Severity Score Research Articles

Identity-related problems: direct and indirect associations with emotional intelligence and childhood environment

ABSTRACT Objective Identity-related problems are associated with various negative outcomes including depression and self-inflicted injury. Researchers theorise that childhood invalidating environments may contribute to identity problems, whereas high parental emotional availability facilitates adaptive identity functioning. We investigated the association between these developmental environments and identity functioning using a cross-sectional design, and the potential intermediary role of emotional intelligence. Method Undergraduate students (N = 186; Mage = 18.43, SD = 1.64; 77% female; 53.2% Asian; 38.2% White) completed online questionnaires assessing emotional intelligence, childhood invalidation, parental emotional availability, and identity functioning. We used PROCESS Macro with bootstrapped samples to examine the direct and indirect associations (via emotional intelligence) between developmental environments (i.e. childhood invalidation and parental emotional availability) and identity functioning (global identity problems, disturbed identity, lack of identity, and consolidated identity). Results Childhood invalidating environments and parental emotional availability were each directly and indirectly (via emotional intelligence) associated with identity problems. Higher childhood invalidating environment scores were associated with poorer emotional intelligence, which in turn were associated with more severe identity problems and lower consolidated identity scores. Conversely, higher parental emotional availability scores were associated with higher emotional intelligence scores, which in turn were associated with higher consolidated identity scores and lower identity problems. Discussion Distinct aspects of identity-related functioning were implicated in these pathways, underscoring the importance of conceptualising identity functioning as a multifaceted construct. Our findings provide preliminary support for the role of emotional intelligence and developmental environments as important correlates of and potential contributors to identity problems.

Sex differences in the time trends of sepsis biomarkers following polytrauma

Sepsis is a major cause of death in polytrauma patients, with delayed antibiotics increasing mortality. Although biological sex influences immune function and disease outcomes, gender-specific differences in inflammatory response and sepsis progression remain underexplored. This study examined the time-dependent behavior of C-reactive protein (CRP), procalcitonin (PCT), and white blood cell count (WBC) in male and female polytrauma patients to evaluate their predictive value for sepsis. Additionally, it compared infection sources between genders. This retrospective cohort study at University Hospital Zurich included polytrauma patients aged ≥ 16 years with an Injury Severity Score (ISS) ≥ 16 who developed sepsis within 31 days of admission. Patients were grouped by sepsis status and gender. Time-dependent inflammatory markers (CRP, PCT, WBC) were analyzed using the Mann–Whitney U-test and binary logistic regression. The Closest Top-Left Threshold Method determined time-specific sepsis thresholds. The study included 3059 polytrauma patients (26% females, 74% males), with a median age of 43 and a median ISS of 27. CRP levels were higher in sepsis cases from 24 h in females and 48 h in males, peaking at 122.5 mmol/L (females, 4 days) and 136.5 mmol/L (males, 48 h). PCT differences were significant only in males from 12 h, with a threshold of 1.55 µg/L. WBC levels became significant from day 3 in males and day 4 in females, peaking at 12.82 counts/µL (males) and 13.16 counts/µL (females) on day 10. Pneumonia was the most common infection (70% males, 65% females). Females had more wound infections (27% vs. 18%, p = 0.042) and borderline higher urinary tract infections (22% vs. 14%, p = 0.059). CRP and PCT are standard sepsis markers, but PCT’s predictive value varies by gender, and women may show different CRP kinetics. Gender-specific differences in inflammatory markers suggest tailored approaches to enhance diagnostic accuracy and improve sepsis management. Further research is needed to evaluate hormonal and genetic influences on immune responses in polytrauma patients.

Factors Associated with the Initiation of Renal Replacement Therapy in Patients on VV-ECMO: A Case-Control Study.

Acute Kidney Injury (AKI) is a common complication in patients with Acute Respiratory Distress Syndrome (ARDS) receiving VV-ECMO support, carrying a high risk of progression to Renal Replacement Therapy (RRT). Both AKI and RRT are linked to an increased risk of mortality. This study aims to evaluate the risk factors associated with the need for RRT in patients undergoing VV-ECMO. Methods: This is a retrospective case-control study involving patients on VV-ECMO therapy admitted to the intensive care unit (ICU) between 2019 and 2023. Patients on VV ECMO support, with or without RRT, were included and their severity scores and associated mortality were calculated. A multivariate logistic regression analysis was performed to assess the variable RRT using odds ratios (OR) with their corresponding confidence intervals (CI) for the outcome variables. Results: A total of 192 subjects were included, with a mortality rate of 39.6%. Of these, 68.7% were male, with an average ICU stay of 25.1 days and a need for RRT in 19.7% of cases. The multivariate analysis independently associated the use of vasopressors with RRT norepinephrine OR 5.61 (95% CI, 1.64-19.1) and vasopressin OR 4.64 (95% CI, 2.15-10.0)). An increase in creatinine levels before ECMO support is associated with an increased risk OR 2.21 (95% CI 1.54-3.18), and 24 h after ECMO support, the risk rises further adjusted odds ratio (AOR) 3.32 (95% IC 1.55-7.09). The accuracy of severity scores presented weak discrimination and similar behavior, except for DEOx for the primary outcome, with an AUC of 0.79 (95% CI, 0.72-0.87), and APACHE II with an AUC of 0.68 (95% CI, 0.59-0.78). Conclusions: The prediction of RRT in patients on VV-ECMO support was superior for DEOx, which is influenced by the use of vasopressors, creatinine levels, and platelet transfusion prior to cannulation. This could be useful for predicting early interventions in this patient population.

Comparison of Different Local Anesthetics in Cervical Facet Medial Branch Blockade.

Cervical medial branch blocks (CMBBs) are frequently used for the treatment of facet arthropathy. The present study compares the effectiveness of lidocaine and prilocaine in CMBB procedures. Patients with facet arthropathy scheduled for CMBB were randomly divided into 2 groups who were administered a combination of 2 mg dexamethasone and either 1% lidocaine or 1% prilocaine with a total volume of 1 mL per level. All patients were assessed prior to the procedure (baseline), and at 1 hour, 1 week, and 1 month after the procedure using the Numeric Rating Scale-11 (NRS-11), Neck Disability Index (NDI), and patient satisfaction was evaluated at 1 hour, 1 week, and 1 month after the procedure. A total of 97 patients were included in the study (n= 49 in the lidocaine group and n= 48 in the prilocaine group). A significant decrease was noted in the NRS-11 and NDI scores recorded during all follow-up assessments in both groups (P < 0.001), while the NRS-11, NDI scores, and patient satisfaction did not statistically differ between groups at 1 hour, 1 week, and 1 month following the procedure (P ˃ 0.05). CMMB achieved with either lidocaine or prilocaine decreased the recorded pain severity and disability scores to a similar degree. The selection of either lidocaine or prilocaine for CMBB is thus at the clinician's discretion.

Irisin-mediated KEAP1 degradation alleviates oxidative stress and ameliorates pancreatitis.

Oxidative stress (OS) injury is pivotal in acute pancreatitis (AP) pathogenesis, contributing to inflammatory cascades. Irisin, a ubiquitous cytokine, exhibits antioxidant properties. However, the role of irisin in AP remains inconclusive. Our study aims to elucidate irisin expression in AP patients and investigate its mechanism of action to propose a novel treatment strategy for AP. Serum irisin levels in 65 AP patients were quantified using an enzyme-linked immunosorbent assay and correlated with disease severity scores. Core genes implicated in AP-related oxidative stress were identified and screened via bioinformatics analysis. The therapeutic efficacy of irisin in AP was confirmed using a murine cerulein-induced AP model. The intrinsic mechanism of irisin's antioxidative stress action was investigated and verified in pancreatic AR42J cells (Supplementary Fig.1). Common targets shared by irisin and AP were further validated using a molecular docking model which was constructed for virtual docking analysis. This study investigated alterations in redox status in AP and found a significant reduction in serum irisin levels, correlating inversely with AP severity. In a murine AP model, we showed that irisin triggers an antioxidative stress program via the KEAP1 gene; this process helps reestablish redox balance by decreasing the buildup of reactive oxygen species (ROS) and suppressing the secretion of inflammatory mediators within pancreatic tissues Notably, increased KEAP1 expression counteracted the antioxidative effects of irisin. Our findings unveil a novel therapeutic mechanism for AP, wherein irisin inhibits KEAP1 to alleviate OS. Increasing irisin levels in vivo presents a promising strategy for AP treatment.

Contribution of nebulized budesonide before bronchoscopy, a prospective clinical study.

This study evaluated the efficacy of adding budesonide to nebulized lidocaine in patients undergoing flexible bronchoscopy (FB) under topical anaesthesia. Patients aged ≥18years, scheduled for FB under topical anaesthesia were randomized into two groups: the combination group received a pre-treatment of 2ml 1mg budesonide with 5ml 2% lidocaine, whilst the lidocaine group received 5ml 2% lidocaine with 2ml saline solution, both administered via nebulization. Blood pressure (BP), heart rate, and percutaneous oxygen saturation were recorded before, during, and 10min after FB. The Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale (FPS-R) were used to evaluate cough severity, discomfort, willingness to accept reoperation, and the operator's satisfaction with patient cooperation. In addition, the duration of the procedure, total lidocaine dosage instilled through the bronchoscope during the procedure, and types of procedures performed were documented. Compared to the lidocaine group, the combination group showed lower maximum systolic and diastolic BP, higher minimum percutaneous oxygen saturation, and lower cough and discomfort severity scores. Operator's satisfaction, as measured via the VAS or FPS-R, was greater in the combination group, which also exhibited shorter procedure times and required lower lidocaine dosages. There were no significant differences between the groups in terms of willingness to accept reoperation or types of procedures performed. In patients undergoing FB with topical anaesthesia, pre-treatment with a combination of nebulized lidocaine and budesonide is more effective than nebulized lidocaine alone. Key message What is already known on this topic? Flexible bronchoscopy (FB) with topical anaesthesia remains a common practice in many settings, although it can cause significant discomfort for patients. What this study adds? Pre-treatment with a combination of nebulized budesonide and lidocaine was more effective and safer than nebulized lidocaine alone for improving patient tolerance during FB. How this study might affect research, practice, or policy? In settings where conscious sedation is not feasible, the combined nebulization of lidocaine and budesonide may offer an optimized approach for FB, enhancing patient comfort and procedural efficiency.

Insights into VTE risk in trauma patients: an observational study in an Irish trauma patient population.

The rate of VTE in trauma patients varies significantly in the reported literature. We aimed to determine the incidence of VTE in trauma patients in a trauma-receiving hospital over a 7-year period. We sought to evaluate the timing and nature of VTE events and explore the patterns of co-occurrence between PE and DVT, while factoring in clinical care and death outcome. Retrospective review of consecutive trauma patients ≥ 18years admitted between January 2014 and December 2020. Data were extracted from the TARN database, picture archiving and communication system, and hospital records. The primary outcome was VTE incidence. Latent class analysis was used to uncover cross combinations of clinical management and VTE outcomes, yielding subgroups of trauma patients. Subgroups were compared for demographic and clinical characteristics. Seventy-three VTE were observed-incidence of 0.0036 cases/people-year (95% CI 0.0 to 3.69). VTE ( +) group consisted mostly of males (75%), had an advanced age, had higher injury severity scores, and had increased length of stay. Most patients (64%) developed a PE only. Most DVT (64%) were proximal. Two subgroups had a high probability of PE/low probability of DVT and two a high probability of DVT/low-to-moderate probability of PE. Subgroup comparisons showed differences in the clinical characteristics which were statistically inconclusive. This is the largest study of VTE incidence in Irish trauma patients and the first to delineate VTE risk in a trauma population. These findings urge reconsideration of VTE risk in trauma patients and implementation of prevention strategies.

Identification of Key Predictors of Cryoglobulinemia Severity at Diagnosis: Threshold, Type, and Severity Score at Diagnosis

Identification of Key Predictors of Cryoglobulinemia Severity at Diagnosis: Threshold, Type, and Severity Score at Diagnosis

Is Cybersecurity a Social Responsibility?

Abstract Cybersecurity incidents damage not only the organizations attacked, but also society in general, harming customers and stakeholders. Through the text mining of the incident database, we observed that the impact of cybersecurity incident trends became more outward-oriented causing increased risks associated with social responsibility. Thus, this study aims to validate the potential effect of cybersecurity incidents on social responsibility risks and stock price drops. To derive meaningful factors from the description of incidents, we mined the texts to extract the features of the severity of incidents and their direction of impact whether inward or outward. The severity score is derived from sentiment analysis and the impact direction by topic modeling and machine learning models including SVM, LSTM, and BERT. The effects of these incident features are studied through regression models with social responsibility risk and stock price drops as dependent variables. To conduct this study, we collected incident texts from the Privacy Rights Clearinghouse database, and social responsibility risk indices from the Privacy and Data Security index and Cyber Risk Rating scores. The subsequent short-term stock price drops are measured by Cumulative Abnormal Returns and their variations. Our analysis revealed a profound impact of cybersecurity incidents on social responsibility risk indices and stock price drops with the moderating effect of outward impact in both models. However, we recognize the incompatibility between an annual index of social responsibility risk and short-term stock price drops. Therefore, we propose a short-term social responsibility risk index for cybersecurity which can be derived from the disclosed incidents. All these scenarios support the premise that cybersecurity incidents significantly impact the social responsibility risk and may lead to potential stock price drops.

A true experimental study to assess the effectiveness of juice in relieving constipation among older adults in a selected hospital, Kolar

: Chronic constipation becomes more common as people age, in both genders, although it becomes most common beyond age 60. is commonly used as a potent laxative and as a substance to enhance gastrointestinal motility. can be used as a natural remedy for constipation at affordable prices among old age people.Study aimed to assess the effectiveness of aloeAloe vera juice to relieve constipation among older adults.For the present study, a randomized control trial pretest-posttest design was adopted. Subjects consist of 60 (30 Experimental and 30 Control) older adults from R.L. Jalappa Hospital and Research Centre. The pretest was conducted using the Constipation Assessment Scale (CAS) through the Block Randomization sampling technique in both groups. A freshly prepared juice of 100 milligrams per day was given for 20 days. Posttest was conducted in both experimental and control group after 10, and 20 day. The data gathered were analyzed by descriptive and inferential statistical method using frequency, percentage, SD, Independent t test, paired t test and RMANOVA with Posthoc test. The dataset comprised 60 elderly patients. In total, the Majority of respondents 70% and 73.3% reported moderate level constipation in the experimental group &amp; and control group during pretest. Constipation scores of no problem during posttest-I was 93.3% &amp; 96% in experimental group during 10 and 20 day. Whereas in control group remains unchanged with moderate and severe constipation scores. Independent “t”test and RMANOVA found to be significant in experimental group. Constipation remains a clinical problem among elderly. There is a significant relationship between effectiveness of juice in relieving constipation among old age people.Furthermore study emphasize that, home remedy based laxatives which are affordable, available aloevera juice are effective to relive constipation among elderly. , Constipation, Old Age

Correlation between serum levels of fibroblast growth factor-21 and the severity of migraine headache in patients undergoing sodium valproate treatment

Background: Mitochondrial metabolism disruption increases neuron excitability and reduces migraine attack threshold. This study investigates whether serum fibroblast growth factor-21 (FGF-21) levels in chronic migraine relate to headache severity and response to sodium valproate treatment. Methods: This pilot study involved 30 patients with chronic migraine treated with sodium valproate. Serum FGF-21 levels were assessed at baseline and after 12 weeks of treatment. Pain severity and disability were evaluated using visual analogue scale (VAS) and Migraine Disability Assessment (MIDAS). Paired t-test was used for the quantitative variables. The qualitative variables were evaluated using Pearson’s chi-square test and Fisher’s exact test. Moreover, correlation coefficients were calculated. A P &lt; 0.05 was considered statistically significant. Results: Mean age of the patients was 42.9 ± 11.3 years. There was a significant reduction in headache severity between baseline and the end of the study regarding VAS scores (8.50 ± 1.50 vs. 5.30 ± 2.20, P &lt; 0.001). The same reduction was observed in MIDAS during the study (61.20 ± 33.20 vs. 20.31 ± 17.07, P &lt; 0.001). However, there was no significant changes in serum levels of FGF-21 over three months (299.53 ± 479.80 vs. 491.33 ± 456.64, P = 0.810), nor any relationship between these levels and headache severity scores (MIDAS: P = 0.658, VAS: P = 0.708). Conclusion: The results of this study did not show a significant correlation between FGF-21 serum levels and changes in VAS and MIDAS throughout the study. Further research on various mitochondrial pathways can provide valuable insights into the migraine pathophysiology and help identify more effective biomarkers for monitoring therapeutic regimens.

Consensus outcomes between health professionals and parents for oral corticosteroids in treating preschool wheeze: a multi-national survey and nominal group technique study

ObjectiveTo obtain priority consensus for outcome measures of oral corticosteroid treatment of preschool wheeze that represent stakeholder groups.Design(1) A systematic review to identify a set of outcome measures; (2) an...

Macroscopic evaluation of road traffic safety using Qgis: A case study of Tuyen Quang province

Road traffic safety in Vietnam is one of the top social concerns due to the complicated situation of traffic accidents, requiring in-depth research to find appropriate solutions. Macroscopic evaluation of traffic safety is one of the effective ways to prevent and reduce road traffic accidents. The paper presents a new method based on an Equivalent Severity Score (ESS) to evaluate road traffic safety in an area using a geographic information system (GIS) tool, namely QGIS. The road traffic accident (RTA) data from 2021 to 2023 in Tuyen Quang province, Vietnam, was used to analyze and test this method. First, the RTA data was divided by the administrative units of Tuyen Quang, using several evaluation indicators, including the number of traffic accidents, fatalities, serious injuries, and slight injuries. Then, the ESS was determined based on these evaluation indicators to measure the seriousness of RTA across the administrative units. Finally, the ranking of road traffic safety of administrative units is presented by using QGIS software. From there, the traffic authorities can easily understand areas where RTA occurs more seriously and provide reasonable solutions. The results of the paper will help traffic authorities have more basis in making decisions related to solutions to solve traffic problems not only in Tuyen Quang province of Vietnam but also in other localities

Predictors of developing severe COVID-19 among hospitalized patients: a retrospective study

BackgroundBased on the comparative statistical tests, patients with severe COVID-19 were statistically significantly associated with older age and had higher respiratory rate, longer hospital stay, and higher prevalence of diabetes than non-severe cases. This work aimed to explore risk factors for developing severe COVID-19 to enhance the quality of care provided to patients and to prevent complications.MethodsA retrospective study was conducted in Saudi Arabia’s eastern province, including all COVID-19 patients aged 18 years or older who were hospitalized at Prince Saud Bin Jalawi Hospital in July 2020. Comparative tests as well as both univariate and multivariate logistic regression analyses were performed to identify risk factors for developing severe COVID-19 and poor outcomes.ResultsBased on the comparative statistical tests patients with severe COVID-19 were statistically significantly associated with older age and had higher respiratory rate, longer hospital stay, and higher prevalence of diabetes than non-severe cases. They also exhibited statistically significant association with high levels of potassium, urea, creatinine, lactate dehydrogenase (LDH), D-dimer, and aspartate aminotransferase (AST). The univariate analysis shows that having diabetes, having high severe acute respiratory infection chest X-ray scores, old age, prolong hospitalization, high potassium and lactate dehydrogenase, as well as using insulin, heparin, corticosteroids, favipiravir or azithromycin were all statistically significant associated with severe COVID-19. However, after adjustments in the multivariate analysis, the sole predictor was serum LDH (p = 0.002; OR 1.005; 95% CI 1.002–1.009). In addition, severe COVID-19 patients had higher odds of being prescribed azithromycin than non-severe patients (p = 0.001; OR 13.725; 95% CI 3.620–52.043). Regarding the outcomes, the median hospital stay duration was statistically significantly associated with death, intensive care unit admission (ICU), and mechanical ventilation. On the other hand, using insulin, azithromycin, beta-agonists, corticosteroids, or favipiravir were statistically significantly associated with reduced mortality, ICU admission, and need of mechanical ventilation.ConclusionThis study sheds light on numerous parameters that may be utilized to construct a prediction model for evaluating the risk of severe COVID-19. However, no protective factors were included in this prediction model.

Neuroprotective effects of hypidone hydrochloride (YL-0919) after traumatic brain injury in mice.

Neurological dysfunction is a common complication of traumatic brain injury (TBI), and early treatments are critical for the long-term prognosis. This study aimed to investigate whether hypidone hydrochloride (YL-0919) improves neurological function impairment in mice with TBI. TBI was induced in adult male C57BL/6J mice using the controlled cortical impact (CCI) method. First, the modified neurological severity score (mNSS), rotarod test, and Morris water maze (MWM) test were conducted to assess the impact of YL-0919 on neurological function in mice with TBI. Next, immunofluorescence and laser speckle contrast imaging were utilized to measure the number and activation of microglia and cerebral blood flow (CBF) after TBI. Enzyme-linked immunosorbent assays (ELISAs) were employed to assess the inflammatory factors. Finally, Western blotting was performed to measure the expression of proteins. Golgi-Cox staining was utilized to investigate the structure of pyramidal neurons. YL-0919significantly alleviated neurological dysfunction in TBI+YL-0919mice compared with TBI+Vehicle mice, increased the time spent on the rotarod (F=1.297, P <0.05), and partially relieved cognitive dysfunction in TBI mice (for mNSS, F=5.540, P <0.01; for MWM test, F=30.78, P <0.05). Additionally, YL-0919 effectively inhibited the proliferation and activation of microglia (both P<0.01), promoted the recovery of CBF around the brain injury site and inhibited the expression of tumor necrosis factor-α (F=9.142, P <0.05) and IL-1β (F=4.662, P <0.05), and increased the concentration of IL-4 (F=5.172, P <0.05). Furthermore, continuous gavage of YL-0919 (2.5mg/kg) for seven days effectively increased the protein expression of brain-derived neurotrophic factor (BDNF), promoted the phosphorylation of mammalian target of rapamycin (mTOR), increased postsynaptic density protein 95 (PSD95) and synapsin1 levels, and increased the neuronal dendritic complexity and the dendritic spine density around the brain injury site (all P <0.05). Our findings indicated that YL-0919 can ameliorate neurological dysfunction in mice after TBI through the suppression of inflammation and the stimulation of the BDNF-mTOR signaling pathway. These findings provide an insightful perspective on the potential pharmacological mechanism involved in the neuroprotective effect of YL-0919.

Neuroprotective Efficacy of Astragalus mongholicus in Ischemic Stroke: Antioxidant and Anti-Inflammatory Mechanisms

Stroke affects over 12 million people annually, leading to high mortality, long-term disability, and substantial healthcare costs. Although East Asian herbal medicines are widely used for stroke treatment, the pathways of operation they use remain poorly understood. Our study investigates the neuroprotective properties of Astragalus mongholicus (AM) in acute ischemic stroke using photothrombotic (PTB) and transient middle cerebral artery occlusion (tMCAO) mouse models, as well as an in vitro oxygen-glucose deprivation (OGD) model. Post-OGD treatment with AM improved cell viability in mouse neuroblastoma cells, likely by reducing reactive oxygen species (ROS). Mice received short-term (0–2 days) or long-term (0–27 days) AM treatment post-stroke. Infarct size was assessed using a 2,3,5-triphenyl tetrazolium chloride (TTC) staining procedure alongside magnetic resonance imaging (MRI). Neuroprotective metabolites including inositol (Ins), glycerophosphocholine+phosphocholine (GPc+ PCh), N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG), creatine + phosphocreatine (Cr+PCr), and glutamine+glutamate (Glx) were analyzed via magnetic resonance spectroscopy (MRS). Gliosis was assessed using GFAP and Iba-1 immunohistochemical markers, while neurological deficits were quantified with modified neurological severity scores (mNSS). Motor and cognitive functions were assessed using cylinder, rotarod, and novel object recognition (NOR) tests. AM treatment significantly reduced ischemic damage and improved neurological outcomes in both acute and chronic stages of PTB and tMCAO models. Additionally, AM increased neuroprotective metabolites levels, reduced gliosis, and decreased oxidative stress, as evidenced by reduced inducible nitric oxide synthase (iNOS). These findings highlight the antioxidant properties of AM and its strong therapeutic potential for promoting recovery after ischemic stroke by alleviating neurological deficits, reducing gliosis, and mitigating oxidative stress.

Therapeutic Neuroscience Education In Fibromyalgia: A Randomized Controlled Trial

Abstract To investigate additive effect of Therapeutic Neuroscience Education (TNE) to pilates exercises in female patients with fibromyalgia (FM).25 female patients FM included in the study. They randomly separated into two groups. There were 11 patients in the intervention group and 14 patients in the control group. Pilates exercises and TNE were applied in the intervention group, and only pilates exercises were applied in the control group. Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), Fibromyalgia Impact Questionnare (FIQ), Symptom Severity Scale (SSS), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Biopsychosocial Questionnaire (BETY-BQ) and pressure algometer was used for evaluation.After the treatment, control group improved in the “visuomotor construction” and “thinking operations"cognitive areas andtotal score of DLOTCA, BPI-pain severity score, VAS, FIQ, SSS, PCS-magnification, and only left medial knee mean score of pressure pain thresholds (p&lt;0.05). Intervention group improved in the “thinking operations” cognitive area and total score of DLOTCA, BPI-pain severity score, BPI-pain interference score, VAS, WPI, FIQ, SSS, TSK, BETY-BQ and all pressure pain thresholds (excluding left trapezius) (p&lt;0.05). In the comparison of delta values, the intervention group improved more in WPI, FIQ, right trapezius mean score and left trapezius, right quadriceps femoris, right-left medial knee maximum and mean scores of pressure pain thresholds (p&lt;0.05). TNE increased the effectiveness of pilates exercises on pain, functional status and pressure pain thresholds in patients with FM.

Evidence-Based Data on How Long to Treat to Achieve Treatment Response With Baricitinib in Severe Alopecia Areata

Introduction: Previous data on baricitinib treatment in severe alopecia areata (AA) has shown that treatment response varies by baseline disease severity and by duration of current episode. In general, hair regrowth response varies, and clinicians lack data on how long to optimally treat patients to achieve response. In the literature, time to onset of improvement (defined as 30% improvement from baseline SALT score, i.e. SALT30 can predict ultimate achievement of SALT score ≤20 by Week 52. In this analysis, we evaluated improvement(SALT30) and meaningful response(SALT score ≤20), in clinically relevant subpopulations to characterize time required to treat patients based on their disease presentation. Procedure: Patients randomized to treatment with baricitinib 4mg daily for up to 52 weeks were evaluated from the pooled BRAVE AA1/AA2 phase 3 trials according to four clinically relevant subpopulations divided by baseline SALT score (severe: 50-94; very severe: 95-100) and current AA episode duration (&lt;4 years; &gt;4 years). Patients achieving SALT30 improvement across visits was evaluated for each subpopulation. Among those achieving SALT30, proportion of patients achieving SALT score ≤20 through Week 52 was evaluated at the timepoint during which SALT30 improvers began to plateau. Non- Responder Imputation was used for the missing SALT30 and SALT score ≤20. Results: Among subpopulations with baseline severe AA, the proportion of SALT30 improvers plateaued between 24weeks (61-70%) and 36 weeks (63%-73%) of treatment. Among those who reached SALT30 improvement at Week 24, achievement of SALT score ≤20 at Week 52 was 75% vs. 65%, respectively among those with &lt; 4 years vs. &gt; 4 years duration of current episode. In the baseline very severe AA group, the proportion of SALT30 improvers continued to increase through 52 weeks without plateau. Discussion: This data suggests that 'how long to treat’ with baricitinib 4 mg monotherapy can be tailored to patient baseline characteristics. Evidence of improvement (SALT30) is seen relatively early among those patients with baseline severe SALT score(50-94). Most who achieve improvement at 6 months achieve clinical response (SALT score &lt; 20) within a year of treatment. This suggests that if improvement is seen by 6 months, treatment should be continued to achieve optimal outcomes. Patients with a very severe SALT score (95-100) at baseline (i.e. alopecia totalis or universalis) show continuing (SALT30) improvement up to 1 year. Very severe AA may need at least 1 year to see evidence of treatment effect before considering a stop or switch in therapy, and longer treatment may be required in some improvers to achieve optimal outcomes.

To Hemoadsorb or Not to Hemoadsorb—Do We Have the Answer Yet? An Updated Meta-Analysis on the Use of CytoSorb in Sepsis and Septic Shock

Severe inflammation leading to organ dysfunction is the cornerstone of the pathophysiology of sepsis. Thus, from a theoretical point of view, rebalancing inflammation has the potential to improve patient outcomes. Methods: To better understand the clinical effectiveness of hemoadsorption in managing inflammation, we conducted an updated meta-analysis on the effects of CytoSorb in critically ill septic patients. Ten studies containing 715 patients (355 in the interventional group and 360 in the control group) have been included in the final analysis. Results: Statistical analysis demonstrated that the use of CytoSorb did not influence overall mortality (OR 0.95, 95% CI [0.58, 1.56], p = 0.85), but we observed a decreased mortality when comparing CytoSorb-treated patients with patients in the control group treated with continuous renal replacement therapy (CRRT) (OR 0.97, 95% CI [0.46, 0.98], p = 0.04). We also observed an increased mortality in patients in whom hemoadsorption was initiated earlier in the treatment course (OR 0.97, 95% CI [0.46, 0.98], p = 0.04). We did not observe any significant difference in either intensive care unit length of stay (p = 0.93) or between end-of-treatment severity scores in the two groups (p = 0.24). Conclusions: Although it has a high risk of bias, current evidence does not support the routine use of CytoSorb in critically ill septic patients. The addition of CytoSorb to CRRT may be associated with decreased survival as compared to CRRT alone, but future studies are needed to draw a definitive conclusion.

Prediction of treatment efficacy in psoriasis vulgaris using dermoscopic and capillaroscopic findings: a prospective cohort study.

Psoriasis is a chronic inflammatory skin disorder affecting millions worldwide. Dermoscopy and proximal nailfold capillaroscopy have emerged as valuable tools for understanding the pathophysiology and treatment response of psoriasis lesions. This study aimed to contribute to the limited literature on using dermoscopic findings to detect treatment effectiveness in patients with psoriasis vulgaris. This prospective, single-blinded, observational cohort study included 101 patients aged 18-71 years diagnosed with psoriasis vulgaris who initiated or altered systemic treatment. Monthly dermoscopic and capillaroscopic evaluations were performed alongside assessments of Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores. A significant relationship was found between first-month dermoscopic findings and third-month severity scores (PASI, BSA, DLQI). Patients with positive treatment responses exhibited changes from baseline regular capillary dilations to hemorrhagic spots or the absence of vascular findings during the first month. The correlations between dermoscopic changes and severity scores evolved over time, becoming stronger in the second and third months. Nailfold capillaroscopy findings at the third month of treatment showed significant differences from baseline. Dermoscopy is a fast, practical, and inexpensive tool for early prediction of treatment effectiveness in psoriasis vulgaris. The disappearance of regular capillary dilations or their change to hemorrhagic spots suggests treatment efficacy, while their persistence indicates poor treatment response. Early detection of treatment effectiveness using dermoscopic findings can facilitate timely adjustments, improving patient outcomes and reducing unnecessary treatment exposure.