Scale Score Research Articles

Abstract 4119744: Evaluation of Neuropsychological development and Factors Affecting it in Children With Cyanotic and Acyanotic Congenital Cardiac Disease After Surgical Treatment

Objective: To evaluate neuropsychological development in children with cyanotic and acyanotic congenital heart diseases (CHDs) after surgical treatment and analyze the risk factors. Methods: 89 children who received follow-up in Fuwai Hospital after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into cyanotic CHDs group and acyanotic CHDs group. Neuropsychological development was assessed according to Pediatric-psychological mental test scale and statistical analysis was employed. Results: The acyanotic CHDs group achieved better distribution of development quotient than cyanotic CHDs group (p < 0.05) but worse than the normal control group (p = 0.004). The proportion in cyanotic CHDs group with developmental quotient below the moderate level was higher than that of the normal control group (p < 0.001), but there was no significant difference between the cyanotic CHDs group and acyanotic CHDs group (p = 0.055). Multivariate regression analysis indicated that for cyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower preoperative blood glucose level, lower BIS level, and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale (p < 0.05); for acyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower temperature during surgery and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale(p < 0.05). Conclusion: Distinct neuropsychological impairment could be present in children with cyanotic CHDs. Younger age at cardiac surgery, body mass, preoperative blood glucose level, BIS level during surgery, temperature during surgery and duration of tracheal intubation after surgery were perioperative factors that could influence long-time neuropsychological development in children with CHDs.

Effects of pericapsular nerve group block on early postoperative cognitive function in older people undergoing hip arthroplasty: a randomized controlled clinical trial.

Pericapsular nerve group (PENG) block has emerged as a reliable analgesia technique for hip arthroplasty (HA). However, the effects of PENG block on perioperative neurocognitive disorder (PND) after HA has not yet been assessed. The present study aimed to investigate the effects of PENG block on early postoperative cognitive function in older people undergoing hip arthroplasty. Sixty older patients undergoing HA under spinal anesthesia were randomly assigned to group P (n = 30) receiving PENG block with ropivacaine and patient-controlled intravenous analgesia (PCIA) pump with sufentanil after surgery or group C (n = 30) only receiving PCIA pump with sufentanil after surgery. The primary outcome was the Mini-Mental State Examination (MMSE) score at 7 days postoperatively. Secondary outcomes consisted of the incidence of PND 7 days postoperatively, the static VAS pain scores at 6, 12, 24, and 48h postoperatively; cumulative sufentanil consumption and the requirement of rescue analgesia during the 0-24h period after surgery; quality of recovery-15 (QoR-15) scale scores at 24h postoperatively; and the plasma levels of high mobility group box protein 1 (HMGB1) preoperatively and 1day after surgery, and adverse events. After surgery, the PENG block group had higher MMSE score than the control group at 7 days postoperatively (27.0 ± 1.8 vs. 26.1 ± 1.7, P = 0.048), with a mean difference of 0.9 (95%CI, 0.1-0.9). The incidence of PND at 7 days postoperatively was 6.7% in group P, lower than that of 30% in group C (P = 0.044). In group P, the static VAS scores at 6, 12, and 24h postoperatively were significantly lower than those in group C (all P < 0.05). Compared with group C, the cumulative sufentanil consumption and the number of patients required rescue analgesia during the 0-24h period after surgery were significantly lower in group P (all P < 0.05). The scores of QoR-15 scale were higher in group P at 24h postoperatively than those in group C (P < 0.05). Patients in group P showed lower plasma levels of HMGB1 than group C at 1day after surgery (P < 0.05), and the rate of complications didn't differ between both groups. Older people undergoing HA receiving a PENG block for perioperative analgesia experience improved early postoperative cognitive function, reduced postoperative pain, higher quality of recovery, and less postoperative inflammatory response. Chictr.org.cn identifier ChiCTR2200061055 (Date of registry: 15/06/2022, prospectively registered).

LEVEL OF LEARNING DISCIPLINE OF CLASS XI HIGH SCHOOL STUDENTS

The undisciplined behavior carried out by some students includes coming to school late, not going to school or skipping class, not doing school assignments. This study aims to understand the level of learning discipline of eleventh grade high school students. The research methodology applied is quantitative descriptive analysis. The research population was all eleventh grade high school students, the research sample was 186 students. Data analysis was carried out calculating the score of the learning discipline scale through filling out questionnaires that had been distributed to the research population. The results showed that 128 students (68.8%) were in the moderate category related to the level of learning discipline. Students need to be given an understanding of the awareness of the importance of studying hard. And it is necessary to arrange learning methods that are in accordance with the characteristics of students.

Modified double-row suture bridge technique for anterior colliculus fractures combined with deltoid ligament injury: a retrospective study.

The management of anterior colliculus fractures in combination with deltoid ligament injuries is a topic of debate, and there is a need to improve surgical outcomes. The purpose of the present study was to describe the application of a modified double-row suture bridge technique and evaluate its early clinical outcomes in the management of anterior colliculus fracture combined with deltoid ligament injury. From 2020 to 2022, 12 patients with anterior colliculus fracture combined with deltoid ligament injury were treated using a modified double-row suture bridge technique. For clinical outcome evaluation, objective data are presented through clinical examination findings; radiographic assessments, including X-rays and computed tomography (CT); and follow-up analysis utilizing American Orthopaedic Foot & Ankle Society ankle‒hindfoot (AOFAS) scores, Olerud Molander Ankle Scores (OMAS), and visual analogue scale (VAS) scores. Preoperative and follow-up scores were compared with Student's t test. (p < .05). The mean age of the patients was 52.67 ± 9.42 years (range: 39-74). The mean duration of follow-up was 14.42 ± 1.51 months (range: 12-17). At the final follow-up, the mean AOFAS score (P < 0.001) improved to 91.50 ± 2.65 points (range: 87-96), the mean OMAS (P < 0.001) improved to 77.08 ± 3.97 points (range: 70-85), and the mean VAS score (P < 0.001) improved to 0.25 ± 0.45 points (range: 0-1). Nine patients achieved excellent outcomes, and three achieved good outcomes according to the AOFAS score. Follow-up imaging evaluation indicated satisfactory alignment of the fracture and complete healing. Clinical examination suggested good mobility of the ankle. At the last follow-up, ankle dorsiflexion mobility was 14-18 degrees, plantar flexion mobility was 42-45 degrees, inversion mobility was 27-32 degrees, and eversion mobility was 22-25 degrees. The modified double-row suture bridge technique is effective for achieving anatomic reduction of anterior colliculus fractures, and the technique also provides substantial benefit to the injured deltoid ligament. With this technique, the clinical outcomes can be significant and encouraging, indicating a new stage in its application and development.

The effect of lumbar multifidus muscle degeneration on upper lumbar disc herniation

PurposeThis study aimed to investigate the effect of lumbar multifidus muscle (MF) degeneration on upper lumbar disc herniation (ULDH).MethodsThis study used 3.0T magnetic resonance imaging (MRI) T2 axial weighted images to retrospectively analyze 93 ULDH patients and 111 healthy participants. Sixty-five pairs of participants were included in this study using propensity score matching (PSM). Cross-sectional area, fat infiltration area, anteroposterior diameter (APD), lateral diameter (LD), cross-sectional area of the bilateral multifidus muscles at the corresponding level, intervertebral disc area at the corresponding section, and visual analog scale (VAS) score for low back pain (LBP). For inter-group comparisons, we used the t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, chi-square test, or Fisher's exact test, according to the type of data. We used Pearson correlation analysis to study the correlation between the VAS score and related indicators, and established a predictive model for upper lumbar disc herniation using the receive operative characteristic (ROC) curve analysis method. Finally, univariate and multivariate logistic regression analyses were performed to establish a predictive model for the risk of high lumbar disc herniation.ResultsWe compared the fat areas at the lumbar vertebral levels L1/2, L2/3, and L3/4, as well as the left lateral diameter (LD) (MF), L1/2 left lumbar multifidus muscle index (LMFI), and L1/2 total fat infiltration cross-section area (TFCSA), and found significant differences between the case and control groups (P &amp;lt; 0.001). Furthermore, we observed a significant positive correlation (P &amp;lt; 0.05) between the VAS scores and multiple muscle indicators. Additionally, we developed ROC prediction models to assess the risk of lumbar intervertebral disc protrusion at the L1/2, L2/3, and L3/4 levels, with the results identifying L1/2 TFCSA, L2/3 TFCSA, and L3/4 relative psoas major muscle cross-section area (rPMCSA) as the most predictive indicators. Finally, univariate and multivariate logistic regression analyses showed that the L1/2 rPMCSA, L2/3 TFCSA were significantly associated with the risk of lumbar intervertebral disc protrusion in both models.ConclusionDegeneration of the MF is significantly correlated with the occurrence of ULDH, and the larger the area of fat infiltration in the MF, the more obvious the lower back pain in ULDH patients. In addition, TFCSA can serve as an indicator of the occurrence of ULDH.

Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures.

The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures. A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively. Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group. The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.

Comparative clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis vs. chemical pleurodesis in the management of spontaneous pneumothorax

ObjectiveThis study aims to observe the clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis compared to traditional iodine chemical pleurodesis in the treatment of patients with spontaneous pneumothorax.MethodsA total of 128 patients with spontaneous pneumothorax who underwent surgical treatment at our institution from January 2021 to December 2022 were selected. Patients were categorized into the study group (n = 65) and the control group (n = 63) based on the surgical method used. The study group received C-shaped pleura cautery for pleurodesis, while the control group underwent traditional iodine chemical pleurodesis. Surgical and clinical outcomes were evaluated, and recurrence rates within one year postoperatively were compared. Serum C-reactive protein (CRP) levels and visual analog scale (VAS) scores were measured at different time points.ResultsNo significant differences were observed between the two groups regarding surgical duration, intraoperative blood loss, or postoperative hospital stay (p &amp;gt; 0.05). However, the study group demonstrated significantly lower serum CRP levels and VAS scores on postoperative days 1 and 2, as well as reduced drainage volumes compared to the control group (p &amp;lt; 0.05). The recurrence rates of pneumothorax within one year postoperatively did not differ significantly between the groups (p &amp;gt; 0.05).ConclusionSingle-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis is an effective treatment for spontaneous pneumothorax. Compared to traditional iodine chemical pleurodesis, this method causes less pleural irritation, results in lower postoperative pain and drainage, and facilitates patient recovery, making it a safe and reliable option for the management of spontaneous pneumothorax.

Indicators of mental adaptation disorders in combatants of the special military operation

Relevance. Participants of armed conflicts are exposed to extreme stress amid life-threatening situations, which can lead to mental adaptation disorders exacerbated by combat stress disorders. Combatants facing these conditions require psychological correction and psychotherapy.The objective is to assess the risk of mental adaptation disorders in combatants using traditional diagnostics and fasts screening methods.Methods. A cohort of 163 combatants who participated in the special military operation underwent clinical and psychological examination. The average age of subjects was 34.3 years, and the average time of service in the special military operation was 8.2 months. The combatants’ psychological status was evaluated using the Mississippi Scale (military version), the Beck Depression Inventory, and the Beck Anxiety Inventory. In addition, a set of screening methods, like PC-PTSD-5, PHQ9, and GAD-7, were used to evaluate the risk of mental maladaptation, depressive symptoms, and anxiety. In the course of examination, the reliability of responses was assessed using 10 adapted questions for sincerity evaluation obtained from a standardized personality assessment method. The present study shows the median value, as well as the upper and lower quartiles (Me [Q1; Q3]). The consistency of the studied indicators was evaluated using Spearman’s rank correlation coefficient.Results and analysis. The average sincerity score was 7 [6; 8] points, showing sufficient reliability of the examination results. The psychological test results re concordant with the overall transformation pattern in the functional and mental profile of stress exposed combatants, depending on the duration of exposure to combat conditions. The average Mississippi Scale scores were 71 [63; 84] points, and 2 [1; 3] points on the PC-PTSD-5, associated with absence of mental adaptation disorders and a low probability of PTSD, respectively. PTSD clinical symptoms were identified in 3.7% of the examined combatants (compared to 14.3% in foreign publications), and mental adaptation disorders were observed in 8.6%. All these methods showed moderate, positive, and statistically significant (r = 0.627; p &lt; 0.001) consistency of obtained indicators. The average Beck Depression Inventory score was 7 [3; 12] points, and the PHQ-9 score was 5 [3; 8] points, suggesting absence or mild depression, respectively. The methods demonstrated strong, positive, and statistically significant (r = 0.799; p &lt; 0.001) consistency among the indicators. The average Beck Anxiety Inventory score was 10 [4; 18] points, and the GAD-7 screening method score was 5 [2; 6] points, corresponding to low or moderate anxiety. For both methods, the consistency among indicators was moderate, positive, and statistically significant (r = 0.567; p &lt; 0.001).Conclusion. The study justified the reliability of results obtained by traditional tests and screening methods, showing trustworthy indications for psychological correction (psychotherapy) in the examined combatants.

Obstructive sleep apnea in patients with fibrotic interstitial lung disease (non-idiopathic pulmonary fibrosis): what should be offered?

Objective: The frequency of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is high. The clinical course of non-IPF interstitial lung disease (ILD) can be similar to that of IPF. We sought to assess the frequency and predictors of OSA in patients with non-IPF fibrotic ILD, as well as the impact of positive airway pressure (PAP) therapy on the quality of life of such patients. Methods: This was a prospective study in which non-IPF fibrotic ILD patients underwent a home sleep apnea test. The patients with and without OSA were compared, and a multivariate logistic regression model was used to identify independent predictors of OSA. At 3 months after initiation of PAP therapy, we evaluated the participating patients for respiratory events, nocturnal hypoxemia, and changes in quality of life. Results: Of a total of 50 patients, 50% were male, and 76% were diagnosed with OSA. The mean age was 67.8 ± 8.3 years. The patients with OSA had significantly lower TLC (p = 0.033) and awake SpO2 (p = 0.023) than did those without OSA. In the multivariate logistic regression model, SpO2 (OR = 0.46; p = 0.016) and TLC (OR = 0.95; p = 0.026) remained significantly associated with OSA risk. A total of 12 patients received PAP therapy. At 3 months after initiation of PAP therapy, 91.7% were well controlled, Epworth Sleepiness Scale scores decreased significantly (p = 0.006), and emotional well-being tended to improve (p = 0.068). PAP therapy corrected nocturnal hypoxemia in all patients. Conclusions: We found a high frequency of OSA in patients with non-IPF fibrotic ILD. A low TLC was an independent predictor of a higher risk of OSA. PAP therapy can correct nocturnal hypoxemia. There should be a low threshold for suspicion of OSA and initiation of PAP therapy in patients with non-IPF fibrotic ILD.

Abstract 4135318: Comparison of Right Ventricular Function Changes Between Volume Control and Pressure Support Ventilation Modes: A Prospective Study Using S' Prime Values

Background: This study assesses changes in right ventricular function by measuring S' values during the transition from volume control-assist control (VC-AC) to pressure support ventilation (PSV). Transitioning from VC-AC to PSV reduces the mean airway pressure (P mean) which causes a decrease in right ventricular afterload and also potentially improves venous return and right ventricular preload. PSV allows spontaneous breathing efforts, possibly increasing cardiac output. Thus, we expect a consistent increase in S' value when changing ventilator modes. Methods: This prospective observational study included ICU patients on invasive mechanical ventilation for over 24 hours. The clinical team decided when to switch from VC-AC to PSV. An average of three S' measurements was taken during VC-AC and within 10 minutes of transitioning to PSV. Sedation, vasopressor use, and Richmond Agitation-Sedation Scale scores were consistent throughout the measurements. The study was approved by the Albert Einstein College of Medicine IRB (#2023-15068) Results: Seventeen patients were included in the study, with an average age of 61.29 years (SD 11.39). Of these, 6 (35.3%) were female. The mean S' during VC-AC was 12.79 ± 4.52, and upon transitioning to PSV, it was 14.56 ± 3.89 (p-value 0.47). The intra-observer variability for S' was 5.3%. Of the seventeen patients, 5/17 (29%) showed an S' change of less than 5.3% and were deemed to have no significant variation; 7/17 (41%) experienced a significant decrease in S' (15.41% ± 7.29% SD), while the remaining 5/17 (29%) showed a significant increase (19.31 ± 13.23%). Conclusion: Our study demonstrates that transitioning from VC-AC to PSV results in variable changes in right ventricular systolic function, as indicated by S' values. Contrary to our expectations of a consistent increase, the interplay between S' values and ventilator mode changes appears to be non-linear, suggesting other factors may influence cardiopulmonary interactions in spontaneously breathing ventilated patients. These findings highlight the complexity of these interactions, underscoring the need for individualized patient management and paving the way for further research with a larger cohort.

Abstract 4136550: In-hospital cardiac arrest can be detected by Innovative smart healthcare syste

Background: Predicting in-hospital cardiac arrest (IHCA) is crucial for preventing patient fatalities. However, it remains challenging due to the irregularities in time series data across various features. Previous studies relied on traditional medical scoring systems, but their accuracy was limited as the models were overly simplistic. Recent research using machine learning methods has shown improved results. In our work, we employ deep learning and time series approaches, which are considered the most powerful models for addressing complex problems in recent years. Method/Research Design: The cohort study took place in a hospital in Taiwan from January 2016 to August 2022, involving 252,000 patients in general wards. Input data encompassed basic information, vital signs, Glasgow Coma Scale scores, medication, etc., to predict IHCA occurrences within 24 hours. Given the immediacy of IHCA events, we utilized left alignment to handle time series. Evaluation metrics included the area under the receiver operating characteristic curve (AUROC). Results: We compared three types of settings. The first was based on scoring systems, where the national early warning system (NEWS) achieved an AUROC of 0.756, and the modified early warning score (MEWS) reached 0.653. In the next setting, based on the data summary within a given time interval, the machine learning models XGBoost and deep learning model TabNet achieved AUROCs of 0.863 and 0.839, respectively. This indicates that machine learning outperforms traditional medical methods. The final setting involved time series analysis, where XGBoost and the Gate Recurrent Unit (GRU) network achieved 0.848 and 0.904, respectively, surpassing all previous settings. Conclusion: Our study demonstrates that learning-based methods outperform rule-based methods in predicting IHCA events. Machine learning algorithms offer more possibilities and have the potential to address complex problems effectively. Moreover, considering time series data rather than summarizing within fixed intervals preserves information and leads to better scores. Leveraging the time series deep learning method, GRU shows promising potential in significantly reducing the risk of IHCA events.

A phase 4, multicenter, global clinical study to evaluate discontinuation and rechallenge of pexidartinib in patients with tenosynovial giant cell tumor previously treated with pexidartinib.

Pexidartinib is effective in patients with tenosynovial giant cell tumor (TGCT) for whom surgery is not feasible. Durability of response after discontinuation of pexidartinib and the safety and efficacy of restarting pexidartinib have not been previously recorded. This phase 4 study was designed to mimic the real-world experience with pexidartinib to evaluate the effects of discontinuation of and retreatment with pexidartinib in patients with TGCT who previously benefited from the drug. This was a global, multicenter, phase 4 study that enrolled patients with TGCT who were experiencing clinical benefit from pexidartinib in one of four prior phase 1 or phase 3 studies investigating pexidartinib in the disease. Patients could choose to continue pexidartinib at the same dose (the treatment-continuation cohort) or discontinue treatment with the option to restart pexidartinib (the treatment-free/retreatment cohort). Tumor progression determined by Response Evaluation Criteriain Solid Tumors (RECIST) version 1.1, patient-reported outcomes (the Patient-Reported Outcomes Measurement Information System-Physical Function [PROMIS-PF] questionnaire and the EuroQol 5-dimension, 5-level [EQ-5D-5L] visual analog scale), and safety were assessed every 3 months. The primary end point was the proportion of patients in the treatment-free/retreatment cohort who remained treatment-free at month 12 and 24; this did not depend on disease progression. Thirty-two patients were enrolled: 21 chose to enter the treatment-continuation cohort, and 11 entered the treatment-free/retreatment cohort. During the treatment-free period, six of 11 (54.5%) patients in the treatment-free/retreatment cohort had progressive disease (PD) according to RECIST, version 1.1, whereas no patient in the treatment-continuation cohort had disease progression. Over the 24-month study, three of 11 (27.3%) patients in the treatment-free/retreatment cohort restarted treatment because of RECIST version 1.1 PD, symptomatic progression, or both (n=1 each). The probability of remaining treatment-free in the treatment-free/retreatment cohort was 73% (95% confidence interval, 37%-90%). In the treatment-free/retreatment cohort, the median progression-free survival of the treatment-free period was 22.8 months (95% confidence interval, 1.6 months to not estimable). By 6 months of retreatment, all retreated patients achieved new disease stabilization with no new safety concerns; two patients had clinically significant improvements in PROMIS-PF and EQ-5D-5L visual analog scale scores. The mean PROMIS-PF and EQ-5D-5L scores remained stable throughout the study. There was no hepatotoxicity and no new safety signal in either cohort. In this small phase 4 study designed to evaluate outcomes in patients who stopped and restarted pexidartinib, 54.5% of patients who discontinued pexidartinib showed PD, with a median progression-free survival of 22.8 months. Each of the three patients who restarted pexidartinib stopped progressing, and some reported a new gain in physical function. No PD was detected in patients who remained on treatment, and the safety profile did not indicate long-term hepatotoxicity or any new safety concerns. Pexidartinib is a medication for people with tenosynovial giant cell tumor (TGCT) for whom surgery is not recommended. This study examined what happens when patients stop taking pexidartinib (after it has helped them) to see whether it is safe and effective to restart if needed. Thirty-two patients were followed for 2 years: 21 chose to continue pexidartinib and did not experience disease progression, while 11 chose to stop pexidartinib; 54.5% of them had disease progression within 2 years. Three patients who stopped pexidartinib restarted treatment after their tumor size increased or their symptoms worsened. Restarting pexidartinib was safe and effective in these patients.

Features of management of patients with seasonal allergic rhinitis

Introduction. Seasonal allergic rhinitis continues to be one of the most common chronic diseases, affecting up to 24% of the adult population of the Russian Federation.Aim. To evaluate the effectiveness of the drug mometasone furoate (Nozefrin Allergy) in patients with seasonal allergic rhinitis in outpatient practice.Materials and methods. The study was conducted in a group of 42 patients aged 18 to 73 years (average age 39.0 ± 15.5 years) diagnosed with seasonal allergic rhinitis. All patients received monotherapy with Nozefrin Allergy, 2 injections (50 mcg of mometasone furoate each) into each nostril once a day for 30 days. The effectiveness of the treatment was determined on the 7th, 14th, 30th day of treatment and on the 60th day.Results and discussion. During the use of the drug Nozefrin Allergy, by the 7th day there was a significant decrease in complaints of impaired smell by 3.6 times, sneezing by 2.4 times, discharge from the nasal cavity decreased by 2.3 times, and nasal congestion by 2.3 times. 2.1 times. After 14 days, nasal congestion disappeared in 64.3%, nasal discharge and itching in the nasal cavity were absent in 69.0% and 88.1% of patients. According to the SST-12 test, already by the 7th day of using the drug Nozefrin Allergy, there was an increase in the average total score to 10.1 ± 1.9 points, which corresponds to normosmia. At days 14, 30, and 60, the mean total SST-12 score remained stable at 10.6 ± 0.9 points, 10.9 ± 1.1 points, and 11.1 ± 0.5 points, respectively. The dynamics of respiratory function at the end of the course of treatment was characterized by an improvementin the total volumetric flow to 783.4 ± 162.7 cm3/s and a decrease in nasal resistance to 0.2 ± 0.1 cPa/ml. The total rTNSS scale score by the 7th day decreased to 9.1 ± 0.4 points, the severity of the assessed complaints was moderate.Conclusion. The data obtained indicate the effectiveness of using the drug Nozefrin Allergy in patients with seasonal allergic rhinitis in outpatient clinical practice.

Future Anxiety and Its Relationship to Identity Crisis among Syrian Refugee Women in Zarqa Governorate

The study aimed to identify the level of future anxiety among Syrian refugees in Zarqa Governorate. It also aimed to identify the identity crisis among Syrian refugees in Zarqa Governorate and the existence of a correlation between future anxiety and identity crisis among Syrian refugees in Zarqa Governorate. The study community consisted of all Syrian refugees in Zarqa Governorate. The study sample was (163) refugees. The study reached several results, the most important of which are: The overall average of the total score for the future anxiety scale was average with an arithmetic mean of (3.23). It also showed that the overall average of the total score for the identity crisis scale was average with an arithmetic mean of (3.30). It showed the existence of a statistically significant positive relationship between the total score for the identity crisis and future anxiety, as the value of the Pearson correlation coefficient reached (0.714). The study recommended launching psychological support and awareness programs, as it is necessary to develop awareness and psychological programs aimed at helping individuals confront anxiety related to the future.

Topical Therapies for Management of Olfactory Dysfunction in Chronic Rhinosinusitis with Nasal Polyps: Steroid-Eluting Stents.

Steroid-eluting stent implantation after endoscopic sinus surgery (ESS) effectively alleviates postoperative symptoms and polyp recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the efficacy of steroid-eluting stents for the treatment of olfactory dysfunction in CRSwNP and the influencing factors therein have not been studied. Fifty-nine patients with CRSwNP with olfactory dysfunction from Peking University Third Hospital who were hospitalized for ESS were recruited and randomly divided into a stent group (n = 30) and a control group (n = 29), and were assessed for symptom scores, olfactory function, endoscopic findings, and type 2 inflammatory mediators (IL-4, IL-5, IL-13, IL-33, eotaxin-3, periostin) expression. Postoperative olfactory Visual Analogue Scale (VAS) scores, T&T olfactometer scores, SNOT-22 scores, and Lund-Kennedy (LK) scores were reduced in patients with CRSwNP (P < .01). Postoperative olfactory VAS scores, T&T olfactometer scores, SNOT-22 scores, and LK scores, IL-5, IL-13, and periostin were significantly lower in the stent group than in the control group (P < .05). Correlation analysis was performed and found that the postoperative olfactory VAS scores were strongly correlated with IL-5 and IL-13 (r = .496, P < .001 and r = .289, P = .026), and the postoperative T&T olfactometer scores were strongly correlated with IL-5 and IL-13 (r = .553, P < .001 and r = .398, P = .002). Steroid-eluting stent implantation after ESS is an effective treatment for olfactory deficits in patients with CRSwNP and may be related to the stent's more effective reduction of local type 2 inflammatory mediators in the nasal cavity.

SURG-06. IMPACT OF LASER INTERSTITIAL THERMAL THERAPY VERSUS RESECTION FOR METASTASES ASSOCIATED WITH THE MOTOR CORTEX

Abstract BACKGROUND For brain metastases (BM), resection remains a mainstay for the upfront management of large, symptomatic lesions, while laser interstitial thermal therapy (LITT) has become a key treatment for radiographically progressive BM following stereotactic radiosurgery (SRS). Compared to LITT, resection-associated morbidity may delay systemic therapies. We evaluated functional outcomes for resection versus LITT to primary motor cortex (PMC)-associated metastases. METHODS Patients receiving resection or LITT for BM radiographically associated with the PMC from 2015-2023 were retrospectively reviewed. Demographic and survival data were collected, with patient Karnofsky Performance Status (KPS) or modified Rankin Scale (mRS) scores assessed out to 1-year by independent raters. RESULTS Forty-one patients underwent resection and 30 underwent LITT to a PMC-associated lesion. Median age was 67 (range 38 – 80) vs 65 (44 – 80) for resection vs LITT; median pre-operative KPS (70 vs 80, P = 0.1) or mRS (2 vs 2, P = 0.66) did not differ between groups. Lung was the most common primary (56.1% resections vs 56.7% LITTs). Resected lesions were of larger median diameter than LITT, 2.8 vs 1.9 cm, P = 0.0001. For resections, length of stay was longer, median 2 vs 1 day, P = 0.0002, and ICU use more frequent (75.6% versus 20.0%, P &amp;lt; 0.0001). At 1-month post-op, 66.7% of resection patients and 51.7% of LITT patients had stable or improved symptoms from pre-op, P = 0.21, with parity at 3-months (65.7% vs 62.9%) and therafter. Further, there was no significant decrement in KPS or mRS score out to a year for either intervention. CONCLUSIONS While there is a short-term increased risk of post-operative neurologic worsening due to LITT-associated edema, our data shows that, relative to resection, this is a transient and clinically limited phenomenon. With careful patient selection, LITT to lesions involving the PMC is feasible.

Evaluation of Door-to-Needle Stroke Patients With Thrombolytic Activation Code in Imam Reza Educational Center in Tabriz

Objectives: To investigate the therapeutic process and golden times for treating stroke patients receiving thrombolytic therapy at Imam Reza Hospital in Tabriz. Design: A cross-sectional descriptive study. Setting(s): The information for all patients entering the study was extracted from the stroke registry of the Neurosciences Research Center. Participants: Participants comprised all patients who were referred to Imam Reza Hospital emergency department (ED) in 2018, hospitalized as stroke patients, and had an indication for receiving thrombolytic therapy. Outcome measures: Data included demographic information, length of stay in the ED, time interval from the onset of symptom to ED arrival, time to CT scan, time to the start of thrombolytic therapy, outcomes (e.g., discharge, hospitalization, or death), and the use of tissue plasminogen activator (tPA) therapy. Results: A total of 140 patients were studied, with a mean and median age of 66.19±12.68 and 67.5 years, respectively. The mode age was 73 years, with the maximum age being 91 years and the minimum age being 34 years. Moreover, 82 (58.6%) of patients were male, and 58 (41.4%) were female. The mean time interval from ED arrival to the start of thrombolytic injection was 54.49±27.42 minutes, with a median and mode of 51 and 60 minutes, respectively. The minimum time was 17 minutes, and the maximum time was 218 minutes. The modified ranking scale (mRS) score at 7 days was significantly related to the National Institutes of Health Stroke Scale (NIHSS) at arrival, NIHSS 36 hours after treatment, NIHSS at 7 days after treatment, the incidence of intracerebral hemorrhage, and hospitalization duration (P≤0.001). Conclusions: Initiating thrombolytic injection within 60 minutes is feasible, and patients’ status 7 days after discharge has a significant relationship with NIHSS at arrival, NIHSS 36 hours post-treatment, and NIHSS 7 days post-treatment. Moreover, there is a significant correlation between mRS at 7 days and an interval of less than 60 minutes from ED arrival to the start of thrombolytic injection. In such cases, mRS is lower.

Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study.

In the clinic, pediatric acute necrotizing encephalopathy (ANE) primarily affects children under five years of age and is characterized by severe brain damage and high mortality. However, some challenges remain regarding the diagnosis and treatment of ANE. In the present study, we analyzed the clinical characteristics and related factors of ANE with the aim of providing improved diagnostic and treatment strategies. Thirty-four pediatric ANE patients admitted to Zhejiang University School of Medicine Hospital between February 2019 and December 2023 were included in this study. To identify the factors associated with mortality, clinical, laboratory and imaging data were analyzed with independent-sample t tests, Mann‒Whitney U tests, Fisher's exact probability tests and receiver operating characteristic (ROC) curve analyses. In this cohort of 34 patients, the most common symptoms were fever, seizures, altered consciousness, vomiting, diarrhea and shock. The mortality rate was 55.9%. Laboratory tests revealed that patients who died had higher creatinine, lactate, activated partial thromboplastin time (APTT), thrombin time (TT), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine kinase (CK), and D-dimer than survivors. Imaging examinations predominantly revealed symmetrical lesions in the thalamus. The fatal group displayed lower Glasgow Coma Scale (GCS) scores and severe complications. Other factors related to mortality included the arterial pH, GCS score and hospitalization duration. The most common symptoms of ANE are fever, seizures, altered consciousness, vomiting, diarrhea and shock, and ANE has a high mortality rate. The GCS score and arterial pH are critical biomarkers for assessing the severity of ANE.

EPCO-22. DEEP PHENOTYPING IDENTIFIES TRUNCATING MUTATIONS IN THE NF2 LINKER DOMAIN ASSOCIATED WITH DISEASE SEVERITY IN NEUROFIBROMATOSIS TYPE II

Abstract INTRODUCTION Neurofibromatosis type 2 (NF2) is an autosomal dominant tumor syndrome with protean presentation and variable penetrance. Our objective was to perform deep phenotypic and genetic analysis of a diverse NF2 population to identify predictors of worse clinical outcome. METHODS We evaluated 167 patients with NF2 and followed them for a mean duration of 4.5 years. Detailed clinical and radiographic characteristics were collected on each patient, and Karnofsky performance scale (KPS) scores and within-study mortality were monitored. CLIA certified genotyping was supplemented with a custom sequencing panel targeting NF2 and other schwannomatosis-related genes. Outcome predictors were assessed using multivariable linear or logistic regression. RESULTS Germline mutations (nonsense 36%, splice-site 16%, and large deletions 16%) were grouped by predicted protein effect (truncating 41%, non-truncating 27%, and mosaic 33%) and mapped to the NF2chromosomal locus. Patients with truncating NF2 mutations had lower mean age of diagnosis (19.9 versus 25.7, P = 0.01) and faster tumor growth rates (2.4% versus 1.1% for all tumors, P = 0.01). Patients whose truncating mutations occurred within the NF2 linker domain (exons 8, 11 and 12) had more total tumors (adjusted coefficient 15.0, 95% CI 0.8 – 29.0, P = 0.04), and specifically more schwannomas (adjusted coefficient 7.0, 95% CI 0.2 – 13.9, P = 0.04). Presence of a-helical domain mutations predicted higher within-study mortality (adjusted OR 4.3, 95% CI 1.1 – 16.2, P = 0.03). CONCLUSIONS The NF2 linker domain functions a hinge, facilitating binding between the tail domain and the LATS binding site within the FERM domain. In our study, truncating mutations in the NF2 linker domain were associated with higher tumor burden and over four-fold within-study mortality. The linker domain may constitute a novel therapeutic target in patients with NF2.

Repetitive Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations in Schizophrenia: A Randomized Clinical Trial.

Auditory verbal hallucinations (AVH) are a common symptom of schizophrenia, increasing the patient's risks of suicide and violence. Repetitive transcranial magnetic stimulation (rTMS) is a potential treatment for AVH. To investigate the effect of imaging-navigated rTMS on AVH in patients with schizophrenia. This 6-week, double-blind, sham-controlled, randomized clinical trial was performed at the Anhui Mental Health Center, Hefei, China, from September 1, 2016, to August 31, 2021. Participants included 66 patients with AVH and schizophrenia. Data were analyzed from May 1, 2022, to March 31, 2023. Participants were randomly assigned 1:1 to either imaging-navigated active or sham rTMS over the left temporoparietal junction for 2 weeks. The primary outcome measured improvements in AVH from baseline to week 2 and week 6 using the Auditory Hallucination Rating Scale (AHRS) scores. In addition, the TMS-induced electric field strength was used to estimate improvements in AVH as a secondary outcome. A total of 62 participants (33 women [53%]; mean [SD] age, 27.4 [9.2] years) completed the 2-week treatments. Of these, 32 were randomized to the active rTMS group (18 women [56%]; mean [SD] age, 26.9 [9.2] years) and 30 to the sham treatment group (15 women [50%]; mean [SD] age, 27.8 [9.4] years). In the intention-to-treat analyses, patients receiving active rTMS showed a significantly greater reduction in AHRS scores compared with those receiving sham treatment at week 2 (difference, 5.96 [95% CI, 3.42-8.50]; t = 4.61; P < .001; Cohen d, 1.17 [95% CI, 0.62-1.71]). These clinical effects were sustained at week 6. Additionally, a stronger TMS-induced electric field within a predefined AVH brain network was associated with greater reductions in AHRS scores (B = 3.12; t = 3.58; P = .002). No serious adverse event was observed. The findings of this randomized clinical trial suggest that imaging-navigated rTMS may effectively and safely alleviate AVH in patients with schizophrenia. Findings also suggest that the electric field strength in the individualized AVH network is a vital parameter for optimizing the efficacy of the rTMS protocol. ClinicalTrials.gov Identifier: NCT02863094.