Recovery Score Research Articles

Rol de los cuidados perioperatorios guiados por protocolo para mejorar la recuperación tras la cirugía de cáncer de cabeza y cuello: experiencia institucional

BackgroundEnhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. MethodsWe performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. ResultsBaseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) versus 11 (8-16); P=.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group (8 [7-11] versus 12 [9-17]; P=.002). Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88±12.50) compared to non-ERAS group (85.44±12.68; P<.001). ConclusionImplementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.

Adapted Portuguese folk dance intervention for subacute rehabilitation post-stroke: study protocol.

Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk dance as a post stroke rehabilitative activity. We will use a mixed-methods pilot study convenience sampling to recruit 16 stroke survivors with mild-moderate lower limb paresis from a rehabilitation center in Lisbon and Tagus Valley. In addition to usual care, participants will attend 3 days per week 1-h dance exercise for 8 weeks. The dance style used for this intervention will be an adaptation of the Portuguese folk dance. Assessment will be conducted before and immediately after the program intervention. Acceptability will be assessed by four key domains (enrollment, retention, satisfaction, and recommendation to others). Safety will be assessed based on the number and type of adverse events. Feasibility will be assessed based on balance performance and functional mobility. Quantitative data will be analyzed through descriptive statistics for sample characterization, followed by inferential statistics to evaluate differences in the balance recovery and functional mobility scores between the initial and final assessment. Qualitative data will be analyzed using an inductive process of content analysis. The Portuguese folk dance program has the potential to improve balance outcomes and functional mobility. Our results will help validate Portuguese folk dance as a tool for rehabilitation settings for stroke survivors. The potential of our program to enhance balance outcomes and functional mobility among stroke survivors bears implications for aging and public health initiatives. Positive results from this study could pave the way for integrating dance-based rehabilitative activities into standard stroke rehabilitation protocols, catering to older stroke survivors' specific needs and preferences.

Psychometric evaluation of a quality of recovery score for the postanesthesia care unit-A preliminary validation study.

Patients' perception of postoperative recovery is a key aspect of perioperative care. Self-reported quality of recovery (QoR) has evolved as a relevant endpoint in perioperative research. Several psychometric instruments have been introduced to assess self-reported recovery 24 hours after surgery. However, there is no questionnaire suitable for use in the postanesthesia care unit (PACU). We aimed to develop and psychometrically evaluate a QoR questionnaire for the PACU (QoR-PACU). The QoR-PACU was developed in German language based on the 40-item QoR-40 questionnaire. Between March and November 2020, adult patients scheduled for elective urologic surgery completed the QoR-PACU preoperatively and during the PACU stay. We evaluated feasibility, validity, reliability, and responsiveness. We included 375 patients. After two piloting phases including 72 and 48 patients, respectively, we administered the final version of the QoR-PACU to 255 patients, with a completion rate of 96.5%. Patients completed the QoR-PACU at a median of 125.0 (83.0; 156.8) min after arrival in the PACU. Construct validity was good with postoperative QoR-PACU sum scores correlating with age (r = 0.23, 95% CI: 0.11 to 0.35, p < 0.001), length of PACU stay (r = -0.15, 95%CI: -0.27 to -0.03, p = 0.02), pain in the PACU (r = -0.48, 95% CI: -0.57 to -0.37, p < 0.001) and piritramide dose administered (r = -0.29, 95% CI: -0.40 to -0.17, p < 0.001). Cronbach's alpha was 0.67 (95% CI: 0.61-0.73) with moderate test-retest reliability (ICC of 0.67, 95% CI: 0.38 to 0.83). Cohen's effect size was 3.08 and the standardized response mean was 1.65 indicating adequate responsiveness. The assessment of QoR in the early postoperative period is feasible. We found high acceptability, good validity, adequate responsiveness, and moderate reliability. Future studies should evaluate the psychometric properties of the QoR-PACU in more heterogeneous patient populations including female and gender-diverse patients with varying degress of perioperative risk.

DIFFERENCES IN EARLY RECOVERY FOLLOWING UNICOMPARTMENTAL KNEE ARTHROPLASTY WITH DAY-CASE AND STANDARD CARE PATHWAYS, ASSESSED USING NOVEL PATIENT-REPORTED MEASURES

AbstractBackgroundDaycase pathways which aim to discharge patients the same day following Unicompartmental Knee Replacement have been introduced in some centres, though most continue with Standard pathways. While Daycase pathways have cost savings, recovery data comparing pathways is limited. This study aims to compare patient-reported early recovery between Daycase and Standard pathways following UKR.MethodThis study was carried out in two centres that originally used the same Standard recovery pathway for UKR. In one centre, the Standard pathway was modified into a Daycase pathway. 26 Daycase-Outpatient, 11 Daycase-Inpatient, and 18 Standard patients were recruited. Patients completed the Oxford Arthroplasty Early Recovery Score (OARS) and SF-36 (Acute) measure between Days 1–42.ResultsStandard patients had significantly better Day-1 scores than Daycase patients, but this difference rapidly diminished, and from Day-3 onwards both groups had near-identical scores (OARS Day-1, 59 vs 37, p=0.002, stemming from differences in Pain, Nausea/Feeling-Unwell, Function/Mobility subscores p=0.003,0.014,0.011. OARS Day-3 48 vs 49, p=0.790).Daycase-Outpatients had a higher overall OARS (p=0.002), recovering 1–2 weeks faster than Daycase-Inpatients. OARS subscores demonstrated that Daycase-Outpatients had better Pain, Nausea/Feeling-Unwell, Fatigue/Sleep scores (p=0.020,0.0004,0.019 respectively). SF-36 scores corroborate OARS scores.ConclusionThe Standard cohort had better Day-1 scores than the Daycase cohort, likely due to later mobilisation and stronger inpatient analgesia; these differences diminished by Day-3. Daycase-Outpatients recovered substantially faster than Daycase-Inpatients – likely due to the factors that delayed their discharge. The convergence of scores at 6 weeks demonstrates that both pathways have similar early recovery outcomes.

Responsiveness of Section GG Scores in Tracking Post-Stroke Functional Recovery From Inpatient Rehabilitation Admission to 90-Day Follow-Up

ObjectiveTo evaluate the responsiveness and scale-to-sample targeting of Section GG of the Inpatient Rehabilitation Facility-Patient Assessment Instrument in measuring the trajectory of functional recovery in patients with stroke from inpatient rehabilitation admission to 90 days after discharge. DesignRetrospective cohort study. Setting150-bed inpatient rehabilitation facility. ParticipantsPatients with stroke (N=1087) discharged between December 2019 to April 2021. InterventionNot applicable. Main Outcome MeasuresAdmission and discharge self-care and mobility scores from Section GG were analyzed for the Inpatient Only group (n= 817). Admission, discharge and 90-day post-discharge Section GG scores from telephone interviews with patients or caregivers were analyzed for the Follow-Up group (n=270). Standardized response means (SRM) determined responsiveness of the tool for each group and time interval. Score means, standard deviations, and floor/ceiling effects illustrated scale-to-sample targeting of the tool. ResultsSelf-care and mobility scores improved significantly from admission to discharge (P<.001) for both groups and from discharge to 90 days (P<.001) for the Follow-Up group. Large SRM existed from admission to discharge for self-care and mobility scores in both groups. ​A small-to-moderate SRM was seen from discharge to 90 days for self-care (0.46) and a moderate SRM was observed for mobility (0.68). Overall floor effects were minor at admission for self-care (9.8%) and mobility (7.2.%). Overall ceiling effects were minor at discharge for self-care (11.2%) and mobility (4.6%)​ and significant at follow-up for both self-care (45.2%) and mobility (32.2%). ConclusionsSection GG is responsive to change and appropriately measures patients’ functional ability during inpatient rehabilitation. More study is required for telephone follow-up after discharge from inpatient rehabilitation.

Efficacy of an enhanced recovery after surgery pathway to manage pain, nausea and vomiting after head and neck surgeries with free tissue transfer reconstruction.

Pain and post-operative nausea and vomiting are the main factors that impair the quality of recovery after surgery. Very few reports have analyzed patient-reported outcomes to investigate the efficacy of an enhanced recovery after surgery protocol to alleviate these symptoms after head and neck surgeries with free tissue transfer reconstruction. We investigated post-operative pain and post-operative nausea and vomiting in 47 patients who underwent head and neck surgeries with free tissue transfer reconstruction with enhanced recovery after surgery support between February 2021 and August 2022. Patient-reported outcomes were assessed using the visual analog scale and Japanese version of the Quality of Recovery-40. Significant increases in the mean visual analog scale scores for pain and post-operative nausea and vomiting were observed only on post-operative Day 1 compared with preoperative values (pain: 3.19±2.78 vs. 1.96±2.42, P=0.0408; post-operative nausea and vomiting: 1.52±2.09 vs. 0.54±1.37, P=0.0194). From post-operative Day 2, there were no significant differences between the pre- and post-operative visual analog scale scores, and no significant increases in the incidences of moderate or severe pain and post-operative nausea and vomiting compared with preoperatively. The Japanese version of the Quality of Recovery-40 score for post-operative pain showed no significant deterioration compared with preoperatively, while the Japanese version of the Quality of Recovery-40 score for post-operative nausea and vomiting showed significant deterioration compared with the preoperative value on post-operative Days 2, 4 and 7. The visual analog scale and Japanese version of the Quality of Recovery-40 scores for post-operative pain and visual analog scale score for post-operative nausea and vomiting suggested that the enhanced recovery after surgery strategy favorably controlled pain and post-operative nausea and vomiting after head and neck surgeries with free tissue transfer reconstruction. However, as the post-operative Japanese version of the Quality of Recovery-40 score for post-operative nausea and vomiting was lower than the preoperative value, there is still a need for further improvement of the enhanced recovery after surgery pathway.

Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes.

Postoperative systemic inflammation is strongly associated with surgical outcomes, but its relationship with patient-centred outcomes is largely unknown. Detection of excessive inflammation and patient and surgical factors associated with adverse patient-centred outcomes should inform preventative treatment options to be evaluated in clinical trials and current clinical care. This retrospective cohort study analysed prospectively collected data from 3000 high-risk, elective, major abdominal surgery patients in the restrictive vs. liberal fluid therapy for major abdominal surgery (RELIEF) trial from 47 centres in seven countries from May 2013 to September 2016. The co-primary endpoints were persistent disability or death up to 90 days after surgery, and quality of recovery using a 15-item quality of recovery score at days 3 and 30. Secondary endpoints included: 90-day and 1-year all-cause mortality; septic complications; acute kidney injury; unplanned admission to intensive care/high dependency unit; and total intensive care unit and hospital stays. Patients were assigned into quartiles of maximum postoperative C-reactive protein concentration up to day 3, after multiple imputations of missing values. The lowest (reference) group, quartile 1, C-reactive protein ≤ 85 mg.l-1 , was compared with three inflammation groups: quartile 2 > 85 mg.l-1 to 140 mg.l-1 ; quartile 3> 140 mg.l-1 to 200 mg.l-1 ; and quartile 4> 200 mg.l-1 to 587 mg.l-1 . Greater postoperative systemic inflammation had a higher adjusted risk ratio (95%CI) of persistent disability or death up to 90 days after surgery, quartile 4 vs. quartile 1 being 1.76 (1.31-2.36), p < 0.001. Increased inflammation was associated with increasing decline in risk-adjusted estimated medians (95%CI) for quality of recovery, the quartile 4 to quartile 1 difference being -14.4 (-17.38 to -10.71), p < 0.001 on day 3, and -5.94 (-8.92 to -2.95), p < 0.001 on day 30. Marked postoperative systemic inflammation was associated with increased risk of complications, poor quality of recovery and persistent disability or death up to 90 days after surgery.

Effectiveness of a digital vs face-to-face preoperative assessment: A randomized, noninferiority clinical trial

Study objectiveDigitalizing the preoperative assessment clinic can be a solution to keep up with the growing demand for surgery. It remains unclear if a digital preoperative assessment clinic is as safe, and effective in terms of patient health outcomes and experience compared to face-to-face consultations. This study aimed to compare quality of recovery and mental state in patients undergoing a digital preoperative assessment versus regular face-to-face consultations. DesignThis was a single centre, randomized (1:1), parallel, open-label, noninferiority trial. SettingThe preoperative clinic and preoperative unit of an urban secondary care hospital. PatientsAll adult, Dutch speaking, ASA I-IV patients with access to an online computer who required surgery. InterventionsDigital preoperative screening, consisting of an electronic screening questionnaire and web-based platform with personalized information and recommendations related to the procedure, or face-to-face screening, consisting of two 20-min in-hospital consultations. MeasurementsThe primary endpoint was quality of recovery, measured 48 h after surgery. The analysis followed a per-protocol principle, and only patients who underwent the intended screening were included in the analysis. The noninferiority margin was set at −6. The trial was registered at ClinicalTrials.gov, NCT05535205, during the study on 09/08/2022, before analysing results. Main resultsBetween March 1, 2021 and 30 august 2021, 480 patients were assessed for eligibility. 400 patients were randomly assigned to the digital group (n = 200) or face-to-face group (n = 201), of which respectively 117 and 124 patients were eventually included in the primary analysis. The mean quality of recovery score of patients undergoing digital screening (158) was non-inferior to that of patients undergoing face-to-face screening (155), with a mean difference of 3·2 points and a 97.5% lower confidence limit of −2.1 points. There were no adverse events. ConclusionsA digital preoperative screening is not inferior to face-to-face consultations in patients undergoing predominantly low to moderate risk surgery. Given its potential to reduce physician workload, reallocate healthcare resources, and lower healthcare costs, a digital preoperative screening may be a better choice for preoperative assessments.

Study on Prevention and Treatment Strategies for Pressure Injury in Operating Room

Objective: To study the prevention and treatment strategies for pressure injury in the operating room. Methods: 116 patients who underwent surgery in our hospital from January 2016 to May 2023 were selected as research subjects by random number method, and were randomly divided into the research group (n=58) and the control group (n=58). The control group was treated with conventional interventions, and the research group was treated with interventions in the operating room. The incidence of pressure injuries, pressure injury recovery scoring, SAS, and SDS scores were compared between the two groups. Results: After the intervention, the incidence of pressure injuries in the research group was lower than that in the control group, and the postoperative mobility and perception were better than those in the control group. In addition, the negative emotions such as anxiety and depression produced during the treatment of the patients in the research group were more effectively alleviated under intervention. The results of this study are statistically significant, with P &lt; 0.05. Conclusion: Intervention measures can effectively alleviate the negative emotions produced during the treatment of patients, reduce the incidence of postoperative pressure injuries, alleviate the patient's pain and financial pressure, shorten the recovery time of patients, and improve the mobility and perception ability of patients after the occurrence of compression injuries.

Pilot Study: Assessing Personal and Clinical Impacts from a Recovery-Centric Intervention in Inpatient Psychiatry Using Mixed Methods

Objective: The conventional model of biomedical mental healthcare focused on diagnosis, crisis stabilization, and pharmaceutical treatment might be enriched with recovery-oriented programming and improve the overall inpatient experience. This study aimed to assess the impacts of a person-centered intervention on patient-reported recovery measures and clinical progression over time. Methods: Eighteen patients from a tertiary-level regional unit enrolled in the pilot program over an eight-month intervention period. Clinical and proxy recovery data was collected and compared before and after the intervention in a combination of within group and between group assessments using unit clinical performance as a control. Results: Contrary to expectation, intervention participants reported a decline in four of five proxy recovery scores from the pretest to the post-test and concurrent deterioration in routine clinical monitoring scores. Research cohort scores declined in three of six domains with a statistically significant change in one category while unit clinical scores declined in five of six domains with statistically significant changes in three categories. A comparison of mean coefficients indicated more favourable outcomes for research participants in five clinical domains. Conclusions: Concurrent declines in recovery-focused and clinical measures suggest a risk of inpatient regression over time in hospital. The findings support the need for innovative approaches to inpatient service delivery including recovery-focused interventions which might improve clinical progression. The results also indicate the need for rigorous program evaluation which can be facilitated by leveraging existing clinical assessment tools and in considering patient perspectives in determining the effectiveness of interventions.

Anomaly Detection in Microservice-Based Systems

Currently, distributed software systems have evolved at an unprecedented pace. Modern software-quality requirements are high and require significant staff support and effort. This study investigates the use of a supervised machine learning model, a Multi-Layer Perceptron (MLP), for anomaly detection in microservices. The study covers the creation of a microservices infrastructure, the development of a fault injection module that simulates application-level and service-level anomalies, the creation of a system monitoring dataset, and the creation and validation of the MLP model to detect anomalies. The results indicate that the MLP model effectively detects anomalies in both domains with higher accuracy, precision, recovery, and F1 score on the service-level anomaly dataset. The potential for more effective distributed system monitoring and management automation is highlighted in this study by focusing on service-level metrics such as service response times. This study provides valuable information about the effectiveness of supervised machine learning models in detecting anomalies across distributed software systems.

Early Detection of COVID-19 in Female Athletes Using Wearable Technology.

Heart rate variability (HRV), respiratory rate (RR), and resting heart rate (RHR) are common variables measured by wrist-worn activity trackers to monitor health, fitness, and recovery in athletes. Variations in RR are observed in lower-respiratory infections, and preliminary data suggest changes in HRV and RR are linked to early detection of COVID-19 infection in nonathletes. Wearable technology measuring HRV, RR, RHR, and recovery will be successful for early detection of COVID-19 in NCAA Division I female athletes. Cohort study. Level 2. Female athletes wore WHOOP, Inc. bands through the 2020 to 2021 competitive season. Of the athletes who tested positive for COVID (n = 33), 14 had enough data to be assessed (N = 14; 20.0 ± 1.3 years; 69.8 ± 7.2 kg; 172.0 ± 8.3 cm). Roughly 2 weeks of noninfected days were used to set baseline levels of HRV, RR, recovery, and RHR to compare with -3, -2, and -1 days before a positive COVID-19 result. Increases in RR (P = 0.02) were detected on day -3. RHR (P < 0.01) and RR increased (P < 0.01), while HRV decreased (P < 0.05) on day -1, compared with baseline. Differences were noted in all variables on the day of the positive COVID-19 result: decreased HRV (P < 0.05) and recovery scores (P < 0.01), and increased RHR (P < 0.01) and RR (P < 0.01). In female athletes, wearable technology was successful in predicting COVID-19 infection through changes in RR 3 days before a positive test, and also HRV and RHR the day before a positive test. Wearable technology may be used, as part of a multifaceted approach, for the early detection of COVID-19 in elite athletes through monitoring of HRV, RR, and RHR for overall team health.

The Influence of Corticosteroid Injections on Postoperative Outcomes of Carpal Tunnel Release: A Systematic Review.

Background Carpal tunnel syndrome can be treated with corticosteroid injections (CIs) and surgery. In this systematic review, the influence of previous CI on different postoperative outcomes after carpal tunnel release is evaluated. Methods A systematic literature search using several databases was performed to include studies that examined patients diagnosed with carpal tunnel syndrome who received preoperative or intraoperative CIs. Results Of 2,459 articles, 9 were eligible for inclusion. Four papers reported outcomes of preoperative and four outcomes of intraoperative CIs. One study evaluated patients who received both intraoperative and preoperative corticosteroids. Conclusion Intraoperative CIs are associated with reduced postoperative pain after carpal tunnel release and support earlier recovery of the hand function that can be objectified in a faster median nerve conduction speed recovery and lower Boston Carpal Tunnel Questionnaire (BCTQ) scores. Using preoperative CIs did not lead to enhanced recovery after carpal tunnel release, and both preoperative and intraoperative CIs might be predisposing factors for infections.

Rhomboid intercostal block or thoracic paravertebral block for postoperative recovery quality after video-assisted thoracic surgery: A prospective, non-inferiority, randomised controlled trial.

The analgesic characteristics of rhomboid intercostal block (RIB) remain unclear. Before it can be fully recommended, we compared the recovery quality and analgesic effects of RIB and thoracic paravertebral block (TPVB) for video-assisted thoracoscopic surgery (VATS). The current study aimed to investigate whether there is a difference in postoperative recovery quality between TPVB and RIB. A prospective, non-inferiority, randomised controlled trial. Affiliated Hospital of Jiaxing University in China from March 2021 to August 2022. Eighty patients aged 18 to 80 years, with ASA physical status I to III, and scheduled for elective VATS were enrolled in the trial. Ultrasound-guided TPVB or RIB was performed with 20 ml 0.375% ropivacaine. The primary outcome of the study was the mean difference of quality of recovery-40 scores 24 h postoperatively. The non-inferiority margin was defined as 6.3. Numeric rating scores (NRS) for pain at 0.5, 1, 3, 6, 12, 24 and 48 h postoperatively in all patients were also recorded. A total of 75 participants completed the study. The mean difference of quality of recovery-40 scores 24 h postoperatively was -1.6 (95% CI, -4.5 to 1.3), demonstrating the non-inferiority of RIB to TPVB. There was no significant difference between the two groups in the area under the curve for pain NRS over time, at rest and on movement, at 6, 12, 24 and 48 h postoperatively (all P > 0.05), except for the area under the curve pain NRS over time on movement at 48 h postoperatively (P = 0.046). There were no statistical differences between the two groups in the postoperative sufentanil use at 0 to 24 h or 24 to 48 h (all P > 0.05). Our study suggests that RIB was non-inferior to TPVB for the quality of recovery, with almost the same postoperative analgesic effect as TPVB after VATS. chictr.org.cn: ChiCTR2100043841.

Comparison the effects of sugammadex and neostigmine/atropine on cognitive functions in bariatric surgery patents: Randomized controlled trial

Background/Aim: A recently introduced drug, sugammadex, can be a good alternative to conventional neuromuscular blockade reversal agents, such as neostigmine. This choice is of great importance, especially in the patients in whom it would be wise to avoid cholinergic side effects. The aim of this study was to compare the effects of sugammadex and the combination of neostigmine/atropine on post-operative cognitive dysfunction in bariatric surgery patients. Methods: This randomized controlled trial included a total of 90 patients with American Society of Anesthesiologists (ASA) I–III physical status and body mass index &gt;30 who were scheduled for elective sleeve gastrectomy were recruited for the study after obtaining ethics committee approval. Written consent was obtained from each patient. The exclusion criteria consisted of several parameters: lack of consent, co-existing muscular diseases, and severe cardiovascular diseases (New York Heart Association [NYHA]). The patients were randomly divided into two groups, and the randomization was performed by the investigator using previously prepared envelopes. In both groups, Mini Mental State Examination (MMSE) was performed before the operation. The patients’ memory, attentive executive functions, and motor skills were evaluated as part of a control cognitive evaluation. After the operation while in the post-anesthesia care unit and when the Modified Aldrete Recovery Score was ≥9, the MMSE evaluation was repeated one and six hours later. Results: The pre-operative MMSE results were similar in both groups. In the post-operative period, MMSEpo, MMSEpo1, and MMSEpo6 values were not significantly different between the groups. When a detailed examination of MMSEpo data was performed, it was determined that the MMSE scores were 20–25 in 14 patients (32.6%) in Group N/A and six patients (14.6%) in Group S. In Group N/A, the percentage of patients with MMSE 20–25 was significantly higher than that of Group S (X2=3.807; P=0.046). Conclusion: In this study, sugammadex produced less effects on cognitive functions when compared with neostigmine/atropine combination. The neostigmine/atropine combination produced mild effects on cognitive functions in the first hour of recovery.

129-OR: Effect of Tirzepatide on the Counterregulatory Response to Hypoglycemia during a Hypoglycemic Clamp in People with Type 2 Diabetes

We explored the effects of tirzepatide (TZP) on counter-regulatory response during a hypoglycemic clamp. Patients with type 2 diabetes (N=42) were randomized to TZP (15 mg) or placebo (PBO) for 12 wk, in a crossover design, with a wash-out period of 8 to 12 wk. The primary objective was the change in glucagon (GCG) during clamp-induced hypoglycemia (HG) from plasma glucose (PG) 100 mg/dL to nadir PG (45 mg/dL). Secondary measures were changes in other counter-regulatory hormones, insulin, and C-peptide during clamp-induced HG and PG recovery from nadir PG to 72 mg/dL. Time to recovery and HG symptom scores were assessed. At 12 wk, HbA1c change from baseline was -1.5% with TZP vs +0.5% with PBO. Increases in GCG from PG 100 mg/dL to nadir PG and during recovery did not differ between treatments (p=0.756 and p=0.565, respectively) (Table). Growth hormone and adrenaline responses did not differ between treatments, while increases in cortisol and noradrenaline responses were delayed with TZP, which explains a lower HG symptom score with TZP vs PBO at nadir (p=0.007). The proportion of patients aware of HG did not differ between treatments. Mean time to recovery from HG was 47 min with TZP and 43 min with PBO (p=0.002); however, nadir PG was lower with TZP (44 vs 47 mg/dL; p=0.015). In conclusion, the response of glucagon to hypoglycemia is maintained with TZP. Disclosure T.Pieber: Advisory Panel; Arecor, Novo Nordisk A/S, Consultant; Lilly, Research Support; AstraZeneca, Novo Nordisk A/S, Sanofi, Speaker's Bureau; Roche Diagnostics. E.Svehlikova: Other Relationship; Mylan. S.Urva: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A.Haupt: Employee; Lilly, Stock/Shareholder; Lilly. C.Zhou: Employee; Eli Lilly and Company. T.Coskun: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Z.Milicevic: Employee; Eli Lilly and Company. E.J.Pratt: Employee; Eli Lilly and Company. Funding Eli Lilly and Company

Efficacy of Ice Compress Combined With Serratus Anterior Plane Block in Analgesia After Thoracoscopic Pneumonectomy: A Randomized Controlled Study

To explore the analgesic effect of the ice pack combined with serratus anterior plane block after thoracoscopic pulmonary resection. A randomized controlled trial design. This prospective randomized controlled trial recruited patients who underwent thoracoscopic pneumonectomy in a grade A tertiary hospital from October 2021 to March 2022. The patients were randomly divided into the control group, the serratus anterior plane block group, the ice pack group, and the ice pack combined with serratus anterior plane block group. The analgesic effect was evaluated by collecting the postoperative visual analog score. A total of 133 patients agreed to participate in this study, of which 120 patients were eventually included (n=30/group). The primary outcome was that the pain in SAP block group, ice pack group, and ice pack combined with SAP block group decreased significantly within 24 hours compared with the control group (P < .05). Also, significant differences were noted in other secondary outcomes, such as Prince-Henry pain score within 12 hours, 15-item quality of recovery (QoR-15) score within 24 hours, and fever times within 24 hours. No significant difference was detected in the C-reactive protein value, white blood cell count, and the use of additional analgesics within 24 hours postoperatively (P > .05). For patients after thoracoscopic pneumonectomy, ice pack, serratus anterior plane block, and ice pack combined with serratus anterior plane block produce better postoperative analgesic effects than intravenous analgesia. The combined group exhibited the best outcomes.

A near-complete genome assembly of Thalia dealbata Fraser (Marantaceae).

This study presents a chromosome-level, near-complete genome assembly of Thalia dealbata (Marantaceae), a typical emergent wetland plant with high ornamental and environmental value. Based on 36.99 Gb PacBio HiFi reads and 39.44 Gb Hi-C reads, we obtained a 255.05 Mb assembly, of which 251.92 Mb (98.77%) were anchored into eight pseudo-chromosomes. Five pseudo-chromosomes were completely assembled, and the other three had one to two gaps. The final assembly had a high contig N50 value (29.80 Mb) and benchmarking universal single-copy orthologs (BUSCO) recovery score (97.52%). The T. dealbata genome had 100.35 Mb repeat sequences, 24,780 protein-coding genes, and 13,679 non-coding RNAs. Phylogenetic analysis revealed that T. dealbata was closest to Zingiber officinale, whose divergence time was approximately 55.41 million years ago. In addition, 48 and 52 significantly expanded and contracted gene families were identified within the T. dealbata genome. Moreover, 309 gene families were specific to T. dealbata, and 1,017 genes were positively selected. The T. dealbata genome reported in this study provides a valuable genomic resource for further research on wetland plant adaptation and the genome evolution dynamics. This genome is also beneficial for the comparative genomics of Zingiberales species and flowering plants.

It's all about the journey! An online museum-based recovery-oriented art psychotherapy group

ABSTRACT Background: Whilst there is evidence of the value of museums for art psychotherapy, evidence about online groups to improve mental health recovery is still scarce. The aim was to assess the impact on mental health recovery of an online museum-based recovery-oriented art psychotherapy group. Context: The group was designed to help adults under the care of a UK community mental health team with their journey of mental health recovery. Approach: The group consisted of six, weekly online sessions and used the collections of two local museums. Quantitative outcome measures and qualitative feedback were used to evaluate the group. Outcomes: Five women participated in the group, and four in the evaluation. Generic wellbeing after each session was rated 4 out of 5. Participants scored higher in the Questionnaire about the Process of Recovery (33.25 vs. 42) and a Visual Numerical Recovery Scale (3 vs. 3.25) after participating in the group. Feeling supported was what participants liked most and found most helpful, and they liked the short duration of the group least. Half found the online setting preferable to face-to-face, and all felt that the museum focus was inspirational, and enjoyed the artmaking. Participants gained a better understanding of their recovery journey and were able to express their emotions better. Conclusions: This group contributed towards participants’ mental health recovery and the museum focus was valued by them. Implications for research: The evaluation findings encourage further exploration of this way of working.

Anterior Quadratus Lumborum Block and Quadriceps Strength: A Prospective Cohort Study.

The decrease in quadriceps strength after anterior quadratus lumborum block (AQLB) has not been quantified. This prospective cohort study investigated the incidence of quadriceps weakness after AQLB. We enrolled patients undergoing robot-assisted partial nephrectomy, and AQLB was performed at the L2 level with 30 mL of 0.375% ropivacaine. We evaluated each quadriceps' maximal voluntary isometric contraction using a handheld dynamometer preoperatively and postoperatively at 1 and 4 days. The incidence of muscle weakness was defined as a 25% reduction in muscle strength compared with the preoperative baseline, and "muscle weakness possibly caused by nerve block" was defined as a 25% reduction compared with the non-block side. We also assessed the numerical rating scale and quality of recovery-15 scores. Thirty participants were analyzed. The incidence of muscle weakness compared with preoperative baseline and the non-block side was 13.3% and 30.0%, respectively. Patients with a numerical rating scale ≥ 4 or quality of recovery-15 score < 122, which was classified as moderate or poor, had decreased muscle strength with relative risks of 1.75 and 2.33, respectively. All patients ambulated within 24 h after surgery. The incidence of quadriceps weakness possibly caused by nerve block was 13.3%; however, all patients could ambulate after 1 day.