Subjective Improvement Research Articles

Can MRI predict olfactory loss and improvement in posttraumatic olfactory dysfunction?

Although most patients with post-traumatic olfactory dysfunction (PTOD) undergo MRI, there is no consensus about its diagnostic or prognostic value. The aims were: 1) to classify the extent of post-traumatic neurodegeneration; 2) to determine its relationship with chemosensory dysfunction (smell, taste, trigeminal); and 3) to establish whether MRI can predict olfactory improvement. We conducted a retrospective cohort study based on a series of 56 patients with PTOD. All patients underwent validated psychophysical tests of their smell, taste, and trigeminal functions, otorhinolaryngologic evaluation, and MRI. An experienced radiologist blinded to patient data evaluated 40 chemosensory-relevant brain regions according to a four-point scale (0=no lesion to 3=large lesion). Follow up data after 4 years (on average) were available in 46 patients. The cluster analysis showed 4 brain lesion patterns that differed in lesion localization and severity. They are associated with diagnostic categories: anosmia, hyposmia and normosmia. Two clusters were highly specific for anosmia (100% specificity)and could accurately predict this condition (100% positive predictive value). No clusters were associated with trigeminal or taste dysfunction. Regarding improvement, 72.7% of patients in the cluster with mild lesions experienced subjective and measurable olfactory improvement whereas this was only the case in 21.7-37.5% of patients with larger lesions. The odds of subjective smell improvement were 5.9 times higher in patients within the milder cluster compared to larger ones. The analysis of brain lesions in PTOD allows corroboration of smell test results and prediction of subjective and measurable improvement.

A Pilot Study to Evaluate the Efficacy and Tolerability of a Topical Combination Serum for the Improvement of Aged Skin.

With intrinsic aging, the epidermis becomes thinner and fine wrinkles appear. Extrinsic aging, or photoaging, is characterized by deep wrinkles, skin laxity, and hyperpigmentation. To evaluate the efficacy and safety of a novel combination serum with retinol, hyaluronic acid, and trichloroacetic acid (Test Product) for the improvement of aged facial skin. Female subjects (n=22) enrolled in the single-site, open-label, pilot study. Subjects had mild to moderate fine lines and wrinkles and mild to moderate photodamage. Subjects applied the Test Product, cleanser, and moisturizer-sunscreen combo once daily to the face during the 12-week study. Radiance, skin tone, skin smoothness, skin texture, red/blotchy, dryness, overall appearance, skin quality, and tolerance were evaluated at each visit. Skin radiance, tone, smoothness, texture, and overall appearance improved significantly with continued use of the Test Product up to week 12. Subjective improvement was significant for texture, tone, glow, smoothness, youthful appearance, pores, and satisfaction. More than half of subjects showed improvement in skin elasticity, redness/broken capillaries, and dryness. The treatment was well tolerated. The combination serum with retinol, hyaluronic acid, and trichloroacetic acid has been shown to improve aged facial skin and is well tolerated when used daily for up to week 12. J Drugs Dermatol. 2023;22(12):1204-1209. doi:10.36849/JDD.6835.

Non-Invasive Treatment of Early Diabetic Macular Edema by Multiwavelength Photobiomodulation with the Valeda Light Delivery System.

Diabetes is associated with ocular complications including diabetic macular edema (DME). Current therapies are invasive and include repeated intravitreal injections and laser therapy. Photobiomodulation (PBM) is a treatment (Tx) that utilizes selected wavelengths of light to induce cellular benefits including reduction of inflammation and edema. This single-center, open-label, post-hoc analysis explored the utility of multiwavelength PBM in subjects with DME. Analysis included review of data from patients undergoing standard clinical care with an approved and marketed PBM medical device, the Valeda® Light Delivery System. Subjects with early-stage DME with good vision (Best-corrected visual acuity (BCVA) > 20/25, logMAR > 0.1) were evaluated in clinic and treated with one series of multiwavelength PBM (Tx delivered 3x/week over 3-4 weeks; total of 9 Tx sessions). Clinical, anatomical, and safety parameters were assessed in addition to subjective quality of life. A total of 30 eyes (19 subjects) were analyzed. Subjects were predominately male (68.4%) with a mean age of 56 ± 14 years. Reductions in central retinal thickness (CRT), resolution of intraretinal fluid (IRF) and improvement in diabetic retinopathy severity scale scores were observed following PBM treatment in select patients. Baseline BCVA remained stable over the follow-up observation period of 3 months post-PBM. Approximately 64% of patients reported subjective improvements in their ocular condition and decreased influence in everyday life. Detailed OCT evaluations confirmed no safety issues related to phototoxicity up to 16 months. Early-stage DME subjects treated with Valeda multiwavelength PBM showed improvements in clinical and anatomical parameters. The Valeda multiwavelength PBM approach demonstrates a favorable safety profile with no signs of phototoxicity following an independent OCT review. PBM therapy may offer an alternative, non-invasive treatment strategy with a unique mechanism and modality for patients with early-stage DME.

Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery

PurposeThe impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before. MethodWe studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups. ResultsBefore the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08). ConclusionAt the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.

P100 Acceptance, Compliance and Efficacy of Oral Appliance Therapy by Patients Suffering from Sleep Apnoea.

Abstract Background Obstructive Sleep Apnoea (OSA) represents an established risk factor for several medical conditions. The evidence demonstrates that OSA can be effectively treated by an oral appliance. However, there less information about the role of an oral appliance in a clinical care model in terms of uptake and efficacy. This study aimed at examining the efficacy of an intervention in dental public health settings in Melbourne, Australia. Methods Data were collected from the 2018-2021. Participants who fitted inclusions criteria completed two instruments. The Epworth Sleepiness Score (ESS) was used to assess the Subjective daytime sleepiness, and the Apnoea Hypopnea Index (AHI) objectively evaluated the severity of OSA. Participants were further asked to self-report felt improvements post intervention. Paired t-tests were used to compare pre-test and the post-test results. Results 34 participants had complete before and after data recorded. The mean age of the final samples of 66.4 (s.d., 14.2), the majority were female (67.7%). Participants unanimously acknowledged improvements after the intervention. Findings also indicated that after the intervention, participants had significantly lower EES scores compared to their baseline scores (6.9 vs 12.7; p<0.001). Regarding the AHI, at post-test, participants had significantly lower AHI scores compared to their baseline scores (13.8 vs. 19.2; p<0.001). Conclusions Present results indicate the use of oral appliance will ultimately benefit public patients who suffer from OSA. After the intervention, there were both objective and subjective improvements in OSA. Thus, findings provide valuable inputs and guidance for the design and implementation for larger efficacy trial.

Pretreatment pupillary reactivity is associated with differential early response to 10 Hz and intermittent theta-burst repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD)

BackgroundRepetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD). Two common rTMS protocols, 10 Hz and intermittent theta burst stimulation (iTBS), have comparable rates of efficacy in groups of patients. Recent evidence suggests that some individuals may be more likely to benefit from one form of stimulation than the other. The pretreatment pupillary light reflex (PLR) is significantly associated with response to a full course of rTMS using heterogeneous stimulation protocols. ObjectiveTo test whether the relationship between pretreatment PLR and early symptom improvement differed between subjects treated with iTBS or 10 Hz stimulation. MethodsPLR was measured in 52 subjects who received solely 10 Hz (n = 35) or iTBS (n = 17) to left dorsolateral prefrontal cortex (DLPFC) for the first ten sessions of their treatment course. Primary outcome measure was the percent change of Inventory of Depressive Symptomatology – Self Report (IDS-SR) from session 1 to session 10. ResultsThere was a positive association between normalized maximum constriction velocity (nMCV) and early improvement in subjects receiving 10 Hz stimulation (R = 0.48, p = 0.004) and a negative association in subjects receiving iTBS (R = −0.52, p = 0.03). ANOVA revealed a significant interaction between nMCV and the type of initial stimulation (p = 0.001). Among subjects with low nMCV, those initially treated with iTBS showed 2.6 times greater improvement after 10 sessions (p = 0.01) than subjects initially receiving 10 Hz stimulation. ConclusionnMCV may detect physiologic differences between those likely to benefit from 10 Hz or iTBS treatment. Future studies should examine whether PLR could guide prospective treatment selection.

Evaluation of modified coblation endoscopic lingual lightening in multilevel surgery for obstructive sleep apnea hypopnea syndrome: an open intervention study

PurposeTo evaluate the efficacy and safety of modified coblation endoscopic lingual lightening to address retrolingual obstruction in multilevel surgery for obstructive sleep apneae (OSA).MethodsPatients with OSA due to retropalatal and retrolingual obstructions were enrolled. Group 1 consisted of patients who underwent modified coblation endoscopic lingual lightening combined with H-uvulopalatopharyngoplasty, while group 2 comprised patients treated by H-uvulopalatopharyngoplasty alone. Objective parameters and subjective evaluations were recorded preoperatively and at 6 months postoperatively.ResultsThe mean (standard deviation) apnea-hypopnea index (AHI) declined from 51.5 (18.9) to 14.3 (7.2) in group 1, and from 51.7 (15.8) to 28.5 (16.9) in group 2. The mean (standard deviation) percentage change in AHI was higher in group 1 than in group 2 (73.2 [10.9] vs. 48.9 [22.4], P < 0.01). The surgical response rate differed significantly between groups 1 and 2 (88.5 [23/26] vs. 46.7 [14/30], P < 0.01). Other outcomes, including the lowest oxygen saturation, Epworth Sleepiness Scale score, snoring visual analog scale score, and subjective improvement rate, were also significantly better in group 1 than in group 2.ConclusionWithout increasing complications, modified coblation endoscopic lingual lightening significantly improved surgical outcomes as part of multilevel surgery in patients with OSA due to multilevel obstruction.

Effects of Analgesics and Sedatives before Silicone-tube Intubation on Patients’ Pain with Nasolacrimal Duct Stenosis

Purpose: We investigated the effect of preoperative administration of analgesics and sedatives on pain levels during silicone tube intubation conducted under local anesthesia in patients with acquired nasolacrimal duct stenosis.Methods: We retrospectively reviewed the medical records from 121 patients at the ophthalmology department of our hospital from July 2016 to May 2022. In total, 71 patients were administered acetaminophen and diazepam orally, while the remaining 50 were not. Postoperative pain (measured using the visual analogue scale [VAS] score [0 = no pain, 10 = severe pain] immediately after operation), operative duration, and improvement in epiphora symptoms were compared between the two groups.Results: The premedication group had significantly lower VAS scores than the non-premedication group (5.23 ± 2.75 vs. 6.34 ± 2.33, p = 0.02). It also had a notably shorter (p &lt; 0.01) operation duration and higher subjective improvement rate of epiphora symptoms. However, premedication did not influence the tube retention period post-surgery (p = 0.86).Conclusions: The administration of analgesics and sedatives prior to silicone tube intubation effectively mitigates operative pain and reduces operation duration. Furthermore, it may help improve postoperative epiphora symptoms.

Monoclonal antibody therapy for COVID-19 during pregnancy

Aim. Pregnancy worsens COVID-19 and has been listed by the US Food and Drug Administration as a high risk factor for complicating COVID-19. The severe course of a new coronavirus infection in some pregnant patients has created the prerequisites for the search for treatment methods that can reduce the likelihood of adverse outcomes. One of these therapy options is treatment with virus-neutralizing antibodies monoclonal antibodies. Experience with the use of monoclonal antibodies for the treatment of pregnant women is very limited, but in 2021 pregnancy was recognized as a high risk factor for the course of a new coronavirus infection, making it possible to use this group of drugs.&#x0D; Materials and methods. We described the experience of COVID-19 monoclonal antibody therapy during pregnancy in the Republic of Tatarstan. A retrospective analysis of 18 case histories of pregnant patients with mild and moderate course of confirmed coronavirus infection, treated with monoclonal antibodies (casirivimab/imdevimab) from March 2022 to June 2022, was carried out on the basis of the Perinatal Center of the Republican Clinical Hospital, Kazan, Republic of Tatarstan.&#x0D; Results. All patients tolerated the administration of casirivimab/imdevimab satisfactorily; no adverse drug reactions were identified. Subjective improvement was observed on the 3rd day of MCA treatment. Delivery through the natural birth canal was carried out on time in 11 women; by caesarean section on time in 5 patients. A follow-up study of children born to 18 patients who had COVID-19 was collected. The age of the children at the time of information collection ranged from 10 months 1 year 1 month. Currently, all children are healthy and developing according to their age.&#x0D; Conclusion. In all pregnant patients with a new coronavirus infection with mild to moderate course, the administration of casirivimab/imdevimab was an effective method of treating the new coronavirus infection. The follow-up of children born from 18 patients was followed: the childrens condition was satisfactory, their development corresponded to their age.

Satisfactory Clinical Outcome, Complications, and Provisional Results of Meniscus Centralization with Medial Meniscus Root Repair for the Extruded Medial Meniscus at Mean 2-Year Follow-Up

To describe the patient-reported clinical outcomes following medial meniscus root repair with meniscus centralization and to identify common complications and detail provisional results. Patients undergoing medial meniscus root repair with meniscus centralization from 2020 to 2022 were identified using an institutional database. Patients were followed prospectively using postoperative Tegner Activity Scale, visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, International Knee Documentation Committee score, and a Likert score for improvement, surgery satisfaction, and subsequent surgeries at minimum 1-year follow-up with mean 2-year follow-up. Demographics, injury characteristics, and surgical details were also collected. Twenty-five patients (age: 50 ± 11 years; sex: 76% female; body mass index: 33 ± 8) were included in this study. Postoperative Tegner score was maintained at preoperative levels (P= .233), and VAS at rest, VAS with use, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, and International Knee Documentation Committee improved significantly postoperatively (P= .003; P < .001, P < .001, P= .023, respectively). Eighty-eight percent of patients reported subjective improvement in their knee at final follow-up. Postoperative radiographs did not show any significant osteoarthritis progression, and no patients had undergone a revision meniscus surgery or total knee arthroplasty at the time of follow-up. At minimum 1-year follow-up and mean 2-year follow-up, patients undergoing medial meniscus root repair with meniscus centralization demonstrated significant postoperative improvements in pain, function, and quality of life and reported high rates of surgery satisfaction. There was no evidence of significant arthritic progression on postoperative imaging, and no patients underwent revision meniscus surgery or total knee arthroplasty. Level IV, case series.

Outcomes of Endonasal Dacryocystorhinostomy Performed for Functional Nasolacrimal Obstruction With Delay on Dacryoscintigraphy.

To report the demographics and outcomes of endonasal dacryocystorhinostomy (DCR) following dacryoscintigraphy (DSG) performed for a series of patients with functional epiphora. Case series of endonasal DCR outcomes in patients with symptomatic epiphora with no evidence of lacrimal hypersecretion or lacrimal pump failure, minimal regurgitation noted on syringing, and DSG-confirmed delayed drainage. A successful outcome was defined as 80% subjective improvement or resolution of tearing on the operated side. Patient charts, DSG results, and operative records were examined, and data were collected. Relevant literature was reviewed and discussed. The case series included 15 eyes of 10 patients. The mean age was 61.7 years at the time of surgery. Most cases (n=13) had post-sac obstruction, retention, or delay. One patient had pre and post-sac retention. A total of 12 cases had success after endonasal DCR, and 3 cases had failure. Follow-up for all operated patients was over 6 months. There were no reported complications by the surgeon or patients. Patients with functional epiphora confirmed by DSG seem to have a high success rate after endonasal DCR. In patients with symptomatic epiphora with subjective patency on syringing, the use of DSG in decision-making and outcome prediction may be supported. Further studies, including clinic-based tests, to demonstrate functional obstruction are warranted.

Micropulse cyclophotocoagulation based on a modified protocol of energy parameters in the treatment of patients with end-stage glaucoma

Purpose: to evaluate the effectiveness of transscleral micropulse cyclophotocoagulation (mCPC) in patients with end-stage glaucoma.Material and methods. 38 patients aged 76.6 ± 7.1 years with end-stage refractory glaucoma were examined, revealing subjective complaints, uncompensated IOP at the maximum hypotensive mode, prior multiple surgical interventions. Indications for mCPC to be performed on a SUPRA 810 device (Quantel Medical, France) according to a modified protocol, in which the laser energy flux is 121.8 J/cm2, were determined. In order to prevent postoperative inflammation after mCPC, a combined drug Floas-T® (glucocorticosteroid fluorometholone + tobramycin) was used.Results. A week after mCPC, the hypotensive effect was achieved in all 38 cases. IOP showed a 30.8 % decrease from the baseline. Considering an additional mCPC given to 14 patients, the entire group showed an IOP 22.8 % decrease (from 34.7 to 26.8 ± 2.9 mm Hg, p &lt; 0.05) achieved after an 18 months’ follow-up. The combined drug Floas-T® was found to contribute to a subjective and clinical improvement, revealing no signs of an increased IOP.Conclusion. The use of mCPC in the treatment of patients with repeatedly operated refractory end-stage glaucoma who receive a maximum hypotensive mode should be estimated as a positive measure. The combined drug based on fluoroquinolone and tobramycin has demonstrated high effectiveness of anti-inflammatory prevention. A survey showed a subjective improvement in the patients’ quality of life. The mCPC method can be recommended as one of the components of a comprehensive rehabilitation program for patients with end-stage glaucoma.

Safety and Efficacy of Posterior Upper Rib Excision and Decompression Technique for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome

There are several approaches used for surgical treatment of neurogenic thoracic outlet syndrome (n-TOS). The posterior upper rib excision and decompression technique is a novel technique that was developed and used by the author for the past 8 years. The purpose of this paper is to report clinical outcomes of patients treated with this approach. All patients with n-TOS operated by single surgeon from 2015 to 2023 were retrospectively analyzed. Demographic, clinical, radiologic, surgical, and postoperative data were collected and reported with emphasis on efficacy and complications. The surgical success was evaluated subjectively as excellent, good, fair, poor, and bad. Radiologic data were analyzed to assess the extent of accessory/first rib removal. Eighty procedures were performed in 61 patients with a mean follow-up of 1153 (87-3048) days. The majority (60.7%) of patients were women, with 39.3% being men. In 11 cases (18%) causative factor was bone abnormality. Two patients were previously operated at another centers (3.3%). Total mean subjective improvement rate was 91.5%. More than half (55) of the patients reported "excellent" (>75%) and 6 "good" improvements (50%-75%); no fair, poor, and worse outcomes were reported. Patients reporting "good" outcome had statistically significant shorter follow-ups than the "excellent" group (P < 0.001). Complications included pleural opening, Horner syndrome, and apical hematoma, none of which were permanent. The posterior upper rib excision and decompression approach provides excellent clinical outcomes in patients with n-TOS. It allows better intraoperative visualization and removal of the first rib and full decompression of the neurovascular bundle.

Outcomes and Adverse Effects of Voretigene Neparvovec Treatment for Biallelic RPE65-Mediated Inherited Retinal Dystrophies in a Cohort of Patients from a Single Center.

Our study evaluated the morphological and functional outcomes, and the side effects, of voretigene neparvovec (VN) gene therapy for RPE65-mediated inherited retinal dystrophies (IRDs) in 12 eyes (six patients) at the Oxford Eye Hospital with a mean follow-up duration of 8.2 (range 1-12) months. All patients reported a subjective vision improvement 1 month after gene therapy. Best-corrected visual acuity (BCVA) remained stable (baseline: 1.28 (±0.71) vs. last follow-up: 1.46 (±0.60); p = 0.25). Average white Full-Field Stimulus Testing (FST) showed a trend towards improvement (baseline: -4.41 (±10.62) dB vs. last follow-up: -11.98 (±13.83) dB; p = 0.18). No changes in central retinal thickness or macular volume were observed. The side effects included mild intraocular inflammation (two eyes) and cataracts (four eyes). Retinal atrophy occurred in 10 eyes (eight mild, two severe) but did not impact FST measurements during the follow-up period. Increased intraocular pressure (IOP) was noted in three patients (six eyes); four eyes (two patients) required glaucoma surgery. The overall safety and effectiveness of VN treatment in our cohort align with previous VN clinical trials, except for the higher occurrence of retinal atrophy and increased IOP in our cohort. This suggests that raised IOP and retinal atrophy may be more common than previously reported.

Treatment of urge incontinence in postmenopausal women: A systematic review.

Urinary incontinence and other urinary symptoms tend to be frequent at menopause because of hormonal modifications and aging. Urinary symptoms are associated with the genitourinary syndrome of menopause which is characterized by physical changes of the vulva, vagina and lower urinary tract. The treatment strategies for postmenopausal urinary incontinence are various and may include estrogens, anticholinergics, and pelvic floor muscle training. A comparison of these treatments is difficult due to the heterogeneity of adopted protocols. We systematically reviewed the evidence from randomized controlled trials (RCTs) focusing on treatment of postmenopausal women with urge incontinence. We conducted a systematic review and meta-analysis by searching PubMed and EMBASE databases for randomized controlled trials (RCTs) reporting results of treatments for postmenopausal urinary urge incontinence. Odds ratios for improvement of urinary incontinence were calculated using random effect Mantel-Haenszel statistics. Out of 248 records retrieved, 35 eligible RCTs were assessed for risk of bias and included in the meta-analysis. Compared with placebo, systemic estrogens were associated with decreased odds of improving urinary incontinence in postmenopausal women (OR = 0.74, 95% CI: 0.61-0.91, 7 series, 17132 participants, Z = 2.89, P = 0.004, I2 = 72%). In most studies, no significant improvement in urinary symptoms was observed in patients treated with local estrogens, although they showed to be helpful in improving vaginal symptoms. Vitamin D, phytoestrogens and estrogen modulators were not effective in improving symptoms of incontinence and other symptoms of genitourinary menopause syndrome or yielded contradictory results. A randomized controlled trial demonstrated that oxybutynin was significantly better than placebo at improving postmenopausal urgency and urge incontinence. The combination of anticholinergics with local estrogens has not been shown to be more effective than anticholinergics alone in improving urinary incontinence symptoms in postmenopausal women. Physical therapy showed an overall positive outcome on postmenopausal urinary incontinence symptoms, although such evidence should be further validated in the frame of quality RCTs. The evidence for effective treatment of postmenopausal urinary incontinence is still lacking. Welldesigned large studies having subjective and objective improvement primary endpoints in postmenopausal urinary incontinence are needed. At present, a combination of different treatments tailored to the characteristics of the individual patient can be suggested.

What happens when pharmacist independent prescribers lead on medicine management in older people’s care homes: a qualitative study

ObjectiveOlder people in care homes frequently experience polypharmacy, increasing the likelihood of medicine-related burden. Pharmacists working within multidisciplinary primary care teams are ideally placed to lead on medication reviews. A...

Clinical outcomes of percutaneous Fontan stenting in adults.

Fontan pathway stenosis is a well-known complication post-palliation. Percutaneous stenting is effective for angiographic/hemodynamic relief of Fontan obstruction, but its clinical impact in adults remains unknown. Retrospective cohort of 26 adults undergoing percutaneous stenting for Fontan obstruction between 2014 and 2022. Procedural details, functional capacity, and liver parameters were reviewed at baseline and during follow-up. Age was 22.5 (19; 28.8) years; 69% were male. Post-stenting, Fontan gradient significantly decreased [1.5±1.7 vs 0 (0; 1) mmHg, p<0.005], and minimal Fontan diameter increased [11.3±2.9 vs 19.3 (17; 20) mm, p<0.001]. One patient developed acute kidney injury periprocedurally. During a follow-up of 2.1 (0.6; 3.7) years, one patient had thrombosis of the Fontan stent, and two underwent elective Fontan re-stenting. New York Heart Association functional class improved in 50% of symptomatic patients. Changes in functional aerobic capacity on exercise testing were directly related to pre-stenting Fontan gradient (n=7; r=0.80, p=0.03) and inversely related to pre-stenting minimal Fontan diameter (r=-0.79, p=0.02). Thrombocytopenia (platelet count <150 109/L) was present in 42.3% of patients pre- and 32% post-procedure (p=0.08), and splenomegaly (spleen size >13 cm) in 58.3% and 58.8% (p=0.57), respectively. Liver fibrosis (aspartate aminotransferase to platelet ratio index and Fibrosis-4) scores were unchanged post-procedurally compared to baseline. Percutaneous stenting in adults is safe and effective in relieving Fontan obstruction, resulting in subjective improvement in functional capacity in some. A subset of patients demonstrated improvement in markers of portal hypertension, suggesting that Fontan stenting could improve FALD in select individuals.

Long-Term Outcomes of Primary Hip Arthroscopy With Labral Repair for Femoroacetabular Impingement: Results at Minimum 9-Year Follow-up.

Hip arthroscopy continues to advance and become increasingly commonly performed. With the evolution of techniques and instrumentation, labral repair rather than debridement has emerged as the treatment of choice for labral pathology. There remains a lack of data on long-term outcomes after labral repair. To (1) evaluate long-term patient-reported outcomes of primary hip arthroscopy with labral repair for femoroacetabular impingement, (2) report achievement rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID), and (3) investigate rates of reoperation and progression to total hip arthroplasty (THA). Case series; Level of evidence, 4. Prospectively collected data were reviewed for patients who underwent primary hip arthroscopy with labral repair between 2010 and 2013. Patients' medical records were reviewed for demographic characteristics, intraoperative findings, reoperation, and progression to THA. Patients were assessed pre- and postoperatively using the following scales: visual analog scale (VAS) for pain; Tegner activity scale; modified Harris Hip Score (mHHS); 12-item International Hip Outcome Tool (iHOT-12); Hip Outcome Score-Activities of Daily Living (HOS-ADL); HOS-Sport-Specific Subscale (HOS-SSS); and Non-Arthritic Hip Score. Patients were also surveyed for satisfaction, subjective improvement, and level of function. A total of 32 patients (n = 24 women; n = 8 men) with a mean age of 27.7 years (range, 13.6-51 years) were evaluated for a mean of 9.4 years (range, 9-12.1 years). Patients achieved significant mean improvements in VAS pain at rest of 2 points, VAS pain with use of 1.9, mHHS of 19.9 points, iHOT-12 of 33.5 points, HOS-ADL of 17.4 points, and HOS-SSS of 29.5 points (P≤ .015 for all). Eleven patients (34.4%) underwent reoperation and 4 (12.5%) progressed to THA during the study period. At the final follow-up, the MCID achievement rate was ≥68%, the PASS achievement rates ranged from 39% to 65%, and the mean patient satisfaction was 8.1 on a 1 to 10 scale, with 10 denoting most satisfied. Patients demonstrated significant postoperative improvements in pain, mHHS, iHOT-12, HOS-ADL, and HOS-SSS scores at 9 years postoperatively. The all-cause reoperation rate was 34.4%, and 12.5% of patients progressed to THA.

Audio-induced medial prefrontal cortical dynamics enhances coadaptive learning in brain–machine interfaces

Objectives. Coadaptive brain–machine interfaces (BMIs) allow subjects and external devices to adapt to each other during the closed-loop control, which provides a promising solution for paralyzed individuals. Previous studies have focused on either improving sensory feedback to facilitate subject learning or developing adaptive algorithms to maintain stable decoder performance. In this work, we aim to design an efficient coadaptive BMI framework which not only facilitates the learning of subjects on new tasks with designed sensory feedback, but also improves decoders’ learning ability by extracting sensory feedback-induced evaluation information. Approach. We designed dynamic audio feedback during the trial according to the subjects’ performance when they were trained to learn a new behavioral task. We compared the learning performance of two groups of Sprague Dawley rats, one with and the other without the designed audio feedback to show whether this audio feedback could facilitate the subjects’ learning. Compared with the traditional closed-loop in BMI systems, an additional closed-loop involving medial prefrontal cortex (mPFC) activity was introduced into the coadaptive framework. The neural dynamics of audio-induced mPFC activity was analyzed to investigate whether a significant neural response could be triggered. This audio-induced response was then translated into reward expectation information to guide the learning of decoders on a new task. The multiday decoding performance of the decoders with and without audio-induced reward expectation was compared to investigate whether the extracted information could accelerate decoders to learn a new task. Main results. The behavior performance comparison showed that the average days for rats to achieve 80% well-trained behavioral performance was improved by 26.4% after introducing the designed audio feedback sequence. The analysis of neural dynamics showed that a significant neural response of mPFC activity could be elicited by the audio feedback and the visualization of audio-induced neural patterns was emerged and accompanied by the behavioral improvement of subjects. The multiday decoding performance comparison showed that the decoder taking the reward expectation information could achieve faster task learning by 33.8% on average across subjects. Significance. This study demonstrates that the designed audio feedback could improve the learning of subjects and the mPFC activity induced by audio feedback can be utilized to improve the decoder’s learning efficiency on new tasks. The coadaptive framework involving mPFC dynamics in the closed-loop interaction can advance the BMIs into a more adaptive and efficient system with learning ability on new tasks.

Outcomes of hyperbaric oxygen treatment for central and branch retinal artery occlusion at a major Australian referral hospital.

This study analysed the treatment outcomes of patients that received hyperbaric oxygen treatment (HBOT) for retinal artery occlusion (RAO) at the Royal Brisbane and Women's Hospital in Brisbane, Australia between 2015 and 2021. Retrospective study from patient records including 22 eyes from 22 patients that received HBOT for either central RAO (17 patients) or branch RAO (five patients). Patients received the Royal Brisbane and Women's Hospital RAO protocol for their HBOT. Analysis included best corrected visual acuity pre- and post-treatment, subjective improvements, side effects and patient risk factors were also recorded. Improvement in best corrected visual acuity was LogMAR -0.2 for central RAO on average with 8/17 (47%) experiencing objective improvement, 5/17 (29%) experienced no change and 4/22 (24%) experienced a reduction in best corrected visual acuity. Subjective improvement (colour perception or visual fields) was reported in an additional 4/17 patients, resulting in 12/17 (71%) reporting improvement either in visual acuity or subjectively. There was no improvement in the best corrected visual acuity of any of the five patients suffering from branch RAO. Cardiovascular risk factors present in the cohort included hypertension, hypercholesterolaemia, previous cardiovascular events, cardiac disease and smoking. Limited side effects were experienced by this patient cohort with no recorded irreversible side effects. Hyperbaric oxygen treatment appears a safe, beneficial treatment for central RAO. No benefit was demonstrated in branch RAO although numbers were small. Increased awareness of HBOT for RAO resulting in streamlined referrals and transfers and greater uptake of this intervention may further improve patient outcomes.