Treatment Interventions Research Articles

Early Non-Surgical Treatment For Microtia Types 1 and 2.

Esthetic concerns and psychosocial distress often accompany auricular deformities and malformations in both children and their parents. Approximately 30% of newborns are affected by auricular anomalies, with 15% to 20% resulting in permanent defects. While surgical intervention is typically considered the gold standard for malformations, a non-surgical approach, such as splinting, molding, or other non-invasive techniques, can effectively address deformations if promptly administered by a specialist. Microtia, classified into 4 types, presents challenges ranging from fundamental structural anomalies in types 1 and 2 to severe defects in type 3 and complete absence of the external ear in type 4 (anotia). This study introduces a novel non-invasive treatment modality for microtia types 1 and 2. The cohort consisted of 5 newborns treated for microtia types 1 or 2 between 2022 and 2023. Utilizing the EarWell system, treatment was initiated before 3 weeks of age (mean age: 2 weeks), with an average treatment duration of 6.6 weeks, supplemented by molding treatment as needed. Minor adverse effects, such as simple dermatitis, were observed in 2 patients. All parents expressed high satisfaction with the esthetic outcomes, with 60% reporting extreme satisfaction. The prompt initiation of the treatment protocol for microtia types 1 and 2 led to outstanding and timely outcomes in infants, enhancing the quality of life for both parents and their children. Early intervention for subsequent treatment may improve the condition and, in certain cases, serve as a satisfactory alternative for parents hesitant about further surgical intervention for their children.

Analysis of interventional treatment options of the common femoral artery - a retrospective single center experience.

Background: Due to the rapid development of treatment techniques of peripheral arterial disease (PAD) treatment is nowadays predominantly interventional. An exception are lesions of the common femoral artery (CFA), which should be treated surgically according to vascular guidelines. However, recent evidence has shown that endovascular techniques, e.g. stenting, have comparable clinical outcomes while causing fewer complications. The aim of the present analysis was to evaluate the therapeutic success of endovascular therapy of CFA lesions in a single center, all - comers registry. Patients and methods: All patients who were treated for a CFA lesion at the Department of Internal Medicine I of the University Hospital Jena in the period from 01/2017 to 12/2020 were included. Treatment success was determined by evaluating the ankle-brachial-index (ABI) pre- and post-interventional as well as after follow-up (FU), measuring walking distance (WD) and by target revascularization rate (TLR) and primary patency rate (PPR). Results: The analysis included 109 patients with a mean age of 73.4 years, with 67% (73) of those being men. 72 patients received interventional treatment, whereas 33 were treated surgically and 4 conservatively. Resting ABI in the overall cohort showed an increase from 0.5 to 0.7 post intervention (p=<0.05; mean FU-time: 6.5 months). In the interventional cohort ABI increases from 0.6 to 0.8 (p=<0.05; mean FU-time: 5,8 months) at FU and from 0.3 to 0.6 (p=<0.05; mean FU-time: 8,8 month) in the surgically treated group. The WD improved in the whole collective from 116.5 meter (m) to 152.5 m (p=<0.05). The TLR showed no significant difference with 8.1% after interventional treatment and 6.1% after vascular surgery in the present analysis (p=0.72) as well as PPR with 89.8% after EVT and 90.9% after surgical approach (p=0.87). The intra-/postinterventional complication rate was 5.5% in the intervention group, compared to postoperative complication rate of 15.2% in the surgically treated group. Conclusions: The present analysis demonstrates that even in a real-world, all-comers collective, interventional therapy for CFA lesions was safe and equally effective as the surgically treated patient cohort. Continuing to generate registry data is important to eventually initiate a paradigm shift.

Analysis of lumbar spine loading during walking in patients with chronic low back pain and healthy controls: An OpenSim-Based study

Low back pain (LBP) is one of the most prevalent and disabling disease worldwide. However, the specific biomechanical changes due to LBP are still controversial. The purpose of this study was to estimate the lumbar and lower limb kinematics, lumbar moments and loads, muscle forces and activation during walking in healthy adults and LBP. A total of 18 healthy controls and 19 patients with chronic LBP were tested for walking at a comfortable speed. The kinematic and dynamic data of the subjects were collected by 3D motion capture system and force plates respectively, and then the motion simulation was performed by OpenSim. The OpenSim musculoskeletal model was used to calculate lumbar, hip, knee and ankle joint angle variations, lumbar moments and loads, muscle forces and activation of eight major lumbar muscles. In our results, significant lower lumbar axial rotation angle, lumbar flexion/extension and axial rotation moments, as well as the muscle forces of the four muscles and muscle activation of two muscles were found in patients with LBP than those of the healthy controls (p &amp;lt; 0.05). This study may help providing theoretical support for the evaluation and rehabilitation treatment intervention of patients with LBP.

Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners

Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.

Modified sports interventions for children and adolescents with disabilities: A scoping review.

To establish the scope of the literature on modified sports interventions for children and adolescents with disabilities. For this scoping review, articles were screened and the characteristics of studies were extracted. The modified sports interventions were described in terms of their structure, using the items of the Template for Intervention Description and Replication. Components of intervention treatment were described by using the language of the Rehabilitation Treatment Specification System. Results were analysed and validated by a group of professionals, using the Public and Patient Involvement strategy. Twelve studies were eligible for inclusion, investigating interventions for children with autism spectrum disorder, cerebral palsy, and other conditions. Most studies presented a moderate level of evidence. Active ingredients were repeated sports-related motor training and introduction to the sport through a 'learning by action' mechanism. The intervention target was gross motor skills performance, and intervention aims (indirect outcomes) were physical activity participation and different body functions. The inclusion of stakeholders in this review helped to validate our findings about the characteristics and structure of modified sports interventions, to identify research gaps, and to provide a step process for clinical implementation. Future investigations are warranted of the effectiveness of modified sports investigations with better quality studies, including participation outcomes and studies with non-ambulant children.

Transarterial Embolisation of Abdominal Aortic Type II Endoleaks Accessed via the Deep Circumflex Iliac Artery: A Case Series and Literature Review.

We report our technique and experience treating 3 patients with native abdominal aortic aneurysm (AAA) sac expansion following EVAR, who were managed with transarterial embolisation via the deep circumflex iliac artery (DCIA). In this case series, we demonstrate that transarterial embolisation via the DCIA is a feasible and safe treatment option. The DCIA should be routinely interrogated with angiography as not only a cause of possible Type II endoleak, but also to identify a potential access route to the abdominal aortic sac for interventional treatment.

Long-term clinical outcomes in patients with CIS treated with interferon beta-1b: results from the 15-year follow up of the BENEFIT trial.

Multiple sclerosis (MS) treatment intervention with immunomodulating therapy at early disease stage improves short term clinical outcomes. The objective of this study is to describe the long-term outcomes and healthcare utilization of patients with clinically isolated syndrome (CIS) included in the Betaferon®/Betaseron® in Newly Emerging MS for Initial Treatment (BENEFIT) randomized, parallel group trial. In BENEFIT patients were assigned to "early" IFNB-1b treatment or placebo ("delayed" treatment). After 2years or conversion to clinically definite multiple sclerosis (CDMS), all patients were offered IFNB-1b and were reassessed 15years later. Of 468 patients, 261 (55.8%) were enrolled into BENEFIT 15 (161 [55.1%] from the early, 100 [56.8%] from the delayed treatment arm). In the full BENEFIT analysis set, risk of conversion to CDMS remained lower in the early treatment group ( - 30.5%; hazard ratio 0.695 [95% CI, 0.547-0.883]; p = 0.0029) with a 15.7% lower risk of relapse than in the delayed treatment group (p = 0.1008). Overall, 25 patients (9.6%; 9.9% early, 9.0% delayed) converted to secondary progressive multiple sclerosis. Disability remained low and stable with no significant difference between groups in Expanded Disability Status Scale score or MRI metrics. Paced Auditory Serial Addition Task-3 scores were better in the early treatment group (p = 0.0036 for treatment effect over 15years). 66.3% of patients were still employed at Year 15 versus 74.7% at baseline. In conclusion, results 15years from initial randomization support long-term benefits of early treatment with IFNB-1b.

Does IPSS-R down-staging before transplantation improve the prognosis of patients with Myelodysplastic Neoplasms?

In MDS patients higher IPSS-R at transplant is associated with worse transplant outcome. Thus, it may seem beneficial to improve IPSS-R by therapeutic intervention prior to transplantation in order to “down-stage” the disease risk. However, there is no evidence to date to support this approach. A retrospective analysis of the EBMT transplant registry was performed to investigate the role of therapeutic interventions prior to transplantation with regard to changes in IPSS-R and transplant outcomes. A total of 1482 MDS patients with sufficient data to calculate IPSS-R at diagnosis and at time of transplantation were selected and analysed for transplant outcome in a multivariable Cox model including IPSS-R at diagnosis, treatment intervention, change in IPSS-R before transplant and several patient and transplant variables.Transplant outcome was unaffected by IPSS-R change in untreated patients and moderately superior in chemotherapy-treated patients with improved IPSS-R at transplant. Improved IPSS-R after hypomethylating agents (HMA) or other therapies showed no beneficial effect. However, when IPSS-R progressed after chemotherapy, (HMA) or other therapies, transplant outcome was worse than without any prior treatment. Similar results were found when reduction or increase in bone marrow (BM) blasts between diagnosis and transplantation was considered. The results show a limited benefit of IPSS-R down staging or reduction of BM blasts after chemotherapy and no benefit for HMA or other treatments and thus question the role of prior therapy in MDS patients scheduled for transplantation. The model-based survival estimates should help inform decision making for both doctors and patients.

A Sole Case of the FGF23 Gene Mutation c.202A&gt;G (p.Thr68Ala) Associated with Multiple Severe Vascular Aneurysms and a Hyperphosphatemic Variant of Tumoral Calcinosis—A Case Report

Tumoral calcinosis is an extremely rare genetic disease caused by mutations in three genes, GALNT3, FGF23, and KL, which disrupt phosphorus metabolism. The hallmark of this condition is the formation of tumors in the soft tissues around the joints. Other phenotypic features of tumoral calcinosis are dental involvement and brain and vascular calcifications. The clinical case reported herein presents for the first time to the scientific community the c.202A&gt;G (p.Thr68Ala) mutation of the FGF23 gene, associated with a hyperphosphatemic variant of tumoral calcinosis and multiple severe vascular aneurysms. A female patient underwent multiple surgeries for tumor formations in her soft tissues that first appeared at the age of 12 months. On this occurrence, the patient was found to have hyperphosphatemia, low phosphate clearance, increased tubular reabsorption with normal levels of total and ionized calcium, vitamin D3, and parathyroid hormone, and no effect of treatment with sevelamer hydrochloride and a low-phosphate diet. At the age of 39, the patient underwent imaging studies due to edema and a pulsating formation in the neck area, which revealed multiple vascular aneurysms with thrombosis, for which she received operative and interventional treatment. In this connection, and because of the established phosphorus metabolism disturbance, a genetic disease was suspected. The sequence analysis and deletion/duplication testing of the 358 genes performed on this occasion revealed that the woman was homozygous for a variant of the c.202A&gt;G (p.Thr68Ala) mutation of the FGF23 gene. The established mutation is not present in population databases. The presented clinical case is the first and only one in the world to demonstrate the role of this type of FGF23 gene mutation in the development of a hyperphosphatemic variant of tumoral calcinosis characterized by aggressive formation of multiple vascular aneurysms.

Personalized Approaches to Cardiovascular Disease: Insights into FDA-Approved Interventions and Clinical Pharmacogenetics.

Cardiovascular diseases place a considerable burden on global health systems, contributing to high rates of morbidity and mortality. Current approaches to detecting and treating Cardiovascular Diseases (CVD) often focus on symptomatic management and are initiated after the disease has progressed. Personalized medicine, which tailors medical interventions to individual characteristics, has emerged as a promising strategy for improving cardiovascular health outcomes. This article provides an overview of personalized medicine in the context of CVD, with a specific emphasis on FDA-approved interventions. It explores the potential benefits, challenges, and future directions of personalized medicine in cardiovascular disorders. By reviewing the advancements in this field, this article underscores the importance of early detection, intervention, and innovative treatment options in reducing the impact of CVD on individuals and society.

Virtual reality modelling in a child after multiple interventions for hypoplastic aortic arch and coarctation.

We present the benefits of advanced multimodality imaging and virtual reality modelling in the diagnosis and treatment planning of a child with aneurysms after numerous interventions for treatment of a hypoplastic aortic arch and coarctation.

Effect of hydration therapy and nursing intervention on preventing contrast-induced nephropathy after interventional treatment of lower extremity arteriosclerosis obliterans.

Endoluminal interventions have become one of the main options for the treatment of arteriosclerosis obliterans (ASO). To explore the effect of hydration therapy and nursing intervention on the prevention of contrast-induced nephropathy (CIN) after interventional treatment of lower extremity ASO. A convenience sampling method was used to select 94 patients who received ASO treatment in our hospital from March 2019 to May 2021 as the study subjects. All patients underwent endovascular interventional therapy and were randomly divided into two groups by the random number table method, with odd numbers entering the observation group (n= 47) and even numbers entering the control group (n= 47). The control group received routine nursing intervention, while the observation group underwent hydration therapy and had a corresponding nursing intervention scheme. The clinical efficacy of the two groups and the incidence of contrast-induced nephropathy after interventional therapy were compared, and an evaluation of satisfaction within the two groups was performed via a questionnaire. The total effective rate of patients in the observation group was higher after hydration treatment (97.87% vs 87.23%, p< 0.05). The blood urea nitrogen, creatinine, and β2 microglobulin levels in the observation group were significantly lower than those in the control group after the intervention (p< 0.05). Patients in the observation group had higher nursing satisfaction after using preventive measures of hydration therapy combined with nursing interventions (100% vs 89.36%, p< 0.05). Hydration therapy and nursing intervention can effectively prevent CIN after interventional treatment of lower extremity ASO. After interventional therapy, patients had better clinical outcomes, lower biochemical indexes and improved satisfaction evaluations. The therapy is worthy of clinical promotion and application.

Percutaneous coronary intervention and risk of major adverse cardiovascular events in patients with coronary artery ectasia and acute coronary syndrome

Abstract Funding Acknowledgements None. Background Coronary artery ectasia (CAE) is defined as segmental or diffuse dilation of a coronary artery with a diameter of at least 1.5 times the normal adjacent segment, affecting more than one-third of the length of the artery. It has been described as a relatively infrequent finding with a prevalence from 0.3% to 5%, however, in our population we have previously found it higher, up to 6.7%. In patients with STEMI and ectatic infarct-related artery (EIRA), performing percutaneous coronary intervention (PCI) has been reported to provide better in-hospital outcomes (3), but long-term prognosis remains controversial, with a high mortality risk and cardiovascular events after PCI. No standard approach has been defined for interventional treatment in the acute setting. High thrombus burden and coronary dilation make interventional treatment more challenging. Aim The aim of the present study was to assess the rate of MACE in the long-term according to the use of PCI in patients with CAE and ACS. Methods This was a retrospective analysis of a randomized controlled trial (OVERTIME NCT). Sixty-two consecutive patients with ACS (STEMI or NSTEMI) in whom coronary angiography demonstrated CAE were included. Results The mean age of the 62 patients was 55.7+/- 10.6 years. Of them, 12.9% were women and 87.1% were men. The most common presentation was STEMI in 52 patients (83.8%) and 10 patients (19.2%) presented with NSTEMI. After coronary angiography, 48.4% received PCI and 51.6% did not. Baseline clinical characteristics were not different between groups. During follow up, 8 patients (12.9%) presented a MACE. We found that the risk of MACE was not statistically different, by PCI use (HR 0.67, 95% CI 0.16-2.84, p = 0.5) (Figure 1). We also analyzed the intracoronary use of glycoprotein IIb/IIIa inhibitors, with no long-term differences between groups. Conclusions In patients with CAE and ACS, we found non-statistically significant differences in the risk of MACE between patients who were treated with PCI compared to those without PCI.

Characteristics of drug resistance mutations in ART-experienced HIV-1 patients with low-level viremia in Zhengzhou City, China

Although most people living with HIV (PLWH) receiving antiretroviral therapy (ART) achieve continuous viral suppression, some show detectable HIV RNA as low-level viremia (LLV) (50–999 copies/mL). Drug resistance mutations (DRMs) in PLWH with LLV is of particular concern as which may lead to treatment failure. In this study, we investigated the prevalence of LLV and LLV-associated DRMs in PLWH in Zhengzhou City, China. Of 3616 ART-experienced PLWH in a long-term follow-up cohort from Jan 2022 to Aug 2023, 120 were identified as having LLV. Of these PLWH with LLV, we obtained partial pol and integrase sequences from 104 (70 from HIV-1 RNA and 34 from proviral DNA) individuals. DRMs were identified in 44 individuals. Subtyping analysis indicated that the top three subtypes were B (48.08%, 50/104), CRF07_BC (31.73%, 33/104), and CRF01_AE (15.38%, 16/104). The proportions of nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) associated DRMs were 23.83% (24/104), 35.58% (37/104), 5.77% (6/104), and 3.85% (4/104), respectively, which contributed to an overall prevalence of 42.31% (44/104). When analyzed by individual DRMs, the most common mutation(s) were V184 (18.27%, 19/104), followed by V179 (11.54%, 12/104), K103 (9.62%, 10/104), Y181 (9.62%, 10/104), M41 (7.69%, 8/104), and K65R (7.69%, 8/104). The prevalence of DRMs in ART-experienced PLWH with LLV is high in Zhengzhou City and continuous surveillance can facilitate early intervention and provision of effective treatment.

Cost-effectiveness and cost–benefit analyses of fluoride varnish for caries prevention in Guangxi, China

ObjectivesThe objectives of this study were to evaluate the cost-effectiveness and cost-benefit of fluoride varnish (FV) interventions for preventing caries in the first permanent molars (FPMs) among children in rural areas in Guangxi, China.MethodsThis study constituted a secondary analysis of data from a randomised controlled trial, analysed from a social perspective. A total of 1,335 children aged 6–8 years in remote rural areas of Guangxi were enrolled in this three-year follow-up controlled study. Children in the experimental group (EG) and the control group (CG) received oral health education and were provided with a toothbrush and toothpaste once every six months. Additionally, FV was applied in the EG. A decision tree model was developed, and single-factor and probabilistic sensitivity analyses were conducted.ResultsAfter three years of intervention, the prevalence of caries in the EG was 50.85%, with an average decayed, missing, and filled teeth (DMFT) index score of 1.12, and that in the CG was 59.04%, with a DMFT index score of 1.36. The total cost of caries intervention and postcaries treatment was 42,719.55 USD for the EG and 46,622.13 USD for the CG. The incremental cost-effectiveness ratio (ICER) of the EG was 25.36 USD per caries prevented, and the cost–benefit ratio (CBR) was 1.74 USD benefits per 1 USD cost. The results of the sensitivity analyses showed that the increase in the average DMFT index score was the largest variable affecting the ICER and CBR.ConclusionsCompared to oral health education alone, a comprehensive intervention combining FV application with oral health education is more cost-effective and beneficial for preventing caries in the FPMs of children living in economically disadvantaged rural areas. These findings could provide a basis for policy-making and clinical choices to improve children’s oral health.

Temporal trends in acute coronary syndrome by subtype

Abstract Funding Acknowledgements None. Introduction Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU). Methods We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data. Results Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p&amp;lt;0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p&amp;lt;0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= &amp;lt;0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= &amp;lt;0.001). Conclusion We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.

Protocol for a systematic mapping review of surgical and pharmacological interventions for the treatment of trigeminal neuralgia.

Trigeminal neuralgia is a painful neuropathic disorder characterized by sudden electric shock-like pain that significantly impacts patients' quality of life. Multiple treatment alternatives are available, including medical and surgical options but establishing the optimal course of action can be challenging. To enhance clinical decision-making for trigeminal neuralgia treatment, it is imperative to organize, describe and map the available systematic reviews and randomized trials. This will help identify the best treatment alternatives supported by evidence and acknowledge potential knowledge gaps where future research is needed. This systematic mapping review aims to provide up-to-date evidence on the different surgical and pharmacological treatment alternatives used for trigeminal neuralgia. A search will be systematically conducted on the Epistemonikos database to identify potentially eligible systematic reviews. Additionally, a search will be made in PubMed, CENTRAL, and EBSCO to identify randomized controlled trials assessing pharmacological and surgical treatment interventions for trigeminal neuralgia. Two independent reviewers will screen and select the studies. Data on the different treatment alternatives and reported outcomes in the included studies will be extracted using standardized forms. Following extraction, descriptive statistical methods will be used to analyze the data. The final output of this study will include an evidence map that will illustrate the connections between different treatments and their respective outcomes, providing a clear depiction of the evidence landscape. This study expects to map, describe and assess the methodological quality of the available systematic reviews and trials on pharmacological interventions and neurosurgical procedures for treating trigeminal neuralgia. It will present the results in an evidence map that organizes the available evidence based on their different interventions and outcomes. This evidence map will serve as a visual tool to assist healthcare professionals and patients to understand evidence-based treatment options and their implications for managing this medical condition. La neuralgia del trigémino es un trastorno neuropático doloroso caracterizado por un dolor súbito y agudo, similar a una descarga eléctrica, que impacta significativamente en la calidad de vida. Dada la variedad de tratamientos disponibles, médicos y quirúrgicos, es crucial organizar y mapear la evidencia proveniente de revisiones sistemáticas y ensayos clínicos para orientar las decisiones clínicas. Esto permite identificar tratamientos respaldados por evidencia y señalar áreas de investigación futura. El propósito de esta revisión sistemática de mapeo es proporcionar una visión actualizada de la evidencia existente en relación con las diversas opciones de tratamiento quirúrgico y farmacológico empleadas en el manejo de la neuralgia del trigémino. Se realizará una búsqueda sistemática en la base de datos Epistemonikos para identificar potenciales revisiones sistemáticas. Adicionalmente, se buscará en PubMed, CENTRAL y EBSCO ensayos clínicos aleatorizados que evalúen intervenciones de tratamiento farmacológico y quirúrgico para la neuralgia del trigémino. Dos revisores independientes cribarán y seleccionarán los estudios. Se extraerán datos sobre las diferentes alternativas de tratamiento y los resultados reportados en los estudios incluidos utilizando formularios estandarizados. Tras la extracción, se utilizarán métodos estadísticos descriptivos para analizar los datos. El producto final de este estudio incluirá un mapa de evidencia que ilustrará las conexiones entre los diferentes tratamientos y sus respectivos resultados, proporcionando una representación clara del panorama de la evidencia. Los resultados que se extraerán de este mapeo sistemático incluyen identificar y describir las diferentes alternativas, tanto farmacológicas como quirúrgicas, que existen para el tratamiento de la neuralgia del trigémino. Además, se planea presentar un mapa de evidencia que se basará en los ensayos clínicos aleatorizados y revisiones sistemáticas, el cual mostrará la evidencia de manera organizada entre las diferentes intervenciones y sus desenlaces. Este mapa de evidencia servirá como una herramienta visual que ayudará a los profesionales de la salud y los pacientes a comprender mejor las opciones de tratamiento respaldadas por la evidencia y sus consecuencias en el manejo de esta condición médica.

Evaluating the effectiveness of a mobile app-based self-guided psychological interventions to reduce relapse in substance use disorder: protocol for a randomized controlled trial

BackgroundSubstance Use Disorder (SUD) persists as a significant public health challenge worldwide, with an estimated prevalence of approximately 10-15% across the global populace. This condition is characterized by a notably high risk of lapses and relapses, even subsequent to treatment interventions. Mobile health interventions, owing to their widespread accessibility, emerge as a promising approach to diminish the risk of relapse post-treatment and to broaden the scope of care, especially in regions with a scarcity of trained medical professionals.MethodThis study is designed to assess the effectiveness of mobile interventions in mitigating cravings and preventing lapses among individuals diagnosed with SUD. Employing a two-armed, randomized controlled trial framework, the study will evaluate a self-administered psychological intervention delivered through a mobile application, Nałogometr 2.0. Over a period of three months, participants will engage with intervention modules that primarily incorporate mindfulness techniques and Cognitive Behavioral Therapy (CBT) principles. Ecological Momentary Assessment (EMA) will be utilized to gather longitudinal data on a range of variables that are indicative of craving intensity and the risk of lapse. In addition to this, a monthly-administered battery of questionnaires will be employed to gauge the severity of substance dependence, as well as to measure levels of anxiety, depression, and overall life satisfaction.ResultsResults will be submitted for publication in peer-reviewed journals.Clinical trial registrationhttps://clinicaltrials.gov/, identifier [NCT05730504].

A comprehensive analysis of patients with cerebral arteriovenous malformation with headache: assessment of risk factors and treatment effectiveness

BackgroundDue to the high mortality and disability rate of intracranial hemorrhage, headache is not the main focus of research on cerebral arteriovenous malformation (AVM), so research on headaches in AVM is still scarce, and the clinical understanding is shallow. This study aims to delineate the risk factors associated with headaches in AVM and to compare the effectiveness of various intervention treatments versus conservative treatment in alleviating headache symptoms.MethodsThis study conducted a retrospective analysis of AVMs who were treated in our institution from August 2011 to December 2021. Multivariable logistic regression analysis was employed to assess the risk factors for headaches in AVMs with unruptured, non-epileptic. Additionally, the effectiveness of different intervention treatments compared to conservative management in alleviating headaches was evaluated through propensity score matching (PSM).ResultsA total of 946 patients were included in the analysis of risk factors for headaches. Multivariate logistic regression analysis identified that female (OR 1.532, 95% CI 1.173–2.001, p = 0.002), supply artery dilatation (OR 1.423, 95% CI 1.082–1.872, p = 0.012), and occipital lobe (OR 1.785, 95% CI 1.307–2.439, p < 0.001) as independent risk factors for the occurrence of headaches. There were 443 AVMs with headache symptoms. After propensity score matching, the microsurgery group (OR 7.27, 95% CI 2.82–18.7 p < 0.001), stereotactic radiosurgery group(OR 9.46, 95% CI 2.26–39.6, p = 0.002), and multimodality treatment group (OR 8.34 95% CI 2.87–24.3, p < 0.001) demonstrate significant headache relief compared to the conservative group. However, there was no significant difference between the embolization group (OR 2.24 95% CI 0.88–5.69, p = 0.091) and the conservative group.ConclusionsThis study identified potential risk factors for headaches in AVMs and found that microsurgery, stereotactic radiosurgery, and multimodal therapy had significant benefits in headache relief compared to conservative treatment. These findings provide important guidance for clinicians when developing treatment options that can help improve overall treatment outcomes and quality of life for patients.

Moyamoya Disease: Advances in Diagnosis, Treatment, and Surgical Interventions

Moyamoya Disease: Advances in Diagnosis, Treatment, and Surgical Interventions