Initial Stage Of Treatment Research Articles

EARLY MOBILIZATION AND ITS PROTOCOLS AT HOSPITAL DISCHARGE IN ADULT PATIENTS IN THE INTENSIVE CARE UNIT

Introduction: The highly complex hospital environment was created with the aim of providing intensive care to patients with severe acute conditions or system instability, with the potential for recovery. A growing number of individuals survive the initial stage of treatment but do not show good progress. Poor progress in critically ill patients is due to immobility, which can cause several complications that influence recovery. The authors warn that the consequences of immobility can last up to 5 years after hospital discharge. Several published studies have highlighted that MP is associated with a reduction in the patient's time in hospital units. Several arguments based on other studies indicate that MP has been proposed as a promising intervention for critically ill patients, important for preventing postoperative complications and reducing hospital stay. Objective: To describe the influence of MP and its protocols on hospital discharge in adult patients in the ICU. Methods: Descriptive research by systematic literature review with the PICO strategy. Results and Discussion: Research conducted in the databases found 96 articles, of which 79 were discarded and 7 articles met all the inclusion criteria for this study. This study analyzed the influence of MP and its protocols on hospital discharge in adult patients in the ICU in the selected articles. Many issues should be investigated for a more assertive and guiding opinion, thus further highlighting the benefits of MP and its significant influence on hospital discharge. There is a need to outline a model to meet the specific needs according to the profile of patients and thus systematize MP in the ICU. Conclusion: We consider it important to conduct more studies to systematize the practice and highlight the improvements in the protocols and, thus, benefit the patient, favoring their recovery, hospital discharge and quality of life.

High‐frequency (470 kHz) ultrasonics‐assisted room temperature CO2 stripping and fate of Sono exposed solvent

AbstractBACKGROUNDThe conventional CO2 stripping process in solvent‐based postcombustion CO2 capture (PCCC) process uses heating to strip the CO2 (~120 °C). However, the challenges associated with this method are high energy consumption in degassing the CO2 from solvent, solvent loss and degradation resulting from the high –temperatures, resulting in high energy consumption typical of solvent‐based PCCC. The present study demonstrates the use of bath‐type sonication (470 kHz frequency) to remove CO2 from CO2 loaded 30 wt% Monoethanolamine under controlled temperature conditions. Solvent performance was evaluated following exposure to 2 h conventional heating and 75 h sonication.RESULTSIn a batch sono‐assisted process, CO2 stripping became possible at 17.5 °C compared to 102.2 °C using the conventional method. Increasing the sonication time led decreased carbon loading and increased stripping efficiency. The stripping rate was high at the initial stages of treatment. Evaluation of sono‐exposed solvents exhibited decreased pH during CO2 loading and decreased absorption capacity of the conventionally heated sample.CONCLUSIONThe sono‐assisted method consumes 3.57‐foldless energy than conventional heating. Its CO2 stripping rate was found to be higher within 5 min of sonication. Notably, the maximum temperature reached for the 1 h intervening mode of sonication at 470 kHz was 49.49 °C. The reduction in absorption capacity per hour of conventional heating was 24.5%, whereas for sonication it was <0.4% and solvent loss was 19.7% lower than conventional. There was no significant change in the color, pH and density of the sample. A 20.4% higher surface tension than that of the virgin sample was observed. © 2024 Society of Chemical Industry (SCI).

Clinical significance of intensity-modulated radiotherapy (IMRT) to the distant metastatic lymph nodes for metastatic cervical cancer

ObjectiveTo retrospectively explore the clinical significance of radiotherapy to the distant metastatic lymph nodes (cervical/ clavicular/ mediastinal et al.) in metastatic cervical cancer. Hereinto, these cervicothoracic lymph nodes were metastasized from IB1-IVA (initial stage at first treatment), and IVB initially had metastatic disease in these areas at diagnosis.MethodsMetastatic cervical cancer only with the distant cervicothoracic metastatic lymph nodes (cervical/ clavicular/ mediastinal et al.), without distant parenchymal organs metastasis such as lung, liver, bone, and peritoneum, were enrolled in the analysis. These patients were classified into IB1-IVA and IVB based on their initial stage of first treatment. All patients received IMRT for the distant metastatic lymph nodes. The progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method.ResultsOverall, the median PFS was 9 months, and the median OS was 27 months. The subgroup analysis showed that for IB1-IVA, the median PFS was 11 months, and the median OS was 30.5 months. For IVB, the median PFS was 8 months, and the median OS was 16 months.ConclusionRadiotherapy is beneficial to the distant metastatic lymph nodes (cervical/ clavicular/ mediastinal et al.), and could effectively bring the longer PFS and OS for metastatic cervical cancer.

Mental Health and Quality of Life of Patients with Differentiated Thyroid Cancer Pre and Post Radioactive Iodine Treatment: A Prospective Study.

Background: Although patients with differentiated thyroid cancer (DTC) have a good prognosis, their long-term clinical course can influence their mental health and their health-related quality of life (HRQoL). However, few studies have evaluated the psychological factors that influence subsequent HRQoL in this population, particularly during the initial treatment stage. Methods: In this 1-month cohort study, we evaluated depressive and anxiety symptoms and HRQoL of patients with DTC and examined possible predictors of further HRQoL impairment. Results: In total, 181 patients completed questionnaires where they self-rated their psychological status (the Chinese Health Questionnaire [CHQ], Taiwanese Depression Questionnaire [TDQ]) and HRQoL (the 36-item Short Form Health Survey [SF-36]) at baseline and 1 month after radioactive iodine (RAI) therapy. Compared with the general Taiwanese population, patients with DTC reported a worse HRQoL in all dimensions of the SF-36. Multivariate regression models indicated that anxiety and depressive symptoms were inversely correlated with some dimensions (physical functioning, bodily pain, and general health perceptions for the CHQ; role limitations due to physical problems and social functioning for the TDQ). However, psychiatric follow-up and treatment history were significantly associated with physical functioning and role limitations owing to the physical problem dimensions of HRQoL. Conclusions: In conclusion, although anxiety and depressive symptoms may negatively affect certain HRQoL domains, psychiatric follow-up can improve the physical dimensions.

Analysis of care-seeking pathways and factors influencing early and appropriate care-seeking for malaria patients in the Republic of Guinea: a cross-sectional study

BackgroundMalaria is a major public health issue in Guinea and care-seeking behaviour is dominated by self-medication and delayed access to appropriate care. However early and appropriate care-seeking are essential to control and reduce complicate forms and mortality, particularly for the most vulnerable. This study was conducted to analyse the diagnostic pathway, and the factors associated with early and appropriate care-seeking for malaria patients in the Republic of Guinea.MethodsA cross-sectional study was carried out between December 2022 to March 2023 in nine health districts within health facilities and at community level. The study population was confirmed malaria patients with RDT or microscopy. Kroeger’s conceptual framework was used to design the questionnaire. Conventional recourse was defined as using a healthcare facility or community services, early and appropriate care-seeking was defined as within 24 h of symptom onset in a conventional recourse, and care pathway as the sequence of recourses followed by each patient. Sankey alluvial plots were used to represent patients' diagnostic pathways, and logistic regression to identify factors associated with early and appropriate care-seeking.ResultsA total of 3300 malaria patients were studied, of which 1632 (49.45%) were female and 1132 (34.30%) were under 5 years of age, with a median age of 23 months. At the time of the survey, 1337 (40.52%), 1423 (43.12%), and 437 (13.85%) of patients were respectively in their first, second and third recourse. A total of 2002 (60.67%) patients had sought care from a conventional recourse as a first line. Of all patients, 1757 (53.25%) had sought care within 24 h, while 28.55% had sought early and appropriate care. In the initial stages of treatment, self-medication was the most common approach, used by 1214 (37.30%). Patients from the health districts of Boffa (Lower Guinea, coastal region) OR = 0.48 95% CI 0.33–0.70, Dabola (Upper Guinea, savanna region) OR = 0.43 95% CI 0.30–0.63 and Labe (Middle Guinea, mountain region) OR = 0.63 CI 95% 0.43–0.91 (p < 0.05) were more likely to delay appropriate care-seeking, when compared to those in Dixinn, (Conakry). However, the under 5-year-old group OR = 1.55 95% CI 1.30–1.85 (p < 0.001) and the availability of a stable monthly household income OR = 4.98 95% CI 3.03, 8.27 (p < 0.001) were positively associated with early and appropriate care seeking.ConclusionA low rate of early and appropriate care-seeking was observed. Patients sought care through multiple means, often resulting in a delay in adequate management. The results show the need to deploy strategies adapted to the needs of communities.

Growth and dissolution behavior and morphology evolution of γ′ precipitates in GH4742 nickel-based superalloy

This work systematically investigated the coarsening, dissolution, and morphological evolution behavior of γ′ precipitates in GH4742 superalloy through carefully designed heat treatment experiments. During long-term aging processes at 650 °C, 750 °C, and 850 °C, the coarsening model of γ′ precipitates followed the classic function of r3 vs. t, consistent with the classical Lifshitz-Slyozov-Wagner (LSW) coarsening model (diffusion-controlled). Due to higher diffusion coefficients of γ′ forming elements at higher temperatures, the coarsening rate K increased with aging temperature. The dynamical models for the dissolution of primary γ′ precipitates were established during sub-solvus (1080 °C) and super-solvus (1120 °C) heat treatment processes. The results indicated rapid dissolution of primary γ′ precipitates in the initial stages of solution heat treatment, with the dissolution rate gradually decreasing as the treatment time extended, approaching the γ′ precipitate size at thermodynamic equilibrium. During subsequent slow cooling at 14 °C/min after super-solvus (1120 °C) heat treatment, irregular-shaped γ′ precipitates formed through “aggregation” of adjacent γ′ precipitates, followed by “splitting” into smaller γ′ precipitates during growing up. Conversely, during subsequent slow cooling at 14 °C/min after sub-solvus (1080 °C) heat treatment, irregular-shaped γ′ precipitates were mainly controlled by unstable growth and “splitting” of cubic-shaped γ′ precipitates. For individual γ′ precipitates, the portion undergoing unstable growth (protrusions) did not undergo further splitting.

무용동작치료가 윌리암스 증후군 아동의 고유수용성 감각과 정서적 상호작용에 미치는 효과

The purpose of this study was to verify the effects of dance movement therapy on proprioception and emotional interaction in children with Williams syndrome. For a thorough diagnosis of the proprioception of Williams syndrome, which shows aspects of a neurodevelopmental multisystem disorder, the seven movement diagnostic tests of dance therapy pioneer Lillan Espenak were used to specify the subject's problematic issues by area. Dance movement therapy tailored to the characteristics of the subject was conducted once a week (50 minutes), for 40 sessions. First, as a result of the LMA analysis by a motion analyst (CMA), compared to the initial stage of treatment, it was effective in improving physical function, including the balance of physical function, stabilization of movement (increased sustainability), and expansion of range of motion and vertical spatial movement. Second, there was a slight but positive improvement in emotional interaction when considering the diversity of language expressions and topics in terms of emotional and cognitive integration ability. In addition, free movement through practice of body dynamics and skills, coordination through interaction, and emotional exchange were confirmed through qualitative changes and progress in movement. In rehabilitation medicine research, many complex methods have been introduced to measure proprioception, but in reality, there is no method that can measure it perfectly. This study is meaningful in that it provides an understanding of the proprioception of children with Williams syndrome and suggests diagnostic and therapeutic effects for the rehabilitation and growth of children with neurodevelopmental disorders.

Evaluation of a PTSD group intervention in a secondary care mental health service

Introduction: Secondary care mental health services in the United Kingdom are under increasing pressure to meet the demand for support for Post-Traumatic Stress Disorder (PTSD), however, there is a lack of clear guidance for treating complex cases of PTSD. Therefore, an evaluation was conducted to investigate the effectiveness of a pilot stabilisation group programme for clients with PTSD in a secondary care mental health service. Method: Attendees of the group (n = 64) were asked to complete routinely collected outcome measures of wellbeing (WEMWBS) and PTSD symptoms (PCL-5). A repeated-measures t-test analysed the pre and post group scores for statistical significance, whilst Reliable Change Indices analysed the data forreliable improvement and clinically significant change. Results: There was a significant difference between the pre and post group scores on the measures of wellbeing and PTSD symptoms. A large proportion of clients demonstrated reliable and clinically significant improvements in wellbeing. A small proportion of service users demonstrated clinically significant improvements in PTSD symptoms. Conclusion: The intervention shows promise as an initial stage of trauma treatment due to the improvements in wellbeing. However, a large proportion of clients are likely to require further intervention to reduce symptoms of PTSD.

Hydration and microstructure evolution of cement paste in low vacuum environments

Low vacuum is one of the most challenging service environments for cementitious materials, which would affect their hydration and microstructure, and thereby impair strength and durability. In this study, the hydration phases and microstructural evolution of pastes based on Portland cement (PC), sulphoaluminate cement (SAC), and tricalcium silicate (C3S, the clinker of PC) were investigated under low vacuum conditions. The results show that rapid mass loss could be observed at the initial stage of low vacuum treatment, which was mainly attributed to the dissipation of free water. After that, the mass loss rate was greatly slowed down and maintained at a relatively low level, which was primarily due to the loss of chemical bound water in hydration products. As a result, C3S samples, with the slowest early hydration procedure, exhibited the highest mass loss, which was followed by PC and SAC samples. The dissipation effect by low vacuum treatment resulted in the inhabitation of cement hydration, and correspondingly the contents of hydration products remained almost constant, or even decreased especially for ettringite (AFt). Moreover, the examination of the hydration product morphology demonstrates that under low vacuum conditions, the needle-like morphology of the hydration product C-S-H transferred gradually from divergence to convergence or underwent collapse, while the AFt crystals experienced degradation and then transformed into an amorphous state. This consequently led to the sample after low vacuum treatment exhibiting increased total volume of pores less than 100 nm and elevated percentage of pores with sizes from 50 nm to 100 nm. Overall, this research holds great scientific significance in guiding the engineering application of concrete in low vacuum environments.

Correlation of previous local vaccination site “flares” during immunotherapy for metastatic melanoma with complete responses to therapy.

e21534 Background: mRNA vaccines have been shown to stimulate T-cells targeting patient-specific tumor neoantigens. When combined with immune checkpoint inhibitors (ICI) in a randomized Phase II trial, mRNA vaccines demonstrated improvement in recurrence free survival and distant metastasis free survival compared to ICI alone. We retrospectively examined patients (pts) with advanced melanoma treated more than 5 years ago on clinical trials with adjuvant NYESO1 or mRNA vaccine therapies (VT) then ICI upon recurrence and analyzed biomarkers correlating with treatment response. Methods: This retrospective study examined 22 pts with advanced melanoma treated between 2004-2017 with adjuvant vaccine therapies (VT). 10 of the 22 pts subsequently developed recurrent disease and were treated with ICI. We evaluated disease free interval following ICI, sex, age, BRAF status, HLA type, site of primary and metastatic disease, initial vaccine treatment, vaccine toxicities, stage and sites of melanoma recurrence, ICI treatment, response and toxicities, vaccine site flares or cutaneous immune related adverse events (irAEs) following ICI. Results: Of the 22 patients (11 male, 11 female) treated with adjuvant VT, median age at first vaccine was 53 years old. HLA type was known for 11 pts. Stage at initial VT was IIB to IIIC. 14 pts recurred following adjuvant VT. Median time from vaccine initiation to melanoma recurrence was 3.2 years (range 6.5 months to 11 years). 10 pts received ICI for recurrent melanoma, 3 pts received ipilimumab, 2 anti-PD1 monotherapy, 4 ipilimumab and nivolumab, and 1 nivolumab/relatlimab. Stage at first ICI was IIIB to IV M1d. 9 pts experienced cutaneous irAEs. 7 pts experienced local vaccine site flare reactions following ICI treatment. Additionally, 2 pts experienced vitiligo, 2 with dermatologic flares (bullous pemphigoid and psoriatic rash), 2 with generalized rash that resolved with steroid cream. 1 pt did not experience rash, vaccine site flare, nor irAE dermatologic flare. Of the pts who recurred, 2 pts had BRAF V600E mutations, and 1 of these pts experienced vaccine flare, the other did not. 1 pt with a BRAF Q16L mutation did not have vaccine flare. 6 out of 7 BRAF wild type pts who recurred and received ICI experienced a localized vaccine site flare. Median disease-free interval following ICI treatment was 1.5 years (range 3 months to 9 years). All 10 pts are disease-free and off ICI being closely monitored. Conclusions: Evidence of prior localized vaccination “flare” may be a biomarker for a complete immunologic response in pts with metastatic disease treated with immunotherapy. ICI targeting CTLA-4 and/or PD-1 both triggered this localized vaccination site response, suggesting that T cell memory and immunologic activation against melanoma antigens translate into clinical responses.

Delayed recrystallization behavior and deformation mechanism of IN738LC alloy prepared by laser powder bed fusion

The design and development of heat treatment regimes adapted to the laser powder bed fusion technology for specific service conditions have become a hot topic of research in the field of additive manufacturing. This paper systematically studies the microstructure changes of the L-PBFed IN738LC alloy, solution heat treated at 1250 °C for various durations (1 h, 3 h, 5 h) and then aged at 850 °C for 24 h. The delayed recrystallization behavior was revealed, and the selective precipitation pattern of the M23C6 carbide on different types of grain boundaries was discussed. Additionally, the tensile deformation mechanism of the alloy before and after heat treatment is clarified. The results indicate that grain boundary migration and transformation are impeded under 1250 °C/1 h conditions due to carbide particle pinning and solute atom segregation during the initial stage of solution treatment, which accounts for the delayed recrystallization behavior, and the microstructure is mainly undergoing recovery. At 1250 °C/5 h, M23C6 carbides selectively precipitate at twin boundaries, accompanied by recrystallization. The samples treated at 1250 °C/1 h exhibit the highest mechanical property (σYS=1305 ± 21 MPa, σUTS=1462 ± 11 MPa, εEL=5.4 ± 0.7 %) owing to the precipitation of γ′ phase and the presence of sub-grain boundaries. The deformation mechanism shows that the as-built samples mainly experience planar dislocations slipping, while the heat-treated samples undergo stacking faults shearing and anti-phase boundary shearing. The dominant mechanism among these is anti-phase boundary shearing.

Assessment of salivary tumor necrosis factor-alpha level in the initial stages of treatment with fixed appliances and clear aligners.

To assess and compare the tumor necrosis factor-alpha (TNF-α) levels in saliva samples during the initial stages of orthodontic treatment with fixed orthodontic appliances (FAs) and clear aligners (CAs). This longitudinal study comprised 40 patients (22 males, 18 females, mean age 22 ± 7 years) who were categorized into two equal-sized groups. Group A comprised 20 patients treated with FA, and Group B comprised 20 patients treated with CA. Unstimulated saliva was collected before the intiation of treatment and then collected again after the placement of the FA/CA at 24 hrs, 7th day, and on the 21st day in both groups. TNF-α levels were determined through ELISA. The data were subjected to statistical analysis. For intragroup comparison of TNF-α at different time points, the Wilcoxon matched-pairs signed-rank test was used, and for intergroup comparison of FAs and CAs at different time points, the Mann-Whitney U test was used. TNF-α levels in the saliva increased significantly at 24 hours, followed by a decline on the 7th day and 21st day in both groups. Changes in TNF-α levels were significantly higher in the FA group than those in the CA group at different time points. This study showed that the salivary TNF-α levels increased significantly during the initial stages of FA and CA treatment at different time points. The mean salivary TNF-α level in both FA and CA groups increased significantly at 24 hours, followed by a decline on the 7th day and then on the 21st day. There was a significant difference between the FA and CA treatment, where the CAs showed a significantly low level of TNF-α in saliva at different intervals of time when compared to the FAs.

Guideline for evaluating the effects of psychotropic drugs on motor vehicle driving performance in Japan: A tiered approach for the assessment of clinically meaningful driving impairment.

In December 2022, the Ministry of Health, Labour and Welfare (MHLW) of Japan issued and implemented the guideline for evaluating the effects of psychotropic drugs on motor vehicle driving performance. This guideline recommends the use of a tiered approach to assess clinically meaningful driving impairment. It is noted that adverse events cannot be solely explained by pharmacokinetics, as the onset and duration of these events vary. Among these adverse events, those affecting alertness, such as drowsiness caused by psychotropic drugs on driving performance, are more frequently observed during initial treatment stages and dose escalation. Hence, when evaluating the effects of psychotropic drugs on driving performance, it becomes crucial to assess the persistence of clinically meaningful impairment. Therefore, the MHLW guideline, developed by the authors, emphasizes the need to assess the temporal profile of adverse events affecting driving in all clinical trials. Additionally, the guideline states that when conducting driving studies, the timing of multiple dosing should consider not only the pharmacokinetics of the investigational drug but also its tolerance.

Microbiological treatment of post-industrial water: Example of efficient bioremediation of the heavily polluted Kalina pond, Poland

The Kalina pond has been well known as a severely degraded area in the Silesia region, Poland. The environmental deterioration results from high contamination of water and bottom sediments with recalcitrant and toxic organic compounds, mainly phenol. The study was aimed at developing a bioremediation-based approach suitable for this type of polluted areas, involving microbiological treatment of water as a key and integral part of other necessary actions: mechanical interventions and the use of physical methods. During the initial biological treatment stage, autochthonous microorganisms were isolated from contaminated samples of water, soil and sediment, then subjected to strong selective pressure by incubation with the pollutants, and finally, cultivated to form a specialised microbial consortium consisting of five extremophilic bacterial strains. Consortium propagation and its biodegradation activity were optimised under variant conditions enabling bacteria to proliferate and to obtain high biomass density at large volumes allowing for the in situ application. After installing aeration systems in the pond, the consortium was surface-sprinkled to launch bioremediation and then both bacterial frequency and the contaminant level was systematically monitored. The complex remediation strategy proved efficient and was implemented on an industrial scale enabling successful remedial of the affected site. Treatment with the specifically targeted and adapted microbial consortium allowed for removal of most organic pollutants within a four-month season of 2022: the chemical oxygen demand (COD) value decreased by 72%, polyaromatic hydrocarbon (PAH) level by 97%, while the content of total phenols and other monoaromatic hydrocarbons (BTEX) dropped below the detection thresholds.

A prognostic model for triple-negative breast cancer patients with liver metastasis: A population-based study

However, it is still difficult for clinicians to establish prognostic stratifications and therapeutic strategies because of the lack of tools for predicting the survival of triple-negative breast cancer patients with liver metastases (TNBC-LM). Based on clinical data from large populations, a sensitive and discriminative nomogram was developed and validated to predict the prognosis of TNBC patients with LM at initial diagnosis or at the later course. Introduction/backgroundLiver metastasis (LM) in TNBC patients is associated with significant morbidity and mortality. The objective of this study was to construct a clinical model to predict the survival of TNBC-LM patients. Materials and methodsClinicopathologic data were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and the Fifth Affiliated Hospital of Sun Yat-Sen University (FAFSYU). Based on patients with newly diagnosed TNBC with LM (nTNBC-LM) from the SEER database, a predictive nomogram was established and validated. Its predictive effect on TNBC patients with LM at later disease course by enrolling TNBC patients from FAFSYU who developed LM later. The prognostic effect of different treatment for nTNBC-LM was further assessed. ResultsA prognostic model was developed and validated to predict the prognosis of TNBC-LM patients. For LM patients diagnosed at the initial or later treatment stage, the C-index (0.712, 0.803 and 0.699 in the training, validation and extended groups, respectively) and calibration plots showed the acceptable prognostic accuracy and clinical applicability of the nomogram. Surgical resection on the primary tumour and chemotherapy were found to be associated with significantly better overall survival (OS). ConclusionA sensitive and discriminative model was developed to predict OS in TNBC-LM patients both at and after initial diagnosis.

"How Can I Trust You When I Know You Can Die?" Surviving the Death of an Analyst in a Child Analysis.

This reflection on the initial stages of treatment of a latency girl whose previous analyst died offers some insights into inner workings of mourning in children. The mourning process intersects in complex ways with a developmental stage, object constancy, unconscious phantasies, and conscious ideas about life and death. Clinical material illustrates some challenges that emerge in the transference-countertransference matrix when working with a child who lost both her primary object (the mother) and her transference object (the analyst). The reality of the analyst's death emphasizes that for a child patient the analyst is always a transference object and a real object at once.

Initial arch wires used in orthodontic treatment with fixed appliances.

Initial arch wires used in orthodontic treatment with fixed appliances.

Alignment Efficiency of Two Archwires in Adolescents with Moderate to Severe Crowding

There is no consensus in clinical orthodontics on which aligning arch wire should be used at the initial stage of treatment. This randomized clinical trial evaluated the efficiency of multistranded Nitinol (Supercable) aligning arch-wire versus a standard arch-wire (Nitinol) in the first stage of orthodontic treatment in adolescents with severe crowding. Forty patients ages 12 to 17 with an Irregularity Index as proposed by Little between 5 to 17 mm were selected. Vinyl polysiloxane impressions (VPS) were taken before treatment (T1) at 6 weeks (T2) and 12 weeks (T3). Roth prescription .022 x .028 Edgewise brackets were bonded using light cure adhesive to the six anterior teeth of each dental arch and bands were placed on all first molars. Subjects were paired by gender and Irregularity Index into two groups of 20 each and assigned either to the control group (Nitinol) or the experimental archwire (Supercable). The predictor variables in this study were the type of archwire, type of dental arch and the time intervals. The outcome variable was the Irregularity Index score. The Irregularity Index was measured using 3D digital study models (e-models) and GeoDigm software from the VPS impressions taken at T1, T2 and T3. The data was analyzed with both a Two and Three-way Analysis of Variance (p≤0.05) to identify differences in the alignment of the maxillary and mandibular teeth and to determine differences between the two archwires. The Two and Three way ANOVA showed that there was a statistically significant difference (p≤0.05) in the alignment capabilities between the maxilla and the mandible. However, there was no evidence of a statistically significant difference (p=0.301) between NiTi and Supercable archwires at any time interval.

Clinical and pathological analysis of 345 cases of vulvar lichen sclerosus and a preliminary study on the frequency of maintenance treatment

Objective: To analyze and summarize the clinical and pathological characteristics, management, and efficacy of patients with vulvar lichen sclerosus (VLS) through a single center large sample study, and preliminarily to explore the frequency of maintenance treatment medication for VLS. Methods: The clinical data of VLS patients in Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2021 were retrospectively collected. The clinicopathological characteristics (patients' age, course of disease, complicated disease history, family history, symptoms, signs and pathology), treatment and effects were retrospectively analyzed. The patients in the maintenance treatment stage were followed up regularly to explore the minimum frequency of individual medication to maintain the stability of the disease. Results: (1) General situation: a total of 345 patients with VLS were included in this study. The average age was (50.4±14.7) years (ranged from 8 to 84 years old), prevalence was highest in the 50-59 years group (30.1%, 104/345). Immune diseases occurred in 18.6% (33/177) of patients, 24.3% (43/177) of patients had allergic skin diseases, and 5.6% (10/177) of the patients' immediate family members had chronic vulvar pruritus or vulvar hypopigmentation. (2) Clinical features: the most common symptom was vulvar pruritus (96.1%, 196/204) among 204 patients with recorded symptoms. The most common sign was hypopigmentation of the vulva (96.3%, 206/214). The most common involved sites were labia minora (70.3%, 142/202), labia majora (67.8%, 137/202), and labial sulcus (59.4%, 120/202). The cumulative number of sites involved in 62 vulvar atrophy patients (2.7±1.1) was significantly higher than that in 152 non-atrophy patients (2.2±1.0; t=3.48, P=0.001). The course of vulvar atrophy was (9.3±8.5) years, which was significantly longer than that of non-atrophy patients [(6.6±5.6) years; t=2.04, P=0.046]. (3) Pathological features: among the 286 patients with electronic pathological sections, the most common pathological feature in the epidermis was epithelial nail process passivation (71.3%, 204/286). The common pathological features in the dermis were interstitial collagenization (84.6%, 242/286), and inflammatory cell infiltration (73.8%, 211/286). (4) Treatment: 177 patients received standardized treatment after diagnosis and were followed up regularly in our hospital. In the initial treatment stage, 26.0% (46/177) of the patients were treated with 0.05% clobetasol propionate cream, and 74.0% (131/177) of the patients were treated with 0.1% mometasone furoate ointment. The complete remission rates of the two methods were respectively 80.4% (37/46) and 74.0% (97/131), and there was no statistically significant difference (χ²=0.76, P=0.385). During maintenance treatment, 27.1% (48/177) of the patients took the medication twice a week, 35.0% (62/177) took the medication once a week, and 37.9% (67/177) took the medication once every 10 days. During follow-up after 6 months of maintenance treatment, there were no patients with recurrence of pruritus or progression of vulvar signs. Conclusions: The majority of VLS patients have itching, hypopigmentation, involvement of labia minora and labia majora, progressive atrophy, and inflammatory infiltration of dermis. Local treatments of mometasone furoate and clobetasol propionate have good initial therapeutic effects. The frequency exploration of individualized maintenance treatment could minimize the occurrence of adverse reactions when ensuring the stability of the patients' condition.

HUBUNGAN PERSEPSI PERAWAT TENTANG PROFESI KEPERAWATAN TERHADAP KINERJA PERAWAT DALAM PENERAPAN ASUHAN KEPERAWATAN DI RUMAH SAKIT X

The community still uses clinics and health centers for inpatient medical care. The degree of discontent with therapeutic communication services in both public and private hospitals. The purpose of this study was to ascertain if patients levels of satisfaction in the inpatient room were correlated with nurses therapeutic communication. Chi square is the statistical test that is employed, the sample technique utilized is known as purposive sampling. A total of 42.8% of participants expressed satisfaction with the univariate analysis findings, while 57.2% expressed dissatisfaction with the outcomes. After doing bivariate analysis, it was discovered that the p value was 0.0001, signifying a substantial correlation between the therapeutic communication of nurses and the degree of pleasure that inpatients felt. Hospitals to provide monitoring or oversight regarding the application of communication. Nurses must focus more on therapeutic communication while providing patients with healthcare, with a focus on the initial stage of treatment.