Functional Scale Research Articles

Quantization-Based Adaptive Fuzzy Consensus for Multiagent Systems Under Sensor Deception Attacks: A Novel Compensation Mechanism.

This study mainly investigates the adaptive leader-following consensus tracking control problem for a class of nonlinear multiagent systems (MASs) subjected to unknown control directions, external disturbances, and sensor deception attacks. To start with, an equivalent MAS with known control directions is obtained by introducing a linear state transformation. For the purpose of estimating the unavailable system states caused by malicious attacks, a quantization-based fuzzy state observer is designed, and the fuzzy-logic system (FLS) is utilized to approximate nonlinear functions. Moreover, a dynamic uniform quantizer with scaling function is established to reduce information transmission. With the help of coordinate transformation and available compromised states, a novel compensation mechanism is designed to offset the influence of filter errors while avoiding the problem of "explosion of complexity" in the backstepping design process. In addition, the Nussbaum-type function is considered to eliminate the design obstacle of unknown control gains resulting from the attacks. Under the constructed consensus protocol, it is proved theoretically that the consensus tracking error converges to an adjustable small neighborhood of the origin, and all signals in the closed-loop system are bounded. Finally, the feasibility of the provided secure control scheme is verified through two simulation examples.

Efficacy and safety of different pharmacological interventions in the treatment of tardive dyskinesia: a systematic review and network meta-analysis.

The aim of this study is to indirectly compare and rank the different drugs that have been studied in randomized clinical trials (RCTs) in patients with tardive dyskinesia (TD) in terms of their efficacy in ameliorating the symptoms of TD and safety. A network meta-analysis and a systematic review were registered prospectively on PROSPERO under the ID: CRD42023407823 and were conducted in accordance with the PRISMA-NMA guidelines. PubMed, Scopus, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Sciences, and Clinicaltrials.gov were searched to identify relevant records. Any parallel randomized blinded controlled clinical trials that studied the use of any medications in treating TD and assessed the symptoms using a functional scale that has been previously validated. The standardized mean difference of improvement along with the reported adverse events for each drug was extracted from each trial, and a network meta-analysis was conducted using a random-effects model. One thousand eight hundred seventeen patients in 33 RCTs were included in the analysis. Twenty-three different drugs were compared to placebo in terms of reduction in TD symptoms. Among these, valbenazine 80mg (SMD = - 1.66, 95%CI = [- 2.55; - 0.78]), valbenazine 40mg (- 1.00, [- 1.89; - 0.11]), and vitamin E (- 0.77, [- 1.45; - 0.1]) significantly reduced TD symptoms in comparison to placebo, while deutetrabenazine 36mg (- 1.00, [- 2.12; 0.11]) and reserpine (- 0.54, [- 1.09; 0.02]) did not significantly reduce symptoms. Some serious adverse events were reported for valbenazine and deutetrabenazine, which included mainly psychiatric symptoms such as depression, worsening of schizophrenia, and suicidal ideation, while mild adverse events were reported for other drugs, and their incidence in the treatment arms was comparable to those in the placebo arm. Valbenazine (80 and 40mg) and vitamin E demonstrated efficacy in treating tardive dyskinesia. However, the significant side effects of valbenazine should prompt further investigation of alternative treatment modalities.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome in High-Level Athletes: A 10-Year Follow-up.

Arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) has previously been reported to have favorable short-term results in high-level athletes. Less is known about long-term outcomes. To report outcomes 10 years after hip arthroscopy for FAIS in high-level athletes using validated patient-reported outcome measures (PROMs). Case series; Level of evidence, 4. Patients who underwent hip arthroscopy between November 2011 and January 2013 were included in a local hip arthroscopy registry and completed preoperative PROMs. At 10-year follow-up, the same PROMs were completed. Inclusion criteria were age <40 years at time of surgery, no prior hip surgeries, and a pre-symptomatic Hip Sports Activity Scale (HSAS) level of 7 or 8. The exclusion criterion was total hip arthroplasty at follow-up. The PROMs included the international Hip Outcome Tool-12 items (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), visual analog scale (VAS) for overall hip function, European Quality of Life-5 Dimensions questionnaire (EQ-5D) and European Quality of Life-visual analog scale (EQ-VAS), HSAS, and a single question on patient satisfaction. The rates of patients achieving minimal important change and reporting Patient Acceptable Symptom State (PASS) were reported for HAGOS and iHOT-12. For iHOT-12, preoperative results were compared with 1, 5, and 10-year follow-ups. A total of 45 patients (34 men, 11 women; 70 hips; mean age 24.4 years at time of surgery) were included, with 77 patients eligible for inclusion. Significant improvements (P < .001) were seen at 10-year follow-up in all HAGOS subscales: Symptoms, Pain, Daily Activity, Sports, Physical Activity, Quality of Life (50.3 vs 78.6, 59.2 vs 86.8, 65.9 vs 88.8, 37.1 vs 81.1, 24.4 vs 81.1, 32.1 vs 79.3), iHOT-12 (40.1 vs 81.6), EQ-5D (0.59 vs 0.89), EQ-VAS (65.6 vs 80.4), and VAS for overall hip function (48 vs 79). For iHOT-12, the largest change was seen between preoperative and 1-year follow-up values, with consistent results over time. There was no statistically significant difference between HSAS levels preoperatively and at 10-year follow-up (HSAS level 4), with 24% of patients reporting a HSAS level 7 or 8 at the follow-up. Of the patients, 93% reported satisfaction with the surgery. PASS was achieved in 82% for iHOT-12, with a range of 76% to 91% for HAGOS subscales. Furthermore, 93% exceeded the minimal important change for iHOT-12, and a range of 67% to 84% for HAGOS. In a high-level athletic population, significant improvements in long-term outcomes are reported after hip arthroscopy for FAIS, with patients reporting a high satisfaction rate. The results also show that the largest improvement occurs within the first postoperative year, with results being maintained for 10 years.

Current investigation of the high prevalence of sexual dysfunction in female patients with systemic lupus erythematosus: a cross-sectional study.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects women of childbearing age and has been reported to cause sexual dysfunction in women. Although there are articles on sexual function in women with SLE, the number of articles is small, and the factors affecting sexual function in women with SLE are controversial. Based on this, this study aimed to investigate the prevalence of sexual dysfunction in Chinese female SLE patients and to explore the factors that influence it. The study design was a cross-sectional study conducted from December 2023 to April 2024 in the Department of Rheumatology and Immunology of a tertiary hospital in Hefei, Anhui Province. A total of 293 female patients diagnosed with SLE were enrolled using face-to-face questionnaires and online questionnaires. The questionnaire consisted of four parts: general information questionnaire, fatigue severity scale (FSS), depression-anxiety-stress scale (DASS-21), and female sexual functioning index (FSFI) scale. A total of 173 (59.04%) patients had sexual dysfunction, including 251 (85.67%) with decreased libido and 186 (63.46%) with difficulty in sexual arousal. There was a correlation between the patients' total FSFI scores and age (p = 0.028), marital satisfaction (p < 0.001), own education level (p = 0.008), partner's education level (p = 0.003), place of residence (p = 0.039), monthly household income (p < 0.001), family financial satisfaction(p < 0.001), menstrual status (p = 0.003), hormone use (p = 0.021),immunosuppressant use (p = 0.042), disease activity (p = 0.016), FSS score (p < 0.001), stress score (p < 0.001), anxiety score (p < 0.001) and depression score (p < 0.001)were correlated. The results of stepwise regression analysis showed that marital satisfaction (b = 2.011, t = 3.797, p < 0.001), monthly household income (b = 0.854, t = 2.316, p = 0.021), menstrual status (b = 1.218, t = 2.350, p = 0.019), fatigue scale score (b = -0.069, t = -2.302, p = 0.022), and depression score (b = -0.117, t = -2.910, p = 0.004) were the influencing factors of FSFI total score, and the difference was statistically significant. The incidence of sexual dysfunction in Chinese female SLE patients is high, and medical personnel should pay more attention to patients' sexual problems, to provide theoretical and practical bases for further prevention, treatment, and care of sexual dysfunction in female SLE patients.

192P A community-based experience with the new 12-Tier functional ability scale for Evolving Spinal Muscular Atrophy (EVOLVE-SMA)

192P A community-based experience with the new 12-Tier functional ability scale for Evolving Spinal Muscular Atrophy (EVOLVE-SMA)

Commentary on "Functional Symmetry Observation Scale, Version 2: Reliability, Construct Validity, and Potential for Clinical Use".

Commentary on "Functional Symmetry Observation Scale, Version 2: Reliability, Construct Validity, and Potential for Clinical Use".

How enteral nutrition modes influence nasopharyngeal carcinoma survivors with late dysphagia after radiotherapy: a randomized controlled study.

Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT). This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC. This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL). Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (zGroup = 5.080, P < 0.001; zTime = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL. Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life. ClinicalTrials.gov Identifier: NCT06301763.

Analysis of the center of pressure variables in women with migraine does not reflect differences in balance: A cross-sectional study

IntroductionMigraine is a neurological disease that affects proportionally more women. It has been documented that migraineurs often experience balance disturbances. ObjectiveTo evaluate the balance between migraineur patients (MG) and healthy volunteers classified as control group (CG). MethodA cross-sectional study. Seventy-four women were evaluated: 37 MG and 37 CG. The evaluation of the center of pressure (COP) variables was carried out using a balance platform in three postures, bipodal eyes closed (BEC), right monopodal with eyes open (RMEO), and left monopodal with eyes open (LMEO). Self-report questionnaires (dizziness handicap inventory (DHI), fall risk efficacy scale (FES I), the functional impact scale (HIT 6) and the timed up and go test (TUG test) were used. The U-Mann Whitney test was used to verify differences in the COP between MG and CG. The Kruskal-Wallis one-way ANOVA was used to analyze the differences between migraine groups (MGs) with postures, self-report questionnaires, and TUG test. A p < 0.05 was considered statistically significant. ResultsNo statistically significant changes were found in the balance variables, except the medial-lateral excursion variable in the BEC (p < 0.02) and LMEO (p = 0.04) postures. No significant differences were found between the MGs with HIT 6 (p = 0.48) or FES I (p = 0.49). Significant differences were found between the MGs with DHI (p = 0.003). The TUG test showed statistically significant changes between groups (p < 0.01). ConclusionThe women with migraine in this sample did not show differences in postural balance, however, dizziness and functional differences are shown compared to healthy women.

Comparison of Connective Tissue Massage and Classic Massage in Women With Primary Dysmenorrhea: A Randomized Clinical Trial

ObjectiveThe purpose of this study was to compare the short-term effects of connective tissue massage (CTM) and classic massage (CM) on pain, functional and emotional status, and menstrual complaints in women with primary dysmenorrhea (PD). MethodsWomen with PD were randomly assigned to 2 groups: CTM (n = 19) and CM (n = 19). CTM or CM was applied 5 days a week from the estimated date of ovulation to the onset of the next menstruation. The pain intensity with the Visual Analog Scale and functional and emotional status with the Functional and Emotional Dysmenorrhea Scale (FEDS) were assessed before and after the applications. Pain duration and the presence of menstrual complaints were recorded. ResultsIn the postintervention period, both groups had decreased menstrual pain intensity and duration, drug use, and FEDS scores (P < .001). Pain duration and FEDS-functional scores decreased more in the CTM group than in the CM group (P < .05). Moreover, in the postintervention period, fewer women were nervous in the CM group, whereas low back pain, constipation, and sleeplessness were less frequent in the CTM group, compared with their preintervention period (P < .05). A difference was observed between groups only in terms of the changes in sleeplessness between before and after intervention (P = .016). ConclusionCTM and CM improved menstrual pain and functional and emotional status, and decreased drug use. Moreover, CTM was superior in improving pain duration, functional status, and sleeplessness compared with CM in PD. CTM and CM might be useful treatment methods for PD.

Combined antegrade and retrograde dilation (CARD) for management of complete esophageal obstruction: Multicenter case series.

Background and study aims Complete esophageal obstruction (CEO) is a rare complication of radiation therapy for esophageal or head and neck cancers and can be challenging to manage endoscopically. A rendezvous approach by combined anterograde and retrograde endoscopic dilation (CARD) can be used to re-establish luminal integrity in such cases. Our study aimed to review our experience with patients with CEOs managed by CARD. Patients and methods Six patients who had CARD for CEO were reviewed. The primary outcomes were immediate technical and clinical success of CARD. Secondary outcomes were adverse events (AEs) associated with the procedure and continued dependency on the percutaneous endoscopic gastrostomy (PEG)-or jejunostomy tube. Results The mean age was 59 years (range 38-83). Five patients had CEO secondary to neoadjuvant chemoradiotherapy for esophageal cancer, and one patient had complete obstruction secondary to neck trauma. CARD was technically successful in five patients (86%). Two patients had AEs. One had pneumomediastinum requiring no intervention, while the other had bilateral pneumothorax requiring chest tube placement. The median follow-up duration of repeated dilations to maintain liminal patency was 20 months. Four patients had improvement in dysphagia, tolerating oral intake, and mouth secretions after the procedure, with a mean functional oral intake scale (FOIS) score > 3 and an overall success rate of 83%. Conclusions The CARD approach to re-establish esophageal luminal patency in CEO is a safer alternative to high-risk blind antegrade dilation or an invasive surgical approach. It is usually technically feasible with improved swallowing ability in most patients.

Oral and general health quality of life following a subtemporal preauricular infratemporal approach with condylar fossa osteotomy in surgical skull base tumor resection.

With the capacity to provide maximal lesion exposure, the subtemporal preauricular infratemporal (SPI) approach with condylar fossa osteotomy is highly utilized in radical resection of skull base tumors. While this approach requires disruption of the temporomandibular joint (TMJ) for access, the effects of this maneuver are poorly appreciated in neurosurgery. The aim of this study was to assess the morbidity of condylar fossa osteotomies by comparing oral health quality of life (OHQOL) and general health quality of life (GHQOL) outcomes after TMJ-involving and TMJ-sparing skull base approaches. A retrospective review of the medical records of patients who underwent surgery with the SPI approach (TMJ-involving approach) for skull base chondrosarcoma (CS) by a single senior surgeon at Vancouver General Hospital between 2002 and 2022 was performed. Patients undergoing TMJ-sparing anterolateral approaches for trigeminal schwannoma (TS) during the same study period by the same surgeon were included as controls. GHQOL was evaluated using the 36-item Short Form Health Survey from preoperative and postoperative periods. Postoperative OHQOL was evaluated using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I/II screening instrument. Data regarding quality of life were available for 13 of 19 CS patients and 12 of 15 TS patients surgically managed between 2002 and 2022. CS patients demonstrated less jaw dysfunction in all parameters of the DC/TMD Axis I/II components when specifically assessing OHQOL. CS patients had a lower likelihood of temporomandibular disorder (TMD) presence on the TMD pain screener than TS patients (25% vs 45%, p = 0.40). Chronic pain scores were higher in the TS group, with significantly more patients with grade 2 or higher pain (36.4% vs 0%, p = 0.01). The mean Jaw Functional Limitation Scale (JFLS) scores were lower in CS patients than in TS patients. Both CS and TS patients demonstrated lower mean JLFS scores (0.50 and 0.81, respectively) than patients with chronic TMD (1.76), but higher mean JLFS scores than patients without TMD (0.16). The authors report novel findings regarding the impact of the SPI approach with a condylar fossa osteotomy on OHQOL and GHQOL among skull base tumor patients. Anatomical disruption of the TMJ was not associated with significant clinical TMJ dysfunction. Compared with TS patients, CS patients had even lower mean scores in TMJ-related morbidity, and both groups had lower TMJ morbidity than patients diagnosed with chronic TMJ dysfunction. Condylar fossa osteotomies can therefore be considered without concern of significant additional morbidity.

Protocol for a phase 2 study of bosutinib for amyotrophic lateral sclerosis using real-world data: induced pluripotent stem cell-based drug repurposing for amyotrophic lateral sclerosis medicine (iDReAM) study

IntroductionAmyotrophic lateral sclerosis (ALS) is a progressive, severe neurodegenerative disease caused by motor neuron death. Development of a medicine for ALS is urgently needed, and induced pluripotent cell-based drug repurposing...

Characteristics and Outcomes of Surgical Treatment for Anterolateral Ankle Impingement Due to the Distal Fascicle of the Anterior Inferior Tibiofibular Ligament.

The pathomechanism of anterolateral ankle impingement (ALAI) due to the distal fascicle of the anterior inferior tibiofibular ligament (DF-AITFL) has not been fully elucidated. In addition, because of its rarity, no definitive diagnostic criteria have been established for ALAI due to DF-AITFL. To document the symptom characteristics and magnetic resonance imaging (MRI) and and arthroscopic findings as well as postoperative clinical outcomes of ALAI due to DF-AITFL. Case series; Level of evidence, 4. Included were 12 patients (5 male and 7 female; mean age, 34.4 years [range, 21-76 years]) who were diagnosed with ALAI due to DF-AITFL and underwent excision of the DF-AITFL from November 2017 to August 2021. Symptom characteristics and symptom-related medical histories were evaluated, as were MRI and arthroscopic findings. Clinical outcomes were assessed using the visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot functional scale, and Foot Function Index. All 12 patients had a history of ankle sprain before symptom onset. DF-AITFL was confirmed by MRI in all patients. Bone edema of the talus was observed in 2 patients (16.7%), and cartilage abnormalities in 3 patients (25%). Arthroscopy showed that the DF-AITFL contacted the anterolateral aspect of the talar dome during range of motion in all patients and that the AITFL was bent where it contacted the anterolateral dome of the talus in 3 patients (25%). Partial tear or adhesion of the DF-AITFL was noted in 7 patients (58.3%), and cartilage deformation at the anterolateral talar dome in 4 patients (33.3%). Mean visual analog scale pain, American Orthopaedic Foot & Ankle Society, and Foot Function Index scores improved significantly from preoperatively to postoperatively. ALAI due to DF-AITFL should be considered a possible cause of anterolateral ankle pain after an ankle sprain. The diagnosis can be reliably made with a thorough clinical examination and imaging studies. Half of the patients in this series also had lateral ankle instability. Surgical resection of the DF-AITFL and ligament reconstruction, if necessary, resulted in significant symptom improvement.

Development and Validation of SCACOMS, a Composite Scale for Assessing Disease Progression and Treatment Effects in Spinocerebellar Ataxia.

Spinocerebellar ataxias (SCA) are rare inherited neurodegenerative disorders characterized by a progressive impairment of gait, balance, limb coordination, and speech. There is currently no composite scale that includes multiple aspects of the SCA experience to assess disease progression and treatment effects. Applying the method of partial least squares (PLS) regression, we developed the Spinocerebellar Ataxia Composite Scale (SCACOMS) from two SCA natural history datasets (NCT01060371, NCT02440763). PLS regression selected items based on their ability to detect clinical decline, with optimized weights based on the item's degree of progression. Following model validation, SCACOMS was leveraged to examine disease progression and treatment effects in a 48-week SCA clinical trial cohort (NCT03701399). Items from the Clinical Global Impression-Global Improvement Scale (CGI-I), the Friedreich Ataxia Rating Scale (FARS) - functional stage, and the Modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA) were objectively selected with weightings based on their sensitivity to clinical decline. The resulting SCACOMS exhibited improved sensitivity to disease progression and greater treatment effects (compared to the original scales from which they were derived) in a 48-week clinical trial of a novel therapeutic agent. The trial analyses also provided a SCACOMS-derived estimate of the temporal delay in SCA disease progression. SCACOMS is a useful composite measure, effectively capturing disease progression and highlighting treatment effects in patients with SCA. SCACOMS will be a powerful tool in future studies given its sensitivity to clinical decline and ability to detect a meaningful clinical impact of disease-modifying treatments.

Impact of prosthodontic rehabilitation on psychological status and quality of life in maxillectomy patients of coronavirus disease 2019-associated mucormycosis at a tertiary care center: A prospective clinical study

Aims: The study was aimed to evaluate the effect of prosthodontic rehabilitation on psychological status (PS) and quality of life (QoL) in maxillectomy patients of coronavirus disease 2019-associated mucormycosis (CAM). Settings and Design: The study was designed as a prospective and clinical study. Materials and Methods: Twenty-four CAM patients undergoing maxillectomy and subsequent prosthetic rehabilitation were included. The treatment involved surgical, intermediate, and definitive obturator delivery at various phases of healing. PS was assessed using the Hospital Anxiety and Depression Scale (HADS), QOL using the European Organization for Research and Treatment of Cancer QoL Questionnaire-Head and Neck Module (EORTC QLQ-HandN35), and the functioning of obturator was assessed utilising the Obturator Functioning Scale (OFS) at various time points: before maxillectomy (T1), 2 weeks after maxillectomy (T2), 2 weeks upon usage of intermediate obturator (T3), just before delivery of definitive obturator (T4), and 12 weeks after the usage of definitive obturator (T5). Statistical Analysis Used: Data were analyzed using a social science statistical analysis program (Stata 14.0; StataCorp LLC, Texas, USA). The significance level was chosen &lt;0.05. Shapiro–Wilk test was used to assess the normality of quantitative data. Student’s t-test was employed (α =0.05) to evaluate if the patient’s PS, QOL, and obturator function had changed over time. The Spearman correlation coefficient (α =0.05) was utilized to evaluate the correlation coefficient between PS, QOL, and obturator function seen at T3 and T5. Results: Out of 24 enrolled patients, nine were dropped out. HADS-anxiety score was the highest at T1 (18.6 ± 1.2) and HADS-depression score was the highest at T2 (18.8 ± 1.6). HADS scores decreased significantly (P = 0.001) after prosthetic rehabilitation. EORTC QLQ-HandN35 score was the highest at T2 (105.8 ± 29.5), with statistical significance (P = 0.001) after rehabilitation. OFS was the highest at T3 (51.9 ± 3.9) and lowest at T5 (25.4 ± 2.8). Conclusion: CAM and maxillectomy deliberately affects the PS and QOL. Prosthetic rehabilitation, psychological motivation, and education create greater improvement in PS and QOL. The progress in parameters showed an upward trend with good obturator quality over a period of time.

Failed labral reconstruction of the hip can be successfully revised to another labral reconstruction: improved patient-reported outcomes at a minimum of 2-year follow-up

Abstract The purpose of this study was to validate the success of revision arthroscopic circumferential allograft labral reconstruction (CLR) in nonarthritic hips, which, in the rare case of failure, had previously undergone labral reconstruction by the same surgeon. Using a minimum of 24-month follow-up, data from 24 hips having undergone revision CLR were analyzed to determine improvements in patient-reported outcomes (PROs). All included cases completed a minimum of 24 months follow-up, with a success rate of 96%. All PROs improved significantly, with exceptionally strong measures of effect. Modified Harris Hip Scores improved by a mean of 26.68 points, with 88% of patients meeting the minimal clinically important difference (MCID) (+6.49, P ≤ .001, d = 1.32). Lower Extremity Functional Scale scores improved by a mean of 21.88 points, with 78% of patients meeting the MCID (+7.79, P ≤ .001, d = 1.32). Pain as rated by the Visual Analog Scale, including at rest, during activities of daily living, and with sports, was significantly improved with strong measures of effect, with &amp;gt;75% of patients having met the MCID. This study validated that a failed labral reconstruction of the hip can be revised safely and effectively to another labral reconstruction of the hip. While labral reconstruction has broadly been shown to result in highly favorable outcomes, this study demonstrated that in the rare case of failure, revision CLR is not only feasible but results in improved pain and functionality.

Intrathecal baclofen therapy as treatment for spasticity and dystonia: Review of cases in a pediatric palliative care unit

IntroductionPatients managed in the Pediatric Palliative Care Integral Unit (PPCIU) have serious neurological conditions that involve significant damage at central nervous system level. The movement disorder is a very common clinical problem and for the patients where an adequate control of muscle tone is not achieved with usual techniques or drugs, intrathecal baclofen therapy (IBT) should be considered. Materials and methodsDescriptive retrospective study based on the review of clinical records of patients who received IBT being followed by the PPCIU of Madrid Autonomous Region in the timeframe between September 2012 and February 2021. ResultsIBT was implanted in 8 patients affected by infantile cerebral palsy (ICP) with a Gross Motor Function Scale (GMFCS) IV–V, 3 patients was a Pantothenate kinase deficit-associated neurodegeneration (PKAN), 2 had Acquired Brain Damage, and the remaining 3 had, respectively, 2 glutaric aciduria type I (GA-1), and poly-malformative syndrome. In all patients we observed a period of clinical stability after IBT, we call this period “honeymoon”. Two patients died while in the honeymoon period, at 24.9 and 19.6 months from implantation of the pump; the median of duration of the honeymoon period in the remaining 14 was 14.4 months (IQ: 8.3–25.8). ConclusionsIBT was not only used in patients with non-progressive diseases, but also in the group of patients with neurodegenerative or progressive diseases. In all of them, after implantation of the device, we have objectified a period of clinical stability and a better control of muscle tone disorders.

Development and Validation of the Youth Back Activity Questionnaire: A Measure of Function for Adolescents with Low Back Pain.

Psychometric study. To develop a reliable and valid patient-reported outcome measure to assess functional ability in adolescents with low back pain (LBP) using the Rasch model. LBP is quite common in adolescence. Currently, no method adequately measures the functional ability of adolescents with LBP. Widely used outcome measures for LBP are problematic in adolescents, with significant ceiling/floor effects. Two hundred adolescents (15.4 ± 1.9 years; 56% female) with LBP. This study was comprised of two parts: Part 1: Development of the Youth Back Activity Questionnaire (YouthBAQ) (n = 75), and Part 2: Psychometric evaluation of the newly designed YouthBAQ using the Rasch Model (n = 125). Participants also completed the Oswestry Disability Index (ODI) and Micheli Functional Scale (MFS), Data Analysis: Reliability and construct validity of the YouthBAQ were assessed using Rasch analyses. Correlations with the ODI and MFS were used to determine the convergent validity of the YouthBAQ. Part 1: Based on the results of the Rasch analysis, 31 items were reduced to 14. Part 2. The 14-item YouthBAQ demonstrated good reliability and construct validity, with good item fit (>0.7 and <1.3), acceptable item hierarchy and spacing, response category functioning, unidimensionality (ratio >3:1), local independence (<0.30). The MFS demonstrated unacceptable reliability (person reliability = 0.62) and was not compared against the YouthBAQ. The ODI demonstrated acceptable reliability (person reliability =0.70), but poor construct validity among adolescents with LBP. The YouthBAQ demonstrated a moderate correlation with the ODI (r = 0.4). The YouthBAQ is a quick and easily understood measure of function with good validity and reliability in adolescents with LBP. The YouthBAQ is a more appropriate measure of functional ability than the ODI or MFS in this population.

A Comparative Analysis of Patient-Reported Outcomes Following Free Tissue Transfer, Partial Foot Amputation, and Below-Knee Amputation in High-Risk Limb Salvage Patients.

The surgical decision for limb-salvage with free tissue transfer (FTT), partial foot amputation (PFA), or below-knee amputation (BKA) for complex lower extremity (LE) wounds hinges on several factors, including patient choice and baseline function. However, patient-reported outcome measures (PROMs) on LE function, pain, and QoL for chronic LE wound interventions are limited. Thus, the study aim was to compare PROMs in patients who underwent FTT, PFA, or BKA for chronic LE wounds. PROMs were collected via QR code for all adult chronic LE wound patients who presented to a tertiary wound center between June 2022 and June 2023. A cross-sectional analysis of patients who underwent FTT, PFA, or BKA was conducted. The 12-Item Short Survey (SF-12), PROM Information System Pain Intensity (PROMIS-3a), and Lower Extremity Functional Scale (LEFS) were completed at 1, 3, and 6 months and 1, 3, and 5 years postoperatively. Patient demographics, comorbidities, preoperative characteristics, and amputation details were collected. Of 200 survey sets, 71 (35.5%) underwent FTT, 51 (25.5%) underwent PFA, and 78 (39.0%) underwent BKA. Median postoperative time points of survey completion between FTT (6.2 months, IQR: 23.1), PFA (6.8 months, IQR: 15.5), and BKA (11.1 months, IQR: 21.3) patients were comparable (P = 0.8672). Most patients were male (n = 92, 76.0%) with an average age and body mass index (BMI) of 61.8 ± 12.6 years and 30.3 ± 7.0 kg/m2, respectively. Comorbidities for FTT, PFA, and BKA patients included diabetes mellitus (DM; 60.6% vs 84.2% vs 69.2%; P = 0.165), peripheral vascular disease (PVD; 48.5% vs 47.4% vs 42.3%; P = 0.790), and chronic kidney disease (CKD; 12.1% vs 42.1% vs 30.8%; P = 0.084). No significant differences were observed between FTT, PFA, and BKA patients in mean overall PROMIS-3a T-scores (49.6 ± 14.8 vs 54.2 ± 11.8 vs 49.6 ± 13.7; P = 0.098), LEFS scores (37.5 ± 18.0 vs 34.6 ± 18.3 vs 38.5 ± 19.4; P = 0.457), or SF-12 scores (29.6 ± 4.1 vs 29.5 ± 2.9 vs 29.0 ± 4.0; P = 0.298). Patients receiving FTT, PFA, or BKA for chronic LE wounds achieve comparable levels of LE function, pain, and QoL postoperatively. Patient-centered functionally based surgical management for chronic LE wounds using interdisciplinary care, preoperative medical optimization, and proper patient selection optimizes postoperative PROMs.

Paediatric survivors of extracorporeal life support functional outcomes at one-year follow-up.

To investigate functional outcomes in children who survived extracorporeal life support at 12 months follow-up post-discharge. Some patients who require extracorporeal life support acquire significant morbidity during their hospitalisation. The Functional Status Scale is a validated tool that allows quantification of paediatric function. A retrospective study that included children placed on extracorporeal life support at a quaternary children's hospital between March 2020 and October 2021 and had follow-up encounter within 12 months post-discharge. Forty-two patients met inclusion criteria: 33% female, 93% veno-arterial extracorporeal membrane oxygenation (VA ECMO), and 12% with single ventricle anatomy. Median age was 1.7 years (interquartile range 10 days-11.9 years). Median hospital stay was 51 days (interquartile range 34-91 days), and median extracorporeal life support duration was 94 hours (interquartile range 56-142 hours). The median Functional Status Scale at discharge was 8.0 (interquartile range 6.3-8.8). The mean change in Functional Status Scale from discharge to follow-up at 9 months (n = 37) was -0.8 [95% confidence interval (CI) -1.3 to -0.4, p < 0.001] and at 12 months (n = 34) was -1 (95% confidence interval -1.5 to -0.4, p < 0.001); the most improvement was in the feeding score. New morbidity (Functional Status Scale increase of ≥3) occurred in 10 children (24%) from admission to discharge. Children with new morbidity were more likely to be younger (p = 0.01), have an underlying genetic syndrome (p = 0.02), and demonstrate evidence of neurologic injury by electroencephalogram or imaging (p = 0.05). In survivors of extracorporeal life support, the Functional Status Scale improved from discharge to 12-month follow-up, with the most improvement demonstrated in the feeding score.