Changes In Symptoms Research Articles

Application of time series analysis in predicting postpartum depression: integrating data from the hospitalization period and early postpartum weeks.

This study aimed to explore the dynamic changes in postpartum depressive symptoms from the hospitalization period to 4-8 weeks postpartum using time series analysis techniques. By integrating depressive scores from the hospital stay and the early postpartum weeks, we sought to develop a predictive model to enhance early identification and intervention strategies for Postpartum Depression (PPD). A longitudinal design was employed, analyzing Edinburgh Postnatal Depression Scale (EPDS) scores from 1,287 postpartum women during hospitalization and at 4, 6, and 8 weeks postpartum. Descriptive statistics summarized demographic characteristics. Time Series Analysis using the Auto-Regressive Integrated Moving Average (ARIMA) model explored temporal trends and seasonal variations in EPDS scores. Correlation analysis examined the relationships between EPDS scores and demographic characteristics. Model validation was conducted using a separate dataset. EPDS scores significantly increased from the hospitalization period to 4-8 weeks postpartum (p < .001). The ARIMA model revealed seasonal and trend variations, with higher depressive scores in the winter months. The model's fit indices (AIC = 765.47; BIC = 774.58) indicated a good fit. The Moving Average (MA) coefficient was - 0.69 (p < .001), suggesting significant negative impacts from previous periods' errors. Monitoring postpartum depressive symptoms dynamically was crucial, particularly during the 4-8 weeks postpartum. The seasonal trend of higher depressive scores in winter underscored the need for tailored interventions. Further research using longitudinal and multi-center designs was warranted to validate and extend these findings. Our predictive model aimed to enhance early identification and intervention strategies, contributing to better maternal and infant health outcomes.

Longitudinal change in symptom severity in children with ASD: Results from the ELENA cohort.

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition and understanding the changes in autism symptoms over time is crucial for tailoring support and interventions. This study therefore aimed to investigate the changes in symptom severity in a large cohort of children with ASD over a three-year follow-up period and identify factors that influence these changes. The study included 575 children diagnosed with ASD, ranging in age from 2 to 12 years, who were assessed at baseline and again 3 years later using the Autism Diagnostic Observational Schedule-2 (ADOS-2). ASD severity changes were investigated using the ADOS calibrated severity score (CSS) scores for total, social affect (SA) and restricted and repetitive behaviors (RRB). Results highlight four distinct patterns: stable high, stable low, increased, and decreased severity. The ADOS CSS total score changed for half of the sample, reflecting an increase in ASD severity for 21.9% and a decrease for 29.1% of children. For the other half, the ADOS CSS score remained stable, either high (34.4%) or low (14.6%). While the majority of previous studies reported stability in ASD severity, our findings revealed significant variability with frequent improvements in SA symptoms whereas RRBs remained stable or worsened. Our findings also showed that an improvement in SA was associated with the youngest group and early diagnosis. However, no clinical or sociodemographic factors were linked to changes in RRB, emphasizing the necessity for RRB-specific therapies. The third six-year follow-up point of the ongoing ELENA cohort study will map the long-term trajectories of the severity of ASD symptoms and their potential risk factors.

Psychophysiological evaluation of life-cycle disorder restoration using VR soundscape

The emotional restorativeness of soundscapes, akin to the healing effects of natural green spaces, can induce recovery from life-cycle emotional and cognitive-related disorders. A digital therapy program that supplements medication was developed through soundscape experiences in a multi-user VR environment and evaluated psychophysiologically. Initially, the program provided natural environment-based role-playing for the treatment of children with ADHD and utilized soundscape audio-visual content for adolescents and soundwalk content as a physical activity program for emotional care and cognitive function improvement in patients with cognitive disorders. The effectiveness of the digital therapeutic under development was verified through clinical symptom assessment tools and changes in psychological and physiological responses.

DNA methylation of serotonin genes as predictive biomarkers of antidepressant treatment response

Selective serotonin reuptake inhibitors (SSRI) are frequently ineffective in treating depressive episodes and biomarkers are needed to optimize antidepressant treatment outcomes. DNA methylation levels of serotonin transporter (SLC6A4) and tryptophan hydroxylase 2 genes (TPH2) have been suggested to predict antidepressant clinical outcomes but their applicability remains uncertain. In this study, we: 1) evaluated SLC6A4/TPH2 methylation biomarker potential for predicting clinical outcomes after escitalopram treatment; 2) evaluated whether changes in SLC6A4/TPH2 methylation are informative of treatment mechanisms. We used a cohort of 90 unmedicated patients with major depressive disorder that were part of a 12-week open-label longitudinal trial and compared our observations with previous findings. Depressive symptoms were measured at baseline and after 8 and 12 weeks of treatment using the Hamilton Depression Rating Scale (HAMD6/17). We found an association between baseline TPH2 methylation and both clinical response (β:3.43; p = 0.01; 95 % CI:[0.80; 6.06]) and change in depressive symptoms after 8 weeks (β:−45.44; p = 0.01; 95 %CI:[− −78.58; −12.30]). However, we found no evidence for predictive value of any gene (TPH2 AUC: 0.74 95 % CI:[0.42;0.79]; SLC6A4: AUC: 0.61; 95 % CI: [0.48–0.78]). Methylation levels changed at the trend level for CpG sites of SLC6A4 and TPH2 over the course of 12 weeks of treatment. In addition, similar to previous observations, we found a trend for an association between methylation of SLC6A4 CpG2 (chr17:30,236,083) and HAMD17 change after 12 weeks. Our findings suggest that although TPH2 and SLC6A4 methylation may be informative of antidepressant treatment outcome, they are unlikely to prove useful as clinical predictor tools.

Long-term COVID-19 sequelae by Theta and SARS-CoV-2 variants in a Philippine cohort.

Millions have been infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) since its emergence in 2019, but most patients make a full recovery. The long-term consequences of the infection are anticipated to unravel in the succeeding years with reports of patients experiencing chronic, debilitating sequelae post-infection commonly referred to as Long COVID. Various Variants of Concern (VoCs) have emerged as the SARS-CoV-2 virus evolved displaying increased infectivity and immune evasiveness. We investigate whether the infecting VoCs affect the sequelae of Long COVID in a Philippine cohort. SARS-CoV-2 cases confirmed using RT-PCR followed by Next Generation Sequencing were identified from selected regions of the Philippines and recruited through a retrospective-prospective cohort design. Participants were divided based on the initial infecting VoC or Variant of Interest (VoI) and were subsequently interviewed regarding the presence, intensity, and frequency of key Long COVID symptoms, and followed up on two more separate sessions at least three (3) months apart for a total of three (3) data collection points (S1, S2, S3) to document changes in symptoms throughout the year-long study period. Long COVID symptoms were reported in 88, 82, and 68% of participants in S1, S2, and S3, respectively, showing declining incidence with elapsed time since the first reported infection. General symptoms including headache, fatigue, and post-exertional malaise were the most frequently reported symptoms, while neuropsychiatric symptoms were the second most frequently reported symptoms. In all three (3) sessions, intermittent brain fog, fatigue, and headache were the most frequently reported symptoms in all SARS-CoV-2 variant cohorts. Factors such as age, sex, comorbidities, and disease severity influenced symptom frequency, providing insight into the risk factors that contribute to the prevalence of this disease. A large proportion (>68%) of cases in this Philippine cohort previously infected with different SARS-CoV-2 variants presented with long-term complications of COVID-19 characterized by a highly heterogeneous set of debilitating symptoms. The study highlights the need for long-term monitoring of Long COVID and its impact on human health and the need for our health systems to adopt policy response strategies.

Advanced practitioners working with older people in primary care and community settings: a survey of roles and use of technology.

Advanced practitioner (AP) roles are becoming increasingly common in primary care and community settings for supporting older people and those living with frailty. The aim of this study was to explore health and social work AP roles in primary care and community settings in the UK, and understand how they support older people and factors that may impact on APs use of technology in practice. A cross-sectional, web-based survey was adopted to explore the views and perspectives of APs. The survey received 111 responses. There were different views as to whether technology was suitable for older people. Although digital exclusion was a concern, it was perceived that this would change in the future as generations become more digitally literate. Respondents suggested that using technology brought about efficiencies and the ability to respond sooner to symptom changes, with some concerns mentioned regarding the accuracy of technology that may miss signs and symptoms. This is the first national survey to explore advanced practice roles with older people in non-hospital settings. While APs have wide-ranging skills, few currently use technology in their practice. Findings will inform a future study on digitally enhanced comprehensive geriatric assessments.

Changes in countertransference and changes in patient working alliance and outcome: An empirical study.

The American Psychological Association task force on empirically supported therapy relationships defined countertransference (CT) management (i.e., awareness of CT) as a "promising" element in psychotherapy research. The present study aimed to examine how changes in therapist CT and awareness of CT relate to therapy process and outcome. The data analysis was based on 41 treatments and used the core conflictual relationship theme to measure CT. We found that changes in therapists' Wishes from the relationship with the patient at the beginning of therapy were related to patients' working alliance and symptom changes at the end of treatment. Changes in therapist awareness of CT moderated the relationship between therapists' wishes from the therapy and patients' symptom changes during therapy. Last, we present a case study and discuss how awareness of CT can help the therapist handle the challenges that arise from it. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of symptom change in the mental health of refugees and asylum seekers (MEHIRA) study examining the effects of a stepped and collaborative care model – A multicentered rater-blinded randomized controlled trial

BackgroundPredictors of symptom improvement are an essential starting point for tailoring psychological treatments to each individual and, in turn, increasing treatment efficacy overall. However, such research regarding refugees/asylum seekers from Arabic-/Farsi-speaking countries is lacking. The current study aimed to characterize predictors for symptom improvement in the Mental Health in Refugees and Asylum Seekers (MEHIRA) study, one of the most extensive multicentered controlled trials on a nationwide stepped and collaborative care model compared to routine German mental health care. MethodsVariables characterizing symptom change were chosen using backward elimination and inserted into logistic regression models for two depression endpoints, namely the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Asberg Depression Rating Scale (MADRS). ResultsSix variables were found to be at least marginally significantly associated with symptom decrease in both outcomes: baseline depressive symptom load, comorbid post-traumatic stress disorder, identifying as a refugee, years of schooling, physical health, and post-migration social status difference. Additionally, psychological health and resilience were marginally significant for one of the models. LimitationsSome predictor constructs - such as social support - were not adequately measured to replicate previous findings. Additionally, the study was underpowered for symptom change prediction of individual treatments beyond the group intervention. ConclusionsThese outcomes indicate that trauma-related elements as well as content on refugee identity and post-migration social status changes should be included in depression interventions for refugees. Further, recommendations for future outcome prediction studies are made.

Effect of childhood trauma on cognitive function in individuals with major depressive disorder and healthy controls

BackgroundIndividuals with major depressive disorder (MDD) exhibit cognitive impairment, while childhood trauma (CT) is associated with an elevated risk of both MDD and cognitive dysfunction. The effect of CT on cognitive function in MDD patients and healthy controls (HCs) is unclear. MethodsMDD patients and HCs were enrolled between December 2013 and December 2016. The Childhood Trauma Questionnaire (CTQ) was used to assess CT. Depressive symptoms and cognitive function were assessed at baseline and after 8-week acute-phase treatment with selective serotonin reuptake inhibitors (SSRIs) in MDD patients. ResultsA total of 909 people were included in the analysis. The interaction between MDD and CT had a main effect on Digit Symbol-Coding Test (DSCT), Stroop Color Test (SCT), and Stroop Color-Word Test (SCWT) scores. The effect of CT on cognitive function disappeared after adjusting for MDD diagnosis and years of education. Neglect could predict poor performance on SCT and SCWT in the HC group. After acute-phase treatment with SSRIs, CT did not significantly predict changes in cognitive function or depressive symptoms. LimitationsThe CTQ assessment might cause recall bias, and the cross-sectional design could not establish the causal link between CT and cognitive function. ConclusionThe effect of CT on cognitive function was modulated by MDD diagnosis and years of education. CT did not predict changes in depressive symptoms or cognitive function after acute-phase treatment with SSRIs. The direct influence of CT on cognitive function in MDD patients may be over-estimated. Trial registrationClinicalTrials.gov: NCT02023567; registration date: December 2013.

Bidirectional changes in depressive symptoms and social functioning in older adults attending psychological therapy services

BackgroundImpairments in the ability to carry out social activities commonly co-occurs alongside depression. Improving social functioning is often overlooked in treatment. This is despite the high value placed by patients on social functioning and the potential for interventions focused on social functioning to have additional benefits in reducing depressive symptoms. In older adults the relationship between depressive symptoms and social functioning during treatment is poorly understood. MethodsWe analysed data across the first four treatment sessions of 3260 older adults receiving psychological therapy for depression at eight NHS Talking Therapies for anxiety and depression services in England. Analyses were random-intercept cross-lagged panel models, modelling bi-directional change between depressive symptoms, and impairments in (a) social leisure activities, and (b) close relationships, controlling for gender and diagnosis. ResultsOver treatment sessions, depressive symptoms and impairments in social functioning decreased. A bi-directional relationship was observed whereby depressive symptoms were associated with future impairments in social functioning and vice versa. Changes in depressive symptoms appeared to have a greater association with future social functioning, compared to the reverse. LimitationsPatients lived in Greater London and findings may not translate to other settings. We included older adults that attended at least four treatment sessions, and had no missing data at the first assessment, potentially biasing the sample and results. ConclusionsOlder adults receiving psychological therapy experience reductions in depressive symptoms and impairment in social functioning early in treatment. Treating core depressive symptoms and impairments in social functioning may benefit one another, and improve outcomes.

Design and Rationale of MYOFLAME-19 RCT: MYOcardial protection to reduce inFLAMmatory heart disease due to COVID-19 Infection using CMR Endpoints.

Cardiac symptoms due to postacute inflammatory cardiac involvement affect a broad segment of previously well people with only mild acute COVID-19 illness and without overt structural heart disease. Cardiac magnetic resonance (CMR) imaging can identify the underlying subclinical disease process, which is associated with chronic cardiac symptoms. Specific therapy directed at reducing postacute cardiac inflammatory involvement prior to development of myocardial injury and impairment is missing. Prospective multicentre randomised placebo-controlled study of myocardial protection therapy (combined immunosuppressive/antiremodelling) of low-dose prednisolone and losartan. Consecutive symptomatic individuals with a prior COVID-19 infection, no preexisting significant comorbidities or structural heart disease, undergo standardised assessments with questionnaires, CMR imaging and cardiopulmonary exercise testing (CPET). Eligible participants fulfilling the criteria of subclinical Post-COVID inflammatory involvement on baseline CMR examination are randomised to treatment with either verum or placebo for a total of 16 weeks (W16). Participants and investigators remain blinded to the group allocation throughout the study duration. The primary efficacy endpoint is the absolute change of left ventricular ejection fraction (LVEF) to baseline at W16, measured by CMR, between the verum treatment and placebo group by absolute difference, using unpaired t-test confirmatively at the 5% significance level. Secondary endpoints include assessment of changes of symptoms, CMR parameters, and CPET after W16, and frequency of major adverse cardiac events after 1 year. Safety data will be analysed for frequency, severity and types of adverse events (AEs) for all treatment groups. The proportion of AEs related to the contrast agent gadobutrol will also be analysed. A calculated sample size is a total of 280 participants (accounting for 8% drop-out), randomised in 1:1 fashion to 140 in the verum and 140 placebo group. Myoflame-19 study will examine the efficacy of a myocardial protection therapy in symptomatic participants with post-COVID inflammatory cardiac involvement determined by CMR. The aim of the intervention is to reduce the symptoms and inflammatory myocardial injury, to improve exercise tolerance and preclude the development of cardiac impairment. NCT05619653.

Peruvian Adolescent Mental Health Across Two Years of the COVID-19 Pandemic: A Four Time-Point Longitudinal Study

PurposeThis study investigated symptoms of anxiety and depression, feelings of loneliness, and life satisfaction among low-to-middle income Peruvian adolescents during 2 years of remote schooling due to the COVID-19 lockdown. MethodsWe used a four-wave longitudinal observational approach. Data were collected in April 2020, October 2020, June 2021, and November 2021 in Perú. A total of 2,392 adolescents (ages 10–15; 57% female) participated in the study. We described longitudinal changes in symptoms of anxiety and depression, feelings of loneliness, and life satisfaction across the four time points and investigated sex and school grade differences. ResultsSymptoms of anxiety, depression, and loneliness increased, and life satisfaction decreased over the course of 2 years of remote education. The rate of change was different for each outcome of well-being. We found robust sex differences for all outcomes. In addition, we found school grade differences for anxiety and depression. DiscussionThe mental health and well-being of Peruvian adolescents, particularly female adolescents, declined during 2 years of remote education, despite loosening of other pandemic restrictions. Depression appears to have the earliest impacts, with anxiety levels showing even some improvement for male adolescents. School grade differences in levels of anxiety and depression for seventh and eighth graders in 2020 and 2021 provide initial evidence to disentangle pandemic from developmental effects.

Temporal Changes in Depressive Symptoms Among Goodville Farm Game Players: A 6-Week Observational Study.

Aim of the Study: The primary objective was to evaluate the potential impact of the Goodville farm game on depressive symptoms. Methods: The Goodville game, characterized by its unique farming features, incorporates elements of emotional well-being and various mental health assessment tools, enabling players to monitor and improve their emotional state. Using self-reported Patient Health Questionnaire-8 (PHQ-8) data from 1717 US and UK players, changes were monitored weekly over a 6-week period. The study focused on the game's ability to integrate emotional well-being elements and various mental health assessments to facilitate self-monitoring and improvement of players' emotional states. Results: There was a significant overall time effect (F = 154.498, df = 1711, P < 0.001), indicating a moderate-to-large effect size, with progressive decreases in PHQ-8 scores throughout the period. About 60% of players reported reduced depressive symptom severity, with around 35% experiencing complete symptom relief. More significant improvements were observed in players with higher initial severity. No correlations were found between symptom changes and demographic data or the number of active playing days. Conclusion: Goodville demonstrates potential as a digital mental health intervention in reducing depressive symptoms through its specific characteristics designed to improve emotional well-being. The study emphasizes the need to consider baseline severity and highlights the therapeutic promise of authentic farming game features. Despite the absence of a control group, the findings contribute meaningful insights into digital interventions for mental health care and set a direction for future studies to validate and expand upon these results.

Vaginal erbium laser versus pelvic floor exercises for the treatment of pelvic organ prolapse: A randomised controlled trial

ObjectivesTo compare the efficacy of Er:YAG laser for mild to moderate pelvic organ prolapse (POP) to that of pelvic floor exercises (PFE). DesignSingle center randomised controlled trial. SettingTertiary center, Belgium. ParticipantsForty-six women with mild to moderate prolapse were enrolled (23 in each group). There were no missing data for the primary outcome; three patients were lost to follow-up at 24-months. InterventionsComparison of vaginal laser treatment (3–6 applications) to PFE (9–18 sessions). Main outcome measuresSubjective change in prolapse symptoms at four months from baseline measured by the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) (primary), adverse events, other subjective outcomes and independent anatomical assessment up to 24 months. ResultsThe mean difference in POPDI-6 scores at 4 months was 1.09 (95 %CI = −6.02;8.12), showing non-inferiority of laser to PFE (p = 0.004). Within groups, the difference in mean POPDI-6 four months following the start of therapy tended to be lower for laser-treatment (65.2 % (15/23) of laser-participants were ‘better’ or ‘much better’) than for PFE (60.9 % (14/23) in the PFE group), yet without difference between groups (OR = 1.21; 95 %CI = 0.39–3.23). There were no obvious between group differences in any other subjective nor objective outcomes. At 24 months, 50 % (11/22) of laser-patients and 43 % (9/21) of PFE-patients requested additional, yet alternative treatment. There were no serious adverse events at any time-point. ConclusionsVaginal laser application and PFE improve symptoms of mild and moderate prolapse to a similar extent. Both treatments had a measurable yet not durable effect. There were no adverse events in either arm. Trial registrationClinicalTrials.gov(NCT04523298) FundingThe laser device was provided by Fotona, Slovenia for the duration of this trial.

Perilymphatic enhancement and endolymphatic hydrops: MRI findings and clinical associations.

In this study, we aimed to summarize magnetic resonance imaging (MRI) findings of perilymphatic enhancement (PE) and endolymphatic hydrops (EH) of the inner ear, which are associated with vestibular and cochlear symptoms. We analyzed data on ears with definite Meniere's disease (MD), sensorineural hearing loss (SNHL), vertigo, and listening difficulties (LiD) from 508 ears of 254 patients who underwent contrast-enhanced 3-Tesla MRI between April 2021 and March 2023. We evaluated the degree of endolymphatic hydrops (EH), signal intensity ratios (SIRs) between the basal turns of the cochlea and cerebellum, and hearing levels for all ears. Ears with definite MD were also assessed for changes in vestibular and cochlear symptoms within 6 months. Ears with definite MD exhibited significantly higher percentages of EH in both the vestibule and cochlea compared with ears with other diseases. Furthermore, ears with MD or sensorineural hearing loss (SNHL) had significantly higher SIRs of PE compared with ears with other diseases or asymptomatic ears. Among patients with definite MD, those experiencing hearing fluctuations or vertigo attacks within the last 6 months had significantly higher SIRs of PE compared with those who did not experience any symptoms. Significant EH in the vestibule and cochlea was a major finding for the imaging diagnosis of definite MD. A high SIR of PE was a good indicator for assessing MD activity, reflecting vestibular and cochlear symptoms and fluctuations.Level of Evidence: 4.

Changes In Asthma Symptoms In College Aged Athletes After Having Covid-19

Changes In Asthma Symptoms In College Aged Athletes After Having Covid-19

Longitudinal changes in patient-reported outcomes (PROs) among early phase clinical trial (EP-CT) participants.

243 Background: Little research has explored associations of longitudinal changes in PROs and clinical outcomes among EP-CT participants. We sought to describe changes in PROs over the first month of EP-CT participation and examine associations of changes with clinical outcomes. Methods: We prospectively enrolled adults participating in EP-CTs at Massachusetts General Hospital from 04/2021-01/2023. We assessed quality of life (QOL) (Functional Assessment of Cancer Therapy-General, with subdomains: physical wellbeing [PWB], emotional wellbeing [EWB], social wellbeing [SWB], functional wellbeing [FWB]); hope (Herth Hope Index); symptom burden (Edmonton Symptom Assessment System); and financial wellbeing (Comprehensive Score for Financial Toxicity) at time of EP-CT enrollment and one month later (1-month). We used descriptive statistics and regression models to describe 1-month changes in PROs and explore associations of patient-reported QOL, hope, symptom burden, and financial wellbeing with patient factors (age, diagnosis, performance status) and clinical outcomes (time on trial [TOT], treatment response, ED visits, hospitalizations, and survival). Results: Of 205 enrolled patients, 159 (77.9%) had baseline and 1-month data evaluable for analysis (median age: 63.0 [range 33.0 – 88.6], 59.8% female, 93.6% metastatic cancer, ECOG 0= 46.2% and ECOG 1=53.8%). Most common cancer types were gastrointestinal (31.5%) and breast (22.0%). There was no significant change from baseline to 1-month in mean QOL (75.2 to 76.2), hope (27.1 to 26.7), ESAS total symptom burden (20.4 to 20.9), ESAS physical symptoms (13.3 to 13.7), and financial wellbeing (28.5 to 28.0). There was no significant change in overall QOL and in each subdomain with the exception of EWB (16.2 to 17.0, p&lt;.001). Older age was associated with increased hope (B=1.29, p=.008) and increased QOL (B=3.02, p=0.024). Increasing EWB at 1-month was associated with longer TOT (HR=0.93, p=.011). Increased symptom burden at 1-month was associated with greater risk of ED visits (HR=1.04, p=.005) and hospitalizations (HR=1.03, p=.012). Improving financial wellbeing at 1-month was associated with lower risk of hospitalization (HR=0.96, p=.046). We found no other significant associations of 1-month changes in PROs with treatment response or survival. Conclusions: We described changes in PROs from baseline to 1-month and identified factors associated with these changes. Despite the rigors and intensity associated with EP-CT initiation, most PROs did not worsen, with significantly improved EWB after 1-month of participation. Results demonstrate changes in physical symptoms predicted for greater risk of ED visits and hospitalizations. Future studies should build upon this work and measure PROs throughout trial participation to identify factors associated with changes and guide intervention development.

Stereotactic radiosurgery for arteriovenous malformations in pediatric patients: an updated systematic review and meta-analysis.

Intracranial arteriovenous malformations are the most common cause of intracranial hemorrhages in pediatric patients. Stereotactic radiosurgery (SRS) has been used extensively to treat these lesions. The authors conducted a systematic review and meta-analysis to report treatment outcomes and long-term complications. This study follows the PRISMA and MOOSE guidelines, with the search spanning electronic databases up to February 6, 2024. The outcome measures included obliteration rate, hemorrhage in the latency period, symptomatic radiation-induced changes (RICs), cyst formation, and radiation-induced tumorigenesis. A total of 1493 patients across 24 studies were included. The pooled complete obliteration after single-fraction SRS was 64.7% (95% CI 58%-69%). The pooled post-SRS hemorrhage rate at the final follow-up was 6.2% (95% CI 5%-8%). The overall incidence rate of RIC was 31.3% (267/854 patients), and the incidence of symptomatic RIC was 8.8% (114/1289 patients). For permanent symptomatic RIC, the pooled incidence was 4.8% (62/1283 patients). At final follow-up, 17 cases of radiation-induced necrosis were documented among 654 patients (2.6%). Similarly, cyst formation was reported in 1.3% of cases (17/1265 patients) and radiation-induced tumors occurred in 0.15% of cases (2/1342 patients). SRS can be considered an effective intervention for appropriately selected pediatric patients with arteriovenous malformations. Long-term complication rates appear to be low but additional longitudinal studies are required to better define the long-term outcomes.

Associations between lateral hip muscle changes and global rating of change of symptoms in active young adults with long standing hip/groin pain

Associations between lateral hip muscle changes and global rating of change of symptoms in active young adults with long standing hip/groin pain

Stereotactic Radiosurgery for Intracranial Cavernous Malformations: International Stereotactic Radiosurgery Society, Systematic Review, Meta-Analysis, and Practice Guidelines

The International Stereotactic Radiosurgery Society (ISRS) aims to establish evidence-based guidelines for single-fraction stereotactic radiosurgery (SRS) in treating intracranial cavernous malformations. We conducted a systematic review following PRISMA and MOOSE guidelines, searching electronic databases up to January 2024 to assess SRS's impact on post-treatment hemorrhage rates. Pooled risk ratios (RR) and confidence intervals were utilized to quantify this effect, along with assessments of lesion volume changes, seizure outcomes, and SRS-related adverse effects. Our meta-analysis included 32 studies with 2672 patients. A significant decrease in annual hemorrhage rates was observed post-treatment (RR=0.17), with rates of RR=0.29 in the first 2 years and RR=0.11 thereafter. Hemorrhage rates significantly differed before and after 2 years post-SRS (RR=0.36). Among epileptic patients, 20.2% had epilepsy pre-treatment, and 49.9% were seizure-free post-SRS, while 30.6% experienced reduced seizure frequency. Lesion volume changes showed a reduction in 46.9%, stability in 47.1%, and an increase in 6.7%. Symptomatic radiation effects affected 8% of patients. Subgroup analysis revealed symptomatic change rates of 6% at doses ≤13Gy compared to 9% at doses >13Gy. Permanent clinical deficits were rare (2%). This meta-analysis suggests SRS is an effective intervention for intracranial cavernous malformations, significantly reducing hemorrhage rates and improving seizure outcomes. ISRS practice guidelines are provided.