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Background: Foot intrinsic muscle dynamic stretching intervention can correct balance ability and induce a change in spatiotemporal parameters gait ability. Our objective was to compare the effects of a 4-week program of foot intrinsic muscle dynamic stretching with those of lunge exercise on static balance, dynamic balance, gait parameters (velocity, cadence, step length, and stride length), and the dynamic gait index (DGI) in chronic stroke patients.

Methods: The participants were randomized to either the foot intrinsic muscle dynamic stretching (n = 10) or standard lunge exercise (n = 10) groups. Both groups performed 3 sets of lunge exercises 5 times per week for 4 weeks. Each set comprised 10 repetitions. Static and dynamic balance, gait parameters, and the DGI were measured after 4 weeks of training.

Results: After 4 weeks of training, the foot intrinsic muscle dynamic stretching group showed significant improvement in all outcome measures compared with the baseline (P < .05). Furthermore, timed up and go, velocity, step length, stride length, and DGI showed greater improvement in the foot intrinsic muscle dynamic stretching group than in the standard lunge exercise group (P < .05).

Conclusions: This study demonstrated that foot intrinsic muscle dynamic stretching training improved dynamic balance, velocity, step lengths, stride length, and DGI in patients with chronic stroke.

Background: The phase 3 randomized, active-controlled GS-US-380-1844 (NCT02603120) study evaluated switching to the single-tablet regimen bictegravir, emtricitabine, and tenofovir alafenamide (B/F/TAF) from dolutegravir (DTG), abacavir (ABC), and lamivudine (3TC) among people with HIV-1. Previously, results from the 48-week double-blind phase showed that switching to B/F/TAF was noninferior to remaining on DTG/ABC/3TC and that B/F/TAF was well tolerated. Here, we show the long-term safety and efficacy of switching to B/F/TAF from DTG/ABC/3TC among people with HIV-1.

Methods: Participants were virologically suppressed people with HIV-1 (HIV-1 RNA <50 copies/mL for ≥ 3 months prior to screening) receiving DTG/ABC/3TC at baseline. Participants were randomized 1:1 to switch to B/F/TAF or remain on DTG/ABC/3TC. Following 48 weeks of treatment with B/F/TAF or DTG/ABC/3TC in the double-blind phase, participants had the option to enter an open-label extension phase, during which they received B/F/TAF. Virologic, immunologic, and safety outcomes during treatment with B/F/TAF through the open-label extension up to 168 weeks, including preexisting and treatment-emergent resistance, were analyzed.

Results: Among 547 participants in the all-B/F/TAF analysis set, virologic suppression (HIV-1 RNA < 50 copies/mL) was maintained in 99% to 100% of participants up to 168 weeks into B/F/TAF treatment, including in those with preexisting resistance; no treatment-emergent resistance was detected. CD4 cell counts remained stable during B/F/TAF treatment, with median (interquartile range) changes from baseline of -17 (-120, 65) cells/µL at week 48 and -9 (-100, 108) cells/µL at week 96. Safety and tolerability findings were consistent with previously reported findings up to week 48; most drug-related adverse events were grade 1 or 2 in severity; no new safety signals were identified.

Conclusion: Switching to B/F/TAF from DTG/ABC/3TC was associated with continued high rates of virologic suppression up to week 168, with no treatment-emergent resistance. B/F/TAF was well tolerated throughout the study period.

Background: The aim of this study is to systematically assess the efficacy of levothyroxine (L-T4) in the treatment of growth and development among children diagnosed with congenital hypothyroidism (CH) through meta-analysis, with the ultimate goal to provide clinicians with a more robust and effective evidence-based foundation for treatment decisions.

Methods: We conducted a comprehensive search of relevant literature from both domestic and international resources, and meticulously screened out clinical studies which meet our inclusion criteria, that is without any time restrictions and the deadline was September 25, 2024, and the language was limited to English and Chinese only. Subsequently, we integrated and analyzed the data using standard meta-analysis methodologies under the Preferred Reporting Items for Systematic reviews and Meta-Analyses rules, aiming to derive more precise and reliable conclusions by summarizing and comparing the findings of multiple studies.

Results: A total of 17 studies with 5 diagnostic indexes of IQ, height, weight, head circumference, and bone age were included, and these studies collectively reported on 1934 patients, with 951 and 983 patients, respectively being divided into the experimental and control group. The included studies were of high quality, and the results of our meta-analysis showed that L-T4 treatment could effectively promote the physical development of children with CH. Specifically, children in the experimental group had a higher level of IQ [mean difference [MD] = 8.38, 95% confidence intervals [CI] (6.89, 987)], height [MD = 6.71, 95% CI (6.08, 7.35)], weight [MD = 1.31, 95% CI (1.14, 1.49)], head circumference [MD = 3.83, 95% CI (3.52, 4.13)], and bone age [OR = 3.49, 95% CI (2.15, 5.68)] compared to those in the control group.

Conclusion: L-T4 is an effective drug for the treatment with CH in children, which significantly promote their growth and development while improving thyroid function. This finding provides strong evidence and support for clinicians, contributing to the progress and advancement in the field of CH treatment.

The emergence of artificial intelligence (AI)-based linguistic models has revolutionized academic writing, prompting concerns about integrity. In response, AI-powered text authenticity detectors have been developed. This study examines AI tool usage in anesthesiology and intensive care journals. 1268 articles from 86 journals in "Anesthesiology" and "Anesthesiology and Intensive Care" were analyzed using Copyleaks and ZeroGPT. English abstracts published between April 18 and May 18, 2023, were scrutinized. ZeroGPT and Copyleaks found average AI usage at 25.1% ± 27.5 and 10.5% ± 15.9, respectively. 16.8% of articles were "human-written," while 83.2% were "AI-assisted". AI assistance correlated positively with abstract length and was more common among nonnative English speakers (P < .001). It was also prevalent in high-impact and science citation index-indexed journals (P < .01; P < .001). This study underscores the widespread adoption of AI tools in academic writing, particularly among nonnative English authors and in high-impact journals, emphasizing the need for improved detection mechanisms and regulatory guidelines.

Notably, several factors are associated with hallux valgus (HV); however, their causal relationship remains unclear. In this study, a 2-sample Mendelian randomization (MR) analysis was performed to investigate the casual relationship between 9 endogenous risk factors and HV, aiming to provide a foundation for the clinical management of HV. Exposure factors such as body mass index (BMI), BMI (male), BMI (female), acquired flatfoot, rheumatoid arthritis, gout, knee osteoarthritis, hip osteoarthritis, and Ehlers-Danlos syndrome were considered, with HV as the outcome. Exposure and outcome data were obtained from the IEU Open Genome-wide association study project, UK Biobank, and FinnGen project. Strongly correlated (P < 5×10-08/5×10-06) single nucleotide polymorphisms (SNPs) were selected from the exposure dataset, and those associated with exposure were selected from the HV dataset. The intersection of these SNPs was used as instrumental variables. Five modes were used for the analysis: inverse variance-weighted (IVW), MR-Egger regression, weighted median (WME), simple mode, and weighted mode. MR analysis results of BMI show that except for MR-Egger, the other 4 modes are significant (P < .05), and the β directions are consistent among the 5 methods. For the 4 BMI (male) methods, except for the simple mode, the P- and β-values of the other results all suggest a positive causal relationship between BMI (male) and HV. Flatfoot-IVW and WME results were <.05, indicating statistical significance, whereas MR-Egger, simple mode, and median mode had no statistical significance. However, their β-values were consistent with those of IVW and WME. Further mediation MR analysis suggested that the effect mediated by HV accounts for 13.33% [95% CI (0.03-0.24)] of the total causal effect between the BMI and flatfoot, indicating HV as a mediator of the causal relationship between the BMI and flatfoot. However, the remaining 6 factors had no direct causal association with HV (P < .05). Flatfoot in all patients and elevated BMI in males are directly associated with HV. Therefore, treating acquired flatfoot and controlling the BMI to prevent HV are recommended.

Rationale: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition often linked to hypertension, eclampsia, or renal failure. PRES typically presenting with seizures, headaches, visual disturbances, and altered mental status. A rarer form, the central variant of PRES, involves atypical radiologic findings such as edema in central brain structures. PRES has not been previously associated with adrenal insufficiency, making this case novel and significant.

Patient concerns: A 59-year-old woman with a history of hypertension, chronic obstructive pulmonary disease, and previous COVID-19 infection presented to the emergency department with seizures and altered mental status. She exhibited a fluctuating systolic blood pressure (79-195 mm Hg) and had a Glasgow Coma Scale (GCS) score of 7.

Diagnoses: Initial imaging and laboratory tests were inconclusive. Continuous electroencephalogram indicated focal cortical irritability, raising concerns about seizures. Brain magnetic resonance imaging revealed increased T2-weighted signals in the bilateral cerebellar hemispheres, consistent with central variant PRES. Endocrine evaluation showed primary adrenal insufficiency, confirmed by low AM cortisol levels and a positive cosyntropin stimulation test.

Interventions: The patient was started on levetiracetam for seizure management and hydrocortisone for adrenal insufficiency. She was intubated for airway protection but later extubated as her condition stabilized.

Outcomes: Follow-up magnetic resonance imaging showed progressive resolution of the cerebellar T2 hyperintensities. The patient was discharged on day 15 with no residual neurological deficits. At a 3-month follow-up, she remained seizure-free and continued oral hydrocortisone and levetiracetam.

Lessons: This case highlights adrenal insufficiency as a possible novel precipitant of the central variant of PRES, emphasizing the need for prompt diagnosis and treatment to prevent serious neurological outcomes. The underlying pathophysiological mechanism of PRES from adrenal insufficiency is most likely labile blood pressure causing rapid alterations in cerebral perfusion pressure (CPP) precipitating PRES.

Data supporting the evidence of changes in the menstrual cycle and premenstrual symptoms associated with coronavirus disease (COVID-19) is quite scarce. To determine the association between COVID-19 vaccination and menstrual cycle changes and its relationship with different types of vaccines among women of reproductive age in Abha City, Saudi Arabia. A cross-sectional study was conducted from January 2022 to June 2022, among participants from Asser region of Saudi Arabia by using a self-administered questionnaire through an electronic survey. Data analysis was performed using SPSS version 16.0. Among 1208 study subjects, majority (66.9%) of females had menarche at the age of <13 years, 17.2% had irregular periods, and 24.8% reported an average regularity of periods (23-35 days). A statistically significant association was found among females who experienced a change in their menstrual cycle after receiving COVID-19 vaccine. Mood swings and lower back pain were common symptoms of premenstrual syndrome symptoms. Only 15% females reported a delay in conception. Out of 176 females, 40% showed 6 month delay in conception after receiving vaccine. Multivariate logistic regression analysis showed that age, regularity of periods, and usual volume of bleeding were significantly associated with changes in the menstrual cycle after vaccination. The relationship between COVID-19 vaccine and associated changes on the menstrual cycle and premenstrual syndrome was established in our study. Further research is needed to produce concrete evidence regarding its relationship to eliminate vaccine hesitancy among women.

Subjective health status comprises an individual's self-assessment of health and indicates their actual health outcomes. This study aimed to explore the relationship between traditional Korean Medicine (KM) inquiry outcomes and subjective health status to provide a better understanding of the potential benefits of KM practices, which have been overlooked in existing research. This observational study recruited 5987 healthy adults (age ≥ 19 years) between April 11, 2022, and December 19, 2023. Participants were surveyed using standardized KM inquiries and subjective health status assessments. Statistical analyses included chi-square tests and multivariate logistic regression analyses to examine the relationship between KM inquiry outcomes and subjective health status. An analysis of 4935 respondents who completed KM inquiries revealed that factors affecting subjective health status for both men and women included appetite, digestive discomfort, residual urine sensation, waking condition, cold intolerance, and exercise habits. Factors affecting subjective health status differed slightly by sex; for men, dry mouth and alcohol consumption were significant, whereas, for women, dry mouth, meal frequency, sleep quality, and feelings after sweating were significant. This study confirms the utility of KM inquiries in assessing the subjective health status of healthy adults and provides insights into the development of sex-specific lifestyle health-management strategies.

A unique measure of inflammatory evaluation, the systemic inflammation response index (SIRI) may offer useful data for the diagnosis and risk assessment of a number of diseases. The aim of this study was to investigate the relationship between SIRI and femur bone mineral density (BMD) in US adults. The association between SIRI and femur BMD was examined using multivariate logistic regression, sensitivity analysis, and smoothing curve fitting using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010, 2013-2014, and 2017-2018. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. This present study included 18,022 participants older than 20 years from NHANES (2005-2010, 2013-2014, and 2017-2018). The present study showed a negative association between SIRI and femur BMD (including total femur BMD, femoral neck BMD, trochanter BMD, and intertrochanter BMD). In the fully adjusted model, we found a negative association between the SIRI and total femur BMD (Beta = -0.0032, 95% CI: -0.0053 to -0.0012), a negative association between the SIRI and femoral neck BMD (Beta = -0.0025, 95% CI: -0.0045 to -0.0005), a negative association between the SIRI and trochanter BMD (Beta = -0.0032, 95% CI: -0.0050 to -0.0013), a negative association between the SIRI and intertrochanter BMD (Beta = -0.0031, 95% CI: -0.0056 to -0.0007). This negative association was more pronounced in older adults > 65 years of age. In addition, we found a U-shaped association between SIRI and femur BMD by further smoothing curve-fitting methods. SIRI was negatively associated with femur BMD in US adults, and this association was more significant in older adults over 65 years. SIRI may be a useful, convenient, and practical indicator of inflammation. Moreover, older adults with high SIRI levels are likely to have low femur BMD.

Rationale: Phosphaturic mesenchymal tumors (PMTs) are rare soft-tissue and bone tumors that can occur intracranially. Low incidence, nonspecific symptoms, and diverse histomorphology of PMTs contribute to a high rate of misdiagnosis.

Patient concerns: This report presents a rare case of an intracranial PMT located in the posterior cranial fossa. In addition, a systematic review of previously reported intracranial PMT cases was conducted and summarized.

Diagnoses: Incorporating clinical symptoms, laboratory findings, and imaging features, the definitive diagnosis of PMT was based on pathological examination.

Interventions: The patient underwent consultations in endocrinology, orthopedics, and neurosurgery, and ultimately had a surgical procedure to remove the intracranial tumor.

Outcomes: After tumor resection, the patient's laboratory values returned to normal, his symptoms improved, and he could walk again.

Lessons: Due to the rarity and high misdiagnosis rate of PMTs, no unified diagnosis and treatment standards have been established. Early identification, accurate diagnosis, and timely treatment are essential for optimal management. Surgical resection remains the preferred treatment for PMTs, with total tumor resection strongly recommended. In case of incomplete resection, tumor recurrence and persistent symptoms may necessitate adjunctive drug therapy and radiation therapy.