Scale Score Research Articles

Examining mindfulness as a strategy to improve the exercise experience

ABSTRACT Mounting evidence shows that positive affective responses to exercise can facilitate continued engagement. Numerous strategies (e.g., mindfulness, music) have been proposed to improve how people feel during exercise. Mindfulness research has primarily occurred in laboratory settings, and the present study sought to examine the effects of listening to a mindfulness recording during a self-paced walk outdoors. It was hypothesized that the mindfulness condition would elicit more positive affective responses during and after exercise and lead to greater associative attentional focus compared to a control condition. Thirty-four participants (M age = 26.62, SD = 3.28 years), divided into two groups (mindfulness recording vs. control), individually completed a self-paced 1.5 mile walk through a park. Participants in the experimental condition listened to a mindfulness recording via headphones during the walk. Feeling Scale scores during exercise indicated greater pleasure (p < .001, ηp 2 = .36), and Physical Activity Enjoyment Scale scores revealed greater enjoyment in the mindfulness group (p < .001, d = 1.50); there were no differences in attentional focus between groups (p = .120, ηp 2 = .07). Both conditions were considered pleasant, and results support the use of mindfulness to further enhance pleasure and enjoyment during a low-to-moderate intensity outdoor walk.

Effects of repetitive transcranial magnetic stimulation therapy on weight and lipid metabolism in patients with treatment‐resistant depression: A preliminary single‐center retrospective cohort study

AbstractAimThis study aimed to elucidate the effects of repetitive transcranial magnetic stimulation (rTMS) on weight, body mass index (BMI), and lipid metabolism in patients with treatment‐resistant depression (TRD).MethodsThis retrospective observational study included patients with TRD who received rTMS treatment at the Jikei University Hospital from September 2018 to August 2021. The patients were diagnosed based on the DSM‐5 and ICD‐10 criteria and treated using the NeuroStar TMS System. For 3–6 weeks, 10‐Hz rTMS was administered to the left dorsolateral prefrontal cortex at 120% motor threshold. The primary outcomes were changes in weight and BMI, whereas the secondary outcomes included changes in total, high‐density lipoprotein (HDL), and low‐density lipoprotein (LDL) cholesterol levels, thyroid function indicators, as well as HAMD‐17, HAMD‐24, and Montgomery–Åsberg Depression Rating Scale (MADRS) scores. Statistical analysis was conducted using paired t‐tests and repeated measures ANOVA.ResultsAmong the 34 patients (20 men and 14 women) included, no significant changes were observed in weight or BMI after rTMS treatment (average weight reduction: −0.50 kg, 95% CI: −0.14 to 0.56, p = 0.24; average BMI reduction: −0.21, 95% CI: −0.10 to 0.61, p = 0.15). However, significant reductions in total, HDL, and LDL cholesterol levels and FT4 were observed. Furthermore, the HAMD‐17, HAMD‐24, and MADRS scores significantly increased post‐treatment.ConclusionrTMS treatment did not affect weight or BMI in patients with TRD but is believed to improve lipid metabolism.

Mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis

ObjectiveThis study was aimed to explore the mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis.MethodsThe clinical data of young and middle-aged patients with lumbar spondylolisthesis were retrospectively analyzed and divided into an observation group and a control group according to surgical methods. The observation group was treated with minimally invasive transforaminal interbody fusion (MIS-TLIF) combined with orthopedic robot-navigated percutaneous pedicle screw fixation; while the control group underwent traditional posterior lumbar interbody fusion (PLIF). Perioperative indicators, waist and leg pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), and complications were compared between groups.ResultsA total of 32 patients with lumbar spondylolisthesis were included in this study, with the average age of 50.3 ± 2.7 years old. There were 17 patients in the observation group and 15 patients in the control group. Although the new surgical technique for the observation group may require longer operative time, it showed significant advantages in reducing intraoperative bleeding, postoperative drainage, and shortening hospital stay. These benefits might result in faster recovery for patients, reduced risk of complications, and improved overall quality of life. The new technology was also significantly better compared to the traditional method in terms of VAS scores and ODI at 1 week, 1 month, 3 months, and 6 months post-surgery. These results provided patients with better treatment options and potentially a faster path to recovery. One case with infectious incision in the observation group and one case with intraspinal hematoma formation in the control group were observed. However, there was no statistical difference in the complication rates between the two groups (P > 0.05).ConclusionThe non-contact orthopedic robot navigation for the treatment of lumbar spondylolisthesis was demonstrated to be minimally invasive, precise, and stable surgical method. It is a treatment option worth considering for suitable patients.

Investigating Factors Associated With Stress in Guardians of Dogs Under 12 Months of Age

ABSTRACT Similar to parenting, raising a puppy can be stressful for guardians; however, this aspect of the guardian experience has received limited research attention. This study sought to fill the gap in understanding the stress experienced by puppy guardians and shed light on the factors influencing stress levels. An online survey was developed for guardians of dogs under 12 months of age and made available worldwide. A validated instrument (Parental Stress Scale) was modified to suit “parenting” of dogs and used to measure guardian stress levels. Data from 783 valid responses were received. For the statistical model, we fitted a linear regression with a modified Parental Stress Scale as the single outcome variable. A full linear model was fitted with predictors with a p-value of 0.2 or less, and a backwards stepwise selection process was used to find the ideal model, using AIC as the heuristic. Guardians who were satisfied with their puppy’s behavior, lived in Australia (compared with those living in the USA and Canada), scored higher in self-esteem, were happy with the division of puppy responsibilities in their household, and were raising puppies scoring higher in trainability were all associated with lower Parental Stress Scale scores. In contrast, first-time puppy guardians, guardians who worked from home some or all of the time, guardians raising puppies scoring higher in extraversion or neuroticism, and guardians who agreed that managing more than one dog in the household took up a lot of their time and energy, were all associated with higher Parental Stress Scale Scores. Although not initially developed for puppy guardians, the modified Parental Stress Scale shows potential as a useful measure for future use in this population.

Functional Outcome of Cast Immobilisation and Functional Treatment in Management of Lateral Ankle Sprain (Grade 1 and 2)

Background: Pain and functional constraints from ankle sprains, which mostly impact the lateral ligamentous complex, can lead to the consumption of medical facilities and unavailability from workplace. No single technique is regarded as the most effective, despite the fact that this injury occurs frequently. This study evaluates the management modalities for lateral ankle sprain i.e. functional treatment and cast immobilization with pain and function as outcome variables.  Materials and methods: Seventy patients with lateral ankle sprains (grade 1 and 2) were included in this study. Each alternate participant was placed in a functional treatment (group A), while the other participants were placed in a cast immobilization group (group B). Every patient was assessed at a follow up of 2 and 6 weeks using Visual analog scale and Karlsson score for quantifying pain and function respectively.  Results: Thirty-two patients in the functional therapy group and twenty-eight in the cast immobilization group finished the study. The functional therapy group's mean age was 27.7 years, while the cast immobilization group's was 29.4 years. While both the right and left ankles were similarly impacted in the cast immobilization group, the dominant ankle involved in the functional treatment group was the right ankle in 19 patients and the left ankle in 16 patients. In both groups, a male preponderance was seen. By the end of the study, the mean differences between the two groups' Karlsson scores and visual analog scale scores were statistically significant.  Conclusion: Our study's findings show that a functional treatment outperforms immobilization in terms of both functional outcome and pain reduction.

Undergraduate health science students’ knowledge, attitudes, practices, and perceived barriers towards research at Kuwait university: a cross-sectional study

Abstract Introduction Research is the most reliable strategy to advance scientific understanding and enhance multiple healthcare services1. Integrating undergraduate health science students into research at an early stage is an important step towards improving critical thinking and problem-based solving, which in return enhances patient health outcomes2. Aim The aim of this study was to assess undergraduate health science students’ knowledge, attitudes, practices and perceived barriers towards research at Kuwait University. Methods A cross-sectional study was conducted among undergraduate health science students from the Colleges of Pharmacy, Medicine, Allied Health, Dentistry, and Public Health at Kuwait University. A self-administered online questionnaire consisting of five sections was used. The first section included questions to assess the demographic characteristics. The second section aimed to assess the knowledge of undergraduate students regarding basic research (score = low ≤3, moderate 4-5, high &amp;gt;5). The third section assessed attitude toward research by a five-point Likert scale (score = negative 31-75, neutral 76-110, positive 111-155). The fourth section of the questionnaire aimed to assess the perception of the barriers toward research practice (score = low 0-50, moderate 51-75, high 76-100). Finally, a section with eight questions on research practices. The questionnaire was distributed through online educational and social media platforms, such as WhatsApp and Microsoft Teams. Students from any academic year and who were enrolled as health science students at the time of the study were eligible to participate. The questionnaire was pilot tested prior to distribution. The recommended sample size was calculated using Raosoft (344 students)3. Ethical approval was received from The Health Sciences Ethical Committee, Kuwait University (reference: VDR/EC-393). Results A total of 364 undergraduate medicine, dentistry, pharmacy, allied health and public health students participated in the study. The participants were from different academic stages, ranging from first-year to seventh-year. The results showed that the students possessed moderate knowledge levels, with a median of 3 out of 8 according to the scoring system of the study. Most students had neutral attitudes (N=253; 69.5%) and moderate levels of perceived barriers (N=200; 54.9%). Medical and pharmacy students had significantly higher knowledge levels compared to the others (p&amp;lt;0.001; Kruskal-Wallis). The majority of students agreed that the lack of time is a barrier towards conducting research (N=237; 65.1%). Almost one half of the study participants took part in research projects (N=175; 48.1%) and a promising number of students had publications or poster presentations (N=67; 18.4%). Discussion/Conclusion The results suggest that undergraduate health science students at Kuwait University possess moderate research knowledge and have neutral attitudes towards research. Time constraints were the most frequently reported barrier to participation. While nearly half of the students participated in research projects, implementing mandatory research projects and providing research methodology workshops could significantly enhance student knowledge, attitudes, and future research engagement. A key limitation in this study is that observed relationships may not reflect long-term shifts in knowledge, attitudes, or practices. The study was also conducted in one university (Kuwait University), therefore the findings and results cannot be generalized to other undergraduate students.

Nice knots assistance in comminuted and displaced clavicle fractures reduce intraoperative blood and shorten operation time with a satisfactory postoperative clinical outcome

BackgroundThis study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures.MethodsA systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated.ResultsScreening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment.ConclusionThis study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

Transoral Atlantoaxial Reduction Plate (TARP) Technique for the Treatment of Irreducible Atlantoaxial Dislocation (IAAD) Caused by Old Odontoid Fracture

Study Design Retrospective case series study. Objectives This study aimed to evaluate the clinical efficacy of TARP technique for treating IAAD caused by old odontoid fracture and assess the outcomes of patients who underwent TARP technique over 2 years of follow-up. Methods Between January 2005 and September 2017, 56 patients with IAAD caused by old odontoid fractures were treated with TARP technique. Patients’ clinical, radiological, and surgical data were retrospectively analyzed. Radiological parameters included the atlantodental interval (ADI) and the space available for the spinal cord (SAC) were measured. Occipitocervical pain levels and neurologic status were evaluated with Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score respectively. Degree of cervical dysfunction was assessed by Neck Disability Index (NDI). Fusion status was evaluated by images during the follow-ups. Results Surgeries for 56 cases were performed successfully with no injury to the spinal cord, nerve, or blood vessels. All patients achieved satisfactory reduction and fixation. Clinical symptomatic relief was obtained in all cases (100%). Patients were followed up for an average of 33.9 ± 9.6 months (ranged 24-60 months). Improvements in the postoperative ADI, SAC, VAS, JOA score and NDI were significant ( P &lt; .05). Besides, Bone fusion was observed in all patients. No hardware failure or re-dislocation occurred during the follow-up period. Conclusions TARP technique is an effective procedure for the treatment of IAAD caused by old odontoid fracture, which can achieve complete release, satisfactory decompression, reduction and fixation, and reliable bone fusion through a single transoral approach.

Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study

Background Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |ρ|&gt;0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25≤|ρ|&lt;0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25≤|ρ|&lt;0.5) or were not correlated (|ρ|&lt;0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5&lt;|ρ|≤0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|ρ|&gt;0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials.

Thyroid hormones and prognosis in adults with status epilepticus: a retrospective study

ObjectivesThyroid hormone levels have been indicated to be associated with the functional outcome in critical illness. However, the studies on thyroid hormones and status epilepticus (SE) are rare. This study aimed to evaluate the predictive value of serum thyroid hormone levels on admission for unfavorable outcome in adult patients with SE.MethodsWe investigated and validated the predictive value of serum thyroid hormone levels on admission for the prognosis of adult SE patients. We extracted the clinical information and outcomes of patients. Modified Rankin scale (mRS) scores were applied to assess the patients’ functional outcome, and mortality at 30 days after SE onset was identified. Serum levels of thyroid hormones including free thyroxin (FT4), free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) were detected on admission.ResultsWe first analyzed the discovery cohort of 87 patients with SE. We found that 35.6% (31/87) of the patients had a poor outcome at discharge, and 18.4% (16/87) of the patients died during hospital stay and at 30-day follow up. The serum FT3 levels in the non-survivors group were significantly lower than those in the survivors group. Low T3 syndrome occurred in 29.9% (26/87) of SE cases and patients with low T3 syndrome were more likely to have unfavorable outcomes. Furthermore, we observed similar results in the external cohort, which validated our findings.ConclusionsSerum FT3 levels measured on admission are independently associated with 30-day mortality in SE patients. Additionally, low T3 syndrome may be a promising candidate for predicting SE prognosis.

Comparative analysis of risk factors and clinical outcomes in young patients with acute ischemic and hemorrhagic stroke

BackgroundStroke is a leading cause of death and disability worldwide and has significant socioeconomic impacts, particularly among young adults. This study focused on young adults (18–55 years) who experienced acute ischemic (AIS) or hemorrhagic stroke (HS) in Zanjan, Iran.MethodsA retrospective registry-based analysis was conducted using data from the Vali-e-Asr Hospital Stroke Center. A total of 5345 stroke patients were recorded between March 2016 and June 2023, and 616 young stroke survivors were included. Baseline demographic data, stroke risk factor data, functional status (modified Rankin scale (mRS) score, stroke severity (NIHSS score), treatment history, and mortality were analyzed. The statistical analyses included chi-square tests, independent t tests, and logistic regression.ResultsThe cohort comprised 525 AIS (85.23%) and 91 HS (14.77%) patients. Significant differences were observed between groups in terms of atrial fibrillation incidence, antiplatelet treatment history, hypertension, previous smoking, and recent stroke history. HS patients had a higher baseline NIHSS score (12.90 ± 6.04 vs. 7.69 ± 8.56, p < 0.05). In-hospital and three-month mortality rates were significantly greater in the HS group. Factors significantly associated with in-hospital mortality included hemorrhagic stroke, female sex, higher NIHSS score, and current smoking status. Lower odds of achieving excellent functional outcomes and functional independence at three months were noted for HS patients, influenced by NIHSS scores and prior health conditions.ConclusionYoung stroke patients, particularly those with hemorrhagic stroke, have higher mortality and poorer outcomes. The key risk factors included stroke type, NIHSS score, smoking status, and sex. Identifying and managing these factors could improve patient outcomes.

The intervention effect of psychological care combined with ondansetron, dexamethasone, and promethazine hydrochloride on chemotherapy in breast cancer surgical patients

BACKGROUND: Breast cancer (BC) is one of the most common malignancies in women and imposes a significant health burden globally. According to data from the World Health Organization, the incidence of BC has been increasing steadily over the years. It has become one of the leading causes of cancer-related death among women worldwide. OBJECTIVE: This work was to evaluate the combined intervention effect of psychological care along with the use of ondansetron, dexamethasone, and promethazine hydrochloride in breast cancer (BC) patients undergoing chemotherapy, including their impact on nausea and vomiting control, quality of life (QoL), and psychological status. METHODS: 64 BC patients undergoing chemotherapy were collected and randomly rolled into a control group (Group C) and an intervention group (Group I). Group C received ondansetron combined with routine psychological support and counseling therapy, while Group I received a combination of ondansetron, dexamethasone, promethazine hydrochloride, and psychological care therapy. Self-assessment scores for anxiety, QoL ratings, white blood cell counts, and incidence of adverse reactions were assessed and compared between the two groups. RESULTS: Group I showed better control of nausea and vomiting versus Group C (P&lt; 0.05). Marked improvements were also observed in the self-rating anxiety scale (SAS) scores, white blood cell counts, and nursing satisfaction in Group I versus Group C (P&lt; 0.05). Nevertheless, the two groups had no significant difference regarding QoL scores (P&gt; 0.05). CONCLUSION: the combination of psychological care with ondansetron, dexamethasone, and promethazine hydrochloride effectively controls nausea and vomiting symptoms in BC patients undergoing chemotherapy and provides higher levels of clinical nursing satisfaction.

Efficacy of Nebulized Dexmedetomidine and Lignocaine Inhalation versus Lignocaine Alone as Premedication for Flexible Fiber-optic Bronchoscopy under Sedation: A Randomized Comparative Study

Abstract Introduction: Airway management is an integral part of general anesthesia, allowing ventilation and oxygenation and working as a mode for delivering anesthetic gases. Awake fiber-optic-guided intubation is an essential component of airway management in difficult cases. We aim to study the benefits of nebulized dexmedetomidine with lignocaine over lignocaine alone for anesthetizing the airway for flexible fiber-optic bronchoscopy. Materials and Methods: In the study, after written informed consent, 50 patients were randomly allocated into two equal groups of 25 each. The intervention group received dexmedetomidine with lignocaine nebulization, while the control group received lignocaine nebulization alone. Baseline pulse rate, blood pressure, and, at regular intervals, cough, sedation, and pain scores were recorded along with the patient satisfaction score. Parametric data were analyzed by the Student’s t-test, while nonparametric data were analyzed by the Wilcoxon Mann–Whitney U test. Results: Out of a total of 54 patients, 4 patients did not give consent to participate in the study. The demographic profile was comparable in both groups. The pulse rate was comparable in both groups throughout the procedure; however, 10 min after the procedure, the pulse rate in the lignocaine group was (mean ± standard deviation) 114.2 ± 11.52, while in the intervention group, it was 87.32 ± 7.24 with a P = 0.027. The mean blood pressure was comparable throughout the procedure. The cough score yielded a Z-score of −5.12 and a P &lt; 0.00001 favoring the dexmedetomidine group. Similarly, Richmond agitation-sedation score and Visual Analog Scale (VAS) also favored the intervention group, with P &lt; 0.00054 and P &lt; 0.00001 in RASS and VAS, respectively. Patient satisfaction score analysis found a Z-score of −5.29 and a P &lt; 0.00001. Conclusion: The overall results favored dexmedetomidine with lignocaine nebulization over lignocaine alone for anesthetizing airways for flexible fiber-optic bronchoscopy.

Efficacy and safety of sequential treatment with botulinum toxin type A, fractional CO2 laser, and topical growth factor for hypertrophic scar management: a retrospective analysis

Hypertrophic scars arise from aberrant wound healing and can lead to functional and aesthetic impairments. One of the common interventions for treating hypertrophic scars is fractional carbon dioxide (CO2) laser, which employs narrow laser beams to stimulate dermal collagen deposition. Recent studies and reports have suggested that combining laser therapy with other interventions such as botulinum toxin type A (BTX-A) and topical growth factors may enhance treatment outcomes. Here, we examine the efficacy and safety of a sequential combination of BTX-A, fractional CO2 laser, and topical growth factors, referred to as combined therapy, for treating hypertrophic scars compared with only using fractional CO2 laser and topical growth factors, referred to as monotherapy. Our retrospective study includes 128 patients with hypertrophic scars (56 underwent monotherapy and 72 underwent combined therapy), which were followed-up for up to 15 months after the initiation of treatment to collect demographic and clinical data. Our analysis showed that the combined therapy significantly outperformed monotherapy in improving Vancouver scar scale scores (P < 0.05) and in the reduction of scar thickness (P < 0.05), without increasing adverse complications. Repeated treatments further augmented the efficacy of the combined therapy. Subgroup analysis revealed that combined therapy was notably more effective in reducing Vancouver scar scale scores and scar thickness in early-stage scars compared to late-stage (P = 0.023 and P = 0.045, respectively). Our study suggests that including BTX-A treatment before fractional CO2 laser and topical growth factors offers superior efficacy in reducing hypertrophic scars. We encourage early intervention and repeated treatments for optimal treatment outcomes.

Brain functional alternation in patients with systemic sclerosis: a resting-state functional magnetic resonance imaging study

BackgroundNeuropsychiatric manifestations, such as cognitive impairment, are relatively prevalent in systemic sclerosis (SSc) patients. This study aimed to investigate the resting state (RS) functional alternations of SSc patients and the potential influenced factors.MethodsForty-four SSc patients (mean age, 46.3 ± 11.4 years; 40 females) and 19 age and sex comparable healthy volunteers (mean age, 42.6 ± 11.3 years; 16 females) were recruited and underwent RS functional MR imaging (fMRI) and neuropsychological assessments. Functional segregation analysis was performed to calculate the amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo). Functional integration analysis was conducted using group independent component analysis to calculate intra-network and inter-network functional connectivity (FC). The fMRI measurements were compared between SSc patients and healthy volunteers using voxel-based pairwise two-sample t-tests. The correlations between clinical characteristics and fMRI measurements were also analyzed.ResultsCompared to healthy volunteers, SSc patients exhibited significantly decreased ALFF and increased ReHo (all P < 0.01, FWE corrected). SSc patients predominantly showed decreased intra-network and inter-network FC in the auditory network, visual network, default mode network, frontoparietal network and attention network (intra-network FC: P < 0.01, uncorrected, cluster size > 30; inter-network FC: P < 0.05, FDR correction). Furthermore, clinical characteristics including disease duration (r value ranged from − 0.31 to 0.36), elevated erythrocyte sedimentation rate (r = 0.35), Montreal Cognitive Assessment score (r = 0.43), and Hamilton Depression Scale score (r = -0.40) were significantly associated with fMRI measurements (all P < 0.05).ConclusionsSpontaneous activity and functional connectivity alternations can be seen in SSc patients, which are partially associated with neuropsychiatric manifestations and tend to aggravate with disease duration.

Improving Pain Assessment After Inpatient Orthopedic Surgery: A Comparison of Two Scales

ABSTRACT Purpose: In pain assessment, the commonly used Numeric Rating Scale (NRS) offers an incremental 0-to-10 range of response options. But this broad range often leads to discordant evaluations between nurses and their patients. This study aimed to compare the NRS to the three-category Interventional Pain Assessment (IPA) scale, validate the IPA scale in an inpatient setting, and determine RN and patient scale preferences. Methods: This prospective study enrolled 122 postoperative orthopedic patients and their designated 104 RNs at a level 1 trauma center in the midwestern United States. Patients were asked to verbally rate their pain from 0 to 10 using the NRS and from 0 to 2 on the IPA scale. Patients were also asked which scale best conveyed their pain. The RNs were asked which scale best informed them of their patient's pain situation and which scale they preferred. To establish a correlation between the two scales, we considered NRS values of 0 to 7 (signifying no pain to moderate pain) to correspond to IPA scale values of 0 to 1 (signifying no pain to tolerable pain). NRS values of 8 to 10 (signifying severe pain) were considered to correspond to IPA scale values of 2 (signifying intolerable pain). Responses in which patients reported IPA scores indicating no pain to tolerable pain but NRS scores above 7 or IPA scale scores indicating intolerable pain but NRS scores of 7 or below were defined as discordant answers. Results: Data analysis revealed a strong significant correlation between the NRS and IPA scale (τ = 0.597), with an 82.7% concordance rate. Once an NRS score rose above 7, more discordance between the two scales became increasingly prevalent, as evidenced by the 45% of patients who also reported tolerable pain on the IPA scale. Significantly more patients (89.3%) preferred the IPA scale to communicate their pain level than the NRS (10.7%). Significantly more RNs (76%) felt the IPA scale best informed them of their patient's pain and was a better guide for treatment than felt the NRS did so (24%). Conclusions: The IPA scale asks about pain tolerability and thus has a direct role in the management of pain medications. Both patients and nurses felt they were better able to convey and understand pain when using the IPA scale than when using the NRS. There was consensus regarding pain scale preference among patients and their RNs, with both groups preferring the IPA scale due to its simplicity and, among the RNs, its usefulness in guiding treatment. The IPA scale may be a much better tool for accurately assessing a patient's pain experience and needs, with the potential to change practice and improve pain management.

Evaluating the impact of rock climbing on mental health and emotional well-being in adolescents

BackgroundRock climbing (RC) has gained attention as a therapeutic tool in psychiatric settings that merges physical exertion with mental engagement. It has potential to enhance mental health, through improved self-efficacy and social interaction, making it a novel intervention for addressing anxiety, depression, and behavioral issues in adolescents. This study aimed to investigate the effects of RC as a physical activity on anxiety, depression, and emotional and behavioral problems in adolescents.MethodsThe current study included 57 athletes aged 14.5 ± 1.7 years and 91 adolescents aged 13.6 ± 1.2 years, matched for age and gender, who were not professionally involved in sport. In addition to the socio-demographic form, a detailed psychiatric assessment was carried out by the child psychiatrist; using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (K-SADS-PL) to detect psychiatric conditions. The Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) and the Strengths and Difficulties Questionnaire (SDQ) were also administered to the adolescents in the study.ResultsIn the comparative analysis of the RCADS-CV outcomes between the athlete and control groups, the athletes demonstrated notably lower scores for both Separation Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD), yielding p-values of &amp;lt; 0.001 and 0.031, respectively. Although the mean scores for social phobia, OCD, panic disorder, and MDD were lower in the athlete group, the differences were not statistically significant (p &amp;gt; 0.05). In the correlation analysis, a moderately significant correlation was found between the duration of doing sport and the scale scores for SAD (p:0.010), OCD (p:0.014), and panic disorder (p:0.016). There was no significant difference between groups in terms of SDQ scores.ConclusionThese results suggest that RC, through its unique combination of physical exertion and mental focus, may offer protective benefits against certain anxiety disorders among adolescents. Further studies should be conducted to explore the potential use of RC as a preventive program for both healthy adolescents, as well as those with psychiatric disorder.

Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes

OBJECTIVES: Septic shock is a common condition necessitating timely management including hemodynamic support with vasopressors. Despite the high prevalence and mortality, there is limited data characterizing patients who require three or more vasopressors. We sought to define the demographics, outcomes, and prognostic determinants associated with septic shock requiring three or more vasopressors. DESIGN: This is a multicenter retrospective cohort of two ICU databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic ICU-Clinical Research Database, which include over 400,000 patients admitted to 342 ICUs. PATIENTS: Inclusion criteria entailed patients who were: 1) age 18 years old and older, 2) admitted to any ICU, 3) administered at least three vasopressors for at least 2 hours at any time during their ICU stay, and 4) identified to have sepsis based on the Sepsis-3 criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 3447 patients met inclusion criteria. The median age was 67 years, 60.5% were male, and 96.6% had full code orders at the time of the third vasopressor initiation. Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. Code status changes occurred in 23.9% of patients following initiation of a third vasopressor. Elevated lactate upon ICU admission (odds ratio [95% CI], 2.79 [2.73–2.85]), increased duration of time between ICU admission and third vasopressor initiation (1.78 [1.69–1.87]), increased serum creatinine (1.61 [1.59–1.62]), and age above 60 years (1.47 [1.41–1.54]) were independently associated with an increased risk of mortality based on analysis of the MIMIC-IV database. Non-White race and Richmond Agitation-Sedation Scale scores were not associated with mortality. CONCLUSIONS: Septic shock requiring three vasopressors is associated with exceptionally high mortality. Knowledge of patients at highest risk of mortality in this population may inform management and expectations conveyed in shared decision-making.

Effect of ultrasound-guided internal branch of superior laryngeal nerve block on postoperative sore throat induced by a NIM-EMG-ETT: study protocol for a double-blinded randomized controlled trial

BackgroundPostoperative sore throat (POST) is a common complaint after general anaesthesia. The prevalence of POST caused by a neural integrity monitor electromyography endotracheal tube (NIM-EMG-ETT) is high. This study aimed to determine whether ultrasound-guided internal branch of superior laryngeal nerve block (iSLNB) could alleviate POST associated with a NIM-EMG-ETT.MethodsThis randomized controlled trial plans to enroll 182 patients scheduled to undergo general anaesthesia with a NIM-EMG-ETT. Patients will be randomly allocated into the iSLNB group or the control group according to randomized numbers generated by Excel. After induction, patients in the iSLNB group will undergo ultrasound-guided iSLNB with ropivacaine, and patients in the control group will undergo the same procedure with normal saline. The prevalence, severity, visual analogue scale score of POST, and postoperative acoustic analysis will be recorded.DiscussionTo the best of our knowledge, this is the first study to evaluate the effect of ultrasound-guided iSLNB with ropivacaine on the mitigation of POST induced by NIM-EMG-ETT. Our study will provide clinical answers to alleviate POST induced by NIM-EMG-ETT. The results of this study may provide a safe method to prevent POST caused by NIM-EMG-ETT.Trial registrationChinese Clinical Trial Registry, ChiCTR2300076393. Registered on October 24, 2023, http://www.chictr.org.cn/index.aspx.

The impact of acupuncture on the brain function of patients with mild to moderate major depressive disorder: a randomized controlled trial protocol

IntroductionMajor depressive disorder (MDD) is a common mental disease that significantly impact the daily lives of those affected. Acupuncture has shown promising therapeutic effects in the treatment of MDD, but its underlying mechanisms remain unclear. This study aims to evaluate the influence of acupuncture on the brain function of patients with MDD and it’s therapeutic effects on MDD.MethodsThis study plans to recruit 112 participants, who will be randomly allocated to either the acupuncture group or the sham acupuncture group in a 1:1 ratio. Both groups will undergo 8 weeks of treatment, consisting of three sessions per week, with each session lasting for 30 min. A follow-up period of 3 months will be conducted after the treatment. Assessments will be conducted at weeks 0, 8, 12, 16, and 20 in this study. The primary outcome measure will be functional near-infrared spectroscopy (fNIRS) brain imaging, while secondary outcome measures will include Beck Depression Inventory II (BDI-II), Self-Rating Anxiety Scale (SAS), 36-Item Short Form Survey Instrument (SF-36), Traditional Chinese Medicine (TCM) syndrome score scale, and symptom elimination rate.DiscussionWhile acupuncture has been confirmed to have a certain degree of therapeutic efficacy in the treatment of MDD, research on the mechanisms underlying acupuncture’s treatment of MDD remains limited, particularly with regards to its impact on the brain function of individuals with MDD. This study aims to explore both the clinical effectiveness and treatment mechanisms of acupuncture for MDD, with a specific focus on its influence on brain function. This research endeavors to provide new insights into the potential of acupuncture as a therapeutic approach for the treatment of MDD in the future.Trial Registrationwww.chictr.org.cn, ID: ChiCTR2300076292. Registered on 28 September 2023.