Follow-up Visit Research Articles

Benign Evolution of Complex Regional Pain Syndrome (CRPS) Type 1 in Patients Treated with Intravenous Neridronate: A Single-Center Real-Life Experience

Objective: To investigate the long-term effects of intravenous neridronate treatment in patients with complex regional pain syndrome type 1 (CRPS) in a real-life setting. Methods: We conducted a retrospective study on consecutive CRPS patients treated at our hospital from February 2018 to July 2023. All were treated within three months of the onset of CRPS symptoms. The Patient-Reported Outcomes Measurement Information System 29-Item Health Profile (PROMIS-29) version 2.1 was administered. The main outcome of interest was the evolution of the PROMIS-29 scores from baseline to the last follow-up visit. Patients were categorized as “complete responders” or “non-complete responders”. The association of clinical and demographic variables with a complete response was analyzed using chi-square tests and univariate logistic regression. Results: Thirty-six patients were included, with a median follow-up time of 4.8 years. A significant improvement was noted in the mean numerical pain rating scale (from 6.4 ± 1.9 to 3.1 ± 2.4, p < 0.001), as well as across all PROMIS-29 domains. Physical function improved from 34.2 ± 4.9 to 49.2 ± 9.9, p < 0.001; anxiety from 58.0 ± 6.7 to 49.6 ± 6.9, p < 0.001; depression from 55.3 ± 6.3 to 47.7 ± 6.6, p < 0.001; fatigue from 55.7 ± 7.7 to 50.9 ± 8.7, p < 0.001; sleep disturbance from 53.8 ± 6.8 to 51.3 ± 6.6, p = 0.034; social roles and activities from 41.8 ± 5.2 to 51.8 ± 8.9, p < 0.001; and pain interference from 64.1 ± 5.9 to 52.4 ± 9.9, p < 0.001. The likelihood of achieving a complete response was associated with the male sex, foot or ankle injuries (compared to hand and wrist injuries), and a younger age. No association was found with the type of inciting event or with the body mass index. Conclusions: Our real-life data indicate that early treatment with neridronate leads to substantial benefits in patients affected by CRPS type 1. The strongest responses are seen in young patients, males, and those with lower limb involvement.

Retreatment and aesthetic restoration of maxillary incisor with calcified root canal using a dynamic navigation system: a case report

BackgroundPulp canal occlusion (PCO) increases the difficulty of root canal treatment as well as tooth preservation and restoration. This is the first case report of successful localization of a calcified root canal under the guidance of a dynamic navigation system (DNS) for complete root canal retreatment and aesthetic restoration after a failed attempt to locate the calcified root canal with a traditional dental operating microscope (DOM).Case presentationThe patient was scheduled for root canal treatment for a labially inclined maxillary central incisor and post-core crown restoration with resin veneers in another hospital, but the calcified root canal could not be located with a microscope, so the patient was referred to our department. Root canal retreatment was planned for tooth #8, and the calcified root canal of tooth #9 was planned to be located and dredged under the guidance of a DNS. We used a DNS for successful positioning and to complete the root canal retreatment operation in the following 4 steps: preoperative CBCT imaging, preoperative plan design, calibration and registration, and real-time dynamic navigation. Three months later, teeth #8 and #9 presented no clinical symptoms, after which the fiber post-cores and zirconia all-ceramic crown restorations were completed. At the 12-month follow-up visit, the patient continued to be symptom­free, and satisfied with the final aesthetic restoration.ConclusionsThis case report suggests that DNS may be a promising technique with high accuracy and effectiveness to reduce the risk of iatrogenic errors and provide maximal preservation of dentin, when the traditional treatment of calcified root canals approaches failure (lateral perforation).

Anxiety and Depression Are Associated with Poor Long-term Quality of Life in Moderate-to-Severe Ulcerative Colitis: Results of a 3-Year Longitudinal Study of the MOSAIK Cohort.

We previously reported that patients with moderate-to-severe ulcerative colitis (UC) often experience common mental disorders (CMDs) such as anxiety and depression, necessitating immediate psychological interventions within the first 4 weeks of diagnosis. In this 3-year follow-up study of the MOSAIK cohort in Korea, we examined the effects of CMDs at initial diagnosis on clinical outcomes and health-related quality of life (HRQoL). We examined differences in clinical outcomes (evaluated based on clinical response, relapse, hospitalization, and medication use) and HRQoL (assessed using the Inflammatory Bowel Disease Questionnaire [IBDQ] and Short Form 12 [SF-12]) according to Hospital Anxiety and Depression Scale (HADS) scores at diagnosis. In a study involving 199 UC patients, 47.7% exhibited significant psychological distress (anxiety and/or depression) at diagnosis. Clinical follow-up showed no major differences in outcomes, including remission rates, response rates, or hospitalization rates, between patients with anxiety or depression at diagnosis and patients without anxiety or depression at diagnosis. The HRQoL at the end of follow-up was notably lower in those with baseline CMDs, particularly anxiety, across all domains of the IBDQ and SF-12. Linear mixed-effect models revealed that higher HADS scores, as well as higher Mayo scores, were independently associated with lower IBDQ scores and both summary domains of the SF-12. Additionally, regular attendance at follow-up visits during the study period was also related to improvements in HRQoL (all p<0.05). While CMDs present at the time of UC diagnosis did not influence long-term clinical outcomes, they persistently impaired HRQoL. Our findings support the routine incorporation of psychological interventions into the long-term management of moderate-to-severe UC.

Association between weight and body composition changes with falls risk in the Malaysian Elders Longitudinal Research (MELoR) study

ObjectiveBoth changes in body composition and increased fall risk occur with increasing age. While weight management may be considered a component of falls prevention, the long-term consequences of changes in...

Association Between Follow-Up Visit Timing After A Concussion and Subsequent Care Seeking in Children and Youth: A Population-Based Study in British Columbia.

To assess the relationship between follow-up visit timing and occurrence of the first subsequent health care seeking visit. The province of British Columbia, Canada. A total of 21029 children and youth who were diagnosed with an initial concussion from January 1, 2016, to December 31, 2017. These data were obtained from Population Data BC. A retrospective, descriptive correlational study. Follow-up timing was measured categorically as timely (4weeks), delayed (1-3months), or no follow-up; the occurrence of a subsequent health care visit beyond 3months postinjury was measured up to 12months at 3-month intervals (ie, 4-6, 7-9, and 10-12months). These variables were measured using diagnostic codes for concussion, post-concussion syndrome, and the 17 concussion symptoms. After controlling for sociodemographic characteristics, having a delayed follow-up, relative to timely follow-up, was associated with higher odds of a subsequent health care seeking visit at 4 to 6months (odds ratio [OR]=2.68; confidence interval [CI], 2.08-3.47), 7 to 9months (OR=1.71; CI, 1.21-2.40), and 10 to 12months (OR=1.67; CI, 1.13-2.48). In contrast to having a delayed follow-up, having no follow-up, relative to timely follow-up, was associated with not having a subsequent health care seeking visit at 4 to 6months (OR=0.57; CI, 0.48-0.67) and 7 to 9months (OR=0.79; CI, 0.66-0.96), respectively. Follow-up visit timing after a concussion in children and youth is associated with subsequent health care seeking. Greater efforts are needed to investigate the importance of initial follow-up visit timing, as they may play an integral role in injury prevention and symptom management following injury.

Survival Outcomes of Patients with Primary Plasma Cell Leukemia in the Era of Proteasome Inhibitors and Immunomodulatory Agents: A Real-Life Multicenter Analysis.

In this study, we aimed to obtain real-life data on the use of antimyeloma agents, which significantly increase overall survival (OS) in multiple myeloma (MM) patients, in primary plasma cell leukemia (pPCL) patients with a poor prognosis. Data from 53 patients who were diagnosed with pPCL between 2011-2020 and who used at least one proteasome inhibitor (PI) and/or immunomodulatory (IMID) agent were analyzed retrospectively. Depending on the year of pPCL diagnosis, 20% leukocytes or ≥2×109/L plasma cells in the peripheral blood were used. The median age of the patients was 58 years, and 23 (43.4%) patients were over 65 years of age. For first-line treatment, PI or IMID alone was used in 31 (58.5%) patients, and PI and IMID were used simultaneously in 15 (28.3%) patients. Additionally, 21 (39.6%) patients received transplantation, and 13 (24.5%) patients received maintenance treatment. The median progression-free survival was 4 (1-42) months. When patients whose primary disease was refractory to first-line therapy were excluded, the duration of treatment was 6.5 months. The median OS was 15 months, with a median follow-up of 15 months. Only 7 (13.2%) of the patients were alive at the last follow-up visit. Those with higher beta-2 microglobulin levels and ISS stage 3 and nontransplant patients receiving first-line treatment had shorter OS (p=0.005, p=0.02 and p=0.008, respectively). Otherwise, the concomitant use of PIs and IMIDs, the addition of chemotherapy to induction therapy, and the response to induction therapy or maintenance therapy did not affect OS. In our study, as in previous similar studies, we could not see the increased survival trend in pPCL which is observed in MM. New studies are needed for pPCL patients, which is likely to increase with the new diagnostic criteria, based on current agents and information in MM.

A study of metamorphopsia following rhegmatogenous retinal detachment surgery

AbstractPurposeOur objective was to quantitatively investigate metamorphopsia in patients who had undergone pars plana vitrectomy for rhegmatogenous retinal detachment at the Department of Ophthalmology of the University of Szeged. We aimed to compare our findings with perioperative clinical data, and in particular the patients' optical coherence tomography (OCT) results.Materials/MethodsOur study is a retrospective analysis of data from 23 patients who had undergone surgery for retinal detachment. We evaluated best corrected visual acuity (BCVA), metamorphopsia (MM) using M-CHARTS, and macular morphological abnormalities using OCT images in patients who attended regular follow-up visits 1–6 months after the surgery.ResultsThe mean preoperative BCVA of the patients was 0.4, while the mean postoperative BCVA was 0.6, indicating a significant improvement (P = 0.03). We observed a negative correlation between preoperative BCVA and postoperative MM (Pearson's r = −0.27), indicating that lower preoperative BCVA was associated with higher postoperative MM. Additionally, we noted a strong trend between disintegration of the ellipsoid zone (EZ), abnormality of the external limiting membrane (ELM), and MM (P = 0.051 and 0.072 respectively).ConclusionsWhile no significant correlation was found between MM and specific perioperative factors, we observed a notable trend between EZ disintegrity and MM, as well as abnormal ELM and MM. This trend is anticipated to become significant with higher numbers of patients.

Sex-specific dietary habits and their association with weight change in healthy adults

BackgroundDietary intake plays a pivotal role in the prevalence and management of obesity. While women and men exhibit differences in dietary habits and food-related behaviors, sex-based weight loss recommendations are lacking. This study aims to examine the impact of specific foods and food categories on weight reduction in men and women over a two-year period.MethodsA total of 8,548 participants from the 10K cohort, from 2019 to 2023, were included in the analysis (53.1% women, mean age 51.7 years). Anthropometric measurements and laboratory results were collected at baseline and at the two-year follow-up visit. Dietary assessment was based on daily food intake digitally logged through an application for at least 3 consecutive days at both timepoints. We compared intake of macronutrients, micronutrients, food groups and daily energy consumption between sex and body mass index (BMI) categories at baseline and weight change categories at follow-up. Using linear regression, we assessed the associations between food categories or specific foods and BMI at baseline as well as weight change percentage at follow-up.ResultsDietary habits varied by BMI and sex. Women and men living with obesity (BMI > 30 kg/m2) reported a greater intake of animal-based protein and lower intake of plant-based proteins and fats at baseline, as compared to participants with normal weight. In linear regression models predicting two-year weight change, including age, income, and baseline weight, the explained variance was 5.6% for men and 5.8% for women. Adding food categories and specific foods increased the explained variance to 20.6% for men and 17.5% for women. Weight reduction in men was linked to daily consumption of an egg (1.2% decrease) and beef (1.5% decrease), while in women, the most pronounced reductions were associated with an apple (1.2% decrease) and cashew nuts (3.4% decrease). Notably, total energy intake changes significantly impacted weight outcomes only in women.ConclusionsSex-specific dietary habits significantly influence weight change over time. In men, weight loss was primarily associated with the addition of animal-based protein, while in women, it was linked to caloric deficit and plant-based fat, suggesting that sex-based nutritional interventions may demonstrate greater efficacy.Trial registrationNCT05817734 (retrospectively registered January 31, 2023).

Identification of meaningful individual-level change thresholds for worsening on the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®).

We derived meaningful individual-level change thresholds for worsening in selected patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®) items and their composite scores. We used two data sources, the PRO-TECT trial (Alliance AFT-39) that collected PRO-CTCAE data from adults with advanced cancer at 26 United States (U.S.) community oncology practices and the PRO-CTCAE validation study that collected PRO-CTCAE data from adults undergoing chemotherapy or radiation therapy at nine U.S. cancer centers or community oncology practices. Both studies administered selected PRO-CTCAE items and EORTC QLQ-C30 scales. Conceptually, relevant QLQ-C30 domains were used as anchors to estimate meaningful change thresholds for deterioration in corresponding PRO-CTCAE items and their composite scores. Items or composites with ǀρǀ ≥ 0.30 correlation with QLQ-C30 scales were included. Changes in PRO-CTCAE scores and composites were estimated for patients who met or exceeded a 10-point deterioration on the corresponding QLQ-C30 scale. Change scores were computed between baseline and the 3-month timepoint in PRO-TECT, and in the PRO-CTCAE validation study between baseline and a single follow-up visit that occurred between 1 and 7weeks later. For each PRO-CTCAE item, change scores could range from - 4 to 4; for a composite, change scores could range from - 3 to 3. Change scores in QLQ-C30 and PRO-CTCAE were available in 406 and 792 patients in PRO-TECT and the validation study, respectively. Across QLQ-C30 scales, the proportion of patients with a 10-point or greater worsening on QLQ-C30 ranged from 15 to 30% in the PRO-TECT data and 13% to 34% in the validation data. Across PRO-CTCAE items, anchor-based meaningful change estimates for deterioration ranged from 0.05 to 0.30 (mean 0.19) in the PRO-TECT data and from 0.19 to 0.53 (mean 0.36) in the validation data. For composites, they ranged from 0.06 to 0.27 (mean 0.17) in the PRO-TECT data and 0.22 to 0.51 (mean 0.37) in the validation data. In both datasets, the minimal meaningful individual-level change threshold for worsening was one point for all items and composite scores. gov: NCT03249090 (AFT-39), NCT02158637 (MC1091).

Phenome-wide associations of human aging uncover sex-specific dynamics.

Aging varies significantly among individuals of the same chronological age, indicating that biological age (BA), estimated from molecular and physiological biomarkers, may better reflect aging. Prior research has often ignored sex-specific differences in aging patterns and mainly focused on aging biomarkers from a single data modality. Here we analyze a deeply phenotyped longitudinal cohort (10K project, Israel) of 10,000 healthy individuals aged 40-70 years that includes clinical, physiological, behavioral, environmental and multiomic parameters. Follow-up visits are scheduled every 2 years for a total of 25 years. We devised machine learning models of chronological age and computed biological aging scores that represented diverse physiological systems, revealing different aging patterns among sexes. Higher BA scores were associated with a higher prevalence of age-related medical conditions, highlighting the clinical relevance of these scores. Our analysis revealed system-specific aging dynamics and the potential of deeply phenotyped cohorts to accelerate improvements in our understanding of chronic diseases. Our findings present a more holistic view of the aging process, and lay the foundation for personalized medical prevention strategies.

A Case Study of Urinary Tract Infection and its Ayurveda Management

A Urinary Tract Infection (UTI) is the most common bacterial infection encountered in daily medical practice. It is more prevalent in females than males due to the shorter urethra in females, which allows bacteria a quicker access to the bladder. One in five women develop UTI at least once in her lifetime. UTIs in men are uncommon, but when they do occur, they can be very serious. In Ayurveda, the symptoms of UTI closely resemble a condition known as Mutrakriccha. Acharya Charaka has explained eight types of Mutrakriccha in Charaka Chikitsa Sthana 26. In this condition, the aggravated Pitta Dosha, along with Apana Vayu, reaches the Vasti (bladder) and affects the Mutravaha Srotas, leading to painful and burning urination. In this case report, a 50-year-old male patient presented with symptoms of urinary urgency, increased frequency, and intermittent burning urination for the past 1-2 months. He was diagnosed with UTI and was effectively managed with Syp. Neeri, Chandraprabha Vati, Gokshuradi Guggulu, Shweta Parpati, and Hajaralyahud Bhasma. The treatment resulted in significant improvement in signs, symptoms, and urine examination results. During follow-up visits, there were no recurrences of UTI. Ayurvedic management offers a promising alternative for treating Mutrakriccha.

Recording of non-musculoskeletal manifestations, comorbidities, and safety outcomes in European spondyloarthritis registries: a survey

Abstract Objectives Real-world evidence is needed to inform treatment strategies for patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), who have non-musculoskeletal manifestations (NMM), various risk factors, and comorbidities. International collaboration is required to ensure statistical power and to enhance generalisability. The first step forward is identifying which data are currently being collected. Across 17 registries participating in the European Spondyloarthritis research collaboration, we aimed to map in a survey recording practices for NMMs, comorbidities, and safety outcomes in patients with PsA and axSpA. Methods Through a survey with 4,420 questionnaire items, we explored the recording practices of 58 pre-defined conditions (ie, NMMs, comorbidities, and safety outcomes) covering 10 disease areas. In all registries we mapped for each condition 1) whether it was recorded, 2) the recording procedure, and 3) the potential to identify it through linkage to other national registries. Results Conditions were generally recorded at entry into the registry and clinical follow-up visits using a pre-specified list or a coding system. Most registries recorded conditions within the following disease areas: NMMs (number of registries, n = 15–16), cardiovascular diseases (n = 10–14), gastrointestinal diseases (n = 12–13), infections (n = 10–13), and death (n = 14). Nordic countries had the potential for data linkage and generally had limited recording of conditions in their registry, while other countries had comprehensive recording practices. Conclusion A wide range of conditions were consistently recorded across the registries. The recording practices of many conditions and disease areas were comparable across the registries. Our findings support the potential for future collaborative research.

Resilience and spiritual well-being as resources for coping with radiotherapy and surviving in patients with glioblastoma.

The primary aims of this multicenter, prospective observational study were to investigate spiritual well-being, resilience, and psychosocial distress in an Italian sample of glioblastoma patients undergoing radiochemotherapy. The secondary aim was to explore the influence of demographic, clinical, and psychological characteristics on survival. The assessment was conducted only once, within the first week of radiochemotherapy treatment. Spiritual well-being was evaluated by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp-12), and religious/spiritual beliefs and practices were evaluated by the System of Belief Inventory. Resilience was evaluated by the Connor-Davidson Resilience Scale (CD-RISC). Psychosocial distress was evaluated the by Distress Thermometer and Hospital Anxiety Depression Scale. We conducted an univariable analysis of overall survival (OS) using data from the most recent follow-up available, considering demographic and clinical variables that could influence survival. Follow-up was defined as either the time of death or the latest follow-up visit recorded. We recruited 104 patients, and the median follow-up time was 18.3 months. "Distressed" patients had lower scores than "not distressed" patients on the FACIT-Sp-12 and CD-RISC. While OS was not significant according to the FACIT-Sp-12 threshold, the Kaplan-Meier log-rank test was 0.05 according to the CD-RISC threshold. Among demographic variables, age showed significant associations with OS (p = 0.011). Resilience showed significant associations with OS (p = 0.025). Data showed that high spiritual well-being was associated with high resilience and an absence of psychosocial distress in our sample of glioblastoma patients undergoing radiochemotherapy. Patients with greater resilience survived longer than those with lesser resilience. Profiling spiritual well-being and resilience in glioblastoma patients undergoing radiochemotherapy can be seen as a resource to identify novel characteristics to improve clinical take-in-charge of glioblastoma patients.

Long-term clinical outcomes of remote monitoring for implantable cardioverter-defibrillators in Singapore.

Remote monitoring (RM) for cardiac implantable electronic devices is on the rise and has been shown to reduce the burden of in-clinic follow-up visits. We aimed to investigate the long-term clinical outcomes of RM versus no RM. This was a prospective, single-centre cohort study of consecutive patients with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy-defibrillator (CRT-D) followed up from 2018 to 2023. Patients who received non-ICD devices were excluded. In general, RM was offered to all patients, but uptake depended on patient preference. For data analysis, patients were stratified according to whether RM was used. The primary outcome was all-cause mortality; secondary outcomes were hospitalisation for heart failure and device therapy (shocks and electrical storm). Of 551 patients, 284 (51.5%) received RM and 267 (49.5%) did not. Baseline demographics were similar between the two arms. All-cause mortality was significantly lower in RM versus non-RM patients (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.33-0.60, P <0.001), as was hospitalisation for heart failure (HR 0.39, 95% CI 0.25-0.59, P <0.001); these remained significant after adjustment for baseline covariates. More patients on RM received appropriate antitachycardia pacing (ATP) (17.6% vs. 10.7%, P = 0.035) and appropriate shocks (24.1% vs. 14.7%, P = 0.017). The incidences of inappropriate ATP, inappropriate shocks and electrical storm were similar. More patients on RM underwent pulse generator change (34.1% vs. 10.1%, P <0.001). Remote monitoring was associated with significantly lower mortality in both ICDs and CRT-Ds and in primary and secondary indications, as well as fewer heart failure hospitalisations. This supports current guidelines recommending the use of RM in all patients with ICD or CRT-D.

Tracking and Transition Probability of Blood Pressure From Childhood to Midadulthood

Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied. To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points. The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years). BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults. Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models. This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71). Results of this cohort study reveal an enduring association of childhood and adolescent BP (AAP thresholds) with later BP. Although childhood normal BP tends to be maintained into adolescence, the probability of reverting to and sustaining normal BP decreases notably from adolescence to young adulthood. The findings of this study underscore the importance of prevention to maintain normal BP starting in childhood, suggesting adolescence as a potential critical period. The results suggest the potential for less frequent screenings for children with initially normal BP.

The cross-sectional and longitudinal associations between fruit intake and cognitive performance: the Chinese Healthy Dance Study

ObjectiveTo analyse the association between fruit consumption and cognitive performance in middle-aged and older adults in China. MethodsParticipants were drawn from the Chinese Square Dance Cohort. The cross-sectional dataset included 4316 individuals, with their first visit from August 2020 to August 2023. The longitudinal dataset included 1465 participants, with their first visit from August 2020 to December 2021 and follow-up visits from August 2022 to December 2023. Fruit consumption was assessed using a food frequency questionnaire. Standardised neuropsychological assessments were used to measure composite z-scores of cognitive performance, and prevalent and incident mild cognitive impairment. ResultsIn the cross-sectional analysis, higher quartiles of citrus fruit, drupe, berry, and tropical fruit consumption were associated with higher composite z-scores for cognitive performance and lower odds of prevalent mild cognitive impairment. In the longitudinal analysis, there was a positive association between higher quartiles of citrus fruit intake and the annual rate of change in the composite z-scores for cognitive performance; standardised regression coefficient (95 % confidence interval) for the highest compared with the lowest quartile was 0.05 (0.02–0.08). Moreover, an association between higher quartiles of citrus fruit intake and a lower risk of incident mild cognitive impairment was detected; in the comparison of the highest with the lowest quartile, the risk ratio (95 % confidence interval) was 0.56 (0.36–0.88). ConclusionsThe relationship between fruit consumption and cognition varies across the different categories of fruit. Cognitive benefits of citrus fruit consumption were found for middle-aged and older adults. Ascertaining this association might enhance comprehensive dietary recommendations for fruit consumption.

Stereotactic Radiosurgery for Choriocarcinoma Brain Metastases: Illustrative Case Presentation and Systematic Review

BackgroundChoriocarcinoma (CC) is a rare and aggressive form of germ cell tumor. There is limited evidence reporting outcomes in patients with primary CC and brain metastases (BM). To date, only a few single case reports have documented the use of SRS for CC BM. MethodsWe retrospectively assessed patients who were treated with SRS for pure CC BM from 1998-2024. Lesion follow-up sizes and local tumor control status were evaluated after SRS treatment using RECIST criteria. A comprehensive literature search was performed for CC BM in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ResultsIn our series, 3 patients with 7 CC BM underwent SRS. Two were male with testicular CC and one was female with gestational CC. The median diameter of the lesions was 8 mm with a median volume of 0.14 cm3 at treatment. The MRIs at 3 and 6 months demonstrated reductions in median diameters to 6 mm and 4 mm, respectively. At the last follow-up visits, one lesion had local progression at 15 months after SRS and one lesion had sustained complete response. Our systematic review yielded 249 articles. After screening, a total of 18 reports were identified for CC BM. Among these, only three single cases documented the use of SRS for CC BM. ConclusionSRS is a feasible and viable approach for CC BM, particularly in cases where immediate surgical management is not necessary. This is yet the largest report evaluating the outcome of CC BM treated with SRS.

A new portable negative pressure wound therapy device: a prospective study investigating clinical outcomes.

Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites. The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected. Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported. In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use.

Frailty and Behavioral and Psychological Symptoms of Dementia: A Single Center Study

Background: During the time-course of cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, negatively impacting the outcomes. Methods: The aim of this single center, longitudinal study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified into three clusters: “mood/apathy” (depression, apathy, sleep disturbances, appetite disturbances), “psychosis” (delusions, hallucinations, and anxiety), and “hyperactivity” (agitation, elation, motor aberrant behavior, irritability, disinhibition). Using the Clinical Frailty Scale (CFS), patients were categorized as “severely frail”, “mild/moderately frail” and “robust” (CFS ≥ 7, 4–6, and ≤ 3, respectively). Results: In total, 209 patients (mean age 83.24 ± 4.98 years) with a clinical diagnosis of dementia were enrolled. BPSD were prevalent among the severely frail patients. A positive correlation at regression analysis was found between frailty and “hyperactivity” cluster at baseline and follow-up visits (p &lt; 0.001, p = 0.022, p = 0.028, respectively), and was confirmed at the network analysis. Loss of independence in IADL was correlated to hyperactivity and psychosis symptoms (p &lt; 0.001 and p = 0.013, respectively). Conclusions: Scarce literature is available regarding the correlation between frailty and BPSD, which in our study is significant, especially for symptoms in the hyperactivity cluster. Frailty assessment may help identify patients at the highest risk for developing BPDS who might benefit from targeted intervention in the earliest phases of the disease.

Corneal Allogenic Intrastromal Ring Segments (CAIRS) Versus Synthetic Segments: A Single Segment Comparative Analysis Using Propensity Score Matching.

To compare and assess the visual, refractive, and tomographic results of patients with corneal ectasia treated with either corneal allogenic intrastromal ring segments (CAIRS) or synthetic intrastromal corneal ring segments (ICRS) without concomitant corneal cross-linking. In this retrospective cohort study, 34 eyes with CAIRS were matched to 34 eyes with ICRS using the propensity score matching technique. Each group was matched on a oneto-one basis using multiple parameters such as central corneal thickness, vertical and horizontal coma, maximum anterior keratometry, steepest keratometry, and age. Visual, refractive, topographic, and aberrometric data were measured at baseline, 1 week, 1 month, 3 months, and 1 year postoperatively. Initial preoperative parameters were similar between the two groups. Both groups showed significant improvement at last follow-up time in corrected distance visual acuity (CDVA) (0.52 ± 0.23 to 0.16 ± 0.18 logarithm of the minimum angle of resolution [logMAR], P < .001; 0.44 ± 0.27 to 0.17 ± 0.21 logMAR, P < .001), topographic astigmatism (4.45 ± 2.75 to 3.14 ± 1.93 diopters [D], P = .001; 3.66 ± 2.22 to 2.36 ± 1.46 D, P = .007), maximum anterior keratometry (55.85 ± 7.53 to 50.69 ± 6.38 D, P < .001; 54.59 ± 6.95 to 50.71 ± 4.51 D, P = .003), and vertical coma (1.49 ± 1.02 to 0.38 ± 0.65 D, P < .001; 1.22 ± 0.75 to 0.52 ± 0.57 D, P < .001) for CAIRS and ICRS, respectively. The improvements observed in both groups at the last follow-up visit were comparable; however, the CAIRS group demonstrated a higher percentage of eyes gaining two or more Snellen lines of CDVA (60% vs 31.58%, P = .04), and a greater magnitude of reduction in vertical coma compared to the ICRS group, although this difference did not reach statistical significance. No major complications were observed with both groups, and one eye lost one CDVA line in the ICRS group. The mean thickness of the CAIRS segments at the last follow-up visit was 401.06 ± 100.12 µm, compared to 435.29 ± 26.19 µm for ICRS. Both CAIRS and ICRS demonstrated significant compression of stromal thickness above the segment (36.19% and 32.00%, respectively). When adequately matched for preoperative disease type and severity, eyes with CAIRS had a similar and notable clinical improvement compared to ICRS, with possibly better improvement in vertical coma and CDVA. [J Refract Surg. 2024;40(11):e863-e876.].