Significant Mean Increase Research Articles

Using a Serious Game to Teach Central Line Care in Pediatric Critical Care Nursing.

Central venous catheters (CVCs) are used in pediatric patients to deliver IV fluids, blood products, medications, and nutrients. Potential complications include central line infection, which carries a high risk of morbidity and mortality in this population. Pediatric critical care nurses play a crucial role in helping to reduce the risk of infection. The aim of this study was to develop, implement, and evaluate the effectiveness of a serious, simulated, gaming-based intervention to improve the skills and knowledge of RNs in the early stages of their career regarding central line insertion, care, and infection prevention. A single-arm, pre- and postinterventional pilot study was conducted at the Riley Hospital for Children at Indiana University Health, from July 2021 to July 2022. The study participants were bedside pediatric critical care nurses who were provided with education and skills training regarding CVC placement and maintenance through a so-called serious game-essentially, a video game with a purpose. A simulation session and multiple-choice knowledge test were used to assess skills and knowledge retention both before and after the intervention. A total of 32 pediatric critical care nurses participated in the study; however, 1 nurse did not complete the follow-up assessment. The study revealed a statistically significant increase in the overall mean (SD) global performance score from 4.06 (2.11) before the intervention to 5.97 (1.80) afterward. Specific areas of performance also showed significant improvement: handwashing prior to the procedure (P = 0.04), covering the procedure site (P = 0.01), cleaning the site properly (P < 0.01), and ensuring central line placement before use (P < 0.01). However, there was no statistically significant difference in the nurses' performance on the multiple-choice knowledge test before and after the intervention. This study suggests that serious games have the potential to improve nursing education, particularly in complex procedures like central line insertion and maintenance. Our findings indicate that serious gaming is effective in engaging learners and enhancing their skills. More research is needed to evaluate the long-term impact of serious games on learning outcomes and patient care.

Effect of long and short half-life PDE5 inhibitors on HbA1c levels: a systematic review and meta-analysis.

Phosphodiesterase 5 (PDE5) inhibitors, owing to their mechanism of action, have been gaining recognition as a potential case of drug repurposing and combination therapy for diabetes treatment. We aimed to examine the effect of long and short half-life PDE5 inhibitors have on Haemoglobin A1c (HbA1c) levels. A systematic review and meta-analysis was conducted of randomised controlled trials (RCTs) in people with elevated HbA1c (>6%) to assess mean difference in HbA1c levels from baseline versus controls after any PDE5 inhibitor intervention of ≥4 weeks, excluding multiple interventions. Cochrane CENTRAL, PMC Medline, ClinicalTrials.gov, and WHO ICTRP were searched without language restrictions up to September 30, 2024. Summary data from published data were extracted. PRISMA and Cochrane guidelines used to extract and assess data using a random-effects meta-analysis. This study is registered with the Research Registry, reviewregistry1733. Among 1096 studies identified, in analysis of 13 studies with 1083 baseline patients, long half-life PDE5 inhibitors (tadalafil, PF-00489791) had decreases in HbA1c while short half-life PDE5 inhibitors (sildenafil, avanafil) had no change. Five (38.5%) studies had a low risk of bias, and eight (61.5%) had some concerns. Long half-life inhibitors had significant mean decrease of-0.40% ([-0.66,-0.14], p=0.002, I2=82%, 7.70% baseline HbA1c). Short half-life inhibitors had insignificant mean difference of+0.08% ([-0.16, 0.33], p=0.51, I2=40%, 7.73% baseline HbA1c). In ≥8-week trials with participants with type 2 diabetes (T2D) and mean HbA1c≥6.5%, long half-life inhibitors had significant mean decrease of-0.50% ([-0.83,-0.17], I2=88%, p=0.003); short half-life inhibitors had significant mean increase of+0.36% ([0.03, 0.68], I2=3%, p=0.03). At the well-controlled HbA1c of the participants, previous literature shows current diabetes treatments have similar HbA1c decreases, so the HbA1c mean difference of long half-life PDE5 inhibitors may indeed be clinically relevant. This suggests future investigation into PDE5 inhibitors as part of combination therapy or as therapy for high HbA1c individuals is needed, especially because of variable risk of biases, homogeneity, and sample sizes in our study. None.

Right ventricular function outcomes of percutaneous balloon mitral valvuloplasty: a 3-dimensional echocardiography and 2-dimensional speckle tracking analysis

Abstract Background Rheumatic heart disease (RHD) is a significant cause of mitral stenosis (MS), particularly affecting young adults in developing regions. Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a recognized intervention for severe symptomatic mitral stenosis with favorable morphology. However, its impact on various cardiac parameters needs thorough evaluation by new imaging techniques to increase measurement accuracy and decrease inter-observer variability. Purpose This study aims to evaluate the impact of PBMV on cardiac function and structure among patients with severe rheumatic mitral stenosis, focusing on mitral valve function, Pulmonary artery systolic pressure (PASP) and right ventricular (RV) parameters. Methods A prospective study was conducted involving 30 patients (80% female, mean age 33.1 years) diagnosed with severe rheumatic mitral stenosis. All participants underwent PBMV. Pre- and 30 days post-procedure assessments included conventional echocardiographic parameters, three-dimensional (3D) RV assessment and two-dimensional (2D) strain RV analysis. Statistical analyses were performed to determine significant changes post-PBMV. Results Echocardiographic evaluation showed a decrease in trans-mitral mean pressure gradient and Pressure Half Time (both P&amp;lt;0.001). Improvements were also noted in 2D and 3D mitral valve planimetry values (P&amp;lt;0.001). However, mitral regurgitation (MR) severity increased in some cases (P=0.022). Regarding right ventricular analysis, significant reductions were observed in RV basal, mid and longitudinal diameters (P&amp;lt;0.001 for all). RV Fractional Area Change (FAC%) increased significantly (P&amp;lt;0.001). TAPSE also showed a significant increase (P&amp;lt;0.001), reflecting improved RV functional performance. PASP and TR severity both showed marked reductions (P&amp;lt;0.001), whereas a subgroup analysis indicated that patients with atrial fibrillation (AF) had a less pronounced decrease in PASP compared to those with sinus rhythm. Strain analysis revealed substantial improvements in RV strain parameters, with significant increases in basal, mid, apical, and mean (RVFW) free wall strain (P&amp;lt;0.001) and RV global longitudinal strain (RV GLS) (P&amp;lt;0.001). 3D echocardiography demonstrated significant decreases in RV end-systolic volume (P=0.004) and marked increases in RV EF ejection fraction (P&amp;lt;0.001) and stroke volume (P&amp;lt;0.001), while end-diastolic volume showed no significant change (P=0.061). the study demonstrates that the decline in PASP can significantly predict improvements in both 2D and 3D RV function parameters following PBMV. Conclusion RV performance showed substantial improvement early post-PBMV, as evidenced by marked increases in 3D right ventricular ejection fraction (3DRVEF), right ventricular free wall (RVFW) strain, and RV global longitudinal strain. These enhancements were significantly predicted by the reduction in pulmonary artery systolic pressure (PASP). RV conventional Echocardiographic Parame RV 3D echocardiography and 2D speckle tr

The effectiveness of varying of Tideglusib gel concentrations in ridge preservation of osteoporotic models

Background: Repairing impaired hard tissues in osteoporotic patients posed challenges with restricted treatment modalities. Meanwhile, Tideglusib is regarded as an exciting treatment for Alzheimer's disease; its applications for ridge preservation in osteoporotic rabbits are not investigated. The aim of this research was to investigate the effects of Tideglusib gel in osteoporotic rabbits with empty sockets. Thirty-two male rabbits weighing 2.5 - 3 kg were used for the study. Then the mandibular first molar of each rabbit was extracted. The rabbits were allocated into 4 study groups: 1. Control normal rabbit with socket healed normally; 2. Osteoporotic rabbit with socket healed normally; 3. Osteoporotic rabbit with socket received 5 μM Tideglusib gel; 4. Osteoporotic rabbit with socket received 10 μM Tideglusib gel. At four weeks, the rabbits were then slaughtered. To assess the bone development in the extraction sockets, histopathologic and histomorphometeric analysis were carried out.Results: After 4 weeks of socket augmentation, a significant increase in mean % of mature bone (MB) in the control group and two treated groups. While Group 2 showed the significantly lowest mean % increase in MB. Also, a significantly mean % increase of collagen deposition was generated in all study groups. However, group 2 showed the statistically significantly lowest mean % increase. Group 4 demonstrated significantly higher new bone formation than those of groups 2 and 3.Conclusion: Tideglusib gel could accelerate bone healing through an increase in the trabecular area and elevate collagen deposition in the extracted socket of a rabbit. A specific dose-dependent response of Tideglusib gel was observed in histological and morphometric parameters, indicating that 10 μM of Tideglusib gel is considered an effective rational therapy for post-extraction socket repair, particularly in the osteoporotic model.

Cresp®: transforming the landscape of chemotherapy-induced anemia - a comprehensive retrospective real-world analysis in 523 Indian patients

IntroductionAnemia, a frequently encountered issue among cancer patients undergoing chemotherapy, is regrettably underappreciated despite its prevalence and profound impact on their well-being. Chemotherapy-induced anemia (CIA) diminishes the quality of life, causing fatigue, breathlessness, and a decline in the performance status. However, correcting anemia can lead to notable improvements in these parameters. Notably, darbepoetin alpha (DA) has shown efficacy in addressing anemia in this context. This real-world study aims to evaluate the efficacy of DA in the treatment of CIA among Indian cancer patients.MethodsThis single-center retrospective study assessed the effectiveness of DA in treating CIA among advanced/metastatic solid tumor patients on palliative myelosuppressive therapy. The study measured the change in hemoglobin levels after DA administration as the primary outcome, with secondary outcomes including impact on blood transfusion dependence, changes in anemia-related symptoms, and occurrence of adverse events.ResultsA total of 523 patients, with a median age of 55, were included in the study. Patients were categorized based on cancer site, type of chemotherapy, response to therapy, and DA doses. A significant mean increase of 2.28 gm/dl in hemoglobin (Hb) levels from baseline to post-DA administration was observed (8.56±0.45 to 10.84±0.92; 26.6%; P&amp;lt;.001). Each sub-group revealed a significant enhancement of mean hemoglobin from baseline to the end of treatment. Significant improvements were noted from baseline in fatigue, and dyspnea. Adverse drug reactions included hypertension (5.4%), deep vein thrombosis (2.9%), and arrhythmias (0.8%).DiscussionDA demonstrates impressive efficacy and safety in managing CIA, leading to substantial improvements in mean hemoglobin levels in palliative setting. This has the potential to reduce the need for blood transfusions and enhance the quality of life for patients.

DLBCL cells with ferroptosis morphology can be detected with a deep convolutional neural network.

It has been demonstrated that diffuse large B-cell lymphoma (DLBCL) is especially sensitive to ferroptosis. Currently, confirming the presence of ferroptosis requires flow cytometry, which is a time consuming and labor-intensive task. Blistering of the cell membrane has been shown to be a ferroptosis-specific morphological change. In this study we developed a deep convolutional neural network to detect the blistering of cell membrane. Buthionine sulfoximine treatment increased the percentage of blistering cells from 2 % to 38 % (p < 0.001) when glutathione was deprived from the culture media. Ferrostatin-1 treatment completely reversed the effect. Imidazole ketone erastin (IKE) and auranofin treatment increased blistering cells gradually in dose response manner from 5.4 % to 18.1 % (p < 0.05) and 6.1-50.1 % (p < 0.0001) respectively. We also tested malignant melanoma and breast cancer cell lines to confirm that the blistering phenomena can also be observed in adherent cell lines. We used fluorescence-activated cell sorting to measure the lipid peroxidation associated with ferroptosis and found a significant increase of bodiby-C11oxidized mean compared to DMSO controls for IKE (345 vs 462, p < 0.01) and auranofin (345 vs 686.5, p < 0.05).

Surgical Timing for Patients with Thyroid Eye Disease Treated with Teprotumumab: A Collaborative Multicenter Study.

To compare regression rates, characteristics, and surgical outcomes of thyroid eye disease patients who underwent orbit, strabismus, or eyelid surgery at various times during or after teprotumumab treatment. Multicenter, retrospective, observational cohort study. Adult patients (age >18) with a minimum of 4 infusions of teprotumumab treatment for thyroid eye disease who had had eye surgery during or after treatment. Two groups were formed based on surgery timing: group 1 (G1) (<180 days since last infusion) and group 2 (G2) (≥180 days since last infusion). The primary outcome was postoperative regression rates. Secondary outcomes were postoperative regression characteristics, regression treatment, and orbital decompression proptosis reduction. This study evaluated 53 patients (81% female) who underwent 78 surgeries. G1 comprised 24 individuals with 34 surgeries, while G2 comprised 29 patients with 44 surgeries. Regression rates did not significantly differ between G1 and G2 (20.8% vs. 14.7%, p = 0.611). Compared with G1 patients, patients in G2 who regressed showed a significant mean increase in Clinical Activity Score (4.2 vs. 6.1, p = 0.027) and a nonsignificant yet measured increase in proptosis when compared with those in G1 (2.9 vs. 4.25, p = 0.298) at the time of regression. Compared with G1 patients, G2 patients who regressed were equally likely to undergo a repeat course of teprotumumab as group 1 (p = 0.14) but underwent a higher number of additional surgical procedures (p = 0.057). Thyroid stimulating immunoglobin levels uptrended more often in patients who regressed. Our study suggests that while the rate of regression may not differ significantly, the severity, clinical impact, and need for additional surgery might be more pronounced for patients who have surgery more than 6 months after their last teprotumumab dose.

Immediate Postoperative Changes After Expansion Pharyngoplasty and Hypoglossal Nerve Stimulation.

Patients with obstructive sleep apnea (OSA) are at an increased risk for perioperative cardiopulmonary complications. Our objective was to assess the postoperative effects of hypoglossal nerve stimulation implantation (HGNS) and expansion pharyngoplasty (EP) on longitudinal sleep apnea measures as a surrogate for respiratory complications. Prospective longitudinal cohort study of patients with OSA undergoing HGNS or EP. Sleep studies were performed with the NightOwl Mini peripheral arterial tonometry (PAT) device. Changes in apnea-hypopnea index (AHI) and oximetry time below 90% (T90) were assessed between two baseline PAT studies prior to surgery and nightly PAT studies for the first postoperative nights (PON) 1-7, 10, and 14. Thirty patients were enrolled (19 HGNS, 11 EP). The mean age was 52.6 years, 76.7% were male, and the mean clinical baseline AHI was 29.8/h. There were no significant changes in the AHI or T90 following HGNS implantation. Following EP, there was a statistically significant mean increase in AHI of +19.2/h on PON1, +24.9/h on PON2, and + 20/h on PON3 compared to baseline. T90 was also elevated after EP on PON1, 4, and 5. The mean increase in T90 was +7.4% (95% CI 2.9, 11.9) on PON1 compared to baseline. In the immediate postoperative period, there were no significant changes in AHI or hypoxemia after HGNS, suggesting that there is no need for routine overnight observation after HGNS. There were significant increases in AHI and hypoxemia after EP suggesting that postoperative disposition should be considered on a case-by-case basis. III Laryngoscope, 2024.

Increasing solar UV radiation in Dortmund, Germany: data and trend analyses and comparison to Uccle, Belgium.

Increasing solar ultraviolet radiation (UVR) can raise human exposure to UVR and adversely affect the environment. Precise measurements of ground-level solar UVR and long-term data series are crucial for evaluating time trends in UVR. This study focuses on spectrally resolved data from a UVR measuring station in Dortmund, Germany (51.5° N, 7.5° E, 130m a.s.l.). After a strict quality assessment, UV data, such as the daily maximum UV Index (UVImax) and daily erythemal radiant exposure (Her,day) values, were analyzed concerning monthly and annual distribution, frequency, occurrence of highest values and their influencing factors. An advanced linear trend model with a flexible covariance matrix was utilized and applied to monthly mean values. Missing values were estimated by a validated imputation method. Findings were compared to those from a station in Uccle, Belgium (50.8° N, 4.3° E, 100m a.s.l.). Parameters possibly influencing trends in both UVR and global radiation, such as ozone and sunshine duration, were additionally evaluated. The 1997-2022 trend results show a statistically significant increase in monthly mean of Her,day (4.9% p. decade) and UVImax (3.2% p. decade) in Dortmund and Her,day (7.5% p. decade) and UVImax (5.8% p. decade) in Uccle. Total column ozone shows a slight decrease in the summer months. Global radiation increases similarly to the UV data, and sunshine duration in Dortmund increases about twice as much as global radiation, suggesting a strong influence of change in cloud cover. To address health-related consequences effectively, future adaptation and prevention strategies to climate change must consider the observed trends.

Comparative analysis of ferric carboxymaltose and iron sucrose in treating iron deficiency anemia in perimenopausal women with heavy menstrual bleeding: a randomized controlled trial.

To evaluate the impact of intravenous ferric carboxymaltose (FCM) compared to iron sucrose (ISC) in perimenopausal women with heavy menstrual bleeding (HMB) and anemia. This prospective, open-label, randomized controlled trial enrolled perimenopausal women (40-50 years) with HMB and hemoglobin levels between 6-10 g/dL, intolerant or non-compliant to oral iron therapy. The study compared FCM and ISC by assessing hematological parameters, including hemoglobin, ferritin, and iron levels, over a 12-week period. The patients were followed up at 3, 6, and 12 weeks after initiation. The adverse effects were also evaluated. The study included 60 perimenopausal women, with 30 in each group. The baseline patient characteristics were comparable. FCM demonstrated a statistically significant higher mean increase in hemoglobin (4.97 g/dL) than ISC (4.63 g/dL) over 12 weeks. The proportion of patients achieving correction of anemia (hemoglobin ≥12 g/dL) was higher in the FCM group (75.9% vs. 65.5%). Serum ferritin levels were significantly higher in the FCM group after 3 weeks. Adverse effects were minimal and comparable between the groups. Although the direct cost of FCM is high, its ability to be administered in larger doses may result in lower total costs. In perimenopausal women with heavy menstrual bleeding and iron deficiency anemia, FCM and ISC show comparable efficacy in increasing hemoglobin levels with similar side effect profiles. This study highlights the potential benefits of FCM and calls for further exploration of these therapies in diverse patient populations.

Leveraging Nudge Theory to Promote Adult Gesture Use During Read-Aloud Experiences With Young Children

Nudge theory, a strategy to influence decision-making, holds promise for enhancing an adult’s use of evidence-based strategies during a read-aloud experience with a young child. This study examined the effectiveness of a nudge theory approach in increasing adult gesture use during a book-reading activity with a young child. Notably, 31 adult–child dyads participated in two conditions of a read-aloud experience. In the control condition, adults were provided with a book without gesture prompts. In the experimental condition, adults were provided with a children’s book containing prompts for gesture use. Using a paired-samples t-test, adults demonstrated a statistically significant mean increase in gesture use of 27.93, 95% CI = [19.00, 36.87], t(29) = 6.39, p &lt; .001 when nudges were available. This study provides preliminary evidence that a nudge theory approach can effectively enhance adults’ gesture use during a read-aloud experience with young children.

Effects of long-term transcutaneous auricular vagus nerve stimulation on circadian vagal activity in people with Prader-Willi Syndrome: A case-series

BackgroundPrader-Willi Syndrome (PWS) is a genetic neurodevelopmental disorder marked by disruptions in circadian rhythms and autonomic nervous system (ANS) activity, hyperphagia, and episodes of emotional outbursts. Previous trials suggest that both invasive and non-invasive vagus nerve stimulation (VNS) can reduce emotional outbursts in PWS, potentially through its effects on vagal activity. AimThis case series investigated the effects of transcutaneous auricular VNS (taVNS) on cardiac markers of circadian vagal activity, specifically heart rate variability (HRV) and heart rate (HR), and their potential links to improvements in emotional outbursts. MethodsFive individuals with PWS (mean age: 26.9 years; 3 males, 2 females) received four hours of daily taVNS for 12 months, followed by one month of two-hour daily sessions. Outcome measures included daily recording of emotional outbursts and every three months 24-h HRV and HR recordings. Mixed cosinor models were applied to analyze changes in circadian rhythms of HRV and HR. A linear mixed model was used to assess the predictive value of cardiac vagal activity on emotional outbursts. ResultsCircadian amplitudes of HRV and HR were significantly higher at the end of the treatment compared to baseline (all p’s < .01). There was a significant increase in the rhythm-adjusted mean of HRV (p < .01), while the rhythm-adjusted HR mean significantly decreased, both indicating increased cardiac vagal activity. Higher rhythm-adjusted mean HRV predicted a lower number of emotional outbursts. ConclusionThe results suggest that taVNS may be effective by targeting ANS activity in individuals with PWS, contributing to improvements in behavioral regulation.

Fluid bolus resuscitation with hypertonic saline albumin solution in critically ill children: a prospective observational pilot study

To evaluate the hemodynamic effects and the safety profile of fluid bolus resuscitation with hypertonic saline albumin (HSA) in critically ill children, we performed a prospective observational pilot study between October 2018 and May 2021 in the pediatric intensive care unit (PICU) in a tertiary hospital in Madrid, Spain. Sixty-four HSA boluses were analyzed in 23 patients. A mean volume of 5.7 ml/kg (Standard Deviation, SD 2.3 ml/kg) per bolus was infused. Acute hypotension was the main indication. 91% of the patients had a cardiac disease, 56% of them had undergone cardiac surgery in the previous 72 h, and 47.8% associated right ventricular dysfunction. A significant increase in systolic, mean, and diastolic blood pressure and a decrease in the vasoactive index was observed after the infusion of HSA. This effect lasted for twenty-four hours (p < 0.05). Moreover, the amount of fluid requirements decreased significantly in the 6 h following HSA infusion [8.7 ml/kg (SD 9.6) vs. 15.1 ml/kg (SD 13.6) in the previous 6 h (p < 0.05)]. Serum levels of sodium and chloride increased after the infusion, reaching their peak concentration after one hour (143 mEq/L (SD 3.5) and 109.7 mEq/L (SD 6) respectively). HSA-related metabolic acidosis or acute kidney injury were not observed in this study. Hypertonic saline albumin is safe and effective when infused at a dose of 5 ml/kg in critically ill children. However, further research is required to confirm our findings.

Missing School Days Following Sport-Related Concussion in High School Athletes

Sport-related concussions (SRC) can significantly impact students' attendance and academic performance, highlighting the importance of gradual return-to-learn protocols for recovery. Understanding the association between missed school days and recovery, especially across genders, is vital for effective concussion management in high school athletes. To describe missed school days in high school athletes with SRC and to determine associations between missed school days and authorized clearance to return to competition; secondarily, to determine whether school days missed differed by gender. Cohort study among student athletes participating in athletics sponsored by the Michigan High School Athletic Association (MHSAA) during academic years 2015 to 2023. SRC was a participant eligibility criterion and was defined as a head injury during participation in a MHSAA-sanctioned event. Data were analyzed from August 2015 to June 2023. Primary exposure was missed school days; additional exposures included gender, year of season, concussion history, event type, sport level, contact level, and athletic trainer involvement. The primary outcome was time to full unrestricted clearance following SRC. The analysis included a total of 20 934 individuals with SRC (13 869 boys [66.25%]). Gender (χ23 = 167.40; P < .001), season (χ221 = 57.41; P < .001), event type (χ23 = 99.29; P < .001), sport level (χ29 = 68.15; P < .001), contact level (χ26 = 56.73; P < .001), and initial evaluation (χ23 = 147.13; P < .001) were independently associated with missed school days. Athletes took a median (IQR) of 11 (7-16) days to return to full unrestricted clearance. Relative to no missed school days, there was a significant mean increase of 57% (incidence rate ratio, 1.57; 95% CI, 1.52-1.62) in time to full unrestricted clearance for 3 or more missed school days. The estimated mean days to return to sport were 12.15 (95% CI, 12.00-12.30) for 0 missed school days, 12.68 (95% CI, 12.39-12.96) for 1 missed school day, 15.47 (95% CI, 15.06-15.87) for 2 missed school days, and 19.08 (95% CI, 18.55-19.62) for 3 or more missed school days. This cohort study found that high school athletes typically missed 2 or fewer school days after SRC, suggesting that concussion management teams adhered to current recommendations of 24 to 48 hours of initial rest. The dose association, with more missed school days associated with slower return to play, suggests athletes' missing more school days (eg, ≥3) may be associated with severity of concussion and warrant additional support to return to school and/or sport.

Five-year radiological outcomes between decompression alone and decompression with an interlaminar device for lumbar spinal stenosis.

There is limited literature regarding radiological outcomes in the use of interlaminar devices as an adjunct to decompression compared to decompression alone (DA) for symptomatic lumbar spinal stenosis (LSS). This study aims to assess and compare 5-year radiological outcomes following spinal decompression and decompression with ILD (D + ILD). We conducted a retrospective review of prospectively collected data of 94 patients who underwent spinal decompression with or without ILD insertion between 2007-2015. Patients with symptomatic LSS who met the study criteria were offered spinal decompression with or without ILD insertion. Those patients who accepted ILD insertion were placed in the D + ILD group (n=39); while those opting for DA, were placed in the DA group (n=55). Radiological indices were assessed preoperatively, immediate post-operative, 2 years and 5 years postoperatively. There were a total of 94 patients with 55 in the DA group and 39 in the D + ILD group. In both groups, there was no significant change post-operatively in the sagittal balance parameters namely, the mean pelvic incidence, pelvic tilt, sacral slope and pelvic incidence minus lumbar lordosis (PI - LL) during the 5-year follow-up. Comparing between the groups, there was no significant difference in sagittal balance parameters. Comparing between DA versus D + ILD, there was no significant difference in overall lordosis, but the D + ILD had a significant reduction in sagittal angle (at the index level) of 2.3° compared to the DA group (P=0.01). In the control group, there was no significant difference in the anterior disc, posterior disc and foraminal height post-operatively. In the D + ILD group, there was a significant mean increase of 1.3 mm in anterior disc height, 1.8 mm in posterior disc height and 4.7 mm in foraminal height compared to the control group. In both groups, there was significant improvement in all clinical outcomes namely 36-item short form survey physical component summary (SF36 PCS), 36-item short form survey mental component summary (SF36 MCS) and visual analogue scale (VAS). Comparing the groups, there was significant improvement in the D + ILD group in SF36 MCS (P=0.01) but no difference in SF36 PCS or VAS. Reoperation rates were equivalent. Our study found that in the management of lumbar stenosis, the use of an ILD as an adjunct device compared to DA had significant improvement in anterior disc, posterior disc and foraminal height with expected focal kyphosis at the level of intervention without change in the lumbar lordosis and sagittal balance at 5 years.

Memory problems in elderly people with traumatic brain injury

AbstractThe aim of this study is to assess the effectiveness of various therapy methods in elderly individuals with traumatic brain injury (TBI), taking into account the degree of memory loss and the severity of the injury. The study was conducted in 2022 in Moscow, Russia, and Sofia, Bulgaria, involving six clinics. A total of 200 elderly patients with TBI participated in the study, with a mean age of 72 years. Patients were categorized into groups based on the degree of memory loss and severity of the injury. Standardized tests, including the Mini‐Mental State Examination (MMSE), Clock Drawing Test, Digit Symbol Substitution Test, and Free, and Cued Selective Reminding Test, were used to assess cognitive functions. The Progressive Learning Test evaluated patients' ability to memorize and reproduce information over time. Groups receiving physical therapy and cognitive rehabilitation showed statistically significant improvement in cognitive functions compared to other therapy methods. Specifically, the mean score of the MMSE in these groups increased by 7 points (p &lt; .001). Patients with more severe memory loss demonstrated more pronounced improvement in cognitive functions following the integrated therapy approach. The mean MMSE score increased by 10 points (p &lt; .001), whereas in patients with milder memory loss, the growth was less significant (mean increase of 5 points, p &lt; .05). Groups receiving physical therapy and cognitive rehabilitation consistently demonstrated significantly better results compared to speech therapy and psychological support throughout the study period.

Surgeon stress, anxiety, and workload: a descriptive study of participant reported responses to fundamentals of laparoscopic surgery exercises

BackgroundStress while operating is an important contributor to surgeon health and burnout. Measuring stress is key to improving surgeon and patient outcomes, however biological responses to stress during surgery are variable and difficult to interpret. Participant reported measures of stress have been suggested as an alternative, but the most appropriate measure has not been defined. This study’s primary aim was to assess measures of anxiety, stress, and workload before and after surgical simulation and characterize the relationship between these measures.MethodsSurgeons completed three laparoscopic exercises from the fundamentals of laparoscopy program (peg transfer, pattern cutting, intracorporeal suturing) in a neutral environment and “stressed” environment (ergonomic, noise, or time pressure). State trait anxiety and self-reported stress on a visual analogue scale were collected prior to simulation and again immediately afterwards. The NASA task load index (TLX) was also administered post-simulation.ResultsOf the 26 participants from gynecological and general surgery specialties, state anxiety increased in 98/148 simulations (62%) with a significant mean increase during simulation (32.9 ± 7.9 vs 39.4 ± 10.2, p < .001). Self-reported stress increased in 107/148 simulations (72%), with a significant increase in mean scores during simulation (38.7 ± 22.5 vs 48.9 ± 23.7, p < .001). NASA-TLX scores immediately after simulation ranged from 40 to 118 (mean 60.5 ± 28.7). Greater anxiety and stress scores were reported in “stressed” simulations (43.6 ± 23.1 vs 54.2 ± 23.3; 68.7 ± 27.0 vs 52.4 ± 28.2 respectively) with a significant interaction effect of the “stressed” environment and type of exercise. Anxiety and stress were moderately positively correlated prior to simulation (r = .40) and strongly positively correlated post-simulation (r = .70), however only stress was strongly correlated to workload (r = .79).ConclusionStress and anxiety varied by type of laparoscopic exercise and simulation environment. Correlations between anxiety and stress are stronger post-simulation than prior to simulation. Stress, but not anxiety, is highly correlated with workload.Graphical

Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study

Background: Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus. Hypothesis: Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy. Study Design: Controlled laboratory study. Methods: Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint. Results: Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° (P = .008 and P < .001, respectively), increased peak contact pressure at 30° (P = .04), and decreased mean contact area in all flexion angles compared with the native condition (P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° (P = .002 and P = .003, respectively) and increased contact area at 30° and 60° (P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy (P > .05). Conclusion: The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status. Clinical Relevance: Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.

The Effect of Educational Intervention on Knowledge, Attitude, and Practices Regarding Colorectal Cancer Screening Practices Among Nursing Students in Jordan.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. This study aimed to examine the impact of an educational intervention on nurses' knowledge, attitude, and practice regarding CRC screening in Jordan. The study was an experimental design conducted before and after the educational intervention. Participants attended four 30-minute sessions held weekly over one month. A paired t-test was used to determine the mean difference in participants' knowledge, attitude, and practice regarding CRC screening before and after the intervention. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY). A total of 43 participants took part in the study, of whom 29 (67.4%) were female and 14 (32.6%) were male. The majority (30, 69.8%) were aged between 20 and 30 years. The results showed a significant mean increase in knowledge (mean difference [MD] = 3.09, P < 0.001), attitude (MD = 4.16, P < 0.001), and practice (MD = 2.67, P < 0.001) regarding CRC screening following the intervention. The implementation of health education about CRC screening for the study participants was successful based on the results. This strategy could provide a solid basis for organizing, implementing, and supervising CRC screening initiatives.

Setrusumab for the treatment of osteogenesis imperfecta: 12-month results from the phase 2b asteroid study.

Osteogenesis imperfecta (OI) is a rare genetic disorder commonly caused by variants of the type I collagen genes COL1A1 and COL1A2. OI is associated with increased bone fragility, bone deformities, bone pain, and reduced growth. Setrusumab, a neutralizing antibody to sclerostin, increased areal bone mineral density (aBMD) in a 21-week phase 2a dose escalation study. The phase 2b Asteroid (NCT03118570) study evaluated the efficacy and safety of setrusumab in adults. Adults with a clinical diagnosis of OI type I, III, or IV, a pathogenic variant in COL1A1/A2, and a recent fragility fracture were randomized 1:1:1:1 to receive 2, 8, or 20mg/kg setrusumab doses or placebo by monthly intravenous infusion during a 12-mo treatment period. Participants initially randomized to the placebo group were subsequently reassigned to receive setrusumab 20mg/kg open label. Therefore, only results from the 2, 8, and 20mg/kg double-blind groups are presented herein. The primary endpoint of Asteroid was change in distal radial trabecular volumetric bone mineral density (vBMD) from baseline at month 12, supported by changes in high-resolution peripheral quantitative computed tomography micro-finite element (microFE)-derived bone strength. A total of 110 adults were enrolled with similar baseline characteristics across treatment groups. At 12mo, there was a significant increase in mean (SE) failure load in the 20mg/kg group (3.17% [1.26%]) and stiffness in the 8 (3.06% [1.70%]) and 20mg/kg (3.19% [1.29%]) groups from baseline. There were no changes in radial trabecula vBMD (p>05). Gains in failure load and stiffness were similar across OI types. There were no significant differences in annualized fracture rates between doses. Two adults in the 20mg/kg group experienced related serious adverse reactions. Asteroid demonstrated a beneficial effect of setrusumab on estimates of bone strength across the different types of OI and provides the basis for additional phase 3 evaluation.