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Background: Although myotomy is crucial in peroral endoscopic myotomy (POEM) surgeries, its optimum length remains controversial. Herein, we propose a modified POEM with new method of tailoring myotomy length aim to evaluate the safety, efficacy, and clinical outcomes of this modified POEM compared with standard POEM in type I or II achalasia. Methods: Seventy-five patients with type I or II achalasia who underwent POEM at the First Hospital of Jilin University between January 2018 and December 2022 were retrospectively analyzed. According to the myotomy approach, these patients were divided into the retrograde on-demand myotomy (RDM, n = 34), with myotomy beginning on gastric side and length tailored by determining the degree of lower esophageal sphincter (LES) distention, and standard myotomy (SM, n = 41) groups. The baseline data, myotomy length, operation time, clinical success rate, adverse event rate, and reflux-related adverse events were compared and analyzed. Results: The median myotomy length in the RDM group was significantly shorter than that in the SM group (6 vs. 8 cm, respectively; p < 0.001). Moreover, the median myotomy time in the RDM group was significantly shorter than that in the SM group (10 vs. 16 min, respectively; p < 0.001). POEM was successfully performed in all the patients. At the 2-year follow-up, high clinical success rates were observed in both the RDM and SM groups (92.0% vs. 93.3%, respectively; p = 1.000). The incidence of intraoperative adverse events and postoperative reflux-related adverse events was low and comparable in both groups. Conclusions: RDM POEM is a safe and effective method for patients with type I or II achalasia. Furthermore, it has a shorter myotomy length and operation time than standard POEM technique. [ABSTRACT FROM AUTHOR]

Sound waves generate acoustic resonance energy that penetrates deeply and safely into body areas normal mechanical vibrations cannot reach. The sonic balance pad utilizes these sound waves to create an optimal musculoskeletal response. The purpose of this study was to investigate the effects of a 4-week ankle stabilization exercise program using a sonic balance pad on proprioceptive sense and balance ability in individuals with ankle instability. This study was conducted as a randomized control-group pre-and post-test design in 30 participants (21 females and 9 males) who had experienced an ankle fracture or sprain within the last 5 years or who scored 11 points or more on The Identification of Functional Ankle Instability. The ankle stabilization exercise program was conducted for 4 weeks in the experimental group (n = 15), to which sonic pads were applied, and the control group (n = 15), to which balance pads were applied. All participants were assessed for their intrinsic proprioceptive sense of dorsiflexion and plantarflexion, static balance test, dynamic balance test, and long jump test were measured before and after 4 weeks as dependent variables. After 4 weeks of training, a significant difference was shown in the right dorsiflexion error (Balance pad = PRE: 2.47 ± 0.92; POST: 2.33 ± 1.40, Sonic pad = PRE: 3.27 ± 1.39; POST: 1.20 ± 0.77) and the left plantar flexion error (Balance pad = PRE: 2.00 ± 1.36; POST: 2.73 ± 1.22, Sonic pad = PRE: 3.53 ± 1.25; POST: 2.20 ± 1.01) (p < 0.05) between the experimental and control groups in the proprioception test. In the static balance test, there was no significant difference between the experimental and control groups during the pre, post, and variation stages. However, in the Y-Balance test, which is one of the dynamic balance tests, there was a significant difference between the experimental and control groups at various points, including anterior left (Balance pad = PRE: 72.85 ± 19.95; POST: 63.41 ± 8.66, Sonic pad = PRE: 68.16 ± 6.38; POST: 76.17 ± 3.67), posteromedial right (Balance pad = PRE: 78.59 ± 15.34; POST: 81.41 ± 10.37, Sonic pad = PRE: 86.33 ± 16.44; POST: 102.23 ± 11.53), posteromedial left (Balance pad = PRE: 78.00 ± 16.99; POST: 83.36 ± 10.15, Sonic pad = PRE: 88.96 ± 19.92; POST: 102.45 ± 12.98), posterolateral right (Balance pad = PRE: 78.16 ± 14.33; POST: 82.61 ± 10.73, Sonic pad = PRE: 87.95 ± 17.51; POST: 101.34 ± 15.37), and posterolateral left (Balance pad = PRE: 80.86 ± 14.96; POST: 81.31 ± 7.16, Sonic pad = PRE: 91.23 ± 17.35; POST: 104.18 ± 11.78) (p < 0.05). Moreover, in the single-leg long jump test, which is another dynamic balance test, the experimental group (Sonic pad = PRE: 100.27 ± 29.00; POST: 116.80 ± 28.86) also demonstrated a significant difference in the right single-leg long jump compared to the control group (Balance pad = PRE: 91.87 ± 17.74; POST: 97.67 ± 17.70) (p < 0.05). When a sonic balance pad using sound waves was applied in addition to a 4-week ankle stabilization exercise program for participants with ankle stability, it helped to improve proprioception and dynamic balance ability. [ABSTRACT FROM AUTHOR]

GINS2 is overexpressed in several cancers, but little is known about its role in osteosarcoma (OS). A series of in vivo and in vitro experiments were conducted to explore the role of GINS2 in OS. In this study, we demonstrated that GINS2 was found to be highly expressed in OS tissues and cell lines, which was associated with poor outcomes in OS patients. GINS2 knockdown hindered the growth and induced apoptosis in OS cell lines in vitro. Furthermore, GINS2 knockdown effectively inhibited the growth of a xenograft tumor in vivo. By using an Affymetrix gene chip and intelligent pathway analysis, it was demonstrated that the GINS2 knockdown could reduce the expression of several targeted genes and reduce the activity of the MYC signaling pathway. Mechanically, LC-MS, CoIP, and rescue experiments revealed that GINS2 promoted tumor progression through the STAT3/MYC axis in the OS. Moreover, GINS2 was associated with tumor immunity and may be a potential immunotherapeutic target for OS. [ABSTRACT FROM AUTHOR]

Objective: Our study aimed to explore the differences in brain microstructure in patients with Alzheimer's disease (AD) and with mild cognitive impairment (MCI) and in individuals with normal cognition using diffusion kurtosis imaging (DKI) to identify a potential non-invasive biomarker of AD. Materials and methods: A total of 61 subjects were included in our study, including 20 subjects diagnosed with AD, 21 patients diagnosed with amnestic MCI, and 20 cognitively normal individuals. We acquired magnetic resonance imaging (MRI) scans, and DKI images were processed. Twelve regions of interest were drawn, and various parameters were measured and analyzed using SPSS version 11.0 software. Results: Comparative analysis showed that differences in brain regions in terms of mean diffusion (MD) and mean kurtosis (MK) between groups were the most marked. Precuneus MD, temporal MK, precuneus MK, and hippocampal MK were significantly correlated with neuropsychological test scores. Hippocampal MK showed the strongest correlation with the medial temporal lobe atrophy score (r = -0.510), and precuneus MD had the strongest correlation with the Koedam score (r = 0.463). The receiver operating curve analysis revealed that hippocampal MK exhibited better diagnostic efficacy than precuneus MD for comparisons between any group pair. Conclusion: DKI is capable of detecting differences in brain microstructure between patients with AD, patients with MCI, and cognitively normal individuals. Moreover, it compensates for the deficiencies of conventional MRI in detecting pathological changes in microstructure before the appearance of macroscopic atrophy. Hippocampus MK was the most sensitive single parameter map for differentiating patients with AD, patients with MCI, and cognitively normal individuals. [ABSTRACT FROM AUTHOR]

Introduction: Subjective cognitive decline (SCD) is a self-reported cognitive decline without objective cognitive impairment. The relationship between audiometric hearing loss (HL) and cognitive function has not been reported in SCD. The purpose of this study was to investigate whether HL affects cognition-related indexes in SCD individuals. Methods: This is a cross-sectional study that used the baseline data of a multicenter cohort study that monitors clinical progression from SCD to dementia. Individuals aged ≥60 years who reported cognitive decline but had no objective cognitive impairment on comprehensive neuropsychological tests were recruited. Participants were grouped into the normal-hearing (NH) and bilateral HL groups. The demographics, clinical characteristics, dementia biomarkers, global cognition, questionnaire scores, neuropsychological test scores, and segmental brain volumes from MRI were compared between the groups. Results: Of a total of 120 participants, one hundred and two had NH (n = 57) or bilateral HL (n = 45). There were no group differences in the demographic and clinical data except the age. The biomarkers, global cognition, and questionnaire scores were not different between the groups. The HL group performed worse (the z-score of −0.06) in the Stroop Color Word Test than the NH group (0.27) (p = 0.025). Brain volumetric analysis revealed that the HL group had reduced gray matter volumes in four brain subregions: left temporal pole, left caudal middle frontal gyrus, left hippocampus, and right isthmus of the cingulate gyrus. Conclusion: In SCD, HL exerted an adverse effect on cognitive function, primarily frontal executive function tested in the Stroop task. HL was also related to gray matter volume reductions in brain subregions, although causality needs further investigation. This study may provide evidence for a potential link between hearing and cognition in SCD, an emerging clinical entity. [ABSTRACT FROM AUTHOR]

Human adipose-derived stem cells (ADSCs) have become a promising therapeutic approach against skin aging. Recent studies confirm that exosomes partially mediate the therapeutic effect of stem cells. This study successfully isolated exosomes from the ADSC culture medium and discovered that ADSC-derived exosomes (ADSC-Exos) could alleviate human dermal fibroblast (HDF) senescence and stimulate HDF migration. Moreover, ADSC-Exos increased the type I collagen expression level and reduced the reactive oxygen species (ROS) and senescence-associated β-galactosidase (SA-β-Gal) activity in HDFs. In addition, we demonstrated that ADSC-Exos significantly inhibited senescence-related protein expression levels of p53, p21, and p16. In conclusion, our results have revealed the antisenescence effects of ADSC-Exos on HDFs and ADSC-Exos may be a novel cell-free therapeutic tool for antiaging. [ABSTRACT FROM AUTHOR]

This cross-sectional study assessed the overall symptom burden, including the prevalence, frequency, severity, and distress of symptoms among hemodialysis patients, and explored the relationship between demographic characteristics, clinical variables, self-management, sense of coherence, social support, and symptom burden in these patients. Herein, a regression analysis was performed to determine associations with symptom burden. The mean score of symptom burden among the participants (n = 382) was 74.12, with an average number of 12 symptoms. The analysis revealed that self-management, sense of coherence, and social support were negatively associated with the overall symptom burden. The multiple regression model showed that 48.6% of the variance in symptom burden was explained by meaningfulness, emotional management, daily urine output, subjective support, gender, and manageability. These findings contribute to the knowledge of symptom burden among hemodialysis patients and some new predictors (self-management, sense of coherence, and social support) of their symptom burden. [ABSTRACT FROM AUTHOR]

Background: Speckle tracking-derived global longitudinal strain (GLS) of left ventricle is a potent prognostic marker for patients with ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to investigate the difference of prognostic impact of GLS between anterior and nonanterior myocardial infarction. Methods: This study included 686 patients who underwent primary percutaneous coronary intervention for their first STEMI between November 2007 and April 2012. Differences in the prognostic impact of GLS between anterior MI group and nonanterior MI group were evaluated. The composite of all-cause mortality and hospitalization for heart failure in 2 years was investigated for outcome. Results: During the follow-up period, 77 (11.2%) adverse events occurred. The anterior and nonanterior MI groups included 339 and 347 patients, respectively. Among patients with anterior MI, GLS significantly predicted 2-year outcome in an adjusted model (adjusted hazard ratio [HR] 1.186; 95% confidence interval [CI] 1.071-1.314, P = 0.001), whereas the association between GLS and mortality was weaker in the nonanterior MI group (adjusted HR 0.977; 95% CI 0.884-1.081, P = 0.657). The interaction between the infarction territory and GLS was significant (P for interaction = 0.018), indicating that GLS was a more sensitive predictor of mortality in patients with anterior MI than that in those with nonanterior MI. Conclusions: Speckle tracking-derived GLS of left ventricle more sensitively predicted clinical outcome in patients with anterior MI than in those with nonanterior MI. [ABSTRACT FROM AUTHOR]

MicroRNAs (miRNAs) play critical roles in the progression of laryngeal cancer (LC). In this study, we aimed to investigate whether miR-149 is associated with the prognosis of patients with LC. A total of 97 laryngeal squamous cell carcinoma patients who underwent tumor resection were included in our follow-up study. In vitro studies was performed in cancer cell line Hep-2 to explore the antitumor role of miR-149 in LC. We found that the expression of miR-149 was significantly lower in tumor tissues, compared with vocal cord polyp tissues (P<0.05). Kaplan-Meier analysis revealed that miR-149 expression status is significantly associated with survival duration (log rank test, P<0.05), and multivariate Cox regression analysis revealed that patients with low miR-149 expression had shorter survival times compared with patients with high miR-149 expression. In vitro studies revealed that the exogenous expression of miRNA-149 inhibits the proliferation of human Hep-2 cells and induces cell apoptosis. Our study suggests that miR-149 expression in laryngeal squamous cell carcinoma tissues is critically associated with the prognosis of patients, and the ectopic expression of miR-149 in Hep-2 cells inhibits proliferation and cell cycle progression. [ABSTRACT FROM AUTHOR]

Background Electrocardiogram (ECG) and signal-averaged ECG (SAECG) are important as diagnostic tools in arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of this study was to investigate changes in follow-up ECGs and SAECGs in patients with ARVC. Methods We collected 185 follow-up ECGs from 38 patients and 35 follow-up SAECGs from 18 patients during a mean follow-up period of 64 ± 36 months. Results On baseline ECG and SAECG, epsilon waves, T-wave inversion (TWI), and terminal activation delay (TAD) of QRS ≥55 ms in right precordial leads, and late potentials (LPs) were observed in six (16%), 11 (29%), 13 (34%), and 23 (68%) patients, respectively. During the follow-up period, 15 (39%) patients had 18 changes in ECG and/or SAECG features included in modified Task Force Criteria (TFC) of ARVC. Two patients developed new epsilon waves, and another two patients had dynamic epsilon waves. Newly developed TAD of QRS ≥55 ms was observed in two patients and disappeared in one patient. Eight patients, seven with and one without TWI in V1-V3 or beyond, showed dynamic changes. LP developed in three patients. One patient with dynamic change of TWI and another patient with dynamic change of epsilon wave and TAD of QRS ≥55 ms could not satisfy the modified TFC during follow-up. Conclusions Follow-up ECGs and SAECGs showed changes in 39% of patients with ARVC. Larger studies with a longer follow-up period are needed to investigate the clinical implications of changes in follow-up ECG and SAECG. [ABSTRACT FROM AUTHOR]

Background: Little is known about the clinical characteristics of patients with situational syncope such as defecation syncope (DS) or micturition syncope (MS) compared with those with common vasovagal syncope (VVS). Methods: Among 680 consecutive patients, who underwent a head-up tilt test between January 2006 and November 2010, 282 patients (40.4± 16.7 years; 48.6% men) diagnosed as DS (n = 38), MS (n = 38), or common VVS (n = 208) were included. Results: Ages at diagnosis (38.7± 17.3 vs 48.3± 14.1 vs 42.0± 13.8, P = 0.004) and the first syncope (33.7± 18.4 vs 44.5± 15.3 vs 37.5± 14.6, P = 0.002) were significantly less in patients with common VVS than those with DS or MS, respectively. The patients with MS were more likely to be men (73.7%, P = 0.036), whereas patients with DS were more commonly women (73.7%). No sexual preference was observed in patients with common VVS. Body mass index was significantly lower (P = 0.047) and syncopal episodes were more recurrent (P = 0.049) in patients with common VVS than those with DS or MS. The frequency of drinking alcohol before syncope was significantly higher in patients with MS (39.5%, P < 0.001). Conclusions: DS tended to occur in older women, whereas MS tended to occur in middle-aged men and drinking alcohol was an important precipitating factor for MS. However, common VVS was observed more in a thin and young population, which was more recurrent compared with those situational syncopes. (PACE 2011;1-7) [ABSTRACT FROM AUTHOR]