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Multiplex computational pathology for remedy result predication.
Results of this study showed that the sleep quality was generally poor in patients with SLE. Sleep quality was affected by some disease and sleep variables. Therefore, comprehensive sleep evaluation is necessary in the planning of treatment and care of SLE patients and to implement initiatives to improve sleep patterns in these patients.We assessed predictors of rising HbA1c during long-term use of closed-loop control (CLC) in children aged 6-13 years with Type 1 diabetes. Participants used a CLC system during a 16-week randomization phase followed by a 12-week extension phase. We compared an "Increased-HbA1c" group (n=17, ≥0.5% rise in HbA1c between randomization and extension phases) to a "Maintained-Improvement" group (n=18, had stable or improved HbA1c). The Increased-HbA1c group had higher pre-CLC HbA1c (8.42% ±0.80 vs. 7.45% ±0.93, p=0.002). Contrary to a-priori hypotheses, there were no differences in -height-for-age z-score, a surrogate for a pubertal growth spurt (+0.16 vs.-0.15, p=0.113), or number of carbohydrate boluses per day, a surrogate for missed boluses (4.4 ±2.2 vs. 5.2 ±2.1, p=0.263). Both groups maintained high rates in closed-loop. Thus, some children exhibit meaningful rise in HbA1c after initial CLC use, likely from multiple contributing factors, and may benefit from added encouragement during ongoing use.Purpose Ultrasound-guided transversus abdominis plane (TAP) blocks have been demonstrated to decrease postoperative pain; however, laparoscopic-assisted TAP (L-TAP) blocks have not been well studied in children. Our study utilized intraoperative ultrasound to verify whether surgeon-administered blocks using only laparoscopic visualization were reliably delivered into the correct plane. Materials and Methods Patients undergoing laparoscopic procedures were enrolled to receive L-TAP blocks. Preblock and postblock ultrasounds were performed to document the plane of local anesthetic delivery. Ultrasound images were reviewed by two blinded anesthesiologists to determine whether the L-TAP block was administered into the desired plane. Results Fifty-one patients were enrolled. The average age was 5.9 years (range 2 days to 17 years) and the mean weight was 25.4 kg (range 2.64-118.8 kg). The most common procedures were inguinal hernia repair (n = 19), appendectomy (n = 10), and gastrostomy-tube placements (n = 13). Nine surgeons performed 93 L-TAP blocks (average 10.3 blocks/surgeon). selleck inhibitor Ultrasound confirmed distribution in the correct plane in 53.5/93 blocks (57.5%; 58.0% for attending surgeons), with 77.4% concurrence between the anesthesiologist reviewers. Conclusion L-TAP achieves delivery of local anesthetic into the correct tissue plane in over half the cases with minimal training. Further studies are needed to examine the effect of L-TAP blocks on reducing postoperative pain in pediatric patients.Objective Modern board and card game-based cognitive interventions and gamification practices showed effectiveness in boosting executive functions and decreasing behavioral problems in children. However, the combination of both game-based methods has not been tested. Therefore, the main aim of this study was to test the effectiveness of gamification in modern board and card game-based cognitive interventions in Spanish schoolchildren at risk of social exclusion. Materials and Methods In this multicenter single-blind study with a quasi-experimental design, 176 schoolers (6-13 years old) were assigned to a gamified group (with a narrative context and a rewarding system) and 107 to a nongamified group (with no narrative context or rewarding system). The interventions were implemented in regular classes. Behavioral executive dysfunction was assessed using the Behavior Rating Inventory of Executive Function, Second Revision (BRIEF-2) (Teacher form), pre- and postintervention. Results We found significant time effects in all BRIEF-2 domains with small and medium effect sizes (d = -0.35 to d = -0.62). The nongamified group showed significantly higher decreases in all measures than those who used gamification. Conclusions It is possible that playing for the joy of playing in the nongamified group was enough motivation to focus on the task, while adding gamification elements did not favor greater effectiveness of the program.Objectives To evaluate the impact of body mass index (BMI), preoperative risk classification, previous inguinal herniotomy, and abdominal operations on several steps of robot-assisted radical prostatectomy (RARP) and lymph node (LN) involvement. Methods A total number of 225 consecutive patients were included in the study who underwent transperitoneal RARP by 1 surgeon. We defined the following parameters as dependent variables duration of prostatectomy, duration of pelvic lymphadenectomy, incision to suture time, console time, number of dissected LNs and number of positive LNs for metastasis. We assessed the impact of the following covariates using univariate nonparametric and multivariate analysis BMI, preoperative D'Amico risk classification, history of inguinal herniotomy, and previous abdominal operations. Results We observed a statistically significant difference among our three BMI groups ( less then 25, ≥25 and less then 30, and ≥30 kg/m2) regarding pelvic lymphadenectomy and LN metastasis. Moreover, among the three risk groups (low, intermediate, and high) duration of prostatectomy, pelvic lymphadenectomy, and LN metastasis were statistically different. Previous abdominal operations have been also demonstrated to significantly influence the pelvic lymphadenectomy. In addition, our multivariate model proved the impact of our covariates on pelvic lymphadenectomy. Conclusions Our findings highlight the impact of BMI and preoperative risk on various steps of RARP. We revealed longer duration of pelvic lymphadenectomy and more nodal yield in patients with higher BMI and high-risk disease. Therefore, we suggest that BMI and risk classification according to D'Amico should be taken into account while a RARP is being planned.Background Virtual reality (VR) experience is the most adopted form of video-gaming to reduce preoperative anxiety. This prospective randomized clinical trial aimed to examine the feasibility and efficacy of preoperative VR experience in children undergoing elective surgery. Materials and Methods All patients older than 13 years and scheduled for elective surgery between March and June 2021 were enrolled. Preoperative VR experience consisted in watching a 5-minute video using a head-mounted display. Four parameters were evaluated and compared between the two groups (1) patient heart rate (HR) before anesthesia; (2) patient evaluation of preoperative anxiety using facial affective scale (FAS); (3) anesthesiologist evaluation of preoperative anxiety using FAS; and (4) subjective stress scoring using a 5-item Likert-type scale. Results A total of 40 patients (23 boys) with a median age of 14.5 years (range 12-17) participated in the study. The patients were randomized in two groups, each of 20 patients, according to preoperative VR experience VR group (G1) and control group (G2). No adverse events related to VR occurred. The patient median HR was significantly lower in G1 (72 bpm) than in G2 (101 bpm) (P = .001). The very relaxed/relaxed face selection rate using FAS was significantly higher in G1 than in G2, in both patient and anesthesiologist evaluations (P = .001). Finally, the subjective patient scoring of operating room experience was significantly greater in G1 [4.6 ± 0.4] than in G2 [2.15 ± 1.07] (P = .001). Conclusions Our preliminary results showed that VR is safe and effective to relieve anxiety and improve relaxation in the preoperative period in pediatric patients undergoing elective surgery. The VR experience resulted in decreased overall anxiety and increased overall positive affect during the preoperative period in VR group compared with the control group. Further studies are needed to investigate this technology in the postoperative phase and on a larger patient cohort.Objective Me & My Wishes involves videos of persons living with dementia talking about their end-of-life (EOL) care preferences. This study aimed to examine the concordance of EOL treatment and psychosocial preferences expressed by assisted living community and nursing home residents in these videos with family and staff knowledge of preferences. Design Randomized wait-list control. Setting/Subjects Assisted living and nursing home residents in the United States, and their family members and caregivers. Measurements Five EOL treatment preferences (cardiopulmonary resuscitation or CPR, breathing machine, tube feeding, life support, and pain treatment) and four near EOL psychosocial preferences (having family at the bedside, engaging in faith practices such as prayer, having a pet at bedside, and engaging in activities such as being read to or listening to music) extracted from residents' videos and captured through family and staff surveys. Results Thirty-six resident videos were shared with family (N = 50) and staff (N = 38) during care plan meetings. Concordance between residents' stated EOL treatment preferences and family and staff knowledge improved, with results showing a treatment effect at time of sharing the video (family Beta = 0.21, p  less then  0.001; staff Beta = 0.35, p  less then  0.001). Conclusion Our findings indicate that sharing Me & My Wishes videos improved family and staff concordance of EOL psychosocial and treatment preferences for assisted living and nursing home residents living with dementia. Personalized videos conveying resident preferences can help informal and formal caregivers understand the resident as a person and foster concordant care. Clinical Trial Registration Number NCT03861429.This study investigated whether the degree of cybersickness varies depending on different virtual reality experience modes (playing vs. watching) and whether specific eye movement parameters reflect changes in cybersickness. Simulator Sickness Questionnaire results from 20 participants (10 playing and 10 watching) showed that cybersickness was much more severe in the watching mode, particularly during the second of the three total trials. Moreover, cybersickness' changing pattern was reflected in the center gaze ratio and scan-path length. These findings imply the importance of physiological measurements for a deeper understanding of cybersickness in theoretical and practical respects.Purpose Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results From the analysis of the interviews of the 31 participants, three main themes were identified (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion.
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