Multidisciplinary Therapy Research Articles

Impact of COVID-19 on Exercise-Based Pulmonary Rehabilitation: What Lessons Have We Learned?

The Coronavirus Disease 2019 (COVID-19) pandemic had a major global impact on health care, including the delivery, modality, and importance of outcomes in pulmonary rehabilitation (PR). This review discusses the impact of the pandemic on PR and the changes that were required to maintain its delivery. This article reviews the current evidence on PR during the COVID-19 pandemic period, focusing on delivery models, modalities, outcomes, perspectives, and barriers. A search of the MEDLINE, Embase, and SciELO databases and the Cochrane Library on this topic was conducted between December 1, 2019 and August 1, 2023. Studies were reviewed and relevant topics were included in this narrative. Rehabilitation of patients with severe acute COVID-19 and symptoms of long COVID has been challenging. The number of rehabilitation programs worldwide is still low, and community-based programs are still rare. Integrated programs with a multidisciplinary approach and exercise therapy with individualized prescription based on symptoms have been an interesting strategy. Telerehabilitation and outpatient rehabilitation are both effective in the treatment of patients with chronic obstructive pulmonary disease. However, the uptake of PR remains considerably low, and technological barriers for patients and lack of technological resources in low-income countries affect the delivery of these services in much of the world.

Transcutaneous stimulation as a niche theme in gastroparesis therapy

Introduction Gastroparesis, a global condition causing bile salt accumulation, is prevalent globally. Diagnosis techniques like bile salt titration and nitric oxide sulfate can improve patient care. However, simptomatic control is needed to reduce inflammation and control potential diseases. Neurological techniques like gyroscope stimulation and endoscopy can diagnose refractive gastroparesis. Interdisciplinary collaboration and bibliometric research are crucial for finding effective treatments. Gastroparesis, a motility issue affecting 0.9-1.3% of diabetics, can be improved by new diagnostic methods like osmotic pressure and gastric emptying, enhancing patient treatment. Methods This study uses a literature review methodology to gather data from the Scopus database on neuroaid, analyzing it using Biblioshiny and VOSviewer software. The focus is on dietary adjustments, glucose regulation, and transcutaneous stimulation’s role in gastroparesis treatment, using quantitative and qualitative analysis. Results The research trend found are documents by year, most relevant sources, factorial map of the most cited documents, factorial map of The documents with the highest contributes, documents by author, documents by country or territory, documents by subject area, documents by affiliation, network visualization, overlay visualization of scopus database using vosviewer, density visualization, thematic map, thematic evolution, cluster analysis, topic dendogram, and country collaboration map. According to our analysis, transcutaneous stimulation holds great promise for treating gastroparesis. We also found the necessity of multidisciplinary collaboration in the management of this illness. Conclusions The study on gastroparesis highlights key themes like diet modification, glucose control, medication therapy, Cajal’s role in smooth muscle concentration, common causes, transcutaneous stimulation, motorcycle themes, vagus nerve, and emerging devices and electronics. Basic themes include gastrointestinal disorders, neuromodulation, patients, diabetes, and gastric electrical stimulation. The management of gastroparesis involves multidisciplinary approaches, lifestyle changes, medication therapy, and bedtime interventions, with further investigation into transcutaneous stimulation being warranted.

Expert opinion on heat therapy for teenagers' musculoskeletal pain management.

Among children and adolescents, up to 40% will experience musculoskeletal pain (MP), which can significantly impair functional ability, reduce quality of life, cause emotional distress, and lead to sleeping disorders for both patients and their families. The first-line treatment often involves pharmacological interventions, even though there is a lack of evidence supporting the efficacy or the safety of this approach in this specific age group. Recent guidelines recommend the implementation of preventative strategies and physical tools as the first option to minimize the use of medications. We aimed to provide an expert opinion on the use of heat therapy for MP management in young patients. This paper is the result of a virtual advisory board held by the authors in order to discuss and provide an expert opinion about the use of heat therapy in MP in children and adolescents. MP is a significant burden affecting children and adolescents. While non-steroidal anti-inflammatory drugs are currently the first-choice treatment of acute and chronic MP in children and adolescents, avoiding or reducing them in such patients is advisable, to reduce side effects and to prevent the development of chronic pain and medication overuse headaches. Heat therapy can be an additional treatment option due to its ability to promote muscle relaxation, enhance blood circulation, and modulate nociceptors with a good safety profile. MP in children and adolescents is a common condition that should be approached multidisciplinary, including information, therapeutic exercise and physical therapies like hot or cold therapies. Future studies should be conducted to evaluate the safety, efficacy and indications of each treatment in MP.

Clinical diagnosis and management of spinocerebellar Ataxia in a resource-constrained setting: a case report from Eastern Nepal

Introduction: Spinocerebellar ataxias (SCA) are a diverse group of neurodegenerative disorders with autosomal dominant inheritance, primarily affecting the cerebellum and its connections. Diagnosis typically involves genetic testing, but in resource-limited settings, clinical and neuroimaging assessments become critical. This case report highlights the role of non-genetic methods in diagnosing SCA and outlines management strategies in such settings. Case Presentation: A 41-year-old male presented with a two-year history of progressive gait imbalance, headache, and abnormal speech. He had a family history of similar symptoms in two siblings, but no significant past medical history. Clinical examination revealed scanning speech, dysmetria, and a broad-based gait. Clinical and neuroimaging findings, including cerebellar atrophy, led to a diagnosis of SCA in the absence of genetic testing. Patient management with speech, occupational, and physical therapies, showed gradual improvement. Discussion: SCA, characterized by cerebellar atrophy and a range of clinical symptoms, is typically diagnosed through genetic testing, but clinical and imaging assessments are crucial when genetic resources are limited. This case illustrates that a comprehensive clinical evaluation, including neuroimaging, can support the diagnosis of SCA even without genetic testing. Strategic management emphasizing symptomatic relief and functional improvement through a multidisciplinary approach, including regular follow-up and personalized therapy, are crucial, as evidenced by the timely improvement observed in our case. Conclusion: In resource-limited settings, a comprehensive clinical and neuroimaging assessment is essential for diagnosing Spinocerebellar Ataxia when genetic testing is not feasible. Effective management through multidisciplinary therapies can improve patient outcomes, underscoring the need for innovative strategies to enhance diagnostic and treatment capabilities in such environments.

Conversion therapy for unresectable hepatocellular carcinoma: Advances and challenges.

Recently, the World Journal of Gastrointestinal Oncology published an article entitled "Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy: A case report and review of the literature", in which the authors shared their successful experience with complete surgical resection after multidisciplinary conversion therapy. The study by Chu et al demonstrates the great challenges that the advanced hepatocellular carcinoma (HCC) poses to surgical oncology, reveals the complexity of conversion therapy for unresectable HCC, emphasizes the important role of a multidisciplinary management model in conversion therapy, and enriches our understanding of the dynamics of personalized treatment for different patients. At present, conversion therapy is a hot research topic in the treatment of unresectable HCC, which has brought new hope to many patients with moderately advanced HCC. However, there are still many urgent problems to be solved in conversion therapy. Here, we would like to further discuss the advances and challenges of conversion therapy for unresectable HCC with the authors and the general readers.

Parenteral nutrition customization in pediatrics: A descriptive cohort study.

The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital. We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels. A total of 264 patients, with a median age of 2.2 years (IQR: 0.3-9.0 years), comprising intensive care (n = 216; 81.8%) and malnourished (n = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (n = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (n = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (n = 226) of cases in the first 48 h; 96.2% (n = 177) of cases on the fourth day; and 90.1% (n = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age z score and number of second individualizations (r = -0.222; P = 0.002). Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.

Exploring Allied Health Professionals’ Perceptions and Practice Regarding Recommendations for Intensity of Multidisciplinary Therapy for Stroke Patients: A Qualitative Study

Abstract Background Stroke is a leading cause of death and disability in Ireland; approximately 7,500 Irish people have a stroke every year. Rehabilitation is a key aspect of stroke care; greater amounts of therapy are associated with better recovery. Data from the Irish National Office of Clinical Audit shows that stroke survivors often do not receive recommended amounts of therapy. The recently updated UK and Ireland stroke clinical guidelines now recommend larger amounts of therapy time. This qualitative study explored how allied health professionals (AHPs) feel about the recommendation, and what methods they employ in working to achieve recommended amounts of therapy. Methods This study used a qualitative research design employing semi-structured interviews to collect data. Participants were AHPs working in stroke care in Dublin, Ireland, and were recruited using a combination of purposive and snowball sampling. Interviews were audio-recorded, transcribed, and analysed using the Braun and Clarke six-step thematic analysis method. An external validator was utilised for code and theme validation. This research was approved by the Royal College of Surgeons in Ireland Research Ethics committee. Results Two main themes emerged: ‘Barriers and enablers to achieving guideline recommended therapy time’ and ‘methods of increasing therapeutic time’. Patient factors and clinical resources impact on the provision of therapy post-stroke. Overall, participants felt positive about the recent guideline recommendation for increased therapeutic time. Various methods are employed to augment patient therapeutic time, including technology and semi-supervised practice. Therapy assistants play an important role in achieving greater amounts of therapy. Conclusion AHPs see the new recommendation as challenging but are generally keen to try and achieve it, citing benefits of increased therapy time for patient outcomes. AHPs utilise a wide range of methods to optimise therapeutic time for stroke patients. The role of therapy assistants in supporting delivery of larger amounts of therapy time warrants further evaluation.

An Innovative Approach To Increasing Speech And Language Therapy Intensity For Stroke Patients

Abstract Background Different national guidelines exist for the provision of Speech and Language Therapy (SLT) intensity for stroke patients. The National Institute for Health and Care Excellence (NICE) guidelines on stroke rehabilitation in Adults (2023) advises 3 hours of multidisciplinary therapy a day, five days a week. The National Clinical guideline for Stroke for the UK and Ireland (2023) does not include SLT in this 3-hour provision of motor therapy, but advises 45 minutes of SLT a day, 5 days a week. Poor SLT staffing levels are commonplace, more recently exacerbated by the HSE recruitment embargo, posing significant challenges to rehabilitation provision. Methods A Speech and Language Therapist in a stroke service assessed whether the use of Therapy assistants could add to the delivery of the targeted 45 minutes of SLT. Training was provided in the execution of speech, language and swallow rehabilitation exercises, using patient specific exercise packs. A month of data collection started on 8 patients. Intensity was measured in 3 percentage groups: Results When rehabilitation was provided by SLT alone, 7 patients received insufficient therapy intensity. One patient scored in the moderate group. With the added input of stroke assistants, 4 patients received sufficient therapy time, 3 patients scored in the moderate group and only one patient received insufficient therapy. Conclusion Use of Stroke assistants for the provision of SLT rehabilitation exercises, can be an effective tool in increasing SLT intensity. Training is time intensive, but essential to make assistants knowledgeable and competent in their abilities. All rehabilitation should be under direct supervision of SLT. However, we should not use stroke assistants to mask or minimise the need for adequate SLT resourcing, as specified in international standards.

Newly established borderline resectable 1 (BR1)category is one of the favorable candidates for selecting the use of multidisciplinary combination therapy in patients with advanced hepatocellular carcinoma treated with systemic therapy.

The aim of this study was to evaluate the newly established oncological criteria of resectability of hepatocellular carcinoma (HCC) for selecting suitable candidates for systemic and combination therapy. The data of 156 consecutive HCC patients with intrahepatic target nodules who had initially received systemic therapy (lenvatinib and atezolizumab plus bevacizumab) were reviewed. The patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2). The prognostic ability and clinical utility for selecting this population to receive combined use of multiple systemic sequential and locoregional therapy was then evaluated. Combined use of systemic sequential therapy with more than two agents and locoregional treatment was defined as multidisciplinary combination therapy (MCT), while systemic sequential therapy only and repeated locoregional treatment was defined as a single treatment procedure (STP). Patients classified as R and BR1 had significantly better overall survival (OS) compared with BR2 (R vs. BR2, p=0.012; BR1 vs. BR2, p=0.004). However, there was no significant difference between R and BR1 (p=1.000), in spite of significantly worse oncological status in the BR1 patients. Following a R0 resection and MCT, the BR1 patients had significantly better OS compared with those receiving STP or no additional treatment (median OS, not reached vs. 25.2months and 20.1 vs. 11.3months, respectively; p=0.034). In patients with advanced HCC with intrahepatic target nodules the BR1 category is one of the favorable candidates for selecting those to be treated with MCT strategies.

Chronic non-specific low back pain disability and depressive symptoms in working men and women: a cross-sectional study.

Chronic non-specific low back pain (LBP) is a serious public health issue that impairs the functional abilities of working men and women. The burden and experience of chronic non-specific LBP are largely influenced by psychological and psychosocial aspects. The objective was to investigate the association between the severity of chronic non-specific LBP disability and depressive symptoms in a sample of Croatian working active men and women with an age distribution from 35 to 65 years. The Roland Morris Disability Questionnaire (RMDQ) assessed disability, whereas the Beck Depression Inventory-II assessed depressive symptoms. During the routine outpatient visit self-reported RMDQ and BDI-II were completed from 203 recruited patients, divided into categories concerning disability scores. The median (IQR) age of 48.59 ± 6.48 was in the lower and the median (IQR) age of 50.65 ± 7.68 in the higher disability category. Disability was significantly associated (p < 0.05) with higher age (r = 0.177), working experience (r = 0.161), LBP duration (r = 0.195), greater pain intensity (r = 0.474 during activity, r = 0.227 at rest), and BDI-II score (r = 0.466). Higher BDI-II scores were associated with confirmatory answers on the 15th, 19th, and 22nd questions in RMDQ (p < 0.05). In patients with chronic non-specific LBP, higher degrees of disability were linked to severe depressive symptoms, aging, longer working experience, and increased pain intensity. These findings support pretreatment screening for depressive symptoms in order to develop individually customized and efficient multidisciplinary therapies.

Multidisciplinary behavioral therapy reduces rumination

AbstractBackgroundBehavioral therapy has proved effective as rumination therapy. Our objective was to treat rumination patients using multidisciplinary behavioral therapy aimed at reducing ≥2 of the rumination score.MethodsAll patients fulfilled Rome IV criteria for rumination and were referred to speech therapy for psychoeducation, diaphragmatic breathing exercises and guided eating, physiotherapy for exercises to relax the thoracic and abdominal muscles, and consultation with the psychologist and the dietitian. Symptoms, depression, anxiety, health‐related quality of life (HRQoL), and functional capacity were evaluated by questionnaires (Rome IV, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), 15D, and World Health Organization Disability Assessment Schedule (WHODAS) 2.0) at baseline and at 6‐month control. Esophageal manometry was performed at 6‐month control.Key ResultsThe study enrolled 11 patients (19–64 years, 10 female). Rumination score: 6.5 (5–8) at baseline, 4.0 (3–5) at the 6‐month control, p = 0.005. BDI/8 (6–13), BAI/15 (8–29) at baseline; BDI/7 (4–8), BAI/15 (7–27) at the 6‐month control, NS. 15D score: 0.800 at baseline, 0.845 at the 6‐month control, NS. WHODAS 2.0 score: 15 (7–33) at baseline, 11 (7–26) at the 6‐month control, NS. Rumination could be evoked in manometry in six of nine (67%) patients at 6‐month control.Conclusions and InferencesBehavioral multidisciplinary therapy significantly reduces the self‐assessed frequency of rumination. These patients have more depression, anxiety and a lower HRQoL compared to the normal population.

Opportunities and challenges of multidisciplinary conversion therapy in advanced hepatocellular carcinoma

Opportunities and challenges of multidisciplinary conversion therapy in advanced hepatocellular carcinoma

Psychosocial Adaptation in Lung Cancer Patients: a Literature Review

ABSTRACT Lung cancer is one type of cancer with the highest mortality rate, this is often due to delays in diagnosis and the impact of prognosis which can affect the psychosocial adaptation of lung cancer patients. Analyze psychosocial adaptation problems in lung cancer patients, their impacts, and treatment strategies. Systematic review used the PRISMA protocol and JBI scoring tool to determine eligible articles. Five electronic databases were used (Pubmed; Science Direct and Google Scholar. Inclusion criteria included research on lung cancer published in English in the last ten years (2014-2024). The results showed that 20 articles met the inclusion criteria. The results of the review show several common problems experienced by lung cancer patients, including depression, anxiety, social isolation, stigmatization, mental health problems, and difficulties in adaptation. The impact is a decrease in emotional well-being, a reduction in quality of life, an increase in physical symptoms, and a worsening of the disease prognosis. Several prevention strategies include providing multidisciplinary therapy through supportive and palliative care, improving the quality of psychosocial health services, cognitive behavioral therapy, social support therapy, psycho-education, increasing social support, spiritual treatment, increasing healthy behavior, and using confrontation and stress coping. Psychosocial problems experienced by lung cancer patients are often complex and can include various aspects. Several common issues experienced by lung cancer patients are related to psychosocial problems. The impact of psychosocial problems can worsen the prognosis of lung cancer so several treatment efforts are needed to overcome psychosocial problems in lung cancer patients. Keywords: Adaptation, Lung Cancer, Literature Review, Psychosocial

Current findings on the antitumor effects of metformin on esophageal squamous cell carcinoma (Review).

Esophageal squamous cell carcinoma (ESCC) is an intractable type of cancer that requires novel therapeutic modalities, since the therapeutic outcomes are often inadequate, even in response to multidisciplinary treatment. The antitumor effect of metformin, an antidiabetic drug, has been reported in esophageal cancer; however, its effects are diverse. Since various multidisciplinary therapies are used in ESCC, the antitumor effect of metformin is expected to be synergistic in some treatment strategies. The present review summarizes the antitumor effects of metformin and discusses its use in combination with existing therapies. The present study reviewed relevant studies where the molecular targets of metformin (AMPK and inflammatory system signals) were described, followed by the classification and organization of its antitumor effects, and subsequently summarized the current research on its antitumor effects, especially in ESCC. A number of studies have reported that metformin prevents the development of ESCC and exerts its antitumor effects through various pathways. In addition, metformin has been shown to inhibit tumor growth, induce apoptosis, inhibit cancer cell invasion, migration and angiogenesis into the tumor, and decrease tumor malignancy, such as metastasis. Furthermore, it may modulate host tumor immunity in a tumor-suppressive manner and is expected to improve prognosis following treatment for ESCC. Notably, metformin may be beneficial in combination with chemotherapy, such as cisplatin, and radiation. By contrast, it has been shown to potentially induce resistance to 5-fluorouracil. Finally, the effects of metformin in combination with other therapies are discussed in the present study, and perspectives on the potential benefits of metformin for future ESCC treatment are presented. In conclusion, the present review may be useful in improving the understanding of the wide range of antitumor effects of metformin. Although some concerning points remain, using metformin in ESCC treatment could be promising. Notably, more knowledge needs to be accumulated regarding the effects of metformin on ESCC.

Missed Opportunity to Triage Patients With Irritable Bowel Syndrome to Multidisciplinary Therapy

Missed Opportunity to Triage Patients With Irritable Bowel Syndrome to Multidisciplinary Therapy

Protocolized Foot Exercises Help in Improvement of Diabetic Foot Ulcers and Quality of Life When Added to Standard Therapy-A Randomized Clinical Trial.

Diabetic foot disease is the major cause of nontraumatic limb amputations worldwide causing a high socioeconomic and psychological toll and a huge burden to the healthcare system. Currently, standard treatment of diabetic foot ulcer is through multidisciplinary therapy. Foot exercises have been shown to improve healing in diabetic ulcers although evidence is limited and applicability is non-uniform. Our study aimed to generate more evidence regarding the benefit of addition of protocolized foot exercises so that it can be instituted as a standard of care. It was an open label Randomized controlled trial with seventy-two patients and study duration of one and half years Patients with diabetic foot ulcers were randomized into two groups. Both groups received standard therapy for diabetic foot ulcer. The intervention group in addition received three months of protocolized foot exercises. At the end of three months ulcer healing and quality of life were m compared among both the groups. Regular exercises for three months caused significant reduction in ulcer area compared to the non-intervention group [100% versus 45.22%, 95% CI =36.30(16.04-56.56), P-value = 0.001]. Quality of life analyzed by SF-36 score showed significant improvement in components like physical function [69.4 ± 8.9 versus 63.7 ± 11.0, 95% CI = 5.73 (0.97-10.48), P-value = 0.01], emotional well-being [65.2 ± 7.6 versus 60.8 ± 7.9, 95% CI = 4.44 (0.79-8.10), P-value = 0.01], and pain components [55.4 ± 18.5 versus 47.5 ± 14.5, 95% CI = 7.99 (0.16-15.81), P-value = 0.04) at 3 months although change in social functioning, physical health limitation, health change, energy and general health improvement were not significant. Addition of protocolized foot exercises are beneficial for patients of diabetic foot ulcers in terms of ulcer healing as well as improvement of quality of life provided compliance to exercises can be ensured.

Case report: Propylthiouracil-induced serious side effect: Perinuclear antineutrophil cytoplasmic antibody-associated vasculitis or IgA vasculitis?

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare disease characterized by the inflammation and destruction of small blood vessels and circulating ANCAs. Drugs such as antithyroid drugs (ATDs), especially propylthiouracil (PTU), have been used for the production of ANCAs and cause the development of drug-induced AAV. The pathogenesis of this disease is unclear but could be related to the physiological processes affecting the degradation of neutrophil extracellular traps (NETs). At present, PTU is widely used in patients with Graves' disease (GD) who are preparing for pregnancy and whose condition has not been controlled. Once drug-induced AAV has occurred with important organ damage, considering NETs have a significant role in the immune system, whether the cessation of drugs could stop the progression of organ damage is unclear, and a consensus regarding standard treatment has not been established. In this case report, a female patient who planned pregnancy was hospitalized with multiple joint pain, impaired renal function, and hematuria. Immunofluorescence of the renal biopsy demonstrated spherical and diffuse mesangial distribution of IgA (3+). Autoimmune serology demonstrated positivity for autoantibodies against p-ANCA and an anti-MPO titer 74.72 RU/mL. She was diagnosed with PTU-induced p-ANCA-associated and IgA-associated vasculitis (IgAV). The patient accepted low doses of glucocorticoid, immunosuppressive therapy and RAI treatment. Both her kidney function and thyroid function remained were on the mend. The authors believe that this type of patient needs to fully consider their pregnancy preparation needs, suspend pregnancy when a small chance of GD remission is indicated, and avoid the use of drugs with reproductive toxicity and other serious adverse events. The multidisciplinary combination therapy of low-dose glucocorticoids and immunosuppressants combined with iodine radiotherapy is one reasonable scheme. At the same time, it is necessary to eliminate the organ damage caused by other reasons. This report provides a clinical treatment basis for patients with drug-induced vasculitis manifestations who cannot receive an accurate diagnosis.

Transcutaneous stimulation as a niche theme in gastroparesis therapy

Introduction Gastroparesis is a condition characterized by the accumulation of bile salts. It is prevalent globally, with a global prevalence of 0.9% and 1.3% in individuals with diabetes. New techniques for diagnosing gastroparesis, such as bile salt titration and nitric oxide sulfate, can improve patient care. However, simptomatic control is needed to increase gastric salts, reduce inflammation, and control potential diseases. Gastroparesis can cause complications like weight loss, malnutrition, and gastrointestinal changes that cannot be predicted. Neurological techniques like gyroscope stimulation and endoscopy (G-POEM) can help diagnose refractive gastroparesis. Interdisciplinary collaboration is crucial in addressing gastroparesis issues, and bibliometric research is essential for finding effective new treatments. Methods In this work, a literature review methodology is employed to gather data from the Scopus database using the keywords neuroaid. Data were analyzed using Biblioshiny and VOSviewer software to produce visualizations and bibliometric maps. We conducted quantitative and qualitative analysis. Results The research trend found are documents by year, most relevant sources, factorial map of the most cited documents, factorial map of The documents with the highest contributes, documents by author, documents by country or territory, documents by subject area, documents by affiliation, network visualization, overlay visualization of scopus database using vosviewer, density visualization, thematic map, thematic evolution, cluster analysis, topic dendogram, and country collaboration map. Conclusions The study on gastroparesis identifies key themes such as diet modification, glucose control, and medication therapy. It also discusses the role of Cajal in smooth muscle concentration, common causes of gastroparesis, and transcutaneous stimulation. The study also explores motorcycle themes, such as the vagus nerve, and emerging themes like devices and electronics. Basic themes include gastrointestinal disorders, neuromodulation, patients, diabetes, and gastric electrical stimulation. Management involves multidisciplinary approaches, lifestyle changes, medication therapy, and bedtime interventions.

Minimally invasive total pancreatectomy with islet autotransplantation for chronic pancreatitis: the robotic approach.

Total pancreatectomy with islet autotransplantation (TPIAT) treats refractory pain in chronic pancreatitis, prevents episodes of acute exacerbation, and mitigates postoperative brittle diabetes. The minimally invasive (MIS) approach offers a decreased surgical access trauma and enhanced recovery. Having established a laparoscopic TPIAT program, we adopted a robotic approach (R-TPIAT) and studied patient outcomes compared to open TPIAT. Between 2013 and 2021, 61 adult patients underwent TPIAT after a comprehensive evaluation (97% chronic pancreatitis). Pancreatic islets were isolated on-site during the procedure. We analyzed and compared intraoperative surgical and islet characteristics, postoperative morbidity and mortality, and 1-year glycemic outcomes. MIS-TPIAT was performed in 41 patients (67%, 15 robotic and 26 laparoscopic), and was associated with a shorter mean length of intensive care unit stay compared to open TPIAT (2.9 vs 4.5days, p = 0.002). R-TPIAT replaced laparoscopic TPIAT in 2017 as the MIS approach of choice and demonstrated decreased blood loss compared to open TPIAT (324 vs 843mL, p = 0.004), similar operative time (609 vs 562min), 30-day readmission rate (7% vs 15%), and 90-day complication rate (13% vs 20%). The glycemic outcomesincluding C-peptide detection at 1-year (73% vs 88%) and insulin dependence at 1-year (75% vs 92%) did not differ. The mean length of hospital stay after R-TPIAT was 8.6days, shorter than for laparoscopic (11.5days, p = 0.031) and open TPIAT (12.6days, p = 0.017). Both MIS approaches had a 1-year mortality rate of 0%. R-TPIAT was associated with a 33% reduction in length of hospital stay (4-day benefit) compared to open TPIAT. R-TPIAT was similar to open TPIAT on measures of feasibility, safety, pain control, and 1-year glycemic outcomes. Our data suggest that robotic technology, a new component in the multidisciplinary therapy of TPIAT, is poised to develop into the primary surgical approach for experienced pancreatic surgeons.

The immunological milieu of oropharyngeal squamous cell carcinoma (OPC) according to HPV and smoking status and its influence on prognosis.

3147 Background: OPC exhibits distinct epidemiological, genetic, and clinical characteristics, significantly influenced by the presence of HPV. Despite multidisciplinary therapy, approximately 40% of OPC patients (pts) experience recurrence, and those who achieve cure often endure late and morbid sequelae of treatment. In this study, we comprehensively explored the composition and functional status of the tumor immune microenvironment (TIME) in a cohort of OPC pts treated with curative intent and investigated TIME differences based on HPV infection, smoking status, and clinical outcomes. Methods: Two tissue microarrays with baseline OPC tissues were stained with a previously validated panel containing 33 metal-tagged markers. Imaging mass cytometry was performed with the Fluidigm Helios CyTOF instrument, and analysis performed with Visiopharm software. HPV status was determined by p16 IHC and/or DNA testing. Comparison of cell types and markers densities among subgroups (HPV positive vs negative) were analyzed with Wilcoxon signed-rank test and its association with clinical outcomes (recurrence vs no-recurrence) with log-rank and Cox Proportional Hazards. Multiple comparisons were corrected by Benjamini Hochberg procedure. Results: A total of 99 samples from 61 pts from a single institution were included in this study. The majority of pts were male (N=47, 77%) and heavy smokers (N=55, 90%); 72% were HPV-negative. The median age was 61 years (range, 39 – 87 years), and 52% of cases were diagnosed with stages III-IVB (AJCC 8th edition). Most pts (57%) was treated with surgery (±RT). Thirty-three pts (54%) experienced recurrent disease. Smoking, stage III-IVB, and HPV-negative tumors were associated with higher recurrence rates (p &lt;0.01). Regarding the OPC TIME, the most prevalent cell populations in the stroma were fibroblasts (22%), followed by T-cells (17%) and endothelial cells (10%). The stroma of HPV+ tumors exhibited higher densities of memory T cells (FDR &lt; 0.01), B cells (FDR = 0.02), and T cells (FDR = 0.02) compared to HPV negative counterparts, which displayed an increased density of neutrophils (FDR = 0.04). The density of cancer stem cells was directly associated with smoking history (FDR&lt;0.001), and an increased density of intra-tumoral B-cells was found in non-smokers (FDR=0.01). Higher intra-tumoral neutrophil density was linked to recurrent disease (FDR &lt; 0.001). Conversely, higher densities of memory CD8+ T cells and non-M2 macrophages in the TIME were associated with a lower chance of recurrence (FDR &lt; 0.1). Conclusions: The intricate analysis of the OPC TIME revealed significant differences according to HPV and smoking status and highlighted the prognostic role of neutrophils, memory CD8+ T cells, and non-M2 macrophages. These findings may guide the development of personalized therapeutic strategies for OPC.