BackgroundEvidence on the feasibility of integrating music therapy into routine post-stroke aphasia rehabilitation in real-world settings remains limited.ObjectiveTo examine the feasibility of integrating a structured music therapy protocol into conventional speech-language therapy for post-stroke aphasia and explore preliminary outcomes.MethodsThis quasi-experimental study was conducted in an outpatient speech-language clinic in Thailand. Participants received standard speech-language therapy or therapy combined with a manualised music therapy protocol. The intervention represents a dose-augmented feasibility design, as the experimental group received increased overall therapeutic contact time. Language performance was assessed using the Thai Adaptation of the Western Aphasia Battery, and anxiety using the State-Trait Anxiety Inventory, Form Y-2. Pre-post changes were examined using descriptive statistics and exploratory analyses, including paired tests for within-group comparisons and independent tests for between-group differences.ResultsThe intervention was feasible, with complete delivery and assessment. Within-group improvements in language performance were observed in both groups, with greater gains in the music therapy-augmented group; however, between-group differences were not statistically significant. Anxiety scores decreased in both groups, with no significant differences. Interpretation of anxiety outcomes is limited by the use of a trait-based measure, which may reflect the limited sensitivity of trait-based measure to short-term changes.ConclusionsIntegrating music therapy into routine speech-language rehabilitation for post-stroke aphasia is feasible in a real-world outpatient setting. Findings should be interpreted as exploratory and reflective of increased therapeutic exposure rather than modality-specific effectiveness. These results inform the design of future dose-matched and methodologically rigorous trials.
Tonsillectomy is the most common procedure in otorhinolaryngology. The common indications are obstructive symptoms and recurrent tonsillitis. Often considered a low-risk procedure, postoperative complications can range from minor to major, such as emphysema, pneumothorax, and pneumomediastinum. A 3-year-old male was referred from a lower facility with a history of 4 hours post-adenotonsillectomy. The patient developed a sudden onset of extensive swelling of the face, neck, and chest, which was associated with difficulty breathing. The diagnoses were post-adenotonsillectomy and bilateral tension pneumothorax. An urgent chest X-ray before intervention revealed bilateral tension pneumothorax with bilateral lung collapse. Chest decompression was performed with a 16-gauge cannula, followed by bilateral chest tube insertion and decompression of subcutaneous emphysema. On the 10th day, the patient recovered and was successfully discharged. Tonsillectomy is generally considered a safe procedure, but rare and potentially life-threatening complications, such as subcutaneous emphysema and tension pneumothorax, can occur. This case highlights the importance of early recognition and timely intervention in managing such rare postoperative complications. Bilateral tension pneumothorax is a rare but life-threatening complication of tonsillectomy. Early recognition, prompt imaging, and immediate intervention are crucial for patient survival.
Liver transplantation (LT) is an effective treatment for hepatocellular carcinoma (HCC), and inflammatory indexes are accessible, non-invasive prognostic biomarkers for HCC patients. This study aims to systematically evaluate the clinical value of various preoperative inflammatory indexes in predicting post-LT outcomes to optimize the stratification of suitable HCC patients that can benefit from LT. This retrospective study included 239 HCC patients who underwent LT from April 2013 to July 2023 and their inflammatory biomarkers were calculated. Univariate and multivariate analysis were applied to identify independent risk factors for postoperative prognosis. Subgroup analysis was used to evaluate the predictive value in different sub-populations. Prediction models based on preoperative indexes were established using multiple machine-learning model. Mediating effect analysis was utilized to elucidate potential mediating factors. Inflammation biomarkers were significantly different in patients with different postoperative prognosis. Lymphocyte-to-monocyte ratio (LMR, RR: 0.806, 95% CI: 0.675-0.962, P=0.017) served as an independent predictor for early tumor recurrence, with an optimal cutoff of 2.03. The systemic immune-inflammation index served as an independent risk factor for both overall survival (HR: 3.472, 95% CI: 1.322-9.119, P=0.012) and disease-free survival (HR: 2.604, 95% CI: 1.012-6.698, P=0.047), with an optimal cutoff value of 155.19. The prognostic value of SII was robust across nearly all clinical subgroups, while the predictive value of LMR was limited to certain subgroups. The random survival forest model, incorporating alpha-fetoprotein and SII as its most important variables, achieved apparent and bootstrap-corrected C-indexes of 0.814 and 0.754 and apparent and bootstrap-corrected area under receiver characteristic curve of 0.854 and 0.788, demonstrating the optimal predictive accuracy in all established models. Mediating analysis indicated that tumor T stage significantly mediated the correlation between SII and postoperative survival outcomes, while liver function and tumor burden (T stage and tumor number) exerted significantly suppression and mediating effect on correlation between LMR and early tumor recurrence. Preoperative LMR and SII are associated with early tumor recurrence and long-term prognosis in HCC patients after LT. A random survival forest model that integrated these inflammatory indexes with other preoperative variables may serve as a potential complementary tool for early risk stratification in the future after verified by further external validation.
While extubation failure in critically ill patients is a significant challenge in intensive care units (ICUs), traditional predictors, such as the rapid shallow breathing index (RSBI), offer limited accuracy. This study aimed to develop a machine-learning model using data collected during a spontaneous breathing trial (SBT) and the rest period after SBT to improve the prediction of extubation failure. This retrospective and single-center cohort study analyzed data from 413 extubation cases involving 372 patients across both medical and surgical ICUs. Vital signs and ventilatory parameters were collected during the SBT and post-SBT rest period. A light gradient-boosting machine (LGBM) algorithm was employed, incorporating features derived from these vital signs. The model's performance was assessed using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), sensitivity, and specificity. Among the included cases, 11.01% experienced extubation failure. The LGBM model, which integrated data from both SBT and post-SBT rest periods, along with RSBI, achieved the highest performance (AUROC: 0.789, AUPRC: 0.451). Key predictors included ICU duration, RSBI, and respiratory rate during SBT. Models utilizing only SBT or rest period data individually demonstrated significantly lower predictive power compared to those incorporating both time intervals (p < 0.05). Multi-parameter data from the SBT and post-SBT rest period provide dynamic insights into extubation readiness. The developed machine-learning model demonstrates modest improvement over traditional metrics such as RSBI and may serve as a complementary tool to support extubation decision-making.
ObjectiveThe study aimed to identify the most accurate protocol for measuring stride-count in post-stroke and healthy individuals, by comparing different wearable-sensors, their placement and data processing against a gold-standard instrumented treadmill.MethodsEighteen post-stroke and 18 healthy adults walked at multiple speeds on an instrumented treadmill equipped with force plates. Participants wore six ActiGraph accelerometers (wrists, hips, ankles), and pressure insoles. Stride counts from each sensor configuration were estimated using a custom raw-acceleration peak-detection algorithm and the manufacturer's algorithm (ActiLife®). Accuracy and agreement with the gold standard were assessed across walking speeds and sensor locations using the concordance correlation coefficient (CCC) and linear mixed-effects model.ResultsStride count accuracy was influenced by walking speed across all wearable configurations, improving with gait velocity. Pressure-sensing insoles demonstrated the highest accuracy and agreement with the gold standard in both groups across speeds (CCC = 0.999 for healthy subjects; 0.996 for post-stroke). The custom peak-detection algorithm applied to ankle-worn accelerometers provided accurate and robust stride estimates across speeds (CCC = 0.986 in healthy subjects; 0.990 post-stroke). In contrast, the manufacturer's algorithm consistently misestimated stride counts in both groups. No side-to-side differences were observed for any sensor placement.ConclusionPressure insoles and our custom raw-acceleration algorithm applied to ankle-worn accelerometers yielded the highest stride-count accuracy across walking speeds in both populations.Trial registry name and URLClinicalTrails.gov (Registration ID: NCT06943014).
ObjectivesTraumatic brain injury (TBI) is a leading cause of long-term disability. This study aimed to evaluate the effectiveness of a Post-Acute Care (PAC) program for patients with TBI in Taiwan and to identify the independent predictors associated with the magnitude of their functional recovery.MethodsThis retrospective cohort study included 168 patients with TBI admitted to a PAC program from a tertiary medical center. The primary outcome was the change score in the Barthel Index (BI)(ADL). The Wilcoxon Signed-Rank Test was used to assess changes in functional scores (BI(ADL), IADL, and EQ-5D) from admission to discharge.ResultsPatients demonstrated statistically significant improvements across all functional measures after the PAC intervention, including the BI(ADL), IADL, and EQ-5D (all p < .001). After adjusting for all covariates, length of stay was the sole significant independent predictor of the BI(ADL) change score (B = 0.309, p < .001), indicating that for each additional day of PAC, a patient's BI score was expected to improve by 0.309 points.ConclusionPost-Acute Care is a highly effective intervention for improving functional outcomes in patients with TBI. These findings provide a strong evidence base for clinicians to advocate for sufficient rehabilitation time and for policymakers.
Current guidelines recommend that long-term oral anticoagulation (OAC) after atrial fibrillation (AF) ablation be guided by CHA2DS2-VASc rather than ablation success. However, two recent randomized trials, ALONE-AF and OCEAN, observed very low stroke and systemic embolism rates in rigorously selected post-ablation populations. Because events were rare and neither trial was powered for noninferiority for stroke, they do not definitively establish equivalence with continued OAC. Integrating these data with AF burden studies, atrial cardiomyopathy research, and post-ablation registries, we examine the hypothesis that a given CHA2DS2-VASc score may confer lower stroke risk when AF burden is durably suppressed. We identify five domains clinicians should weigh: time since ablation, monitoring quality, AF burden, atrial substrate, and baseline thromboembolic risk. Within patients with 1-2 non-sex CHA2DS2-VASc risk factors, arrhythmia-free beyond 12 months with robust monitoring, and without advanced atrial cardiomyopathy, the discussion of OAC de-escalation can now be informed by randomized data rather than extrapolation alone. We also identify the uncertainties that remain and the populations in whom guideline-directed OAC remains the standard of care.
Diabetic kidney disease (DKD) remains a principal microvascular complication of diabetes, driven by a multifaceted pathogenesis that extends beyond pure metabolic dysregulation. Post-translational modifications (PTMs) have emerged as pivotal mechanisms that dynamically regulate protein function and stability under diabetic stress. This review provides a comprehensive synthesis of the regulatory networks governing PTMs in DKD, systematically dissecting the molecular landscapes of phosphorylation, acetylation, ubiquitination, glycosylation, methylation, and SUMOylation. Beyond clarifying individual pathogenic mechanisms, the dysregulation of PTM networks links systemic metabolic disturbances to persistent renal injury. Furthermore, we evaluate emerging therapeutic strategies designed to modulate these modifications. We conclude that targeting PTMs represents a critical advance in DKD therapy, shifting from broad symptomatic management to precise molecular intervention-offering new directions for arresting the progression of DKD.
This study aimed to characterize the magnetic resonance imaging (MRI) features of cervical metastatic lymph nodes in differentiated thyroid carcinoma (DTC) and provide imaging-based evidence for identifying metastatic cervical lymph nodes prior to administration of radioactive iodine (¹³¹I) therapy. Clinical and imaging data from 32 patients with histologically confirmed DTC who underwent ¹³¹I therapy at Haikou People's Hospital between June 2019 and May 2024 were retrospectively analyzed. All patients demonstrated cervical radioiodine-avid lymph nodes on post-therapeutic ¹³¹I whole-body scintigraphy (¹³¹I-Rx-WBS). Cervical ultrasonography (US) and MRI examinations were conducted prior to 131I therapy. The MRI characteristics of the lymph nodes identified as radioiodine-avid on ¹³¹I-Rx-WBS were assessed, including anatomical location, number, shape, margin definition, presence of hilum, proximity to vascular structures, and relative size within the nodal population. All participants were diagnosed with papillary thyroid carcinoma. The median age was 45.5 years (range, 28-66 years). Cervical US detected lymph node metastasis in 15.6% (5/32) of cases. A total of 58 radioiodine-avid lymph nodes were identified across cervical levels II-VI and the supraclavicular region. MRI analysis demonstrated that most radioiodine-avid lymph nodes exhibited hyperintensity on T1- and T2-weighted sequences. Morphologically 65.5% were round to ovoid and 32.8% were irregular in shape. Ill-defined margins were observed in 69.0% of nodes, absence of the lymphatic hilum in 91.4%, and vascular adjacency in 77.6%. In 96.9% (31/32) of patients, at least 4 lymph nodes were visualized on MRI, however, imaging features of radioiodine-negative lymph nodes often overlapped with those of radioiodine-avid nodes. Cervical lymph nodes demonstrating radioiodine uptake on ¹³¹I-Rx-WBS frequently present with round to ovoid or irregular morphology and indistinct margins on MRI. However, given the high density of cervical lymph nodes and overlapping imaging characteristics between radioiodine-avid and radioiodine-negative nodes, a comprehensive assessment integrating multimodal imaging and clinical correlation is essential for accurate assessment before ¹³¹I therapy.
Extensive burn injury can result in hypertrophic, retracting scars that, based on their location, can lead to reduced functionality for the patient. This study reports the clinical case of a young man who presented at the clinic with second-degree burn injuries to the chin, hand, and forearm. The patient complained of pruritus and had difficulty moving his hand, which impacted his professional life. The scars were treated with the sequential emission of two laser wavelengths: 10 600 and 1540 nm. The patient was very satisfied with the outcome and was able to resume his work. Recent histological studies have demonstrated that the sequential emission of the CO2 laser at 10 600 and the 1540 nm non-ablative laser extends the thermal effects on the micro-ablative zone, stimulating and enhancing collagen remodeling compared with the use of CO2 alone. The sequential emission of these two wavelengths has been proven to be a valid treatment choice for skin remodeling for aesthetic purposes, with shorter healing times and a lesser risk of hypopigmentation. This study used a combination of ablative and non-ablative lasers to remodel hypertrophic burn scars, achieving improved aesthetics, symptom relief, and restored hand function through the resolution of joint contractures.
Displaced olecranon fractures often require surgical fixation. A mobility loss following surgery may occur from fibrosis due to immobilization, malunion, and associated diagnoses. This case highlights the diagnostic uncertainty that may arise when postoperative stiffness presents with overlapping mechanical and soft tissue features. A 14-year-old girl experienced a displaced olecranon fracture with loss of the triceps extensor mechanism following a fall off an electric scooter. Acute surgical fixation healed with a malunion that caused posterolateral impingement and a persistent loss of elbow extension. The initial course of care was protracted over 7-months due to discordance between healthcare providers. Specifically, inter-professional interpretation of end-feel, pain patterns, and imaging were paramount to delays in a necessary surgical revision. Seven months following the initial surgery, a 20-degree loss of elbow extension with posterior elbow pain and a bone-to-bone end-feel were present, preventing a return to pre-morbid activities. Imaging confirmed an olecranon malunion with posterolateral impingement. Subsequently, the patient underwent arthroscopic revision surgery and a 10-week course of physical therapy. At the 11-month post-revision follow up she resumed pre-morbid kickboxing and weight-training activities pain-free. Elbow strength was symmetrical with 0-135 degrees of elbow mobility. QuickDash was scored 0% and the global rating of change was a 6+. Persistent stiffness following olecranon fracture fixation may reflect a combination of soft tissue and mechanical factors. When limited progress or an atypical symptom presentation occurs, the integration of clinical findings with appropriate imaging may assist with a differential diagnosis. A diagnostic synthesis integrating clinical and imaging results with the lack of clinical progression was essential for identifying a surgical fixation malunion and need for revision surgery. Physiotherapists should consider posterior impingement in their differential diagnosis when a persistent loss of elbow extension is coupled with posterior elbow pain following a surgical fixation.
This study aimed to evaluate condylar positional changes in patients with facial asymmetry undergoing orthodontic treatment and orthognathic surgery by comparing the affected side (the side toward which the chin deviates) and the non-affected side (the contralateral side) across different treatment stages. A retrospective cone-beam computed tomography (CBCT) analysis was conducted on 25 patients with facial asymmetry (menton deviation >4 mm) treated at Taipei Veterans General Hospital. CBCT scans were obtained at 4 timepoints: pre-treatment (T1), post-orthodontic dental decompensation (T2), post-surgery (T3), and post-treatment (T4). Linear measurements of anterior joint space (AJS), superior joint space (SJS), posterior joint space (PJS), and the condylar angle were assessed. At baseline (T1), no significant differences were observed in linear measurements between the affected and non-affected sides; however, the condylar angle was significantly smaller on the affected side (69.6° vs. 76.5°, P < 0.05). Following surgery (T2-T3), AJS increased significantly on both sides (P < 0.05), whereas SJS and PJS changes varied by side. From T3 to T4, significant differences between the affected and non-affected sides emerged in SJS (P < 0.05), PJS (P < 0.05), and condylar angle (P < 0.05), suggesting differential remodeling during post-surgical orthodontic finishing. Overall, orthodontic decompensation alone (T1-T2) did not significantly influence condylar position. Pre-surgical orthodontic treatment did not significantly affect condylar position, whereas orthognathic surgery induced measurable positional and angular changes. Post-surgical orthodontic finishing revealed divergent remodeling patterns between affected and non-affected condyles. Further studies with larger samples and long-term follow-up are necessary to clarify the clinical implications of these changes.
Objectives To compare the short- and mid-term surgical outcomes in patients undergoing mini-thoracotomy (MT) and conventional open thoracotomy (COT) as anterior approaches to the thoracic spine. Methods Data were collected for adults who underwent thoracic spine procedures via an anterior surgical approach for various indications at the Department of Neurosurgery, Queen Elizabeth Hospital Birmingham (QEHB), between 2016 and 2021. Electronic medical records and clinical imaging of the patients enrolled on the study were reviewed. Primary outcomes measured were complications and post-operative pain levels. Secondary outcomes included the lengths of hospitalisation and intensive care unit (ICU) stays, estimated blood loss (EBL), duration and output of the post-operative chest drain, operation time, and radiation exposure. These outcomes were then compared between the MT and COT cohorts. The software, IBM SPSS Statistics, version 28 (IBM Corp., Armonk, NY, USA), alongside parametric and non-parametric tests, was used, with a p-value set at <0.05. Results A total of 31 patients (18 females and 13 males) with an average age of 53±15 were included. Fourteen underwent MT, while 17 had COT. There were no significant demographic differences between the cohorts. MT resulted in fewer complications, but the difference was not statistically significant. Pain levels were lower at 48 hours post-operation but higher on discharge in MT. Secondary outcome results yielded that the MT group had a statistically significant 80% shorter post-operative ICU stay than the COT group (p=0.034). Duration of the procedure and EBL were comparable in both groups. The differences between duration and output of the chest drain and post-operative opioid use favoured MT, but were not statistically significant. Conclusion Based on our study, MT is non-inferior to COT. MT seemed related to shorter post-operative ICU stay and is potentially positively associated with the other outcomes. However, studies involving larger patient cohorts are required to verify the statistical significance and clinical relevance of these observations.
Background Simultaneous pancreas-kidney transplantation (SPK) provides important metabolic and renal benefits, but cardiovascular complications remain a source of post-transplant morbidity and mortality. Factors associated with major adverse cardiovascular events (MACE) in contemporary SPK populations remain incompletely characterized. Methods We performed a single-center retrospective cohort analysis of 80 adult SPK recipients transplanted between 2018 and 2025. The primary endpoint was post-transplant MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, cardiovascular death, heart failure hospitalization, or clinically significant arrhythmia. MACE was evaluated as a binary outcome. The multivariable logistic regression model included one-month estimated glomerular filtration rate (eGFR) and kidney cold ischemic time. Results MACE occurred in 14 recipients (17.5%). Compared with recipients without MACE, those with MACE had more frequent post-transplant insulin use (P=0.013), longer kidney cold ischemic time (P=0.015), and higher donor body mass index (P=0.001). The triglyceride-glucose index was not significantly associated with MACE. In multivariable analysis, higher one-month eGFR was associated with lower odds of MACE (adjusted odds ratio, 0.61 per 10 mL/min/1.73 m² increase; 95% confidence interval (CI), 0.38-0.97; P=0.040). Kidney cold ischemic time showed a borderline association with MACE (adjusted odds ratio per hour, 1.28; 95% CI, 1.00-1.67; P=0.057). Model discrimination was modest, with an area under the curve of 0.68. Conclusions Among SPK transplant recipients, lower early kidney allograft function was associated with higher observed odds of post-transplant cardiovascular events. The triglyceride-glucose (TyG) index was not independently associated with MACE. Because few events occurred, these findings should be interpreted as exploratory and validated in larger studies.
Transcatheter aortic valve replacement (TAVR) is now recognized as an important treatment for pure severe aortic regurgitation (PSAR). Some patients with PSAR also suffer from functional mitral regurgitation (FMR). However, whether TAVR can improve FMR in patients with PSAR and the predictors of this improvement remain unknown. Thus, this study aimed to explore predictors of FMR improvement in patients with PSAR undergoing TAVR. Patients with PSAR and ≥mild FMR who underwent TAVR at the Zhongshan Hospital Affiliated with Fudan University were enrolled from June 2020 to June 2024. Participants were divided into groups with or without FMR improvement depending on whether FMR improved 1 month post-TAVR. Baseline data, imaging results, and follow-up data of the patients were collected. This study included 111 patients, among whom 59 had improved FMR, and 52 did not. Compared to patients without FMR improvement, significantly fewer patients in the FMR-improved group were diagnosed with renal insufficiency (0% vs. 10%; p = 0.015) and left bundle branch block (0% vs. 8%; p = 0.030). Moreover, more were diagnosed with hypertension (80% vs. 56%; p = 0.007), and right bundle branch block (10% vs. 0%; p = 0.018). On transthoracic ultrasound, patients with FMR improvement were more likely to have a lower left ventricular ejection fraction (LVEF) and larger left ventricular end-diastolic (LVED) dimensions. In both groups, the degree of aortic regurgitation was significantly improved during 1-day and 1-month follow-ups post-TAVR (p < 0.001). No significant differences in the incidence of postoperative adverse events were found between the two groups during the short-term follow-up. Patients with higher degrees of FMR, lower LVEF, and hypertension were more likely to experience improvement in FMR post-TAVR. FMR improvement is observed in approximately half of PSAR patients undergoing TAVR. Higher FMR, lower LVEF, and hypertension before a TAVR are independent predictors of improvement in FMR.
Chylopericardium (CP), a rare condition characterized by the accumulation of chylous fluid in the pericardial cavity, results from lymphatic system disruption. It represents a potentially life-threatening complication following coronary artery bypass grafting (CABG), usually resulting from iatrogenic injury to the thoracic duct. We present a case of a 57-year-old male who, 2 weeks after CABG, developed progressive dyspnea. Subsequent echocardiography revealed severe pericardial effusion. Pericardial fluid analysis demonstrated chylous fluid with elevated triglycerides and protein concentrations, consistent with a diagnosis of CP. The patient achieved complete recovery following pericardiocentesis, continuous drainage, and the initiation of a strict high-protein, low-fat diet, without the need for further surgical intervention. CP following CABG is a rare but severe complication, typically attributed to inadvertent injury to the thoracic duct or its tributaries during surgery. While most reported cases present early in the postoperative period, this case is distinguished by a delayed onset approximately 2 weeks after surgery. The mechanism underlying this delayed presentation may involve gradual dilation of a partially injured thoracic duct or its branches during the operation, leading to chyle leakage into the pericardial cavity. Alternatively, the increase in chyle flow associated with the resumption of oral intake may contribute, rather than an immediate high-volume leak. CP should be included in the differential diagnosis for late-onset postoperative pericardial effusion, even after an initially uneventful early postoperative course. Our case demonstrates that a structured, non-operative approach can be curative for hemodynamically stable patients with post-CABG CP, even with delayed presentation, thereby offering a management pathway that may avoid the morbidity associated with repeat thoracic surgery.
Brief emotion-focused family therapy (EFFT) interventions have demonstrated numerous positive outcomes across the domains of child mental health and parent psychosocial well-being. However, there is limited research examining interpersonal processes at the family-level of analysis following 2-day EFFT programs. This study explored family functioning in the year following a virtual, parent-focused EFFT intervention (n = 159 caregivers, representing 124 families and 264 children). Caregivers completed the General Functioning subscale of the Family Assessment Device at 6 timepoints from baseline to 12-month post-intervention. Multilevel modeling was used to complete growth curve analysis, exploring post-intervention changes in family functioning over time. This allowed for the exploration of between versus within family differences pre- to post-intervention in the study sample. Variance in family functioning was attributable to stable differences between caregivers (level 2; 59%) and change over time (level 1; 41%), including measurement error. Growth curve analysis identified positive changes in family functioning post-intervention, with a cubic trajectory of improvement. Higher COVID-19 disruption, caregiver psychological distress, and parenting stress significantly predicted lower baseline family functioning, but did not significantly interact with change over time. These results suggest that there is a general pattern of non-linear change following EFFT workshops, specifically relating to family interpersonal dynamics. Overall, the study findings expand the evidence base for this promising, brief, relational intervention, now available in virtual formats, thereby increasing access for busy families.
Primary dysmenorrhea has a main impact on quality of teenagers 'life, productivity and daily activities. Due to the potential risks associated with pharmacological treatments, non-pharmacological approaches have gained importance in managing primary dysmenorrhea. In this study, isometric exercises and self-care activities were combined into a structured program aimed at alleviating menstrual pain. The current study was conducted to evaluate the effect of isometric exercises and self-care activities on primary dysmenorrhea among secondary school students. A quasi-experimental research design was utilized. A purposive sample of 97 secondary school students who had primary dysmenorrhea was recruited for the research for ten weeks. two schools; Dr. Mohamed Rabie Falah Studied for Girls and Mohamed Nasr Abdeen Compound Schools at Diarb Negem City, Zagazig, Sharkia Governate. three tools were used; 1) A structured Interview Questionnaire, 2) Visual Analogue Scale (VAS), and 3) Abdominal muscles force measuring tests. The mean age was of the studied students was15.89± 0.54 years. There was a highly statistical significant difference in pain intensity among studied students pre and post-intervention (p= 0.001). In which mean & SD of pain intensity pre-intervention was 7.61 ± 1.91 compared to 4.68 ± 2.39 post-intervention. The study hypothesis was accepted. There were highly statistically significant differences pre and post intervention. A combined structured program of isometric exercises and self-care activities was effective for reducing intensity of primary dysmenorrhea among secondary school students. Designing and implementing efficient programs to raise awareness of students about different benefits of isometric exercises and self-care activities on primary dysmenorrhea intensity.
Effective communication is central to psychiatric evaluation and treatment. Patients with acquired communication impairments, such as post-stroke aphasia, are at increased risk for misdiagnosis, delayed care, and suboptimal treatment. We aim to better understand the unique needs of psychiatric patients with communication difficulties, common pitfalls in their care, and ways to improve clinical assessment, diagnosis, and treatment of their mental health conditions. We present the case of a 49-year-old woman with a history of major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, functional neurological symptom disorder, and a left middle cerebral artery ischemic stroke resulting in non-fluent aphasia. She was admitted to an inpatient psychiatric unit for suicidal ideation in the context of significant post-stroke functional decline. Her hospitalization was complicated by limited verbal communication and reliance on nonverbal modalities, cognitive fatigue related to communicating, persistent depression symptoms, as well as fluctuating reports of perceptual disturbances. Communication barriers significantly impacted assessment of mood, suicidality, and perceptual symptoms, contributing to diagnostic uncertainty and complex medical decision-making. This case highlights how expressive aphasia can obscure psychiatric assessment, increase reliance on interpretation by clinicians and caregivers, and contribute to potential misunderstanding of symptoms. It also underscores the importance of multimodal communication strategies and interdisciplinary collaboration. Psychiatric patients with communication impairments require tailored assessment approaches to reduce diagnostic error, gain greater understanding of the patient's clinical presentation, and improve overall patient care. Increased awareness and structured communication strategies may mitigate disparities in this vulnerable population.
Despite advancements in sleep medicine, inadequate sleep habits among young children persist. Establishing appropriate sleep habits in early childhood is essential for supporting physical, emotional, and cognitive development. However, scalable and personalized behavioral interventions for caregivers in community settings remain scarce, particularly AI-enabled systems designed for real-world implementation. This study evaluated adherence, perceived usefulness, and feasibility of Nenne Navi-AI among 50 caregivers recruited in Hirosaki City, Japan, through community health checkups, childcare facilities, and public advertisements. The culturally tailored application integrates supervised machine-learning models with rule-based algorithms to provide personalized guidance and ongoing support for promoting healthier sleep habits. During the 6-month intervention, only 3 of 50 caregivers (6%) experienced continuous 3-month data-entry lapses, with no withdrawals. Significant pre-post improvements were observed in children's number of awakenings after sleep onset and subjective sleep quality ratings. Subgroup analyses suggested improvements among children with poorer baseline sleep habits (≥0.5 SD worse than the sample mean). Post-intervention assessments confirmed high caregiver acceptability, satisfaction, and reduced parenting stress. Nenne Navi-AI demonstrates high feasibility with excellent 6-month adherence and favorable usability feedback. The system shows promise for improving early childhood sleep (night-waking), enhances caregiving experiences, reduces negative parenting emotions, and provides a scalable framework for future AI-enabled pediatric sleep interventions.