Effects of telerehabilitation-based respiratory and corrective exercises among the elderly with thoracic hyper-kyphosis: a clinical trial.

BACKGROUND: Aging is associated with changes in the musculoskeletal system, including increased susceptibility to spine malalignments. Utilizing corrective exercises with a therapeutic emphasis can be beneficial in the elderly with thoracic spine hyperkyphosis. OBJECTIVE: This study aimed to investigate the effects of six weeks of telerehabilitation-based respiratory and corrective exercises on quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and chest expansion in the elderly with thoracic spine hyperkyphosis. METHODS: In this clinical trial, a total of 40 participants aged 60 and above with thoracic hyperkyphosis were randomly divided into the control (N = 20) and experimental (N = 20) groups. The experimental group performed the corrective exercises for six weeks (3 sessions per week). The control group performed general stretching exercises during the same time period. We measured the outcomes of quality of life, disability, thoracic kyphosis, craniovertebral angle, shoulder angle, cranial angle, and lung expansion before and after the intervention. Analysis of covariance (ANCOVA) was employed to analyze the data. A P-value ≤ 0.05 was considered statistically significant. RESULTS: Quality of life (P < 0.001, Effect Size (ES): 0.44), chest expansion (P < 0.001, ES: 0.56), thoracic kyphosis angle (P < 0.001, ES: 0.31), craniovertebral (P < 0.001, ES: 0.33), cranial (P < 0.001, ES: 0.38), and shoulder (P = 0.005, ES: 0.20) angles were significantly improved in the experimental group as compared with controls. However, no statistically significant difference was observed between the two groups in terms of physical ability (P = 0.251, ES: 0.04). CONCLUSION: It is therefore recommended that online corrective exercises be used in the rehabilitation protocol to improve the quality of life, posture, chest expansion, and disability in the elderly with thoracic kyphosis.

INDIVIDUAL ARTICLE: Real-World Patient Cases Using Botanical Serum-Containing Corrective Gel as an Adjunct to Aesthetic Facial Laser or Microneedling Radiofrequency (MRF) Treatment.

Integrated skin care is defined as the complementary use of topical treatments to nonsurgical facial rejuvenation procedures, such as lasers and radiofrequency microneedling devices, to produce pleasing aesthetic results. Real-world experience from expert dermatologists is invaluable in guiding patient treatment plans, as there are limited clinical trials on the efficacy of integrated skincare regimens. The SkinCeuticals (New York, NY) Phyto Corrective gel (botanical serum-containing corrective gel) contains a lightweight botanical serum that hydrates, calms, and soothes skin. It contains antioxidant and anti-inflammatory ingredients derived from plant and fruit extracts, making it an appealing option for adjunctive treatment of post-procedure erythema and swelling.  J Drugs Dermatol. 2024;23:3(Suppl 2):s3-s14.

A Psychoanalyst's Confrontation With Illness, Aging, and Death.

Offering a personal example, the author argues for the protocols of respectful, confidential, and responsible institutional support as a corrective to an individual clinician's lack of optimal judgment when facing difficult clinical challenges or personal crises.

Corrective mechanisms of motion extrapolation.

Transmission and processing of sensory information in the visual system takes time. For motion perception, our brain can overcome this intrinsic neural delay through extrapolation mechanisms and accurately predict the current position of a continuously moving object. But how does the system behave when the motion abruptly changes and the prediction becomes wrong? Here we address this question by studying the perceived position of a moving object with various abrupt motion changes by human observers. We developed a task in which a bar is monotonously moving horizontally, and then motion suddenly stops, reverses, or disappears-then-reverses around two vertical stationary reference lines. Our results showed that participants overestimated the position of the stopping bar but did not perceive an overshoot in the motion reversal condition. When a temporal gap was added at the reverse point, the perceptual overshoot of the end point scaled with the gap durations. Our model suggests that the overestimation of the object position when it disappears is not linear as a function of its speeds but gradually fades out. These results can thus be reconciled in a single process where there is an interplay of the cortical motion prediction mechanisms and the late sensory transient visual inputs.

Intraoperative Neurophysiological Monitoring in Corrective Surgery of Scoliosis - Experience at a Tertiary Care Hospital.

OBJECTIVE: To evaluate the role of intraoperative neurophysiological monitoring (IONM) in reducing the postoperative neurologic deficit following corrective surgery of scoliosis. STUDY DESIGN: Observational Study. Place and Duration of the Study: Spine Surgery Department, Combined Military Hospital, Rawalpindi, from December 2022 to May 2023. METHODOLOGY: The study included 170 cases of scoliosis operated under multimodal IONM. Decreased amplitude of ≥50% in SSEP or 70-80% in MEPs were considered warning signs. Cases were divided into two groups: Group 1 (signal drop) and Group 2 (no signal drop). Group 1 was subdivided into Group 1a (true positive), Group 1b (false positive) and Group 1c (intermediate positive). Group 2 was subdivided into Group 2a (true negative) and Group 2b (false negative). RESULTS: Evoked potential changes were observed in 27 (15.9%) cases. This includes transient drop of signals in 16 (9.4%) and sustained drop of signals in 11 (6.5%) cases. Among sustained signal drop, 9 (5.29%) cases had exhibited postoperative neurological deficit whereas 2 (1.17%) cases did not show postoperative neurological deficit (false positive). Multimodal IONM in the current study shows sensitivity of 100%, specificity of 98.6%, positive predictive value of 92.6%, and negative predictive value of 100%. CONCLUSION: Multimodal IONM reduces the incidence of postoperative neurological deficit in corrective surgery of scoliosis by effectively detecting neurologic injury during surgery. Monitoring events alert surgical team to exercise immediate corrective measures which likely results in recovery of lost signals and predict the favorable outcome. KEY WORDS: Intraoperative monitoring, Motor evoked potentials, Neurological deficit, Scoliosis, Somatosensory evoked potentials.

Visual authenticating hazardous adulterant phenolphthalein in slimming foods: Target-mimicking hapten epitope improved immunoassay.

Screening for the hazardous adulterant phenolphthalein (PTH) in slimming foods is necessary. Herein, the linkage of the PTH target epitope with various spacer arms was proposed for hapten design, aiming to produce highly sensitive and specific antibodies targeting PTH. To understand the influence of spacer arms on epitope, comprehensive evaluations were conducted using computer-aided chemistry and animal immunization. The resulting antibody exhibited maximal half-inhibitory concentration (IC50) of 0.25 ng/mL. Then, a lateral flow immunoassay (LFIA) was established with detection capability for screening (CCß) of less than 140, 240, and 25 ng/g for PTH in tea, instant coffee, and oral liquid, respectively. Furthermore, blind sample results agreed well with LFIA and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Therefore, this work not only provides a robust tool for detecting PTH adulteration but also suggests that the careful pairing of spacer arms with hapten epitope is a key factor in advancing rational hapten design.

Corrective Osteotomy and Ligamentous Reconstruction in a Neglected Elbow Dislocation with Radial Neck Malunion: A Case Report.

CASE: Neglected elbow dislocation and radial neck malunion frequently result in chronic pain, instability, and early arthrosis. These complications are best prevented by early treatment with open reduction, corrective osteotomy, and ligament reconstruction, followed by early supervised physiotherapy. We present a peculiar case with neglected complex elbow dislocation and radial head malunion. In this case, we performed an open reduction of the elbow joint and radial neck corrective osteotomy, medial collateral ligament, annular ligament reconstruction, and lateral collateral ligament repair. CONCLUSION: Neglected complex elbow dislocations require reconstruction of both ligamentous and osseous structures to achieve a good functional outcome.

Classifying disaster risk reduction strategies: conceptualizing and testing a novel integrated approach.

BACKGROUND: Although disaster risk reduction (DRR) addresses underlying causes and has been shown to be more cost-effective than other emergency management efforts, there is lack of systematized DRR categorization, leading to insufficient coherence in the terminology, planning, and implementation of DRR. The aim of this study was to conceptualize and test a novel integrated DRR framework that highlights the intersection between two existing classification systems. METHODS: Grounded theory was used to conceptualize a novel DRR framework. Next, deductive conceptual content analysis was used to categorize interventions from the 2019 Cities100 Report into the proposed DRR framework. The term "connection" indicates that an intervention can be categorized into a particular section of the novel integrated approach. A "connection" was determined to be present when the intervention description stated an explicit connection to health and to the concept within one of the categories from the novel approach. Further descriptive statistics were used to give insight into the distribution of DRR interventions across categories and into the application of the proposed framework. RESULTS: The resulting framework contains nine intersecting categories: "hazard, prospective", "hazard, corrective", "hazard, compensatory", "exposure, prospective", "exposure, corrective", "exposure, compensatory", "vulnerability, prospective", "vulnerability, corrective", and "vulnerability, compensatory". The thematic analysis elucidated trends and gaps in the types of interventions used within the 2019 Cities100 Report. For instance, exposure-prospective, exposure-compensatory, and vulnerability-compensatory were the most under-utilized strategies, accounting for only 3% of the total interventions. Further descriptive statistics showed that upper middle-income countries favored "hazard, corrective" strategies over other DRR categories while lower middle-income countries favored "exposure, corrective" over other DRR strategies. Finally, European cities had the highest percentage of DRR connections (51.39%) compared to the maximum possible DRR connections, while African cities had the lowest percentage of DRR connections (22.22%). CONCLUSIONS: The study suggests that the proposed DRR framework could potentially be used to systematically evaluate DRR interventions for missing elements, aiding in the design of more equitable and comprehensive DRR strategies.

Usefulness of the spectral shaping dual-source computed tomography imaging technique in posterior corrective fusion for adolescent idiopathic scoliosis.

PURPOSE: Since childhood exposure to radiation has been demonstrated to increase cancer risk with increase in radiation dose, reduced radiation exposure during computed tomography (CT) evaluation is desired for adolescent idiopathic scoliosis (AIS). Therefore, this retrospective study aimed to investigate the radiation dose of dual-source CT using a spectral shaping technique and the accuracy of the thoracic pedicle screw (TPS) placement for posterior spinal fusion (PSF) in patients with AIS. METHODS: Fifty-nine female patients with thoracic AIS who underwent PSF using CT-guided TPSs were included and divided into two groups comprised of 23 patients who underwent dual-source CT (DSCT) with a tin filter (DSCT group) and 36 who underwent conventional multislice CT (MSCT group). We assessed the CT radiation dose using the CT dose index (CTDIvol), effective dose (ED), and accuracy of TPS insertion according to the established Neo's classification. RESULTS: The DSCT and MSCT groups differed significantly (p < 0.001) in the mean CTDIvol (0.76 vs. 3.31 mGy, respectively) and ED (0.77 vs. 3.47 mSv, respectively). Although the correction rate of the main thoracic curve in the DSCT group was lower (65.7% vs. 71.2%) (p = 0.0126), the TPS accuracy (Grades 0-1) was similar in both groups (381 screws [88.8%] vs. 600 screws [88.4%], respectively) (p = 0.8133). No patient required replacement of malpositioned screws. CONCLUSION: Spectral shaping DSCT with a tube-based tin filter allowed a 75% radiation dose reduction while achieving TPS insertion accuracy similar to procedures based on conventional CT without spectral shaping.

Optimized Patient Outcomes With the Novel Modality of Corrective Chemical Peel and Neurotoxin on Same-Day Treatment.

BACKGROUND: This study was conducted to improve standards of care in the cosmetic treatment of sun damage, fine lines, and wrinkles. Chemical Peels and Neurotoxins have been traditionally used cosmetically as monotherapies. This study aimed to confirm that the same-day combination created no additional side effects while also improving outcomes. METHODS: The multi-generational study enrolled 30 patients with Fitzpatrick I-VI representation. The Roberts Skin Type Classification System was used to establish baseline patient information. Patients were treated with a VI Peel®, followed by Botox®. Objectively, photographic matching, Wrinkle Severity Scale, Uniformity of Pigment Scale, and Skin Tone Scales were used to evaluate skin improvement. Patient questionnaires were issued to assess satisfaction. RESULTS: Safety of the same-day combination was established with no adverse events reported. Improvements on the Wrinkle Severity Scale showed an average rating dropping from 1.46 to 0.59 representing a 60% improvement. Improvements on the Uniformity of Pigment Scale showed an average rating dropping from 2.27 to 0.92 representing a 59% improvement. Improvements on the Skin Tone Scale showed an average rating dropping from 2.35 to 0.71 representing a 70% improvement. Questionnaires correlated with objective findings with high satisfaction.  Conclusion: This study confirmed the safety of the same-day combination. The efficacy of VI Peel & Botox same-day treatment was clinically proven by the improvements to Wrinkle Severity, Uniformity of Pigment, and Skin Tone via photographic matching. While perception studies indicated strong patient satisfaction with the combination. J Drugs Dermatol. 2024;23(1):1349-1354.   doi:10.36849/JDD.7194R1.

Can We Control Lateral Shoulder Balance Through Proximal Thoracic Curve Correction in Lenke Type 2 Adolescent Idiopathic Scoliosis?

BACKGROUND: Proximal thoracic curve (PTC) correction has been considered to prevent lateral shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis (AIS) patients; however, postoperative shoulder imbalance (PSI) commonly occurs despite these strategies with PTC correction. We investigated the hypothesis that PTC correction would not directly affect PSI in the majority of Lenke type 2 AIS cases. Furthermore, we investigated the risk factors for lateral PSI after corrective surgery. METHODS: This study examined the records for AIS patients with Lenke type 2 who underwent corrective surgery and followed up for >2 years. Patients were categorized into PSI (-); radiologic shoulder height (RSH)<15 mm, and PSI (+); RSH≥15 mm. Repeated measures analysis of variance was performed at preoperatively, postoperatively, 1 month, and final follow-up. Postoperative lateral shoulder imbalance was predicted by the identification of univariate analysis and multivariate analysis. RESULTS: Among the 151 patients reviewed, 29 (19.2%) showed PSI at final follow-up. Lateral shoulder balance parameters showed different directionalities between PSI (-) and (+) groups at postoperatively, 1 month, and final follow-up ( P <0.01 each). Preoperative PTC, middle thoracic curve (MTC) curve and MTC correction showed strong correlations with the RSH ( P =0.01, 0.03, and 0.04, respectively). However, PTC correction did not show a significant correlation with the RSH. Moreover, only a smaller MTC curve and larger MTC correction rate were related to lateral PSI in multivariate analysis. CONCLUSIONS: In Lenke type 2 AIS curves, the MTC curve and its correction predominantly influence lateral shoulder imbalance after corrective surgery, irrespective of the PTC correction extent. Consequently, overemphasizing the correction of the PTC curve may not necessarily lead to an improved lateral shoulder balance. When MTC curve is smaller, surgeons should be more careful for MCT overcorrection leading to a lateral shoulder imbalance. LEVEL OF EVIDENCE: Level III.

[Improvement of quality characteristics of medical services based on patient satisfaction measurement results and QFD tools].

One of the directions to increase the effectiveness of medical organizations in the region is the development of managerial tools for improving the quality of medical services. The aim of the study is to develop an approach to improving the quality of medical services based on the results of measuring patient satisfaction with the quality of medical services, mapping satisfaction criteria to medical and technological characteristics of the quality of services, substantiation and selection of appropriate corrective measures. The method of measuring patient satisfaction with the quality of the provided medical service and the method of deploying quality functions ensuring transformation of patient needs and expectations into characteristics of service quality were used. The measurement of patients' satisfaction with the quality of medical services is carried out during medical and sociological research. The measurement results are obtained by statistical processing using a software set. To determine measures to improve the quality of cardiological services, the results of changing patient satisfaction were used in accordance with the method of deploying quality functions, which consists in implementing a number of steps that ensure the determination of a minimum set of additional requirements for medical services in order to meet the requirements of patients. This technique is supported by specialized software. Implementation of the proposed approach makes it possible to form tools aimed at creating an information model of medical services and ensure the change in the quality of such services demanded by patients.

Analysis of health care professionals' incident reports on medical devices in Croatia.

AIM: To assess the quantity and quality of incident reports on medical devices by health care professionals from 2012 to 2021 and evaluate the effect of reporting on manufacturers' post-market surveillance. METHODS: Eighty-five incident reports were scored according to a self-developed evaluation system, and categorized as excellent, good, medium, qualified, and unqualified. The completeness of data in critical fields was assessed. For each report, the type and city of the reporter, and medical device risk class were extracted to calculate the frequency of report occurrence per risk class and outcomes for reportable reports. RESULTS: The number of reports received from health care professionals was low; the highest number of reports in a year was 17. The majority of reports were deemed as unqualified (61.18%) and only 4.71% as excellent. Still, 67.65% of incident reports importantly affected the manufacturer's post-market surveillance, either as added information that contributes to risk monitoring or directly triggering a field safety corrective action. CONCLUSION: The number of total reports and reports per year shows extensive underreporting in Croatia, and the quality of the provided reports is insufficient.

Pulmonary and clinical outcomes of patients with severe rigid scoliosis and type I respiratory failure treated with halo-pelvic distraction.

BACKGROUND: The severe rigid scoliosis patients with type I respiratory failure could not tolerate complicated corrective surgery. Preoperative halo-pelvic distraction (HPD) is used to reduce the curve magnitude and improve the pulmonary function before surgery. The present study aimed to retrospectively analyze the pulmonary and clinical outcomes of preoperative HPD in severe rigid spinal deformity with type I respiratory failure. METHODS: Eighteen cases of severe rigid scoliosis and type I respiratory failure treated with preoperative HPD and corrective surgery for spinal deformity between 2016 and 2018 were retrospectively reviewed. Patient demographics, major coronal curve and kyphosis, correction rates, heights, pulmonary function, distraction time, and postoperative neurological complications were recorded for all cases. RESULTS: The averaged duration of distraction was 9.1 ± 2.3 months. The coronal curve was corrected from 168° ± 14° to 58° ± 11° at the end of HPD. The kyphosis curve reduced from 151° ± 29° to 65° ± 10°. Meanwhile, the mean stand body height increased by 23.9 ± 5.3 cm. Significantly increased mean FVC (1.52 ± 0.43 L vs. 0.95 ± 0.44 L) and improved percent-predicted values for FVC (37 ± 10% vs. 23 ± 9%) were observed after HPD. The pressure of oxygen (PaO2) increased from 54.5 ± 2.0 to 84.8 ± 4.7 mmHg. Scoliosis and kyphosis curve, respectively, averaged 48 ± 8°and 30 ± 14° after final fusion and instrumentation, with a mean correction of 71% and 80%, respectively. No severe complication occurred during the distraction. CONCLUSIONS: HPD may be useful for severe rigid scoliosis patients with type I respiratory failure. Pulmonary functions in patients with severe rigid scoliosis can be significantly improved by HPD. They are then better able to tolerate complicated corrective surgery.

Retrieval practice benefits for spelling performance in fifth-grade children.

Retrieval practice typically benefits learning in children, although little is known about the benefits of retrieval practice for learning spelling. We investigated this issue in three experiments with fifth-grade children from a low-income area of Brazil. In the experiments, children first read a list of words (study), and after a short interval wrote down the studied words after hearing and rereading them (copy) or after only hearing them (retrieval practice). After an interval of 4 days, spelling performance was greater for words from the retrieval practice condition than for words from the copy condition, but only when immediate corrective feedback was provided (Experiment 3). The current findings, therefore, suggest that retrieval practice followed by corrective feedback is an effective strategy to improve spelling performance of fifth-grade children.

Corrective and preventive actions (CAPAs) in eye bank.

This case series highlights the challenges in eye banking and the importance of a quality assurance program. Three cases triggered corrective and preventive actions (CAPAs) to improve the processes. Case 1 emphasized training to prevent retrieval failures. Case 2 stressed the need for blood samples and comprehensive documentation. In Case 3, mishandling led to policy revisions and staff training. CAPA involved identifying concerns, root cause analysis, action plans, implementation, checks, and closure. Errors can occur in man, machinery, process, and policies. Continuous CAPA ensures continuous quality improvement and safe corneal tissue transplantation, benefiting patients in need.

[Treatment with fully implantable intramedullary distraction nails for limb lengthening-a paradigm shift]. / Behandlung mit voll implantierbaren Distraktionsmarknägeln zur Extremitätenverlängerung ­ ein Paradigmenwechsel.

More than almost any other implant, fully implantable intramedullary distraction nails have changed corrective and reconstructive bone surgery. Based on the fundamentals of callus distraction, these new apparatus developments with their novel planning strategies and minimally invasive surgical techniques have opened up a wide range of indications and made the treatment reproducible and safe. The prerequisite, however, is that standardized procedures are adhered to, which concern both the preparation for the surgery, the surgery itself and the subsequent distraction treatment. Treatment with fully implantable intramedullary distraction nails should be performed at specialized centers, so that the paradigm shift in corrective and reconstructive limb surgery, which is already recognizable, will open the door for further developments.

Task Instructions and the Need for Feedback Correction Influence the Contribution of Visual Errors to Reach Adaptation.

Previous research has questioned whether motor adaptation is shaped by an optimal combination of multisensory error signals. Here, we expanded on this work by investigating how the use of visual and somatosensory error signals during online correction influences single-trial adaptation. To this end, we exposed participants to a random sequence of force-field perturbations and recorded their corrective responses as well as the after-effects exhibited during the subsequent unperturbed movement. In addition to the force perturbation, we artificially decreased or increased visual errors by multiplying hand deviations by a gain smaller or larger than one. Corrective responses to the force perturbation clearly scaled with the size of the visual error, but this scaling did not transfer one-to-one to motor adaptation and we observed no consistent interaction between limb and visual errors on adaptation. However, reducing visual errors during perturbation led to a small reduction of after-effects and this residual influence of visual feedback was eliminated when we instructed participants to control their hidden hand instead of the visual hand cursor. Taken together, our results demonstrate that task instructions and the need to correct for errors during perturbation are important factors to consider if we want to understand how the sensorimotor system uses and combines multimodal error signals to adapt movements.

A violation of Fitts' Law occurs when a target range is presented before and during movement.

According to Fitts' Law, the time to reach a target (movement time, MT) increases with distance. A violation of Fitts' Law occurs when target positions are outlined before and during movement, as MTs are not different when reaching to the farthest and penultimate targets. One hypothesis posits that performers cognitively process the edges of a target array before the center, allowing for corrective movements to be completed more quickly when moving to edge targets compared to middle targets. The objective of this study was to test this hypothesis by displaying a target range rather than outlines of individual targets in an effort to identify the effects of array edges. Using a touch-screen laptop, participants (N = 24) were asked to reach to one of three targets which would appear within a presented range. Separately, targets were also presented without a range to determine if the display protocol could evoke Fitts' Law. Movements were assessed with the touch screen and optical position measurement. A main effect was found for relative position within a range (touch: F2,44 = 15.4, p < 0.001, η2p = 0.412; position: F2,40 = 15.6, p < 0.001, η2p = 0.439). As hypothesised, MT to the farthest target in a range was not significantly different than MT to the middle target (touch: p = 0.638, position: p = 0.449). No violation was found when a target range was not presented (touch: p = 0.003, position: p = 0.001). Thus, a target range reproduces the Fitts' Law violation previously documented with individually outlined targets, which supports and extends the discussed hypothesis.

The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome.

BACKGROUND: This study aims to investigate the effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players. METHODS: 30 adolescent volleyball players with upper cross syndrome were purposefully selected and assigned into 2 control and training groups. The degree of back curvature was evaluated using a flexible ruler, forward head and forward shoulder size by photographic method, scapula-humeral rhythm by Lateral Scapular Slide Test (LSST), and performance by closed kinetic chain test. The training group performed the exercises for 10 weeks. After the exercises, the post-test was administered. To analyze the data, analysis of co-variance tests and paired t-test at the level of 0.05 were employed. RESULTS: The research results showed that corrective exercises have a significant effect on abnormalities of forward head, forward shoulder, kyphosis, scapula-humeral rhythm and performance. CONCLUSIONS: Corrective exercises can be effective in reducing shoulder girdle and spine abnormalities and improving scapula- humeral rhythm and performance of volleyball players.