Significant Degree Of Improvement Research Articles

The role of 755-nm alexandrite picosecond laser in melasma management.

Melasma is a skin dyspigmentation condition that disproportionately affects women, particularly those of Latino, Black, and Asian ethnicities, significantly impacting their quality of life. Efforts to identify effective treatment options have led to the exploration of picosecond laser technology which utilizes brief pulse durations to break down pigment while minimizing thermal damage to surrounding tissue. The 755-nm alexandrite picosecond laser, currently FDA approved for benign pigmented lesion removal, including melasma, is a promising solution. We aim to assess the efficacy and safety of the 755-nm alexandrite picosecond laser both as a stand-alone treatment for melasma and in combination with topical agents. We conducted a PubMed search using "755-nm picosecond" AND "melasma," "755-nm picosecond" AND "hydroquinone," and "755-nm picosecond" AND "tranexamic acid." English-written studies examining this laser as monotherapy or in combination with the topical agents were included. Those not meeting the criteria or lacking data related to melasma improvement were excluded. Monotherapy with the 755-nm picosecond laser led to a 50-75% improvement in melasma appearance in 40% of participants and a significant reduction in the average Melasma Area and Severity Index (MASI) score (p < 0.001) in all patients of one study. Notably, the use of topical tranexamic acid (TTA) in conjunction with the picosecond laser exhibited the most significant degree of improvement in hemi-MASI scores compared to the laser monotherapy group at one- and three-months post-treatment (p < 0.05). Patient satisfaction was also significantly higher for the combination group (p < 0.05). In contrast, combining hydroquinone (HQ) with the picosecond laser demonstrated no significant difference in outcomes compared to HQ alone, both of which were less effective than TTA with picosecond laser. The combination of the 755-nm picosecond laser with TTA proves promising, outperforming both laser monotherapy and laser with HQ. While monotherapy with the picosecond laser or topical agents is effective, literature favors combination therapy, especially the 755-nm picosecond laser with TTA, for superior benefits and minimal side effects. Ultimately, individualized regimens, considering factors like skin type, should be prioritized, given the heightened risk of postinflammatory hyperpigmentation, especially in skin of color patients.

Development of a novel approach for recovering SIP effects from 1-D inversion of HEM data: Case study from the Alut area, northwest of Iran

We have developed a novel approach for recovering the induced polarization (IP) effects from one-dimensional (1-D) inversion of helicopter-borne electromagnetic data (HEM). To achieve this aim, we incorporate both electromagnetic and spectral induced polarization effects within the HEM data by taking the frequency dependence behaviour of resistivity/conductivity of polarizable formation into account. Furthermore, we have included the EM sensor altitude, magnetic permeability and dielectric permittivity of subsurface layers in order to conduct the full solution of forward operator. In this regard, we have calculated the magnetic permeability from the inversion of aeromagnetic data and incorporated the sensor altitude and dielectric permittivity as additional model parameters to be recovered using the inversion of the HEM data. We have carried out both forward and inverse modelling of the HEM data by implementing fast Hankel transform and hybrid algorithm including very fast simulated annealing (VFSA) and Marquardt-Levenberg (ML) strategies, respectively. This approach enables us to recover model parameters comprising of relaxation parameters of Cole-Cole model, dielectric permittivity and thickness of layered half space model and sensor altitude above the earth surface using 1-D inverse modelling of HEM data.We have tested our approach on both synthetic and field DIGHEM data. Implementing the forward solution indicates that incorporation of the IP effects may shift the frequency domain electromagnetic (FDEM) response so that it yields the sign reversal signature in the in-phase component at low frequencies. Moreover, the results of the inverse modelling of the HEM data show that the IP effect could be recovered using our approach effectively. It provides fast and cost-effective quantitative tool for recovering the IP effect from HEM data for the sake of more precise characterization of buried polarizable formations in the wide area. In addition, incorporation the IP effect along with magnetic permeability and sensor altitude provides a significant degree of improvement in the inversion and interpretation of negative responses occurred in the in-phase component at low frequencies.

Outcome of Cochlear Implantation in Children With Narrow Bony Cochlear Nerve Canal.

To investigate the diameter of the bony cochlear nerve canal (BCNC) as a prognostic indicator of cochlear implantation (CI) in children. Retrospective study. Tertiary referral center. Two hundred ninety two prelingual deaf children (323 ears) who received CI before the age of 5 years. CI in pediatric patients. Postoperative auditory performance was analyzed according to the diameter of the BCNC using the Mann-Whitney U test. Using the images of temporal bone computed tomography, patients were grouped according to the diameter of the BCNC: narrow (<1.4 mm, Group 1), normal (Group 2), and other anomalies (Group 3). Group 1 (10.5%) showed a less significant degree of improvement in category of audiological performance (CAP) score than Groups 2 (57.3%) and 3 (32.2%). Scores obtained from both the open-set monosyllabic words and sentence tests were lower in Group 1 than Groups 2 and 3. Of the patients with narrow BCNC, the CAP score of patient with complete stenosis of BCNC (<0.2 mm) was lower than that of patients with BCNC between 0.2 and 0.8 mm, also 0.8 and 1.4 mm. The improvement in auditory performance was limited in children with narrow BCNC and the narrower the BCNC, the more severe the limitation. However, gradual improvement can be expected and even children with narrow BCNC may be candidates for early CI and rehabilitation.

The impact of high intensity versus low intensity behavioral therapy in establishment of functional routines in Egyptian autistic children

ObjectiveTo compare the effect of high-intensity versus low-intensity treatment in the establishment of functional routines in autistic children.Patients and MethodsThis quasi-experimental study was conducted on 25 children of 2–6 years of age of both sexes at the Unit of Phoniatrics, Department of Otorhinolaryngology, Alexandria Main University Hospitals. An informed consent was taken from all patients in this part of the study. All cases included in the study underwent thorough history taking, comprehensive neurological examination, and diagnosis of autism based on Diagnostic and Statistical Manual of Mental Disorders, fifth ed., Childhood Autism Rating Scale, and Autism diagnostic interview-revised. The children were trained for 1 year using the STAR program. The children were divided into two groups: group I included 15 children who were trained 5 days per week, and group II included 10 children who were trained 3 days per week owing to family commitments.ResultsThere was significant improvement in both groups in all lessons when comparing pretherapy and post-therapy results; however, group I showed significant degree of improvement when compared with group II in specific items.ConclusionEarly intervention for autistic children helps in improving their prognosis and yields better results. The need to apply the treatment on daily basis is highly recommended.

Outcomes of infants undergoing laparoscopic pyeloplasty: A single-center experience.

The aim of this study was to evaluate the outcomes of laparoscopic pyeloplasty in children less than 12 months of age. The records of 20 infants, who had pelviureteric junction obstruction and subsequently underwent LP from January 2013 to November 2016 with at least 1 year of follow-up, were retrospectively reviewed. Patients demographics, the results of preoperative and postoperative imaging studies, perioperative details, complications, and results were noted. The mean age of 20 infants was 4.75 months. The gender of cases was 5 females (25%) and 15 males (75%). Of that, 13 (65%) laparoscopic pyeloplasties were in left side and 7 (35%) were in right side. No cases needed open conversation. Aberrant crossing vessel was observed in three patients (15%). The mean operation time was 79.35 min (45-128 min). The mean hospital stay was 2.9 ± 0.308 days (2-3 days). There were complications in three children (15%); two patients developed stent migration and one child had fever over 38°. Three children with complications did not require a second intervention. In one child, the kidney was non-functioning in follow-up and nephrectomy was performed. The anteroposterior diameter significantly reduced. Preoperative mean value was 24.305 ± 5.6157 and postoperative mean value was 15.40 ± 6.030 (p = 0.000, p < 0.05). There was a significant degree of improvement in renal split function for all patients. Preoperative mean values were 45.53 ± 11.512, while postoperative values were 47.850 ± 13.347 (p = 0.029, p < 0.05). Although there are doubts about the reliability and efficacy of results for pyeloplasty in children less 12 months, many studies including this study show that laparoscopic pyeloplasty is an effective and reliable method for infants.

Abnormal Long-Term Episodic Memory Profiles in Multiple Sclerosis?

Objective: Various verbal episodic memory impairments have been demonstrated in multiple sclerosis (MS), including encoding, retrieval and storage processes. Our clinical experiment suggests that a subset of MS patients may show another pattern with a distinctive evolution of performances after a 20 minutes delay (short-delay versus long-delay free recall). Methods: The current study assessed performances on the California Verbal Learning Test (CVLT) in MS with a special focus on evolution after delay to identify a subgroup of patients who may show a significant spontaneous improvement of long-delay free recall in comparison with short-delay free recall. Data from 52 MS patients were compared with those from 32 controls. Group analyses were conducted on classical scores. Individual MS performances were also analyzed, according to confidence intervals calculated using control data. Results: From individual analysis, memory comorbidities were frequently observed in a MS patient (17% of MS patients had only one impaired score, 17% had two or three scores, 27% had four or five scores and 38% had six or more). Regarding the evolution after delay, three profiles were highlighted: two classical (stable and worsening, i.e. storage deficit) and a third showing a significant degree of improvement. The improvement was significantly correlated with processing speed, primacy effect and sensitivity to retroactive interference only in this third MS subgroup. This benefit from delay was not related to the effect of semantic clustering. Conclusion: The current study suggests that a subgroup of MS patients might present a previously unreported abnormal long-term memory profile, in which an impaired short-term performance contrasts with a significant spontaneous improvement with delay. Previous studies have demonstrated the relevance of spaced learning in MS rehabilitation. If our results are corroborated in a larger sample, the CVLT may help to select patients that are likely to benefit from this temporal memory care.

The Impact of the Spine Patient Outcomes Research Trial (SPORT) Results on Orthopaedic Practice

The benefits of spinal surgery for relief of low back and leg pain in patients with degenerative spinal disorders have long been debated. The Spine Patient Outcomes Research Trial (SPORT) was designed to address the need for high-quality, prospectively collected data in support of such interventions. SPORT was intended to provide an evidential basis for spinal surgery in appropriate patients, as well as comparative and cost-effectiveness data. The trial studied the outcomes of the surgical and nonsurgical management of three conditions: intervertebral disk herniation, degenerative spondylolisthesis, and lumbar spinal stenosis. Both surgical and nonsurgical care of intervertebral disk herniation resulted in significant improvement in symptoms of low back and leg pain. Still, the treatment effect of surgery for intervertebral disk herniation was less than that seen in patients who underwent surgical versus nonsurgical treatment of degenerative spondylolisthesis and lumbar spinal stenosis. Across SPORT, more significant degrees of improvement with surgery were noted in chronic conditions of lumbar spinal stenosis and lumbar spinal stenosis with spondylolisthesis. In addition, no catastrophic progressions to neurologic deficit occurred as a result of watchful waiting.

The Impact of the Spine Patient Outcome Research Trial (SPORT) Results on Orthopaedic Practice

The benefits of spinal surgery for relief of low back and leg pain in patients with degenerative spinal disorders have long been debated. The Spine Patient Outcomes Research Trial (SPORT) was designed to address the need for high-quality, prospectively collected data in support of such interventions. SPORT was intended to provide an evidential basis for spinal surgery in appropriate patients, as well as comparative and cost-effectiveness data. The trial studied the outcomes of the surgical and nonsurgical management of three conditions: intervertebral disk herniation, degenerative spondylolisthesis, and lumbar spinal stenosis. Both surgical and nonsurgical care of intervertebral disk herniation resulted in significant improvement in symptoms of low back and leg pain. Still, the treatment effect of surgery for intervertebral disk herniation was less than that seen in patients who underwent surgical versus nonsurgical treatment of degenerative spondylolisthesis and lumbar spinal stenosis. Across SPORT, more significant degrees of improvement with surgery were noted in chronic conditions of lumbar spinal stenosis and lumbar spinal stenosis with spondylolisthesis. In addition, no catastrophic progressions to neurologic deficit occurred as a result of watchful waiting.

Use of 1,320 nm Nd:YAG laser for wrinkle reduction and the treatment of atrophic acne scarring in Asians.

The role of 1,320 Nd:YAG in non-ablative skin rejuvenation in Asians is has not been established. Furthermore, no study has investigated the effectiveness of 1,320 Nd:YAG laser in the treatment of atrophic scarring in Asians. The objective of our study was to investigate the effectiveness of 1,320 Nd:YAG laser in wrinkle reduction and the treatment of atrophic acne scarring in Asians. Twenty-seven female patients were included in the study: seven were treated for acne scarring and the others for wrinkle reduction. A 1,320 nm Nd:YAG laser (Cooltouch II, Roseville, CA) was used to treat both the cheeks and forehead for the patients with wrinkles, and both cheeks only for patients with atrophic acne scarring. All patients received treatment in the post-auricular areas. A spot size of 10 mm was used, and three passes were performed (two pre-cooling and one post-cooling). Patients were treated monthly for 6 months. All patients were subjectively assessed before and after their last treatment sessions using a structured questionnaire, and objectively assessed by the use of clinical photographs for by independent observers. A cutometer was used to assess viscoelasticity, and biopsies were taken at the post-auricular site for assessment by a pathologist. The overall degree of patients' satisfaction was rated as 4.9 (range 0-9.8) for wrinkle reduction and 4 (range 0-10) for acne scarring. In terms of objective assessment by independent observers, the degree of improvement was considered to be mild or no change in most cases. The independent pathologist who assessed the degree of improvement in terms of increased collagen production detected no change in 8 patients, mild improvement in 9, and moderate improvement in 10. There was also improvement in term of epidermal thickness in 13 cases. Assessment by viscoelasticity indicated a significant degree of improvement in most parameters in both groups of patients. Blistering occurred in five cases, all in the central facial areas, and post-inflammatory hyperpigmentation occurred in three cases. All cases of PIH resolved after the use of 4% hydroquinoine. There was no scarring or hypopigmentation. The 1,320 nm Nd:YAG laser is effective for wrinkle reduction and atrophic acne scar improvement, but to further enhance the clinical outcome a combination approach with another device such as IPL and a surgical technique such as subcision is necessary.

The follow-up of patients with unfavourable early results of transurethral prostatectomy.

To determine the natural course of patients with subjectively disappointing early results after transurethral prostatectomy (TURP), who experience prolonged discomfort and an initial deterioration in symptoms. A consecutive series of 127 patients undergoing urodynamic studies and TURP were assessed 3 months after surgery using symptom scores and measurements of urinary flow rate; 107 patients reported improved symptom and quality-of-life scores, but 20 did not improve, with no change or a deterioration. These 20 patients were followed for several months using symptom scores, and measurements of flow rates and residual urine volumes. Baseline variables, including preoperative urodynamic studies, were compared between those who improved and those who did not. Over a mean (range) follow-up of 10.6 (6-15) months, all those initially not improving showed spontaneous improvement in all three variables with no further treatment and eventually achieved the same significant degree of improvement as those who improved soon after TURP. Preoperatively, those initially not improving had mean lower symptom scores, more bladder irritability and less obstruction than did those who improved. A significant proportion (approximately 15%) of patients with obstructive symptoms will experience considerable symptomatic discomfort for a prolonged period after an uncomplicated TURP and will not gain the full symptomatic benefit from the procedure until 6-9 months afterward.

A Non-linear Inverse Technique for Calculating Palaeotemperature and Other Variables Using Noble Gas Concentrations in Groundwater: The Last Glacial Maximum in the Continental Tropics Re-examined

We present here an error weighted non-linear inverse technique adapted from Menke (1984). This method fits palaeotemperature and up to two other variables, gives an estimate of the precision of the fitted variables and enables us to assess the confidence of the conceptual models with the input data. We illustrate the utility of this method with comprehensive data sets from the Pannonian basin, San Juan basin and tropical Brazil (Stute and Deak, 1989; Stute et al., 1995a,b). Solving for temperature and 'excess air' we demonstrate that the inverse method reproduces literature iterative techniques, but with a bias of up to 1.0~ This is due to error weighting placing more emphasis on the heavy noble gas concentrations in the temperature determination. Solving for either recharge salinity or altitude as a third variable, synthetic data sets reproduce input values. All the literature data produces a significant average negative offset from known recharge salinity and altitude. This offset in natural systems points to a significant and ubiquitous noble gas fractionation effect in all of the aquifer systems investigated. We also solve for fractionation by diffusive gas loss at recharge (Stute et al., 1995b). The tropical Brazil data set reproduces independently derived literature fractionation constants. Although this improves the data fit, a simple statistical test shows that diffusive fractionation alone cannot account for the sample noble gas abundance pattern observed in the tropical Brazil samples. Our derived errors of between +1.6 to _+6.3~ ( lc0 are significantly higher than the quoted literature error of +0.8~ This is due to both the inclusion of the third variable and the poor fit of the sample data to the conceptual model. When solving for fractionation in the Pannonian basin and San Juan data, we demonstrate that optimal recharge salinity for the combined data is now within error of meteoric water (Fig. 1). Palaeotemperature errors range between _+0.4 to _+2.5~ and _+0.8 to +2.4~ respectively. In both cases the data show a significant degree of improvement in the fit of the data to the model, the conceptual model is statistically consistent with both data sets, young samples are within error of the current day recharge temperatures, and samples previously considered outliers now agree with samples in the same age bracket. Despite the incomplete fit to the tropical Brazil data, it would appear that diffusive gas loss, at the very least, provides a necessary and reasonable proxy to this seemingly ubiquitous aquifer fractionation process.

Correlations Between Objective Measures of Function and a Clinical Knee Rating Scale Following Total Knee Replacement

Few objective measurements of function, other than range of motion, have been reported for patients with total condylar knee replacement. Moreover, to our knowledge, no studies have been reported which assess the degree of relationship between clinical ratings and measurements of function in these patients. Kinesiologic tests of function and the Hospital for Special Surgery (HSS) Knee Rating Form were used to evaluate 34 patients before and 2 years after 39 total condylar knee replacements. Prosthetic alignment was also evaluated postoperatively. The kinesiologic studies showed postoperative improvement in muscle strength, weight-bearing ability, and use of assistive devices, and in velocity, knee flexion-extension, and lateral head motion during walking. A moderate but significant degree of improvement was measured by the HSS score. Correlation coefficients showed that the postoperative knee rating score was significantly related to almost all of the postoperative objective measurements of function. Correlation coefficients between the prosthetic alignment scores and measurements of function were not statistically significant. The study strengthens the validity of use of the HSS Knee Rating Form as a tool for evaluating functional performance, particularly during the postoperative period.

How to Make a Token System Fail

A token system was instituted in an adjustment class of six third and fourth graders. The aim of the study was to examine aspects of token systems critical in making them effective. The results indicated a significant degree of improvement in behavior attributable to the token program, but when compared to the highly effective program reported by O'Leary and Becker (1961), it is apparent that an effective program requires more than tokens and back up reinforcers.

Fascia Lata Transfer to the Erector Spinae for the Treatment of Flexion-Abduction Contractures of the Hip in Patients with Poliomyelitis and Meningomyelocele

Twenty patients with hip-flexion contractures related to the residua of poliomyelitis and nine patients with similar contractures secondary to meningomyelocele were treated by transferring the fascia lata to the erector spinae muscle. In many of these patients, tight structures anterior to the hip were released concomitantly. The operation was found to be an effective procedure for relief of hip flexion and abduction deformity and of lumbar lordosis. This relief appeared to be permanent. Better results were obtained when the fascia lata transfer to the erector spinae was combined with an anterior release at the hip. Most patients with dislocated or subluxated hips were improved and their hips became more stable. No significant degree of improvement was observed in the extensor or abductor power of the hip. Few of the patients were able to discard any part of their braces or their crutches. The operation appeared to produce a dynamic fasciodesis. Relief of hip-flexion contracture, stabilization of the hip, and relief of lumbar lordosis resulted in a better stance and easier gait. The operation was as effective in patients with meningomyclocele as in those with residua of poliomyclitis.

The effects of chlordiazepoxide (librium) in anxiety states. A multi-blind study.

1. Chlordiazepoxide (Librium) was studied in a setting which was called “multi-blind” because of the establishment of (a) a pharmacotherapeutic blind unit, and (b) multiple observer assessment. 2. Ninety-two patients (75 neurotics and 17 psychotics) received Librium with an average daily dose of 70 mgm. for an average period of three weeks. A second group of 92 patients (75 neurotics and 17 psychotics) received placebo. The selection of patients was at random. Fifteen additional patients were taken as their own control and received placebo and Librium sequentially. The common major target symptoms in all patients were anxiety and tension, and the aim of the study was to determine the effect of Librium on these symptoms. 3. Out of 75 neurotics receiving Librium, 35 patients (46.3%) showed from marked to moderate improvement, while out of 75 patients receiving placebo, 6 (8%) showed comparable degree of improvement. X2 analysis of the data indicated that the results with Librium were significant at P &lt; 0.001 level. Divided into sub-groups, only anxiety states and mixed states showed statistically significant degree of improvement (0.01 &gt; P &gt; 0.001). Out of 17 psychotics in both categories, the degree of improvement was not significant. In 15 patients taken as their own control, Librium showed a statistically significant superiority over placebo at 0.01 level. 4. Side effects were rather mild in the majority of cases and consisted of head-aches, dizziness, tremors, weakness, drowsiness, nausea and vomiting, and palpitations. One patient developed ataxia, which disappeared after the discontinuation of the drug. 5. The general conclusion was that Librium is an adequate anti-anxiety and anti-tension substance in neurotic patients, solely in anxiety reactions and mixed states.