bluuebunny/crossref_metadata_2025 huggingface dataset:
36 THE IMPACT OF ART THERAPY ON THE MENTAL HEALTH OF TEACHER EDUCATION STUDENTS
Authors: Zhang Xiaoyu
Published: February 2025

Background

Regarding the mental health issues of teacher education students, research focuses on the impact of occupational and social factors on students’ mental health. Students usually have a good acceptance of art therapy methods. In recent research, painting art therapy has been a commonly used scientific method, and its colors, lines, etc. fully reflect the psychological state of the painter, which is helpful for physicians’ assessment and treatment. Research on the use of painting art therapy and the College Students’ Psychological Health Quality Scale to reflect the psychological health status and intervention effects of teacher education students, providing better methods for shaping students’ mentality and relieving stress in the future.

Methods

The study selected 350 sophomore students majoring in teacher education from a comprehensive university and collected data using the Symptom Check List (SCL-90). Then, 116 students were randomly selected and divided into an experimental group (58 people) and a control group (58 people). The experimental group underwent painting art therapy six times within two weeks, each lasting 90 minutes. After the treatment, the two groups were evaluated using the College Student Psychological Quality Scale (CSPS). Finally, the scoring results were subjected to SPSS 25.0 statistical analysis and Multivariate Analysis of Variance (MANOVA) to compare the psychological health status before and after treatment.

Results

In the CSPS scoring system, the interaction effect of students’ overall mental health quality is significant, with F (1,69) =30.60, P<0.001, and ηP2=0.32. In the adaptive dimension, the score for emotional adaptation reached 3.84 ± 0.75, and the interaction effect was significant and statistically significant (P<0.01), indicating that painting art therapy has a positive guiding effect on students’ mental health. The results are shown in Table 1.

Discussion

Painting art therapy has become a mature and reliable individual psychological treatment program in art therapy due to its advantages of easy acceptance and authenticity in reflecting problems. The results show that painting art therapy has a positive impact on the mental health of teacher education students, which is conducive to alleviating employment, interpersonal, and social pressures, and thus shaping students’ confident and optimistic psychological state.

Funding

No. XJK23CZY114.
41 EFFECT OF MECT ON COGNITIVE FUNCTION OF ECOTOURISM PRACTITIONERS WITH MENTAL DISORDERS
Authors: Shen Chenming
Published: February 2025

Background

Cognitive impairment is a common problem faced by patients with depression and schizophrenia throughout the course of the disease, which greatly affects the daily quality of life of those with mental illness who are engaged in the ecotourism industry. Modified Electroconvulsive Therapy (MECT) has been widely used in the clinical treatment of mental illness, but its impact on the cognitive function of patients is still inconclusive. At the same time, for patients engaged in the ecotourism industry, the applicability of MECT treatment research is relatively insufficient. This study conducted a series of dynamic observation studies on the cognitive function of mental illness patients engaged in ecotourism industry before, during and after MECT treatment, in order to provide a more scientific reference for clinicians to make MECT treatment plan.

Methods

From March to December 2023, 12 schizophrenic patients engaged in ecotourism industry were selected from the Third People’s Hospital of Yancheng City. The treatment was arranged three times a week, each treatment interval was one day, and six treatments were completed as a complete course of treatment, which lasted for two weeks. In order to conduct a dynamic assessment of Neurocognitive function in these patients, the Chinese version of Brief Neurocognitive Test Battery (C-BCT) was used as an assessment tool.

Results

According to the data in Table 1, no statistically significant differences in C-BCT scores were observed in patients with schizophrenia before MECT treatment began (P > 0.05). At 1-2 weeks after treatment and at 1 month after treatment, patients’ scores for connection tests, continuous manipulation, and digital breadth showed statistically significant differences compared with those before treatment (P < 0.05). Patients’ scores on the symbol coding test also showed statistically significant differences compared to before treatment at 1-2 weeks and 1 month after treatment ended (P < 0.05).

Discussion

The study dynamically observed cognitive function in patients with mental disorders who received MECT and found that the treatment significantly improved clinical symptoms. In particular, one month after the end of MECT treatment, patients’ cognitive function not only gradually recovered, but in some respects even exceeded the pre-treatment level. This study provides strong clinical evidence for clinicians to decide whether to use MECT treatment, reduce patients’ concerns and fears about MECT treatment, and improve patients’ cooperation with treatment. However, the potential influence of drug factors on the study results could not be completely excluded during the implementation of the study. In future studies, drug variables should be strictly controlled to avoid possible bias during the study.
49 THE THERAPEUTIC EFFECT OF EXPRESSIVE ART THERAPY ON COGNITIVE FUNCTION IN PATIENTS WITH SCHIZOPHRENIA
Authors: Gao Yuan , Yang Kaiqi , Du* Dalong
Published: February 2025

Background

Schizophrenia is a severe mental illness in which patients are often accompanied by impairments in cognitive functions such as attention, working memory, language fluency, and executive function. These defects not only affect patients’ daily living abilities, but also significantly limit their recovery of social functions. In recent years, expressive arts therapy has gradually attracted attention as a non-drug intervention method. This treatment method promotes the improvement of patients’ mental health and cognitive function through the combination of music, painting and other art forms.

Methods

The study included 50 patients who met the diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), with an age range of 18-55 years. They were randomly divided into a treatment group of 25 and a control group of 25. The treatment group received 12 weeks of expressive art therapy, 3 times a week, 1 hour each time, including music, painting and dance activities. The control group only received conventional drug treatment. Both groups of patients were evaluated by cognitive function battery tests before and after the intervention, and the measurement dimensions included attention, working memory, language fluency and executive function.

Results

The scores of each dimension of cognitive function in the treatment group were significantly improved compared with those before the intervention (P < 0.05), while the improvement in the control group was smaller. Comparison between groups showed that the scores of each cognitive function dimension in the treatment group were significantly higher than those in the control group after the intervention (P < 0.05). See Table 1 for details. As can be seen from Table 1, the treatment group improved most significantly in the attention and executive function dimensions (P < 0.01), reaching 47.3±6.2 and 28.4±5.3 respectively, while the improvement in the control group was smaller, only improving to 38.5 ±5.9 and 22.0 ±4.8. In the dimensions of working memory and verbal fluency, the improvement in the treatment group was equally significant (P < 0.05), while the control group only showed a slight improvement.

Discussion

Expressive arts therapy has potential value in improving cognitive function in patients with schizophrenia, especially in the areas of attention and executive function. Multisensory art forms may provide an effective cognitive intervention path for patients by activating brain cognitive networks and improving information processing capabilities. Compared with conventional drug treatment, expressive arts therapy showed more comprehensive improvement effects.

Funding

No. 2021XZC006.
50 EFFICACY OF DIARY PSYCHOEDUCATION AND HIERARCHICAL NURSING IN PATIENTS WITH SCHIZOPHRENIA
Authors: Sun Limei
Published: February 2025

Background

Schizophrenia is a chronic mental disorder. Patients often show symptoms such as cognitive impairment, emotional disorders and social dysfunction, which seriously affect their daily life and social adaptability. Psychological education and nursing intervention are important components of treatment. Diary psychoeducation promotes patients’ self-reflection and emotional expression, while hierarchical nursing implements precise intervention according to the individual needs of patients.

Methods

The study included 100 inpatients who met the diagnostic criteria for schizophrenia according to DSM-5 and were randomly divided into an intervention group (n=50) and a control group (n=50). The control group received conventional drug treatment and basic nursing care, while the intervention group received 12 weeks of diary psychoeducation and hierarchical nursing intervention on this basis. The study used the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Assessment Scale (SDSS) to evaluate the changes in clinical symptoms and social function of patients before and after the intervention, statistical analysis was performed using paired t-test and independent sample t-test.

Results

The intervention group improved significantly better than the control group in PANSS total score, positive symptoms, negative symptoms and general psychopathology dimensions (P < 0.05). At the same time, the intervention group’s social function improvement in SDSS scale scores was also significantly better than that of the control group (P < 0.01). See Table 1 for specific data. As can be seen from Table 1, the intervention group improved significantly better than the control group in terms of PANSS total score, positive symptoms, and negative symptom scores (P < 0.05). The PANSS total score dropped from 89.4 ± 10.6 to 58.3 ± 8.7, while the control group improved significantly (P < 0.05). Only dropped from 88.7 ± 11.2 to 72.5 ± 9.8. In terms of SDSS total score, the intervention group dropped from 17.9 ± 3.1 to 9.8 ± 2.5.

Discussion

Diary psychoeducation and hierarchical care have certain positive effects in alleviating core symptoms of schizophrenia and improving social functions, especially in terms of positive and negative symptoms and general psychopathology scores. At the same time, this intervention model also significantly promotes the recovery of patients’ social functions and provides an important reference for the comprehensive treatment of patients with schizophrenia.
59 USING DIGITAL MEDIA TECHNOLOGY TO ANALYZE THE EMOTIONAL AND COGNITIVE FUNCTION OF PATIENTS WITH DEPRESSION
Authors: Wang Qiaqia
Published: February 2025

Background

Depression is a common mental illness characterized by persistent low mood, cognitive dysfunction, and impaired social functioning. In recent years, with the rapid development of digital media technologies, using these technologies to study the changes of emotional and cognitive functions has become a new research direction. Digital media technologies such as digital applications, online assessment tools and biofeedback devices, which provide real-time data collection and analysis, offer innovative approaches to depression assessment and intervention. These techniques not only help researchers gain a deeper understanding of the emotional experience and cognitive function of people with depression, but also support the development of personalized treatment programs. The purpose of this study is to analyze the emotional state and cognitive function performance of patients with depression by using digital media technology.

Methods

The study was designed using a hybrid approach, combining quantitative and qualitative studies, to gain insight into the emotional and cognitive functions of patients with depression. Taking 160 patients diagnosed with depression who were treated at a mental health center, The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) meets the DSM-5 criteria for depression. Participants were randomly divided into an experimental group (n=50, receiving the digital media technology intervention) and a control group (n=50, receiving the usual treatment). Groups are grouped using a computer-generated list of random numbers to ensure that the two groups match on baseline features. Prior to the study, all participants completed a self-rated questionnaire on depressive symptoms and daily mood performance, including the Hamilton Depression Rating Scale (HAM-D). At the end of the 12-week intervention, all participants filled out the Hamilton Depression Scale again, and cognitive function was assessed via an online cognitive platform.

Results

The score results of the two groups of patients before and after the experimental intervention are shown in Table 1. The baseline HAM-D score of the experimental group was 22.5 points, which decreased to 12.3 points after 12 weeks, with a mean change range of 45.5%. The statistical results showed significant changes in depressive symptoms in the group (P<0.001). The experimental group had a baseline cognitive function score of 72.8, which improved slightly to 74.0 after 12 weeks, a change of only 1.6%. Showed little substantial improvement in cognitive function in the control group.

Discussion

The results of the study support the validity of using digital media techniques to analyze mood and cognitive function in patients with depression. Through precise data collection and analysis, the study revealed a close relationship between mood swings and cognitive function in patients with depression, suggesting that emotion management may be an important way to improve cognitive function.
74 THE IMPROVEMENT OF COGNITIVE FUNCTION IN PATIENTS WITH SCHIZOPHRENIA BY COMBINING VISUAL AND AUDITORY TRAINING MODE: BASED ON VISUAL SCANNING IMAGING ANALYSIS
Authors: Wang* Xinyang , Pan Ruihong , Lai Liping , Zhu Simi
Published: February 2025

Background

Schizophrenia is a serious mental disorder, and one of its core symptoms is cognitive impairment, which seriously affects the patient’s daily life, social function, and rehabilitation outcomes. Visual scanning imaging technology, as an emerging and objective means of assessing cognitive function, can accurately capture indicators such as eye movement trajectory and gaze time of patients during visual information processing, providing a new perspective for a deeper understanding of cognitive function. The research aims to explore whether a new training mode that integrates vision and hearing can more effectively improve the cognitive function of patients with schizophrenia, and to comprehensively and objectively evaluate the training effect using visual scanning imaging analysis technology.

Methods

The study recruited 50 patients with schizophrenia as the experimental group and 50 healthy volunteers matched for age, gender, etc. as the control group. Firstly, conduct a comprehensive clinical evaluation of all participants, including medical history collection, assessment of psychiatric symptoms, etc. Then, the DEM-2000 eye tracker was used to conduct baseline visual scanning imaging tests on the two groups of participants, recording their eye movement data during scene browsing and target search, including the number of fixation points, fixation time, scanning path, etc. The experimental group received 10 weeks of visual and auditory fusion training. The training content includes visual stimulation tasks and synchronized auditory guidance. The training frequency is 3 times a week, with each session lasting approximately 45 minutes. After the training, visual scanning imaging tests were conducted again on the experimental group patients and the control group to obtain visual cognitive data after training.

Results

The comparison of data before and after training is shown in Table 1. Before training, the experimental group had an average of 25 fixation points, while the control group had 40 fixation points. After training, the average number of fixation points in the experimental group was 35, an increase of 40% compared to before training. The standard deviation of average fixation time is 9 ms, which is 25% lower than before training. In terms of attention testing, the average correct reaction time of the experimental group before training was 800 ms, which was shortened to 600 ms after training. In memory tests, the average number of correct memories before training was 4, which increased to 7 after training.

Discussion

The training mode that integrates visual and auditory senses has a positive effect on improving cognitive function in patients with schizophrenia, and visual scanning imaging technology can effectively capture the manifestation of this improvement at the visual cognitive level.

Funding

No. Pdjh2024a557.
88 STUDY ON THE INFLUENCE OF OUTWARD-BOUND TRAINING ON MENTAL HEALTH OF SCHIZOPHRENIC PATIENTS IN CONVALESCENT PERIOD
Authors: Huang Zhangquan
Published: February 2025

Background

Schizophrenia is a chronic and serious mental disorder. Although the symptoms of patients have been alleviated during rehabilitation, they still face challenges in the recovery of social and cognitive functions, and are susceptible to external stimuli. The lack of communication and social support during the recovery period may aggravate and worsen the condition. Outward bound training, as an experiential learning activity, can promote patients’ teamwork, self-confidence and self-efficacy, and has a potential positive effect on improving patients’ social function and mental health. The aim of the study was to explore how outreach training can improve patients’ mental health and reduce anxiety and depression levels by enhancing their self-confidence, social skills and coping abilities.

Methods

From January 2022 to March 2023, 60 patients with schizophrenia admitted to the Third Hospital of Zhuzhou City were selected as the observation group. Meanwhile, a group of volunteers with similar health conditions were selected as the control group. The SCL-90 Symptom Checklist was used in the study to assess the psychological health status of participants. The students in the experimental group underwent a two-day, 8-10 hours, 12 weeks expansion training program over the weekend. The training content includes orienteering, jungle exploration, wilderness camping, as well as field projects such as horizontal bars, bridge crossings, and winding trails. The control group of students maintained their regular physical education schedule, twice a week, which included aerobics, athletics, football, basketball, and more.

Results

From Table 1, it can be seen that before intervention, there was no significant difference in the scores of each factor of the symptom self-assessment scale between the experimental group and the control group (P values were all greater than 0.05). After 12 weeks of expansion training, the experimental group showed significantly lower scores in all factors compared to the control group (P values were all less than 0.01), especially in the reduction of hostile factors. The scores of each factor in the experimental group decreased significantly after intervention compared to before intervention (P values were all less than 0.01), while there was no significant difference in the scores of each factor in the control group before and after intervention (P values were all greater than 0.05).

Discussion

The results of this study indicate that after the intervention of expansion training, the psychological health level of participants has significantly improved. Compared with the control group, the differences in various factors have reached statistical significance, indicating that the intervention effect of expansion training is positive. In addition, during the training process, patients’ attention is diverted from worries and setbacks in daily life, which helps regulate emotions and promotes the improvement of mental health.
95 IMPROVEMENT OF LANGUAGE FUNCTION AND EXPRESSION ABILITY OF SCHIZOPHRENIA PATIENTS IN ONLINE AND OFFLINE MUSIC TEACHING
Authors: Li Yanmei
Published: February 2025

Background

Schizophrenia patients usually show language dysfunction and difficulty in emotional expression, which has a serious impact on the social adaptation and quality of life of patients. In recent years, music therapy, as an auxiliary treatment, has been shown to have potential in improving cognitive function and emotional disorders. However, the specific improvement effect of online and offline music teaching on the language function and expression ability of patients with schizophrenia is still unclear. This study aims to evaluate the improvement effect of online and offline music teaching modes on the language function and expression ability of patients with schizophrenia, and compare the effects of the two teaching modes.

Methods

A total of 60 patients with schizophrenia were selected and randomly divided into an online teaching group and an offline teaching group, with 30 cases in each group. All patients underwent a baseline assessment of language function and expression ability before the start of the study, using the Language Function Scale (LFS) and the Emotional Expression Ability Scale (EEAS). The online teaching group conducted a 12-week music learning through video courses, and the offline teaching group conducted the same period of training through face-to-face classroom teaching. All patients were evaluated again after the intervention.

Results

The results showed that both online and offline music teaching significantly improved the language function and expression ability of patients with schizophrenia. Specific data are shown in Table 1. Table 1 shows that both online and offline music teaching can effectively improve the language function and expression ability of patients with schizophrenia. The language function score of the online teaching group increased from 45.2 points to 66.8 points, an improvement of 21.6 points. The expressive ability score increased from 42.6 points to 64.3 points. The language function score of the offline teaching group increased from 45.5 points to 72.1 points, an improvement of 26.6 points. The expressive ability score increased from 43.0 points to 70.2 points. The improvement rate of the offline teaching group was significantly higher than that of the online teaching group (P < 0.05).

Discussion

Research shows that music teaching, especially offline teaching mode, can significantly improve the language function and expression ability of patients with schizophrenia. Compared with online teaching, offline teaching mode helps to more effectively improve patients’ language expression ability and emotional cognitive ability through more interaction and emotional communication. The study provides effective evidence support for the application of music therapy in the rehabilitation of patients with schizophrenia.

Funding

No. LG231758.
American Society of Anesthesiologists 2023 Guidance on Neurological Complications of Neuraxial Analgesia/Anesthesia in Obstetrics
Authors: Vallejo MC , Kumaraswami S , Zakowski MI
Published: February 2025

(Anesthesiology. 2024; 140:1235–1239. doi:10.1097/ALN.0000000000004967)

Neuraxial analgesia or anesthesia comes with inherent risks, and many patients and providers fear neurological complications even with established low odds of such occurrences. Studies show that a large proportion of individuals want to be informed of risks even if odds are 1 in 10,000 or less. This article is a letter to the editor regarding the guidance surrounding complications of neuraxial analgesia/anesthesia in obstetric populations given by the American Society of Anesthesiologists (ASA).
Shoulder Dystocia by Severity in Families: A Nationwide Population Study
Authors: Rasmussen S , Ebbing C , Baghestan E , Linde LE
Published: February 2025

(Acta Obstet Gynecol Scand. 2024;103(10):1955–1964. doi:10.1111/aogs.14766)

Shoulder dystocia (SD) is a serious problem during childbirth that is connected to significant risks for newborns, such as brachial plexus injury, fractures, cerebral palsy, and perinatal death. The occurrence varies from 0.13% to 3.0%, and reoccurrence rates range from 7.3% to 13.5%. Important risk factors consist of considerable birth weight (risk grows more than 50 times for weights >4500 g), maternal diabetes, previous SD, assisted delivery, and labor dystocia. Research indicates that severe instances of SD have a greater likelihood of happening again, but there has not been enough research done on how severity affects recurrence and intergenerational transmission.
A Statewide Mobile Simulation Program for Improving Obstetric Skills in Rural Hospitals
Authors: Thenuwara K , Santillan D , Henkle J , Forman J , Dunbar A , Faro E , Hunter S
Published: February 2025

(Anesth Analg. 2024;139(5):931–939. doi:10.1213/ANE.0000000000006883)

The closure of rural obstetric (OB) units has created maternal care deserts, requiring expectant mothers in rural areas to travel long distances for essential maternity care. This situation also poses challenges for emergency departments (EDs) in hospitals without OB units, which must ensure that their staff regularly train to maintain OB skills. Similarly, rural level-1 OB units with low volumes of maternity cases struggle to provide comprehensive training. To address these challenges, a team used a federal grant to develop an OB mobile simulation program aimed at improving OB skills and standardizing care in Iowa. The program was based on the Alliance for Innovation in Maternal Health (AIM) Patient Safety Bundles framework.
Extreme Inequity in Analgesia and Perioperative Management of Pregnant Patients
Authors: Dennis AT , Sheridan N
Published: February 2025

(Anaesthesia. 2024;79:455–460. doi:10.1111/anae.16237)

On January 1, 2016, the United Nations introduced 17 Sustainable Development Goals (SDGs) with the aim of promoting global equality and building a sustainable future by 2030. These objectives, such as SDGs 3, 4, 5, 10, and 16, are particularly significant in enhancing maternal health care. SDG 3 promotes well-being by targeting improved health outcomes, seeking to cut worldwide maternal mortality to below 70 per 100,000 live births. It also stresses the importance of ensuring universal availability of sexual and reproductive health care, providing financial protection against risks, promoting fair access to high-quality medications, and ensuring safe surgical procedures such as cesarean sections, which are deemed necessary surgeries.
An Umbrella Review of Systematic Reviews on Interventions of Physical Activity Before Pregnancy, During Pregnancy, and Postpartum to Control and/or Reduce Weight Gain
Authors: González AG , Sánchez del Pino A , Amezcua-Prieto C , Luef BM , Vinter CA , Jorgensen JS , García-Valdés L
Published: February 2025

(Int J Gynecol Obstet. 2024;166:915–931. doi:10.1002/ijgo.15453)

The increasing global prevalence of overweight and obesity represents a significant public health concern, particularly when it affects younger populations and women of childbearing age. This trend poses numerous risks, as obesity is associated with a range of adverse reproductive and obstetric outcomes, including abortion, reduced fertility, pregnancy complications (such as gestational diabetes and preeclampsia), and negative postpartum events. In addition, children born to obese mothers are at increased risk of infant adiposity, high birth weight, metabolic syndrome, and childhood obesity.
Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients’ Satisfaction With Pain Management During Cesarean Delivery
Authors: Sanchez J , Prabhu R , Guglielminotti J , Landau R
Published: February 2025

(Anesth Analg. 2024 ;139(5):921–930. doi:10.1213/ANE.0000000000006764)

This study examined if the racial and ethnic alignment between patients and anesthesia teams influences satisfaction with pain control during cesarean delivery (CD). Concordance denotes having a shared racial or ethnic identity, which is recognized to improve communication and trust in various health care settings. Nonetheless, its effect on obstetric anesthesia practice is still not thoroughly investigated. The study involved English-speaking women who had CD at an academic medical center in New York from May to September 2022. Satisfaction regarding anesthesia care was evaluated through a survey carried out within 48 hours postdelivery.
Regional Analgesia Differential Sensory Block During Labor Epidural Analgesia: A Prospective Observational Study to Investigate the Relationship of Lower and Upper Sensory Block Levels to Cold, Pinprick, and Light Touch
Authors: Casellato JF , Balki M , Wang A , Ye XY , Downey K , Carvalho JCA
Published: February 2025

(Can J Anesth. 2024;71(6):802–807. doi:10.1007/s12630-023-02638-5)

The prevailing choice for mothers requesting pain management during labor and delivery is epidural analgesia (EA). The use of a sensory block assessment is necessary to understand how the body is responding to the analgesia, both in an effort to ensure pain is effectively managed and the dose is not affecting the body adversely. Various assessment methods have been investigated, however, the use of a pragmatic bedside assessment by a clinician is the most favored. When anesthesia is used in preparation for a cesarean delivery, published data demonstrates that the use of either cold, pinprick, or light touch may be applied to accurately assess the sensory block. However, there is a lack of data firmly describing the use of these methods in anesthetics used during a vaginal birth. Thus, the authors sought clarification on whether cold, pinprick, and light touch are substrates equally attuned for such assessments.
The 90% Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Delivery Under Combined Spinal-Epidural Anesthesia in Parturients With Super Obesity: An Up-Down Sequential Allocation Study
Authors: Tan HS , Fuller ME , Barney EZ , Diomede OI , Landreth RA , Pham T , Rubright SM , Ernst L , Habib AS
Published: February 2025

(Can J Anesth. 2024;71(5):570–578. doi:10.1007/s12630-024-02705-5)

A greater number of obese parturients are giving birth through cesarean delivery (CD), in part due to rising rates of both obesity and CDs worldwide. To avoid various complications during a CD, the ideal option for anesthesia is a neuraxial technique, with either spinal or combined spinal-epidural (CSE) anesthesia. A sensory block at the T4 dermatome is achieved using intrathecal hyperbaric bupivacaine and opioids. Previous studies have reported the efficiency of intrathecal hyperbaric bupivacaine to be 95% when the dose is between 11 and 15 mg, however, these studies were performed mostly in patients who were not obese. In addition, magnetic resonance imaging has shown reduced levels of cerebrospinal fluid within the lumbar region, which has further been explained to cause excessive spread of the block cephalad. Thus, it has been suggested that reducing the dose of intrathecal bupivacaine within the obese population is essential to avoiding adverse effects across several systems of the body. However, various clinical trials contain data which suggest that this dosage reduction in obese woman is not necessary, although their data do not include individuals considered to be super obese (BMI ≥50 kg/m2). Importantly, the dose of intrathecal bupivacaine should be high enough to create adequate surgical anesthesia, otherwise the use of general anesthesia may be employed, increasing the risk of morbidity. Since the field lacks a consensus on intrathecal hyperbaric bupivacaine dosage for patients with super obesity undergoing a CD under CSE, the authors sought clarification with this study. The hypothesized 90% effective dose (ED90) was between 7.5 and 12 mg when administered with opioids.
Postoperative Analgesia A Personalized Protocol for Prescribing Opioids After Cesarean Delivery: Leveraging the Electronic Medical Record to Reduce Outpatient Opioid Prescriptions
Authors: Imo CS , Macias DA , McIntire DD , McGuire J , Nelson DB , Duryea EL
Published: February 2025

(Am J Obstet Gynecol. 2024; 230:446.e1–446.e6. doi:10.1016/j.ajog.2023.09.092)

Cesarean deliveries (CD) are highly prevalent in the United States, with over 1.1 million performed in 2020. Despite this, standardized pain management at discharge is lacking. Many patients still receive excess opioids at discharge, often leading to unused medication that can contribute to misuse and addiction. Studies show similar opioid prescriptions for all patients regardless of varying pain levels and opioid requirements, highlighting the need to address overprescribing. In 2021, updated guidelines from the American College of Obstetricians and Gynecologists Committee on Clinical Consensus-Obstetrics recommended a multimodal approach, combining acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, tailored to individual needs.
Effect of adjuvant chemotherapy with toad venom injection in the treatment of intermediate and advanced colon cancer and its effect on cellular immunity, PTEN, and PI3k
Authors: Ding Haijun , Tang Xuedian , Tang Wenjun
Published: February 2025

The objective of this study is to explore the effect of adjuvant chemotherapy with toad venom injection in patients with intermediate and advanced colon cancer, in order to provide new reference drugs for clinical treatment. Prospectively, 148 patients with mid-stage to late-stage colon cancer in our hospital from January 2021 to May 2023 were selected for the study and randomly divided into two groups of 74 cases each. The control group was treated with FOLFOX4 chemotherapy, and the observation group was treated with four consecutive chemotherapy cycles based on the control group combined with toad venom injection. The treatment effects, adverse reactions, quality of life improvement rate, prognosis and cellular immune indexes [natural killer (NK) cells, CD4+/CD8+, CD4+, CD3+], phosphatase tensin gene (PTEN), phosphatidylinositol-3-kinase (PI3k), and serine threonine protein kinase (pAKT) protein expression before and after treatment were counted in the two groups. The total effective rate of treatment in the observation group was 58.11% (43/74) after four cycles of chemotherapy, which was higher than that in the control group of 41.89% (31/74) (P < 0.05). After two cycles of chemotherapy and four cycles of chemotherapy, PTEN, CD4+/CD8+, CD4+, CD3+, and NK cells in peripheral blood were higher in the observation group than in the control group, and PI3k and pAKT were lower than in the control group (P < 0.05). There was no statistically significant difference in the rate of adverse reactions in the observation group compared with the control group (P > 0.05); the improvement rate of quality of life in the observation group was better than that in the control group after four chemotherapy cycles of treatment (P < 0.05); the survival rate was 75.00% (54/72) in the observation group compared with 54.29% (38/70) in the control group at 1-year follow-up. Toad venom injection adjuvant chemotherapy is effective in treating patients with intermediate and advanced colon cancer, which can upregulate PTEN level, inhibit PI3k and AKT expression, and improve immune function and quality of life of patients, thus improving prognosis.
The Association Between Selective Serotonin Reuptake Inhibitors and the Incidence of Delirium in Critically Ill Patients: A Systematic Review
Authors: Schwab Hailey , Sines Benjamin , Moreton Elizabeth , Palanca Ben Julian , Austin C. Adrian
Published: February 2025

OBJECTIVES:

To investigate the: 1) correlation between the maintenance or cessation of selective serotonin reuptake inhibitors (SSRIs) during hospitalization and the incidence of delirium among critically ill patients; 2) evaluate the effectiveness of utilizing SSRIs as a potential intervention for managing delirium in critically ill adults; and 3) evaluate the effects of continuing SSRIs in patients who were previously prescribed these medications on incidence of delirium or withdrawal symptoms manifesting as delirium.

DATA SOURCES:

PubMed, Scopus, Embase, PsycInfo, and ProQuest Central, and additional studies identified from reference lists and relevant systematic reviews.

STUDY SELECTION:

Studies included adults 18 years old and older with critical illness necessitating ICU care administered SSRIs during their hospital stay, where delirium and/or adverse effects were reported as outcomes.

DATA EXTRACTION:

Two team members extracted data from included studies into evidence tables, which were subsequently discussed to synthesize and align the extracted findings. Extraction criteria included study population and the type of control or comparison group, exposures, primary and secondary outcome measures, results, and implications. We used Study Quality Assessment Tools provided by the National Heart, Lung, and Blood Institute and National Institutes of Health public websites along with the TREND checklist to evaluate the quality of articles and analyze for bias.

DATA SYNTHESIS:

Two reviewers analyzed the studies’ risk for bias. Analysis followed the Grading of Recommendations Assessment, Development, and Evaluation criteria used in Cochrane systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to design and report the study.

CONCLUSIONS:

The cessation of SSRIs in patients who were previously prescribed these medications is associated with an increased incidence of delirium or withdrawal symptoms manifesting as delirium. Continuing these medications in the setting of critical illness may mitigate the risk of delirium. Further investigation is warranted into the impact of SSRIs on delirium in patients not taking these medications prior to ICU admission.
How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis
Authors: Biancari Fausto , Mäkikallio Timo , L’Acqua Camilla , Ruggieri Vito G. , Cho Sung-Min , Dalén Magnus , Welp Henryk , Jónsson Kristján , Ragnarsson Sigurdur , Hernández Pérez Francisco J. , Gatti Giuseppe , Alkhamees Khalid , Loforte Antonio , Lechiancole Andrea , D’Errigo Paola , Rosato Stefano , Spadaccio Cristiano , Pettinari Matteo , Fiore Antonio , Mariscalco Giovanni , Perrotti Andrea , Arafat Amr A. , Albabtain Monirah A. , AlBarak Mohammed M. , Laimoud Mohamed , Djordjevic Ilija , Samalavicius Robertas , Alonso-Fernandez-Gatta Marta , Wilhelm Markus J. , Kaserer Alexander , Bonalumi Giorgia , Juvonen Tatu , Polvani Gianluca
Published: February 2025

Objectives:

To investigate the optimal duration of venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock refractory to medical therapies after cardiac surgery and whether its prolonged use is justified.

Data Sources:

Previously published articles on postcardiotomy venoarterial ECMO.

Study Selection:

Articles reporting on the early outcome after postcardiotomy venoarterial ECMO in adult patients were identified through a systematic review of the literature.

Data Extraction:

Data on prespecified patients’ characteristics, operative variables, and outcomes were provided by the authors of previous studies on this topic.

Data Synthesis:

Individual data of 1267 patients treated at 25 hospitals from ten studies were included in this meta-analysis. In-hospital mortality rates were lowest among patients treated 3–6 days with venoarterial ECMO. Multilevel mixed-effects logistic regression considering the cluster effect of the participating hospitals adjusted for individual patient‘s risk profile and operative variables showed that the risk in-hospital mortality did not significantly increase in patients treated more than 6 days up to 20 days.

Conclusions:

The present study demonstrated that prolonged venoarterial ECMO support after adult cardiac surgery may be justified. However, the analysis was limited by the knowledge of only those circumstances known at the start of ECMO.
Burden and risk factors of colorectal cancer in Europe from 1990 to 2021
Authors: Zhang Tao , Wang Shuai , Li Dongming , Wang Yifei , Cao Xueyuan
Published: February 2025

Background

Colorectal cancer (CRC) poses a significant health burden in Europe, but comprehensive studies on this region are limited.

Methods

Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021, we analyzed the regional distribution and temporal trends of the CRC and early-onset CRC burden in Europe from 1990 to 2021. Decomposition analysis was applied to quantify the contributions of population growth, aging, and epidemiological changes. The research also evaluated major risk factors associated with CRC and early-onset CRC.

Results

The burden of CRC in Europe was found to be higher than the global average. While the age-standardized incidence rate (ASIR) increased, both the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) decreased. Early-onset CRC exhibits similar distribution characteristics and patterns of change. Males had a significantly higher CRC burden than females. Population aging was the primary driver of increased burden in Europe. Risk factor analysis revealed that low whole grain intake and high red meat consumption were the primary contributors to the elevated ASMR and ASDR of CRC and early-onset CRC. Additionally, the CRC and early-onset CRC burden associated with high BMI and high fasting plasma glucose showed an increasing trend.

Conclusion

The overall burden of CRC and early-onset CRC in Europe remains higher than the global level, with increasing ASIR and decreasing ASMR and ASDR. Targeted prevention and control strategies should be developed based on the major risk factors for CRC. Older adults and men should be prioritized for interventions.
Effect of Continuous Nutritionist-led Guidance on Bowel Preparation in Patients Undergoing Prostate Stereotactic Body Radiation Treatment With Endorectal Spacing
Authors: Carmeli Yonatan , Shpatz Yael , Oren-Ivry Iris , Mansano Anat , Lewin Ron , BarOrian Idan , Mattout Jacob , Weiss Ilana , Haisraely Ory , Lawrence Yaacov Richard , Symon Zvi
Published: February 2025

Objective:

To evaluate the effect of a daily nutritionist consultation on rectal volume, gas, and prostate displacement during Stereotactic Body Radiation Treatment (SBRT) with an endorectal spacer.

Methods:

Twenty-six consecutive patients receiving 5 fraction SBRT with endorectal spacing were prospectively enrolled for an intensive daily nutritionist intervention utilizing biofeedback based on image guidance from each fraction. A retrospective control cohort receiving a standard bowel preparation was compared. Rectal volume, rectal gas, and prostate displacement were assessed by analysis of cone beam computed tomography. Data was analyzed using the SPSS statistics software.

Results:

Intense dietary intervention with biofeedback led to a consistently lower rectal gas score over 5 fractions (P<0.001) and less variability in rectal volume during prostate SBRT indicating a nonsignificant trend for superior preparation in the intervention group compared with controls, particularly for the first 2 fractions. However, there was no significant impact on prostate displacement as measured by couch correction.

Conclusions:

Intense dietary consultations effectively reduce rectal gas and variation of rectal volume during prostate SBRT with endorectal spacing. However, there was no advantage in reducing prostate displacement. Thus, labor-intensive daily nutritionist intervention with biofeedback is not cost-effective in reducing organ motion in patients with endorectal spacers compared with standard pretreatment dietary advice and is not recommended.
HIV diagnosis during acute infection: implications of long-acting preexposure prophylaxis and other evolving challenges
Authors: Elliott Tamara , Bradshaw Daniel , Fidler Sarah
Published: February 2025

Purpose of review

Tests for HIV may perform differently in some circumstances such as with preexposure prophylaxis (PrEP) or other HIV prevention agents. Testing algorithms may not account for this, with a risk of false negative or positive HIV results. In this review we have explored the challenges of HIV testing in these special circumstances.

Recent findings

Long-acting injectable PrEP using cabotegravir or lenacapavir has been studied in large randomized controlled trials (HPTN083/084 and PURPOSE1/2 respectively). Injectable PrEP was significantly more efficacious than oral PrEP, but infections still occurred risking the emergence of HIV drug-resistance. HIV diagnostic test results were atypical in those receiving injectable PrEP, with low or undetectable HIV viral loads, delayed or diminished antibody, and HIV detection assays reverting from reactive to unreactive; so-called long acting early viral inhibition (LEVI) syndrome. In these cases, missed or delayed HIV diagnoses could be reduced with the use of HIV nucleic acid amplification tests in addition to routine testing, but this remains unfeasible in many settings.

Finding HIV testing strategies that are affordable and practical in low- and middle-income countries that can accurately diagnose HIV in the context of HIV prevention is of high importance, but more research is needed in this area.
Anaesthesia as a risk factor for long-term cognitive decline
Authors: Pennings Christoph H. , Van Boxtel Martin , De Korte-De Boer Dianne , Buhre Wolfgang , Vossen Carine J.
Published: February 2025

BACKGROUND

There are concerns whether (repeated) exposure to general anaesthesia is associated with long-term cognitive decline.

OBJECTIVE

We investigated the potential, negative relationship between total exposure to surgery under general anaesthesia and its impact on long-term cognitive development.

DESIGN

A prospective longitudinal cohort study.

SETTING

The Netherlands.

PARTICIPANTS

1823 Adults, aged 25–84 with normal cognitive functioning on inclusion with three serial cognitive assessments between 1995 and 2008, with comprehensive documentation on demographic, lifestyle, and health factors.

MAIN OUTCOME MEASURES

The primary outcomes were test scores in the cognitive domains of learning and memory, executive function, selective attention, mental speed, and information processing speed. Linear mixed models were used to analyse the effects of the estimated total time under general anaesthesia at baseline on cognitive development during a 12-year follow-up period.

RESULTS

When adjusting for demographic and systemic health-related factors, prolonged exposure to surgery under general anaesthesia (measured in total baseline minutes) negatively affected three cognitive domains. These included the CST (executive functioning, P < 0.05), Stroop (selective attention and mental speed, P < 0.001) and LDST (information processing speed, P < 0.005). Age and education were the primary factors impacting lifetime cognitive decline. Hypertension, diabetes, and smoking negatively affected various cognitive domains.

CONCLUSION

Increased exposure to surgery under general anaesthesia independently contributes to long-term cognitive decline. Demographic variables and health-related factors are key contributors to accelerated cognitive decline over an individual's lifetime.