Multiple Trigger Research Articles

Advances in colon-targeted drug technologies

Purpose of review Herein, we present an overview of innovative oral technologies utilized in colonic drug delivery systems that have made significant translational and clinical advancements to treat inflammatory bowel disease (IBD) in recent years. Recent findings The colon is home to distinct physiological conditions, such as pH and microbiota, that have been exploited in the development of colonic drug delivery systems for the treatment of local and systemic diseases. However, given the intra and interindividual variability in the gastrointestinal tract of both healthy and diseased states, various systems have shown inconsistencies in targeted drug release to the colon. Recent breakthroughs have led to systems that incorporate multiple independent trigger mechanisms, ensuring drug release even if one mechanism fails due to physiological variability. Such advanced platforms have bolstered the development of oral biologics delivery, an especially promising direction given the lack of commercially available oral antibody medications for IBD. These concepts can be further enhanced by employing 3D printing which enables the personalisation of medicines. Summary Leveraging these novel technologies can accurately deliver therapeutics to the colon, allowing for treatments beyond gastrointestinal tract diseases. To realize the full potential of colonic drug delivery, it is paramount that research focuses on the clinical translatability and scalability of novel concepts.

Comparing the performance of multiple trigger tools in identifying medication-related hospital readmissions.

Multiple trigger tools have been developed to identify medication-related hospital (re)admissions (MRRs); however, the accuracy of these tools in real-world clinical practice is uncertain. The objective of this study was to compare the accuracy of four different trigger tools (OPERAM, STOPP/START criteria, ADR-tool, and QUADRAT) to identify MRRs compared with clinical adjudication. We conducted a secondary analysis of patients readmitted within 30 days to seven departments of a teaching hospital. In the primary study, which involved a retrospective chart review of 1111 readmissions, MRRs and their potential preventability were clinically adjudicated by physicians and pharmacists. In the current study, four trigger tools were applied by a different physician and pharmacist panel. Patients of all ages were included. Trigger tools included both explicit items specifying the event and the associated medication and implicit items requiring clinical knowledge. The accuracy of each trigger tool was assessed by calculating the proportion of clinically adjudicated MRRs each tool identified overall as well as according to explicit and implicit triggers separately. The accuracy of each tool to identify potentially preventable MRRs was also calculated. Of 1111 readmissions, 181 were adjudicated as medication-related (mean age 69 years, 56% male); 72 (40%) MRRs were potentially preventable. The original OPERAM tool identified 166 (92%) MRRs (62% through explicit triggers). The STOPP/START criteria identified 23 (13%, 7% through explicit triggers), the ADR tool identified 51 (28%, all explicit triggers), and the QUADRAT tool identified 76 (42%; all explicit triggers) MRRs. Of the 72 potentially preventable MRRs, OPERAM identified 59 (82%), STOPP/START identified 18 (25%), ADR identified 20 (28%), and QUADRAT identified 21 (29%). The original OPERAM tool identified the highest proportion of (preventable) MRRs. However, this tool includes many implicit triggers requiring expert clinical knowledge. Future studies should assess the practicality of implementing this tool in daily practice.

Multiple congenital bilateral trigger fingers in a 2-year-old child: A case report

BackgroundCongenital trigger finger is a rare pediatric condition characterized by a finger fixed in a flexed position due to tendon anomalies. This rare condition involves multiple trigger fingers in children and is not extensively covered in the medical literature. MethodsWe examined a 2-year-old boy with multiple trigger fingers present since birth. Surgical release of the A1 pulleys was performed. ResultsSurgery resulted in normal finger function at the one-year follow-up. ConclusionsAlthough rare, congenital trigger finger is treatable in children. Adaptive and timely interventions can significantly improve outcomes and reduce disability. This case highlights the importance of early and effective treatment strategies.

Critical Path-Based Backdoor Detection for Deep Neural Networks.

Backdoor attack to deep neural networks (DNNs) is among the predominant approaches to bring great threats into artificial intelligence. The existing methods to detect backdoor attacks focus on the perspective of distributions in DNNs, however, limited by its ability of generalization across DNN models. In this article, a critical-path-based backdoor detector (CPBD) is proposed, which approaches to detect backdoor attacks via DNN's interpretability. CPBD is designed to efficiently discover the characteristics of backdoors, which distinguish the critical paths in the attacked DNNs. To deal with the intractably large number of neurons, we propose to simplify the neurons, and the preserved key nodes are integrated into a set of critical paths. Thus, a DNN model can be formulated as a combination of several critical paths. Afterward, the detection of backdoors is performed based on the analysis of critical paths corresponding to different classes. Then, combining all the above steps, the CPBD algorithm is integrated to present the results in a standard and systematic manner. In addition, CPBD is able to locate neurons associated with malicious triggers, the combination of which is named as trigger propagation path. Extensive experiments are conducted, which testify the efficiency of the proposed method on multiple DNNs and different trigger sizes.

A Comparison of Patient Characteristics and Outcomes Between Patients Receiving Flexor Digitorum Superficialis Slip Excision or Isolated A1 Pulley Release for Trigger Finger

Resection of the radial or ulnar slip of the flexor digitorum superficialis (FDS) tendon is a known treatment option for persistent trigger finger. Risk factors for undergoing FDS slip excision are unclear. We hypothesized that patients who underwent A1 pulley release with FDS slip excision secondary to persistent triggering would have a higher comorbidity burden compared to those receiving A1 pulley release alone. We identified all adult patients who underwent A1 pulley release with FDS slip excision because of persistent triggering either intraoperatively or postoperatively from 2018 to 2023. We selected a 3:1 age- and sex-matched control group who underwent isolated A1 pulley release. Charts were retrospectively reviewed for demographics, selected comorbidities, trigger finger history, and postoperative course. We performed multivariable logistic regression to assess the probability of FDS slip excision after adjusting for several variables that were significant in bivariate comparisons. We identified 48 patients who underwent A1 pulley release with FDS slip excision and 144 controls. Our multivariable model showed that patients with additional trigger fingers and a preoperative proximal interphalangeal (PIP) joint contracture were significantly more likely to undergo FDS slip excision. Patients who underwent A1 pulley release with FDS slip excision were significantly more likely to have multiple trigger fingers or a preoperative PIP joint contracture. Clinicians should counsel patients with these risk factors regarding the potential for FDS slip excision in addition to A1 pulley release to alleviate triggering of the affected digit. Therapeutic III.

Retrograde Percutaneous Release of Trigger Finger or Thumb Using Sono-Instruments®: Detailed Technique, Pearls, and Pitfalls.

Percutaneous release is a common treatment option for trigger finger stenosing tenosynovitis. While surgical and conservative treatments are available, percutaneous techniques offer several advantages, including faster recovery time, reduced complications, and simultaneous treatment of multiple trigger fingers. The sono-instrument is a minimally invasive device designed for surgical release of the A1 pulley in adults. The device is efficient and safe, and in addition, several design features enhance the visibility of the instrument under ultrasound imaging. The technique is truly percutaneous, as the whole operation is done through a single needle puncture. This minimizes postoperative discomfort and allows an immediate return to daily living and professional activities. The technique can be performed in an outpatient clinic under local anesthesia. The learning curve is quick; however, surgeons must acquire experience in hand sonography to master this new form of surgery. The aim of this article is to provide an in-depth exposition of the technical nuances, pearls, and pitfalls of this novel retrograde percutaneous release method. To our knowledge, this is the first retrograde truly percutaneous release technique yet described, facilitated by the novel Sono-Instruments®.

Intelligent Design and Application of Traditional Cultural and Creative Products Based on Digital Art Elements

Abstract Cultural and creative industry is one of the main fields of digital art element design, and this paper utilizes digital art design for visualization programming of cultural and creative works. Through the three elements of 3D model, registration method and animation composition, the intelligent design process of AR cultural and creative products is defined, and the editing process of AR cultural and creative products is sorted out on this basis. Construct the model of cultural and creative products containing digital art elements, solve the problem of inconsistency between the coordinates and the model network appearing in the modeling, and then carry out the back-end design processing for AR cultural and creative products editing, which constitutes the whole back-end module through real-time methods and multiple trigger events. Through the method of empirical analysis, the feasibility of adding digital art elements to cultural and creative products, the consumers’ willingness to purchase cultural and creative products, and the innovation performance of cultural and creative products are analyzed. In the test of the moderating effect of the intelligent design of digital art elements on the cultural and creative products, the performance of the cultural and creative products improves synchronously with the embedding of the digital art elements, and the mean value finally stays at 0.375, and all the straight lines are above zero.

The third Medical Emergency Teams – Hospital outcomes in a day (METHOD3) study: The application of quality metrics for rapid response systems around the world

AimThis cross-sectional study aimed to assess the readiness of international hospitals to implement consensus-based quality metrics for rapid response systems (RRS) and evaluate the feasibility of collecting these metrics. MethodsA digital survey was developed and distributed to hospital administrators and clinicians worldwide. The survey captured data on the recommended quality metrics for RRS and collected information on hospital characteristics. Statistical analysis included descriptive evaluations and comparisons by country and hospital type. ResultsA total of 109 hospitals from 11 countries participated in the survey. Most hospitals had some form of RRS in place, with multiple parameter track and trigger systems being commonly used. The survey revealed variations in the adoption of quality metrics among hospitals. Metrics related to patient-activated rapid response and organizational culture were collected less frequently. Geographical differences were observed, with hospitals in Australia and New Zealand demonstrating higher adoption of core quality metrics. Urban hospitals reported a lower number of recorded metrics compared to metropolitan and rural hospitals. ConclusionThe study highlights the feasibility of collecting consensus-based quality metrics for RRS in international hospitals. However, variations in data collection and adoption of specific metrics suggest potential barriers and the need for further exploration. Standardized quality metrics are crucial for effective RRS functioning and continuous improvement in patient care. Collaborative initiatives and further research are needed to overcome barriers, enhance data collection capabilities, and facilitate knowledge sharing among healthcare providers to improve the quality and safety of RRS implementation globally.

Event Detection with Word-Word Relation Classification

Event detection (ED) is a critical task in information extraction, aiming to identify triggers and types. Current research has increasingly focused on fine-grained types, where a single sentence may contain multiple trigger words and event types. Previous models only considered sentence-level features, neglecting word-word features and word positional information in the text. We propose a novel labeling scheme that treats event detection as a word-word relation recognition task. In this approach, we first identify relationships between word pairs and then utilize these relationships to perform trigger and event-type detection. By adopting this method, we can efficiently and concurrently identify triggers and types in a sentence. Leveraging word pair relationships effectively addresses scenarios in which multiple trigger words appear in a single sentence. The results demonstrate that our approach outperforms several baseline models.

Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report

BackgroundFew reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment.Case presentationThe patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.ConclusionA patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.

Комплексный миофасциальный болевой синдром

Myofascial pain syndrome is one of the most common manifestations of musculoskeletal pain, and it is manifested not only by the pain syndrome but also by localized highly sensitive areas of pain sensitivity changes. Clinical manifestations of isolated trigger zones have been described in the literature. However, in practice, one has to deal with the myofascial pain syndrome caused by multiple trigger zones in the muscles of one or several neighboring regions. In this case, pain patterns overlap and change the clinical picture and, in some cases, lead to misdiagnosis. In order to illustrate such a course of the myofascial pain syndrome, the article presents a clinical case. As a matter of discussion, it is suggested to designate myofascial pain syndrome with multiple active trigger zones in several muscles with interference ofthe referred pain zones as “complex myofascial pain syndrome”.

Modern view on rosacea: Topical issues of epidemiology, pathogenesis and therapy. Literature review

Rosacea is a multifactorial dermatological disease that is widespread throughout the world, initially manifested as a cosmetic defect, and in the absence of systemic and topical therapy leads to a change in the structure and functions of the facial skin.
 Patients with rosacea often seek medical attention, as these aesthetic problems impair their quality of life and contribute to the development of social and psychological problems. Chronic stress is often the cause of the development of social maladaptation, which occurs because of a constant feeling of self-doubt, own inferiority, and anxiety. Anxiety and chronic depression can cause even minor manifestations of rosacea, as it is localized on the skin of the face. Dermatosis often manifests itself in women older than 30 years, under the influence of multiple trigger factors, has a chronic relapsing course.
 Understanding the pathophysiology and the use of combined therapies can improve the effectiveness of therapy in patients with rosacea, achieve and prolong clinical remission, identify trigger factors and possible prevention. This explains the need to study rosacea not as an independent dermatosis, but as a sign of more significant disorders that can lead not only to social and aesthetic problems, but also affect the general health of the patient.

Immediate effect of stretched myofascial dry needling on the myofascial trigger point in the upper trapezius muscle: a case report

Background/Aims A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, that is painful on compression and can cause motor dysfunction. The authors present a case report of a 21-year-old woman with myofascial trigger points in the upper trapezius muscle who reported a pre-assessment pain score of 7 on the visual analogue scale, a pressure pain threshold of 1.32 kg/cm2 and a reduction in all cervical ranges of motion. To provide more immediate results in comparison to traditional dry needling, the upper trapezius muscle was kept in a stretched position and then dry needling was performed. Methods With the patient lying in the prone position, the therapist stretched the right upper trapezius muscle. Fast in-and-out movements of dry needling were performed to target multiple active myofascial trigger points until the first visible local twitch response occurred. Results Immediately after the procedure, the patient's pain level reduced to a score of 3 on the visual analogue scale, the patient's pressure pain threshold increased to 3.07 kg/cm2, and cervical ranges of motions increased between 10 and 20°. Conclusions Stretched myofascial dry needling is effective to treat symptoms immediately related to myofascial trigger points in the upper trapezius muscle, although further research is needed.

An Ultrasonic RF Acquisition System for Plant Stems Based on Labview Double Layer Multiple Triggering.

Ultrasound is widely used in medical and engineering inspections due to its non-destructive and easy-to-use characteristics. However, the complex internal structure of plant stems presents challenges for ultrasound testing. The density and thickness differences in various types of stems can cause different attenuation of ultrasonic signal propagation and the formation of different echo locations. To detect structural changes in plant stems, it is crucial to acquire complete ultrasonic echo RF signals. However, there is currently no dedicated ultrasonic RF detection equipment for plant stems, and some ultrasonic acquisition equipment has limited memory capacity that cannot store a complete echo signal. To address this problem, this paper proposes a double-layer multiple-timing trigger method, which can store multiple trigger sampling memories to meet the sampling needs of different plant stems with different ultrasonic echo locations. The method was tested in experiments and found to be effective in acquiring complete ultrasonic RF echo signals for plant stems. This approach has practical significance for the ultrasonic detection of plant stems.

Basic clinical management of preschool wheeze.

Preschool wheeze is very common and often difficult to treat. Most children do not require any investigations; only a detailed history and physical examination to ensure an alternative diagnosis is not being missed; and the differential diagnosis, and hence investigation protocols for the child in whom a major illness is suspected, shows geographical variation. The pattern of symptoms may be divided into episodic viral and multiple trigger to guide treatment, but the pattern of symptoms must be re-assessed regularly. However, symptom patterns are a poor guide to underlying pathology. Attention to the proper use of spacers, and adverse environmental exposures such as tobacco smoke exposure, is essential. There are no disease-modifying therapies, so therapy is symptomatic. This paper reviews recent advances in treatment, including new data on the place of leukotriene receptor antagonists, prednisolone for acute attacks of wheeze, and antibiotics, based on new attempts to understand the underlying pathology in a way that is clinically practical.

Rapid response events with multiple triggers are associated with poor outcomes in children.

We describe the characteristics and outcomes of pediatric rapid response team (RRT) events within a single institution, categorized by reason for RRT activation (RRT triggers). We hypothesized that events with multiple triggers are associated with worse outcomes. Retrospective 3-year study at a high-volume tertiary academic pediatric hospital. We included all patients with index RRT events during the study period. Association of patient and RRT event characteristics with outcomes including transfers to ICU, need for advanced cardiopulmonary support, ICU and hospital length of stay (LOS), and mortality were studied. We reviewed 2,267 RRT events from 2,088 patients. Most (59%) were males with a median age of 2 years and 57% had complex chronic conditions. RRT triggers were: respiratory (36%) and multiple (35%). Transfer to the ICU occurred after 1,468 events (70%). Median hospital and ICU LOS were 11 and 1 days. Need for advanced cardiopulmonary support was noted in 291 events (14%). Overall mortality was 85 (4.1%), with 61 (2.9%) of patients having cardiopulmonary arrest (CPA). Multiple RRT trigger events were associated with transfer to the ICU (559 events; OR 1.48; p < 0.001), need for advanced cardiopulmonary support (134 events; OR 1.68; p < 0.001), CPA (34 events; OR 2.36; p = 0.001), and longer ICU LOS (2 vs. 1 days; p < 0.001). All categories of triggers have lower odds of need for advanced cardiopulmonary support than multiple triggers (OR 1.73; p < 0.001). RRT events with multiple triggers were associated with cardiopulmonary arrest, transfer to ICU, need for cardiopulmonary support, and longer ICU LOS. Knowledge of these associations can guide clinical decisions, care planning, and resource allocation.

Multicentric Observational Study on Safety and Tolerability of COVID-19 Vaccines in Patients with Angioedema with C1 Inhibitor Deficiency: Data from Italian Network on Hereditary and Acquired Angioedema (ITACA).

Angioedema due to C1 inhibitor deficiency (AE-C1-INH) is a rare disease characterized by recurrent and unpredictable attacks of angioedema. Multiple trigger factors, including trauma, emotional stress, infectious diseases, and drugs, could elicit angioedema attacks. The aim of this study was to collect data on the safety and tolerability of COVID-19 vaccines in a population of patients affected by AE-C1-INH. Adult patients with AE-C1-INH, followed by Reference Centers belonging to the Italian Network for Hereditary and Acquired Angioedema (ITACA), were enrolled in this study. Patients received nucleoside-modified mRNA vaccines and vaccines with adenovirus vectors. Data on acute attacks developed in the 72 h following COVID-19 vaccinations were collected. The frequency of attacks in the 6 months after the COVID-19 vaccination was compared with the rate of attacks registered in the 6 months before the first vaccination. Between December 2020 and June 2022, 208 patients (118 females) with AE-C1-INH received COVID-19 vaccines. A total of 529 doses of the COVID-19 vaccine were administered, and the majority of patients received mRNA vaccines. Forty-eight attacks of angioedema (9%) occurred within 72 h following COVID-19 vaccinations. About half of the attacks were abdominal. Attacks were successfully treated with on-demand therapy. No hospitalizations were registered. There was no increase in the monthly attack rate following the vaccination. The most common adverse reactions were pain at the site of injection and fever. Our results show that adult patients with angioedema due to C1 inhibitor deficiency can be safely vaccinated against SARS-CoV-2 in a controlled medical setting and should always have available on-demand therapies.

Efficacy of Dry Needling Versus Transcutaneous Electrical Nerve Stimulation in Patients With Neck Pain Due to Myofascial Trigger Points: A Randomized Controlled Trial.

Introduction Myofascial pain is defined as pain arising primarily in muscles and associated with multiple trigger points. Among the non-pharmacological methods, trigger point injection and electrotherapy are effective methods to treat myofascial pain syndrome. This study compares the effectiveness of dry needling (DN) and transcutaneous electrical nerve stimulation (TENS) in reducing cervical pain intensity and improving cervical range of motion in patients with neck pain due to myofascial trigger points. Methods Fifty patients were enrolled and randomized into two groups. Patients in group A received dry needling, and those in group B received TENS. Patients were evaluated using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Cervical Range of Motion (CROM) before the treatment and on days 14and 28 after the treatment. The unpaired t-test was used to evaluate quantitative data, except for VAS, where the Mann-Whitney U test was used. All quantitative variables had a normal distribution with a standard deviation except for pain intensity (VAS), which deviated from the normal distribution. The significance level was set at a P-value=0.05. Results Both DN and TENS groups showed significant improvement in VAS, NDI, and CROM between days 0 and 28 (p=<0.001). The DN group showed greater improvements in pain intensity from day 0 to day 28 (p=<0.001). Between days 0 and 28, there was no discernible difference in NDI changes between the groups (p = 0.157 and p = 0.799, respectively). Mixed results were obtained for CROM, with significant improvement of cervical flexion in the dry needling group (p=<0.008) and significant improvement of cervical rotation to the painful side in the TENS group (<0.001). Conclusion Both dry needling and TENS are effective in reducing pain and improving NDI and CROM in patients with neck pain due to myofascial trigger points. However, as dry needling is more effective in pain reduction, a single session of dry needling is more beneficial and cost-effective as compared to multiple sessions of TENS.

Kinesio Taping as a Therapeutic Tool for Masticatory Myofascial Pain Syndrome—An Insight View

Myofascial pain syndrome (MPS) is thought to stem from masticatory muscle hypersensitivity. Masticatory myofascial pain syndrome (MMPS) is characterized by multiple trigger points (MTrPs), also known as hyperirritable points, in taut bands of affected muscles, regional muscle pain, or referred pain to nearby maxillofacial areas like teeth, masticatory muscles or the temporomandibular joint (TMJ). Muscle stiffness, reduced range of motion, muscle weakening without atrophy, and autonomic symptoms may accompany regional discomfort. Multiple treatments have been utilized to reduce trigger points and mandibular function restrictions. As a result of these incapacitating symptoms, MMPS can significantly impair many elements of quality of life. The application of Kinesio tape (KT) is a non-invasive method of treating dormant myofascial trigger points. Utilizing the body's innate capacity for self-repair, this technique entails taping specific regions of the skin. KT alleviates discomfort, decreases swelling and inflammation, enhances or suppresses motor function in the muscles, stimulates proprioception, promotes lymphatic drainage, stimulates blood flow, and expedites tissue recovery. However, studies conducted to assess its effects have frequently yielded contradictory results. To the best of our knowledge, just a few research has looked into the therapeutic effects of KT on MMPS. The purpose of this review is to determine the efficacy of KT as a therapeutic tool for regular treatment or as an adjunct to existing therapy for MMPS based on the evidence presented in this review. To establish KT as a reliable independent treatment option, additional research is necessary to confirm the efficacy of KT techniques and applications, specifically randomized clinical trials.

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.