Six-month Follow-up Research Articles

An intensive eye-tracking intervention in children with dyskinetic cerebral palsy: a multiple case study

This study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers’ perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.

Recent evaluation and analysis of the clinical effect of two closed treatment methods in children with intracapsular condyle fracture

Objective: To summarize and analyze clinical characteristics of pediatric mandibular condylar fractures and the long-term therapeutic effects of closed treatment. Methods: A retrospective study was conducted for pediatric condylar fracture in the Department of Oral and Maxillofacial Surgery of Peking University School and Hospital of Stomatology from October 2015 to October 2019, including 33 males (67.3%) and 16 females (32.7%), with an average age of (8.3±2.1) years old. According to the treatment methods, the children were divided into two groups: group A was a removable occlusal splint accompanied with functional exercise, group B was a pure functional exercise. Forty-nine cases (76 sides) children with intracapsular condylar fracture were included in this study. Twenty-three cases in group A and 26 cases in group B. The maximum month opening increased from (20.0±6.2) mm to (46.0±5.3) mm 6 months after closed treatment. Subjective evaluation, special examination, qualitative analysis and quantitative analysis of imaging were used to evaluate the condylar remodeling and functional recovery of temporomandibular joint in two groups of children after closed treatment of intracapsular condyle fracture. Results: There was no significant difference in subjective evaluation, maximum opening examination, mouth open-type, mandibular protrusion, lateral movement and qualitative analysis of imaging at the six-month follow-up after injury. Quantitative imaging measurements showed that the condylar anteroposterior diameter and condylar height in Group B were significantly higher than those in Group A after 1 year of injury. Conclusions: Closed treatment for pediatric condylar fractures can achieve satisfactory results. After 6 months of injury, the children in the two groups could recover the temporomandibular joint function and promote the condylar adaptative remodeling.

Assessing renal function as a predictor of adverse outcomes in diabetic patients undergoing percutaneous coronary intervention

Background Cardiovascular diseases remain a leading cause of global mortality, particularly among diabetic patients undergoing percutaneous coronary intervention (PCI). Chronic kidney disease (CKD) poses an additional risk in this population. Yet, its specific impact on major adverse cardiovascular events (MACEs), mortality, and triple vessel disease (TVD) post-PCI remains a topic of debate, specifically in patients with type 2 diabetes mellitus (T2DM). Objective This study aimed to examine the impact of renal function on MACE, mortality, and TVD among diabetic patients undergoing PCI. Methods Diabetic patients undergoing PCI were analysed for renal function and outcomes. Participants were stratified by glomerular filtration rate (GFR). Logistic regression and receiver operating characteristic (ROC) analysis assessed associations and predictive capabilities. Results A total of 505 patients enrolled in the study. A significant difference was observed regarding age, creatinine levels, and number of culprit vessels between diabetics with and without CKD. Severe CKD was associated with higher odds of 1-month mortality (OR: 15.694, p value <.001), 1-month MACE (OR: 7.734, p value <.001), and TVD (OR: 3.740, p value <.001). Patients with severe CKD also had significantly higher odds of 6-months mortality (OR: 12.192, p value <.001) and 6-months MACE (OR: 3.848, p value: .001). Moreover, GFR showed significant predictive accuracy for mortality at one- and six-months follow-up (AUC: 0.77 and 0.71, respectively). Conclusions Renal dysfunction, particularly severe CKD, significantly elevates risks of MACE, mortality, and TVD. Strategies to optimise renal function and tailor cardiovascular management could mitigate adverse outcomes in this high-risk population.

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries.

Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns. A multi-centre prospective cohort study across six burn services. Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected. Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns. Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.

Six-month Follow-up Of Fatigue Reduction In Rural Cancer Survivors Participating In A Telehealth Exercise Program

Six-month Follow-up Of Fatigue Reduction In Rural Cancer Survivors Participating In A Telehealth Exercise Program

Urologist-Administered MRI-Guided Transurethral Ultrasound Ablation of the Prostate Using a Mobile Treatment Center: A Case Series

Introduction: Transurethral ultrasound ablation (TULSA) relies on real-time MRI to precisely control the treatment of prostate cancer and avoid side effects. To overcome limited urologist access to MRI, we present a case series on the first use of a mobile TULSA treatment center. Methods: Clinical outcomes were retrospectively reviewed from our institutional database. A mobile MRI scanner was installed next to a surgical hospital, equipped with the ablation system and MRI-compatible anesthesia. Manufacturer testing confirmed that mobile TULSA continued to meet the requirements of fixed installations. Patients underwent preoperative assessment of candidacy for anesthesia and treatment in a mobile MRI setting. Positioning, anesthesia induction, and device placement were performed in the MRI scanner room. The intended ablation zone was delineated by the urologist using magnetic resonance images acquired with treatment devices in place. Ablation was controlled by the treatment software and monitored by the urologist using real-time MRI. A Foley catheter was placed for postoperative drainage; the patients awoke in the mobile MRI before transfer to postanesthesia care unit. Results: Six patients underwent TULSA in the mobile treatment unit, with no intraoperative complications. The median procedure time was 3.2 hours, with workflow improvements during equipment setup, patient positioning, and treatment planning. Contrast-enhanced images confirmed devascularization of the index lesion and successful nerve sparing. Six-month follow-up demonstrated promising PSA and MRI findings, and improvements in lower urinary tract symptoms. Conclusions: TULSA can be safely administered by urologists using a mobile MRI treatment center. Mobile MRI units could be used to expand patient access to TULSA.

Relapse of COVID-19-associated mucormycosis in patients receiving posaconazole as maintenance treatment.

Coronavirus disease 2019 (COVID-19) has been associated with secondary fungal infections such as mucormycosis. We investigated the relapse rate of mucormycosis and its risk factors. A prospective study was conducted on COVID-19-associated mucormycosis (CAM) patients discharged from Imam Khomeini Hospital Complex, Tehran, Iran, from July 2021 to February 2022. Patients who received posaconazole as a step-down therapy were included and examined monthly for six months. A relapsing mucormycosis case was defined as a patient with new clinical or radiological symptoms, confirmed by observing aseptate hyphae in the histopathological examination or tissue culture. The characteristics of patients with and without relapse were analyzed and compared. Seventy-seven patients completed the six-month follow-up after discharge. Most patients were male (n = 46, 59.8%), with a mean age of 53.1 years (median 19-84). The most common underlying diseases were diabetes (52/77, 67.5%), hypertension (33/77, 42.8%), and cancer/chemotherapy (25/77, 32.4%). Seven patients (7/77, 9%) were reported as relapsing cases. There was no difference in demographic features and underlying diseases between the groups. A significant difference was seen in the mean duration of posaconazole consumption between patients with and without relapse (24 ± 4.4 days vs. 49.4 ± 4.3 days, respectively, p = 0.015). The primary orbital involvement was also significantly associated with relapse (p = 0.04). Our findings showed a significant relapse of CAM (9%). A longer duration of posaconazole consumption and completion of treatment for initial orbital involvement in CAM patients are recommended for better patient management and prevention of relapse.

A clinical case of gastrointestinal stromal tumor of the duodenum

Background. Gastrointestinal stromal tumors localized in the duodenum are very rare and account for only 4–5%. They can be asymptomatic, while reaching large sizes and causing dangerous complications. Gastrointestinal stromal tumors of the duodenum are a special problem for diagnosis and treatment. Therefore, it is relevant to highlight the issue of their detection and treatment on the example of the presented clinical case. Purpose – present a description of the literature and present a rare clinical case of gastrointestinal stromal tumor of the duodenum. Material and methods. The patient, a 49-year-old woman, was diagnosed with a tumor of the abdominal cavity during a routine preventive ultrasound examination. The patient underwent a laboratory and instrumental examination, which included determination of blood and urine parameters, video esophagogastroduodenoscopy, contrast x-ray examination of the gastrointestinal tract, contrast-enhanced computer tomography and contrast-enhanced magnetic resonance imaging of the abdominal cavity. Results. The patient underwent surgical resection of the tumor of the duodenum. During the immunohistochemical study, the tumor cells were positive for markers DOG-1, CD117. As a result, «Gastrointestinal stromal tumor of the wall of the duodenum of a low degree of malignancy pT2N0M0R0» was diagnosed. During the six-month follow-up of the patient, no data on tumor recurrence were found. The relatively rare frequency of gastrointestinal tumors of the duodenum leads to difficulties at the diagnostic stage. In this clinical case, the tumor was asymptomatic, was not visualized during video esophagogastroduodenoscopy and was suspected during ultrasound examination. This indicates the importance of preventive examinations. Oncological awareness of doctors is extremely important for early diagnosis of oncology. Conclusion. Based on the analysis of the literature, the data on the epidemiology, clinical picture, methods of diagnosis and treatment of this rare pathology are displayed.

The Effect of Levetiracetam and Valproic Acid Treatment on Anger and Attention Deficit Hyperactivity Disorder Clinical Features in Children and Adolescents with Epilepsy: A Prospective Study.

Antiseizure medications (ASMs) can potentially trigger psychobehavioral adverse events associated with the onset or exacerbation of psychiatric symptoms such as irritability, aggression, and hyperactivity. The objective of this study was to evaluate the effects of levetiracetam and valproic acid on changes in clinical features of anger, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The purpose was to furnish guidance on rational drug selection in children and adolescents with epilepsy to minimize psychiatric comorbidity in the treatment of epilepsy. This was a prospective, observational, cohort study involving treatment-naïve children aged 7-18 years with newly diagnosed generalized or focal epilepsy who were prescribed levetiracetam or valproic acid as monotherapy for a 6-month period and regularly followed up. Psychiatric assessment was conducted at the time of the new epilepsy diagnosis and at the six-month follow-up. These assessments were performed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Current and Lifetime Version (DSM-5), a structured psychiatric interview, as well as the State-Trait Anger Expression Style Inventory and Turgay DSM-IV Based Disruptive Behaviour Disorders Screening and Rating Scale. Anger subscores, ADHD symptoms, change in diagnosis, focal and generalized epilepsy groups, continuous seizures and seizure-free periods before and 6 months after treatment with valproic acid and levetiracetam were compared. A total of 50 children, 25 in the valproic acid group and 25 in the levetiracetam group, with a mean age of 11.92 ± 3.08 years, were included in the study. There was a statistically significant increase in the ADHD subscale score post-treatment among patients receiving levetiracetam (p = 0.045) and valproic acid (p = 0.034) compared with pre-treatment. The change in both anger-in and anger-out expression scores with treatment was significantly higher in patients receiving levetiracetam (p = 0.035) compared with those receiving valproic acid (p = 0.026). Statistically, there was a significant difference in the diagnostic criteria of the levetiracetam group pre- and post-treatment (p = 0.026). The proportion of patients in whom the diagnostic criteria for ADHD+ODD were fulfilled increased from 16% before treatment to 48% after treatment, a statistically significant increase (p = 0.026). This study found an increase in internalized anger features and ADHD symptom severity in children with epilepsy treated with valproic acid and levetiracetam. In those prescribed levetiracetam, there was a statistically significant rise in the proportion meeting the diagnostic criteria for ADHD + ODD. Our research is one of the first to prospectively examine the psychiatric assessment of children diagnosed with epilepsy. The remarkable results demonstrate changes in psychiatric diagnoses associated with the treatment of levetiracetam and valproic acid. Furthermore, a considerable rise in ADHD symptoms was observed in those treated with valproic acid.

Imagery rehearsal therapy and mianserin for trauma-affected refugees: Follow-up of a randomized controlled trial.

In order to identify the efficacy of treatment interventions for trauma-affected refugees follow-up studies are highly warranted. Hence, the overall aim of this study was to examine the effi-cacy of sleep-enhancing treatment, IRT and mianserin, in a sample of 219 trauma-affected refugees at six-month follow-up post-treatment. Data were derived from a four-armed randomized controlled trial in a sample of trauma-affected refugees with PTSD. All four arms received Treatment as Usual (TAU), an interdisciplinary treatment approach: one group received solely TAU, serving as a control group, whereas the remaining three groups were active-treatment groups receiving add-on treatment with either IRT, mianserin, or a combination. Mixed models were used to analyze the combinations of the two treatment factors (IRT vs. non-IRT and mianserin vs non-mianserin) and time (baseline vs follow-up and post-treatment vs follow-up) for the primary outcome sleep quality and for several secondary outcome measures. A total of 36.7% of the participants had been exposed to torture and 44% had been imprisoned. The only significant effect of IRT was on well-be-ing (measured with WHO-5), where IRT showed higher improvement in well-being six months post-treatment (p =.027). There was no significant effect of mianserin on any of the outcome mea-sures. This follow-up study found improvements from baseline to post-treatment on sleep quality and most of the secondary outcome measures that were maintained for all treatment condi-tions at the six-month follow-up assessment. A limitation of the study was that a high proportion (53.4%) of the participants did not attend the follow-up evaluation. The results indicate that add-on IRT-treatment and add-on mianserin-treatment were not superior to TAU at six-month follow-up post-treatment.

Medication-related osteonecrosis of the jaw: a retrospective single center study of recurrence-related factors after surgical treatment

ObjectivesTo provide an overview of the features of patients with medication-related osteonecrosis of the jaw (MRONJ) and explore recurrence-related factors after surgery.Materials and methodsAll pathological records of patients diagnosed with osteonecrosis or osteomyelitis of the jaw were reviewed. Only patients who had a history of use of medication related to bone turnover were included. All demographic and clinical characteristics were collected during review. Univariate and logistic regression analyses were performed to evaluate the associations between risk factors and recurrence. A p value < 0.05 was considered to indicate statistical significance in all analyses.ResultsA total of 313 patients were ultimately included. Most patients (89.14%) underwent bone turnover-related treatment due to malignancy. The breast and prostate were the most common locations of primary tumors in females and males, respectively. Almost all MRONJ patients experienced inflammatory symptoms. Recurrence occurred in 55 patients at 60 locations. The total recurrence rate was 16.85%, with no significant differences between the maxilla and mandible. Extensive surgery and flap transfer were strongly related to a lower recurrence risk. Nearly 80% of patients had recurrence-related symptoms within 6 months.ConclusionWhen MRONJ is treated with surgical methods, extensive resection and flap transfer can reduce recurrence risk. Six-month follow-up is needed to exclude recurrence after surgery.Clinical relevanceThis study revealed the surgical-related risk factors, such as extensive surgery and flap transfer, when treating MRONJ patients, and 6-month follow-up is needed to detect recurrence. This could provide clinical guidance for head and neck surgeons.

Cerebrospinal Fluid Neurofilaments Light-Chain Differentiate Patients Affected by Alzheimer's Disease with Different Rate of Progression (RoP): A Preliminary Study.

Alzheimer's disease (AD) is the most common neurodegenerative disorder and a leading cause of dementia. One major challenge for clinicians is accurately assessing the rate of disease progression (RoP) early in the diagnostic process, which is crucial for patient management and clinical trial stratification. This study evaluated the role of cerebrospinal fluid biomarkers-Aβ42, t-Tau, pTau, Neurogranin (Ng), and Neurofilament light-chain (NF-L)-in predicting RoP at the time of AD diagnosis. We included 56 AD patients and monitored cognitive impairment using MMSE scores at diagnosis and during six-month follow-up visits. RoP scores were calculated based on these assessments. Our correlation analyses revealed significant associations between RoP and pTau, Aβ42/Ng ratio, and NF-L levels. When patients were stratified by median RoP values into low-to-moderate (L-M: <2) and upper-moderate (U-M: >2) groups, those in the U-M group had notably higher CSF NF-L levels compared to the L-M group. Logistic regression analysis further demonstrated that elevated CSF NF-L levels were predictive of a faster RoP. These findings highlight the potential of CSF NF-L as a prognostic biomarker for rapid disease progression in AD. By identifying patients at risk for accelerated cognitive decline, CSF NF-L could significantly enhance early intervention strategies and improve patient management in clinical settings.

Single-Incision Direct Lateral Approach Versus Dual-Incision Approach for Distal Tibial and Fibular Fractures.

Distal tibial and fibular fractures are typically the result of high-energy trauma. Open reduction and internal fixation (ORIF) are often used to reconstruct and reduce displaced fractures, especially intra-articular ones. These fractures can be addressed either by a dual-incision approach (medial approach for the distal tibia and lateral approach for the fibula) or by a single-incision direct lateral approach to fix both the tibia and fibula. The direct lateral approach avoids injury to the medial soft tissues. This study was conducted to compare the postoperative clinico-radiological and functional outcomes of the single-incision direct lateral approach and the dual-incision approach for distal tibial and fibular fractures. A prospective comparative cohort study of 40 patients was conducted. The patients were classified into two cohorts of 20 each based on the surgical approach: those who underwent a single-incision direct lateral approach and those who underwent a dual-incision approach for distal tibial and fibular fractures (procedure: ORIF with plating). The study was conducted from September 2022 to March 2024. A follow-up period of at least 12 months was carried out, comparing operative time, discharge time, and postoperative outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, ankle range of motion (ROM), Southampton wound score for wound healing, visual analog scale (VAS) pain score, and periodic radiographs at each follow-up. Complications were also studied. The mean operative time was 95.06 ± 7.04 minutes for thesingle-incision approach and 109.89 ± 7.88 minutes for the dual-incision approach. The average blood loss was 202.41 ± 32.76 mL for thesingle-incision approach and 248.39 ± 28.18 mL for the dual-incision approach. The hospital stay was shorter in the direct lateral approach group, and the AOFAS score at 12 months was better in the direct lateral approach group (91.47 ± 2.55 for thesingle-incision approach vs. 83.33 ± 8.71 for the dual-incision approach). Postoperative wound healing was observed, and the Southampton wound score was compared. Overall, soft tissue complications were fewer in the direct lateral approach group. The postoperative VAS pain score was consistently lower in the single-incision direct lateral approach group, which also demonstrated better ankle ROM. The p-value was significant (<0.05) for these parameters. At the six-month follow-up, all patients exhibited clinical and radiographic healing and bone union, except for one case in the dual-incision group. A medial compound wound, treated by plastic surgery with flap cover intervention, was identified as one of the definitive indications for single-incision plating. The single-incision approach was associated with better soft tissue healing, fewer wound complications, and superior ankle functional outcomes compared to the dual-incision approach.

Successful Arthrodesis Using a Blended Allograft and Autograft Mixture in Lumbar Interbody Fusion: A Retrospective Case Series.

Introduction Achieving successful arthrodesis after lumbar interbody fusion remains a challenge, especially for minimally invasive surgical approaches that limit the amount of local bone autograft. However, using an allograft blend as an autograft extension mixture may hold promise but requires further research. The purpose of this study is to examine the impact of an allograft blend added to autograft on the quality of arthrodesis after lumbar interbody fusion in adult patients. Methods This study is a retrospective case series of adult patients (>21 years old) who underwent lumbar interbody fusion between October 2021 and January 2022, performed by a single spine surgeon. The quality of arthrodesis was assessed via the Bridwell grade (I-IV) for up to six months. The impact of surgical technique, age, sex, or amount of allograft utilized during fusion on Bridwell grade was assessed. Results Patients (n = 18; 27 levels fused) had a mean age of 58.6 (1.9) years and a mean BMI of 32.8 (1.2) kilograms per meter squared (kg/m²). A mean of 18.0 (standard deviation = 2.4) cubic centimeters (cc) (range: 3.4-50.0 cc) of allograft was used per fused level. A Bridwell grade of I (successful arthrodesis) was achieved at three months in 11.1% (3/27) of fusions and at six months in 85.2% (23/27) of fusions. Four fusions remained at a Bridwell grade of II at six months and subsequently achieved complete arthrodesis at 12 months. No patients received a Bridwell grade of IV (lucency with collapse of graft) at three- or six-month follow-up. There was no difference in Bridwell grade when stratified by surgical technique, age, sex, or amount of allograft used. Conclusion The allograft and autograft blend utilized in this study resulted in successful arthrodesis at all fused levels after one year, irrespective of surgical technique or other patient factors. Prospective studies with larger sample sizes are needed to corroborate the findings of this small case series.

Posterolateral Versus Posteromedial Approach for Posterior Malleolus Fixation in Trimalleolar Fractures of the Ankle.

Background Ankle fractures, particularly those involving the posterior malleolus, are prevalent injuries that can lead to significant functional impairment if not managed appropriately. The choice of surgical approach for posterior malleolus fixation - posteromedial (PM) or posterolateral (PL) - remains a debate among orthopedic surgeons. The PM approach is a traditional technique involving extensive soft tissue dissection, while the PL approach offers improved visualization and precision with potentially less soft tissue disruption. Materials and methods This prospective comparative study was conducted at the Department of Orthopedics, Dr. D. Y. Patil Hospital and Research Centre, Pune, between February 2022 and August 2024.Atotal of 42 patients with trimalleolar fractures involving the posterior malleolus were randomly assigned to either the PL or PM surgical groups, with 21 patients in each group. Surgical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores, articular surface step-off, range of motion (ROM), and complications such asosteoarthritis, infection, neurovascular injury, nonunion, and deep vein thrombosis at six months, 12 months, and final follow-up. Results Patients in the PL group demonstrated superior clinical outcomes with higher mean AOFAS scores at six-month(87.52 ± 2.92) and 12-month(90.28 ± 1.72) follow-ups compared to the PM group (84.95 ± 3.25 at six months; 88.86 ± 2.41 at 12 months), with statistically significant differences favoring the PL approach. However, as per the final follow-up, the difference in AOFAS scores between the two groups was not statistically significant. The PL group also had more patients with excellent ROM and fewer complications, such as arthritis, than the PM group. Conclusion The PL approach for posterior malleolus fixation in trimalleolar fractures offers superior early functional outcomes and fewer complications than the PM approach. However, the long-term outcomes between the two approaches show no significant difference, indicating that both techniques can be effective depending on the specific fracture pattern and patient characteristics.

Effectiveness of Pilates compared with home-based exercises in individuals with chronic non-specific low back pain: Randomised controlled trial

Objective To investigate the effectiveness of a Pilates exercise program compared with home-based exercises in individuals with chronic non-specific low back pain. Design A randomised controlled trial with a six-month follow-up. Setting Rehabilitation clinic. Participants One hundred and forty-five individuals (18–50 years of age) with low back pain for ≥ 12 consecutive weeks were enrolled and randomly allocated to either Pilates (n = 72) or home-based exercise groups (n = 73). Interventions Method Pilates (Mat Pilates exercises using accessories) versus home-based exercise (postural exercises, muscle stretching and strengthening, and spine stabilisation/mobilisation), twice a week, for 6 weeks. Main measures Assessments were performed at baseline, post-intervention, and six months follow-up. Outcomes were pain intensity, disability, and health-related quality of life. Results At post-intervention, the Pilates group had significantly lower pain intensity (mean difference = −1.14; 95% CI −2.05; −0.23), less disability (mean difference = −6.7; 95% CI −11.3; −2.0), and higher health-related quality of life (mean difference = 0.102; 95% CI 0.054; 0151) compared to the home-based exercise group. At follow-up, the Pilates group had a significantly higher health-related quality of life (mean difference = 0.055; 95% CI 0.003; 0.106) compared with the home-based exercise group but there were no significant differences in pain and disability. A significant overall effect of Pilates compared to home-based exercise was found for disability (mean difference = −4.4; 95% CI −7.6; −1.1), and health-related quality of life (mean difference = 0.049; 95% CI 0.022; 0.076), but not for pain. Conclusion Although Pilates was significantly superior to home exercise for pain and disability, the differences were not considered clinically relevant. However, Pilates did provide significant and clinically relevant differences in utility.

Local Transplantation of Mesenchymal Stromal Cells Is Safe and Could Alleviate Kienböck Disease's Complications: A Clinical Trial Study.

Kienböck disease is a rare condition characterized by severe pain and restricted wrist movement. Various palliative methods have been proposed as therapeutic strategies for alleviating symptoms. Mesenchymal stromal cell transplantation has been suggested as an innovative and promising approach due to its potential for inducing regeneration and immunomodulation in the necrotic tissue. This study aims to evaluate the safety of autologous bone marrow derived mesenchymal stromal cells (BM-MSCs) transplantation after core decompression in Kienböck disease. In this phase I of an open-label clinical trial, three patients (one female and two males) with stage 2 Kienböck disease underwent autologous BM-MSCs transplantation following lunate core decompression. The patients were followed up for six months to assess safety as well as secondary clinical outcomes, including pain level, range of motion (ROM), and functional disability. Safety of BM-MSCs injection following the core decompression was evaluated by recording post-treatment complications during the six-month follow-up. No adverse events (AEs) or severe AEs (SAEs) were reported, indicating that BM-MSCs injection after core decompression is a safe intervention. All patients showed a remarkable reduction in visual analog scale (VAS) scores and "Disabilities of the Arm, Shoulder, and Hand" (DASH) questionnaire scores, suggesting the therapeutic potential of this intervention. Moreover, an increase in the ROM indicated that BM-MSCs transplantation can improve wrist functionality. Additionally, radiographic assessments before and after cell infusion demonstrated a reduction in lunate sclerosis after six months of follow-up. The transplantation of autologous BM-MSCs following lunate core decompression seems to be a safe clinical intervention and may lead to pain relief in patients with Kienböck disease. Furthermore, this procedure may help prevent disease progression during the follow-up period (registration number: NCT02646007).

Implementing changing behaviour towards aerobic and strength exercise: Results of a randomised, phase I study determining the safety, feasibility, and consumer-evaluation of an online exercise program in persons with multiple sclerosis

BackgroundMany people with MS do not meet the recommended exercise regime to elicit health benefits. This study aimed to determine the feasibility, safety, acceptability, and appropriateness of an exercise intervention delivered online to persons with MS that meets current exercise recommendations and behaviour change principles. MethodsSeventy-two participants (age: 43.3 ± 13.3 years) with mild to moderate MS were stratified according to previous exercise behaviour and block-randomised into one of three groups: Control (CON; n = 24), General Exercise (GE; n = 24) who at screening did not meet current exercise recommendations, and Advanced Exercise, (AE; n = 24) who at screening met the current exercise recommendations. GE and AE groups received a four-month online-supervised, behaviour change theory-based exercise program and were assessed at baseline, four-months, five-months, and eleven-months for physical activity participation. The feasibility of process, resources, management, and scientific outcomes was assessed. ResultsOf 198 potential participants, 143 met the eligibility criteria (72 %), and 72 were randomised. Fifty-three participants completed the intervention (74 % immediate retention), and 44 were retained at the six-month follow-up (61 %). Personnel time was 369 h, and total per-participant cost was Au$1036.20. Adherence rate to ≥70 % of exercise sessions was 73 % (GE) and 38 % (AE). The GE group observed a small magnitude of improvement in physical activity (d = −0.23). ConclusionsAn online exercise program embedded with behaviour interventions for either GE or AE appears feasible, acceptable, appropriate and safe and may show long-term efficacy in increased exercise behaviours for persons with mild to moderate MS.Trial registration: ANZCRT number ACTRN12619000228189p.

Effectiveness of dexamethasone implants in treating diabetic macular edema with hard exudates: a clinical observation

ObjectiveThis study seeks to explain the relationship between systemic conditions and hard exudate formations in diabetic macular edema patients. Besides, the study aimed to quantitatively examine changes in the area, location, and impact on visual function of hard exudates following intravitreal dexamethasone implant injections.MethodsA retrospective analysis was conducted, including 40 patients (40 eyes) diagnosed with non-proliferative diabetic retinopathy and concurrent macular edema between January 1, 2022, and January 1, 2024. Preoperative evaluations included glycated hemoglobin, lipid profile, and renal function examinations. Based on the location of HE, patients were divided into two groups: Group A, with HE in 1 mm of the central fovea, and Group B, with HE outside 1 mm of the central fovea. Selected eyes were subject to pre- and postoperative examinations, including best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopy, scanning laser ophthalmoscopy (SLO), optical coherence tomography, and multifocal electroretinography. Following screening and examination, patients received an immediate intravitreal injection of the DEX implant, with an injection administered at the four-month mark. Hard exudate (HE) areas were measured utilizing SLO fundus imaging.ResultsTotal cholesterol, low-density lipoprotein, and triglyceride levels were found to be positively correlated with the presence of HE. Following surgical intervention, all patients demonstrated an improvement in BCVA. The mean BCVA increased from a preoperative measurement of 0.79 ± 0.04 to 0.39 ± 0.02 at the 6 month follow-up, indicating a statistically significant difference (p < 0.001). The baseline HE area for the entire patient cohort was 2.28 ± 0.22. One month post-operation, the HE area exhibited a slight increase to 2.27 ± 0.22. However, by the 6 month follow-up, the HE area had significantly decreased to 0.8 ± 0.87, representing a 35.09% reduction from the baseline measurement (p < 0.001). It is worth noting that Patient P1 did not exhibit a statistically significant difference between preoperative and six-month postoperative HE area (p = 0.032). Preoperative BCVA measurements for Group A and Group B were 0.81 ± 0.03 and 0.77 ± 0.03, respectively, with no statistically significant intergroup difference (p = 0.333). The baseline HE area for Group A was 2.61 ± 0.16, which decreased to 0.38 ± 0.20 at the six-month follow-up, representing a 14.60% reduction from the baseline total area. For Group B, the baseline HE area was measured at 1.95 ± 0.09, then decreasing to 1.21 ± 0.13 at the six-month follow-up, indicating a 62.05% reduction from the baseline total area. A statistically significant difference in the postoperative 6 month HE area was observed between Group A and Group B (p < 0.001). In Group A, the reduction in HE area (initial HE area-final HE area) was positively correlated with the improvement in P1 (initial P1-final P1) (r = 0.610, p = 0.004). In Group B, a similar positive correlation was found (initial HE area-final HE area with initial P1-final P1) (r = 0.488, p = 0.029). In Group B, the reduction in HE area (initial HE area-final HE area) correlated positively with the improvement in BCVA (initial BCVA-final BCVA) (r = 0.615, p = 0.004). Additionally, in Group B, the reduction in HE area (initial HE area-final HE area) was positively correlated with the improvement in CMT (initial CMT-final CMT) (r = -0.725, p< 0.001). Aggravated cataracts were observed in thirteen eyes during a follow-up examination 6 months later.ConclusionHE formation is associated with lipid levels. Dexamethasone implants demonstrate effectiveness in reducing HE areas in the short term, reducing macular edema, improving retinal structure, and enhancing visual function. The incidence of postoperative complications such as cataracts and glaucoma remains low.

Group metacognitive therapy for children and adolescents with anxiety and depression: A preliminary trial and test of proposed mechanisms

Preliminary research supports the feasibility of metacognitive therapy (MCT) in children with generalized anxiety, but the effectiveness of MCT in treating children with other anxiety and depressive disorders largely remains unknown. The purpose of this study was to investigate the effects associated with MCT in targeting symptoms of anxiety and depression in children and adolescents and to investigate mechanisms proposed by the metacognitive model. Ninety-seven participants aged 10–17 years (M = 12.9 ± 1.9, 82.5 % females) with anxiety and depressive disorders received eight sessions of group MCT. Participants were diagnostically assessed at pre- and post-treatment and completed symptom and process measures before, during, and after treatment, and again at three- and six-month follow-up. Multilevel models were conducted to investigate treatment-related and mediation effects. Results showed large reductions in total symptoms following treatment (d = 1.28). These reductions were associated with, and temporally preceded by changes in cognitive attentional syndrome (CAS), metacognitive beliefs, and self-reported attention control, but not objective attention control. Treatment gains were maintained at six-month follow-up (d = 1.18). Our results indicate that MCT may be a promising treatment for children and adolescents with anxiety and depression and provide preliminary evidence of changes in CAS, metacognition, and perceived attention control as potential drivers of treatment effects.