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Laparoscopic adhesiolysis for chronic abdominal pain is controversial and is not evidence based. We aimed to test our hypothesis that laparoscopic adhesiolysis leads to substantial pain relief and improvement in quality of life in patients with adhesions and chronic abdominal pain. Patients had diagnostic laparoscopy for chronic abdominal pain attributed to adhesions; other causes for their pain had been excluded. If adhesions were confirmed during diagnostic laparoscopy, patients were randomly assigned either to laparoscopic adhesiolysis or no treatment. Treatment allocation was concealed from patients, and assessors were unaware of patients' treatment and outcome. Pain was assessed for 1 year by visual analogue score (VAS) score (scale 0–100), pain change score, use of analgesics, and quality of life score. Analysis was by intention to treat. Of 116 patients enrolled for diagnostic laparoscopy, 100 were randomly allocated either laparoscopic adhesiolysis (52) or no treatment (48). Both groups reported substantial pain relief and a significantly improved quality of life, but there was no difference between the groups (mean change from baseline of VAS score at 12 months: difference 3 points, p=0-53; 95% CI −7 to 13). Although laparoscopic adhesiolysis relieves chronic abdominal pain, it is not more beneficial than diagnostic laparoscopy alone. Therefore, laparoscopic adhesiolysis cannot be recommended as a treatment for adhesions in patients with chronic abdominal pain.

The abundances, molecular weights, molar absorptivities, and polydispersities of sediment pore water dissolved organic matter (DOM) and ferrous iron, Fe(II), were measured from three sites within a freshwater wetland (Old Woman Creek) adjacent to Lake Erie. DOM concentrations (expressed as organic carbon) increased with depth. Number-average molecular weight, weight-average molecular weight, and molar absorptivities (at 280 nm) also increased with depth up to 5 cm and remained relatively constant below this depth. These properties are indicative of the respective changes in the size of the DOM constituents and the number of aromatic moieties present. Moreover, a strong correlation was observed between Fe(II) and DOM, which suggests that both constituents coaccumulate in these pore fluids. It is hypothesized that reduction of iron oxides coated with organic matter releases both DOM and Fe(II). Increases in the molecular weights and molar absorptivities of the DOM constituents suggest that the \"sorbed\" component released by iron oxide dissolution is composed of larger and more aromatic molecules. The molecular-weight data also suggest that much of the refractory organic carbon in the interstitial waters comprises smaller-than-expected polymeric molecules. Thus, the release of the sorbed organic materials during the reductive dissolution of the oxide phases in anoxic sediments coupled with the selective preservation of refractory organic components may play an important role in both the DOM-mediated fate of pollutants and the cycling of carbon in wetlands.

As technological advances allow the use of robotic exoskeleton devices with gait training, there is a critical need to establish a robotic gait training (RGT) program to meet the needs of people with spinal cord injury (SCI) during inpatient rehabilitation. The purposes of this study are to prospectively examine the efficacy of a stakeholder informed RGT program compared to usual care gait training (UC) during inpatient rehabilitation in people with incomplete SCI and compare the intensity of RGT and UC gait training during inpatient rehabilitation. 128 patients with incomplete SCI admitted to our inpatient rehabilitation facility will be screened for eligibility and randomized to either the RGT or UC group. RGT sessions will use the Ekso robotic exoskeleton [class II medical device (United States FDA)]. UC sessions will use traditional gait training approaches such as manually assisted overground gait training with walkers and orthotics and body weight-supported treadmill training (BWSTT). Our primary outcome is gait function as characterized by the Walking Index for Spinal Cord Injury-II (WISCI-II). Secondary outcomes are gait speed, Spinal Cord Independence Measure (SCIM), Numeric Pain Rating Scale (NPRS), Fatigue Severity Scale (FSS), Penn Spasm Frequency Scale (PSFS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder- 7 (GAD-7), International Spinal Cord Injury Quality of Life Basic Data Set, and a Qualitative Questionnaire. Assessments of primary and secondary outcomes will occur at admission and discharge from inpatient rehabilitation. General or generalized linear models will be used to analyze differences between groups for all measures. Successful completion of this study will provide a usable, replicable, stakeholder informed RGT intervention for use with individuals with incomplete SCI during inpatient rehabilitation.

Spinal cord injury (SCI) often results in severe motor and sensory deficits, leading to significant disability. Preclinical studies and retrospective studies suggest that a critical window of enhanced neuroplasticity may exist immediately after SCI, during which therapeutic interventions could yield greater functional improvements. The impact of time interval since SCI on efficacy of rehabilitation has not been directly assessed and is the focus of this clinical trial. This study will compare the efficacy of high-intensity gait training, initiated at different time intervals post-injury, on walking performance in individuals with SCI. We hypothesize that early intervention will yield the greatest improvements in walking ability and community ambulation, compared to training initiated at 3 or 6 months after SCI, or standard of care. This randomized, multi-site clinical trial will enroll 108 participants with acute, traumatic SCI. Participants will be randomized to receive 20 h of high-intensity gait training that will be initiated either early (< 60 days post-SCI), sub-acute (3 months), chronic (6 months), or to a control group receiving standard of care. Primary outcomes include gait speed (10 m Walk Test) and walking endurance (6-Minute Walk Test). Secondary outcomes include daily step count via wearable sensors, lower extremity strength, and quality of life measures. Assessments will occur at baseline, pre/post-intervention, and at 3, 6, 9, and 12 months post-SCI. This study will provide insights into the optimal timing of rehabilitation post-SCI and could have profound effects on our approach to training individuals with SCI in the healthcare setting as well as long term recovery outcomes. Trial registration ClinicalTrials.gov NCT06176833 was completed on 12/11/2023.

Various screening questionnaires have been established to identify psychopathology in children and adolescents. Some of these instruments include the pediatric symptom checklist (PSC), the pediatric symptom checklist (CBCL) and reporting questionnaire for children (RQC). However, many of the patients and their families may not speak English, and this can be a barrier to identifying and properly treating monolingual Spanish-speaking patients and families. There is a need for optimal mental health screening in Spanish speaking populations given the continued growth of the United States as a diverse country with complex demographic structure. Because of the diversity within the use of Spanish in Hispanic countries of origin, the aim of this study is to present unified Spanish versions of the RQC and PSC achieved through simultaneously and independently translating them into three versions of Spanish (RQC-SP and PSC-SP). To test the psychiatric validity of RQC-SP and PSC-SP, these both were administered simultaneously along with the Spanish version of the CBCL, which had already been well established. All three of these tools were given to Spanish speaking parents of pediatric outpatients (n = 22) while waiting for their clinic appointments. The RQC-SP had a correlation to the CBCL with R = 0.779 and p  < 0.001. The RQC-SP as compared with the CBCL had a false negative of 0/8 (0.00) with a sensitivity of 8/8 = 1.00. The false positives were 2/14 (0.143) and specificity 12/15 (0.85). The PSC-SP correlated with the CBCL with R = 0.897 and p  < 0.001. The PSC-SP correlation with the CBCL had false negative of 7/8 (0.875) and sensitivity of 1/8 (0.125) and false positive 0/14 (0.00) and specificity 14/14 (1.00). The RQC-SP and PSC-SP are brief, well-validated, reliable instruments designed.

Background Walking impairment after stroke is associated with substantial limitations in functional independence, quality of life, and long-term survival. People in the subacute phase after stroke who are unable to walk are most likely to benefit the greatest from use of overground robotic gait training (RGT). This study will provide preliminary evidence regarding the clinical use and efficacy of RGT during the subacute phase of stroke recovery as well as observational findings associated with the safety, tolerability, feasibility, and cost of delivering RGT during inpatient stroke rehabilitation. Methods This prospectively registered randomized controlled trial will enroll 54 patients admitted to inpatient rehabilitation within six months of stroke. Admitted patients will be screened at admission to inpatient rehabilitation for eligibility. Consented patients will be randomized based on stroke severity to receive either RGT or usual care for 90 minutes per week of gait training intervention during inpatient rehabilitation length of stay. Patients will complete assessments on walking and health outcomes at admission and discharge from inpatient rehabilitation and at 1- and 3-month follow-up. Intent-to-treat and per protocol analysis will be performed to evaluate safety [rate of adverse events, visual analog scale, and treatment completion rate], walking function [gait speed via 10-Meter Walk Test, Functional Ambulation Category, gait endurance via 6-Minute Walk Test] and health outcomes [Modified Rankin Scale, Stroke Rehabilitation Assessment of Movement, Continuity Assessment Record and Evaluation Tool, 5 Times Sit-to-Stand Test, Berg Balance Scale, and Stroke Impact Scale–16], and cost-analysis. Discussion This study will provide foundational evidence regarding the clinical use and efficacy of a RGT program during the subacute phase of stroke recovery with specific findings associated with the safety, tolerability, feasibility, and cost-analysis of delivering RGT during inpatient stroke rehabilitation. Trial registration NCT06430632.

Background Robotic exoskeletons have changed rehabilitation care available to people after spinal cord injury (SCI). Yet, the current evidence base is insufficient to identify the optimal dose and neurophysiological mechanism of robotic exoskeleton gait training (RGT) as an effective rehabilitation approach. This study will (1) examine whether the frequency of RGT after motor incomplete SCI impacts function and health outcomes, (2) analyze the neuroplastic effects of RGT dose, and (3) evaluate the safety, tolerability, and feasibility of delivering RGT. Methods We will enroll 144 participants with motor incomplete SCI admitted to inpatient rehabilitation within 6 months of SCI. Participants will be randomized based on injury severity and level into one of 3 RGT frequency groups (high, moderate, low) or none/usual care only. Participants will complete 24 RGT sessions and be assessed at admission and discharge to inpatient rehabilitation, post-RGT intervention, 1-month post-RGT, and 9-month post-SCI. Outcomes include Walking Index for Spinal Cord Injury-II, health outcomes (gait speed, Spinal Cord Independence Measure, pain, fatigue, spasticity, general health, quality of life, physical activity), and motor evoked potential amplitudes obtained using transcranial magnetic stimulation. Discussion Successful completion of this study will provide an evidence-based intervention, specifically tailored to meet the unique needs of people with SCI, which supports walking recovery; maximizing health, function, and ultimately participation. The intervention will further support widespread clinical implementation of exoskeleton use during acute rehabilitation. Trial registration ClinicalTrials.gov NCT05218447. Registered on June 23, 2022.

Weight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient's risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA). This randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group. This RCT will enroll and randomize 64 patients over an 18-month period. Currently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible. It is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke. ClinicalTrials.gov NCT03873467; https://clinicaltrials.gov/ct2/show/NCT03873467.

Critical dressing, the simultaneous dressing of two spin species to the same effective Larmor frequency, is a technique that can, in principle, improve the sensitivity to small frequency shifts. The benefits of spin dressing and thus critical dressing are achieved at the expense of generating a large (relative to the holding field \\(B_{0}\\),) homogeneous oscillating field. Due to inevitable imperfections of the fields generated, the benefits of spin dressing may be lost from the additional relaxation and noise generated by the dressing field imperfections. In this analysis the subject of relaxation and frequency shifts are approached with simulations and theory. Analytical predictions are made from a new quasi-quantum model that includes gradients in the holding field \\(B_{0}=\\omega _{0}/\\gamma \\) and dressing field \\(B_{1}=\\omega _{1}/\\gamma \\) where \\(B_{1}\\) is oscillating at frequency \\(\\omega \\). The results are compared with a Monte Carlo simulation coupled with a 5\\(^{\\text{th}}\\) order Runge-Kutta integrator. Comparisons of the two methods are presented as well as a set of optimized parameters that produce stable critical dressing at a range for oscillating frequencies \\(\\omega ,\\) as well as pulsed frequency modulation parameters for maximum sensitivity.

Previous work investigating the strategies that observers use to intercept moving targets has shown that observers maintain a constant target-heading angle (CTHA) to achieve interception. Most of this work has concluded or indirectly assumed that vision is necessary to do this. We investigated whether blindfolded pursuers chasing a ball carrier holding a beeping football would utilize the same strategy that sighted observers use to chase a ball carrier. Results confirm that both blindfolded and sighted pursuers use a CTHA strategy in order to intercept targets, whether jogging or walking and irrespective of football experience and path and speed deviations of the ball carrier during the course of the pursuit. This work shows that the mechanisms involved in intercepting moving targets may be designed to use different sensory mechanisms in order to drive behavior that leads to the same end result. This has potential implications for the supramodal representation of motion perception in the human brain.