Types of nasal deformities in individuals seeking rhinoplasty at governmental hospital in Saudi Arabia.

Introduction: This study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants. Material and methods: This retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15-54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling. Results: Our study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%). Conclusion: In conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty.

A Comparative Study of Correction of Caudal Septal Deviations.

BACKGROUND: There are multiple surgical approaches for the correction of caudal septal deviation. OBJECTIVES: To compare the surgical outcomes of the widely used techniques of correction of caudal septal deviation. MATERIALS AND METHODS: In a prospective study done over a period of 3 years, 36 patients with caudal septal deviation were selected and randomly divided into 3 groups of 12 each who underwent surgery by the following techniques: Group A - Swinging Door technique. Group B- Tongue-in-groove technique. Group C- The cutting and suture technique with unilateral bony batten grafting. The preoperative and postoperative (at 6 months) NOSE score, anterior rhinoscopy and subjective assessment were used to measure surgical outcomes and the techniques were compared. RESULTS: Out of the 36 patients, the mean NOSE score preoperatively and postoperatively were as follows. For Group A- 72.5 and 23.33. For Group B- 73.75 and 19.17. For Group C- 72 and 22. A significant improvement of mean 49.17, 54.58 and 50.00 with p-value of < 0.05 respectively. Anterior rhinoscopy done at 6 months postoperatively showed that 30 patients (83%) had a straight septum while 6 patients (17%) had some residual deviation. Subjective patient satisfaction was "much improved" in 17 (47.2%) patients, and "improved" in 19 (52.8%) patients. Four patients had postoperative synechia which were managed conservatively. CONCLUSION: Surgical correction of caudal septal deviation resulted in significant improvements in nasal airway. The tongue-in -groove technique was found to be the most effective among the three.

Prevalence of Obstructive Sleep Apnoea in patients with primary nasal and nasopharyngeal pathologies.

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations.

Predictive Value of Esophageal Deviation Index for Clinical Outcomes of Patients With Left-Sided Congenital Diaphragmatic Hernia.

PURPOSE: This study aimed to evaluate the prognostic value of postnatal esophageal deviation index (EDI) measured within the first 24 h of life for predicting mortality and morbidity in neonates with left-sided congenital diaphragmatic hernia (L-CDH). METHOD: This retrospective study analyzed clinical data from 133 neonates with L-CDH admitted to Guangzhou Women and Children's Medical Center between January 2016 and January 2024. Patients were categorized into two groups based on outcomes: survivors (n = 108) and non-survivors (n = 27). Risk factors for mortality were identified using both univariate and multivariate analyses. A receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of EDI for mortality in L-CDH patients. Subsequently, patients were divided into two groups: those with an EDI> 16.1% and those with an EDI≤16.1%. The relationship between EDI and both mortality and morbidity was analyzed using Kaplan-Meier analysis, chi-square test, Fisher's exact test, and multivariate analysis. RESULTS: EDI (adjusted OR: 0.822, 95% CI 0.723-0.935; P = 0.003) was identified as the independent predictor of mortality through both univariate and multivariate logistic regression analysis. The ROC curve demonstrated that the area under the curve (AUC) for predicting the mortality was 0.854 (95%CI: 0.782-0.930) for EDI, with an optimal cut-off value of 16.125%. The cumulative mortality rate through Day 200 was higher in patients with an EDI>16.1% (P＜0.001). Among the 133 neonates with L-CDH, 24.8% had an EDI>16.1%. This was associated with significantly worse CDH characteristics, including a high incidence of intrathoracic stomach and a high occurrence of high-risk defect sizes (type C/D), (P＜0.001), as well as more severe pulmonary hypertension (P＜0.001). An EDI>16.1% was associated with higher mortality and a greater need for ECMO support compared to an EDI≤16.1% (P＜0.001). CONCLUSION: EDI within the first 24 h of life in patients with L-CDH is associated with increased mortality and the need for ECMO, particularly when EDI exceeds 16.1%. LEVEL OF EVIDENCE: III.

Transient vertical diplopia following ibuprofen intake: a case report.

Ibuprofen, a commonly used over-the-counter medication, is widely recognized for its effective pain relief properties but is also associated with various adverse effects, including rare ocular and neurological manifestations. We report a case of a 27-year-old male who experienced transient vertical diplopia following a standard ibuprofen dosage for back pain. Symptoms resolved promptly upon discontinuation of the drug, with normal findings on extensive clinical and laboratory evaluations. The clinical presentation, suggestive of skew deviation, implies central toxicity. This case underscores the potential for diplopia associated with NSAIDs like ibuprofen to be underdiagnosed and offers valuable insights into the central toxicity of ibuprofen. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in similar scenarios.

Classifying physical activity levels using Mean Amplitude Deviation in adults using a chest worn accelerometer: validation of the Vivalink ECG Patch.

BACKGROUND: The development of readily available wearable accelerometers has enabled clinicians to objectively monitor physical activity (PA) remotely in the community, a superior alternative to patient self-reporting measures. Critical to the value of these monitors is the ability to reliably detect when patients are undergoing ambulatory activity. Previous studies have highlighted the strength of using mean amplitude deviation (MAD) as a universal measure for analysing raw accelerometery data and defining cut-points between sedentary and ambulatory activities. Currently however there is little evidence surrounding the use of chest-worn accelerometers which can provide simultaneous monitoring of other physiological parameters such as heart rate (HR), RR intervals, and Respiratory Rate alongside accelerometery data. We aimed to calibrate the accelerometery function within the VivaLink ECG patch to determine the cut-point MAD value for differentiating sedentary and ambulatory activities. METHODS: We recruited healthy volunteers to undergo a randomised series of 9 activities that simulate typical free-living behaviours, while wearing a VivaLink ECG Patch (Campbell, California). MAD values were applied to a Generalised Linear Mixed Model to determine cut-points between sedentary and ambulatory activities. We constructed a Receiver Operating Characteristic (ROC) curve to analyse the sensitivity and specificity of the cut-off MAD value. RESULTS: Eighteen healthy adults volunteered to the study and mean MAD values were collected for each activity. The optimal MAD cut-point between sedentary and ambulatory activities was 47.73mG. ROC curve analysis revealed an area under the curve of 0.99 (p < 0.001) for this value with a sensitivity and specificity of 98% and 100% respectively. CONCLUSION: In conclusion, the MAD cut-point determined in our study is very effective at categorising sedentary and ambulatory activities among healthy adults and may be of use in monitoring PA in the community with minimal burden. It will also be useful for future studies aiming to simultaneously monitor PA with other physiological parameters via chest worn accelerometers.

Comparative evaluation of accuracy of implants placed with thermoplastic and three-dimensional-printed surgical guides: A randomized controlled trial.

Background: The current study was planned to evaluate the accuracy of dental implant placement with two different types of surgical guides: Thermoplastic and three-dimensional (3D) printed. Materials and Methods: A total of 32 implants were placed in 20 healthy, partially dentate individuals with an isolated single missing tooth. The implant sites were randomly allocated into two treatment groups: Group A (thermoplastic implant surgical guide, n = 16 implants) and Group B (3D printed implant surgical guide, n = 16 implants). All the cases in both groups were digitally planned according to a defined protocol, and a comparison of the planned and actual implant positions was performed using the medical image analysis software. The differences in the outcome variables, i.e., angular deviation (AD), 3D error at the entry, 3D error at the apex (3D EA), vertical deviation (VD), and composite deviation, were statistically analyzed. Results: All the outcome variables showed improvements, but statistically significant improvement was shown by AD (P = 0.005), 3D EA (P = 0.01), and VD (P = 0.007). The mean and standard deviation (SD) for AD, (3D EA), and VD were 5.58° ±1.93°, 0.96 ± 0.32 mm, and 0.58 ± 0.36 mm, respectively, for group A. The mean and SD for AD, (3D EA), and VD were 3.94° ± 0.64°, 0.64 ± 0.35 mm, and 0.29 ± 0.13 mm, respectively, for group B (P < 0.05). Conclusion: Within the limits of the study, dental implants placed using 3D-printed surgical guides were positioned clinically with greater accuracy, and fewer deviations were observed from their presurgical planned positions as compared to the thermoplastic surgical guides.

Improvement of the gait deviation index for spinal cord injury to broaden its applicability: the reduced gait deviation index for spinal cord injury (rSCI-GDI).

Background: The SCI-GDI is an accurate and effective metric to summarize gait kinematics in adults with SCI. It is usually computed with the information registered with a photogrammetry system because it requires accurate information of pelvic and hip movement in the three anatomic planes, which is hard to record with simpler systems. Additionally, due to being developed from the GDI, the SCI-GDI is built upon nine joint movements selected for a pediatric population with cerebral palsy, for which the GDI was originally developed, but those nine movements are not necessarily as meaningful for adults with SCI. Nevertheless, pelvic movement and hip rotation have been proven to have low reliability even when acquired with gold-standard photogrammetry systems. Additionally, the use of photogrammetry is limited in real-life scenarios and when used with rehabilitation technologies, which limits the use of the SCI-GDI to evaluate gait in alternative scenarios to gait laboratories and to evaluate technologies for gait assistance. This research aimed to improve the SCI-GDI to broaden its applicability beyond the use of photogrammetry. Methods: An exploration of the mathematical relevance of each joint movement included in the original GDI for the performance of the metric is performed. Considering the results obtained and the clinical relevance of each of the 9 joints used to compute the SCI-GDI in the gait pattern of the SCI population, a more adaptable SCI-GDI is proposed using four joint movements that can be precisely captured with simpler systems than photogrammetry: sagittal planes of hip, knee and ankle and hip abduction/adduction. Results: The reduced SCI-GDI (rSCI-GDI) effectively represents gait variability of adults with SCI as does the SCI-GDI, while providing more generalizable results and equivalent or stronger correlations with clinical tests validated in the population. During the derivation of the improved index, it was demonstrated that pelvic movements, hip rotation, and foot progression angle introduce high variability to the dataset of gait patterns of the adult population with SCI, but they have low relevance to characterize gait kinematics of this population. The rSCI-GDI can be calculated using the 14-feature vectorial basis included in the electronic addendum provided.

Effect of Implant Analog Design and Additively Manufactured Casts' Printing Layer Thickness on the Linear and Angular Accuracy of Analogs for Direct Digital Workflow: An In Vitro Study.

PURPOSE: To evaluate how implant analog design and printing layer thickness affect the linear and angular accuracy of implant analogs in additively manufactured casts, comparing with conventional implant analogs in stone casts. MATERIAL AND METHODS: A reference cobalt chromium mandibular model with a single implant was digitized with an industrial optical scanner and scan bodies compatible with a pressure/friction fit (S) or a screw-retained (N) implant analog for direct digital workflow. These scans were used to fabricate casts with 50 µm (S-50 and N-50) and 100 µm (S-100 and N-100) layer thickness (n=10). Ten stone casts were made after single-step closed-tray polyvinylsiloxane impressions of the model (CNV). All casts were digitized with the same metal scan body and scanner used to digitize the master model, and these scans were superimposed over the scan of the master model to measure the linear (x, y, and z-axes) and angular (XY and YZ planes) deviations (Geomagic Control X). The precision of measured deviations was defined with the average deviation values. Generalized linear model analysis was used to compare the deviations within implant analogs for direct digital workflow, while 1-way analysis of variance and Dunnett's test were used to compare these analogs and conventional analogs (α = .05) Results. The analog design affected the linear deviations (y-axis), while the interaction between the analog design and the layer thickness, and the analog design affected the angular deviations (XY plane, P ≤ .030). S analogs had lower linear and angular deviations than N analogs, and S-50 led to lower angular deviations than N-50 (P ≤ .030). CNV led to higher linear accuracy (y-axis) than N-50, N-100, and S-100 and led to lower angular deviations than all test groups (XY plane) (P ≤ .025). CONCLUSIONS: The analogs in S-50 casts had positional trueness similar to or higher than those in other test groups and their accuracy was mostly similar to those in CNV casts. Implant analogs for direct digital workflow deviated more towards lingual and gingival, and conventional analogs deviated more towards buccal, occlusal, and distal. All analogs had a tendency to tilt towards lingual and distal.

Biomechanical effects of mandibular deviation on the temporomandibular joint in patients with mandibular prognathism under incisal occlusion.

PURPOSE: The aim of this study was to investigate the biomechanical effects of mandibular deviation on the TMJ in patients with mandibular prognathism before and after orthognathic surgery using three-dimensional finite element analysis. METHODS: Eight patients with mandibular prognathism without deviation, eight patients with mandibular prognathism with deviation and sixteen normal subjects were recruited. Three-dimensional models of the maxillofacial were reconstructed using MIMICS. Nine muscle forces were used to simulate incisal occlusion and contact was used to simulate fossa-disc-condyle interactions. RESULTS: Before surgery, the stress in the TMJ was generally greater in the Pre-MD&MP group than in the Pre-MD group; it was much greater in both groups than in the control group, ranging from about 2 to 12 times as great in the Pre-MD group and from about 5 to 64 times as great in the Pre-MD&MP group. After orthognathic surgeries, the stresses in the Post-MP&MD were significantly reduced by approximately 21.7 % to 93.4 %. And in the Post-MP group, the stresses were reduced by approximately 1.4 % to 51.1 %. CONCLUSION: Mandibular deviation exacerbated the abnormal stress distribution in the TMJ of patients with mandibular prognathism. Orthognathic surgeries could improve the stress distribution in patients with mandibular prognathism (with and without deviation). TMD was closely related to the stress levels of the TMJ.

Low-intensity extracorporeal shock wave therapy for Peyroniès disease: a systematic review and meta-analysis.

BACKGROUND: A systematic review of the evidence was conducted to assess the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) for patients with Peyronie`s Disease (PD). METHODS: A comprehensive search of the Cochrane Registry, PubMed and Embase databases was conducted to identify all controlled trials, including randomised controlled trials (RCTs), cohort studies and case-control studies, focusing on the efficacy of LI-ESWT in treating PD, and published before February 2023. The size of plaques, curvature deviation, visual analog scale [VAS] and International Index of Erectile Function (IIEF) were the most commonly used tool to evaluate the treatment effectiveness of LI-ESWT. RESULTS: There were 7 studies including  475 patients from 1999 to 2023. The meta-analysis of the data revealed that LI-ESWT could considerably enhance the proportion of men experiencing a reduction in penile plaques (RD 0.27, 95% CI: 0.04-0.50, P = 0.02), improvement in penile curvature (RD: 0.13; 95% CI, 0-0.26; p = 0.05), alleviation of pain (RD 0.22, 95% CI: 0.01-0.42, P = 0.04), and complete remission (RD 0.38, 95% CI 0.23-0.52, P < 0.00001). However, there were no significant differences in improvement of sexual function (MD: 1.44; 95% CI, -3.10-5.97; p = 0.53) between LI-ESWT and the placebo group. CONCLUSIONS: According to these studies, LI-ESWT has the potential to decrease plaque size and improve penile curvature or pain in men with PD. The publication of robust evidence from additional well-designed long-term multicenter randomized controlled trials would provide more confidence regarding use of these devices in patients with PD.

A retinal detachment based strabismus detection through FEDCNN.

Ocular strabismus, a common condition in the present generation is an absolute risk factor for amblyopia and blinding premorbid visual loss. Despite the availability of new optometry tools with eye-tracking data, the issues persist in attaining accuracy and reliability in diagnosing strabismus. These two concerns are specifically accommodated in this study by the proposed novel approach that involves CNNs with eye-tracking datasets from subjects. The presented work aims to improve the accuracy of diagnostics in ophthalmology utilizing the integration of the further proposed algorithms into an automatic strabismus detection system. For this purpose, the proposed FedCNN model combines the CNN with eXtreme Gradient Boosting (XGBoost) and uses the Gaze deviation (GaDe) images to capture dynamic eye movements. This method tries to make the feature extraction as accurate as possible in its best working state to enhance the diagnosis precision. The model proves to be accurate, reaching 95.2%, which is even more prominent because of the more or less detailed connection layer of the CNN, which is used for the selection of features designated for such tasks of strabismus recognition. The presented method has the potential of shifting the approach to diagnosing diseases of the eyes in more or less half of the patients.

Can retroreflective rings enhance drivers' safety perception of spatial right-of-way in freeway tunnels? A simulation exploration.

In order to investigate whether retroreflective rings can enhance drivers' perception of spatial right-of-way in freeway tunnels, this paper explores a simulation test. The characteristics of spatial right-of-way in tunnels are elucidated, and a comparative test is conducted using commonly used delineators and raised pavement markers against retroreflective rings to enhance the perception of spatial right-of-way. The test employs the perception of lateral deviation and longitudinal distance as indicators to reflect the lateral and longitudinal right-of-way. Video scenarios, incorporating different facilities and spacing, are created using 3Ds Max software following the design standards of freeway tunnels. The indicators of Stimulation of Subjectively Equal Distance (SSED), lateral deviation, and perception reaction time (PRT) are chosen to assess the effects of different facilities on drivers under varying spacing conditions. Fifty-two participants, divided into two groups of novice drivers and experienced drivers, underwent perception testing in a simulated driving environment. The results indicate that drivers exhibit the highest overestimation of longitudinal distance and the longest PRT of lateral deviation in the absence of facilities. Installing retroreflective rings with a spacing of 50-200 m significantly mitigates the overestimation of longitudinal distance, while reducing the PRT of lateral deviation. On the other hand, setting up delineators and raised pavement markers with a spacing of 6-12 m significantly reduces the PRT of lateral deviation, while there is no significant enhancement to the perception of longitudinal distance. A spacing of 200 m for retroreflective rings and 10 m for delineators and raised pavement markers in the straight section is recommended as a safer and more economical setting scheme. The combination of these facilities can enhance drivers' safety perception of spatial right-of-way in freeway tunnels, facilitating rapid perception, correct judgment, and timely decision-making for the safe passage of vehicles.

A Kinematic Deviation Index (KDI) for Evaluation of Forelimb Function in Rodents.

Rodent models are widely used to study neurological conditions and assess forelimb movement to measure function performance, deficit, recovery and treatment effectiveness. Traditional assessment methods based on endpoints such as whether the task is accomplished, while easy to implement, provide limited information on movement patterns important to assess different functional strategies. On the other side, detailed kinematic analysis provides granular information on the movement patterns but is difficult to compare across laboratories, and may not translate to clinical metrics of upper limb function. To address these limitations, we developed and validated a kinematic deviation index (KDI) for rodents that mimics current trends in clinical research. The KDI is a unitless summary score that quantifies the difference between an animal movement during a task and its optimal performance derived from spatiotemporal marker sequences without pre-specifying movements. We demonstrate the utility of KDI in assessing reaching and grasping in mice and validate its discrimination between trial endpoints in healthy animals. Furthermore, we show KDI sensitivity to interventions, including acute and chronic spinal cord injury and optogenetic disruption of sensorimotor circuits. The KDI provides a comprehensive measure of motor function that bridges the gap between detailed kinematic analysis and simple success/failure metrics, offering a valuable tool for assessing recovery and compensation in rodent models of neurological disorders.

Temperature-controlled radiofrequency treatment of the nasal valve in nasal airway obstruction patients with septal deviation.

KEY POINTS: Nasal valve treatment with TCRF results in NAO symptom improvement in the presence of septal deviation. Severe septal deviation does not impact the beneficial effect of TCRF nasal valve treatment. Symptoms improve with TCRF nasal valve treatment even if septal deviations involve the nasal valve.

Borderline Range Determined Using Data From Validation Study of Alternative Methods for Skin Sensitization: ADRA, IL-8 Luc Assay, and EpiSensA.

Most predictive models that use alternatives to animal experiments divide judgements into two classes with a cutoff value for each model. However, if the results of alternative methods are close to the cutoff values, the true result may be ambiguous because of variability in the data. Therefore, the OECD GL497 uses a judgement method that establishes a borderline range (BR) around a cutoff value using a statistical method. However, because there is no detailed description of how the BR is calculated, we clarified two specific points. The scale-constant correction method was used to calculate the median absolute deviation (MAD) around the median. In addition, the bottom-raised transformation method was used when the data were "0" because calculation of the BR requires that all data are logarithmic. Indeed, the BRs for the amino acid derivative reactivity assay (ADRA), interleukin-8 reporter gene assay (IL-8 Luc), and epidermal sensitization assay (EpiSensA) were calculated using data from each validation study. The results showed that the BR for ADRA and IL-8 Luc ranged from 4.1 to 5.9 and 1.25 to 1.57, respectively. Furthermore, the BRs of four genes (ATF3, GCLM, DNAJB4, and IL-8) evaluated using EpiSensA ranged from 10.71 to 21.02, 1.64 to 2.45, 1.61 to 2.52, and 3.11 to 5.16, respectively. The difference (deviation) between the lower and upper BR limits and cutoff value for each alternative method were comparable to those of the alternative methods listed in the guidelines (DPRA, KerarinoSens, and h-CLAT) and thus were considered as adequate.

Landscape transcriptomic analysis of bovine follicular cells during key phases of ovarian follicular development.

BACKGROUND: There are many gaps in our understanding of the mechanisms involved in ovarian follicular development in cattle, particularly regarding follicular deviation, acquisition of ovulatory capacity, and preovulatory changes. Molecular evaluations of ovarian follicular cells during follicular development in cattle, especially serial transcriptomic analyses across key growth phases, have not been reported. This study aims to address this gap by analyzing gene expression using RNA-seq in granulosa and antral cells recovered from ovarian follicular fluid during critical phases of ovarian follicular development in Holstein cows. RESULTS: Integrated analysis of gene ontology (GO), gene set enrichment (GSEA), protein-protein interaction (PPI), and gene topology identified that differentially expressed genes (DEGs) in the largest ovarian follicles at deviation (Dev) were primarily involved in FSH-negative feedback, steroidogenesis, cell proliferation, apoptosis, and the prevention of early follicle rupture. In contrast, DEGs in the second largest follicles (DevF2) were mainly related to loss of cell viability, apoptosis, and immune cell invasion. In the dominant (PostDev) and preovulatory (PreOv) follicles, DEGs were associated with vascular changes and inflammatory responses. CONCLUSIONS: The transcriptome of ovarian follicular fluid cells had a predominance of granulosa cells in the dominant follicle at deviation, with upregulation of genes involved in cell viability, steroidogenesis, and apoptosis prevention, whereas in the non-selected follicle there was upregulation of cell death-related transcripts. Immune cell transcripts increased significantly after deviation, particularly in preovulatory follicles, indicating strong intrafollicular chemotactic activity. We inferred that immune cell invasion occurred despite an intact basal lamina, contributing to follicular maturation.

Effect of adapted dance program on gait in adults with cerebral palsy: a pilot study.

Background: The gait function in adults with cerebral palsy (CP) deteriorates rapidly with age. Dance has been used as an effective intervention to improve balance, postural control, and gait. This study aimed to investigate the feasibility and effects of an adapted dance program (ADP) on the gait in adults with CP. The ADP, which consists of floor and barre workouts, was designed to be adapted for individuals with CP. Method: Ten female adults with spastic diplegic CP (mean age 52.3 ± 6.34, Gross Motor Function Classification System level II) participated in this study. Outcome measures, examined using 3D gait analysis, included spatiotemporal gait parameters and the Gait Deviation Index (GDI) based on nine kinematic variables in all planes of motion. To assess feasibility, we conducted post-questionnaires and a group interview. The ADP, each lasting 90 min, was held twice per week for 12 weeks. Results: A statistically significant improvement was observed in GDI (Δ5.74 points, p = 0.014), with a large effect size (d = 0.76). Foot off (Δ-0.72%), first double support (Δ-0.2%), second double support (Δ1.5%), and single support (Δ0.64%) showed no significant differences. Step length (Δ1.48 cm), cadence (Δ3.95 steps/min), and walking speed (Δ6.41 cm/s) tended to increase, though the differences were not statistically significant. Participants expressed high levels of physical and emotional satisfaction, suggesting a need for early intervention. Conclusion: The ADP may improve gait patterns in adults with spastic diplegic CP. The feasibility results indicated that the ADP is suitable for adults with spastic diplegic CP. This study provides evidence for improvement in gait patterns through dance, which has not been reported in previous dance studies on individuals with CP, offering additional information on the benefits of dance.

A Comparison of In-Person and Telemedicine Triage in Otolaryngology.

INTRODUCTION: The integration of virtual visits has been met with skepticism by many surgical specialties, including otolaryngology, due to the lack of a complete physical exam. Analysis of differences in the workup between patients triaged virtually or in-person is warranted. METHODS: A chart review was performed for a cohort of adults undergoing septoplasty (January 2021-May 2022). Groups (telemedicine, in-person) were compared by 2-sample t-test and chi-square test to determine the difference in the number of preoperative visits and to assess the variation in patients with preoperative laboratory testing, imaging, or referrals. RESULTS: Of 338 patients, initial evaluation was in-person for 225 (66.5%) and via telemedicine for 113 (33.5%). The groups were similar in demographics (mean age 39.1 years for telemedicine vs 38.8 years for in-person, female 28.9% vs male 37.7%, P = 0.088). The telemedicine group had a significantly higher number of preoperative visits (3.03) compared to the in-person group (2.38, P = 0.001). There was no significant difference in patients who underwent preoperative laboratory testing, imaging, or referrals. Patients triaged via telemedicine experienced a shorter time to surgery compared to those triaged in person (434 vs 208, P = 0.003). DISCUSSION: In this cohort, triage by telemedicine allowed otolaryngology patients to have an expedited path to surgery despite having more visits. There is no evidence to suggest that otolaryngologists had an overreliance on diagnostic modalities when triaging by telemedicine. CONCLUSION: Among patients undergoing septoplasty, those initially evaluated by telemedicine were more likely to have more preoperative visits and shorter time to surgery than those evaluated in person. Telemedicine can serve as an effective method for triaging surgical patients without excess diagnostics.

Exploring the temporal-spatial characteristics and determinants of high-quality development of city clusters in China.

The complexity, severity, and uncertainty of the international situation have prompted the development of city clusters to focus more on resilience and the building of infrastructures and safeguards. Chinese-style modernization proposes a new realization path for the high-quality development (HQD) of city clusters, based on which an evaluation system for HQD indicators of city clusters is constructed. We also measured the HQD levels of 19 city clusters from 2011 to 2021 and analyzed their spatial differentiation characteristics, agglomeration evolution characteristics, and influencing factors by using kernel density, standard deviation ellipse, Moran's index, geographic detector, and geographically weighted regression. The study revealed that (1) the overall level of HQD of China's city clusters shows a trend of continuous growth, and there is obvious polarization in the high quality of city clusters in different regions. (2) The spatial distribution of HQD in city clusters decreased in the "East, Center and West" direction, but the spatial patterns of "Southeast highlighting" and "Northwest rising" became more obvious. (3) The HQD of city clusters shows obvious spatial agglomeration characteristics and overall presents a spatial pattern of "hot in the east and cold in the west", with the scope of the cold spot area gradually shrinking, and the hot spot area tends to spread outward, with mature city clusters at the core. (4) The influencing factors of HQD in Chinese city clusters are diverse, with financial levels, digital economics, human capital and green innovations having decreasing influence on HQD in city clusters but showing an obvious two-factor enhancement trend, with financial levels being able to effectively stimulate the driving potential of other factors. Financial levels can effectively stimulate the driving potential of other factors. (5) The coefficients of the driving factors affecting the HQD of city clusters vary significantly spatially, with human capital, financial levels and green innovations showing a north‒south hierarchical banded distribution of "high in the south and low in the north", and digital economy shows an east-west hierarchical belt distribution of "high west and low east". Based on the above conclusions, the realization path of accelerating the HQD of China's city clusters is proposed by optimizing the functional division of labor of the city clusters, giving full play to the comparative advantages of the hinterland city clusters, and relying on the high level of the city clusters for opening up.