Effects of patient-based self-assessed fatigue intervention on early postoperative ambulation following gynaecological oncology surgery: a randomised controlled non-inferiority trial.

OBJECTIVES: To assess the impact of a patient-based self-assessed fatigue intervention aimed at promoting early postoperative ambulation. DESIGN: Prospective randomised controlled trial. SETTING: Single-centre, conducted at the Obstetrics and Gynaecology Department of the Xiangyang Central Hospital, China. PARTICIPANTS: Eligible were adult patients undergoing elective gynaecologic oncologic surgery. INTERVENTIONS: The intervention group utilised a modified Borg Rating of Perceived Experience (RPE) scale for self-assessment of fatigue levels. The control group followed fixed-activity distance guidelines postoperatively. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the self-reported the time to first flatus postoperatively. Secondary outcomes encompassed the time to first defecation, incidence of moderate-to-severe abdominal distention, ileus, postambulation adverse events (nausea, vomiting and dizziness), patient satisfaction with early ambulation instructions, compliance with early ambulation and average hospital costs and length of stay. RESULTS: Between June 2021 and October 2022, 552 patients were enrolled. The self-assessed fatigue intervention group demonstrated non-inferior the time to first flatus compared with the fixed-activity distance assessment group (25.59±14.59 hours vs 26.10±14.19 hours, pnon-inferiority<0.001). Compliance with activity was higher in the intervention group (49.40% vs 36.02%, p<0.001), although it did not reach 50%. The intervention group also exhibited significantly higher mean hospital costs, length of stay and incidence of moderate-to-severe abdominal distention (p<0.001). CONCLUSIONS: The self-assessed fatigue intervention for early postoperative ambulation in gynaecologic oncology patients shows promise as an effective strategy; however, compliance is suboptimal. An intervention based on mandatory, yet reasonable, fixed-activity distance may represent the most viable current approach. Further research is warranted to confirm these findings. TRIAL REGISTRATION NUMBER: CTR2100046035.

Highly efficient Cu(II) capture by salicylaldoxime functionalized magnetic polydopamine core-shell hybrids: Behavior and mechanism.

Functionalized magnetic nanocomposites were considered as promising adsorbents owing to their abundant functional groups and ease of separation properties. Herein, we combined the solvothermal method with molecular copolymerization to synthesize a salicylaldoxime-grafted magnetic polydopamine (SMP) core-shell hybrid and exploited it for Cu(II) adsorption. The physicochemical properties of SMP were comprehensively studied by SEM, TEM, XRD, FT-IR, TGA, XPS, and VSM measurements. The results manifested that polydopamine acts as a bridge connecting magnetic iron oxide and salicylaldoxime to fabricated core-shell hybrids with rich functional groups. The batch experimental results showed that the Cu(II) adsorption was consumingly pH-reliant behavior, while adsorption data fitted the pseudo-second-order kinetic model and Langmuir isothermal model well, and the adsorption process achieved equilibrium within 60 min. Moreover, SMP exhibited remarkable anti-interference and can be recycled for 5 times with an inconspicuous decrease in adsorption performance. Importantly, salicylaldoxime functionalization endowed SMP with maximum Cu(II) adsorption capacity of 141.24 mg/g at pH 6.0 and 25 °C as compared with pure MP. Based on FT-IR and XPS study, the main adsorption mechanisms were proposed with a synergistic effect including a strong chemical chelation and partial Cu(II) reduction. Importantly, this strategy can be extended to multifunctional magnetic composites for Cu-contaminated wastewater cleanup.

Validity, feasibility, and effectiveness of a voice-recognition based digital cognitive screener for dementia and mild cognitive impairment in community-dwelling older Chinese adults: A large-scale implementation study.

INTRODUCTION: We investigated the validity, feasibility, and effectiveness of a voice recognition-based digital cognitive screener (DCS), for detecting dementia and mild cognitive impairment (MCI) in a large-scale community of elderly participants. METHODS: Eligible participants completed demographic, cognitive, functional assessments and the DCS. Neuropsychological tests were used to assess domain-specific and global cognition, while the diagnosis of MCI and dementia relied on the Clinical Dementia Rating Scale. RESULTS: Among the 11,186 participants, the DCS showed high completion rates (97.5%) and a short administration time (5.9 min) across gender, age, and education groups. The DCS demonstrated areas under the receiver operating characteristics curve (AUCs) of 0.95 and 0.83 for dementia and MCI detection, respectively, among 328 participants in the validation phase. Furthermore, the DCS resulted in time savings of 16.2% to 36.0% compared to the Mini-Mental State Examination (MMSE) and Montral Cognitive Assessment (MoCA). DISCUSSION: This study suggests that the DCS is an effective and efficient tool for dementia and MCI case-finding in large-scale cognitive screening. HIGHLIGHTS: To our best knowledge, this is the first cognitive screening tool based on voice recognition and utilizing conversational AI that has been assessed in a large population of Chinese community-dwelling elderly. With the upgrading of a new multimodal understanding model, the DCS can accurately assess participants' responses, including different Chinese dialects, and provide automatic scores. The DCS not only exhibited good discriminant ability in detecting dementia and MCI cases, it also demonstrated a high completion rate and efficient administration regardless of gender, age, and education differences. The DCS is economically efficient, scalable, and had a better screening efficacy compared to the MMSE or MoCA, for wider implementation.

Associations Between Abdominal Obesity, Chewing Difficulty and Cognitive Impairment in Dementia-Free Chinese Elderly.

OBJECTIVE: To investigate the independent and synergistic associations between abdominal obesity, chewing difficulty and cognitive impairment in a community-dwelling older adults sample in China. METHODS: Cognitive function was measured by the 5 min- Montreal Cognitive Assessment (5 min-MoCA) and abdominal obesity was measured by A Body Shape Index (ABSI) in 572 participants recruited from local communities. Chewing difficulty was assessed via a self-report questionnaire. Linear regression and general logistic regression were performed to investigate the association of chewing difficulty and abdominal obesity with cognition. RESULTS: Chewing difficulty score [ß (95% CI) = -.30 (-.49, -.11)] and ABSI [ß (95%CI) = -.30 (-.55, -.05)] were independently associated with worse performance on the 5 min-MoCA. Whilst ABSI was not associated with cognitive impairment, the co-existence of chewing difficulty and abdominal obesity [OR (95% CI) = 2.22 (1.18, 4.17)] was found associated with the presence of cognitive impairment. CONCLUSION: Chewing difficulty and abdominal obesity were independently associated with cognition. Abdominal obesity and chewing may have an additive effect on cognitive function.

Neurilemmoma of the Nasal Cavity and Paranasal Sinuses.

OBJECTIVES: Neurilemmoma in the nasal cavity and paranasal sinuses is very rare. The study aimed to improve the understanding of neurilemmoma in the nasal cavity and paranasal sinuses. MATERIALS AND METHODS: The clinical data of 10 patients with neurilemmoma in the nasal cavity and paranasal sinuses treated from January 2014 to June 2019 in our hospital were retrospectively studied. RESULTS: There were 6 females and 4 males patients in our study. The mean age was 49.5 years (range 37-77 years), and the most common clinical symptom was unilateral nasal obstruction. The site of tumor included the nasal cavity, maxillary sinus, ethmoid sinus, and sphenoid sinus. There were 2 cases with malignant neurilemmoma. Nine patients underwent functional endoscopic sinus surgery (FESS); however, 1 patient underwent FESS combined with the lateral rhinotomy for complete resection of the tumor. Two patients with malignant neurilemmoma received postoperative radiotherapy. The mean follow-up was 3.82 years (range 2-7 years). There were no incidences of tumor recurrence during the study period. CONCLUSIONS: Neurilemmoma in the nasal cavity and paranasal sinuses is a mainly benign tumor. Complete surgical excision by FESS is the only treatment option for neurilemmoma in the nasal cavity and paranasal sinuses; while malignant neurilemmoma needs postoperative radiotherapy.

A voice recognition-based digital cognitive screener for dementia detection in the community: Development and validation study.

Introduction: To facilitate community-based dementia screening, we developed a voice recognition-based digital cognitive screener (digital cognitive screener, DCS). This proof-of-concept study aimed to investigate the reliability, validity as well as the feasibility of the DCS among community-dwelling older adults in China. Methods: Eligible participants completed demographic, clinical, and the DCS. Diagnosis of mild cognitive impairment (MCI) and dementia was made based on the Montreal Cognitive Assessment (MoCA) (MCI: MoCA < 23, dementia: MoCA < 14). Time and venue for test administration were recorded and reported. Internal consistency, test-retest reliability and inter-rater reliability were examined. Receiver operating characteristic (ROC) analyses were conducted to examine the discriminate validity of the DCS in detecting MCI and dementia. Results: A total of 103 participants completed all investigations and were included in the analysis. Administration time of the DCS was between 5.1-7.3 min. No significant difference (p > 0.05) in test scores or administration time was found between 2 assessment settings (polyclinic or community center). The DCS showed good internal consistency (Cronbach's alpha = 0.73), test-retest reliability (Pearson r = 0.69, p < 0.001) and inter-rater reliability (ICC = 0.84). Area under the curves (AUCs) of the DCS were 0.95 (0.90, 0.99) and 0.77 (0.67, 086) for dementia and MCI detection, respectively. At the optimal cut-off (7/8), the DCS showed excellent sensitivity (100%) and good specificity (80%) for dementia detection. Conclusion: The DCS is a feasible, reliable and valid digital dementia screening tool for older adults. The applicability of the DCS in a larger-scale community-based screening stratified by age and education levels warrants further investigation.

The discriminant validity of single-question assessments of subjective cognitive complaints in an Asian older adult population.

Objective: To compare the discriminant validity of three different single-question assessments of subjective cognitive complaints (SCC) for dementia in a community-based older adult population in Singapore. Methods: Eligible older adults aged ≥60 were recruited into phase I for identifying those who require further assessment using the Abbreviated Mental Test (AMT) and progressive forgetfulness question (PFQ). Participants who failed either tests entered phase II and were administered various single-question assessments of SCC, such as the 8th question on the patient Ascertain Dementia 8 (AD8-8pt), informant AD8 (AD8-8info), and the 10th item on the Geriatric Depression Scale (GDS-10), followed by the Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery to identify the participant's cognitive status by a research diagnosis and DSM-IV criteria. Differences in characteristics among diagnostic groups were compared. All discriminatory indices (sensitivity, specificity, positive, and negative predictive values, overall accuracy) for these single-question assessments and their combinations with the MoCA were calculated and reported to confirm their discriminant validity in identifying the existence of subjective complaints and objective impairment. Results: A total of 3,780 participants were assessed at phase I, of which 957 entered and completed phase II. Of whom, 911 were dementia-free and 46 had dementia. The MoCA (13/14) displayed good sensitivity (95.6%), specificity (81.5%), and overall accuracy (82.1%) for dementia detection. The GDS-10 and AD8-8pt showed poor discriminant validity, while the AD8-8info had the highest specificity (83.2%) and the greatest overall accuracy (82.5%) for dementia. Compensatory combination of the AD8-8info with MoCA, the sensitivity and positive predictive values were optimized (100%), while the conjunctive combination of two tools achieved excellent specificity (96.3%) and overall accuracy (94.8%) in discriminating dementia patients. Conclusion and implications: Combining a reliable single-question SCC assessment with an objective tool can efficiently discriminate dementia patients from healthy older adults in the community.

Clinical characteristics of sinonasal inverted papilloma associated with recurrence and malignant transformation.

OBJECTIVE: Sinonasal inverted papilloma is a benign tumor but has a potential for recurrence and malignant transformation. The aim of this article is to analyze the clinical characteristics of sinonasal inverted papilloma associated with recurrence and malignant transformation. MATERIAL AND METHODS: A retrospective study was performed in all patients with sinonasal inverted papilloma diagnosed between in our hospital during May 2013 and May 2018. RESULTS: A total of 151 patients were enrolled in this study. The average age of these patients was 52.24 years, with a male-to-female ratio of 2.775:1, and the most frequent clinical symptom was nasal obstruction. The recurrence rate was 39.07% (59/151), the mean time of recurrence was 35.8 months and most recurrences occur within the first three years after surgery. There was no significant difference in recurrence rate between all four stages and between after endoscopic surgery and a combined endoscopic and external approach. The malignant transformation rate was 5.96% (9/151) and the mean time of malignant transformation was 9.06 months. CONCLUSIONS: Because of its high recurrence rate and the potential of malignant transformation, so it is important to determine the primary site of the tumor and to make a complete removal and a follow-up of at least five years after surgery is recommended.

[Clinical analysis of 31 cases of esthesioneuroblastoma].

Objective:To investigate the clinical characteristics and prognostic factors of esthesioneuroblastoma. Methods:The clinical data of 31 patients with esthesioneuroblastoma were retrospectively studied. Results:The average time from first onset to diagnosis in 31 patients was 7.84 months, among which 3 patients（9.68%） had cervical lymph node metastasis at the first visit. By the end of follow-up, there were 25 coexisting cases and 6 deaths. The mean recurrence time of 6 patients was 10.6 months. There were 6 patients with distant metastasis, including 4 patients with cervical lymph node metastasis, 1 patient with liver metastasis and 1 patient with bone metastasis. Modified Kadish stage, different treatment methods, recurrence, first diagnosis of cervical lymph node metastasis, and distant metastasis were all factors affecting the prognosis of the patients. Conclusion:The incidence of esthesioneuroblastoma is low and the comprehensive treatment of surgery combined with radiotherapy is the optimal treatment plan. Patients with low Kadish staging, surgical combined with radiotherapy, no recurrence, no initial cervical lymph node metastasis, and no distant metastasis have a better prognosis.