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Spectral domain‐optical coherence tomography plays a crucial role in the early detection and monitoring of multiple sclerosis (MS) pathophysiology. We aimed to quantify differences in retinal layer measures among different groups of MS and explored different variables that correlate with retinal measures. This study was reported according PRISMA guidelines. A comprehensive search was done across PubMed, Embase, and Google Scholar. The mean difference in thickness of retinal layers and macular volume was assessed. Meta‐regression was done to assess the sources of heterogeneity. A total of 100 articles were included in the meta‐analyses. The peripapillary retinal nerve fiber layer (pRNFL) thickness significantly decreased in the MSON (MD: −16.44, P < 0.001), MSNON (MD: −6.97, P < 0.001), and PMS (MD: −11.35, P < 0.001) versus HC. The macular RNFL was lower among the MSON (MD: −6.24, P = 0.013) and MSNON (MD: −3.84, P <0.001) versus HC. Macular ganglion cell layer and inner plexiform layer (GCIPL) was thinner among MSON (MD: −14.83, P <0.001), MSNON (MD: −6.38, P < 0.001), and PMS (MD: −11.52, P < 0.001) compared with control eyes. Inner nuclear layer (INL) was higher in the MSON (MD: 0.49, P < 0.001) versus HC. Outer nuclear layer (ONL) thickness significantly lower in the MSNON (MD: −1.15, P = 0.019) versus HC. Meta‐regression showed that disease duration, age, EDSS score, and percentage of patients taking DMT are all negatively correlated with pRNFL and GCIPL thickness; however, female gender was correlated with less atrophy. As conclusion, the study highlights substantial thinning in the pRNFL and macular GCIPL between MS versus controls. INL as valuable parameter for capturing inflammatory disease activity. [ABSTRACT FROM AUTHOR]

Despite significant advances in the treatment of psoriatic arthritis (PsA) in the last two decades, remission remains elusive and there is no cure. Evidence from rheumatoid arthritis (RA) confirming enhanced response and outcome from earlier treatment intervention suggests the plausibility of the window of opportunity in the pathogenesis of RA. Yet, data are lacking in PsA. Although treatment response may be enhanced in shorter disease duration, it is unknown how this early intervention may impact long-term outcomes. Furthermore, it remains to be demonstrated whether there is a best treatment strategy and time of intervention. Crucially, the main hurdle when aiming for early treatment intervention is the ability to achieve a timely diagnosis that highlights the need to focus research efforts on characterizing the very early disease stages including the transition to PsA in the at-risk psoriasis population. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with hospitalization among Mexican Americans aged 75 years and older with diabetes (with and without complications) and without diabetes over 12 years of follow up. Methods: Participants (N = 1454) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005-2016) residing in Arizona, California, Colorado, New Mexico, and Texas. Measures included socio-demographics, medical conditions, falls, depressive symptoms, cognitive function, disability, physician visits, and hospitalizations. Participants were categorized as no diabetes (N = 1028), diabetes without complications (N = 180), and diabetes with complications (N = 246). Results: Participants with diabetes and complications had greater odds ratio (1.56, 95% Confidence Interval = 1.23-1.98) over time of being admitted to the hospital in the prior year versus those without diabetes. Participants with diabetes had greater odds of hospitalization if they had heart failure, falls, amputation, and insulin treatment. Conclusions: In Mexican American older adults, diabetes and diabetes-related complications increased the risk of hospitalization. [ABSTRACT FROM AUTHOR]

Introduction: Freezing of Gait (FOG) is a prevalent and debilitating symptom in idiopathic Parkinson's disease (PD). This study evaluated spatiotemporal and kinematic gait parameters in individuals with PD with a history of FOG and explored the effects of dopaminergic therapy on FOG subtypes. Methods: One hundred and nine individuals with PD underwent clinical assessments and quantitative biomechanical measures during walking cycles before and after dopaminergic therapy. Individuals with FOG were classified into levodopa-responsive and levodopa-unresponsive groups. Results: Individuals with FOG displayed longer disease duration and higher Unified Parkinson's Disease Rating Scale (UPDRS) II, III, IV scores, and total scores and levodopa equivalent dose, than those without FOG (all p < 0.0001). Following propensity score matching of 15 pairs based on UPDRS total score and disease duration during the off-medication state, the analysis comparing the FOG and non-FOG groups revealed no significant differences in spatiotemporal and kinematic parameters. In 39 cases of FOG, dopaminergic therapy improved gait performance in individuals with PD, enhancing spatiotemporal parameters (speed, stride length, step length, step variability) and kinematic parameters (shoulder and elbow flexion/extension range of motion (ROM), pelvic rotation, and hip abduction/adduction ROM) regardless of FOG responsiveness to dopaminergic therapy. A significant difference in trunk sway ROM (p = 0.029) remained before and after dopaminergic therapy, even after adjusting for disease duration and clinical severity. Discussion: Dopaminergic therapy had varying effects on PD with FOG, improving several spatiotemporal and kinematic gait parameters but being less effective in levodopa-unresponsive cases. Quantitative biomechanical measures offer detailed insights into gait performance, aiding personalized fall risk assessment and guiding individualized rehabilitation programs. [ABSTRACT FROM AUTHOR]

Most published results have revealed variations in the association of serum/plasma levels of malondialdehyde (MDA), apolipoprotein B (ApoB), and oxidized low‐density lipoprotein (OxLDL) and systemic lupus erythematosus (SLE). This study was performed to establish MDA, ApoB, and OxLDL levels in systemic lupus erythematosus (SLE) patients. Electronic databases were searched for the included articles up to 27th February 2023. The meta‐analysis included 48 articles with 2358 SLE patients and 2126 healthy controls considered for MDA, ApoB, and OxLDL levels. There were significantly higher MDA, ApoB, and OxLDL levels in SLE patients than those in the control groups. Subgroup analysis indicated that European/American SLE patients and patients of both ages <36 and ≥36 exhibited higher MDA, ApoB, and OxLDL levels. Arab and Asian SLE patients had higher ApoB and MDA/OxLDL levels. African SLE patients recorded higher OxLDL levels than the control groups. SLE patients with a body mass index (BMI) of ≥23 and a disease duration of <10 recorded significantly higher MDA, ApoB, and OxLDL levels. Patients with systemic lupus erythematosus disease activity index (SLEDAI) ≥8 of SLE had higher MDA and ApoB levels, whereas SLE patients with SLEDAI <8 showed significantly higher ApoB levels. Patients with BMI <23 of SLE had higher MDA and OxLDL levels. This study established significantly higher MDA, ApoB, and OxLDL levels in SLE patients, suggesting a possible role of MDA, ApoB, and OxLDL in the disease. [ABSTRACT FROM AUTHOR]

Background: Osgood–Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences. [ABSTRACT FROM AUTHOR]

Purpose: Ulcerative colitis (UC) is an inflammatory bowel disease with an unclear etiology that can lead to irreversible changes in distal colonic function in chronic patients. This study investigated anorectal function in recurrent UC patients and identified influencing factors. Methods: This prospective study enrolled 33 recurrent UC patients and 40 newly diagnosed patients from January 2019 to December 2022. Data collection included clinical records, scores, and anorectal function assessments. Regression analyses were used to identify factors impacting anorectal function. Results: Recurrent UC patients had higher baseline CRP and fecal calprotectin levels, increased anxiety and depression, and more severe fecal incontinence. They also had lower BMIs, serum Hb and albumin (ALB) levels, and Inflammatory Bowel Disease Questionnaire scores than did initial-onset UC patients. Multivariate linear regression analysis revealed that long disease duration (coef. − 0.376, P < 0.001) and high fecal calprotectin level (coef. − 0.656, P < 0.001) independently influenced the initial sensation threshold in recurrent UC patients. Additionally, high fecal calprotectin (coef. − 0.073, P = 0.013) and high Zung Self-Rating Anxiety Scale score (coef. − 0.489, P = 0.001) were identified as two independent determinants of the defecation volume threshold. For the defecation urgency threshold, the independent factors included high disease duration (coef. − 0.358, P = 0.017) and high fecal calprotectin level (coef. − 0.499, P = 0.001). Similarly, the sole independent factor identified for the maximum capacity threshold was high fecal calprotectin (coef. − 0.691, P = 0.001). Conclusion: Recurrent UC patients had increased rectal sensitivity and compromised anorectal function, which significantly impacted quality of life. Proactively managing the disease, reducing UC relapses, and addressing anxiety are effective measures for improving anorectal function in these patients. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusions We assessed whether the effectiveness of monoclonal antibodies (mAbs) targeting the calcitonin gene‐related peptide (CGRP) pathway changes according to the duration of chronic migraine (CM) over 12 months.In most patients, CM is a progressive disease starting with episodic migraine. Longer CM duration might be associated with more difficult treatment, probably because the mechanisms underlying chronicization are strengthened. Therefore, early treatment of CM could lead to better outcomes compared with later treatment.This cohort study included individuals with CM treated with anti‐CGRP mAbs in two tertiary headache centers from April 2019 to May 2023. The primary outcome included a change in monthly migraine days (MMDs) from baseline to the third trimester of treatment, 10–12 months. Secondary outcomes established whether response to anti‐CGRP mAbs has a more rapid onset in individuals with shorter CM duration compared with longer duration; they included change in MMDs, monthly headache days (MHDs), and days and number of intakes of acute medication during each trimester compared to baseline. Additional outcomes included persisting MMDs, MHDs, and days and number of intakes of acute medication during each trimester of treatment. Patients were compared across tertiles of the overall CM duration.The study included 335 individuals with CM, with a median (interquartile range [IQR]) age of 48 (39–57) years; 270 (80.6%) were women. Patients in the highest tertile of CM duration (aged 18–60 years) were older than patients in the lower duration tertiles (0–7 years and 8–18 years, respectively), with a median (IQR) age of 56 (48–64) years compared with 42 (31–50) years, and 48 (39–56)years, respectively (p = 0.025); however, this difference was likely due to a correlation between age and disease duration. The change in MMDs from baseline to the last trimester of treatment (10–12 months) was comparable across tertiles of CM duration (median [IQR] −12 [−18 to −5] days, −12 [−17 to −6] days, and −12 [−18 to −4] days; p = 0.946). No difference emerged in secondary outcomes, suggesting a similar time to onset of anti‐CGRP mAbs effect across all tertiles of CM duration.Our data showed that anti‐CGRP mAbs are effective and have a rapid onset of action in CM regardless of disease duration. [ABSTRACT FROM AUTHOR]

Background In high-resource settings, the survival of children with immunocompromise (IC) has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools, and outcome of IC children with tuberculosis (TB) in Europe. Methods Multicenter, matched case-control study within the Pediatric Tuberculosis Network European Trials Group, capturing TB cases <18 years diagnosed 2000–2020. Results A total of 417 TB cases were included, comprising 139 children who are IC (human immunodeficiency virus, inborn errors of immunity, drug-induced immunosuppression, and other immunocompromising conditions) and 278 non-IC children as controls. Nonrespiratory TB was more frequent among cases than controls (32.4% vs 21.2%; P =.013). Patients with IC had an increased likelihood of presenting with severe disease (57.6% vs 38.5%; P <.001; odds ratio [95% confidence interval], 2.073 [1.37–3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs 6.0%; P <.001) and QuantiFERON-TB Gold assay (30.0% vs 7.3%; P <.001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs 49.3%; P =.083). Although the mortality in children with IC was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs 6.1%; P =.004). Conclusions Children with IC and TB in Europe have increased rates of nonrespiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in patients with IC, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusion Pediatric multiple sclerosis (MS) displays different pathological features compared to adult MS, which can be studied in vivo by assessing tissue magnetic susceptibility with 3T‐MRI. We aimed to assess different white matter lesions (WMLs) phenotypes in pediatric MS patients using quantitative susceptibility mapping (QSM) and susceptibility mapping weighted imaging (SMWI) over 12 months.Eleven pediatric MS patients [female: 63.6%; mean ± standard deviation (SD) age and disease duration: 16.3 ± 2.2 and 2.4 ± 1.5; median (range) Expanded Disability Status Scale (EDSS) 1 (0‐2)] underwent 3 Tesla‐MRI exams and EDSS assessments at baseline and after 1 year. QSM and SMWI were obtained using 3‐dimensional (3D)‐segmented echo‐planar‐imaging with submillimetric spatial resolution. WMLs were classified according to their QSM appearance and SMWI was used to identify QSM hyperintensities ascribable to veins. Total brain volumes at baseline and follow‐up were computed using high‐resolution 3D T1‐weighted images.Mean ± SD paramagnetic rim lesions (PRLs) prevalence was 7.0% ± 9.0. Fifty‐four percent (6/11) of patients exhibited at least one PRL, with one patient exhibiting ≥ 4 PRLs. All patients showed QSM‐iso‐/hypo‐intense lesions, which represented a mean ± SD of 65.8% ± 22.7 of total WMLs. QSM‐hyperintense WMLs showed a positive correlation with total brain volume reduction at follow‐up (r = 0.705; p =  .02). No lesion was classified as different between baseline and follow‐up.Chronic compartmentalized inflammation seems to occur early in pediatric MS patients with short disease duration. A high prevalence of iso‐/hypo‐intense lesions was found, which could account for the higher remyelination potential in pediatric MS. [ABSTRACT FROM AUTHOR]

The first postmortem neuropathological findings of a hemiparkinsonism and hemiatrophy (HPHA) patient are presented. A 50‐year‐old man developed resting tremors affecting the right hand and leg, followed by mild clumsiness of the right hand. On examination, he exhibited muscle atrophy of the right leg extremity, accompanied by right‐sided parkinsonism. Brain magnetic resonance imaging was normal. Based on the clinical and radiological findings, HPHA syndrome was diagnosed, showing a good response to L‐DOPA. He gradually developed muscular atrophy of the right distal upper extremity. Thirteen years after the onset of the disease, left‐sided parkinsonism appeared. The patient died of Trousseau's syndrome associated with a rapidly emerging pancreatic tumor. The total duration of the disease was 14 years. Neuropathologically, the substantia nigra showed markedly left‐predominant neuronal loss, along with almost symmetrical Lewy body (LB) pathology. These findings indicated that the patient originally had fewer neurons in the left substantia nigra than in the right, probably caused by congenital or childhood cerebral injury, followed by the development of unilateral parkinsonism due to the progression of LB pathology. Despite our extensive neuropathological analysis, we could not specify the etiology or anatomical substrate responsible for the development of right upper and lower extremity atrophy. Further clinicopathological studies are needed to elucidate the pathoanatomical areas causing hemiparkinsonism and hemiatrophy. [ABSTRACT FROM AUTHOR]

Background: To investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS). Methods: This comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared. Results: Thirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P < 0.001). The mean SCCT, CMT, and CMV were higher in eyes with FUS than in fellow eyes (P < 0.05). Conclusions: The result of our study demonstrated that affected eyes in patients with FUS tend to have thinner SCT and thicker SCCT and CMT compared to uninvolved fellow eyes. [ABSTRACT FROM AUTHOR]

Introduction: People with Parkinson's Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear. Methods: We analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson's Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods. Results: Freezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior-posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047). Conclusion: APA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk. [ABSTRACT FROM AUTHOR]

Introduction: Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease. In which, in addition to pharmacotherapy, regimen measures play an integral role in complex therapy, including physical activity. Many clinical studies have demonstrated the positive effect of regular physical activity on on the symptoms of the disease, yet people with the disease seem to be insufficiently physically active. Therefore, the aim of our study was to evaluate the level of and type of physical activity that people with MS in the Czech Republic engage in, and how their exercise regimen was affected by the impact of the coronavirus pandemic. Methodology: The study was realized in the form of an international questionnaire survey. Only results from Czech patients are presented in this paper. Results: A total of 265 people with MS (55 men) participated in the study, from newly diagnosed to chronic stage patients (with disease duration of more than 20 years). The majority of respondents (more than 80%) engaged in some form of exercise, with walking, health exercises or cycling being the most common activities. However, only 64% were meeting the recommended amount of exercise according to the guidelines. The use of modern technology in exercise activities also increased significantly during the pandemic. Conclusion: Information on patients' usual exercise regimens can help neurologists and rehabilitation professionals to better plan exercise and physical activities for this group of patients. [ABSTRACT FROM AUTHOR]

Background/Aims: The objectives of our study were to determine salivary α-amylase activity (stress biomarker) and its association with psychological status and quality of life (QoL), disease duration and intensity of symptoms (pain/burning) in patients with OLP. Methods: A total of 50 subjects participated in this case-control study: 30 patients with oral lichen planus (OLP); 20 control subjects. Unstimulated whole saliva (UWS) was collected between 9 and 10 am to avoid diurnal fluctuations. Psychological status was assessed using the Croatian validated version of the original Depression, Anxiety and Stress Scale (DASS-21). The impact of oral health on QoL was assessed using the Croatian version of the Oral Health Impact Profile Questionnaire (OHIP-CRO14). Results: There was no statistically significant difference in salivary α-amylase activity between patients with OLP (N=30) and control subjects (N=20) (133813.3 vs. 166815.5 U/L, p=0.314; t-test). Depression, anxiety and stress showed no statistically significant difference between patients with OLP and control subjects (p=0.076, p=0.111, p=0.209; t-test). The patients with OLP had statistically significantly poorer QoL (total) compared to control subjects (p=0.004, t-test). There was a moderate positive correlation between symptom intensity (pain/burning) and poor QoL (total) (r=0.584, p<0.001), the OHIP-CRO14 dimension "physical pain" (r=0.661, p<0.001), "psychological impossibility" (r=0.555, p<0.01), "handicap" (r=0.546, p<0.01). Conclusion: Although salivary α-amylase showed no statistically significant difference between patients with OLP and control subjects, the patients with OLP had poorer psychological status (three times higher scores for depression and two times higher scores for anxiety) and poorer QoL compared to the control subjects. Recognising and treating mental disorders in patients with OLP is important in order to break the „vicious circle” and achieve a better QoL in these patients. [ABSTRACT FROM AUTHOR]

Background and Objective: Primary hemifacial spasm (HFS) is caused by neurovascular conflict (NVC) at the root entry zone of the facial nerve. Whether reduction of posterior cranial fossa (PCF) cerebrospinal fluid (CSF) volume is a risk factor for HFS is not clear. The study aims at the radiologic assessment of PCF CSF volume and its clinical correlation. Methods: A cross-sectional, hospital-based, case--control study was conducted, in which 50 cases of primary HFS and 50 age- and sex-matched controls were recruited. PCF CSF volume was quantified in 3-T brain magnetic resonance imaging. Results: The mean age at presentation of cases was 50.7 ± 10.7 years (42-69 years) and controls was 52.4 ± 8.7 years (45-68 years). The mean duration of symptoms was 3.5 ± 1.3 years (1.5-8 years). About 52% of patients had grade 2 (mild) severity of HFS. The mean PCF CSF volume of patients was 13,725.1 ± 909.5 mm3 and controls was 14,458.5 ± 973.5 mm³p (P < 0.001). The mean PCF CSF volume of females with HFS was 13,714.8 ± 852.5 mm³ and female controls was 14,521.8 ± 973.5 mm³ (P = 0.006). PCF CSF volume was significantly associated with the presence of HFS (P = 0.007), the severity of HFS (P < 0.001), and the presence of NVC (P = 0.02). Conclusion: PCF CSF volume was lesser in HFS patients and was associated with the presence of HFS, the severity of HFS, and the presence of NVC. Females with HFS had smaller PCF CSF volume. Small PCF CSF volume is a risk factor for HFS, particularly in females with HFS. [ABSTRACT FROM AUTHOR]

Introduction/Aims Methods Results Discussion Despite being a prominent feature of myasthenia gravis (MG), extraocular muscle (EOM) has received little attention in clinical research. The aim of this study was to examine EOM volume in patients with MG and controls using time‐of‐flight magnetic resonance angiography (TOF‐MRA).EOM volumes (overall and individual rectus muscles) were calculated using TOF‐MRA images and compared between MG patients (including subgroups) and controls. The correlation between EOM volume and disease duration was examined. Predictive equations for the selected parameters were developed using multiple linear regression analysis.EOM volume was lower in MG patients than controls, especially in MG patients with ophthalmoparesis (MG‐O). MG‐O exhibited a moderate negative correlation between EOM volume and disease duration. Multiple linear regression showed that disease duration and EOM status (ophthalmoparesis or not) account for 48.4% of EOM volume.Patients with MG show atrophy of the EOMs, especially those with ophthalmoparesis and long disease duration. [ABSTRACT FROM AUTHOR]

Objectives: In clinical trials, tocilizumab (TCZ) is efficacious in patients with giant cell arteritis (GCA). This study evaluated the real-world tolerability and effectiveness of TCZ in Japanese patients with GCA. Methods: In this multicentre, prospective, Phase 4, large-scale, observational study, patients with GCA (with no TCZ treatment 6 months before the study) were recruited from 71 centres across Japan. Patients received subcutaneous TCZ 162 mg weekly (observation period, 52 weeks). Results: Of the 117 patients [female, 70.1%; mean age, 74.2 years; mean disease duration, 1.4 years; treated for new-onset GCA, 71.8%; presence of large-vessel lesions (LVLs), 61.5%; previous immunosuppressant use, 28.2%; glucocorticoids at baseline, 95.7% (mean: 22.4 mg/day)], 38.5% reported adverse events. The most common adverse events of special interest were neutropaenia and leukopaenia (7.7%), followed by serious infection (6.0%). The relapse-free proportion was 85.0%; relapse after remission, 6.0%; and no remission, 9.0%. At the last observation, 94.2% of relapse-free patients received a concomitant glucocorticoid dose of <10 mg/day. Fatigue, headache, neck pain, and absence of LVLs were positively associated with the relapse. Conclusions: TCZ was effective and well tolerated in Japanese patients with GCA and may be an effective treatment option combined with glucocorticoids. [ABSTRACT FROM AUTHOR]

Introduction: Evaluating the Health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD) holds significant importance in clinical and research settings. The EQ-5D is a widely recognized tool for comprehensive measurement of HRQoL using utility values. This study aims to systematically review and synthesize EQ-5D utility values from existing literature on patients with PD and their caregivers. Methods: We conducted a systematic search for studies that provided EQ-5D utility scores for patients with PD, using PubMed-Medline, Scopus, and Embase and selected the studies. The selected studies underwent systematic review, including an assessment of their quality. We performed a meta-analysis using a random-effect model and conducted a meta-regression analysis to investigate sources of heterogeneity among the studies. Results: The search result of 13,417 articles that were reviewed, 130 studies with 33,914 participants were selected for systematic review, and 79 studies were included for meta-analysis. The pooled EQ-5D utility values and visual analog score (VAS) among PD were 62.72% (60.53–64.93, I2 = 99.56%) and 0.60 (0.55–0.65, I2 = 99.81%), respectively. The pooled scores for caregivers' EQ-VAS and EQ-5D utility were 70.10% (63.99–76.20, I2 = 98.25%) and 0.71 (0.61–0.81, I2 = 94.88%), respectively. Disease duration (P < 0.05) showed a negative correlation with EQ-5D utility values on meta-regression. Conclusion: The pooled utility values of PD and their caregivers help to understand their HRQoL and aid in conducting health economics research. The negative association between disease duration and utility values highlights the evolving nature of HRQoL challenges, suggesting the need for appropriate long-term disease management. [ABSTRACT FROM AUTHOR]

Behçet's syndrome (BS) is a variant vasculitis that can involve multiple organs with inflammatory manifestations. This study aimed to provide a more comprehensive analysis of the clinical phenotypes and characteristics of BS patients. We enrolled 2792 BS patients referred from China nationwide to Huadong Hospital Affiliated to Fudan University from October 2012 to December 2022. Detailed assessments of demographic information, clinical manifestations, laboratory results, gastroscopy, and medical imaging were conducted. Cluster analysis was performed based on 13 variables to determine the clinical phenotypes, and each phenotype was characterized according to the features of BS patients. A total of 1834 BS patients were included, while 958 invalid patients were excluded. The median age at onset was 31 years (IQR, 24–40 years), and the median disease duration was 10 years (IQR, 5–15 years). Eight clusters were identified, including mucocutaneous (n = 655, 35.7%), gastrointestinal (n = 363, 19.8%), articular (n = 184, 10%), ocular (n = 223, 12.2%), cardiovascular (n = 119, 6.5%), neurological (n = 118, 6.4%), vascular (n = 114, 6.2%), and hematological phenotype (n = 58, 3.2%). Ocular (RR = 1.672 (95% CI, 1.327–2.106); P < 0.001), gastrointestinal (RR = = 1.194 (95% CI, 1.031–1.383); P = 0.018), cardiovascular (RR = = 2.582 (95% CI, 1.842–3.620); P < 0.001), and vascular (RR = = 2.288 (95% CI, 1.600–3.272); P < 0.001) involvement were more prevalent in male BS patients, while the hematological (RR = 0.528 (95% CI, 0.360–0.776); P = 0.001) involvement was more common among female patients. BS presents significant heterogeneity and gender differences. The eight phenotypes of BS patients we propose hold the potential to assist clinicians in devising more personalized treatment and follow-up strategies. Key Points • This cluster analysis divided adult-onset BS into eight clinical phenotypes. • BS demonstrates a high level of clinical heterogeneity and gender differences. • Hematologic phenotypes of BS present distinctive clinical characteristics. [ABSTRACT FROM AUTHOR]

Background: To examine the willingness of older patients to take less diabetes medication (de‐intensify) and to identify characteristics associated with willingness to de‐intensify treatment. Methods: Survey conducted in 2019 in an age‐stratified, random sample of older (65–100 years) adults with diabetes on glucose‐lowering medications in the Kaiser Permanente Northern California Diabetes Registry. We classified survey responses to the question: "I would be willing to take less medication for my diabetes" as willing, neutral, or unwilling to de‐intensify. Willingness to de‐intensify treatment was examined by several clinical characteristics, including American Diabetes Association (ADA) health status categories used for individualizing glycemic targets. Analyses were weighted to account for over‐sampling of older individuals. Results: A total of 1337 older adults on glucose‐lowering medication(s) were included (age 74.2 ± 6.0 years, 44% female, 54.4% non‐Hispanic white). The proportions of participants willing, neutral, or unwilling to take less medication were 51.2%, 27.3%, and 21.5%, respectively. Proportions of willing to take less medication varied by age (65–74 years: 54.2% vs. 85+ years: 38.5%) and duration of diabetes (0–4 years: 61.0% vs. 15+ years: 44.2%), both p < 0.001. Patients on 1–2 medications were more willing to take less medication(s) compared with patients on 10+ medications (62.1% vs. 46.6%, p = 0.03). Similar proportions of willingness to take less medications were seen across ADA health status, and HbA1c. Willingness to take less medication(s) was similar across survey responses to questions about patient‐clinician relationships. Conclusions: Clinical guidelines suggest considering treatment de‐intensification in older patients with longer duration of diabetes, yet patients with these characteristics are less likely to be willing to take less medication(s). See related Editorial by Pilla and Maruthur [ABSTRACT FROM AUTHOR]

We aimed to examine the drug retention rate (DRR) of the interleukin-17 inhibitor ixekizumab in a real-world monocentric cohort of psoriatic arthritis (PsA) patients and to assess the predictors of drug discontinuation. Consecutive PsA patients who underwent treatment with ixekizumab from October 2019 to February 2023 were enrolled in this observational, retrospective, monocentric study. Clinical records were assessed at baseline and throughout the follow-up period. We collected sociodemographic data, smoking habits, body mass index, the presence of Human Leukocyte Antigen B27, comorbidities, disease involvement and duration, previous therapy, discontinuation of ixekizumab, reasons for discontinuation, and adverse events (AEs). DRR was evaluated as time to drug discontinuation and assessed through Kaplan–Meier curves. Baseline factors predicting drug discontinuation were investigated through logistic regression models. Eighty PsA patients were included in this study. Ixekizumab was administered at a dose of 160 mg by subcutaneous injection at baseline, followed by 80 mg every four weeks thereafter. Ixekizumab had a 38-month-cumulative DRR of 43.8%, accounting for both inefficacy and AEs. When considering only inefficacy, the DRR was 62.6%. Comorbidities (p = 0.665), obesity (p = 0.665), smoking (p = 0.884), disease duration ≤ 2 years (p = 0.071), axial (p = 0.131) and skin involvement (p = 0.460), and previous therapies, including conventional synthetic (p = 0.504) and biological (p = 0.474) Disease-Modifying Antirheumatic Drugs (bDMARDs), as well as the number of previous bDMARDs or targeted synthetic Disease-Modifying Antirheumatic Drugs (tsDMARDs), did not significantly affect the DRR (p = 0.349). Multivariate analysis found no independent predictors of drug discontinuation. The most frequent AEs leading to discontinuation were skin reactions; no severe infections were observed. In our real-world study, comorbidities, disease duration, and previous therapies did not affect the DRR of ixekizumab. Ixekizumab had a favorable safety profile, with no severe AEs observed. [ABSTRACT FROM AUTHOR]

Background: Interstitial lung disease (ILD) represents a frequent cause of morbidity and mortality in primary Sjogren syndrome (pSS). However, the prevalence and behavior of pSS-ILD remains incomplete, largely based on retrospective heterogeneous studies. Aim of the study: To investigate the prevalence of progressive pulmonary fibrosis (PPF) in a multicentric cohort of patients with pSS-ILD. Additionally, this study explored possible correlations between PPF and clinical, demographic, and serological features of pSS. Methods: All consecutive patients with pSS-ILD were enrolled in a 6-month period. Clinical, demographic, and serological features of pSS, other than functional and radiological lung features, were collected. Clinical behaviors of ILD other than PPF were also investigated. Results: Seventy-two patients were enrolled. A fibrosing ILD pattern was observed in 65.3% of patients with pSS-ILD; among them, 55.3% showed a PPF. The radiologic pattern (NSIP, UIP, or others) was not associated with PPF; in particular, patients with PFF had UIP in 42.3% of cases and NSIP in 57.7%, without a significant difference with respect to the non-PPF group (p = 0.29). Shorter pSS disease duration, higher age at pSS diagnosis, and lower frequency of antinuclear antibodies were correlated with the PPF subgroup. However, multivariate analysis did not confirm these associations. Discussion: This study provides valuable insights into the prevalence and characteristics of PPF in pSS-ILD. In particular, UIP and NSIP showed a similar evolution towards PPF in patients with pSS; for NSIP, this behavior was more frequent than for other rheumatic diseases. Our results emphasize the importance of early recognition of PPF for timely intervention and careful follow-up. Conclusions: This study provides valuable insights into the prevalence and characteristics of PPF in pSS-ILD. In particular, UIP and NSIP showed a similar evolution towards PPF in patients with pSS; for NSIP, this behavior was more frequent than for other rheumatic diseases. Our results emphasize the importance of early recognition of PPF for timely intervention and careful follow-up. [ABSTRACT FROM AUTHOR]

This study aimed to ascertain the effects of health education combined with nutrition support nursing on the nutritional status and quality of life of patients with pulmonary tuberculosis. A clinical study was conducted. Sixty-four patients with tuberculosis were selected as the study participants and divided into control and observation groups (n = 32). Both groups received antituberculosis drugs. The control group received standard nursing care, while the observation group received health education in conjunction with nutrition support nursing. After 3 months of intervention, the total effective treatment rate and adherence were compared. Before and after the intervention, the albumin (ALB), prealbumin (PA), transferrin (TF), and hemoglobin (Hb) level, body mass index (BMI), and Short Form-36 (SF-36) scores were compared. The occurrence of adverse reactions during intervention was recorded. Following the intervention, the observation group exhibited a higher treatment total effective rate and increased levels of ALB, PA, TF, Hb, and BMI compared with the control group (p < 0.05). The observation group demonstrated a higher total adherence rate and a lower incidence of adverse reactions compared with the control group (p < 0.05); the SF-36 score of the observation group was higher than that of the control group (p < 0.05). The integration of health education and nutrition support nursing can effectively enhance the therapeutic outcomes of patients with pulmonary tuberculosis. This approach not only improves their nutritional status, treatment adherence, and quality of life, but also reduces the incidence of adverse reactions. The findings of this study lay a solid foundation for further exploration of the combined effects of health education and nutrition support nursing on pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

• Avalanche transition matrices are used to investigate the spatio-temporal spreading of neuronal avalanches in ALS; • ALS patients present higher values of the nodal strength in both cortical and sub-cortical brain areas, as compared to controls; • The nodal strength directly correlates with disease duration, corroborating the clinical relevance of brain dynamics. To test the hypothesis that patients affected by Amyotrophic Lateral Sclerosis (ALS) show an altered spatio-temporal spreading of neuronal avalanches in the brain, and that this may related to the clinical picture. We obtained the source-reconstructed magnetoencephalography (MEG) signals from thirty-six ALS patients and forty-two healthy controls. Then, we used the construct of the avalanche transition matrix (ATM) and the corresponding network parameter nodal strength to quantify the changes in each region, since this parameter provides key information about which brain regions are mostly involved in the spreading avalanches. ALS patients presented higher values of the nodal strength in both cortical and sub-cortical brain areas. This parameter correlated directly with disease duration. In this work, we provide a deeper characterization of neuronal avalanches propagation in ALS, describing their spatio-temporal trajectories and identifying the brain regions most likely to be involved in the process. This makes it possible to recognize the brain areas that take part in the pathogenic mechanisms of ALS. Furthermore, the nodal strength of the involved regions correlates directly with disease duration. Our results corroborate the clinical relevance of aperiodic, fast large-scale brain activity as a biomarker of microscopic changes induced by neurophysiological processes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive‐behavioral therapy (CBT‐E) in patients aged between 12 and 18 years with anorexia nervosa with a duration of illness <3 versus ≥3 years. Methods: One hundred and fifty‐nine consecutively treated patients (n = 122 with illness duration <3 years and n = 37 ≥ 3 years) were enrolled in a 20‐week intensive CBT‐E program. All patients underwent assessment at admission, end of treatment (EOT), and 20‐week follow‐up. The following measures were used: body mass index (BMI)‐for‐age percentile and percentage of expected body weight (EBW), Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment. Results: Approximately 81% of eligible patients began the program, with over 80% successfully completing it. Patients with a longer or shorter duration of illness did not show significantly different treatment outcomes. In detail, BMI‐for‐age percentile and percentage of EBW outcomes were significantly improved from baseline to EOT, remaining stable until 20‐week follow‐up in both groups. Similarly, in both groups, scores for eating disorder psychopathology, general psychopathology, and clinical impairment decreased significantly at EOT and remained stable from EOT to follow‐up. Furthermore, a substantial percentage of adolescents in both groups achieved a good BMI outcome at EOT and 20‐week follow‐up, with approximately 60% maintaining a full response at the latter time point. Discussion: These findings suggest that intensive CBT‐E appears to be an effective treatment for severely ill adolescent patients with anorexia nervosa, regardless of whether the duration of illness is shorter or longer than 3 years. Public Significance: Existing treatment outcome studies in adolescents, whether randomized controlled trials or longitudinal investigations, typically involve patients with less than 3 years of illness, while data on the treatment outcomes for adolescents with anorexia nervosa with an illness duration of 3 years or over is very limited. Our findings suggest that adolescents with anorexia nervosa, irrespective of the duration of their illness, can derive similar benefits from intensively CBT‐E. [ABSTRACT FROM AUTHOR]

Heterozygous RTN2 variants have been previously identified in a limited cohort of families affected by autosomal dominant spastic paraplegia (SPG12-OMIM:604805) with a variable age of onset. Nevertheless, the definitive validity of SPG12 remains to be confidently confirmed due to the scarcity of supporting evidence. In this study, we identified and validated seven novel or ultra-rare homozygous loss-of-function RTN2 variants in 14 individuals from seven consanguineous families with distal hereditary motor neuropathy (dHMN) using exome, genome and Sanger sequencing coupled with deep-phenotyping. All affected individuals (seven males and seven females, aged 9–50 years) exhibited weakness in the distal upper and lower limbs, lower limb spasticity and hyperreflexia, with onset in the first decade of life. Nerve conduction studies revealed axonal motor neuropathy with neurogenic changes in the electromyography. Despite a slowly progressive disease course, all patients remained ambulatory over a mean disease duration of 19.71 ± 13.70 years. Characterization of Caenorhabditis elegans RTN2 homologous loss-of-function variants demonstrated morphological and behavioural differences compared with the parental strain. Treatment of the mutant with an endoplasmic/sarcoplasmic reticulum Ca2+ reuptake inhibitor (2,5-di-tert-butylhydroquinone) rescued key phenotypic differences, suggesting a potential therapeutic benefit for RTN2-disorder. Despite RTN2 being an endoplasmic reticulum (ER)-resident membrane shaping protein, our analysis of patient fibroblast cells did not find significant alterations in ER structure or the response to ER stress. Our findings delineate a distinct form of autosomal recessive dHMN with pyramidal features associated with RTN2 deficiency. This phenotype shares similarities with SIGMAR1-related dHMN and Silver-like syndromes, providing valuable insights into the clinical spectrum and potential therapeutic strategies for RTN2-related dHMN. [ABSTRACT FROM AUTHOR]

Introduction: Atypical or nontuberculous mycobacteria (NTM) are an environmental organism responsible for opportunistic infection. Rapid-growing NTM are more commonly associated with hospital-acquired infections. Many of the organisms responsible for diseases in immunocompromised patients and hospital-acquired infections originate from tap water, such as Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium gordonae, Mycobacterium simiae, Mycobacterium mucogenicum, Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus. NTM is a rare organism responsible for the injection abscess. Considering low incidents, not much clinical data are available for this condition. Here, we discuss such cases which can be helpful to spread awareness and provide data for future policy makers. Materials and Methods: This was a retrospective study. Data on patients with injection abscess were collected from the last 6 years. Detailed history and clinical examination findings were analyzed. Children with injection abscess were operated and their further management and outcome were studied. Results: A total of 13 cases with confirmed culture of NTM were treated over 6 years. The age ranged from 2 1/2 months to 5 3/4 years with male:female ratio of 7:6. All patients hailed from the same geographical area. All children were healthy with no history of any long-term or chronic illness, without additional symptoms and had received Bacillus Calmette-Guérin vaccination at birth. The total duration of illness varied from 1 to 5 months, with a mean of 3 months. All patients had a history of intramuscular age-appropriate vaccination as per the national immunization schedule. All patients were followed up to 6 months after intervention and none of our patients developed relapse. Conclusion: Patient who does not respond with optimum treatment should have a high suspicion of such opportunistic infection, which is crucial to their management. Hospital-acquired NTM infections often result from contaminated instruments or fluids. Adherence to strict aseptic precautions, hand hygiene and environmental precautions are the key to preventing these infections. In case of skin and soft tissue infections / abscesses, surgical intervention plays a significant role for managing the patient. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q) and investigate its validity and reliability. Methods: After translating the NFOG-Q according to a standardised protocol, 56 patients with Parkinson's disease (PD) were administered it. Additionally, the MDS-UPDRS parts II and III, Hoehn and Yahr (H&Y) stage, and number of falls over 1 month were evaluated. Spearman's correlation coefficients (rho) were used to determine construct validity, and Cronbach's alpha (α) was used to examine reliability. Results: The interquartile range of the NFOG-Q scores was 10.0–25.3 (range 0–29). The NFOG-Q scores were strongly correlated with the MDS-UPDRS part II, items 2.12 (walking and balance), 2.13 (freezing), 3.11 (freezing of gait), and 3.12 (postural stability) and the postural instability and gait difficulty score (rho = 0.515–0.669), but only moderately related to the MDS-UPDRS item 3.10 (gait), number of falls, disease duration, H&Y stage, and time of the Timed Up-and-Go test (rho = 0.319–0.434). No significant correlations were observed between age and the time of the 10-m walk test. The internal consistency was excellent (α = 0.96). Conclusions: The Japanese version of the NFOG-Q is a valid and reliable tool for assessing the severity of freezing in patients with PD. [ABSTRACT FROM AUTHOR]

There is wide variation in the time from the onset to secondary progressive multiple sclerosis (MS) and some controversy regarding the clinical characteristics of the courses (phenotypes) of MS. The present study aimed to characterize demographic and clinical factors that potentially influence long-term disability progression in the cohort of Latvian MS patients. A descriptive longitudinal incidence study was conducted using a cohort of 288 MS patients beginning in 2011 (disease duration from 1 to 51 years). Socio-demographic and clinical information from the first visit to 15/20 years was analysed in groups stratified by gender and visits at five-time points (the first visit; after a year or 2; after 5 ± 1 year; after 10 ± 2 years; after 15–20 years). Our study was dominated by patients from urban areas and non-smokers. The female/male ratio was 2.4:1; the distribution of clinical courses at the first visit was consistent with most European studies. The most common symptom at presentation in our study was optic manifestations, followed by sensory disturbances and motor deficits. In the Latvian study, gender was not a significant influencing factor on the rate of disease progression; however, patient age was statistically significantly associated with EDSS (Expanded Disability Status Scale) value at the first visit. Early clinical features of MS are important in predicting the disability accumulation of patients. Despite the small differences regarding the first MS symptoms, the disability outcomes in the cohort of Latvian patients are similar to other regions of the world. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment (CI) is a frequent symptom of multiple sclerosis (MS) and has a great impact on the patients' quality of life, so screening is essential. The brief international cognitive assessment for multiple sclerosis (BICAMS) was developed for this purpose. However, longitudinal data is lacking with the use of the battery. Objective: This study is to assess the performance of patients after 5 and 7 years of the original BICAMS validation study and to identify any influencing factors. Methods: BICAMS was used to measure cognitive function of 52 relapsing-remitting MS patients (RRMS) from the original validation study after 5 years (n = 43) and again, after 7 years (n = 42). Patients filled out the fatigue impact scale (FIS) and multiple sclerosis quality of life-54 (MSQoL-54) questionnaire, and we evaluated expanded disability status scale (EDSS). Results: There was an improvement in the BVMT-R and the CVLT-II assessments at both the 5-year (p<0.001 and p=0.025) and the 7-year retest (p<0.001 and p=0.002). The prevalence of CI significantly decreased at the 5-year mark (p=0.021) but remained stable after that. There was no deterioration in MSQoL scores during the study. The basic cognitive performance is the most important influencing factor, but the duration of the disease, the EDSS score, and the escalation of the therapy also affect the cognitive scores. Conclusion: This is the longest longitudinal study utilizing the BICAMS battery, reinforcing its feasibility as a clinical screening tool. It seems that cognitive performance may improve in the long term and early initiation of effective therapy may influence this outcome. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the benefit of inpatient treatment in reducing disease activity in patients with complex regional pain syndrome (CRPS) who have exhausted outpatient options. Furthermore, the study sought to identify patient-related outcome variables that predict a reduction in disease activity. Methods The primary outcome was disease severity (CRPS Severity Score, range 0-16 points). Secondary outcomes included depression, anxiety, physical function, pain interference, fatigue, sleep disturbance, and the ability to participate in social roles and activities, all of which were assessed using the PROMIS-29. Furthermore, pain catastrophizing, neuropathic pain, quality of life, pain self-efficacy, medication intake, and the patient's global impression of change were examined in accordance with current international agreed recommendations, assessed at discharge, 3-month, and 6-month post-discharge. Mixed-effects models were conducted to identify baseline variables associated with CRPS severity. Results Twenty-five patients completed the program (mean age 49.28 [SD 11.23] years, 92% females, mean symptom duration 8.5 [SD 6.5] months). Results showed a significant reduction between baseline and discharge of disease activity (CSS −2.36, P  < .0001), pain (PROMIS-29 pain −0.88, P  = .005), and emotional function (PROMIS-29 depression −5.05, P  < .001; fatigue −4.63, P  = .002). Moderate evidence for a reduction between baseline and discharge could be observed for pain interference (+2.27, P  = .05), social participation (PROMIS-29 + 1.93, P  = .05), anxiety (PROMIS-29 −3.32, P  = .02) and physical function (PROMIS-29 + 1.3, P  = .03). On discharge, 92% of patients (23 of 25) reported improvement in their overall condition. In the follow-up period, medication intake could be reduced after 3 (MQS −8.22, P  = .002) and 6 months (MQS −8.69, P  = .001), and there was further improvement in social participation after 3 months (PROMIS-29 + 1.72, 0.03) and sleep after 6 months (PROMIS-29 + 2.38, 0.008). In the mixed models, it was demonstrated that patients experiencing less pain at baseline also exhibited lower disease activity. Conclusion The results of this study confirm that inpatient interdisciplinary treatment of CRPS patients improves disease activity, pain, physical function, emotional function, and social participation. Most improvements were maintained for up to 6 months after discharge. The majority of patients reported that their overall condition had improved during the study period. [ABSTRACT FROM AUTHOR]

We investigated the extent of literature and findings on relationships between vestibular issues, noise sensitivity (NS), and anxiety. We were interested in how relationships among these factors impacted adults' recovery three months or more after mild traumatic brain injury (mTBI). We conducted a scoping review to evaluate the extent of evidence linking relationships between vestibular issues, NS and anxiety with recovery after mTBI. Data relating to study characteristics and key findings were extracted and used to inform a critical narrative synthesis of findings. After screening and full-text review, we included two studies. Both studies considered the combination of vestibular issues, NS and anxiety and mTBI recovery. Vestibular issues, NS and anxiety were all significantly associated with one another and their presence was the strongest indicator that symptoms would extend beyond three-months after mTBI. Few studies have focused on the relationships that vestibular issues, NS and anxiety have with one another and recovery after mTBI. Given the apparent strong relationships between these factors and prolonged recovery, we highlight this as an area warranting further investigation. Vestibular issues, noise sensitivity and anxiety all appear to impact on recovery from mild traumatic brain injury. There appear to be quite strong relationships between vestibular, noise sensitivity and anxiety symptoms following mild traumatic brain injury. More work exploring these key symptoms and how they impact recovery from mild traumatic brain injury using a wide range of study methods and approaches are needed to advance the field. [ABSTRACT FROM AUTHOR]

Background: In this study, we decided to investigate the state of depression, anxiety, and quality of life and its relationship with some demographic characteristics of lung neoplasm patients who were candidates for surgery. Materials and Methods: In a cross-sectional study, all patients with lung neoplasm who were referred to medical centers affiliated to Isfahan University of Medical Sciences and were candidate for lung surgery in 2020--2021. Based on the inclusion and exclusion criteria, 52 people were assigned to the study consecutively. Then, the patients completed the demographic information questionnaire, the Hospital Anxiety and Depression Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) (EORTC QLQ-C30). Results: The score of depression and anxiety was normal (range 7-0) and the score of quality of life was in the relatively good range (50-175). As the patient's age increases (P = 0.014) and the duration of the disease increases (P = 0.041), the level of depression increases significantly. People with higher education had lower depression (P = 0.001) and anxiety (P = 0.003). People living in the city had a significantly better quality of life (P = 0.039). The higher the depression (P < 0.0001) and anxiety (P = 0.037) of the people, the lower the quality of life of the patients. Conclusion: As anxiety and depression increase, the quality of life of lung neoplasm patients decreases. Some demographic characteristics such as old age, insufficient education, rurality, and increased duration of the disease can be the risk factors for depression, anxiety, and reduced quality of life of patients with lung neoplasm. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) patients are frequently exposed to antidepressant medications (ADMs). Norepinephrine (NE) and serotonin (5HT) systems have a role in levodopa-induced dyskinesias (LID) pathophysiology. Methods: We performed a longitudinal analysis on the PPMI cohort including drug-naïve PD patients, who are progressively exposed to dopamine replacement therapies (DRTs) to test the effect of ADM exposure on LID development by the 4th year of follow-up. Results: LID prevalence (according to MDS UPDRS score 4.1 ≥ 1) was 16% (42/251); these patients were more likely women (p = 0.01), had higher motor (p < 0.001) and depression scores (p = 0.01) and lower putaminal DAT binding ratio (p = 0.01). LID were associated with the exposure time to L-DOPA (2.2 ± 1.07 vs 2.6 ± 0.9, p = 0.02) and to the exposure to ADMs, in particular to SNRI (4.8% vs 21.4%, p < 0.001). The latter persisted after correcting for significant covariates (e.g., disease duration, cognitive status, motor impairment, depression, dopaminergic denervation). A similar difference in LID prevalence in PD patients exposed vs non-exposed to SNRI was observed on matched data by the real-world TriNetX repository (22% vs 13%, p < 0.001). Discussion: This study supports the presence of an effect of SNRI on LID priming in patients with early PD. Independent prospective cohort studies are warranted to further verify such association. [ABSTRACT FROM AUTHOR]

Background: GNE myopathy is an ultra-rare autosomal recessive distal myopathy caused by pathogenic variants of the GNE gene, which encodes a key enzyme in sialic acid biosynthesis. The present study aimed to examine the long-term progression of GNE myopathy, genotype–phenotype correlations, and complications to provide useful information for predicting patient progression and designing clinical trials using a large collection of registry data over a 10-year period. Methods: We analyzed 220 Japanese patients with GNE myopathy from a national registry in Japan. Diagnoses were confirmed by genetic curators based on genetic analysis reports. We analyzed registration sheets and annually updated items completed by attending physicians. Results: In total, 197 of 220 participants (89.5%) carried p.D207V or p.V603L in at least one allele. The median disease duration to loss of ambulation was estimated to be 10 years in p.V603L homozygotes (n = 48), whereas more than 90% of p.D207V/p.V603L compound heterozygotes were estimated to be ambulatory even 20 years after disease onset according to Kaplan–Meier analysis (p < 0.001). Moreover, participants with a younger age of onset lost ambulation earlier regardless of genotype. A decline in respiratory function was observed as the disease progressed, particularly in p.V603L homozygotes, whereas none of the p.D207V/p.V603L compound heterozygotes showed a decline. Conclusions: The present study demonstrated large differences in disease progression and respiratory function between genotypes. Moreover, age of onset was found to be an indicator of disease severity regardless of genotype in GNE myopathy patients. These results may help stratify patients in clinical trials and predict disease progression. [ABSTRACT FROM AUTHOR]

Introduction: Incorporation of the real-time quaking-induced conversion (RT-QuIC) assays for diagnosis of sporadic Creutzfeldt-Jakob disease (CJD) has transformed diagnosis largely related to its extremely high specificity. However, the test has a c.10% false-negative result and we aim to characterize the clinical features, investigation profile, and molecular subtype in this cohort of patients. Methods: 250 individuals diagnosed with definite sporadic CJD were identified from the UK National CJD Research and Surveillance Unit from 2012 to 2023. We compared the clinical features and investigation profile in those with a negative CSF RT-QuIC to those with a positive RT-QuIC. Results: 27 individuals (10.8%) were CSF RT-QuIC negative. Median age of onset was younger (62 years vs 68 years, p = 0.002), median disease duration was longer (4.4 months vs 10.5 months, p < 0.001), and these individuals were less likely to present with gait difficulties (73% vs 93%, p = 0.003) or motor symptoms (62% vs 80%, p = 0.04). The sensitivity of electroencephalography and diffusion-weighted MRI were similar in both groups. In those who were RT-QuIC negative, there was an overrepresentation of the VV1 (32% vs 1%) and MM2 molecular subtypes (21% vs 3%). Co-occurring neurodegenerative disease was found in 33% (9/27) of those who were RT-QuIC negative. Conclusions: Individuals with sporadic CJD and a negative CSF RT-QuIC present with younger age of onset, different clinical features and are over-represented with the VV1 and MM2 subtypes of sporadic CJD. Further work is required to better understand the biochemical properties contributing to RT-QuIC negative results in these cases. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease affecting synovial joints with periods of flares which leads to joint erosion and bone destruction and consequent disability. Due to lack of diagnostic and prognostic markers to evaluate patients, several tests have emerged such as CTHRC1 protein. Methods: A case-control study was carried on 60 subjects, 30 healthy controls and 30 RA patients. Disease activity assessment was done for all patients using DAS28. Laboratory parameters as ESR, CRP, RF, anticcp. Serum CTHRC1 was measured in healthy individuals and RA patients using quantitative ELISA technique. Results: 30 RA patients (24 females and 6 males) with age mean of 37.3 ± 12.2 years and disease duration median of 5 years. We found that serum CTHRC1 was higher in RA patients than healthy controls.CTHRC1 was significantly correlated with DAS28 (p=0.02), tender joint number (p=0.004), swollen joint number (p=0.03) and dry mouth (p=0.03). No association was found between serum CTHRC1 and laboratory parameters. ROC curve analysis of serum CTHRC1 could significantly discriminate between active patients and in remission with a cut off value 10.3 ng/mL with sensitivity 65.4%, specificity 100%, PPV 100%, NPV 30.8% with area under the curve 83%. Conclusions: serum CTHRC1 is a favorable marker to evaluate RA patients. Significant association was found between serum CTHRC1 and disease activity which may serve as a valuable marker for RA patients monitoring. [ABSTRACT FROM AUTHOR]

Aims: To generate pre‐hospital symptom networks, explore core, bridge and sentinel symptoms, identify pre‐hospital symptom clusters and analyse relationship between influencing factors and symptom clusters in decompensated cirrhosis patients. Design: A cross‐sectional study design using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Methods: Demographical, physiological, psychological and sociological characteristics and the pre‐hospital symptoms of 292 decompensated cirrhotic patients were collected from October 2021 to March 2023 in China. Frequencies, percentages, means, standard deviations, independent samples t‐tests, one‐way analysis of variance, exploratory factor analysis, multiple stepwise regression analysis and network analysis were used for data analysis. Results: 'I don't look like myself' and itching were core and bridge symptoms, while bloating and lack of energy were sentinel symptoms in decompensated cirrhotic patients. Monthly family income, anxiety, depression, social support and disease duration influenced the neuropsychological symptom cluster, with worrying as the strongest predictor symptom. Influential factors for cirrhosis‐specific symptom cluster included Child‐Pugh class, monthly family income, disease duration, anxiety and depression, with itching being the strongest predictor symptom. Monthly family income, disease duration and depression were influential factors for gastrointestinal symptom cluster, with loss of appetite as the strongest predictor symptom. Conclusions: Neuropsychological, cirrhosis‐specific and gastrointestinal symptom clusters were formed in decompensated cirrhotic patients. Through network analysis, direct connections between symptoms, symptom clusters and their influencing factors were revealed, thereby offering clinicians a foundation for effectively managing patients' pre‐hospital symptoms. Impact: Decompensated cirrhosis patients commonly have multiple symptoms, while the management of pre‐hospital symptoms is often suboptimal. This study identified neuropsychological, cirrhosis‐specific, gastrointestinal symptom clusters and recognized core, bridge and sentinel symptoms in these patients. It also revealed the most prominent symptoms within each cluster. This provides insight into the hierarchy of symptoms, improving symptom management in decompensated cirrhosis. Patient and Public Involvement: There was no patient or public involvement. [ABSTRACT FROM AUTHOR]

Background: Levodopa‐induced dyskinesias (LID) are frequent in Parkinson's disease (PD). Objective: To analyze the change in the frequency of LID over time, identify LID related factors, and characterize how LID impact on patients' quality of life (QoL). Patients and Methods: PD patients from the 5‐year follow‐up COPPADIS cohort were included. LID were defined as a non‐zero score in the item "Time spent with dyskinesia" of the Unified Parkinson's Disease Rating Scale—part IV (UPDRS‐IV). The UPDRS‐IV was applied at baseline (V0) and annually for 5 years. The 39‐item Parkinson's disease Questionnaire Summary Index (PQ‐39SI) was used to asses QoL. Results: The frequency of LID at V0 in 672 PD patients (62.4 ± 8.9 years old; 60.1% males) with a mean disease duration of 5.5 ± 4.3 years was 18.9% (127/672) and increased progressively to 42.6% (185/434) at 5‐year follow‐up (V5). The frequency of disabling LID, painful LID, and morning dystonia increased from 6.9%, 3.3%, and 10.6% at V0 to 17.3%, 5.5%, and 24% at V5, respectively. Significant independent factors associated with LID (P < 0.05) were a longer disease duration and time under levodopa treatment, a higher dose of levodopa, a lower weight and dose of dopamine agonist, pain severity and the presence of motor fluctuations. LID at V0 (β = 0.073; P = 0.027; R2 = 0.62) and to develop disabling LID at V5 (β = 0.088; P = 0.009; R2 = 0.73) were independently associated with a higher score on the PDQ‐39SI. Conclusion: LID are frequent in PD patients. A higher dose of levodopa and lower weight were factors associated to LID. LID significantly impact QoL. [ABSTRACT FROM AUTHOR]

Objective: Cognitive and affective symptoms in multiple sclerosis (MS) can be independently impaired and have different pathways of progression. Cognitive alterations have been described since the earliest MS stages; by contrast, the social cognition (SC) domain has never been investigated in the first year from MS diagnosis. We aimed to evaluate SC and unravel its neural bases in newly diagnosed MS patients. Methods: Seventy MS patients underwent at diagnosis a 3 T‐MRI and a neuropsychological/SC assessment (median time between diagnosis and MRI/cognitive evaluation = 0 months). We tested two matched reference samples: 31 relapsing–remitting MS patients with longer course (mean ± SD disease duration = 7.0 ± 4.5 years) and 38 healthy controls (HCs). Cortical thicknesses (CTh) and volumes of brain regions were calculated. Results: Newly diagnosed MS patients performed significantly lower than HCs in facial emotion recognition (global: p < 0.001; happiness: p = 0.041, anger: p = 0.007; fear: p < 0.001; disgust: p = 0.004) and theory of mind (p = 0.005), while no difference was found between newly diagnosed and longer MS patients. Compared to lower performers, higher performers in facial emotion recognition showed greater volume of amygdala (p = 0.032) and caudate (p = 0.036); higher performers in theory of mind showed greater CTh in lingual gyrus (p = 0.006), cuneus (p = 0.024), isthmus cingulate (p = 0.038), greater volumes of putamen (p = 0.016), pallidum (p = 0.029), and amygdala (p = 0.032); patients with higher empathy showed lower cuneus CTh (p = 0.042) and putamen volume (p = 0.007). Interpretations: SC deficits are present in MS patients since the time of diagnosis and remain persistent along the disease course. Specific basal, limbic, and occipital areas play a significant role in the pathogenesis of these alterations. [ABSTRACT FROM AUTHOR]

Background: Treatment of anorexia nervosa (AN) sometimes requires hospitalisation, which is often lengthy, with little ability to predict individual trajectory. Depicting specific profiles of treatment response and their clinical predictors could be beneficial to tailor inpatient management. The aim of this research was to identify clusters of weight recovery during inpatient treatment, and their clinical predictors. Methods: A sample of 181 inpatients who completed a treatment programme for AN was included in a retrospective study. A latent class mixed model approach was used to identify distinct weight‐gain trajectories. Clinical variables were introduced in a multinomial logistic regression model as predictors of the different classes. Results: A four‐class quadratic model was retained, able to correctly classify 63.7% of the cohort. It encompassed a late‐rising, flattening, moderate trajectory of body mass index (BMI) increase (class 1), a late‐rising, steady, high trajectory (class 2), an early‐rising, flattening, high trajectory (class 3) and an early‐rising, steady, high trajectory (class 4). Significant predictors of belonging to a class were baseline BMI (all classes), illness duration (class 2), and benzodiazepine prescription (class 3). Conclusion: Predicting different kinetics of weight recovery based on routinely collected clinical indicators could improve clinician awareness and patient engagement by enabling shared expectations of treatment response. Highlights: Treatment of anorexia nervosa lacks tailored strategies to optimise individual patients' management.Latent class mixed model approach is a promising strategy to analyse treatment response as a dynamic entity.Baseline body mass index, duration of illness and benzodiazepine prescription are significant indicators of distinct weight recovery profiles. [ABSTRACT FROM AUTHOR]

The Freezing of Gait Severity Tool (FOG Tool) was developed because of limitations in existing assessments. This cross-sectional study investigated its validity and reliability. People with Parkinson's disease (PD) were recruited consecutively from clinics. Those who could not walk eight-metres independently (with or without an assistive device), comprehend instructions, or with co-morbidities affecting walking were excluded. Participants completed a set of assessments including the FOG Tool, Timed Up and Go (TUG), and Freezing of Gait Questionnaire. The FOG Tool was repeated and those reporting no medication state change evaluated for test-retest reliability. Validity and reliability were investigated through Spearman's correlations and ICC (two-way, random). McNemar's test was applied to compare the FOG Tool and TUG on the proportion of people with freezing. Thirty-nine participants were recruited [79.5%(n = 31) male; Median(IQR): age–73.0(9.0) years; disease duration–4.0(5.8) years]. Fifteen (38.5%) contributed to test-retest reliability analyses. The FOG Tool demonstrated strongest associations with the Freezing of Gait Questionnaire (ρ = 0.67, 95%CI 0.43–0.83). Test-retest reliability was excellent (ICC = 0.96, 95%CI 0.88–0.99). The FOG Tool had 6.2 times the odds (95%CI 2.4–20.4, p < 0.001) of triggering freezing compared to the TUG. The FOG Tool appeared adequately valid and reliable in this small sample of people with PD. It was more successful in triggering freezing than the TUG. The Freezing of Gait Severity Tool's assessment course is more effective than the commonly-used Timed Up and Go's assessment course for eliciting freezing of gait for clinical evaluation in people with Parkinson's disease. The Freezing of Gait Severity Tool can be considered for scoring freezing of gait severity in people with Parkinson's disease in the clinical setting. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion In comparison with TNF‐α inhibitors, anti‐IL‐17A agents are considered to have a lower risk of active tuberculosis (TB) or latent TB infection (LTBI) reactivation.In this study, we aimed to evaluate the TB infection status and serial QuantiFERON‐TB‐Gold in tube test (QFT) results of psoriasis patients using IL‐17 inhibitors (secukinumab [SEC] and ixekizumab [IXE]) in a real‐world setting from a tuberculosis‐endemic country. Patients who used an anti‐IL‐17 agent for at least 3 months in our follow‐up were included in the study. Patients' clinical and demographic features, baseline QFT results and latest QFT results (if any), and TB infection status were noted from the past medical records.A total of 717 patients, of whom 333 (46.4%) were female, were included in the study. The cumulative exposure time to an anti‐IL‐17 agent was 14,147 patient‐months, 9743 patient‐months for SEC and 4404 patient‐months for IXE. Also, 459 (SEC = 305/IXE = 154) patients used an anti‐IL‐17 agent for ≥ 12 months. Of these, 125 had positive baseline QFT results. In all, 334 had negative baseline QFT results. The latest QFT result of 309 was also negative (persistent seronegative group). During follow‐up, the QFT results of 10 patients changed from negative to positive (positive seroconversion group). Seven of them were using SEC and three were using IXE, respectively. No case of active TB infection was detected.In our study, the positive seroconversion rate of 10/334 seems high, but this did not translate to active disease. However, closer monitoring may be required, especially in patients with advanced age, the presence of PsA, long disease duration and long anti‐IL‐17 treatment duration. [ABSTRACT FROM AUTHOR]

Birdshot chorioretinitis (BSCR) is a form of posterior uveitis that is classically characterized by hypopigmented choroidal lesions outside of the major arcades. However, little is known about the extent of choroidal involvement in the macula. We aim to describe the vascular abnormalities observed at the level of the choriocapillaris (CC) in the maculae of BSCR patients, using swept source optical coherence tomography angiography (SS-OCTA). A cross-sectional, observational study was conducted. Eligible patients underwent clinical examination and SS-OCTA imaging. The main outcome measures were the frequency of vascular abnormalities observed at the level of the CC on SS-OCTA and foveal choriocapillaris vascular density (CVD). Twenty-one patients were included, with a median age of 61.5 years. All patients had bilateral disease with a median disease duration of 6 years. All but one patient received systemic immunosuppressive drug therapy, and 19 patients had suppressed inflammation on treatment at the time of the SS-OCTA assessment. Of the 42 affected eyes, 39 (92.9%) had gradable SS-OCTA images, with a mean LogMAR visual acuity of 0.18 (Snellen equivalent 20/30). In total, 34 of 39 (87.2%) eyes had some degree of pathologic flow loss, and after controlling for patient age and disease activity, both worse VA and longer disease duration remained statistically significantly associated with reduced foveal CVD. Our findings suggest that pathologic CC flow loss in the macula is frequently encountered and may contribute to visual function decline in patients with BSCR. Further studies with longitudinal follow-up are needed to characterize the evolution of these areas of pathologic CC flow loss over time. [ABSTRACT FROM AUTHOR]

Background: The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. Methods: A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). Results: Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. Conclusion: Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool. [ABSTRACT FROM AUTHOR]

Objective: Manic and mixed episodes of bipolar disorder are important episodes of this disorder. The aim of the current study was to assess serum vitamin D (SVD) levels in patients with mania and mixed bipolar disorder, compared to healthy subjects. Method: The current cross-sectional study was conducted on 75 subjects, including healthy subjects (n = 25), patients with acute-phase mania (n = 25), and patients with mixed bipolar disorder (n = 25). The SVD levels were measured in all of the enrolled subjects. The Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), and Clinical Global Impression- Severity (CGI-S) were used to assess disease activity in patient groups. Data analysis was performed using SPSS version 18. For statistical analysis, analysis of variance (ANOVA), independent-sample t test, Pearson correlation, and Chi-square tests were utilized. P-values < 0.05 were considered statistically significant. Results: The results showed that the mean of SVD was significantly lower in mania and mixed bipolar patients compared to healthy subjects (P < 0.05). In addition, the number of subjects with SVD ≥ 20 ng/ml was higher in the healthy group compared to the patient groups (P < 0.05). Also, SVD was negatively correlated with the CGI-S (r = -0.311; P = 0.028), YMRS (r = -0.464; P = 0.001), and HDRS (r = -0.393; P = 0.005) in the total patient subjects. Conclusion: Prevalence of low SVD was considerably high in mania and mixed bipolar patients compared to healthy subjects. Additionally, meaningful negative correlations were found between SVD and disease activity-related variables including the HDRS, YMRS, and CGI-S. [ABSTRACT FROM AUTHOR]

BACKGROUND: The first-line treatment for cervical dystonia (CD) consists of repeated intramuscular injections of botulinum toxin (BoNT). However, the efficacy in some patients may be unsatisfactory and they may discontinue treatment. OBJECTIVE: To examine the factors associated with the maximum rate of remission in patients with CD after initial botulinum neurotoxin type A (or botulinum toxin type A abbreviated as BTX-A or BoNT-A) treatment. METHODS: Patients with CD who received BoNT-A injections were evaluated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Tsui scale, with follow-up endpoints lasting until the start of the second injection. Patients who did not receive a second injection of BoNT-A were followed up for at least 5 months. The maximum remission rates were determined using the lowest Tsui and TWSTRS total scores during the follow-up period. We obtained basic information about these patients such as age, gender, duration of disease, presence of additional disease, types of torticollis, presence of anxiety, depression, tremors, single-photon emission computed tomography (SPECT) findings, injected dose, and so on from their medical records. RESULTS: A total of 70 patients with CD participated in this study, with males comprising 35.7% (25 individuals) with an average age of 45 ± 14 years old. The duration of disease was an independent risk factor for determining whether a complete remission has been attained using the Tsui scale (odds ratio [OR] = 0.978, 95% confidence interval [CI]: 0.959–0.997, P = 0.026). The optimal cut-off point for predicting patients who were unable to achieve complete remission based on duration of disease was 7.5 months (AUG = 0.711). Patients with CD with additional disease had greater difficulty achieving complete remission than those with CD alone based on TWSTRS assessments (P = 0.049). During the study, approximately 17% of all participants reported experiencing adverse reactions that lasted between 1 to 3 weeks before disappearing. CONCLUSION: BoNT is an effective and safe method for treating CD. The maximum remission rates of patients after their first injections are influenced by the duration of their disease. Thus, treatment using BoNT injections must be administered as soon as possible. [ABSTRACT FROM AUTHOR]

Reports on hand dysfunction and rehabilitation in SSc are quite scarce in the literature and mainly focus on functional assessment tools, such as the Duruoz Hand Index and the HAMIS test for evaluating hand mobility by simulating specific grasps with nine different objects. This study aimed to provide an adequate assessment methodology for hand grasp dysfunctions in patients suffering from systemic sclerosis (SSc) through the 16-grasp test. Case-control study. Ninety-seven consecutive SSc patients were recruited at our Scleroderma Unit, where a 16-grasp test was performed by all patients and supervised by an experienced hand therapist. Sixteen different patterns of grasp have been divided into power grasps and precision pinch and two more modalities: static and dynamic prehension evaluation on scale from 0 to 4. We also compared previous evaluations on 19 of patients recruited. The majority of SSc patients (84 females and 13 males; mean age 56.0±12.0 years; mean disease duration 8.0±6.0 years) displayed grasp dysfunctions; in particular 48% and 54% reported slight difficulty in the right and left grasps respectively, 6% medium difficulty in both hands, and only 3% and 1% experienced severe difficulty respectively, while 31.5% had no issues in either hand. Our results showed that the limited cutaneous subset (lcSSc) scored a lower deficit for either grasp compared to diffuse form (dcSSc). No statistically significant differences in total grasp deficit had been noticed when comparing patients having a disease duration < 5 years or longer. In the retrospective study on 19 of these patients, 8 out of 10 lcSSc patients showed no significant changes, while in 2 out of 10, slight improvements were observed in both hands. However, in the dcSSc group, 4 out of 9 worsened bilaterally while the grasp scores for 5 of them remained unchanged. Our study reported hand involvement in both lcSSc and dcSSc forms, more significantly in dcSSc patients. This test is intended to be a more objective means of assessing grasp alterations linked to scleroderma hand deformities. Furthermore, thanks to its intuitiveness, the test may be useful for engineers designing personalized ergonomic assistive devices. [ABSTRACT FROM AUTHOR]