Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial.

Background: Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health. Methods: We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital. Data analysis: Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ). Discussion: Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Electroencephalogram patterns with the presence of an unknown musical stimulus

The cerebral activity presents different behaviors in different situations and levels of consciousness, especially under musical stimulation. Signals of the central nervous system may disclose bioelectrical patterns, since listening to rhythmic sequences activates specific brain areas. In this paper, we analyze 42 neurologically normal Brazilian individuals, submitted to musical stimulation based on a procedure consisting of three different steps, during which the volunteer is kept with closed eyes. The first step is associated with the preliminary control silence period, without any stimulus, as the volunteer remains at rest. The second step consisted of unknown music stimulation. Finally, the third step involves post-music rest. Quantitative signal analysis computes the power spectrum time variations. Results point out stronger changes in gamma and high gamma waves (30 ­ 100 Hz). Even though the clinical rhythms (0 ­ 30 Hz) change throughout the whole period of the experiment, quantitative differences at gamma and high gamma bands are remarkably greater. Particularly, when comparing the initial silent period and the final post-stimulation silent one, bioelectrical differences are only highlighted by gamma and high gamma rhythms. In consequence, this paper points out that the EEG analysis of cognitive issues related to musical perception cannot disregard gamma and high gamma waves.

A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib.

BACKGROUND & AIMS: Sorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR. METHODS: Survival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses. RESULTS: After a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis. CONCLUSIONS: In a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.

Successful treatment of calciphylaxis by a multidisciplinary approach.

A 48-year-old woman performing peritoneal dialysis for end-stage renal disease presented with a painful leg ulcer. The investigation revealed an elevated parathyroid hormone level and the histological examination of the biopsy tissue from the ulcer revealed medial calcification of the arterioles, consistent with calciphylaxis. The patient developed additional ulcers in the lower limbs and treatment with antibiotics, cinacalcet, sevelamer, sodium thiosulfate, low calcium dialysate and hyperbaric oxygen therapy was instituted. The patient had a favourable outcome and after 9 months the ulcers had healed and the parathyroid hormone level reached the normal range. Calciphylaxis is a rare and life-threatening disorder associated with a mortality of 60-80%. Its pathogenesis is not fully understood hence there is no consensus in the treatment of this pathology.

Eficacia y seguridad de la acupuntura y kinesioterapia en la rehabilitación del paciente con gonartrosis / Effectiveness and security of acupuncture and kinesiotherapy in rehabilitation of patients with gonartrosis

Se realiza un ensayo clínico controlado, aleatorizado, fase II, en 60 pacientes con el diagnóstico de Gonartrosis sin criterio quirúrgico que acuden a la Consulta de Fisiatría del Hospital Provincial Universitario Carlos Manuel de Céspedes de Bayamo, Granma remitidos por los médicos especialistas en Ortopedia y Reumatología en el período comprendido entre septiembre de 2006 a septiembre de 2007 con el objetivo de evaluar la eficacia y seguridad de la combinación de la Acupuntura y Kinesioterapia en la rehabilitación de pacientes con Gonartrosis. Los pacientes fueron asignados mediante una tabla de asignación aleatoria a dos grupos de tratamiento: Control y Experimental, con 30 cada uno. El primer grupo recibe un tipo de tratamiento convencional con Diatermia Onda Corta Continua y Kinesioterapia y en el segundo se sustituye la Diatermia por la Acupuntura. Los datos se recogieron en una planilla de recolección de datos y se empleó la prueba Chi Cuadrado (X2c) para verificar el comportamiento entre ambos grupos respecto a las variables objeto de estudio; además de la prueba de diferencia de proporciones para determinar el comportamiento de la amplitud de movimiento articular referente a la flexión y la extensión. Se trabajó con un nivel de significación 0,05; lo que permitió arribar a la conclusión de que la aplicación combinada de la acupuntura y la kinesioterapia logra desaparecer el dolor, alcanzar la máxima amplitud de movimiento articular y la capacidad funcional muscular con un menor número de sesiones sin la aparición de eventos adversos en la rehabilitación del paciente con Gonartrosis(AU)

It was performed a clinical, control, aleatorized essay, type II, in 60 patients with gonarthrosis and without surgical treatment. They came to the Physiatric consult at Carlos Manuel de Cespedes Province Hospital in Bayamo. They were remitted by Orthopedists and Reumatologists, since September 2006 to September 20007 with the objective to evaluate the effectiveness and security of Acupuncture and Kinesiotherapy in rehabilitation for patients with gonarthrosis. The patients were assigned through a table of aleatory design for two groups of treatment: the control and the experimental, with 30 patients each group. The first group received a conventional treatment with Short wave diathermy and Kinesiotherapy and the second group substituted Diathermy by acupuncture. The data was gathered and it was applied the Chi square test to verify the behavior between both groups according to the variables object of study, it was also applied the test for difference between proportions to determine the behavior of the enlargement of the articular movement according to flexion and extension. The level of significance was about 0,05, concluding that the combined application of acupuncture and kinesiotherapy dissapears the pain, obtains the highest enlargement of the articular movement and the functional muscle capacity with less number of sessions without the presence of adverse events in the rehabilitation of patients with Gonarthrosis(EU)