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In the present study, we assessed the oral mucosal irritation potential of antimicrobial chemotherapy involving hydrogen peroxide (H2O2) photolysis with a 405-nm laser device at an output power of ?100 mW in hamsters. Twenty-four cheek pouches from 12 male Syrian hamsters received 7-min treatment with pure water (PW), 3% H2O2, laser irradiation of PW at 100 mW, laser irradiation of 3% H2O2 at 100 mW, laser irradiation of PW at 200 mW, or laser irradiation of 3% H2O2 at 200 mW (n = 4 each). The diameter of the irradiation area was set at 3 mm; accordingly, the calculated irradiances (optical power densities) of the 100- and 200-mW laser lights were approximately 1400 and 2800 mW/cm2, respectively. In addition, 12 cheek pouches from six animals received laser irradiation of 3% H2O2 at 100 mW for 1, 3, or 5 min (n = 4 each). Each treatment was repeated three times at 1-h intervals. Macroscopic and histological changes were evaluated 24 h after the last treatment. In addition, in vitro bactericidal activity of the treatment against periodontal pathogens was evaluated. We found that 405-nm laser irradiation of 3% H2O2 caused moderate to severe oral mucosal irritation when performed at powers of 100 and 200 mW for ?3 min, while the same treatment performed at 100 mW for 1 min resulted in mild irritation. Moreover, 1-min H2O2 photolysis at 100 mW caused a >4-log decrease in viable bacterial counts. These findings suggest that 1-min H2O2 photolysis, which can effectively kill periodontal pathogens, may be acceptable when a 405-nm laser device is used at 100 mW. However, use of the laser at a lower power would be preferable for the prevention of unnecessary oral mucosal irritation. | [
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] |
Objective: To investigate the mechanism of Al (mal) (3)-induced ferroptosis in rat adrenal pheochromocytoma cells (PC12), to explore the effect of deferoxamine (DFO) . Methods: Taken PC12 cells growing at logarithmic phase and divided into 6 groups: control group, 200 mol/L Al (mal) (3) group, 0.5% DMSO group, 200 mol/L DFO group, Al (mal) (3)+DMSO group, Al (mal) (3)+DFO group. DMSO and DFO were added to the DMSO group and the Al (mal) (3)+DMSO group, the DFO group and the Al (mal) (3)+DFO group for 2 h, respectively, Al (mal) (3) was then added to the Al (mal) (3) group, Al (mal) (3)+DMSO group, and the Al (mal) (3)+DFO group to a final concentration of 200 mol/L. The cell viability was detected by CCK8, the morphology and ROS levels of PC12 cells was observed by inverted microscope, the cell proliferation toxicity and intracellular iron ion content were detected by colorimetry, the GSH content and GSH-PX activity were detected by biochemical method. Results: Al (mal) (3) exposure significantly inhibited the growth of PC12 cells and destroyed the cell morphological structure, resulting in increased LDH activity and intracellular iron ion content in PC12 cells, decreased GSH content and GSH-PX activity, increased ROS levels; the combined treatment of Al (mal) (3)+DFO can significantly improve the cell viability of PC12 cells, improved cell morphology, decreased cell LDH activity and intracellular iron ion content (P>0.05), increased GSH content and GSH-PX activity, decreased ROS levels. Conclusion: Al (mal) (3) can induce ferroptosis in PC12 cells, DFO may inhibit ferroptosis by reducing intracellular iron levels and reducing oxidative damage. | [
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] |
Objective: To observe the lung injury of male rats induced by sub-chronic exposure to crotonaldehyde, and to explore the possible mechanism of injury. Methods: Forty SPF male Wistar rats were randomly divided into control group and 3 groups in each group, and each group received 0.0, 2.5, 4.5, 8.5 mg/kg body weight crotonaldehyde solution for continuous intragastric administration. 120 d, once a day. After the end of the exposure, the body weight of the rats was measured, and the lung tissues were quickly separated after cervical dislocation. The organ coefficients were calculated and histopathological examination was performed to determine malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione. Peroxidase (GSH-Px) content; ELISA was used to measure interleukin (IL) -6, IL-1, and tumor necrosis factor (TNF) - in lung tissues. Results: Compared with the control group, the weight gain of the rats in the 4.5 and 8.5 mg/kg exposure groups was small, and the lung weight and organ coefficient of the exposed group decreased, the difference was statistically significant (P<0.05). In the exposed group, the lung tissue structure was disordered, the alveolar wall was thickened, and inflammatory cell infiltration was observed. Compared with the control group, the MDA activity in the serum of the rats in the 4.5 mg/kg and 8.5 mg/kg groups increased, and the SOD and GSH-Px activities decreased, the difference was statistically significant (P<0.05). TNF- levels in the lung tissues of rats exposed to 4.5 mg/kg and 8.5 mg/kg, and levels of (IL) -6 and IL-1 in the lungs of rats in the 2.5, 4.5, and 8.5 mg/kg groups. Significantly increased, the difference was statistically significant (P<0.05) . Conclusion: Crotonaldehyde may induce inflammatory and oxidative stress damage in rats by up-regulating the expression of inflammatory factors in lung tissue and changing the oxidative balance. | [
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] |
Objective: To observe the changes of extracellular histones and pulmonary microvascular endothelial cells, and study the activating role of extracellular histones to pulmonary microvascular endothelial cells in the pathogenesis of acute respiratory distress syndrome (ARDS) . Methods: The correlation of the severity of acute lung injury with extracellular histones and pulmonary endothelial damage was studied through mice model, and acute lung injury was produced by aspiration of different concentrations of hydrochloric acid (0.01?0.1?0.3 and 0.5 mol/L, 2 ml/kg). Tumor necrosis factor- (TNF-), soluble thrombomodulin (sTM) and lung pathological change were measured. The pro-inflammatory role of extracellular histones was tested by injecting calf thymus histones (CTH) or specific anti-H4 antibody through tail vein. The direct activating role of extracellular histones to pulmonary microvascular endothelial cells was studied through pulmonary endothelial model. Results: The extracellular histones in plasma were increased obviously 6h after aspiration of different concentrations of hydrochloric acid in mice. A positive correlation was seen between extracellular histones and concentrations of aspirated hydrochloric acid (r=0.9180, P<0.05). The sTM in plasma also showed a positive correlation with concentrations of aspirated hydrochloric acid (r=0.8701, P<0.05). Merely administering CTH could not only increase TNF- and sTM in plasma but also cause obvious lung injury, while specific anti-H4 antibody could relieve the inflammation and lung damage caused by CTH. Extracellular histones could directly damage pulmonary endothelial cells to release sTM in pulmonary endothelial model in vitro, while anti-H4 antibody could protect the endothelial cells. Conclusion: Extracellular histones are the key endogenic inflammatory mediators during the pathogenesis of ARDS caused by aspiration of hydrochloric acid, which could promote inflammation by directly activating pulmonary endothelial cells. | [
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] |
Objective: To investigate the antioxidant mechanism of diallyl sulfide (DAS) in antagonizing the reduction in peripheral blood white blood cells (WBC) induced by benzene in rats. Methods: A total of 60 specific pathogen-free adult male Sprague-Dawley rats, with a body weight of 180-220 g, were selected, and after 5 days of adaptive feeding, they were randomly divided into blank control group, DAS control group, benzene model group, benzene+low-dose DAS group, benzene+middle-dose DAS group, and benzene+high-dose DAS group, with 10 rats in each group. The rats in the benzene+low-dose DAS group, the benzene+middle-dose DAS group, the benzene+high-dose DAS group, and the DAS control group were given DAS by gavage at a dose of 40, 80, 160, and 160 mg/kgbw, respectively, and those in the blank control group and the benzene model group were given an equal volume of corn oil; 2 hours later, the rats in the benzene model group, the benzene+low-dose DAS group, the benzene+middle-dose DAS group, and the benzene+high-dose DAS group were given a mixture of benzene (1.3 g/kgbw) and corn oil (with a volume fraction of 50%), and those in the blank control group and the DAS control group were given an equal volume of corn oil. The above treatment was given once a day for 4 consecutive weeks. At 1 day before treatment, anticoagulated blood was collected from the jugular vein for peripheral blood cell counting. After anesthesia with intraperitoneally injected pentobarbital (50 mg/kgbw), blood samples were collected from the abdominal aorta, serum was isolated, and the thymus, the spleen, and the femur were freed at a low temperature to measure oxidative and antioxidant indices. The femur at one side was freed for WBC counting in bone marrow. Results: Compared with the blank control group, the benzene model group had significant reductions in the volume, weight, and organ coefficient of the spleen and the thymus (P<0.05) ; compared with the benzene model group, the benzene+low-dose DAS group, the benzene+middle-dose DAS group, and the benzene+high-dose DAS group had significant increases in the volume of the spleen and the thymus and the weight and organ coefficient of the spleen (P<0.05), and the benzene+middle-dose DAS group and the benzene+high-dose DAS group had significant increases in the weight and organ coefficient of the thymus (P<0.05). Compared with the blank control group, the benzene model group had a significant reduction in WBC count in peripheral blood and bone marrow (P<0.05), and compared with the benzene model group, the benzene+middle-dose DAS group and the benzene+high-dose DAS group had a significant increase in WBC count in peripheral blood and bone marrow (P<0.05). Compared with the blank control group, the benzene model group had a significant increase in the serum level of malondialdehyde (MDA) (P<0.05) and significant reductions in total superoxide dismutase (T-SOD) activity, reduced glutathione (GSH) level, GSH/oxidized glutathione (GSSG) ratio, total antioxidant capacity (T-AOC) (P<0.05) ; compared with the benzene model group, the benzene+high-dose DAS group had a significant reduction in the serum level of MDA and significant increases in T-SOD activity, GSH level, GSH/GSSG ratio, and T-AOC (P<0.05). Compared with the blank control group, the benzene model group had a significant increase in the level of MDA (P<0.05) and significant reductions in GSH level, GSH/GSSG ratio, and T-AOC (P<0.05) in the spleen; compared with the benzene model group, the benzene+low-dose DAS group, the benzene+middle-dose DAS group, and the benzene+high-dose DAS group had a significant reduction in MDA level (P<0.05) and significant increases in GSH level and T-AOC (P<0.05), and the benzene+high-dose DAS group had significant increases in T-SOD activity and GSH/GSSG ratio (P<0.05). Compared with the blank control group, the benzene model group had a significant increase in the level of MDA in bone marrow cells (BMCs) and peripheral blood mononucleated cells (PBMCs) (P<0.05) and a significant reduction in T-AOC in PBMCs (P<0.05) ; compared with the benzene model group, the benzene+low-dose DAS group, the benzene+middle-dose DAS group, and the benzene+high-dose DAS group had a significant reduction in the level of MDA in BMCs and PBMCs (P<0.05), and the benzene+high-dose DAS group had significant increases in GSH level and GSH/GSSG ratio (P<0.05) . Conclusion: DAS can antagonize the benzene-induced reduction in peripheral blood WBC, possibly by exerting an anti-oxidative stress effect. | [
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] |
Objective: To investigate the influence of different variable combinations of the carrying system on gait and muscle fatigue during weight-bearing walking on both shoulders and back, and to optimize daily carrying experience. Methods: From September to December, 2018, 6 male college students were selected as subjects; the electromyographic signal of the anterior tibial muscle and plantar pressure were measured during weight-bearing walking under six different variable combinations of the carrying system (with the three variables of gravity center, single or double shoulders, and waist cushion), and a subjective evaluation test was performed for the degree of fatigue. The electromyographic data and plantar pressure data were processed and compared to evaluate behavior and fatigue. Results: Different variable combinations of the carrying system had significant influence on the degree of fatigue and gait (P<0.05). Both subjective and objective analyses found that the carrying system with different heights of gravity center and single-or double-shoulder carrying mode had great influence on human fatigue and walking gait, while the hardness of waist cushion had little influence. Compared with the other groups, the group with a high gravity center, a double-shoulder carrying mode, and a soft waist cushion had a significantly smaller slope of average electromyographic amplitude, a significantly larger slope of median frequency, and a significantly lower degree of plantar pressure curve disorder. Conclusion: The carrying system with a relatively high gravity center, a double-shoulder carrying mode, and a soft waist cushion can significantly relieve fatigue, with low influence on walking gait. | [
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] |
Objective: To explore the prevalence of occupational musculoskeletal disorders (OMD) and its influencing factors among rural migrant workers in Tianjin, with the aim of developing strategies to improve the health condition of this specific population. Methods: Questionnaire survey was conducted among 415 rural migrant workers working in Tianjin about their fundamental state and occupational musculoskeletal disorders (OMD) during January 2015 to January 2016. Statistical methods were utilized to analyze the influencing factor. Results: A total of 415 rural migrant workers were investigated, in which young Young adults and low education level were in the majority of rural migrant workers. The prevalence of OMD for whole population, male and female were 28.92% (120/415), 33.06% (81/245) and 22.94% (39/170), respectively. Prevalence showed significant differences njin and workplace hygiene. Multivariate logistic regression analysis showed that the risks of OMD increased with age group, and decreased with higher education level. The risk of OMD among rural migrant workers with monthly income between 3000 to 5000 yuan was 2.26 times (95%CI: 1.37-3.75) higher than that of low-income workers (<3000 yuan per month). Workers engaged in housekeeping service had 2.28 times higher risk of OMD than those in manufacturing industry (95%CI: 1.06-4.89) . Conclusion: Prevalence of OMD among rural migrant workers is higher than that of general people. Age, education, monthly income, occupation are the independent influencing factors for OMD among rural migrant workers. | [
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Objective: To investigate the sleep quality of prison policemen and explore its influencing factors, so as to provide reference for improving the sleep quality of prison policemen. Methods: In August 2013, 177 policemen in a prison were selected by cluster sampling. The sleep quality of 177 prison policemen was investigated by Pittsburgh Sleep Quality Index Scale and General Situation Questionnaire, and the influencing factors were analyzed. Results: The PSQI scores of 177 prison policemen were (7.47+3.80). There were significant differences between the PSQI scores of prison policemen and the normal adult norm (P<0.05). According to the standard of poor sleep quality, 84 prison policemen (47.46%) had poor sleep quality, and the prison policemen scored higher on daytime dysfunction, subjective sleep quality, sleeping time and sleeping time components. Single factor t test and single factor variance analysis showed that there were significant differences in sleep quality among prison policemen in gender, age, educational level and job classification (P <0.05). The results of multiple stepwise regression analysis showed that gender, age and job classification entered the regression equation with PSQI total score as dependent variable (=0.167, 0.270, 0.222) . Conclusion: The sleep quality of prison policemen is worse than that of normal adults, and is affected by gender, age, job classification and other factors, which should be paid attention to by prison administrators. | [
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] |
Objective: To analyze the relationships between the exposure of occupational noise and the occurrence of noise-induced high frequency hearing loss in automobile manufacturing industry. Methods: From June to November 2017, 1579 male workers were selected for exposure to noise hazards in the automobile manufacturing industry in Guangzhou for more than one year (including one year) using the convenient sampling method. According to the hearing test results, 276 people in the high frequency hearing loss group and 1303 in the normal hearing group were surveyed, occupational health tests were conducted, and the noise intensity in the workplace was measured. The cumulative noise exposure (CNE) was calculated. The relationship between shift work and high frequency hearing loss of noise work is analyzed. Results: Compared with the normal hearing group, the noise exposure intensity, age, length of service, marital status, working system, and physical exercise of the high frequency hearing loss group were statistically significant (P<0.05). Through logistic regression analysis, after correcting the effects of organic solvent contact, marital status, and physical exercise, CNE, age, and shift operations (double-shift operations, three-shift operations) are the risk factors for high frequency hearing loss to occur. Conclusion: The risk of hearing loss of workers exposed to noise in the whole vehicle manufacturing industry may be related to CNE, age, and shift work. Two-shift and three-shift work are possible risk factors for noise-induced high frequency hearing loss. | [
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Objective: To clarify the association between occupational exposure to wood dust and chronic obstructive pulmonary disease risk by a meta-analysis. Methods: A systematic search of the studies was conducted using 3 English databases (Pubmed, Embase, and Cochrane library) and 3 Chinese databases (CNKI, WanFang, and VIP) before March 2019. The following key words was used: 1) wood, 2) hardwood, 3) softwood, 4) saw, 5) dust, 6) chronic obstructive pulmonary disease, 7) chronic obstructive airway disease, 8) lung function. A quality score was evaluated by Newcastle-Ottawa Scale, NOS (Wells, 2012). Pooled effect value with 95% confidence interval (CI) was calculated using fixed-effect model (Heterogeneity test I(2)<25%) or random-effect model (Heterogeneity test I(2)?25%). Meta-regression was used to explore heterogeneous source. Sensitivity analysis was used to verify the stability of the results. Publication bias was assessed by Egger?s test. Fill and trim method was used to correct the pool effect value with 95%CI for studies which wit publication bias. The TSA threshold was calculated by the O?Brien-Fleming loss function in the TSA data. The studies were evaluated based on the accrued information size (AIS) . Results: A total of 9 studies were included in the analysis. The occupational exposure to wood dust was not significantly associated with increased chronic obstructive pulmonary disease risk (ES=1.01, 95%CI: 0.856-1.194). TSA showed that the cumulative Z-value curve neither gone beyond the traditional (Z=1.96) threshold line, nor exceed the TSA threshold, but has reached the expected amount of information. This result was consistent with the meta-analysis. Conclusion: This study does not yet consider that COPD is associated with occupational wood dust exposure. | [
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] |
Objective: To investigate the visual application of the CiteSpace software in the field of work-related musculoskeletal disorders (WMSDs) . Methods: The literature on WMSDs research, published from 1991 to 2017, was retrieved in Web of Science database. The CiteSpace 5.2 was used to make visualization analysis on the hotspots and tendency of the keywords, authors, countries (regions) and research institutes in relevant literature. Results: A total of 3224 literatures were included in the analysis. The amount of the literatures published was increasing annually. The key word co-occurrence network showed that the research hotspots mainly focused on the study of epidemiology, risk factors, symptoms, and other aspects of WMSDs. The cooperation network and time network of counties and regions showed that America and Europe were at the leading position in the field of WMSD, and the top three were America, Canada and Sweden. The developing countries, like Brazil and China, had also begun to make relative research since 2000. In research cooperation, the collaboration among countries, research institutions was relatively close, and multiple leading core authors and teams were formed in the international arena. Conclusion: The CiteSpace software can directly demonstrate the hotspots and tendency in the area of WMSDs. | [
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Objective: To analyze the hearing self-protection behavior patterns and internal factors of workers exposured to occupational noise in an aircraft manufacturing industry based on health belief model, so as to provide reference for further health promotion programs and intervention measures. Methods: A total of 1600 front-line workers were selected from 10 units of an aircraft manufacturing enterprise by cluster sampling method. The basic and occupational information of employees were collected, and a self-reported questionnaire was designed according to the health belief model to acquire the hearing self-protection behaviors of workers. Results: There were significant differences in the perceived severity, perceived benefit, perceived impairment, self-efficacy and behavioral incentive scores of different hearing self-protection behaviors among the noise-causing workers (P<0.05). There were significant differences in the distribution of hearing self-protection behaviors among different genders, ages, education levels, length of service, initial noise exposure time and cumulative noise reception time (P<0.05). The perceived benefits, perceived barriers, behavioral incentives, self-efficacy scores, and educational attainment of the noise-causing workers were all related to the type of hearing self-protection behavior (P<0.05) . Conclusion: The educational level and health belief model can predict the hearing self-protection behavior patterns of front-line workers to some extent, more attention should be paid to the monitoring of the well-educated employees. | [
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Retrospective analysis of 18 cases of occupational acute 1, 2-dichloroethane (1, 2-DCE) poisoning. The results showed that all patients have the main manifestations such as dizziness, headache, unresponsiveness and other symptoms of nervous system damage; Brain CT showed varying degrees of diffuse white matter lesions. Brain MRI showed extensive involvement of white matter in both cerebral hemispheres. Affected white matter area presented low intensity on T1WI, hyperintensity on T2WI and T2-Flair; Lumbar puncture examination of cerebrospinal fluid (CSF) pressure (262.548.39) mm H(2)O; After treatment, the required time for CSF pressure to restore was (161.5675.27) days (50-280) days. Summary, Occupational acute 1, 2-DCE poisoning caused by toxic encephalopathy can be manifested as persistent abnormalities in CSF pressure, and the CSF pressure drops slowly during treatment; Early head CT and lumbar puncture examination will be helpful for early detection of intracranial pressure in toxic encephalopathy caused by acute 1, 2-DCE poisoning. Dynamic monitoring of CSF provides guidance for acute 1, 2-DCE poisoning with a long time of treatment and various types of dehydrating agents. | [
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] |
Immune checkpoint inhibition suggests promising progress for the treatment of advanced hepatocellular carcinoma (HCC). However, the underlying cellular mechanisms remain unclear because liver cancer cells apparently do not upregulate inhibitory checkpoint molecules. Here, we analysed whether regulatory T cells (Tregs) can alternatively trigger checkpoint inhibition pathways in HCC. Using flow cytometry we analysed expression of checkpoint molecules (PD-1, PD-L1, CTLA-4, GITR, Tim-3) on peripheral CD4+CD25+Foxp3+ Tregs and their secretion of inhibitory mediators (IL-10, IL-35, TGF-beta, galectin-9) in 116 individuals (50 patients with HCC, 41 non-tumour bearing liver disease controls, 25 healthy controls). Functional activity of Tregs on T effector cells (IFN-gamma production, cytotoxicity) was characterized in vitro using a lectin-dependent cellular cytotoxicity (LDCC) assay against checkpoint inhibitor-negative P815 target cells. Unlike liver patients without malignancy and healthy controls, the frequency of checkpoint inhibitor-positive Tregs inversely correlated to age of patients with HCC (PD-L1, p = 0.0080; CTLA-4, p = 0.0029) and corresponded to enhanced numbers of Tregs producing IL-10 and IL-35 (p < 0.05 each). Tregs inhibited IFN-gamma secretion and cytotoxicity of CD8+ T cells when added to LDCC against P815 cells. Treg-induced inhibition of IFN-gamma secretion could be partially blocked by neutralizing PD-1 and PD-L1 antibodies specifically in HCC patients. In HCC peripheral Tregs upregulate checkpoint inhibitors and contribute to systemic immune dysfunction and antitumoural activity by several inhibitory pathways, presumably facilitating tumour development at young age. Blocking PD-L1/PD-1 interactions in vitro selectively interfered with inhibitory Treg -T effector cell interactions in the patients with HCC and resulted in improved antitumoural activity also against checkpoint inhibitor-negative tumour cells. | [
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BACKGROUND: Physiotherapy, including vibration-assisted therapy, has been proven to be effective for patients with ataxic cerebral palsy. Herewith, we studied the effect of a functional, goal-oriented interval rehabilitation program, including vibration-assisted home-training on the motor function of children with congenital ataxias.PATIENTS: 45 children (mean age 7.7 years, SD 4.70) with ataxia, having received a 6-month home-based side-alternating vibration-assisted therapy combined with intensive, goal-oriented, functional rehabilitation intervals, were included in the study, classified according to the progressive or non-progressive ataxia character.METHOD: Retrospective analysis of the prospectively collected data of the registry of the Cologne rehabilitation program "Auf die Beine". Motor abilities have been assessed prior to the intervention (M0), after 6 months of home-training (M6) as well as in a follow-up 6 months later (M12). We performed a gait analysis, a 1-minute walking test (1-MWT), and the Gross Motor Function Measure (GMFM-66).RESULTS: The GMFM-66 improvement (M6-M0 vs. M12-M6) was statistically significant with median improvement of 2.4 points (non-progressive) and 2.9 points (progressive) respectively, and clinically relevant. The 1-MWT improvement was statistically significant and clinically relevant for non-progressive ataxia.CONCLUSION: The intensive training, including vibration-assisted therapy significantly improved the motor function of children with ataxia. Six months later the skills were preserved in children with progressive ataxia and could be further developed in non-progressive forms. | [
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] |
OBJECTIVE: To observe the clinical efficacy of Tongdu Tiaoshen acupuncture method for mild cognitive impairment in the elderly.METHODS: A total of 96 patients were randomly divided into an observation group, a control group and a waiting group, 32 cases in each group. The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Yintang (GV 29) and Sishencong (EX-HN 1), etc, while the patients in the control group were treated with non-penetrating sham acupuncture at the same acupoints as the observation group. The treatment was given once every other day, three times a week for 8 weeks. The patients in the waiting group only received health guidance for 8 weeks. Montreal cognitive assessment scale (MoCA) and mini-mental state examination (MMSE) were used before and after 8-week treatment in all three groups. The observation group and the control group were followed up for 2 months and evaluated with MoCA and MMSE.RESULTS: The MoCA scores in the observation group after treatment and during follow-up were higher than before treatment (P<0.01), but there was no significant difference between follow-up and after treatment (P>0.05). The MoCA scores in the control group after treatment and during follow-up were higher than before treatment (P<0.01, P<0.05), and the MoCA score during follow-up was lower than after treatment (P<0.01). There was no significant difference before and after treatment in the waiting group (P>0.05). The difference before and after treatment in the observation group was higher than the control group and waiting group (P<0.01), while that in the control group was higher than the waiting group (P<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (P<0.01), and the improving between follow-up and after treatment was superior to the control group (P<0.01). The MMSE scores after treatment and during follow-up were higher than before treatment in the observation group (P<0.01), but there was no significant difference between the follow-up and after treatment (P>0.05). The MMSE scores after treatment and during follow-up were higher than before treatment in the control group (P<0.01), and the MMSE score during follow-up was lower than after treatment (P<0.01). There was no significant difference before and after treatment in the waiting group (P>0.05). The difference before and after treatment the observation group and control group was not significant (P>0.05), and those in the two groups were higher than the waiting group (P<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (P<0.01), and the difference between follow-up and after treatment was lower than the control group (P<0.01).CONCLUSION: Tongdu Tiaoshen acupuncture method could improve cognitive impairment in elderly patients with mild cognitive impairment. | [
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OBJECTIVE: To explore the clinical therapeutic effect and mechanism of acupuncture on headache in the recovery phase of ischemic stroke.METHODS: A total of 97 patients with headache in the recovery phase of ischemic stroke were randomized into an acupuncture group (57 cases) and a western medication group (40 cases). In the western medication group, flunarizine hydrochloride capsule was taken orally 5 mg each time, once a day. In the acupuncture group, acupuncture was applied at Qiuxu (GB 40), Zulinqi (GB 41), Xuanli (GB 6), Shuaigu (GB 8), Fengchi (GB 20) and Baihui (GV 20) for migraine; Chongyang (ST 42), Neiting (ST 44), Jiexi (ST 41), Zusanli (ST 36), Hegu (LI 4), Cuanzhu (BL 2) and Baihui (GV 20) for forehead pain; Jinggu (BL 64), Kunlun (BL 60), Tianzhu (BL 10), Fengchi (GB 20), Baihui (GV 20) and Sishencong (EX-HN 1) for occipital headache; Taichong (LR 3), Yongquan (KI 1), Sanyinjiao (SP 6), Fengchi (GB 20), Baihui (GV 20) and Sishencong (EX-HN 1) for parietal headache. The needles were retained for 30 min each time, once a day and 5 times a week. Both of the two groups were given consecutive treatment for 14 days. The visual analogue scale (VAS) and the headache scores before and after treatment and the recurrence rate 1 month after treatment were observed to evaluate the therapeutic effect, before and after treatment, the contents of substance P (SP), dopamine (DA), serotonin (5-HT), alpha-endorphin (-EP) and beta-endorphin (-EP) in plasma were determined by ELISA in the two groups.RESULTS: Compared before treatment, the VAS scores, the headache scores and the contents of SP, DA and 5-HT in plasma were reduced and the contents of-EP and-EP in plasma were increased in the two groups (all P<0.01). After treatment, the changes of the VAS score, the headache score and the contents of pain-related factors and endogenous opioid peptides in plasma in the acupuncture group were larger than the western medication group (all P<0.05). The total effective rate in the acupuncture group was 84.2% (48/57), which was superior to 62.5% (25/40) in the western medication group, and the recurrence rate in the acupuncture group was lower than the western medication group (both P<0.01).CONCLUSION: The therapeutic effect of acupuncture on headache in the recovery phase of ischemic stroke is superior to flunarizine hydrochloride capsule, and the mechanism may relate to down-regulate the pain-related factors and up-regulate endogenous opioid peptides in plasma. | [
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] |
OBJECTIVE: To compare the therapeutic effect of Yinyang Ruyin acupuncture, conventional acupuncture and oral estazolam tablet on refractory insomnia.METHODS: A total of 180 patients with refractory insomnia were randomized into a Yinyang Ruyin acupuncture group, a conventional acupuncture group and a medication group, 60 cases in each group. In the Yinyang Ruyin acupuncture group, Yinyang Ruyin acupuncture was applied at Baihui (GV 20), Waiguan (TE 5), Neiguan (PC 6), Weishu (BL 21), Zhongwan (CV 12) and Taixi (KI 3); in the conventional acupuncture group, conventional acupuncture was applied at Baihui (GV 20), Shenmen (HT 7), Sanyinjiao (SP 6), Zhaohai (KI 6), Shenmai (BL 62) and Anmian (Extra). Supplementary acupoints were added according to different patterns in the two acupuncture groups, and the treatment was given once a day, 7 times as one course and 4 courses were required. In the medication groups, estazolam was taken orally 1 h before sleep, 1 mg each time, once a day for 4 weeks. The Pittsburgh sleep quality index (PSQI) score was observed before and after treatment and the therapeutic effect was evaluated in the 3 groups.RESULTS: The total effective rates in the Yinyang Ruyin acupuncture group and the conventional acupuncture group were 90.0% (54/60) and 83.3% (50/60), which were superior to 30.0% (18/60) in the medication group (both P<0.05). Compared before treatment, the PSQI scores were significantly reduced in the two acupuncture groups (all P<0.05), the sleep efficiency and the total score of PSQI were reduced in the medication group (both P<0.05). After treatment, the changes of sleep latency, sleep efficiency, sleep disorder, daytime function and total score of PSQI in the Yinyang Ruyin acupuncture group were significantly larger than those in the conventional acupuncture group (all P<0.05). The changes of PSQI scores in the Yinyang Ruyin acupuncture group were significantly larger than the medication group (all P<0.05). The changes of sleep quality, sleep latency, sleep time, sleep disorder, daytime function and total score of PSQI in the conventional acupuncture group were significantly larger than the medication group (all P<0.05).CONCLUSION: The therapeutic effect of Yinyang Ruyin acupuncture on refractory insomnia is superior to estazolam and conventional acupuncture. | [
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OBJECTIVE: To observe the effect of acupuncture at Renying (ST 9) on morning blood pressure, daytime peak blood pressure and 24-hour blood pressure load in patients with ischemic stroke complicated with essential hypertension.METHODS: A total of 80 patients (3 cases dropped off) were randomized into an observation group (39 cases) and a control group (38 cases). Xingnao Kaiqiao acupuncture and nifedipine were given in the control group. On the basis of treatment in the control group, acupuncture at Renying (ST 9) was applied in the observation group, once a day, 6 times a week for 4 weeks. The changes of morning blood pressure, daytime peak blood pressure and blood pressure load were observed before and after treatment in the two groups.RESULTS: Compared before treatment, morning blood pressure, daytime peak blood pressure and blood pressure load after treatment were reduced in the two groups (all P<0.05). The change of morning systolic pressure in the observation group was not significant as compared with that in the control group (P>0.05); the changes of morning diastolic pressure, daytime peak blood pressure and blood pressure load in the observation group were larger than those in the control group (all P<0.05).CONCLUSION: On the basis of Xingnao Kaiqiao acupuncture and nifedipine, acupuncture at Renying (ST 9) can effectively reduce morning blood pressure, daytime peak blood pressure and blood pressure load in patients with ischemic stroke complicated with essential hypertension. | [
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] |
OBJECTIVE: To observe the clinical effect of acupuncture at "experienced ten acupoints" for postprandial distress syndrome.METHODS: A total of 62 patients with postprandial distress syndrome were randomly divided into an observation group (31 cases, 5 cases dropping off) and a control group (31 cases, 6 cases dropping off ). Acupuncture was applied at Baihui (GV 20), Zhongwan (CV 12), Qihai (CV 6), Tianshu (ST 25), Neiguan (PC 6), Zusanli (ST 36), Gongsun (SP 4), Danzhong (CV 17) in the observation group. In the control group, 6 non-acupoint points were intervened with shallow puncture. The treatment was given 20 min each time, once every other day, 3 times a week for a total of 4 weeks in the two groups. Symptom index of dyspepsia (SID) and Nepean dyspepsia index (NDI) scores were compared before and after treatment, and the efficacy was evaluated in the two groups.RESULTS: The effective rate in the observation group was 76.9% (20/26), which was higher than 28.0% in the control group (7/25, P<0.01). After treatment, the SID and NDI scores in the two groups were lower than those before treatment (P<0.01, P<0.05), and the SID and NDI scores in the observation group were lower than those in the control group (P<0.01, P<0.05).CONCLUSION: Acupuncture at "experienced ten acupoints" can significantly reduce the symptoms of dyspepsia and improve the quality of life in patients with postprandial distress syndrome. | [
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OBJECTIVE: To observe the effect of grain-moxibustion at Zusanli (ST 36) and Weishu (BL 21) on neutrophil to lymphocyte ratio (NLR) and quality of life (QOL) in patients with advanced gastric cancer.METHODS: Sixty patients with advanced gastric cancer were randomly divided into an observation group and a control group, 30 cases in each one. In the control group, conventional chemotherapy regimen combined with symptomatic treatment?such as antiemetic, acid-suppressive, liver-protecting drugs. On the basis of the treatment in the control group, grain-moxibustion was applied at Zusanli (ST 36) and Weishu (BL 21) in the observation group, 9 cones for each acupoint, once a day for a total of 90 days. The levels of NLR were observed before and after treatment, and the clinical efficacy and quality of life were evaluated in the two groups.RESULTS: After treatment, the value of NLR in the observation group was significantly lower than before treatment (P<0.05), there was no significant difference before and after treatment in the control group (P>0.05), and the descend range of observation group was larger than the control group (P<0.05). The effective rates (RR) were 33.3% (10/30) in the observation group and 36.7% (11/30) in the control group, there was no significant difference between the two groups (P>0.05). After treatment, the QOL in the observation group was improved in diarrhea, loss of appetite, fatigue, nausea and vomiting, general health states (P<0.05), there was no significant difference in the control group before and after treatment in varions scores (P>0.05), and the observation group was superior to the control group in fatigue, sleep disorder, loss of appetite, diarrhea and general health states after treatment (P<0.05).CONCLUSION: Grain-moxibustion at Zusanli (ST 36) and Weishu (BL 21) can decrease NLR and improve QOL of patients with advanced gastric cancer. | [
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] |
OBJECTIVE: To compare the clinical efficacy of needle-knife and hydroxychloroquine sulfate in the treatment of dry mouth and eyes symptoms of primary Sj?gren's syndrome.METHODS: A total of 60 patients with primary Sj?gren's syndrome were randomly divided into an observation group and a control group, 30 cases in each group. In the observation group, needle-knife was used in the range of 2 cm and 2-3 cm below the occipital protuberance, the left and right lateral bone edges of the C2 spinous process, between and within the range of 1.5-3 cm beside the C3 and C4 spinous processes, points between the left and right mandibular angle and the mastoid, the treatment was given 1 time a week for 8 times. The hydroxychloroquine sulfate was applied 0.2 g each time, 2 times daily, 4 weeks as a course and a total of 2 courses in the control group. The changes of salivary flow rate, tear volume, serum immunoglobulin IgG, IgA, IgM contents and Chinese medicine symptom score were observed before and after treatment in the two groups, and the efficacy was evaluated.RESULTS: The total effective rate in the observation group was 86.7% (26/30), which was better than 70.0% (21/30) in the control group (P<0.05). The salivary flow rates, tear volume, serum IgG contents and Chinese medicine symptom scores in the two groups were significantly improved after treatment (all P<0.05), and the improvement degree in the observation group was better than the control group (all P<0.05). There was no significant difference in IgA and IgM between the two groups and before and after treatment (all P>0.05).CONCLUSION: Needle-knife is superior to hydroxychloroquine sulfate in improving dry mouth and eyes symptoms and reducing serum IgG content in patients with primary Sj?gren's syndrome. | [
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OBJECTIVE: To observe the clinical efficacy of SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel for neurogenic bladder after spinal cord injury.METHODS: A total of 64 patients with neurogenic bladder after spinal cord injury were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with routine acupuncture and rehabilitation of bladder function; based on the treatment in the control group, the patients in the observation group were treated with SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel, twice a week for 8 weeks. Urodynamic test, including residual urine volume (RUV), maximum flow rate of urination (Qmax), bladder pressure at filling phase (Pves), maximum detrusor pressure (Pdet-max) and maximum urinary bladder volume (VMCC), was performed before and after 8-week treatment.RESULTS: The urodynamic indexes in the two groups were improved compared with before treatment (P<0.01, P<0.05); after treatment, VMCC in the observation group was significantly higher than the control group (P<0.01), while RUV and Pves in the observation group were significantly lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax and Pdet-max between the two groups (P>0.05).CONCLUSION: Based on routine acupuncture and rehabilitation of bladder function, SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel could effectively improve urodynamic indexes, reduce residual urine, reduce bladder pressure and increase the maximum capacity of bladder, thereby improving bladder compliance and bladder function. | [
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OBJECTIVE: To explore the clinical effect of acupuncture and the potential effect mechanism in patients with premature ovarian failure.METHODS: A total of 104 patients with premature ovarian failure were randomized into an acupuncture group and a western medication group, 52 cases in each one. In the western medication group, the conjugated estrogens tablets were prescribed for oral administration, 0.625 mg each time, once a day, consecutively for 21 days. On the 16th day of medication with conjugated estrogens tablets, the oral administration of medroxyprogesterone acetate tablets were supplemented, 10 mg each time, once a day, consecutively for 5 days, and then, these two kinds of western medication were discontinued for 1 week. A total of 3 cycles were required in treatment with 28 days as an artificial cycle. In the acupuncture group, acupuncture was applied. Two groups of acupoints were selected. The first group of acupoints were stimulated before ovulation and the acupoints were Guanyuan (CV 4), Guilai (ST 29), Taichong (LR 3), Taixi (KI 3), Xuehai (SP 10), Sanyinjiao (SP 6), Zigong (EX-CA 1), Yinlingquan (SP 9), Zusanli (ST 36), Shuidao (ST 28), Dahe (KI 12) and Tianshu (ST 25). The second group of acupoints were stimulated after ovulation and the acupoints included Ciliao (BL 32), Shiqizhui (EX-B 8), Ganshu (BL 18), Shenshu (BL 23), Geshu (BL 17) and Pishu (BL 20). The therapeutic effect was observed and compared in the patients between the two groups, as well as the expressions of interferon- (IFN-) and tumor necrosis factor- (TNF-) and the levels of serum luteinizing hormone (LH), follicule stimulating hormone (FSH) and estradiol (E2) before and after treatment.RESULTS: The total effective rate was 90.4% (47/52) in the acupuncture group, higher than 67.3% (35/62) in the western medication group (P<0.05). After treatment, the expressions of IFN- and TNF- in the acupuncture group were obviously lower than the western medication group (P<0.05). Except for serum LH after treatment, at the end of treatment and in 30 days and 90 days after treatment, the levels of serum E2 in the acupuncture group were higher obviously than the western medication group and the levels of serum LH and FSH were lower obviously than the western medication group (all P<0.05).CONCLUSION: Acupuncture promotes the regular menstruation, effectively regulates the levels of serum LH, FSH and E2 and improves the pituitary gland and the ovary endocrine in the patients with premature ovarian failure. Such effect may be related to the the improvements in the expressions of IFN- and TNF-, the inhibition of the apoptosis of ovarian granulosa cells, the recovery of ovarian function and the enhancement of reserve capacity. | [
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Four controversial types of simplex reinforcing-reducing manipulation of acupuncture and their possible meanings were summarized to explore several key elements of reinforcing-reducing manipulation of acupuncture, in addition, the simplex reinforcing-reducing manipulation of acupuncture was classified by single factor. It is concluded that the definition of simplex reinforcing-reducing manipulation of acupuncture should try not to include other non-manipulative elements. According to single factor, it can be divided into: needle-oriented reinforcing-reducing manipulation, twisting reinforcing-reducing manipulation, lifting and interpolating reinforcing-reducing manipulation, fast and slow reinforcing-reducing manipulation, breathing reinforcing-reducing manipulation, opening and closing reinforcing-reducing manipulation. In addition, after considering the effect and principle of number reinforcing-reducing manipulation, it can be considered. | [
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] |
OBJECTIVE: To observe the correlation between referred pain distribution and acupoint sensitization in patients with intestinal diseases.METHODS: In clinical research, 443 patients from 8 hospitals were recruited, including the outpatients and inpatients of Crohn's disease (n=143), ulcerative colitis (n=108), chronic appendicitis (n=87) and other intestinal diseases (n=105). The site with tenderness on the body surface and the morphological changes of local skin were observed and recorded in the patients. Using a sensory tenderness instrument, the pain threshold at the sensitization point was measured in 60 patients with ulcerative colitis. In animal experiment, SD rats were used and divided into a enteritis group (n=8), in which the enteritis model were established, and a control group (n=3), in which no any intervention was given. After the injection of Evans blue (EB) at caudal vein, the blue exudation points on the body surface were observed and the distribution rule was analyzed statistically.RESULTS: The referred pain on the body surface in the patients with intestinal diseases was mainly located in the lower abdomen (93.9%, 416/443), the lumbar region (70.9%, 314/443) and the lower legs (33.0%, 146/443). The diameter of tenderness region was 1.5 to 2.5 cm. Compared with the region without sensitization, the pain threshold of the sensitization point in the patients with ulcerative colitis was reduced significantly (P<0.001). The referred pain on the body surface in the patients with appendicitis was located in the right lower abdomen (97.7%, 85/87), the waist and back (54.0%, 47/87) and the right lower limbs on the medial side (71.3%, 62/87). The tenderness region was 1 to 2 cm in diameter and was irregular in form. After modeling of enteritis in the rats, the EB exudation points were visible from T12 to L2.CONCLUSION: Intestinal diseases induce referred pain on the body surface where is the same as or adjacent to the location of the spinal segment corresponding to the affected intestinal section. These sensitization regions are related to the locations of acupoints. | [
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] |
OBJECTIVE: To observe the effects of electroacupuncture (EA) on inflammatory response and intestinal mucosal barrier in obese rats with insulin resistance, and to explore the mechanism of EA on improving insulin resistance in rats.METHODS: Among 45 Wistar male rats, 15 rats were randomly selected and fed with common diet. After eight weeks, 10 rats were randomly selected and divided into the normal group. The remaining 30 rats were fed with high-fat diet for 8 weeks to establish obesity model of rat, among 28 rats with successful model of obesity, 20 rats were randomly selected and divided into the model group and EA group, 10 rats in each one. At the same time, 3 rats in the model group and the EA group were randomly selected for hyperinsulinemia-euglycemic clamp operation to determine whether the insulin resistance model was successful. After model establishment, the rats in the EA group were intervented with EA at "Zhongwan" (CV 12), "Guanyuan" (CV 4), "Zusanli" (ST 36) and "Fenglong" (ST 40) with continuous wave, frequency of 2 Hz and intensity of 1 mA; "Zusanli" (ST 36) and "Fenglong" (ST 40) were used alternately on both sides; the needles were sustained for 10 min; EA was given once every other day, three times a week for a total of 8 weeks. During the intervention, the rats in the normal group and the model group were fixed but not intervented. The body mass and postprandial blood sugar were measured in each group before and after 8-week intervention. After 6-week intervention, 3 rats in each group were clamped to detect systemic insulin sensitivity. Before the rats were killed, blood was taken from the apex of the heart to detect the serum insulin content. After the rats were killed, the mRNA levels of tumor necrosis factor- (TNF-) and interleukin-6 (IL-6) in liver and adipose tissue and occlidin and ZO-1 in colon tissue were detected by Real time-PCR; the protein expression levels of occludin and ZO-1 in colon tissue were detected by Western blot method.RESULTS: Compared with the normal group, the body mass, postprandial blood sugar and serum insulin content in the model group were increased significantly, the glucose infusion rate (GIR) was decreased significantly (all P<0.01), the mRNA expressions of TNF- and IL-6 in liver and adipose tissue were increased (P<0.05, P<0.01), the mRNA and protein expressions of ZO-1 in colon tissue were decreased significantly (both P<0.01), and the mRNA expression of occludin was significantly decreased (P<0.01). Compared with the model group, the body mass, postprandial blood sugar, serum insulin content, mRNA expressions of TNF-a and IL-6 in liver and adipose tissue were significantly decreased (P<0.01, P<0.05), GIR was significantly increased (P<0.01), and the mRNA and protein expressions of ZO-1 in colon tissue were increased (P<0.01, P<0.05).CONCLUSION: EA could decrease blood sugar and increase insulin sensitivity. Its mechanism may be related to inhibiting the expression of inflammatory factors and improving intestinal mucosal barrier. | [
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] |
OBJECTIVE: To observe the effect of electroacupuncture (EA) on the expressions of growth arrest-specific protein 7 (Gas7) and nerve growth factor (NGF) in arcuate nucleus (ARC) of rats with focal cerebral ischemia and explore the potential action mechanism of EA in treatment of focal cerebral ischemia.METHODS: A total of 50 SD rats were randomized into 4 groups, named a normal group (n =12), a sham-operation group (n =12), a model group (n =14) and an EA group (n =12). In the model group and the EA group, the thread embolization method was adopted to duplicate the model of the right middle cerebral arterial embolism. In the sham-operation group, the skin of the neck was opened and sutured without any other intervention. In the EA group, EA was applied to "Baihui" (CV 20) and "Zusanli" (ST 36) on the left side, once a day, 30 min each time, consecutively for 21 days, while there was no any intervention in the normal group, the sham-operation group and the model group. Using the immunohistochemistry (IHC) method and Western blot method, the expressions of Gas7 and NFG of ARC on the ischemic side were determined. Using Nissle staining, the morphological changes in ARC neurons were observed.RESULTS: The results of Nissle staining showed that there was no significant change in the morphology of ARC neurons in the normal group and the sham-operation group. In the model group, the volume of neuron cells was atrophied obviously and the cells were arranged irregularly. In the EA group, the morphology of ARC neuron was similar to the normal group. The results of IHC and Western blot indicated that the expressions of immunoreactive neurons and protein of Gas7 and NGF in ARC of the rats in the model group were increased obviously as compared with the normal group and the sham-operation group and the expressions in the EA group were further enhanced as compared with the model group (all P<0.05).CONCLUSION: Gas7 and NGF may be participated in the compensatory process of partial protection of the body in the patients with focal cerebral ischemia. EA up-regulates the expressions of Gas7 and NGF in ARC, which may be one of the neuroprotective mechanisms of EA in treatment of cerebral ischemia. | [
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Professor CHU Hao-ran successively followed famous doctors of acupuncture and spleen-stomach disease, such as ZHOU Mei-sheng, inherited their academic thoughts and clinical experience, and studied the classics to summarize and propose the clinical academic proposition regulating spleen-stomach, differentiating meridians-collaterals. In clinical practice, professor CHU focuses on individual differences of patients, carefully examines syndrome and refines acupoint selection; he pays attention to regulating spleen-stomach, and actively uses Zusanli (ST 36); he simultaneously uses acupuncture-moxibustion and acupoints with efficacy; he inherits traditional reinforcing and reducing methods, and extends the scope of acupoint diagnosis and treatment, while he emphasizes keeping spirit and treating spirit, and the combination of mind and qi, in order to improve clinical diagnosis and treatment effect. | [
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The clinical experience of professor ZUO Chang-bo in treatment of dysmenorrhea with "three-regulation and one-harmonization" therapy of acupuncture was introduced. Professor ZUO Chang-bo invented a needling technique for "three-regulation and one-harmonization", meaning qi regulation, blood regulation and regulation of meridian tendon region as well as the spirit (shen) harmonization. In qi regulation, the extreme fine needles are used to regulate qi movement of the whole function with the coordination of respiration and the corresponding acupoint prescriptions. In blood regulation, the special small bleeding device is selected and the bloodletting theory is improved for bloodletting at the specific stagnant site. In the regulation of meridian tendon region, a special sterile injection needle is chosen to release the cord-like mass. The spirit harmonization is exerted in combination with qi regulation. During acupuncture, the spirit of both the clinical practitioner and the patient should be in a harmonized spirit condition, coordinated with respiration regulation. In the treatment with acupuncture therapy of "three-regulation and one-harmonization" for dysmenorrhea, bloodletting therapy is used firstly to remove stasis, secondly, the "releasing cord-like mass" technique is followed to regulate meridian tendon region, finally, the fine needling technique is adopted to regulate qi and harmonize spirit. The clinical effect is definite in clinical practice. | [
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] |
OBJECTIVE: To carry out the methodological quality evaluation and content analysis of the evidence-based clinical practice guidelines for acupuncture-moxibustion in China, and to provide reference for the development and updating of future guidelines.METHODS: With Appraisal of Guidelines for Research and Evaluation?(AGREE?), 20 evidence-based clinical practice guidelines for acupuncture and moxibustion in China were evaluated from six aspects: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence. In addition, the contents of 20 guidelines were systematically analyzed, and the characteristics of guidelines were summarized from the aspects of disease selection, operation technology type and safety.RESULTS: The scores of six domains were scope and purpose (91.1%), stakeholder involvement (68.5%), rigour of development (68.6%), clarity of presentation (90.3%), applicability (34.5%) and editorial independence (16.7%). The recommendations of the 20 acupuncture guidelines covered common clinical problems such as diagnosis, treatment and precautions, which were in line with the clinical characteristics of acupuncture and moxibustion in terms of content structure.CONCLUSION: The methodology of the evidence-based clinical practice guidelines for acupuncture and moxibustion in China conformed to the requirements of AGREE? on the quality evaluation, and the overall quality was moderate, but the aspects of applicability and editorial independence were still needed to be improved. The contents of recommendations in 20 guidelines were specific and clear, in line with the characteristics of acupuncture and moxibustion, presenting clinical reference value. In the future, in the process of guideline development, the method of developing acupuncture and moxibustion guidelines should be constantly improved to improve the quality of the guidelines; in the meantime, more attention should be paid to the generalization and clinical applicability evaluation. | [
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To discuss the advantages and necessity of hidden curriculum construction in the academic experience inheritance of distinguished TCM veteran doctors by analyzing the characteristics of the hidden curriculum and the academic experience inheritance of distinguished TCM veteran doctors, and put forward viewpoints and pathways of promoting academic experience inheritance of distinguished TCM veteran doctors through the construction of hidden curriculum?such as optimal design of teaching environment?reasonable planning of teaching content and development of teaching information model?to effectively improve student cultivation quality and achieve the TCM talent cultivation goal which clinical diagnosis and treatment skills and clinical innovation ability are the core. | [
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] |
OBJECTIVE: To observe the effect of the interaction teaching mode integrated with Visible Body virtual anatomy platform in teaching Meridian and Acupoints.METHODS: A total of 60 students in the class of 2017 in the discipline of acupuncture-moxibustion and tuina, Xiangnan University were recruited and randomized into an observation group and a control group, 30 students in each one. In the control group, the traditional practical teaching mode was used. In the observation group, the interaction teaching mode integrated with virtual anatomy platform was adopted. The teaching duration was 10 class hours in both groups. After accomplishing the teaching schedule, the practical examination was conducted in the localization of commonly-used acupoints, very useful acupoints and the dangerous acupoints as well as acupuncture manipulation techniques. Moreover, the degree of satisfaction was investigated among the students in the two groups and the self-learning ability was evaluated in 3-month follow-up visit.RESULTS: In the observation group, the scores for the localization and acupuncture manipulation of commonly-used acupoints, very useful acupoints and the dangerous acupoints, as well as the degree of satisfaction of the 3 items, i.e. interesting, interaction and leaning-assistance were all higher than those in the control group (P<0.05). The degree of satisfaction in the acceptance and leaning-participation, as well as the scores of self-learning ability in 3-month follow-up visit were not different statistically between the two groups (P>0.05).CONCLUSION: The interaction teaching mode integrated with virtual anatomy platform improves the effect on teaching Meridian and Acupoints and achieves the high student satisfaction. | [
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Under the revised demand of theoretic development in clinical practice and scientific research of acupuncture and moxibustion, the reconstruction of the theory was discussed on the "three yin and three yang" subarea division in the body and acupuncture effect in line with the traditional thinking of Chinese medicine so as to explore the longitudinal foundation and rule in the human body for the "effective stimulation". ?Based on the theory of "qi-space correlation" in Internal Classic and the source of nomenclature of "three yin and three yang", the body is divided in stereo zone in accordance with the theory of "three yin and three yang". ?In view of theoretical reasoning and practical interpretation, it is expounded that the same longitudinal stereo zone subarea in the body could respond to diseases and generate therapeutic effects. ?It is pointed out that the subareas of "three yin and three yang" in the body are closely related to meridians and collaterals, which is the basis of the spatial structure and and physical effect. The importance of the "body" itself is ignored nowadays because of the conventional thinking of "qi and blood" in traditional Chinese medicine. | [
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] |
OBJECTIVE: To evaluate the methodological quality and reporting quality of Meta-analysis literature published by acupuncture journals included in Chinese Science Citation Database (CSCD), and to provide references and demonstration for relevant studies.METHODS: The Meta-analysis literature published before December 2017 in Chinese Acupuncture & Moxibustion, Acupuncture Research, Journal of Acupuncture and Tuina Science and World Journal of Acupuncture-Moxibustion was retrieved by computer. AMSTAR was used for methodology quality evaluation, and PRISMA was used for reporting quality evaluation.RESULTS: A total of 69 literature was included. Among them, the co-authorship rate was 100% and the cooperation degree was 5.45. The first authors came from 32 institutions, and 29 literature (42.0%) was funded. The cited rate was 98.6%, and averagely each paper was cited 16.3 times. The mean score of methodology quality evaluation was (7.781.14) points, including 14 high-quality literature (20.3%), 50 moderate-quality literature (72.5%) and 5 low-quality literature (7.2%). The average score of reporting quality evaluation was (20.332.36) points, including 24 relatively complete literature (34.8%), 41 literature with certain defects (59.4%) and 4 literature with serious defects (5.8%).CONCLUSION: The Meta-analysis reports published by acupuncture journals in CSCD have relatively high methodological quality and reporting quality, which could provide evidence for clinical decision making, but still the quality level needed to be further enhanced according to the writing standard of Meta-analysis report. At the same time, the overall level of experimental research should be constantly improved to promote the development of evidence-based research on acupuncture and promote the formation of high-quality evidence. | [
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Chryseobacterium spp. (Family Flavobacteriaceae) are emergent fish pathogens in Europe, Asia and North America. In 2016-2017, 7 bacterial isolates were recovered from posterior kidney or spleen of cultured diseased rainbow trout Oncorhynchus mykiss (n = 1), green sturgeon Acipenser medirostris (n = 1), white sturgeon A. transmontanus (n = 2), blue ram cichlid Mikrogeophagus ramirezi (n = 1), and returning fall Chinook salmon O. tshawytscha (n = 2) from different freshwater systems. Bacterial colonies were visible after 24-48 h incubation at 20C on agar media. Isolates were Gram-negative, rod-shaped, catalase and oxidase positive. Amplification and partial sequence analysis of the 16S rRNA and gyrB genes allocated the microorganisms to the genus Chryseobacterium sharing 97.2-99.6% similarity to 6 described Chryseobacterium spp. at the 16S rRNA locus, and 87.8-99.1% similarity at gyrB. Phylogenetic analyses in conjunction with percent sequence identity suggest some of the recovered isolates may represent novel Chryseobacterium subspecies or species. The pathogenicity of 5 isolates was evaluated experimentally in rainbow trout (n = 60), brown trout Salmo trutta (n = 60) and white sturgeon (n = 36) in flow-through freshwater at 18C. Approximately 107 CFU fish-1 was injected in the epaxial musculature of anesthetized animals. Limited mortality was observed and no bacteria were recovered from dead or moribund fish post-challenge. Thirty days post-challenge, survivors were euthanized and multiple tissues were collected and fixed for histological analysis. No consistent histopathological changes were observed in challenged or control fish. While results suggest the recovered Chryseobacterium spp. may be opportunistic pathogens, further research is warranted to better understand the role of these bacteria in fish disease. | [
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The protozoans Toxoplasma gondii and Sarcocystis spp. (Sarcocystidae: Apicomplexa) affect a wide variety of vertebrates. Both have been reported to infect pinnipeds, with impacts on health ranging from inapparent to fulminant disease and death. However, little is known regarding their infections and associated pathology in South American pinnipeds. We used histological techniques to survey for the presence of T. gondii and Sarcocystis spp. in 51 stranded pinnipeds from Brazil. Immunohistochemical and molecular assays were employed in those cases consistent with Sarcocystidae infection. T. gondii cysts were detected in the central nervous system and heart of a South American fur seal Arctocephalus australis, associated with meningoencephalitis, myocarditis and endocarditis, and confirmed by immunohistochemistry. Additionally, this animal presented Sarcocystis sp. cysts in brain and heart tissues. Four additional specimens-2 Subantarctic fur seals A. tropicalis, an Antarctic fur seal A. gazella and another South American fur seal-presented intrasarcoplasmic cysts compatible with Sarcocystis spp. in muscle samples. There was no inflammation associated with the Sarcocystis spp. tissue cysts and all cysts were negative for S. neurona immunohistochemistry. The B1 gene of T. gondii was amplified in the 5 pinnipeds infected by Sarcocystidae protozoans. To our knowledge, this is the first report of toxoplasmosis in wild South American pinnipeds and of Sarcocystis spp. in South American fur seals. Detection of terrestrial parasites in aquatic mammals could be an indicator of their presence in the marine environment. | [
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This study investigated the toxicological, hematological and immunological effects of diets supplemented with levamisole and ivermectin on Colossoma macropomum. Fish were fed for 24, 96 and 240 h with diets containing 300, 600, 900 and 1200 mg of levamisole kg-1 of feed. None of the levamisole concentrations caused either mortality or behavioral alterations among the fish over 10 d of feeding. In comparison, a single feeding of ivermectin at 4500, 9000, 13500 or 18000 mg kg-1 caused 100% mortality among the fish within 10 h. There were no alterations in erythrocyte parameters or albumin in any treatments with levamisole after 24, 96 and 240 h of feeding. At concentrations of 900 and 1200 mg kg-1, levamisole caused decreases in the albumin-to-globulin ratio compared to the control group and the 300 and 600 mg kg-1 diet treatment groups. Levels of glucose and total plasma protein were higher in the fish fed with 600, 900 and 1200 mg kg-1 than in the controls and the 300 mg kg-1 diet treatment group. After 10 d of receiving feed supplemented with levamisole, globulin levels were higher in the 600 mg kg-1 group than in the controls. Respiratory burst activity of leukocytes also increased in the fish supplemented with the 900 and 1200 mg kg-1 diets compared to the controls and other treatments. This is the first study to investigate how diets supplemented with these drugs affect C. macropomum. Our research indicates that all the levamisole concentrations tested can be used in the diet of C. macropomum for antiparasitic treatments against helminth species, and that dietary treatments with levamisole can stimulate components of the innate immune system. | [
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Bilateral nephrolithiasis with a concurrent vaginal calculus was identified in a stranded free-ranging long-beaked common dolphin Delphinus capensis. Necropsy and radiologic examinations of the sexually mature D. capensis revealed multiple small irregularly round nephroliths and a 6.4 ? 4.1 ? 9.2 cm vaginal calculus weighing 182 g. Nephroliths numbered 68 and 71 in the left and right kidneys, respectively, and ranged from 1.7 to 6.9 mm in diameter. Nephroliths were composed of 100% ammonium urate, which has been found in captive dolphin populations. However, the vaginolith consisted of struvite and calcium carbonate suggesting an alternate etiology. The composition of the vaginolith suggests that bacterial vaginitis could have served as the predisposing condition. Renal lesions included chronic tubulointerstitial nephritis with tubular degeneration and loss, likely secondary to the nephroliths. The pathogenesis of ammonium urate nephrolithiasis in managed care is suspected to be linked to diet and age but in this case may be due to metabolic disruption. However, if environmental changes cause a shift in prey species, the risk of nephrolithiasis in free-ranging cetaceans could increase. Careful surveillance for nephroliths in free-ranging populations should be considered by researchers. | [
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This case study describes a persistent M??llerian duct syndrome (PMDS), a rare form of XY disorder of sex development (DSD), in a mature (>15 yr) beluga whale Delphinapterus leucas. The phenotypically and genetically male beluga whale had both M??llerian (paramesonephric) and Wolffian (mesonephric) duct derivatives. A mild hydrometra was present. Gross and histological analyses indicated the testes were atrophied. Histopathologic findings in the testes also included fibrosis in addition to ductus deferens ductular dilation, epididymal ductular dilation, lymphoplasmacytic balanitis, uterine glandular atrophy, and endometrial fibrosis. DSDs are rarely reported in cetaceans, and PMDS has never been described in a cetacean. | [
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OBJECTIVES: This systematic review examines elementary school-aged children's involvement in oral health interventions.METHODS: A systematic review of randomised controlled studies was carried out according to the PRISMA guidelines. PubMed, CINAHL, Embase, and Scopus databases were searched for publications listed between 2008-2018. The review was focused on randomised controlled studies investigating educational oral health interventions for elementary school-age children ages 6-12 years. Data were analysed using deductive content analysis using the Typology of Youth Participation and Empowerment model. The quality of reporting was assessed using the CONSORT checklist for randomised trials. The Cochrane risk of bias assessment tool was used to assess the risk of bias.RESULTS: Eight studies were reviewed involving a total of 3232 children. The studies mostly represented the Vessel type of participation. Interventions usually consisted of researcher-designed tasks and assignments given to the children. No mentions of collaboration or consultation with children during the intervention design, implementation of the design, analysis or study process were found.CONCLUSION: Children's views of oral health education and their potential role as active participants in the overall research process should be examined using qualitative methods prior to any intervention design. The use of participatory research methodology when planning pre-intervention studies and developing interventions, including ones with a randomised controlled trial design, is, therefore, recommended. | [
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BACKGROUND/AIMS: Heart failure is characterized by chronic low-grade vascular inflammation, which in itself can lead to endothelial dysfunction. Clinical trials showed reductions in heart failure-related hospitalizations of type 2 diabetic patients using sodium glucose co-transporter 2 inhibitors (SGLT2i's). Whether and how SGLT2i's directly affect the endothelium under inflammatory conditions is not completely understood. The aim of the study was to investigate whether the SGLT2i Empagliflozin (EMPA) and Dapagliflozin (DAPA) reduce tumor necrosis factor (TNF) induced endothelial inflammation in vitro.METHODS: Human coronary arterial endothelial cells (HCAECs) and human umbilical vein endothelial cells (HUVECs) were (pre-)incubated with 1 M EMPA or DAPA and subsequently exposed to 10 ng/ml TNF. ROS and NO were measured using live cell imaging. Target proteins were either determined by infrared western blotting or fluorescence activated cell sorting (FACS). The connection between Cav-1 and eNOS was determined by co-immunoprecipitation.RESULTS: Nitric oxide (NO) bioavailability was reduced by TNF and both EMPA and DAPA restored NO levels in TNF-stimulated HCAECs. Intracellular ROS was increased by TNF, and this increase was completely abolished by EMPA and DAPA in HCAECs by means of live cell imaging. eNOS signaling was significantly disturbed after 24 h when cells were exposed to TNF for 24h, yet the presence of both SGLT2is did not prevent this disruption. TNF-induced enhanced permeability at t=24h was unaffected in HUVECs by EMPA. Similarly, adhesion molecule expression (VCAM-1 and ICAM-1) was elevated after 4h TNF (1.5-5.5 fold increase of VCAM-1 and 4-12 fold increase of ICAM-1) but were unaffected by EMPA and DAPA in both cell types. Although we detected expression of SGLT2 protein levels, the fact that we could not silence this expression by means of siRNA and the mRNA levels of SGLT2 were not detectable in HCAECs, suggests aspecificity or our SGLT2 antibody and absence of SGLT2 in our cells.CONCLUSION: These data suggest that EMPA and DAPA rather restore NO bioavailability by inhibiting ROS generation than by affecting eNOS expression or signaling, barrier function and adhesion molecules expression in TNF-induced endothelial cells. Furthermore, the observed effects cannot be ascribed to the inhibition of SGLT2 in endothelial cells. | [
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OBJECTIVES: To evaluate the reliability and validity of the Financial Management Competency Self-assessment (FMCA) in executive nurse leaders (ENLs) and to determine how ENLs develop and apply financial knowledge.BACKGROUND: Financial literacy (FL) helps in planning, implementing, and evaluating fiscal decisions, but many ENLs report weaknesses in this core competency.METHODS: An explanatory-sequential mixed-methods study was conducted to psychometrically test the FMCA and explore how ENLs with different levels of FL develop and apply financial knowledge. Eligible participants (n = 178) were recruited from a population of ENLs across the United States.RESULTS: The test-retest reliability of the FMCA was good (mean difference, 6.80; 95% confidence interval). Correlations between domain scores (P < .01) and the overall score (Cronbach's = .99) demonstrated the reliability and validity of the instrument. The cutoff scores were fair indicators of different levels of FL in ENLs (P < .001). Self-awareness, gaps in hospital and graduate nursing education, application of financial knowledge, and a micro versus macro view emerged as important themes in the qualitative analysis.CONCLUSION: FMCA reliability and validity were established. FMCA cutoff scores were established to determine FL level, and the ENL lived experience described in financial knowledge development and application. | [
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] |
OBJECTIVE: Describe clinical nurse involvement in antibiotic stewardship programs (ASPs).BACKGROUND: The extent to which clinical nurses are supported and integrated into ASPs is unknown.METHODS: Electronic survey of infection preventionists (IPs) working in acute care hospitals.RESULTS: A total of 207 IPs nationwide reported on clinical nurses' involvement in their hospital's ASP. Among respondents, 42% reported the presence of a designated nurse executive that championed nurses' involvement in ASPs; 33% reported that the hospital provides antibiotic stewardship education and training to clinical nurses, and only 14% believed that clinical nurses have adequate stewardship knowledge to participate in ASP activities.CONCLUSIONS: Study findings indicate the need for nurse leaders to improve the preparation and integration of clinical nurses in ASPs. While clinical nurses routinely perform activities that contribute to optimal antibiotic use, the knowledge and competency of clinical nurses in these activities and their formal integration in ASPs are minimal. | [
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] |
Creating a nursing journal club is an initiative to promote nurses' use of best evidence in practice. A virtual nursing journal club (VNJC) was implemented in a Magnet-designated, midsize community hospital. The VNJC fostered nurses' reading nursing research studies and subsequent interaction with other nurses. The VNJC's formation, implementation, and evaluation are described. Quantitative and qualitative research critique items and an evaluation form are included that are essential to the site's ongoing processes. | [
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PrhA from Penicillium brasilianum and AusE from Aspergillus nidulans are nonheme Fe(ii)/-ketoglutarate-dependent oxygenases, which are involved in the fungal meroterpenoid biosynthetic pathways. Both enzymes use preaustinoid A1 as a common substrate to form divergent products through dynamic skeletal rearrangement. Importantly, structure-guided mutagenesis results in the successful interconversion of AusE and PrhA functions, for example, the PrhA(V150L/A232S) double mutant carried out the same catalysis as AusE. Here, on the basis of the crystal structure of the PrhA (V150L/A232S) double mutant in complex with Fe(ii), KG and the substrate preaustinoid A1, computational models were constructed, and combined quantum mechanics/molecular mechanics (QM/MM) calculations were performed to illuminate the reaction mechanism at the atomistic level. According to our calculation results, the whole reaction occurs on the quintet state surface. All three steps, including desaturation, ring rearrangement and hydroxylation, require three hydrogen abstractions by FeIV[double bond, length as m-dash]O to trigger the reaction. Owing to the relative position of FeIV[double bond, length as m-dash]O to the hydrogen atoms in the substrate to be extracted, the three H-abstractions correspond to different energy barriers, which are 17.9, 23.6 and 21.8 kcal mol-1, respectively. For the ring rearrangement, as soon as the H5 is extracted, the skeletal rearrangement is very easy. However, in the hydroxylation of intermediate preaustinoid A3, the final O-rebound corresponds to a high barrier, which is mainly caused by the long distance between the Fe-OH and -CH2 radical. It is the relative orientation of the substrate to the highly reactive FeIV[double bond, length as m-dash]O that controls the catalytic chemistry of these enzymes. The reaction barriers are sensitive to the geometry of FeIV[double bond, length as m-dash]OHx (Hx is the hydrogen atom to be extracted). These results may provide useful information for understanding the mechanisms of AusE and PrhA as well as other nonheme Fe(ii)/-ketoglutarate-dependent oxygenases. | [
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The pace of change in today's healthcare environment is unprecedented. What used to happen every few months now seems to happen every day. From rapidly shifting technology to evolving models of care to new payment systems, nursing leaders must navigate constant change to stay relevant. How well they manage it has a direct bearing on everything from patient safety and outcomes to nursing cohesion and satisfaction. In this month's Magnet Perspectives column, we explore the essential elements that contribute to successful change management and the strategies leaders can employ to keep their nurses, and their organizations, forward-focused. In addition, we take a deep dive into the Magnet Model component of transformational leadership and examine its impact on creating and sustaining an environment where change flourishes and nurses thrive. | [
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The American Organization of Nurse Leaders and the American Association of Colleges of Nursing have been working together since 2010 to address how academic-practice partnerships can most effectively advance the profession by preparing a well-educated workforce. This article describes the work to date and future strategic priorities. | [
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Hospitals and health systems are facing a new kind of shortage among the nursing workforce: a shortage of experience. As older nurses retire and the influx of new nurses continues to grow, the net effect is a decline in the overall experience of the nursing workforce. At the same time, care delivery is becoming more complex. We call this phenomenon "the experience-complexity gap." If left unaddressed, the experience-complexity gap will widen and could put quality and safety at risk. In this article, the authors explore this new challenge and suggest 3 key strategies for addressing it. | [
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Developing a professional practice model (PPM) is essential for hospitals seeking Magnet designation. The article describes the development and implementation of a PPM in a tertiary hospital that was the 1st hospital in mainland China applying for Magnet recognition. This article provides a framework for hospital administrators who wish to reference a successful process when creating their own Magnet PPMs. | [
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] |
OBJECTIVE: The aim of this study was to describe the transition-to-practice experience of new-graduate nurses (NGNs) in long-term-care (LTC) settings.BACKGROUND: Transitioning to professional practice is a challenging time for an NGN. This experience is scarcely described for RNs outside of acute care settings and not described for the LPN.METHODS: A qualitative case study was used to explore the described transition-to-practice experience of new-graduate RNs and LPNs in LTC.RESULTS: This study revealed that the transition-to-practice experience of new-graduate LPNs was similar to the experience described by RNs. Differences in experience were related to leadership roles in the setting.CONCLUSIONS: Findings contribute to new understanding of the experience of the NGN in LTC settings. This study reinforces the need for greater support for nursing graduates in this setting. | [
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Caring for multiple complex patients simultaneously is 1 of the biggest challenges for clinical nurses (CNs) in acute care. We utilized the results of research to develop a 6-hour Professional Nursing Practice Curriculum (PNPC) specifically for CNs who are professionally and legally responsible for providing holistic care to an assigned group of patients on inpatient clinical units in acute care hospitals. The curriculum can be used by faculty to prepare senior nursing students for their 1st professional practice role in an acute care setting. Components of the PNPC will be beneficial for nurse leaders in an assessment of their educational practices for transitioning newly licensed RNs to practice and addressing professional development needs of CNs. | [
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In healthcare, timely communication of critical information is imperative among workforce members. Nurse leaders struggle with how to reach clinical staff effectively when informing them of program updates, practice changes, or available resources. This article provides a review of the marketing and communication literature sharing best practices for improving visibility and program uptake for infrastructure supporting the conduct of inquiry projects among hospital employees using an evidence-based practice approach. | [
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Magnet designation requires that nurses be actively involved in activities that lead to obtaining evidence through conducting research. Unfortunately, several barriers limit nurses' ability to engage in research activities, including insufficient resources. This article explains how a community-based hospital implemented a fellowship model to circumvent some of these barriers. Two fellowship positions are described, 1 in research and 1 in library sciences. The method, outcomes, and cost of the fellowship model are discussed. | [
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Despite the availability of the political process, it has not been used optimally by nurses to improve negative issues facing the profession. This study indicates that nurses are generally not astute regarding the political process and are not significantly involved. Nurse leaders have an opportunity to educate and motivate nurses to be formidable participants in the political process, champion the healthcare agenda, and propound policy efforts to improve patient care and the nursing profession. | [
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] |
To evaluate the clinical value of NeuroGam software in assessing the brain foci perfusion changes by TC-ECD single photon emission computed tomography/computed tomography (SPECT/CT) brain imaging in patients with Moyamoya Disease (MMD).Seventy-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgical revascularization were included. Baseline and follow-up TC-ECD SPECT/CT brain scans were performed on all patients at least twice before and after operation. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam Software package. Additional visual analysis was performed. Differences mean pixel value between pre- and post- operation brain perfusion were assessed with paired t test and McNemar test.Significant differences in the number of hypoperfusion foci were found between visual assessment and NeuroGam aided assessment. More hypoperfusion foci were found by NeuroGam software aided assessment in the frontal, parietal, temporal, occipital lobe, thalamus, basal ganglia and cerebellum before and after surgery (P < .0001). According to NeuroGam software assessment, the perfusion of frontal, parietal, temporal lobe, anterior and middle cerebral regions on the operative side significantly improved before and after surgery (t = -3.734, t = -3.935, t = -5.099, t = -4.006, t = -5.170, all P < .001). However, no significant differences were found in the occipital lobe (t = -1.962, P = .054), thalamus (t = 1.362, P = .177), basal ganglia (t = -2.394, P = .019), and cerebellum (t = 1.383, P = .171) before and after surgery.The NeuroGam software provides a quantitative approach for monitoring surgical effect of MMD in a variable time (3-12 months after surgery). It could discover the perfusion changes that are neglected in conventional visual assessment. | [
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] |
The purpose of this study was to determine the trends in consumption of antibiotics and evaluate the antibiotic prescription rates in the pediatric population in Lithuania during 2003 to 2012.A cross-sectional study. Data of systemic antibiotic use in pediatric population for outpatient treatment was derived from National Health Insurance Fund database. Consumption was expressed as WHO ATC defined daily dose (DDD)/1000 children/day and as a number of prescriptions written in the general population per year. Statistical analysis was performed using the SPSS/W 20.0 software (Statistical Product and Service Solutions for Windows).Total utilization of antibiotics (expressed in DDD units) during study period increased by 8.40% (from 5.67 to 6.19 DDD/1000 children/day) and by 5.96% expressed in prescription rate (from 585.84 to 622.97 prescriptions/1000 children/year). The most popular antibiotic group was macrolides which showed the highest increase of utilization 5.9 times (from 0.27 DDD/1000 children/day in 2003 to 1.66 DDD/1000 children/day in 2012).The most common indications for antibiotic prescribing for children in 2012 were acute bronchitis (25.6%), acute tonsillitis (21.7%) and acute pharyngitis (14.6%). Amoxicillin had the highest probability to be chosen to treat acute tonsillitis (prob. [probability] = .2875) and acute pharyngitis (prob. = .5553). Clarithromycin had the highest probability to be chosen to treat acute bronchitis (prob. = .4222).Most of the diseases treated with antibiotics were viral infections. The most commonly prescribed antibiotics were broad-spectrum. The consumption of antibiotics was evenly increasing during 2003 to 2012 period, but the distribution of separate antibiotic group remained the same. | [
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BACKGROUND: Neck pain is an important cause of disability. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Exercise therapy appears to be effective at decreasing pain and improving function for patients with NP in practice guidelines. Core stability exercise is becoming increasingly popular for NP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with NP. The aim of this study is to explore the therapeutic effect of core stability exercise for neck pain.METHODS: This review will only include randomized controlled trials (RCTs). Published articles from July 2009 to July 2019 will be identified using electronic searches. Search strategy will be performed in 3 English databases, 1 Chinese database, and the WHO International Clinical Trials Registry Platform. Two reviewers will screen, select studies, extract data, and assess quality independently. The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.RESULTS: We will provide some more practical and targeted results investigating the effect of Core Stability Exercise (CSE) for Neck Pain (NP) in the current meta-analysis. Meanwhile, we will ascertain study progress of Core Stability Exercise for Neck Pain and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.CONCLUSION: The stronger evidence about Neck Pain's rehabilitative effect and safety will be provided for clinicians and policymakers.SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017055711.ETHICS AND DISSEMINATION: We do not apply for formal ethical approval from ethics committee because all of the study data in our review will be obtained in an anonymous way. Findings of this study are projected to be disseminated through peer-review publications. | [
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] |
OBJECTIVE: The aim of our study was to assess the efficacy and safety of sarpogrelate hydrochloride by comparing the effects of sarpogrelate with conventional treatment on the improvement of symptoms in PAD patients.METHODS: The search was conducted in PubMed, Embase, Cochrane library database, CNKI, CBM for relevant randomized controlled trials (RCTs) before January 1st, 2019. Inclusion and exclusion of studies, assessment of quality, outcome measures, data extraction and synthesis were completed by two reviewers independently. The meta-analysis was performed with RevMan 5.3.RESULTS: Totally, 12 eligible RCTs were included in our analysis. Comparing the results of sarpogrelate group and control group, sarpogrelate significantly improved ankle-brachial index (ABI) levels (SMD = 0.05, [95%CI 0.20 to 0.74, P = .0005]), dorsalis pedis artery blood flow (MD = 0.16, [95%CI 0.09 to 0.23, P < .001]) and pain-free walking distance (PFWD) (MD = 201.86, [95%CI 9.34 to 394.38, P = .04]). The pooled analysis showed that a significant decrease in hsCRP (MD = -0.57, [95%CI -1.12 to -0.02, P = .04]) and IL-6 (MD = 1.48,[95%CI 0.39 to 2.56, P = .008]) was observed in the sarpogrelate treatment.CONCLUSION: Sarpogrelate was effective for improving the symptoms of PAD and showed good tolerability without significant adverse events. | [
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PURPOSE: To evaluate preterm infants' exposure and reactions to intense noise during incubator care.METHODS: An observational and prospective study was performed in the intermediary care unit of a hospital in Ribeir?o Preto (SP). Thirty-five preterm infants participated in the first stage of the study (measuring noise) and 20 in the second (analysis of responses to intense noise). Noise was measured for two hours using a dosimeter, and the responses were video recorded by three cameras connected to a computer. The preterm infants' responses to an Lmax higher than 65 decibels were analyzed.RESULTS: Every preterm infant presented Leq above the limit recommended by international organizations, and more than half of the babies had a mean Leq above the limit permitted by the Brazilian standard. Regarding the babies' responses to the intense noise, the majority of them showed blink reflex, startle reflex, facial mimics, changed bodily activities or changed sleep and wake state, all with statistically significant differences.CONCLUSION: The sound levels measured were intense. The noises that preterm infants are exposed to while being cared for in incubators constitute a stressor event. Sudden, intense noises change their behavioral state and causes reflexive and bodily responses, facial manifestations and changes in their sleep and wake state. | [
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] |
PURPOSE: To verify the effect of dog intervention on the regular session of speech therapy for developmental stuttering in adults.METHODS: The study involved young adults and adults with developmental stuttering. The study sample was composed of eight participants, six males and two females, ranging in age from 16 to 45 years. Participants were divided into two groups: G1 - those who underwent treatment for stuttering with the presence of a dog-therapist in the therapy room and G2 - those who underwent treatment for stuttering without the presence of the dog therapist. We included a control group, G3, composed of fluent participants, matched in age and sex to G1 and G2 to control the natural variability of speech fluency.RESULTS: Comparative results between the groups indicated that the group that performed the treatment without the presence of the dog achieved better performance, evolution and efficacy rates.CONCLUSION: for the population in this study, the dog intervention on speech therapy did not improve treatment. | [
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This study aimed to evaluate the effect of the commercial probiotic (Saccharomyces cerevisiae), antibiotic (florfenicol), and its combination for Nile tilapia culture. The experiment was arranged in a completely randomized design with five replications, and five treatments diets: Control: water and diet without additives; YD: yeast in the diet (1 g Kg-1); AW: antibiotic in the water (0.002 g L-1); AWYD: antibiotic in the water, and yeast in the diet (0.002 g L-1 and 1 g Kg-1); and AD: antibiotic in the diet (0.01 g kg-1). The growth parameters as total and standard length, weight, weight gain, biomass, Fulton's condition factor, specific growth rate and plasma cortisol of tilapia did not show the difference between the treatments. The survival rates and food conversion rate of fish were greater in treatment with florfenicol included in the diet. The commercial probiotic did not improve growth or survival. The administration of the antibiotic florfenicol in the water needs more studies. The inclusion of the antibiotic in the diet promotes growth and survival in Nile tilapia juvenile. | [
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Management of remnants in Atlantic Forest is an alternative for their conservation, however, information on the growth and ecology of those species is lacking. This study aimed to describe diametric growth of Balfourodendron riedelianum, Cordia trichotoma and Ocotea diospyrifolia based on its growth rings and to verify the relationship between this growth with the environmental characteristics in different altitude levels and forest types. Diametric growth was higher for the largest tree diameters of the three species. Based on the fitted growth model, the age in which mean annual increment in diameter becomes greater than the current annual increment was 55 years for B. riedelianum (DBH = 18.27 cm), 45 years for C. trichotoma (DBH = 26.56 cm) and 44 years for O. diospyrifolia (DBH = 26.05 cm). Environmental conditions and forest types affected diametric growth of these species. B. riedelianum and O. diospyrifolia showed higher diametric growth in plain regions with higher fertility soil and few frosts. C. trichotoma was negatively affected by low water availability in winter at lower altitudes and showed higher diametric growth at higher altitudes, where soil fertility is low but there is well-drainage, high rainfall and high relative humidity during the dry season. | [
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Conventional cotton production in western Bahia, Brazil, involves intensive use of agricultural inputs and mechanization, which may affect arbuscular mycorrhizal fungi (AMF). This work aimed at studying the impact of conventional and organic cotton production in the AMF of western Bahia. Soil samples were obtained from conventional white cotton and colored cotton organic production systems as well as from native Cerrado areas, close to the white cotton fields, and from the subcaducifolia vegetation, close to the organic colored cotton farms. The most frequent species in the conventional farming areas belonged to the genera Acaulospora (10 spp.); Glomus (8 spp.); Dentiscutata (3 spp.); Ambispora, Pacispora and Scutellospora (2 spp. each), as well as Claroideoglomus etunicatum, Diversispora sp., Entrophospora infrequens, Gigaspora sp., Orbispora pernambucana, Paradentiscutata maritima, and Paraglomus occultum. Eighteen species were found in the organic farming areas, with the predominance of Glomus (5 spp.) and Acaulospora (5 spp.), and with Claroideoglomus, Dentiscutata, Gigaspora, Corymbiglomus, Orbispora, Paraglomus, Scutellospora, and Simiglomus (1 spp. each). Paraglomus bolivianum was first reported in Cerrado. In the native vegetation, nine species were found, with the predominance of Glomus and Acaulospora. The highest number of AMF species was found in the organic farming areas, which deserves further investigation. | [
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The re-examination of nematodes collected decades ago from a spiny rat, Proechimys roberti (Echimyidae) from Par? State, revealed the presence of Acanthostrongylus acanthostrongylus Travassos, 1937, and two coparasitic species of Pudica (Heligmonellidae: Pudicinae), one of them new to science. Pudica minima n. sp. mostly resembles Pudica tenua Durette-Desset, 1970, described from Proechimys semispinosus in Colombia. Nevertheless, it differs from P. tenua by having a synlophe with 12 ridges with poorly developed careen, bursal pattern of type 2-2-1 on the right lobe, bursal rays 2 and 3 similar in length, and spicules longer with spoon-shaped tips. Pudica evandroi (Travassos, 1937) was already described from Pr. roberti but its synlophe remained undescribed and the original description lacked some details. A detailed study of the synlophe is provided and the range of morphometric data for males and females is enlarged. The study of the synlophe allowed ratifying the placement of this species within Pudica, as early suggested by previous authors. The species list and identification key to species of Pudica are updated with the inclusion of three species. The status of Heligmosomum alpha Travassos, 1918, which was transferred to Pudica in 1990, is emended and the species is considered a Nippostrongylinae incertae sedis. | [
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] |
A new species of Stethelmis, S. shepardi sp. nov., is described for Patagonia, Argentina from adults of both sexes. A full description and illustrations of both the adult and the larva of the new species are provided with comments on its habitat and distribution. Adults of the new species are compared with those of S. kaszabi (Hinton 1970) and S. chilensis (Hinton 1945). The larva of S. shepardi is compared with that of S. kaszabi, the other Stethelmis larva described. We also describe and illustrate for the first time the male genitalia of S. kaszabi. A key to the known species of Stethelmis is also included. | [
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This study investigated the ability of formulation containing Zingiber officinale (ginger) to reverse health changes promoted by unhealthy diet in Wistar rats. Five compounds from the gingerol family and three from the shogaol family were identified in the chromatographic analyzes of the extract. The animals were fed a combination of unhealthy foods, the cafeteria diet, which promoted increases in body weight, hepatocyte nucleus area, total hepatocyte area and liver fat accumulation, as well as reduced hepatic glutathione S-transferase concentration, compared to the control group, which received commercial chow. The treatment with ginger improved all these results, highlighting the reduction of 10% of body weight and 66% of the total area of lipid droplets deposited, compared to the group that received the cafeteria diet. Ginger treatments also attenuated lipid peroxidation, with a mean reduction of 41% in malondialdehyde levels and a mean increase of 222% in glutathione S-transferase activity in the liver. The cafeteria diet and ginger extract did not promote significant changes in glycemic and lipid profile, liver weight and liver enzymes compared to the control group. We suggest that ginger can have beneficial effects on health complications associated with unhealthy diet, such as excessive adiposity, oxidative stress and hepatic injury. | [
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Different physiognomies across the Cerrado could influence the microbial C:N:P ratio in the soil since these physiognomies present different abundance and diversity of plant species. Thus, the aim of this study was to evaluate the microbial C:N:P ratio in soil across three different physiognomies of Cerrado in the Northeast, Brazil, namely campo gramin?ide (dominance of grasses), cerrado stricto sensu (dominance of grasses, shrubs, low trees, and woody stratum), and cerrad?o (dominance of woody stratum). Campo gramin?ide was characterized by lower values of total organic C, N, microbial C:P, N:P, and soil C:N. Cerrado stricto sensu presented average values for most of the measured parameters, while cerrad?o presented higher values of microbial C, N, P, organic C, N and soil C:P and C:N ratios. The principal component analysis showed that the samples grouped according to the sites, with a clear gradient from campo gramin?ide to cerrad?o. Therefore, the differences of vegetation across physiognomies of Cerrado influenced the soil microbial C:N:P ratio, where cerrad?o showed highest microbial C:N:P ratio than soil under campo gramin?ide. | [
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This work aimed to study the inheritance of resistance to Phytophthora infestans in tomato plants, using the maximum likelihood estimation function. The susceptible cultivar Santa Clara (Solanum lycopersicum) was used as the female genitor and the P. infestans resistant S. habrochaites f. glabratum accession (BGH 6902) as the male genitor. F1 plants from the crossing were self-pollinated to produce F2 progenies, and also backcrossed with PR and PS to produce BC1:R and BC1:S generations, respectively. The tomato plants were inoculated 50 days after transplanting. Disease severity was evaluated via a diagrammatic scale. Comparison of the genetic models created using the maximum likelihood function revealed that the inheritance of resistance to P. infestans in S. habrochaites is conferred by a major gene with additive and dominance effects, polygenes with additive effects, plus the environmental effect. Vertical resistance can be explored using genes with major effects. Programs of recurrent and maker-assisted selection are considered efficient strategies with which to select genotypes that hold P. infestans resistance conferred by polygenes. | [
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BACKGROUND: Many countries have stockpiled vaccines because of concerns about the reemergence of smallpox. Traditional smallpox vaccines are based on replicating vaccinia viruses; these vaccines have considerable side effects.METHODS: To evaluate the efficacy of modified vaccinia Ankara (MVA) as a potential smallpox vaccine, we randomly assigned 440 participants to receive two doses of MVA followed by one dose of the established replicating-vaccinia vaccine ACAM2000 (the MVA group) or to receive one dose of ACAM2000 (the ACAM2000-only group). The two primary end points were noninferiority of the MVA vaccine to ACAM2000 with respect to the peak serum neutralizing antibody titers and attenuation of the ACAM2000-associated major cutaneous reaction by previous MVA vaccination, measured according to the maximum lesion area and the derived area attenuation ratio.RESULTS: A total of 220 and 213 participants were randomly assigned and vaccinated in the MVA group and ACAM2000-only group, respectively, and 208 participants received two MVA vaccinations. At peak visits, MVA vaccination induced a geometric mean titer of neutralizing antibodies of 153.5 at week 6, as compared with 79.3 at week 4 with ACAM2000 (a ratio of 1.94 [95% confidence interval {CI}, 1.56 to 2.40]). At day 14, the geometric mean titer of neutralizing antibodies induced by a single MVA vaccination (16.2) was equal to that induced by ACAM2000 (16.2), and the percentages of participants with seroconversion were similar (90.8% and 91.8%, respectively). The median lesion areas of the major cutaneous reaction were 0 mm2 in the MVA group and 76.0 mm2 in the ACAM2000-only group, resulting in an area attenuation ratio of 97.9% (95% CI, 96.6 to 98.3). There were fewer adverse events or adverse events of grade 3 or higher after both MVA vaccination periods in the MVA group than in the ACAM2000-only group (17 vs. 64 participants with adverse events of grade 3 or higher, P<0.001).CONCLUSIONS: No safety concerns associated with the MVA vaccine were identified. Immune responses and attenuation of the major cutaneous reaction suggest that this MVA vaccine protected against variola infection. (Funded by the Office of the Assistant Secretary for Preparedness and Response Biomedical Advanced Research and Development Authority of the Department of Health and Human Services and Bavarian Nordic; ClinicalTrials.gov number, NCT01913353.). | [
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BACKGROUND: The small-molecule phosphodiesterase 4 inhibitor apremilast modulates cytokines that are up-regulated in Beh?et's syndrome. In a phase 2 trial involving patients with Beh?et's syndrome, apremilast reduced the incidence and severity of oral ulcers. Data on the efficacy and safety of apremilast in patients with Beh?et's syndrome who had active oral ulcers and had not previously received biologic agents are limited.METHODS: In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients who had Beh?et's syndrome with active oral ulcers but no major organ involvement to receive either apremilast at a dose of 30 mg or placebo, administered orally, twice daily for 12 weeks, followed by a 52-week extension phase. The primary end point was the area under the curve (AUC) for the total number of oral ulcers during the 12-week placebo-controlled period (with lower values indicating fewer ulcers). There were 13 secondary end points, including complete response of oral ulcers, change from baseline in pain associated with oral ulcers, disease activity, and change from baseline in the Beh?et's Disease Quality of Life score (range, 0 to 30, with higher scores indicating greater impairment in quality of life). Safety was also assessed.RESULTS: A total of 207 patients underwent randomization (104 patients to the apremilast group and 103 to the placebo group). The AUC for the number of oral ulcers was 129.5 for apremilast, as compared with 222.1 for placebo (least-squares mean difference, -92.6; 95% confidence interval [CI], -130.6 to -54.6; P<0.001). The change from baseline in the Beh?et's Disease Quality of Life score was -4.3 points in the apremilast group, as compared with -1.2 points in the placebo group (least-squares mean difference, -3.1 points; 95% CI, -4.9 to -1.3). Adverse events with apremilast included diarrhea, nausea, and headache.CONCLUSIONS: In patients with oral ulcers associated with Beh?et's syndrome, apremilast resulted in a greater reduction in the number of oral ulcers than placebo but was associated with adverse events, including diarrhea, nausea, and headache. (Funded by Celgene; ClinicalTrials.gov number, NCT02307513.). | [
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] |
BACKGROUND: Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.METHODS: Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatch-based irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days. Surveys were administered 90 days after notification of the irregular pulse and at the end of the study. The main objectives were to estimate the proportion of notified participants with atrial fibrillation shown on an ECG patch and the positive predictive value of irregular pulse intervals with a targeted confidence interval width of 0.10.RESULTS: We recruited 419,297 participants over 8 months. Over a median of 117 days of monitoring, 2161 participants (0.52%) received notifications of irregular pulse. Among the 450 participants who returned ECG patches containing data that could be analyzed - which had been applied, on average, 13 days after notification - atrial fibrillation was present in 34% (97.5% confidence interval [CI], 29 to 39) overall and in 35% (97.5% CI, 27 to 43) of participants 65 years of age or older. Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 (95% CI, 0.76 to 0.92) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 (97.5% CI, 0.69 to 0.74) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram. Of 1376 notified participants who returned a 90-day survey, 57% contacted health care providers outside the study. There were no reports of serious app-related adverse events.CONCLUSIONS: The probability of receiving an irregular pulse notification was low. Among participants who received notification of an irregular pulse, 34% had atrial fibrillation on subsequent ECG patch readings and 84% of notifications were concordant with atrial fibrillation. This siteless (no on-site visits were required for the participants), pragmatic study design provides a foundation for large-scale pragmatic studies in which outcomes or adherence can be reliably assessed with user-owned devices. (Funded by Apple; Apple Heart Study ClinicalTrials.gov number, NCT03335800.). | [
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BACKGROUND: Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation.METHODS: We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator. The primary end point was overall survival.RESULTS: A total of 485 patients underwent randomization, 240 to secondary cytoreduction before chemotherapy and 245 to chemotherapy alone. The median follow-up was 48.1 months. Complete gross resection was achieved in 67% of the patients assigned to surgery who underwent the procedure. Platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance was administered to 84% of the patients overall and was equally distributed between the two groups. The hazard ratio for death (surgery vs. no surgery) was 1.29 (95% confidence interval [CI], 0.97 to 1.72; P = 0.08), which corresponded to a median overall survival of 50.6 months and 64.7 months, respectively. Adjustment for platinum-free interval and chemotherapy choice did not alter the effect. The hazard ratio for disease progression or death (surgery vs. no surgery) was 0.82 (95% CI, 0.66 to 1.01; median progression-free survival, 18.9 months and 16.2 months, respectively). Surgical morbidity at 30 days was 9%; 1 patient (0.4%) died from postoperative complications. Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery.CONCLUSIONS: In this trial involving patients with platinum-sensitive, recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy did not result in longer overall survival than chemotherapy alone. (Funded by the National Cancer Institute and others; GOG-0213 ClinicalTrials.gov number, NCT00565851.). | [
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Biosynthesis of Zinc oxide nanoparticles (ZnONPs) from natural plants stands as a promising nanodrug delivery system in cancer therapeutics. Marsdenia tenacissima (M.t), a Chinese medicinal plant has been extensively used as clinical remedy for treating several types of cancer. In this present study, ZnONPs were synthesized from Marsdenia tenacissima and its anti cancer potency was assessed against in vitro laryngeal cancer cell line Hep-2. The biosynthesized Marsdenia tenacissima Zinc Oxide Nanoparticles [M.t-ZnONPs] was characterized using UV-visible Spec, SEM, TEM and EDAX analysis. The cytotoxic and apoptotic inducing potential of M.t-ZnONPs was assessed by MTT assay and staining such as DCFH-DA, AO/EtBr, Rhodamine 123, DAPI and comet assay. The anticancer potential of M.t-ZnONPs was analysed by Real time PCR analysis of proapoptotic, antiapoptotic and caspases proteins. Our present findings showed characteristic and morphological representation of synthesized M.t-ZnONPs by UV-visible Spec, SEM, TEM and EDAX analysis. M.t-ZnONPs exhibits its cytotoxicity by inhibiting the viability of Hep-2 cells and IC50 value was obtained by MTT assay. The results of apoptotic staining techniques in M.t-ZnONPs treated Hep-2 cells confirm with excess ROS generation, disruption of mitochondrial membrane potential and nuclear damage. The apoptotic inducing potential of M.t-ZnONPs was also evidenced by upregulation of proapoptotic proteins Bax, Caspase 3 & 9 and downregultion of antiapoptotic protein Bcl-2 by RT-PCR analysis. Finally, these results suggested that biosynthesized M.t-ZnONPs is an effective anticancer agent which induces apoptosis in Hep-2 laryngeal cell line and thus conclude that M.t-ZnONPs, a valid anticancer strategy in treating various cancer. | [
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Among the proposed ALS diagnostic criteria, the revised El Escorial diagnostic criteria was the most frequently utilized in clinical trials and clinical practice. However, its low sensitivity in early stage ALS prompted development of the Awaji electrodiagnostic criteria that incorporated fasciculation potentials and resulted in greater diagnostic sensitivity than the revised El Escorial criteria. Further improvements could include the updated Awaji criteria that is concordant between clinically- and electrodiagnostically-diagnosed cases, as well as the inclusion of ultrasound-detected fasciculations. | [
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'Split hand' is dissociated hand muscle atrophy, characterized by preferential atrophies in the thenar and first dorsal interosseous muscles, with relative sparing of the hypothenar muscle. This symptom has been recognized as specific to amyotrophic lateral sclerosis (ALS), and distinct pathomechanisms are assumed to underlie this phenomenon. Recently, characteristic distributions of weakness and symptoms in ALS have been reported. Here, we describe characteristic symptoms of ALS, including split hand, split-hand plus sign, split elbow, split leg, relative preservation of finger flexion. Moreover, through these phenomena, potent mechanisms of motor neuron death in ALS are considered. Revealing the underlying pathophysiology of these symptoms may lead to the development of therapies for ALS. | [
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] |
The basic neuropathology of amyotrophic lateral sclerosis (ALS) is defined as the involvement of the upper motor neurons system (UMN) and the lower motor neuron system (LMN), with variable degree and combination. The characteristic pathological feature of sporadic ALS is cytoplasmic mislocalization of nuclear TDP-43 and aggregation of abnormally phosphorylated TDP-43 inclusions in cytoplasm in LMN, UMN and glial cells. TDP-43 inclusions correlate with cell loss and distribute beyond the UMN and LMN system. It has been proposed that phosphorylated TDP-43 (pTDP-43) disseminates in a sequential pattern along the motor pathways, as suggested by the hypothesis of corticofugal ('prion-like') propagation of misfolded proteins in ALS. | [
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The molecular pathogenesis of amyotrophic lateral sclerosis (ALS) has been studied through analysis of the function of the protein produced by the causative genes of familial ALS. The products of these genes are classified as RNA binding proteins, or proteins related to proteolytic systems. However, most case of familial ALS, and sporadic ALS show TAR DNA binding protein-43 (TDP-43) immune-positive cytoplasmic inclusions. Therefore, the molecular mechanism of formation of TDP-43 inclusions and dysfunction caused by TDP-43 inclusions has been studied. As for the mechanism of inclusion formation, non-membrane organelle formation by liquid-liquid phase separation (LLPS) is important. The ubiquitin-proteasome and autophagy systems are important for the degradation of these inclusions. Several genes associated with these systems have been identified as causative genes for ALS. The formation of cytoplasmic inclusions results in the loss of TDP-43 from the nucleus, resulting in abnormalities in RNA metabolism, through the alteration of spliceosomes and Gemini of coiled bodies. Furthermore, in ALS, the regulation of TDP-43 mRNA/protein expression levels has failed. Failure of the autoregulation system facilitates TDP-43 inclusion formation. Development of treatments for ALS based on these elucidated molecular mechanisms is desirable. | [
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] |
In 2011, C9orf72 hexanucleotide (GGGGCC) repeat expansion (HRE) in intron 1 was reported as the most common cause of sporadic and familial amyotrophic lateral sclerosis (ALS)/frontotemporal dementia (FTD) in the Caucasian population. In the Japanese population, the C9orf72 repeat expansion was found to account for 0.2% cases of sporadic ALS and 2.6% of familial ALS. Notably, among individuals in the Kii peninsula which has recorded high incidence of ALS or ALS/PDC (parkinsonism-dementia complex), the frequency of C9orf72 repeat expansion was 20% (3/15) indicating high prevalence. It is important to obtain detailed family history of ALS and FTD to understand the cause of the diseases including the C9orf72 mutation. | [
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The most common neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis, are known to be protein-misfolding diseases, and characterized by the presence of disease-specific protein aggregates in neuronal and glial cells. Recently, the propagation hypothesis of prion-like protein inclusions in neurodegenerative diseases has been proposed. Many studies have shown that aggregation-prone proteins such as tau, alpha-synuclein and TDP-43 can form aggregates in a seed-dependent and self-templating prion-like manner, and these aggregates can be transferred intercellularly to neighboring cells and seeded for further aggregation. Propagation of aggregated proteins in these diseases may therefore occur through mechanisms similar to those that underlie prion pathogenesis. If this hypothesis is verified in vivo, it will suggest new therapeutic strategies to block the propagation of aggregated proteins throughout the brain. | [
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] |
Amyotrophic lateral sclerosis (ALS) patient registries can assist in the provision of appropriate care to patients and promote therapeutic developments related to ALS. In Japan, a multicenter registration and follow-up system called the Japanese Consortium for Amyotrophic Lateral Sclerosis research (JaCALS) was built in 2006. Genomic DNA samples and B-cell lines of patients with ALS were stored and linked to clinical information. Information obtained from JaCALS shows the natural histories of Japanese patients with ALS, including their genetic backgrounds and clinical and genetic factors associated with disease progression and prognosis. Research efforts that focus on pathophysiology, identification of biomarkers related to progression and prognosis, and drug discoveries for patients with ALS are advanced using data obtained from JaCALS. In the future, we expect that JaCALS will be a source of real-world evidence, combining data from a large number of cases. | [
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Amyotrophic lateral sclerosis (ALS) is often comorbid with frontotemporal dementia (FTD). Patients may exhibit language deficits as seen in progressive non-fluent aphasia (PNFA) or semantic dementia (SD). In behavioral variant FTD (bvFTD), cognitive impairments such as executive function, verbal fluency and language abnormalities are frequently seen, while apathy and disinhibition are major behavioral changes. Further, there are many ALS patients who do not fulfill the criteria for FTD but have mild cognitive and/or behavioral impairments. Appropriate evaluation of these conditions is necessary for non-pharmacological and pharmacological interventions. | [
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In 1993, a mutation in the superoxyde dismutase gene, SOD1, was found causative for familial ALS, suggesting that free radical-related injury may be involved in ALS pathogenesis. Therefore, clinical trials were conducted with ALS patients using a free radical scavenger, edaravone, which was already approved for acute phase treatment of cerebral infarction in Japan. Because edaravone showed a therapeutic effect in suppressing the progression of ALS symptoms, it was approved as a new therapeutic agent in Japan, in June, 2015. In this article, we discuss the recent progress of basic and clinical research for the development of new ALS treatments. | [
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] |
Amyotrophic lateral sclerosis (ALS) is an adult onset neurodegenerative disorder characterized by the death of upper and lower motor neurons. About 10% of all ALS cases are familial, and we have identified SOD1 and FUS mutations as the most common causes in a consecutive series of 111 familial ALS pedigrees in Japan (Nishiyama A, 2017). From studies of the TDP43, FUS, and C9orf72 genes, perturbations of RNA processing can be highly adverse in motor neurons. Hepatocyte growth factor (HGF) is one of the most potent survival-promoting factors for motor neurons. We administered human recombinant HGF (hrHGF) by continuous intrathecal delivery to transgenic rats at onset of paralysis for 4 weeks. Intrathecal administration of hrHGF attenuated motor neuron degeneration and prolonged the duration of the disease by 63% (Ishigaki A, 2007). To translate this strategy to human treatment, we induced a contusive cervical spinal cord injury in the common marmoset, a primate, and then administered hrHGF intrathecally. We conducted a first-in-human phase I trial of intrathecal hrHGF in 15 Japanese patients with ALS (Warita H, 2019). Based on the results, we are conducting a phase II trial of intrathecal hrHGF for patients with ALS. | [
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High-dose methylcobalamin was found to be a therapeutic candidate for amyotrophic lateral sclerosis (ALS) through clinical experience. Our previous study (E0302-J081-761) has suggested that high-dose methylcobalamin (E0302) prolonged the overall survival and suppressed progression in ALS patients with a disease duration less than 12 months in, exploratory analyses. Therefore, we plan to conduct an investigator-initiated trial "The Japan Early-stage Trial of high dose methylcobalamin for ALS (JETALS)" to evaluate the efficacy and safety of E0302 for ALS patients within 12 months from onset. JETALS is a prospective, multicenter, placebo-controlled, double-blind, randomized Phase III study, conducted at 25 tertiary neurology centers, and is funded by the Japan Agency for Medical Research and Development. A total of 128 patients were randomized at a 1:1 ratio to receive intramuscular injection with E0302 50 mg or placebo, twice a week for 16 weeks. The primary endpoint is changes in the ALS Functional Rating Scale (ALSFRS-R) total score at 16 weeks. The patient enrollment period is from November 2017 to September 2019, and the follow-up is scheduled to end in March 2020. If the results are positive, we intend to apply for E0302 approval for methylcobalamin as a new drug for treating ALS. | [
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Disease-specific and site-selective deficiency of an RNA editing enzyme, adenosine deaminase acting on RNA 2 (ADAR2), has been demonstrated in sporadic amyotrophic lateral sclerosis (sALS) motor neurons. ADAR2 regulates Ca<sup>2+</sup> influx through -amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors via adenosine-to-inosine conversion at the glutamine/arginine site of GluA2 mRNA, which makes ADAR2 a key factor in acquired Ca<sup>2+</sup> resistance in motor neurons. Deficient ADAR2 of sALS motor neurons is supposed to lead to excessive Ca<sup>2+</sup> influx through AMPA receptors, resulting in TDP-43 pathology and nuclear pore complex pathology, and eventually motor neuronal death. We considered that AMPA receptor antagonists could strongly prevent excessive Ca<sup>2+</sup> influx through AMPA receptors and block motor neuronal degeneration in sALS. Perampanel, a selective non-competitive AMPA receptor antagonist, has been reported to prevent deterioration in a mouse model for sALS, in which ADAR2 is conditionally knocked out in motor neurons. Because of the therapeutic potency of perampanel for sporadic ALS, we have performed a multicenter randomized, double-blinded, placebo-controlled, parallel-group phase 2 clinical trial. The primary outcome measure is the change in ALS functional rating scale-revised after 48 weeks of treatment. The results of this study will be available in early 2020. | [
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Our laboratory previously established spinal motor neurons (MN) from induced-pluripotent stem cells (iPSCs) prepared from both sporadic and familial ALS patients, and successfully recapitulated disease-specific pathophysiological processes. We next searched for effective drugs capable of slowing the progression of ALS using a drug library of 1232 existing compounds and discovered that ropinirole hydrochloride prevented MN death. In December 2018, we started an investigator-initiated clinical trial testing ropinirole hydrochloride extended-release tablets in ALS patients. This is an on-going phase I/IIa randomized, double-blind, placebo-controlled, single-center, open-label continuation clinical trial (UMIN000034954). The primary aim is to assess the safety and tolerability of ropinirole hydrochloride in patients with ALS. We will also perform an efficacy evaluation using patient-derived iPSCs/MN. Major inclusion criteria were as follows: 1) 'clinically possible and laboratory-supported ALS', 'clinically probable ALS' or 'clinically definite ALS', according to the criteria for the diagnosis of ALS (El Escorial revised) and within 60 months after disease onset; 2) change in ALSFRS-R score of -2 to -5 points during the 12-week run-in period. Finally, 15 patients will be assigned to the active drug and 5 patients to the placebo. Our trial will be a touchstone trial for iPSC-based drug development strategies. | [
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] |
Protein misfolding crucially underlies the pathogenesis of amyotrophic lateral sclerosis (ALS). Mutant superoxide dismutase 1 (SOD1) and TAR DNA-binding protein 43kDa (TDP-43) are major causal proteins for familial and sporadic ALS, respectively, provoking diverse pathogenic pathways in both intracellular and extracellular environments. Of note, cell-to-cell spreading behavior is implicated in the progression of neurodegeneration, suggesting application in immunotherapies including vaccination, and antibody application as a molecular targeting therapy, due to strict antigen-specificity. Although immunotherapy of intravenous application of full-length immunoglobulin is aimed at targeting the extracellular proteins because of low access to the cytosol, it is therefore necessary to generate expression vectors for variable single chain fragments (scFv) that target intracellular proteins. Despite the advantages of scFv, such as low molecular size and the ability to apply molecular modifications adding proteolytic signals, safety and efficacy should be cautiously estimated in preclinical studies, using appropriate animal models. In ALS, we firstly succeeded in the vaccination of mutant SOD1 transgenic mice, which was followed by accumulating evidence showing the efficacy of immunization against misfolded SOD1. In TDP-43 proteinopathy, we are developing immunotherapy using intrabodies with proteolytic properties against mislocalized or aggregated forms of TDP-43 inside cells. | [
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We report the case of a 71-year-old man with impaired left finger extension. The presence of nodular fibrosing lesions in his palm suggested Dupuytren contracture as the diagnosis. However, detailed neurological examination revealed muscle weakness associated with C7-Th1 lesions, and needle electromyography revealed denervation within the same distribution. Therefore, the patient was diagnosed with distal-type cervical spondylolisthesis muscular atrophy complicated with Dupuytren contracture. Due to shared symptoms with impaired finger extension, the other two conditions can be overlooked in patients affected by both diseases. Detailed clinical investigation of nodular fibrosing lesions, muscle weakness at the C7-Th1 level, and needle electromyography findings facilitate differential diagnosis of Dupuytren contracture and distal-type cervical spondylolisthesis. (Received June 24, 2019; Accepted September 17, 2019; Published November 1, 2019). | [
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] |
OBJECTIVES: To quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.DESIGN: Population based cohort study.SETTING: National Health Service in England between 2005 and 2013.POPULATION: All people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr).MAIN OUTCOME MEASURES: National trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers.RESULTS: The overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix.CONCLUSIONS: Wide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes. | [
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] |
OBJECTIVE: To review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex.DESIGN: Systematic review and meta-analysis of all available studies.DATA SOURCES: PubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings.ELIGIBILITY CRITERIA: Studies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas).RESULTS: 28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women.CONCLUSIONS: Although detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals.STUDY REGISTRATION: Prospero CRD42019127842. | [
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BACKGROUND: Gastroesophageal reflux disease (GERD) is a common comorbidity among patients with asthma. In addition, functional dyspepsia (FD) is characterized by upper abdominal symptoms without organic disease manifestations. However, the prevalence of FD among patients with asthma remains uninvestigated; therefore, herein, we investigated the prevalence of dyspepsia symptoms in these patients.METHODS: We recruited 156 patients with asthma from the outpatient clinic of Teikyo University Hospital and investigated the prevalence of dyspepsia symptoms using the modified Frequency Scale for the Symptoms of GERD. Further, the relationship between dyspepsia symptoms and clinical background of asthma was also investigated.RESULTS: Certain digestive organ symptoms were exhibited by 83% of patients with asthma, dyspepsia symptoms by 44%, and reflux symptoms by 26%. The dyspepsia-dominant group showed significantly higher female ratio and numerically lower %FEV1 than the asymptomatic group. In the group with dyspepsia score >5 points, the ratio of patients undergoing step 4 asthma treatment and the ratio of those using long-acting muscarinic receptor antagonist were higher than those in the group with a score <5 points. Furthermore, endoscopic diagnosis was also made in 84 patients and the prevalence of FD was 21%.CONCLUSION: A considerable proportion of patients with asthma exhibited dyspepsia symptoms, and the asthma severity in patients with dyspepsia was higher than those in asymptomatic patients. Based on the current findings, more attention should be directed to FD, in addition to GERD, as a comorbidity of the digestive system in patients with asthma. | [
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] |
We present a case of early childhood-onset pork-cat syndrome possibly due to sensitization by both cats and dogs. A 6-year-old girl was referred to our hospital because of repetitive episodes of urticaria when she consumed pork meat. The patient lived with a dog and the ground floor of her house was a veterinary clinic run by her veterinarian parents. Blood tests demonstrated high specific IgE (?50UA/ml) against cat dander, dog dander, pork, Sus s 1, Fel d 2, Can f 1, Can f 2, and Can f 3. The skin prick test was positive for raw pork and beef. Western blotting analysis detected hot spots on 67-kDa proteins in pork meat and cat dander extract. Cross-reactivity between these two proteins was confirmed by an inhibition test. Furthermore, crossreactivity between pork meat and dog dander extract was also noted. Taken together, the diagnosis of porkcat syndrome was made, and both cats and dogs were suggested to have led to the sensitization. The patient was advised to only eat well-cooked pork, and has been followed thereafter without additional reactions. The previously reported cases of this syndrome developed during adolescence and young adulthood because a considerable period from the sensitization to the development cross-reactivity with pork meat is required. To our best knowledge, this is the youngest reported case of pork-cat syndrome among English and Japanese literatures. The nomenclature of this syndrome as pet animal-meat syndrome improves the understanding of the underlying pathogenesis of cross-reactivity between animal albumins and meat albumins. | [
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] |
Organoboron reagents are important synthetic intermediates that have a key role in the construction of natural products, pharmaceuticals and organic materials1. The discovery of simpler, milder and more efficient approaches to organoborons can open additional routes to diverse substances2-5. Here we show a general method for the directed C-H borylation of arenes and heteroarenes without the use of metal catalysts. C7- and C4-borylated indoles are produced by a mild approach that is compatible with a broad range of functional groups. The mechanism, which is established by density functional theory calculations, involves BBr3 acting as both a reagent and a catalyst. The potential utility of this strategy is highlighted by the downstream transformation of the formed boron species into natural products and drug scaffolds. | [
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Introduction: Every 90 seconds, a woman dies of complications related to pregnancy and childbirth, resulting in more than 340,000 maternal deaths a year. Antenatal care (ANC) and postnatal care (PNC) are significant determinants of maternal health and, particularly, safe motherhood. Antenatal care is an important predictor of safe delivery and provides health information and services that can improve the health of women and infants. mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. This study aimed at assessing the acceptable implementation modalities of mHealth intervention on pregnant Women in Dschang health district, West Region of Cameroon.ng ba.Methods: This was a cross sectional descriptive study in the Dschang health district, West region of Cameroon. Key informants were all pregnant women from 18 years and above and a total of 372 pregnant women were included. This study was carried out from March to July 2017.Results: Majority of the women, that is, 252(67.74%) were married, 117(31.45%) declaredtheir status as being single, while 3(0.81%) were devorced. Out of the 335 women that declared wanting an mHealth intervention, 41.79% of this number preferred SMS texts in the afternoon, 111(33.13%) in the evening, 46(13.73%) anytime and 38(11.34%) in the morning hours. A total of 83.33% women confirmed using telephone services.Conclusion: This study reveals that cell phones would be the acceptable medium of providing pregnancy and postpartum support to women in the Dschang health district. This is justified by the fact that a vast majority of women interviewed had access to a cell phone and referred to it as their desired and accepted means of communication. | [
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Introduction: Hepatitis B virus (HBV) infection is a major health problem worldwide owing to its high prevalence and significant morbidity and mortality. There are about 2 billion people living with HBV worldwide and over 360 million chronic carriers. The purpose of this study was to assess the knowledge and practices of pregnant women and health care workers in the ANC and maternity units on HBV infection and its transmission.Methods: About 270 women attending ANC and 31 health care workers were selected by convenience sampling. They were evaluated using a structured questionnaire to assess their knowledge and practices on HBV prevention and transmission.Results: Pregnant women in the Limbe Health District demonstrated good knowledge but adopted poor practices whereas in the Muyuka Health District, pregnant women demonstrated poor knowledge and adopted poor practices regarding the mode of transmission and prevention of HBV infection. Health care workers in both the Limbe and Muyuka Health Districts however, demonstrated good knowledge and adopted good practices.Conclusion: There was a significant relationship between the knowledge and practice of pregnant women and health care workers on Hepatitis B prevention in the Muyuka Health District (P = 0.0006). | [
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Introduction: The study investigated the prevalence of stillbirth at the Buea regional hospital, by taking cases of pregnant women who attended antenatal clinic(s) and those who did not attend but had their deliveries at the Buea regional hospital. The study specifically estimated the prevalence of stillbirths; identified possible risk factors associated with stillbirths, and determined whether the number of antenatal clinic visits is related to the occurrence of stillbirths-because during antenatal clinic visits, pregnant women are educated on risk factors of stillbirths such as: preterm deliveries; sex of the stillbirth; history of stillbirth; history of abortion(s); what age group of mothers are more likely to have a stillbirth.Methods: The study was a hospital based retrospective study at the maternity in which there were 3577 deliveries registered at the Buea regional hospital dated May 1st, 2014 to April 30th, 2017. With the aid of a checklist data was collected, analysed and presented with the use of tables, pie-charts and bar charts.Results: The prevalence of stillbirths was 26‰; possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; sex of stillbirths were more of females than males; and insufficient antenatal clinic attendance (?1 antenatal clinic attendance) had more stillbirths.Conclusion: The study established that stillbirths can occur in any woman of child-bearing age. possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; gender of stillbirths were more of females than males; and insufficient antenatal clinic attendance (?1 antenatal clinic attendance) had more stillbirths. | [
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Background: Diphtheria remains a health problem, especially in developing countries. In November 2017, the Indonesian Ministry of Health stated that there was a diphtheria outbreak in Indonesia. East Kalimantan is one of the provinces that experienced this disease outbreak. This study analyzes the risk factors for diphtheria outbreak in children aged 1-10 years. Methods: A case-control study was conducted on 37 respondents. Research variables consist of immunization status against diphtheria, pertussis and tetanus (DPT), nutritional status, children mobility, source of transmission, physical home environment (natural lighting, ventilation area, occupancy density, wall and floor type), knowledge of diphtheria and attitudes towards the diphtheria prevention program. Results: We found that the most of the children who had diphtheria had been immunized against DPT. Additionally the nutritional status of children (p=0.049), mobility (p=0.000) and the source of transmission (p=0.020) were significantly associated with diphtheria. Conclusions: Child/parent mobility (OR=8.456) is the main risk factor for diphtheria outbreak. It is recommended to limit the mobility of children to travel to areas that are experiencing increased cases of diphtheria, improve the nutritional status, and further research on the effectiveness of diphtheria vaccine. | [
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] |
BACKGROUND: Metabolic syndrome (MetS) has a negative impact on functional recovery and complications after many surgical procedures.AIM: To assess the role of Mets on functional outcomes and complications after radical prostatectomy (RP) for prostate cancer.PATIENTS AND METHODS: Complete data were collected from 5758 patients, undergoing RP at a single referral centers in a 10-year period and the presence of MetS before surgery was ascertained in 17.7% of them using a modified version of the IDF-AHA/NHLBI criteria. Outcomes included 1-year continence and potency rates, early (?90 days) and late (>90 days) complications.RESULTS: Postoperative continence (no pads) was significantly less likely in MetS patients (75.4% vs 82.6%, P < .01), despite no difference in preoperative continence. Erections with or without therapy were reached in 55.8% of non-MetS and 41.8% of MetS patients (P < .01), in this case a significant difference in preoperative function was seen. No differences in early and late complications, except for wound infections (5.8% vs 3.9%, P < .01) were observed.CONCLUSIONS: In the present study RP was safe from the complications standpoint in MetS patients, but the presence of the syndrome was a significant risk factor for post-RP incontinence and impotence. | [
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] |
BACKGROUND: As most risk factors for anastomotic complications (AC) in rectal cancer patients appear to be noncorrectable, it is needed to find the correctable causes. Additionally, the outcomes of indocyanine-green fluorescence imaging (IFI) and robot-stapled anastomosis have yet been undetermined.METHODS: This study retrospectively analyzed 968 consecutive patients with rectal cancer, who underwent curative robot-assisted anterior resections between 2010 and 2018. IFI parameters and stapling features in the surgical records were reviewed, and reconfirmed.RESULTS: AC occurred in 54 patients (5.6%), 34 (3.5%) with anastomotic leakage (AL) and 24 (2.5%) with anastomotic stenosis (AS). Mechanotechnical faults including defective stapling configurations, including angles lesser than or equal to 150 and outer deviation (more than half from the center of the circle) of linear staples, between the two linear staples were independently associated with AL (P < .001 each). IFI significantly reduced AL rate (2.5% vs 5.3%, P = .029) and AS rate (2% vs 18.8%, P = .006), respectively. Robot linear stapling enabled to maintain the obtuse angle during consecutive staplings and reduced console time. AL and AS were independent risk factors for disease-free survival (P = .02) and local recurrence (P = .03), respectively.CONCLUSIONS: AC were associated with some correctable causes, namely, mechanotechnical errors and lack of use of IFI. | [
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