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In this 10-month, crossover, double-blind study of 16 patients with severe, refractory obsessive–compulsive disorder (OCD), stimulation of the subthalamic nucleus reduced the symptoms of OCD. Eleven patients had serious adverse events, including one intracerebral hemorrhage and two infections requiring electrode removal. Stimulation of the subthalamic nucleus reduced the symptoms of OCD in 16 patients; however, 11 patients had serious adverse events. Severe obsessive–compulsive disorder (OCD) is characterized by intrusive, anxious thoughts and repetitive, ritualized behaviors. It is one of the most disabling of the chronic psychiatric disorders and has considerable repercussions on family relationships, social life, and the ability to function at work. 1 The current treatment of OCD consists of a combination of serotonin-reuptake inhibitors and cognitive–behavioral therapy; with this treatment, however, 25 to 40% of patients have persistent symptoms and lasting functional repercussions. 2 In the hope of reducing the disability and debilitation of patients whose OCD is highly refractory, ablative neurosurgical stereotactic treatments have been attempted, but the efficacy of . . .

Background The Jamar hydraulic dynamometer is a widely recognized tool for measuring grip strength. Nevertheless, the devices used most often in Asian countries are spring-type dynamometers, represented by the CAMRY dynamometer or Smedley dynamometer. We aimed to evaluate the reliability and validity of the CAMRY dynamometer compared with the Jamar dynamometer. Methods This was a cross-sectional study using a random crossover design in the grip strength test with two dynamometers. A total of 1064 healthy community-dwelling older adults aged 50–90 years old, which included 686 minorities and 378 Han Chinese, were recruited into the study from July to September 2021. We assessed the reliability and validity of the CAMRY EH101 dynamometer, and the Jamar dynamometer was regarded as the reference device. The order of testing with two dynamometers was randomized in a 1:1 ratio, with a 10-min gap between the two devices. Intraclass correlation coefficients (ICCs) and Bland–Altman analysis were calculated to assess reliability and validity between the two devices. Results The average handgrip strength (HGS) values at six times by the Jamar and CAMRY devices were 25.0 ± 7.9 kg and 24.6 ± 7.5 kg, respectively. The ICC values between the two devices were 0.815–0.854, and the systematic bias underestimated by the CAMRY dynamometer was 0.5 kg in men and 0.6 kg in women. We carried out a linear regression equation by sex, and their relationship was found as follows: male HGS (kg) Jamar  = 8.001 + 0.765 × HGS (kg) CAMRY ; female HGS (kg) Jamar  = 3.681 + 0.840 × HGS (kg) CAMRY . Conclusions The CAMRY EH101 dynamometer provides excellent reliability and validity. This device can serve as a reliable, inexpensive, and practical device to assess grip strength in geriatric clinical practice. Clinical trial registration Chinese Clinical Trial Registry: ChiCTR2100046367 ; Date of clinical trial reistration: 15/05/2021.

Background Studies on the associations between ambient temperature and asthma hospitalizations are limited, and the results are controversial. We aimed to assess the short-term effects of ambient temperature on the risk of asthma hospitalizations and quantify the hospitalization burdens of asthma attributable to non-optimal temperature in adults in Beijing, China. Methods We collected daily asthma hospitalizations, meteorological factors and air quality data in Beijing from 2012 to 2015. We applied a time-stratified case-crossover design and fitted a distributed lag non-linear model with a conditional quasi-Poisson regression to explore the association between ambient temperature and adult asthma hospitalizations. The effect modifications of these associations by gender and age were assessed by stratified analyses. We also computed the attributable fractions and numbers with 95% empirical confidence intervals (eCI) of asthma hospitalizations due to extreme and moderate temperatures. Results From 2012 to 2015, we identified a total of 18,500 hospitalizations for asthma among adult residents in Beijing, China. Compared with the optimal temperature (22 °C), the cumulative relative risk (CRR) over lag 0–30 days was 2.32 with a 95% confidence interval (CI) of 1.57–3.42 for extreme cold corresponding to the 2.5th percentile (− 6.5 °C) of temperature distribution and 2.04 (95% CI 1.52–2.74) for extreme heat corresponding to the 97.5th percentile (29 °C) of temperature distribution. 29.1% (95% eCI 17.5–38.0%) of adult asthma hospitalizations was attributable to non-optimum temperatures. Moderate cold temperatures yielded most of the burdens, with an attributable fraction of 20.3% (95% eCI 9.1–28.7%). The temperature-related risks of asthma hospitalizations were more prominent in females and younger people (19–64 years old). Conclusions There was a U-shaped association between ambient temperature and the risk of adult asthma hospitalizations in Beijing, China. Females and younger patients were more vulnerable to the effects of non-optimum temperatures. Most of the burden was attributable to moderate cold. Our findings may uncover the potential impact of climate changes on asthma exacerbations.

To evaluate the effect of prismatic dental loupes on clinician posture during periodontal treatment performed by periodontology assistants. This cross-sectional observational study was conducted using a counterbalanced crossover design. Ten periodontology assistants performed supragingival scaling on two different patients; once with and once without loupes. Posture was assessed using Branson’s Posture Assessment Instrument (BPAI) through photographic evaluation at the 1st, 3rd, and 5th minutes of treatment. BPAI scores were compared between the two conditions, and correlations among posture components were analyzed. The use of loupes significantly improved overall posture, with lower total BPAI scores in the loupe condition. Significant improvements were observed in the hip, trunk, head/neck, and shoulder regions, while wrist posture did not differ significantly. A strong positive correlation was found between total BPAI and head/neck scores, indicating the influence of head/neck alignment on overall posture. Magnification loupes contribute to improved clinician posture, especially in the head/neck region, which strongly correlated with overall posture. The observed interdependence among body regions supports the need for holistic posture assessment. These findings highlight the ergonomic benefits of loupes in reducing musculoskeletal risks in dental practice. Incorporating magnification loupes into clinical practice may improve operator posture and contribute to long-term occupational health among dental professionals.

(1) Background: The recovery method is important and decisive in the training system. This study aimed to assess the effects of various post-training recovery methods on muscle damage and strength indicators in Paralympic powerlifting athletes. (2) Methods: A crossover study was conducted involving eleven male athletes (25.4 ± 3.3 years, 70.3 ± 12.1 kg). Muscle damage was assessed using blood biochemical markers (cytokines IL-6, IL-10, and TNF-α) and isometric force indicators, including the maximum isometric force (MIF), time to MIF, and Rate of Force Development. The following assessments were performed before, immediately after, and at 24 and 48 h after the recovery protocol: (a) passive recovery (RP) or (b) cold-water immersion (CWI). (3) Results: The main results indicated that maximum isometric force (MIF) significantly improved after 48 h of CWI application (p < 0.05; for all comparison). The analysis of biochemical markers did not yield significant differences between the recovery methods at different time points (p > 0.05). For IL-6, there were significant differences between CWI before (2.29 ± 1.08, 95% CI 1.57–3.01) and CWI 2 h later (2 h) (4.59 ± 2.96, 95% CI 2.60–6.57; p = 0.045), and between CWI 15 min later (15 min) (4.14 ± 2.24, 95% CI 2.63–5.64) and CWI 48 h later (48 h) (2.33 ± 1.25, 95% CI 1.49–3.17; p = 0.034). There were differences between CWI 2 h (4.14 ± 2.24, 95% CI 2.63–5.64) and CWI 48 h later (2.33 ± 1.25, 95% CI 1.49–3.17; p = 0.035; F = 9.202; η2p = 0.479; high effect). (4) Conclusions: CWI significantly improved the post-resistance training muscle damage and strength in Paralympic powerlifting athletes.

Despite a practical guideline of 30-meter walking path during 6-minute walk test (6MWT), such walking course length is not possible in every clinical setting due to unavailable sufficient space. Existing evidence has investigated using several shorter course lengths, it remains unclear whether a walking course length shorter than the standard walking course length is appropriate for 6MWD testing. This study aimed (i) to compare maximum walking distances at various shorter walking course lengths (i.e., 10, 20, and 25 meters) and 30 meters, and (ii) to assess agreements in maximum walking distances achieved at intervals below 30 meters, specifically 10, 15, 20, and 25 meters. This study was a cross-sectional with cross-over design. Forty-eight healthy participants were randomly ordered to perform 6MWT with five different walkways (10, 15, 20, 25, 30 meters). The maximum walking distance (six-minute walk distance, 6MWD) covered was recorded. Eligible participants aged 41.0 ± 17.2 years, with equal sex (24 males) participated in this study. The 6MWD at 10, 15, and 20-meter walkways significantly shorter than the 30-meter standard walkway (489.6 ± 59.3 m, 513.1 ± 62.6 m, 524.7 ± 63.7 m vs 539.1 ± 63.1 m, respectively (P<0.01)). Very strong agreement was observed at 15, 20, and 25 meters with the standard 30 meters (0.819-0.875, P<0.001). Subgroup analysis showed strong to very strong agreement in 10-meter walkway length onwards with the standard walkway length among older adults (0.757-0.918, P<0.001). Testing on 20 meters walkway and shorter yielded varied results compared to the standard 30-meter walk, with exceptional congruence observed at 15 meters onwards. In particular, a minimum walkway of 10 meters had strong agreement with a standard 30-meter walkway in elderly.

Background Hidradenitis suppurativa affects up to 4% of the population worldwide. Many treatment options exist but these come with a significant side-effect profile. Exercise, weight loss, and dietary modifications may be simple inexpensive alternatives and/or adjuncts to treating this disease. Objectives We aimed to summarize published evidence on the effects of dietary, weight loss, and exercise interventions on the clinical course, severity, or subjective improvement of hidradenitis suppurativa and to provide a framework regarding dietary changes and exercise modalities for clinicians treating this disease. Methods A literature search of Scopus (1993 onwards), PubMed (1986 onwards), and MEDLINE (OVID interface, 1946 onwards) was conducted on 22 October, 2022. Case–control studies, cohort studies, and randomized controlled trials with five or more subjects conducted on adult participants (aged >18 years) were included; case reports, case series, and review papers were excluded. Results Fifteen studies involving 2829 patients were included, encompassing nine cohort studies, five cross-sectional studies, and one cross-over study. Patients who were female, lost more than 50 pounds (22.7 kg), or were obese prior to weight loss saw improvement in hidradenitis suppurativa severity with weight loss. There was evidence for beneficial effects of diets, such as the Mediterranean diet that minimizes sugar, highly processed carbohydrates, and dairy, and emphasizes chicken, fruits, and vegetables, in patients with hidradenitis suppurativa. Evidence also supported benefit from oral zinc and vitamin D supplementation. Conclusions More evidence is needed in the form of randomized controlled trials or well-designed controlled trials to evaluate the effect of exercise and dietary manipulation on the hidradenitis suppurativa disease course. Overall, there is significant but weak evidence to support improvement in hidradenitis suppurativa severity with weight loss, dietary changes, and micronutrient supplementation. There is no significant evidence to support improvement in hidradenitis suppurativa symptomology with any type of exercise intervention. Clinical Trial Registration This protocol was registered with PROSPERO with the registration number CRD4202235099.

BackgroundPersistent somatic symptoms are a common feature in many psychiatric disorders. Moderate-to-severe cases often necessitate treatment in specialised inpatient psychiatric settings.AimsThis study evaluated the efficacy, safety and acceptability of resonant breathing (personalised slow breathing to maximise heart rate variability (HRV)) as adjunctive treatment for hospitalised patients with psychiatric disorders presenting with persistent somatic symptoms on admission, when patients typically present with high symptom severity.MethodsThis multicentre, randomised, placebo-controlled cross-over study included 78 patients diagnosed with somatic symptom disorder or affective disorders with persistent somatic symptoms. Participants underwent light-guided resonant breathing and sham light therapy two times per day for 5 weekdays each, starting an average of 11 days after admission. The primary outcomes were changes in self-reported somatic well-being and arousal (efficacy), and adverse effects (safety). Secondary outcomes included somatic, anxiety, depression and insomnia symptoms, HRV measures and patient satisfaction (acceptability). The trial was preregistered in the German Clinical Trial Register (ID: DRKS00027323) and funded by the Austrian Research Promotion Agency (Grant ID. F0999886082).ResultsResonant breathing rates were six breaths per minute in 60% of patients and higher in the remaining participants. The study found no intervention-specific effect on primary outcomes of self-reported somatic well-being and arousal. Patients reported no adverse effects and expressed high satisfaction with the breathing intervention. Resonant breathing significantly reduced secondary outcomes of self-reported anxiety (η²p=0.09, 95% CI 0.01 to 0.22) and insomnia symptoms (η²p=0.10, 95% confidence interval (CI) 0.01 to 0.23) after 10 sessions. It also significantly improved several HRV measures acutely (η²p range: 0.23 (95% CI 0.09 to 0.38) to 0.51 (95% CI 0.35 to 0.62)).ConclusionsWhile resonant breathing did not improve somatic well-being or arousal, it was safe, well-tolerated and effective at reducing anxiety and insomnia symptoms during early hospitalisation. These findings support further investigation into resonant breathing for these specific indications over extended periods.Trial registration numberDRKS00027323

Gonadal hormones influence neuronal organization and plasticity. Yet the consequences of altering their concentrations by administering contraceptive agents, which are used by most reproductive-age women in the United States, are unclear. Cross-sectional studies have found both larger and smaller cortical regions alongside a variety of mood alterations in women who use oral contraceptive pills (OCPs) compared to naturally-cycling women. The goal of this study, therefore, was to determine whether there is an effect of OCPs on MRI measures of prefrontal cortical brain structure that may influence regulation of mood. We performed a double-blind, placebo-controlled, randomized crossover study comparing effects of OCPs (0.15 mg levonorgestrel + 0.30 μg ethinyl estradiol) vs placebo (N = 26) on MRI measures of prefrontal cortical thickness and on mood, as indicated by self-report on the Daily Record of Severity of Problems, which also includes one item related to somatic symptoms. MRI measures that reflect cortical thickness were smaller bilaterally in the pars triangularis and in the pars opercularis and frontal pole of the right hemisphere during the OCP arm vs. placebo. Only the effect in the right pars triangularis survived multiple comparisons correction. Right pars triangularis MRI measures of cortical thickness were not related to mood symptoms, but negatively correlated across conditions with severity of somatic symptoms on the DSRP. The somatic symptoms and MRI measures may be independently related to the actions of steroid hormones in OCPs, with OCPs simultaneously inducing both more effects on MRI measures of cortical thickness and somatic symptoms.

In the cluster randomized crossover trial, a sequence of treatment conditions, rather than just one treatment condition, is assigned to each cluster. This contribution studies the optimal number of time periods in studies with a treatment switch at the end of each time period, and the optimal number of treatment switches in a trial with a fixed number of time periods. This is done for trials with a fixed number of clusters, and for trials in which the costs per cluster, subject, and treatment switch are taken into account using a budgetary constraint. The focus is on trials with a cross-sectional design where a continuous outcome variable is measured at the end of each time period. An exponential decay correlation structure is used to model dependencies among subjects within the same cluster. A linear multilevel mixed model is used to estimate the treatment effect and its associated variance. The optimal design minimizes this variance. Matrix algebra is used to identify the optimal design and other highly efficient designs. For a fixed number of clusters, a design with the maximum number of time periods is optimal and treatment switches should occur at each time period. However, when a budgetary constraint is taken into account, the optimal design may have fewer time periods and fewer treatment switches. The Shiny app was developed to facilitate the use of the methodology in this contribution.