Evaluation Of Symptoms Research Articles

Radiofrequency Ablation for Solitary Autonomously Functioning Thyroid Nodules: Multicenter Study from Latin America.

Background: Autonomously functioning thyroid nodules (AFTNs) represent ∼5% of all thyroid nodules and often necessitate definitive treatments such as surgery or radioiodine (131I), both of which have inherent risks. Radiofrequency ablation (RFA) has emerged as an effective and safe therapeutic option for managing AFTNs. This study aims to assess the effectiveness and safety of RFA for solitary AFTNs in various countries across Latin America. Methods: This retrospective, observational, multicenter cohort study included patients with a solitary AFTN that was histologically confirmed as benign and treated with a single session of RFA. The study included an analysis of patient demographics, sonographic characteristics of the nodules, thyroid profile assessment at each follow-up visit, evaluation of clinical symptoms to determine the achievement of a euthyroid state, and the measurement of nodule volume reduction. In addition, a bivariate analysis was conducted to identify associations between these variables and the resolution of hyperthyroidism. Results: Our study enrolled 81 patients with a solitary, benign AFTN. The volume reduction ratio (VRR) consistently increased over the follow-up period, with medians of -50%, -74.9%, -78.4%, and -90.2% at 1, 3, 6, and 12 months, respectively. The rate of resolution of hyperthyroidism was 93.8% (76/81). Following the RFA procedure, 58.02% of patients (47/81) normalized their thyrotropin levels within 1 month of follow-up, and by 3 months, an additional 33.3% had achieved normalization (27/81). Notably, a baseline volume ≥10, 20, or 30 mL did not affect the achievement of clinical success. In bivariate analyses, a VRR ≥50% at the 6-month follow-up was associated with the resolution of hyperthyroidism. Overall complications occurred in 6.2% of patients (5/81), including 1.2% (1/81) of a major complication (transient Horner syndrome), 3.7% cases of transient dysphonia (3/81), and 1.2% (1/81) of hypothyroidism requiring low-dose levothyroxine replacement. Conclusions: The results of this multicenter study suggest that RFA is a promising treatment option for patients with solitary AFTN, regardless of their baseline characteristics, including volume, age, or composition. The clinical success of the intervention may be related to the VRR at 6 months.

Race/ethnicity, sex, and age differences in pediatric SCAT-5 concussion symptoms

Objective To examine sociodemographic differences in concussion symptom reporting, among young children by race/ethnicity, sex, and age at initial presentation to guide potential interventions for children from different backgrounds. Method Participants were elementary-age children (ages 5 to 12 years; n = 392) who sustained a concussion within 30 days of specialty concussion clinic visit. Independent variables were self-defined race/ethnic group, participants’ sex, and age. Dependent variables were number and severity of 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool5® (SCAT-5) Symptom Evaluation. Results Analyses of variance (ANOVAs) showed no differences in reporting of symptoms across race/ethnic or age groups. There was no interaction between race/ethnic, sex and age groups. Females in this sample reported a greater number and severity of concussion symptoms than males. Conclusions Concussion symptom endorsement on the SCAT-5 Symptom Evaluation did not appear to be affected by race/ethnicity or age. However, consistent with existing literature, females reported higher endorsement of concussion symptoms than males and therefore may merit special consideration in evaluation of symptoms. Future research should examine the intersection of other sociodemographic variables with race/ethnicity and should consider the influence of respondent (child vs. parent) in studies of this age cohort.

Beyond Mono-Method Symptom Assessment: Multimethod Extension of the Trilevel Model of Anxiety and Depression

The wide array of symptoms of and high comorbidity rates between unipolar depressive and anxiety-related disorders have raised questions about the relations among their symptoms. Factor analysis examines these relations, yet factor-analytic symptom-measurement models have relied on a single method of measurement and do not always replicate. We conceptually replicate and extend the trilevel model of anxiety and depression symptoms to encompass interviewer-rated symptoms. In the trilevel model, symptom-specific items load on three levels of factors: a narrow (or disorder-specific) factor, an intermediate-breadth factor, and a general-distress factor. The trilevel model fit well in this sample and fit better than comparison models that eliminated one of the three levels. Extension analysis successfully integrated interviewer-rating variables into the trilevel model—particularly for the broad and narrow levels. These results provide some support for the trilevel model and the use of interviewer ratings of symptoms. Research and treatment implications are discussed.

Assessment of Nasal Breathing Function and Tip Definition after the Implementation of the Cephalic Lateral Crural Advancement Flap Technique.

Cephalic trimming of the lower lateral cartilage (LLC) can result in the collapse of the internal and external nasal valves, pinched nose, and alar retraction. The cephalic lateral crural advancement flap (CLCAF) technique is introduced as a method to prevent these complications by avoiding grafts in the LLC. A retrospective study was conducted on 126 open-approach rhinoplasties (82 female and 44 male) employing the CLCAF technique between January 2021 and March 2022. Preoperatively, 20 patients exhibited collapse of the internal nasal valve. CLCAF was performed in all patients following cephalic incision, leaving 7 to 8 mm horizontally and caudally of LLC, and preserving the scroll ligament. The CLCAF was advanced onto the lateral crura to reinforce it and tension the scroll ligament. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess the technique. The average postoperative follow-up period was 14 months. Overall, 114 patients (90.5%) experienced improved nasal breathing on the NOSE scale, and the overall NOSE score significantly decreased from a mean of 30.4 to 14.0 (p < 0.001). A statistically significant reduction in NOSE scores was observed in groups with moderate, severe, and extreme obstruction (p < 0.001), with greater improvement seen in the patients with more severe preoperative nasal breathing obstruction. Postintervention, no patient exhibited collapse of the internal valve, and all patients with preoperative collapse of the internal nasal valve showed an increase of at least 40 points in the NOSE scale. Two patients required revision due to tip asymmetry related to CLCAF. Pinched nose or alar retraction was not observed postoperatively in any patient. The implementation of CLCAF, combined with other techniques, enhances nasal breathing function, prevents the collapse of the internal nasal valve, and leads to optimal nasal tip definition, resulting in a better-shaped and functioning nose.

Engagement With Daily Symptom Reporting, Passive Smartphone Sensing, and Wearable Device Data Collection During Chemotherapy: Longitudinal Observational Study.

Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. Participants completed daily surveys on 61% (SD 27%) of days and collected sufficient smartphone data and wearable sensor data on 73% (SD 35%) and 70% (SD 33%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95% CI 1.03-1.36; P=.02). Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments.

Symptoms of acute stress, anxiety, and depression following Türkiye-Syria earthquake among Syrian population: national survey during the acute phase

ABSTRACT Background: On 6 February 2023, an earthquake with a 7.8 magnitude wreaked destruction in northern Syria to add a new emergency status in the country. This study aims to evaluate the mental health status of the Syrian population in the immediate phase of the earthquake. Methods: This nationwide cross-sectional study was conducted in Syria from 17 February to 6 April. Data were collected on socio-demographics, trauma exposure characteristics, and levels of acute stress, depression, and anxiety. The NSESSS Checklist for the APA was used to assess ASD symptoms, PHQ-9 for depression, and GAD-7 for anxiety. Linear mixed-effects models were employed to identify predictive factors while accounting for governorate as a random effect and time elapsed as a fixed factor. Results: The rate of probable ASD symptoms was significant, with 55.3% of participants exhibiting these symptoms, including 10.3% reporting severe-to-extreme levels of severity. Similarly, 71.6% of participants exhibited symptoms of depression and 59.1% showed symptoms of anxiety. Furthermore, 40.4% of participants displayed a co-occurrence of ASD along with anxiety and depression. Linear mixed effects models indicated that symptoms were predicted by female sex, displacement, poor economic status, and a positive mental health history time elapsed, physical trauma, belief in the ongoing risk of earthquakes, feelings of dizziness, recurrent night-time fear arousal, and a continued sensation of seismic activity. Conclusion: This study demonstrated the high rates of symptoms of ASD, anxiety, and depression across the Syrian population during the immediate aftermath of the earthquake. High portions of people may acquire co-occurring symptoms represented by different mental health problems. These findings highlight the need for immediate actions to enhance mental health support in Syria.

Laparoscopic Shull Technique for Uterine Prolapse and Risk of Recurrences: A Retrospective Comparison with Vaginal Hysterectomy.

The objective was to compare the vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms. This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS). The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group.Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001). Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP.

How Different Are Family Medicine Residents Who Desire Additional Training?

Background and Objectives: Limited knowledge is present regarding how fellowship training correlates with graduate outcomes and whether current residents desire an additional year of residency training. The aim of this study is to examine trends in fellowship training and compare residency and practice outcomes between those interested and those not interested in fellowship training as well as the proportion of residents desiring an additional year of residency training. Methods: We compared data from the American Board of Family Medicine Initial Certification Questionnaire (2017–2019) to the National Graduate Survey (NGS; 2020–2022). We used bivariate analysis and ꭓ2 tests to assess for changes over time and to determine whether an association exists between those likely to pursue a fellowship and those interested in an additional year of residency training. Results: The final sample included 4,930 residency graduates with NGS data (response rate 46.8%). Overall, most (71.0%) respondents were not interested in any type of additional training. We found no differences in interest in a fellowship based on in-training examination (ITE), certification scores, or milestones attainment. Respondents without interest in a fellowship were more likely to provide continuity of care in practice, while respondents with interest in a fellowship were more likely to be faculty and less likely to have symptoms of burnout. Conclusions: Intention for fellowship training is associated with future faculty members and lower rates of symptoms of burnout and continuity practice. A majority of responding family medicine residents (&amp;gt;70%) do not favor an additional year of residency training.

An intracranial yolk sac tumor with initial symptom of hemorrhage in the basal ganglia: a case report

We report a case and follow-up of an adult male with intracranial yolk sac tumor (YST). Initially, the patient presented with abnormal high signals in the right basal ganglia on MRI, misdiagnosed as a cavernous hemangioma. However, within 2 years, the condition rapidly progressed into a large, hypervascular solid neoplasm leading to a basal ganglia hemorrhage. Comprehensive evaluation of clinical symptoms, imaging, surgical findings, serology, histopathology, and genetic analysis confirmed the diagnosis of a yolk sac tumor. The patient underwent prompt surgical resection followed by radiotherapy and chemotherapy. Six months post-treatment, his condition remains stable, with no recurrence. Notably, early MRI revealed Wallerian degeneration in the brainstem suggesting that benign-appearing basal ganglia lesions may sometimes result from malignant infiltration by germ cell tumors or other cancers. To prevent misdiagnosis and ensure timely treatment, a stereotactic biopsy is recommended. We hope this case provides a valuable reference for diagnosing and treating YSTs and contributes to ongoing research aimed at improving patient survival.

Omic characterizing and targeting gut dysbiosis in children with autism spectrum disorder: symptom alleviation through combined probiotic and medium-carbohydrate diet intervention - a pilot study

ABSTRACT Autism spectrum disorder (ASD) currently lacks effective diagnostic and therapeutic approaches. Disruptions in the gut ecosystem have been observed in individuals with ASD, suggesting that targeting gut microbiota through probiotic and dietary supplementation may serve as a potential treatment strategy. This two-phase study aimed to characterize the fecal metagenome of children with ASD and investigate the beneficial effects of a combined probiotic and medium-carbohydrate intervention in ASD. Fecal metagenomes of children with ASD were compared to those of typically developing children, revealing intestinal dysbiosis in ASD, characterized by reduced levels of Prevotella sp. Dialister invisus, and Bacteroides sp. along with increased predicted abundances of inosine, glutamate, xanthine, and methylxanthine. The gut bacteriome and phageome exhibited high cooperativity. In a 3-month pilot study, Bifidobacterium animalis subsp. lactis Probio-M8 (Probio-M8) was administered alongside a medium-carbohydrate diet to Chinese children with ASD. The primary endpoint was the Childhood Autism Rating Scale (CARS), while the secondary endpoint was the Gastrointestinal Symptom Rating Scale (GSRS). A total of 72 autistic children were initially recruited for the intervention study, but only 53 completed the intervention. Probio-M8, in combination with dietary intervention, significantly improved CARS and GSRS scores, increased fecal levels of Bifidobacterium animalis, Akkermansia muciniphila, Fusicatenibacter saccharivorans, and Sutterella sp. while also reducing Blautia obeum (Benjamini-Hochberg corrected p ≤ 0.05 for all cases). The intervention also modulated fecal metabolites associated with the metabolism of amino acids (lysine), neurotransmitters (glutamate, γ-aminobutyric acid), polyunsaturated fatty acids (arachidonate, myristic acid), and vitamin B3. In conclusion, Probio-M8 combined with medium-carbohydrate diet effectively improved ASD symptoms, with associated changes in the gut microbiome and metabolome, supporting its potential as an adjunctive therapy for ASD.

Anxiety and Depression Disorders in Undergraduate Medical Students During the COVID-19 Pandemic: An Integrative Literature Review

Introduction: The COVID-19 pandemic has triggered several challenges on the front of mental health. Undergraduate medical students face considerable stress in their academic routines. Thus, there is a need to explore the implications for the mental health of undergraduate medical students during the COVID-19 pandemic. Objective: To review the global literature about anxiety and depressive disorders in undergraduate medical students during the COVID-19 pandemic. Method: We developed an integrative literature review on the occurrence of anxiety and depressive symptoms in undergraduate medical students during the COVID-19 pandemic. We included the manuscripts that used the PHQ-9 and/or GAD-7 questionnaires. We excluded systematic reviews, narrative reviews, integrative reviews, meta-analyses, and qualitative analytical studies. We assessed the results on the occurrence of anxiety and depression and the severity of symptoms in medical students during the COVID-19 pandemic using quantitative studies applying the GAD-7 questionnaire for anxiety or the PHQ-9 for depression. Results: We reviewed 85 selected studies, and the results showed a significant prevalence of moderate and severe symptoms of anxiety and depression, with 28.2% of participants presenting scores of ≥ 10 on the GAD-7 and 38.9% on the PHQ-9. Statistical analyses using simple and multiple regression tests revealed associations between higher rates of anxiety symptoms among students from developing countries and data collected after the lockdown period in 2020 during the pandemic lockdown. In addition, female students were at risk of depressive disorders. We emphasize as a limitation that the diagnosis of depression and anxiety requires a detailed clinical evaluation, which is not focused on in this actual study. Conclusions: Our findings highlight the need for specific interventions to support the mental health of undergraduate medical students, especially female students from developing countries, during a pandemic crisis.

US of Acute Tendon Tears.

US is an effective tool for appraising acute tendon injury, allowing rapid evaluation of symptoms at bedside and paving the way for prompt diagnosis and treatment selection. It offers three main advantages in the acute or emergent setting. First, it is more sensitive and specific than physical examination. This is beneficial in tendons such as the distal triceps wherein incomplete and complete tears may manifest with similar clinical presentations. Tendon injury may also be clinically innocuous because bruising or a palpable defect is not always present and swelling may mask palpation of the tendon gap. Second, US provides important descriptors that may affect treatment selection, such as injury site, injury extent, and length of retraction. Pectoralis major tears at the tendon or musculotendinous junction warrant operative referral and are readily illustrated at US. A torn distal biceps tendon with significant retraction may require additional graft augmentation rather than reattachment to the insertion alone. Soleus and gastrocnemius strains may mimic each other clinically. Although both are managed conservatively, distinction between the two facilitates formulation of a specific rehabilitation regimen. Finally, US can narrow the differential diagnosis and rule out mimics of musculoskeletal abnormalities. Nonmusculoskeletal conditions, such as deep venous thrombosis and a ruptured Baker cyst, can manifest with the same clinical presentation as acute calf injuries and must be considered in a patient presenting with sudden calf, posterior leg, or ankle pain. The authors review the anatomic features, US techniques, and imaging findings of acute tendon injuries to aid in meaningful reporting and timely treatment selection. ©RSNA, 2024 Supplemental material is available for this article.

Acute gastrointestinal and post-acute COVID-19 gastrointestinal syndrome assessment on the Gastrointestinal Symptom Rating Scale scoring system: A questionnaire-based survey

ABSTRACT Background: Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is the persistence of sequel of acute SARS-COV-2 infection. Persistent/acquired gastrointestinal symptoms (GI-PACS) include loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility, dyspepsia, and irritable bowel syndrome. The study aimed to assess the short- and long-term GI-PACS syndrome on the GSRS scale. Methods: A cross-sectional, retrospective record analysis and telephonic questionnaire-based survey were conducted at a tertiary referral center in northern India. The data incorporated patients treated from April 2021 to March 2023. Exclusion criteria were neurological disorders, dementia, inability to understand Hindi/English languages, and psychiatric problems. All patients who met the inclusion criteria were telephonically called from November 2023 to January 2024. Results: The study population was 350 recovered patients from SARS-COVID-19 illness. Forty-three responses were removed during data cleaning and removal of duplication. The data analysis of 307 participants (ICU admissions=92, non-ICU admissions=123, and outdoor treatment =92) was done. The proportion of patients not having any GI symptoms, having at least one GI symptom, and having more than one GI symptom before SARS-COV-2 illness was 3%(3/307), 4.9% (15/307), and 3.6% (11/307), respectively. The four major GI symptoms analyzed in the study were vomiting, pain in the abdomen, diarrhea, and constipation. Overall, 13% (40/307) of the study population did not have any major GI symptoms before SARS-COV-2 diseases. During acute SARS-COV-2 illness, 86.97% (267/307) of patients develop new GI symptoms. Post SARS-COV-2 illness, the overall mean GSRS score for 15 items was 2.14 ± 0.829. The acquired GI-PACS was abdominal pain syndrome (mean score 2.5190 ± SD 0.86650), constipation syndrome (mean score 2.3844 ± 0.83840), reflux syndrome (mean score 2.2866 ± 1.31889), indigestion syndrome (mean score 1.8591 ± 0.93076), and diarrhea syndrome (mean score 1.8122 ± 0.90899). Overall, fever (95.1%, P = 0.007), anosmia (45.0%, P = 0.042), cough (80.1%, P = 0.032), and hospitalization (30.0%, P = 0.003) had a more significant association with one of the major four GI symptoms during the acute phase of SARS-COV-2 illness. Home-isolated patients having loss of appetite (95.4%, P = 0.0001) had a significant association with one of the major four GI symptoms during the acute phase of SARS-COV-2 illness. Hospitalized patients having fever (80.7%, P = 0.031), breathlessness (83.8%, P = 0.003), loss of smell (97.0%, P = 0.001), and cough (82.7%, P = 0.048) had a more significant association with one of the major four GI symptoms during the acute SARS-COV-2 illness. Abdominal pain, reflux, and constipation were considered severe GI symptoms (symptom GSRS score greater than total mean GSRS score). Diarrhea and indigestion were considered mild symptoms (symptom GSRS score was less than the total mean GSRS score). The GI symptoms during acute SARS-COV-2 illness recovered in 66.1% (203/307) patients within 3 months. The respondents taking medicines for more than 1 year following SARS-COV-2 illness were 19.2%. 12.0% (37/307) of respondents suffered from persistent GI symptoms on a mean follow-up of 20.1 ± 0.82 months. Conclusion: Long-term COVID-19 syndrome frequently manifested as GI symptoms, whereas most symptoms subsided with time.

Quality Of Life In Post Septorhinoplasty Our Experience

Background: The demand for Septorhinoplasty has significantly increased over past two decades due to increased personal interest, media awareness and advances in surgical techniques. This trend is most common in younger age group for both men and women. The quality of surgery, surgeon’s level of expertise and most importantly the patient’s level of expectation are important factors in patient satisfaction with Septorhinoplasty. Materials and Methods: After approval from ethics committee, a prospective observational study was taken at our tertiary care Centre for a period of 18 months in 32 patients of age group between 18 years to 50 years both males and females both literates and illiterates. NOSE (Nasal Obstruction Symptom Evaluation) questionnaire, which scores nasal function and ROE (Rhinoplasty Outcome Evaluation) questionnaire, which scores cosmetic status is used to measure the outcome evaluation questionnaire undertaken 1 day prior to surgery, 3 months and 6 months post-surgery and outcome noted Results: The mean pre and post operative nose score were 72.50± (15.34) and 19.06 ±(11.03) respectively. Post op NOSE score was significantly lower than pre op score (p&lt;0.0001). Post op ROE score 75.10± (10.66) were significantly higher than pre op score 28.10± (8.2) (p&lt;0.0001). Conclusion: The present study showed that in our patient population both form and function are overwhelming improved with septorhinoplasty

The Effect of Test Anxiety on Nutritional Habits, Anthropometric Measurements, and Gastrointestinal Symptoms in Adolescents

Objective: Since exam periods are used as a benchmark to determine academic achievement, they may result in increased anxiety, changes in dietary behavior, weight fluctuations and increased gastrointestinal symptoms in students. For this reason, this research was conducted to evaluate the effect of test anxiety on nutritional status and gastrointestinal symptoms in adolescents. Methods: This study was conducted with 104 senior high school students who agreed to participate in the study in a private and public school in Ankara 7 months before the exam and 1 month before the exam to evaluate the effect of exam anxiety on nutritional status and gastrointestinal symptoms of students preparing for the university exam. Health status, nutritional status, anthropometric measurements, information about exam anxiety, International Physical Activity Questionnaire Short Form, Test Anxiety Inventory, Gastrointestinal Symptom Rating Scale, Food Frequency Questionnarie (FFQ) were asked to the students. Results: In both genders, the mean BMI-Z score increased during the second evaluation, indicating a significant difference in various dietary and lifestyle factors such as meal frequency, water intake, and nutrient intake. Most students were classified as minimally active. Additionally, the total score of affective, delusional, and test anxiety inventory increased closer to the exam date. Weak positive correlations were observed between gastrointestinal symptoms and affective, delusional, and test anxiety scores during the first evaluation, while a moderately strong positive correlation emerged during the second evaluation. Conclusion: The results of the current study support that students experience increased gastrointestinal symptoms during the exam period. Nutrition and stress reduction educations should be given in high schools both during and before the exam period in a multidisciplinary team consisted of dietitians and psychologists in order to provide healthy stress management.

A retrospective single-center study of transnasal ileus tube insertion accompanied with cap-assisted endoscopic advancement for malignant adhesive bowel obstruction

To investigate the effectiveness of cap-assisted endoscope synchronous advancement and tube direction adjustment for inserting transnasal ileus tubes in patients with malignant adhesive bowel obstruction (MABO). 25 patients with cap-assisted endoscopic synchronous method (Group A, Dec 2023–Apr 2024) were reviewed retrospectively. Accordingly, those with forceps-grasping method (Group B: 27, Aug 2022–Nov 2023) were included as controls. Both groups were similar in terms of age, sex, primary tumor, doctor experience distribution and technical success rate. The proportion of gynecological cancers was the highest in either group. The time required for insertion was shorter in Group A than in Group B (5 vs. 12 min; P = 0.000). Group A also had slightly longer tube insertion length than Group B (129.8 ± 14.1 vs. 121.3 ± 12.0 cm; P = 0.008), and the remission rate of intestinal obstruction symptoms in Group A was similar to that in Group B (75.0% vs. 74.1%; P = 0.940). There were no significant differences in complications between the two groups. One patient suffered MABO recurrence 14 days after withdrawal of the tube. Our findings indicate that transnasal ileus tube insertion with cap-assisted endoscopic synchronous method took shorter time and had the same rate of technical success and advantage of decompression compared with forceps-grasping method.

Sling fiber preservation during POEM reduces incidence of postoperative reflux symptoms.

Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) has been a limiting factor with POEM. Sling-fiber preservation during POEM was reported to reduce postoperative GERD in Japan. This study investigates the efficacy of this technique in a western population. This is a retrospective, single-center study of patients undergoing POEM from October 2017 to January 2023. The initial cohort of patients were treated by conventional POEM, after which a second cohort underwent POEM with sling-fiber preservation. The primary outcome was the incidence of postoperative reflux symptoms. The secondary outcomes were clinical success rate (Eckardt score≤3), procedure time, and adverse events rate. Multivariate regression was then performed to identify factors associated with the incidence of postoperative reflux symptoms. One hundred and forty eight POEM cases (52.5 ± 15.6y/o, female: 61[43%]) were included. The mean procedure time (108.6 ± 34.5 vs. 109.1 ± 45.7min, P = 0.93) was similar between the groups. In the sling-fiber preservation group, gastric myotomy length was significantly longer (2.2 ± 0.7 vs. 1.6 ± 0.8cm, P < 0.05), yet the incidence rate of postoperative reflux symptoms at follow-up was significantly lower (22.4% vs. 42.3%, P < 0.05). The clinical success rate was similar between groups (89.5% vs. 83.1%, P = 0.32), and the rate of adverse events requiring intervention (13.5% vs. 12.2%, P = 0.36) was similar. Regression analysis indicated that, after adjusting for other risk factors of postoperative GERD, sling-fiber preservation during POEM had an odds ratio of 0.24 (95% CI: 0.07-0.85, P < 0.05) for the incidence of reflux symptoms. Sling-fiber preservation during POEM reduces the incidence of postoperative reflux symptoms. As such, sling-fiber preservation may be a useful solution to reduce post-POEM GERD in western populations.

Temperament and executive functioning correlates of ADHD symptom severity during early versus middle childhood.

This study investigated associations among temperament, executive functioning (EF), and attention-deficit/hyperactivity disorder (ADHD) symptom severity at two developmental stages. Participants were 61 4-year-old children and 165 8-11-year-old children (126 ADHD, 39 typically developing [TD]). Caregivers reported on temperament (effortful control [EC], negative affect, and surgency), and ADHD symptoms. Three aspects of EF (working memory, inhibitory control, and processing speed) were measured with neuropsychological tests. Among 4-year-olds, variance in ADHD symptom severity was only explained by the temperament variables. EC was not significantly correlated with any of the EFs in this cohort. Among school-aged children, low EC, high surgency, high negative affect, and reduced working memory were associated with greater ADHD symptom severity. EC was significantly and positively correlated with processing speed in the school-aged children. Results are consistent with a neurodevelopmental model of ADHD, wherein dysregulated temperament is associated with ADHD in young children, while both dysregulated temperament and cognitive skills are associated with ADHD in middle childhood. Results could inform the selection of clinical tools for diagnostic evaluation of pediatric ADHD symptoms and clinical follow-up.

Coronary Artery Disease and Microvascular Ischemia in Patients with Cardiac Amyloidosis

Introduction: The prevalence of pre-existing obstructive coronary artery disease (CAD) and the occurrence of anginal chest pain as a presenting symptom in patients with light chain (AL) and transthyretin (ATTR) cardiac amyloidosis (CA) are undetermined. Methods: A single-center analysis of clinical, laboratory, imaging and angiographic characteristics of CA cohort. Results: Included were 98 CA patients (43 AL, 47 wtATTR, 8 mutant ATTR). Eighteen patients (18%) had pre-existing obstructive CAD at the time of CA diagnosis. These patients were older and had worse left ventricular ejection fraction, yet revealed similar cardiac biomarkers’ levels. The 3-year survival rate was comparable between patients with versus without pre-existing CAD (p=0.974). Anginal chest pain was a presenting symptom of newly-diagnosed CA in 24% (n=19) of patients with no pre-existing CAD, 53% (n=10) of which had AL-CA. Two patients had an acute myocardial infarction. The prevalence of diabetes mellitus, dyslipidemia, hypertension and smoking was similar among CA patients presenting with versus without chest pain. Of the newly-diagnosed CA patients with no pre-existing CAD who underwent symptoms evaluation (n=37), 99mTc-Sestamibi myocardial perfusion scintigraphy demonstrated stress-induced perfusion defects in 45% (9/20) and normal study in 45% (9/20) of patients. Coronary evaluation revealed non-obstructive coronary artery lesions or normal coronaries in 75% of patients (18/24). Conclusion: CA patients may initially present with anginal chest pain and myocardial perfusion defects which may reflect coronary microvascular ischemia. CA should be considered in the differential diagnosis of patients presenting with chest pain, non-obstructive CAD and elevated cardiac biomarkers.

Symptom burden and clusters during chemotherapy in patients with lung cancer

ObjectiveThis study aims to investigate the distribution characteristics of symptoms in patients with lung cancer during chemotherapy, identify the symptom clusters (SCs) and explore the underlying mechanisms. The findings will provide evidence to assist clinical staff in effectively managing symptoms and SCs.MethodsParticipants were recruited from the Oncology Department of Guang’anmen Hospital, China Academy of Chinese Medical Sciences, between July 2022 and December 2022. The incidence and severity of symptoms were assessed and SCs were identified. Spearman’s correlation analysis was used to examine the correlation between lung cancer-specific SC and routine blood indices.ResultsA total of 169 patients participated in the study. The most prevalent and severe symptom was loss of appetite. Based on the occurrence rate and severity of symptoms, SC extraction was performed for mild, moderate, and severe symptoms, resulting in the identification of five SCs: psycho-emotional SC, chemotherapy-related SC, lung cancer-specific SC, urinary-related SC, and gastrointestinal SC. When only the moderate and severe symptoms were considered, two SCs were identified: chemotherapy-related SC and lung cancer-specific SC. Additionally, the lung cancer-specific SC showed a negative correlation with eosinophils.ConclusionPatients with lung cancer undergoing chemotherapy experience complex and diverse symptoms. A total of five SCs were extracted based on mild, moderate and severe symptoms and two SCs were extracted based on moderate and severe symptoms. The results of the study showed that lung cancer-specific SC was negatively correlated with eosinophils. Future research should focus on developing and refining research tools, methodologies, understanding the pathogenesis, and exploring intervention measures for SCs.