Follow-up Time Points Research Articles

Surgical interventions for degenerative lumbar spinal stenosis: a systematic review with network meta-analysis.

Several surgical options for degenerative lumbar spinal stenosis (LSS) are available, but current guidelines do not recommend which one should be prioritized. Although previous network meta-analyses (NMAs) have been performed on this topic, they have major methodological problems and could not provide the convincing evidence and clinical practical information required. Randomized controlled trials(RCTs) comparing at least two surgical interventions were included by searching AMED, CINAHL, EMBASE, the Cochrane Library, and MEDLINE (inception to August 2023). A frequentist random-effects NMA was performed for physical function and adverse events due to any reason. For physical function, three follow-up time points were included: short-term (< 6months post-intervention), mid-term (≥ 6months but < 12months), and long-term (≥ 12months). Laminectomy was the reference comparison intervention. A total of 43 RCTs involving 5017 participants were included in the systematic review and 28 RCTs encompassing 14 types of surgical interventions were included in the NMA. For improving physical function (scale 0-100), endoscopic-assisted laminotomy (mean difference: - 8.61, 95% confidence interval: - 10.52 to - 6.69; moderate-quality evidence), laminectomy combined with Coflex (- 8.41, - 13.21 to - 3.61; moderate quality evidence), and X-stop (- 6.65, - 8.60 to - 4.71; low-quality evidence) had small effects at short-term follow-up; no statistical difference was observed at mid-term follow-up (very low- to low-quality evidence); at long-term follow-up, endoscopic-assisted laminotomy (- 7.02, - 12.95 to - 1.08; very low-quality evidence) and X-stop (- 10.04, - 18.16 to - 1.93; very low-quality evidence) had a small and moderate effect, respectively. Compared with laminectomy, endoscopic-assisted laminotomy was associated with fewer adverse events due to any reason (odds ratio: 0.27, 0.09 to 0.86; low-quality evidence). For adults with degenerative LSS, endoscopic-assisted laminotomy may be the safest and most effective intervention in improving physical function. However, the available data were insufficient to indicate whether the effect was sustainable after 6months. PROSPERO (CRD42018094180).

Changes in choroidal thickness and blood flow in response to form deprivation-induced myopia and repeated low-level red-light therapy in Guinea pigs.

To evaluate ocular refractive development, choroidal thickness (ChT) and changes in choroidal blood flow in form-deprived myopia (FDM) Guinea pigs treated with repeated low-level red-light (RLRL) therapy. Twenty-eight 3-week-old male tricolour Guinea pigs were randomised into three groups: normal controls (NC, n = 10), form-deprived (FD, n = 10) and red light treated with form-deprivation (RLFD, n = 8). Interocular refraction and axial length (AL) changes were monitored. Optical coherence tomography angiography (OCTA) measured choroidal thickness, vessel area density, vessel skeleton density and blood flow signal intensity (flux) in the choriocapillaris and medium-large vessel layers. The experimental intervention lasted 3 weeks. At week 3, the FD group had higher myopia and longer axial length than the NC group (all p < 0.001). The RLFD group had higher hyperopia and shorter axial length than the FD group (all p < 0.001). At week 1, the NC group had a thicker choroidal thickness than the FD group (p < 0.05). At weeks 2 and 3, the RLFD group had a thicker choroidal thickness than the FD group (p = 0.002, p < 0.001, respectively). Additionally, the NC group had higher vessel area density, vessel skeleton density and flux in the choriocapillaris layer than the FD group at the three follow-up time points (all p < 0.05). At week 3, the vessel skeleton density and flux were higher in the RLFD group than in the FD group (all p < 0.05). Correlation analysis results showed that weekly changes in refraction and choroidal thickness were negatively correlated with changes in axial length (all p < 0.05). Choroidal thickness changes were positively correlated with alterations in the vessel area density, vessel skeleton density and flux in the choriocapillaris layer, as well as vessel skeleton density and flux changes in the medium-large vessel layers (all p < 0.05). Repeated low-level red-light (RLRL) therapy retards FDM progression in Guinea pigs, potentially through increased choroidal blood flow in the choriocapillaris layer.

A-049 Effect of Supplementation With Prebiotics on Levels of 25-Hydroxy Vitamin D and on Biomarkers of Bone Remodelling-Results From the OSTEOME Clinical Trial

Abstract Background It is proven that intestinal microbes regulate bone metabolism and can affect the quality of the bone. Prebiotics contain no microorganisms, only substances stimulating their growth. Moreover, flavonoids and catechines are transformed by the microbes into bioactive compounds and polyphenols can modify the microflora composition. OSTEOME is a randomized double-blinded clinical trial to evaluate the efficacy of dietary supplements enriched with prebiotics, in advancing the role of gut microbiota in bone remodelling. We present the effect of supplementation with prebiotics on the serum levels of 25-hydroxy vitamin D (25OHD) and on levels bone markers Osteocalcin (OCN), and C-Terminal Telopeptide of Type-I Collagen (CTX). Methods We enrolled 120 postmenopausal women with osteopenia. Participants were randomized into three groups of 40-participants. Group-A received a supplement containing 600mg calcium citrate and 2400IUof vitamin D3 only, group-B received a supplement additionally containing flavonoids (120mg Naringin and 120mg Hesperidine) and group-C received additionally prebiotic oligosaccharides (2000mg fructooligosaccharides and acacia gum). Blood collections were performed at baseline and at 3, 6 and 9 months for the measurement of bone remodelling biomarkers. Levels of serum Calcium (sCa), 25OHD, as well as levels bone markers OCN, and CTX were measured at all timepoints of follow-up. Results The mean age of group-A, group-B and group-C participants was 60.72(+8.08), 62.37(+7.70) and 62.09(+7.09) (p=NS), and the mean BMIs were 25.35(+3.96), 25.89(+3.80) and 26.25(+4.56) (p=NS). All women were osteopenic as mean total hip T-score was -1.282(+0.617), -1.193(+0.659) and -1.273(+0.573) at baseline for all three groups respectively. The results of OCN, CTX and 25OHD are shown in the table. Conclusions Only patients in group-C showed significant changes in CTX and 25OHD at 9-months, and OCN at 6- and 9-months. Addition of prebiotics to supplements might improve the vitamin D absorption from the gut and give positive balance to biomarkers of bone metabolism.

Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial.

Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning. This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression. A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes. BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes. ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165.

Increased Postoperative Deltoid Signal seen after Suprapectoral Biceps Tenodesis: Potential Risk to the Anterior Branch of the Axillary Nerve

BackgroundArthroscopic suprapectoral biceps tenodesis is a common procedure for lesions of the long head of the biceps in the setting of anterior shoulder pain. However, the distal portal poses a theoretical risk to the terminal branches of the axillary nerve as the nerve travels from posterior to anterior to innervate the anterior deltoid. The purpose of this retrospective cohort study was to assess for axillary nerve branch injury, identified by deltoid signal change in postoperative magnetic resonance imaging (MRI) in patients who underwent an arthroscopic suprapectoral biceps tenodesis. MethodsPatients who underwent rotator cuff repair with a concomitant arthroscopic suprapectoral biceps tenodesis, had a postoperative MRI, and at least 1 year of follow-up were included. The incidence of increased deltoid signal consistent with injury to an anterior branch of the axillary nerve on proton density fat saturated sequences was collected. Age, sex, body mass index (BMI), and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons Shoulder Score (ASES) score, Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function (PF), and upper extremity (UE) scores, and Single Assessment Numeric Evaluation (SANE) score were compared in patients with and without increased deltoid signal on postoperative MRI. P<0.05 was used for significance. ResultsTwenty-four patients were eligible for inclusion (9 female, average age 59.0±10.1, BMI 27.6±6.7). Edema-like signal within the anterior deltoid musculature was observed in 9 patients on postoperative MRI. Two patients had a second follow-up MRI performed which demonstrated resolution of signal, and one patient required a second surgery for release of adhesions. Patients with increased deltoid signal had higher BMI (p=0.03). There was no difference in any other demographic or postoperative PROM between patients with increased signal and those without at any follow-up time point. No patient demonstrated persistent weakness or numbness in the axillary nerve distribution at final follow-up. DiscussionOver one third of patients in our cohort had MRI evidence of axillary nerve branch injury as seen on proton density fat saturated MRI sequences postoperatively. The distal arthroscopic portal for a suprapectoral biceps tenodesis may place anterior terminal branches of the axillary nerve at risk for injury. Additional investigation and strategies for avoidance of nerve injury in this area should be pursued.

Quality of Life After Transcatheter Tricuspid Valve Replacement: 1-Year Results From TRISCEND II Pivotal Trial.

Severe tricuspid regurgitation (TR) often causes substantial impairment in patient-reported health status (ie, symptoms, physical and social function, and quality of life), which may improve with transcatheter tricuspid valve replacement (TTVR). We performed an in-depth analysis of health status of patients enrolled in the TRISCEND (Edwards EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy using a Novel Device) II pivotal trial to help quantify the benefit of intervention to patients. The TRISCEND II pivotal trial randomized 400 patients with symptomatic and severe or greater TR 2:1 to TTVR with the EVOQUE tricuspid valve replacement system plus optimal medical therapy (OMT) or OMT alone. Health status was assessed with the Kansas City Cardiomyopathy Questionnaire and the 36-Item Short Form Health Survey. Changes in health status over 1 year were compared between treatment groups using mixed-effects repeated-measures models. The analysis cohort included 392 patients, of whom 259 underwent attempted TTVR and 133 received OMT alone (mean age 79.2 ± 7.6 years, 75.5% women, 56.1% with massive or torrential TR). Patients had substantially impaired health status at baseline (mean Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS] 52.1 ± 22.8; mean 36-Item Short Form Health Survey physical component summary score 35.2 ± 8.4). TTVR+OMT patients reported significantly greater improvement in both disease-specific and generic health status at each follow-up time point. Mean between-group differences in the KCCQ-OS favored TTVR+OMT at each time point: 11.8 points (95%CI: 7.4-16.3 points) at 30days, 20.8 points (95%CI: 16.1-25.5 points) at 6months, and 17.8 points (95%CI: 13.0-22.5 points) at 1 year. In subgroup analyses, TTVR+OMT improved health status to a greater extent among patients with torrential or massive TR vs severe TR (treatment effect 23.3 vs 22.6 vs 11.3; interaction P=0.049). At 1 year, 64.6% of TTVR+OMT patients were alive and well (KCCQ-OS≥60 points and no decline of≥10 points from baseline) compared with 31.0% with OMT alone. Compared with OMT alone, treatment of patients with symptomatic and severe or greater TR with TTVR+OMT resulted in substantial improvement in patients' symptoms, function, and quality of life. These benefits were evident 30days after TTVR, continued to increase through 6months, and remained durable through 1 year. (TRISCEND II Pivotal Trial [Edwards EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy using a Novel Device]; NCT04482062).

Efficacy of Fragility Fracture Integrated Rehabilitation Management in Older Adults With Hip Fractures: A Randomized Controlled Trial With 1-Year Follow-Up

ObjectivesComprehensive multidisciplinary rehabilitation has been proven to benefit patients recovering from hip fracture surgery, enhancing postoperative outcomes. However, challenges persist in delivering such rehabilitation due to health care system limitations and inadequate policies. This study aimed to evaluate the clinical effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) in comparison to a conventional rehabilitation after hip fracture surgery. DesignA parallel-group, single-blind, multicenter randomized clinical trial. Setting and ParticipantsThree in-hospital rehabilitation settings; 203 hip fracture surgery patients aged 65 years and older were randomized and followed up for 1 year. MethodsThe main outcome assessed ambulatory function, using the Koval and Functional Ambulation Category (FAC) scales. Functional outcomes were evaluated upon rehabilitation admission, discharge, and during follow-up at 3, 6, and 12 months post-surgery. The prevalence of independent ambulation and recovery to prefracture ambulatory status at each follow-up time point were analyzed. ResultsThe FIRM group demonstrated superior improvements in Koval and FAC scores, along with most secondary outcomes during the 1-year follow-up. Significant changes from baseline to 12 months were observed in Koval scores (mean difference, −4.13 [95% CI, −4.56 to −3.70] vs −3.22 [95% CI, −3.86 to −2.61], P = .016) and FAC scores (mean difference, 3.37 [95% CI, 3.01 to 3.72] vs 2.56 [95% CI, 2.10 to 3.02], P = .006). At the 12-month follow-up point, this group also showed higher rates of independent ambulation (53 [76.8%] vs 28 [56.0%], P = .016) and recovery to prefracture ambulatory status (56 [81.2%] vs 31 [62.0%], P = .020) than the conventional group. Conclusions and ImplicationsThe FIRM demonstrated superior effectiveness compared with conventional rehabilitation in improving ambulation and other functional outcomes in older adults with hip fracture. This finding provides valuable insights for managing comprehensive multidisciplinary postoperative care for hip fractures in South Korea and beyond.

Swedish Translation and Cultural Adaptation of the Head and Neck Patient Symptom Checklist: An Instrument to Screen for Nutrition Impact Symptoms in Clinical Practice and Research.

The Head and Neck Patient Symptom Checklist (HNSC) is a validated 2-part instrument used to ask patients with head and neck cancer about the nutrition impact symptoms they experience (part 1) and how these interfere with their eating (part 2). The purpose of this work was to translate and culturally adapt the HNSC into Swedish in accordance with the guidelines of the International Society for Health Economics and Outcomes Research (ISPOR). The ISPOR guidelines include 10 steps, and these were thoroughly followed. In step 7, 9 health care professionals from the field of head and neck cancer assessed the perceived relevance (content validity) of each item in the HNSC, as well as the full HNSC. A total of 522 participants with head and neck cancer were included and followed up on 7 occasions using the HNSC to assess internal consistency. The HNSC was translated from English into Swedish, ensuring accuracy through forward and backward translation and harmonization in the research team. Content validity for each part of the HNSC was rated excellent (scale content validity index 0.96). Internal consistency demonstrated a good Cronbach's alpha score (>0.8) across the 7 follow-up time points (from baseline [before the start of treatment] and up to 24 months posttreatment). The HNSC has been successfully translated and culturally adapted into Swedish. The HNSC can be used in both clinical practice and research to screen for nutrition impact symptoms and symptoms that interfere with eating in patients with head and neck cancer. ClinicalTrials.gov NCT03343236 (date of registration: November 17, 2017).

Adaptive sleep behaviours and shift work tolerance during the transition to shift work

ObjectiveTo evaluate whether recruit paramedics adapt their sleep behaviour during the first 12-months of shift work and to identify sleep behaviours that are associated with better shift work tolerance (SWT) after 12-months of shift work. MethodsRecruit paramedics (n = 105; Mage = 25.81 years; 51.38% female) were evaluated before (baseline), and after six- and 12-months of shift work. At each timepoint, participants completed questionnaires evaluating their mental health and sleep. Participants also underwent 14 days of sleep and shift monitoring (sleep/work diaries and actigraphy) at each timepoint to examine sleep behaviours, including sleep opportunity (SO), sleep regularity and number of sleep episodes. ResultsLinear mixed models found SO increased (on day shifts and rest days), and sleep regularity decreased between baseline and follow-up timepoints. There were no changes in SO (on day shifts, nightshifts, and rest days) or sleep regularity between six- and 12-months of shift work. Latent profile analysis at 12-months follow-up identified high (n = 52), medium (n = 27), and low (n = 9) SWT levels (measured via depression, anxiety, insomnia, sleep quality and sleep efficiency) in paramedics. Reduced sleep regularity (i.e., more irregular sleep) between six- and 12-months of work and prioritising major sleep (rather than naps) at six-months predicted high SWT. ConclusionsThese findings suggest clear SWT levels exist early in paramedics' careers whereby symptoms of depression, anxiety, and insomnia were the strongest contributors to SWT. New paramedics’ sleep behaviours, including sleep regularity and prioritisation of longer sleep between nightshifts, may play an important role in influencing how paramedics tolerate shift work.

The Relationship Between Age at Diabetes Onset and Clinical Outcomes in Newly Diagnosed Type 2 Diabetes: A Real-World Two-Center Study.

This study was developed with the goal of clarifying whether there is any relationship between type 2 diabetes mellitus (T2DM) age of onset and clinical outcomes for patients in National Metabolic Management Centers (MMC). From September 2017 - June 2022, 864 total T2DM patients were recruited in MMC and assigned to those with early-onset and late-onset diabetes (EOD and LOD) based on whether their age at disease onset was ≤ 40 or > 40 years. All patients received standardized management. Baseline and 1-year follow-up data from these two groups of patients were assessed. Associations between onset age and other factors were evaluated with a multivariate linear regression approach, adjusting for appropriate covariates. Outcomes in particular subgroups were also assessed in stratified analyses. Markers of dysregulated glucose metabolism and BMI values were significantly higher among EOD patients as compared to LOD patients. Subjects in both groups exhibited significant improvements in several disease-related parameters on 1-year follow-up after undergoing metabolic management. EOD patients exhibited significantly greater percentage reductions in HbA1c levels (-28.49 (-44.26, -6.45)% vs -13.70 (-30.15,-1.60)%, P =0.017) relative to LOD patients following adjustment for confounders. Significant differences were also detected between these groups when focused on subgroups of patients who were male, exhibited a BMI ≥ 25, an HbA1c ≥ 9, or had a follow-up frequency < 2. Data from a 1-year follow-up time point suggest that a standardized metabolic disease management model can promote effective metabolic control in newly diagnosed T2DM patients, particularly among individuals with EOD.

The effects of Baduanjin on fine motor skills in mild and moderate Parkinson’s disease: A randomized controlled trial

BackgroundFine motor impairment is common in Parkinson’s disease (PD), which reduces patients’ quality of life. There are few suitable targeted treatments. We conducted a clinical trial to determine whether Baduanjin Qigong exercise would increase fine motor skills in PD patients. MethodsSixty PD patients (Hoehn-Yahr stage 1–4) with hand fine motor impairment were randomly assigned to the Baduanjin group and the physical activity group. Baduanjin group practiced Baduanjin exercise five times weekly for 40 min (warm-up 5 min, Baduanjin 30 min, cool-down 5 min). The usual physical activity groups maintained their habit of usual physical activities. The participants underwent assessments in the “ON” medication state at baseline and 4-week follow-up time points. The Purdue Pegboard Test (PPT) was used as the primary outcome to assess manual dexterity. The secondary outcomes included the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, part III (MDS-UPDRS III), and the Parkinson’s disease questionnaire (PDQ-39). ResultsThe results of PPT revealed the Baduanjin group showed statistically significant improvement in the “non-dominant hand” and “assembly” scores compared to the usual physical activity group (P < 0.05), but with no significant difference in “dominant hand” and “both hands” (P > 0.05). Additionally, the Baduanjin group showed better performance in the PDQ-39 (P < 0.05). ConclusionOur study concludes that a 4-week Baduanjin exercise is effective in improving fine motor function and quality of life in patients with mild and moderate PD. The results suggest a promising intervention to be implemented in community or home settings for managing fine motor impairment in PD.

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial

PurposeThis study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. MethodsIn this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. ResultsAt all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). ConclusionUltrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

Cyanoacrylate versus Collagen Membrane as a Sealing for Alveolar Ridge Preservation: A Randomized Clinical Trial.

This study involved a randomized clinical trial that included 140 patients. Alveolar ridge preservation was performed with xenografts. Sealing in the control group consisted of a collagen membrane versus cyanoacrylate in the test group. The dental implants were placed immediately after extraction. The variables were evaluated at 3, 12, and 18 months of follow-up. Pearson's chi-squared test was used for qualitative variables and the Student t-test for related samples was used for quantitative variables. The change in buccolingual alveolar bone width was significantly greater in the CMX group than in the CX group after three months (p < 0.005). However, significance was not reached at the other follow-up timepoints (p > 0.005). CAL showed significantly greater values in the CMX group than in the CX group (p < 0.005), and MBL proved greater in the CMX group than in the CX group, with p < 0.001. Five membrane exposures were recorded in the CMX group. Cyanoacrylate as a sealing method for alveolar ridge preservation seems to afford better clinical and radiological results than collagen membrane.

Predictors of Psychiatric Hospitalization After Discharge From Inpatient Neurorehabilitation for Traumatic Brain Injury.

To examine, among persons discharged from inpatient rehabilitation for traumatic brain injury (TBI), the degree to which pre-TBI factors were associated with post-TBI hospitalization for psychiatric reasons. The authors hypothesized that pre-TBI psychiatric hospitalization and other pre-TBI mental health treatment would predict post-TBI psychiatric hospitalization following rehabilitation discharge, up to 5years post-TBI. Five Veterans Affairs Polytrauma Rehabilitation Centers. Participants with nonmissing rehospitalization status and reason, who were followed at 1 year (N=1006), 2years (N =985), and 5years (N =772) post-TBI. A secondary analysis of the Veterans Affairs TBI Model Systems, a multicenter, longitudinal study of veterans and active-duty service members with a history of mild, moderate, or severe TBI previously admitted to comprehensive inpatient medical rehabilitation. This study examined participants cross-sectionally at 3 follow-up timepoints. Psychiatric Rehospitalization was classified according to Healthcare Cost and Utilization Project multilevel Clinical Classifications diagnosis terminology (Category 5). Rates of post-TBI psychiatric hospitalization at years 1, 2, and 5 were 4.3%, 4.7%, and 4.1%, respectively. While bivariate comparisons identified pre-TBI psychiatric hospitalization and pre-TBI mental health treatment as factors associated with psychiatric rehospitalization after TBI across all postinjury timepoints, these factors were statistically nonsignificant when examined in a multivariate model across all timepoints. In the multivariable analysis, pre-TBI psychiatric hospitalization was significantly associated with increased odds of post-TBI psychiatric hospitalization only at 1-year post-TBI (adjusted odds ratio=2.65; 95% confidence interval, 1.07-6.55, P =.04). Posttraumatic amnesia duration was unrelated to psychiatric rehospitalization. Study findings suggest the limited utility of age, education, and pre-TBI substance use and mental health utilization in predicting post-TBI psychiatric hospitalization. Temporally closer social and behavior factors, particularly those that are potentially modifiable, should be considered in future research.

Leukocyte-Poor Platelet-Rich Plasma for the Management of Knee Osteoarthritis: A Retrospective Study With 12 Months of Follow-Up.

Introduction The knee, the most frequently affected joint in osteoarthritis (OA), impacts the life quality of millions of individuals globally, resulting in a considerable healthcare burden. Conservative treatments are preferred, turning to surgical intervention when necessary. Nonetheless, these conventional modalities have drawbacks. Recently, the use of regenerative medicine therapies, including autologous peripheral blood-derived orthobiologics (APBOs), such as leukocyte-poor platelet-rich plasma (LP-PRP), has evolved and demonstrated the ability to manage knee OA. The primary objective of this investigation was to evaluate the efficacy of LP-PRP via widely used patient-reported outcome measures (PROMs) in grade I or II (on the Kellgren-Lawrence scale) knee OA patients. The secondary objective was to characterize the formulated LP-PRP and determine the efficiency of the leukodepletion filter used for leukocyte removal and platelet recovery. Methods This investigation was a retrospective analysis of data collected from patients treated at a single center over a period of 15 months.Data from 40 patients included in this study were intra-articularly injected with 3mL of formulated LP-PRPunder ultrasound guidance. PROMs questionnaires, including Kujala and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, were used and responses were documented at baseline and up to 12 months follow-up. The characterization of the formulated LP-PRP and the efficiency of the leukodepletion filter in removing leukocytes and recovering platelets were assessed via complete blood count (CBC) analysis. Results The intra-articular administration of LP-PRP resulted in statistically significant improvements in Kujala and WOMAC scores in patients with Grade I or II OA of the knee at all follow-up time points (four to 12 months) compared to the respective baseline scores. The subgroup analysis showed significant improvements in Kujala and WOMAC scores inboth male and female grade I or II knee OA patients with or without comorbidities, including diabetes and/or hypertension. The characterization of formulated PRP showedplatelet concentration to be at least 6x compared to the baseline whole blood levels, the absolute platelet count to be at least 5 billion, and total leukocytes, lymphocytes, neutrophils, and RBCs were depleted by over 88%, 82%, 98%, and 98%, respectively. In addition, the utilization of the PuriBlood leukocyte reduction filter (Puriblood Medical Co. Ltd., Baoshan Township, Taiwan) led to the depletion of approximately 93% of leukocytes and the recovery of about 83% of platelets. Conclusions Administration of LP-PRP resulted in significant improvements in pain and function of patients suffering from grade I or II OA of the knee. In addition, the leukodepletion filter used to formulate LP-PRP, successfully resulted in the depletion of leukocytes while recovering the platelets. More sufficiently powered, multi-center, prospective, non-randomized, and randomized controlled trials with long-term follow-up are needed to further establish the effectiveness of this formulation in knee OA patients.

Effects of Clinic-based and Telerehabilitation-based Motor Control Exercises in Individuals with Chronic Low-back Pain: A Randomized Controlled Trial With 3-Month Follow-up.

To evaluate the effectiveness of clinic-based and telerehabilitation-based motor control exercises in individuals with chronic low-back pain 3 months posttreatment. Forty-two participants were randomized to either clinic-based or telerehabilitation-based groups, performing exercises 3 times weekly for 8 weeks. Assessments were conducted pre-intervention, postintervention and 1 and 3 month follow-ups. The primary outcome was pain intensity (Visual Analog Scale) for low-back pain. Both exercise approaches were found to be similarly effective in improving pain disability, quality of life (except for emotional response, energy level, sleep, and social isolation), and pain catastrophizing at both follow-up time points. The Visual Analog Scale showed statistically significant reductions in pain from baseline at all time points in both groups ( P <0.001), with effect sizes ranging from moderate to strong. Nottingham Health Profile showed significant improvements in physical activity, pain, and total score, with effect sizes ranging from moderate to strong. No statistically significant changes in spatiotemporal gait parameters were observed in either group. According to the postintervention intention-to-treat analysis, lumbar flexion range of motion showed statistically significant improvements in both groups with small effect sizes ( P <0.05). Telerehabilitation-based motor control exercises proved as effective as clinic-based methods in treating chronic low-back pain, offering a viable alternative tailored to individual needs and circumstances.

Stepwise dual-target magnetic resonance-guided focused ultrasound in tremor-dominant Parkinson disease: One-year follow-up.

Magnetic resonance-guided focused ultrasound (MRgFUS) is a nonsurgical treatment for Parkinson disease (PD). Some selected anatomical structures can be targeted by MRgFUS in PD. However, there is no uniform target yet. We have reported that stepwise dual-target MRgFUS was successfully applied to treat refractory tremors with akinetic-rigid features in PD. It generated two precise thermal ablations in the ventral intermediate nucleus (VIM) and pallidothalamic tract (PTT). Here, we report more PD patients to verify the safety and efficacy of stepwise dual-target MRgFUS. Ten tremor-dominant PD patients (mean age = 66.7 ± 3.2 years, eight men) received the stepwise dual-target MRgFUS treatment with a series of primary and secondary outcome measures. The VIM and PTT were navigated based on brain magnetic resonance images. Outcome measures were categorized into primary and secondary assessments. The primary outcome measures consisted of resting tremor, action/kinetic tremor, rigidity, and bradykinesia. Secondary outcome measures encompassed non-motor symptoms scale of PD. Data collected at follow-up time points, including 1 day, 3 months, 6 months, and 1 year posttreatment, were compared with baseline data. The severity of tremor and motor deficits represented by Clinical Rating Scale for Tremor parts A and B during off-medication status and Unified Parkinson's Disease Rating Scale III on the treated side were significantly improved (p < 0.05 by paired t-test) at 1-year follow-up. At the 1-year follow-up, significant improvement was observed in the non-motor symptoms scale. Additionally, no severe adverse effects were reported, except temporary treatment-related discomfort during the procedure. In conclusion, stepwise dual-target MRgFUS emerges as a safe and effective therapeutic modality for PD patients, particularly in addressing medication-refractory tremor and akinetic-rigid syndrome.

Study to determine the efficacy and onset of Bonipar, a topical analgesic for the management of acute and chronic musculoskeletal pain

BackgroundOpioid abuse and mortality are ravaging American society, highlighting the need to find alternative effective analgesics with fewer side effects. FDA-approved topical analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), are commonly used to treat musculoskeletal pain but can cause adverse effects. Natural compounds, including essential oils, are potential therapeutic alternatives for managing musculoskeletal pain. If these compounds can provide comparable analgesia to FDA-approved products, it will increase the available options for people with pain, improving quality of life with minimal morbidity and mortality. ObjectiveThis study assesses the effectiveness and onset of action of Bonipar, a topical analgesic formulated with camphor, methyl salicylate, and oils of coconut, eucalyptus, nutmeg, and rosemary, in managing musculoskeletal pain compared to 1.5 % diclofenac solution, an FDA-approved topical non-steroidal anti-inflammatory drug. MethodsOne hundred sixty-four adult patients with localized musculoskeletal pain were randomly assigned to twice-daily applications of either Bonipar or Diclofenac for one week. The primary outcome measure was a 50 % reduction in pain after one week. Secondary outcomes included the change in pain from baseline and onset of action, defined as the first reduction in pain by 20 %. ResultsAll patients completed the initial pain assessment to determine the onset of action. One-week data was available for 74 patients treated with diclofenac and 72 patients treated with Bonipar. Data for 18 patients were incomplete. The proportion of patients achieving a 50 % reduction in pain was statistically similar between the two groups. The success rates of achieving a 50 % pain reduction with Bonipar were found to be non-inferior to those treated with diclofenac. All follow-up time points showed roughly similar results between the groups. Regression models adjusted for age and sex revealed no significant effects on pain changes. Secondary analyses demonstrated no significant differences between the groups. DiscussionThe topical analgesic Bonipar demonstrates a comparable onset of action, with efficacy non-inferior to diclofenac in the management of musculoskeletal pain, while showing fewer adverse effects compared to diclofenac. These findings highlight the potential of Bonipar as a valuable alternative for the treatment of localized pain.

Impact of congenital spinal stenosis on the outcome of three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy: a retrospective study.

To investigate whether congenital cervical spinal stenosis (CCSS) affects the outcome of three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). One hundred seventeen patients with CSM who underwent three-level ACDF between January 2019 and January 2023 were retrospectively examined. Patients were grouped according to presence of CCSS, which was defined as Pavlov ratio ≤ 0.75. The CCSS and no CCSS groups comprised 68 (58.1%) and 49 (41.9%) patients, respectively. The Japanese Orthopaedic Association (JOA) score did not significantly differ between the two groups at any postoperative time point (p > 0.05). The JOA improvement rate was lower in the CCSS group 1 month after surgery (41.7% vs. 45.5%, p < 0.05), but showed no difference at any follow-up time point after one month. Multivariate logistic regression identified preoperative age (OR = 10.639), JOA score (OR = 0.370), increased signal intensity (ISI) in the spinal cord on T2-weighted MRI (T2-WI) (Grade 1: OR = 6.135; Grade 2: OR = 29.892), and degree of spinal cord compression (30-60%: OR = 17.919; ≥60%: OR = 46.624) as independent predictors of a poor oneyear outcome (JOA recovery rate < 50%). Although early JOA improvement is slower in the CCSS group, it does not affect the final neurological improvement at 1 year. Therefore, CCSS should not be considered a contraindication for three-level ACDF in patients with CSM. The main factors influencing oneyear outcome were preoperative age, JOA score, ISI grade, and degree of spinal cord compression.

Percutaneous endoscopic transforaminal decompression surgery for symptomatic double-level lumbar spinal stenosis with ossification.

This study aimed to explore the short-term effects of percutaneous endoscopic transforaminal decompression (PETD) for the treatment of symptomatic double-level lumbar spinal stenosis (LSS) with ossification. Twenty-eight patients diagnosed with double-level lumbar spinal stenosis who underwent double-level PETD surgery between January 2021 and January 2023 at our institution. General information, such as age, sex, disease duration, hospitalization time, and operation time, was recorded. Magnetic resonance imaging (MRI) dural sac cross-sectional area (DSCA) was recorded to assess the degree of spinal canal decompression. The White-Panjabi scoring system (WP) was used to assess preoperative and postoperative lumbar spine stability. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess symptom improvement, and surgical efficacy was evaluated using the modified Macnab evaluation criteria at the 1-year postoperative follow-up. The types and risks of complications were also recorded. The patient's 1-year postoperative follow-up MRI showed that both L3/4 and L4/5 DSCA were significantly enlarged compared with preoperative values (P < .001). There was no significant difference in the WP scores at 3 months postoperatively compared with those preoperatively (P > .05). The VAS scores for hip and lower extremity pain at 3 days, 3 months, and 1 year postoperatively were significantly lower than those preoperatively (P < .001), and the ODI scores at 3 months and 1 year postoperatively were significantly lower than those preoperatively (P < .001). There were no significant differences in hip pain, lower extremity pain VAS scores, or ODI scores between the postoperative follow-up time points (P > .05). There was 1 case of lower limb numbness and 1 case of neuroedematous pain in the postoperative period, and all patients had no complications, such as dural sac tear, infection, or recurrence. The 1-year postoperative follow-up was assessed as excellent in 17 cases, good in 9 cases, and possible in 2 cases using the modified Macnab criteria, with an excellent rate of 92.9%. The efficacy of double-level PETD for symptomatic double-level LSS is clear, the local stability of the lumbar spine is less affected, and the risk is low, which can reduce the chances of reoperation in patients. Thus, it is a recommended surgical procedure.