Subjective Functional Improvement Research Articles

Successful Adjunctive Treatment of Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP) with High-Dose Intravenous Immunoglobulin Therapy (IVIG).

Purpose: The management of bilateral diffuse uveal melanocytic proliferation is controversial, with most earlier reports advocating for plasmapheresis. Here, we report a case of bilateral diffuse uveal melanocytic proliferation secondary to gastric adenocarcinoma that was successfully treated with adjunctive intravenous immunoglobulin, using a loading dose followed by a treat-and-extend strategy. Methods: Clinical case report with 3 years of follow-up including serial ophthalmologic examinations. Functional assessments included visual acuity and subjective visual complaints. Periodic anatomic assessments were performed including serial optical coherence tomography, ultra-widefield fundus imaging, multimodal angiography, and ophthalmic ultrasound. Results: A 75-year-old man presented with a 6-month history of blurry vision and difficulty with dark and light adaptation in both eyes. A diagnosis of bilateral diffuse uveal melanocytic proliferation was established based on clinical findings and subsequent discovery of an underlying gastric malignancy; the diagnosis of a paraneoplastic syndrome was further substantiated by documentation of cancer-associated antiretinal antibodies and serum reactivity against human retina by immunohistochemistry. Treatment with high-dose (2 g/kg) intravenous immunoglobulin was initiated with biweekly, followed by monthly, then q2-3 monthly dosing intervals. Meanwhile, the patient received surgical resection and systemic chemotherapy resulting in complete radiographic remission of the primary cancer. Over the course of 3 years, the patient has demonstrated clinically significant improvements in visual acuity and subjective visual function. Rapid and sustained anatomic improvements were observed in serous retinopathy and choroidal thickness. Conclusion: Intravenous immunoglobulin may be a viable adjunctive treatment option for some patients with bilateral diffuse uveal melanocytic proliferation.

Procognitive Effects of Adjunctive D-Cycloserine to Intermittent Theta-Burst Stimulation in Major Depressive Disorder: Effets procognitifs de la D-cyclosérine en traitement complémentaire par la stimulation thêta-burst intermittente dans le trouble dépressif caractérisé.

Major depressive disorder (MDD) is associated with cognitive impairments that persist despite successful treatment. Transcranial magnetic stimulation is a noninvasive treatment for MDD that is associated with small procognitive effects on working memory and executive function. We hypothesized that pairing stimulation with N-methyl-D-aspartate (NMDA) receptor agonism would enhance the effects of stimulation and its procognitive effects. The effect of NMDA receptor agonism (D-cycloserine, 100 mg) on cognitive performance was tested in two randomized double-blind placebo-controlled trials: (1) acute effects of in the absence of stimulation (n = 20 healthy participants) and (2) a treatment study of individuals with MDD (n = 50) randomized to daily intermittent theta-burst stimulation (iTBS) with placebo or D-cycloserine for 2 weeks. Cognitive function was measured using the THINC-it battery, comprised of the Perceived Deficits Questionnaire, the Choice Reaction Time, the Trail Making Test, the Digit Symbol Substitution Test, and the 1-Back tests. D-cycloserine had no acute effect on cognition compared to placebo. iTBS + D-cycloserine was associated with significant improvements in subjective cognitive function and correct responses on the 1-Back when compared to iTBS + placebo. Improvements in subjective cognition paralleled depressive symptoms improvement, however 1-Back improvements were not attributable to improvement in depression. An intersectional strategy pairing iTBS with NMDA receptor agonism may restore cognitive function in MDD.

Functional Level and Dynamic Posturography Results Two Years after Vestibular Neurectomy in Patients with Severe Meniere's Disease.

Objectives: The aim of this study was to evaluate the functional outcomes and balance compensation in patients with severe Meniere's disease after vestibular neurectomy. Methods: Pre- and postoperative results were analyzed in twenty patients with unilateral Meniere's disease before and two years after vestibular neurectomy. Clinical evaluation was performed using a subjective grading scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery and the Dizziness Handicap Inventory. Sensory organization test results were analyzed to assess the balance system before and after the surgery. Results: All patients reported a complete resolution of vertigo attacks after the vestibular neurectomy; 95% of patients reported functional level improvement according to a scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery, and the average score decreased from 4.5 to 1.6. Clinical improvement, evaluated with the Dizziness Handicap Inventory, was present in all patients, with the average result decreasing from 81.7 to 16.4. Analyzing both grading systems, differences between pre- and postoperative results were statistically significant. No statistically significant differences were found between the sensory organization test results before and after vestibular neurectomy. Significant correlations were found between a patient's age and postoperative results of the Dizziness Handicap Inventory and posturography. Conclusions: Vestibular neurectomy is an effective vertigo treatment in patients with severe Meniere's disease with no clinical improvement despite conservative treatment. It results in subjective physical, functional, and emotional improvement, enabling patients to return to daily activities and work. An appropriate qualification of patients and comprehensive preoperative evaluation are essential to obtaining satisfactory clinical outcomes.

Gender difference on the mediation effects of filial piety on the association between chronic obstructive pulmonary disease and depressive symptoms in older adults: A community-based study.

Filial piety is viewed as strong family support for older Chinese people, and strongly associated with depressive symptoms. It is unknown if there exists gender difference in the mediation effects of filial piety on the relationship between chronic obstructive pulmonary disease (manifested as lung function) and depression. We investigated whether filial piety mediates the association between lung function and depression in community-dwelling older men and women using the Healthy Aging Longitudinal Study in Taiwan (HALST). Community dwelling adults aged 65 and above were analyzed. Pulmonary function, depressive symptoms, and filial piety expectation (FPE) and receipt of filial piety (RFP) were collected. The interaction and mediation of filial piety between lung function and depression was analyzed. We found that in older men, forced expiratory volume in the first second (FEV1) was inversely correlated with depression (β = -0.1281, p = 0.004) with no mediation effect of FPE. In older women, FEV1 was negatively associated with FPE, but FPE did not increase the risk of depression (β = 0.0605, p = 0.12). In both older men and women, FEV1 was negatively associated with RFP, while RFP reduced the risk of depression (p< 0.001). In older women, the correlation between FEV1 was complete mediation of RFP. Results indicate that feelings of insufficient filial piety may increase the likelihood of depression, especially in elderly women with worse lung function. Although modest, the main mediation effect of filial piety was improvement of lung function in older subjects, which might decrease depression.

Pooled Minimal Clinically Important Differences of the Mini-Balance Evaluation Systems Test in Patients With Early Subacute Stroke: A Multicenter Prospective Observational Study.

Balance problems are common in patients with stroke, and the Mini-Balance Evaluation Systems Test (Mini-BESTest) is a reliable and valid assessment tool for measuring balance function. Determining the minimal clinically important difference (MCID) is crucial for assessing treatment effectiveness. This study aimed to determine the MCID of the Mini-BESTest in patients with early subacute stroke. In this prospective multicenter study, 53 patients with early subacute stroke undergoing rehabilitation in inpatient units were included. The mean age of the patients was 72.6 (SD = 12.2) years. The Mini-BESTest, which consists of 14 items assessing various aspects of balance function, including anticipatory postural adjustments, postural responses, sensory orientation, and dynamic gait, was used as the assessment tool. The global rating of change (GRC) scales completed by the participants and physical therapists were used as external anchors to calculate the MCID. The GRC scale measured subjective improvement in balance function, ranging from -3 (very significantly worse) to +3 (very significantly better), with a GRC score of ≥+2 considered as meaningful improvement. Four methods were used to calculate the MCID: mean of participants with GRC of 2, receiver operating characteristic-based method, predictive modeling method, and adjustment of the predictive modeling method based on the rate of improvement. From the MCID values obtained using these methods, a single pooled MCID value was calculated. The MCID values for the Mini-BESTest obtained through the 4 methods ranged from 3.2 to 4.5 points when using the physical therapist's GRC score as the anchor but could not be calculated using the participant's GRC score. The pooled MCID value for the Mini-BESTest was 3.8 (95% CI = 2.9-5.0). The Mini-BESTest MCID obtained in this study is valuable for identifying improvements in balance function among patients with early subacute stroke. Determination of the MCID is valuable for evaluating treatment effectiveness. The study findings provide clinicians with practical values that can assist in interpreting Mini-BESTest results and assessing treatment effectiveness.

Treatment of Vulvovaginal Laxity by Electroporation: The Jett Plasma Medical for Her II Study.

Vaginal laxity is a widespread and undertreated medical condition associated especially with vaginal parity. To evaluate the efficacy and safety of electroporation therapy treatment of vulvovaginal laxity by the Jett Plasma for Her II device. The Jett Plasma for Her II Study is a multicentric, prospective, randomized, single-blinded, and controlled study. Women presenting with vaginal laxity were randomized to receive electroporation therapy delivered to the vaginal tissue (active-82 patients) vs. therapy with zero intensity (placebo-9 patients). A total of 91 subjects whose average age was 48.69 ± 10.89 were included. Due to the results of a one-way analysis of variance, it may be concluded that in the case of the vaginal laxity questionnaire (VLQ), there is a statistically significant difference between actively treated patients and the placebo group (F1,574 = 46.91; p < 0.001). In the case of the female sexual function index (FSFI), a one-way ANOVA test also showed a statistically significant difference between the actively treated patients and the placebo group (F1,278 = 7.97; p = 0.005). In the case of the incontinence impact questionnaire-7 (IIQ-7), a one-way ANOVA test showed a statistically significant difference between the actively treated patients and the placebo group (F1,384 = 15.51; p < 0.001). It confirms that improvement of vaginal laxity is conjoined with benefits in symptoms of urinary incontinence. Biopsy performed after the end of the treatment shows an increase in the vaginal mucosa thickness by an average of 100.04% in the active group. The treatment was well tolerated with no adverse events. No topical anesthetics were required. Treatments of vulvovaginal laxity by electroporation therapy achieved significant and sustainable 12-month effectiveness. Responses to the questionnaires also suggest subjective improvement in self-reported sexual function, incontinence, sexual satisfaction, and urogenital distress.

Cerebellar deep brain stimulation for the treatment of movement disorders in cerebral palsy.

Cerebral palsy (CP) represents the most common childhood physical disability that encompasses disorders of movement and posture attributed to nonprogressive disturbances that occurred in the developmental fetal or infant brain. Dyskinetic CP (DCP), the second most common type of CP after spastic forms, refers to a subset of patients in whom dystonia and choreoathetosis are the predominant motor manifestations. Most children with CP have abnormal brain MRI studies indicative of cortical and deep gray matter damage consistent with hypoxic ischemic encephalopathy, which may preclude or suggest decreased efficacy of standard deep brain stimulation (DBS) targets. The cerebellum has been posited as an attractive target for treatment of DCP because it is frequently spared from hypoxic ischemic damage and has shown promise in alleviating patient symptoms both in early work in the 1970s and in more recent case series with DBS. The authors performed bilateral cerebellar DBS implantation, targeting the dentate nucleus (DN) and cerebellar outflow pathway, in 3 patients with DCP. Leads were connected to a pulse generator that senses local field potentials during chronic continuous DBS. The authors report their surgical methods, examples of chronic cerebellar local field potential recordings, and preliminary clinical outcomes. Motor outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale. Three patients 14-22 years old with DCP and MRI evidence of structural damage to the basal ganglia were offered cerebellar stimulation targeting the DN. All patients tolerated the procedure well and demonstrated improvement in subjective motor function as well as objective improvement in the Burke-Fahn-Marsden Dystonia Rating Scale movement subscale, although the range of responses was variable (19%-40%). Patients experienced subjective improvement in motor function including ease of hand movements and coordination, gait, head control, speech, decreased overflow, and diminished muscle tightness. DBS of the dentate nuclei in patients with DCP appears to be safe and shows preliminary evidence of clinical benefit. New chronic sensing technology may allow for determination of in vivo mechanisms of network disruption in DCP and allow for further understanding of the effects of neuromodulation on brain physiology. Larger studies with long-term follow up will be required to further elucidate the clinical benefits of this therapy. This report addresses a gap in the literature regarding the technical approach to image-based stereotactic targeting and chronic neural recording in the DN.

Reconstructing a Patellar Tendon Rupture Neglected for 14 Years When Anatomic Restoration Is Not Possible: A Case Report.

This case highlights the utility and outcomes of an Achilles tendon bone-block allograft in reconstructing the patellar tendon of a 44-year-old man in the setting of a high-riding, irreducible patella after a chronic patellar tendon rupture of 14 years. In cases of a neglected patellar tendon rupture with an irreducible high-riding patella, an Achilles tendon bone-block allograft can provide the length and tissue necessary to reconstruct the extensor mechanism. Although reconstruction may not be anatomic, patients can still experience great subjective and objective functional improvement with restoration of the extensor mechanism even after delayed reconstruction.

Effects of Exercise Intervention (with and without Joint Mobilization) in Patients with Adhesive Capsulitis: A Systematic Review and Meta-Analysis.

This review aimed to investigate the effects of exercise and exercise with joint mobilization on shoulder range of motion (ROM) and subjective symptom recovery in patients with adhesive capsulitis (AC). Related Studies published from 2000 to 2021 that were peer-reviewed and for which pre-and post-values could be calculated were extracted from PubMed, CINAHL, SPORTDiscus, and Web of Science. Nine studies met our inclusion criteria. As a result of calculating the standard mean difference (SMD) and 95% confidence intervals (CI), both exercise and exercise with joint mobilization showed a large effect on shoulder ROM and subjective outcomes. The combination showed a more significant effect than exercise alone on shoulder flexion (SMD = -1.59 [-2.34, -0.65]), extension (SMD = -1.47 [-2.05, -0.89]), internal rotation (SMD = -1.77 [-2.17, -1.36], external rotation (SMD = -2.18 [-2.92, -1.44]), and abduction ROM (SMD = -1.99 [CI -3.86, -0.12]). Patients who performed exercise alone showed a higher effect of improvement in subjective function (SMD = 3.15 [2.06, 4.24]) and pain (SMD = 4.13 [1.86, 6.41]). Based on these results, an AC rehabilitation exercise program should be developed by adjusting the amount of exercise and joint mobilization by identifying the patient's needs, subjective symptoms, and ROM.

Feasibility and Acceptability of a Virtual "Coping with Brain Fog" Intervention for Improving Cognitive Functioning in Young Adults with Cancer.

Purpose: Cancer-related cognitive deficits (CRCDs) are common among young adults (YAs) (ages: 18-39) with cancer and can be debilitating. We aimed to determine the feasibility and acceptability of a virtual Coping with Brain Fog intervention among YAs with cancer. Our secondary aims were to explore the intervention's effect on cognitive functioning and psychological distress. Methods: This prospective feasibility study involved eight weekly, 90-minute virtual group sessions. Sessions focused on psychoeducation on CRCD, memory skills, task management, and psychological well-being. The primary outcomes were feasibility and acceptability of the intervention evaluated through attendance (>60% not missing >2 consecutive sessions) and satisfaction (Client Satisfaction Questionnaire [CSQ] score >20). Secondary outcomes included the following: cognitive functioning (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog] Scale) and symptoms of distress (Patient-Reported Outcomes Measurement Information System [PROMIS] Short Form-Anxiety/Depression/Fatigue) and participants' experiences using semistructured interviews. Paired t-tests and summative content analysis were used for quantitative and qualitative data analyses. Results: Twelve participants (five male, mean age = 33 years) were enrolled. All but one participant met feasibility criteria of not missing >2 consecutive sessions (11/12 = 92%). The mean CSQ score was 28.1 (standard deviation 2.5). Significant improvement in cognitive function as measured by FACT-Cog Scale was observed postintervention (p < 0.05). Ten participants adopted strategies from the program to combat CRCD, and eight reported CRCD symptom improvement. Conclusion: A virtual Coping with Brain Fog intervention is feasible and acceptable for the symptoms of CRCD among YAs with cancer. The exploratory data indicate subjective improvement in cognitive function, and will inform the design and implementation of a future clinical trial. ClinicalTrials.gov Registration: NCT05115422.

All-Inside Repair of Complex Posterior Horn Meniscus Tears

Background: Due to difficult-to-access location and complex tear patterns, the management of meniscus injuries in isolation and in conjunction with anterior cruciate ligament injury may be challenging. The aim of this video is to present techniques and tips that may help surgeons perform arthroscopic all-inside repair of complex meniscus tears. Indications: Indications for the presented repair techniques are young patients with high activity demands, symptomatic lateral and medial meniscus lesions, ligamentous knee instability, chondral changes grade 2 or less, neutral joint alignment, and body mass index below 35 kg/m2. Technique Description: High anterolateral, low anteromedial, and accessory anterolateral portals are used for the arthroscopic assessment of meniscus tear quality and pattern, and to ensure adequate access to the lesion. Horizontal mattress, vertical mattress, and cerclage sutures are passed using a range of all-inside devices to approximate tear edges with the aim of restoring native hoop stresses along the circumferential meniscus collagen fibers. Tear edges are abraded to enhance healing potential. Two separate cases and complex tear configurations are presented to illustrate these all-inside meniscus repair techniques. Results: Meniscus repair yields superior long-term outcomes compared with partial meniscectomy. Improvements in subjective knee function and lower rates of progression to long-term knee osteoarthritis are reported in patients treated with meniscus repair versus resection. Advantages of all-inside meniscus repair include the reduced risk of iatrogenic neurovascular lesions, decreased operative time, restoration of native contact surfaces, and repair without fixation of the menisci to the surrounding soft tissue. Discussion/Conclusion: Arthroscopic all-inside meniscus repair enables the safe and efficient management of complex meniscus tears in active patients with symptomatic meniscus pathology, and can be performed concurrent with knee ligament surgery. Consequently, all-inside meniscus repair techniques are a versatile addition to the toolkit of complex knee surgeons. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Cannabis use in cancer patients: acute and sustained associations with pain, cognition, and quality of life

Aim: Given the myriad of negative sequalae associated with cancer and its treatment, the palliative use of cannabis by cancer patients is increasingly of special interest. This research sought to explore associations of acute and sustained use of legal market edible cannabis products on pain, cognition, and quality of life in a group of cancer patients. Methods: In this observational study, cancer patients completed a baseline appointment, a two-week ad libitum cannabis use period, and an acute administration appointment that included assessments before cannabis use, one-hour post-use, and two-hour post-use. Participants completed self-report questionnaires related to the primary outcomes and the Stroop task as a measure of objective cognitive function. Results: Twenty-five participants [mean (standard deviation, SD) age = 54.3 years (15.6); 13 females (52.0%)] completed all study appointments and were included in the analysis. Sustained cannabis use was associated with improvements in pain intensity, pain interference, sleep quality, subjective cognitive function, and reaction times in the Stroop task, but no change in general quality of life was observed. High levels of cannabidiol (CBD) use during the two-week ad libitum use period was associated with steeper improvements in pain intensity and sleep quality. Participants reported improvements in pain intensity and increased feelings of subjective high after acute use. High levels of ∆9-tetrahydrocannabinol (THC) use during the acute administration appointment was associated with steeper increases in feelings of subjective high. Improvements in pain were associated with improvements in subjective cognitive function. Conclusions: This observational study is among the first of its kind to examine associations between legal market, palliative cannabis use, and subjective and objective outcomes among cancer patients. These early findings concerning pain intensity, sleep quality, and cognitive function can help to inform future, fully powered studies of this important topic (ClinicalTrials.gov identifier: NCT03617692).

A randomized, single-blind, parallel-group comparative study on the effects of long-term pineapple intake for improvement of skin function and intestinal environment in healthy subjects

本研究では, パイナップルの8週間の摂取によって, 肌トラブルが気になり便秘傾向の日本人男女の肌質と腸内環境が改善される可能性が示唆された. 特に肌質に関しては, 先行研究と同様に肌の乾燥やシミの自覚的評価が改善したことに加え, これらの効果について機器測定値による裏付けも得られた. 本研究により, パイナップル摂取による健康効果について更なる知見が得られたことから, 人々の美容や健康に貢献できる食材であることが期待される.

Clinical Examination and Electrodiagnostic Testing in a Rare Case of Long Thoracic Nerve Palsy Following Surgeries Related to an Emergency Appendectomy: A Case Report

BACKGROUND: Postoperative neuropathy is an infrequent but potentially serious complication of surgery and may result in significant morbidity. While mechanical injury and perioperative factors are commonly implicated, etiology of postoperative neuropathy can be unclear, particularly when the lesion is spatially remote from the surgical site. CASE PRESENTATION: A 27-year-old male Doctor of Physical Therapy student presented to his orthopaedic professor during class describing a 10-week history of significant right shoulder weakness following surgeries related to an emergency appendectomy. Examination revealed unilateral scapular winging and findings consistent with long thoracic nerve (LTN) palsy. Given the unknown etiology, electrodiagnostic (EDX) testing was subsequently performed for diagnostic clarity. OUTCOME AND FOLLOW-UP: Clinical and EDX examinations confirmed an isolated LTN palsy, while ruling out competing neurogenic and orthopaedic etiologies. Seven-month follow-up revealed minimal subjective and objective improvement in shoulder function and continued scapular winging. DISCUSSION: Orthopaedic physical therapy examination, including EDX testing, correctly identified a rare case of LTN palsy following surgeries related to an emergency appendectomy. Findings informed prognosis and guided exercise prescription. JOSPT Cases 2023;3(1):53–58. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11457

Treatment of Avascular Necrosis with Hyaluronic Acid in the Cancer Population: A Case Series

Background: Intra-articular hyaluronic acid (HA) injections in non-cancer patient populations have shown some positive outcomes in treating avascular necrosis, however outcomes in the oncology population are scarce. This pilot study describes 7 oncology patients who received ultrasound-guided HA injections and their associated outcomes. Case Report: This study included 4 female and 3 male patients with radiographic evidence of avascular necrosis. Six of the patients had avascular necrosis of the hip, while one patient had avascular necrosis of the shoulder. All patients underwent single or multiple ultrasound-guided injection(s) of hyaluronic acid to the affected joint. Outcomes were tracked using a combination of subjective pain and functional improvement and/or numeric pain scale. Five patients had improvement in their symptoms, while 2 patients did not. Conclusion: Intra-articular HA may be a viable alternative to the treatment of avascular necrosis in oncology patients. Key words: Avascular necrosis, cancer pain, case series, hyaluronic acid, joint pain

Experience in the use of endoscopic technology in surgery for tunnel syndromes of the upper limb

Carpal and cubital tunnel syndromes are the most common compressive neuropathies of the upper limb. Since the end of the 20th century, endoscopic technologies have become increasingly popular in decompression surgery for compression neuropathies. Since 2017, 194 patients have been operated on the basis of the Institute of Microsurgery (Tomsk, Russia), of which 154 with carpal tunnel syndrome (1st group) and 40 with cubital tunnel syndrome (2nd group). In the postoperative period, the results of the operation were assessed by changes in the level of neuropathic pain using the PainDetect questionnaire and the degree of hand dysfunction according to the DASH questionnaire, before and after the operation, and an analysis of early and late postoperative complications was also performed. The data obtained indicate a significant decrease in the level of neuropathic pain and a subjective improvement in hand function in patients of both groups 1 month after surgery. No early postoperative complications were detected in 1st group, late ones were noted in 7 patients, which amounted to 4.5%. In 2nd group, in the early postoperative period, 2 out of 40 patients had early postoperative complications, which amounted to 5%, late ones were not detected. It has been proven that endoscopic decompression of the median nerve in the carpal tunnel and the ulnar nerve in the cubital tunnel are effective and relatively safe types of surgery.

Modified traditional dance therapy: An applicative balance therapy for Hargo Dedali’s Elderly

One of the problems in the elderly is the high prevalence of falls. Prevalence rate falls around 28-35% in the 65-69 years old elderly and increases to 32-42% in the aged over 70 years. Dance is a promising intervention to improve balance and brain structure for the elderly. Dance is a multimodal intervention with multiple components. Dance combines aerobic fitness, sensorimotor skills and cognitive demands with a low risk of injury. One of the dances that have a combination of various movements is the Javanese dance. Javanese dance is a fun physical activity/exercise and can be a therapeutic option to improve muscle strength, flexibility, functional capacity and postural stability. Therefore, the study purpose was to determine modified traditonal javanese dance effect on balance function through one-leg stance test and timed up-and-go test examination on female elderly at the Hargo Dedali Nursing Home. The improvement of static balance function in elderly female subjects after being given modified Javanese dance 3x/week with a duration of 35 minutes for 12 weeks. There was also an increase in dynamic balance function in elderly female subjects after being given modified Javanese dance 3x/week with a duration of 35 minutes for 12 weeks.

Assessment of Objective and Subjective Cognitive Function in Patients With Treatment-Resistant Depression Undergoing Repeated Ketamine Infusions.

Subanesthetic ketamine infusions can elicit rapid and sustained antidepressant effects, yet the potential cognitive impact of ketamine has not been thoroughly examined. This study measured changes in objective and subjective cognitive function following repeated ketamine treatment. Thirty-eight patients with treatment-resistant depression were administered cognitive assessments before and after undergoing 7 i.v. ketamine infusions (0.5 mg/kg over 40 minutes) within a clinical trial examining the efficacy of single and repeated administrations. Depression severity and perceived concentration were evaluated with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptoms Self-Report. Twenty-three participants (60.5%) responded after repeated infusions (≥50% decrease in MADRS total scores). We measured significant improvements in several cognitive domains, including attention, working memory, verbal, and visuospatial memory (effect sizes ranging from Cohen d = 0.37-0.79). Cognitive changes were attributed to reduction in depressive symptoms except for improvement in verbal memory, which remained significant after adjustment for change in MADRS total score (P = .029, η p2 = 0.13). Only responders reported improvement in subjective cognitive function with repeated ketamine administration (MADRS item 6, P < .001, d = 2.00; Quick Inventory of Depressive Symptoms Self-Report item 10, P < .001, d = 1.36). A short course of repeated ketamine infusions did not impair neurocognitive function in patients with treatment-resistant depression. Further research is required to understand the potential mediating role of response and remission on improved cognitive function accompanying ketamine treatment as well as to examine longer-term safety outcomes. ClinicalTrials.gov identifier NCT01945047.

Neural networks outperform expert humans in predicting patient impressions of symptomatic improvement following overactive bladder treatment.

The objective was to accurately predict patient-centered subjective outcomes following the overactive bladder (OAB) treatments OnabotulinumtoxinA (OBTX-A) injection and sacral neuromodulation (SNM) using a neural network-based machine-learning approach. In the context of treatments designed to improve quality of life, a patient's perception of improvement should be the gold standard outcome measure. Cutting-edge neural network-based algorithms using reproducing kernel techniques were trained to predict patient-reported improvements in urinary leakage and bladder function as assessed by Patient Global Impression of Improvement score using the ROSETTA trial datasets. Blinded expert urologists provided with the same variables also predicted outcomes. Receiver operating characteristic curves and areas under the curve were generated for algorithm and human expert predictions in an out-of-sample holdout dataset. Algorithms demonstrated excellent accuracy in predicting patient subjective improvement in urinary leakage (OBTX-A: AUC 0.75; SNM: 0.80). Similarly, algorithms accurately predicted patient subjective improvement in bladder function (OBTX-A: AUC 0.86; SNM: 0.96). The top-performing algorithms outcompeted human experts across outcome measures. Novel neural network-based machine-learning algorithms accurately predicted OBTX-A and SNM patient subjective outcomes, and generally outcompeted expert humans. Subtle aspects of the physician-patient interaction remain uncomputable, and thus the machine-learning approach may serve as an aid, rather than as an alternative, to human interaction and clinical judgment.

MP18-08 NOVEL MACHINE LEARNING ALGORITHMS ARE ACCURATE AND NONINFERIOR TO HUMAN EXPERTS IN PREDICTING SUBJECTIVE PATIENT OUTCOMES FOLLOWING THIRD LINE THERAPY FOR OVERACTIVE BLADDER

You have accessJournal of UrologyCME1 May 2022MP18-08 NOVEL MACHINE LEARNING ALGORITHMS ARE ACCURATE AND NONINFERIOR TO HUMAN EXPERTS IN PREDICTING SUBJECTIVE PATIENT OUTCOMES FOLLOWING THIRD LINE THERAPY FOR OVERACTIVE BLADDER Glenn T. Werneburg, Eric Werneburg, Howard Goldman, Andrew Mullhaupt, and Sandip Vasavada Glenn T. WerneburgGlenn T. Werneburg More articles by this author , Eric WerneburgEric Werneburg More articles by this author , Howard GoldmanHoward Goldman More articles by this author , Andrew MullhauptAndrew Mullhaupt More articles by this author , and Sandip VasavadaSandip Vasavada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We demonstrated machine learning (ML) algorithms accurately predict objective outcomes following third-line treatment for overactive bladder (OAB). Importantly, objective improvements (e.g. leak number) do not necessarily translate to subjective improvements, and thus here we developed ML algorithms to predict patient-reported subjective improvement in bladder leakage and function following OnabotulinumtoxinA (OBTX-A) or sacral neuromodulation (SNM) for OAB. We hypothesized algorithms would exhibit noninferiority to human experts. METHODS: ROSETTA datasets for OAB patients randomized to OBTX-A or SNM were obtained from NICHD. Novel ML algorithms, using reproducing kernel techniques, were trained and tasked to predict improvement in bladder leakage and function measured by Patient Global Impression of Improvement (PGI-I), a robust and valid patient-reported outcome measure of improvement following OAB treatment in a subset of patients in which algorithms were blinded to outcomes. Blinded expert FPMRS urologists given the same data also predicted outcomes. ROC curves with AUC and 95% CI were generated. RESULTS: Top algorithms exhibited excellent predictive accuracy for bladder function improvement in patients who underwent both OBTX-A (yellow; AUC 0.86, CI: 0.77–0.99, figure left) and SNM (AUC 0.96, CI: 0.88–1.0, figure right), and were noninferior to expert FPMRS urologists (purple and blue; Figure left: OBTX-A; Figure right: SNM). Top algorithms also exhibited excellent predictive accuracy for bladder leakage improvement in patients who underwent both OBTX-A (AUC 0.75, CI: 0.58–0.90) and SNM (AUC 0.80, CI: 0.62–0.98), and were noninferior to experts. CONCLUSIONS: Novel ML algorithms were accurate and noninferior to experts in prediction of patient-reported subjective improvements in bladder function and leakage in OAB. Objective outcomes do not necessarily translate to subjective improvement, and thus patient-reported outcomes are an optimal outcome measure. ML algorithms generated using the described novel techniques may complement clinical judgement in patient counseling, and their generalizability to other scenarios within and outside urology is promising and warrants investigation. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e298 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Glenn T. Werneburg More articles by this author Eric Werneburg More articles by this author Howard Goldman More articles by this author Andrew Mullhaupt More articles by this author Sandip Vasavada More articles by this author Expand All Advertisement PDF DownloadLoading ...