Predictors Of Treatment Success Research Articles

Combined Ultrasound and Fluoroscopy versus Ultrasound versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Retrospective Comparative Study.

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.

Clinical outcome of intravenous urography-assisted shockwave lithotripsy for radiolucent ureteral stones

ObjectiveWe aimed to compare the clinical outcome of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones. MethodsWe retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021. The primary outcome was a stone-free rate with one session within 30 days, defined as no residual stones without auxiliary treatment. Multivariate analysis was used to examine whether intravenous urography use predicted treatment success. Furthermore, we compared the outcomes using propensity score matching. ResultsNinety-eight patients underwent intravenous urography use protocol (Group I), and the remaining 636patients underwent non-intravenous urography protocol (Group N). Stone-free rates with one session within 30 days were 37.8% and 31.7% in groups I and N, respectively (p=0.20). No statistical differences were observed in the conversion rate to ureteroscopy (p=0.26) and complication rate (p=0.70) between Group I and Group N. One patient who developed skin redness was considered a complication of the contrast medium. Propensity score matching examined 88 matched pairs. Treatment success was obtained in 31 (35.2%) patients in Group I and 33 (37.5%) patients in Group N (p=0.88) within 30 days with one session. ConclusionsRadiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.

Peripheral NK cells identified as the predictor of response in extensive-stage small cell lung cancer patients treated with first-line immunotherapy plus chemotherapy.

Although immunotherapy improves outcomes in extensive-stage small-cell lung cancer (ES-SCLC), the search for biomarkers predicting treatment success is crucial. Natural killer (NK) cells are potential indicators in various cancers, however, their precise role in ES-SCLC prognosis remains unclear. In this retrospective study, 33 patients with ES-SCLC treated with first-line immuno-chemotherapy were enrolled. The peripheral NK cell percentage and its longitudinal dynamics were analyzed using flow cytometry. Progression-free survival (PFS) and overall survival (OS) were calculated as hazard ratio (HR) and compared statistically. The median PFS was better in the group with normal baseline NK cell levels than the low group (7.0 vs. 4.6months; HR = 0.17; 95% CI 0.07-0.41; P < 0.0001), but there was no association with OS (14.9 vs. 10.3months; HR = 0.55; 95% CI 0.23-1.31; P = 0.171). Furthermore, the NK cell% for 95.0% of patients increased after immunochemotherapy in the clinical response group (P = 0.0047), which led to a better median PFS (6.3 vs. 2.1months; HR = 0.23; 95% CI 0.05-0.98; P < 0.0001) and OS (14.9 vs. 5.9months; HR = 0.20; 95% CI 0.04-1.02; P < 0.0001). Similar trends were observed with NK cell% changes up to disease progression, improving PFS (6.5 vs. 4.3; HR = 0.41; 95% CI 0.12-0.92; P = 0.0049) and OS (17.4 vs. 9.7; HR = 0.42; 95% CI 0.17-1.02; P < 0.0001). In patients with ES-SCLC, the percentage and changes in peripheral NK cells can predict the response to combined immunotherapy and chemotherapy.

The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic

BackgroundThe clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as “Working Alliance,” which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients’ care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients’ perspective to inform evidence-based practice.MethodsParticipants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance.ResultsThe findings highlight that an early working alliance entails the gradual development of patients’ confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients’ expectations, the trainee chiropractors’ qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance.ConclusionsEstablishing an early trainee chiropractor-patient working alliance involves a process of building patients’ confidence in the trainee chiropractors’ expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients’ perceptions of trainee chiropractors’ qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors’ explanations.

Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy.

This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.

Predictors of successful treatment after transforaminal epidural steroid injections in patients with lumbar disc herniation.

Epidural steroid injections are common procedures used to treat lumbosacral radicular pain due to lumbar disc herniation (LDH). It is crucial for the clinician to anticipate which patients can benefit from interventional treatment options. This study aimed to examine the effect of radiological and clinical parameters on lumbar transforaminal epidural steroid injections (TFESI)/local anesthetic injection outcomes in patients with LDH. This study included 286 patients with LDH (146 males and 140 females). All patients received a fluoroscopically guided TFESI (triamcinolone acetonide 40 mg, lidocaine 2%, and 2.5 ml of physiological saline). Patients were evaluated according to radicular pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale at baseline and 3 months after the injections. Demographic, clinical and magnetic resonance imaging (MRI) findings were recorded to assess the predictive factors for TFESI outcomes. Pfirrmann Grades 1 and 2 were classified as low-grade nerve root compression and Grade 3 was classified as highgrade nerve root compression. Compared to baseline measurements there were significant improvements in radicular pain, ODI score, Laseque angle, and Schober test scores 3 months after injection. Improvements of at least 50% in radicular pain relief and the ODI functionality index were (n= 214) 82%, (n= 182) 70% respectively at 3 months. Correlation analyses revealed that a shorter duration of symptoms, lowgrade nerve root compression and foraminal/extraforaminal location on MRI findings were associated with a favorable response. Lowgrade nerve root compression was a predictor of a favorable response to TFESI.

Eosinophil granulocytes in chronic inflammatory respiratory diseases and CRSwNP: Function, immunological basis, and clinical significance.

Eosinophils play an important regulatory and immunomodulatory role in airway mucosa and have antiparasitic and antiviral properties as well as pro-inflammatory effects that may also cause persistence of inflammation with tissue remodeling. The number of eosinophils and the detection of specific mediators in biological samples from, e.g., blood, nasal secretions, and bronchial fluid can serve as biomarkers that reflect the underlying pathophysiology of certain diseases, predict treatment success, and detect therapy effects. A literature search was conducted to determine the immunologic basis, mode of action, clinical significance, and available evidence for therapeutic approaches using eosinophil-targeted monoclonal antibodies by searching Medline, Pubmed, and the national and international trial database (ClinicalTrials.gov) and guideline registries as well as the Cochrane Library. Human studies published on the topic in the period up to and including 10/2023 were considered. Based on the international literature and previous experience, the results are summarized, and recommendations are given. The important role of eosinophils in immunological processes in the airway mucosa is comprehensively analyzed and can serve as a basis for current and future treatment approaches.

Assessing the Utility of artificial intelligence in endometriosis: Promises and pitfalls.

Endometriosis, a chronic condition characterized by the growth of endometrial-like tissue outside of the uterus, poses substantial challenges in terms of diagnosis and treatment. Artificial intelligence (AI) has emerged as a promising tool in the field of medicine, offering opportunities to address the complexities of endometriosis. This review explores the current landscape of endometriosis diagnosis and treatment, highlighting the potential of AI to alleviate some of the associated burdens and underscoring common pitfalls and challenges when employing AI algorithms in this context. Women's health research in endometriosis has suffered from underfunding, leading to limitations in diagnosis, classification, and treatment approaches. The heterogeneity of symptoms in patients with endometriosis has further complicated efforts to address this condition. New, powerful methods of analysis have the potential to uncover previously unidentified patterns in data relating to endometriosis. AI, a collection of algorithms replicating human decision-making in data analysis, has been increasingly adopted in medical research, including endometriosis studies. While AI offers the ability to identify novel patterns in data and analyze large datasets, its effectiveness hinges on data quality and quantity and the expertise of those implementing the algorithms. Current applications of AI in endometriosis range from diagnostic tools for ultrasound imaging to predicting treatment success. These applications show promise in reducing diagnostic delays, healthcare costs, and providing patients with more treatment options, improving their quality of life. AI holds significant potential in advancing the diagnosis and treatment of endometriosis, but it must be applied carefully and transparently to avoid pitfalls and ensure reproducibility. This review calls for increased scrutiny and accountability in AI research. Addressing these challenges can lead to more effective AI-driven solutions for endometriosis and other complex medical conditions.

Efficacy of pegylated interferon α-2b plus entecavir therapy and predictors of treatment success in children with chronic hepatitis B.

Interferon therapy, used in the treatment of chronic hepatitis B (CHB), is one of the means by which patients can achieve a functional cure. Pegylated interferon is currently used in the treatment of CHB. There are two main types of pegylated interferon: α-2b and α-2a. This study explored the efficacy, safety, and predictors of treatment response for α-2b plus entecavir among children in a real-world setting. The study included 76 patients aged 3-18 years, all of whom were treated with interferon α-2b plus entecavir. The mean duration of treatment was 401.99 days, and 31.6% (24/76) of patients achieved HBsAg clearance. Competing risk model analyses showed that children with baseline HBsAg <1500 IU/mL (subdistribution hazard ratio [sHR]=2.643, P=0.022) and a higher baseline alanine aminotransferase (ALT) level (sHR=1.005, P=0.000) had a higher probability of achieving HBsAg clearance during treatment. Conversely, children with a higher hepatitis B virus loading level (sHR=0.835, P=0.043) and age ≥10 years (sHR=0.243, P=0.002) had a lower probability of achieving HBsAg clearance during treatment. A decrease of >1 log10 in HBsAg level (sHR=3.479, P=0.001) at 12 weeks of treatment was associated with a higher probability of achieving surface antigen clearance. These results indicated that interferon plus entecavir therapy is a promising means of achieving HBsAg clearance in children with CHB. Moreover, HBsAg, ALT, virus loading, and age are indicators of treatment success probability.

Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients.

Osteoarthritis (OA) is a heterogenous condition, in which different subgroups are present. Individualized interdisciplinary multimodal pain treatments (IMPT) based on the biopsychosocial model have resulted in positive improvement of pain, health and disability in OA patients. Moreover, predictive factors for treatment success of IMPT in different musculoskeletal pain populations have been examined, but a clinical prediction model which informs whether an OA patient is expected to benefit or not from IMPT is currently lacking. The aim was to develop and internally validate a clinical prediction model to inform patient-tailored care based on identified predictors for positive or negative outcomes of IMPT in patients with OA. Longitudinal prospective cohort study. Center for Integral Rehabilitation at six locations in the Netherlands. Chronic OA patients. Data in this study were collected during January 2019 until January 2022. Participants underwent a 10-week IMPT program based on the biopsychosocial model. Treatment success was defined by a minimal decrease from baseline of 9 points on the Pain Disability Index (PDI). Candidate predictors were selected by experts in IMPT and literature review. Backward logistic regression analysis was performed to develop the clinical predication model and bootstrap validation was performed for internal validation. Overall, 599 OA patients were included, of which 324 experienced treatment success. Thirty-four variables were identified as possible predictors for good IMPT outcome. Age, gender, number of pain locations, PDI baseline score, maximal pain severity, use of pain medication and alcohol, work ability, brief illness perceptions questionnaire subscales timeline, consequences, identity and treatment control, pain catastrophizing scale and self-efficacy questionnaire score were found as predictors for treatment success. The internally validated model has an acceptable discriminative power of 0.71. This study reports a specific clinical prediction model for good outcome of IMPT in patients with OA. The internally validated model has an acceptable discriminative power of 0.71. After external validation, this model could be used to develop a clinically useful decision tool.

Factors for predicting treatment success and severe adverse events of chimeric antigen receptor (CAR) T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma

Factors for predicting treatment success and severe adverse events of chimeric antigen receptor (CAR) T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma

Radiofrequency ablation of benign thyroid nodules: A prospective, multi-institutional North American experience

BackgroundRadiofrequency ablation for benign thyroid nodules aims to achieve a volume reduction rate of ≥50%. However, factors that predict treatment success have not been defined in a large-scale study. MethodsA prospective cohort study of biopsy-proven benign thyroid nodules treated with radiofrequency ablation at 3 institutions was performed. Patient demographics, nodule sonographic features, procedural data, and nodule volume reduction were evaluated. Binary logistic regression analysis was performed to identify features associated with treatment response. ResultsA total of 620 nodules were analyzed. The pooled median volume reduction rate at 12 months was 70.9% (interquartile range 52.9–86.6). At 1 year follow-up, 78.4% of nodules reached treatment success with a volume reduction rate ≥50%. The overall complication rate was 3.2% and included temporary voice changes (n = 14), vasovagal episodes (n = 5), nodule rupture (n = 3), and lightheadedness (n = 2). No permanent voice changes occurred. Four patients developed postprocedural hypothyroidism. Large baseline nodule volume (>20 mL) was associated with a lower rate of successful volume reduction (odds ratio 0.60 [0.37–0.976]). Large nodules achieved treatment success by 12-month follow-up at a rate of 64.5%, compared with 81.4% for small nodules and 87.2% for medium nodules. ConclusionTo our knowledge, this is the largest North American cohort of patients with benign thyroid nodules treated with radiofrequency ablation. Overall, radiofrequency ablation was an effective treatment option with a low risk of procedural complications. Large volume nodules (>20 mL) may be associated with a lower rate of successful reduction with radiofrequency ablation treatment.

Predictive Biomarkers of Treatment Response in Major Depressive Disorder.

Major depressive disorder (MDD) is a highly prevalent, debilitating disorder with a high rate of treatment resistance. One strategy to improve treatment outcomes is to identify patient-specific, pre-intervention factors that can predict treatment success. Neurophysiological measures such as electroencephalography (EEG), which measures the brain's electrical activity from sensors on the scalp, offer one promising approach for predicting treatment response for psychiatric illnesses, including MDD. In this study, a secondary data analysis was conducted on the publicly available Two Decades Brainclinics Research Archive for Insights in Neurophysiology (TDBRAIN) database. Logistic regression modeling was used to predict treatment response, defined as at least a 50% improvement on the Beck's Depression Inventory, in 119 MDD patients receiving repetitive transcranial magnetic stimulation (rTMS). The results show that both age and baseline symptom severity were significant predictors of rTMS treatment response, with older individuals and more severe depression scores associated with decreased odds of a positive treatment response. EEG measures contributed predictive power to these models; however, these improvements in outcome predictability only trended towards statistical significance. These findings provide confirmation of previous demographic and clinical predictors, while pointing to EEG metrics that may provide predictive information in future studies.

Pharmacogenomics: New Personalized Medicine Approach

Ineffective treatments and the management of adverse drug reactions are responsible for a large proportion of health resources. Drug response and toxicity are significantly influenced by genetic variations in drug-metabolizing enzymes, transporters, and targets. This information may be used to help in selecting the appropriate drug and dosage. One of the newest methods of precision medicine is pharmacogenomics, which adjusts drug selection and dosage based on a patient's genetic characteristics. Pharmacogenomics can reduce the chances of negative effects of the drugs and increase the chances of successful treatment, as the medicines are only for the targeted individuals. It can also revolutionize the healthcare industry to be more specific.&#x0D; The main reason that drugs and their dosages are designed based on individuals’ genetic characteristics is that they have a great influence on drug metabolism and its response. The main evidence is the link between dosage requirements and genetic differences in drug transporters such as p-glycoprotein (ABCB1) and OATP-C (SLC21A6), and drug-metabolizing enzymes such as cytochrome P450 (CYP) 2D6, CYP2C19, and CYP2C9. Polymorphisms in these enzymes can alter the drug metabolism phenotype. As these are all proteins translated from genetic information, any change or point mutation can increase or decrease the effectiveness of the enzymes. This can cause more adverse effects in some individuals. Every individual’s body function is unique, and its right to say that the dosage of drugs depends on that.&#x0D; Many pharmacogenomic tests and their outcomes have confirmed the potential to improve therapeutic activities. In the field of oncology, the use of this technique to establish a connection between drug metabolism and genetic biomarkers is more reliable, effective, and precise. PD-L1 expression analysis is an example of pharmacogenomics potential. Expression analysis helps physicians select which cancer patients are suitable for immunotherapy techniques. Survival rates for lung and other cancers have drastically increased by comparing the genetic factors and immunotherapies that trigger the immune response against tumors. Similarly, pharmacogenomics has promising potential in antiviral drugs. It targets the genes that influence such drugs to predict treatment success. Therefore, as our understanding of the genome becomes clearer, the potential of pharmacogenomics will also grow.&#x0D; Although this is a very promising technique and many scientific organizations are pursuing this approach, there has been very little success in implementing it in clinical trials. Targeted drugs are very costly, as they require the identification of candidate genes and drug responses to these genes. Acceptance is another matter to focus on as most people are not comfortable with these approaches; they prefer conventional approaches. Implementation, cost, acceptance, defining targeted genes, and defining drug responses are all barriers to pharmacogenomics right now. Physicians and patients must adapt to avoid the side effects of drugs by implementing a personalized medicine approach.&#x0D; Despite growing interest, the adoption of pharmacogenomics is still in its early stages of development. Attempts to fully apply pharmacogenomics to enhance health will likely take decades. It is important to find a balance between equality concerns across varied populations and increased healthcare efficiency to successfully implement pharmacogenomics. This can be done more effectively through coordinated studies and worldwide collaboration. This not only makes it possible to better utilize resources and knowledge but also sparks political interest in and support for the personalized medicine approach.&#x0D;

Effectiveness of first-line anticancer treatment may predict treatment response in further lines in stage III/IV patients with non-small cell lung cancer

PurposeThe aim of our study was to evaluate if therapeutic success in the first-line of anticancer treatments in patients with NSCLC may predict treatment success in the following lines.MethodsWe analyzed the data of patients with NSCLC stage III/IV from the TULUNG registry separately for chemotherapy, TKIs, ALK inhibitors, and immunotherapy in the first line during the years 2011–2019. „Succesful treatment “ was defined as PFS ≥ 6 months, a „good responder “ was a patient with ˃50% of „successful treatment “ lines. Treatment responses were analyzed separately for each drug group. Descriptive statistics, Fisher exact test, Pearson Chi-Squared test, log-rank test, and univariate/multivariate logistic regression models were used.ResultsThe first-line TKI therapy was successful in 66.2%, while good responders accounted for 50.7% of the cohort and their rates were similar for all types of TKIs. First-line platinum-based chemotherapy was successful in 43.1% and 48.6% for combinations with pemetrexed and bevacizumab, respectively. Good responders accounted for 29.5% and 25.9%, respectively. In the group of ALK inhibitors, we observed treatment success in 52.3% of cases, while alectinib showed the highest effectiveness (up to 70%). Good responders constituted 50% of the group. In the first-line immunotherapy group, survival benefit was observed in 52.3%, and good responders constituted 52.3% of the cohort.ConclusionWe concluded that the treatment success in first-line therapies in patients with NSCLC may predict survival benefits in the subsequent lines, particularly in EGFR- or ALK-positive disease and immunotherapy-treated patients.

Reliability of the multipeg™ transducer in measuring dental implant stability by using a resonance frequency analysis device (Osstell®): An observational clinical study

Background: Measuring implant stability is an important issue in predicting treatment success. Dental implant stability is usually measured through resonance frequency analysis (RFA). Osstell® RFA devices can be used with transducers (Smartpeg™) that correspond to the implants used as well as with transducers designed for application with Penguin® RFA devices (Multipeg™). Aims: This study aims to assess the reliability of a MultiPeg™ transducer with an Osstell® device in measuring dental implant stability. Materials and Methods: Sixteen healthy participants who required dental implant treatment were enrolled in this study. Implant stability was measured by using an Osstell® device with two transducers, namely, Smartpeg™ and Multipeg™. Insertion torque was also measured and recorded as &gt;50 and ≤50 N·cm. Unpaired t-test and Mann–Whitney U test were conducted to assess the relationships of the implant stability values obtained by the two transducers with insertion torque, whereas Pearson and Spearman's correlations were utilized to investigate correlations between the two transducers. Interclass correlation coefficients were applied to assess the reliability between the two transducers. Results: Implant stability measurements (primary and secondary) showed strong positive correlations between Smartpeg™ and Multipeg™. The reliability values between both transducers in primary and secondary implant stability measurements were 0.922 and 0.981, respectively. The use of both transducers revealed higher implant stability measurements for implants inserted with insertion torque &gt; 50 N·cm than those inserted with insertion torque ≤ 50 N·cm. Conclusions: This study demonstrated that the Multipeg™ transducer is reliable in measuring the stability of dental implants using an Osstell® device.

Hypnotherapy for agoraphobia-Feasibility and efficacy investigated in a pilot study.

https://classic.clinicaltrials.gov/ct2/show/NCT03684577, identifier: NCT03684577.

Analyzing Resilience in the Orthopedic Sports Medicine Patient Population.

Little research has been done to compare resilience, as measured by the Brief Resilience Scale (BRS), across common sports medicine patient populations. Our purpose was to investigate resilience levels across sports medicine patient populations. All patients who underwent reconstruction of the anterior cruciate ligament (ACLR), partial meniscectomy (PM), meniscal repair (MR), rotator cuff repair (RCR), or shoulder stabilization (SS) between January 1 and June 30, 2020, were screened for inclusion. At our institution, BRS scores are routinely collected during the preoperative period. Patients with preoperative BRS scores available were included for analysis. Patients who were eligible on the basis of ACLR who underwent concomitant PM or MR were included in the ACL group. A total of 655 patients with a median age of 49 years were included in analysis. The median preoperative resilience score across all patients was 3.83 (interquartile range, 3.50-4.17), and the highest scores were seen in the ACLR group (median, 4.00; interquartile range, 3.67-4.17). On multivariate regression, scores were significantly and independently lower in the PM and RCR groups. Male patients were found to have significantly higher scores than female patients overall (P=.028), but in subgroup analysis by pathology, this effect was only seen in the SS and PM groups. Psychological factors are important to consider when surgically treating patients, and resilience specifically may play a role in predicting treatment success. Patients undergoing PM and RCR tend to report lower resilience scores than patients undergoing ACLR at preoperative baseline. [Orthopedics. 2024;47(2):95-100.].

What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers.

To identify variables predictive of durable clinical success after MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids. In this prospective, multicenter trial, 99 women with symptomatic uterine fibroids were treated using MRgFUS. Pelvic MRI was obtained at baseline and treatment day. The Uterine Fibroid Symptom-Quality of Life questionnaire was used to calculate a symptom severity score (SSS) at baseline and 6, 12, 24, and 36months following treatment. Clinical, imaging, and treatment variables were correlated with symptom reduction sustained through the 12- and 24-month time points using univariable and multivariable logistic regression analyses. A novel parameter, the ratio of non-perfused volume to total fibroid load (NPV/TFL), was developed to determine association with durable outcomes. Post-treatment, mean symptom severity decreased at the 6-, 12-, 24-, and 36-month follow-ups (p < 0.001, all time points). In univariable analysis, three variables predicted treatment success (defined by ≥ 30-point improvement in SSS) sustained at both the 12-month and 24-month time points: increasing ratio of NPV/TFL (p = 0.002), decreasing total fibroid load (p = 0.04), and the absence of T2-weighted Funaki type 2 fibroids (p = 0.02). In multivariable analysis, the NPV/TFL was the sole predictor of durable clinical success (p = 0.01). Patients with ratios below 30% had less improvement in SSS and lacked durable clinical response compared with those between 30-79 (p = 0.03) and ≥ 80% (p = 0.01). Increased non-perfused volume relative to total fibroid volume was significantly associated with durable reduction of symptoms of abnormal uterine bleeding and bulk bother. Patient selection for sustained clinical benefit should emphasize those with likelihood of achieving high ablation ratios, as determined by imaging (e.g., device access, Funaki type) and by considering the total fibroid load, not just the primary symptomatic fibroid. Clinical trial ID: NCT01285960. • Patient selection/treatment approach associated with durable symptom relief in MRI-guided focused ultrasound ablation of uterine fibroids remains unclear. • The ablation ratio, non-perfused volume/total fibroid volume, was positively associated with sustained symptom relief in both bleeding and bulk bother at 1- and 2-year follow-ups. • Selecting patients with imaging features that favor a high ratio of ablation to total fibroid load (including non-targeted fibroids) is the main factor in predicting durability of symptom relief after uterine fibroid treatment.

Factors affecting Naseptin treatment success - A prospective cohort study.

To assess patient factors to predict treatment success of Naseptin for recurrent paediatric epistaxis. This prospective cohort study of paediatric patients referred to a tertiary paediatric otolaryngology clinic with recurrent epistaxis treated with Naseptin cream and education. Patients with red flag symptoms and bleeding diathesis were omitted, along with patients with concurrent otolaryngology complaints. Statistical analysis included logistic regression analysis to assess for predictive factors contributing to treatment success. 125 of 210 patients on the waiting list met the inclusion criteria and were given a complete trial of Naseptin. 80.8% (n=101) of patients found that the frequency and severity of epistaxis had reduced, with the remaining 19.2% (n=24) reporting that the episodes of epistaxis remained the same and required further management (i.e., silver nitrate cautery). Five patients (4%) reported minor side effects (skin irritation etc.) with no significant adverse events reported. We found that Naseptin is a safe, well-tolerated treatment that should be trialled in most cases of recurrent paediatric epistaxis. Most children will benefit from it with complete epistaxis cessation or at least reduced frequency and severity.