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Introduction and objectiveMultiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system. MS patients usually present with lower urinary tract dysfunction (LUTD). Objective of this study is to evaluate and compare the efficacy and safety of treating MS patients with LUTD with either a b3 agonist (mirabegron) or anticholinergics. The study’s primary outcome is the LUTD symptom improvement. Material and MethodsThis is a multi-center, single-blinded, comparative study including 91 MS patients with LUTD. At baseline, patients underwent thorough clinical examination, urine cultivation and abdominal ultrasound and completed urination diaries and specific, validated questionnaires (NBSS, MusiQoL). At second visit, patients were administered either mirabegron or anticholinergics. Treatment was always carried out alongside with MS treatment. Reevaluation was performed 3 months after first visit. Patients underwent the same clinical and imaging tests that were carried out at first visit.ResultsWe compared several clinical and imaging parameters between the two groups at first visit and month 3 after treatment. Νo statistical difference was noted between the mirabegron group and the anticholinergic group in terms of LUTD improvement. In both groups, improvement from baseline regarding LUTD was recorded. Statistical analysis was performed using the paired and unpaired t test method. No patient discontinued either medication due to side effects.ConclusionsMS patients receiving either mirabegron or anticholinergic therapy for LUTD showed improvement. Nevertheless, no statistical difference was noted between the two cohorts at 3 months in terms of drug efficacy in all the statistically significant parameters.

The enduring impact of COVID-19 on patients has been examined in recent studies, leading to the description of Long-COVID. We report the lasting symptom burden of COVID-19 patients from the first wave of the pandemic. All patients with COVID-19 pneumonia discharged from a large teaching hospital trust were offered follow-up. We assessed symptom burden at follow-up using a standardised data collection technique during virtual outpatient clinic appointments. Eighty-six percent of patients reported at least one residual symptom at follow-up. No patients had persistent radiographic abnormalities. The presence of symptoms at follow-up was not associated with the severity of the acute COVID-19 illness. Females were significantly more likely to report residual symptoms including anxiety ( p  = 0.001), fatigue ( p  = 0.004), and myalgia ( p  = 0.022). The presence of long-lasting symptoms is common in COVID-19 patients. We suggest that the phenomenon of Long-COVID may not be directly attributable to the effect of SARS-CoV-2, and believe the biopsychosocial effects of COVID-19 may play a greater role in its aetiology.

Background This study aims to identify symptom clusters in patients with intermediate and advanced liver cancer receiving targeted immunotherapy, focusing on core and bridge symptoms to establish a foundation for precise symptom management. Methods This study used a cross-sectional survey and utilized convenience sampling from May 2023 to January 2024 at a third-class hospital in Shanghai, China. The severity of symptoms in liver cancer patients during treatment was evaluated using the Memorial Symptom Assessment Scale. Network analysis was employed to depict the interrelation of symptom clusters and identify core and bridge symptoms. Results The symptoms were classified by severity into five clusters: oral, gastrointestinal, fatigue-related, body image, and pain-sleep. Within the symptom network, the core symptoms were pain, “I don’t look like myself,” and nausea, while the critical bridge symptoms included pain, itching, and feeling bloated. The strongest connections were observed between nausea and vomiting, followed by taste changes and dry mouth, as well as weight loss and “I don’t look like myself.” Conclusion In patients receiving targeted immunotherapy for intermediate and advanced liver cancer, multiple symptoms can emerge simultaneously, forming interconnected clusters. By identifying and intervening in core and bridge symptoms, personalized management strategies can be developed to relieve other symptoms and disrupt connections between symptom clusters, thereby enhancing symptom management efficacy. This study has significant clinical and research implications, offering new insights to improve patients’ quality of life and treatment outcomes.

The symptoms of stroke jeopardize patients’ health and increase the burden on society and caregivers. Although the traditional symptom cluster research paradigm can enhance management efficiency, it fails to provide targets for intervention, thereby hindering the development of patient-centered precision medicine. However, the symptom network paradigm, as a novel research approach, addresses the limitations of traditional symptom management by identifying core symptoms and determining intervention targets, thereby enhancing the efficiency and precision of symptom management. This study. aims to explore the symptom network and core symptoms of acute-phase stroke patients. A convenience sample of 505 stroke patients was selected for this study. Symptoms were assessed by the Stroke Symptom Experience Scale.Exploratory factor analysis was utilized to extract symptom clusters, and network analysis was conducted to construct the symptom network and characterize its nodes. In this study, four symptom clusters were extracted through exploratory factor analysis. Based on the results of node predictability(re) and node centrality such as strength centrality (rs), it was found that the symptoms of “No interest in surroundings” (rs = 1.299, re = 1.081), “Be disappointed about future” (rs = 0.922, re = 0.901), and “Unable to maintain body balance” (rs = 0.747, re = 0.744) had the highest centrality and predictability values, indicating their core positions within the symptom network. No interest in surroundings, Be disappointed about future, and Unable to maintain body balance are core symptoms in the symptom network. In the future, intervention methods for core symptoms can be constructed and validated for their intervention effects to further demonstrate the benefits of core symptoms.

PurposeThe aim of this randomized clinical trial was to examine the efficacy of Pennebaker’s expressive writing intervention (EWI) in improving the perceived quality of life (QoL) and in reducing psychiatric symptoms among patients who received a cancer diagnosis.MethodsSeventy-one consecutively recruited patients who received a cancer diagnosis for the first time in their life were randomized into two groups: an EWI group (EWG: n = 35) and a control group (CG n = 36). At the baseline, anamnestic information was collected for all patients, and the patients completed a series of self-reported measures assessing psychiatric symptoms, alexithymia, and health-related QoL. A modified Pennebaker’s EWI adapted to cancer diagnosis was also administered to the EWG. Six months later, 32 patients (EWG: n = 17, CG: n = 15) participated in the follow-up and filled out the same questionnaires.ResultsThe Pennebaker’s EWI was effective in decreasing global psychopathology (d =  -.55). Small but significant effects were also observed for alexithymia levels and health-related QoL, with the EWG showing a reduction in alexithymia levels (d =  -.31) and an increase in the mental component of QoL (d = .31) compared to the CG.ConclusionsOur findings indicate that the Pennebaker’s EWI is effective in reducing the negative impact of cancer diagnosis on patients’ mental health.

Background Patient outcomes were assessed 2 years after treatment with the Optilume BPH Catheter System, a minimally invasive surgical therapy for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods One-hundred forty-eight adult males with symptomatic BPH were enrolled and randomized in a 2:1 fashion to Optilume BPH or Sham (100 Optilume BPH; 48 Sham). Long-term measures include International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), Post-Void Residual Urine (PVR), quality of life measures and sexual function. Follow-up beyond one year was limited to those treated with Optilume BPH. Results At 2 years, 67.5% (56/83 CI 56.3%, 77.4%) of participants in the Optilume BPH arm were symptomatic responders as defined by ≥30% improvement in IPSS without medical or surgical retreatment. IPSS significantly improved from 23.4 ± 5.5 ( n  = 100) to 11.0 ± 7.0 ( n  = 74). Qmax improved by 116.8.% (8.9 ± 2.2 ( n  = 97) to 19.0 ± 16.3 ( n  = 65)), while PVR showed a slight reduction (83.7 ± 70.3 ( n  = 99) to 65.9 ± 74.5 ( n  = 65)). Improvement in uroflowmetry measures was consistent across all prostate volumes. BPH-II improved from 7.0 ± 2.9 ( n  = 98) to 2.3 ± 2.5 at 1 year ( n  = 89) and remained consistent at 2.3 ± 2.9 at the 2-years ( n  = 74), representing a 53.9% improvement. IPSS QoL also improved from 4.6 ± 1.3 ( n  = 100) at baseline to 2.2 ± 1.5 ( n  = 74). The most common adverse events reported in the Optilume BPH arm were hematuria and urinary tract infection (UTI). No device and/or treatment related serious adverse events were reported occurring beyond 12 months post-procedure. There was no impact to sexual function. Conclusions In the PINNACLE study, participants treated with the Optilume BPH Catheter System demonstrated continued and durable results at 2 years, affirming tolerability, safety, and the enduring effectiveness. The Optilume BPH Catheter System provides lasting results that are comparable to the more invasive therapies, while preserving the advantages with being a minimally invasive therapy. Registration ClinicalTrials.gov NCT04131907.

Purpose To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia. Methods We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL). Results All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate ( Q max ), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q max . TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q max and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria. Conclusions TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.

Purpose To evaluate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to improve urinary symptoms in men with prostate cancer. Methods The randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and with moderate to severe urinary symptoms defined as scores ≥ 8 on the International Prostate Symptom Score (IPSS) questionnaire. Sixty-three men were randomised either; to SMaRT, a 10-week symptom-management intervention including group support, education, pelvic floor muscle exercises, or a care-as-usual group. The primary outcome was the IPSS at 6 months from baseline assessment. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months from baseline. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention. Results SMaRT group intervention did not improve urinary symptoms as measured by IPSS at 6-months. The adjusted difference was − 2.5 [95%CI − 5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (− 1.1 [− 2.0 to − 0.2], p = 0.017), ICS urinary incontinence (− 1.0 [− 1.8 to − 0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months. Conclusions SMaRT group intervention provided short-term benefit in urinary voiding and continence and helped men manage symptoms but was not effective long term.

For over 35 years, Kline's Neuro-Ophthalmology Review Manual has presented a unique and user-friendly approach to address clinical neuro-ophthalmology principles used in everyday practice. This Eighth Edition continues that tradition, providing a timely update, while also maintaining the same user-friendly and concise format. Dr. Rod Foroozan and Dr. Michael Vaphiades have taken the mantle of updating this respected manual from Dr. Lanning Kline and continue his tradition of a simple summary of the most important clinical aspects of neuro-ophthalmology with schematic illustrations and material relevant to everyday practice. They are joined by their contributing authors, all seasoned neuro-ophthalmologists, and have organized the book to provide the essential key information on neuro-ophthalmic disorders. The Eighth Edition provides a comprehensive update to the latest information, adds many new effective exercises for case study, and is a complete update on neuro-ophthalmic conditions, including results of recent clinical trials and emerging literature. Also new is the inclusion of a table of neuro-ophthalmic emergencies which serves as a quick guide so that these potentially life-threatening and blinding conditions can be accessed easily. Chapters include:Nystagmus and Related Ocular OscillationsMyasthenia and Ocular MyopathiesNonorganic Visual DisordersDisorders of Higher Visual FunctionNeuroimaging Kline's Neuro-Ophthalmology Review Manual, Eighth Edition has all the fundamentals presented logically for all practitioners and residents in ophthalmology, neurology, and neurosurgery. A popular choice among colleagues for more than 35 years, this a must-have resource in neuro-ophthalmology.

Recent network models propose that mutual interaction between symptoms has an important bearing on the onset of schizophrenic disorder. In particular, cross-sectional studies suggest that affective symptoms may influence the emergence of psychotic symptoms. However, longitudinal analysis offers a more compelling test for causation: the European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. We predicted that the persistence of psychotic symptoms would be driven by the continuing presence of affective disturbance. EuroSC included 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures of psychotic and affective symptoms were repeated four times at 6-month intervals, thereby furnishing five time-points. To examine interactions between symptoms both within and between time-slices, we adopted a novel technique for modelling longitudinal data in psychiatry. This was a form of Bayesian network analysis that involved learning dynamic directed acyclic graphs (DAGs). Our DAG analysis suggests that the main drivers of symptoms in this long-term sample were delusions and paranoid thinking. These led to affective disturbance, not vice versa as we initially predicted. The enduring relationship between symptoms was unaffected by whether patients were receiving first- or second-generation antipsychotic medication. In this cohort of people with chronic schizophrenia treated with medication, symptoms were essentially stable over long periods. However, affective symptoms appeared driven by the persistence of delusions and persecutory thinking, a finding not previously reported. Although our findings as ever remain hostage to unmeasured confounders, these enduring psychotic symptoms might nevertheless be appropriate candidates for directly targeted psychological interventions.