Long-term Improvement Research Articles

A Pilot One and Two-Year Prospective, Blinded Clinical Evaluation of Efficacy, and Safety of Combined Treatment With Crosslinked Hyaluronic Acid Dermal Filler and Barbed Polydioxanone Suspension Threads for Mid-Face Contour Enhancement.

The combination of hyaluronic acid (HA) fillers and polydioxanone (PDO) thread lifting is gaining popularity for mid-face rejuvenation, especially among the Asian population. Despite the common use of these techniques, there is a paucity of long-term studies assessing their combined efficacy and safety. This study aims to evaluate the efficacy and safety of combined HA filler and PDO thread treatment for mid-face rejuvenation over a 24-month period in a Korean population. This prospective, blinded, single-center, open-label trial included 11 Korean subjects, aged 29-70 years, with mid-face volume loss graded 1-4 on the antero-medial cheek fullness scale. Participants were treated with crosslinked HA dermal fillers and PDO threads. Assessments were conducted using the Global Aesthetic Improvement Scale (GAIS), investigator-led clinical evaluations, and volumetric measurements using the Morpheus 3D system at baseline, 6, 12, and 24 months post-treatment. Quantitative analysis revealed a significant reduction in mid-face width from an average baseline of 149.27-145.00 mm at 24 months (p < 0.00001). Similarly, lower-face width decreased from 130.36 to 117.27 mm at 24 months (p < 0.00001). The GAIS scores demonstrated high levels of subject satisfaction, with 9 out of 11 patients reporting consistent satisfaction or improvement over 24 months. Minimal adverse events were reported, and no serious complications occurred. The combination of HA fillers and PDO threads was effective in achieving and maintaining long-term improvements in facial volume and contour. The Morpheus 3D system provided objective volumetric data, which supported the subjective improvements observed by patients and investigators. The study results highlight the benefits of ongoing neocollagenesis and tissue remodeling beyond the dissolution period of the materials. The combination of HA filler injections and PDO thread lifting offers a promising and minimally invasive option for long-term mid-face rejuvenation with high patient satisfaction and a favorable safety profile. Further studies are warranted to confirm these findings across diverse populations and compare this approach with other aesthetic treatments.

Electroconvulsive therapy-specific volume changes in nuclei of the amygdala and their relationship to long-term anxiety improvement in depression.

Electroconvulsive therapy (ECT) is one of the most effective treatments for depression. ECT induces volume changes in the amygdala, a key center of anxiety. However, the clinical relevance of ECT-induced changes in amygdala volume remains uncertain. We hypothesized that nuclei-specific amygdala volumes and anxiety symptoms in depression could explain the clinical correlates of ECT-induced volume changes. To test this hypothesis, we enrolled patients with depression who underwent ECT (N = 20) in this multicenter observational study and collected MRI data at three time points: before and after treatment and a 6-month follow-up. Patients who received medication (N = 52), cognitive behavioral therapy (N = 63), or transcranial magnetic stimulation (N = 20), and healthy participants (N = 147) were included for comparison. Amygdala nuclei were identified using FreeSurfer and clustered into three subdivisions to enhance reliability and interpretability. Anxiety symptoms were quantified using the anxiety factor scores derived from the Hamilton Depression Rating Scale. Before treatment, basolateral and basomedial subdivisions of the right amygdala were smaller than those of healthy controls. The volumes of the amygdala subdivisions increased after ECT and decreased during the follow-up period, but the volumes at 6-month follow-up were larger than those observed before treatment. These volume changes were specific to ECT. Long-term volume changes in the right basomedial amygdala correlated with improvements in anxiety symptoms. Baseline volumes in the right basolateral amygdala correlated with long-term improvements in anxiety symptoms. These findings demonstrate that clinical correlates of ECT-induced amygdala volume changes are existent, but in a nucleus and symptom-specific manner.

Vascularized lymph node transfer (VLNT) versus lymphaticovenous anastomosis (LVA) for chronic breast cancer-related lymphedema (BCRL): a retrospective cohort study of effectiveness over time.

Microsurgical reconstruction, including vascularized lymph node transfer (VLNT) and lymphaticovenous anastomosis (LVA), have emerged as promising treatment options for chronic breast cancer-related lymphedema (BCRL). Despite their clinical relevance, the precise timelines for patient improvement following these interventions remain rather unexplored. Therefore, the goal of this study was to compare the long-term outcomes and improvement patterns over time of VLNT versus LVA to lay open potential differences and aid in personalized counseling of future patients. A prospectively maintained, encrypted database was analyzed for patients with chronic BCRL treated with either VLNT or LVA with a minimum follow-up of one year. Patient-specific variables, such as body weight and circumferential arm measurements at distinct locations on both arms were documented preoperatively and on regular postoperative outpatient follow-ups. This study comprised 112 patients, of which 107 patients fully completed the one-year follow-up period. Both VLNT and LVA achieved significant arm size reductions. LVA showed an early peak in effectiveness within the first three months, followed by a subsequent decrease and eventual stabilization. Contrarily, VLNT exhibited a distinct pattern with two significant peaks at three and eighteen months. VLNT and LVA are both effective in long-term lymphedema management, yet they demonstrate marked differences in the timing of improvement. VLNT shows a delayed but more durable response, in contrast to the greater but shorter-lasting surge in effectiveness achieved by LVA. Interestingly, VLNT demonstrates an earlier onset of therapeutic impact than previously understood.

Enhancing Islamic Banking through Accounting and Taxation Harmonization: A Comparative Study of Indonesia and Malaysia

The dynamics of Islamic banking growth offer unique insights into the opportunities and challenges in accounting and tax harmonization. Conducted in 2023, this qualitative study explores barriers and solutions to accounting and tax integration within the Islamic banking sector through case studies of leading Islamic banks in Indonesia and Malaysia. Through in-depth analysis based on expert interviews and regulatory document review, this research identifies divergences in accounting principles, regulatory infrastructure, and human resource readiness as primary constraints. A proposed theoretical framework, integrating Maqasid Sharia principles with good governance, aims to create an accountable, sustainable, and integrated accounting and taxation system. Its implementation is expected to enhance transparency and accountability of Islamic banks, thereby strengthening the broader Islamic economy in both nations, with long-term improvements in operational efficiency and fiscal compliance.

English education in a globalized world: uncovering new themes and research gaps for the 21st century

Purpose This study aims to explore the intersection of English and education through a systematic review of academic literature. It focuses on identifying key research themes and future research areas, particularly in sustainable teaching and learning practices within the field of English education. Design/methodology/approach This study analyzed 84 papers published between May 2000 and May 2024 using a bibliometric approach. Keyword co-occurrence analysis was used to identify clusters of research themes. These clusters helped in categorizing research areas and provided a systematic overview of the current literature in English education. Findings This study identified four distinct research clusters that represent core themes in English education research. These themes informed the development of a research agenda focusing on areas that require further exploration, particularly in sustainable teaching and learning practices. This study also examined the theoretical and practical implications of these themes. Practical implications The findings provide educators and policymakers with a framework to prioritize research efforts, allocate resources and develop strategies to enhance sustainable teaching and learning practices in English education. Social implications By emphasizing the importance of sustainability in teaching and learning, this study promotes educational practices that contribute to long-term improvements in both student outcomes and teacher development. It identifies opportunities for sustainable growth in English education that benefit diverse learners. Originality/value To the best of the author’s knowledge, this is the first study to apply a bibliometric approach to systematically review the intersection of English and education. By identifying core research clusters and creating a research agenda, this study contributes new insights into sustainable practices in English education.

Leucencephalopathy in Patients with Parkinson's Disease and Deep Brain Stimulation.

Leucencephalopathy (LE) is often detected on magnetic resonance imaging in elderly patients. These white matter lesions may interfere with lead trajectories for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) and are associated with complications after DBS surgery. This study was conducted to assess the incidence of LE in PD patients and to evaluate correlations with complications after DBS surgery. A consecutive cohort of PD patients who underwent DBS surgery in the subthalamic nucleus (STN-DBS) was retrospectively analyzed. The presence and extent of LE were quantified using the Fazekas scale. Postoperative complications were extracted from the medical records. DBS efficacy was calculated using the side-specific motor symptom ratio (Unified Parkinson's Disease Rating Scale, Part III, postoperative stimulation ON/medication off divided by preoperative medication off) at 1-year follow-up. A total of 135 PD patients were included in the study. LE was detected in 35.6% (48/135) of the patients. In 87.7% (57/65), LE was mild, in 10.7% (7/65) moderate, and in 1.6% (1/65) severe. A higher incidence of mild to moderate LE did not correlate with postoperative hemorrhage or postoperative infection. There was no correlation of LE with stimulation efficacy (r = -0.05, P = 0.69) or with surgical index (r = -0.10, P = 0.35). Neither was the presence of mild to moderate LE associated with an increased risk for surgical complications, nor did it negatively impact the long-term improvement in motor function after DBS surgery in PD patients. Therefore, mild to moderate LE should not be considered a contraindication for DBS.

An Indian multicentre real-world study on long-term quality of life outcomes following bariatric surgery.

The purpose of this study was to assess the impact of metabolic and bariatric surgery (MBS) on Quality of Life (QoL) in Indian patients with obesity over 10 years. A retrospective chart review was conducted at 11 centres for individuals with MBS between February 2013 and May 2022. Patient medical records provided the source of de-identified data. Data from 2132 individuals with a mean age of 43.28 ± 11.96 years was analysed. There were 37.43% men and 62.57% females in the study population. The study population had a mean preoperative body mass index (BMI) of 45.71 ± 10.38 kg/m2. The Bariatric Analysis and Reporting Outcome System (BAROS) scoring method showed a higher overall QoL score throughout all follow-up periods, with 'very good' outcomes at one, three and 7 years and 'good' outcomes at 5 and 10 years. Improvements in QoL were associated with a substantial improvement (p < .01) in BMI at every follow-up time point. Following MBS, individuals with obesity exhibited a substantial and long-term improvement in their overall QoL for up to 10 years. This study presents Indian data on QoL, which is considered one of the most important decision-making factors for or against an intervention.

Efficacy of an Online Self-Management Program for Chronic Burn Pain: A Randomized Controlled Trial of the Take Charge of Burn Pain Program

This randomized controlled trial investigated the effectiveness of an online self-management program, "Take Charge of Burn Pain (TCBP)," for 96 individuals living with chronic burn pain. Participants were randomly assigned to either the 7-week TCBP program integrating cognitive-behavioral therapy techniques, pain education, and self-management strategies or an attention control group focused on general burn recovery information. Assessments conducted at baseline, post-treatment, and 2 and 5-month follow-ups included measures of pain severity, pain interference, pain self-efficacy, posttraumatic stress disorder symptoms, and depression. Compared to the control group, participants in the TCBP program demonstrated greater reductions in pain severity (mean difference: -1.24, 95% CI: -1.93 to -0.55, p = 0.0007) and pain catastrophizing (mean difference: -5.41, 95% CI: -10.33 to -0.49, p = 0.0318) post-treatment when adjusting for key variables. At the two-month follow-up, the TCBP group showed significant improvements in pain interference (P = 0.0123), self-efficacy (P = 0.0269), functional abilities (P = 0.0014), and social role participation (P = 0.0498) compared to the control group. Treatment effects were not sustained at five-month follow-up. Participants in both groups reported high levels of satisfaction with the online intervention, with the majority finding the program helpful, easy to use, and willing to recommend it to others with pain. Findings suggest preliminary support for short-term benefits of TCBP for managing certain facets of chronic burn pain. This underscores the need to refine digital approaches to maintain and promote long-term improvements. The potential of self-guided online psychological interventions to enhance pain coping strategies for burn survivors persists.

A Review of the Long-Term Efficacy of Submucosal Medpor Implantation for Empty Nose Syndrome: A Short Communication

To evaluate the long-term effects of submucosal Medpor implants in patients with empty nose syndrome (ENS), using the Sinonasal Outcome Test (SNOT) score as a measure of clinical improvement. A comprehensive search of six databases was conducted up to October 2024. The analysis included studies that examined the impact of submucosal Medpor implants on refractory ENS symptoms, as assessed by various symptom-specific questionnaires. Post-intervention SNOT scores were evaluated during follow-up periods of over 12 months, showing a statistically significant improvement in ENS symptoms (standardized mean difference [95% confidence interval]= 1.4676 [1.2067; 1.7285]; I&lt;sup&gt;2&lt;/sup&gt;=37.2%). This meta-analysis indicates that submucosal Medpor implantation in patients with ENS is associated with significant long-term improvements in nasal symptoms.

Safety of alteplase intravenous thrombolysis and influencing factors of clinical outcome in elderly patients with acute ischemic stroke

ObjectiveTo explore the safety of intravenous thrombolysis with alteplase (rt-PA) in the treatment of acute ischemic stroke (AIS) in the elderly (≥ 80 years old) and with analyze the influencing factors of its clinical outcome.MethodsA total of 144 elderly patients (≥ 80 years old) with AIS who were admitted to our hospital from April 2018 to October 2019 were divided into the elderly thrombolytic group (n = 55) and the elderly non-thrombolytic group (n = 89) according to their different treatment methods, and 166 non-elderly AIS thrombolytic patients in the same period were selected as the non-elderly thrombolytic group. Routine antiplatelet therapy or anticoagulant therapy was given to the elderly non-thrombolytic group, while intravenous thrombolysis with rt-PA was given to the elderly thrombolytic group and the non-elderly thrombolytic group. The changes in National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and intracranial hemorrhage transformation within 7 days, mortality within 3 months were used to evaluate the prognosis and safety of patients in each group. Binary Logistic regression was used to analyze the independent factors affecting the long-term prognosis of thrombolytic therapy for AIS in the elderly.ResultsAfter the treatment, the short-term prognosis and the long-term prognosis improvement rates in the non-elderly thrombolytic group and the elderly thrombolytic group were higher than that in the elderly non-thrombolytic group (P < 0.05). There was no statistical difference in mortality between the elderly thrombolytic group and the elderly non-thrombolytic group or in intracranial hemorrhage transformation among the different groups (P > 0.05). Binary logistic regression analysis showed that NIHSS score before treatment was an independent risk factor affecting the long-term prognosis of elderly AIS patients after thrombolysis (P < 0.05).ConclusionElderly AIS patients after rt-PA thrombolysis therapy can improve the short-term, long-term prognosis. The risk of intracranial hemorrhage transformation and death is not higher than that of elderly non thrombolytic patients, indicating that rt-PA treatment is safe for elderly AIS patients. The NIHSS score before treatment was an independent risk factor affecting the long-term prognosis of elderly AIS patients after thrombolytic therapy.

Undernutrition before two years in Algeria: Repeated cross-sectional analyses (2012-13 to 2018-19)

Background Algeria has made significant progress in addressing childhood undernutrition. Despite improvements, nearly 12% of Algerian children under five years of age suffered from stunting in 2022. This study aimed to evaluate the prevalence of three indicators of undernutrition (stunting, wasting, and underweight) and their associated variables in children aged 0–23 months in Algeria between 2013 and 2019. Methods Pooled data from Multiple Indicator Cluster Surveys (MICS) (2012-13 and 2018-19) covering 14,498 children were used. Univariate and multiple logistic regression analyses were performed to test the associations. Results Stunting decreased significantly, but wasting and being underweight showed no significant reductions from 2013 to 2019. Stunting, wasting, and underweight decreased by 2.2%, 1.3%, and 0.3%, respectively, with an overall prevalence of 10.1%, 5.4%, and 3.6%, respectively. Factors associated with undernutrition included child age and small size at birth, whereas stunting was linked to the poorest households, male children, higher maternal body mass index (BMI), and low antenatal care (ANC) visits. Wasting was associated with younger age and paternal age, fewer maternal ANC visits, underweight male sex, low maternal education, high maternal BMI, and delayed breastfeeding initiation. Conclusion Public health experts and stakeholders must adopt a comprehensive community-centered approach to achieve long-term improvements in child nutrition in Algeria. This strategy should focus on key factors including high maternal BMI, low maternal education, male children, and infrequent ANC visits. This action can help Algeria progress towards achieving the UN’s goal of eradicating malnutrition.

Sentiment Analysis on Social Media: Investigating Users' Perceptions of MRT and LRT Transportation Services

Providing excellent public transportation in response to the passenger’s complaints and recommendations results in long-term improvements to the service. This study investigates public perceptions of the MRT and LRT rail transportation services within the Klang Valley Integrated Transit System, operated by Rapid KL, through sentiment analysis in X. With 4.4 million users in Malaysia as of January 2022, X (previously Twitter) media social serves as a significant platform for public discourse. However, analyzing these perceptions poses challenges due to the limited platforms for analysis, and seeking from X is even more challenging due to the unstructured and noisy nature of the tweets. Therefore, this study aims to develop a sentiment analysis model that organizes tweets into structured data, utilizing machine learning techniques for sentiment classification into positive, neutral, and negative categories. Following the model implementation, the data are collected, translated, cleaned, labeled, analyzed, and classified using a Support Vector Machine before being deployed in a web system for ease of access. Analysis results revealed that user sentiment is predominantly neutral, with a significant focus on MRT services and topic finding related to scheduling. The model scored good accuracy 80% without a kernel and 84% with a Linear kernel, with evaluation metrics demonstrating strong performance on all three sentiment categories. Future enhancements will include label refining and applying more hyperparameter tuning to improve analysis accuracy.

Jaga Kesehatan Lansia dengan Deteksi Dini Penyakit tidak Menular sebagai Langkah Awal

Non-Communicable Diseases (NCDs) pose a growing threat to public health, especially among elderly populations. This community service program was conducted in RT 001 and RT 01A, 20 Ilir 4 Village, Palembang, focusing on early detection and education to prevent NCDs such as hypertension, diabetes, and high cholesterol. The program utilized a participatory action research approach, incorporating health screenings and interactive health education sessions. Activities included blood pressure, glucose, cholesterol measurements, and lifestyle counseling. The results demonstrated a significant increase in awareness and proactive health behaviors among residents. Over 60% of participants with high-risk conditions were referred for further medical evaluation. Regular exercise initiatives and dietary modifications were adopted by the community. The program also established health cadres trained to sustain these efforts post-intervention. This initiative highlights the effectiveness of early detection and education in reducing NCD risks and fostering long-term community health improvements.

The Intra-Articular Delivery of a Low-Dose Adeno-Associated Virus-IL-1 Receptor Antagonist Vector Alleviates the Progress of Arthritis in an Osteoarthritis Rat Model

Background/Objectives: Interleukin-1 (IL-1) is a pivotal mediator in the pathological progression of osteoarthritis (OA), playing a central role in disease progression. However, the rapid clearance of IL-1 receptor antagonist (IL-1Ra) from the joints may hinder the efficacy of intra-articular IL-1Ra injections in reducing OA-associated pain or cartilage degradation. Methods: Sustaining sufficient levels of IL-1Ra within the joints via adeno-associated virus (AAV)-mediated gene therapy presents a promising therapeutic strategy for OA. In this study, we constructed an IL-1Ra expression cassette employing intron insertion in the coding sequence (CDS) region to enhance protein expression levels. Furthermore, we incorporated precisely targeted liver-specific microRNA (miRNA) sequences to specifically downregulate transgene expression within hepatic tissues, thereby ensuring more targeted and controlled regulation of gene expression. Results: A rat model of OA was employed to compare the efficacy of AAV5 and AAV9 for IL-1Ra delivery at both high and low doses. It was observed that low-dose, but not high-dose, AAV9-IL-1Ra resulted in a significant reduction in joint swelling, accompanied by a decrease in the diameter of the affected area and the preservation of biomarkers associated with trabecular bone integrity. Conclusions: These results highlight the great potential of AAV9-IL-1Ra in osteoarthritis therapy, with the promise of achieving long-term improvement through a single intra-articular injection.

Increasing Urban Flood Challenges: Spatial Analysis of the 2024 Flood in Rajabasa, Bandar Lampung, Indonesia

This study explores the spatial analysis of flood-prone areas in Rajabasa by utilizing Digital Elevation Model data from DEMNAS and high-resolution aerial photographs obtained via commercial drones. The research aims to understand the region’s flood dynamics and watershed characteristics. The elongated shape of the Rajabasa basin, with a calculated circularity ratio (Rc) of 0.19, indicates that runoff follows the existing stream network, resulting in gradual and prolonged flood events. Field surveys were conducted to validate land cover data, revealing that the majority of the area was residential and classified under Hydrology Soil Group (HSG) D, leading to high Curve Number (CN) values between 88 and 93. These values suggest that nearly all rainfall converts to runoff, exacerbating flooding conditions. Effective flood management strategies were proposed by focusing on areas with the highest CN values and integrating long-term land improvement with short-term flood control infrastructure. The study also highlights the importance of preserving natural drainage lines, which are often overlooked, for enhancing flood mitigation, educating residents about floodplain management, and implementing proper land use regulations. The findings underscore the necessity of combining spatial analysis, high-resolution data, and targeted flood management strategies to mitigate flood risks in Rajabasa and similar flood-prone areas.

Factors Responsible for Environmental Sustainability in G-20 Nations: A Panel Data Analysis

Deleterious external consequences of various productive activities have impacted the quality of the environment in all countries worldwide. These productive activities damage the environment by emitting greenhouse gases, particularly carbon dioxide, excessively using natural resources and producing solid pollutants or waste. Since these significantly contribute to environmental deterioration, policymakers should take appropriate action to reduce the external effects of these three outcomes of productive activities. In light of this challenging situation, the present study considers environmental impact (EI)—a combined external effect of three factors—as a representative of ecological degradation and examines the impact of four driving forces on the environmental effect across all G-20 nations from 1990 to 2019 based on the STIRPAT model. This study employs several econometric methodologies, including ARDL-PMG and FMOLS, to investigate the causal relationship between the four forces and EI. The primary conclusion of the analysis is based on the ARDL-PMG results, which reveal that while urbanisation and gross capital formation (GCF) have positive effects, GDP per capita and population levels have a long-term negative impact on EI. The results also demonstrate that population growth and productive activities pose the most significant obstacles to long-term improvements in environmental sustainability.

Public complaints of water pollution: A long-term spatiotemporal analysis in Japan

Public complaints about water pollution are important indicators of public environmental risk perception and provide crucial feedback for evaluating the effectiveness of water resource management strategies. This study conducts a comprehensive analysis of water pollution complaints in Japan from 1989 to 2021, utilizing integrated datasets that include river networks, water quality monitoring stations, regional industrial demographics, and socioeconomic indicators. Our findings reveal a significant decline in complaints—over 45% from the peak in 2006—following the implementation of various environmental policies aimed at reducing industrial discharge and restoring natural ecosystem function. The shift in complaint targets from industries to individuals suggests that these policies have been effective in mitigating industrial pollution, while also highlighting the need to address individual behaviors that impact water quality. Despite long-term improvement in water quality indicators such as Suspended Solids (SS) and Dissolved Oxygen (DO), no significant correlation was observed between these indicators and the temporal or spatial patterns of water pollution complaints. Instead, a strong positive correlation was observed between complaints and reported water quality incidents, reflecting heightened public sensitivity to acute pollution events. Spatial analysis further identified a significant association between complaints and the manufacturing workforce, indicating that industrial activity continues to shape public perception of water pollution risks. Our findings underscore the complex interaction between public perception, environmental policies, and industrial activities, and suggest that effective water management requires a multifaceted approach. Policymakers should continue to enforce stringent industrial regulations, while also enhancing public education and communication strategies to improve awareness of individual responsibilities in water protection. This research provides a theoretical basis for developing more responsive and effective environmental policies and public education strategies.

Long-term reproducibility improvement of LIBS quantitative analysis based on multi-period data fusion calibration method

Long-term reproducibility is one of the important problems that urgently need to be solved in the quantitative analysis of laser-induced breakdown spectroscopy (LIBS). In this work, a new calibration method based on multi-period data fusion was proposed. Under the same experimental equipment and parameters, LIBS data collected at different times were fused together to establish calibration models. The spectra of the same set of standard samples were collected once a day for 20 days, the spectral data from the first 10 days were used as the training set for the calibration model, and the data from the last 10 days were used as the test set. As a comparison, three types of calibration models of four elements (Mn, Ni, Cr, and V) were established, including the internal calibration model (IS-1) based on the data from first day, multi-period data fusion internal calibration model established using internal calibration (IS-10) and genetic algorithm based back-propagation artificial neural network (GA-BP-ANN) based on the data from first 10 days. The test set spectral data were used to verify the prediction effect of the above three models. It was found that the GA-BP-ANN models have the lowest average relative errors (ARE) and the average standard deviations (ASD). Therefore, the proposed multi-period data fusion GA-BP-ANN model provides a novel method for improving the reproducibility of LIBS long-term repeated measurement.

Disability and Patient-Reported Satisfaction in Women with Idiopathic Intracranial Hypertension: A Comparative Study of Venous Sinus Stenting and Medical Management.

Patients with chronic idiopathic intracranial hypertension (IIH) commonly experience a high level of disability and low satisfaction with medical treatment. We aim to evaluate long-term functional improvement and patient satisfaction in IIH patients with similar symptoms by comparing venous sinus stenting (VSS) to standard medical therapy. We conducted a cross-sectional questionnaire study of 111 IIH patients, comparing 37 adult female patients who underwent venous sinus stenting with 74 patients treated medically. Propensity score matching was used to balance age and presence of papilledema at presentation between groups. Headache-related disability was evaluated using the Migraine Disability Assessment Scale (MIDAS), while general function and treatment satisfaction were assessed using custom questionnaires. Electronic medical records and the results of imaging upon diagnosis were reviewed retrospectively. The stented group reported significantly better outcomes in physical well-being (median 4.0 vs. 1.0, p < 0.001), task completion (4.0 vs. 1.0, p < 0.001), work/school persistence (5.0 vs. 1.0, p < 0.001), and mental well-being (4.0 vs. 1.0, p < 0.001). Additionally, the stented group had a lower proportion of patients with severe MIDAS (MIDAS > 4, 24.3% vs. 47.9%, p = 0.017). Logistic regression suggested venous stenting as a protective factor against severe MIDAS scores (OR = 0.174, p = 0.004). Cerebral venous stenting in patients with IIH is associated with lower disability and higher patient satisfaction from medical treatment compared to those treated with medications only. These findings suggest that venous sinus stenting may be a valuable treatment option for selected IIH patients. However, larger prospective studies are needed to further validate our results.

Brainstem Cavernomas: Functional Results and Prognosis Long-Term Follow-Up Cohort of Patients Treated Non-Operatively and Operatively

Introduction: Cerebral cavernous malformation (CCM) is an abnormally large collection of low flow vascular channels without brain parenchyma intervening between the sinusoid vessels. Brainstem Cavernoma Malformations (BSCMs) account for 0.5 to 0.9 % in the literature. Functional results, bleeding and subsequent bleeding have been reported in several studies in the literature relative to the management both for surgery and non-operative treatment. Our study aimed to evaluate long term functional outcomes of patients treated both operatively and non-operatively. Materials and Methods: A cohort of 44 patients has been followed for 29 years either retrospectively and prospectively. The retrospective period extended from October 1992 to September 2020 while the prospective one was the one year follow-up (FU) till September 2021. Data have been collected from patients’ archived files, schedule visits to the physician and phone calls. Patients in whom the diagnosis of BSCMs have been confirmed clinically and by image findings were included in our study. Functional status were assessed using both modified Rankin Scale (mRs) score over an interval from 0 to 5 and Karnosky Index (KI) from 0 to 100. Muscle strength was assessed by muscular testing over an interval from 0 to 5. Zero meant absence of muscular contraction while 5 was normal muscle motion. Magnetic Resonance Imaging (MRI) was systematically carried out in patients who had not got imaging control for 2 years. During FU period each patient who presented a new and sudden clinical symptom related to the involvement of brainstem was reassessed clinically and image work-up to rule out a rebleeding episode. Univariate analysis was conducted for establishing statistical significance between early haemorrhages, rebleeding, clinical and demographic features. Results: Forty patients presented 57 bleeding episodes. Thirteen patients (29.54 %) underwent surgery. Thirteen ones had eighteen recurrent bleeding episodes, i.e. a rate of 31.69±0.65 SD. Initial average mRs score was 0.67±0.79 SD for the conservative treatment group while the operated on patients had 2.15±1.14 SD. Postoperatively, mRs score was 2.07±1.44 SD. Final FU mRs was 0.93±00 SD and 1.81±00 SD for non-operative and operative treatment respectively. Surgery reduced the rate of rebleeding (p=0.04). The long-term functional outcome improvement was similar between non-operative and operative treatment (p=0.27). The predictive factors of bleeding and rebleeding reported were woman gender (p=0.0074) and pons location (p=0.0001) while age and Zabramski radiologic type were not significant. Conclusion: Our finding sustains similar functional outcomes to both non-operative and operative treatment. Nevertheless, surgery reduced the rate of rebleeding and remains largely related to the precise patient selection regarding clinical, radiologic and microsurgery features.