Tag: nevin manimala

Zh Nevrol Psikhiatr Im S S Korsakova. 2024;124(12):79-85. doi: 10.17116/jnevro202412412179.

ABSTRACT

OBJECTIVE: Evaluation of the safety and effectiveness of Relatox, botulinum toxin type A in patients with focal spasticity (FS) of the upper limb as a result of a cerebrovascular accident (CVA) or traumatic brain injury (TBI).

MATERIAL AND METHODS: A multicenter, prospective, single-blinded, randomized, comparative clinical study included 210 patients of both sexes aged 18-75 years after moderate to severe TBI and CVA in seven sites in the Russian Federation. The patients were randomized into two groups. Group 1 patients (n=105) with focal spasticity of the upper limb received Relatox injections into the muscles of the target pathological patterns (flexion of the elbow, hand, or fingers); Group 2 patients (n=105) received Dysport injections (reference agent). The drugs were injected with electromyographic (EMG) or ultrasound (US) control at a dose of no more than 400 Units of Relatox or 1000 Units of Dysport. Botulinum therapy was administered to patients for the first time or repeatedly, but not earlier than 3 months after CVA or TBI and 3 months (12 weeks) after the previous injection. At 4 and 12 weeks, spasticity was assessed using the Modified Ashworth Scale (MAS) for the muscles of the target spasticity pattern of the upper limb, the severity of disability was used to assess the Disability Assessment Scale (DAS), the severity of pain was evaluated using to the Numerical Pain Rating Scale (NPRS), and the satisfaction with treatment was measured by the Patient Global Impression of Improvement (PGI-I). The rate of adverse events (AEs) was reported.

RESULTS: A decrease in spasticity (decrease in MAS values) was shown in both groups without statistically significant intergroup differences at 4 weeks after injection for the muscles of the leading spasticity pattern of the upper limb (efficacy was assessed jointly for all target patterns) compared to the total score at the screening visit. The effect persisted for 12 weeks (more pronounced in the Relatox group). A significant decrease in pain severity according to the NPRS scale without significant intergroup differences was reported in both groups (slightly greater in Relatox group patients). The decrease in the mean DAS score with a statistically significant intergroup difference in hygiene, dressing, and overall well-being according to the PGI-I overall improvement scale was also greater in patients who received Relatox. Few local and systemic AEs were reported in both groups, with no intergroup differences. There were no significant deviations in laboratory parameters.

CONCLUSION: The results indicate the safety, good tolerability, and efficacy of Relatox in patients with focal spasticity of the upper limb after focal brain damage due to CVA or TBI, comparable and even slightly longer in duration than those of Dysport, which supports its widespread use in the rehabilitation.

PMID:39731375 | DOI:10.17116/jnevro202412412179

Zh Nevrol Psikhiatr Im S S Korsakova. 2024;124(12):69-74. doi: 10.17116/jnevro202412412169.

ABSTRACT

OBJECTIVE: Identification of therapeutic targets in the treatment of adolescent depression with attenuated symptoms of schizophrenia and assessment of the effectiveness of therapeutic interventions.

MATERIAL AND METHODS: One hundred and twenty-three patients (mean age 19.6±2.3 years) hospitalized in the clinic of the Mental Health Research Center for adolescent depression with non-psychotic mental disorders (ICD-10: F31, F32, F33, F34; F60; F21) were examined. Group 1 (44.7%, n=55) received only psychopharmacotherapy, Group 2 (24.4%, n=30) additionally received a course of repetitive transcranial magnetic stimulation (rTMS) therapy, Group 3 (13.0%, n=16) was administered to TMS, Group 4 (17.9%, n=22) received psychotherapy. Psychometric scales (HDRS SOPS CGI, SANS) were used. Statistical analysis was performed using Statistica 12 software.

RESULTS: The addition of additional non-drug treatment methods (brain feedback and TMS) did not lead to a reliable improvement in the results, and in some cases negative results were obtained. Psychotherapy conducted according to protocols, taking into account the clinical characteristics of patients, demonstrated a significantly higher treatment effectiveness (p<0.05).

CONCLUSION: Additional therapy targets for adolescent depression with attenuated symptoms of schizophrenia have been identified, including specific mild positive, negative symptoms, and disorganization symptoms, which, although not prominent, are fundamentally important in the effectiveness of treatment.

PMID:39731373 | DOI:10.17116/jnevro202412412169

Ann Med. 2025 Dec;57(1):2443564. doi: 10.1080/07853890.2024.2443564. Epub 2024 Dec 27.

ABSTRACT

OBJECTIVE: To comprehensively investigate the predictive value of thyroid hormone sensitivity parameters for cervical lymph node metastasis in patients diagnosed with differentiated thyroid cancer (DTC) undergoing total thyroidectomy and neck lymph node dissection.

METHODS: A retrospective cohort study was conducted involving patients diagnosed with DTC and evaluated for cervical lymph node metastasis. Relevant demographic, tumour, lymph node and thyroid hormone sensitivity parameter data were extracted from medical records and laboratory reports. Thyroid hormone sensitivity parameters including thyroxine (T4), triiodothyronine (T3), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), thyroglobulin antibodies (TgAbs), thyroid peroxidase antibody, thyroid hormone receptor α and TSH receptor antibody were assessed. Statistical analyses including descriptive statistics, comparative analysis, Pearson’s correlation analysis, logistic regression analysis, receiver operating characteristic (ROC) analysis and construction of a multivariable prediction model based on machine learning using the xgbTree method were employed to evaluate the associations and predictive value of thyroid hormone sensitivity parameters for cervical lymph node metastasis.

RESULTS: The study revealed significant associations between several thyroid hormone sensitivity parameters and cervical lymph node metastasis in patients with DTC. Specifically, higher levels of T4, T3, Tg, TgAbs and TSH receptor antibody were associated with lymph node metastasis. Pearson’s correlation analysis, logistic regression analysis and ROC analysis further underscored the predictive performance of these parameters, with strong overall discriminative abilities. The machine learning-based prediction model demonstrated promising performance with a high area under the curve (AUC) of 0.979.

CONCLUSIONS: The findings provide compelling evidence for the predictive value of thyroid hormone sensitivity parameters, particularly T3, T4, Tg, TgAbs and TSH receptor antibody, in identifying and evaluating the likelihood of cervical lymph node metastasis in patients with DTC. These parameters hold potential implications for risk stratification, clinical decision-making and personalized management strategies, contributing to improved outcomes for patients at risk of lymph node metastasis.

PMID:39731362 | DOI:10.1080/07853890.2024.2443564

J Res Adolesc. 2025 Mar;35(1):e13056. doi: 10.1111/jora.13056.

ABSTRACT

The current study examined whether adverse childhood experiences and racial discrimination predicted adolescents’ internal developmental assets, external developmental assets, and depressive symptoms. We also tested whether these relations were buffered by aspects of caregivers’ reports of ethnic-racial socialization efforts (i.e., cultural socialization and preparation for bias). Participants were Black adolescents 12 to 17 years of age (Mage = 15.09, SD = 1.36) and their caregivers. Findings indicated that adolescents’ racial discrimination experiences and adverse childhood experiences were associated with less internal assets, less external assets, and greater depressive symptoms. Preparation for bias was a protective moderator in two associations, such that at low levels of preparation for bias, racial discrimination predicted less external assets, but this relation became non-significant at high levels of preparation for bias. Similarly, at low levels of preparation for bias, adverse childhood experiences predicted greater depressive symptoms, but this relation became non-significant at high levels of preparation for bias. Caregivers’ cultural socialization was also protective in that at low levels of cultural socialization, adverse childhood experiences predicted less internal developmental assets, but this relation became non-significant at high levels of cultural socialization. Adverse childhood experiences and racial discrimination contribute to poorer outcomes, but caregivers’ efforts to teach their children about their race, ethnicity, and culture are protective in some of these associations. Findings highlight that it is important to focus on both risk factors and protective family cultural processes to promote Black adolescents’ positive developmental and mental health.

PMID:39731359 | DOI:10.1111/jora.13056

J Rural Health. 2025 Jan;41(1):e12905. doi: 10.1111/jrh.12905.

ABSTRACT

PURPOSE: This study compares 2018-2023 Medicare Advantage (MA) days as a percentage of total Medicare days in rural and urban hospitals, describes 2022-2023 operating profitability of rural and urban hospitals by quartiles of MA days as a percentage of total Medicare days, and explores hospital characteristics that may be important for understanding the relationship between MA and profitability of rural hospitals.

METHODS: Financial and hospital data were obtained from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) for the years 2018 to 2023. Hospitals were assigned to quartiles based on MA days as a percentage of total Medicare days. Descriptive analyses were conducted to compare hospital characteristics and financial performance across quartiles.

FINDINGS: Between 2018-2019 and 2022-2023, the median percentage of total Medicare days from MA grew from 11.3% to 28.0% for rural hospitals. The 2022-2023 median operating margin varied from 0.0% for rural hospitals in Q1 (lowest MA days as a percentage of total Medicare days) to 3.4% for hospitals in Q4 (highest MA days as a percentage of total Medicare days).

CONCLUSION: Among rural hospitals, higher MA days as a percentage of total Medicare days was found to be associated with higher operating margin. However, results suggest that MA is not randomly distributed: rural hospitals with higher MA days as a percentage of total Medicare days exhibit distinct characteristics. This non-random distribution suggests that descriptive analysis may not fully capture the actual financial impact of MA on rural hospitals. Future research should recognize these complexities.

PMID:39731350 | DOI:10.1111/jrh.12905

J Rural Health. 2025 Jan;41(1):e12901. doi: 10.1111/jrh.12901.

ABSTRACT

PURPOSE: Few studies have examined disparities in-and social determinants of-contraception use among rural adolescents despite evidence of higher teen birth rates and greater STI risk in rural communities. Guided by a social determinants of health (SDoH) framework, this cross-sectional study aimed to address these gaps.

METHODS: Data come from the 2018 Healthy Youth Survey, including N = 3757 sexually active, rural-based adolescents. Chi-square and independent samples t-tests examined group differences in rates of self-reported contraception use (condoms and any form of contraception) at last sex. Logistic regression models examined associations between SDoH factors (social/community, economic, and health care access) and contraception use outcomes.

FINDINGS: Contraception use disparities were observed for rural-based youth identifying as Black, Asian, Indigenous, and Latino/a/x/e; lesbian, gay, bisexual, and questioning their sexual identity (LGBQ); and those experiencing poverty. Regression models accounting for youth characteristics found that SDoH factors across the social/community domain-but not economic or health care access-were the strongest predictors of contraception use outcomes. In these models, LGBQ status remained negatively associated with contraception use.

CONCLUSIONS: Rural disparities in contraception use, particularly for marginalized youth, call for service approaches that are relevant and responsive to diverse needs. Findings also suggest that rural disparities are influenced by a complex interplay of social factors, where existing health care resources may not sufficiently mitigate youths’ adverse living conditions. Addressing contraception use disparities in rural communities will require greater uptake of comprehensive sexuality education and multilevel service approaches that attend to youths’ social contexts.

PMID:39731344 | DOI:10.1111/jrh.12901

J Rural Health. 2025 Jan;41(1):e12908. doi: 10.1111/jrh.12908.

ABSTRACT

PURPOSE: The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well-positioned to contribute to our understanding of rural environments and contexts, which has implications for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation.

METHODS: This analysis uses data from children in the ECHO Cohort study who had residential address information between January 2010 and October 2023, including a subset who also had height and weight data. Several rural-urban classification schemes were examined with and without collapsing into binary rural/urban groupings (ie, the Rural-Urban Continuum Codes, 2010 Rural-Urban Commuting Area [RUCA] Codes, and Urban Influence Codes).

FINDINGS: Various rural/urban definitions and classification schemes produce similar obesity prevalence (17%) when collapsed into binary categories (rural vs urban) and for urban participants in general. When all categories within a classification scheme are examined, however, the rural child obesity prevalence ranges from 5.8% to 24%.

CONCLUSIONS: Collapsing rural-urban classification schemes into binary groupings erases nuance and context needed for interpreting findings, ultimately impacting health disparities research. Future work should leverage both individual- and community-level datasets to provide context, and all categories of classification schemes should be used when examining rural populations.

PMID:39731317 | DOI:10.1111/jrh.12908

J Rural Health. 2025 Jan;41(1):e12906. doi: 10.1111/jrh.12906.

ABSTRACT

BACKGROUND: Recent legislative initiatives in the United States have focused on the medical and legal status of psychedelics, prompting interest in understanding public perceptions of their risks. This study investigates rural-urban differences in the perception of LSD and cannabis risks using national survey data.

METHODS: Data from the National Survey of Drug Use and Health (NSDUH) between 2015 and 2021 were analyzed. Logistic regression models were used to compare risk perceptions of LSD and cannabis between rural and urban respondents, adjusting for relevant factors.

RESULTS: Rural residents were 1.2 to 1.4 times more likely to perceive using LSD once or twice as of great risk compared to urban residents during the survey period. However, the perception of monthly cannabis use as having great risk was slightly higher among rural residents only until 2019, with no significant differences observed in 2020 and 2021.

CONCLUSION: The study highlights a significant rural-urban divide in the perception of LSD risk, which could impact policymaking on psychedelic therapies. Understanding these differences is crucial for developing effective and equitable policies regarding psychedelic substances and treatments.

PMID:39731315 | DOI:10.1111/jrh.12906

Eur J Neurol. 2025 Jan;32(1):e70031. doi: 10.1111/ene.70031.

ABSTRACT

BACKGROUND AND PURPOSE: The aim of this study was to assess the intracerebral hemorrhage (ICH) burden in 204 countries and territories worldwide from 1990 to 2021, disaggregated by sex, age, and sociodemographic index (SDI) at the global, regional, and country levels.

METHODS: Data from the 2021 Global Burden of Disease Study (GBD) were used to calculate age-standardized prevalence (ASPR), incidence (ASIR), death (ASDR), and disability-adjusted life year (DALY) rates for ICH. The estimated annual percentage change (EAPC) was used to assess time patterns. The Bayesian age-period-cohort (BAPC) model was employed to predict future ICH burden.

RESULTS: In 2021, the global ICH burden remained high, with a total of 16.6 million cases and an ASPR of 194.51 cases per 100,000 people. The ASIR was 40.83 cases per 100,000 people, the ASDR was 39.09 cases per 100,000 people, and the age-standardized DALY rate was 923.64 per 100,000 people. The low-SDI regions had the highest ASPR, ASIR, ASDR, and DALY rates. Geographically, western sub-Saharan Africa had the highest ASPR, Central Asia had the highest ASIR, and Oceania had the highest ASDR and DALY rates. High systolic blood pressure was the leading risk factor for ICH death, contributing to 57.9% of global fatalities.

CONCLUSION: Despite the decline in the ASIR, there is an ongoing increase in the absolute number of ICH cases, with significant differences observed across age, sex, region, country, and SDI. More attention and emphasis should be placed on improving the ICH burden in low-SDI areas.

PMID:39731311 | DOI:10.1111/ene.70031

J Cosmet Dermatol. 2025 Jan;24(1):e16728. doi: 10.1111/jocd.16728.

ABSTRACT

BACKGROUND: Hypertrophic scar (HS) is a fibroproliferative disorder resulting from abnormal healing of skin tissue after injury. Although various therapies are currently employed in clinical to treat HSs, there is no widely accepted standard therapy. Micro-plasma radiofrequency (MPR) and autologous chyle fat grafting are emerging treatments for this condition, and they have demonstrated promising therapeutic outcomes in clinical applications. The aim of this study is to investigate the effectiveness and safety of combining MPR with autologous chyle fat grafting for the treatment of HSs.

METHODS: We performed a retrospective study on patients diagnosed with HS in a single center between January 2020 and December 2023. According to the treatments, patients were divided into three groups, with 6 months follow-up. The single therapy group received MPR alone for two times. The combined therapy Group 1 first received the MPR treatment followed by the combined treatment. The combined therapy Group 2 first received the combined treatment and then received the MPR treatment. The effectiveness of treatment was evaluated using the Vancouver Scar Scale (VSS) and the Patient Scar Assessment Scale (PSAS). The Visual Analog Scale (VAS) was used to assess the patients’ pain on the day of treatment and 1 day after treatment. Adverse events and complications were recorded to assess the safety of treatment.

RESULTS: A total of 73 patients diagnosed with HS were enrolled in this study, including 35 patients in the single therapy group, 18 patients in the combined therapy Group 1, and 20 patients in the combined therapy Group 2. After the treatments were completed, all three groups exhibited significant effectiveness. The two combined therapy groups scored lower after treatments in the VSS, which includes height, vascularity, pliability, and total scores, as well as in the PSAS, which includes color, stiffness, thickness, and total scores, compared to the single therapy group, with a statistically significant difference. Regarding pain response to treatment, there was no statistical difference in VAS among the three groups. No statistical difference in the overall incidence of adverse events was observed among the three groups, and no severe complications were recorded.

CONCLUSIONS: This study revealed the combination of MPR and autologous chyle fat grafting showed superior effectiveness compared to MPR alone in treating HSs, without any observed increase in overall adverse event frequency. For patients diagnosed with HS, this combination therapy stands as a promising and effective clinical intervention.

PMID:39731280 | DOI:10.1111/jocd.16728