Effects Of Different Modalities Research Articles

Beneficial effects of non‐pharmacological interventions for post‐stroke pain: A meta‐analysis

AbstractPurposePain is a frequent post‐stroke health concern, and several non‐pharmacological interventions are commonly employed to manage it. However, few reviews have examined the effectiveness of such interventions, making it difficult to draw conclusions about their usefulness. Furthermore, subgroup analysis based on post‐stroke pain level or intervention characteristics is rarely performed. This study aimed to investigate the effectiveness of non‐pharmacological interventions and evaluate the significant factors associated with post‐stroke pain through subgroup analysis.DesignSystematic review and meta‐analysis.MethodsRelevant studies were obtained from seven databases, from their commencement up to March 2024, as well as from the gray literature. The PICOS approach was used to evaluate the eligibility criteria of the studies. The RoB‐2 tool was used to determine the risk of bias in each randomized trial. Pooled estimations of standardized mean difference and heterogeneity (quantified with I2) were obtained using a random‐effects model. The stability of the pooled result was then assessed using the leave‐one‐out approach. STATA 17.0 was used to run the meta‐analysis.FindingsNon‐pharmacological interventions were effective in reducing pain immediately after intervention (pooled SMDs: −0.79; 95% confidence interval [CI]: −1.06 to −0.53; p < 0.001). The approach involving acupuncture, aquatic therapy, or laser therapy and rehabilitation training was effective for post‐stroke hemiplegic shoulder pain. A pooled analysis of non‐pharmacological interventions showed that both less than 4 weeks and more than 4 weeks of interventions were effective in alleviating pain in stroke patients.ConclusionNon‐pharmacological approaches appear to be beneficial for reducing post‐stroke pain. The outcomes based on the modalities merit further research.Clinical relevanceFurther studies are needed to determine the effects of different modalities on pain intensity following a stroke. Furthermore, to avoid overestimation of intervention efficacy, future randomized trials should consider blinding approaches to the interventions delivered.

Auditory, Visual, or Both? Comparing Visual and Auditory Representations of Game Elements in a Gamified Image-Tagging Task

In gamification users show increased motivation and engagement towards tasks. So far, this effect has mostly been empirically tested based on the visual depiction of game elements, while research on the use and addition of auditory aspects is sparse. In this work we investigate the effect of different modalities of game elements (auditory, visual, audiovisual) on user experience, perception and performance in a gamified image-tagging task. We approached this via an online validation survey to find suitable sound effects (N=50), a main quantitative study (N=109) and a qualitative semi-structured interview (N=9). Our results show that while visual gamification increases performance, auditory and audiovisual gamification had no effect. However, they were shown to have an influence on the user's flow state. Our qualitative follow-up study shed light on underlying reasons and revealed each modality has its own drawbacks and advantages and that combining both visual and auditory aspects was preferred by participants.

Effect of different modalities of exercise on Fatty Liver Index in patients with metabolic syndrome: The RESOLVE randomized trial

IntroductionMetabolic associated liver disease (MASLD) is the most common liver disease in the world especially in people with metabolic syndrome. First-line treatments mainly consist in lifestyle modifications for these populations. The main objective of this study is to assess the effect of a short intervention program with different exercise modalities on Fatty Liver Index (FLI) in patients with metabolic syndrome. Methods85 patients (40 men, 45 women) with metabolic syndrome and liver steatosis were randomized in 3 groups for a 3 weeks residential program: Re group—high-resistance-moderate-endurance; rE group—moderate-resistance with high-endurance and re group—moderate-resistance with moderate-endurance. Patients also followed a negative energy balance of 500 kcal/day. Then, a follow-up of 1 year with interviews with dieticians and exercise physicians to maintain lifestyle modification was performed. Anthropometric, cardiometabolic and hepatic outcomes were performed at baseline, at the end of the 3-week residential program, 3 months, 6 months and 12 months after baseline. ResultsThis study demonstrated that all three training programs significantly improve FLI and that this effect was lasting among the follow-up (p < 0.001). More specifically, the Re group exhibited a more pronounced decrease in FLI compared with re (p < 0.05). Finally, the decrease in FLI was associated with improvement in anthropometric and cardiometabolic outcomes at 3-weeks (p < 0.001) and 3-months (p < 0.01). ConclusionShort duration program is effective to improve FLI and cardiometabolic parameters in MASLD patients. Encourage to increase physical activity even for a short duration is relevant in this population.

Evaluation of different modalities in prevention of seroma formation post-modified radical mastectomy – An observational study from a rural tertiary care center

Background: Seroma, a recognized complication of modified radical mastectomy (MRM) delays the administration of adjuvant therapy and also effects adverse events. Aims and Objectives: This study was conducted to study the sociodemographic and clinical profile of patients developing seroma post MRM and compare the effectiveness of different modalities of seroma prevention since there is a dearth of literature on this matter in our sub-Himalayan region. Materials and Methods: This was an observational study conducted from February 2021 to August 2022 on 60 women with carcinoma breast who underwent MRM. They were studied for sociodemographic profile, cancer characteristics, and seroma prevention techniques and followed up during the study period. Preventive modalities used were quilting, octreotide therapy, suction drains with early drain removal, passive low suction drains, sharp dissection technique, and sclerotherapy. The results were analyzed using the Statistical Package for the Social Sciences version 22. Results: The mean age was 49.7±9.4 years, 18.3% had hypertension and 10.0% diabetes mellitus, and 58.3% presented with breast lump. Overall incidence of seroma was 23.3%; the highest was observed in sclerotherapy (50%), and the lowest was in quilting (7.1%) (P=0.235). The presence of hypertension (P=0.026) and the non-administration of neoadjuvant chemotherapy (P=0.010) was significantly associated with developing seroma. Sharp dissection was associated with wound infection (33.3%), sclerotherapy with flap necrosis (50%), and quilting with shoulder stiffness (21.4%). Conclusion: The lowest incidence of seroma was in quilting and the highest in sclerotherapy. Adverse events such as wound infection, shoulder stiffness, and flap necrosis were the lowest among patients discharged with passive drains and highest in sclerotherapy.

The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions.

The effect of different modalities of anaesthesia in microvascular free flap surgery has been a topic of ongoing debate. Comparative data to study the effect of general anaesthesia and regional anaesthesia in the form of peripheral nerve blocks (PNBs) on lower extremity free flap survival is lacking to date. This study aims to elucidate the effect of regional anaesthesia on flap survival in lower extremity free flap reconstructions. A retrospective cohort study of all patients who underwent free vascularised flap reconstruction of the lower extremities between 2012 and 2021 at the Amsterdam University Medical Centre (UMC), The Netherlands, and between 2019 and 2021 at the Radboud UMC, Nijmegen, The Netherlands. In this cohort, we analysed partial and total flap failures. In this cohort, 87 patients received a total of 102 microvascular free flap reconstructions of the lower extremity. In 20.5% of these operations, patients received a supplemental PNB. Total flap failure was 23.8% in the regional anaesthesia group compared to 21% in the group with general anaesthesia only (p = 0.779). Operation time was longer for patients with regional anaesthesia (p = 0.057). Length of stay was on average 2 days shorter for patients with supplemental regional anaesthesia (p = 0.716). This is the largest cohort comparing flap survival in patients receiving general anaesthesia to general anaesthesia with a PNB in lower extremity reconstructions to date. We cannot attribute a significant beneficial or detrimental effect of regional anaesthesia to flap survival. High failure rates stress the need for future studies. Koster ITS, den Os MM, Rutten MVH, et al. The Effect of Regional Anaesthesia on Free Flap Survival in Lower Extremity Reconstructions. Strategies Trauma Limb Reconstr 2024;19(1):15-20.

Effects of different modalities of transcranial magnetic stimulation on post-stroke cognitive impairment: a network meta-analysis.

The study aimed to evaluate, using a network meta-analysis, the effects of different transcranial magnetic stimulation (TMS) modalities on improving cognitive function after stroke. Computer searches of the Cochrane Library, PubMed, Web of Science, Embass, Google Scholar, CNKI, and Wanfang databases were conducted to collect randomized controlled clinical studies on the use of TMS to improve cognitive function in stroke patients, published from the time of database construction to November 2023. A total of 29 studies and 2123 patients were included, comprising five interventions: high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS), intermittent theta rhythm stimulation (iTBS), sham stimulation (SS), and conventional rehabilitation therapy (CRT). A reticulated meta-analysis showed that the rankings of different TMS intervention modalities in terms of the Montreal Cognitive Assessment (MoCA) scores, Mini-Mental State Examination scores (MMSE), and Modified Barthel Index (MBI) scores were: HF-rTMS > LF-rTMS > iTBS > SS > CRT; the rankings of different TMS intervention modalities in terms of the event-related potential P300. amplitude scores were HF-rTMS > LF-rTMS > iTBS > CRT > SS; the rankings of different TMS intervention modalities in terms of the P300 latency scores were: iTBS > HF-rTMS > LF-rTMS > SS > CRT. Subgroup analyses of secondary outcome indicators showed that HF-rTMS significantly improved Rivermead Behavior Memory Test scores and Functional Independence Measurement-Cognitive scores. High-frequency TMS stimulation has a better overall effect on improving cognitive functions and activities of daily living, such as attention and memory in stroke patients.

Comparison of liver resection and radiofrequency ablation in long-term survival among patients with early-stage hepatocellular carcinoma: a meta-analysis of randomized trials and high-quality propensity score-matched studies

BackgroundWhether radiofrequency ablation (RFA) and liver resection (LR) are comparable treatments for early-stage hepatocellular carcinoma (HCC) is controversial. We conducted this study to provide ample clinical evidence for the argument.MethodsThe PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched (PSM) studies that compared long-term outcomes of both RFA and LR for patients with early-stage HCC. The hazard ratios (HRs) with 95% confidence intervals (95% CI) of overall survival (OS) and disease-free survival (DFS) were calculated.ResultsThirty-six studies consisting of six RCTs and 30 PSM studies were included in this study, and a total of 7384 patients were involved, with 3694 patients being treated with LR and 3690 patients with RFA. Meta-analysis showed that LR provided better OS and DFS than RFA (HR: 1.22, 95% CI: 1.13–1.31; HR: 1.56, 95% CI: 1.39–1.74, respectively). A sensitivity analysis indicated that the results were stable. For the subgroup of patients with BCLC 0 stage, RFA and LR resulted in similar OS and DFS. For the subgroup of patients with single tumor sizes less than 3 cm, RFA reached similar OS (HR: 1.19, 95% CI: 0.90–1.58) but worse DFS compared with LR (HR: 1.45, 95% CI: 1.11–1.90). For the subgroup of ablation margin larger than 0.5 cm, LR still resulted in better OS than RFA (HR: 1.29, 95% CI: 1.09–1.53); while the ablation margin was larger than 1 cm, both RFA and LR resulted in similar OS. The modality of RFA was also a factor that affected results. Subgroup analysis showed that patients receiving ultrasound-guided RFA had worse OS and DFS than LR (HR: 1.24, 95% CI: 1.14–1.36; HR: 1.44, 95% CI: 1.25–1.66, respectively).ConclusionsMeta-analysis showed that LR provided better OS and DFS for patients with early-stage HCC. However, RFA and LR had similar effects on long-term survival in patients with BCLC 0 stage HCC. RFA and LR probably had similar effects on OS in patients with solitary HCC less than 3 cm or when the ablation margin was larger than 1 cm which need more studies to confirm. The effects of different modalities of RFA on long-term survival are needed for further assessment.

Retracted: Meta-Analysis of the Application Effect of Different Modalities of Thermal Ablation and Surgical Treatment in Papillary Thyroid Microcarcinoma

Retracted: Meta-Analysis of the Application Effect of Different Modalities of Thermal Ablation and Surgical Treatment in Papillary Thyroid Microcarcinoma

Patient response to the management during the acute presentation of cough variant Asthma: Retrospective cohort study

The clinical improvement after assessing patients with cough variant asthma in outpatient clinics, and therapy success varied depending on the subjective improvement. Cough could be controlled within appropriate time and subsequent management can consist of inhaled corticosteroids. In this study we used the cough improvement, the only available clinical response, as a predictable factor to determine the effect of different modalities of treatment among patients with cough variant asthma. Retrospective observational analysis was performed in Saudi Arabia's King Saud University Medical City, on the presentation, diagnosis, course of therapy, and responsiveness to oral and inhaled steroids in patients with cough variant asthma. All patients who visited the clinic on multiple occasions with persistent, acute coughing without being pre-screened between September 2021 and September 2022 included based on medical records. Cough resembles cough variant asthma is the term used to describe a cough without a diagnosed etiology. To identify patients eligible for CVA treatment, iindividuals having GERD-associated cough, allergic rhinitis, bronchial asthma, smokers and atopic cough was excluded. For the examination of these findings, IBM SPSS version 28 (Armonk, NY, USA) was employed. As a result of using budesonide-formoterol inhaler, most patients (86.3 %) showed improvement in their cough symptoms (with 95 %CI: 78.3 to 94.9). There was a significant yet weak positive correlation between the frequency of cough symptoms before and after using budesonide-formoterol (r = 0.318, P value < 0.001). The understanding of treatment response and patient selection for budesonide-formoterol inhaler therapy, providing clinicians with valuable information to optimize patient care.

Effect of Different Modalities of Facial Images on ASD Diagnosis using Deep Learning-Based Neural Network

This paper aims to investigate the effectiveness of different modalities of facial images for diagnosing Autism Spectrum Disorder (ASD) using deep learning-based neural networks. The motivation behind this study is the potential of advanced technologies to aid in accurately diagnosing ASD. The research revolves around the need to explore the performance of deep learning models on different modalities of facial images and to identify the challenges and potential solutions associated with each modality. The methodology involves training and testing the models on the respective datasets and analysing their accuracy and performance. ResNet50V2 achieved a 100% accuracy on the 2D test dataset, while Xception achieved an accuracy of 93.75% on the 3D test set. The detection accuracy suggests that neural networks-based deep learning methods have the potential to diagnose ASD using facial images accurately. However, the models perform better on 2D data, highlighting the need for additional training on larger 3D datasets to improve accuracy on 3D images. The study contributes to the field by providing insights into the performance of different modalities of facial images, emphasizing the need for robust datasets, and suggesting future research directions to enhance the accuracy and efficiency of ASD diagnosis using deep learning techniques.

Evaluating the Effectiveness of Mobile Health in Breast Cancer Care: A Systematic Review.

Breast cancer is affecting millions of people worldwide. If not appropriately handled, the side effects of different modalities of cancer treatment can negatively impact patients' quality of life and cause treatment interruptions. In recent years, mobile health (mHealth) interventions have shown promising opportunities to support breast cancer care. Numerous studies implemented mobile health interventions aiming to support patients with breast cancer, for example, through physical activity promotion or educational content. Nonetheless, current literature reveals that real-world evidence for the actual benefits remains unclear. In this systematic review, we focus on analyzing the methodology used in recent studies to determine the effects of mHealth applications and wearable devices on the outcome of patients with breast cancer. We followed the PRISMA guideline for the selection, analysis, and reporting of relevant studies found in the databases of Medline, Scopus, Web of Science, and Cochrane Library. A total of 276 unique records were identified, and 20 studies met the inclusion criteria. Study quality was assessed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. While many of the studies used standardized questionnaires as patient-reported outcome measures, there was minimal use of objective measurements, such as activity sensors. Adoption, drop-out rates, and usage behavior of users of the mobile health intervention were often not reported. Future work should clearly define the focus and desired outcome of mHealth interventions and select outcome measures accordingly. Greater transparency facilitates the interpretation of results and conclusions about the real-world evidence of mobile health in breast cancer care.

No effects of different modalities of a single bout of exercise on sleep architecture and appetite in healthy overweight or obese young adults

BackgroundStudies on the effect of acute exercise on sleep quality and quantity reported contradictory results and the bulk of these studies were conducted in lean individuals. Furthermore, not many studies have assessed subsequent changes in appetite following an acute bout of exercise. Therefore, the exact effect of aerobic acute exercise on sleep parameters in overweight/obese young adults remains unclear. As such, the purpose of this study was to investigate the effects of a single bout of aerobic exercise on sleep architecture in healthy, overweight/obese, young adults. MethodsEighteen participants (50% female; mean age 21±1 year) with no self-reported sleep disorders or chronic health conditions took part in this study. The Balke-Ware procedure (treadmill-graded test) was used to determine exhaustion peak oxygen consumption (VO2peak). The intervention consisted of three conditions (no exercise, moderate, and intensive). Heart rates corresponding to 50% and 75% VO2peak were used to establish work rates for moderate and intense exercise conditions, respectively. Following each intervention, sleep parameters were measured throughout the night using polysomnography. Additionally, participants completed appetite visual analogue scales before each meal, on the day of the exercise, and the following day. ResultsUnivariable analyses did not yield significant results between the independent variables (condition, order, and sex) and sleep parameters; however, the intense condition (normalised to the moderate condition) had a positive relationship with the number of arousals during the subsequent night. No significant effects were noted for the multivariate analysis. Further, there was no global effect of order (p = 0.651), sex (p = 0.628), and appetite time (p = 0.400) and individual sleep characteristics did not have an effect on the Hunger and Fullness scales. However, the percentage of stage 2 had a positive effect on the Quantity scale, and the amount and percentage of time spent in REM had a negative effect on the Quantity scale, but multivariable analyses were not significant. ConclusionAcute aerobic exercise (intense or moderate) does not have beneficial or adverse effects on sleep quality and quantity in young adults with overweight/obesity. Subjective appetite may have a relationship with REM and stage 2 sleep independent of exercise.

Radioresistance Mechanisms in Prostate Cancer Cell Lines Surviving Ultra-Hypo-Fractionated EBRT: Implications and Possible Clinical Applications.

The use of a higher dose per fraction to overcome the high radioresistance of prostate cancer cells has been unsuccessfully proposed. Herein, we present PC3 and DU-145, castration-resistant prostate cancer cell lines that survived a clinically used ultra-higher dose per fraction, namely, radioresistant PC3 and DU-145 cells (PC3RR and DU-145RR). Compared to PC3, PC3RR showed a higher level of aggressive behaviour, with enhanced clonogenic potential, DNA damage repair, migration ability and cancer stem cell features. Furthermore, compared to PC3, PC3RR more efficiently survived further radiation by increasing proliferation and down-regulating pro-apoptotic proteins. No significant changes of the above parameters were described in DU-145RR, suggesting that different prostate cancer cell lines that survive ultra-higher dose per fraction do not display the same grade of aggressive phenotype. Furthermore, both PC3RR and DU-145RR increased antioxidant enzymes and mesenchymal markers. Our data suggest that different molecular mechanisms could be potential targets for future treatments plans based on sequential strategies and synergistic effects of different modalities, possibly in a patient-tailored fashion. Moreover, PC3RR cells displayed an increase in specific markers involved in bone remodeling, indicating that radiotherapy selects a PC3 population capable of migrating to secondary metastatic sites. Finally, PC3RR cells showed a better sensitivity to Docetaxel as compared to native PC3 cells. This suggests that a subset of patients with castration-resistant metastatic disease could benefit from upfront Docetaxel treatment after the failure of radiotherapy.

Effectiveness of Different Modalities of Remote Online Training in Young Healthy Males.

Since 2020 there has been an increase in demand for home workouts. Therefore, different ways of delivering distance training have been proposed to promote "stay active at home." This study aimed to compare the effectiveness of three different training programs consisting of a total of 15 workouts (three sessions per week): supervised livestreaming (LS), unsupervised following a video recording (VR), and unsupervised following a written program (WP). Changes in anthropometric and cardiovascular variables, muscle fitness, and physical activity levels were evaluated. To provide a meaningful analysis for significant comparisons between small groups, mean differences (∆), 95% confidence interval (95% C.I.), and Cohen's effect sizes (E.S.) were also calculated. The three training modalities increased physical activity levels, with an adherence rate of LS = 93.3%, VR = 86%, and WP = 74%. Although there was no reduction in body weight, waist circumference decreased by 1.3 cm (95% C.I. = -2.1, -0.5; E.S. = 0.170; p &lt; 0.004). Furthermore, where LS, VR, and WP resulted in improvements in muscle fitness, only LS showed changes in cardiovascular variables, such as resting heart rate (∆ = -7.3 bpm; 95% C.I. = -11.9, -2.7; E.S. = 1.296; p &lt; 0.001) and Ruffier's index (∆ = -2.1bpm; 95% C.I. = -3.5, -0.8; E.S. 1.099; p &lt; 0.001). Remote online training proved its effectiveness over a short period of time. However, supervised training proved to be the most effective, highlighting the importance of an experienced trainer.

Meta-Analysis of the Application Effect of Different Modalities of Thermal Ablation and Surgical Treatment in Papillary Thyroid Microcarcinoma.

Background Papillary thyroid microcarcinoma (PTMC) refers to papillary thyroid carcinoma (PTC) with a maximum diameter of 10 mm. Thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA), has been applied in the treatment of benign thyroid nodules and captured extensive attention. At present, the application of thermal ablation in PTMC has been extensively reported, but outcomes such as volume reduction rate (VRR), complete remission rate (CRR), and adverse reaction rate (ARR) vary considerably. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of different treatment methods of PTMC. Methods We did a systematic review and network meta-analysis. We searched PubMed, EMBase, and Cochrane-Library from the date of inception to January 10, 2022, to retrieve the VRR, CRR, and ARR of MWA, RFA, LA and surgical treatment of PTMC, and a meta-analysis was performed using the R meta-package. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and sensitivity analyses, cumulative meta-analyses, and publication bias were also performed. Relevant literature was retrieved with keywords; the eligible cohort studies were screened based on the established inclusion and exclusion criteria. Results A total of 1515 patients were included in the 12-month follow-up. The overall VRR was 86.25% (95% CI: 77.89, 94.60), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1483 patients were included in the last follow-up. The overall VRR was 99.41% (95% CI: 99.11, 99.72), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1622 patients showed complete remission at the last follow-up, and the overall CRR was 0.63 (95% CI: 0.46, 0.79). The CRR was RFA > LA > WMA, but the differences were not significant. A total of 1883 patients had adverse reactions at the last follow-up, and the overall ARR was 0.06 (95% CI: 0.03, 0.08). The ARR at the last follow-up was RFA = Surg < LA < WMA. The ARR of the RFA and Surg subgroups was significantly lower than that of the WMA subgroup. Conclusions Similar good efficacy and safety profiles were observed in WMA, RFA, LA, and surgical treatment in PTMC, among which RFA showed the best volume reduction, complete remission rate, and adverse reaction reduction. However, there is a slight bias in the limited literature included in this study, and we did not conduct or refer to mechanistic studies to confirm its specific mechanism of action. Clinicians are advised to use their discretion in the choice of treatment.

Different modalities of treatment of trigeminal neuralgia

Background; Trigeminal Neuralgia: It is a syndrome characterised by recurrent sudden &amp; usually unilateral severe brief stabbing. One &amp; more branches of 5th cranial nerve are causing pain. It is painful, brief experience. Pain can occur spontaneously &amp; be triggered by innocuous stimuli like yawning, chewing, light touch, &amp; other transmitted stimuli. &amp; divided by different lengths of pain-free intervals, Aim and objectives; to assess effectiveness of Different Modalities in studied cases with trigeminal neuralgia, Subjects &amp; methods; This research Was showed on group of 20 patients having trigeminal neuralgia manged by different modalities, percutaneous radiofrecuency, microvascular decompression, perephiral neurectomy and nerve block. This study was conducted on patients with variant ages at the time of diagnosis, presenting with trigeminal neuralgia, admitted and managed at neurosurgery- Functional unit -Faculty of medicine Al-Azhar University From 2017 To 2021, Result; The description of of radiologiucal findings by MRI FIESTA. The major finding was no loop compassing (50%) in patients followed by Arterial loop compassing trigeminal nerve (35%). Most of the patients had V1, V2, V3 affected in 70% of the patients, and 20% of the patients had V2, V3 affected, The major surgery done was Radiofrequency (40%) followed by MVD (30%).

Effects of aerobic, resistance, and combined training on endothelial function and arterial stiffness in older adults: study protocol for a systematic review and meta-analysis

IntroductionAging is an independent risk factor for cardiovascular events. It promotes vascular dysfunction which is associated with risk factors for cardiovascular diseases (CVDs). Exercise can modulate vascular function parameters, but little is known about the effects of different modalities of training (aerobic, resistance, and combined) on endothelial function and arterial stiffness in older adults.MethodsThis systematic review study will include randomized controlled trials (RCTs) selected from the electronic databases MEDLINE (PubMed), Cochrane, LILACS, EMBASE, and Web of Science. We will follow the PRISMA guidelines and PICOS framework. Studies involving both male and female older adults (≥60 years old) with or without comorbidities undergoing aerobic, resistance, and/or combined training compared to a control group (no exercise) will be eligible. We will use the Cochrane Risk of Bias 2 (RoB 2) tool to evaluate the quality of individual studies and GRADE to assess the strength of evidence. Statistical analyses will be conducted with RStudio for Windows (v1.3.959) using R package meta.DiscussionA systematic review and meta-analysis involving data from studies of older adults would deepen our understanding of vascular adaptations to exercise training in this population. It could provide new insights into how health providers can improve patient management and prevention of cardiovascular events in older adults.Systematic review registrationPROSPERO 42021275451

Ventilatory Muscle Training for Early Cardiac Rehabilitation Improved Functional Capacity and Modulated Vascular Function of Individuals Undergoing Coronary Artery Bypass Grafting: Pilot Randomized Clinical Trial.

Background: Cardiac rehabilitation with aerobic exercises is the first strategy for nonpharmacological treatment in the postoperative period of individuals undergoing coronary artery bypass grafting (CABG) to improve functional capacity and vascular health. However, other exercise modalities remain uncertain regarding the same benefits. Objectives: Evaluation of the effect of different modalities of exercise, such as early cardiac rehabilitation on subjects submitted to CABG in the six-minute walk test (6-MWT) and on the percentage of flow-mediated dilatation (FMD) of the brachial artery. Methods: A randomized clinical trial in which 15 patients (62.7 ± 6.7 years) who underwent CABG were randomly assigned to the following groups: isometric (IG, Handgrip Jamar®), ventilatory muscle training (VG, PowerBreathe®) and control (CG, conventional respiratory and motor physiotherapy). All patients were attended to physically twice a day (20 min/session) for a consecutive week after the CABG (hospital admission). Functional capacity was assessed by 6-MWT and endothelial function was assessed through the technique of FMD, before and after (~7 days) admission to CABG. The doppler ultrasound videos were analyzed by Cardiovascular Suite® software (Quipu, Pisa, Italy) to measure %FMD. Statistics: Generalized estimation equation, followed by Bonferroni post hoc (p < 0.05). Results: Systolic, diastolic and mean arterial pressure (SBP/DBP/MAP, respectively) were 133, 76 and 95 mmHg. The groups presented walking meters (m) distance before and after intervention of: IGbasal 357.80 ± 47.15 m vs. IGpost 306.20 ± 61.63 m, p = 0.401 (+51 m); VGbasal 261.50 ± 19.91 m vs. VGpost 300.75 ± 26.29 m, p = 0.052 (+39 m); CG basal 487.83 ± 83.23 m vs. CGpost 318.00 ± 31.08, p = 0.006 (−169 m). %FMD before and after intervention was IGbasal 10.4 ± 4.8% vs. IGpost 2.8 ± 2.5%, p = 0.152; VGbasal 9.8 ± 5.1% vs. VGpost 11.0 ± 6.1%, p = 0.825; CGbasal 9.2 ± 15.8% vs. CGpost 2.7 ± 2.6%, p = 0.710 and resting mean basal blood flow was IGbasal 162.0 ± 55.0 mL/min vs. IGpost 129.9 ± 63.7 mL/min, p = 0.662; VGbasal 83.74 ± 12.4 mL/min vs. VGpost 58.7 ± 17.1 mL/min, p = 0.041; CGbasal 375.6 ± 183.7 mL/min vs. CGpost 192.8 ± 115.0 mL/min, p = 0.459. Conclusions: Ventilatory muscle training for early cardiac rehabilitation improved acute functional capacity and modulated mean flow of individuals undergoing CABG.

You Won’t Believe What They Just Said! The Effects of Political Deepfakes Embedded as Vox Populi on Social Media

Disinformation has been regarded as a key threat to democracy. Yet, we know little about the effects of different modalities of disinformation, or the impact of disinformation disseminated through (inauthentic) social media accounts of ordinary citizens. To test the effects of different forms of disinformation and their embedding, we conducted an experimental study in the Netherlands ( N = 1,244). In this experiment, we investigated the effects of disinformation (contrasted to both similar and dissimilar authentic political speeches), the role of modality (textual manipulation versus a deepfake), and the disinformation’s embedding on social media (absent, endorsed or discredited by an (in)authentic citizen). Our main findings indicate that deepfakes are less credible than authentic news on the same topic. Deepfakes are not more persuasive than textual disinformation. Although we did find that disinformation has effects on the perceived credibility and source evaluations of people who tend to agree with the stance of the disinformation’s arguments, our findings suggest that the strong societal concerns on deepfakes’ destabilizing impact on democracy are not completely justified.

Successful use of telemedicine for evaluation of infantile hemangiomas during the early COVID-19 pandemic: A cross-sectional study.

The COVID-19 pandemic prompted a rapid expansion in the use of telemedicine. This study aimed to assess the experiences of hemangioma specialists utilizing telemedicine during the COVID-19 pandemic to evaluate and manage infantile hemangiomas (IH), including perceived effectiveness of different modalities and barriers to care delivery. Multicenter cross-sectional study asking providers to describe their experiences using telemedicine for initial evaluation of IH from March to September 2020. The study included 281 patients from 15 medical centers internationally. Median time from referral to evaluation was 17 days. Median physician confidence in performing evaluations via telemedicine was 95.0 (IQR 90.0-100.0). Most evaluations were performed via video communication with photographs or audio communication with photographs; when not initially available, photographs were requested in 51.4%. Providers preferred follow-up modalities that included photographs. Physicians with extensive expertise in managing IH are confident in their abilities to assess and manage IH via telemedicine including initiating treatment in patients without risk factors for beta-blocker therapy. There was a preference for hybrid modalities that included photographs. The data suggest that telemedicine can be effective for managing IH and may decrease wait times and improve specialist reach to underserved areas.