Longer Intervention Times Research Articles

Assessment of Hospital Medical Emergency Team Operations in a Tertiary Care Center in Turkey.

Rapid Response Teams, strategically devised to mitigate mortality and morbidity stemming from unforeseen deteriorations and cardiac arrests within healthcare facilities, are ubiquitously implemented on a global scale. The aim of the study is to compare emergency physicians (EPs) and non-EPs on management protocols of Hospital Medical Emergency Teams (HoMET). This was a retrospective cross-sectional study. The hospital archive underwent a retrospective scanning process, and patient records were meticulously examined. The assessment encompassed various facets, including demographic characteristics, activation locations, and response and intervention times of HoMET teams, composed of both EPs and other healthcare professionals. Data analysis was conducted using SPSS software version 20.0. A total of 1056 calls were included, with 52% (n = 549) involving male patients. The average age was 67.15 ± 19.45 years. EPs served as the team leader in 53% of the calls. Cardiac arrest was considered in 93.6% of the cases. The EPs group exhibited a higher average patient age, longer intervention times, and shorter arrival times (P < 0.001, P = 0.027, P < 0.001, respectively). A significant difference was observed in the locations of the calls and the groups of calls considering cardiac arrest (P < 0.001, P < 0.001, respectively). The optimization of intervention teams is imperative given the persistently high incidence and mortality rates associated with in-hospital cardiac arrests. Leveraging the expertise of EPs in the management of arrests and critical patients can potentially enhance the effectiveness of these teams. Nonetheless, further research is warranted to comprehensively explore and validate this aspect.

Effects of Pilate Mat Exercises on Agility and Flexibility of Athletes - A Pilot Study

Background-Athletes are always looking for ways to get better at what they do and get hurt less frequently. Movement efficiency and total physical capability are influenced by flexibility and agility, which are essential elements of athletic success. Pilates mat movements have a reputation for enhancing body awareness, flexibility, and core strength. Despite its growing popularity, the impact of incorporating Pilates into athletes' training routines, particularly concerning flexibility and agility, remains largely unexplored. Objective-The purpose of this study was to evaluate the agility and flexibility of athletes who included Pilates mat movements in their training regimen to a control group who continued with their regular training regimen. Methods-Two groups, Group A (experimental) and Group B (control), each with fifteen participants, were randomly selected from among the thirty participants. Group B adhered to their regular training program without making any alterations, Group A engaged in Pilates mat exercises three days per week for six weeks, following informed consent obtained from each participant prior to the intervention. Agility and flexibility were assessed using the 4 x 10-meter shuttle run test and the sit and reach test before and after a six-week intervention period. Results and Conclusion-Compared to Group B, Group A showed noticeably greater flexibility and agility after the intervention. With a standard deviation of improvement of 2.90, the experimental group (Group A) demonstrated an average improvement in the sit and reach test score from 21.5 to 27.7. Group B, the control group, saw very little improvement; mean scores varied greatly, going from 22.18 to 22.20. Group A's mean time in the 4 x 10-meter shuttle run test increased from 23.3 to 21, while Group B's mean time only marginally improved from 21.53 to 22.07. These results imply that adding Pilates mat exercises to athletes' training regimens can increase their flexibility and agility, which may help them perform better on the field and avoid injuries. To confirm these results and investigate the long-term advantages of Pilates for athletes, more studies with bigger sample numbers and longer intervention times are necessary.

Comparison of the Effect of Yoga and Aerobic Exercise on Nurses' Burnout: A Randomized Controlled Trial

Background: There is evidence of yoga and aerobic exercises as an effective therapy for nurse burnout; however, these methods have yet to be compared. Objectives: This study aimed to compare the effects of yoga and aerobic exercises on burnout among nurses. Methods: This was a randomized controlled trial with a pre-test and post-test design. The study was conducted in two medical and educational hospitals in the south of Iran (February 2019 to April 2019). A total of 81 female nurses were randomized to yoga (n = 27), aerobics (n = 27), and control (n = 27) groups. In this study, 24 sessions of yoga and aerobic practices were run. The Maslach Burnout Inventory was filled out before the intervention, immediately after, and one month later. The data were analyzed using IBM SPSS software 16.0. Shapiro test, analysis of variance (ANOVA) test, chi-square test, Friedman test, and Kruskal-Wallis one-way analysis test were used to analyze the data. Results: A total of 71 participants remained and continued the study, and 56% were married. The participants’ mean age and mean work history were 35.78 ± 3.94 and 11.65 ± 5.10 years, respectively. The mean of overtime work in the month was 35.67 ± 23.85 hours. There were no significant differences between the three groups before intervention (T0) and one month after intervention (T2), although the mean scores of the aerobic and yoga groups were reduced, compared to the control group. Immediately after intervention (T1), a significant difference was observed in emotional exhaustion (P = 0.007, Df = 2, Kruskal-Wallis x2 = 10.016, size effect = 0.95 - 2.26). The mean score of emotional exhaustion in the yoga group (23.13 ± 4.13) was reduced compared to the aerobic (36.00 ± 5.65) and control (38.44 ± 10.96) groups. Conclusions: Both yoga and aerobics reduced burnout, compared to the control group. Yoga was better than aerobics in the emotional exhaustion dimension. Although further research is needed to compare these two interventions, using each of them can reduce the burnout of nurses. Nursing managers can use yoga as an effective method to reduce job burnout. For future research, it is suggested to use other yoga techniques with longer intervention time and long-term follow-up.

Ten-year experience of whole lung lavage in pediatric Pulmonary Alveolar Proteinosis.

Pulmonary Alveolar Proteinosis (PAP) is extremely rare and can be caused by hereditary dysfunction of the granulocyte macrophage colony-stimulating factor receptor (GM-CSF) receptor, autoantibodies against GM-CSF, or other diseases leading to alveolar macrophage (AM) dysfunction. This leads to protein accumulation in the lung and severe dyspnea and hypoxemia. Whole lung lavage (WLL) is the first line treatment strategy. Here, we present data from more than ten years of WLL practice in pediatric PAP. WLL performed by the use of a single lumen or double lumen tube (SLT vs. DLT) were compared for technical features, procedure time, and adverse events. A total of n=57 procedures in six PAP patients between 3.5 and 14.3 years of age were performed. SLT based WLL in smaller children was associated with comparable rates of adverse events but with longer intervention times and postprocedural intensive care treatment when compared to DLT based procedures. Our data shows that WLL is feasible even in small children. DLT based WLL seems to be more effective, and our data supports the notion that it should be considered as early as possible in pediatric PAP. WLL lavage is possible in small PAP patients but should performed in close interdisciplinary cooperation and with age appropriate protocols.

The Efficacy of Egg White Powder on Anthropometric Indices in Malnourished Children

Background: White egg powder provides essential amino acids compounds. This study aims to investigate the theory that a regular consumption of white egg powder would improve weight gain and appetite in children with malnutrition. Methods: The present experimental study was conducted among children aged 3-6 years with mild to severe malnutrition referred to Ghadir Mother and Child Hospital affiliated with Shiraz University of Medical Sciences from April to October 2017. The malnourished children received egg white protein (1 g/kg of their current body weight) for 3 weeks. Weight loss as a primary outcome and weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and BMI-for-age Z-score (BAZ) were measured as secondary outcomes, assessed at baseline and after six weeks of study. Results: Of the 23 children included, 20 finished the study. Weight increased in all children although it was not significant (P = 0.101). A lower appetite was seen at the end of the intervention, but it was not significant (P = 0.575). Malnutrition based on WHZ and BAZ decreased compared to the baseline measurement, while the changes were not significant. Regarding other markers, no statistically significant changes were found compared to the baseline measurement. Conclusion: The addition of white egg powder to complementary nutrition could not improve weight gain and appetite in malnourished children. Further research with a larger study population and longer intervention time is needed to demonstrate the clear effect of egg white on improving malnutrition in children.

The Effect of Probiotic Supplementation on Glucolipid Metabolism in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Type 2 diabetes mellitus (T2DM) is a persistent metabolic condition with an unknown pathophysiology. Moreover, T2DM remains a serious health risk despite advances in medication and preventive care. Randomised controlled trials (RCTs) have provided evidence that probiotics may have positive effects on glucolipid metabolism. Therefore, we performed a meta-analysis of RCTs to measure the effect of probiotic therapy on glucolipid metabolism in patients with T2DM. With no constraints on the language used in the literature, Excerpta Medica Database, PubMed, the Cochrane Library, and the Web of Science were searched for pertinent RCTs published between the date of creation and 18 August 2022. Stringent inclusion and exclusion criteria were applied by two reviewers to independently examine the literature. The risk of bias associated with the inclusion of the original studies was assessed using the Cochrane risk-of-bias tool, and Stata 15.0 was used to perform the meta-analysis. Thirty-seven publications containing a total of 2502 research participants were included in the meta-analysis. The results showed that after a probiotic intervention, the experimental group showed a significant decrease in body mass index (standardised mean difference (SMD) = -0.42, 95% confidence interval (CI) [-0.76, -0.08]), fasting glucose concentration (SMD = -0.73, 95% CI [-0.97, -0.48]), fasting insulin concentration (SMD = -0.67, 95% CI [-0.99, -0.36]), glycated haemoglobin concentration (SMD = -0.55, 95% CI [-0.75, -0.35]), Homeostatic Model Assessment for Insulin Resistance score (SMD = -0.88, 95% CI [-1.17, -0.59]), triglyceride concentration (SMD = -0.30, 95% CI [-0.43, -0.17]), total cholesterol concentration (SMD = -0.27, 95% CI [-0.43, -0.11]), and low-density lipoprotein concentration (SMD = -0.20, 95% CI [-0.37, -0.04]), and an increase in high-density lipoprotein concentration (SMD = 0.31, 95% CI [0.08, 0.54]). Moreover, subgroup analyses showed that patients with a longer intervention time, or those who were treated with multiple strains of probiotics, may benefit more than those with a shorter intervention time or those who were treated with a single probiotic strain, respectively. Probiotic supplementation improves glucolipid metabolism in patients with T2DM, offering an alternative approach for the treatment of these patients.

Safety and Feasibility of Robot-assisted Gait Training in Adults with Cerebral Palsy in an Inpatient Setting – an Observational Study

Background: To investigate the safety and feasibility of six sessions of Hybrid Assistive Limb (HAL) robot-assisted gait training (RAGT) integrated into an inpatient therapy concept and their influence on walking speed and gait parameters in adult CP patients. Methods: Eleven subjects (male = 8, female = 3, mean age: 23 years and 2 months, ± 4.5 years) with spastic CP underwent six 20-minute RAGT sessions with the HAL during an 11-day hospital stay. Additionally, physiotherapy, physician-performed manual medicine, massage and exercise therapy were provided. Pre- (T1) and post- (T2) intervention assessments were: 10-metre walking test (10MWT), 6-minute walking test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion (pROM). Results: All subjects completed the study. No adverse events were noted. Walking speed in the 10MWT test increased from 32.5 s (± 24.5 s) at T1 to 27.5 s (± 21.4 s) at T2, without significance. Slight, but non-significant improvements were detected in the 6MWT, GMFM and pROM. Confounding factors did not significantly affect the results. Conclusion: Intensive therapy including HAL training leads to non-significant improvements. Further studies with more patients and longer intervention time could provide further insights into the RAGT therapy of adult patients with CP. Registration DRKS-ID: DRKS00020275.

Dietary fiber and probiotics based on gut microbiota targeting for functional constipation in children with cerebral palsy.

Gastrointestinal (GI) disorders are very common among children with cerebral palsy. Gut microbiota has been confirmed to maintain normal GI physiological function and further contributed to cerebral palsy through the gut-brain axis. Our study was to investigate the effect of dietary fiber combined with probiotics on functional constipated children with cerebral palsy. In total, 35 patient children were enrolled and divided into general diet group (n = 14) and liquid diet group (n = 21). All the participants received Compound Dietary Fiber (CDF) for 1 month and lactic acid-producing and butyric acid-producing probiotics for 6 months. After a 1-month intervention, the frequency of spontaneous and manual defecation, and Bristol score were all significantly improved (P < 0.001). The α-diversity of the gut microbiota was significantly increased after a 1-month intervention (P < 0.05), with a higher abundance of butyric acid-producing bacteria and a lower abundance of opportunistic pathogens (P < 0.05, FDR < 0.05). However, the impersistent effect of the 6-month intervention suggested the insufficient impact of intaking probiotics alone and the short duration of CDF intervention. Moreover, although the intervention had affected the constipation symptoms equally in cerebral palsy children with a general diet and liquid diet, the general diet group showed a greater and more durable change in gut microbiota and clinical phenotypes after intervention than the liquid diet group, which indicated that longer intervention time should be considered for liquid diet children. This study not only illustrated that supplementation of dietary fiber combined with probiotics can improve functional constipation in children with cerebral palsy, but also provides guidance for optimal intervention strategy for future studies, which will further benefit cerebral palsy children.Clinical trial registration:http://www.chictr.org.cn/showproj.aspx?proj=46902, identifier: ChiCTR1900028257.

Systematic Evaluation of the Efficacy of Acupuncture Associated with Physical and Mental Intervention when Treating Idiopathic Tinnitus and the Improvement of Tinnitus Symptoms.

Objective To systematically evaluate the efficacy of acupuncture associated with physical and mental intervention when treating idiopathic tinnitus and the improvement of tinnitus symptoms, so as to supply evidence-based medicine for its popularization and adoption. Methods PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) online database were searched for the controlled trial of acupuncture associated with physical and mental intervention when treating idiopathic tinnitus. The retrieval time limit is from January 2010 to March 2022. Separately, two researchers extracted the data, and according to the Cochrane Handbook 5.3, the bias risk of each piece of literature was assessed. The collected data were measured using RevMan5.3 statistical software. Results Finally, 5 CT articles were included in this study, with a total sample size of 282. Meta-analysis showed that the effective rate of the study group was significantly higher than that of the control group (P < 0.05). The scores of tinnitus disorder scale (THI) after treatment were analyzed by Meta. The THI scores of the study group after treatment were significantly lower than those before treatment. Meta-analysis of the severity of tinnitus after treatment showed that the severity of tinnitus in the observation group after treatment was significantly lower than that before treatment. There is a certain publication deviation in the literature, which may be related to the heterogeneity of the research and the small number of literatures. Conclusion On the basis of acupuncture treatment, associated with physical and mental intervention is helpful to the recovery of patients with idiopathic tinnitus, can effectively improve their clinical symptoms, and is suitable for clinical application. A popularization of this concept in clinical practice is worth considering, but further research and follow-up with a higher methodological quality and longer intervention time are needed to confirm its efficacy.

Clinical Efficacy, Survival, and Adverse Reaction Evaluation of Immune Checkpoint Inhibitor in Advanced Gastric Cancer: A Systematic Review and Meta-Analysis.

Objective To systematically assess the clinical effect and survival time of immune checkpoint inhibitor (ICIs) in advanced gastric cancer (GC) and adverse reactions to provide evidence-based medicine for its enhancement and adoption. Methods PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network database (CNKI), China VIP database, Wanfang database, and China Biomedical Literature Database (CBM) online database were searched for randomized controlled trials (RCT) of immuno-checkpoint inhibitors in advanced GC therapy. Retrieval time was limited to the period from the date the database was established to present. Separately, two researchers gathered the data. Statistical software RevMan5.4 was used to estimate bias risk according to the Cochrane Handbook 5.3 standard. Results The computer database retrieved 1723 articles, and 465 articles were eliminated when repeated studies were removed. After screening the titles and abstracts of 287 articles, 124 articles were contained after eliminating irrelevant studies, reviews, case reports, and no control literature. After carefully reading 108 studies with insufficient data and no major outcome markers, 6 RCTs were eventually contained. 4 articles compared the levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) after treatment. The result indicated that the levels of serum CEA and CA199 in the study group were notably lower, and the difference was statistically significant (P < 0.05). The immune function indexes after treatment were compared, suggesting that the improvement of immune function indexes in the study group was notably better, and the difference was statistically significant (P < 0.05). Three clinical trials reported the median progression-free survival (PFS). The PFS of the study group was notably longer after treatment, and the difference was statistically significant (P < 0.05). The occurrence of adverse reactions after treatment was analyzed by meat, and all the literatures were analyzed. No notable differences were observed in the incidence of adverse reactions. Conclusion ICIs associated with chemotherapy is effective when treating GC, which can effectively promote the disease control rate of patients, enhance immune function, reduce the level of tumor markers, and prolong survival time. The safety is controllable, which is worth popularizing in clinical practice. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify it.

The Impact of Vitamin D Supplementation on the IFNγ-IP10 Axis in Women with Hashimoto's Thyroiditis Treated with Levothyroxine: A Double-blind Randomized Placebo-controlled Trial.

Hashimoto's thyroiditis (HT) results from chemoattraction of inflammatory cells toward the thyroid gland by inducing the production of interferon-gamma (IFNγ)-induced protein 10 (IP10) by T helper (Th) 1 cells. Vitamin D may suppress the IFNγ-IP10 axis, but this new function of vitamin D has not yet been investigated in HT patients. In an intervention and control group, patients received 50000 IU cholecalciferol or placebo every week for three months, respectively. The CD4+ T cells of 40 patients were isolated, and the mRNA expression levels of vitamin D receptor (VDR), peroxisome proliferator-activated receptors (PPAR)-α, and PPAR-γ genes were determined by real-time PCR. ELISA method was used to determine serum levels of vitamin D, tumor necrosis factor-alpha (TNF-α), IFN-γ, and IP10. Vitamin D levels in the intervention group were significantly higher than in the placebo group after supplementation. PPAR-α and PPAR-γ gene expression levels did not differ significantly between the two groups. The serumlevels of IP10, IFNγ, and TNF-α decreased significantly in the vitamin D group, as well as in the placebo group. During this study, vitamin D levels significantly increased in the intervention group and inflammatory factors decreased. Based on the similar results obtained in the placebo group, further studies with larger sample sizes and longer intervention times are recommended.

Meta-Analysis of the Efficacy and Safety of Olanzapine versus Clozapine when Treating Senile Dementia.

Objective To systematically assess the safety and efficacy of olanzapine versus clozapine when treating senile dementia and to provide evidence-based medicine basis for its promotion and use. Methods PubMed, Embase, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) online database were searched for randomized controlled trials (RCT) of olanzapine and clozapine when treating senile dementia. The retrieval time limit is from the establishment of the database to the present. The data were extracted independently by two researchers, and the bias risk of each contained literature was analyzed in accordance with the standard of Cochrane Handbook 5.3. RevMan 5.4 statistical software was used to analyze the collected data by meta-analysis. Results Finally, 6 randomized controlled trial articles were included, with a total of 490 samples. Meta-analysis of clinical efficacy showed that the clinical efficacy was similar and there was no significant difference (P > 0.05). Two articles used Alzheimer's disease pathological behavior rating scale (BEHAVE-AD) to compare the pathological behavior of different stages after treatment. Statistical analysis showed that there was no significant difference between the total score of BEHAVE-AD and the scores of each factor in each week after treatment. The non-treatment adverse reaction scale (TESS) of the study group and the control group was analyzed by meta-analysis. The TESS score of the study group after treatment was significantly lower than that of the control group. The BPRS scores of different stages after treatment were analyzed by meta-analysis, and there was no significant difference in the total score and factor scores of BPRS in each week after treatment. Two clinical trials reported the incidence of neurological symptoms after treatment. Olanzapine and clozapine treatment can effectively reduce the risk of aging. There was no significant difference in the incidence of neurological symptoms in patients with dementia (P > 0.05). According to the analysis of meat products, the incidence of adverse reactions in the study group was significantly lower than that in the control group (P < 0.05). Conclusion Olanzapine and clozapine have similar efficacy when treating mental and behavioral disorders in patients with senile dementia, in which olanzapine is more effective in improving the symptoms of patients with Alzheimer's disease (AD), with less adverse reactions and high safety, which is worth popularizing in clinical practice. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.

Effect of Optimized Emergency Care on Treatment Rate and Prognosis of Elderly Patients with Acute Stroke in Emergency Department: A Systematic Review and Meta-Analysis.

Objective This research was to detect the treatment rate and prognosis of elderly patients with acute stroke in emergency department by the optimization of emergency care applying meta-analysis. Methods The online databases including PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) were searched. The retrieval time limit was set from the establishment of the database to the present. The data were extracted independently by two investigators. The bias of per publication was assessed following Cochrane manual 5.1.0 standard. RevMan5.4 statistical software was used to analyze the collected data by meta. Results The 8 randomized controlled trials included in this meta-analysis all reported patients' baseline status. The meta-analysis of the rescue time of the study group and the control group (CH2 = 1507.80, df = 4, P ≤ 0.001, and I2 = 100%) showed that the emergency nursing with optimized emergency procedures can shorten the rescue of elderly acute stroke patients in the emergency department time. There are 6 literatures reporting the case fatality rate (Chi2 = 1.12, df = 5, P = 0.95 > 0.05, and I2 = 0%), and the death rate of the study group was not higher than that of the control group (Z = 4.4 and P < 0.0001). The use of optimized first aid can reduce mortality in elderly patients with acute stroke. Six articles on disability rate reported the heterogeneity of disability rate (CH2 = 2.88, df = 5, P = 0.72 > 0.05, and I2 = 0%), indicating that the disability rate in the study group was lower than that in the control group (Z = 3.91 and P < 0.0001), indicating that emergency nursing by optimizing emergency procedures can reduce the disability rate of elderly stroke patients in emergency department. Conclusion Optimizing the emergency care process can effectively improve the emergency rate and prognosis of elderly patients with acute stroke in emergency department; however, further research with higher methodological quality and longer intervention time are needed to verify later.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis.

Objective To systematically evaluate the effects of peritoneal dialysis and hemodialysis on renal function and quality of life in patients with end-stage renal disease. An evidence-based medical rationale would be provided for peritoneal dialysis or hemodialysis treatment in patients with end-stage renal disease. Methods The PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang, and China Biomedical Literature Database (CBM) online databases were searched. Comparisons on the effects of peritoneal dialysis on renal function and quality of life were taken between patients with end-stage renal disease (RD). The data were extracted independently by two researchers. The bias-risk-included literatures were assessed according to the Cochrane manual 5.1.0 standard. RevMan 5.4 statistical software was used to analyze the collected data via meta-analysis. Results Seven RCT articles were finally included. A total of 745 samples were analyzed via meta-analysis. The obvious heterogeneities of serum creatinine (Scr) and blood urea nitrogen (BUN) were discovered (P < 0.00001) in the selective investigations. According to the results of this analysis, it was indicated that the renal function of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. According to the meta-analysis, there was obvious heterogeneity of life quality among the included research data. It was indicated that the score of quality of life of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. Conclusion Compared with hemodialysis in the treatment of end-stage renal disease, the renal function and quality of life of patients with peritoneal dialysis are better than those of hemodialysis. More further studies and follow-up with higher methodological quality and longer intervention time are still needed for further verification.

Effects of Acupuncture Combined with Biofeedback Therapy on Limb Motor Rehabilitation in Patients with Acute Stroke: Systematic Review and Meta-Analysis.

Objective The purpose of the systematic review is to verify the effect of biofeedback therapy on limb motor rehabilitation in patients with acute stroke and to provide evidence-based medicine for the promotion and use of biofeedback therapy. Methods The randomized controlled trials (RCT) of biofeedback therapy in the treatment of cerebral palsy were searched in PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang Database, and Chinese Biomedical Literature Database (CBM). The starting time and ending time of this study are from the time of building the database of the number of pieces to October 31, 2018. The data included in this study were extracted by two independent researchers and evaluated the bias risk of all the literature included in the study according to the Cochrane manual 5.1.0 criteria. RevMan5.4 statistical software was used to analyze the collected data by meta. Results This systematic review included 9 RCT studies with a total of 1410 patients. The results of meta-analysis showed that there were significant differences in the improvement of lower limb muscle tension, comprehensive spasm scale score, EMG score, and passive range of motion of ankle joint between biofeedback therapy and routine rehabilitation therapy. Conclusion Biofeedback therapy can improve lower limb muscle tension, spasticity, EMG integral value, and passive range of motion of ankle joint in children with cerebral palsy and provide better conditions for improving the motor ability of lower extremities in children with cerebral palsy. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.

Comparison of the Efficacy and Complications of Soft Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Urinary Calculi: A Systematic Review and Meta-analysis.

Objective To systematically evaluate the efficacy and complications of soft ureteroscopic lithotripsy (SUL) and percutaneous nephrolithotomy (PCNL) in the treatment of urinary calculi and to provide evidence-proof medicine basis for the popularization and application of flexible ureteroscopic lithotripsy. Methods PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) were searched for randomized controlled trials (RCT) related to soft ureteroscopic lithotripsy and percutaneous nephrolithotomy in the treatment of urinary calculi from Jan. 2010 to Mar. 2022. The bias risk of each included literature was assessed according to the standard of Cochrane manual 5.1.0. The collected data were meta-analyzed by RevMan 5.4 statistical software. Results Ultimately, 6 RCT (a total of 794 samples) were included for meta-analysis. Heterogeneity test results of stone clearance rate were chi2 = 2.44, df = 5, P = 0.79 > 0.05, and I2 = 0%, indicating none obvious heterogeneity among the included research data. The test of WMD was Z = 2.11 (P = 0.03). It could be considered that compared with PCNL in the treatment of urinary calculi, SUL had a higher stone clearance rate in patients with urolithiasis. Secondly, heterogeneity test of operation time was chi2 = 184.95, df = 5, P < 0.00001, and I2 = 97%. The results of heterogeneity test of intraoperative blood loss displayed chi2 = 645.47, df = 5, P < 0.00001, and I2 = 99%. Then, heterogeneity test results of postoperative hospital stay existed chi2 = 57.37, df = 5, P < 0.00001, and I2 = 91% with an obvious heterogeneity. According to the results of this analysis, it could be considered that compared with PCNL in the treatment of urolithiasis, the operation time of SUL in the treatment of urolithiasis was longer, but the amount of intraoperative bleeding and postoperative hospital stay was significantly reduced. The results of heterogeneity of stress index level NE showed as chi2 = 0.32, df = 2, P = 0.85 > 0.05, and I2 = 0%, and COR was chi2 = 1.09, df = 1, P = 0.30 > 0.05, and I2 = 8%. It showed that there was no obvious heterogeneity. The heterogeneity of ACTH was chi2 = 390.36, df = 2, P < 0.00001, and I2 = 99%, suggesting obvious heterogeneity. The test of combined effect dose WMD was Z = 21.90, 4.50, and 15.42, (P < 0.00001). It could be considered that there was a statistical difference in the WMD of stress response between patients with urinary calculi treated by soft ureteroscope and percutaneous nephrolithotomy, indicating that the stress response of patients with urinary calculi treated with SUL is less than that of PCNL. For the heterogeneity test of serum creatinine level, NE showed chi2 = 0.78, df = 2, P = 0.68 > 0.05, and I2 = 0% without obvious heterogeneity, and the combined effect dose WMD is analyzed by random effect model. The test of combined effect dose WMD was Z = 4.22 (P < 0.00001). It can be considered that the improvement of serum creatinine level in patients with urolithiasis treated with SUL was better than that of PCNL. The results of heterogeneity test on the safety of operation are as follows: chi2 = 13.76, df = 5, P = 0.02, and I2 = 64%, indicating obvious heterogeneity among the included research data. The combined effect dose of WMD was Z = 5.53 (P < 0.00001). This could be considered that soft ureteroscopic lithotripsy had higher safety and less postoperative complications than percutaneous nephrolithotomy in the treatment of urinary calculi. An inverted funnel chart was used to analyze the publication bias of the study with stone clearance rate as the outcome index. The results showed that the figure was not completely symmetrical and the Egger's test showed that the figure was P = 0.0005 < 0.001. It was suggested that there may be a certain degree of publication bias. Conclusion PCNL and SUL can achieve higher stone clearance rate in the treatment of renal calculi. However, SUL has the advantages of less intraoperative bleeding, short stress reaction and postoperative hospital stay, less damage to renal function, and low incidence of complications, which is beneficial to the rapid recovery of patients after operation. More studies with higher methodological quality and longer intervention time are needed to further verify.

Excimer Laser Corneal Refractive Surgery in the Clinic: A Systematic Review and Meta-analysis.

Objective To systematically evaluate the efficacy, safety, recovery speed, and long-term visual quality of excimer laser corneal refractive surgery and to provide evidence-based medicine for the promotion and use of excimer laser corneal refractive surgery. Methods Randomized controls on excimer laser refractive surgery in Web of science, PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network (CNKI), China VIP Database, Wan Fang Database, and China Biomedical Literature Database (CBM) were searched by the computer. Randomized controlled trial (RCT) data were extracted independently by two researchers, and the risk of bias of each included RCT was assessed according to the Cochrane Handbook 5.1.0 criteria. Meta-analysis of the collected data was performed using RevMan5.4 statistical software. Results In the end, 9 high-quality literatures were included, with a total of 4366 samples, and meta-analysis was used. There was no significant difference in uncorrected visual acuity WMD after excimer laser keratorefractive surgery, but there was a statistically significant difference in WMD in the safety of excimer laser keratorefractive surgery. The results of uncorrected visual acuity (close) indicated the following: Chi2 = 13.56, DF = 5, P = 0.02, and I2 = 100%; the results of uncorrected visual acuity (distance) indicated the following: Chi2 = 34.44, DF =5 (P < 00000), and I2 = 85%; the results of best corrected visual acuity (myopia) indicated the following: Chi2 = 0.65, DF = 3, P = 088 > 0.05, and I2 = 0%; the results of best corrected visual acuity (hyperopia) indicated the following: Chi2 = 1.80, DF = 3, P = 0.61 > 0.05, and I2 = 0%. Conclusion Excimer laser corneal refractive surgery is safe and effective, with faster recovery and better long-term visual acuity treatment effect. However, more studies and follow-up with higher methodological quality and longer intervention time are needed for further validation.

Effects of Nasturtium officinale Extract on Antioxidant and Biochemical Parameters in Hemodialysis Patients: A Randomized Double-Blind Clinical Trial.

Background Increased oxidative stress play an important role in the risk of cardiovascular disease, mortality, and mortality patients undergoing dialysis. Nasturtium officinale (watercress) contains numerous phytochemical compounds that act as an antioxidant by preventing oxidative damage to biomolecules. Therefore, this research aimed to explore the effect of the ethanolic extract of Nasturtium officinale (EENO) on antioxidant and biochemical markers of hemodialysis patients. Methods In this double-blind, placebo-controlled trial, 46 hemodialysis patients were randomly recruited to consume either 500 mg/day EENO (n = 23) or placebo capsule (n = 23) for 4 weeks, at Shahid Beheshti Hospital, Yasuj, Iran, in 2019. Biomarkers of oxidative stress including glutathione peroxidase (GPX), superoxide dismutase (SOD), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant capacity (TAC), and total sulfhydryl protein (T-SH) and biochemical parameters such as BUN, Hb, WBC, PLT, Ca, Ph, K, ALB, TChol, TG, LDL, and HDL were evaluated on days 0 and 28. Results The serum levels of MDA and BUN significantly decreased after taking EENO supplementation (P < 0.001); however, SOD activity increased during the same period (P < 0.001). The serum levels of TAC remained constant in the intervention group, while it significantly declined in the placebo group (P < 0.09). The extract also prevented elevation in the serum levels of LDL and TG compared to the placebo group, although it was not statistically significant. Conclusions The data indicated that the consumption of EENO improved some of the antioxidant parameters and minimizes the change in TG and LDL in hemodialysis patients. Therefore, due to the role of these factors in mortality and morbidity of dialysis patients, EENO can improve the condition of dialysis patients. However, more studies with longer intervention times and different doses of EENO are recommended.

Intervention Time and Adverse Events in a Canadian Epilepsy Monitoring Unit.

Intervention time (IT) in response to seizures and adverse events (AEs) have emerged as key elements in epilepsy monitoring unit (EMU) management. We performed an audit of our EMU, focusing on IT and AEs. We performed a retrospective study on all clinical seizures of admissions over a 1-year period at our Canadian academic tertiary care center's EMU. This EMU was divided in two subunits: a daytime three-bed epilepsy department subunit (EDU) supervised by EEG technicians and a three-bed neurology ward subunit (NWU) equipped with video-EEG where patients were transferred to for nights and weekends, under nursing supervision. Among 124 admissions, 58 were analyzed. A total of 1293 seizures were reviewed to determine intervention occurrence, IT, and AE occurrence. Seizures occurring when the staff was present at bedside at seizure onset were analyzed separately. Median IT was 21.0 (11.0-40.8) s. The EDU, bilateral tonic-clonic seizures (BTCS), and the presence of a warning signal were associated with increased odds of an intervention taking place. The NWU, BTCS, and seizure rank (seizures were chronologically ordered by the patient for each subunit) were associated with longer ITs. Bedside staff presence rate was higher in the EDU than in the NWU (p < 0.001). AEs occurred in 19% of admissions, with no difference between subunits. AEs were more frequent in BTCS than in other seizure types (p = 0.001). This study suggests that close monitoring by trained staff members dedicated to EMU patients is key to optimize safety. AE rate was high, warranting corrective measures.

Tele-Rehabilitation for Individuals with Multiple Sclerosis and Mobility Disorders—A Feasibility and Pilot Study

Objective: To determine the feasibility of conducting an 8-week physical therapist (PT)-guided tele-rehabilitation (TR) program for persons with multiple sclerosis (MS) and mobility deficits. Design, setting, and participants: This feasibility study had a pre–post-intervention, non-randomized design. Nine subjects with a confirmed diagnosis of MS without a clinical exacerbation in the last year were selected from the MS Center of Excellence at UF Health Jacksonville (UFHJ). Inclusion criteria included demonstrated mobility deficits on initial examination, basic computer competency, and a home with high-speed internet connection. Examinations were performed face-to-face, pre–post-intervention in the Neurology Research Clinic at UFHJ. TR was delivered to the patient’s homes in Florida and South Georgia. Intervention: An informed consent was obtained prior to initial examination. Self-reported measures included quality of life (QOL) and fatigue. Mobility measures included timed 10-m walk, five times sit to stand, and Berg balance scale. Following inclusion, home safety was evaluated and computer equipment was installed. TR intervention utilized the Jintronix® web-based platform system with a kinetic camera that demonstrated selected exercises by an avatar, allowing for real-time feedback on the quality of performance as well as tracking of adherence. The individualized exercises were assigned by the evaluating PT based on the initial assessment. Subjects participated in weekly TR visits with the prescribing PT to further monitor and adjust the therapy program. Main outcome measures: Primary outcome measures were patient satisfaction, safety, and compliance. Secondary outcome measures were projected travel cost, self-reported fatigue and QOL, and mobility testing measures. To compare the TR effect on mobility, a comparator persons with MS group was selected retrospectively. Eight persons with MS referred from the MS Center at UFHJ for outpatient (OP) PT from January 2018 through September 2019 were identified by UFHJ electronic database search for ICD 10 code G35. The inclusion criteria for mobility deficits and functional measurements were the same as those in TR group. Results: Eight subjects completed the TR program with no adverse events. They reported satisfaction, demonstrated compliance, and saved $8,487 in projected travel costs. All TR subjects noted improvement in self-reported fatigue, QOL, or mobility measures. Improvement in mobility measures had wide variability but did not differ between TR and OP groups. Conclusions: The 8-week PT-monitored TR program was shown to be feasible, safe, and well received by persons with MS. Larger studies focused on specific dysfunction leading to mobility deficits and longer intervention times will be necessary to determine efficacy.