Medical Science Monitor最新文献

BACKGROUND Surface electromyography (sEMG) of pelvic floor muscles (PFM) offers insights into neuromuscular control but lacks standardized normative values. This study aimed to evaluate baseline and contractile sEMG signal characteristics - including root mean square (RMS) amplitude in microvolts and normalized to maximum voluntary contraction (%MVC) - in a healthy control (H) group, pelvic floor dyssynergia (DS) group, and urinary incontinence (UI) group. MATERIAL AND METHODS A retrospective analysis included 68 women (H=28, UI=22, DS=18). UI was confirmed by the International Consultation on Incontinence Questionnaire-Short Form, and DS diagnosed via anorectal manometry. sEMG was recorded with a intravaginal probe using the Glazer protocol. RMS and %MVC were analyzed using Bayesian multivariate regression adjusted for age and BMI. RESULTS No significant differences were found at baseline rest or rapid contractions (P>0.05). The DS group showed higher RMS during tonic contractions vs H group (Δ=4.20, 95% BCI [0.99, 7.29], P<0.05) and UI (Δ=3.44, 95% BCI [0.48, 6.20], P<0.05), and impaired post-tonic relaxation vs H group (Δ=1.13, 95% BCI [0.10, 2.15], P<0.05). Normalized to %MVC, DS group showed lower rapid contraction activity than H group (Δ=-10.49, 95% BCI [-19.46, -1.86], P<0.05). H group outperformed UI group in tonic contraction (P<0.05). CONCLUSIONS DS showed higher RMS amplitudes during tonic contractions, impaired relaxation, and reduced %MVC efficiency, indicating paradoxical activity. UI patterns were heterogeneous, highlighting its multifactorial nature. Reliance on raw RMS alone may misclassify dysfunctions; multiparametric assessment and validation in larger cohorts are needed.

BACKGROUND Pathology of the long head of the biceps tendon (LHBT) frequently accompanies rotator cuff tears. Whether concurrent LHBT tenotomy during arthroscopic rotator cuff repair (RCR) adversely affects postoperative shoulder proprioception or upper-limb strength remains uncertain; intra-individual evidence is limited. MATERIAL AND METHODS A prospective intra-individual comparison was conducted at a single center between May 2018 and December 2021. Consecutive adults who underwent arthroscopic RCR with LHBT tenotomy were evaluated at a postoperative visit. Standardized assessments were performed by a single team. Primary outcomes included shoulder joint-position sense, measured by active position reproduction at predefined targets, and maximum isometric strength, measured with a handheld dynamometer. Statistical analysis included normality testing, paired tests, effect sizes, and 95% confidence intervals (CIs) with Holm adjustment. RESULTS Seventy-seven patients were analyzed (mean age 58.1 years; 73% women; 69% right side). Side-to-side differences were small. Representative metrics included elbow flexion Δ=-0.56 (95% CI, -1.05 to -0.06; P=0.028) and shoulder flexion Δ=-0.87 (95% CI, -1.41 to -0.33; P=0.002). Absolute proprioception error at 30° rotation was modestly lower on the operated side (Δ=-2.00°; 95% CI, -3.68° to -0.32°; P=0.020). Other targets showed no clinically meaningful differences. Effect sizes were small. CONCLUSIONS In patients with clinical indications for tenotomy, concurrent LHBT tenotomy during arthroscopic RCR was unrelated to measurable deficits in shoulder proprioception or upper-limb strength. These findings support clinical acceptability of tenotomy when indicated. Comparative studies are warranted to refine patient selection.

BACKGROUND Post-COVID-19 condition (long COVID) is characterized by persistent symptoms following acute infection. Given the limited efficacy of pharmacologic treatments, there is growing interest in complementary, non-contact interventions. Virtual pet-assisted therapy (VAT), a virtual reality-based adaptation of animal-assisted therapy, may offer a novel strategy for symptom management in this population. MATERIAL AND METHODS A prospective intervention was conducted in the long COVID clinic at Juntendo University Hospital between July and December 2023. Adult patients with long COVID engaged with a virtual dog for 10 minutes prior to their clinical consultation. Twelve symptoms considered potentially responsive to short-term intervention were self-rated on a 10-point scale before and after the session, with scores representing mean values. RESULTS Forty-two participants (median age: 46 years; 71.4% female) were included in the analysis. The mean total symptom score decreased by 7.2%, from 34.6 points before the intervention to 32.1 points after (P=0.004). Fatigue scores decreased by 9.5% (from 6.3 to 5.7, P=0.004), dyspnea decreased by 17% (from 2.3 to 1.9, P=0.038), memory impairment decreased by 13% (from 4.8 to 4.2, P=0.015), and tinnitus decreased by 22% (from 2.3 to 1.8, P=0.012). CONCLUSIONS VAT could be a feasible and well-tolerated intervention worth further investigation as a potential adjunct for alleviating key symptoms of long COVID, particularly those with psychological components. Although this preliminary study is limited by the lack of a control group, it serves as a pilot study that demonstrates the potential of VAT.

BACKGROUND Secretory otitis media (SOM), a common otorhinolaryngological disorder, impairs hearing and quality of life. Eustachian tube balloon dilatation (ETBD) is increasingly used, and its combination with tympanic membrane catheterization (TMC) may enhance outcomes. This study compared ETBD alone with ETBD combined with TMC in adult SOM. MATERIAL AND METHODS Ninety patients (110 ears) with SOM were randomized equally into 2 groups between September 2020 and September 2022. The balloon-only group received ETBD, while the balloon plus catheterization group underwent ETBD combined with TMC. Clinical efficacy was defined as symptom resolution, effusion clearance, and hearing recovery. Eustachian tube function was assessed by manometry (R score) and Eustachian Tube Score (ETS). The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) assessed symptom burden of ear pressure, pain, tinnitus, and muffled hearing. Serum procalcitonin, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured by ELISA. Hearing thresholds were determined using pure-tone audiometry. Six-month recurrence was defined as the reappearance of effusion or symptoms following tympanic membrane healing, determined by otoscopy, tympanometry, and symptom verification. RESULTS The effective rate was significantly higher in the ETBD combined with TMC group (95.56%) than the ETBD-only group (77.78%, P<0.05). Combination therapy yielded greater improvements in R scores, ETS, ETDQ-7, and hearing thresholds, and greater reductions in procalcitonin, hs-CRP, and IL-6 (all P<0.05). Recurrence was lower (4.44% vs 22.22%, P<0.05), with comparable complication rates (P>0.05). CONCLUSIONS ETBD combined with TMC significantly enhanced ET function, symptom relief, inflammatory control, and hearing recovery while reducing recurrence, supporting its adoption in adult SOM management.

BACKGROUND Maxillofacial fractures represent one of the most common forms of traumatic injuries, affecting both function and aesthetics, and are associated with significant morbidity and long-term sequelae. The incidence and distribution of these fractures vary considerably depending on demographic, socioeconomic, and geographic factors. This retrospective study from a single center aimed to evaluate the presentation, imaging findings, and outcomes in 195 patients with maxillofacial fractures treated with closed reduction or open reduction with internal fixation (ORIF). MATERIAL AND METHODS Clinical and radiographic data from 195 patients were reviewed, including age, sex, etiology, fracture site, and treatment modality. Fractures were managed with ORIF using titanium miniplates and screws, intermaxillary fixation (IMF) with screws and elastics, dental splints for selected pediatric cases, or closed reduction for midfacial fractures. Statistical analysis included chi-square or Fisher's exact tests, with P<0.05 considered significant. RESULTS The most common cause of injury was traffic accidents (63.1%), followed by assaults (19.5%) and falls (17.4%). Mandibular fractures were most frequent, particularly in the parasymphysis (29.2%) and symphysis (24.6%) regions. ORIF was performed in 75.4% of cases, IMF in 23.1%, and splints in 9.7%. Significant associations were found between fracture etiology, sex, and treatment modality (P<0.05). CONCLUSIONS Maxillofacial fractures primarily affect young men and are predominantly caused by traffic accidents. Mandibular fractures, especially in the parasymphysis and symphysis regions, are the most common type, and often require ORIF. These findings emphasize the importance of road safety measures and trauma care resources in regions with limited healthcare access.

BACKGROUND Peripheral intravenous (IV) access is a fundamental pre-hospital procedure performed by emergency medical services (EMS) personnel and remains the primary route for drug administration. Pediatric IV cannulation is often challenging in out-of-hospital settings. The aim of this study was to evaluate the frequency of peripheral intravenous access being established in pre-hospital settings by EMS staff in pediatric patients. MATERIAL AND METHODS This retrospective study analyzed 6331 records of emergency medical services (EMS) dispatches involving patients under 18 years of age between 2020 and 2022. The study protocol included an assessment of cannulation rate depending on the patient's age, case characteristics, ICD 10 (International Classification of Diseases, Tenth Revision) diagnosis and whether the patient required transport to a hospital. RESULTS Peripheral intravenous access was established in 1073 of 6331 pediatric patients (16.94%). The cannulation rate increased significantly with age, from 1.03% in infants (<1 year) to 75.12% in adolescents (12-18 years) (p<0.001). Logistic regression analysis identified age, trauma (OR=1.96), poisoning (OR=3.88), and transfer by Helicopter Emergency Medical Services (HEMS) (OR=5.86) as predictors of IV cannulation (p<0.001). CONCLUSIONS The overall rate of peripheral intravenous access establishment in pediatric patients in pre-hospital settings is relatively low, with the lowest rates observed in children under 1 year of age. Age, trauma, poisoning, and referral to HEMS teams significantly increased the likelihood of cannulation. It is essential to develop evidence-based algorithms and targeted training to support EMS personnel in managing vascular access in critically ill children.

BACKGROUND Schizophrenia is a heterogeneous disorder characterized by varying degrees of positive and negative symptoms. Rather than relying on outdated categorical subtypes, current research emphasizes dimensional approaches. This study aimed to investigate differences in prefrontal cortex activation between patients with predominantly positive symptom schizophrenia (PSZ) and predominantly negative symptom schizophrenia (NSZ), as defined by the Positive and Negative Syndrome Scale (PANSS)-derived Bipolar Index (PBI). MATERIAL AND METHODS A total of 36 patients with PSZ (PBI>0) and 35 patients with NSZ (PBI<0) were recruited. All patients underwent functional near-infrared spectroscopy (fNIRS) measurements during the verbal fluency task. Hemodynamic changes in the prefrontal cortex were analyzed using a general linear model. The relationship between ß values of specific channels and Brief Psychiatric Rating Scale factor scores was examined. RESULTS The results showed no significant differences in hemodynamic responses between the PSZ and NSZ groups in the different regions of interest. However, channels Ch21 and Ch51 (involving the frontal pole, orbitofrontal cortex, and triangular part of Broca's area) exhibited significant activation differences between the 2 groups after false discovery rate correction. Additionally, the ß value of channel Ch51 was negatively correlated with the activators of the Brief Psychiatric Rating Scale (r=-0.292, P=0.022). CONCLUSIONS This study highlights distinct patterns of prefrontal cortex activation between patients with PSZ and NSZ, particularly in specific channels. These findings support a dimensional approach to schizophrenia heterogeneity and suggest that fNIRS-derived neurobiological markers can inform symptom-specific interventions.

BACKGROUND Patient monitoring systems are widely used in intensive care units (ICUs) to monitor patient's conditions. A high false alarm rate can lead to alarm fatigue among nurses, increasing workload and stress. This study aimed to improve the accuracy of arrhythmia detection by enhancing the noise detection algorithm in patient monitoring systems and to determine whether false alarm rate and workload decreased through clinical trials. MATERIAL AND METHODS Trials were conducted on adult patients in the ICU at Yongin Severance Hospital who required continuous electrocardiogram (ECG) monitoring for at least 2 days. After the first trial, the noise detection algorithm of the M50 (investigational device) was improved, and a second trial was conducted to evaluate its performance. Both trials followed the same study design. During the study period, M50 and MX700 (comparator device) were applied simultaneously for 3 days. Arrhythmia alarms were reviewed by an independent evaluator who assessed false alarms by comparing them with the ECG signals. False alarm rates were compared between trials using the chi-square (χ²) test. RESULTS The clinical trial was conducted through 2 separate trials, with 17 and 11 participants, respectively. A comparative analysis of false alarm rates of the investigational device demonstrated a reduction from 71.75% to 27.61%. Statistical analysis using the chi-square test indicated a P value of 0.000 (<0.001), confirming a statistically significant difference. CONCLUSIONS The results of 2 trials demonstrated reductions in false alarm rate and NASA-TLX score. These findings suggest that enhancing the noise detection algorithm in the patient monitoring system improved arrhythmia detection accuracy and helped reduce nurses' workload.

BACKGROUND Gestational diabetes mellitus (GDM) is a pregnancy complication associated with increased risks of metabolic disorders in mothers and their children. Interleukins (ILs) such as IL-10 and IL-37 play key roles in modulating inflammation during pregnancy. Exploration of their postpartum concentrations may help characterize the immunometabolic profile of women with a history of GDM. MATERIAL AND METHODS This study compared serum concentrations of IL-10 and IL-37 between postpartum women with GDM (n=30) and healthy controls (n=50) within the first few days after delivery. Correlation analyses were performed between IL levels and clinical variables, including gestational weight gain, physical activity, smoking, alcohol use, hydration status, body composition (assessed via bioimpedance), and family history of obesity or diabetes. RESULTS IL-37 concentrations were significantly lower in the GDM group than in controls. No significant differences in IL-10 levels were observed. In women with GDM, IL-10 showed key negative correlations with pre-pregnancy body mass index, total body weight, and extracellular-to-intracellular water ratio; IL-37 was negatively correlated with reported water intake and positively correlated with gestational age at delivery. CONCLUSIONS The altered IL profile observed in postpartum women with GDM, particularly reduced IL-37 levels, may reflect persistent low-grade inflammation. These findings support further investigation of IL-37 as a potential biomarker of immune dysregulation in the early postpartum period after GDM.

BACKGROUND This study examines the efficacy of biologically guided dose painting in Gamma Knife stereotactic radiosurgery (GKSRS) to improve radiographic response in patients with recurrent high-grade gliomas by increasing radiation dosage in functionally active tumor subregions identified through magnetic resonance spectroscopy (MRS) and T1-weighted perfusion magnetic resonance imaging (T1-PMRI). MATERIAL AND METHODS In this single-arm cohort of patients (n=23) with recurrent high-grade glioma, all patients previously treated with surgery, chemotherapy, and fractionated radiotherapy underwent GKSRS. Functional imaging (MRS and T1-weighted PMRI) delineated metabolically active ("aggressive") and less active ("passive") tumor regions. A modified radiosurgery plan prescribed 18 Gy to aggressive and 15 Gy to passive zones. For intra-patient comparison, a uniform-dose plan (plan 1, 16 Gy) was generated but not delivered. All statistical analyses were performed in Python 3.11 (SciPy-v1.11, statsmodels-v0.14, lifelines-v0.28) executed in Visual Studio Code 1.88 (Microsoft). RESULTS Across 23 patients, plan 2 vs plan 1 showed no significant change in whole-brain mean dose (P=0.716), integral dose (P=0.792), or V12 (P=0.583). Among 11 patients with follow-up imaging, K-trans decreased significantly (median, -18%; P=0.028; Wilcoxon) with a trend for initial area under the gadolinium concentration-time curve (IAUC; median, -22%; P=0.031 for table; overall P=0.08 for initial under curve analysis). Higher baseline K-trans correlated with greater K-trans reduction (r=-0.84, P=0.0012). CONCLUSIONS Using advanced MRI techniques (accounting for K-trans and IAUC on T1-PMRI, and MRS) to determine aggressive zones in salvage treatment for recurrent high-grade gliomas, and then focusing radiotherapy on these zones, can increase Gamma Knife efficiency without increasing the morbidity rate.