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Lateral epicondylitis, also termed as “tennis elbow,” is the most common cause of elbow pain and dysfunction, mainly resulting from repetitive gripping or wrist extension during various activities. The exact pathogenesis remains largely elusive with putative tendinosis, a symptomatic degenerative process of the local tendon. It is usually diagnosed by clinical examinations. Sometimes, additional imaging is required for a specific differential diagnosis. Although most cases can be self-healing, the optimal treatment strategy for chronic lateral epicondylitis remains controversial. This article presents a landscape of emerging evidence on lateral epicondylitis and focuses on the pathogenesis, diagnosis, and management, shedding light on the understandings and treatment for healthcare professionals.

Chronic non-specific low back pain (NLBP) affects people of all ages and pose a serious threat to human health. Fu's subcutaneous needling (FSN) has been reported to be effective in treating such disorders, but the control group is lacking. The aim of this randomized parallel study is to compare the long-term efficiency of FSN therapy with massage therapy for treatment of NLBP.A total of 60 chronic NLBP patients recruited from Yongchuan Hospital of Chongqing Medical University were randomly assigned to the FSN therapy group or massage therapy group. The main prognostic indicators included pain intensity measured on the visual analog scale (VAS), functional outcomes assessed by the Japanese Orthopedic Association (JOA) scoring system, functional disability estimated using Oswestry Disability Index (ODI), and quality of life evaluated by Short Form Health Survey Questionnaire (SF-36). These indicators were evaluated at baseline, post-treatment, 3 months after treatment, and 12 months after treatment.After 12 months of follow-up, we found that the 2 treatment regimens exhibited similarly favorable results in terms of all prognostic indicators in comparison with their respective baseline data (all P0.01). However, compared with the massage group, the FSN group showed more significant improvements in VAS, JOA, and ODI at all follow-up time points, as well as SF-36 at post-treatment and 12 months after treatment (all P0.05).Our findings suggest that FSN therapy is significantly more effective than massage therapy in the improvement of pain intensity, functional outcomes, functional disability, and quality of life in a long-term follow-up. However, future studies with larger sample sizes are needed to corroborate the long-term efficiency of FSN therapy for chronic NLBP.Chinese Clinical Trial Registry ChiCTR2100050866.

(1) Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. (2) Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and Beck’s Depression Index (BDI). The outcome was reported as a standardized mean difference (SMD), 95% confidence intervals (CIs), and I2 for heterogeneity at three observational time points. GRADE was used to evaluate the strength of evidence. (3) Results: Amongst 884 citations, 11 RCTs were included (n = 672). Various BT regimens were reported (water types, duration, temperature, and ingredients). BT can benefit FMS with statistically significant improvement at different time points (pain of two weeks, three and six months: SMD = −0.92, −0.45, −0.70; 95% CI (−1.31 to −0.53, −0.73 to −0.16, −1.34 to −0.05); I2 = 54%, 51%, 87%; GRADE: very low, moderate, low; FIQ: SMD = −1.04, −0.64, −0.94; 95% CI (−1.51 to −0.57, −0.95 to −0.33, −1.55 to −0.34); I2 = 76%, 62%, 85%; GRADE: low, low, very low; TPC at two weeks and three months: SMD = −0.94, −0.47; 95% CI (−1.69 to −0.18, −0.71 to −0.22); I2 = 81%, 0; GRADE: very low, moderate; BDI at six months: SMD = −0.45; 95% CI (−0.73 to −0.17); I2 = 0; GRADE: moderate). There was no statistically significant effect for the TPC and BDI at the remaining time points (TPC at six months: SMD = −0.89; 95% CI (−1.85 to 0.07); I2 = 91%; GRADE: very low; BDI at two weeks and three months: SMD = −0.35, −0.23; 95% CI (−0.73 to 0.04, −0.64 to 0.17); I2 = 24%, 60%; GRADE: moderate, low). (4) Conclusions: Very low to moderate evidence indicates that BT can benefit FMS in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. Established BT regimens with a large sample size and longer observation are needed.

ImportanceSARS-CoV-2 is associated with multiple direct and indirect effects to the heart. It is not yet well defined whether patient groups at increased risk of severe respiratory disease due to SARS-CoV-2 infection also experience a heightened incidence of cardiac complications.ObjectiveWe sought to analyse the role of pre-existing chronic disease (chronic respiratory illness, cardiovascular disease (CVD), hypertension and diabetes mellitus) in the development of cardiac complications from SARS-CoV-2.Data SourcesWe retrospectively investigated published (including pre-prints), publicly released, de-identified, data made available between Dec 1, 2019, and May 11, 2020. Information was accessed from PubMed, Embase, medRxiv and SSRN.Study Selection379 full-text articles were reviewed and 321 excluded for lack of original research, irrelevance to outcome, inappropriate cohort, or small patient numbers (case reports of Data Extraction and SynthesisThis systematic review was conducted based on PRISMA and MOOSE statements. Included studies were critically appraised using Newcastle Ottawa Quality Assessment Scale (NOS). Data were extracted independently by multiple observers. A fixed-effects model was selected for the meta-analysis based on relatively low heterogeneity between the studies (I2Main Outcome and MeasuresCardiac complications were determined via blood levels of cardiac biomarkers above the 99thpercentile of the upper reference limit, abnormalities in electrocardiography, and/or abnormalities in echocardiography.ResultsSARS-CoV-2-infected patients who developed cardiac complications were, on average, 10 years older than those that did not. Pooled analyses showed the development of cardiac complications from SARS-CoV-2 was significantly increased in patients with underlying chronic respiratory illness (OR 2.88[1.45,5.71]), CVD (OR 5.12[3.09,8.48]), hypertension (OR 4.37[2.99,6.39]) and diabetes mellitus (OR 2.61[1.67,4.09]).Conclusions and RelevanceOlder age and pre-existing chronic respiratory illness, CVD, hypertension, and diabetes mellitus may represent prognostic factors for the development of additional cardiac complications in COVID-19, highlighting the need for a multidisciplinary approach to chronic disease patient management and providing justification for a larger scale observational study.

BackgroundNotwithstanding the clinical hallmarks of COVID-19 patients were reported, several critical issues still remain mysterious, i.e., prognostic factors for COVID-19 including extrinsic factors as viral load of SARS-CoV-2 and intrinsic factors as individual’s health conditions; myocarditis incidence rate and hallmarks.MethodsDemographic, epidemiologic, radiologic and laboratory data were collected by medical record reviews of adult hospitalized patients diagnosed as COVID-19. Cycle threshold (Ct) value data of real-time PCR (RT-PCR) were collected. The time duration was from 21 January to 2 March, 2020. Pulmonary inflammation index (PII) values were used for chest CT findings. Multivariate logistic regression analysis was used to identify independent severity risk factors.RESULTSIn total, 84 hospitalized adult patients diagnosed as COVID-19 were included, including 20 severe and 64 nonsevere cases. The viral load of the severe group was significantly higher than that of the non-severe group, regardless of the Ct values forNorORF1abgene of virus (all pInterpretationThree key-independent risk factors of COVID-19 were identified, including age, PII, and Ct value. The Ct value is closely correlated with the severity of COVID-19, and may act as a predictor of clinical severity of COVID-19 in the early stage. SARS-CoV-2 myocarditis should be highlighted despite a relatively low incidence rate (4.8%). The oxygen pressure and blood oxygen saturation should not be neglected as closely linked with the altitude of epidemic regions.Research in contextEvidence before this studyWe searched Pubmed on March 15, 2020 using the terms (“COVID-19” OR “novel coronavirus” OR “2019 novel coronavirus” OR “2019-nCoV” OR “pneumonia” OR “coronavirus”), AND “Myocarditis” OR “Cycle threshold (Ct)” OR “Altitude”. We found that one article analyzed the risk factors affecting the prognosis of adult patients with COVID-19 in terms of survivorship, without considering Ct values as extrinsic factors. Moreover, there are no reported studies on viral myocarditis caused by COVID-19 and the relationship between the altitude and COVID-19.Added value of this studyWe retrospectively analyzed the clinical data, Ct values, laboratory indicators and imaging findings of 84 adult patients with confirmed COVID-19. Three key-independent risk factors of COVID-19 were identified in our study, including age [OR 2.350; 95% CI (1.206 to 4.580); p=0.012], Ct value [OR 0.158; 95% CI (0.025 to 0.987); p=0.048] and PII [OR 1.912; 95% CI (1.187 to 3.079); p=0.008]. Amongst 84 patients, 13 patients (15.48%) were noted with abnormal electrocardiograms (ECGs) and serum myocardial enzyme levels; whereas 4 (4.8%) were clinically diagnosed as SARS-CoV-2 myocarditis. Moreover, altitude should be considered for COVID-19 severity classification, given that oxygen partial pressure and blood oxygen saturation of regional patients vary with altitudes.Implications of all the available evidenceThree key-independent risk factors of COVID-19 were identified, including age, PII, and Ct value. The Ct value is closely correlated with the severity of COVID-19, and may act as a predictor of clinical severity of COVID-19 in the early stage. SARS-CoV-2 myocarditis should be highlighted despite a relatively low incidence rate (4.8%). The oxygen pressure and blood oxygen saturation should not be neglected as closely linked with the altitude of epidemic regions.

A centralized forecasting method is difficult to accurately follow load variation and weather diversity throughout the region in a bulk power system that covers a large geographical area. A distributed load forecasting method based on local weather information is proposed in this paper. First, the bulk power system is partitioned into some subnets based on local weather information. Second, separate forecasting models are established for subnets. These models are selected from load forecasting model base, which includes neural network, autoregressive integrated moving average model, autoregressive and moving average, gray model, and so on. Cosine distance is used to evaluate the similarity between vectors of influencing factors, so that representative samples can be selected from large data sets as training set for local load forecasting models. Finally, a system load forecasting model is developed to aggregate local load forecasts. Case study shows the advantages of the proposed method in a bulk power system.

Human amniotic epithelial cells (hAECs) have recently been recognized as a potential source of stem cells. The present study was designed to investigate the effects of mechanical stretch on the osteogenic differentiation of hAECs. As it has been previously reported that the physical environment is an important factor in maintaining the phenotype and functionality of differentiated cells, mechanical stretch was use to mimic the mechanical environment in the present study, with the following parameters: 5% elongation of the hAECs at a frequency of 0.5 Hz, with evaluation at 2, 6, 12 and 24 h time points. The osteogenic differentiation process of the hAECs followed by mechanical stimulation was evaluated by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR), western blotting and immunocytochemistry. Additionally, in a parallel study, a runt‑related transcription factor 2 (Runx2)/core binding factor α 1 (Cbfa1)‑specific short hairpin RNA (shRNA) plasmid vector and a scrambled shRNA control plasmid was constructed for transfection into the hAECs prior to mechanical stimulation. The cultured hAECs exhibited a cobblestone‑shaped epithelial‑like phenotype and were positive for stage‑specific embryonic antigen‑4, cytokeratin‑19, cluster of differentiation 44 and octamer‑binding protein 4, as detected by flow cytometry, western blotting or confocal microscopy. The qPCR and western blotting data demonstrated that the mRNA and protein expression levels of Runx2/Cbfa1, alkaline phosphatase and osteocalcin were upregulated compared with the control group following stretching and they peaked at 12 h. These results indicated that the osteogenic differentiation of the hAECs was induced by mechanical stimuli. Additionally, the mRNA and protein expression levels of β‑catenin and cyclin D were increased significantly following stretching; however, they were decreased following Runx2/Cbfa1‑shRNA transfection as observed by RT‑qPCR and western blotting. These results suggested that the Wnt/β‑catenin pathway may have an important role in mechanical stretch‑induced osteogenic differentiation of the hAECs. Furthermore, the combination of stretch and osteogenic induction medium had synergistic effects on the osteogenic differentiation. The results of the present study demonstrated that mechanical stimuli have an important role in osteogenic differentiation of hAECs via the Wnt/β‑catenin signalling pathway, which may be a potential therapeutic strategy in bone regenerative medicine.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with multiple direct and indirect cardiovascular complications. We sought to analyze the association of host co-morbidities (chronic respiratory illnesses, cardiovascular disease [CVD], hypertension or diabetes mellitus [DM]) with the acute cardiovascular complications associated with SARS-CoV-2 infection. Individual analyses of the majority of studies found median age was higher by ~10 years in patients with cardiovascular complications. Pooled analyses showed development of SARS-CoV-2 cardiovascular complications was significantly increased in patients with chronic respiratory illness (odds ratio (OR): 1.67 [1.48, 1.88]), CVD (OR: 3.37 [2.57, 4.43]), hypertension (OR: 2.68 [2.11, 3.41]), DM (OR: 1.60 [1.31, 1.95]) and male sex (OR: 1.31 [1.21, 1.42]), findings that were mostly conserved during sub-analysis of studies stratified into global geographic regions. Age, chronic respiratory illness, CVD, hypertension, DM, and male sex may represent prognostic factors for the development of cardiovascular complications in COVID-19 disease, highlighting the need for a multidisciplinary approach to chronic disease patient management., Graphical abstract, Virology; Omics

MiR-429 functions as a tumor suppressor and has been observed in multiple types of cancer, but the effects and mechanisms of miR-429 in osteosarcoma are poorly understood. This study is performed to evaluate the functions of miR-429 in the progression of osteosarcoma. Firstly, the miR-429 expression in osteosarcoma tissues and oste- osarcoma cells was detected using real time PCR, and the relationship between miR-429 expression and overall survival of osteosarcoma was analyzed. Secondly, the effects of miR-429 on the migration, invasion, proliferation and apoptosis of osteosarcoma cells were evaluated using transwell assay, wound-healing assay, CCK-8 assay and flow cytometry, respectively. Proteins related to epithelial-mesenchymal transition (EMT), E-cadherin, Vimentin, N-cadherin and Snail, were also detected using Western blot. Finally, the target gene of miR-429 in osteosarcoma was predicted and verified using dual luciferase assay and the expression correlation between them was analyzed using Pearson’s correlation. MiR-429 was down-regulated in osteosarcoma tissues and osteosarcoma cells; the expression level of miR-429 was associated with the prognosis of osteosarcoma. High level of miR-429 in osteo- sarcoma cells significantly suppressed the migration, invasion and proliferation of cells but induced cells apopto- sis. Furthermore, high level of miR-429 in osteosarcoma cells obviously increased the expression of E-cadherin protein but decreased the expression of Vimentin, N-Cadherin and Snail proteins. EMT inducer ZEB1 was the target gene of miR-429 and the expression of ZEB1 was negatively related to the miR-429 expression in osteosar- coma. In conclusion, miR-429 may functions as a tumor suppressor and be down-regulated in osteosarcoma. MiR- 429 may suppress the progression and metastasis of osteosarcoma by down-regulating the ZEB1 expression., EXCLI Journal;Vol. 16 2017