Search

Objectives Emerging evidence implicates atypical plasticity in the neurophysiology of autism spectrum disorder (ASD). Specifically, autistic people demonstrated hyperplasticity in response to theta-burst stimulation (TBS). We hypothesized that autistic adults would display hyperplasticity to TBS and that repetitive transcranial magnetic stimulation (rTMS) – which potentiates brain inhibitory mechanisms – would ‘stabilize’ hyperplasticity. Methods Using a randomized, cross-over design, plasticity was assessed using TBS in the left motor cortex (M1) in 31 autistic adults and 30 sex-, intelligence quotient-, and age-matched controls. Autistic adults (n = 29) were further randomized (1:1) to receive a single session of active (n = 14) or sham (n = 15) rTMS (6000 pulses at 20 Hz) over left M1 and plasticity was reassessed on the next day following rTMS. Results Both long-term potentiation (LTP) and long-term depression (LTD) were significantly increased in the ASD group, indicating hyperplasticity. Active, but not sham rTMS, attenuated LTD in autistic adults. Conclusions We provided further evidence for the presence of brain hyperplasticity in ASD. To our knowledge, this is the first study to show preliminary evidence that an excessive LTD in ASD can be ‘stabilized’ using rTMS. Such ‘stabilizing’ effect of rTMS on LTP was not observed, likely due to small sample size or a more specific ‘attenuating’ effect of rTMS on LTD, compared to LTP. Significance These findings indicate atypical brain inhibitory mechanisms behind hyperplasticity in ASD. Utilizing a larger sample, future replication studies could investigate therapeutic opportunities of ‘mechanism-driven’ rTMS.

Suicide is a considerable public health concern, particularly among U.S. veterans. Despite inpatient psychiatric hospitalization being a primary recommended treatment for acute suicidality, available inpatient group treatments remain limited. The current quality improvement project (QIP) aimed to examine the feasibility and acceptability of a newly developed single-session suicide-focused psychoeducation for veterans during psychiatric hospitalization. This project was conducted in two phases among veterans hospitalized for suicidal thoughts or behaviors. The first phase (

BACKGROUND Significant disparities in surgical outcomes exist. It is imperative to prepare future doctors to eliminate disparities. Our team of senior medical students developed a surgical clerkship module examining equity in prostate cancer. Student attitudes before and after a facilitated teaching session were assessed. METHODS A surgical equity pilot module was integrated into the core surgical clerkship starting in July 2020. This module was composed of (1) asynchronous preparatory material and (2) a synchronous interactive case discussion regarding disparities in prostate cancer. Discussion sessions were facilitated by upper-level medical students. Participants answered optional anonymous Likert-style and open-ended survey questions before and after the session. Pre- and post-responses were compared. RESULTS One hundred and sixteen students completed the module between July 2020 and January 2021. Pre- and post-survey response rates were 66% and 29%, respectively. At baseline, almost all students (95%) agreed knowledge of disparities would make them a better physician. However, the majority (95%) described their general knowledge of surgical disparities as "nonexistent," "poor," or "average." Most students did not have a framework for assessing causes of surgical disparities (86%) and were not aware of interventions for reducing disparities (90%). After intervention, the majority rated their knowledge of surgical disparities as "good" or "excellent" (71%; P < .001). Most students indicated they had a framework 79%; P < .001) and were aware of effective interventions (62%; P < .001). CONCLUSION We demonstrated a successful pilot of an equity-focused clerkship module. Student attitudes after a single session reflected significant improvement in knowledge of causes and interventions related to surgical disparities. Equity-focused teaching can be incorporated into the surgical clerkship.

Beato, M, Bianchi, M, Coratella, G, Merlini, M, and Drust, B. A single session of straight line and change-of-direction sprinting per week does not lead to different fitness improvements in elite young soccer players. J Strength Cond Res 36(2): 518-524, 2022-Effective prescription is especially important in elite soccer players, who have a very limited time to dedicate to specific physical development as a consequence of factors such as congested match schedules and travel. The aim of this study was to compare the effectiveness of one repeated-sprint training (RST) session per week over an 8-week period on physical performance. A second aim was to compare the effect of RST involving straight sprints (RST-SS) or changes of direction (RST-COD). This study used a randomized pre-post parallel group trial design. The elite soccer players were randomly assigned to either an RST-SS (10 players) or RST-COD (10 players). RST-SS was 3 sets of 7 × 30-m sprints with 20-second and 4-minute recovery between sprints and sets, respectively. RST-COD was 3 sets of 7 × 20 + 20 m (one COD of 180°) shuttle sprints with 20-second and 4-minute recovery between sprints and sets, respectively. The physical tests selected were long jump, repeated-sprint ability (RSA) best, RSA mean, 505 agility test, Yo-Yo recovery level 1, 10, 30, and 40 m sprints. RST-SS reported unclear variations in long jump, sprint 30 m, sprint 40 m, RSA best, and RSA mean, whereas RST-COD showed unclear and trivial variations in sprint 10 m, sprint 30 m, sprint 40 m, RSA best, and RSA mean. The between-group analysis did not report any statistical difference. In conclusion, a single session of RST-SS and RST-COD do not improve soccer-specific fitness indicators in elite youth players during the season.

Objective Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. Methods The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n = 24) and IF Group (n = 16). Results The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p = 0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p = 0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p = 0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p = 0.041). Conclusion The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients’ general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

The objective of this study was to determine the immediate effects of transcutaneous electrical nervous stimulation (TENS) and semi-occluded vocal tract (SOVT) exercises on acoustic parameters in teachers in the city of Chillan. The study was based on a quantitative methodological perspective, with a comparative descriptive scope and a quasi-experimental longitudinal design. The sample was composed of 30 teachers belonging to the Reyes de Espana School, who were evaluated using Praat software, pre and post treatment. The teachers were divided into 2 groups; control group (semi-occluded vocal tract therapy) and experimental group (semi-occluded vocal tract therapy and electrostimulation) who were treated during a single session of approximately 10 min. The values of the acoustic parameters were then compared [Jitter, Shimmer, Harmonic to Noise Ratio (HNR) and Maximum Phonation Time (MPT)] between both groups. The acoustic analysis showed statistically significant post-intervention changes in all the parameters evaluated for both study groups, however, in the experimental group the means showed a greater difference, with a p value less than .01. Semi-occluded vocal tract exercises in resonance tubes combined with TENS have immediate positive effects on TMF, Jitter, Shimmer and HNR acoustic parameters in teachers without vocal pathology.

Two decades of research support Dugas and colleagues’ (1998) Intolerance of Uncertainty (IU) Model of Generalized Anxiety Disorder (GAD), suggesting that IU is a key factor involved in the maintenance of excessive worry. As such, a cognitive behavioural treatment targeting IU (CBT-IU) has been developed, and it is a highly efficacious treatment for GAD. Given the importance of IU in GAD, the current research investigated attitudes and behaviours associated with uncertainty that are not yet well understood, and tested the effects of a technique employed in CBT-IU called uncertainty exposure on IU and GAD symptoms. Study 1a and 1b present the results of a mixed methods study that involved asking individuals with GAD (n = 20) and non-psychiatric control participants (NPCs; n = 20) about their experience with uncertainty, coding their responses into themes, and examining between-group differences in responses. Study 1a compared the responses of people with GAD to NPCs on: beliefs about uncertainty, attitudes toward different “types” of uncertainty, and reflections on clinical observations about IU. Study 1b compared the responses of the GAD and NPC groups on: what behaviours they engage in when uncertain, as well as the frequency, functions, discontinuation factors, and problems associated with such behaviours. Study 1a and 1b produced rich data that offer novel insights about the nature of IU in GAD. Study 2 tested the impact of completing a single session of training in uncertainty exposure and 1 week of practice with uncertainty exposure (exposure group; n = 20), compared to completing assessment only (control iv group; n = 20) in a GAD sample. Participants in the exposure group showed large significant improvements in IU and GAD symptoms from baseline to 1 or 2 weeks post baseline, whereas the control group showed no change. Completing more uncertainty exposure practice was associated with larger improvement in outcomes. These findings provide novel support for the proposed role of IU in maintaining GAD, and for the use of uncertainty exposure in GAD treatment. Overall, findings from this dissertation inform theoretical conceptualizations of IU in GAD and the clinical application of this model.

Single session therapy (SST) is an increasingly popular approach to mental health treatment that aims to address clients’ presenting difficulties in a single appointment. However, experiential appr...

Purpose: High intensity interval training (HIIT) produces significant health benefits. However, the acute physiological responses to HIIT are poorly understood. Therefore, we aimed to measure the acute cardiac autonomic, haemodynamic, metabolic and left ventricular mechanical responses to a single HIIT session. Methods: Fifty young, healthy participants completed a single HIIT session, comprising of three 30-second maximal exercise intervals on a cycle ergometer, interspersed with 2-minutes active recovery. Cardiac autonomics, haemodynamics and metabolic variables were measured pre, during and post HIIT. Conventional and speckle tracking echocardiography was used to record standard and tissue doppler measures of left ventricular (LV) structure, function and mechanics pre and post HIIT. Results: Following a single HIIT session, there was significant post-exercise systolic hypotension (126±13mmHg to 111±10mmHg p

Objective Current competencies required for fellowship of the RANZCP require psychiatry registrars to have experience in working with clients across all age groups, as well as working with families and the client’s wider network, however gaining this experience is not always easy for trainees. This paper reports on the experience of participating in Single Session Family Therapy (SSFT) during registrar training as a different modality for learning. Method: An online survey was conducted with fourteen registrars who had participated in SSFT during their child and adolescent rotation. Qualitative and simple quantitative data were collected and analysed. Results: Participating in SSFT during training was initially daunting, but had a positive effect on trainees, including influencing some towards focussing their future sub-specialisation in the child and youth area. Experience came through learning by doing, and seeing change. Registrars learnt about: understanding the role of the family; teamwork; technical skills; and gained confidence. Conclusions: Opportunities for trainees to participate in SSFT enables powerful learning beyond what can be taught in the classroom. Such opportunities may enhance registrars’ perceptions of family work, and may positively influence decision about future sub-specialisation.

Branched-chain amino acids (BCAA) are used as a recovery method after exercise-induced muscle damage (EIMD). Although data suggest that BCAA may alleviate the delayed-onset muscle soreness (DOMS) evoked by EIMD, there is no consensus about the most effective supplementation protocol. To investigate the effects of BCAA on DOMS after a single exercise session that caused EIMD, a systematic review and meta-analysis were conducted on the effectiveness of BCAA supplementation to reduce DOMS symptoms in healthy subjects after a single session of EIMD. Randomized clinical trials (RCT) were searched in Medline, Cochrane Library, Science Direct, SciELO, LILACS, SciVerse Scopus, Springer Link journals, Wiley Online Library, and Scholar Google, until May 2021. Ten RCTs were included in the systematic review and nine in the meta-analysis. Seven studies demonstrated that BCAA reduced DOMS after 24 to 72 h. BCAA doses of up to 255 mg/kg/day, or in trained subjects, for mild to moderate EIMD, could blunt DOMS symptoms. However, high variability between studies due to training status, different doses, time of treatment, and severity of EIMD do not allow us to conclude whether BCAA supplementation is efficient in untrained subjects, applied acutely or during a period of pre to post days of EIMD, and at higher doses (> 255 mg/kg/day). The overall effects of BCAA on DOMS after a single session of exercise were considered useful for improving muscle recovery by reducing DOMS in trained subjects, at low doses, in mild to moderate EIMD, and should not be administered only after the EIMD protocol.

The performance profile technique is a standard, theory-driven sport and performance psychology intervention for enhancing various psychological outcomes within athletes and teams. Despite the popu...

Background and Aims EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE. Methods We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation. Results Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding. Conclusions Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.

Amaç: Bu çalışmanın amacı, ventral hernide eş zamanlı pannikülektomi uygulamasının postoperatif morbidite oranlarını artırıp artırmadığını araştırmaktır.Gereç ve Yöntem: Çalışma Ocak 2018- Aralık 2020 tarihleri arasında Yozgat Şehir Hastanesi Genel Cerrahi Servisinde, retrospektif olarak gerçekleştirildi. Hastaların cinsiyet, yaş, vücut kitle indeksi, yandaş hastalıkları, herni tipi ve boyutu, geçirilmiş karın cerrahisi öyküsü, ASA değeri (American Society of Anesthesiology), post-operatif komplikasyonlar, hastane yatış ve takip süreleri değerlendirildi. Post-operatif komplikasyonlar Clavien-Dindo sınıflamasına göre değerlendirildi. Bulgular: On dört hastaya eş zamanlı pannikülektomi ve ventral herni onarımı (Grup 1), 27 hastaya sadece ventral herni onarımı (Grup 2) yapıldı. Grup 1’de herni defekti alanı yaklaşık 6,25 kat daha fazlaydı. Hastane yatış süresi pannikülektomi uygulanan hastalarda anlamlı olarak daha uzundu. Ortanca takip süresi Grup 1 hastalarda 8,5 ay (2-14), diğer grupta 14 aydı (3-36). Çoklu lineer regresyon analizlerinde hastane yatış süresi üzerinde sadece herni defekt alanın anlamlı etkisi olduğu görüldü. En ciddi komplikasyon Clavien-Dindo sınıflamasına göre 3b (genel anestezi altında cerrahi müdahale) grubunda oluşan cilt nekrozuydu. Yara yeri komplikasyon ve herni rekürrensi açısından gruplar arasında anlamlı fark saptanmadı.Sonuç: Ventral herni onarımların eş zamanlı pannikülektomi uygulaması komplikasyonları ve nüks oranını artırmamaktadır. Her iki probleminden de tek seansta kurtulmak isteyen hastalara güvenle uygulanabilir., simultaneous panniculectomy applications in ventral hernia repair increases postoperative morbidity rates.Materials and Methods: The study was carried out retrospectively between January 2018 and December 2020. The patients were evaluated in terms of sex, age, body mass index, accompanying diseases, hernia type and size, abdominal surgery history, ASA value (American Society of Anesthesiology), postoperative complications, hospitalization, and follow-up durations. Post-operative complications were evaluated according to the Clavien-Dindo classification. Results: It was determined that 14 patients underwent simultaneous panniculectomy and ventral hernia repair (Group 1), while 27 patients underwent sole ventral hernia repair (Group 2). In Group 1, the hernia defect area was approximately 6.25-fold higher. In patients with a panniculectomy, hospitalization time was significantly longer. The median follow-up period was 8.5 months (2-14) in Group 1, and 14 months in Group 2 (3-36). In multiple linear regression analyses, only the effect hernia defect area was significant on the hospitalization time. There were no significant differences between the groups in terms of complications and hernia recurrence.Conclusion: Simultaneous panniculectomy applications in ventral hernia repairs do not increase the rate of complications and hernia recurence. A simultaneous panniculectomy application can be applied safely to patients who want to “eliminate” both of their problems in a single session.

Metaphors play an important role in contemporary approaches to grief therapy by helping clients (re)construe their continuing relationship with the deceased. Relevant studies have illustrated the substantive elements of metaphors (i.e. sources, targets, and mappings) in this regard, often focusing on localized bursts of intense metaphoric activity. This paper highlights the extended nature of metaphoric conceptualizations and their relationship with key meaning-making processes, following the principle of ‘correspondent analysis’ as a collaborative move between language analysts and therapy practitioners. Three specific phenomena are detailed through a mixed methods analysis of 18 motivated segments in a single session of grief therapy: (i) sporadic sources, (ii) persistent sources, and (iii) metaphor ‘chaining’ across embodied and verbal activity. Their respective links to treatment objectives and processes demonstrate how metaphor theoretic constructs dovetail with therapeutic work, and suggest future avenues for modeling unfolding metaphoric activity as a time series.

This study assesses the feasibility of a brief intervention among women with hazardous alcohol use at a primary health care service in Brazil. A two-arm randomized pilot study was carried out from July 2017 to January 2018 with 44 women aged 18 years or older with hazardous alcohol use. The intervention group completed a brief intervention in a single session lasting 20 to 30 minutes. The control group received five minutes of brief advice. Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT), and the frequency and quantity of alcohol consumed in the previous month were assessed at baseline and the first and third months of follow-up in both groups. The AUDIT score was decreased in both groups at baseline (intervention group 12.89, control group 10.64), the 1st month (intervention group 12.78 p = .9; control group 7.9 p = .01) and the 3rd month (intervention group 10.11 p = .13; control group 7.09 p

Purpose: To analyze the relationships between the evolution of training-load values and countermovement jump (CMJ) as an indicator of stress and fatigue in a high-level 800-m runner during a whole season, including indoor (ID) and outdoor season (OD). Methods: Over 42 weeks, daily training load was quantified as the result of the product of the intensity and volume, and it was termed load index (LI). CMJ was measured in every running session after warm-up and immediately after the last effort of the session. Other jump-related variables such as CMJ height loss, average weekly CMJ, initial CMJ of the next consecutive session, and initial CMJ of the following week were studied. Results: A significant negative relationship was observed between LI and weekly CMJ (ID: r = −.68, P r = −.73, P r = −.71, P r = −.58, P r = −.52, P r = .72; P r = −.74; P r = −64, P Conclusions: CMJ may be a valid indicator of the degree of stress or fatigue generated by specific training sessions of a competitive athlete within a single session, a week, or even the following week. There could be an individual limit LI value from which the training volume does not allow a positive effect on high-speed actions such as a CMJ in the next consecutive session.

Background Facial nerve injury after facelift is rare; hence, its treatment is poorly established. Botulinum toxin type A (BTXA) can be employed to resolve the asymmetry. To our knowledge, there is no protocol in the literature about the best timing for this treatment, injection sites, or recommended dose. Objectives The authors sought to propose a protocol to guide the management of asymmetries post-facelift. Methods Fifteen patients with post-rhytidectomy facial palsies were treated in the non-paralyzed side with BTXA. After analysis of the smile deviation vectors, it is possible to identify the muscles that should be treated. The dose varied from 1 to 2 volume-unit per point. Patients were examined after 15 days for outcomes evaluation and touch-up if needed. Patients were re-treated after 5 to 6 months in case of asymmetry recurrence. Results Symmetry was achieved in all cases. Six patients had definitive nerve lesions and required treatment every 6 months after the first session. Five patients had lesions affecting the upper third of the face; 4 of them were definitive nerve lesions. Two of the 4 patients who were treated less than 2 weeks after surgery recovered early from the post-facelift paralysis and developed reversed asymmetry due to the BTXA. In 7 patients, the post-facelift asymmetry was due to neuropraxis: the recovery from the nerve injury and BTXA treatment occurred symmetrically on both sides of the face in the following months after 1 single session. Conclusions Asymmetries post-facelift were successfully managed with the proposed protocol. The best time for injection was 2 to 4 weeks after surgery. Level of Evidence: 4

Emotionally Focused Couple Therapy, an experiential modality, views emotion central to therapeutic change. In this exploratory study, we examined therapists' repetition of somatically focused interventions (therapist verbalizing somatic cues, such as facial expressions) and their impact on clients' emotional experiencing in-session. We also assessed difference for withdrawing versus pursuing partners. The sample included 13 EFT therapists who worked with one couple each for a single session. From transcripts we coded therapists' repetition of somatically focused interventions and clients' depth of experiencing pre-and post-intervention. Multilevel modeling demonstrated that a higher number of repetitions of somatically focused interventions predicted greater increase in depth of experiencing, unlike length of time spent repeating interventions. Somatically focused interventions resulted in greater increase in depth of experiencing for withdrawing as compared to pursuing partners. The results of this exploratory study suggest that such interventions may be a specific technique of EFT therapists that enhances emotional experiencing especially among withdrawing partners. peerReviewed

According to the American Urological Association and European Association of Urology guidelines, shockwave lithotripsy (SWL) is the least-invasive treatment option for kidney stones smaller than 2 cm. However, it is well known that SWL stone-free rates (SFR) decline as stone size increases. We sought to evaluate whether the size limit of 1.5 cm could be a better predictor of success after a single SWL session than current recommendations.Data from an SWL-dedicated center were prospectively scrutinized according to stone locations and sizes. Information on patients' demography, lithotripsy parameters, and outcomes was evaluated by multivariate analysis among 1902 SWLs.The overall SFR was 70.8% (1347/1902). SFRs according to stone size were1 cm: 73.8% (825/1118), 1-1.5 cm: 70.4% (401/569) and1.5 cm: 56.2% (121/215); and according to calculi location were lower pole (LP) 64.4% (398/618), mid pole 73.8% (339/459), upper pole 73.8% (273/370) and renal pelvis 74.1% (337/455). Multivariate analysis revealed better SFR independent better SFR in1.5 cm (SWL is an effective treatment modality for kidney stones. The single session reached up to 74.8% SFRs (range 70.8%-74.8%) when indicated for intrarenal non LP stones smaller than 1.5 cm. Patients with stones1.5 cm or1 cm located in the LP should be counseled on the lower SFRs after a single SWL session.

This study determined the effect of a single session of sprint interval training in hypoxia on muscle glycogen content among athletes. Ten male college track and field sprinters (mean ± standard error of the mean: age, 21.1 ± 0.2 years; height, 177 ± 2 cm; body weight, 67 ± 2 kg) performed two exercise trials under either hypoxia [HYPO; fraction of inspired oxygen (FiO2), 14.5%] or normoxia (NOR: FiO2, 20.9%). The exercise consisted of 3 × 30 s maximal cycle sprints with 8-min rest periods between sets. Before and immediately after the exercise, the muscle glycogen content was measured using carbon magnetic resonance spectroscopy in vastus lateralis and vastus intermedius muscles. Moreover, power output, blood lactate concentrations, metabolic responses (respiratory oxygen uptake and carbon dioxide output), and muscle oxygenation were evaluated. Exercise significantly decreased muscle glycogen content in both trials (interaction, P = 0.03; main effect for time, P

Background and aim Bilateral stent deployment for malignant biliary obstruction (MHBO) can be achieved using side-by-side (SBS) or stent-in-stent (SIS) procedures. Compared with SBS techniques, the procedural steps of SIS are technically complex due to the necessity of introducing the delivery system into a contralateral biliary tract through the mesh of the SEMS. To overcome this issue, a novel uncovered SEMS, the HILZO Moving Cell Stent (MCS) has been released. The present study examined the technical feasibility of treating MHBO using bilateral deployment of this novel stent without dilating the mesh of the first stent to achieve insertion of the second stent within a single session, using a prospective, multicenter setting. Method The primary outcome in the present study was the technical success rate. Technical success was defined as deployment of bilateral MCSs into two or more biliary tracts using SIS without a dilation device in a single-session. Results A total of 27 patients with complications of MHBO were enrolled in this study. Bilateral SIS using two MCS was successfully performed in 23 patients without using dilation devices among 27 patients (initial technical success rate; 85.2%). Median time to recurrent biliary obstruction (TRBO) was 271 days. Stent dysfunction was observed in 12 patients (44.4%), and re-intervention was successfully performed in all patients without one patient who instead received best supportive care. Conclusions The SIS technique using MCS without dilation of the mesh may be technically feasible and safe. In addition, this may be useful for re-intervention. Further comparative randomized trials are needed.

Law enforcement violence has emerged as a leading public health concern, and law enforcement officers are themselves at greater risk for a range of psychiatric disorders. Drawing on the significant...

Objetivo avaliar o efeito de uma sessão de treino de força nos ní­veis de cortisol em homens e correlacionar ao score de estresse durante a pandemia do COVID-19. Participaram do estudo 10 voluntários fisicamente ativos com idade de 18 a 31 anos. Após repouso de 48 horas foi aplicado uma anamnese, avaliação da composição corporal, hemodinâmica em repouso, avaliação da variabilidade da frequência cardí­aca, coleta de sangue. Foi observada redução nos ní­veis de cortisol um dia após a sessão de treino de força. Uma forte correlação foi observada entre o score de estresse e os ní­veis de cortisol bem como entre o cortisol e o í­ndice LFms em repouso e entre a razão SD1/SD2 e o peso magro. Uma única sessão de treino de força com alta intensidade se mostrou eficaz na redução do cortisol em homens adultos que apresentaram ní­veis elevados de estresse percebido durante a pandemia do COVID-19.

Background: Tendinitis is a term that is often used to describe various regional musculoskeletal conditions that are common and often occur, which are described mainly by pain and disability at the affected site. In calcareous (or calcific) tendinitis (CT) of the shoulder, a calcified deposit (hydroxyapatite) is located within 1 or more of the rotator cuff tendons (commonly the supraspinatus). CT is found in 10%–42% of chronic shoulder pain. Conservative treatment is always the first line of treatment. Acupuncture has been widely accepted by patients who experience musculoskeletal pain compared with other nonsurgical modalities and it is a minimal risk intervention. Case: A 56-year-old woman was diagnosed with shoulder CT. Physical examination revealed limited range of motion (ROM) in abduction (78.6°) and lateral rotation (82.5°) of the right shoulder joint with a pain scale using numeric rating scale (NRS) assessment score of 5 (with diclofenac sodium 2 × 50 mg since 1 day ago). She received single session of acupuncture with balance method and distal point with a total of 10 needles, then all needles were retained for 45 minutes and the therapy was done only unilaterally. Then follow-up was made 2 days later. Results: After the session ended, NRS assessment score reduced from 5 to 2, ROM in abduction and lateral rotation of the right shoulder was improved, respectively, to 179.2° and 150.4°. In follow-up 2 days after, ROM in abduction and lateral rotation became 168.9° and 147.8°, respectively, and NRS was still 2. Conclusions: Acupuncture with the use of the balance method and distal point effectively relieved the pain and improved ROM of CT even after 2 days.

Both memory and choice are influenced by context: Memory is enhanced when encoding and retrieval contexts match, and choice is swayed by available options. Here, we assessed how context influences risky choice in an experience-based task in two main experiments (119 and 98 participants retained, respectively) and two additional experiments reported in the Supplemental Material available online (152 and 106 participants retained, respectively). Within a single session, we created two separate contexts by presenting blocks of trials in distinct backgrounds. Risky choices were context dependent; given the same choice, people chose differently depending on other outcomes experienced in that context. Choices reflected an overweighting of the most extreme outcomes within each local context rather than the global context of all outcomes. When tested in the nontrained context, people chose according to the context at encoding and not retrieval. In subsequent memory tests, people displayed biases specific to distinct contexts: Extreme outcomes from each context were more accessible and judged as more frequent. These results pose a challenge for theories of choice that rely on retrieval as guiding choice.

The user base of the virtual reality (VR) medium is growing, and many of these users will experience cybersickness. Accounting for the vast interindividual variability in cybersickness forms a pivotal step in solving the issue. Most studies of cybersickness focus on a single factor (e.g., balance, sex, or vection), while other contributors are overlooked. Here, we characterize the complex relationship between cybersickness and several measures of sensorimotor processing. In a single session, we conducted a battery of tests of balance control, vection responses, and vestibular sensitivity to self-motion. Following this, we measured cybersickness after VR exposure. We constructed a principal components regression model using the measures of sensorimotor processing. The model significantly predicted 37% of the variability in cybersickness measures, with 16% of this variance being accounted for by a principal component that represented balance control measures. The strongest predictor was participants’ sway path length during vection, which was inversely related to cybersickness [ r(28) = −0.53, P = 0.002] and uniquely accounted for 7.5% of the variance in cybersickness scores across participants. Vection strength reports and measures of vestibular sensitivity were not significant predictors of cybersickness. We discuss the possible role of sensory reweighting in cybersickness that is suggested by these results, and we identify other factors that may account for the remaining variance in cybersickness. The results reiterate that the relationship between balance control and cybersickness is anything but straightforward.NEW & NOTEWORTHY The advent of consumer virtual reality provides a pressing need for interventions that combat sickness in simulated environments (cybersickness). This research builds on multiple theories of cybersickness etiology to develop a predictive model that distinguishes between individuals who are/are not likely to experience cybersickness. In the future this approach can be adapted to provide virtual reality users with curated content recommendations based on more efficient measurements of sensorimotor processing.

OBJECTIVE Treadmill training with an upward incline could improve gait parameters altered in persons with stroke, especially lower limb flexion. This study aimed to determine the effects of a treadmill single-session training with a 10% upward incline on biomechanical gait parameters in persons with stroke. METHODS Fifteen persons with stroke-related hemiparesis performed a 20-min treadmill training session with a 10% ascending incline in this interventional pilot study. Spatiotemporal, kinematic and kinetic parameters were evaluated, overground, with a tridimensional optoelectronic system, before the session, immediately after and after a 20-min rest period. RESULTS The single-session training on a treadmill with a 10% incline has significantly increased hip flexion peak on the paretic side (39.8°± 8.1 in baseline to 42.7°± 8.6 after the session, P

The aim of the study is to study the safety and efficacy of three cyclodestructive treatments; high-intensity focused ultrasound (HIFU) cyclocoagulation versus micropulse cyclophotocoagulation (MP-CPC) versus transscleral continuous-wave cyclophotocoagulation (CW-CPC) for treatment of non-refractory glaucoma. This is a prospective comparative single-center study. Thirty non-refractory, medically uncontrolled, primary open-angle glaucoma patients with good vision were randomized to a single session of HIFU, MP-CPC or CW-CPC. Intraocular pressure (IOP) reduction, number of medications, success rate, visual acuity and complications were compared between the three groups. Success was defined as an IOP reduction of 30% and IOP between 6 and 21 mmHg with or without medications, in the absence of vision-threatening complications. Thirty patients were enrolled in our study: 10 patients received HIFU, 10 patients received MP-CPC and 10 patients received CW-CPC. At 6 months, IOP was reduced by 31.5%, 23.9% and 19.4% (P = 0.4) achieving a success rate of 50%, 60% and 50% (P = 0.8) for continuous, micropulse and HFU groups, respectively, with reduction in the number of drops and stop of oral acetazolamide. Although the difference in the rate of complications between groups was not significant, CW-CPC group had more complications. Cyclophotocoagulation could be an option in the treatment of non-refractory glaucoma even in patients with good visual acuity, with similar outcomes between the three types of cyclodestruction.

This study refers to clinical and histologic analysis of effects on photorejuvenation after one single treatment of fractional CO2 laser with low fluence and low density. To analyze histologically the quantitative variation of collagen fibers type I and III, elastic fibers, and epidermal thickness on D84, besides clinical evaluation of amount, length, thickness, and depth of periocular wrinkles during the same period. This is an open, prospective, interventional study. There were 40 healthy female with age between 35 and 65 years. Twenty-six participants were randomly selected for D0 and D84 biopsy. A single session of fractional CO2 laser was done in the hole face, using a 800-µm tip, 5% density, and 10 mJ fluence with a single pass. On D0, D42, and D84, a clinical comparative analysis of amount, length, depth, and thickness of periocular wrinkles has been done. On histological analysis, a comparative quantitative evaluation of collagen fibers type I and III, elastic fibers, and epidermal thickness has been done on D0 and D84. The results of this study denoted a significant clinical improvement of amount (− 32.17%; p

The present experiment sought to further understanding of the psychological and psychophysiological mechanisms underlying the effects of a single session of audio-guided meditation during moderate-...

To determine the effect of a single session of arm crank ergometry (ACE) exercise on carbohydrate metabolism immediately and 24 h after the exercise bout in paraplegia and able-bodied controls (ABC).Paraplegia (VOA single bout of ACE at 75% VO

Objective We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo (HC BPPV-AG) in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management. Methods In a retrospective review of cases from an ambulatory tertiary referral center, patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres, were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored, until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed. Results Fifteen patients were studied. All but one [14/15 cases] showed a positive therapeutic response to the repositioning procedure in a single session. In two cases, a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase. Although in three patients the affected ear was not initially identified, it was ultimately identified and successfully treated by the square wave manoeuvre in all of them. Conclusions The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction, where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.

Objective: The aim of the present study was to compare the effects of acupuncture treatment on arterial blood pressure (BP) and heart rate (HR) in patients with mild hypertension with high sympathe...

A large proportion of young people accessing specialist mental health services do so for a single session. The aim of the present study was to examine the characteristics of young people attending specialist mental health services for a single session and to examine associations between single session attendance and clinical characteristics. Secondary analysis of administrative data on N = 23,300 young people (mean age = 12.73 years, 57% female, 64% White British) was conducted. The mean number of sessions attended was 4.33 and 46% (10,669) attended for a single session. Multilevel logistic regression analysis showed that younger children, Black young people (OR = 1.20, 95% CI = 1.01–1.43) or those whose ethnicity was not stated (OR = 1.25, 95% CI = 1.15–1.35), young people with peer relationship difficulties (OR = 1.11, 95% CI = 1.04–1.19) or low frequency problems (OR = 1.06, 95% CI = 0.99–1.14), and those with more complexity factors (OR = 1.07, 95% CI = 1.04–1.10) were more likely to attend services for a single session. The present study sets out research questions to prompt future research: (1) the experience of attending services for a single session, (2) identifying groups of single session attenders who do not require further support compared to those who are not able to sustain engagement with more sessions, and (3) whether new care pathways are needed for these groups who currently access specialist mental health services for a single session.

The purpose of the study was to determine if concurrent training (endurance and resistance in a single session) elicits leg muscular adaptations beyond the ones obtained by endurance training alone in sedentary individuals with metabolic syndrome (MetS). Sixty-six MetS individuals (37% women, age 56 ± 7 years, BMI 32 ± 5 kg m-2 and 3.8 ± 0.8 MetS factors) were randomized to undergo one of the following 16-week isocaloric exercise programs: (i) 4 + 1 bouts of 4 min at 90% of HRMAX of intense aerobic cycling (IAC + IAC group; n = 33), (ii) 4 IAC bouts followed by 3 sets of 12 repetitions of 3 lower-limb free-weight exercises (IAC + RT group; n = 33). We measured the effects of training on maximal cycling power, leg press maximum strength (1RM), countermovement jump height (CMJ), and mean propulsive velocity (MPV) at workloads ranging from 10% to 100% of baseline 1RM leg press. After intervention, MetS components (Z-score) improved similarly in both groups (p = 0.002). Likewise, maximal cycling power during a ramp test improved similarly in both groups (time effect p < 0.001). However, leg press 1RM improved more in IAC + RT than in IAC + IAC (47 ± 5 vs 13 ± 5 kg, respectively, interaction p < 0.001). CMJ only improved with IAC + RT (0.8 ± 0.2 cm, p = 0.001). Leg press MPV at heavy loads (ie, 80%-100% 1RM) improved more with concurrent training (0.12 ± 0.01 vs 0.06 ± 0.02 m s-1 , interaction p = 0.013). In conclusion, in unconditioned MetS individuals, intense aerobic cycling alone improves leg muscle performance. However, substituting 20% of intense aerobic cycling by resistance training further improves 1RM leg press, MPV at high loads, and jumping ability while providing similar improvement in MetS components.

For optimizing the quality of repeated-sprint training in hypoxia, the differences in the acute performance responses to a single session of repeated-sprint exercise with various (i) inspired oxygen fractions; (ii) exercise-to-recovery (E:R) ratios and (iii) recovery modalities were examined. Ten male participants performed three sets, 5 × 5-s all-out treadmill sprints, E:R ratio of 1:5, passive recovery, in seven trials randomly. In four of the seven trials, hypoxic levels were set corresponding to sea level (SL1:5P), 1500 (1.5K1:5P), 2500 (2.5K1:5P), and 3500 m (3.5K1:5P), respectively. In a further two trials, the hypoxic level of 3.5K1:5P was maintained, while the E:R ratio was reduced to 1:4 (3.5K1:4P) and 1:3 (3.5K1:3P), respectively. In the last trial, the passive recovery mode of 3.5K1:5P was changed to active (3.5K1:5A). In comparison to SL1:5P, the averaged peak velocity (P-Vel), mean velocity (M-Vel), and velocity decrement score (Sdec) of the sprints, and the cumulative HR-based training impulse (cTRIMP) in 1.5K1:5P and 2.5K1:5P were well maintained. Minor decrement in the M-Vel was found in 3.5K1:5P. Conversely, lowered E:R ratio in 3.5K1:4P and 3.5K1:3P significantly reduced the P-Vel (≥ −2.3%, Cohen’s d ≥ 0.43) and M-Vel (≥ −2.4%, ≥ 0.49), and in 3.5K1:3P altered the Sdec (107%, ≥ 0.96), and cTRIMP (−16%, 1.39), when compared to 3.5K1:5P. Furthermore, mild reductions in M-Vel (−2.6%, 0.5) was observed in 3.5K1:5A using the active recovery mode. Other variables did not change. The findings suggest that a 3.5K1:5P marginally maintained sea-level training loads, and as a result, could maximally optimize the training stress of hypoxia.

Introduction: Low-level laser therapy (LLLT) can promote and accelerate the tissue regeneration as it causes the early healing of extraction sockets but the accurate mechanism is unknown. Aim: The study aimed to evaluate the effect of LLLT which was applied in a single session immediately after odontectomy of impacted lower wisdom tooth on pain, swelling, and trismus. Patient and Methods: This study was done on 24 healthy patients who required surgical extraction of impacted lower third molar. The patients were randomly selected and randomly divided into two equal groups, each consisted of 12 patients for group, group I received LLLT immediately after surgical extraction of impacted lower third molar, group II was subjected to routine surgical extraction of impacted lower third molar without application of LLLT. LLLT was applied at ten points: four intra-oral beside to the extracted socket and six extra-oral along the masseter muscle. Laser energy was applied at 100mW for a total of 150 sec, 15 sec for each point. Results: The results showed the effect of a single session of LLLT in control of postoperative pain on the day of surgery and reduction of swelling and trismus after surgical removal of impacted lower third molars (p < 0.05). Conclusion: LLLT could represent a viable tool to control pain in patients who are contraindicated to the medications.

Video Video 1 Single-session EDGE with ERCP and EUS gallbladder drainage.

Monahan, M, Petrakos, G, and Egan, B. Physiological and perceptual responses to a single session of resisted sled sprint training at light or heavy sled loads. J Strength Cond Res 36(10): 2733-2740, 2022-The acute physiological and perceptual responses to a single session of resisted sled sprint (RSS) training are largely unexplored, nor have differences, if any, between male and female athletes been compared. Team field sport athletes (n = 27; male/female, 15/12; 21.1 ± 2.7 years) were assessed for Maximal Resisted Sled Load (MRSL) from which light (L-RSS, 30%MRSL) and heavy (H-RSS, 80%MRSL) sled loads were prescribed. On separate occasions in random order, 2 training sessions of 12 × 20 m RSS repetitions at either L- or H-RSS were performed, and assessments of physiological and perceptual responses were performed before (PRE), during, after (POST) and 24 hours after (+24 hours POST) each session. Compared to unresisted sprints, velocity decrements of 7.5 ± 2.2 and 22.7 ± 8.1% were produced by L-RSS and H-RSS, respectively. Heart rate, blood lactate, and ratings of perceived exertion were higher in H-RSS compared to L-RSS. Decrements in 20 m sprint and countermovement jump performance observed at POST had returned to PRE values at +24 hours POST. Except for a higher heart rate (∼7-12 b·min-1) in females during the respective sessions, responses to L- and H-RSS were generally similar between males and females. A single session of heavy RSS training is more demanding than light RSS training when matched for sprint number and distance, but measures of lower limb power and sprint performance return to pre-training levels within 24 hours regardless of sled load. Males and females respond similarly to a single session of RSS training when individualized, relative intensity sled loads are prescribed.

OBJECTIVE To compare outcomes after application of full-thickness, meshed free-skin grafts in single-session versus delayed (staged) procedures after tumor excision from the distal aspects of the limbs in dogs. ANIMALS 52 client-owned dogs. PROCEDURES Medical records were retrospectively reviewed to identify dogs that received full-thickness, meshed free-skin grafts after tumor excision from the distal aspects of the limbs between 2013 and 2018. Signalment; diagnostic test results; comorbidities; procedure type (single session or staged); tumor characteristics; donor site, recipient site, and size of grafts; concurrent procedures; surgeon; antimicrobial administration; external coaptation type; number of bandage applications; percentage graft survival; graft outcome; postoperative complications; and time to complete healing were recorded. Graft outcome was deemed successful if there was full-thickness graft viability over ≥ 75% of the original graft area. Variables were compared between dogs grouped by procedure type. RESULTS The number of bandage applications was significantly greater for dogs that had staged versus single-session procedures. Twenty-seven of 30 (90%) and 18 of 22 (82%) skin grafts placed in single-session and staged procedures, respectively, were successful. Percentage graft survival, graft outcome, and complication rate did not differ between groups. All complications were minor. Time to complete healing was significantly longer after staged procedures (median, 51 days) than after single-session procedures (29.5 days). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested both procedure types are appropriate for skin graft placement. The shorter healing time and fewer bandage changes associated with single-session skin graft placement may be beneficial after tumor excision. Prospective studies are needed to confirm these findings.

Purpose The aim of this randomized placebo-controlled crossover study was to compare the acute effect on young athletes of a single session of roller massager (RM) with that obtained from passive static stretching (PSS) and a placebo intervention (PL) on hamstring flexibility and on strength. Methods Twenty-nine (23 male, 6 female) young athletes completed the study. Maximal voluntary contraction (MVC) and two-leg sit-and-reach test were performed before and immediately after PL, PSS and RM on three different days. Results Results showed that all three interventions increased the flexibility of the hamstring muscles compared to the pre-test measurements (Wilcoxon signed-rank test, p Conclusions RM can be considered as an effective alternative to stretching to increase the flexibility of the hamstring. This could be meaningful when stretching is contraindicated or evokes pain.

Military Veterans are at overall greater risk of suicide than non-Veterans and have experienced increases in rates of suicide that are on par with or exceed those of the general population. The Department of Veterans Affairs has undertaken several initiatives to reduce suicide among Veterans, including the development and expansion of the Veterans Crisis Line (VCL). The VCL has the potential to reduce suicidal behaviors, but it is likely underutilized by high-risk Veterans. This paper describes the development of Crisis Line Facilitation (CLF) a brief intervention, designed to increase use of the VCL in this high-risk population. In a single session, CLF presents psychoeducational information about the VCL, discusses the participant's perceived barriers and facilitators to future use of the VCL, and culminates in the Veteran calling the VCL with the therapist to provide firsthand experiences that may counter negative impressions of the line. The intervention development process, intervention and control condition, and self-reported change indices are presented. Preliminary results (N = 301) suggest Veterans receiving CLF may experience a significant increase in comfort with, and confidence in, using the VCL during future crises compared to those in the control condition.