Medical Factors Research Articles

Penerapan Bentuk Dinamis Dalam Membangun Suasana Pada Ruang Tunggu RSUD Pandega Pangandaran

The interior design of hospital waiting rooms plays a crucial role in providing comfort and reducing stress for patients and visitors. In a medical environment, the psychological and physical factors of waiting room design can significantly impact the overall user experience. This study aims to explore and implement dynamic design forms in the waiting room of RSUD Pandega Pangandaran to enhance user experience quality. The methodology employed in this research includes field observations to understand the existing conditions, in-depth interviews with users to identify their needs and preferences, and a comprehensive literature review on dynamic interior design, ergonomic principles, and environmental psychology theories. The findings of the study indicate that the use of dynamic forms, combined with soothing color elements, optimal natural and artificial lighting, and ergonomic and flexible furniture arrangements, can significantly improve the comfort and satisfaction of waiting room users. This study emphasizes the importance of a holistic approach in designing hospital waiting rooms that not only focuses on aesthetics but also on functional and psychological aspects to create a more humane environment that supports the healing process

The Efficacy of Medical Interventions for Free-Floating Thrombus in Cerebrovascular Events: A Systematic Review.

Although free-floating thrombus (FFT) poses a significant risk of stroke or transient ischemic attack (TIA), optimal management strategies are uncertain. To determine the state-of-the-art of medical interventions for FFT, we conducted a systematic review of the efficacy of various medical interventions and factors influencing FFT resolution and recurrence. A comprehensive search of Embase, PubMed, and ScienceDirect identified 61 studies encompassing 179 patients with FFT-related stroke or TIA treated with anticoagulants, antiplatelets, or their combinations. Primary outcomes assessed were stroke recurrence and thrombus resolution. Statistical analyses (Fisher's exact test, chi-square test, Mann-Whitney test, and Kruskal-Wallis test) utilized significance set at p < 0.05. Over a median follow-up of 7 months, thrombus resolution occurred in 65% of patients, while 11.2% experienced recurrence, primarily as TIAs. Cardioembolism was significantly less common in resolved cases (p = 0.025). Combination therapy (antiplatelets, anticoagulants, and statins) significantly enhanced clot resolution (OR 11.4; 95% CI 1.436-91.91; p = 0.021) compared to monotherapies. Ulcerated plaque was a significant predictor of recurrence (OR 8.2; 95% CI 1.02-66.07; p = 0.048). These findings underscore the superiority of combination therapy in FFT management and highlight the need for targeted interventions in patients with ulcerated plaques to mitigate recurrence risk.

Assessing Risk Factors for Cognitive Decline Using Electronic Health Record Data: A Scoping Review.

The data and information contained within electronic health records (EHR) provide a rich, diverse, longitudinal view of real-world patient histories, offering valuable opportunities to study antecedent risk factors for cognitive decline. However, the extent to which such records' data have been utilized to elucidate the risk factors of cognitive decline remains unclear. A scoping review was conducted following the PRISMA guideline, examining articles published between January 2010 and April 2023, from PubMed, Web of Science, and CINAHL. Inclusion criteria focused on studies using EHR to investigate risk factors for cognitive decline. Each article was screened by at least two reviewers. Data elements were manually extracted based on a predefined schema. The studied risk factors were classified into categories, and a research gap was identified. From 1,593 articles identified, 80 were selected. The majority (87.5%) were retrospective cohort studies, with 66.3% using datasets of over 10,000 patients, predominantly from the US or UK. Analysis showed that 48.8% of studies addressed medical conditions, 31.3% focused on medical interventions, and 17.5% on lifestyle, socioeconomic status, and environmental factors. Most studies on medical conditions were linked to an increased risk of cognitive decline, whereas medical interventions addressing these conditions often reduced the risk. EHR data significantly enhanced our understanding of medical conditions, interventions, lifestyle, socioeconomic status, and environmental factors related to the risk of cognitive decline.

Public healthcare efficiency in India: Estimates and determinants using two stage DEA approach

BackgroundNearly 400 million Indians (30 % of the total population) lack any financial protection for health which leads to very high out of pocket expenditure. In India more than 90 million people spend 10–25 % of household expenses on healthcare. This is a serious threat to Sustainable Development Goal 3, which aims at providing universal health coverage along with protection from catastrophic spending on health. AimThe aim of this paper is to estimate the efficiency and determinants of public health in India at subnational level. MethodsTo estimate the efficiency of public healthcare, input oriented bias corrected DEA model has been used. In this model life expectancy at birth and infant survival rate have been treated as outputs. Public health spending and per capita income are treated as inputs. In the second stage Tobit regression is used to analyse the determinants of efficiency. ResultsThe mean bias corrected efficiency score across Indian states is 0.60, implying that on average there is a 40 % inefficiency in public healthcare in India. Maharashtra and Mizoram are the most and least efficient states with efficiency score of 0.921 and 0.218, respectively. Fourteen states have efficiency scores less than 0.60, two states have efficiency score of 0.60 and 15 states have the efficiency score greater than 0.60. Socio economic factors outweigh the medical factors in determining the public healthcare efficiency in India. ConclusionThere are 40 % inefficiencies in public health in India implying significant wastages in public health. By improving public health efficiency, there would be savings of 48 % in terms of government expenditure on health per capita. It will also improve infant survival rate by 27.19 % and life expectancy by 20.65 %.

Experiences of community reintegration after obstetric fistula repair at Jean Paul 2 hospital, Conakry, Guinea.

The study explored women's experiences of their community reintegration process after surgical repair of obstetric fistula at Jean Paul 2 Hospital in Conakry, Guinea. The study examined how lived experiences of the disease impacted on the community reintegration of treated women. Using a qualitative research methodology, ten women participated after giving informed consent. Semi- structured interviews, lasting an average of 30 to 60 minutes were guided by an interview guide. The main themes covered were experiences with the disease, perceived social support and reintegration into the community. According to the participants, delays in obstetric care were the main cause of obstetric fistula. Socio- economic, cultural and medical factors such as early marriage, lack of education and poverty contributed to these delays. Even after surgical repair, women continued to endure the physical and psychosocial consequences of the disease, exposing them to stigma, discrimination and even rejection within the community. Study participants also reported a lack of social support. The little support perceived by these women concerned food and medical needs. This made the women dependent on their families. Reintegration into the community also proved difficult due to the persistent silence and stigma surrounding their situation. The study results highlight the complexity of the challenges faced by women with obstetric fistula in their journey towards integration. Effective management of obstetric fistula requires a holistic approach victims, their communities, health professionals and decision-makers in solving this problem. So, to improve women's reintegration after treatment for obstetric fistula, it is vital to raise awareness of the causes and consequences of the disease among the women concerned and their families, and to provide rapid access to emergency obstetric care, reinforce social support and set up economic empowerment programs.

Willingness to trade-off years of life for an HIV cure – an experimental exploration of affective forecasting

BackgroundIn the US, 1.2 million people live with HIV (PWH). Despite having near-normal life expectancies due to antiretroviral therapy (ART), many PWH seek an HIV cure, even if it means risking their lives. This willingness to take risks for a cure raises questions about “affective forecasting biases,” where people tend to overestimate the positive impact of future events on their well-being. We conducted a study to test two interventions to mitigate affective forecasting in the decisions of PWH about taking HIV cure medication.MethodsWe recruited PWH to complete a 30-minute survey about their current quality of life (QoL) and the QoL they anticipate after being cured of HIV, and assigned them to either no additional intervention, to one of two interventions intended to reduce affective forecasting bias, or to both interventions: (1) a defocusing intervention designed to broaden the number of life domains people consider when imagining life changes associated with new circumstances (e.g. HIV cure); and (2) an adaptation intervention to help them gauge fading of strong emotions over time. The study design included a 2 × 2 design: defocusing (yes/no) x adaptation (yes/no) intervention. We assessed PWH’s willingness to take hypothetical HIV sterilizing cure medication using the Time Trade-Off (TTO) and their quality of life predictions with WHOQOL-HIV.Results296 PWH participated. Counter to what we had hypothesized, neither intervention significantly reduced PWH’s willingness to trade time for a cure. Instead, the defocusing intervention increased their willingness to trade time (IRR 1.77, p = 0.03). Exploratory analysis revealed that PWH with lower current quality of life who received the defocusing intervention were more willing to trade time for a cure.ConclusionThese negative findings suggest that either these biases are difficult to overcome in the settings of HIV curative medication or other factors beyond affective forecasting biases influence willingness to participate in HIV curative studies, such as respondents’ current quality of life.

Prediction of Functional Academic Outcomes by Fine Motor Skills in Individuals With Sickle Cell Disease.

Individuals with sickle cell disease (SCD) are at heightened risk of poor neurocognitive and academic outcomes. The relationship between fine motor skills and academic outcomes is not well understood. To compare the fine motor skills of individuals with SCD with normative expectations, test whether demographic and medical factors are associated with fine motor performance, and determine the impact of fine motor performance on academic performance. Cross-sectional. St. Jude Children's Research Hospital. Individuals with SCD (N = 376; ages 8-24 yr). Fine motor outcomes included visual-motor integration, manual dexterity, and graphomotor speed. Academic outcomes included math fluency and word reading. Demographic and medical variables were obtained via medical records and interviews. Compared with normative expectations, the performance of individuals with SCD on all fine motor measures was lower than expected. Male sex, lower socioeconomic status, and lower oxygen saturation was associated with slower graphomotor speed. Lower socioeconomic status and older age were associated with lower visual-motor integration scores. Performance on all fine motor measures was positively associated with math fluency and word reading. Individuals with SCD exhibited poorer than expected fine motor skills across multiple motor domains, and these deficits were associated with poorer academic outcomes. Early referral to intervention services for fine motor skills may facilitate improved academic outcomes for individuals with SCD. Plain-Language Summary: This study had three objectives: (1) Compare the fine motor skills of people with sickle cell disease (SCD) with normative expectations, (2) test whether demographic and medical factors are associated with fine motor performance, and (3) determine the impact of fine motor performance on academic performance. We found that SCD is a risk factor for lower than expected fine motor performance across multiple fine motor domains and that these deficits also affect functional academic skills.

Calcium Pyrophosphate Crystal Deposition: Insights to Risks Factors and Associated Conditions.

This review provides an overview of medical conditions and risk factors associated with CPPD. Recent studies have indicated that CPPD patients may have a higher risk for systemic conditions such as cardiovascular diseases. Calcium pyrophosphate deposition disease (CPPD) is a common crystal arthropathy that primarily affects older adults, and, in most cases, the aetiology is idiopathic. Age is the most remarkable risk factor and due to the aging population, the prevalence of this condition is expected to increase. Strong evidence supports an association between CPPD and several metabolic and endocrine conditions, including hemochromatosis, hyperparathyroidism, hypomagnesemia, and hypophosphatasia. Additionally, there is growing evidence of an increased risk for cardiovascular diseases among CPPD patients, alongside potential links to rheumatic disorders, gender, medications, and joint trauma. Further research is needed to explore the underlying mechanisms linking CPPD to associated conditions and to develop targeted therapies with the aim of improving patient outcomes.

A Survey on End-of-Life Contemplation Among Patients on Dialysis

Considering that mortality among patients on dialysis is high, it would be advisable for patients, relatives, and care givers to acknowledge that after dialysis initiation for many patients, the last phase in life has begun. We sought to investigate the frequency of precautionary planning directives, contemplation about the end-of-life (EOL) and embedding of patients' wishes in the interaction with relatives and the treating nephrologists. In a questionnaire-based interview survey, we investigated the frequency of precautionary planning, EOL wishes, and frequency of relatives' or medical professionals' conversations with patients about those wishes as well as possibly associated demographic, socioeconomic and medical factors. The interviews were conducted by a single investigator in 7 dialysis centers in Germany. From 349 identified patients, 268 (77%) participated. The participants (36% female) had a median age of 70 (interquartile range [IQR]: 58-80) years and had spent a median of 3 (IQR: 1-7.5) years on dialysis. Overall, 46% of patients on dialysis contemplated their EOL wishes at least occasionally. Of those, 85% talked about EOL wishes with their relatives, whereas 19% discussed them with their nephrologists, yet another 28% would like to have such a discussion with their nephrologist. Almost half of patients on dialysis contemplate their EOL and the vast majority engage in discussions about that with their relatives. Despite patients being interested, the frequency of consultation of nephrologists on EOL care is low. This study suggests that there is a substantial but unmet need for EOL care consultation for patients on dialysis.

Cervicovaginal foetal fibronectin in predicting success of induced labour among nulliparous women: a systematic review

Background The global rates of labor induction continue to exhibit a surge, attributed to a range of medical, obstetric, and non-medical factors. Although the Bishop score is often used to assess cervical preparation, its ability to accurately predict outcomes, particularly in nulliparous women with an unfavorable cervix, is still unknown. Method A complete review of the literature was undertaken, including PubMed, EMBASE, Cochrane Library, and Google Scholar databases, with the search period extending until April 2023. The studies included in this analysis focused on investigating the predictive value of fFN concerning induced labor outcomes in nulliparous women. The process of data extraction primarily concentrated on the features of the study, interventions, controls, criteria for inclusion and exclusion, and the outcomes that were evaluated. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results The review synthesized findings from five studies, revealing varied predictive values of fFN. Sciscione et al. (2005) reported no significant difference in vaginal delivery rates between positive and negative fFN groups (Positive fFN: 55.8% vs. Negative fFN: 53.3%; P &gt; .70). Uygur et al. (2016) found a higher cesarean section rate in patients with negative fFN results (P = 0.002). Reis et al. (2003) highlighted that higher parity and Bishop scores were more predictive than fFN alone (P = .021 for funneling; P = .157 for fFN presence). Grab et al. (2022) and Khalaf et al. (2023) further corroborated fFN's role in predicting labor outcomes, with the latter study demonstrating high sensitivity (85%), specificity (80%), and accuracy (82.6%) in predicting successful labor induction (P &lt; .05 for Bishop score relation with fFN; P = 0.029 for positive vs. negative fFN). Conclusion This systematic review validated that fFN is a significant biomarker for predicting labor induction outcomes, especially in nulliparous women. The combination of additional clinical factors with fFN has been shown to boost its prediction accuracy, indicating the need for a personalized strategy to labor induction.

Social participation of women with breast cancer compared to the general population 5 years after primary surgery—what role do medical data and cancer-related complaints play?

PurposeThis study analyzes levels of social participation in patients with breast cancer on average 5 years following primary surgery as compared to women in the general population. In addition, the role of breast cancer-related complaints and medical data as possible influencing factors on levels of patients’ social participation is investigated.MethodsA total of n = 454 patients after primary surgery (t0) were recruited for a third follow-up study, and n = 372 completed this survey (t3), corresponding to a response rate of 82.2%. For measuring breast cancer-related complaints, participants completed a written questionnaire. Social participation was measured by a questionnaire on different leisure activities that was taken from the Socio-Economic Panel Study. Medical information was extracted from medical reports at t0. A principal component analysis was carried out to identify different dimensions of social participation. Chi2-tests and logistic regression analyses were applied to analyze social participation as compared to the general population and the role of possible medical and diagnosis-related influencing factors thereby.ResultsCompared to the general population, patients show lower levels of social participation in the domains “socio-cultural participation” and “participation in institutions,” while no significant differences for “social participation in the private sphere” and “social participation via social media” were found. Psychological symptoms, pain, and a history of mastectomy were most strongly associated with restrictions in social participation.ConclusionsOur study suggests that social withdrawal may happen due to disease-related symptoms, preventing some breast cancer patients from participating fully in society. Cancer-related follow-ups should address this issue and support patients’ reintegration into society through appropriate therapeutic interventions.

Academy of Breastfeeding Medicine Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Period (Revised 2024).

Background: The Academy of Breastfeeding Medicine revised the 2015 version of this clinical protocol to review the evidence and provide recommendations related to breastfeeding promotion in the prenatal period. Key Information: Promoting and normalizing breastfeeding in the prenatal period can improve breastfeeding outcomes including initiation and duration of breastfeeding. Ideally, prenatal interventions should be a part of a comprehensive longitudinal breastfeeding support program. Recommendations: Clinicians or other health workers should discuss breastfeeding at each prenatal visit. Counseling topics should include the health benefits of breastfeeding versus not breastfeeding, the basics of breastfeeding (e.g., physiology, positioning), what to expect of hospital-based and immediate postpartum breastfeeding support (i.e., Baby-Friendly Ten Steps), and the risks of unnecessary supplementation. Medical, anatomical, and other risk factors for breastfeeding challenges should be identified, and targeted anticipatory guidance should be given. Prenatal counseling should include distribution of structured breastfeeding education at low literacy levels and in the parent's preferred language. Counseling should be culturally sensitive and patient-centered, including family members when appropriate. Prenatal support may integrate various health workers (e.g., medical doctors, midwives, community health workers, lactation consultants, among others) and include various modalities including telecommunication. Enhancing breastfeeding education for prenatal care providers is also imperative. Additional themes related to implementation of recommendations for specific populations are also reviewed.

Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression.

Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). University degrees were associated with lower incidence (aNIR=0.253, 95% confidence interval [CI]=[0.221 to 0.289], p<0.001), while black participants had a higher incidence (aNIR=1.995, [1.858 to 2.141], p<0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.

Insulin Resistance in Women Correlates with Chromatin Histone Lysine Acetylation, Inflammatory Signaling, and Accelerated Aging.

Epigenetic changes link medical, social, and environmental factors with cardiovascular and kidney disease and, more recently, with cancer. The mechanistic link between metabolic health and epigenetic changes is only starting to be investigated. In our in vitro and in vivo studies, we performed a broad analysis of the link between hyperinsulinemia and chromatin acetylation; our top "hit" was chromatin opening at H3K9ac. Building on our published preclinical studies, here, we performed a detailed analysis of the link between insulin resistance, chromatin acetylation, and inflammation using an initial test set of 28 women and validation sets of 245, 22, and 53 women. ChIP-seq identified chromatin acetylation and opening at the genes coding for TNFα and IL6 in insulin-resistant women. Pathway analysis identified inflammatory response genes, NFκB/TNFα-signaling, reactome cytokine signaling, innate immunity, and senescence. Consistent with this finding, flow cytometry identified increased senescent circulating peripheral T-cells. DNA methylation analysis identified evidence of accelerated aging in insulin-resistant vs. metabolically healthy women. This study shows that insulin-resistant women have increased chromatin acetylation/opening, inflammation, and, perhaps, accelerated aging. Given the role that inflammation plays in cancer initiation and progression, these studies provide a potential mechanistic link between insulin resistance and cancer.

Ambient Air Pollution Exposure and Adverse Outcomes Among Medicare Beneficiaries With Heart Failure.

Exposure to fine particulate matter (<2.5 um, particulate matter with an aerodynamic diameter <2.5 microns [PM2.5]) has been implicated in atherogenesis. Limited data in animal studies suggest that PM2.5 exposure leads to myocardial fibrosis and increased incidence of heart failure (HF). Whether PM2.5 is associated with adverse outcomes in patients with preexisting HF has not been widely studied. In this retrospective cohort study, Medicare patients hospitalized with first HF between 2013 and 2020 were identified from the Medicare Provider Analysis and Review Part A 100% files. Patients were linked with integrated estimates of ambient PM2.5 obtained at 1×1 km using the zip code of participants' residence. The study outcomes were all-cause death, HF, and all-cause readmissions burden. A total of 2 599 525 patients were included in this study, with 6 321 731 person-years of follow-up. Mean PM2.5 was 7.3±1.7 μg/m3. Each interquartile range of PM2.5 was associated with 0.9% increased hazard of all-cause death, 4.5% increased hazard of first HF readmission, 3.1% increased risk of HF hospitalization burden, and 5.2% increase in all-cause readmission burden, after adjusting for 11 sociodemographic and medical factors. Subgroup analyses showed that the effects were more pronounced at levels <7 μg/m3 and in patients aged <75 years, Asians, and those residing in rural areas. Ambient air pollution is associated with higher risk of adverse events in Medicare beneficiaries with established HF. These associations persist below the National Air Quality Standards (12 μg/m3), supporting that no threshold effect exists for health effects of air pollution exposure.

J-shaped associations of pan-immune-inflammation value and systemic inflammation response index with stroke among American adults with hypertension: evidence from NHANES 1999-2020.

Stroke, a leading cause of death and disability worldwide, is primarily ischemic and linked to hypertension. Hypertension, characterized by systemic chronic inflammation, significantly increases stroke risk. This study explores the association of novel systemic inflammatory markers (SII, PIV, SIRI) with stroke prevalence in hypertensive U.S. adults using NHANES data. We analyzed data from hypertensive participants in the NHANES 1999-2020 survey, excluding those under 20, pregnant, or with missing data, resulting in 18,360 subjects. Systemic inflammatory markers (SII, PIV, SIRI) were calculated from blood counts. Hypertension and stroke status were determined by self-report and clinical measurements. Covariates included sociodemographic, lifestyle, and medical history factors. Weighted statistical analyses and multivariate logistic regression models were used to explore associations, with adjustments for various covariates. Ethical approval was obtained from the NCHS Ethics Review Board. In a cohort of 18,360 hypertensive individuals (mean age 56.652 years), 7.25% had a stroke. Stroke patients were older, had lower PIR, and were more likely to be female, single, less educated, smokers, non-drinkers, physically inactive, and have diabetes and CHD. Multivariate logistic regression showed that SII was not significantly associated with stroke. However, PIV and SIRI were positively associated with stroke prevalence. Each unit increase in lnPIV increased stroke odds by 14% (OR = 1.140, p = 0.0022), and lnSIRI by 20.6% (OR = 1.206, p = 0.0144). RCS analyses confirmed J-shaped associations for lnPIV and lnSIRI with stroke. Stratified analyses identified gender and smoking as significant effect modifiers. Smoking was significantly associated with elevated PIV, SIRI, and SII levels, especially in current smokers. Elevated PIV and SIRI levels significantly increase stroke prevalence in hypertensive individuals, notably among males and smokers. A predictive model with PIV, SIRI, and sociodemographic factors offers strong clinical utility.

Identification of Time-Series Pattern Marker in Its Application to Mortality Analysis of Pneumonia Patients in Intensive Care Unit.

Electronic Health Records (EHRs) are a significant source of big data used to track health variables over time. The analysis of EHR data can uncover medical markers or risk factors, aiding in the diagnosis and monitoring of diseases. We introduce a novel method for identifying markers with various temporal trend patterns, including monotonic and fluctuating trends, using machine learning models such as Long Short-Term Memory (LSTM). By applying our method to pneumonia patients in the intensive care unit using the MIMIC-III dataset, we identified markers exhibiting both monotonic and fluctuating trends. Specifically, monotonic markers such as red cell distribution width, urea nitrogen, creatinine, calcium, morphine sulfate, bicarbonate, sodium, troponin T, albumin, and prothrombin time were more frequently observed in the mortality group compared to the recovery group throughout the 10-day period before discharge. Conversely, fluctuating trend markers such as dextrose in sterile water, polystyrene sulfonate, free calcium, and glucose were more frequently observed in the mortality group as the discharge date approached. Our study presents a method for detecting time-series pattern markers in EHR data that respond differently according to disease progression. These markers can contribute to monitoring disease progression and enable stage-specific treatment, thereby advancing precision medicine.

The effect of core stability training combined with fascial release on patients with nonspecific low back pain.

Non-specific lower back pain (NLBP) is treated with a variety of therapies, including health education, exercise therapy, soft tissue release, psychological interventions, and shockwave therapy. However, some studies have shown that core stability training or fascial release therapy alone is not effective in the treatment of low back pain. The aim of this study was to investigate the effects of core stability training on patients' inflammatory cytokine levels and lumbar muscle temperature when combined with fascial release for the treatment of non-specific low back pain. In this study, a total of 60 patients with non-specific low back pain who were treated in Mindong Hospital of Ningde City between December 2021 and January 2023 were selected and randomly and equally divided into a control group (30 cases) and an experimental group (30 cases). The control group received core stability training, while the experimental group added fascial release surgery to this. We compared and assessed the pain visual analog score (VAS), Oswestry dysfunction index (ODI), lumbar spine mobility (including anterior flexion, posterior extension, left flexion, and right flexion), as well as levels of inflammatory factors IL-6, TNF-a, and muscle tissue temperature in the two groups. This study has been successfully implemented and covered 60 patients throughout the trials. Upon comparison, the two groups did not show statistically significant differences in baseline data such as age, gender and duration of disease (p> 0.05). After four weeks of treatment, the test group showed statistically significant (p< 0.05) differences in VAS scores, ODI scores, and IL-6 and TNF-a levels that were significantly lower than those of the control group. It is worth mentioning that the muscle tissue temperature of the patients in the test group, as well as their performance in lumbar anterior flexion, posterior extension, left flexion, and right flexion mobility, were significantly better than those of the control group, and these differences also showed statistical significance (p< 0.05). The combination of core stability training and fascial release demonstrates significant clinical results in the treatment of nonspecific lower back pain. Through medical thermography and serum inflammatory factor testing, we were able to assess the treatment effect more objectively, providing a strong basis for future clinical practice.

Timely cholecystectomy: important factors to improve guideline adherence and patient treatment

ObjectiveCholecystectomy is one of the most frequently performed surgeries in Germany and is performed as a treatment of acute cholecystitis (guideline S3 IIIB.8) and after endoscopic retrograde cholangiopancreatography for choledocholithiasis...

MetSCORE: a molecular metric to evaluate the risk of metabolic syndrome based on serum NMR metabolomics

BackgroundMetabolic syndrome (MetS) is a cluster of medical conditions and risk factors correlating with insulin resistance that increase the risk of developing cardiometabolic health problems. The specific criteria for diagnosing MetS vary among different medical organizations but are typically based on the evaluation of abdominal obesity, high blood pressure, hyperglycemia, and dyslipidemia. A unique, quantitative and independent estimation of the risk of MetS based only on quantitative biomarkers is highly desirable for the comparison between patients and to study the individual progression of the disease in a quantitative manner.MethodsWe used NMR-based metabolomics on a large cohort of donors (n = 21,323; 37.5% female) to investigate the diagnostic value of serum or serum combined with urine to estimate the MetS risk. Specifically, we have determined 41 circulating metabolites and 112 lipoprotein classes and subclasses in serum samples and this information has been integrated with metabolic profiles extracted from urine samples.ResultsWe have developed MetSCORE, a metabolic model of MetS that combines serum lipoprotein and metabolite information. MetSCORE discriminate patients with MetS (independently identified using the WHO criterium) from general population, with an AUROC of 0.94 (95% CI 0.920–0.952, p < 0.001). MetSCORE is also able to discriminate the intermediate phenotypes, identifying the early risk of MetS in a quantitative way and ranking individuals according to their risk of undergoing MetS (for general population) or according to the severity of the syndrome (for MetS patients).ConclusionsWe believe that MetSCORE may be an insightful tool for early intervention and lifestyle modifications, potentially preventing the aggravation of metabolic syndrome.