Scale Score Research Articles

Impact of cognitive fatigue on balance in individuals with multiple sclerosis without cognitive impairment

ABSTRACT Purpose This study aims to examine the impact of cognitive fatigue on balance among individuals with multiple sclerosis (MS) without cognitive impairment. Method A total 50 individuals with MS aged 20–50 years, without cognitive impairment and with an Expanded Disability Status Scale (EDSS) score of 0–4, participated in the study. Participants were randomly assigned to either a control group (CG) or a study group (SG). The CG rested for 30 minutes, while the SG engaged in cognitive activities lasting 30–45 minutes to induce cognitive fatigue. Cognitive fatigue was assessed using the Visual Analog Scale (VAS) before and after the tasks. Balance was evaluated using clinical tests: the Functional Reach Test (FRT) and the Single Leg Stance Test (SLST), as well as laboratory assessments including the Modified Clinical Test of Sensory Integration and Balance (mCTSIB) and Limits of Stability (LOS) with static posturography. Results Within-group analyses showed a significant increase in cognitive fatigue on the VAS in the SG (p < 0.001). In the mCTSIB, the SG showed significant changes in firm/eyes open, foam/eyes open, and composite scores, while between-group differences were observed only in firm/eyes open and foam/eyes open conditions (p < 0.005). No significant differences were found between groups in LOS, FRT, or SLST outcomes (p > 0.05). Conclusion In individuals with MS, the impact observed only in the eyes-open static balance condition suggests that dynamic balance and eyes-closed static balance parameters rely more on automatic mechanisms compared to the eyes-open condition and are not influenced by cognitive fatigue.

Stroke-Related Factors Influencing Thrombolysis Eligibility and Outcomes.

Intravenous thrombolysis (IVT) improves outcomes of acute ischemic stroke (AIS) when timely administered. The aim of this study was to collect and analyze data of stroke-related factors which may influence the performance of stroke-related rescue chains, the use of IVT, and patients' outcomes. This study enrolled patients with AIS admitted to our Stroke Unit (SU) between January 1, 2023, and December 31, 2023. We investigated whether age, occurrence of baseline disabling deficits, stroke severity, or stroke location influenced the median Onset-to-Door Time (ODT), the chance of receiving IVT, or the outcomes of AIS in our facility. A total of 208 patients were enrolled. Patients who received IVT had higher baseline National Institute of Health Stroke Scale (NIHSS) scores (12.26±1.2) than those who did not (6.77±0.51) (P<0.0001). Patients with IVT further showed a greater strength deficit, less ataxia, and lower median ODT (108±20min) than patients with NO IVT (720±67) (P<0.0001). Weakness of the lower limbs and higher total NIHSS predicted ODT≤ 3.5 hours and the use of IVT. Ataxia and Posterior Circulation Stroke slowed the rescue chain and were negatively correlated with the use of IVT. Stroke-related factors may slow the rescue chain and affect the application of IVT for AIS. New evaluation strategies are warranted to overcome the detrimental effects of these factors and to allow clinicians to effectively manage strokes of any severity and location.

Non-inferiority study to compare the efficacy of relugolix with dienogest for endometriosis-associated pain and usefulness of administering relugolix prior to dienogest (READY study): study protocol for a multicenter randomized controlled study

BackgroundEndometriosis presents as endometrial tissue growths outside the uterine cavity with its major symptoms including dysmenorrhea and infertility. Progestin preparations, such as dienogest, are the first-line therapy for endometriosis symptoms, but may cause abnormal uterine bleeding. A gonadotropin-releasing hormone (GnRH) agonist may also be used to ease symptoms, but may induce flare-ups. Relugolix is a non-peptide GnRH antagonist that does not induce flare-ups. This study aims to compare the efficacy of relugolix with that of dienogest for reducing endometriosis-associated pain, and to evaluate if relugolix, administered prior to dienogest, decreases abnormal uterine bleeding.MethodsA multicenter, open-label, active-controlled, non-inferiority randomized study will be conducted at 11 sites in Japan. A total of 100 premenopausal patients aged ≥ 18 years with endometriosis, a maximum visual analog scale (VAS) score > 30 for endometriosis-associated pain, and dysmenorrhea or pelvic pain of at least moderate severity on the Biberoglu & Behrman (B&B) scale will be randomized in a 1:1 ratio to either a relugolix group or dienogest group. Patients in the relugolix group will receive 40 mg oral relugolix once daily for 16 weeks, followed by 1 mg oral dienogest twice daily for 24 weeks. Patients in the dienogest group will receive oral dienogest 1 mg twice daily for 24 weeks. The primary outcome will be change in maximum VAS score for endometriosis-associated pain from baseline to 13–16 weeks after start of treatment. The secondary outcomes will include VAS score for dyspareunia, B&B score for dysmenorrhea, severity of induration in the pouch of Douglas, restricted uterine mobility, pelvic tenderness, quality of life, analgesic use, and ovarian endometrioma diameter. The safety outcomes will include treatment-emergent adverse events, bone density, bone markers, menstrual status, genital bleeding, and endometrial thickness.DiscussionThis study will determine the efficacy of relugolix for improving endometriosis-associated pain and dienogest-induced abnormal uterine bleeding. The results will support treatment decisions regarding endometriosis-associated pain, and the introduction of new treatments to reduce dienogest-induced abnormal uterine bleeding.Trial registrationJapan Registry of Clinical Trials ID jRCTs061230064. Registered on 29 September 2023.

Validity and reliability of the Turkish version of the Ottawa sitting scale in patients with multiple Sclerosis.

This study aimed to examine the validity and reliability of the Turkish version of the Ottawa Sitting Scale (OSS-TR) in patients with multiple sclerosis (MS). The study included 52 patients aged 29-45 who were diagnosed with MS based on McDonald criteria. To establish construct validity, structural (with confirmatory factor analysis, CFA) and convergent validity were examined. For convergent validity, the associations between the OSS-TR score with the Trunk Impairment Scale (TIS) and Berg Balance Scale (BBS) scores were analyzed. The average variance extracted (AVE) and construct reliability (CR) were calculated to enhance the assessment of convergent validity. To assess the reliability of the OSS-TR, the scale was re-administered to all participants seven days later by the same rater, and the intraclass correlation coefficient (ICC) was computed to determine the test-retest reliability. According to the factor analysis results, the scale was found to have a single factor. CFA indicated that the model fit indices for the OSS-TR were acceptable, verifying its construct validity. Strong correlations between the OSS-TR score and BBS (r = 0.843) and TIS (r = 0.867) scores confirmed the convergent validity of the OSS-TR (p < 0.05). Furthermore, the fact that the AVE score (0.578) was greater than 0.50 and the CR score (0.905) was greater than 0.70 supported convergent validity. The OSS-TR had high test-retest reliability (ICC = 0.953) and internal consistency (Cronbach's alpha = 0.934). According to the results of the study, the OSS-TR is a reliable and valid tool for assessing sitting balance in Turkish-speaking MS patients.

Effects of TTP-PECS Block Under Opioid-Sparing General Anesthesia on Postoperative Analgesia and Early Recovery Quality in Patients Undergoing Modified Radical Mastectomy.

Potent analgesics such as sufentanil and remifentanil play a pivotal role in general anesthesia, but these medications have disadvantages, including respiratory depression, nausea, vomiting, immune system suppression, and gastrointestinal function inhibition. This study aimed to evaluate the effects of the transversus thoracic muscle plane-pectoral nerves(TTP-PECS) block on postoperative analgesia, immune function and early postoperative recovery quality inpatients undergoingmodified radical mastectomy under opioid-sparing general anesthesia. A total of 100 patients scheduled for modified radical mastectomy under general anesthesia were randomly divided into the TTP-PECS block combined with opioid-sparing general anesthesia group (TO group, n=50) or the conventional general anesthesia group (GA group, n=50). The TO group underwent TTP-PECS block prior to induction, using oxycodone as the analgesic during induction instead of sufentanil, no additional continuous infusion of analgesic was performed intra-operatively. Visual analogue scale (VAS) scores at rest and during movement at different time points were recorded in both groups, and the levels of T cell subsets, natural killer (NK) cells were measured before the surgery and at 24h and 48h after the surgery. Quality of Recovery-40 (QoR-40) scores were assessed at 24h postoperatively, and the incidence of peri-operative adverse reactions was also observed in both groups. Except for 48h postoperatively, patients in the TO group had significantly lower VAS scores than those in the GA group at 2h, 6h, 12h, and 24h postoperatively at rest and during movement (P<0.05). At 24h and 48h postoperatively, the expression of CD4+ T cells and the CD4+/CD8+ ratio were significantly higher in the TO group than in the GA group (P<0.05). The QoR-40 scale, assessed at 24h postoperatively, showed that the TO group significantly outperformed the GA group in total scores as well as in sub-scores for emotional state, physical comfort, physical independence, psychological support, and pain (P<0.05). In addition, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were lower at time points T1-T4 than at T0 in both groups (P<0.05), but the differences between the two groups were not statistically significant(P>0.05). The incidence of cough reflex during induction and postoperative nausea and vomiting were significantly lower in the TO group than in the GA group (P<0.05). There was no statistically significant difference between the two groups in the incidence of other adverse reactions (P>0.05). The combination of TTP-PECS block and oxycodone-propofol opioid-sparing general anesthesia can provide superior postoperative analgesia and reduce the incidence of postoperative nausea and vomiting. It also alleviated the suppression of cellular immune function and improves the quality of early recovery in breast cancer patients. At the same time, opioid-sparing general anesthesia is a safe strategy for modified radical mastectomy. Chinese Clinical Trial Registry; ChiCTR2200066753.

Association of motoric cognitive risk syndrome and high C-reactive protein serum levels with incident major neurocognitive disorder: Results from the Quebec NuAge cohort

Abstract Both motoric cognitive risk syndrome (MCR) and C-reactive protein (CRP) serum levels have been separately associated with increased risk of incident major neurocognitive disorder. The study aims to compare the CRP serum levels of older adults with and without MCR, and to examine the associations of MCR, CRP serum levels and their combination with incident major neurocognitive disorder. 915 individuals participating in an older adults population-based observational cohort study with a 3-year follow-up design, were selected. MCR and CRP serum levels were collected at baseline. Incident major neurocognitive disorder was measured at annual follow-up visits using the modified mini-mental state (≤79/100) and simplified instrumental activity daily living scale (&amp;lt;4/4) score values. The prevalence of MCR at baseline assessment was 3.7%. The overall incidence of major neurocognitive disorder was 3.0%. MCR alone (Hazard Ratio (HR)=28.09 with 95% Confidence Interval (CI=[7.00;112.72] and P≤0.001) and MCR with a high CRP serum level (HR=6.33, with 95% CI[1.45;27.62] and P=0.014) were significantly associated with incident major neurocognitive disorder. MCR is a significant risk factor for predicting major neurocognitive disorder in older adults, while serum CRP levels are not. In addition, serum CRP levels reduce the predictive strength of MCR for major neurocognitive disorder.

Stress shielding influences shoulder function after reverse shoulder arthroplasty using a short stem at minimum 2 years follow-up and can be predicted using a preoperative planning software: A retrospective cohort study

Background The aim of the study was to assess if 3D CT-scan-based planification of distal filling ratio (DFR) is accurate when compared to postoperative DFR calculated on plain X-rays. A secondary aim was to investigate if an association between clinical outcomes and the degree of stress shielding (SS) exists. Methods Fifty patients with short-stem reverse shoulder arthroplasties, preoperative CT scans, and a minimum 24-month radiographic follow-up were included in the study. At 24 months follow-up, all patients were evaluated by assessing the postoperative filling ratios, the 3D DFRs, the simple shoulder test, Constant-Murley score, and visual analogue scale through a prospectively data collection and statistically analyzed. Results A correlation between the 3D DFR and SS onset (rs 0.54; P &lt; 0.001), and between postoperative DFR and SS (rs 0.71; P &lt; 0.001), was found. The 3D DFR and the postoperative DFR were correlated (rs 0.89; P &lt; 0.0001). SS negatively affects the postoperative range of motion, decreasing the forward elevation of the shoulder. Conclusion The calculation of DFR based on 3D CT planning is a good predictor of humeral SS after short-stem RTAs. The presence of SS decreases clinical outcomes by lowering the anterior elevation of the shoulder. Level of evidence Case series.

The association between the circadian misalignment of serum cortisol acrophase and sleep end time with chemotherapy-induced peripheral neuropathy

ABSTRACT Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of chemotherapy. The objective of this prospective observational study was to examine the association between circadian misalignment (CM), as measured by phase angle difference (PAD) of biological and behavioral rhythms and CIPN. The PAD of cortisol acrophase and actigraphy-based sleep end time in breast cancer patients was measured and categorized into low PAD (n = 11) and high PAD (n = 12) groups based on median value. CIPN was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN20 (CIPN20). The assessment of CM revealed that the sleep end time of the low PAD group was more delayed in relation to cortisol acrophase compared to the high PAD group. The low PAD group demonstrated significantly higher CIPN20 global and sensory scale scores compared to the high-PAD group at one month post-chemotherapy, with an estimated group difference of 17.63 ± 4.75 and 27.07 ± 6.70 (p = 0.001 and p < 0.001, respectively). The present findings indicate that the low PAD group, which exhibited a relatively delayed behavioral rhythm with respect to its biological rhythm, displayed an increased susceptibility to CIPN. Further large-sample research is necessary to attain a comprehensive understanding of the mechanisms through which CM affects CIPN.

Development and Psychometric Evaluation of the Swallowing Satisfaction Scale (SSS).

The purpose of the current study was to develop a new scale to assess a level of satisfaction associated directly with swallowing ability. First, by interviewing 10 adults with dysphagia, 10 experts, as well as reviewing literature, the initial version of the swallowing satisfaction scale (SSS) was developed. The content validity of the SSS was evaluated using two qualitative and quantitative methods and expert opinions. The qualitative method was also used to determine face validity through interviews with 10 adults with dysphagia. Finally, the reliability of the scale was assessed by determining the values of internal consistency and test-retest reliability. Interviews with patients with swallowing disorders and experts in the field of dysphagia, as well as a literature review, led to the development of an initial version of the SSS with 36 items. After determining content and face validity, the number of items in the scale was reduced to 24. The calculation of Cronbach's alpha coefficient with participation of 53 patients with dysphagia showed the appropriate internal consistency of the SSS (0.968). Moreover, the ICC coefficient of the scale score in the test-retest phase was 0.983 and the ICC of each scale item was between 0.87 and 0.98. In this study, a suitable tool was developed to evaluate the level of satisfaction associated directly with swallowing ability in individuals with dysphagia, and its psychometric properties were investigated. The SSS is a valid and reliable tool with 24 items that can be used by therapists and researchers for clinical or research purposes.

Remote Site Delayed Extradural Hematoma Secondary to Decompressive Craniectomy for Traumatic Brain Injury: Incidence, Predictors, Characteristics, and Outcomes

Objective: Remote site delayed extradural hematoma (RDEDH) is an uncommon but serious complication that can occur after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). This study aims to clarify the incidence, predictors, clinical and radiological characteristics, and outcomes of RDEDH to improve the authors' understanding and management of this complication. Methods: This study identified 36 patients with TBI who developed RDEDH after DC. The incidence, predictors, clinical and radiological characteristics, and outcomes were analyzed retrospectively. Continuous variables were compared using the student t test, whereas categorical variables were assessed using the χ2 test. Variables with a P value of &lt;0.05 in univariable analysis were included in the multivariable logistic regression analysis. Results: The incidence of RDEDH after DC was 14.6%. Preoperative pupillary dilation [bilaterally; odds ratio (OR): 8.797; 95% CI: 1.969–39.297; P = 0.004], intraoperative acute brain swelling (OR: 33.696; 95% CI: 5.073–227.005; P &lt; 0.001), and pupillary abnormalities after DC (OR: 8.141; 95% CI: 2.117–31.307; P = 0.002) were identified as independent risk factors for the development of RDEDH after DC. The average length of hospitalization in the RDEDH group was significantly longer than that in the non-RDEDH group (P = 0.018). The Glasgow Outcome Scale score at 6 months in the RDEDH group was significantly lower than that in the non-RDEDH group (P = 0.01). The incidence of poor prognosis in the RDEDH group (80.6%) was significantly higher than that in the non-RDEDH group (59.8%; P = 0.017). Conclusion: Preoperative bilateral pupillary dilation, intraoperative brain swelling, and pupillary abnormalities after surgery were independent risk factors for the development of RDEDH after DC in patients with TBI. The occurrence of RDEDH in patients with TBI after DC did not significantly increase mortality, it was associated with a prolonged length of stay and an increased incidence of poor prognosis.

Safety and Efficacy of Neuroprotective Agents as Adjunctive Therapies for Reperfusion in the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

There is still no clear evidence of the efficacy of the application of neuroprotective agents (NPAs) for acute ischemic stroke (AIS) patients receiving reperfusion therapies. This meta-analysis aimed to determine the effects of NPAs versus placebo on functional and safety outcomes as an adjunctive treatment to intravenous thrombolysis (IVT) or endovascular therapy (EVT) in AIS patients. The primary outcome was neurological functional independence, as evaluated by the proportion of patients whose modified Rankin Scale scores were 0 to 2 at 90 days after treatment. Thirteen randomized controlled trials with a total of 3736 patients were included. The application of NPAs was associated with greater odds of functional independence (odds ratio [OR]: 1.28; 95% CI: 1.12 to 1.46; P < 0.001; I2 = 0.0%) within 90 days. However, subgroup analysis of reperfusion therapy type (IVT, EVT, or both) revealed that only the EVT subgroup showed a significant association between NPAs or placebo and functional independence at 90 days (EVT group, OR: 1.43; 95% CI: 1.05 to 1.94; P = 0.022; I2 = 0.0%; IVT group, OR: 1.51; 95% CI: 0.93 to 2.46; P = 0.099; I2 = 39.8%; IVT plus EVT group, OR: 1.17; 95% CI: 0.94 to 1.45; P = 0.157; I2 = 16.0%). This meta-analysis revealed that NPAs could increase the possibility of AIS patients undergoing reperfusion therapies achieving functional independence within 90 days of onset; however, with the limited number of studies on each drug, further evidence is still needed to demonstrate the efficacy of each individual agent as an adjunctive therapy for different means of reperfusion.

Factors influencing the quality of life and social skills of children living with HIV: A case-control study.

Our objective was to understand the current status of and factors influencing the quality of life and social skills of children living with HIV and to provide a reference for improving medical service management and formulating support policies. A total of 183 children aged 7-14 years, living with HIV, and admitted to the Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention from March 2022 to February 2024 were included retrospectively. We used the children's basic information and their scores from the Quality of Life Scale for Children and Adolescents (QLSCA) and Normal Development of Social Skills From Infant to Junior High School Children (S-M scale) to explore their the status of their quality of life and social skills and the factors influencing both. Four factors (life satisfaction, socio-psychological functioning, physical and mental health, and living environment) and QLSCA T-scores in the case group were significantly lower than those in the control group (p < 0.01). S-M scale scores (self-help, locomotion, operation, communication, socialization, self-direction) in the case group were significantly lower than those in the control group (p < 0.001). The main factors affecting the social skills of children living with HIV were side effects from antiretroviral therapy (odds ratio [OR] 7.365, p < 0.003), comorbidities (OR 12.948, p < 0.006), intellectual development (OR 6.045, p < 0.027), and awareness of HIV infection status (OR 0.261, p < 0.014). Children living with HIV have low quality of life and poor social skills. Clinicians should pay attention to side effects from antiretroviral therapy, comorbidities, children's intellectual development, and their awareness of their HIV infection status.

Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure-Pediatric Insulin Titration Trial.

To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure-Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941). Non-prespecified post hoc analysis. Thirty-one PICUs in the United States, and one in Canada. Non-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission. Patients were randomized to insulin infusion to target lower-BG (80-110 mg/dL; 4.4-6.1 mmol/L) or higher-BG (150-180 mg/dL; 8.3-10 mmol/L). Primary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups (p = 0.47). In this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.

A randomized controlled trial to compare the effect of oxycodone and sufentanil on postoperative analgesia and immune function for laparoscopic resection of colorectal cancer

BackgroundThe purpose of this study is to evaluate the effect of oxycodone and sufentanil on postoperative analgesia and immune function in patients with laparoscopic resection of colorectal cancer (CRC), as well as the serum level of inflammatory cytokine.Methods40 patients from August 2023 to August 2024 in Shenzhen Nanshan Hospital undergoing laparoscopic resection of CRC were randomly divided into Group O (n = 20) and Group S (n = 20). The visual analog scale (VAS) score and serial blood samples were assessed during perioperative period. The primary outcomes were VAS scores and immune indicators (including IL-2, C3, C4, IgG, IgA, IgE, IgM, CD3+, CD4+, CD8+ and CD4+/CD8+) at 24 h and 72 h post-surgery at 24 h and 72 h after surgery. The secondary outcomes were inflammatory markers (including IL-4, IL-6, IL-10, TNF-a and INF-y) at 24 h and 72 h after surgery.ResultsThe VAS scores at cough in Group O at 24 h and 72 h postoperative were lower than those in Group S (p < 0.001). No significant difference was found in VAS scores at rest between the two groups (P > 0.05). The immune indicators did not show significant changes after using oxycodone or sufentanil for patient-controlled intravenous analgesia (PCIA), respectively. There was no significant difference in inflammatory factors at 24 h and 72 h after surgery between the Group O and Group S.ConclusionOxycodone is more effective than sufentanil in alleviating visceral pain, although it does not surpass sufentanil in managing cutting pain. In addition, there is no significant superiority in the effects of oxycodone on immune function and inflammatory cytokine release compared to sufentanil.Trial registrationChinese Clinical Trial Registry (ChiCTR2400089072).

Predictors of prognosis in stroke patients with tandem lesions who undergo emergent stenting.

The optimal endovascular approach for tandem lesions (extracranial internal carotid artery and intracranial large vessel occlusion) is not clear. Aims: The aim was to evaluate the follow-up results of stroke patients with tandem lesions who underwent emergent stenting of extracranial lesions with antithrombotic therapy combined with intracranial MT. Outcomes and predictors of poor prognosis and mortality compared with those of good prognosis at 90days, 1year, and 2years were assessed. A modified Rankin scale (mRS) score was used. Symptomatic intracranial hemorrhage (sICH), National Institutes of Health Stroke Scale (NIHSS) scores at admission and at 24h, successful recanalization, asymptomatic ICH, embolization, malignant infarction, decompression, in-stent restenosis and extracranial complications were also evaluated. The best age cutoff for predicting mortality was analyzed. A total of 71 subjects were included. Using patients with a good prognosis as a reference, the independent variables predicting a poor prognosis were a high 24-h NIHSS score and extracranial complications at all timepoints (3-month, 1-year, and 2-year follow-up). The most appropriate age cutoff for predicting 1-year mortality was 67years [AUC = 0.802 (95% CI = 0.684-0.920); p < .001]. The age cutoff determined for the first year was correlated with the prediction of mortality in the third month and the second year. No significant association was observed between sICH and the groups. In this study, the 24-h NIHSS score after reperfusion and age were predictors of poor prognosis and mortality in stroke patients with tandem lesions who underwent emergent stenting during thrombectomy.

Cognitive Processing Therapy for Posttraumatic Stress Disorder in Japan: A Randomized Clinical Trial.

Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD). However, there is little evidence on the efficacy of CPT in East Asia. To evaluate whether CPT is effective in treating PTSD among outpatients in a Japanese medical setting. This randomized clinical trial used a 16-week, single-center, assessor-blinded, parallel-group superiority design to examine the efficacy of CPT in conjunction with treatment as usual (CPT-TAU) vs waiting list with TAU (WL-TAU) from April 2016 through December 2022. The trial included adult patients with PTSD at a national psychiatric referral hospital in Tokyo, Japan. Analysis was based on intention to treat and per protocol and was performed from February 1 to April 30, 2024. Participants were randomized 1:1 to CPT-TAU (n = 29), which consisted of 12 weekly individual CPT sessions, or WL-TAU (n = 31), which consisted of clinical monitoring and/or pharmacotherapy. The primary outcome was the Clinician-Administered PTSD Scale (CAPS-5) score for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) at 17 weeks. Secondary outcomes included self-reported PTSD symptoms assessed by the PTSD Checklist-5 and responder status at 17 weeks. Adverse events were evaluated using the Japanese version of the Common Terminology Criteria for Adverse Events, version 4.0. Among 60 eligible participants (all included in the intention-to-treat analysis), mean (SD) age was 36.9 (9.9) years; 54 (90.0%) were women. The CPT-TAU group showed a mean (SE) reduction in CAPS-5 scores of 14.00 (1.92) points, with a low dropout rate (2 of 29 [6.9%]). Patients in the CPT-TAU group showed superiority in all secondary and other outcomes. The mean change difference was observed in depression (8.83; 95% CI, 6.00-11.66), suicidal ideation (6.73; 95% CI, 1.25-12.22), disability (8.16; 95% CI, 3.90-12.43), clinical global impression (0.84; 95% CI, 0.41-1.26), and loss of principal PTSD diagnosis (59.09; 95% CI, 37.19-81.00). There were no serious adverse events in the CPT-TAU group and 3 serious adverse events in the WL-TAU group during the intervention period. In this randomized clinical trial of CPT-TAU vs WL-TAU, CPT was superior in reducing PTSD symptoms. These results strengthen the evidence for use of CPT in East Asian populations. Umin.Uc.Jp/Ctr Identifier: UMIN000021670.

Early Results of All-Dorsal Arthroscopic Scapholunate Ligamentoplasty

Abstract Introduction We report early outcomes of all-dorsal arthroscopic scapholunate ligamentoplasty (ADAL) in 12 patients. Materials and Methods Dorsal internal brace and capsulodesis were performed in all patients. In half of the patients, a palmaris gracilis tendon graft was used to reconstruct the dorsal aspect of the scapholunate complex. Patients were evaluated for pain, wrist range of motion, grip strength, clinical scores, and radiological appearance at a mean follow-up of 15.9 months. Results We obtained similar results in the technique with and without tendon graft. Visual analog scale (VAS 10) score improved from 6 to 1. Wrist range of motion in Flexion–extension increased from 123 to 144 degrees. Postoperative grip strength was 180% more than preoperative, with a mean Mayo wrist score of 79.5 and quick Disabilities of the Arm, Shoulder and Hand (quickDASH) of 14.9. The radiolunate angle decreased from 29 to 10 degrees, the scapholunate (SL) angle from 83 to 52 degrees, and the scapholunate gap from 6 to 3mm. Conclusion ADAL has many advantages compared with other scapholunate ligamentoplasties, including minimal invasiveness, association with internal brace and dorsal capsulodesis, and lower risk of carpal fracture or avascular necrosis. Its short-term results are promising.

Validation of the Polish version of the Functional Oral Intake Scale against flexible endoscopic evaluation of swallowing and the International Dysphagia Diet Standardization Initiative Functional Diet Scale

IntroductionThe Functional Oral Intake Scale (FOIS) is a widely used instrument for assessing oral intake in dysphagic patients. Despite its frequent use, a validated version for the Polish population has been lacking.MethodsThis study aimed to validate the Polish adaptation of FOIS (FOIS-PL) by examining its concordance with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) outcomes and the International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) scores across patients with diverse clinical profiles. The primary outcome measures included the Penetration-Aspiration Scale (PAS) score from FEES, pharyngeal residue quantification, and IDDSI-FDS scores. A total of 302 participants with varying clinical conditions were recruited. The cohort included individuals with head and neck malignancies, cerebrovascular incidents, neuromuscular disorders, and other dysphagia aetiologies.ResultsPatients with gastroesophageal reflux disease and those post-thyroidectomy consistently exhibited oral food intake with a FOIS-PL score of ≥5. A strong inverse correlation was found between FOIS-PL scores and PAS scores (rho = −0.739; p &amp;lt; 0.001), indicating that reduced oral intake was associated with increased penetration or aspiration risk. Significant differences in FOIS-PL scores were evident across patient subgroups stratified by PAS severity (PAS ≤ 2, PAS 3–5, PAS &amp;gt; 5) and IDDSI levels. Lower FOIS-PL scores corresponded with more impaired swallowing safety (PAS &amp;gt; 5). The median FOISPL score was 5 for individuals with pharyngeal residue and 6 for those without (p &amp;lt; 0.001). Inter-rater reliability between evaluations conducted by a dietitian (FOIS I) and a speech-language pathologist (FOIS II) demonstrated high consistency (tau = 0.995; p &amp;lt; 0.001). Convergent validity was supported by strong correlations between FOIS-PL and IDDSI-FDS scores (FOIS I vs. IDDSI-FDS I: tau = 0.819; p &amp;lt; 0.001; FOIS II vs. IDDSI-FDS II: tau = 0.815; p &amp;lt; 0.001).ConclusionThe Polish version of the Functional Oral Intake Scale (FOIS-PL) is a valid and reliable tool for assessing oral intake in dysphagia. The findings demonstrate high accuracy, reliability, and validity, supporting its use across diverse clinical conditions.

Evaluation of the efficacy of percutaneous spinal cord stimulation according to the single or double leads

AimThe aim of the study was to compare the efficacy of single or double lead in percutaneous spinal cord stimulation (SCS).MethodFollow-up data of 41 patients (20 patients with double lead, 21 patients with single lead) who underwent percutaneous SCS were analysed. Demographic and clinical examination findings (gender, age, pain characteristic, neurological examination, medications used) and visual analogue scale (VAS) scores were recorded. VAS pain scores, clinical and neurological examination and complication findings were recorded at 1st and 12th months at post-procedure follow-up.ResultsTwenty patients had double lead and 21 patients had single lead. Five patients had root avulsion, 1 patient had complex regional pain syndrome, 1 patient had postherpetic neuralgia, 2 patients had phantom pain, 3 patients had ischaemic pain and 29 patients had postlaminectomy syndrome. In 10 patients, leads were placed in the cervical region and in 31 patients in the thoracic region. There was at least 50% reduction in VAS scores in 71.4% (15 patients) with single lead implantation and 65% (13 patients) with double lead implantation (p = 0.7). Infection was significantly higher in patients with double lead than in patients with single lead implantation (p < 0.05). In 1 patient, generator exchange was performed because the generator was exposed due to skin necrosis. No major complication was recorded.ConclusionSCS with single and double lead is an effective method in chronic pain syndromes. SCS with single lead can be preferred in terms of time, cost and labour saving.

Clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy

BackgroundThis study aimed to evaluate the clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy (PECD) in treating patients with symptomatic cervical spondylotic radiculopathy (CSR).MethodsA total of 105 patients with single-segment symptomatic CSR treated between January 2020 and January 2022 were retrospectively analyzed and divided into PECD and ACDF groups based on the surgical approach. Patient demographics, operation time, estimated intraoperative blood loss, complications, postoperative hospital stay, total hospitalization cost, neck dysfunction index (NDI), arm and neck visual analog scale (VAS) scores were compared and analyzed. The learning curve of the PECD group was assessed using cumulative sum (CUSUM) analysis.ResultsThere was no statistically significant difference in baseline data between the two groups (P > 0.05). The PECD group had shorter operative time, smaller incision length, less estimated intraoperative bleeding, lower total hospitalization costs, and shorter postoperative hospital stays compared to the ACDF group (P < 0.05). Postoperative NDI, arm VAS, and neck VAS scores improved significantly in both groups compared to preoperative values (P < 0.05). However, no significant difference was found between the two groups during the same period (P > 0.05). There were also no significant differences between the PECD and ACDF groups in the number of intraoperative fluoroscopies, complications, or surgical success rates (P > 0.05). As more cases accumulated, a trend toward shorter operative times was observed in the PECD group. When grouped according to the learning curve, with the 23rd case as the cutoff point, there was no significant difference in clinical outcomes between the learning phase and proficient phase groups (P > 0.05).ConclusionsPECD is a safe and effective procedure for treating single-segment CSR, offering clinical outcomes comparable to ACDF. PECD has a notable learning curve, requiring beginners to perform 23 cases to reach proficiency. However, longer operative times do not negatively impact preclinical outcomes.Trial registrationRetrospectively registered.