training, which was administered to the infants in the EI group immediately after discharge and to those in the SC group after 60 days of enrollment.ResultsSeventy-three families were enrolled in this study, with 37 allocated to the EI group, and 36 to the SC group. Prior to intervention, higher stress levels were reported by mothers in both groups than fathers, with no difference observed between the EI and SC groups. Re-assessment performed at 60 days of the study showed that mothers and fathers in the EI group had significantly lower total stress score than those in the SC group (82.00 ± 5.64 vs. 94.26 ± 7.99, p < 0.001; 80.74 ± 7.14 vs. 89.94 ± 9.17, p < 0.001, respectively), which was predominantly due to the lower scores in parental distress and parental-child dysfunction interaction subdomains in the EI group (both had p < 0.001). Mothers in the EI group exhibited a more pronounced reduction in total stress score after intervention when compared to fathers (13.15 ± 4.68 vs. 8.26 ± 4.03, p < 0.001). At six months of infant age, the total stress score and subdomain scores of parents in the EI and SC groups were similar, but significantly higher than those of the reference group.ConclusionThe home-based, post-discharge EI program demonstrated significant effectiveness in reducing parental stress levels among the parents of very preterm infants.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (registration number: CTR1900028330). Registration date: December 19, 2019.

Investigating the Effectiveness of a Workplace Musculoskeletal Disorders Management Program.

Musculoskeletal disorders (MSDs) present a major occupational health challenge, especially among office workers. Objective: To evaluate the effectiveness of a workplace intervention program for managing MSDs and measure its impact on presenteeism/absenteeism and health status. Methods: This semi-experimental study was conducted between May 2019 and October 2022 in Greece and involved 247 office workers randomly assigned to early and late intervention groups. The intervention included a seminar on ergonomics and proper workstation practices with a demonstration of exercises. Data were collected by the SF-36, the Standardised Nordic, and the Work Productivity and Activity Impairment Questionnaires. Results: In the early intervention group (n = 143), presenteeism significantly decreased (p = 0.045), from a mean value of 0.11 to 0.07, but not absenteeism. Significant improvements were observed in physical (p = 0.007) and mental health (p = 0.012). Reductions in pain were recorded for the neck (p = 0.032), shoulders (p = 0.015), wrists (p = 0.014), upper back, lower back, hips, and knees (p = 0.044 for each). In the late intervention group (n=104), there were no significant changes in absenteeism or presenteeism. Mental health improved significantly (p = 0.008), and reductions in pain were noted for the neck (p = 0.001), wrist (p = 0.0005), and upper back (p = 0.001). Conclusions: This workplace intervention program proved effective both in reducing pain in various body areas and reducing presenteeism, and improved physical and mental health were observed in the intervention groups while absenteeism remained unchanged.

Stroke Risk Reduction in Atrial Fibrillation Through Pharmacist Prescribing

Major gaps in the delivery of appropriate oral anticoagulation therapy (OAC) exist, leaving a large proportion of persons with atrial fibrillation (AF) unnecessarily at risk for stroke and its sequalae. To investigate whether pharmacist-led OAC prescription can increase the delivery of stroke risk reduction therapy in individuals with AF. This prospective, open-label, patient-level randomized clinical trial of early vs delayed pharmacist intervention from January 1, 2019, to December 31, 2022, was performed in 27 community pharmacies in Alberta, Canada. Pharmacists identified patients 65 years or older with 1 additional stroke risk factor and known, untreated AF (OAC nonprescription or OAC suboptimal dosing) or performed screening using a 30-second single-lead electrocardiogram to detect previously unrecognized AF. Patients with undertreated or newly diagnosed AF eligible for OAC therapy were considered to have actionable AF. Data were analyzed from April 3 to November 30, 2023. In the early intervention group, pharmacists prescribed OAC using guideline-based algorithms with follow-up visits at 1 and 3 months. In the delayed intervention group, which served as the usual care control, the primary care physician (PCP) was sent a notification of actionable AF along with a medication list (both enhancement over usual care). After 3 months, patients without OAC optimization in the control group underwent delayed pharmacist intervention. The primary outcome was the difference in the rate of guideline-concordant OAC use in the 2 groups at 3-month follow-up ascertained by a research pharmacist blinded to treatment allocation. Eighty patients were enrolled with actionable AF (9 [11.3%] newly diagnosed in 235 individuals screened). The mean (SD) age was 79.7 (7.4) years, and 45 patients (56.3%) were female. The median CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack) score was 2 (IQR, 2-3). Seventy patients completed follow-up. Guideline-concordant OAC use at 3 months occurred in 36 of 39 patients (92.3%) in the early intervention group vs 23 of 41 (56.1%) in the control group (P < .001), with an absolute increase of 34% and number needed to treat of 3. Of the 23 patients who received appropriate OAC prescription in the control group, the PCP called the pharmacist for prescribing advice in 6 patients. This randomized clinical trial found that pharmacist OAC prescription is a potentially high-yield opportunity to effectively close gaps in the delivery of stroke risk reduction therapy for AF. Scalability and sustainability of pharmacist OAC prescription will require larger trials demonstrating effectiveness and safety. ClinicalTrials.gov Identifier: NCT03126214.

Assessing the Efficacy of Early versus Late Orthodontic Intervention in the Management of Class II Malocclusion: A Comparative Analysis

ABSTRACT Background: Class II malocclusion is a common orthodontic issue characterized by the excessive protrusion of the upper teeth relative to the lower teeth. Early intervention during mixed dentition has been advocated to guide skeletal growth and potentially reduce the severity of malocclusion. Materials and Methods: A comparative analysis was conducted to evaluate the efficacy of early (before the pubertal growth spurt) versus late (after the pubertal growth spurt) orthodontic intervention in managing Class II malocclusion. A cohort of 100 patients diagnosed with Class II malocclusion was divided into two groups: early intervention group (n = 50) and late intervention group (n = 50). Treatment outcomes including changes in overjet, molar relationship, and cephalometric measurements were assessed before and after orthodontic treatment. Results: In the early intervention group, the mean reduction in overjet was 5.2 mm (SD = 1.3), while in the late intervention group, it was 3.8 mm (SD = 1.6). The improvement in molar relationship was greater in the early intervention group (mean change = 4.5 mm, SD = 1.1) compared to the late intervention group (mean change = 3.1 mm, SD = 1.4). Cephalometric analysis revealed significant differences in skeletal and dental parameters between the two groups, with greater improvements observed in the early intervention group. Conclusion: Early orthodontic intervention shows superior efficacy in managing Class II malocclusion compared to late intervention. Early treatment leads to greater reductions in overjet, improvements in molar relationship, and favorable changes in skeletal and dental parameters. These findings underscore the importance of timely orthodontic intervention, particularly during the mixed dentition stage, for optimal management of Class II malocclusion.

Does the Timing of Surgical Intervention Impact Outcomes in Necrotizing Enterocolitis?

The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>48h) operative intervention to allow for resuscitation. A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P=< .05) with more pneumoperitoneum (76% vs 23%; P=< .05). The early intervention group had a higher mortality (35% vs 15%; P=< .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P < .05) and had more bowel resected (29 ± 17cm vs 9 ± 8cm; P < .05), with the same number of patients scoring above 3 on the MD7 criteria. Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed.

Effects of early nutritional intervention on oral mucositis and basic conditions in patients receiving radiotherapy for head and neck cancer: Randomized controlled trial (ChiCTR2000031418)

Background & AimsThis study aims to observe the effects of early nutritional intervention on radiation-induced oral mucositis (OM) and the nutritional status of patients with head and neck cancer (HNC) receiving radiotherapy. MethodsEligible patients receiving radiotherapy for HNC were randomly divided into an early nutritional intervention group (enteral nutritional intervention was administered at the beginning of radiotherapy) and a late nutritional intervention group (enteral nutritional intervention was administered at the beginning of eating restriction) in a 1:1 ratio. The primary endpoint was radiation-induced OM. Secondary endpoints included nutrition-related indicators, immune function, overall survival (OS), progression-free survival (PFS), quality of life, and other radiotherapy-induced adverse effects. ResultsA total of 100 patients were enrolled between 2020 and 2021, including 50 each in the early nutritional intervention group and in the late group. The incidence of Grade-III/IV OM was lower in the early treatment group than in the late treatment group (2% vs 14%, P = 0.059). By week 7 weight loss was significantly lower in the early group than in the late group (1.08 kg, 95% CI: 0.08-2.09, P = 0.035). Regarding the PG-SGA scores after receiving radiotherapy, the early group comprised more well-nourished and fewer malnourished patients than those in the late group (P = 0.002). The scores of the immune function indices of T cell CD3+, CD4+/CD8+, and B cell CD19+ were slightly higher in the early group than in the late group; however, the difference was not statistically significant (all P > 0.05). PFS and OS were better in the early group than in the late group; however, the differences were not statistically significant (P > 0.05). ConclusionsEarly nutritional intervention can effectively improve the nutritional status and reduce the incidence of high-grade OM in patients with HNC receiving radiotherapy. Trial registrationChinese Clinical Trials Registry (http://www.chictr.org.cn) ChiCTR-IDChiCTR2000031418.

Effect of Timing of Rehabilitation Nursing Intervention on Children with Acute Viral Encephalitis

Background: Viral encephalitis (VE) refers to an acute intracranial inflammation mainly caused by various viral infections. Objectives: Viral encephalitis (VE) refers to an acute inflammation of the brain primarily caused by various viral infections. Methods: Data from 60 children with acute viral encephalitis (VE) who received 4 weeks of rehabilitation nursing from July 2019 to July 2020 were collected for retrospective analysis. These children were divided into two groups: An early intervention group (n = 30), where rehabilitation nursing started in the second week after admission, and a late intervention group (n = 30), where rehabilitation nursing began in the fourth week after admission. Motor function, daily living abilities, and limb spasticity were compared before and four weeks after nursing. Additionally, the outcomes of rehabilitation nursing—including recovery times from convulsions, cranial nerve disorders, and consciousness disorders—were also compared. Results: The scores for motor function and daily living ability were significantly higher, while the score for limb spasticity was lower in the early intervention group compared to the late intervention group (P &lt; 0.05). Additionally, the early intervention group experienced a significantly shorter recovery time from convulsions, cranial nerve disorders, and consciousness disorders than the late intervention group (P &lt; 0.05). Conclusions: Early rehabilitation nursing is effective in enhancing motor function, relieving limb spasticity, and improving the nursing outcomes for children with acute viral encephalitis (VE).

Analysis of the effect and safety of lumen reshaping after endovascular repair of Stanford B type aortic dissection at different intervention times

Objective: To Compare the effects and safety of lumen reshaping after thoracic endovascular aortic repair (TEVAR) for Stanford B type aortic dissection (AD) at different intervention times. Methods: A retrospective analysis was conducted on the clinical data of 189 patients with Stanford type B aortic dissection treated with TEVAR at the Affiliated Hospital of Chengde Medical College from January 2016 to December 2020.Based on the time from onset to surgery, patients were divided into an early intervention group (≤14 days, n=127) and a delayed intervention group (>14 days, n=62).The diameters of the total aorta, true lumen and false lumen at different times and planes (S1 plane: at the bifurcation of the pulmonary artery; S2 plane: at the lower edge of the left atrium; S3 plane: at the upper edge of the celiac trunk) post-surgery were compared between the two groups, and the rate of change in diameters of true and false lumens across these planes was calculated. The patients were followed until December 1st, 2023, and the median follow-up time was 45(40, 49) months. The postoperative complications and survival of the two groups were compared. Results: The early intervention group comprised 86 men and 41 women, with an average age of (58.3±10.7) years. The delayed intervention group included 41 men and 21 women, with an average age of (58.5±9.2) years. Both groups had an operation success rate of 100%. Six months post-surgery, the early intervention group had an expansion rate of the true lumen diameter at planes S2 and S3 of 40.1%(25.5%, 56.1%) and 5.3%(-2.5%, 15.8%), respectively, which was superior to the delayed intervention group's 18.5%(10.6%, 39.8%) and 1.0%(-8.2%, 9.6%) (both P<0.05).The early intervention group had a reduction rate of the false lumen diameter at planes S1, S2, and S3 of -56.2%(-61.3%, -48.8%), -70.4%(-81.8%, -56.6%), and -5.4%(-17.4%, 0.1%), respectively, better than the delayed intervention group's -44.2%(-53.7%, -38.3%), -49.0%(-57.6%, -35.8%), and -3.1%(-6.7%, 1.8%) (all P<0.05).At plane S1, the true lumen diameter of patients in both groups showed an increasing trend over 36 months post-surgery, while the false lumen diameter showed a decreasing trend (both P<0.05).At plane S2, the true lumen diameter of patients in the early intervention group exhibited an increasing trend over 36 months post-surgery, and the false lumen diameter exhibited a decreasing trend (both P<0.05).At plane S3, the total aortic diameter of patients in the delayed intervention group showed a slight increasing trend over 36 months post-surgery (P<0.05).The overall survival time were 45.0 months (95%CI: 42.9-47.1) for patients in the early intervention group and 46.0 months (95%CI: 43.5-48.5) for those in the delayed intervention group, with no statistically significant difference observed (P>0.05).The incidence rates of complications such as aortic rupture, retrograde Type A dissection, new distal endograft dissection, endoleak, paraplegia, and others showed no statistically significant difference between the two groups (all P>0.05), with no cases of stent migration or deformation observed. Conclusion: Early intervention for Stanford type B aortic dissection provides a better aortic remodeling outcome than delayed intervention, with similar safety.

Early sleep intervention for improving infant sleep quality: a randomized controlled trial, preliminary result

BackgroundHealthy sleep issues should provide to family within first 6 months of infant’s life. This study aimed to evaluate the effect of early sleep intervention on nighttime sleep quality.MethodsEligible infants aged 4 months ± 2 weeks were randomized to receive early sleep intervention or usual care. Data on sleep variables were obtained via parental interview at baseline and 6 months of age. Using logistic regression to analyze the efficacy of early sleep intervention.ResultsAt baseline, 335 eligible infants were enrolled and randomized. In total, 306 participants were final analyzed: early sleep intervention group (n = 148) and the usual care group (n = 158). The early sleep intervention group had a significantly longer nighttime sleep duration and a shorter night waking duration than the usual care group (585.20 ± 80.38 min vs. 496.14 ± 87.78 min, p < .001 and 61.01 ± 36.38 min vs. 89.72 ± 45.54 min, p < .001). At 6 months of age, the early sleep intervention group had a longer night sleep duration (≥ 4 h/time) than the usual care group (adjusted odds ratio: 2.39, 95% confidence interval: 1.34–4.28).ConclusionsEarly sleep intervention should be recommended to infants at 4 months of age as a part of well childcare to improve infant sleep quality.Trial RegistrationThai Clinical Trials Registry (thaiclinicaltrial.org). Retrospective registered TCTR20230117001 (17/01/2023).

Lengthening in congenital posteromedial bowing of tibia: a follow-up series at skeletal maturity.

Congenital posteromedial bowing (CPMB) of tibia is a rare, usually self-resolving condition that is present at birth. The data on the long-term outcome of lengthening, choice of fixator, outcome in early and late age groups, and complications is sparse, hence the need for this study. This retrospective study included 93 patients with 94 affected legs from 1991 to 2023. The patients were categorized into early (under 10years) and late (10years or above) intervention groups. Eighteen patients with nineteen lengthening episodes who attained skeletal maturity made the basis of this study and will be discussed in detail. The outcome for the lengthening group at maturity was satisfactory, with 5.53cm of average length gained per lengthening episode, a mean LLD of 0.31cm at final follow-up, a mean age of 23.63years (range 14-38years), and an average follow-up of 12.51years (range 3-28years) post-lengthening, but the procedure was associated with difficulties like ankle stiffness, tibial valgus, pin tract infections, and fractures through regenerate. This study represents a large single-centre series on CPMB. We recommend that surgery for lengthening should be done at an older age, close to skeletal maturity, wherever possible to reduce the risk of repeat lengthening procedures. Based on our experience, we recommend the use of a circular fixator. Uniplanar distractors should have an adequate number and spread of Schanz screws in each segment to reduce the risk of valgus malalignment of distracting segments of bone.

Safety and Efficacy of Early Rehabilitation With Assistance From a Single-Joint Hybrid Assistive Limb in Patients With Total Knee Arthroplasty: A Randomized Controlled Clinical Pilot Study.

Background This study aimed to evaluate the safety and effectiveness of knee exercise within four hours aftertotal knee arthroplasty (TKA) using a single-joint hybrid assistive limb (HAL-SJ). Materials and methods This pilot single-blind randomized controlled trial included participants who underwent TKA for osteoarthritis and were randomly allocated to the early rehabilitation (n = 14) or control rehabilitation (n = 16) group. Knee rehabilitation exercises using the HAL-SJ began within four hours postoperatively in the early group and seven days after surgery in the control group. Knee circumference, range of motion (ROM), pain, muscle strength, and extension lag were assessed before and one and two weeks after surgery. Results Circumferences at 1 and 10 cm from the upper edge of the patella did not differ between the groups before surgery or one week postoperatively. The extension lag and knee flexion ROM after one week were significantly better in the early intervention group than in the control group. However, the quadriceps and hamstring isometric knee strength and pain scores did not differ between the groups at one and two weeks postoperatively. HAL-SJ-related complications were not reported. Conclusion Rehabilitation knee exercises using the HAL-SJ within four hours after TKA improved extension lag and knee flexion ROM without exacerbating knee swelling and pain.

Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients

To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients. The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C 2-C 7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group ( P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C 2-C 7 ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up. Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups ( P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group ( P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up ( P>0.05). Imaging evaluation showed that there was no significant difference in CL, C 2-C 7 ROM, DA, DROM, and DIH between the two groups at each time point before and after operation ( P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C 2-C 7 ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up. Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.

Effectiveness of Early Intervention with Palatal Expansion Versus Late Orthodontic Treatment for Correcting Maxillary Crowding

ABSTRACT Background: Maxillary crowding is a common orthodontic issue that can impact a patient’s oral health and overall well-being. The timing of orthodontic treatment plays a crucial role in achieving optimal results. Materials and Methods: Thirty patients who received early intervention with palatal expansion (Group A) and 30 patients who underwent late orthodontic treatment (Group B) were included in this study. The age range for Group A was 8–10 years, while Group B had an age range of 16–18 years. Pretreatment and posttreatment records, including dental models and cephalometric radiographs, were analyzed to assess the effectiveness of the respective treatments. Results: In Group A, the mean duration of treatment was 12 months, and the maxillary crowding was corrected by an average of 4.5 mm. In Group B, the mean treatment duration was 24 months, and maxillary crowding was corrected by an average of 3.2 mm. The early intervention group (Group A) exhibited a statistically significant reduction in treatment duration and greater correction of maxillary crowding compared to the late orthodontic treatment group (Group B) (P &lt; 0.05). Conclusion: Early intervention with palatal expansion is an effective approach for correcting maxillary crowding, leading to shorter treatment duration and greater improvement compared to late orthodontic treatment.