Mean Difference Research Articles

Effectiveness of Calf Muscle Stretching Exercise on leg Cramps among Antenatal Mothers Attending a Tertiary Care Centre Thiruvananthapuram

Background: Leg cramps during pregnancy is a common discomfort characterized by involuntary,painful contraction of muscle groups that usually occur in the calf or small muscles of the foot but canaffect different part of the leg. The severity of the leg cramp pain is variable and each attack may takefew minutes. 1 The prevalence of leg cramps occurred among 30% to 50% of pregnant women. Legcramping means painful spasm especially in the lower extremities occurs during pregnancy andmainly occurred in the second half of pregnancy typically occurs at night and usually lasts for a fewseconds or 2 minutes. 2Materials and Methods:The objective of the present study was to assess the effectiveness of calfmuscle stretching exercise on leg cramps among antenatal mothers. The research approach adopted for the study was quantitative approach and the research design was quasi experimental pre-test post-test control group design. Sample size was 80 and the samples who satisfied the inclusion andexclusion criteria were selected consecutively. Informed consent was obtained from those participantswho were willing to participate in the study. The investigator collected socio demographic data,clinical data and history of leg cramps by a self- prepared semi structured questionnaire and intensityof leg cramps was assessed using numeric pain rating scale. The investigator demonstrated thestretching exercise and provided with a diary to note down the intensity, duration and frequency of legcramps and the post-test was conducted after two weeks.Results: The collected data was analyzed using SPSS version 22 and description of participants basedon socio demographic data, clinical data and history of leg cramps were analyzed using percentageand frequencies and the effectiveness of calf muscle stretching exercise on frequency and duration ofleg cramps among experimental and control group was analyzed using chi-square test and thecalculated p value was <0.05, it was concluded that calf muscle stretching exercise was effective inreducing frequency and duration of leg cramps among experimental group also the effectiveness ofcalf muscle stretching exercise on intensity of leg cramps was analyzed by independent t-test. It wasfound that the mean difference in NPRS score in the experimental was 2.03±0.66 and in the controlgroup was 0.35±1.14 and the calculated p value was <0.05.Conclusion: calf muscle stretching exercise is effective in reducing intensity of leg cramps amongantenatal mothers.

Impact of Omega-3 Fatty Acids Supplementation Combined with Resistance Training on Muscle Mass, Neuromuscular and Physical Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Age-related declines in muscle mass, neuromuscular, and physical function can be mitigated by resistance training (RT). Omega-3 polyunsaturated fatty acids (Ω-3 PUFAs) supplementation has shown benefits in older adults. However, it remains unclear if combining Ω-3 PUFAs with RT is more effective than RT alone or with placebo. This systematic review and meta-analysis examined the effects in randomized controlled trials (RCTs) of Ω-3 PUFAs combined with RT compared to RT alone or placebo on muscle mass and function in healthy older adults (≥65 y). Databases such as PubMed, Embase, SPORTDiscus, and Web of Science were searched on 11 April 2024. No restriction on language or publication date was implemented. Mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals and pooled effects were calculated. Nine studies (n = 286, 54% men) met the inclusion criteria. The meta-analysis found no significant effect of Ω-3 PUFAs on muscle mass or neuromuscular function but a large effect on chair-rise performance. Potential impact of Ω-3 PUFAs dose, duration, or sex were not observed. Most studies had varying levels of bias, and none met recommended quality standards for investigating Ω-3 PUFAs, but findings suggest no clear advantage of combining Ω-3 PUFAs with RT.

Adrenocorticotropic Hormone versus Prednisolone for Infantile Epileptic Spasms Syndrome: A Systematic Review and Economic Evaluation.

Infantile epileptic spasms syndrome (IESS) is the most common epileptic encephalopathy in infancy and early childhood. At present, adrenocorticotropic hormone (ACTH) and prednisolone are commonly used as drug treatment regimens for IESS. However, evidence of efficacy and economics remains controversial. This study aimed to evaluate the effectiveness, safety, and economy of ACTH and prednisolone of IESS. Seven literature databases and two clinical trial registration platforms were searched, and a meta-analysis was conducted. From the perspective of the health care system, a 14-day economic evaluation was conducted. The rate of spasm cessation on the 14th day was used as the effect index. The univariate sensitivity analysis was used to verify the robustness of the results. Nine randomized controlled trials (RCTs) were included. Current clinical evidence is not sufficient to prove the difference in the rate of spasm cessation on the 14th day (risk ratio [RR] = 1.05, 95% CI 0.86-1.27, p = 0.64) and total adverse event rate (RR = 0.87, 95% CI 0.53-1.42, p = 0.57). ACTH had an advantage in improving electroclinical response on the 14th day (RR = 1.46, 95% CI 1.09-1.96, p = 0.01) and reducing the number of months taken for relapse (mean difference = 1.65, 95% CI 1.01-2.29, p < 0.01). The cost of ACTH and prednisolone was 5,629.19 yuan and 5.56 yuan, respectively. Univariate sensitivity analysis showed the most influential factor was the cost of ACTH. There is insufficient evidence to determine whether ACTH or prednisolone is better in the short-term regimen of IESS. ACTH may have more advantages in improving the long-term outcome of IESS. In China, a prednisolone regimen of IESS has a lower cost within 14 days.

Differences in fatty infiltration in thigh muscles and physical function between people with and without knee osteoarthritis and similar body mass index: a cross-sectional study

BackgroundPeople with knee osteoarthritis (OA) may have more thigh intermuscular and intramuscular adipose tissue (interMAT and intraMAT, respectively) compared to those without knee OA. Literature has not considered differences in body mass index (BMI) in the context of comparing intraMAT and interMAT between individuals with and without knee OA, matched for BMI (± 1 kg/m²). This study aims to compare interMAT and intraMAT, along with physical function (including knee extension strength), between individuals with and without knee osteoarthritis, matched by BMI.MethodsParticipants aged ≥ 40 years with symptomatic and radiological knee OA group (grade 2 and 3 on the Kellgren and Lawrence (KL) scale) were included in the affected group, while those with no knee pain and no radiological knee OA changes were included in the unaffected group. No participants were lost to assessment, ensuring complete data analysis for all participants. We used independent t-test and mean difference (95% CI) to compare thigh intraMAT and interMAT volume, self-reported measures (WOMAC questionnaire), physical function measures, and knee extension strength between groups.ResultsForty-six participants were analyzed (23 in each group). The affected group had significantly higher intraMAT compared to the unaffected group (p < 0.05), but no differences were observed for interMAT. Self-reported outcomes and physical function measures were worse in the affected group, as was knee extension strength.ConclusionPeople with knee OA present higher levels of intraMAT and poorer physical function compared to those without knee OA. These findings highlight the need for further research to explore the clinical significance of intraMAT and its potential impact on physical function in this population.

Impact on global health status, quality-sexual life and chronic fatigue state of risk-reducing salpingo-oophorectomy in women who are BRCA1/2 mutation carriers: experience from a third level italian center.

Objective: BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic ovarian surgery. These recommendations impact many aspects of their lives. The primary objective of this study was to assess the overall quality of life (HRQoL) before and after prophylactic bilateral salpingo-oophorectomy (BSO). Secondary objectives were investigating sexual health (SH) and fatigue severity state (FSS). Design: This was a single-center, retrospective observational, study. Setting: Women who underwent surgical treatment of bilateral salpingo-oophorectomy between 2018 and 2024 at “DAI Materno Infantile” of Azienda Ospedaliera Universitaria “Federico II” of Naples were included. Methods: These patients were tracked down to undergo specific questionnaires, such as “Global Health Status and Quality of Life Scale (QOL) (EORTC QLQ-C30)”, “EORTC Sexual Health Questionnaire (QLQ-SH22), and “Fatigue Severity Scale (FSS)”, to evaluate their psychological, sexual and general physical condition impact before the surgery, 3 and 6 months later. Results: The overall mean QoL score was 88.3±29.8 (mean + standard deviation), and this score worsened when the surgery was performed at 3 months (p &lt;.0001) with a score of 51.7±30.7 with a mean difference (MD) of 36.6 points; instead, when we evaluated at 6 months, the overall mean QoL score was 73.1±24.3 with an MD of 21.4 points. FSS reported a score of 2.7±1.15 vs 4.2±1.59 (p&lt;.0001) vs 3.5±1.43 (p&lt;.0001), respectively, before and 3-6 months after surgery. EORTC QLQ-SH22 before and after treatment showed statistically significant changes in sexual satisfaction (p&lt;.0001). Conclusion: BSO may impact the quality of life regardless of the hormonal status of patients related to age or menopause, both about the functional evaluation and the psychological and emotional assessment report. The physical change related to the surgical procedure is associated with a mental shift that affects both the physical and sexual energy of our patients in the first 3 months postoperatively, with a slight improvement of these data at 6 months.

Effectiveness of Ginseng on the Symptoms of Depression and Anxiety in Patients Referred to Addiction Treatment Clinics in Ahvaz: A Randomized Clinical Trial

Background: Anxiety and depression are significant factors that can increase the likelihood of concurrent substance use in patients undergoing treatment. Objectives: This study aims to address the gap in knowledge regarding the treatment of anxiety and depression resulting from substance withdrawal by evaluating the effectiveness of ginseng on depression and anxiety symptoms in patients at addiction treatment clinics in Ahvaz. Methods: This research is categorized as applied research and falls under experimental designs for data collection. It was a randomized clinical trial with a pre-test and post-test design involving two groups. The statistical population included all patients visiting addiction treatment clinics in Ahvaz during 2023 - 2024. A total of 68 participants meeting the inclusion and exclusion criteria were randomly assigned to two groups: One receiving ginseng and the other a placebo (34 participants each). One group received 100 mg capsules of ginseng, while the other received a placebo for four weeks. All participants were assessed at the beginning of the study and after the intervention using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Data analysis was conducted using descriptive statistics and analysis of covariance, utilizing SPSS-26 software. Results: The study involved 68 individuals aged 28 to 59 years, with a mean age of 43.22 ± 8.89. The mean ± standard deviation of depression and anxiety in the pre-test of the intervention group was 29.85 ± 6.19 and 25.00 ± 6.06, respectively, and in the placebo group was 27.79 ± 7.21 and 23.91 ± 4.82, respectively. The mean ± standard deviation of depression and anxiety in the post-test of the intervention group was 15.44 ± 11.37 and 12.26 ± 10.40, respectively, and in the placebo group was 11.91 ± 10.83 and 13.32 ± 10.10, respectively. The results indicate no significant difference between post-test and pre-test scores in the intervention group compared to the placebo group (P &gt; 0.05). Conclusions: The results indicate that there was no significant difference in post-test means compared to pre-test means in the intervention group relative to the placebo group. However, further randomized trials with larger sample sizes are necessary for confirmation. Findings should be interpreted with caution.

Nutritional Anemia Reductions Due to Food Fortification Among Women of Childbearing Age: A Literature Review and Bayesian Meta-Analysis.

Food fortification can deliver essential micronutrients to populations at a large scale, thereby reducing nutritional anemia. This study aimed to review and meta-analyze the literature on the impact of wheat flour, maize flour, rice, and oil (singly or combined) fortification on women's (10-49 years) hemoglobin and anemia. A search of 17 databases yielded 2284 results. Longitudinal, pre-post cross-sectional, efficacy, and effectiveness studies were included. Primary outcomes were changes in hemoglobin concentration and anemia prevalence. Studies were synthesized using arm-based network meta-analysis. In women who consumed fortified rice, hemoglobin mean change was 3.24 g/L (95% credibility interval (CrI) 0.9, 5.98), higher than for women in the control, with a 99.1% probability that the true mean difference was > 0. Hemoglobin was 2.08 g/L (95% CrI -0.76, 4.35) higher in women who consumed wheat flour versus control, with a 93.5% probability that the true mean difference was > 0. After rice fortification, anemia prevalence in women was 1.38 percentage points (95% CrI -106.6, 99.2) lower than for control women, with a 51.2% probability that the true mean difference was < 0. Wheat flour fortification decreased anemia prevalence by 1.84 percentage points (95% CrI -93.4, 92.4) with a 52.72% probability that the true mean difference was < 0. The treatment effects of fortified maize flour and fortified oil could not be calculated due to the absence of control arms compared to the intervention arms. Fortified rice and wheat flour appear likely to modestly increase hemoglobin and may also reduce anemia in women of childbearing age.

Comprehensive health assessment of retired martial arts athletes: bone density, dietary intake, physical activity, and wellbeing

Regular physical activity offers benefits like enhanced bone density, which often persists post-retirement. However, retirement can lead to weight gain and changes in quality of life due to reduced physical activity. Therefore, this study investigates the long-term effects of elite athletic experience by comparing retired Jordanian male elite athletes (ages 40–50) with non-athletes of the same age. The differences were explored in weight changes, bone density, quality of life, happiness, stress, insomnia, physical activity, and dietary intake to understand how martial arts impact these health dimensions.MethodsA descriptive case-control study was conducted among 30 retired male elite athletes and 20 age-matched non-athletes. Bone density and body composition were measured using dual-energy X-ray absorptiometry (DEXA) scans. Additional assessments included anthropometric measurements, a 3-day dietary recall, physical activity (International Physical Activity Questionnaire), quality of life (WHOQOL), happiness (Subjective Happiness Scale), stress (Perceived Stress Scale), and insomnia (Insomnia Severity Index).ResultsRetired athletes showed significantly higher Z-scores for the left femur (neck and total) and the AP spine, with p-values &amp;lt;0.05. Among non-athletes, 65% had normal bone density with a Z-score ≥ −1.9 and a T-score &amp;gt; −1.1, 20% had abnormal bone density with a Z-score &amp;lt; −1.9, and 15% had osteopenia with a T-score between −1.1 and −2.4. In contrast, 100% of retired athletes had normal bone density with a Z-score ≥ −1.9 and a T-score &amp;gt; −1.1. Retired athletes exhibited greater weight changes than non-athletes, with a p-value &amp;lt;0.05; the average weight gain among retired athletes was 18.548 kg, and the mean weight gain among non-athletes was 4.3 kg. There were statistically significant mean differences in perceived stress levels between retired athletes and non-athletes with a p-value &amp;lt;0.05. In contrast, there were no statistically significant mean differences between the groups in quality of life, subjective happiness, and the Insomnia Severity Index.ConclusionThe study reveals that retired elite athletes maintain better bone density but face greater weight gain and stress than their non-athlete counterparts. Both groups enjoy a high quality of life and low levels of insomnia. These findings underscore the importance of continued physical activity for health and suggest that both retired athletes and non-athletes should adopt a balanced lifestyle to manage weight and stress effectively.

Pharmacologic Management of Acute Pain in Children

Several pharmacologic options exist for the management of acute pediatric pain; however, their comparative effectiveness remains uncertain. To assess the relative benefits and harms of pharmacotherapy for acute pediatric pain through a network meta-analysis of randomized clinical trials. Cochrane Database of Systematic Reviews, Medline, Embase, CINAHL, Web of Science, and Scopus to October 2023. Trials that enrolled children (aged <18 years) with acute pain and randomized them to receive a pharmacologic analgesic vs an alternate analgesic or placebo were included. Pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. A frequentist random-effects model was used for all meta-analyses, and the certainty of evidence was assessed for treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcomes were pain severity (range, 0-10 cm using a visual analog scale; minimally important difference [MID], 1 cm), need for rescue medication, symptom relief, and adverse drug events. A total of 41 trials involving 4935 children were included. High- to moderate-certainty evidence found that compared with placebo, nonsteroidal anti-inflammatory drugs (NSAIDs) (weighted mean difference [WMD], -1.29; 95% CI, -1.89 to -0.70; modeled risk difference [RD] for achieving the MID, 16%), ketamine (WMD, -1.12; 95% CI, -2.09 to -0.14; modeled RD for achieving the MID, 14%), and mid-high potency opioids (WMD, -1.19; 95% CI, -1.83 to -0.55; modeled RD for achieving the MID, 15%) reduced pain. Only NSAIDs reduced the need for rescue medication (relative risk [RR], 0.31; 95% CI, 0.14 to 0.68; modeled RD, 16% fewer patients). Neither NSAIDs (RR, 0.69; 95% CI, 0.31 to 1.55) nor acetaminophen (RR, 0.63; 95% CI, 0.21 to 1.87) increased the risk of short-term gastrointestinal adverse events. All other comparisons showed moderate-certainty evidence of little to no difference from placebo or were supported by low/very low-certainty evidence. Compared with placebo, NSAIDs, ketamine, and mid- to high-potency opioids are effective in reducing acute pediatric pain. NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children.

The effect of prenatal balanced energy and protein supplementation on gestational weight gain: An individual participant data meta-analysis in low- and middle-income countries.

Understanding the effects of balanced energy and protein (BEP) supplements on gestational weight gain (GWG) and how the effects differ depending on maternal characteristics and the nutritional composition of the supplements will inform the implementation of prenatal BEP interventions. Individual participant data from 11 randomized controlled trials of prenatal BEP supplements (N = 12,549, with 5,693 in the BEP arm and 6,856 in the comparison arm) in low- and middle-income countries were used. The primary outcomes included GWG adequacy (%) and the estimated total GWG at delivery as continuous outcomes, and severely inadequate (<70% adequacy), inadequate GWG (<90% adequacy), and excessive GWG (>125% adequacy) as binary outcomes; all variables were calculated based on the Institute of Medicine recommendations. Linear and log-binomial models were used to estimate study-specific mean differences or risk ratios (RRs), respectively, with 95% confidence intervals (CIs) of the effects of prenatal BEP on the GWG outcomes. The study-specific estimates were pooled using meta-analyses. Subgroup analyses were conducted by individual characteristics. Subgroup analyses and meta-regression were conducted for study-level characteristics. Compared to the comparison group, prenatal BEP led to a 6% greater GWG percent adequacy (95% CI: 2.18, 9.56; p = 0.002), a 0.59 kg greater estimated total GWG at delivery (95% CI, 0.12, 1.05; p = 0.014), a 10% lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.99; p = 0.025), and a 7% lower risk of inadequate GWG (RR: 0.93; 95% CI: 0.89, 0.97; p = 0.001). The effects of prenatal BEP on GWG outcomes were stronger in studies with a targeted approach, where BEP supplements were provided to participants in the intervention arm under specific criteria such as low body mass index or low GWG, compared to studies with an untargeted approach, where BEP supplements were provided to all participants allocated to the intervention arm. Prenatal BEP supplements are effective in increasing GWG and reducing the risk of inadequate weight gain during pregnancy. BEP supplementation targeted toward pregnant women with undernutrition may be a promising approach to delivering the supplements.

Closer look at circulating nitric oxide levels and their association with polycystic ovary syndrome: A meta-analytical exploration

Background: Polycystic ovary syndrome (PCOS) casts a wide shadow over the reproductive health of millions of women worldwide, emerging as one of the most complex and multifaceted endocrine disorders. In addition, nitric oxide (NO) stands out as a pivotal signaling molecule, orchestrating a symphony of physiological processes.Objective: This meta-analysis aims to elucidate the association between NO levels and PCOS, investigate the potential of NO as a biomarker for PCOS diagnosis, and evaluate its clinical significance.Materials and Methods: A systematic review was conducted in several electronic databases, including PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, and Google Scholar, to identify relevant studies published up to January 2024. Standardized mean difference and 95% CI were calculated using a random effects model to assess the overall effect size. Meta-regressions and subgroup analysis were performed to investigate sources of heterogeneity.Results: A meta-analysis of 14 studies with 1171 participants showed that NO levels were significantly lower in the PCOS group than in the control group. The pooled analysis yielded a standardized mean difference of -0.482; 95% CI: -0.908 to -0.056; p = 0.027. Subgroup analyses further demonstrated variations in NO levels between different PCOS phenotypes and in relation to metabolic parameters.Conclusion: This meta-analysis provides evidence for an association between PCOS and dysregulated NO levels and suggests a potential role of NO as a biomarker in the diagnosis and pathogenesis of PCOS.

Evaluating the safety of robotic total gastrectomy with D2 lymphadenectomy for gastric cancer against the conventional laparoscopic approach: a systematic review and meta-analysis.

Gastric cancer poses a significant global health challenge, necessitating effective surgical interventions. A critical gap in the literature exists, as most studies do not differentiate between various surgical approaches, i.e., total, distal, and subtotal gastrectomy, and level of lymphadenectomy, when comparing robotic to conventional laparoscopic gastrectomy. This leads to a lack of clear evidence regarding the safety and efficacy of robotic total gastrectomy (RTG) specifically in the context of total gastrectomy with D2 lymphadenectomy.This systematic review and meta-analysis evaluates the safety of RTG with D2 lymphadenectomy compared to conventional laparoscopic total gastrectomy (LTG). A literature search was conducted up to November 1, 2024, following PRISMA guidelines. Eligible studies included studies comparing RTG and LTG, focusing on anastomotic leakage, Clavien-Dindo Grade ≥ III complications, conversion rates, mortality, overall complications, and reoperation rates. Data were synthesized using odds ratios (OR) and weighted mean differences (WMD), with statistical heterogeneity assessed using the I2 statistic. Five studies comprising 1131 patients (432 RTG, 700 LTG) were included. No significant differences were found in the following outcomes: anastomotic leakage (OR = 0.79 [95% CI: 0.35, 1.78], I2 = 0%, P = 0.57), Clavien-Dindo Grade ≥ III complications (OR = 0.86 [95% CI: 0.51, 1.45], I2 = 0%, P = 0.56), conversion to open surgery (OR = 0.34 [95% CI: 0.10, 1.18], I2 = 0%, P = 0.09), mortality (OR = 1.78 [95% CI: 0.23, 13.48], I2 = 0%, P = 0.58), overall complications (OR = 0.84 [95% CI: 0.62, 1.14], I2 = 0%, P = 0.26), and reoperation rates (OR = 0.88 [95% CI: 0.29, 2.67], I2 = 0%, P = 0.82). Sensitivity analysis proves the robustness of the findings. The analysis shows no significant differences in safety outcomes between RTG and LTG for gastric cancer, indicating both techniques are comparable. RTG may be a viable alternative to LTG, especially in centers with appropriate robotic capabilities. Further research is warranted to investigate long-term outcomes and the learning curve of robotic surgery.PROSPERO Registration: CRD42024606570.

Accuracy of Visual Estimation of Left Ventricular Ejection Fraction Compared With Echocardiography in Children.

This study compared visual assessments of left ventricular systolic function in children by pediatric physicians with quantitative measurements using the Simpson method. This was a transverse, cohort study conducted between January and June 2023. Patient's echocardiography were performed by a certified pediatric cardiologist in the presence of 2 pediatricians: a senior pediatric intensivist (S.Z.) and a pediatric resident (A.D.). Both pediatricians had prior training in cardiac ultrasound. Following the visual assessment of the echocardiography, each pediatrician records their evaluation of the left ventricular ejection fraction (LVEF) as a percentage. We compared the visual assessment of LVEF with that obtained with quantitative measurements using the Simpson method by the pediatric cardiologist. Bland-Altman analysis was performed between the pediatrician and the cardiologist's LVEF evaluation. Besides the correlation coefficients (r) were calculated. A total of 136 patients, aged between 0 and 18 years, were enrolled. The mean LVEF measured by the cardiologist was 65.05±14.15. The mean LVEF estimated by the senior pediatrician and the pediatric resident was 64.48±13.59 and 64.87±13.17, respectively. Strong correlations were found between visual estimates by both pediatricians and 2-dimensional LVEF (r=0.832 and r=0.763 respectively, P<0.001). The bland-Altman plot showed that the mean difference of LVEF determined by 2-dimensional LVEF and eyeballing by a senior pediatric intensivist and the junior pediatrician was 0.57±3.64% and 0.18±4.37%, respectively. The study suggests that visual assessment of LVEF in children is reliable when conducted by experienced pediatricians familiar with echocardiography. However, the results of this study are primarily applicable to the assessment of normal or near-normal left ventricular function.

Acceptance and Commitment Therapy Eczema Management Program for Children With Eczema: A Pilot Randomised Controlled Trial.

Eczema significantly affects the quality of life of affected children and their families, with psychological stress often overlooked. Acceptance and Commitment Therapy (ACT) provides a supplementary approach to address these psychological challenges and enhance overall care. This pilot randomised controlled trial aimed to examine the feasibility, acceptability and preliminary effectiveness of the Family ACT-based Eczema Management Program (FACT-EMP). Parents and children aged 6-12 diagnosed with eczema from three outpatient clinics in Hong Kong were randomly assigned to either the FACT-EMP group, receiving four weekly ACT-based sessions plus eczema management education, or a waitlist control group receiving routine care. Feasibility and acceptability were assessed through recruitment, retention and completion rates, supplemented by focus group feedback on parental experiences. Primary clinical outcomes were children's eczema Severity Scoring of Atopic Dermatitis (SCORAD) and parental self-efficacy. Secondary outcomes included parental distress, quality of life, psychological flexibility and self-compassion of both parents and children. From July 2021 to June 2023, 181 of 944 screened parent-child dyads met the inclusion criteria, and 78 were randomised and analysed (parents' mean [SD] age, 41.3 [11.0] years; 70 mothers [89.7%]; children's mean [SD] age, 8.3 [1.9] years; 53 boys [67.9%]). Recruitment, retention and completion rates were 43.1%, 87.2% and 76.9%, respectively. No significant between-group differences in SCORAD scores were observed immediately post-intervention. At 3-month post-intervention, SCORAD scores decreased significantly more in the FACT-EMP group than in the waitlist control group (adjusted mean difference, aMD, -7.73; 95% CI, -13.92 to -1.54). Parental self-efficacy scores also improved significantly more in the FACT-EMP group than the control, with an aMD of 18.69 (95% CI, 13.80 to 33.58) immediately post-intervention and 28.90 (95% CI, 13.93 to 43.84) at 3 months. FACT-EMP is potentially feasible, acceptable and effective in improving children's eczema symptoms and enhancing parents' self-efficacy in disease management over 3 months. NCT04919330.

Short-Term Metformin Protects Against Glucocorticoid-Induced Toxicity in Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled Trial.

Glucocorticoids (GCs) are potent anti-inflammatory drugs, but strategies to prevent side effects are lacking. We investigated whether metformin could prevent GC-related toxicity and explored the underlying mechanisms. This single-center, randomized, placebo-controlled, double-blind, crossover trial compared metformin with placebo during high-dose GC treatment in 18 lean, healthy, male study participants. The trial was conducted at the University Hospital Basel, Switzerland. Participants received prednisone 30 mg/d in combination with metformin or placebo for two 7-day periods (1:1 randomization). The primary outcome, change in insulin sensitivity, was assessed using a two-sided paired t test. Before and after each study period, we conducted a mixed-meal tolerance test, blood metabolomics, and RNA sequencing of subcutaneous adipose tissue biopsy specimens. Metformin improved insulin sensitivity as assessed by the Matsuda index (n = 17; mean change: -2.73 ± 3.55 SD for placebo, 2.21 ± 3.95 for metformin; mean difference of change -4.94 [95% CI, -7.24, -2.65)]; P < 0.001). Metabolomic and transcriptomic analyses revealed that metformin altered fatty acid flux in the blood and downregulated genes involved in fatty acid synthesis in adipose tissue. Metformin reduced markers of protein breakdown and bone resorption. Furthermore, metformin downregulated genes responsible for AMPK inhibition and affected GLP1 and bile acid metabolism. Metformin prevents GC-induced insulin resistance and reduces markers of dyslipidemia, myopathy, and, possibly, bone resorption through AMPK-dependent and -independent pathways.

Effect of Ultrasound Combined with Dry Needling on Myofascial Pain in the Upper Trapezius : a Controlled Randomised Study

INTRODUCTION. Myofacscial Pain Syndrome (MPS) Upper trapezius is a condition of tightness in the upper trapezius characterized by the appearance of myofascial trigger points in the upper trapezius muscle fibers. This causes pain and decreased elastitrapezius muscle fibers, resulting in cervical motion limitations. AIM. To determine the effect of the addition of ultrasound to Dry needling intervention on reducing pain and increasing cervical range in the condition of upper trapezius MPS. MATERIALS AND METHODS. This type of research is a quasi-experiment with a randomized pre-test-post-test control group design that uses 2 sample groups, where the treatment group is given Ultrasound Therapy and Dry needling intervention, and the control group is given Dry needling intervention only. The sample obtained was 30 people according to the inclusion criteria, then randomized into 2 groups, namely 15 people in the treatment group and 15 people in the control group. Data collection was obtained through measurement of tenderness using Visual Analog Scale (VAS) and measurement of Range of Motion (ROM) using a goniometer. RESULTS AND DISCUSSION. Based on the independent sample t-test for the VAS scale, the value of p = 0.619 (mean difference of 3.767 control 3.553 treatment), and based on the Mann-Whitney test, the value of p = 0.074 for flexion ROM (mean difference of 17.00 control 12.33 treatment), p = 0.311 for lateral flexion ROM (mean difference of 9.33 treatment 8.00 control), and p = 0.494 for rotation ROM (mean difference of 13.33 treatment 11.67 control), which means that there is no significant difference in effect between the treatment and control groups. CONCLUSION. The addition of ultrasound to the dry needling intervention resulted in an increase of 9.33 in lateral flexion and 13.33 in rotation which means this number is greater when compared to dry needling alone with an increase of 8.00 in lateral flexion and 11.67 in rotation. However, the addition of ultrasound did not result in a decrease in tenderness and a greater improvement in cervical flexion where the value of 3.767 in dry needling alone compared to the value of 3.553 in the addition of ultrasound and 17.00 12.33.

Impact of walnut consumption on glycemic control and anthropometric indices: a systematic review and meta-analysis of randomized controlled trials.

Previous studies have led to conflicting results regarding the effect of walnut consumption on glycemic control, and anthropometric indices. This study aimed to evaluate the efficacy of walnut consumption on serum levels of fasting blood sugar (FBS), fasting insulin, hemoglobin A1C (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), weight and body mass index (BMI) through a systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Scopus, Web of Science, and the Cochrane databases were searched up to February 2023. Weighted mean difference (WMD) was analyzed using random effects models to assess the overall effect. A total of thirty-two RCTs were included in the systematic review and meta-analysis. Walnut supplementation was found to significantly reduce HOMA-IR (WMD = -0.29; 95% CI: -0.57, -0.01, P = 0.04), and body weight (WMD = -0.14kg; 95% CI: -0.24, -0.04; P = 0.008). However, the meta-analysis showed that walnut supplementation did not have a significant effect on FBS (WMD = 0.62 mg/dL; 95% CI: -0.66, 1.91; P = 0.34), insulin levels (WMD = 1.27 mIU/ml; 95% CI: -0.59, 3.14; P = 0.18), HbA1C (WMD = 0.00%; 95% CI: -0.09, 0.10; P = 0.95), and BMI (WMD = -0.10 kg/m2; 95% CI: -0.40, 0.20; P = 0.50). In conclusion, this study found a significant reduction in HOMA-IR levels and body weight with walnut supplementation, while other glycemic markers, and obesity-related indices did not change significantly. Future well-designed trials are needed to confirm these results.

Pengaruh Model Pembelajaran Creative Problem Solving (CPS) Terhadap Pemahaman Konsep Peserta Didik pada Pembelajaran Fisika di SMA Negeri 1 Ampek Angkek

This study aims to determine the influence of the creative problem solving (CPS) learning model on students' understanding of physics concepts in physics learning in class XI phase F at SMA N 1 Ampek Angkek. This study utilizes a quantitative approach with the type of Quasi Experiment Design. The research instrument is in the form of multiple-choice questions with five possible answers. Before the test is given, the instrument will be tested for validity, reliability, difficulty level and differentiation first. A total of 72 physics students of eleventh grade phase F participated in this study; 32 from the experimental group and 36 from the control group. The data analysis techniques used are normality tests, homogeneity, and mean difference tests. The findings of the study show that the application of the CPS learning model affects students' understanding of concepts. Both groups of students who use the direct learning model and those who use the CPS model have a significance value of &lt;0.05 in the statistical analysis carried out using the t-test.

AI-Assisted Physiotherapy for Patients with Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis

Background: Non-specific low back pain (LBP) is a widespread condition with significant impacts on physical activity, muscle strength, psychological well-being, and economic status. Traditional physiotherapy shows variable efficacy, prompting growing interest in AI-assisted physiotherapy for its potential to offer personalized feedback and multidisciplinary care integration. Objective: This systematic review and meta-analysis aimed to evaluate AI-assisted physiotherapy’s effectiveness in reducing pain intensity and functional impairment and improving mental health compared to usual physiotherapy. Method: A comprehensive search strategy was employed across Embase, MEDLINE, Cochrane Library, and Web of Science databases from inception to 30 May 2024. Comparative studies were identified and screened using PICOS criteria. Data extraction involved detailed study characteristics and outcomes, with methodological quality assessed via the Cochrane Risk of Bias tool. Meta-analyses using random-effects models calculated standardized mean differences (SMDs). Results: Eight studies met the inclusion criteria. Compared to usual physiotherapy, AI-assisted physiotherapy did not demonstrate any statistically significant differences in outcomes across the aspects studied, including pain intensity (SMD = −0.2711, 95% CI: −0.5109 to −0.0313, p = 0.267), functional impairment (SMD = −0.2508, 95% CI: −0.5574 to 0.0559, p = 0.1089), and mental health (SMD = −0.0328, 95% CI: −0.1972 to 0.1316, p = 0.6956). These findings indicate that AI-assisted physiotherapy had no demonstrable additional effect compared to usual physiotherapy for patients with LBP. Sensitivity analyses were conducted to address inter-study heterogeneity, confirming the robustness of these results. Conclusions: While AI-assisted physiotherapy shows potential in managing LBP by providing personalized treatment and feedback, the current evidence does not demonstrate significant advantages over usual physiotherapy. Further large-scale, long-term, and methodologically rigorous randomized controlled trials are necessary to validate these findings, assess their clinical relevance, and explore broader public health applications.

Early exclusive enteral feeding in 30-33 weeks gestation infants: a randomized controlled trial.

To evaluate feasibility and efficacy of early exclusive enteral feeding (EEEF) in reducing time to achieve full enteral feeds. A pragmatic randomized controlled trial of infants born at 300/7-336/7 weeks gestation. Infants were randomly assigned to receive EEEF (60-80 mL/kg/day) or conventional feeding (20-30 mL/kg/day) with intravenous fluids after birth. Feed volumes were increased by 20-30 mL/kg/day. Primary outcome was time to reach full enteral feeds. Seventy infants were enrolled. Infants in EEEF group achieved full feeds sooner [Mean difference (MD) -1.2 (95%CI -1.8, -0.7)], required fewer hours of parenteral nutrition [0 (IQR 0, 19) vs. 91 (IQR 48, 132) hours, P < 0.001], had less need for central venous access (11.4% vs. 37.1%, P = 0.01) and had shorter hospital stays [MD -6.6 (95%CI -12.9, -0.2) days]. Early exclusive enteral feeding in 300/7-336/7 weeks gestation infants is feasible and reduces time required to achieve full enteral feeds and length of hospital stay. ClinicalTrials.gov: NCT03708068.