Symptoms In Patients Research Articles

Static Posture Instability as a Sensitive Biomarker for Motor Abnormalities in Pre-ataxic Spinocerebellar Ataxia Type 3 Patients.

Spinocerebellar ataxia type 3 (SCA3) is a neurodegenerative disorder, with balance instability as a feature of the disease. Balance instability often manifests before the onset of obvious ataxic symptoms in patients. However, current clinical scales exhibit limited sensitivity in characterizing changes in pre-ataxic patients. Our research aims to identify appropriate postural characteristics for tracking motor changes in pre-ataxic patients with SCA3 over time. The posturographic platform assessed 102 participants (34 pre-ataxic SCA3 patients, 34 ataxic patients with SCA3, and 34 healthy controls) to measure their postural balance. Multivariate comparative analyses assessed the differential postural characteristics across the three groups. The Taiwanese formula was employed to estimate the age of onset for pre-ataxic patients. A Spearman's rho test was employed to assess correlations between postural characteristics and the time manifestation for pre-ataxic patients. Compared to the healthy control group, we observed significant abnormalities in the static posture of pre-ataxic patients (P < 0.01). Compared to the pre-ataxic group, ataxic patients have significant abnormalities in all variables (P < 0.05). The sway range standard deviation (SD), total sway area, and limits of stability were positively correlated with the estimated time to onset. The total sway area is more closely associated with time to manifestation, whereas the sway range SD in the medial-lateral direction of the center of foot pressure is the most sensitive indicator of postural instability in pre-ataxic patients. Static posture instability is a sensitive diagnostic parameter that may assist in capturing disease progression in the pre-ataxic stage of SCA3. © 2025 International Parkinson and Movement Disorder Society.

Single Versus Dual Therapy for Diabetic Gastroparesis

Gastroparesis is a disorder of gastric motility hallmarked by nausea, vomiting and early satiety. While dietary and medical therapy are the mainstay of treatment, surgery has been useful to palliate symptoms. Two long-used first line surgical therapies for gastroparesis are gastric electrical stimulation and pyloric procedures (including pyloroplasty and pyloromyotomy). This manuscript will focus on the use of these surgical modalities, both separately and in combination, to treat refractory gastroparesis symptoms in patients with diabetes.

Clustering and drivers of symptoms observed at week six after antidepressant treatment in depressed outpatients.

Depressive symptoms remaining after antidepressant treatment increase the risk of relapse and recurrence. We aimed to analyze the distribution and main drivers of remaining symptoms in patients with a major depressive episode. Two independent samples of 8,229 and 5,926 patients from two large naturalistic studies were retrospectively analyzed. DSM-IV criteria for major depressive episodes were assessed during two face-to-face visits with clinicians: before the prescription of a new antidepressant, and after 6weeks of treatment. The Hospital Anxiety and Depression Scale (HADS) was used to assess baseline severity of anxiety and depression. In both samples, two clusters of remaining symptoms were observed. The first cluster encompassed symptoms related to a negative emotional and cognitive bias and was specifically driven by the baseline severity of depression. The second cluster encompassed neurovegetative symptoms and was specifically driven by the baseline severity of anxiety. The baseline anxiety-depressive balance of patients could be considered to adapt the treatment, focusing on emotional and cognitive symptoms with patients with high baseline severity of depression, and neurovegetative symptoms with patients with high baseline anxiety severity.

Temperature-Controlled Radiofrequency Treatment of the Nasal Valve in Patients With Nasal Obstruction: Long-Term Outcomes.

To evaluate the efficacy, safety, and durability of temperature-controlled radiofrequency (TCRF) treatment of the nasal valve in patients with severe or extreme nasal airway obstruction (NAO). A long-term, prospective, multicenter, single-blind, randomized controlled trial. Sixteen otolaryngologic clinics and academic centers. Patients received TCRF treatment on the lateral nasal valve. All patients were followed through 3 years. Outcome measures included the Nasal Obstruction Symptom Evaluation (NOSE) Scale, Epworth Sleepiness Scale (ESS), and adverse events (AEs). Treatment responders were defined as a ≥1 reduction in severity class or ≥20% reduction in NOSE score. Out of 108 patients who received TCRF treatment, 54 reached the 3-year follow-up timepoint. The baseline mean NOSE score was 76.3 (95% confidence interval [CI], 73.6 to 79.1). The 3-year NOSE score treatment effect was -49.4 ([95% CI, -56.5 to -42.4]; P < .001) a 64.7% improvement from baseline; 88.7% of patients were responders. Most patients reported significant improvements in sleep post-treatment with a mean ESS score of 4.5 (95% CI, 3.4 to 5.7) at 3 years compared to 10.3 (95% CI, 9.2 to 11.4) at baseline. Treatment with the TCRF device for nasal valve obstruction resulted in sustained improvements in nasal obstruction symptoms and sleep quality over a 3-year period without any serious AEs. These findings support the long-term benefits and sustained improvements in symptoms in patients with NAO.

Prevalence and Predictors of Thirst in Patients With Heart Failure.

Thirst is among the most unpleasant symptoms in patients with heart failure (HF). Intense thirst can lead to uncontrolled fluid intake, resulting in congestion and frequent readmissions. Many predictors of thirst were identified, but little research addressed its association with salt intake. The aims were to describe the prevalence and characteristics of thirst in patients with HF, examine its association with salt intake, and identify its predictors. Using a descriptive correlational design, 100 patients with New York Heart Association classes I, II, and III HF were interviewed about thirst, salt-related behaviors, and the Patient Health Questionnaire-2. Demographic and clinical information were extracted from medical records. Descriptive statistics as well as bivariate and multivariable regression analyses were used. Most participants were male and married, with university education and a mean age of 66.7 ± 13.2 years. The mean thirst intensity score was 3.81 ± 2.17 (out of 10), and its prevalence was 93%. The mean thirst distress score was 23.58 ± 7.66 (out of 40); 68% reported moderate or strong distress. Patients prescribed salt restriction had lower thirst intensity (3.60 vs 5.70, P = .003) than their counterparts and thirst distress (22.78 vs 27.50, P = .062) that approached significance. Salt restriction; use of statins, antidepressants, and any renin angiotensin aldosterone system (RAAS) blocker; and Patient Health Questionnaire-2 score predicted thirst intensity. Female sex as well as use of any RAAS blocker and antidepressants predicted thirst distress. Thirst was prevalent, distressing, and predicted by salt restriction, use of any RAAS blocker, and depression. Assessing thirst and relieving it are recommended.

A case of 18F-FDG PET/MR facilitates early diagnosis of anti-GFAP encephalitis disease.

Glial fibrillary acidic protein (GFAP) astrocytosis is a rare autoimmune encephalitis discovered in the last decade. The diagnosis depends on clinical symptoms, imaging, and antibody testing. However, most cases require several months or even longer to make a definite diagnosis. Early-stage diagnosis of this condition poses significant challenges. A 54-year-old female patient presented high fever and headache as the initial symptoms, accompanied by persistent hyponatremia. Antiviral therapy and dexamethasone anti-inflammatory therapy did not yield satisfactory effects. The patient subsequently developed confusion, lethargy, polyuria, bladder dysfunction, and movement disorder, accompanied by intractable hyponatremia, which was slightly relieved by intravenous immunoglobulin (IVIG). With the help of 18F-FDG PET/MR imaging combined with antibody testing, we diagnosed the patient with anti-GFAP encephalitis approximately one month after symptom onset. Following a course of high-dose methylprednisolone therapy, the patient's symptoms gradually improved. During the one-year follow-up period, the use of methylprednisolone was gradually tapered and the patient remained asymptomatic. This case presented a rare disease with atypical manifestations, highlighting the importance of utilizing 18F-FDG PET/MR imaging as a valuable adjunct tool for patients with unclear lesions on conventional MRI scans. Early diagnosis and timely treatment are crucial for ensuring a favorable prognosis for patients.

Effectiveness of breathing exercises on urinary symptoms, muscle activity, and strength in women with multiple sclerosis and urinary incontinence—a study protocol for a randomized controlled trial study

BackgroundUrinary incontinence (UI) is a common and debilitating condition among people with multiple sclerosis (MS) and is more prevalent among women. Over the past decade, numerous studies have investigated the effects of pelvic floor muscle training (PFMT) as a treatment for UI in people with MS. MS negatively impacts pulmonary function even in the early stages of the disease and people with MS may experience respiratory muscle weakness. Considering the synergy between the pelvic floor muscle (PFM) and respiratory muscles, this trial will evaluate the effects of PFMT and breathing exercises on PFM activity and strength, diaphragm activity, and urinary symptoms in women with MS who experience UI.MethodsFifty women with MS and UI will participate in this parallel randomized controlled trial, comprising 32 treatment sessions. The intervention group consists of PFMT and breathing exercises, and the control group includes PFMT. The severity of UI symptoms, PFM activity, diaphragm activity, and PFM strength will be evaluated using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, ultrasound imaging, and modified Oxford grading scale, respectively before and after the intervention.DiscussionThe current trial is designed to examine the effects of a combined exercise program for UI in women with MS. It is hypothesized that using breathing exercises in conjunction with PFM exercises will improve patient symptoms compared to PFMT alone.Trial registrationThe trial was registered in the Iranian Registry of Clinical Trials with code IRCT20180916041051N3 and was approved on 23 May 2024.Graphical

Exploring early postoperative core symptoms in Chinese patients with primary liver cancer: a cross-sectional and longitudinal network analysis.

Patients with primary liver cancer (PLC) experience a range of symptoms in the early postoperative period. Symptoms include cancer-related symptoms and adverse effects of treatment. Exploring the core symptoms and their dynamics in the early post-hepatectomy patients may help provide better symptom management programs. The purpose of this study was to identify the core symptoms in early post-hepatectomy patients and to explore the trajectory of their dynamics. During the period from March 2021 to September 2022, a total of 281 patients diagnosed with PLC and undergoing radical curative surgery were recruited from the hepatobiliary surgery departments of two hospitals in Eastern China, among whom 249 individuals (88.6%) agreed to participate in the study. A comprehensive symptom assessment was administered to the patients 1-2days after surgery (T1) and 1-2days before discharge (T2). Network analysis was used to identify core symptoms in early post-hepatectomy patients based on symptom severity. The network analysis identified the core symptoms of dry mouth, pain, abdominal distension, the lack of appetite, and nausea at T1. In contrast, at T2, the lack of appetite, pain, shortness of breath, and disturbed sleep were revealed. At the two early time points, while the results of the network structure test showed no statistically significant difference in the overall symptom network structure, there was a significant difference in the results for the core symptoms. Our study demonstrates the need to identify core symptoms in the early post-hepatectomy to improve symptom management in PLC patients. It is crucial to apply network analysis as an essential component of cancer care.

The “prostate-pelvic syndrome” theory used in patients with type-III prostatitis and its correlation with prostate volume

BackgroundType-III prostatitis is the most common prostate disease in adult males below 40 years old. The actual operation of its diagnosis process is cumbersome. Recently, a group of top Chinese urologists have proposed the theory of “prostate-pelvic syndrome (PPS)” and suggested using it to replace the traditional term for type-III prostatitis. However, the practical application effectiveness of PPS theory in clinical practice is still unclear.ObjectiveThe aims of this study were to verify the clinical outcome of PPS theory in diagnosing the adult patients with type-III prostatitis below 40 years old and analyze the related factors for the main symptoms of PPS in adult males below 40 years old, providing references for the prevention and treatment of PPS in young adult males.MethodsThe clinical medical records of 548 adult outpatients with type-III prostatitis under 40 years old between August 2018 and May 2023 were retrospectively analyzed. The patients were diagnosed retrospectively again by using PPS diagnostic criteria in this retrospective cohort study. Subsequently, the age, disease duration, prostate volume (PV), PV ≥ 20 mL detection rate and other related indicators among different symptom groups were analyzed by univariate analysis. The correlation between different symptoms of PPS patients and PV as well as disease duration was analyzed by correlation analysis. Additionally, the related factors for different main symptoms of PPS patients were analyzed by multivariate analysis.ResultsOf the 548 patients, 229 patients had lower urinary tract symptoms, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with voiding symptoms (VS), pain symptoms (PS), and voiding + pain symptoms (VS + PS) defined according to the concept of PPS. There were significant differences in PV and disease duration among the three main symptoms groups of PPS. PV in the VS group was larger than that in the PS group. Spearman correlation analysis showed that VS was positively correlated with PV and disease duration, while four secondary symptoms (including sexual dysfunction, psychosocial symptoms, reproductive dysfunction and other symptoms) were not related to PV. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group. Multivariate logistic analysis showed that PV and disease duration were independent related factors for VS in adult PPS patients below 40 years old.ConclusionsType-III prostatitis in Chinese adult males below 40 years old can be diagnosed and treated with PPS. PV and disease duration were independent related factors for VS in Chinese adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL.

Disopyramide Revisited for Treatment of Symptomatic Obstructive Hypertrophic Cardiomyopathy: Efficacy and Safety in Patients Treated for at Least 5 Years.

Disopyramide is used to treat heart failure symptoms in patients with obstructive hypertrophic cardiomyopathy (HCM) with known medium-term efficacy and safety, while long-term outcomes are unknown. A total of 92 consecutive patients with symptomatic obstructive HCM with peak left ventricular outflow tract gradients of ≥30 mm Hg at rest or with provocation who were maintained on disopyramide for ≥5 years at 2 dedicated HCM centers were included: 92 patients; mean age, 62.5 years; 54% women; treated with disopyramide for median 7.2 years (left ventricular wall thickness 18±4 mm; median peak outflow gradient 95 mm Hg). At last follow-up, 62 (67%) patients continued disopyramide, including 57 with symptom improvement ≥1 New York Heart Association class. The other 30 (33%) patients discontinued disopyramide due primarily to incomplete symptom resolution and required surgical myectomy or alcohol septal ablation (n=23) at 7.4 years from initiation. With disopyramide, resting left ventricular outflow gradients were reduced by 37% (to median 19 mm Hg), and provoked gradients decreased by 57% (to median 41 mm Hg), with no residual outflow obstruction (<30 mm Hg at rest or with provocation) in 42 (46%) patients and no change in ejection fraction (69%±6% versus 69%±9%, P=0.51). Ventricular tachyarrhythmias and left ventricular systolic dysfunction were uncommon (n=3 and n=1) and were not attributed to disopyramide. Death on disopyramide was exceedingly rare (n=3 [5%]) and non-HCM-related occurring at age ≥90 years. In patients with obstructive HCM, disopyramide is safe and effective at relieving heart failure symptoms from outflow obstruction in a subgroup of patients who were maintained on disopyramide for >5 years.

Angina Severity and Symptom Improvement Are Associated With Diagnostic Acetylcholine Provocation Dose in Vasospastic Angina.

A coronary function test (CFT) isthe recommended diagnostic test to identify coronary vasomotor dysfunction as a cause of symptoms in patients with angina and nonobstructive coronary arteries (ANOCA). Acetylcholine is the commonly used pharmacological agent for spasm provocation. We aimed to investigate an association between severity of symptoms and provocative acetylcholine dose. We included ANOCA patients undergoing clinically indicated CFT from the Netherlands Registry of Invasive Coronary Vasomotor Function Testing: NL-CFT. Patients with epicardial spasm (n=251) were divided according to acetylcholine spasm triggering dose: low (2-20 mcg, EpiLOW), middle (100 mcg, EpiMIDDLE) or high (200 mcg, EpiHIGH). Patients with microvascular spasm (n=157) were analyzed irrespective of triggering dose. The patient groups were compared to each other and to a control group with negative CFT results (n=101). We assessed mean Seattle Angina Questionnaire angina frequency and summary scores at baseline and follow-up and the proportion of patients improving or deteriorating. An inverse relationship between provocation dosage and angina frequency at baseline was found in epicardial spasm: the lower the triggering dose, the more frequently patients experienced angina (EpiLOW 48±20, EpiMIDDLE 53±21, EpiHIGH 57±19, microvascular spasm61±21, controls 64±21, overall P=0.003). A trend was seen toward most patients improving in the high triggering dose group, and most patients deteriorating in the low triggering dose group. A significant dose-dependent relationship between spasm provocation and anginal complaints exists. Acetylcholine provocation dose could be incorporated as a risk stratification factor or surrogate outcome in future clinical trials. URL: https://www.clinicaltrials.gov; Unique identifier: NCT06083155.

Progression of nutritional impact symptoms in cancer patients undergoing radiotherapy.

To analyze the presence of nutritional impact symptoms (NIS) throughout radiotherapy treatment in the head and neck, thorax, abdomen, and pelvis areas. A prospective cohort study was conducted with individuals undergoing radiotherapy for cancer. Three assessments were carried out: at the start of radiotherapy, midway through, and in the last week of treatment. Clinical, anthropometric data, and the Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess symptoms. A total of 254 participants were evaluated at the start, 165 at the midpoint, and 120 at the end of the treatment. More than half of the participants at all stages were elderly. At the start, 51.6% were women, while at the end, 57.5% were men. Pelvic tumors were the most common, followed by tumors in the head and neck and thorax. The prevalence of NIS increased from 58.2% at the beginning to 76.9% at the midpoint (RR 1.32; 95% CI 1.17-1.48; p = < 0.001) and 78.3% at the end of treatment (RR 1.34; 95% CI 1.18-1.52; p = < 0.001). Odynophagia was the most reported symptom among patients with head and neck tumors, increasing from 24.5 to 66.6%, and from 3.0 to 22.2% by the end of treatment in patients with thoracic tumors. Diarrhea was common at the end of treatment among those with abdominal (69.2%) and pelvic (35.8%) tumors. NIS increased during radiotherapy. The location of tumors influences symptom prevalence, highlighting the need for continuous nutritional support.

The "gift of love" as a candidate mechanism of psychopathology and change in interpersonal reconstructive therapy for patients with high-acuity clinical needs.

A key mechanism of psychopathology and change proposed by the theory of interpersonal reconstructive therapy (IRT; Benjamin, 2003, 2018) is termed the "gift of love" (GOL). The GOL hypothesis is that wishes to receive love and acceptance from specific internalized attachment figures shape and maintain problem patterns and their associated symptoms for many patients across a wide range of psychopathology. According to IRT theory, optimal intervention is defined by therapist alignment, or "adherence," to a core algorithm of principles that are tailored individually and bring awareness to (a) attachment-based yearnings for love and acceptance from internalized figures and (b) how those yearnings shape and motivate current problems and symptoms. The method then seeks to enhance choice about those relationships and their attendant feelings, hopes, and fears. The study sample includes 30 patients, referred while receiving inpatient treatment and followed on an outpatient basis, with complex, high-acuity clinical needs (i.e., histories of multiple psychiatric hospitalizations, recurrent suicidality, ineffectiveness of prior treatment, and significant personality pathology). Reliable measures were developed to track therapist adherence to IRT principles, as well as patient stages of change coming to terms with the GOL. IRT adherence was associated with retention, reduced depression and anxiety, and improved self-treatment. Mediation analyses support the proposition that change in IRT is contingent upon patient progress at grieving the losses and associated wishes linked to attachment figures. Implications for theory-guided research and practice at the level of underlying principles are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Ranolazine effectively improves clinical symptoms in patients with slow flow coronary arteries: a randomized, double-blind, placebo-controlled clinical trial.

The coronary slow flow phenomenon (CSF) causes persistent chest pains that can affect patients' quality of life. We aimed to examine the ranolazine impacts on clinical symptoms in CSF patients. The present randomized, double-blind, placebo-controlled trial consisted of 44 patients with CSF. For two months, patients were randomized to receive ranolazine (500mg/twice daily) or placebo plus optimal medications. EuroQol-visual analogic scale (VAS) and Seattle Angina Questionnaire (SAQ) were performed at baseline and after one and two months of treatment. At the beginning and after one month of treatment, no remarkable difference was assumed in the mean of EuroQol-VAS and all five SAQ parameters between the ranolazine and placebo groups. Additionally, the median of EuroQol-VAS (P < 0.001) and all five SAQ parameters, including physical limitation (P < 0.001), stability of angina (P < 0.001), frequency of angina (P < 0.001), treatment satisfaction (P = 0.003 and P < 0.001), and understanding of the disease (P < 0.001), has significantly propagated after two months of treatment in both ranolazine and placebo groups. Interestingly, following two months of treatment, the mean of EuroQol-VAS (P = 0.013), physical limitation (P = 0.041), stability of angina (P = 0.016), frequency of angina (P = 0.042), and treatment satisfaction (P = 0.037), in the ranolazine group has notably elevated comparatively to the placebo group. Our findings showed that ranolazine ameliorates clinical symptoms in CSF patients after two months of treatment. Therefore, ranolazine may be an appropriate candidate in CSF patients.

Psychometric Evaluation of the Scleroderma Skin Questionnaire: A Novel Patient Reported Outcome for Skin Disease in Patients with Systemic Sclerosis.

To evaluate the psychometric properties of the Scleroderma Skin Questionnaire (SSQ), a novel patient-reported outcome (PRO) to assess systemic sclerosis (SSc) related skin symptoms. The SSQ was administered to 799 adults (mean age 52.7; 82% female) enrolled in the SSc Collaborative National Quality and Efficacy Registry (CONQUER). Internal consistency was determined using Cronbach's α and McDonald's ω total (ωt). The correlation of the SSQ was assessed with the modified Rodnan Skin Score (mRSS), Physician Global Assessment (PGA), Scleroderma Health Assessment Questionnaire (SHAQ), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and Patient Global Assessment to assess criterion, convergent, and divergent validity. Correlations were also assessed between patients' self-reported recall of skin changes over the past six months ("SSQ 6-Month") and six-month change in mRSS. Cronbach's α was 0.90 and ωt was 0.92, indicating high internal consistency. The SSQ was moderately correlated with mRSS (r=0.56), with stronger correlations in diffuse (r=0.54) versus limited subtypes (r=0.24; all p<0.05). The SSQ was also moderately-to-strongly correlated with PROMIS-29 physical (r=-0.50) and pain interference subscales (r=0.61), strongly with SHAQ's HAQ score (r=0.63) and severity subscale (r=0.62), and moderately with PGA's scleroderma activity score (r=0.48; all p<0.05). SSQ 6-Month correlated weakly with the six-month change in mRSS (r=0.26; p<0.05). SSQ demonstrated high reliability and moderate correlation with mRSS and legacy PROs. This study provides initial support for SSQ but not SSQ 6-Month to assess skin symptoms in patients with SSc.

Surgical technique and outcomes associated with the use of femoral vein in venous reconstruction for superior vena cava syndrome.

Superior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction. This was a single-center, retrospective study that included all patients who underwent SVC reconstruction using femoral vein from January 2000 to December 2023. Follow-up period analysis included reconstruction patency, surgical reinterventions, patient's symptoms, and complications. Ten patients underwent central venous reconstruction or bypass using the femoral vein, with an average age of 51.88years ± 10.20years. SVC syndrome was primarily caused by benign etiologies including pacemakers and indwelling central venous catheters. Common presenting symptoms included head or neck fullness and upper extremity edema. The median follow-up duration was 21months. Primary patency at 1year was 79%. Femoral vein reconstruction presents a promising solution for managing SVC obstruction, offering effective symptom relief and acceptable venous patency rates. Further research including prospective trials and comparative studies is crucial to refining surgical techniques and understanding long-term efficacy in addressing this complex clinical issue.

The use of the Prospector calculator reduces antibiotic therapy in exacerbations of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) exacerbations frequently cause patient consultations in both out- and inpatient settings. Recent data suggest that only 40–60% of exacerbations are of bacterial origin and mandate antibiotic treatment. However, a reliable tool to justify prescribing antibiotics for COPD exacerbation is still lacking. This study was designed to explore the hypothesis that utilization of a novel decision-making tool called Prospector would lead to lower consumption of antibiotics and provide a more rational approach to managing COPD exacerbations versus standard therapy in patients with COPD. The study included 77 COPD patients who experienced a COPD exacerbation and were treated in outpatient settings. The Prospector group (PG) (n = 40) were treated by the study author using the Prospector calculator (a tool designed by the first author that translates: patient symptoms, exacerbation, and medical history of COPD into a decision on the use of antibiotics in COPD exacerbation treatment). Other primary care specialists treated the control group (CG) (n = 37) in the same outpatient clinic; antibiotic therapies were implemented at the physician’s discretion, most often using Anthonisen’s criteria. All other medications were administered at the physician’s discretion. Safety endpoints were set as: death, hospitalization, and number of exacerbations. Antibiotics were administered in 32.8% and 81.2% of exacerbations in the PG and CG, respectively (p < 0.0001). A comparable percentage was verified positively in both PG patient subsets: those that did and did not receive antibiotics at visit 1 (94.7% and 94.9%, respectively). Twenty-eight patients in the PG and 37 in the CG were followed for up to 35 months. Failure to recover (defined as deterioration or lack of improvement) in 30 days following exacerbation was 10.7% in the PG and 47.2% in the CG. In the CG, the failure rate was significantly higher (p = 0.0043). Hospitalization rates in the PG and the CG were 42.9% and 94.4%, respectively. In the CG, the hospitalization rate was significantly higher (p < 0.0001). COPD hospitalization rates in the PG and the CG were 17.9% and 33.3%, respectively (p = 0.1643). This preliminary study suggests that using the Prospector calculator results in markedly reduced antibiotic prescription for COPD exacerbations. No new safety signals have been identified for the method.

Combination therapy of low-dose radiotherapy and immunotherapy in advanced metastatic nasopharyngeal carcinoma: a case report and literature review.

Nasopharyngeal cancer (NPC) is a common head and neck malignant tumor, which is difficult to treat at the advanced NPC due to its occult and high metastatic potential to the cervical lymph nodes and distant organs. Low-dose radiotherapy (LDRT) is increasingly being investigated for potential cancer treatment. When combined with immune checkpoint inhibitors, LDRT has been shown to significantly improve the immune microenvironment of tumors, thereby promote the immune attack on tumor cells. However, the therapeutic effect of LDRT combined with immunotherapy in advanced NPC is not well understood. We report a case of a 31-year-old man was diagnosed with advanced metastatic nasopharnygeal non-keratinizing carcinoma (T4N3M1 stage IVb AJCC8th). The patient was treated with a high-dose of radiation therapy combined with LDRT and immunotherapy to inhibit tumor cell proliferation and activate the body's immune system. The initial treatment procedure was as follows: chemotherapy regimen (nedaplatin + docetaxel + fluorouracil) induction, followed by radical radiotherapy for the primary lesion, LDRT for the L5 vertebral body metastasis, and concurrent use of low-dose capecitabine beat chemotherapy and toripalimab immunotherapy. The patient was also administered with human granulocyte-macrophage colony-stimulating factor and aspirin to enhance the immune function. This combination therapy approach alleviated patient symptoms, improved bone changes in the L5 vertebral body and resolved the tumor without any adverse effects signals. The progression-free survival (PFS) has reached 27 months and he is currently stable without tumor recurrence. The combination of chemotherapy and LDRT with aspirin and human granulocyte macrophage colony-stimulating factor improved the disease state of advanced NPC cancer, effectively reducing the level of tumor markers, enhanced the immune function without significant adverse reactions.

Effectiveness of a Videoconference-Based Cognitive Behavioral Therapy Program for Patients with Schizophrenia: Pilot Randomized Controlled Trial.

Cognitive behavioral therapy for psychosis (CBTp) is not sufficiently widespread in clinical practice, although evidence has been presented. The purpose of this study was to explore whether one-on-one videoconference-based CBTp (vCBTp) is more effective than usual care (UC) alone for improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp program was conducted once a week, with each session lasting for 50 minutes, for a total of 7 sessions conducted in real-time and in a one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline (week 0) to posttest (week 8). The study included 24 participants. There were no significant differences between the 2 groups at baseline. With regard to significant differences between the 2 groups in terms of the primary outcome, the mean change in the PANSS total score from baseline to week 8 in the vCBTp plus UC group was -9.5 (95% CI -12.09 to -6.91) and the mean change in the UC alone group was 6.9 (95% CI 1.54-12.30). The difference between the 2 groups was significant (P<.001). In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder-7 (GAD-7; P=.04) and EQ-5D-5L (P=.005). There were no dropouts and no serious adverse events in this study. A total of 7 remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life. However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the 2 groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety regarding transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. University Hospital Medical Information Network Clinical Trials Registry UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544. RR2-10.1136/bmjopen-2022-069734.

Polysomnographic findings and psychiatric symptoms in patients with comorbid insomnia and sleep apnea: a retrospective study focusing on sex differences.

Comorbid insomnia and obstructive sleep apnea (COMISA) present significant clinical challenges, given their overlapping symptoms and detrimental effects on health. Only a few studies have explored sex differences in patients with obstructive sleep apnea (OSA) and COMISA. This retrospective study investigated sex differences in psychiatric symptoms and polysomnographic findings between patients with COMISA and those with OSA alone. Patients who underwent polysomnography (PSG) and completed questionnaires at a single tertiary hospital sleep center were enrolled. Patients diagnosed with OSA using PSG (apnea-hypopnea index ≥ 5) were categorized based on the Insomnia Severity Index-Korean version (ISI) into OSA without insomnia (OSA-only group; ISI < 15) and OSA with insomnia (COMISA group; ISI ≥ 15). This study included 1,096 adult patients diagnosed with OSA, of whom 426 (38.9%) were in the COMISA group. COMISA was more common in women than in men (50.7% vs. 34.5%, p < 0.001). The COMISA group reported more severe subjective psychiatric symptoms, including depression, anxiety, and daytime sleepiness in both men and women. The male COMISA group had lower sleep efficiency (p = 0.02) and longer sleep latency (p = 0.002) than those had by the OSA-only group. The male COMISA group had a higher apnea-hypopnea index (p = 0.04) and a lower mean oxygen saturation (p = 0.004) than those had by the OSA-only group. These findings highlight the importance of considering sex-specific clinical and polysomnographic characteristics when managing patients with COMISA.