Reduction In Score Research Articles

Quantitative Evaluation of Multiple Treatment Regimens for Treatment-Resistant Depression.

This study aims to quantitatively evaluate the efficacy and safety of various treatment regimens for treatment-resistant depression (TRD) across oral, intravenous, and intranasal routes to inform clinical guidelines. A systematic review identified randomized controlled trials on TRD, with efficacy measured by changes in the Montgomery-Åsberg Depression Rating Scale (MADRS). We developed pharmacodynamic and covariate models for different administration routes, using Monte Carlo simulations to estimate efficacy distribution. Dropout and adverse event-related dropout rates were analyzed via single-arm meta-analysis. Involving 22 studies with 56 treatment arms and 3,059 patients, our findings suggest combination therapies outperform monotherapy, achieving an additional 6.5% reduction in MADRS scores over 12 weeks. The most effective combinations were olanzapine with fluoxetine and quetiapine with SSRIs/SNRIs. Injectable treatments, particularly ayahuasca, produced rapid effects, with a 77% reduction in MADRS scores at 15 days. Intranasal treatments reached efficacy sooner than oral ones, with 28-day efficacy similar to the 12-week efficacy of the olanzapine-fluoxetine combination. Dropout rates due to adverse events were similar across methods (4.5%-5.2%), but total dropouts were highest for oral (17.9%) and lowest for intranasal routes (10.6%). Additionally, there was considerable variation in the incidence of headache, dizziness, and nausea across different administration routes. The quantitative evaluation of 22 TRD treatments illuminates key pharmacodynamic parameters, bolstering the development of clinical guidelines and aiding the design of clinical trials and medical decision-making.

Changes in Cerebral Hemodynamic Among Patients With Schizophrenia or Bipolar Disorder Receiving Electroconvulsive Therapy: A Task-Related Functional Near-Infrared Spectroscopy Study.

There remains a scarcity of studies to evaluate the treatment effect of electroconvulsive therapy (ECT). Functional near-infrared spectroscopy (fNIRS) offers a cost-effective method to measure cerebral hemodynamics. This study used fNIRS to evaluate the effect of ECT in patients suffering from schizophrenia or bipolar disorder (manic phase). Thirty patients with mania and 31 with schizophrenia were recruited. Each participant received 6 sessions of ECT. This study utilized the Positive and Negative Syndrome Scale, Young Mania Rating Scale, and fNIRS-verbal fluency test paradigm at baseline and after each session of ECT. The prefrontal cortex hemodynamic response during the performance of verbal fluency test was recorded via a commercial wireless high-density continuous-wave fNIRS system device. The effect of categorical and continuous variables was determined using Pearson's chi-square test and Student's t test or 1-way analysis of variance with Bonferroni-corrected post hoc pairwise comparison, respectively. Comparing the Positive and Negative Syndrome Scale and Young Mania Rating Scale scores between baseline, sessions 3 and 6, the scores were significantly decreased (P < 0.001), with both patient groups achieving more than 50% reduction in scores from baseline to session 6. The fNIRS also showed significant increases in oxy-hemoglobin levels (session 6 vs baseline) in the right ventrolateral prefrontal cortex and left dorsolateral prefrontal cortex for both patient groups (P < 0.05). There were significant correlations in the reduction of symptom severity and increase in HbO2 levels in people with bipolar disorder (manic phase) and schizophrenia (P < 0.05). Monitoring the activation in the right ventrolateral prefrontal cortex and left dorsolateral prefrontal cortex is an objective ECT monitoring indicator for patients suffering from bipolar disorder (manic phase) or schizophrenia.

Curative and preemptive treatment of amputee pain by targeted muscle reinnervation: experience from a French military trauma center.

Targeted muscle reinnervation (TMR) is a technique that has proven effective for the treatment and prevention of chronic pain following amputation, though its adoption remains limited. The authors report on their initial experience using TMR. A prospective study was conducted in a military trauma center involving traumatic amputees treated with either curative or preemptive TMR. Their outcomes were compared to those of control patients who underwent neuroma burial or simple neurectomy during primary amputation. Data included a numerical rating scale (NRS) and patient-reported outcomes measurement information System (PROMIS) scores evaluating residual limb pain (RLP) and phantom limb pain (PLP). Eighteen patients with a median age of 45.5 years were included and followed up for a median period of 13 months. The curative TMR group consisted of 8 patients whose results were compared to those of 9 control patients. There was a significant reduction in almost all pain scores with TMR and only in RPL NRS scores with neuroma burial. Reduction in RLP and PLP scores was significantly greater with TMR. The preemptive TMR group included 10 patients whose results were compared to those of 18 control patients. No significant difference was observed in the postoperative evolution of RLP or PLP. These results confirm the benefits of TMR for the curative treatment of RLP and PLP. However, within the limits of this small sample size, preemptive TMR did not show added value. TMR appears to be a complex technique that requires a learning curve.

Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review.

The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents. A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application. Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others. Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

Tocilizumab – a disease-modulating treatment for thyroid associated ophthalmopathy?

ABSTRACT Purpose To analyze Tocilizumab (TCZ, an interleukin 6 inhibitor) as a second-line treatment for thyroid-associated ophthalmopathy (TAO). Methods In this retrospective observational study, the charts of patients with moderately severe to severe TAO who received intravenous Tocilizumab as a second-line treatment 2020-2023 were reviewed. Results Twenty-three patients were enrolled in the study. At the follow-up visit 24 weeks after the initiation of treatment, 14 out of 22 patients (63.6%, one missing data) had a reduction of proptosis of 2 mm or more. The mean proptosis decreased from 21.07 (±3.23) to 19.18 (±2.52) mm in the right eye (RE) and from 20.61 (±3.12) to 19.95 (±2.81) mm in the left eye (LE). Twenty patients (87%) also showed a reduction of the clinical activity score (CAS) of at least two points with a mean decrease from 5.22 (±1.53) pre-treatment to 2.09 (±1.38) post-treatment points. The median patient total follow-up time after treatment was ten (range 6–26) months. The comparisons reached strong significance between pre-treatment and 24 weeks, as well as pre-treatment and final visit assessments for both proptosis and clinical activity scores. Serum TRAb levels also dropped significantly, and only two patients needed re-treatment with TCZ. Improvement of diplopia did not reach statistical significance. Conclusions Intravenous Tocilizumab as a second-line treatment for TAO led to a significant improvement of proptosis and CAS at 24 weeks follow-up, with a sustained effect over time.

Effects of the Transcutaneous Electrical Stimulation System on Heartburn, Regurgitation and Esophageal Acid Exposure in GERD Patients-An Uncontrolled Feasibility Study.

Proton pump inhibitors (PPI) for gastroesophageal reflux disease (GERD) are associated with a high failure rate. Our uncontrolled feasibility study aimed determining the effect of a transcutaneous electrical stimulation system (TESS) on GERD symptoms and acid exposure time (AET). Recruited patients with heartburn and regurgitation. During the first phase (one-week, run-in period, off-PPI's), patients completed symptom diaries and demographic questionnaires. Thereafter, all patients underwent gastroscopy with subsequent placement of a wireless esophageal pH capsule, off-PPI. Based on pH analysis in the first 24 h, only those with increased AET (percent total time pH < 4 above 6%) continued to the next phase. During that phase, patients were treated for up to 3 weeks with TESS and documented their symptoms. The Primary endpoint was the magnitude of reduction in GERD-related symptoms. The secondary endpoints were the magnitude of reduction of AET and DeMeester score, as compared with their baseline values. Included 31 patients and of those, 26 patients (42% females, aged 49 ± 15 years, mean BMI 25 ± 3 kg/m2) completed the first two phases of the study. At baseline, mean number of daily heartburn and regurgitation episodes was 2.55 ± 1.79 and 1.40 ± 1.73, respectively. Following TESS, mean number of daily heartburn and regurgitation episodes dropped to 0.77 ± 0.75 and 0.36 ± 0.8, respectively (p < 0.001). At base line, mean AET and DeMeester score were 12.4 ± 5.6 and 32.1 ± 12.7, respectively. Following TESS mean AET dropped to 6.0 ± 3.5 and DeMeester score dropped to 16.2 ± 8.2 (p < 0.001). TESS is effective in reducing both symptoms and esophageal AET in GERD patients.

Hearing and cognitive scores measured with the Montreal Cognitive Assessment Scale in The HUNT Study, Norway.

Hearing impairment is associated with dementia. We aimed to clarify the association between hearing impairment and future cognitive test performance measured by the Montreal Cognitive Assessment Scale (MoCA), adjusted for confounders, avoiding reverse causation through long follow-up. We used the Norwegian population-based longitudinal cohort study, The Trøndelag Health Study (HUNT). At baseline, we invited all residents 20+ for an audiometric hearing assessment, and at 20+ years follow-up, we cognitively assessed all persons 70+ including MoCA adjusted for hearing impairment. We analyzed the association using linear regression. We included 6879 persons (mean 56.1 years, standard deviation 6.2). At follow-up, the MoCA score was -0.25 (95% confidence interval [CI] -0.35, -0.14), per 10dB increase in hearing threshold and for persons<85 years, -0.31 (95% CI -0.42, -0.20). This study finds a long-term association between hearing impairment and dose related reduced cognitive performance, particularly in those aged <85. ID NCT04284384, hearing impairment as a risk factor for dementia in older adults. Hearing loss predicts long-term cognitive decline measured by MoCA over 20+ years. Long follow-up is crucial to avoid reverse causation in the hearing-cognition relationship. A 10dB hearing threshold increase is linked to a 0.25-point reduction in MoCA score. Strongest cognitive decline associations are seen in people aged below 85 years. The association remained after excluding hearing-dependent tasks in the MoCA.

Efficacy of repetitive transcranial magnetic stimulation for phantom limb pain- a meta analysis of randomized controlled trials.

Phantom limb pain (PLP) is a neuropathic syndrome experienced by the majority of amputees. Various treatment options are available for amputees suffering from PLP including pharmacological, psychological and neuromodulation techniques. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has proven its efficacy in alleviating PLP. Hence, we aimed to conduct a meta-analysis to evaluate the effectiveness of rTMS in improving pain in patients with PLP. Literature search was carried out on 5 electronic databases from the inception of the paper till 13th August, 2024. Randomized Controlled Trials evaluating the efficacy of rTMS in patients with PLP against a control group were included in our study. The Visual Analogue Scoring (VAS) system was used to evaluate the severity of pain. Quality assessment was performed with the Cochrane bias assessment tool and data was pooled on Review manager using the Mantel-Haenszel Random-effects model. 5 RCTs included in this paper were included and consisted of 140 participants experiencing PLP. There was a significant reduction in pain score in the rTMS group at the end of treatment when compared to the control group (P = 0.00001). A drop out sensitivity analysis significantly improved the results by reducing the heterogeneity to null (P = 0.00001). After 30 days of treatment, there was a significant difference of pain score from baseline in rTMS groups. Our meta-analysis demonstrates the role of rTMS in significantly reducing VAS score in patients with PLP. In the future, larger clinical trials are required that evaluate the long-term efficacy profile of rTMS to establish it as a mainstay of therapy in patients with PLP.

The role of facet joint degeneration in the treatment success of transforaminal epidural steroid injection: a retrospective clinical study.

Transforaminal epidural steroid injection (TFESI) is highly effective in alleviating radicular back pain. While predictive factors for TFESI treatment outcomes have been previously studied, there is a lack of data on the relationship between facet joint degeneration and TFESI efficacy. This study is aimed at studying the impact of facet joint degeneration on TFESI treatment outcomes for unilateral radicular pain. A retrospective analysis was conducted on patients with unilateral radicular pain who underwent lumbosacral TFESI. Pain severity was assessed using the Numerical Rating Scale (NRS) at baseline, 1h post-procedure, and 3weeks post-procedure. Degree of facet joint degeneration was evaluated via MRI. Patients were categorized into two groups: low-grade facet joint degeneration group (group 1) and high-grade facet joint degeneration group (group 2). A total of 147 patients were included in the study. NRS scores were significantly higher in group 2 compared to group 1 at the 3rd week follow-up. Treatment success, defined as a ≥ 50% reduction in NRS scores, was also significantly higher in group 1. Facet joint degeneration adversely impacts the treatment success of TFESI. A comprehensive evaluation of facet joint pathologies prior to procedure planning is imperative for optimizing treatment outcomes.

Alterations of triple network dynamic connectivity and repetitive behaviors after mini-basketball training program in children with autism spectrum disorder

Physical exercise has been demonstrated to effectively mitigate repetitive behaviors in children with autism spectrum disorder (ASD), but the underlying dynamic brain network mechanisms are poorly understood. The triple network model consists of three brain networks that jointly regulate cognitive and emotional processes and is considered to be the core network underlying the aberrant manifestations of ASD. This study investigated whether a mini-basketball training program (MBTP) could alter repetitive behaviors and the dynamic connectivity of the triple network. 28 male children with ASD were scanned twice with resting-state functional MRI and assessed for repetitive behaviors using the repetitive behavior scale (RBS-R). 15 children in the exercise group participated in a 12-week MBTP, while 13 in the control group maintained their regular routines. The feature of Dynamic independent component analysis (dyn-ICA) is its ability to capture the rate of change in connectivity between brain regions. In this study, it was specifically employed to examine the triple network dynamic connectivity in both groups. Compared to the control group, the exercise group exhibited distinct dynamic connectivity patterns in two networks: Network 1 involved cross-network dynamic connectivity changes within the triple network, and Network 2 pertained to dynamic connectivity alterations within the default mode network. Furthermore, a reduction in the RBS-R Total score was observed in the exercise group, reflecting improvements in self-injurious behavior and restricted behavior. Correlation analysis revealed that the amelioration of repetitive behaviors was associated with enhanced dynamic connectivity in parts of the triple network. These findings suggest that MBTP can improve repetitive behaviors in ASD children and is linked to changes in triple network dynamic connectivity.

Qualitative and quantitative analysis of reduced bed position acquisition time on FDG PET image quality.

The study aim was to evaluate whether reducing bed position acquisition time would result in significant detriment to image quality. Secondary aims were to compare effect of time of flight (TOF) and Q.Clear reconstructions and patient BMI on image quality. Fluorodeoxyglucose PET-CT performed in 30 patients on a new scanner at our institution between March and May 2024 was retrospectively evaluated. Four PET reconstructions were performed: (a) 1 min 45 s TOF, (b) 2 min TOF, (c) 1 min 45 s Q.Clear, and (d) 2 min Q.Clear. For qualitative analysis, four maximum intensity projection images were evaluated side-by-sideusing a five-point visual score (1 = non-diagnostic, 5 = excellent). For quantitative analysis, liver signal-to-noise ratio (SNR) was calculated. A statistically significant reduction in visual score occurred when reducing bed position time from 2 min to 1 min 45 s (mean TOF scores 0.24 reduction, P = 0.0002; mean Q.Clear scores 0.04 reduction, P = 0.02. There was also a statistically significant difference in liver SNR when reducing bed position time. Deterioration in image quality was minimised when bed position acquisition time was reduced if Q.Clear construction was utilized. This could facilitate increased scanning capacity without clinical detriment.

Speech therapy for exercise-induced laryngeal obstruction.

Exercise- Induced Laryngeal Obstruction (EILO) can lead to disabling exercise related dyspnea and hamper participation in physical activity. In this study, we aimed to investigate the effects of a standardized speech therapy protocol as treatment for EILO. Patients diagnosed with EILO at our institution were invited to participate. We compared laryngeal findings obtained during a continuous laryngoscopy exercise (CLE) test and questionnaire based self-reported breathing symptoms, before vs. after the treatment intervention. The laryngeal obstruction was characterized using a standardized CLE scoring system (0-12 points). A total of 28 patients were evaluated. Following speech therapy, the mean reduction in the CLE score was 1.5 (95% confidence interval: 1.1-2.0) points, with the improvement primarily associated with decreased glottic-level obstruction. Twenty-four (86%) patients reported reduced symptoms during exercise. A moderate correlation was observed between changes in CLE scores and subjective symptom improvements. This study suggests that a standardized speech therapy protocol reduces observed laryngeal obstruction during the CLE test, with the most notable improvement occurring at the glottic level, alongside a parallel reduction in self-reported symptoms of EILO.

A randomised double-blind, placebo-controlled trial of pramipexole in addition to mood stabilisers for patients with treatment-resistant bipolar depression (the PAX-BD study).

Options for 'treatment-resistant bipolar depression' (TRBD) are limited. Two small, short-term, trials of pramipexole suggest it might be an option. To evaluate the clinical effectiveness and safety of pramipexole in the management of TRBD. A multi-centre randomised, double-blind controlled trial including participants ⩾18 years old with TRBD (failure to respond, tolerate or clinical contraindication/patient refusal of ⩾2 of quetiapine, olanzapine, lamotrigine or lurasidone) randomised 1:1 to pramipexole (max 2.5 mg/day salt weight) or placebo added to ongoing mood stabiliser (n = 39). Primary outcome: Quick Inventory of Depressive Symptoms, Self-rated (QIDS-SR) at 12 weeks. Up to 48 weeks follow-up. Pramipexole (n = 18) was associated with a greater reduction in QIDS-SR score at 12 weeks versus placebo (n = 21, 4.4 (4.8) vs 2.1 (5.1)): a medium sized (d = -0.72) but not statistically significant difference (95% CI: -0.4 to 6.3, p = 0.087). Similarly, there was a non-significant approximate 2-point (d = -0.76) improvement in pleasure at 6 weeks (95% CI: -0.11 to 4.20). Significant advantages of pramipexole on QIDS-SR score (6.28 points: 95% CI: 1.85-10.71) and psychosocial function (5.36 points: 95% CI: 0.38-10.35) were seen at 36 weeks post-randomisation, and on the response (46% vs 6%; p = 0.026) and remission (31% vs 0%; p = 0.030) rates at trial exit (48 weeks or last available data after 16 weeks for those affected by the early study closure). Hypomania ratings were significantly higher at 12 weeks. Otherwise, pramipexole was well tolerated. Clinically large, but statistically non-significant, effects of pramipexole on depression at 12 weeks, with significant longer-term benefits on mood and function were observed. Pramipexole use was complicated by dose titration and increased hypomanic symptoms. The small sample size limits interpretation. Furthermore, larger randomised placebo-controlled trials are warranted.

Efficacy and Safety of Abhal (Juniperus communis L). on Pain intensity, Uterine Artery Doppler Flow, and Quality of Life in Primary Dysmenorrhea: A Double-Blind, Randomized Controlled Trial.

Incorporating ancient wisdom from Unani Medicine, this study delves into the therapeutic efficacy of Juniperus communis L. in primary dysmenorrhea. By seamlessly merging traditional knowledge with modern scientific evaluation, this research illuminates Juniperus communis L. (Juniper) potential. This study stands as a testament to the value of exploring ethnopharmacological insights and bridging the gap between ancient healing traditions and evidence-based medicine. To assess the efficacy and safety of Juniper berry compared to mefenamic acid in menstrual cramps and its associated symptoms, and overall quality of life in women with PD. Additionally, the study aimed to explore the impact of these interventions on uterine blood flow using Doppler evaluation. This was a double-blind, standard-controlled study conducted on 62 participants aged 18 to 35 years. They were randomly assigned to receive either two capsules (750mg) of Juniper berry or 250mg mefenamic acid thrice daily from day 1 to day 3 of menstruation, spanning two menstrual cycles. Primary outcomes were measured using the Visual Analogue Scale (VAS) for pain intensity and the Numerical Rating Scale (NRS) for systemic symptoms. Pelvic Doppler flow indices and responses to the SF-12 questionnaire were analyzed as secondary outcomes. After the intervention in cycle 2, both the juniper and standard groups exhibited a significant reduction in mean VAS scores from 8.1±1.3 to 2.87±1.17 and 8.1±1.13 to 3.61±1.14, respectively (p = 0.012). Intergroup comparisons revealed no statistically significant differences in systemic symptoms at baseline, and cycle 2 (C2) follow-up (p > 0.05). Similarly, there were no significant differences in the SF-12 questionnaire scores at baseline, C2, and C4 (p > 0.05). However, intragroup comparisons for VAS, NRS, and SF-12 in both groups showed significant differences at C2 and C4 compared to the baseline (p < 0.001). In the juniper group, intergroup and intragroup comparisons indicated a small effect size for the right uterine artery (Rt UtA) RI and SD at C3 compared to C1 (0.2 and 0.33). Left UtA-PI and RI also demonstrated a medium effect size (0.482 and 0.501), respectively, between C3 and C1. Juniper demonstrated significant efficacy and safety in reducing menstrual cramps, and its associated symptoms and improving health-related quality of life. Further, changes in pelvic uterine artery flow indices were also observed.

Putting an Ethics Training Program Online: It May Be More Complicated Than We Think.

This project evaluated the online implementation of a Responsible Conduct of Research/Professional Ethics Training for graduate students. The program was offered as a video-streamed remote, real-time training with an in-person option. Effectiveness of the remote program was evaluated using multiple measures: perceptions of ethical dilemmas, ethical decision-making, and reactions to the training. Pre-post training comparisons indicated participants' scores were lower after training on some outcomes. Results comparing training modalities suggest post-training reductions in scores were largely driven by remote participants. In-person participants performed significantly better on several measures compared to remote participants. All participants had favorable reactions to the program. Results suggest that putting an ethics training online may require an innovative approach to program development, better planning and preparation by the training institution, and more research, to determine the most effective way to proceed.

Desvenlafaxine with mindfulness-based cognitive therapy reduces Hamilton anxiety scores compared to escitalopram with mindfulness-based cognitive therapy in treatment-resistant generalized anxiety disorder.

This study aims to assess the effectiveness of low-dose Escitalopram (10 mg) or low-dose Desvenlafaxine (25 mg) combined with mindfulness-based cognitive therapy (MBCT) in addressing challenges in treating generalized anxiety disorder (GAD), particularly in patients resistant to conventional therapies. A prospective cohort study was conducted with individuals diagnosed with treatment-resistant GAD. group A included patients unresponsive to citalopram, imipramine, paroxetine, and sertraline, who were then treated with low-dose Escitalopram (10 mg) combined with MBCT. group B comprised those unresponsive to venlafaxine and duloxetine, who were treated with Desvenlafaxine (25 mg) alongside MBCT. Participants were monitored over 24 weeks for changes in Hamilton Anxiety Rating Scale (HAM-A) and Mindful Attention Awareness Scale (MAAS) scores, with medication adherence measured using the Medication Adherence Rating Scale (MARS). The primary outcomes focused on the improvement in anxiety symptoms and overall mental well-being. Comparative analysis between the groups showed significant improvement in HAM-A and MAAS scores at week 16 in group B compared to group A (P < 0.01). Within-group analysis also demonstrated a significant reduction in scores at week 12 in group B compared to group A at week 16 (P < 0.01). No significant difference was observed in medication adherence between the two groups (P = 0.122). Patients treated with low-dose Desvenlafaxine combined with MBCT exhibited greater improvements in managing treatment-resistant GAD compared to those treated with low-dose Escitalopram. This approach highlights the potential for more inclusive and effective mental health strategies, contributing to enhanced quality of life and well-being.

Clinical value of combining epirubicin with mindfulness intervention in patients with urinary system tumors and depression.

Urinary system tumors often cause negative psychological symptoms, such as depression and dysphoria which significantly impact immune function and indirectly affect cancer prognosis. While epirubicin (EPI) is recommended by the European Association of Urology and can improve prognosis, its long-term use can cause toxic side effects, reduce treatment compliance, and increase psychological burden. Therefore, an appropriate intervention mode is necessary. To explore the clinical value of EPI combined with mindfulness intervention in patients with urinary system tumors and depression. This was a retrospective study including 110 patients with urinary system tumors and depression admitted to Zhumadian Central Hospital between March 2021 and July 2023. Patients were divided into conventional (n = 55) and joint intervention (n = 55) groups. The conventional group received mitomycin and routine nursing, while the joint intervention group received EPI and mindfulness intervention. Both groups underwent three cycles of chemotherapy. Immune function (CD4+ cells, CD8+ cells, CD4+/CD8+ ratio), tumor marker levels [urinary bladder cancer antigen (UBC), bladder tumor antigen (BTA) and nuclear matrix protein 22 (NMP22)], quality of life questionnaire-core 30 (QLQ-C30), 17-item Hamilton depression scale (HAMD-17), and cancer-related fatigue [cancer fatigue scale (CFS)] were assessed. Adverse reactions and nursing satisfaction were recorded and evaluated. Post-intervention, CD4+, CD8+, and CD4+/CD8+ levels increased in both groups, with the joint intervention group showing more significant improvement (P < 0.05). Tumor marker levels (NMP22, BTA, and UBC) were lower in the joint intervention group compared to the conventional group (P < 0.05). The joint intervention group also showed a greater reduction in HAMD-17 scores (9.38 ± 3.12 vs 15.45 ± 4.86, P < 0.05), higher QLQ-C30 scores, and lower CFS scores (both P < 0.05). Additionally, the joint intervention group had a lower incidence of adverse reactions and higher nursing satisfaction (P < 0.05). EPI combined with mindfulness intervention significantly improved clinical outcomes in patients with urinary system tumors and depression and is worthy of clinical application.

Lay-health workers-led physical activity counseling in Ugandan people living with HIV and suicidal ideation

The aim of this one-group quasi-experimental study was to assess the efficacy of 8-week physical activity (PA) counseling program delivered by lay health workers (LHWs) in reducing suicidal ideation among people with HIV in Uganda. The counseling, based on the self-determination and motivational interviewing frameworks, consisted of 15-20 minute individual sessions for individuals from remote areas or 60-90 minute group sessions within the health center. Thirty-five (26 women, median age = 29.5years) participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), HIV/AIDS Stress Scale (HSS), World Health Organization Disability Assessment Schedule-2 (WHODAS-2) and Simple PA Questionnaire pre- and post-intervention. Post-intervention only 2 of the 35 participants reported suicidal ideation (PHQ-9 item 9 ≥ 1) (p < 0.001). Significant reductions in GAD-7, PHQ-9, HSS, SIMPAQ sedentary and WHODAS-2 scores and an increase in SIMPAQ PA score were observed. LHWs-led PA counselling is promising in reducing suicidal ideation in most people with HIV in low-resourced settings.

Impact of Fatty Acid Supplementation on Migraine Outcomes: A Systematic Review and Meta-analysis.

Migraines are a prevalent neurological condition that significantly impacts the quality of life. Although narrative reviews and clinical trials suggest the potential effects of fatty acid supplementation as a promising approach for migraine prophylaxis, the findings remain inconsistent. The aim was to evaluate the efficacy of fatty acid supplementation on migraine clinical outcomes through a systematic review and meta-analysis. This systematic review and meta-analysis was conducted using electronic databases including Medline, Scopus, Web of Science, and CINAHL from their inception up to October 7, 2024. Studies meeting the PICOS criteria were included: adults diagnosed with migraine, dietary supplementation with fatty acids, assessing migraine clinical outcomes, and only randomized controlled trials. Methodological quality and risk of bias were assessed independently by 2 reviewers using the Cochrane Risk of Bias 2 tool. Meta-analyses were conducted using Review Manager software. A random-effects model was applied to account for heterogeneity among studies. A standardized mean difference (SMD) of 0.2, 0.5, and 0.8 was interpreted as small, moderate, and large effects, respectively. Six randomized controlled trials, including 407 participants with chronic migraines, were analyzed. Interventions varied, including omega-3 supplementation with or without omega-6 restriction, lasting from 8 to 16 weeks, and 1 trial assessing alpha-lipoic acid. The overall risk of bias was assessed as low. The pooled analysis demonstrated significant reductions in headache intensity (SMD = -1.77; 95% CI: -3.32 to -0.21; P = .03), headache duration (SMD = -0.77; 95% CI: -1.05 to -0.50; P < .00001), headache frequency (SMD = -1.91; 95% CI: -2.61 to -1.21; P < .00001), and HIT-6 score (SMD = -2.44; 95% CI: -4.13 to -0.76; P = .004). This meta-analysis provides moderate evidence that fatty acid supplementation, particularly omega-3, improves migraine clinical outcomes. Additional high-quality, randomized controlled trials are needed to confirm these findings, particularly for the promising effects of alpha-lipoic acid. PROSPERO registration no. CRD42024592084.

Digital Frequency Customized Relieving Sound for Chronic Subjective Tinnitus Management: Prospective Controlled Study.

Tinnitus is a major health issue, but currently no tinnitus elimination treatments exist for chronic subjective tinnitus. Acoustic therapy, especially personalized acoustic therapy, plays an increasingly important role in tinnitus treatment. With the application of smartphones, personalized acoustic stimulation combined with smartphone apps will be more conducive to the individualized treatment and management of patients with tinnitus. The aim of this study was to evaluate the efficacy of a new personalized approach known as the digital frequency customized relieving sound (DFCRS) for tinnitus treatment and to explore the factors that may influence its therapeutic effect. Patients with subjective tinnitus were enrolled in this study from July 14, 2020, to May 24, 2021, in the tinnitus specialist clinic of Eye and ENT Hospital, Fudan University, Shanghai, China. In this nonrandomized concurrent controlled trial, a total of 107 participants were assigned to listen to personalized DFCRS through our developed app, while the other 77 participants who did not want to download and use the app were assigned to listen to unmodified music (UM). All the recruits were instructed to listen to DFCRS or UM for at least 2 hours a day and complete follow-up assessments at baseline, 1, 2, and 3 months. Multidimensional assessment scales, that is, Tinnitus Handicapped Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Fear of Tinnitus Questionnaire (FTQ), and Tinnitus Catastrophizing Scale (TCS) were used to evaluate the severity of tinnitus and the quality of life. Linear mixed models were used to test for changes in the THI scores across 3 months of acoustic treatment between group (DFCRS or UM treatment) and time. A multiclass logistic model was built with a stepwise function to determine the influence of the different covariates on the effects of acoustic treatment. The results of the multidimensional assessment scales after 3 months of treatment showed that DFCRS-treated patients had significant tinnitus relief compared to those in the UM group. Linear mixed models revealed a significant reduction in the THI scores over time (P<.001), with the DFCRS group showing significantly greater improvement than the UM group (P<.001). At 3 months, 92.5% (99/107) of the patients undergoing DFCRS reported tinnitus relief or disappearance, and longer daily treatment time was associated with better outcomes (P=.007). Multiclass logistic regression confirmed that longer treatment time (odds ratio [OR] 13.07-64.78; P<.001) and more severe tinnitus at baseline (OR 10.46-83.71; P<.001) predicted better treatment response. All secondary outcomes (HADS, AIS, FTQ, TCS) showed significant improvements over time (P<.001). Our study suggests that DFCRS is a new promising and noninvasive therapy for chronic tinnitus, and it can be delivered through a mobile app to bring more convenience to patients with tinnitus.