Tag: nevin manimala

Cornea. 2024 May 17. doi: 10.1097/ICO.0000000000003536. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this review was to summarize the different surgical approaches combining photorefractive keratectomy (PRK) and corneal crosslinking (CXL), present each protocol template in a simple format, and provide an overview of the primary outcomes and adverse events.

METHODS: A literature review was conducted as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eight different databases were searched. Papers were included if PRK was immediately followed by CXL.

RESULTS: Thirty-seven papers met the inclusion criteria of a total yield of 823. The latest research into simultaneous PRK and CXL has been shown to not only stabilize the cornea and prevent keratoconus progression but also improve the visual acuity of the patient. Improvements in uncorrected distance visual acuity and (spectacle) corrected distance visual acuity were found to be significant when considering all protocols. There were also significant reductions in K1, K2, mean K, Kmax, sphere, cylinder, and spherical equivalent. Random-effects analysis confirmed these trends. Corrected distance visual acuity was found to improve by an average of 0.18 ± 1.49 logMAR (Cohen’s D [CD] 0.12; P <0.02). There was also a significant reduction of 2.57 ± 0.45 D (CD 5.74; P <0.001) in Kmax. Cylinder and spherical equivalent were also reduced by 1.36 ± 0.26 D (CD 5.25; P <0.001) and 2.61 ± 0.38 D (CD 6.73; P <0.001), respectively.

CONCLUSIONS: Combining the 2 procedures appears to be of net benefit, showing stabilization and improvement of ectatic disease, while also providing modest gains in visual acuity. Since customized PRK and CXL approaches appear superior, a combination of these would likely be best for patients.

PMID:38759151 | DOI:10.1097/ICO.0000000000003536

Neurology. 2024 Jun 11;102(11):e209312. doi: 10.1212/WNL.0000000000209312. Epub 2024 May 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: Guidelines for posterior circulation ischemic stroke (PCIS) treatment are lacking and outcome prediction is crucial for patients and clinicians. We aimed to develop and validate a prognostic score to predict the poor outcome for patients with PCIS.

METHODS: The score was developed from a prospective derivation cohort named the Third China National Stroke Registry (August 2015-March 2018) and validated in a spatiotemporal independent validation cohort (December 2017-March 2023) in China. Patients with PCIS with acute infarctions defined as hyperintense lesions on diffusion-weighted imaging were included in this study. The poor outcome was measured as modified Rankin scale (mRS) score 3-6 at 3 months after PCIS. Multivariable logistic regression analysis was used to identify predictors for poor outcome. The prognostic score, namely PCIS Outcome Score (PCISOS), was developed by assigning points to variables based on their relative β-coefficients in the logistic model.

RESULTS: The PCISOS was derived from 3,294 patients (median age 62 [interquartile range (IQR) 55-70] years; 2,250 [68.3%] men) and validated in 501 patients (median age 61 [IQR 53-68] years; 404 [80.6%] men). Among them, 384 (11.7%) and 64 (12.8%) had poor outcome 3 months after stroke in respective cohorts. Age, mRS before admission, NIH Stroke Scale on admission, ischemic stroke history, infarction distribution, basilar artery, and posterior cerebral artery stenosis or occlusion were identified as independent predictors for poor outcome and included in PCISOS. This easy-to-use integer scoring system identified a marked risk gradient between 4 risk groups. PCISOS performed better than previous scores, with an excellent discrimination (C statistic) of 0.80 (95% CI 0.77-0.83) in the derivation cohort and 0.81 (95% CI 0.77-0.84) in the validation cohort. Calibration test showed high agreement between the predicted and observed outcomes in both cohorts.

DISCUSSION: PCISOS can be applied for patients with PCIS with acute infarctions to predict functional outcome at 3 months post-PCIS. This simple tool helps clinicians to identify patients with PCIS with higher risk of poor outcome and provides reliable outcome expectations for patients. This information might be used for personalized rehabilitation plan and patient selection for future clinical trials to reduce disability and mortality.

PMID:38759139 | DOI:10.1212/WNL.0000000000209312

Neurology. 2024 Jun 11;102(11):e209423. doi: 10.1212/WNL.0000000000209423. Epub 2024 May 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: Poverty is associated with greater stroke incidence. The relationship between poverty and stroke recurrence is less clear.

METHODS: In this population-based study, incident strokes within the Greater Cincinnati/Northern Kentucky region were ascertained during the 2015 study period and followed up for recurrence until December 31, 2018. The primary exposure was neighborhood socioeconomic status (nSES), defined by the percentage of households below the federal poverty line in each census tract in 4 categories (≤5%, >5%-10%, >10%-25%, >25%). Poisson regression models provided recurrence rate estimates per 100,000 residents using population data from the 2015 5-year American Community Survey, adjusting for age, sex, and race. In a secondary analysis, Cox models allowed for the inclusion of vascular risk factors in the assessment of recurrence risk by nSES among those with incident stroke.

RESULTS: Of 2,125 patients with incident stroke, 245 had a recurrent stroke during the study period. Poorer nSES was associated with increased stroke recurrence, with rates of 12.5, 17.5, 25.4, and 29.9 per 100,000 in census tracts with ≤5%, >5%-10%, >10%-25%, and >25% below the poverty line, respectively (p < 0.01). The relative risk (95% CI) for recurrent stroke among Black vs White individuals was 2.54 (1.91-3.37) before adjusting for nSES, and 2.00 (1.47-2.74) after adjusting for nSES, a 35.1% decrease. In the secondary analysis, poorer nSES (HR 1.74, 95% CI 1.10-2.76 for lowest vs highest category) and Black race (HR 1.31, 95% CI 1.01-1.70) were both independently associated with recurrence risk, though neither retained significance after full adjustment. Age, diabetes, and left ventricular hypertrophy were associated with increased recurrence risk in fully adjusted models.

DISCUSSION: Residents of poorer neighborhoods had a dose-dependent increase in stroke recurrence risk, and neighborhood poverty accounted for approximately one-third of the excess risk among Black individuals. These results highlight the importance of poverty, race, and the intersection of the 2 as potent drivers of stroke recurrence.

PMID:38759136 | DOI:10.1212/WNL.0000000000209423

J Clin Oncol. 2024 May 17:JCO2302445. doi: 10.1200/JCO.23.02445. Online ahead of print.

ABSTRACT

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.NRG Oncology RTOG 0415 is a randomized phase III noninferiority (NI) clinical trial comparing conventional fractionation (73.8 Gy in 41 fractions) radiotherapy (C-RT) with hypofractionation (H-RT; 70 Gy in 28) in patients with low-risk prostate cancer. The study included 1,092 protocol-eligible patients initially reported in 2016 with a median follow-up of 5.8 years. Updated results with median follow-up of 12.8 years are now presented. The estimated 12-year disease-free survival (DFS) is 56.1% (95% CI, 51.5 to 60.5) for C-RT and 61.8% (95% CI, 57.2 to 66.0) for H-RT. The DFS hazard ratio (H-RT/C-RT) is 0.85 (95% CI, 0.71 to 1.03), confirming NI (P < .001). Twelve-year cumulative incidence of biochemical failure (BF) was 17.0% (95% CI, 13.8 to 20.5) for C-RT and 9.9% (95% CI, 7.5 to 12.6) for H-RT. The HR (H-RT/C-RT) comparing biochemical recurrence between the two arms was 0.55 (95% CI, 0.39 to 0.78). Late grade ≥3 GI adverse event (AE) incidence is 3.2% (C-RT) versus 4.4% (H-RT), with relative risk (RR) for H-RT versus C-RT 1.39 (95% CI, 0.75 to 2.55). Late grade ≥3 genitourinary (GU) AE incidence is 3.4% (C-RT) versus 4.2% (H-RT), RR 1.26 (95% CI, 0.69 to 2.30). Long-term DFS is noninferior with H-RT compared with C-RT. BF is less with H-RT. No significant differences in late grade ≥3 GI/GU AEs were observed between assignments (ClinicalTrials.gov identifier: NCT00331773).

PMID:38759121 | DOI:10.1200/JCO.23.02445

J Vestib Res. 2024 May 11. doi: 10.3233/VES-240002. Online ahead of print.

ABSTRACT

BACKGROUND: Health disparities (HD) impact care delivery and health outcomes in individuals with vestibular disorders (IVD).

OBJECTIVE: The purpose of this study is to identify whether health disparities (HD) exist in Vestibular Rehabilitation (VR) between individuals identifying as Caucasians or racial or ethnic minorities (REM).

METHODS: This study was a retrospective chart review of IVD who attended outpatient VR between 1/2014 and 9/2020. Data recorded included age, gender, race/ethnicity, vestibular diagnosis, VR interventions, and pre-post outcome measures such as Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC), Gait speed (GS), and Functional Gait Assessment (FGA). Chi-squared tests, one-tailed, and two-tailed t-tests (α= 0.05) were utilized to compare Caucasian and REM groups.

RESULTS: Three hundred and forty-three charts (N = 343) met inclusion/exclusion criteria. REM demonstrated higher median DHI scores (46 vs. 38, p = 0.008) and lower ABC scores (53.10% vs. 66.30%, p < 0.001) at VR evaluation compared to Caucasians. There were no statistically significant differences in DHI, ABC, FGA, and GS scores between Caucasians and REM at discharge.

CONCLUSIONS: VR was able to equalize HD in DHI and ABC which initially existed between REM and Caucasians. VR therapists should work with public health and policy researchers to improve access to VR.

PMID:38759079 | DOI:10.3233/VES-240002

Technol Health Care. 2024 Apr 21. doi: 10.3233/THC-248044. Online ahead of print.

ABSTRACT

BACKGROUND: The etiology of Burning Mouth Syndrome (BMS) remains unclear.

OBJECTIVE: To explore the differences in the therapeutic efficacy of pain improvement between medication therapy and laser therapy in patients with BMS.

METHODS: 45 BMS patients were randomly divided into three groups: The Combination therapy group (Group A, n= 15), The Medication therapy group (Group B, n= 15), and the Laser therapy group (Group C, n= 15). The pain condition of the patients was evaluated using the Numeric Rating Scale (NRS), and the improvement in pain before and after treatment was compared among the three groups.

RESULTS: All three groups (A, B, and C) showed a significant reduction in NRS scores after treatment, with statistically significant differences observed among the different groups. Group A exhibited the most significant improvement, with a statistically significant difference before and after treatment.

CONCLUSION: Laser and medication therapy are effective methods for reducing oral burning pain * symptoms, and their combined use yields more significant therapeutic effects.

PMID:38759078 | DOI:10.3233/THC-248044

Technol Health Care. 2024 Apr 21. doi: 10.3233/THC-248044. Online ahead of print.

ABSTRACT

BACKGROUND: The etiology of Burning Mouth Syndrome (BMS) remains unclear.

OBJECTIVE: To explore the differences in the therapeutic efficacy of pain improvement between medication therapy and laser therapy in patients with BMS.

METHODS: 45 BMS patients were randomly divided into three groups: The Combination therapy group (Group A, n= 15), The Medication therapy group (Group B, n= 15), and the Laser therapy group (Group C, n= 15). The pain condition of the patients was evaluated using the Numeric Rating Scale (NRS), and the improvement in pain before and after treatment was compared among the three groups.

RESULTS: All three groups (A, B, and C) showed a significant reduction in NRS scores after treatment, with statistically significant differences observed among the different groups. Group A exhibited the most significant improvement, with a statistically significant difference before and after treatment.

CONCLUSION: Laser and medication therapy are effective methods for reducing oral burning pain * symptoms, and their combined use yields more significant therapeutic effects.

PMID:38759072 | DOI:10.3233/THC-248044

Technol Health Care. 2024 Apr 15. doi: 10.3233/THC-248031. Online ahead of print.

ABSTRACT

BACKGROUND: A growing body of evidence has shown that activating spinal cord glial cells (typically astrocytes and microglial cells) is closely related to hyperpathia and persistent pain.

OBJECTIVE: To investigate the expression of GFAP and CR3/CD11b in cornu dorsale medullae spinalis of rats with nonbacterial prostatitis, to explore the therapeutic efficacy and action mechanism of intrathecal injection of BNP alleviating chronic neuropathic pain.

METHODS: Eighteen male SPF SD rats were randomly divided into sham operation control group, nonbacterial prostatitis group (NBP) and intrathecal injection BNP group, the NBP model was established by intraprostatic injection of CFA, and the spinal cord of L6-S1 segment was extracted seven days after intrathecal injection of BNP; The expression of GFAP and CR3/CD11b in dorsal horn of spinal cord were detected by immunofluorescence and Western blot.

RESULTS: The cumulative optical density values of GFAP and CR3/CD11b immunofluorescence assay in the NBP group were higher than those in the sham operation group, with statistical significance (p⁢ï⁢¼⁢ 0.01); The expression of GFAP and CR3/CD11b in intrathecal injection BNP group were lower than those in NBP group, the differences were statistically significant (p⁢ï⁢¼⁢ 0.01). Western blot results showed that the expression of GFAP and CR3/CD11B in NBP group were higher than those in sham operation group, with statistical significance (p⁢ï⁢¼⁢ 0.05). The expression of GFAP and CR3/CD11B in intrathecal injection BNP group were lower than those in NBP group, the differences were statistically significant (p⁢ï⁢¼⁢ 0.05).

CONCLUSION: Intrathecal injection of BNP can down-regulate the expressions of GFAP and CR3/CD11b in L6-S1 spinal cord of NBP rat model and to further inhibit chronic pain caused by NBP.

PMID:38759060 | DOI:10.3233/THC-248031

Technol Health Care. 2024 Apr 25. doi: 10.3233/THC-248016. Online ahead of print.

ABSTRACT

BACKGROUND: Brain tumor is a highly destructive, aggressive, and fatal disease. The presence of brain tumors can disrupt the brain’s ability to control body movements, consciousness, sensations, thoughts, speech, and memory. Brain tumors are often accompanied by symptoms like epilepsy, headaches, and sensory loss, leading to varying degrees of cognitive impairment in affected patients.

OBJECTIVE: The study goal is to develop an effective method to detect and segment brain tumor with high accurancy.

METHODS: This paper proposes a novel U-Net+⁣+ network using EfficientNet as the encoder to segment brain tumors based on MRI images. We adjust the original U-Net+⁣+ model by removing the dense skip connections between sub-networks to simplify computational complexity and improve model efficiency, while the connections of feature maps at the same resolution level are retained to bridge the semantic gap.

RESULTS: The proposed segmentation model is trained and tested on Kaggle’s LGG brain tumor dataset, which obtains a satisfying performance with a Dice coefficient of 0.9180.

CONCLUSION: This paper conducts research on brain tumor segmentation, using the U-Net+⁣+ network with EfficientNet as an encoder to segment brain tumors based on MRI images. We adjust the original U-Net+⁣+ model to simplify calculations and maintains rich semantic spatial features at the same time. Multiple loss functions are compared in this study and their effectiveness are discussed. The experimental results shows the model achieves a high segmention result with Dice coefficient of 0.9180.

PMID:38759048 | DOI:10.3233/THC-248016

Technol Health Care. 2024 May 2. doi: 10.3233/THC-231868. Online ahead of print.

ABSTRACT

BACKGROUND: Double rocking jump rope training can effectively enhance physical recovery, adaptability to exercise load, and lower limb muscle strength of badminton players in sports colleges, thus offering valuable insights for improving training methods in sports colleges and universities.

OBJECTIVE: To investigate the effect of double rocking jump rope training on the lower limb muscle strength of badminton players specializing in badminton in sports colleges.

METHODS: An experimental study was conducted through a ten-week teaching intervention experiment with badminton players. Relevant heart rate indexes and badminton related lower limb muscle strength indexes were measured before and after the experiment. The data of the measured relevant indexes were statistically and analytically analyzed. At the end of the experiment, the physical recovery level and the heart’s adaptability to the exercise load of the control group were improved, and the lower limb muscle strength test indexes and sports performance were better than before the experiment. In the experimental group, badminton players’ physical function, anaerobic metabolism of the body and other aspects also improved.

RESULTS: The physical function of the experimental group of badminton players, the energy supply capacity of the body anaerobic metabolism and aerobic work capacity all have an enhancement effect, enabling badminton players to adapt to large exercise loads quickly and improve the recovery rate of physical fitness.

CONCLUSION: The introduction of double rocking jump rope into badminton training classes in sports colleges and universities as a means of lower limb muscle strength training is conducive to improving the level of lower limb muscle strength of special badminton players, enriching the teaching and training means of lower limb muscle strength in sports colleges and universities, and broadening the research field of lower limb muscle strength in badminton in sports colleges and universities.

PMID:38759034 | DOI:10.3233/THC-231868