Search

Increased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes.To review current outcomes of solid pancreas transplantation in recipients and donors over the TSANZ reference ages.Studies comparing transplant outcomes between a reference-age and an older-age donor (45 years) or recipient (≥50 years) cohort for solid pancreas transplantation were included. Primary outcomes were pancreas/kidney graft and patient survival at 1 and 5 years. Secondary outcomes were post-transplant complications (graft thrombosis, acute rejection and relaparotomy rates).Eleven studies were included (two studies assessing solid pancreas outcomes between older vs reference-aged donors and nine studies assessing outcomes between older vs reference-aged recipients). Seven of 11 studies were judged to be at high risk of bias. Primary and secondary outcomes were not significantly different between recipient age groups in nine studies. A sensitivity analysis of older versus reference-aged studies excluding studies at high risk of bias also showed non-inferior primary and secondary outcomes at 1 year. Two studies comparing outcomes by donor age showed worse graft survival but non-inferior patient survival with older donors.Increased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.

To determine the recovery of structural and functional corneal sensory nerves within the LASIK flap in order to provide insight to more proximal corneal reinnervation and symptoms post-LASIK. Twenty participants underwent femtosecond LASIK with a superior flap hinge. Ocular Comfort Index in Chinese (OCI-C), Cochet-Bonnet esthesiometry, and in vivo confocal microscopy were conducted before surgery and 1 week, 1-, 3-, and 6-months post-LASIK to measure symptoms, corneal sensitivity, nerve fiber density, width, and the number of interconnections within the flap (central and mid-temporal regions), and next to the superior flap hinge. Linear mixed models were used to compare differences between corneal regions at each time point post-LASIK and changes over time post-LASIK. Spearman’s correlation tests were used to examine the associations between variables post-LASIK. The least reduction in sensitivity (P

Background:. Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients. Methods:. A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate. Results:. Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P

Wei Cao,1 Zhimei Cheng,1 Lizhou Wang,1 Xuya Zhao,2 Junxiang Li,2 Shi Zhou1,2 1School of Medical Imaging of Guizhou Medical University, Guiyang, 550002, People’s Republic of China; 2Department of Interventional Radiology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550005, People’s Republic of ChinaCorrespondence: Shi ZhouSchool of Medical Imaging of Guizhou Medical University, No. 9 Beijing Road, Guiyang, Guizhou, 550002, People’s Republic of ChinaTel +86-851-86774195Email zhou_shi89@21cn.comPurpose: To search for risk factors for bleeding complications after percutaneous biopsy of primary or secondary space-occupying lesions of liver guided by imaging.Methods: Consecutive 555 patients with liver space-occupying lesions who underwent ultrasound or CT-guided percutaneous biopsy in our hospital from January 2015 to January 2021 were retrospectively analyzed. Those who cannot cooperate with breath-holding and cannot successfully complete the operation, cytology, and incomplete clinical data. After screening, a total of 502 patients were enrolled, including 313 males and 189 females. Abdominal cavity or liver subcapsular hemorrhage after procedure was used as the dependent variable, and patient’s gender, age, pathological results, tumor size, preoperative platelets and international normalized ratio (INR) and hemoglobin as independent variables. All independent variables were analyzed by a single factor logistic regression analysis. The independent variables with P< 0.05 were included in the regression model and analyzed by multivariate logistic regression analysis to search for the risk factors for bleeding complications of liver space-occupying lesions.Results: A total of 502 patients with liver space-occupying lesions undergoing percutaneous liver biopsy guided by imaging equipment were included. Twenty-six of 502 (5.2%) patients occurred abdominal cavity or liver sub-capsule bleeding after procedure. Univariate logistic regression analysis observed that liver cirrhosis, the number of punctured tissues and the depth of puncture were related to bleeding complications after puncturing. Multivariate logistic regression analysis showed that liver cirrhosis and puncture depth were risk factors for bleeding complications (P< 0.05). The ROC curve for predicting bleeding complications after needle biopsy in patients with liver cirrhosis has a sensitivity of 94.3% and a specificity of 46.2%.Conclusion: Liver cirrhosis and puncture depth are risk factors for bleeding complications during percutaneous biopsy of liver occupying lesions.Keywords: percutaneous puncture biopsy, risk factors, bleeding

Objectives. Metabolic syndrome (MetS) is now becoming a serious public health threat. Some behaviors risk factors were considered to be associated with MetS and interacted to adversely affect MetS. However, the clustering effects of behavior risk factors of MetS among Chinese population remain unclear. The aim of this study is to observe the behavior risk factors and their clustering effects of MetS in China. Methods. A cross-sectional study design was used. Subjects were recruited in the departments of Cardiology Clinic, Endocrine Clinic, and Health Management from March to December 2019. A demographic sheet was designed to collect the demographic and clinical characteristics of the subjects. International Physical Activity Questionnaire-Short was applied to evaluate the level of PA in this study. Other behavior risk factors were observed by the questionnaire. The stepwise logistic regression analysis was performed to identify the determinants of MetS. The multiple logistic regression analysis was used to analyze the clustering effects of behavior risk factors in MetS. Results. There are a total of 532 eligible subjects (56.6% females; mean age was 48.4±15.3 years), and approximately 33.3% were diagnosed as MetS. The subjects with a smoking habit (heavy and long-time history) had a 1.833-fold higher risk for MetS than their counterparts (none and light smoking), and the subjects that preferred salty taste had a 1.626-fold higher risk for MetS than the comparison cohort. Smoking and alcohol drinking had the highest clustering effect on MetS among the behavior risk factors. Conclusions. The main finding of this study was that smoking and salty taste preference were the independent determinants of MetS. Smoking and alcohol consumption had the highest clustering effect on southern Chinese MetS.

OBJECTIVE: To evaluate the clinical and computed tomographic (CT) features in the patients with COVID-19 pneumonia confirmed by the real-time reverse transcriptase polymerase chain reaction (rRT-PCR) amplification of the viral DNA from a sputum sample. MATERIAL AND METHODS: Clinical information and CT findings of a total of 14 patients with COVID-19 infection (age range, 12-83 years; females 6) were analyzed retrospectively. The clinical information includes the history of exposure, laboratory results, and the symptoms (such as fever, cough, headache, etc.); CT findings of chest include the extension and distribution of lesion, the ground-glass opacity (GGO), consolidation, bronchovascular enlarged, irregular linear appearances, pleural effusion, and lymphadenopathy. RESULTS: Eight patients had the exposure history for recent travel to Wuhan of Hubei province (8/14, 57%), 6 had the exposure to patients with COVID-19 infection. Significant statistical differences were observed in lymphocyte percentage decreased and C-reactive protein elevated (p = 0.015). Seven patients had fever, 7 had cough, 2 had headache, 3 had fatigue, 1 had body soreness, 3 had diarrhea, and 2 had no obvious symptoms. In chest CT examination, 10 patients were positive (10/14, 71.43%). Among these patients, 9 had lesions involving both lungs (9/10, 90%), 8 had lesions involving 4 to 5 lobes (8/10, 80%). Most of lesions were distributed peripherally and the most significant lesions were observed in the right lower lobe in 9 patients (9/10, 90%). Nodules were observed in 5 patients (5/10, 50%); GGO, consolidation, and bronchovascular enlarged were shown in 9 patients (9/10, 90%); irregular linear appearances were revealed in 7 patients (7/10, 70%); and pleural effusions were exhibited in 2 patients (2/10, 20%). Last, no patients showed lymphadenopathy. CONCLUSION: There were some typical CT features for diagnosis of COVID-19 pneumonia. The radiologists should know these CT findings and clinical information, which could help for accurate analysis in the patients with 2019 novel coronavirus infection.

In recent years, there are increasing evidences of epidemiology and clinic which indicate that vitamin D deficiency has relationship with cardiovascular disease. It was found the levels of vitamin D were negatively correlated with cardiovascular events such as hypertension, heart failure, atrial fibrillation and coronary heart disease. This article reviews the connection between cardiovascular diseases and vitamin D, and explains the underlying mechanisms including regulating renin-angiotensin system or endothelial function, inhibition of natriuretic peptide expression or the release of parathyroid hormone, effects on inflammation or obesity, bioenergetics, activation of extracellular Ca2+, inhibition of oxidative stress, and so on. These mechanisms provide novel strategy for the treatment of these cardiovascular diseases.

Purpose Risk of radiation pneumonia (RP) could not be effectively detected due to non-specific clinical symptoms in the early stage. The purpose of this investigation was to evaluate serum biomarkers of cytokines interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT) for its early detection in patients with thoracic malignant tumors receiving radiotherapy. Patients and methods The clinical data of 105 patients with thoracic malignant tumors (lung cancer, esophageal carcinoma and mediastinal tumors) treated by radiotherapy were retrospectively analyzed. The patients were divided into RP group and non-RP group according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). The serum level of IL-6 was detected by chemiluminescence, and the level of CRP was measured by nephelometry during radiotherapy. The level of PCT, one of the specific indicators to distinguish infection and non-infectious etiologies, was also detected by chemiluminescence. Results Among 105 patients treated by radiotherapy, 28 developed RP, and the other 77 had no RP. There was no significant difference in the risk of RP between patients' factors (age, sex, PS score, smoking, tumor type) and treatment factors (chemotherapy, V5, GTV dose). However, chronic obstructive pulmonary disease (COPD), V20 and mean lung dose (MLD) were significantly different between the two groups (χ2 = 4.131, 3.986, 7.830, P 0.05). However, there were significant differences between the groups in the levels of IL-6 and CRP (P < 0.05). The IL-6 levels significantly increased earlier than that of conventional CT imaging when patients suffering from RP and peaked at 6 weeks during radiotherapy. CRP had a similar change as IL-6. Single cytokine and combination of IL-6 and CRP possessed a good ability to predict RP with the AUC of IL-6 of 0.89±0.04 (95% CI, 0.80-0.95, P

Qiu, J, Huang, L, Davie, AJ, and Zhou, S. Comparison of the effects of endurance training on alternate days and on consecutive 4 days each week for 8 weeks on the abundance of PGC-1α, CaMKII, NRF-1, mtTFA, and COXIV proteins in rat skeletal muscle. J Strength Cond Res 33(11): 3136-3144, 2019-The aim of this study was to compare the effects of 2 training protocols, training on alternate days (A) or on consecutive 4 days followed by 3 days of rest in each week (C) for 8 weeks, on selected proteins involved in the biogenesis and function of mitochondria in skeletal muscle. Eighty male Sprague Dawley rats were randomly allocated into 10 groups (n = 8 each), including Pre and Post control groups and A or C training groups with 8, 16, 24, and 32 training sessions, respectively. The vastus lateralis and soleus muscle samples were obtained 24 hours after the last training session, or at rest for the controls. The abundance of the proteins for PGC-1α, CaMKII, NRF-1, mtTFA, and COXIV was analyzed by Western blotting. Analysis of the results with 2-way ANOVA showed no significant effect and interaction (training protocol by duration) in abundance of the proteins by the 2 protocols. However, fold changes normalized to control showed significant increases COXIV of the soleus muscle at most time points in both A and C training as indicated by Kruskal-Wallis H tests. There were significant correlations found between the abundance of the measured proteins of the vastus lateralis. The findings suggest that the 2 training protocols with the same intensity and total volume of work would not make a significant difference in respect of the changes in the targeted proteins. Alternative regulatory factors and the responses in different types of muscles to the training programs need to be examined in future research.

To investigate the relationship between the spinal sagittal alignment and arc of pelvic motion from standing to sitting in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis following pedicle subtraction osteotomy (PSO). AS patients who underwent PSO for thoracolumbar kyphosis from January 2016 to July 2018 were recruited. EOS standing and sitting images were obtained pre- and postoperatively. Radiographic parameters were measured on the sagittal radiographs, including lumbar lordosis, thoracic kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), spinosacral angle, anterior pelvic plane angle (APPA) and knee flexion angle. Thirty-six patients were enrolled. From standing to sitting, APPA was increased by a mean of 14.7° (P

Background Context Rod fracture (RF) has a negative impact on the surgical outcome of patients with ankylosing spondylitis (AS) after lumbar pedicle subtraction osteotomy (PSO). However, there is a paucity of published studies analyzing the risk factors for RF in PSO-treated patients with AS with thoracolumbar kyphosis. Purpose The objective of this study was to investigate the risk factors for RF after PSO for thoracolumbar kyphosis secondary to AS. Study Design/Setting This is a retrospective single-center study. Patient Sample Patients with AS who underwent PSO for thoracolumbar kyphosis between January 2002 and December 2016 were included. Outcome Measures Demographic data, including age, sex, body mass index, and smoking status, were summarized. The surgical data analyzed included the levels of osteotomy, the fusion levels, the upper instrumented vertebra, the lower instrumented vertebra, the osteotomy site, the rod material, the rod diameter, and the rod contour angle (RCA). Radiographic parameters included the sagittal vertical axis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. Radiographic parameters were measured at baseline, immediately after the operation, and at the final follow-up. Adequate ossification of the anterior longitudinal ligament (ALL) at the PSO level was defined by a total bony bridge. Adequate ossification of the ALL was also measured at baseline, immediately after the operation, and at the final follow-up. Methods Patients with a minimum of 2 years' follow-up or patients who developed RF were enrolled in the study. Recruited patients were divided into the RF group and the no-RF group based on whether they developed RF. Patient demographics, operative data, radiographic parameters, and adequate ossification of the ALL were analyzed to determine the risk factors for RF. For patients with RF, the fusion status at the PSO level, the time course to the development of RF, the site of RF, and the corresponding solution were also recorded. Results Rod fracture occurred in 11 (8.9%) of the 123 recruited patients. Solid fusion at the PSO level was found in all patients in the RF group. The average duration to the onset of RF was 31.4 months (range, 12–68 months). All RFs occurred at or immediately adjacent to the PSO level. The RCA was greater in the RF group than in the no-RF group (27.8° vs 22.9°, p=.031). A greater proportion of patients with a rod diameter of 5.50 mm were found in the RF group than in the no-RF group (100.0% vs 68.8%, p=.033). There was a larger proportion of patients with adequate ossification of the ALL at the final follow-up visit in the no-RF group than in the RF group (67.0% vs 27.3%, p=.018). Multivariate analyses demonstrated that the RCA (odds ratio, 1.174; 95% confidence interval, 1.018–1.354; p=.028) and adequate ossification of the ALL at the final follow-up visit (odds ratio, 0.079; 95% confidence interval, 0.014–0.465; p=.005) were independent factors for RF. Notably, revision surgery was performed among six patients, whereas conservative treatment was used for the remaining five patients. Conclusions In patients with AS after PSO for thoracolumbar kyphosis with solid fusion at the PSO level, the incidence of RF was 8.9%. Rod diameter was identified as a risk factor for RF. Furthermore, the RCA was identified as an independent risk factor for RF. In contrast, adequate ossification of the ALL around the PSO level at the final follow-up visit was identified as an independent protective factor for RF.

Purpose The aim of this study was to evaluate the risk of immune-related adverse events (irAEs) among cancer patients receiving nivolumab-plus-ipilimumab therapy and nivolumab monotherapy. Patients and methods PubMed and Web of Science were searched for related studies from inception to June 2018. Eligible studies included randomized controlled trials comparing nivolumab-plus-ipilimumab with nivolumab alone in cancer patients reporting on all-grade (grade 1-4) and high-grade (grade 3/4) irAEs. Paired reviewers selected studies for inclusion and extracted data. The odds risk and 95% CI were calculated. Results A total of 2,946 patients from four studies were included in the meta-analysis. The underlying malignancies included lung cancer (two trials) and melanoma (two trials). Compared with nivolumab monotherapy, the nivolumab-plus-ipilimumab therapy was associated with a significantly higher risk of all- and high-grade irAEs such as pruritus, rash, diarrhea, colitis, alanine aminotransferase elevation, and pneumonitis. Conclusion The combination therapy of nivolumab and ipilimumab increased the incidence of irAEs in patients with advanced cancer.

Study Design: Retrospective study. Objectives: To analyze the change in acetabular anteversion (AA) after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who have already undergone total hip arthroplasty (THA). Methods: AS patients with thoracolumbar kyphosis following lumbar PSO from January 2005 to January 2020 were retrospectively reviewed. Only the patients performed with THA prior to the PSO were included. AA was measured on the full-length standing posterior-anterior radiographs using the ellipse method. Results: Twenty patients (34 hips) with a mean age of 36.8 years (range, 22 to 63 years) were included. After lumbar PSO, AA was reduced from 18.59° to 5.85° ( P < 0.001). Postoperative change in AA was correlated with the spinal deformity correction. Additionally, the change in AA postoperatively was correlated with pelvic incidence (PI) (R = 0.346, P = 0.045). Although the postoperative change in sagittal vertical axis (SVA) was larger in the patients after L2 or L3 PSO (153.97 mm vs 70.03 mm, P = 0.006), no difference was found in the postoperative change in AA (12.83° vs 10.96°, P = 0.540) compared with the patients following L1 PSO. Conclusions: AA was significantly decreased following lumbar PSO and the postoperative change in AA was correlated with the magnitude of spinal deformity correction. Notably, the effect of osteotomy level on the postoperative change in AA was limited in the AS patients underwent 1-level PSO.

Islet transplantation (IT) is considered the most effective endocrine replacement therapy for diabetes mellitus (DM). Studies have demonstrated that IT can repair testicular structural injury caused by inflammatory and oxidative stress in a diabetic rat model. However, highly effective exogenous antioxidant and anti-inflammatory drugs can achieve this effect. Testicular interstitial fibrosis caused by long-term hyperglycemia is however difficult to reverse or recover. Thus far, there are no effective drugs that prevent or relieve testicular interstitial fibrosis. Therefore, it is necessary to explore the potential benefit of IT on testicular interstitial fibrosis induced by DM and its underlying molecular mechanisms. In the present study, Wistar rats were used to establish a DM model by intraperitoneal injection of streptozotocin. The diabetic models then underwent IT or received insulin treatment after 12 weeks. IT was more effective than insulin treatment in ameliorating diabetic-induced testicular interstitial fibrosis, Leydig cells apoptosis, testosterone deficiency and poor sperm motility. IT and insulin treatment both significantly inhibited the upregulation of TGF-β1 and phosphorylated Smad2 in DM, with IT being more effective than insulin. The present study's findings proved that IT effectively protects diabetic-induced testicular interstitial fibrosis probably by inhibiting the TGF-β1/Smad2 signaling pathway, which offers hope in male patients with DM complicating with testicular interstitial fibrosis.

The objectives of this study were to compare the antidepressant effects between endurance and resistance exercise for optimizing interventions and examine the metabolomic changes in different types of skeletal muscles in response to the exercise, using a rat model of chronic unpredictable mild stress (CUMS)-induced depression. There were 32 male Sprague-Dawley rats randomly divided into a control group (C) and 3 experimental groups: CUMS control (D), endurance exercise (E), and resistance exercise (R). Group E underwent 30 min treadmill running, and group R performed 8 rounds of ladder climbing, 5 sessions per week for 4 weeks. Body weight, sucrose preference, and open field tests were performed pre and post the intervention period for changes in depressant symptoms, and the gastrocnemius and soleus muscles were sampled after the intervention for metabolomic analysis using the 1H-NMR technique. The results showed that both types of exercise effectively improved the depression-like symptoms, and the endurance exercise appeared to have a better effect. The levels of 10 metabolites from the gastrocnemius and 13 metabolites from the soleus of group D were found to be significantly different from that of group C, and both types of exercise had a callback effect on these metabolites, indicating that a number of metabolic pathways were involved in the depression and responded to the exercise interventions.

Risk factors for vasculopathy range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. This chapter illustrates the different imaging options for the diagnosis of acute vasculopathy and to assess the value of interventional strategies in an emergency setting. Recent advances in imaging technology have enabled us to utilize a range of diagnostic approaches to better characterize vascular pathologies. This review summarizes the signs in diagnosis, indications for treatment, and endovascular strategies in patients with symptoms.

OBJECTIVE: To study the diagnostic value of real-time ultrasound shear wave elastography (US-SWE) in evaluating the histological stages of nonalcoholic fatty liver disease (NAFLD) in a rabbit model. MATERIALS AND METHODS: Twenty-one 8-week-old rabbits were fed a high-fat, high-cholesterol diet (experimental groups), and seven rabbits were fed a standard diet (control group). All rabbits underwent real-time US-SWE at various time points to document the histological stages of NAFLD. We categorized the histological stages as normal, NAFL, borderline nonalcoholic steatohepatitis (NASH), and NASH. We measured the elastic modulus of the liver parenchyma and analyzed the diagnostic efficacy of real-time US-SWE using the area under receiver operating characteristic curve (AUC) for the four histological stages. RESULTS: The mean, minimum, and maximum elastic modulus increase for NAFL, borderline NASH, and NASH. For the mean, minimum, and maximum elastic modulus, AUCs are 0.891 (95% confidence interval [CI]: 0.716–0.977), 0.867 (95% CI: 0.686–0.965), and 0.789 (95% CI:0.594–0.919) for differentiating normal liver from liver with NAFLD, respectively; AUCs are 0.846 (95% CI: 0.660–0.954), 0.818 (95% CI: 0.627–0.937), and 0.797 (95% CI:0.627–0.913) for differentiating normal liver or liver with NAFL from liver with borderline NASH or NASH, respectively; AUCs are 0.889 (95% CI: 0.713–0.976), 0.787 (95% CI: 0.591–0.918), and 0.895 (95% CI:0.720–0.978) for differentiating liver with NASH from liver with lower severity NAFLD or normal liver, respectively. CONCLUSIONS: Real-time US-SWE is an accurate, noninvasive technique for evaluating the histological stages of NAFLD by measuring liver stiffness. We recommend using the mean elastic modulus to differentiate the histological stages, with the minimum and maximum elastic modulus as valuable complements.

Background Patients with advanced body/tail pancreatic cancer have poor quality of life and low overall survival rate. In recent years, interventional diagnosis and treatment of advanced pancreatic cancer have become increasingly widespread. This retrospective cohort study investigated the efficacy of routine intravenous chemotherapy (the control group), transcatheter arterial infusion (TAI) chemotherapy, and TAI combined with radioactive particles as therapeutic methods for advanced body/tail cancer pancreatic by assessing the short-term and overall survival rates. Methods We screened our prospective database for patients with advanced body/tail pancreatic cancer, which tumor deemed unresectable and no other confirmed malignant tumors, patients were assigned into three groups according to their treatment. Analyses with regard to the clinical responses, the 6, 12, and 18-month survival rates and overall survival rates were performed. Results The median survival time was 6 months in the control group, 10 months in the TAI group and 13 months in the TAI combined group. The Kaplan–Meier estimates of the OS among the three groups, indicating that there is significant difference among three groups (P༜0.000). The clinical remission rates were 17.5% in the control group, 41.5% in the TAI group, and 48.0% in the TAI combined group. Covariates analyzed showed that different treatment methods and times affected the results significantly (P༜0.002). Conclusions In the treatment of advanced body/tail pancreatic cancer, TAI and TAI combined with radioactive particles significantly improved the clinical outcomes in patients compared with routine intravenous chemotherapy.

The correction of global kyphosis (GK) for ankylosing spondylitis (AS) patients with pre-existing pseudarthrosis were frequently over 45°. Mismatch between kyphosis correction of GK and pedicle subtraction osteotomy (PSO) may be ascribed to contribution of pseudarthrosis. The aim of the present study was to evaluate surgical outcomes of PSO away from the level of pseudarthrosis and to elucidate the contribution of pre-existing spinal pseudarthrosis in surgical correction of thoracolumbar kyphosis caused by AS. Eighteen AS patients with pre-existing pseudarthrosis were included. PSO outside the level of pseudarthrosis were performed for all the patients. The average follow-up period were 29 months. Radiographs were analyzed for correction and complications. Significant improvement in all sagittal parameters were found postoperatively without obvious correction loss at the final follow-up. Local kyphosis (LK) improved from 23.88° preoperatively to 12.67° postoperatively with a mean correction of 11.47°. Average correction of per PSO segment, GK and sum of disc wedging within fused region (SDW) were 33.53°, 49.27° and 4.00°, respectively. PSO away from the level of pseudarthrosis, but with posterior instrumentation crossing it was a feasible method and was able to maintain sustained surgical outcomes. Regarding GK correction, PSO accounted for 68.1% while pre-existing pseudarthrosis provided 23.3%, which resulted from anterior column opening postoperatively. Thus, extra kyphosis correction attributed to pre-existing pseudarthrosis should be considered for surgical-decision making to prevent overcorrection.

Background To investigate the safety and effectiveness of Fuaile medical adhesive (FAL) with superselective catheterization in endovascular embolotherapy for the treatment of gastrointestinal hemorrhage (GIH) that was unresponsive to internal medicine treatment and gastroscopy management. Methods A total of 25 patients with GIH, confirmed using angiography but with failed results after internal medicine treatment or gastroscopy were retrospectively analyzed. A mixture of lipiodol and FAL (1:1) was used to embolize the bleeding vessels. In the follow-up, the operation time, FAL amount, technical success rate, clinical success rate, postoperative complications, and survival conditions were compared and analyzed. Results Among the 25 patients with GIH, FAL was applied alone in 23 patients and microcoil combined with FAL was applied in two patients. Hemostasis was successfully achieved in all patients. Two patients treated with embolotherapy experienced relapse of bleeding within 30 days but achieved successful hemostasis with FAL. Four patients died during follow-up: three patients died of advanced cancer and one patient died of severe infection induced by necrotizing pancreatitis. Three patients developed postoperative intestinal ischemic symptoms, which resolved spontaneously in two patients. In one patient, abdominal pain progressively aggravated. This patient underwent surgical resection, which confirmed the presence of colonic neoplasms. The intraoperative view revealed obvious ischemia of the local normal bowel near the tumor; however, the patient finally recovered and was discharged after surgery. The remaining patients exhibited good survival during the postoperative follow-up. Conclusion FAL embolotherapy has a high success rate for arterial GIH that was unresponsive to internal medicine treatment and gastroscopy management, with low postoperative rates of bleeding and complications; thus, this method has a high cost-efficacy.

OBJECTIVE The aim of this study was to analyze the specific patterns and risk factors of sagittal reconstruction failure in ankylosing spondylitis (AS)–related thoracolumbar kyphosis after pedicle subtraction osteotomy (PSO). METHODS A retrospective study was performed in patients with AS and thoracolumbar kyphosis after lumbar PSO with a minimum follow-up of 2 years. Patients were classified as having successful realignment (group A), inadequate correction immediately postoperatively (group B), and sagittal decompensation during follow-up (group C) according to the immediately postoperative and latest follow-up sagittal vertical axis (SVA). Radiographic parameters and clinical outcomes were collected. Pelvic tilt (PT) was used to assess the magnitude of pelvic backward rotation. Hip structural damage and ossification of the anterior longitudinal ligament (ALL) at the proximal junction, PSO level, and distal junction were also evaluated on radiographs. RESULTS Overall, 109 patients with a mean age of 35.3 years were included. Patients in both group B (n = 16) and group C (n = 13) were older than those in group A (n = 80) (mean ages 43.6 vs 32.9 years, p < 0.011; and 39.2 vs 32.9 years, p = 0.018; respectively). Age (OR 1.102, p = 0.011), and preoperative PT (OR 1.171, p = 0.041) and SVA (OR 1.041, p = 0.016) were identified as independent risk factors of inadequate correction. Additionally, a higher distribution of patients with adequate ALL ossification at the PSO level was found in group B than in group A (37.5% vs 22.5%, p = 0.003). Age (OR 1.101, p = 0.011) and preoperative SVA (OR 1.013, p = 0.020) were identified as independent risk factors of sagittal decompensation. Furthermore, compared with group A, group C showed a higher distribution of patients with severe hip structural damage (15.4% vs 0, p = 0.018) and higher incidences of rod fracture (RF) (38.5% vs 8.8%, p = 0.011) and pseudarthrosis (15.4% vs 0, p = 0.018). Additionally, the incidence of RF (19.6% vs 6.9%, p = 0.045) and changes in the proximal junctional angle (0.5° vs 2.2°, p = 0.027) and the distal junctional angle (0.3° vs 2.2°, p = 0.019) were lower during follow-up in patients with adequate ALL ossification than in those without adequate ossification. CONCLUSIONS Sagittal reconstruction failure in patients with AS could be attributed to inadequate correction immediately after surgery (14.7%) and sagittal decompensation during follow-up (11.9%). Adequate ALL ossification was a risk factor of inadequate correction. However, adequate ALL ossification could decrease the development of RF and relieve the junctional kyphotic change during follow-up. Older age and greater baseline SVA were independent risk factors for both inadequate correction and sagittal decompensation.

This study investigated the effects of six weeks of normobaric hypoxic training on transcriptional expression of the genes associated with mitochondrial and glycolytic activities in Thoroughbred horses. Eight horses were divided into two groups of four. They completed an identical incremental, moderate intensity training program, except that one group trained in a hypoxic chamber with 15% oxygen for 30 min on alternate days except Sundays (HT), while the other group trained in normal air (NC). Prior to and post training, heart rate and blood lactate were measured during an incremental treadmill test. Muscle biopsy samples were taken prior to and 24 h post the training period for qPCR analysis of mRNA changes in VEGF, PPARγ, HIF-1α, PGC-1α, COX4, AK3, LDH, PFK, PKm and SOD-2. No significant differences between the HT and NC were detected by independent-samples t-test with Bonferroni correction for multiple comparisons (P>0.05) in relative changes of mRNA abundance. There were no significant differences between groups for heart rate and blood lactate during the treadmill test. The outcomes indicated that this hypoxia training program did not cause a significant variation in basal level expression of the selected mRNAs in Thoroughbreds as compared with normoxic training., Summary: This was one of the first studies that examined transcriptional and physiological responses of Thoroughbred racehorses to six weeks moderate intensity treadmill training in a hypoxia chamber with 15% oxygen.

Cisplatin resistance is still one of the main reasons for failure of clinical therapy for cervical cancer. But the underlying molecular mechanisms involved in cisplatin resistance of cervical cancer have still remained unclear. Recent studies reported that long noncoding RNAs (lncRNAs) are novel nonprotein-coding transcripts, which might play a key role in cancer biogenesis and prognosis. One of the lncRNAs, urothelial cancer associated 1 (UCA1), has been shown to promote different types of cancer cell proliferation, migration, and invasion. This study showed that overexpression of UCA1 confers cisplatin resistance by promoting cancer cell proliferation and inhibiting apoptosis. In addition, knockdown of UCA1 remarkably decreased cisplatin resistance in cervical cancer cells. Moreover, results also indicated that UCA1 was involved in signaling pathways modulating cell apoptosis and proliferation. UCA1 suppressed apoptosis by downregulating caspase 3 and upregulating CDK2, whereas enhanced cell proliferation by increased level of survivin and decreased level of p21. This study reports for the first time that UCA1 might play an important role in the cisplatin resistance in cervical cancer, and also explain partially how UCA1 promotes cisplatin resistance in cancer cells. These results provide evidence to support that UCA1 can be used as a potential target for a novel therapeutic strategy for cervical cancer.

This study compared the effect of prolonged moderate-intensity continuous training (MICT) on reducing abdominal visceral fat in obese young women with that of work-equivalent (300 kJ/training session) high-intensity interval training (HIIT). Forty-three participants received either HIIT (n=15), MICT (n=15), or no training (CON,n=13) for 12 weeks. The abdominal visceral fat area (AVFA) and abdominal subcutaneous fat area (ASFA) of the participants were measured through computed tomography scans preintervention and postintervention. Total fat mass and the fat mass of the android, gynoid, and trunk regions were assessed through dual-energy X-ray absorptiometry. Following HIIT and MICT, comparable reductions in AVFA (−9.1, −9.2 cm2), ASFA (−35, −28.3 cm2), and combined AVFA and ASFA (−44.7, −37.5 cm2,p>0.05) were observed. Similarly, reductions in fat percentage (−2.5%, −2.4%), total fat mass (−2.8, −2.8 kg), and fat mass of the android (−0.3, −0.3 kg), gynoid (−0.5, −0.7 kg), and trunk (−1.6, −1.2 kg,p>0.05) regions did not differ between HIIT and MICT. No variable changed in CON. In conclusion, MICT consisting of prolonged sessions has no quantitative advantage, compared with that resulting from HIIT, in abdominal visceral fat reduction. HIIT appears to be the predominant strategy for controlling obesity because of its time efficiency.

This study aims to investigate the effects of contrast enhancement computed tomography (CECT) images on the malignant distinguishes of solid lung nodules. As a representational describer of tumor heterogeneity on images, texture features are used as the classification basis for lung cancers and non-cancers in this preliminary study. 49 patients with malignant bias suspicious lung nodules (all about 3cm) underwent non-contrast and contrast enhancement CT in arterial and venous phases were collected. And the biopsy reports show that there are 28 malignant (or cancer) and 21 benign (or non-cancer) nodules. To enlarge the feature difference between malignant and benign nodules, we proposed an improved logarithmic texture feature analysis scheme. Support vector machine classification and leave-one-out validation were implemented. The areas under the receiver operating characteristic curves of the non-contrast and contrast enhancement CT images in arterial and venous phases are 0.67, 0.73 and 0.77 respectively. Therefore the texture features presented by contrast enhancement CT images show better distinguishing capacity on solid lung nodules than the non-contrast enhancement CT images.

Purpose To investigate the interobserver agreement of different thyroid imaging report and data system (TI-RADS) and ultrasound (US) features. Methods Two researchers independently searched PubMed, Embase and the Web of Science for relevant studies published between October 1972 and December 2018. Studies investigating interobserver agreement between different radiologists were included. The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) score tools were applied to assess the quality of the studies. The data for the inter-agreements of TI-RADS categories and ultrasound features were extracted, and combined with STATA 12.0 (StataCorp, College Station, TX) was used. Results Seven studies including 927 patients were eligible for this meta-analysis. There was a moderate variability in the TI-RADS categories among radiologists (0.54; 95% CI: 0.49−0.58). Regarding the US features, the reliability of composition (0.61; 95% CI: 0.55−0.66) and calcification (0.71; 95% CI: 0.65−0.77) was good, the reliability of echogenicity (0.58; 95% CI: 0.51−0.64), shape (0.53; 95% CI: 0.45−0.62), margin (0.40; 95% CI: 0.32−0.48) and echogenic foci (0.43; 95% CI: 0.32−0.54) was moderate. Subgroup analyses showed that experience/training, the number of observers and the number of patients were the main factors influencing the variability. Conclusions The interobserver agreement for the TI-RADS categories was moderate. There remains potential for improvement, especially in terms of the echogenicity, shape, margin and echogenic foci, the precision of the description and the targeted training needed.

A 25-year-old man presented with microangiopathic haemolytic anaemia and acute kidney injury. With a normal ADAMTS-13 level, negative faecal shiga-toxin test and strong family history of atypical haemolytic uremic syndrome, he was commenced on eculizumab to good clinical response. Subsequent genetic testing revealed a heterozygous complement factor H mutation. Eculizumab was discontinued after 44 months of treatment, and he relapsed within 6 months, with the first sign being downtrending haptoglobin levels, with no other markers of haemolysis or thrombocytopaenia, 5 weeks prior to development of acute kidney injury. He was recommenced on eculizumab and to date still remains on it. This case highlights the unusual pattern of relapse and discusses the considerations for eculizumab discontinuation in patients with stable atypical haemolytic uremic syndrome receiving maintenance therapy.

We report a case of a 21-year-old woman with Klippel-Trenaunay-Weber syndrome (KTWS), a rare congenital syndrome involving capillary malformations, arteriovenous malformations, and soft tissue or bone hypertrophy. For this patient, ultrasound and digital subtraction angiography (DSA) were used to evaluate arteriovenous malformations. Arteriovenous shunts could be identified with both ultrasound and DSA. DSA was able to provide an overall view of the malformed blood vessels, whereas ultrasound was effective in showing the condition of the blood vessel walls and in assessing blood flow velocity. This case suggests that multiple imaging studies may be needed for the diagnosis and treatment of KTWS disease in these patients.

Aim The Barwon Health nocturnal home haemodialysis (NHHD) program was established in 2000 as the first formal NHHD program in Australia. We aimed to assess reasons for and factors associated with program exit, and technique and patient survival rates. Methods This retrospective audit included all patients enrolled in the NHHD program from 1st September 2000 to 31st July 2017. The primary outcome was technique failure, defined as transfer to satellite haemodialysis (HD) or to peritoneal dialysis (PD) for greater than or equal to 60 days, or death. Predictors of technique failure were identified by competing risk regression analyses. Patient and technique survival were estimated by Kaplan-Meier methods. Results A total of 109 patients underwent 112 periods of NHHD during the study period. Technique failure occurred in 33 patients (30%), of whom 16 were transferred to satellite HD for medical reasons, 16 died, and 1 transferred to PD due to a lack of vascular access. Median technique survival was 7.8 years (interquartile range 4.1, 11.1) and median patient survival 14.6 years (interquartile range 6.2,-). Average NHHD duration for those who transferred to satellite HD was 5.2 ± 3.6 years, and for those who died was 4.7 ± 3.8 years. Older age and diabetes were associated with technique failure. However, due to a small number of events the risk of confounding in this study was high. Conclusion Nocturnal home haemodialysis has excellent long-term technique and patient outcomes. Clinicians should be aware of factors associated with poorer outcomes, to ensure that additional support can be provided to patients at greatest risk.

To compare the efficacy of long and short segment instrumentation after pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis caused by ankylosing spondylitis (AS).Sixty-four consecutive AS patients were analyzed and divided into groups according to length of instrumentation. We defined short segment instrumentation (SSI) as construct length7 levels (≤3 levels above and below the osteotomy) (n = 17). By contrast, long segment instrumentation (LSI) was defined as construct length ≥7 levels (≥4 levels above and ≥3 levels below the osteotomy) (n = 47). Both groups were matched cohorts. Radiographs were analyzed for correction, ossification, and complications.Correction loss in global kyphosis (GK) and lumbar lordosis (LL) of the LSI group was slightly higher than that of SSI group. Notably, a significantly higher modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) was noted in the SSI group. Pearson correlation analysis demonstrated that thoracic and lumbar spine mSASSS were significantly associated with correction loss in GK and LL, respectively. Two cases of proximal junctional kyphosis and 1 case of rod fracture occurred in the LSI group.Both approaches were able to maintain sustained surgical outcomes. Short segment instrumentation is recommended for AS patients with bridging syndesmophytes. Long constructs are better indicated for patients without fully ossified anterior longitudinal ligaments. Nevertheless, extension of the length of instrumentation might not prevent complications such as proximal junctional kyphosis or rod fracture in patients without fully ossified vertebrae.

Aims The aims of this study were to determine the effects of four weeks of intermittent exposure to a moderate hypoxia environment (15% oxygen), and compare with the effects of exercise in normoxia or hypoxia, on glucose homeostasis, insulin sensitivity, GLUT4 translocation, insulin receptor phosphorylation, Akt-dependent GSK3 phosphorylation and Akt activity in skeletal muscle of obese mice with type 2 diabetes. Methods C57BL/6J mice that developed type 2 diabetes with a high-fat-diet (55% fat) (fasting blood glucose, FBG = 13.9 ± 0.69 (SD) mmol/L) were randomly allocated into diabetic control (DC), rest in hypoxia (DH), exercise in normoxia (DE), and exercise in hypoxia (DHE) groups (n = 7, each), together with a normal-diet (4% fat) control group (NC, FBG = 9.1 ± 1.11 (SD) mmol/L). The exercise groups ran on a treadmill at intensities of 75–90% VO2max. The interventions were applied one hour per day, six days per week for four weeks. Venous blood samples were analysed for FBG, insulin (FBI) and insulin sensitivity (QUICKI) pre and post the intervention period. The quadriceps muscle samples were collected 72 hours post the last intervention session for analysis of GLUT4 translocation, insulin receptor phosphorylation, Akt expression and phosphorylated GSK3 fusion protein by western blot. Akt activity was determined by the ratio of the phosphorylated GSK3 fusion protein to the total Akt protein. Results The FBG of the DH, DE and DHE groups returned to normal level (FBG = 9.4 ± 1.50, 8.86 ± 0.94 and 9.0 ± 1.13 (SD) mmol/L for DH, DE and DHE respectively, P < 0.05), with improved insulin sensitivity compared to DC (P < 0.05), after the four weeks treatment, while the NC and DC showed no significant changes, as analysed by general linear model with repeated measures. All three interventions resulted in a significant increase of GLUT4 translocation to cell membrane compared to the DC group (P < 0.05). The DE and DH showed a similar level of insulin receptor phosphorylation compared with NC that was significantly lower than the DC (P < 0.05) post intervention. The DH and DHE groups showed a significantly higher Akt activity compared to the DE, DC and NC (P < 0.05) post intervention, as analysed by one-way ANOVA. Conclusions This study produced new evidence that intermittent exposure to mild hypoxia (0.15 FiO2) for four weeks resulted in normalisation of FBG, improvement in whole body insulin sensitivity, and a significant increase of GLUT4 translocation in the skeletal muscle, that were similar to the effects of exercise intervention during the same time period, in mice with diet-induced type 2 diabetes. However, exercise in hypoxia for four weeks did not have additive effects on these responses. The outcomes of the research may contribute to the development of effective, alternative and complementary interventions for management of hyperglycaemia and type 2 diabetes, particularly for individuals with limitations in participation of physical activity.

Analysis of fresh capillary blood using darkfield microscopy (FCB-DM) is a point of care screening tool, used by healthcare practitioners in Australia. However, the relationship between the outcomes of FCB-DM measures and the automated venous haematology measures has not been determined. Objectives The aim of this study was to compare differential white blood cell counts obtained using automated haematology and FCB-DM. Methods Data of 125 individuals were collected either retrospectively ( n = 74) or from participants specifically recruited for the project ( n = 51). Retrospective data were collected from active files at a naturopathic clinic. Newly recruited participants provided a fasting capillary blood sample for FCB-DM analysis within 1 h of providing a venous blood sample at a commercial laboratory for automated haematologic analysis. Results The mean score of neutrophils was found to be higher, and lymphocytes and basophils to be lower, in FCB-DM analysis ( p r = 0.60, p r = 0.63, p r s = 0.32, p r s = 0.596, p Conclusion Despite significant differences in the mean scores of cells counts, significant correlations between the data obtained by the two techniques for neutrophil, lymphocyte, monocyte and eosinophil cells were observed. Given the small amount of blood sample required, FCB-DM would have an advantage in clinical practice, though further research is required to determine the clinical implications of the FCB-DM cell counts.

Background/Objective: The aim of this study was to determine whether unilateral manual needling at nonacupoints could result in bilateral strength gain similar to that found in electroacupuncture at specific acupoints. Methods: Fifty healthy male volunteers with an age range of 19–27 years were recruited and randomly allocated into five groups: (1) manual acupuncture and (2) electroacupuncture at two acupoints (ST-36 and ST-39); (3) manual acupuncture and (4) electroacupuncture at two nonacupoints on the tibialis anterior muscle; and (5) control group. The intervention groups received needling in each session on the right leg for 15 minutes in Week 1, 20 minutes in Week 2, and 30 minutes in Weeks 3–8, three sessions per week. The maximal isometric ankle dorsiflexion strength and muscle activation (as determined by twitch interpolation) of both legs were assessed pre, post, 2 weeks post, and 3 weeks post the experimental period. Results: Mixed models (linear) with repeated-measures analysis identified significant strength gains (p

To understand the molecular mechanisms of adaptation to different training protocols, this study compared the effects of 4 sessions of 90 min treadmill exercise on alternate days or consecutive days in 1 week on messenger RNA (mRNA) and protein expression of proliferator-activated receptor-γ coactivator 1-α in rat gastrocnemius muscle. The mRNA significantly increased by 25.8-fold after alternate-day and 10.1-fold after consecutive-day training, while the protein showed no significant cumulative effect, 1.5–1.7-fold above baseline, in the 2 protocols.

Background: The aim of this meta-analysis was to assess the efficacy of the apparent diffusion coefficient ( ADC) value of diffusion-weighted MRI (DWI) for differentiating biliary tract cancer (BTC) from benign biliary tract diseases in Asians. Materials and Methods: We systematically searched Embase and PubMed prior to December 2014. Eight studies conducted in Asians met our predetermined inclusion criteria. Results: Our meta-analysis results showed that ADC values in BTC tissues were significantly lower than in benign biliary tract tissues (SMD = -1.54, 95%CI: -1.75~-1.33, P

Purpose: To help improve efficacy of screening mammography by eventually establishing a new optimal personalized screening paradigm, the authors investigated the potential of using the quantitative multiscale texture and density feature analysis of digital mammograms to predict near-term breast cancer risk. Methods: The authors’ dataset includes digital mammograms acquired from 340 women. Among them, 141 were positive and 199 were negative/benign cases. The negative digital mammograms acquired from the “prior” screening examinations were used in the study. Based on the intensity value distributions, five subregions at different scales were extracted from each mammogram. Five groups of features, including density and texture features, were developed and calculated on every one of the subregions. Sequential forward floating selection was used to search for the effective combinations. Using the selected features, a support vector machine (SVM) was optimized using a tenfold validation method to predict the risk of each woman having image-detectable cancer in the next sequential mammography screening. The area under the receiver operating characteristic curve (AUC) was used as the performance assessment index. Results: From a total number of 765 features computed from multiscale subregions, an optimal feature set of 12 features was selected. Applying this feature set, a SVM classifier yielded performance of AUC = 0.729 ± 0.021. The positive predictive value was 0.657 (92 of 140) and the negative predictive value was 0.755 (151 of 200). Conclusions: The study results demonstrated a moderately high positive association between risk prediction scores generated by the quantitative multiscale mammographic image feature analysis and the actual risk of a woman having an image-detectable breast cancer in the next subsequent examinations.

The current study aimed to (a) determine the rates of symptoms of muscle dysmorphia (MD), body dysmorphic disorder (BDD), and eating disorder; (b) determine the relationships among symptoms of MD, BDD, and eating disorders; and (c) provide a comprehensive comparison of symptoms of MD, BDD, and eating disorders in a nonclinical population of adult male weightlifters in Australia. The participants (N = 648, mean age = 29.5 years, SD = 10.1) participated in an online survey, consisting of Muscle Appearance Satisfaction Scale, the Body Dysmorphic Disorder Questionnaire, and the Eating Attitude Test-26. Results indicated that 110 participants (17%) were at risk of having MD, 69 participants (10.6%) were at risk of having BDD, and 219 participants (33.8%) were at risk of having an eating disorder. Furthermore, 36 participants (5.6%) were found at risk of having both MD and BDD, and 60 participants (9.3%) were at risk of having both MD and an eating disorder. Significant correlations and associations were found between symptoms of MD and BDD, and symptoms of MD and eating disorders. Support was provided for the comorbidity of, and symptomatic similarities between, symptoms of MD and BDD, and symptoms of MD and eating disorders. This may reflect a shared pathogenesis between symptoms of MD, BDD, and eating disorders. Strength and conditioning professionals, exercise scientists, athletic trainers, and personal trainers should be aware that adult males who are working out with weights (i.e., free weights or machines) may be at increased risk of having MD, BDD, and eating disorders.

This study aimed to: (a) determine the inter-rater reliability of the proposed muscle dysmorphia criteria, (b) investigate if muscle dysmorphia (MD) represented a syndrome of frequently co-occurring symptoms, and (c) determine the level of correlation between the proposed MD criteria and the Muscle Appearance Satisfaction Scale. Men (N = 48) aged 18 years and older who were currently participating in resistance training were assessed using the Muscle Appearance Satisfaction Scale and a one-on-one interview. Two qualified psychologists assigned a diagnosis of MD to those participants who appeared to meet the proposed criteria for MD. Inter-rater reliability and the frequency of co-occurring symptoms in participants were assessed. The correlation between MD and the Muscle Appearance Satisfaction Scale was explored. The inter-rater reliability between the researchers was low (Cohen's kappa = .39; p ≤ .05). A Binomial test revealed that MD represented a syndrome of frequently co-occurring symptoms; there was ...

Purpose To compare best-corrected visual acuity (BCVA) and central macular thickness (CMT) after 532-nm subthreshold laser grid photocoagulation and threshold laser grid photocoagulation for the treatment of diabetic macular oedema (DME). Patients and methods Twenty-three patients (46 eyes) with binocular DME were enroled in this study. The two eyes of each patient were divided into a subthreshold photocoagulation group and a threshold photocoagulation group. The eyes of the subthreshold group underwent 532-nm patter scan laser system (PASCAL) 50% end point subthreshold laser grid photocoagulation therapy, whereas the threshold photocoagulation group underwent short-pulse grid photocoagulation with a 532-nm PASCAL system. BCVA and CMT were assessed in all patients before treatment, 7 days after treatment, and 1, 3, and 6 months after treatment. Results After grid photocoagulation, the mean BCVA improved in both the subthreshold group, and the threshold group, and the two groups did not differ statistically significantly from each other. Similarly, the macular oedema diminished in both groups after treatment, and the two groups did not differ statistically significantly from each other with regard to CMT. Conclusion Both 532-nm subthreshold laser grid photocoagulation and threshold laser grid photocoagulation can improve the visual acuity and reduce CMT in DME patients.

Background/Purpose: Physical deconditioning and impaired balance and gait are common barriers to exercise in frail older adults. This case report describes the efficacy of Nintendo Wii Fit exercises in improving functional capacity, exercise tolerance, strength and balance in an elderly woman with CREST syndrome and multiple chronic conditions. Case description: A sedentary 77-year-old woman with: scleroderma (CREST syndrome) and secondary Sjögren's syndrome; pulmonary hypertension; coronary artery disease; interstitial lung disease; and tremor. The patient could ambulate with a cane and had a high risk of falling. Methods: The participant completed three 30-minute sessions of Wii Fit exercises per week for 12 weeks. The exercises included step aerobics, marching and interactive games to develop balance, weight transfer and upper and lower body strength. Results: Substantial improvements were seen in the following: 6-minute walk test (6MWT) (100%); Timed Up and Go (TUG) (5.3%); 30-second sit to stand (25%); hand grip strength (right 21%; left 8.6%); ankle plantarflexion (right 16.7%; left 33.3%) and dorsiflexion (right 125%; left 88.9%), Tinetti Balance and Gait Assessment (balance score 35.5%; falls efficacy scale score 21.4%); resting systolic blood pressure (5.1%); and oxygen saturation (3.3%). The average movement of centre of pressure decreased post-intervention, but average velocity increased. Conclusions: Specific Wii Fit games may improve health, exercise capacity, mobility, balance and fall risk in older adults affected with CREST and associated severe cardiopulmonary symptoms.

This study investigated the effect of restricting nasal breathing during a series of 20-m shuttle runs. Ten male participants (mean age = 21.7 ± 2.4 years, height = 1.80 ± 0.62 m, mass = 79.2 ± 10.4 kg, sum of 4 skinfolds = 54.5 ± 7.8 mm) were required to either (a) dive on the ground and complete a rolling sequence (condition = GRD) or (b) complete the shuttles while staying on their feet and tagging the line with 1 foot, at the end of each 20-m segment (condition = STD). The shuttle runs were completed with and without a nose clip (no clip = nc; with a clip = clip) under 4 different trial conditions in a randomized order (GRDnc; GRDclip; STDnc; and STDclip), requiring the participants to return on 4 separate occasions separated by 5-7 days. Heart rate was recorded throughout each trial, and the rate of perceived exertion (RPE) was measured at the completion of each shuttle sequence. Pretrial and posttrial lactate and respiratory function measures were also recorded. The general linear model with repeated measures analysis indicated that there was a significant effect for Roll (GRD > STD) (p ≤ 0.05) but not for Clip (p > 0.05) on total time to completion in the trials. There was no significant interaction of the conditions (Roll × Clip) for RPE (p > 0.05). Similarly, there was no significant effect for blood lactate measured 3 minutes post the last shuttle for Roll (p > 0.05) and Clip (p > 0.05). There was a significant main effect on the HR across all 6 time points (i.e., pre, intervals 1-4 and 10 minutes post) (p ≤ 0.05) and for Roll (GRD > STD) (p ≤ 0.05), but not for Clip (p > 0.05). No significant effect of Roll or Clip was found for any of the recorded ventilation measures (p > 0.05). On the basis of these findings, the use of restricted nasal breathing, while performing a high-intensity shuttle sequence as a method of increasing the acute training effect on athletes, is questionable, so strength and conditioning coaches should carefully consider their rationale for using such a training strategy.

A range of biological and molecular effects caused by nicotine are considered to effect bone metabolism. Vitamin C functions as a biological antioxidant. This study was to evaluate the in vitro effects of nicotine on human bone marrow stromal cells and whether Vitamin C supplementation show the antagonism action to high concentration nicotine. We used CCK-8, alkaline phosphatase (ALP) activity assay, Von Kossa staining, real-time polymerase chain reaction and Western Blot to evaluate the proliferation and osteogenic differentiation. The results indicated that the proliferation of BMSCs increased at the concentration of 50, 100 ng/ml, got inhibited at 1,000 ng/ml. When Vitamin C was added, the OD for proliferation increased. For ALP staining, we found that BMSCs treated with 50 and 100 ng/ml nicotine showed a higher activity compared with the control, and decreased at the 1,000 ng/ml. Bone morphogenetic protein-2 (BMP-2) expression and the calcium depositions decreased at 100 and 1,000 ng/ml nicotine, while the addition of Vitamin C reversed the down regulation. By real-time PCR, we detected that the mRNA expression of collagen type I (COL-I) and ALP were also increased in 50 and 100 ng/ml nicotine groups (P

The aim of this study was to evaluate the effects of an aquatic exercise program designed to enhance muscular strength in paretic lower limbs in subacute stroke patients.Thirty-six subacute stroke patients were randomly divided to a conventional or an aquatic group (n = 18 each). Outcome measures were assessed at baseline and after 8 wks of training. For the paretic lower limbs, maximum isometric voluntary contraction strength of the rectus femoris and biceps femoris caput longus and the tibialis anterior and lateral gastrocnemius was measured. Cocontraction ratios during knee extension and flexion and ankle dorsiflexion and plantarflexion were calculated respectively. In addition, Modified Ashworth Scale, Functional Ambulation Category, and Barthel Index were assessed.Compared with the conventional intervention, the aquatic intervention resulted in significantly higher knee extension (P = 0.002) and ankle plantarflexion torque (P = 0.002), accompanied with a significantly lower knee extension cocontraction ratio in the paretic limb (P = 0.000). Functional Ambulation Category (P = 0.009) and Barthel Index (P = 0.024) were greater in aquatic group than conventional group posttreatment. Modified Ashworth Scale scores did not show any differences between groups.Aquatic exercise enhanced muscle strength in paretic lower limbs and improved muscle cocontraction without increasing spasticity in subacute stroke patients.

Purpose To help improve efficacy of screening mammography and eventually establish an optimal personalized screening paradigm, this study aimed to develop and test a new near-term breast cancer risk prediction scheme based on the quantitative analysis of ipsilateral view of the negative screening mammograms. Methods The dataset includes digital mammograms acquired from 392 women with two sequential full-field digital mammography examinations. All the first (“prior”) sets of mammograms were interpreted as negative during the original reading. In the sequential (“current”) screening, 202 were proved positive and 190 remained negative/benign. For each pair of the “prior” ipsilateral mammograms, we adaptively fused the image features computed from two views. Using four different types of image features, we built four elastic net support vector machine (EnSVM) based classifiers. Then, the initial prediction scores form the 4 EnSVMs were combined to build a final artificial neural network (ANN) classifier that produces the final risk prediction score. The performance of the new scheme was evaluated by using a 10-fold cross-validation method and an assessment index of the area under the receiver operating characteristic curve (AUC). Results A total number of 466 features were initially extracted from each pair of ipsilateral mammograms. Among them, 51 were selected to build the EnSVM based prediction scheme. The AUC = 0.737 ± 0.052 was yielded using the new scheme. Applying an optimal operating threshold, the prediction sensitivity was 60.4% (122 of 202) and the specificity was 79.0% (150 of 190). Conclusion The study results showed moderately high positive association between computed risk scores using the “prior” negative mammograms and the actual outcome of the image-detectable breast cancers in the next subsequent screening examinations. The study also demonstrated that quantitative analysis of the ipsilateral views of the mammograms enabled to provide useful information in predicting near-term breast cancer risk.

The purpose of this study was to examine whether a video-based warm-up could provide an acute performance benefit to response time for athletes in a sport-specific agility task. In addition, 2 learning strategies, explicit and implicit, were compared for their effectiveness in facilitating an improvement in sport-specific agility. Thirty representative male junior rugby union players (age 14–16 y, mean age 14.6 ± 1.09 y) were placed in 3 experimental groups (explicit, implicit, and control) and completed 2 intervention sessions. Testing sessions included preintervention testing, completion of the video-based warm-up intervention, and postintervention testing. A 3D motion-analysis system was used to assess response time in the testing battery. The athletes’ response times on the pre- to postintervention tests were compared to determine the effectiveness of the video-based warm-up. A 2-way general linear model with repeated-measures analysis indicated that both the explicit (P = .030, d = 0.28) and implicit (P = .049, d = 0.33) groups significantly improved their response time by the intervention compared with the control group (P = .367, d = 0.08). The mean postintervention response time for the explicit group improved by 19.1% (from 0.246 s pre to 0.199 s post), and the implicit group improved by 15.7% (from 0.268 s to 0.226 s). Findings suggest that a video-based warm-up may provide an acute benefit to sport-specific agility performance for junior athletes.

Junxiang Li,1 Xuya Zhao,1 Dazhi Wang,1 Wei He,1 Shuai Zhang,1 Wei Cao,1 Yu Huang,1 Ling Wang,1 Shi Zhou,1 Kaijian Luo21Department of Interventional Radiology, 2Department of Oncology, GuiZhou Cancer Hospital, Cancer Hospital of Guizhou Medical University, Guiyang, People’s Republic of ChinaBackground: Phospholipase C, β1 (PLCB1) plays critical roles in intracellular transduction and regulating signal activation which are important to tumorigenesis. However, the mechanism of PLCB1 in hepatocellular carcinoma (HCC) is still unknown. This study aims to investigate whether its expression is associated with the clinicopathological parameters and prognosis of the patients with HCC.Methods: Immunohistochemistry on two tissue microarrays containing 141 cases of HCC tissues and adjacent non-tumorous tissues were performed to analyze the correlation between PLCB1 expression and clinicopathological features. Kaplan–Meier analysis and Cox multivariate analysis were performed to determine the PLCB1 expression in HCC prognosis. Furthermore, effects of PLCB1 on proliferation of HCC cells were explored using a colony formation assay and apoptosis assay.Results: We identified that PLCB1 expression was significantly higher in tumor tissues than that in adjacent non-tumorous tissues and associated with advanced tumor stage. Kaplan–Meier survival analysis showed that patients with PLCB1-positive tumors had poorer survival than the patients with PLCB1-negative tumors. In multivariate analyses, PLCB1 expression was an independent prognostic factor. Moreover, overexpression of PLCB1 in HCC cells promoted cell proliferation and inhibited apoptosis, while knocking down PLCB1 reduced cell viability in vitro. Further investigation found that activation of ERK signaling might involve in PLCB1-mediated cell growth.Conclusion: Our study suggests that PLCB1 promotes the progression of HCC and can be served as an independent prognostic factor and a promising therapeutic target in HCC.Keywords: PLCB1, HCC, prognosis, cell proliferation, ERK

The aim of this study was to evaluate the feasibility of transjugular intrahepatic portosystemic shunts using FLUENCY expanded polytetraf luoroethylene (PTFE)-covered stents and the effect on the patency rate. A total of 114 cirrhotic patients who were treated by transjugular intrahepatic portosystemic stent shunt (TIPS) placement using a FLUENCY expanded, PTFE-covered stent were enrolled in the present study. Of the patients, 15 underwent an additional bare metal stent implantation on the portal side of the covered stent, simultaneously. Patients underwent Doppler sonography during the follow-up. Mean portal venous pressure dropped from 2.499±0.588 cmHg to 1.764±0.294 cmHg. The cumulative patency rates for one and two years were 86.7% and 75.2%, respectively. The results demonstrate the feasibility of TIPS placement with the FLUENCY expanded PTFE-covered stent. TIPS placement with the FLUENCY expanded PTFE-covered stent was able to improve patency when compared with the use of conventional bare-metal stents.

Objective To review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Design The criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system. Method Peer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011. Results The search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met. Conclusion Literature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.

Objectives/Hypothesis: Is the severity of acute oral mucositis in patients who receive postoperative intensity-modulated radiotherapy (PO-IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)? Study Design: Prospective, randomized trial. Methods: Forty-eight patients with oral tongue SCC who received PO-IMRT at our institution were randomized to two groups: the oral-sparing (OR-SP) group and oral-unsparing (OR-USP) group. For the OR-SP group (n = 24), the oral mucosa outside of the PTV was spared. Furthermore, the mucosa including the bilateral cheeks, upper lip, and lower lip was defined as the united site and given