Mean Improvement Research Articles

Outcomes of keratoplasty in a cohort of Pythium insidiosum keratitis cases at a tertiary eye care center in India.

To assess outcomes of keratoplasty performed in patients diagnosed with keratitis caused by Pythium insidiosum (PI). Retrospective review. Preoperative, intra operative and post operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were collected from the central patient database of a tertiary eye care hospital in India. The data were analyzed for anatomic success, elimination of infection, graft survival, incidence of repeat keratoplasty, final visual acuity and varied complications. In total, 16 eyes underwent penetrating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from onset of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, seven of which required a repeat keratoplasty for elimination of infection. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Three grafts remained clear at 6-month follow up while 11 grafts failed. Mean improvement in uncorrected visual acuity from 2.32 to 2.04 logMAR was observed at last follow up. Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after keratoplasty. PI keratitis is a tenacious and potentially blinding condition. Keratoplasty remains the choice of treatment in this condition, however recurrence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post operative use of antibiotics can help in improving outcome of keratoplasty in these patients.

The Art of Medicine: Applying the Visual Thinking Strategy to Radiology.

The purpose of this project was to develop a formal visual arts training curriculum and evaluate if there was improvement in the observational and descriptive skills of first- and second-year medical students for radiologic images. Materials and methods: A demographic survey and an initial pre-test of 12 radiologic images were administered asking an open-ended question to describe the image and to identify the abnormality in their own words.Three virtual one-hour sessions of visual thinking strategy (VTS) training occurred, and an immediate post-test and a six-month post-test were administered, each with images different from the pre-test, as well as a final questionnaire. All tests were independently graded by two graders with a previously established grading rubric.Differences in scores were analyzed using paired T-tests. Thirty-nine medical students participated.The mean pre-test score was 62.2 +/- 18.6, and the mean post-test score improved by 41.7 +/- 17.9 points (p<0.01) to an average score of 103.9 +/- 20.4.Nine participants were lost to follow-up at six months, and the average six-month post-test score was 110.2 +/- 29.1 for a mean improvement of 9.3 +/- 13.1 points (p=0.320) from the initial post-test. Conclusion: There was a significant improvement in observational and descriptive skills in first- and second-year medical students when describing radiologic images, which was retained after six months.A formal VTS curriculum could play a beneficial role in medical student and radiology training programs not only to improve observational skills but also to address perceptual errors in diagnostic imaging.

Multidisciplinary Complex Treatment of Parkinson's disease : Cornerstone of an individualized treatment

The inpatient Parkinson's disease multimodal complex treatment (PD-MCT) was applied more than 15,000 times in 2022, in Germany. This number is increasing as is Parkinson's disease (PD), which affects more than 400,000 people in Germany and leads to 100,000 disability-adjusted life years. In recent years, several observational studies have been conducted on the effectiveness of this kind of multidisciplinary care. To summarize and discuss the evidence on the nature, benefits and potential of PD-MCT. Anarrative review of selected empirical findings was carried out. The PD-MCT frequently lasts for 2-3 weeks and aims to maintain the quality of life of people with PD. Disease symptoms and activities of daily living are jointly improved by pharmacological strategies and activating therapies (physiotherapy, occupational therapy, speech and language therapy, physical training, art therapy). The PD-MCT is auseful measure to avoid or mitigate crisis situations in the course of the disease. A total of eight observational studies (n = 1246) have shown good effectiveness with a total mean improvement of the International Parkinson and Movement Disorder Society unified Parkinson's disease rating scaleIII (MDS-UPDRSIII) by 7.8points. The transfer of effects into everyday life through intensive and specialized community-based care must be ensured in order to achieve sustained effects on the quality of life. Ideally, this transfer can be supported by integrated PD networks and digital technologies in the future. There is potential for development in the standardization, patient selection and quality assurance of PD-MCT as well as in the embedding in care structures such as PD networks. Open research questions include aprecise definition of the target group and higher quality evidence of short-term and long-term effectiveness.

Safety and Efficacy of Staged, Bilateral Focused Ultrasound Thalamotomy in Essential Tremor

Unilateral magnetic resonance-guided focused ultrasound ablation of ventralis intermedius nucleus of the thalamus for essential tremor reduces tremor on 1 side, but untreated contralateral or midline symptoms remain limiting for some patients. Historically, bilateral lesioning produced unacceptable risks and was supplanted by deep brain stimulation; increasing acceptance of unilateral focused ultrasound lesioning has led to interest in a bilateral option. To evaluate the safety and efficacy of staged, bilateral focused ultrasound thalamotomy. This prospective, open-label, multicenter trial treated patients with essential tremor from July 2020 to October 2021, with a 12-month follow-up, at 7 US academic medical centers. Of 62 enrolled patients who had undergone unilateral focused ultrasound thalamotomy at least 9 months prior to enrollment, 11 were excluded and 51 were treated. Eligibility criteria included patient age (22 years and older), medication refractory, tremor severity (Clinical Rating Scale for Tremor [CRST] part A score ≥2 for postural or kinetic tremor), and functional disability (CRST part C score ≥2 in any category). A focused ultrasound system interfaced with magnetic resonance imaging allowed real-time alignment of thermography maps with anatomy. Subthreshold sonications allowed target interrogation for efficacy and off-target effects before creating an ablation. Tremor/motor score (CRST parts A and B) at 3 months for the treated side after treatment was the primary outcome measure, and secondary assessments for efficacy and safety continued to 12 months. The mean (SD) population age was 73 (13.9) years, and 44 participants (86.3%) were male. The mean (SD) tremor/motor score improved from 17.4 (5.4; 95% CI, 15.9-18.9) to 6.4 (5.3; 95% CI, 4.9 to 7.9) at 3 months (66% improvement in CRST parts A and B scores; 95% CI, 59.8-72.2; P < .001). There was significant improvement in mean (SD) postural tremor (from 2.5 [0.8]; 95% CI, 2.3 to 2.7 to 0.6 [0.9]; 95% CI, 0.3 to 0.8; P < .001) and mean (SD) disability score (from 10.3 [4.7]; 95% CI, 9.0-11.6 to 2.2 [2.8]; 95% CI, 1.4-2.9; P < .001). Twelve participants developed mild (study-defined) ataxia, which persisted in 6 participants at 12 months. Adverse events (159 of 188 [85%] mild, 25 of 188 [13%] moderate, and 1 severe urinary tract infection) reported most commonly included numbness/tingling (n = 17 total; n = 8 at 12 months), dysarthria (n = 15 total; n = 7 at 12 months), ataxia (n = 12 total; n = 6 at 12 months), unsteadiness/imbalance (n = 10 total; n = 0 at 12 months), and taste disturbance (n = 7 total; n = 3 at 12 months). Speech difficulty, including phonation, articulation, and dysphagia, were generally mild (rated as not clinically significant, no participants with worsening in all 3 measures) and transient. Staged, bilateral focused ultrasound thalamotomy significantly reduced tremor severity and functional disability scores. Adverse events for speech, swallowing, and ataxia were mostly mild and transient. ClinicalTrials.gov Identifier NCT04112381.

Five-Year Results of the Salto XT Revision Ankle Arthroplasty.

The treatment of failed ankle replacements is debated, and little is published about the medium- and long-term results of revision implants. We wanted to examine prosthesis survival and physical function at least 5 years after insertion of the Salto XT revision prosthesis. All consecutive patients operated with a Salto XT revision prosthesis underwent clinical and radiologic examinations preoperatively and after 3, 12, 24, and 60 months. Complications and reoperations are described, and changes in patient-reported outcome measures and clinical scores are reported. Thirty patients were operated with a Salto XT revision prosthesis between March 2014 and March 2017. Three of these were revised (1 to a fusion and 2 to a new prosthesis), and 3 patients were reoperated with screw removal. A concurrent subtalar fusion was performed on 13 patients, and there was 1 case of likely nonunion after these procedures, but no reoperations. The mean AOFAS score increased from 39.2 (95% CI 30.8-47.5) preoperatively to 75.1 (95% CI 67.3-82.9) after 5 years, and the mean improvement was 34.2 points (95% CI 23.8-44.6). Mean EQ-5D increased from 0.36 (95% CI 0.30-0.42) preoperatively to 0.74 (95% CI 0.64-0.85) after 5 years, an improvement of 0.34 (95% CI 0.19-0.49). Radiolucent lines were present in all but 3 patients. Five-year prosthesis survival was 93% (83.6-100). This is the first study to present medium-term results of this implant. We found good improvement in outcome scores and good implant survival, but also a high prevalence of radiolucent lines.

The effect of sodium bicarbonate mini-tablets ingested in a carbohydrate hydrogel system on 40km cycling time trial performance and metabolism in trained male cyclists.

Sodium bicarbonate (NaHCO3) ingestion has been found to be ergogenic in high-intensity exercise that ranges from 1 to 10min; however, limited studies have investigated high-intensity exercise beyond this duration. The present study aimed to determine the effect of NaHCO3 ingested using a carbohydrate hydrogel delivery system on 40km time trial (TT) performance in trained male cyclists. Fourteen trained male cyclists ingested 0.3gkg-1 BM NaHCO3 (Maurten AB, Sweden) to determine individualised peak alkalosis, which established time of ingestion prior to exercise. Participants completed a 40km familiarisation TT, and two 40km experimental TTs after ingestion of either NaHCO3 or placebo in a randomised, double-blind, crossover design. NaHCO3 supplementation improved performance (mean improvement = 54.14s ± 18.16s; p = 0.002, g = 0.22) and increased blood buffering capacity prior to (HCO3- mean increase = 5.6 ± 0.2mmolL-1, p < 0.001) and throughout exercise (f = 84.82, p < 0.001, pη2 = 0.87) compared to placebo. There were no differences in total gastrointestinal symptoms (GIS) between conditions either pre- (NaHCO3, 22 AU; Placebo, 44 AU; p = 0.088, r = 0.46) or post-exercise (NaHCO3, 76 AU; Placebo, 63 AU; p = 0.606, r = 0.14). The present study suggests that ingesting NaHCO3 mini-tablets in a carbohydrate hydrogel can enhance 40km TT performance in trained male cyclists, with minimal GIS. This ingestion strategy could therefore be considered by cyclists looking for a performance enhancing ergogenic aid.

Graph-Based Traffic Forecasting with the Dynamics of Road Symmetry and Capacity Performance

Symmetry in traffic patterns is a fundamental aspect of intelligent transportation systems, aiming to precisely predict traffic flow in real time despite the complex interplay of spatial and temporal factors. This paper presents a novel method of traffic forecasting that incorporates parameters related to road symmetry into a Graph Convolution Network model. Our model is crafted to dynamically adjust to real-time changes in road conditions, including the presence of symmetric and asymmetric road layouts, which substantially influence traffic flow. We have developed a GCN model that not only accounts for standard traffic flow metrics but also integrates a matrix representing road symmetry. The model undergoes training and validation on the METR-LA dataset, showcasing a significant enhancement in prediction accuracy. In the comparative analysis of state-of-the-art methods, our model demonstrated a significant enhancement in performance, achieving 30.68% improvement in Mean Squared Error (MSE) and a 24.28% improvement in Mean Absolute Error (MAE) over the best-performing method. The implications of our research are profound for urban planners, traffic management systems, and navigation service providers, as it offers a more dependable tool for forecasting traffic conditions, aiding in road design, and refining route planning strategies based on the symmetry of road networks.

Tricaprilin (CER-0001) for the preventive treatment of migraine: A phase 2 randomised, double-blind, placebo-controlled pilot study

BackgroundIncreasing evidence indicates a metabolic etiology for migraines, with ketosis potentially rectifying metabolic and clinical features. We conducted a pilot study to evaluate CER-0001, a ketogenic agent, for migraine prevention without dietary changes. MethodsThis was a 2-part, double-blind, randomised, placebo-controlled study conducted in Australia. Adults with at least a 1-year history of migraine and ≥ 1 prior preventive treatment failure were randomised to either oral CER-0001 (up to 30 g twice a day) or placebo for 12 weeks. The primary endpoint was Month 3 change in Migraine Headache Days from baseline. ResultsPart 1 results are presented. 81 participants were randomised and dosed (n = 40 CER-0001, n = 41 placebo), and 61 participants had evaluable efficacy data. No statistically significant difference was observed in the primary endpoint (LSMean difference 0.92 days; p = 0.586). During Month 2, a mean improvement of −2.8 days was observed for CER-0001 (p = 0.056). Withdrawal rates were 45.0% and 53.7% (CER-0001; placebo). The proportion of participants reporting at least one treatment-emergent adverse event was similar between arms (90.0% CER-0001, 82.9% placebo), mostly gastrointestinal (85.0% CER-0001, 70.7% placebo). ConclusionResults suggest positive directional promise over 2–3 months for CER-0001. A new formulation will be used for larger, fully powered phase 2/3 studies. Trial registrationThis study is registered at ClinicalTrials.gov (NCT04437199).

Safety and Efficacy of Multiple Escalating Doses of RC28-E for Neovascular Age-Related Macular Degeneration: A Phase 1b Trial.

To assess the safety and efficacy of repeated intravitreal injections of RC28-E, a novel bispecific antibody that simultaneously binds vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in patients with neovascular age-related macular degeneration (AMD). This was a prospective, multicenter, open-label clinical trial; 37 patients with choroidal neovascularization secondary to AMD and best-corrected visual acuity (BCVA) letter scores between 73 and 34 were enrolled. Treatment regimens consisted of a 3-month loading phase and a pro re nata (PRN) maintenance phase. This study included three treatment groups: the 0.5, 1.0, and 2.0mg RC28-E groups, with escalating doses ranging from 0.5 to 2.0mg. Patients were evaluated monthly for 48weeks. Safety was assessed based on ocular and systemic adverse events (AEs), pharmacokinetic characteristics, and the presence of anti-RC28-E antibodies. Efficacy was assessed using the mean change in BCVA and central subfield thickness (CST) from baseline to week 48. Most AEs were mild or moderate. The most common AE was a minor injection-related subconjunctival hemorrhage (16.2%). The AEs did not increase with dose or repeated injections. At week 48, mean improvements in BCVA from baseline in the 0.5, 1.0, and 2.0mg groups were 6.1 ± 8.3, 9.9 ± 10.7, and 7.6 ± 9.38 letters, respectively; mean reductions in CST in the three groups were 112.1 ± 160.5, 175.1 ± 212.4, and 128.7 ± 145.8μm, respectively. The serum RC28-E concentrations in 95% of the patients were below the quantification limit of the assay. No significant change from baseline was observed in the mean plasma concentrations of VEGF or FGF over the 48weeks of treatment. Pre-treatment antibodies to RC28-E were detected in 1 of the 37 patients. Antibodies to RC28-E were detected in two patients after dosing with RC28-E for 48weeks. RC28-E was well tolerated and exhibited an overall favorable safety profile with evidence of improvements in BCVA and anatomical parameters.

Efficacy and Safety of High-Dose TBS on Post-Stroke Upper Extremity Motor Impairment: A Randomized Controlled Trial.

Upper extremity (UE) motor function impairment is a major poststroke complication whose recovery remains one of the most challenging tasks in neurological rehabilitation. This study examined the efficacy and safety of the personalized neuroimaging-guided high-dose theta-burst stimulation (TBS) for poststroke UE motor function recovery. Patients after stroke with UE motor impairment from a China rehabilitation center were randomly assigned to receive high-dose intermittent TBS (iTBS) to ipsilesional UE sensorimotor network, continuous TBS (cTBS) to contralesional UE sensorimotor network, or sham stimulation, along with conventional therapy for 3 weeks. The primary outcome was the score changes on the Fugl-Meyer assessment-UE from baseline to 1 and 3 weeks. The secondary outcomes included the response rate on Fugl-Meyer assessment-UE scores posttreatment (≥9-point improvement) and score changes in multidimensional scales measuring UE, lower extremity, and activities and participation. From June 2021 to June 2022, 45 participants were randomized and 43 were analyzed. The iTBS and continuous TBS groups showed significantly greater improvement in Fugl-Meyer assessment-UE (mean improvement, iTBS: 10.73 points; continuous TBS: 10.79 points) than the sham group (2.43 points) and exhibited significantly greater response rates on Fugl-Meyer assessment-UE (iTBS, 60.0%; continuous TBS, 64.3%) than the sham group (0.0%). The active groups consistently exhibited superior improvement on the other 2 UE assessments at week 3. However, only the iTBS group showed greater efficacy on 1 lower extremity assessment than the sham group at week 3. Both active groups showed significant improvements in activities and participation assessments. The study provides evidence for the efficacy and safety of high-dose TBS in facilitating poststroke UE rehabilitation. URL: www.chictr.org.cn; Unique identifier: ChiCTR2100047340.

MOTOR QUALITIES IN THE NAVAL PENTATHLON

By paying special attention to combat training of soldiers, it is highlighted the need for multidisciplinary training through elements of theoretical, technical, tactical training, training skills in various fields, specific to combat actions, such as shooting with different categories or types of weapons, first aid, rescue from drowning, underwater swimming, solving technical-tactical situations in different environments, moving over different distances or crossing watercourses with improvised means. All these can be achieved and verified during specific training or in sports-applicative competitions, on the stable foundation of a well-trained fighter. The basis of this preparation can only be a high level of physical and mental capacity. Educating the character of the military, improving their potential, is achieved against the background of good effort capacity and training through specific exercises, and these objectives can be achieved within military physical education classes and through training allocated for sports competitions. Research objectives: Highlighting the naval pentathlon as a basis for training future professional soldiers; Highlighting the need for scientific planning in order to obtain the necessary physical and mental capacity for professional soldiers; Methods: Study of specialized literature; Measurement and testing of effort parameters specific to naval pentathlon samples; Results and conclusions: Using the above-mentioned methods, information necessary for the optimal organization and conduct of military and sports training for the development at a higher level of physical and mental capacity of servicemen was obtained, using training means specific to the naval pentathlon. The information obtained from the research shows the major importance of a physical training as complex as possible to achieve maximum performances both in naval pentathlon sports competitions and in combat actions specific to professional fighters in the naval forces.

Changes in Physical Fitness in Youth Padel Players during One Season: A Cohort Study.

The aim of this study was to investigate how physical fitness performance, which is related to the strength and power of the lower extremities and core, as well as lateral agility, changes across 20 weeks of in-season training in youth female and male padel players. This study was conducted using a prospective cohort design on 16 Swedish high school padel players aged between 15 and 18 years old. The players were assessed at baseline with five tests of their physical fitness and followed prospectively, with the registration of their training load for 20 weeks, and then assessed at a follow-up, approximately five months later. The players increased their performance in all tests (p ≤ 0.02). The mean improvement in their Isometric squat test performance was 20% for peak force, 18% for relative strength value and 69% for average rate of force development. Their improvement in the squat jump test performance was 9%, whereas the improvement in their countermovement jump test was 6%. For the 30 second sit-up test, an improvement of 14% was observed. Improvements were also noted for the 30 second side hop test performance on both the right (9%) and left leg (11%). The effect size ranged from 0.31 to 1, respectively, for the tests, representing a small to large effect. The data from this study suggest that an improvement in physical fitness performance can be obtained during 20 weeks of padel training.

Evaluation of a prototype metal artifact reduction algorithm for cone beam CT in patients undergoing radioembolization

Metal artifacts notoriously pose significant challenge in computed tomography (CT), leading to inaccuracies in image formation and interpretation. Artifact reduction tools have been designed to improve cone beam computed tomography (CBCT) image quality by reducing artifacts caused by certain high-density materials. Metal artifact reduction (MAR) tools are specific algorithms that are applied during image reconstruction to minimize or eliminate artifacts degrading CBCT images. The purpose of the study is to evaluate the effect of a MAR algorithm on image quality in CBCT performed for evaluating patients before transarterial radioembolization (TARE). We retrospectively included 40 consecutive patients (aged 65 ± 13 years; 23 males) who underwent 45 CBCT examinations (Allura FD 20, XperCT Roll protocol, Philips Healthcare, Best, The Netherlands) in the setting of evaluation for TARE between January 2017 and December 2018. Artifacts caused by coils, catheters, and surgical clips were scored subjectively by four readers on a 5-point scale (1 = artifacts affecting diagnostic information to 5 = no artifacts) using a side-by-side display of uncorrected and MAR-corrected images. In addition, readers scored tumor visibility and vessel discrimination. MAR-corrected images were assigned higher scores, indicating better image quality. The differences between the measurements with and without MAR were most impressive for coils with a mean improvement of 1.6 points (95%CI [1.5 1.8]) on the 5-point likert scale, followed by catheters 1.4 points (95%CI [1.3 1.5]) and clips 0.7 points (95%CI [0.3 1.1]). Improvements for other artifact sources were consistent but relatively small (below 0.25 points on average). Interrater agreement was good to perfect (Kendall’s W coefficient = 0.68–0.95) and was higher for MAR-corrected images, indicating that MAR improves diagnostic accuracy. A metal artifact reduction algorithm can improve diagnostic and interventional accuracy of cone beam CT in patients undergoing radioembolization by reducing artifacts caused by diagnostic catheters and coils, lowering interference of metal artifacts with adjacent major structures, and improving tumor visibility.

An effective method for improving GNSS precise point positioning performance at the day boundary

Abstract Aiming to address poor self-consistency of the satellite clock and orbit interpolations at the day boundary, which is caused by the discontinuities of their International GNSS Service (IGS) products for two consecutive days, an effective method is proposed to improve the precise point positioning (PPP) performances at the day boundary. According to different orders of Lagrange interpolator and different IGS Analysis Centers products of Center for Orbit Determination in Europe (CODE), GeoForschungsZentrum (GFZ) and Wuhan University (WUH), biases at the day boundaries are estimated and analyzed using a 4 day (DOY 94-97, 2022) data set of GPS, BDS-3 and Galileo from 123 IGS stations. These estimated biases show the time-varying characteristics. The differences in biases across 9th-11th orders of Lagrange interpolator are minimal, and these variances have a negligible impact on positioning. The results show that this poor self-consistency at the day boundary has an obvious influence on the kinematic PPP positioning, especially there is a centimeter-level variation at time of 24:00:00/00:00:00. This influence on the Up direction of kinematic PPP positioning is more serious than other directions. When the bias is estimated and corrected, the kinematic PPP positioning accuracies at the day boundary have a mean improvement of 0.043, 0.064 and 0.027 m for WUH, GFZ and CODE, respectively. The mean improvements for GPS, BDS-3 and Galileo are 0.021, 0.062 and 0.051 m. Additionally, the static PPP performances at the day boundary show the convergence times are shortened by 3.2, 6.2, and 2.5 min for WUH, GFZ and CODE, respectively, when the poor self-consistency of the satellite clock and orbit interpolations is estimated and corrected. Meanwhile, its 0.5 and 1 h positioning accuracies are improved.

Treat-and-Extend Versus Pro re nata Regimens of Ranibizumab and Aflibercept in Neovascular Age-Related Macular Degeneration: A Comparative Study from Routine Clinical Practice.

Anti-vascular endothelial growth factor (VEGF) is generally given using pro re nata or "treat-and-extend" (T&E) regimens for neovascular age-related macular degeneration (nAMD). Randomized clinical trials have reported that T&E is superior to Pro re nata (PRN), but results from clinical trials may not always be replicated in clinical practice. Real-world data comparing T&E and PRN regimens for nAMD are limited. The objective of this work was to report 24-month outcomes of PRN versus T&E regimens for ranibizumab and aflibercept to treat nAMD in routine clinical practice. We conducted a retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project (FRB). Treatment-naïve eyes starting nAMD treatment with at least three injections using a T&E or PRN regimen were tracked by using the FRB. The primary outcome was the mean change in visual acuity (VA) measured by the number of letters read on a logarithm of the minimum angle of resolution chart at 2years versus baseline. The secondary outcome was the number of injections at 2years. From January 1, 2015 to January 31, 2019, 3313 eyes from 2948 patients with nAMD were included: 1243 eyes from 1065 patients were classified as PRN and 2070 eyes from 1935 patients started a T&E regimen. At 24months, patients on the T&E regimen experienced significantly greater mean (95% confidence interval) improvement in VA than those on PRN (+ 4.2 [3.1, 5.2] vs. + 1.3 [0.1, 2.6] letters; p < 0.001), with more injections (14.9 standard deviation(SD) 4.3) vs. 9.8(SD 4.3); p < 0.001). Eyes treated with a T&E regimen had better VA outcomes from VEGF inhibitors than eyes treated PRN. This large real-world data assessment supports previous data from randomized clinical trials that the T&E regimen delivers better outcomes than PRN.

822 Burn Bright, Learn Brighter: Igniting Expertise in Burns Care with Virtual Reality

Abstract Aim To assess the effectiveness of a burns assessment and management course for junior doctors, comparing virtual reality (VR) training with traditional didactic instruction and moulage. Method Foundation doctors (n=36) were divided into two groups: one receiving VR training and the other traditional instruction with in-person moulage practicals covering burns assessment and emergency management. An objective structured clinical examination (OSCEs) and pre, post and 6-weeks post-course questionnaires assessed knowledge retention and performance. Analysis involved paired sample t-tests. Qualitative analysis evaluated post course feedback. Results The VR group exhibited a significant increase in burns assessment accuracy and knowledge (p&amp;lt;0.05) but a decrease in burns management (p&amp;lt;0.05) compared to the control group in the OSCE. Both groups demonstrated significant improvement of 24% (VR, p&amp;lt;0.05) and 21% (control, p&amp;lt;0.05) in knowledge post-course. There was also significant retention at 6-weeks, with mean improvement of 19% (VR, p&amp;lt;0.05) and 17% (control, p&amp;lt;0.05). Qualitative feedback highlighted the VR's superior visualisation in assessment scenarios, while moulage-based practicals were perceived as more realistic for burns management. 33% considered an occupation in burns as a subspecialty, 100% reported increased confidence in burns assessment and management. Conclusions VR training proved effective in enhancing burns assessment skills, but its realism in burns management scenarios was questioned. Integrating VR alongside traditional methods demonstrated a comprehensive improvement in participants' overall burns care competency and a notable boost in confidence levels. Findings underscore the importance of balancing technological advancements with practical realism in plastic surgery education.

Comparison of Cambridge vision stimulator (CAM) therapy with passive occlusion therapy in the management of unilateral amblyopia; a randomized clinical trial

ABSTRACT Introduction There are limited studies on the effectiveness of Cambridge vision stimulator (CAM) therapy as a management strategy in amblyopic patients. In addition, all these studies have a low sample size. The main purpose of this study was to compare the effect of CAM therapy with passive occlusion therapy in the management of unilateral amblyopia. Methods In this randomized clinical trial study, 110 cooperative amblyopic children, who had not been managed previously, were randomly divided into two groups of CAM therapy (n = 55) and passive occlusion therapy (n = 55). In the CAM procedure, five discs with different spatial frequencies (SF) (2, 6, 15, 20, 30 cycles/degree) were presented to the patient (30 minutes a day, twice a week). Plates with SF equal to the two lines better than the measured corrected distance visual acuity (CDVA) were chosen. During the training, the non-amblyopic eye was occluded. The standard occlusion therapy protocols were performed in the occlusion therapy group. The CDVA for all patients was measured at baseline and then at one, two, and three months after the treatment. Results The mean age of patients in CAM and occlusion therapy groups was 7.0 ± 2.1 and 6.9 ± 1.9 years, respectively (p = .721). There was no significant difference in the mean CDVA between CAM and occlusion therapy groups after one (0.30 ± 0.16 vs. 0.25 ± 0.14, p = .079), two (0.15 ± 0.10 vs. 0.15 ± 0.11, p = .732) and three months (0.05 ± 0.08 and 0.05 ± 0.06, p = .919) from baseline. However, the mean amount of CDVA increased significantly in each follow-up in both groups (all p < .001). Regarding the amblyopia type and severity, the mean improvement of CDVA from baseline in the anisometropic patients and in moderate amblyopia was significantly higher in the CAM group than the occlusion group after two and three months (p < .05). Discussion CAM and conventional occlusion therapies significantly improved CDVA in children with amblyopia, and the difference was not significant; therefore, they could be used as alternatives. CAM therapy requires cost and time for the amblyopic patient and parents. Thus, it can be considered as a second treatment option in amblyopic patients, especially anisometropic type and moderate amblyopia, with poor compliance to patching.

Patient-reported outcomes in chronic hepatitis delta: An exploratory analysis of the phase III MYR301 trial of bulevirtide

Once-daily treatment of chronic hepatitis delta (CHD) with bulevirtide is well tolerated and associated with significant reductions in HDV RNA in the blood and in biochemical liver disease activity. This study explored the effects of 48-week bulevirtide treatment on health-related quality of life (HRQoL) in patients with CHD. In an open-label, randomised, Phase 3 trial, 150 patients with CHD and compensated liver disease were stratified by liver cirrhosis status and randomised 1:1:1 to no treatment (control), bulevirtide 2 mg/day, or bulevirtide 10 mg/day for 48 weeks. HRQoL was evaluated by the following patient-reported outcome (PRO) instruments at baseline, 24 weeks, and 48 weeks: EQ-5D-3L, Hepatitis Quality of Life Questionnaire (HQLQ), and Fatigue Severity Scale (FSS). Patient characteristics and HRQoL scores were balanced at baseline between the treatment (2 mg, n = 49; 10 mg, n = 50) and control (n = 51) groups. Patients receiving 2-mg bulevirtide reported significant improvements compared with controls on the HQLQ domains of role physical, hepatitis-specific limitations, and hepatitis-specific health distress. Numerically higher scores for general health, hepatitis-specific limitations, and hepatitis-specific health distress domains were reported by patients with cirrhosis who received bulevirtide vs control. FSS scores remained stable across treatment groups throughout. At week 48, patients in the 2-mg group showed greater mean improvement from baseline in health status compared with controls on the EQ-5D-3L visual analogue scale. PROs indicate that 48-week treatment with bulevirtide monotherapy may improve aspects of HRQoL in patients with CHD. Bulevirtide 2 mg is the only approved treatment for patients with chronic hepatitis delta (CHD) in the EU. Patients with CHD have worse quality of life scores than those with chronic hepatitis B. Bulevirtide treatment for 48 weeks reduced HDV RNA and alanine aminotransferase levels and was well tolerated among patients with CHD. For the first time, this study shows that patients who received bulevirtide therapy for 48 weeks reported improvements in physical and hepatitis-related quality of life domains compared to those who did not receive therapy (control group). ClinicalTrials.gov Identifier, NCT03852719.

Efficacy of Pharmacological Treatments in Managing Generalized Anxiety Disorder among Adults in Saudi Arabia: A Cross-sectional Analysis

Abstract Introduction: Generalized anxiety disorder (GAD) is a significant mental health concern characterized by excessive and uncontrollable worry about everyday activities. Despite its prevalence, there is a scarcity of research on pharmacological management strategies for GAD, particularly within the Saudi Arabian context. This study aims to address this gap by identifying and evaluating the most commonly used pharmacological strategies among adults in Saudi Arabia. It will assess the effectiveness of these strategies, examine factors influencing the preference of these strategies, and explore the prevalence and impact of adverse effects associated with them. Methods: This cross-sectional study employed stratified random sampling to select a representative sample of adults aged 18 years and above from various regions of Saudi Arabia. Participants provided data through self-administered questionnaires, which included information on sociodemographic characteristics, GAD symptoms, pharmacological strategies utilized, their effectiveness, and any adverse effects. The study’s analytical approach encompassed statistical methods such as correlation, regression, and Chi-square tests, aiming to uncover relationships and patterns among the collected data, particularly focusing on treatment efficacy and the occurrence of adverse effects. Results: We found a demographic skewing among Saudi patients with GAD, particularly toward young adults aged 18–24 and women. The majority of these patients were diagnosed with GAD and had been experiencing symptoms for less than six months. In addition, there was a notable willingness among them to seek professional help. The most commonly used pharmacological strategy was classified as “Others,” with a high satisfaction rate reported by users. Adverse effects were infrequent, affecting only a minority of patients frequently. Selective serotonin reuptake inhibitors demonstrated the highest mean improvement in GAD symptoms, indicating their effectiveness. Our study also emphasized the importance of considering medication side effects, especially for individuals with a greater tendency to adverse events. Conclusion: This research emphasizes the importance of personalized treatment plans, medication efficacy, and side effect profiles for managing GAD in Saudi Arabia. It also underscores the need for evidence-based treatment guidelines and suggests areas for future research to optimize GAD treatment strategies based on individual patient needs and therapy responses.

Efficacy of McKenzie, Maitland Mobilisation and Myofascial Release in Chronic Low Back Pain

Objective: To compare the effectiveness of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain and find out the effects of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain. Background: Low back pain is defined as the pain that occurs in an area with boundaries between the lowest rib and the crease of the buttocks. It is one of the most common complain of working-age population. Low back pain is associated with deconditioning of spine and trunk due to lack of core strength and stability in which 60-80% of general population suffer with high recurrence rates of 60 - 85% within following three years. The global prevalence of LBP as 7.3%. Activities that are required for daily living are affected because of LBP. The significance of disability is created because of LBP. The lumbosacral, sacroiliac and lumbar regions are the main regions of LBP. Pain in the back region that lasts for more than three months is called chronic lower back pain (CLBP). Lower?back pain (LBP) is seen in all age groups. Half of the people encounter back pain in a year and nearly three-fourths of the population account for LBP in their lifetimes. It is one of the most disabling factors often preventing sports person for participation in sporting activities. In United States, the workers compensation claims account for about one fourth of all claims and one third of total compensation costs. It results in about 40% of absences from work. In total spinal pain cases low back pain accounts for 60-70%.Chronic Low back pain is the pain that persists longer than the expected time period for healing, with a duration of more than three months. The natural course of most low back pain is of self-limiting in nature, with vast majority of individuals improving within six weeks or less. Study design: Experimental study Methods: 51 subjects were selected through convenient sampling. All the subjects who were diagnosed with chronic low back pain from Orthopaedics OPD was referred to physiotherapy department and was screened and assessed according to inclusion and exclusion criteria. The eligible subjects were approached with proposal of the study. Aim and procedure of the study was explained to the subject and a written informed consent was taken from them in their preferred language. At first the demographic data (age, sex, duration) was collected forever subject. Then the baseline data (pre intervention) of CLP intensity, functional disability was taken before commencement of the study. Then the subjects were randomly allocated each 17 subjects. A final data of pain intensity, functional disability was recorded. Results: For all the outcome measures, no significant difference results were found for all three techniques. Whereas, Mc Kenzie techniques is the most effective and the least effective is Maitland Mobilisation. Mean Improvement calculated as Pre- post values of VAS and RMQ scores at follow-up on 7th and 14th day was compared between the 3 techniques. Its significance was tested by testing whether the 95% CI of the mean improvement included 0 or not. Mckenzie techniques howed maximum improvement 4.68 (2.29, 7.07) on Day 7th and Maitland mobilisation the least improvement, 1.56(0.95, 2.93). Improvement by all techniques was significant at 95% CI using paired t test. However, on day 14th McKenzie showed maximum improvement 5.56(2.72, 7.07)) Maitland mobilization remaining the least effective. Conclusion: LBP is a common condition and all age groups are facing it. Pain can be due to various causes and the line of treatment depends upon the cause of pain. In this review, we found out that LBP is a condition everyone is facing. Mc Kenzie is a better treatment approach over other two techniques to reduce chronic LBP. Pain and disability were the points considered while concluding. LBP affects the quality of life and to maintain or improve the quality of life strengthening the muscles plays an important role. This review gives a brief about the treatment methods available for treating CLBP clinically. Hence physiotherapy treating subjects with chronic low back pain may choose any one technique but Mc Kenzie Technique is the most effective technique for pain and for functional disability in CLBPis the most effective. However sufficient experience and expertise is necessary. Key words: Chronic Low Back Pain, Mc Kenzie, Maitland Mobilisation, Myofascial Release, VAS, RMQ