Need For Treatment Research Articles

Bias Mitigation via Synthetic Data Generation: A Review

Artificial intelligence (AI) is widely used in healthcare applications to perform various tasks. Although these models have great potential to improve the healthcare system, they have also raised significant ethical concerns, including biases that increase the risk of health disparities in medical applications. The under-representation of a specific group can lead to bias in the datasets that are being replicated in the AI models. These disadvantaged groups are disproportionately affected by bias because they may have less accurate algorithmic forecasts or underestimate the need for treatment. One solution to eliminate bias is to use synthetic samples or artificially generated data to balance datasets. Therefore, the purpose of this study is to review and evaluate how synthetic data can be generated and used to mitigate biases, specifically focusing on the medical domain. We explored high-quality peer-reviewed articles that were focused on synthetic data generation to eliminate bias. These studies were selected based on our defined inclusion criteria and exclusion criteria and the quality of the content. The findings reveal that generated synthetic data can help improve accuracy, precision, and fairness. However, the effectiveness of synthetic data is closely dependent on the quality of the data generation process and the initial datasets used. The study also highlights the need for continuous improvement in synthetic data generation techniques and the importance of evaluation metrics for fairness in AI models.

Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine.

Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable. In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 - 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed. Seventy-four patients were included, with a mean age of 62.9years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, p < 0.001), and the difference between healthcare professional (19.3 ± 9.4s) and patient measurements (18.4 ± 9.7s) was insignificant (p = 0.116). Interrater reliability remained high in patients > 65years (ICC 0.8584, p < 0.001), patients with ASA grades 3&4 (ICC 0.7066, p < 0.001), patients considered frail (ICC 0.8799, p < 0.001), and in patients not using any walking aid (ICC 0.8012, p < 0.001). High symptom severity still showed strong reliability (ICC 0.8279, p < 0.001 for Oswestry Disability Index > 40; ICC 0.8607, p = 0.011 for Neck Disability Index > 40). Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.

Age-dependent prevalence of malocclusions requiring treatment according to the KIG classification : Amultipart cross-sectional study over a10-year period from the district of Viersen/North Rhine.

Patients with statutory health insurance (SHI) in Germany must undergo an assessment of orthodontic treatment need using the "Kieferorthopädische Indikationsgruppen" (KIG; orthodontic indication groups) classification system since 2002. Atreatment need only exists if anomalies of acertain degree of severity are present. The aim of this study was to evaluate the age-dependent prevalence and percentage distribution of KIG grades requiring treatment in patients with SHI before the age of 18over a10-year period. Between 2012 and 2021, treatment indication existed for 1951 (1025female, 926male) out of 2288 patients with SHI in the cohort of this study before the age of 18according to current SHI guidelines. The KIG classification was based on the highest existing KIG grade. There were no multiple classifications. The patient cohort was divided into three patient groups (PG) according to chronological age for analysis: PG1 < 10years of age (early treatment), PG2 10 to < 13years of age (main treatment) and PG3 13 to < 18years of age (late treatment). In PG1 (454 patients), the KIG classificationsD(26.5%), K(25.5%), M(19.4%), and P(18.0%) dominated. In PG2 (998 patients), classifications D(33.2%), predominated, whereas K(7.5%) and M(5.9%) rarely occurred. The classifications E(12.6%) and P(13.3%) appeared quite frequently. Transverse deviations occurred only about half as often in PG2 as in PG1 and PG3. In PG3 (499patients), the classification E(17.6%) was particularly common, while P(2.6%) was rare. The proportion of KIG grades 5decreased depending on age: 19% in PG1, 13.5% in PG2, 10.4% in PG3. The prevalence of sagittal classifications was highest in all age groups (45.9% in PG1, 39.1% in PG2, 31.5% in PG3). The distribution of KIG classifications requiring treatment was not homogeneous, but age dependent. The differences were particularly evident in the early treatment group and may be due to the limited applicability of the KIG classification system in patients before late mixed dentition. With increasing age at initial examination, the prevalence of sagittal classifications decreased, while that of vertical classifications increased. Still, the sagittal classifications DandM occurred most frequently in all age groups. The KIG classification Dwas always the most common in all patients until the age of18.

Ultrasound stimulation of the vagus nerve as a treatment modality for anxiety.

Anxiety is an increasingly prevalent mental disorder, causing widespread hardship and interfering with society's economic progression. Standard treatments include various talk therapies with poor prognoses or drug interventions with complex side effects, both introducing unnecessary burdens to patients. To remedy this, non-invasive ultrasound stimulation to the vagus nerve is a novel, low-cost treatment that is showing promise. Although vagus nerve stimulation is already approved for epilepsy and other conditions, it requires regular maintenance. In contrast, studies using non-invasive ultrasound stimulation have shown preliminary positive results in affecting vagal activity with minimal drawbacks. This review covers a variety of studies investigating the effects of ultrasound stimulation on the vagus nerve. With rising levels of anxiety with each generation, there is a pressing need for more innovative and diverse treatments with fewer costs and more benefits.

Orthodontic Treatment Need of an Iranian versus an Arab Population Using the Index of Orthodontic Treatment Need: A Cross-sectional Study

Aim: This study assessed the orthodontic treatment needs of Iranian and Arab university students using the Index of Orthodontic Treatment Need (IOTN). Methods: This cross-sectional study was conducted on 100 Arab and 100 Iranian patients presenting to Ajman University dental clinic in 2023. The subjects were selected by convenience sampling and were 19‒25 years of age. The dental health component (DHC) and esthetic component (AC) of the IOTN were used to assess their malocclusion and the need for orthodontic treatment. Data were analyzed using the chi-squared test at a significance level of 0.05. Results: According to the DHC, 60% of Arab and 64% of Iranian patients had malocclusion with moderate to extreme need for treatment. Of the Iranian population, 12% were Grade I (no need), 24% were Grade 2 (little or mild need), 28% were Grade 3 (moderate need), 20% were Grade 4 (severe need), and 16% were Grade 5 (extreme need). These values were 17%, 23%, 32%, 20%, and 8%, respectively, for the Arab population. According to the AC, 59% of Iranians and 56% of Arabs required little or no treatment, while 27% of Iranians and 31% of Arabs had moderate need, and 14% of Iranians and 13% of Arabs had severe need for treatment. The difference between the two populations was insignificant in the DHC (P=0.431) or AC (P=0.681) grading. Conclusion: The two groups with different ethnic backgrounds exhibited no significant difference regarding orthodontic treatment needs.

Impact of malocclusion and oral habits on oral health-related quality of life and sleep disturbance in young adults : Across-sectional study.

The aim of this study was to investigate the impact of malocclusion and oral habits on oral health-related quality of life and sleep disturbance in young adults. Across-sectional study was conducted with asample of 213 young adults aged 18-30years. Dental occlusion data were assessed through clinical examination. Aquestionnaire was used to collect data on oral habits. Outcomes were collected using the Oral Health Impact Profile (OHIP-14) and Mini Sleep Questionnaire. Anterior open bite (adjusted odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.02-5.67, p = 0.044), swallowing disorders (adjusted OR = 2.39, 95% CI = 1.13-5.05, p = 0.022), and sleeping on hands were associated with anegative impact on oral health-related quality of life. Females (adjusted OR = 2.61, 95% CI = 1.10-6.17, p = 0.029), teeth grinding (adjusted OR = 2.78, 95% CI = 1.08-7.14, p = 0.034), biting lips or cheeks (adjusted OR = 4.28, 95% CI = 1.49-12.29, p = 0.007), and self-perception of need for orthodontic treatment (adjusted OR = 7.88, 95% CI = 2.12-29.30, p = 0.002) were associated as arisk for sleep disturbances. The findings suggest that oral habits and some types of malocclusions can impact oral health-related quality of life. In addition, sleep disturbances were associated with agreater need for orthodontic treatment and ahabit of grinding teeth in young adults.

NMDAR Down-Regulation: Dual - Hit Molecular Target For COPD - Depression Comorbidity.

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease characterized by sustained airflow limitation that represents one of the main causes of disability in modern society. Depression affects approximately 40% of COPD patients. Both COPD and depression are associated with chronic systemic inflammation and their comorbidity represents a critical unmet treatment need. N-methyl-D-aspartate glutamatergic receptors (NMDAR) are well characterized in the central nervous system (CNS) and widely expressed in lung tissue and inflammation-related cells. Accumulating evidence indicates that pathologic NMDAR up-regulation, leading to pro-inflammatory pathways activation and tissue damage, may play a crucial role in chronic lung injury as well as in depression. D-cycloserine, a bacteriostatic antibiotic used since the 1950's in tuberculosis, acts at therapeutic dosages also as a NMDAR functional antagonist and has antidepressant and anti-inflammatory effects. We hypothesize that NMDAR down-regulation may represent a unified molecular target for the treatment of COPD - depression comorbidity and may simultaneously alleviate both respiratory and depression symptomatology. We postulate that D-cycloserine treatment may achieve these dual - hit objectives and envisage that our hypotheses may apply to additional inflammation disorders that are frequently accompanied by depression.

“To exercise sustainably” – Patients’ experiences of compulsive exercise in eating disorders and the Compulsive Exercise Activity Therapy (LEAP) as a treatment: a qualitative interview study

BackgroundCompulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants’ subjective experiences.MethodsNine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis.ResultsThe informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed.ConclusionsOverall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment.Trial registrationThe trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391.

In vivo and ex vivo gene therapy for neurodegenerative diseases: a promise for disease modification.

Neurodegenerative diseases (NDDs), including AD, PD, HD, and ALS, represent a growing public health concern linked to aging and lifestyle factors, characterized by progressive nervous system damage leading to motor and cognitive deficits. Current therapeutics offer only symptomatic management, highlighting the urgent need for disease-modifying treatments. Gene therapy has emerged as a promising approach, targeting the underlying pathology of diseases with diverse strategies including gene replacement, gene silencing, and gene editing. This innovative therapeutic approach involves introducing functional genetic material to combat disease mechanisms, potentially offering long-term efficacy and disease modification. With advancements in genomics, structural biology, and gene editing tools such as CRISPR/Cas9, gene therapy holds significant promise for addressing the root causes of NDDs. Significant progress in preclinical and clinical studies has demonstrated the potential of in vivo and ex vivo gene therapy to treat various NDDs, offering a versatile and precise approach in comparison to conventional treatments. The current review describes various gene therapy approaches employed in preclinical and clinical studies for the treatment of NDDs, including AD, PD, HD, and ALS, and addresses some of the key translational challenges in this therapeutic approach.

Unveiling Resmetirom: A systematic review and meta-analysis on its impact on liver function and safety in non-alcoholic steatohepatitis treatment.

The role of Resmetirom in non-alcoholic steatohepatitis (NASH) represents a promising therapeutic approach in addressing the growing global burden of liver disease. With NASH emerging as a leading cause of liver-related morbidity and mortality worldwide, there is an urgent need for effective treatments. Resmetirom, a selective thyroid hormone receptor-β agonist, offers potential benefits in improving liver histology and metabolic parameters in patients with NASH. This review examines the current evidence surrounding Resmetirom's role in NASH management. A systematic review and meta-analysis was done by searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE (including MEDLINE InProcess) (OvidSP), Web of Science, Embase (OvidSP), and Scopus databases. ROB2 Cochrane tool was used for assessing risk of bias in randomized controlled trials (RCTs). In the analysis, we used RevMan Cochrane software. The study showed that patients who were treated with Resmetirom had significantly lower low-density lipoprotein-cholesterol (LDL-C) levels (mean difference [MD] -10.45; 95% confidence interval [CI] -15.86 to -5.83; P < 0.001) and alanine aminotransferase (ALT) levels (MD -7.18; 95% CI -12.67 to -1.68; P = 0.01) as compared with those in the placebo group. The risk of adverse events including diarrhea [risk ratio (RR)1.81; 95% CI 1.40 to 2.35; P < 0.001] and nausea (RR 1.72; 95% CI 1.31 to 2.27; P < 0.001) was significantly increased for the Resmetirom group as compared with the placebo group. Resmetirom presents a promising therapeutic option for NASH, offering potential benefits in reducing liver fat content and improving histological outcomes. The encouraging results from clinical trials suggest that Resmetirom may address an unmet need in NASH management, providing hope for patients with this progressive liver disease. Further research and long-term studies are warranted to validate its efficacy and safety profile in larger patient populations.

A Consensus on Staphylococcus aureus Exacerbated Atopic Dermatitis and the Need for a Novel Treatment.

The skin microbiome is essential for skin barrier function because it inhibits pathogen colonization, and decreased microbiome diversity correlates with increased Staphylococcus aureus (S. aureus) burden and atopic dermatitis (AD) severity. Managing S. aureuss-driven AD in clinical practice remains problematic due to complications such as AD exacerbation, impetigo, abscesses, and invasive infections. This project used a modified Delphi process comprising face-to-face discussions followed by a blinded vote to define 5 final consensus statements. A panel of 6 pediatric dermatologists developed a consensus on S. aureus-driven AD exacerbation, challenges in current treatments for AD with secondary bacterial infections, and new developments to improve patient care and outcomes. The panel's 5 consensus statements provide recommendations for dermatologists, pediatricians, and healthcare providers treating patients with secondary infected AD. These recommendations underscore the importance of recognizing and managing S. aureus skin infection in AD clinical practice and promoting antibiotic stewardship to mitigate resistance. The panel defined a significant unmet need for a single topical AD therapy effective against all symptoms, including pruritus, S. aureus-driven AD exacerbation, infection, and inflammation, across AD severity levels. J Drugs Dermatol. 2024;23(10):825-832. doi:10.36849/JDD.8240.

The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits.

U.S. state electronic prescription drug monitoring programs (PDMPs) are associated with reduced opioid dispensing among people with chronic pain and may impact use of other chronic pain treatments. In states with medical cannabis laws (MCLs), patients can use cannabis for chronic pain management, reducing their need for chronic-pain related treatment visits and moderating effects of PDMP laws. Given high rates of chronic pain among Medicaid enrollees, we examined associations between PDMP enactment in the presence or absence of MCL on chronic pain-related outpatient and emergency department (ED) visits. We created annual cohorts of Medicaid enrollees with chronic pain diagnoses using national Medicaid claims data from 2002-2013 and 2016. Negative binomial hurdle models produced adjusted odds ratios (aOR) for the likelihood of any chronic pain-related outpatient or ED visit and incident rate ratios (IRR) for the rate of visits among patients with ≥ 1 visit. Medicaid enrollees aged 18-64years with chronic pain (N = 4,878,462). A 3-level state-year variable with the following categories: 1) no PDMP, 2) PDMP enactment in the absence of MCL, or 3) PDMP enactment in the presence of MCL. Healthcare codes for chronic pain-related outpatient and ED visits each year. The sample was primarily female (67.2%), non-Hispanic White (51.2%), and ages 40-55years (37.2%). Compared to no-PDMP states, PDMP enactment in the absence of MCL was not associated with chronic pain-related outpatient visits but PDMP enactment in the presence of MCL was associated with lower odds of chronic pain-related outpatient visits (aOR = 0.81, 95% CI:0.71-0.92). PDMP enactment was not associated with ED visits, irrespective of MCL. During a period of PDMP and MCL expansion, our findings suggest treatment shifts for persons with chronic pain away from outpatient settings, potentially related to increased use of cannabis for chronic pain management.

Comprehensive evaluation of deep neck infections: A retrospective analysis of 111 cases.

Our study will analyze patients' clinical characteristics, treatment strategies, and complications with deep neck infection (DNI) using their medical records for five years. The present study included 111 patients diagnosed with DNI in our clinic between January 2018 and March 2023. The patients' complaints at admission, sociodemographic characteristics, season of diagnosis, findings from laboratory tests, radiological imaging performed at the time of first diagnosis, abscess localization, medical and surgical treatment methods used, and complications developing during follow-up were retrospectively examined. The mean age of the patients included in the study was 38.51 ± 16.92 (6-87 years). There was a significant correlation between chronic disease, smoking behaviours, oral hygiene, and DNI among patients based on their sociodemographic characteristics and medical history (p < .005). DNI development did not differ by season (p > .005). Physical examination findings predominantly revealed neck masses (39.6%) and peritonsillar abscesses (32.4%), and patients with peritonsillar abscesses had a shorter length of hospital stay than those with other localizations. No severe complications occurred during the clinical follow-up. Chronic diseases, smoking, and poor oral hygiene are the primary risk factors for developing DNIs. If an abscess is located in a critical area, it may require extended hospitalization and surgery under general anesthesia. Therefore, addressing these risk factors and encouraging good oral hygiene practices are crucial to preventing DNIs and reducing the need for intensive treatment.

Review of current and new drugs for the treatment of metabolic-associated fatty liver disease.

In the past 3 decades, metabolic-associated fatty liver disease (MAFLD) has emerged as a widespread liver condition, with its global prevalence on the rise. It ranks as a leading contributor to hepatocellular carcinoma (HCC) and necessitates liver transplantation. Under the multiple parallel hits model, the pathogenesis of MAFLD stems from various liver stressors, notably nutrient overload and sedentary lifestyles. While medical management for MAFLD is well-established, encompassing non-pharmaceutical and pharmaceutical interventions, determining the most effective pharmaceutical therapy has remained elusive. This review discusses diabetic medications for MAFLD treatment, emphasizing recent studies and emerging drugs while reviewing other nondiabetic agents. Emerging evidence suggests that combination therapies hold promise for resolving MAFLD and metabolic steatohepatitis (MASH) while managing side effects. Ongoing trials play a pivotal role in elucidating the effects of mono, dual, and triple receptor agonists in individuals with MASH. With the rising burden of MAFLD/MASH and its severe consequences, the need for effective treatments is more pressing than ever. This review provides a comprehensive overview of the current landscape of pharmaceutical interventions for MAFLD and MASH, shedding light on the potential of newer drugs especially diabetic medications and the importance of ongoing research in this field.

Rational treatment of acute rhinosinusitis in the context of increasing antibiotic resistance.

Acute rhinosinusitis is one of the most common diseases in the population, both in primary and specialist otolaryngological care. It is also responsible for a disturbingly high percentage of prescribed antibiotic therapy, regardless of the etiology of the disease. Despite the fact that acute viral and acute postviral rhinosinusitis dominate among the phenotypes of acute rhinosinusitis, and the development of acute bacterial rhinosinusitis occurs in only 0.5-2% of all cases in adults and 5-10% in children, antibiotics still remain an important element of treatment, despite alarming data on the growing antibiotic resistance and the adverse effect of antibiotics on the human microbiome, leading to dysbiosis. The discovery of antibiotics was one of the greatest achievements of modern medicine, but their inappropriate use leads to the gradual increase in the phenomenon of antibiotic resistance, considered one of the most serious public health problems, recognized by the WHO as one of the 10 greatest threats to human health in the 21&lt;sup&gt;st&lt;/sup&gt; century. The unjustified use of antibiotics in outpatient care is the key to the growth of this problem, in parallel with the lack of patient compliance. The COVID pandemic has intensified this unfavourable trend. That is why the knowledge of antibiotic stewardship is so important. According to the guidelines, in the therapy of acute rhinosinusitis, symptomatic and anti-inflammatory treatment dominates, and antibiotic therapy has very strictly defined and limited indications. The latest guidelines also recommend herbal medicines, including BNO 1016, in the treatment of acute viral and postviral rhinosinusitis. Available studies indicate that it has a beneficial effect not only on shortening the duration of the disease and reducing symptoms, but also reduces the need for antibiotic treatment in acute rhinosinusitis. Complications of acute rhinosinusitis are relatively rare and are not related to taking antibiotics.

Platelet and Erythrocyte Membranes Coassembled Biomimetic Nanoparticles for Heart Failure Treatment.

Cardiac fibrosis is a prevalent pathological process observed in the progression of numerous cardiovascular diseases and is associated with an increased risk of sudden cardiac death. Although the BRD4 inhibitor JQ1 has powerful antifibrosis properties, its clinical application is extremely limited due to its side effects. There remains an unmet need for effective, safe, and low-cost treatments. Here, we present a multifunctional biomimetic nanoparticle drug delivery system (PM&EM nanoparticles) assembled by platelet membranes and erythrocyte membranes for targeted JQ1 delivery in treating cardiac fibrosis. The platelet membrane endows PM&EM nanoparticles with the ability to target cardiac myofibroblasts and collagen, while the participation of the erythrocyte membrane enhances the long-term circulation ability of the formulated nanoparticles. In addition, PM&EM nanoparticles can deliver sufficient JQ1 with controllable release, achieving excellent antifibrosis effects. Based on these advantages, it is demonstrated in both pressures overloaded induced mouse cardiac fibrosis model and MI-induced mouse cardiac fibrosis that injection of the fusion membrane biomimetic nanodrug carrier system effectively reduced fibroblast activation, collagen secretion, and improved cardiac fibrosis. Moreover, it significantly mitigated the toxic and side effects of long-term JQ1 treatment on the liver, kidney, and intestinal tract. Mechanically, bioinformatics prediction and experimental validation revealed that PM&EM/JQ1 NPs reduced liver and kidney damage via alleviated oxidative stress and mitigated cardiac fibrosis via the activation of oxidative phosphorylation activation. These results highlight the potential value of integrating native platelet and erythrocyte membranes as a multifunctional biomimetic drug delivery system for treating cardiac fibrosis and preventing drug side effects.

Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Spina Bifida.

While the Ponseti method is the primary treatment for idiopathic clubfoot, its application in treating myelodysplastic clubfeet is less certain. Myelodysplastic clubfoot tends to be more severe and difficult to treat. Although the Ponseti method can initially correct these cases, there is conflicting evidence about recurrence rates and the need for additional treatment. This study aims to assess the effectiveness of the Ponseti method in treating myelodysplastic clubfeet compared with idiopathic clubfeet over a 20-year period. The study conducted a retrospective review of medical records from patients treated for clubfoot at a single institution (2002 to 2021), comparing children with myelodysplastic and idiopathic clubfoot. Included patients were under 18, initially treated with Ponseti-casting, and had a minimum 2-year follow-up. Data on demographics, treatment details, recurrence, and Patient-reported Outcomes Measurement Information System (PROMIS) scores were analyzed. Forty-nine myelodysplastic and 512 idiopathic clubfeet in 366 patients met the inclusion criteria. Myelodysplastic cases had a median age of 5 months at presentation versus 2 months for idiopathic cases ( P =0.002). Initial correction was achieved in 95% of idiopathic and 87.8% of myelodysplastic feet ( P =0.185). Recurrence rates were higher in the myelodysplastic cohort, 65.3% versus 44.1% ( P =0.005). Surgery was necessary to treat recurrence in 59.2% of myelodysplastic and 37.7% of idiopathic cases, P =0.003. Follow-up was 3.9±1.8 years for myelodysplastic and 3.3±1.5 years for idiopathic feet, P =0.030. Myelodysplastic feet had lower PROMIS mobility scores; 31.94±7.56 versus 49.21±8.64, P <0.001. To the best of our knowledge, we report the largest series of myelodysplastic clubfeet treated by Ponseti casting and the first to assess PROMIS data. Overall, the Ponseti method is as effective in obtaining initial correction in myelodysplastic clubfoot as it is in idiopathic clubfoot. However, myelodysplastic clubfeet has a higher risk of relapse and increased need for surgical interventions. Children with spina bifida may need closer follow-ups and more stringent adherence to bracing. Level III-therapeutic studies-investigating the results of treatment.

Social epidemiological mediators of rural and urban differences in perceived need for cocaine use treatment.

Social epidemiological mediators of rural and urban differences in perceived need for cocaine use treatment.

Differences Between Vietnamese Living in Germany and German Periodontitis Patients in Periodontal Conditions and Subgingival Microbiota

Introduction and aimsA number of studies have reported ethnic differences in the prevalence and severity of periodontitis. Such discrepancies could be attributed to disparities in periodontal risk factors, as well as variations in the composition of the subgingival microbiota. Given the substantial Vietnamese population residing in the former German Democratic Republic, the present study aimed to compare the clinical and microbial characteristics of periodontitis patients of Vietnamese Asian origin living in Germany with those of German Caucasian periodontitis patients. MethodsA total of 60 patients with a minimum stage II periodontitis diagnosis were included in the study. Of these, 30 were of Vietnamese origin, with an average age of 55 years and a male prevalence of 33.3%. The remaining 30 patients were of German origin, with an average age of 54.5 years and a male prevalence of 40%. The periodontal diagnosis was made in accordance with the recently revised classification of periodontal disease. The pooled subgingival plaque samples were subjected to next-generation sequencing on the MiSeq platform (Illumina). ResultsThe German patients were significantly more likely to be smokers (56.7% vs 13.3%), had significantly higher body mass index (26 vs 22.6 kg/m²), probing depth (4.1 vs 3.6 mm), and clinical attachment loss (5 vs 4.1 mm). In terms of microbiota, the Vietnamese patients exhibited significantly lower beta diversity compared to the German patients, and smokers demonstrated a significantly higher beta diversity compared to nonsmokers. The microbiota of both groups differed most significantly in the relative abundance of Porphyromonas gingivalis (Vietnamese) and Fusobacteriia (German). ConclusionsGerman patients with periodontitis showed more severe periodontal symptoms and more pronounced periodontal risk factors compared to Vietnamese patients. Both patient groups also showed significant differences in the subgingival microbiota. Clinical relevanceCompared to Vietnamese living in Germany, German patients have a higher need for periodontal treatment and at the same time the risk factors of smoking and obesity should be reduced. More research is needed before the differences in oral microbiota between the two groups can lead to individualised therapeutic approaches.

Quantifying and Assessing Post-Stroke Patients' Functional Capability Level for Independent Daily Activities: A Review

Every year, over 13.7 million stroke episodes occur worldwide, addressing the pressing need for efficient rehabilitation treatments to restore motor function in stroke patients is paramount. The escalating number of stroke cases emphasises the urgency of developing robust rehabilitation methodologies. Currently, therapists rely on subjective and manual assessments to determine subsequent patient interventions, a method fraught with challenges, including subjectivity and dependence on the therapist's experience. This paper critically reviews the quantification and assessment of post-stroke patients' functional capability for independent daily activities. It delves into the existing standards of clinical assessment, explores the integration of sensors in limb rehabilitation prototypes, and observes the mathematical methods and algorithms employed by previous researchers to assess and quantify stroke patients' functional capability automatically. The discussion covers the advantages and disadvantages encountered in developing these prototypes and evaluating their suitability in addressing the complexities of stroke rehabilitation. In conclusion, this paper provides a perception of existing research and identifies crucial gaps. Based on the current research landscape, it presents proposals for prototype development, paving the way for future advancements in stroke rehabilitation methodologies.