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Pediatric patients with tenosynovial giant cell tumor: real-world evidence from an observational registry
No full textAbstract Background Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive tumor originating in the synovial lining of the joint, bursa, and tendon sheath. TGCT typically affects individuals between 20 and 50 years of age and pediatric cases are considered ultra-rare. Research and clinical trials thus far have been largely focused on the adult TGCT population. Therefore, data are needed to understand the impact of TGCT on pediatric patients’ quality of life and any differences between adults. Here we report the result of the pediatric TGCT population enrolled in an observational patient registry. Patients and methods A total of 122 pediatric patients (9.5%) were included in this exploratory, cross-sectional analysis of a longitudinal 1,278-patient registry from October 06, 2022 to November 26, 2024. Among pediatric patients, 73.0% had diffuse TGCT (D-TGCT; n = 89), 16.4% had localized TGCT (L-TGCT; n = 20), and 10.6% had unspecified TGCT (n = 13). Pediatric patients had a median age at diagnosis of 14.5 years. Results More than half of pediatric patients were initially misdiagnosed and were more likely to be misdiagnosed than adults (62.3% vs. 49.9%, p < 0.01) and received joint aspirations significantly more frequently than adult patients (47.5% [n = 58] vs. 22.5% [n = 112], p < 0.05). Most pediatric patients were diagnosed by orthopedic surgeons (n = 79, 64.8%), and 52.5% of pediatric patients were diagnosed ≥ 1 years after symptom onset. Pediatric patients with D-TGCT underwent an average of 3.4 surgeries, compared to 1.8 surgeries for those with L-TGCT. Recurrence rates were similar among adults and pediatric patients with 66.3% of pediatric patients with D-TGCT having ≥ 1 post-operative recurrence compared to 15.0% of L-TGCT pediatric patients, respectively. Despite no approved systemic therapies for pediatric use, pediatric and adult patients consulted medical oncologists in similar rates and systemic therapies were prescribed similarly but infrequently overall (n = 21, 17.2% in pediatric patients and n = 95, 19.1% in adults). Conclusions Pediatric patients had significant disease burden, as compared to adults with TGCT, which severely affected their quality of life. The reliance on surgical treatment and underuse of multidisciplinary care emphasizes the unmet need for provider education and treatment advancements tailored to this population. Trial registration This study was an analysis of an observational patient registry and therefore was not registered as a clinical trial; no trial registration number is available. The study protocol was approved by Advarra (protocol reference number: Pro00077310). Patient enrollment for this analysis occurred from October 6, 2022, to November 26, 2024
Novel PSMA targeting alpha-emitting radioligand [211At]PSAt-3-Ga inhibits tumor growth and increases survival in a preclinical model of human xenograft prostate cancer
No full textStudy on the association between dietary inflammatory index and sarcopenia in older adults
No full textAbstract Objective To investigate the association between the Dietary Inflammation Index (DII) and sarcopenia in older adults, providing theoretical support for clinical prevention and treatment. Methods Elderly individuals aged 60 years and older in Urumqi were selected. Data were collected through questionnaires and physical examinations to assess sarcopenia prevalence. Logistic regression analyzed the relationship between DII and sarcopenia. A stepwise logistic regression model incorporating age, BMI, waist circumference, DII, and PSQI total score was constructed for prediction. Results Each 1-unit increase in DII significantly elevated sarcopenia risk (OR = 2.02, 95% CI: 1.49 to 2.73). The predictive model demonstrated good discrimination (AUC = 0.736 in training set, AUC = 0.742 in testing set) and calibration (Hosmer-Lemeshow test P > 0.05). Decision curve analysis indicated significant clinical net benefit within the 15% to 45% risk threshold range. Conclusion Elevated dietary inflammation index represents an independent risk factor for sarcopenia in older adults. The multifactorial prediction model demonstrates robust discriminatory capability and clinical utility. Optimizing dietary patterns to reduce DII is recommended for sarcopenia prevention
The effectiveness of a nation-wide implemented fall prevention intervention in the Netherlands in reducing falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: a randomized controlled trial
No full textAbstract Background Fall prevention programs have been proven effective in reducing falls and fall-related injuries in specific target groups and settings. However, implementing these programs on a larger scale often requires adjustments for feasibility. This study assessed the effectiveness of the nationally implemented In Balance fall prevention intervention compared to usual care in community-dwelling older adults. Methods In this single-blinded randomized controlled trial, 264 non- and pre-frail adults of 65 years or older with an increased fall risk were recruited from eleven centers. The intervention group followed an adapted nation-wide 14-week group In Balance program, including educational sessions and Tai Chi-based balance and strength exercises, delivered by trained therapists. The control group received general physical activity recommendations. Primary outcomes were the number of falls and fall-related injuries over 12 months, recorded via fall diaries and follow-up calls. Secondary outcomes included balance, mobility, and general health. Data were analysed using generalized linear- and mixed-effects models, with multiple imputation for missing data. To obtain a difference in the number of falls per year between the intervention and control groups of 50%, 106 participants per group were required, increased to 264 to account for dropout. Results The mean age was 75.2 (SD 5.6) years in the intervention and 75.7 (SD 5.1) years in the control group (p > 0.05). The mean number of falls per person over 12 months was not statistically different between the intervention and control group (1.67 (SE 0.24) and 1.98 (0.37), respectively; incidence rate ratio 0.85 (95% CI 0.51–1.43)), nor the mean number of fall-related injuries (0.70 (SE 0.11) and 0.97 (0.18), respectively; incidence rate ratio 0.73 (95% CI 0.44–1.19)). Secondary outcomes also showed no significant differences between groups, frailty status and over time. Attendance averaged 15.5 of 24 sessions. Conclusions The adapted In Balance program did not significantly reduce falls, injuries, or improve secondary outcomes compared to usual care. The implemented In Balance program appears to be less effective than a priori assumed, possibly due to limited adherence in practice or insufficient frequency and duration of the program. Trial registration Research with human participants: NL9248 (registered February 13 2021, URL: https://www.onderzoekmetmensen.nl/nl/trial/26195 )
When a chatbot asks “How are you?”: A cross-sectional study of AI call conversations and depressive symptom detection among older adults in rural South Korea
No full textAbstract Background Rapid population aging in Korea has intensified the need for emotional and health-related support among older adults, especially in rural regions facing depopulation and limited care resources. Conversational artificial intelligence (AI) call systems have emerged as potential tools for monitoring daily well-being and detecting early signs of psychological distress. This study examined the association between conversational patterns in a conversational AI call service and risk of depressive symptoms among community-dwelling older adults, integrating quantitative and qualitative analyses to evaluate the system’s feasibility and limitations. Methods This cross-sectional study included 2,896 adults aged 65 years or older residing in Jeongeup City, who used the Naver Clova AI CareCall service and completed a survey between May and August 2024. We linked 37,294 call records with survey data to compare service utilization patterns between high-risk (Geriatric Depression Scale-Short Form score ≥ 2) and low-risk groups. Multivariable logistic regression was used to identify predictors of the risk of depressive symptoms. We reviewed 73 conversation cases containing depressive cues, categorized into ten subthemes based on World Health Organization’s criteria. Three researchers independently assessed AI detection accuracy as correct, misinterpreted, or missed. Results Among all participants, 42.0% were classified as high-risk for depressive symptoms. They were older, more likely to live alone, received social assistance more frequently, and reported poorer health. The high-risk group had fewer positive responses, more negative and unasked responses, and longer call durations. After adjustment, average negative responses (aOR = 1.18, 95% CI = 1.04–1.35), unasked domains (aOR = 1.12, 95% CI = 1.03–1.21), and longer call time (aOR = 1.01, 95% CI = 1.00–1.02) were associated with a higher risk of depressive symptoms. Qualitative findings revealed expressions such as appetite loss, fatigue, and hopelessness, though the AI frequently misinterpreted or failed to detect them due to contextual or speech-recognition errors. Conclusions This study provides real-world evidence that conversational and linguistic features in AI call service are associated with the risk of depressive symptoms among older adults in rural communities. AI call service may complement mental health monitoring by enabling early detection of emotional distress. However, limited contextual understanding and variable user acceptance highlight the need for continued technical refinement and integration with professional interpretation
Diameter of the fetal pancreas and abdomen-to-pancreas-ratio: novel ultrasound parameters in fetal growth restriction
No full textAbstract Purpose The aim of this study was to compare fetal pancreas size at second trimester ultrasound screening of growth-restricted and normal weight fetuses. Methods One hundred sixty-six fetuses between 18 + 0 and 21 + 6 weeks of gestation were included in this retrospective study. 83 fetuses with a birth weight below the 10th centile were included in the study group which was further subdivided into two subgroups depending on the presence (subgroup 1) or absence (subgroup 2) of prenatal signs of fetal growth restriction. The control group consisted of 83 normal fetuses matched for sex and gestational age at examination. The pancreatic diameter (PD) was measured in a standard 2D plane of the fetal abdomen. Statistical analyses comprised descriptive statistics, reliability testing, and multivariable modelling to explore group differences and covariate effects on pancreatic diameter. Results The diameter of the pancreas was increased in the LBW group compared to the control group [3.7 mm vs. 3.1 mm (p < 0.001)]. The ratio of abdominal circumference (AC) to pancreatic diameter was significantly smaller in the LBW group [41.51 vs. 50.62 (p < 0.001)]. The result was consistent in the subgroup analysis. The difference of the median PD and ratio of AC/PD is greatest in subgroup 1 compared to the control group [PD: 4.2 mm vs. 3.1 mm (p < 0.001) and AC/PD-ratio 35.33 vs. 51.88 (p < 0.001)]. Conclusion The diameter of the fetal pancreas, as measured in this study, is a valuable parameter for the detection of small for gestational age and growth-restricted fetuses. Further studies are needed to further validate our results and their implication for clinical decision-making
The impact of gaming on functioning among people with schizophrenia: study protocol for a randomised controlled trial (GAME-A)
No full textAbstract Background Gaming interventions hold promising potential for methods of mental health treatment. Games designed for individuals with serious mental illness have demonstrated high acceptability. They have been shown to improve treatment engagement and increase a sense of self-efficacy and social integration. However, concerns remain over the potential adverse effects of regular gaming. Therefore, to investigate both the benefits and the risks, there is a need for well-designed, -conducted and -reported high-quality trials. This study aims to evaluate the effectiveness of a gaming intervention in improving functional and clinical outcomes in people with psychotic disorders and to assess the feasibility of the intervention. Methods The effectiveness of the gaming intervention will be assessed using a controlled clinical trial with a pragmatic, multicentre, two-arm parallel-group design. The participants will be recruited from various types of outpatient units (e.g. outpatient psychiatric units, day hospitals, residential care homes). Following the baseline assessment, participants will be centrally randomised (1:1) to receive either the gaming intervention plus treatment as usual (TAU) or TAU alone. The primary outcome will be the change in social functioning, measured at 3- and 6-month follow-ups. The secondary outcomes will include the patients’ major psychiatric symptoms, self-efficacy, quality of life, and aggression and potential adverse effects, also measured at 3 and 6 months. We will also test the feasibility of the gaming intervention from the perspectives of patients and nursing staff at a 3-month follow-up. Data will be collected from outpatient psychiatric services across Finland. Eligible participants will be between 18 and 60 years old and have a formal diagnosis of a psychotic disorder (F20–F29). We aim to recruit a total of 356 participants (178 for each group). We will estimate the efficacy of the intervention on the primary and secondary outcomes based on the intention-to-treat principle. Feasibility data will be analysed separately. Discussion This study will be one of the first trials to address the effectiveness of video gaming on improving functional and clinical outcomes in people with schizophrenia. The study will offer new information to confirm both the benefits and possible disadvantages of using gaming to improve patients’ health and well-being as new approaches to patient care in mental health services in Finland are explored. The results may provide insight into treatment for other health conditions in which motivational problems impact health outcomes. Trial registration NCT05707689 . Registered on 21 January 202
Group-based versus individual-based circuit training in elderly women with knee osteoarthritis: study protocol for a non-inferiority randomized controlled trial
No full textAbstract Background Knee osteoarthritis (KOA) is one of the most prevalent health issues, affecting approximately 67% of women over 60 years old. Clinical guidelines recommend individualized muscle training to treat this condition. However, a lack of human and financial resources hinders the delivery of this treatment. In response to this limitation, group training may be an alternative. Although a few studies have compared group and individual exercise for knee OA, none have tested the non-inferiority of group-delivered circuit training specifically in elderly women. Therefore, this study aims to compare the non-inferiority of a group-delivered muscle training program to the same individually delivered training in clinical and functional aspects in elderly women with KOA. Methods This is a randomized controlled non-inferiority trial with two arms, parallel groups, blinded evaluator, conducted in Petrolina—PE, evaluating women aged 60 or older. Participants randomly assigned will undergo an 8-week training, either in individual sessions (control group—IB) or as part of a group (intervention group—GB) of four participants, supervised by a physical therapist. Blind assessments at baseline, immediately post-intervention, and 4 weeks post-intervention will include feasibility, safety, and satisfaction analysis of the training program; pain; quality of life; and physical function. Data will be analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Estimated marginal means of each clinical and functional outcome for both groups (IB and GB) will be compared using mixed-effects generalized linear models. The primary analysis will test our main hypothesis that group training is non-inferior to individualized training regarding the primary outcome: relative reduction (%) in the WOMAC questionnaire pain subscale. Confidence intervals of 95% will be calculated. A significance level of p < 0.05 will be adopted in all analyses. Discussion Expected results suggest that a group-based approach is not inferior to an individual one in this population. Trial registration Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-5bq9jh3. Registered on 18 August 2023. Link: http://www.ensaiosclinicos.gov.br ; Universal Trial Number (UTN) of World Health Organization: U1111-1289–2580
Ultrasound-guided pecto-intercostal fascial plane block for chronic postoperative pain after cardiac surgery via median sternotomy: study protocol for a randomized controlled trial
No full textAbstract Background Median sternotomy As per our journal style, article titles should not include capitalised letters unless these are proper nouns/acronyms. We have therefore used the article title "Ultrasound-guided Pecto-intercostal fascial plane block for chronic postoperative pain after cardiac surgery via median sternotomy: study protocol for a randomized controlled trial" as opposed to "Ultrasound-guided Pecto-intercostal Fascial Plane Block for Chronic Postoperative Pain after Cardiac Surgery via Median Sternotomy: study protocol for a randomized controlled trial". Please check if this is correct.remains the preferred incision technique for cardiac surgery. Consequently, postoperative pain is a prevalent complication following such procedures, potentially leading to delayed recovery and a diminished quality of life for patients. The parasternal intercostal fascial plane block (PIFPB) is a superficial regional anesthetic technique targeting the interfacial plane between the pectoralis major and internal intercostal muscles. Currently, no randomized controlled trials have evaluated the impact of PIFPB on chronic pain following cardiac surgery via median sternotomy. To address this knowledge gap, we conducted a prospective, randomized, double-blind, placebo-controlled trial specifically designed to evaluate the effect of preoperative PIFPB on chronic pain incidence in patients undergoing median sternotomy for cardiac surgery. Methods This study protocol has been approved by the Ethics Review Committee of Zhongda Hospital, Southeast University. We plan to enroll 304 adult patients scheduled for cardiac surgery via median sternotomy under general anesthesia. Participants will be randomly allocated to one of two groups: the PIFPB group will receive a single injection of 40 ml of 0.375% ropivacaine hydrochloride administered, while the control group will receive an equivalent volume of 0.9% saline placebo. The primary outcome is the incidence of chronic pain at 3 months post-surgery. Discussion This is a novel randomized controlled trial designed to evaluate the impact of preoperative ultrasound-guided single parasternal intercostal fascia plane block on the incidence of chronic post-surgical pain (CPSP) in patients undergoing cardiac surgery via median sternotomy. The study will comprehensively describe the severity of postoperative acute and chronic pain, as well as associated clinical outcomes, in this patient population. Our findings may provide a foundation for optimizing analgesic strategies in cardiac surgery via median thoracotomy, further elucidate the role of regional anesthesia in postoperative chronic pain development, and ultimately improve postoperative quality of life for these patients. Trial registration The trial protocol was prospectively registered with the China Clinical Trial Registry on June 16, 2025, (trial identifier: ChiCTR2500104378)
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