Symptom Score Research Articles

The Diagnosis and Treatment of Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by local chronic inflammation of the mucous membranes of the nose and paranasal sinuses. It affects approximately 5% of the population. This review is based on relevant publications retrieved by a selective search of the literature, with particular attention to current national and international guidelines. CRS is defined by, and diagnosed on the basis of, a combination of symptoms and objective findings of nasal endoscopy and imaging studies. It markedly impairs quality of life and gives rise to both direct and indirect health care costs. In 20-45% of cases, CRS is associated with comorbid bronchial asthma and a significantly elevated risk of further diseases (e.g., COPD, OR 1.73; depression, HR 1.50; obstructive sleep apnea, OR 1.91; carcinoma, OR 1.14-5.30). CRS is primarily treated medically with topical steroids (standardized mean difference of nasal symptoms, -0.63 (95% confidence interval [-0.89; -0.37]; standardized mean difference of quality of life as measured by SNOT -22, -5.46 [-8.08; -2.84]), as well as with nasal lavage and, as an option, systemic steroids (and antibiotics where appropriate). If appropriate medical treatment fails to bring about adequate and sustained improvement, endoscopic surgery on the paranasal sinuses is indicated. This improves the individual symptoms, the overall symptom score, and patients' quality of life. Severe refractory CRS with nasal polyposis can be treated with biological agents. CRS calls for individually adapted medical and/or surgical treatment.

Efficacy of Shugan Hewei formula combined with rabeprazole in refractory gastroesophageal reflux disease: randomized, double-blind, placebo-controlled trial

ObjectivesTo assess the efficacy of the Chinese herbal medication Shugan Hewei formula (SHF) combined with rabeprazole in patients with refractory gastroesophageal reflux disease (rGERD).MethodA total of 264 participants were randomly assigned to the treatment group (n = 132) receiving SHF granules (20 mg) combined with rabeprazole (10 mg) and the control group (n = 132) receiving placebo SHF granules (20 mg) combined with rabeprazole (20 mg). Both groups undergo 8 weeks of treatment and 2 weeks of follow-up.ResultsThe treatment group showed higher total clinical symptom efficacy and lower total symptom scores compared to the control group. The treatment group was superior to the control group in reducing rGERD major symptom scores, including heartburn, retrosternal pain, regurgitation and belching, and acid regurgitation. Additionally, treatment group (Z = 8.169, P < 0.001) and control group (Z = 9.800, P < 0.001) treatments were all significantly attenuated esophageal inflammation, demonstrating comparable efficacy. Patients with esophagitis grade A decreased from 40.34% to 17.23%, and those with grade B decreased from 11.76% to 3.78% in the treatment group. The results of the SF-36 scale showed that combination therapy was more effective in improving role limitations due to physical health, vitality, general health, total somato-physical health, and psychiatric mental health.ConclusionOur study reveals that the combined treatment of SHF with rabeprazole is more efficacious in managing patients with rGERD when contrasted with sole rabeprazole treatment.

Intra- and Post-procedural Patient-reported Experience Measures and their Correlation with post-ERCP Adverse Events and Unplanned Healthcare Utilization

Background and Study Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs) are common, as is unplanned healthcare utilization (UHU). We aimed to elucidate potential associations between intra- and post-procedural patient-reported experience measures (PREMs) and post-ERCP AEs and UHU. Patients and Methods Prospective data from a multi-center collaborative were used. A validated 0-10 Likert-based PREM assessing intra- and post-procedural symptoms was applied to patients following ERCP and protocolized follow-up was performed at 30 days to identify AEs and UHU for reasons not meeting the definitions of any AE. Multivariable logistic regression was conducted using PREM domains as exposures and individual AEs and UHU as outcomes, with a priori selected patient- and procedure-related covariates. Test performance characteristics and odds ratios (ORs) and 95% confidence intervals (95% CIs) for each PREM domain were reported. Results From September 2018 through October 2023, 3,434 ERCPs were included. Post-procedural abdominal pain of &gt;3 was predictive of pancreatitis (OR 3.71, 2.37-5.73), while a score &gt;6 was strongly predictive of perforation (OR 9.54, 1.10-59.37). Post-procedural pain was also predictive of UHU within 30 days when used as a continuous predictor (OR 1.08 per point, 1.01-1.16). Post-procedural pain of &gt;6 demonstrated high negative predictive values and specificities for post-ERCP AEs. Conclusions Patient-reported symptom scores from a simple Likert-based PREM at the time of discharge from ERCP are associated with presentations for pancreatitis, perforation, and UHU within 30 days. Applying PREMs post-ERCP could potentially prevent UHU and/or facilitate earlier management and improved outcomes for patients with post-ERCP AEs.

Measuring clinically relevant change in apathy symptoms in ADMET and ADMET 2.

Among participants with Alzheimer's disease (AD) we estimated the minimal clinically important difference (MCID) in apathy symptom severity on three scales. Retrospective anchor- and distribution-based analyses of change in apathy symptom scores. Apathy in Dementia Methylphenidate Trial (ADMET) and ADMET 2 randomized controlled trials conducted at three and ten clinics specialized in dementia care in United States and Canada, respectively. Two hundred and sixty participants (60 ADMET, 200 ADMET 2) with clinically significant apathy in Alzheimer's disease. The Clinical Global Impression of Change in Apathy scale was used as the anchor measure and the MCID on the Neuropsychiatric Inventory - Apathy (NPI-A), Dementia Apathy Interview and Rating (DAIR), and Apathy Evaluation Scale-Informant (AES-I) were estimated with linear mixed models across all study visits. The estimated thresholds were evaluated with performance metrics. Among the MCID was a decrease of four points (95% CI: -4.0 to -4.8) on the NPI-A, 0.56 points (95% CI: -0.47 to -0.65) on the DAIR, and three points on the AES-I (95% CI: -0.9 to -5.4). Distribution-based analyses were largely consistent with the anchor-based analyses. The MCID across the three measures showed ∼60% accuracy. Sensitivity analyses found that MMSE scores and apathy severity at baseline influenced the estimated MCID. MCIDs for apathy on three scales will help evaluate treatment efficacy at the individual level. However, the modest correspondence between MCID and clinical impression of change suggests the need to consider other scales.

Management of triggering factor effects in sensitive skin syndrome with a dermo-cosmetic product.

Environmental factors are important in the generation or aggravation of sensitive skin syndrome (SSS). Creams can be useful for patients with SSS, particularly when triggering factors cannot be avoided. Several clinical studies have investigated the safety and efficacy of specific creams in patients with SSS, but the majority were assessed with a single type of triggering factor and were non-comparative. Therefore, this study's aim was to investigate, the benefit of a specific dermo-cosmetic product in response to physical and chemical factors in subjects with SSS. Three clinical studies were performed on subjects presenting SSS. The physical impact was assessed in a stripping test, and in a randomized intra-individual study with a newly developed heat-cold stress model. To assess chemical factors, a capsaicin test on the nasolabial fold was performed. The product significantly reduced the increase in skin microcirculation caused by stripping after 30 min versus. The untreated condition (45.8% vs. 62.0%; p < 0.01). Immediately and at D28, the product induced a significant increase in skin hydration even after a heat-cold stress, while the overall score of unpleasant symptoms significantly decreased compared with the control (8.1 vs. 10.7 and 3.7 vs. 8.0, respectively; p < 0.01). Regarding chemical factors, a significant difference in the sensation intensity (p < 0.001) was observed after capsaicin stress, also in terms of the sensation duration due to the product application versus the control (192 s vs. 403 s; p < 0.001). These studies show that topical application of a dermo-cosmetic product can prevent unpleasant symptoms and improve the skin state in SSS exposed to physical and chemical triggering factors.

Erectile Function in Men Presenting with Lower Urinary Tract Symptoms from Benign Prostate Enlargement: Association with Quality of Life Scores in the Context of Interviewer-Assisted Questionnaire Administration

Abstract Background: Interviewer-assisted administration of International Prostate Symptoms Score (IPSS) and Internal Index of Erectile Function-5 (IIEF-5) questionnaires in men with lower urinary tract symptoms (LUTS) due to benign prostate enlargement (BPE) may generate inconsistent outcomes. Objectives: To assess the correlation between the scores from interviewer-assisted administration of the IPSS questionnaire and the IIEF-5 questionnaire in men with uncomplicated LUTS due to BPE. Materials and Methods: The IPPS and the IIEF-5 questionnaires were administered with interviewer assistance to a cross-section of men presenting to the hospital with symptoms of LUTS due to uncomplicated BPE. The demographics were ascertained, and the association between IPPS and IIEF-5 scores was determined using linear correlation. Results: There were 211 participants in 18 months with a mean age of 66.5 ± 9.5years. The mean prostate volume, prostate-specific antigen, peak flow rate, and post-void residual volume were 55.2 ± 10.1 mL, 3.1 ± 0.7 ng/mL, 20.8 ± 8.2 mL/s, and 38.1 ± 21.5 mL, respectively. One hundred and eighty-six participants (88.2%) attained post-primary level of formal education. Moderate LUTS was reported in 51.7% (n = 109), while severe LUTS was reported in 10.4% (n = 22) participants. The mean storage LUTS (sLUTS) score was 6.25 ± 2.84, the mean voiding LUTS (vLUTS) score was 4.27 ± 4.56, and the mean IPSS was 10.38 ± 6.44. The mean IIEF-5 score was 15.17 ± 6.09. There was a poor correlation between IIEF-5 and sLUTS (Spearman rho –0.02; P = 0.77), vLUTS (Spearman rho –0.058; P = 0.403), IPSS scores (Spearman rho –0.048; P = 0.49), as well as with quality of life (QoL) preferences (F 1.722; P = 0.117). Conclusions: Interviewer-assisted IIEF-5 scores do not relate with sLUTS, vLUTS IPSS, and QoL due to LUTS, as is the case with reports on self-administered IIEF-5 scores.

Epineurectomy of extracranial facial nerve trunk for non-flaccid sequelae following Bell's palsy: A single-arm trial.

Non-flaccid facial palsy sequelae manifest as sequelae following Bell's palsy. Currently, there are no effective remedies for addressing this issue. In this study, we proposed a new surgical solution, epineurectomy of the extracranial facial nerve trunk, and assessed its safety and efficacy as a potential remedy.. In this single-arm trial, adult patients with non-flaccid facial palsy sequelae were enrolled and subjected to epineurectomy of the extracranial facial nerve trunk. The primary efficacy endpoint was the Sunnybrook scores at months 12 postoperatively. The secondary endpoints included non-flaccid facial palsy sequelae symptom scores, such as facial tightness or facial stiffness, facial synkinesis, eyefissures narrowing or difficulty in opening the eyes, House-Brackmann grade scale, and Facial Disability Index. A total of 22 patients were enrolled between July 2020 and January 2021. One patient was lost to follow up. One year after surgery, the Sunnybrook score was 72.0 (63.0 - 75.0) at 12 months versus 68.0 (58.0 - 70.8) at baseline. The mean difference was -5.4 (-7.2 to -3.6). The scores of facial tightness or facial stiffness, synkinesis, eye fissures narrowing or difficulty in opening eyes were 0.0 (0.0 - 1.0), 1.0 (1.0 - 1.0), 1.0 (1.0 - 2.0) at 12 months versus 3.0 (1.3 - 3.0), 2.0 (1.0 - 2.8), 2.0 (2.0 - 3.0) at baseline, respectively. The median (IQR) values of the Facial Disability Index physical function were 92.0 (90.0 - 95.0) at months 12, and the mean difference (95% CI) was -32 (-38 to -26) compared to baseline. The mean difference (95% CI) in the Facial Disability Index social/well-being function between month 12 and baseline was -38 (-46 to -31). Epineurectomy of the extracranial facial nerve trunk can effectively and safely alleviate the sequelae of non-flaccid facial palsy.

Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on hemorrhoidal disease: A case-matched analysis

BackgroundHemorrhoidal disease (HD) significantly impacts patients’ quality of life. This study aimed to evaluate the effectiveness of preoperative treatment with the micronized purified flavonoid fraction (MPFF) and a sucralfate-based rectal ointment in managing HD symptoms and reducing interventions.MethodsA prospective quasi-experimental study including consecutive cases and controls matched on the basis of sex was performed in a tertiary referral center. Cases received systemic and local therapy for HD, consisting of a rectal ointment containing 3% sucralfate and herbal extracts plus MPFF, in addition to conservative therapy, while controls received conservative therapy alone. The hemorrhoidal disease symptom score (HDSS), the Short Health Scale for HD (SHS-HD) score, and the Vaizey Incontinence Score were used to evaluate symptoms severity and their impact on quality of life and continence. Intervention requirements were assessed at baseline (T0) and after 60 days of treatment (T1).ResultsBetween January and December 2023, a total of 98 patients were assessed for eligibility. After exclusions, 56 patients were enrolled, with 28 in each group. Significant improvements were observed in HD symptom scores from T0 to T1: the intervention group showed a mean change in HDSS of −9 [95% confidence interval (CI) −10 to −8], and the control group showed no significant change (mean change of 0; 95% CI −1.5 to 0). At T1, a higher proportion of patients in the intervention group underwent less invasive interventions compared with controls (18% versus 11%). Age, treatment group, and baseline symptom severity significantly predicted post-treatment symptom scores.ConclusionsIn our study the preoperative treatment with MPFF and a sucralfate-based rectal ointment demonstrated clinical benefits in managing HD symptoms and reducing interventions. Further prospective trials are warranted to confirm and explore additional therapeutic strategies.

Quality of Life of Older People Living with COPD in Nepal

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic health conditions in older people and is increasingly becoming a major public health concern. Objectives: The study aims to assess the quality of life among older patients living with COPD. Methods: A hospital-based cross-sectional study was conducted from February 2017 to July 2018 in a tertiary care hospital in Kavre, Nepal. A total of 220 patients aged 60 years and above were the respondents. Quality of Life (QOL) of participants was assessed through a widely used shorter version of ST George’s Respiratory Questionnaire (SGRQ-C). The mean and Pearson correlation coefficients were used while analysing the data. Results: The mean total score for all domains of QOL was 68.57 (SD=18.66). The mean QOL scores for symptom, activity, and impact domains were 70.51 (SD=±22.37), 68.12 (SD=±23.42), and 68.19 (SD=±20.32) respectively, which suggested marked impairments in QOL in all SGRQ-C domains. The factors significantly related to the overall QOL of COPD patients in this study were: gender, education, type of family, and economic status. Conclusion: Nepalese older patients with COPD had poor quality of life. Older patients with COPD had an impaired QOL in all three components of symptom, activity, and impact domains. There should be some initiation on how the QOL of older patients with COPD can be improved.

Network analysis of Tourette syndrome and attention-deficit/hyperactivity disorder symptoms in children and adolescents

BackgroundWhile Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, the nature of the relationship between their symptoms is not well understood. Network analysis of psychopathology allow for detailed examinations of symptom interactions, providing an effective approach to explore the patterns of comorbidity between TS and ADHD symptoms.MethodsThis study included 3,958 participants (male/female = 3,004/954, age mean ± SD = 8.60 ± 2.25 years). We collected data on TS symptoms using the Motor Tic, Obsessions and Compulsions, Vocal Tic Evaluation Survey (MOVES), and ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV). Network analysis was employed to construct a combined network of TS and ADHD symptoms at the symptom level. We utilized the expected influence (EI) and bridge EI metrics to explore the core and bridge symptoms within the network.ResultsThe network structure demonstrated a moderate number of non-zero connections between TS and ADHD symptoms, constituting 23.06% of all potential connections. Core symptoms in the comorbidity network included “Often has difficulty sustaining attention in tasks or play activities,” “Certain bad words or thoughts keep going through my mind,” and “Words come out that I can’t stop or control.” Bridging symptoms identified were “Words come out that I can’t stop or control,” “I do certain things like jumping or clapping over and over,” “I can’t control all my movements,” and “Often talks excessively.”ConclusionThe core and bridging symptoms identified in this study serve as potential therapeutic targets for the treatment of TS and ADHD comorbidity in clinical children and adolescents.

Using biothesiometer, Neuropathy Symptom Score, and Neuropathy Disability Score for the early detection of peripheral neuropathy: A cross-sectional study.

Patients with peripheral neuropathy could have damaged peripheral nerves, which leads to sensory and motor dysfunction. Diabetes, infections, and trauma are the major causes of peripheral neuropathy. Vibratory perception threshold (VPT) tools are commonly used to detect peripheral neuropathy. This study aims to determine the assessment of peripheral neuropathy through the different diagnostic tools in the community in Malaysia. A total number of 1283 participants were recruited from the seven retail pharmacies located in Selangor, Malaysia. The peripheral neuropathy test was conducted based on VPT tools on both feet using the digital biothesiometer. Following that, Neurological Symptom Score (NSS) and Neurological Disability Score (NDS) were taken from the participants to assess the neurological symptoms. Participants had an average age of 40.6 ± 12.9 years and were mostly of Chinese ethnicity (54.1%). The findings show that increasing age was associated with more severe peripheral neuropathy across the various assessment tools, but gender differences were found with the biothesiometer test and ethnicity has severity in the biothesiometer and disability scores. The sensitivity and specificity of the biothesiometer test were 0.63 and 0.84, respectively. The combined tool NSS and NDS had high specificity and a high positive predictive value, suggesting that it could be a reliable indicator of peripheral neuropathy when both scores are elevated. The findings show that the biothesiometer test, NSS, and NDS are considered screening VPT tools for diagnosing peripheral neuropathy. However, further evaluation and diagnostic testing are necessary in cases of a positive test result.

Distinct Effects of Major Affective Disorder Diagnoses and Suicidal Symptom Severity on Inhibitory Control Function and Proinflammatory Cytokines: Single-Site Analysis of 800 Adolescents and Adults.

Inhibitory control function and proinflammatory cytokines play a role in the pathomechanisms underlying major affective disorders and suicidal behavior. However, the distinct or interactive effects of major affective disorders and suicidal symptom severity on inhibitory control function and proinflammatory cytokines remain unclear. This study included 287 patients with bipolar disorder, 344 with major depressive disorder, and 169 healthy controls. We categorized the participants into three groups on the basis of Montgomery-Åsberg Depression Rating Scale (MADRS) item 10 (suicidal symptoms) score: 0, 2 or 3, and ≥4. The participants completed the go/no-go task and the measurements for C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels. Errors in the go/no-go task were associated with suicidality (p = .040), regardless of the severity of suicidal symptoms and diagnosis. An elevated CRP level was especially associated with MADRS item 10 score ≥ 4 (p = 0.001). Increased TNF-α level could distinguish bipolar disorder from major depressive disorder (p < .001). Our study indicated the distinct effects of major affective disorder diagnosis and suicide symptom severity on inhibitory control function and CRP and TNF-α levels. Importantly, individuals with the poorest inhibitory control function and highest CRP levels had more severe suicidal symptoms.

Group A Streptococcus infections in children and adolescents in the post-COVID-19 era: a regional Italian survey

BackgroundDespite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated.MethodsIn June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0–16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023.ResultsAmong 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1–3 years, 42,3% 3–6 years, 26,5% 6–9 years, 11,4%, 9–12 years, and 2,6% 12–16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis.Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection. ConclusionsWe reported a certain prevalence of nGAS infections in children, mainly those aged 3–6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool.In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis.

Comparison of combination therapy with tamsulosin and dutasteride or finasteride in patients with benign prostatic hyperplasia: a randomized clinical trial

BackgroundBased on our observations at the largest outpatient urology clinic in Iran, patients for whom finasteride is prescribed as a secondary drug to tamsulosin tend to experience earlier and more severe sexual side effects without any difference in the amelioration of symptoms. This study aimed to compare the time lag, efficacy, and side effects of combination therapy with varying doses of dutasteride or finasteride added to tamsulosin for benign prostatic hyperplasia (BPH) treatment.MethodsIn this study 165 were randomized into 5 groups (each N = 33); receiving tamsulosin 0.4mg plus either of A: finasteride 3mg, B: placebo, C: dutasteride 0.25mg, D: finasteride 5mg or E: dutasteride 0.5mg. During the 6-month period of the study, International Prostate Symptom Score (IPSS), post-void residual urine (PVR), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate specific antigen (PSA) and maximum urinary flow rate (Qmax) were evaluated at baseline and at the 1st, 3rd and 6th month. The differences between each time point and baseline were then compared between groups.ResultsAt 3-month follow-up, group E exhibited a higher decrease in PSA but a greater increase in Qmax compared to group A (p = 0.047 and 0.006, respectively). Group C showed higher Qmax increase compared to group A at 3 and 6 months (p = 0.003 and 0.014) and concurrently a more pronounced PV decrease at 1 and 3 months (p = 0.047 and 0.003, respectively). Group D had a significantly more decrease in their IIEF-5 compared to group A at one-month visit (p = 0.006).ConclusionsIn summary, at the sixth-month follow-up, dutasteride demonstrated superiority over finasteride solely in enhancing Qmax. Therefore, dutasteride may be marginally more beneficial as a secondary component of combination therapy in BPH.Trial registration IRCT, IRCT20120516009772N2. Registered 18 January 2021 Retrospectively registered, https://irct.behdasht.gov.ir/search/result?query=IRCT20120516009772N2.

Does Mechanism of Injury Affect Recovery After Sport-Related Concussion in Basketball? A Pilot Study.

Understanding sport-related concussion (SRC) mechanisms can aid in prevention and treatment. Concussions in basketball have received relatively less attention compared with collision sports. In a cohort of concussed high school basketball players, this pilot study sought to (1) describe the mechanisms of how concussions occur in basketball and (2) assess the relationship between mechanisms and acute symptomatology and recovery time. A retrospective cohort, pilot study examined concussed adolescent athletes (aged 14-18 years) treated at a sports concussion center from 11/2017 to 04/2022. The primary independent variable was mechanism of injury, categorized into (1) contact (head-to-head, head-to-body, head-to-ball, head-to-ground), (2) player (offensive play, defensive play, both), and (3) awareness mechanisms (aware, unaware). The outcomes included acute symptom severity, time to return-to-learn, symptom resolution, and return-to-play. Associations between mechanisms and outcomes were analyzed using one-way analysis of variance, independent t-tests, multivariable linear regressions, and Cox regression. Of 105 basketball players (16.2 ± 1.4 years; 50.5% male), head-to-ground contact (n = 44/105; 41.9%) was most common. Taking-a-charge (n = 12/53; 22.6%) was the most frequent player mechanism, with similar rates for offensive (n = 24/53; 45.3%) and defensive (n = 23/53; 43.4%) plays. Most were aware of impending collision (n = 37/46; 80.4%). Head-to-body concussions were associated with higher initial symptoms severity scores when compared with head-to-head (β = 0.33, P = .003) and head-to-ground (β = 0.23, P = .050) contacts. Player and awareness mechanisms were not significant predictors of outcome measures. Only higher initial symptom scores were associated with a longer time to return-to-learn, symptom resolution, and return-to-play. In this pilot study of concussed high school basketball players, head-to-ground was the most common concussion mechanism, with similar rates during offensive and defensive plays. Although head-to-body contact increased acute symptoms, other mechanisms did not predict recovery time. Given the limited information on concussions in basketball, the preliminary results of this pilot study may help inform larger studies on basketball SRC mechanisms.

Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study.

The purpose of this study was to assess the impact of testosterone therapy on mood and cognitive symptoms in perimenopausal and postmenopausal women. A retrospective cohort study undertaken in a UK specialist menopause clinic. 510 women using hormone replacement therapy (HRT) with persistent low libido, cognitive and negative mood symptoms were treated with testosterone cream or gel for 4 months. A modified version of the Greene Climacteric Scale was used to measure self-reported symptom frequency and severity at baseline and 4 months after initiating treatment. All nine cognitive and mood symptoms significantly improved across the study period. Mood improved more than cognition (47% of women reported an improvement in mood vs. 39% reported an improvement in cognition; 34% vs. 22% decrease in mean symptom scores, respectively). Regarding libido, 52% of women reported an improvement; mean symptom score decreased by 33%. Transdermal testosterone therapy for 4 months was associated with significant improvements in mood and cognition. Further research including randomised clinical trials are needed to establish the long-term efficacy and safety of testosterone for the treatment of menopausal cognitive and psychological symptoms.

Stem Cells Rehabilitate Diabetic Neuropathy

To report the effectiveness of stem cell treatment in diabetic neuropathy. This study recruited 83 Iraqi females from 45 to 73 years old who had NIDDM between August 31, 2020 and June 30, 2023. All of them had a "Diabetic neuropathy symptom score (DNS)" (grade 3–4) and a "Diabetic foot sensory neuropathy score" (grade 1-2). They all had HbA1c (10-13%) from 7 to 10 years. The patient/family provided informed permission when they visited the "Al Zahrawy Center for Stem Cells in Baghdad". For four treatment sessions (once every three weeks), Hamad dispersed stem cells around the tibial and deep peroneal nerves. Among 83 Iraqi females, 49 (59.1%) had a grade 4 "Diabetic neuropathy symptom score" upon presentation, which decreased to 24.2% in 20 females after three months of medication. Their "Diabetic foot sensory neuropathy (DNS)" was (54.3%) in 45 females at presentation and decreased to (21.8%) in 18 females after three months of treatment. The satisfaction rate for therapy was 74.6% for the "Diabetic neuropathy symptom score" and 78.3% for "Diabetic foot sensory neuropathy (DNS)". Stem cell therapy is a good treatment option for diabetic neuropathy. The researchers supported it and suggested a greater sample size in other places.

Impact of Preoperative Continence on HoLEP Symptom Recovery: A Close Investigation of Patient-Reported Outcomes.

Introduction Holmium Laser Enucleation of the Prostate (HoLEP) is an increasingly utilized surgical intervention for Benign Prostatic Hyperplasia (BPH) with Lower Urinary Tract Symptoms (LUTS). It is unclear how pre-HoLEP voiding performance (including pre-HoLEP incontinence) affects post-HoLEP urinary symptom performance and recovery, which challenges effective patient counseling. Methods This is a single-institution retrospective analysis of 266 patients who underwent HoLEP. Pre-HoLEP continence status was determined by patient report. The Michigan Incontinence Symptom Index (MISI) was used to assess continence (severity and bother, severity broken into urge and stress). The International Prostate Symptom Score (IPSS) was used to assess LUTS (total IPSS score and Quality of Life (QoL)). Surveys were completed pre-operatively and one week (1wk), one month (1m), three months (3m), and one-year (1y) post-HoLEP. Primary outcome measures were MISI differences between groups at each time point. Results Of the 266 patients evaluated, 178 participants were continent and 88 were incontinent pre-HoLEP. Average age at time of HoLEP was 70.3 and 70.8 respectively, average preoperative prostate size measured by ultrasound or axial imaging was 109.0 g and 113.7 g, respectively. Based on MISI stress (#1-3) and urge (#4-6) items, pre-HoLEP Stress:Urge ratio in continent pre-HoLEP patients was 1.29:3.02. In the incontinent pre-HoLEP group, Stress:Urge was 2.45:6.18. MISI scores were statistically similar between cohorts at 1wk. Preop incontinent patients had a statistically and clinically significant improvement in MISI severity score at 1y post-HoLEP (5.62 n=11 vs 10.170 n=50, p=0.013). IPSS Total scores were statistically similar between cohorts at 1m and IPSS QoL scores were statistically similar at pre-op. At preop evaluation, urge symptoms were worse than stress symptoms in all cohorts. Conclusions Preoperative incontinence should not be considered a predictor of poor intermediate or long-term post-HoLEP outcomes. Pre-HoLEP incontinence is likely largely urge-related.

Research on the soothing Liver - Qi stagnation method in the treatment of postoperative papillary thyroid carcinoma patients' concomitant depression: A randomized controlled clinical trial.

Postoperative papillary thyroid carcinoma (P-PTC) patients often grapple with depression fueled by the looming threat of recurrence. While the Liver-Qi stagnation method is frequently employed for depression management, a notable scarcity of clinical trials exists regarding its application in patients with P-PTC and concurrent depression. This study presents a randomized controlled clinical trial, aiming to establish the efficacy of the Liver-Qi stagnation method in alleviating depression in patients with P-PTC. In this randomized controlled clinical trial, P-PTC patients diagnosed with concomitant depression were systematically enrolled. Subjects were randomly assigned to either the control or test group, both receiving standard treatment comprising Levothyroxine sodium tablets and decoction of benefiting Qi and nourishing Yin. Additionally, the test group received supplementation with bupleuri radix-paeoniae alba radix (CH-BS) alongside the baseline therapy. The intervention spanned 12 weeks. Pre- and post-treatment evaluations were conducted using the Hamilton Depression Scale (HAMD), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Traditional Chinese Medicine (TCM) syndrome score scale. Concurrently, blood inflammatory factors and serum 5-hydroxytryptamine (5-HT) levels were measured to comprehensively assess treatment outcomes. During the 12-week intervention, the test group demonstrated a significant reduction in HAMD scores compared to the control group (P < .05). Moreover, post-treatment serum 5-HT levels were significantly elevated in the test group compared to the control group (P < .05). Findings gleaned from the EORTC QLQ - C30 revealed a noteworthy improvement in social function and overall quality of life scores within both groups post-treatment in comparison to baseline (P < .05). Concurrently, post-treatment scores for fatigue and insomnia symptoms witnessed a significant decrease compared to baseline (P < .05). Notably, the test group exhibited superior scores in the emotional domain in contrast to the control group (P < .05). Both groups exhibited a substantial decrease in TCM syndrome scores from baseline (P < .05). Noteworthy increases were found in IFN-γ < 2.44 rate (62.86%) and IL-6 < 2.44 rate (74.29%) in the test group compared to pretreatment levels (P < .05). The soothing Liver-Qi stagnation method induces a rise in serum 5-HT levels, reducing depression-related inflammatory factors, culminating in the alleviation of depression for P-PTC.

Elevated preoperative lower esophageal sphincter pressure predicts improved clinical outcomes after per oral endoscopic myotomy (POEM).

Although per oral endoscopic myotomy (POEM) has shown to be beneficial forthe treatment ofachalasia, it can be difficult to predict who will have a robust and long-lasting response. Historically, it hasbeen shownthat higher lower esophageal sphincter pressures havebeen associatedwith poorer responses to alternative endoscopic therapies such as Botox therapy and pneumatic dilation. This studywas designedto evaluate if modern preoperative manometric data could similarly predict response totherapyafter POEM. This was a retrospective study of 237 patients who underwent POEM at a single institution over a period of 13years (2011-2023) and who had a high-resolution manometry performed preoperativelyandan Eckardt symptom score performed both preoperative and postoperatively. The achalasia type and integrated relaxation pressures (IRP) were tested for potential correlation with the need for any further achalasia interventions postoperativelyaswell asthe degree of Eckardt score reduction using a linear regression model. The Achalasia type on preoperative manometry was not predictive for further interventions or degree of Eckardt score reduction (p = 0.76 and 0.43, respectively). A higher IRP was not predictive of the need forfurtherinterventions, however, it was predictive of agreaterreduction in postoperative Eckardt scores (p = 0.03)asshown by the non-zero regression slope. In this study, achalasia type was not a predictive factor in the need for further interventions or the degree of symptom relief.Although IRPwas not predictive ofthe need for further interventions, a higher IRPdid predictbetter symptomatic relief postoperatively.This result is opposite that of other endoscopic treatment modalities (Botox and pneumatic dilation). Therefore, patients with higher IRP on preoperative high-resolution manometry would likely benefit from POEMwhichprovides significant symptomatic relief postoperatively.