Functional Scale Score Research Articles

Selective dorsal rhizotomy long-term effects on functional motility in Jordanian children with spastic cerebral palsy

IntroductionSpasticity management in children with cerebral palsy (CP) is a challenge for healthcare providers worldwide. In the US and Europe, treatment options include non-surgical and surgical (i.e., selective dorsal rhizotomy, SDR) procedures, with beneficial effects on functional motility. SDR was introduced in Jordan in 2019. We performed the first assessment of the long-term effects on motor function in Jordanian children with spastic CP (SCP) who underwent SDR.MethodsA retrospective cohort study of 43 patients (28 boys, 15 girls, mean ± SD age at surgery, 6.2 ± 2.5 years, 67.4% with diplegia, 30.2% quadriplegia, and 2.3% hemiplegia, 97.7% bilateral deficits) who received SDR (42 bilateral) was conducted between 01/01/2019 and 03/01/2023. Gross Motor Function Classification System (GMFCS) and Functional Mobility Scale (FMS) scores were compared before and 12 months after SDR. Sex, age and clinical scores at surgery, and post-SDR surgical treatment were included in the model (IBM SPSS Statistics 29.0).ResultsClinical scores improved 12 months after SDR: GMFCS decreased by at least one level (in 58.5% of patients), and FMS significantly increased (p < 0.001); GMFCS decreased in 77.7% of those with pre-SDR severe impairment vs. 43.5% in moderately to mildly impaired patients. An age sub-analysis demonstrated higher changes in GMFCS in younger children (GMFCS decreased in 46.9% of those aged <10 years old vs. none in those older than 10 years). These findings suggest that younger children (<10 years old) and more impaired (levels IV and V on GMFCS) are likely the best candidates for this procedure. Twelve-month functional improvement was similar in boys and girls (GMFCS decreased in 44.0% of boys vs. 37.5% of girls). Compared to pre-SDR management, all patients continued physiotherapy, less received Botox (by 97.7%), and more received adjunct orthopedic surgeries (32.6% vs. none) after SDR; out of those receiving post-SDR adjuvant surgeries, 50.0% improved GMFCS (compared to 64.0% of those without).ConclusionOur data demonstrated SDR’s beneficial long-term effects on functional mobility in SCP children, particularly those younger than 10 years and more severely impaired. These findings provide critical information that may aid in identifying “the best” therapeutic window and “the best” candidate for SDR in Jordan.

Can invasive interventions be avoided with a holistic swallowing therapy program in older patients in intensive care units: percutaneous endoscopic gastrostomy tubes or oral intake?

IntroductionThe use of percutaneous endoscopic gastrostomy (PEG) tubes in older patients did not show any benefits in terms of survival, improvement in quality of life, or reduction in aspiration pneumonia. Significant gaps exist regarding the evidence for the evaluation and management of dysphagia in older patients. This study aimed to diagnose swallowing disorders and highlight the importance of swallowing therapy in older patients in intensive care units (ICUs).Materials and methodsTwenty-five older patients (12 men, 13 women, mean age 67.22 ± 24.03 years) hospitalized in the ICUs with complaints of dysphagia were analyzed prospectively. The 12 weeks (14−16 sessions) of swallowing therapy were administered to patients with dysphagia who signed the (voluntary) consent form. The bedside water swallowing test (BWSS), Functional Oral Intake Scale (FOIS) Score, Clinical Swallowing Evaluation, Mini Nutritional Assessment Test (MNAT), Eating Assessment Tool (EAT-10), the Turkish version of the World Health Organisation Quality of Life Scale Elderly Module, and the Swallowing Therapy Programme Protocol were applied. Pretherapy stage (T1) and post-therapy stage (T2) results were compared with videofluoroscopy swallowing study (VFSS) recordings with thin liquids, moderately thick liquids, extremely thick liquids, and crackers (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 0, 3, 4, and 7, respectively).ResultsThe World Health Organisation Quality of Life Scale Elderly Module (WHOQOL-OLD) raw scores significantly improved from T1 (38.63 ± 7.05) to T2 (73.07 ± 4.82). The bedside water swallowing test results demonstrated statistically significant differences in therapy timings among older patients (p < 0.001). There were significant improvements in swallowing physiology, as represented by the improved oral and pharyngeal composite scores of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scala (PAS) levels. Before therapy, all patients exhibited high rates of oropharyngeal residue with thin liquids and spoon-thick pudding viscosities (MNA ≤ 17). The results reported in the present study show that malnutrition risk is linked to a poorer QoL in older patients on admission to ICUs. Statistical analyses revealed the dominant effects of functional status and eating-related factors on QoL in this group.DiscussionEarly dysphagia diagnosis of older patients and subsequent application of exercise-based swallowing therapy increase the quality of life of patients. In this study, exercise-based swallowing therapy was developed in Turkey and can be used in older patients as part of a holistic cognitive-communication-swallowing intervention program. Results prove the effectiveness of the developed exercise-based swallowing therapy on the cognitive-communication-swallowing skills of older patients. The present findings reinforce the role of nutrition as a priority for improving patients’ perceptions of QoL. Further studies are required to investigate and identify the interventions that improve QoL in older patients. More studies with better research designs are required to establish whether nutritional intervention is effective in enhancing QoL in this vulnerable group.

Digital phenotyping of social functioning and employment in people with schizophrenia: Pilot data from an international sample.

Individuals living with schizophrenia experience significant impairments in social functioning. As a major clinical outcome, social functioning requires appropriate measurement tools that can capture its dynamic nature. Digital phenotyping, using smartphone technology to collect high volume ecologically valid data, can potentially capture these facets. We investigated the viability of digital data, such as GPS, Accelerometer, and screen activation as a proxy for common social functioning measurements. We used an ordinary least squares linear regression approach to compare the performance of digital signals with the performance of past social functioning scale (SFS) scores for predicting current SFS scores and subdomain values in 62 individuals with schizophrenia using smartphone and clinical assessments over the course of a year. The outcome of interest was the current SFS, for which we compared the capacity of the digital data (active and passive), and prior SFS scores to predict SFS scores. Overall, the sub-scale models in order of performance (measured by RMSE score) were: (i) employment, (ii) social engagement, (iii) interpersonal behavior, (iv) recreation, (v) prosocial activities, (vii) performance, and (vii) competence. Digital data were particularly capable of predicting subdomain scores for employment (R2 = 0.746, Mean Squared Error (MSE) = 1.663) and social engagement (R2 = 0.710, MSE = 2.318). Digital phenotyping may have the capacity to operate as a proxy for certain social functioning measures. Future research should expand on this pilot data by focusing on establishing the reliability and validity of digital phenotyping to measure social functioning, and exploring which subdomains of social functioning are best measured digitally.

Factors Determining Rehabilitation Needs After Intradural Spinal Tumor Surgery: A Prospective Study.

While most studies on the postoperative condition of patients with spinal cord tumors describe long-term outcomes, data are needed on immediate surgical outcomes demanding rehabilitation to make informed assessments for postoperative planning. The aim of this study was to identify factors predicting function and rehabilitative needs after intradural spinal tumor surgery. Eighty-five prospectively recruited patients underwent surgery for intradural intramedullary (ID-IM; n = 23) and extramedullary (ID-EM; n = 62) tumors. Neurological and functional status were assessed before surgery, after surgery, and at discharge using the modified McCormick scale (MMS), Karnofsky performance status (KPS) scale, Barthel index (BI), and the gait index (GI). There were no significant predictors of early postoperative rehabilitation in the ID-IM group. In the ID-EM group, age, thoracic level, subtotal resection (STR), repeat surgery, and functional scale scores predicted the need for rehabilitation. In multivariable analysis, MMS (odds ratio (OR) 8.7; 95% confidence interval (CI): 2.37-32.44) and STR (OR 13.00; 95%CI: 1.56-107.87) remained independent predictors of rehabilitation need (area under curve, 92%). Despite their younger age, most patients with ID-IM tumors, especially ependymomas, required rehabilitation but improved quickly (KPS, BI, p < 0.001). Among ID-EM tumors, meningiomas were characterized by poorer preoperative function and low gross total resection (GTR) rates, but did not deteriorate neurologically after surgery. Patients with schwannoma and ID-EM ependymomas achieved the highest GTR rate and had the best function both before and after surgery. These results may be useful for estimating early rehabilitation needs after intradural tumor surgery and counseling patients before surgery about the expected postoperative course.

A single-center, single-arm, prospective, open-label, and comparative trial to evaluate the safety and tolerability profile of a 90-day oral L-arginine hydrochloride intervention for patients with amyotrophic lateral sclerosis

Weight loss, a key indicator of malnutrition in amyotrophic lateral sclerosis (ALS) patients, negatively impacts patient prognosis. However, effective nutritional interventions have not been adequately established. Research in ALS model mice has shown that L-arginine can prolong survival; however, no human intervention studies have been conducted. We conducted a single-center, single-arm, prospective, open-label, and comparative trial to assess the safety and tolerability of L-arginine hydrochloride in ALS patients. ALS patients were administered 15 g/day L-arginine hydrochloride for 90 days. The primary outcome of safety was evaluated on days 45 and 90. The secondary outcome of efficacy was evaluated by measuring nutritional status, ALS Functional Rating Scale (ALSFRS) scores, and the occurrence of events such as the initiation of tracheostomy positive pressure ventilation (TPPV) and death. The study included 20 patients (40% female; mean age, 62.0 ± 6.9 years; median disease duration, 1.9 years). Six participants (30%) experienced treatment-emergent adverse events (TEAEs), including elevated creatine kinase levels, liver function test abnormalities, glucose tolerance issues, hyperammonemia, anorexia, dysgeusia, and vasculitis. No serious TEAEs were associated with L-arginine hydrochloride. Over the course of three months, the average changes in body weight, body mass index, and the ALSFRS score were − 0.37 kg, -1.1 kg/m2, and − 1.7 points, respectively. There were no events requiring TPPV initiation or deaths. This study demonstrated that the oral administration of L-arginine hydrochloride over three months was well tolerated by ALS patients, with no serious TEAEs or deaths attributed to the study drug.Trial Registration number: Japan Registry of Clinical Trials (jRCTs061230001), first registered 11/04/2023.

Effect of pre-hospital living setting on nutritional intake route upon discharge in older adults with aspiration pneumonia: a prospective cohort study

BackgroundAspiration pneumonia, which often recurs due to dysphagia, worsens as patients move between homes, facilities, and hospitals. The impact of pre-hospital living setting on oral intake at discharge remains unclear. The purpose of this study was to identify the effects of the pre-hospital living setting on the nutritional intake route upon discharge in older patients with aspiration pneumonia.MethodsThis prospective cohort study included patients aged ≥ 65 years who were admitted to an acute care hospital and diagnosed with aspiration pneumonia. Patients were followed up until discharge or death during hospitalisation. Patient demographic information, pre-hospital living setting (home or nursing facility), functional oral intake scale (FOIS) score, pneumonia severity index, clinical frailty scale score, history of aspiration pneumonia, and pneumonia recurrence during hospitalisation were recorded. Binary logistic regression was used to assess the impact of the pre-hospital living setting on oral intake at discharge as the primary outcome.ResultsAmong the 89 included patients (52 males (58.4%); mean age, 84.8 ± 7.9 years), 39.3% (n = 35) had pneumonia recurrence during hospitalisation. The average follow-up period was 44.0 ± 36.6 days. The pre-hospital living setting was independently associated with the nutritional intake route upon discharge (odds ratio = 7.72, 95% confidence interval (95%CI) = 1.70–35.1, p = 0.008).ConclusionsThe pre-hospital living setting could serve as a good indicator of the nutritional intake route upon discharge. It is essential to optimize care in both nursing facilities and hospital settings when caring for older patients with aspiration pneumonia.

Myelin measurement in amyotrophic lateral sclerosis with synthetic MRI: A potential diagnostic and predictive method

Background: Myelin damage has recently been highlighted as a major causative factor of amyotrophic lateral sclerosis (ALS). Although myelin damage has been pathologically identified in ALS, it has not been clinically evaluated. This study aimed to quantify myelin volume using synthetic MRI to evaluate myelin damage in patients with ALS, and determine its association with clinical parameters.Methods: We evaluated patients with ALS (n = 35) and individuals (n = 16) without intracranial disease using synthetic magnetic resonance imaging (MRI) and measured total myelin volume (TMV), myelin fraction (MYF), and myelin partial volume (VMY) in the cerebral peduncle and the posterior limb of the internal capsule (PLIC). We also investigated factors associated with acquired quantitative values.Results: The TMV was significantly lower in the patients with ALS than in the control group (P = 0.045). The TMV (r = 0.42, P = 0.013) and MYF (r = 0.34, P = 0.047) significantly correlated with Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores in the patients, and MYF was independent of the traditional white matter lesion grading score. The VMY of the PLIC was significantly lower in the ALS than the control group (P = 0.018), and the ALS group significantly correlated with ALSFRS-R scores (r = 0.36, P = 0.033).Conclusions: Myelin damage can be quantified by synthetic MRI as reduced myelin volume, with the possibility of predicting prognoses in patients with ALS. Furthermore, myelin measurements in the PLIC might be a novel diagnostic marker for ALS.

Applications of transcranial direct current stimulation over vagus nerve on dysphagia after stroke.

Vagus nerve stimulation (VNS) has been commonly employed for the functional rehabilitation of stroke patients. This study aimed to investigate the therapeutic effects of transcranial direct current stimulation on the vagus nerve (TDCSVN) in improving dysphagia in stroke patients. Patients experiencing dysphagia following a stroke were diagnosed with dysphagia by a water swallow test. Swallowing function was evaluated with the standard swallowing scale score and the functional dysphagia scale. Serum levels of interleukin (IL)-1β and IL-8 were measured with enzyme-linked immunosorbent assays. TDCSVN treatment resulted in a significantly greater reduction in both the standard swallowing scale and functional dysphagia scale scores compared to conventional treatment. Furthermore, TDCSVN treatment led to a notable increase in hemoglobin and albumin levels, suggesting a more substantial improvement in dysphagia compared to conventional methods. Additionally, TDCSVN treatment was more effective in decreasing serum levels of IL-1β and IL-8 in dysphagic patients after a stroke. TDCSVN treatment demonstrated a significant inhibitory effect on inflammatory cytokines, resulting in a more pronounced improvement in dysphagia among stroke patients.NEW & NOTEWORTHY The present study demonstrates that transcranial direct current stimulation on the vagus nerve (TDCSVN) treatment shows a significant inhibitory effect on the production of inflammatory factors, resulting in a more pronounced improvement in dysphagia among stroke patients.

Submandibular Gland Flap Reconstruction for Oropharyngeal Defects After Transoral Robotic Surgery (TORS)

ABSTRACTBackgroundTo describe utilization and outcomes of submandibular gland flap (SGF) reconstruction after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).MethodsA multi‐institutional retrospective case series of patients who underwent TORS for OPSCC followed by SGF reconstruction with harvest via transcervical approach from 1/1/2016 to 4/1/2023.ResultsIn total, 14 patients underwent SGF reconstruction after TORS for OPSCC. All patients had HPV‐positive disease, predominantly in early local (N = 10 with pT1/pT2 disease, 71%) and regional stages (N = 11 with pN0/pN1 disease, 79%). Most patients received adjuvant radiation treatment (N = 9, 64%). Median hospital LOS after surgery was 4 days (IQR 2 days) with median functional oral intake scale (FOIS) score of 5 (IQR 0.8) at 1–3 weeks after surgery.ConclusionsSGF reconstruction is a useful technique for closure of appropriately selected TORS defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue but not large enough to warrant free flap reconstruction.

Children Requiring 3 or More Days of Invasive Ventilation: Secondary Analysis of Post-Discharge Change in Caregiver Employment.

To describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure. Preplanned secondary analysis of prospective cohort dataset, 2018-2021. Quaternary Children's Hospital PICU. Children who required greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 post-discharge survey. None. We measured change in caregiver employment 1 and 12 months post-discharge relative to pre-admission and, when present, change in caregiver identity defined by relationship to the patient. Data were collected by survey. We used logistic regression to identify factors associated with these changes. We evaluated 130 children, median age 6.4 years (interquartile range, 1.10-13.3 yr), 40 (30.8%) with a complex chronic condition (CCC), and 99 (76.2%) with normal pre-illness Functional Status Scale scores. Of 123 with 1-month post-discharge data, 25 of 123 (20.3%) experienced a change in caregiver employment and an additional 14 of 123 (11.4%) had a change in caregiver(s). Of 115 with 12-month post-discharge data, 33 of 115 (28.7%) experienced a change in caregiver employment and an additional 16 of 115 (13.9%) had a change in caregiver(s). After controlling for age, CCC, baseline caregiver employment, new morbidity at discharge, and social and economic index; higher maximum Pediatric Logistic Organ Dysfunction-2 score (odds ratio [OR], 1.19 [95% CI, 1.01-1.41]) and government insurance (OR, 3.85 [95% CI, 1.33-11.11]) were associated with the composite outcome of change in caregiver employment or caregiver(s) at 1-month post-discharge. At 1 and 12 months post-discharge, more than one-in-five children who survived greater than or equal to 3 days of invasive ventilation had a change in caregiver employment and one-in-ten had a change in caregiver(s). Identification of risk factors, such as illness severity and social determinants of health, associated with a significant family change may improve our support of these families.

Health-related quality of life analysis from ENTER, a randomized, controlled phase III trial of whole-brain radiotherapy with and without concurrent erlotinib in NSCLC with brain metastases.

Health-related quality of life (HRQoL) is critical for patients with lung cancer due to poor prognosis. We presented patient-reported outcomes in patients with non-small cell lung cancer (NSCLC) brain metastases (BM) who received whole-brain radiotherapy (WBRT) in combination with erlotinib or WBRT alone in the phase 3 ENTER study. The patients' HRQoL was assessed by using the European Organization for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire (EORTC QLQ-C30). Mean changes in scores on different quality of life (QoL) scales relative to baseline were reported. The QoL response and time to deterioration of QoL were compared between different treatment arms. The absolute mean differences in global health status/QoL scores, all functional and symptom scale scores from baseline between the two arms were not significantly different at all follow-up time points. After month 5, there was an improvement in nausea/vomiting symptom scores in the WBRT arm relative to their pretreatment baseline (P=0.003), while the WBRT + erlotinib arm had improved scores in fatigue (P=0.01), nausea/vomiting (P=0.02), pain (P=0.04) and insomnia (P=0.01). Compared to the WBRT arm, a greater proportion of patients in the combination treatment arm had deteriorating diarrhea (P=0.009), along with significantly delayed time to deterioration in role function (4.4 vs. 7.0 months, P=0.03), insomnia (7.0 vs. 4.7 months, P=0.02), and constipation (12.7 vs. 9.3 months, P=0.02) symptoms. The simultaneous addition of erlotinib during WBRT did not decrease the QoL in the overall or epidermal growth factor receptor (EGFR)-mutant patients with BM and resulted in improvements on more QoL scales and slower worsening of some self-reported symptoms compared to WBRT alone. ClinicalTrials.gov identifier: NCT01887795.

Quantity of Caloric Support After Pediatric Severe Traumatic Brain Injury: Description of Associated Outcomes in a Single Retrospective Center Cohort, 2010-2022.

To examine the relationship between adequacy of caloric nutritional support during the first week after severe traumatic brain injury (TBI) and outcome. Single-center retrospective cohort, 2010-2022. Tertiary care children's hospital with a level 1 trauma center. Children younger than 18 years with PICU stay greater than 7 days for management of TBI, who had severe TBI, defined as Glasgow Coma Scale (GCS) score less than or equal to 8 at initial presentation and/or placement of an intracranial pressure monitor or external ventricular drain, and/or decompressive hemicraniectomy. None. A total of 93 patients were identified (median age 46 mo; 53% male; median GCS 5; hospital mortality 4%). Caloric goal was assigned by a dietician and the proportion of prescribed calories delivered to each patient over the first 7 days of PICU admission were analyzed. At the end of the first 7 days post-injury, overall median (interquartile range [IQR]) caloric and protein adequacies were 42% (IQR, 28-62%) and 48% (IQR, 29-61%), respectively. We failed to identify an association between adequacy of caloric support and greater odds of higher Functional Status Scale (FSS) score or higher Glasgow Outcome Scale Extended for Pediatrics score at discharge. However, at outpatient follow-up, prior adequacy of PICU caloric support was associated with greater odds of worse FSS (multiplicative increase per 10% increase in calories [MI], 1.10; 95% CI, 1.03-1.18; p = 0.002) and worse GOS E-Peds (MI, 1.16; 95% CI, 1.08-1.27; p < 0.001) at outpatient follow-up. In pediatric patients with severe TBI, there is an association between delivery of a greater proportion of their goal calories during the first 7 days after injury and greater odds of worse outcome at outpatient follow-up.

Reconstruction of radial deviation after preaxial polydactyly surgery: use of an ulnar fascial flap.

Radial deviation of the interphalangeal (IP) joint is a common complication of treating Wassel type IV-D preaxial polydactyly. Long-term radial deviation can place excessive tension on the radial skin and cause overabundance of the ulnar skin. To overcome this problem, we aimed to utilize a fascial flap for ulnar reconstruction of a defect in the radial skin. We used a fascial flap for ulnar reconstruction of a defect in the radial skin, eight patients (average: 12 years, range: 5-33 years) who underwent reconstructive surgery at our department for radial deviation of the interphalangeal (IP) joint after the initial operation were included between August 2017 and August 2021. An incision was made on the radial side of the thumb. An olive-shaped flap was designed on the ulnar eminence of the IP joint. The skin and fascia in the other three quadrants were incised. While the flap was protected, children with epiphyseal plates underwent wedge osteotomy at the maximum ulnar deviation of the proximal phalanx, and adults underwent direct fusion of the distal IP joint. Absorbable sutures were used to suture the flap. The Tada functional and visual analog scale (VAS) scores were recorded before and after the operation. All flaps survived without infection or necrosis. The preoperative and postoperative Tada scores were 1 and 5, respectively, and the preoperative and postoperative VAS scores were 3 and 9, respectively. The postoperative scores showed a statistically significant degree of improvement. An ulnar fascial flap is an effective and feasible option for repair of radial deviation following surgery for preaxial polydactyly.

Interstitial HDR brachytherapy for anal cancer-results and quality of life.

While anal cancer is avery rare oncological diagnosis representing less than 2% of lower gastrointestinal tract cancers, the incidence has doubled in the past 20years. Radical radiochemotherapy with sequential or simultaneous boost is now the standard treatment modality. Interstitial HDR brachytherapy is one of the boost application options. Implementation of new radiotherapy techniques has resulted in improved therapeutic outcomes; however, it is still associated with acute and especially late toxicity. Gastrointestinal disorders and sexual dysfunction are the most frequent factors affecting the long-term quality of cured patients' lives. Atotal of 96patients consecutively treated between 2000 and 2022 with external beam radio-/chemotherapy and an interstitial brachytherapy boost for histologically verified nonmetastatic anal squamous cell carcinoma were evaluated. The median follow-up time was 15.4 years (range 13.4-17.3 years). The primary objective of the study was to assess local control (LC) and quality of life (QoL). The Czech versions of internationally validated EORTC questionnaires were used to evaluate life quality-the basic EORTC QOL-C30v.3 and the specific QOL-ANL27 questionnaire. Local control was 85.5% at 5years, 83.4% at 10years, 83.4% at 15years, and 83.4% at 20years, and there was no dependence on clinical stage. The most common forms of acute toxicity were cutaneous and hematological but were gastrointestinal for late toxicities. In the evaluation of quality of life, 80.5% of patients alive at the time participated. In the EORTC quality of life questionnaire C30v.3, patients rated the functional scale score as 86.2 points (standard deviation [SD] = 12.6) and the symptom score as 15.5 points (SD = 12.5). The global health score achieved 68.4 points (SD = 23.6). The most common symptoms were fatigue with 25.6 points (SD = 20.2) and diarrhea with 19.0 points (SD = 27.8). In the QOL-ANL27 questionnaire, symptom scales assessing bowel symptoms were scored 27.5 points (SD = 19) in non-stoma patients and 11.9 points (SD = 17.2) in stoma patients. In the single-item symptom scales, the highest scores were rated for frequency of urination with 26.4 points (SD = 30.8), need to be close to atoilet with 22.4 points (SD = 27.3), and self-cleaning more often with 25.3 points (SD = 31.8). In the functional scales assessing sex life and interest, men and women reported scores of 45.2 (SD = 23) and 45.5 points (SD = 19), respectively. Boost with interstitial HDR brachytherapy is an established safe method of anal cancer treatment, with excellent results and limited late toxicity. Functioning scales were rated relatively highly in QoL questionnaires, and the overall global health score was comparable to published data. Gastrointestinal difficulties, fatigue, and sexual dysfunction dominated the symptom scales in our cohort.

The in-vivo medial and lateral collateral elongation correlated with knee functional score and joint space following unicompartmental knee arthroplasty

BackgroundThe medial collateral ligament (MCL) and lateral collateral ligament (LCL) are paramount for joint stability. Their elongation patterns may change during fixed-bearing and mobile-bearing unicompartmental knee arthroplasty (FB and MB UKA). This study aims to explore the relationship between the elongation of MCL, LCL, and changes in joint space, as well as their correlation with functional scale scores during FB and MB UKA. HypothesisWe hypothesize that MCL and LCL have different elongation patterns in UKA patients, and there is a correlation between elongation and joint space and functional scores. Materials and methodsThe study recruited 24 patients undergoing UKA on a unilateral knee (13 FB and 11 MB). A dual fluoroscopic imaging system was employed to assess in-vivo knee kinematics during static standing and single-leg lunge. The superficial and deep MCL (sMCL, dMCL) and LCL were divided into anterior, medium, and posterior portions. The virtual ligament method quantified in-vivo ligament lengths. Analysis focused on the correlation of normalized ligament lengths with functional scores and joint space. Results1. LCL Elongation in FB UKA: There is a significant increase in LCL elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 2. MCL Elongation in MB UKA: Both sMCL and dMCL exhibit significant elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 3. Correlation with Functional Scores: Differences in collateral ligament elongation in FB UKA are significantly correlated with the OKS and KSS, highlighting the impact on functional outcomes. In MB UKA, differences in ligament elongation are significantly correlated with the FJS. 4. Joint Space Correlation: There is a significant correlation between the elongation of the anterior and medium portions of dMCL and joint space in the surgical compartment during mid- and deep flexion (30−100°, p < 0.05, r > 0.64). ConclusionThe study reveals distinct ligament elongation patterns between UKA and native knees in LCL for FB UKA and MCL for MB UKA. These patterns are associated with knee functional scores. Moreover, dMCL elongation correlates significantly with the joint space for MB UKA during middle and deep flexion phases. Level of evidenceIII; prospective retrospective cohort study.

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study.

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.

Online advertisements with scarcity messages and the association with attitudes for functional and symbolic aspects of vitamins and supplements

Purpose Scarcity appeals in advertising can increase consumer purchase intentions. This study aims to examine the impact of different online scarcity message appeals and the association with consumer attitudes for functional and symbolic aspects of vitamins and supplements. Design/methodology/approach This survey of 789 participants evaluated the scarcity appeals of high-demand message, limited-time message, low-stock message and countdown timer and the association with consumer attitudes for functional and symbolic aspects of vitamins and supplements. Findings The results showed that high-demand messages as compared to regular advertising messages was significantly associated with increased functional and symbolic scale scores. African Americans, Hispanics and Asian/Asian Americans were each significantly associated with increased functional and symbolic scale scores as compared whites. Advertising deception of veracity was significantly negatively associated with symbolic scale score but not associated with functional scale score. Advertising deception of ethical was significantly positively associated with symbolic scale score but not associated with functional scale score. Practical implications In conclusion, high-demand messages may be a particularly useful type of scarcity appeal to use in online advertising for vitamins and supplements. Originality/value To the best of the authors’ knowledge, this is the first study of online advertising message scarcity types and how they are associated with consumers attitudes for functional and symbolic aspects of vitamins and supplements.

Superthin Anterolateral Thigh Flap for Head and Neck Reconstruction.

This study was performed to clarify whether the superthin anterolateral thigh (ALT) flap is an appropriate choice for head and neck reconstructions requiring thinner and more pliable flaps. Data of patients who underwent head and neck reconstruction from January 2020 to December 2022 were retrospectively collected. Nine patients (4.2%) underwent reconstruction with a superthin ALT flap. All the flaps survived with no cases of total or partial necrosis. Six patients treated with superthin ALT flaps and 15 patients treated with conventional ALT flaps who underwent oral cavity reconstruction were compared. The mean body mass index was significantly higher in the superthin flap group than in the conventional ALT flap group (25.2 vs 21.2kg/m2, respectively; P = 0.04). The rate of postoperative complications requiring debridement was 0% and 13% (P = 0.37). The mean postoperative Hirose score was 9.7 and 8.7 (P = 0.17). The mean postoperative Functional Oral Intake Scale score was 6.7 and 5.9 (P = 0.12). Secondary flap refinement surgery after facial skin reconstruction was performed in 0 of 2 patients (0.0%) in the superthin flap group and 4 of 52 patients (7.7%) in the conventional ALT flap group (P = 0.04). Oral cavity reconstruction with superthin ALT flaps did not increase the incidence of postoperative flap necrosis and resulted in comparable postoperative function. In addition, superthin ALT flaps did not require additional flap refinement surgeries after facial skin reconstruction. The superthin ALT flap is a safe and reliable choice for obese patients with thick thigh subcutaneous tissue.

Social conditions impact functional outcome in patients with hand osteoarthritis: the low-income hand osteoarthritis (LIHOA) cohort

BackgroundHand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA).MethodsData from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [</≥ 9 school-years (SY)].Results107 out of the 119 patients were included. Mean age was 61.9 (±10.3) years with 94 (92%) women. Systemic arterial hypertension (48%), metabolic syndrome (42.8%), dyslipidemia (28.4%), and obesity (25%) were the most common comorbidities. Mean disease duration was 7.5 ± 7.1 years. Median VAS values at rest and activity were 3 (3–5) and 8 (5–9), respectively (p < 0.001). Fifty-seven (56.4%) patients had ≥4 symptomatic joints with a median of 4 (2–8) painful joints at activity. The 2nd distal interphalangeal (IF), joint was the most symptomatic (21; 23.3%) and most had >4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5–14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1–0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared </≥3 MW earnings, respectively. Most declared >9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone.ConclusionClinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.

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.