The efficacy and safety of topical Tretinoin combined with superficial X-ray therapy (SXRT) in treating periungual warts.

There are multiple treatment modalities for periungual warts (PWs), although most are destructive and painful, limiting their application. Radiotherapy is a non-invasive method suitable for treating PW patients with contraindications to invasive procedures. To investigate the efficacy and safety of topical Tretinoin combined with Superficial X-ray therapy (SXRT) in treating PWs. This study included patients with 65 PWs who underwent treatment and a 3-month follow-up. Twenty four PWs were subjected to SXRT alone (group A). The remaining 41 PWs were subjected to SXRT combined with the application of the Tretinoin cream from the first day (group B). The overall clinical response rate, recurrence rates, cosmetic outcomes, and adverse events were observed during the follow-up period. The complete clearance rate (75% vs. 92.7% in groups A and B, respectively) and healing times (19.9 vs. 16.0 days in groups A and B, respectively) between the two groups were significantly different (p < 0.046 and 0.04), indicating the combination treatment is more effective. Notably, there was no damaging or permanent deformation on the nail, and the other adverse effects were mild and bearable. Topical Tretinoin combined with SXRT therapy is an effective strategy for treating PWs, with minor side effects. It is painless and with excellent cosmetic outcomes.

[Systematic evaluation and Meta-analysis of efficacy and safety of Tianzhi Granules in treatment of vascular cognitive impairment].

Tianzhi Granules has effects in calming liver wind, nourishing liver and kidney and activating blood. At present, it is used for treatment of vascular cognitive impairment. However, its efficacy and safety remained to be verified. Therefore, this study aims to systematically analyze the efficacy and safety of Tianzhi Granules in the treatment of vascular cognitive impairment. CNKI, VIP, WanFang, SinoMed, PubMed and Cochrane Library, ClinicalTrials.gov were retrieved to screen out relevant randomized controlled trials about the effect of Tianzhi Granules on vascular cognitive impairment according to the inclusion criteria. Two researchers independently used the risk of bias assessment tool for quality assessment, and extracted and checked the data. Cochrane systematic evaluation software RevMan 5.3 was used for data analysis. Twenty-seven articles involving 2 741 subjects were included. The intervention measure was Tianzhi Granules alone, and the control measure was Western medicine alone or blank control. According to the results, Tianzhi Granules was better than blank control and brain metabolism promoter in clinical efficacy rate and improvement of MMSE score. And it was better than blank control and nimodipine in the improvement of event-related potential(ERP) P300. Within 3 months, Tianzhi Granules had better effects than Western medicine group and blank group, with a low incidence of adverse events. Tianzhi Granules can be recommended for clinical use. However, due to the low quality of the include literatures, these potential benefits need to be confirmed in future standardized clinical trials with a large sample size.

Effects of Chinese heart-healthy diet on blood lipids, glucose, and estimated 10-y cardiovascular disease risk among Chinese adults: results on secondary outcomes of a randomized controlled trial.

BACKGROUND: Healthy diet is essential for cardiovascular disease risk management, but its effects among Chinese patients, whose diets differ from Western diets, remain largely unknown. METHODS: In this multicenter, patient- and outcome assessor-blind, randomized controlled feeding trial, 265 Chinese adults with baseline systolic blood pressure 130 to 159 mmHg were randomly assigned into Chinese heart-healthy (CHH) diet or usual diet for a 28-d intervention after a 7-d run-in period on usual diet. Blood lipids and glucose were measured from overnight fasting blood samples before and after the intervention. Ten-year cardiovascular disease risk was estimated using models previously developed and validated in Chinese. The changes in secondary outcomes of serum total cholesterol (TC), blood glucose, and 10-y cardiovascular disease risk over the intervention period were compared between intervention groups, adjusting for center, among participants with baseline and follow-up blood samples available. Sensitivity analyses were done with further adjustment for baseline values and covariables; missing data imputed; and among per-protocol population. RESULTS: Among 256 eligible participants (130 on CHH diet, 126 on control diet), 42% had hypercholesterolemia and 15% had diabetes at baseline. In the control group, TC and 10-y cardiovascular disease risk decreased after the intervention by 0.16 mmol/L and 0.91%, respectively, but blood glucose increased by 0.25 mmol/L. Compared with usual diet, the CHH diet lowered TC (-0.14 mmol/L, P = 0.017) and 10-y cardiovascular disease risk (-1.24%, P = 0.001) further. No effect on blood glucose was found. All sensitivity analyses confirmed the results on TC and 10-y cardiovascular disease risk, and analysis with multiple variables adjusted showed a borderline significant effect on blood glucose (-0.17 mmol/L, P = 0.051). The differences in intake of nutrients and food groups between intervention groups explained the results. CONCLUSIONS: The CHH diet reduced TC and 10-y cardiovascular disease risk and was likely to reduce blood glucose among Chinese adults with mild hypertension. Further studies with longer terms are warranted. This trial was registered at clinicaltrials.gov as NCT03882645.

Promotion of fatty acid metabolism and glucose metabolism in the muscle of sub-adult grass carp (Ctenopharyngodon idella): The role of alpha-linoleic acid/linoleic acid (ALA/LNA) ratios.

The n6/n3 ratios improved meat quality of terrestrial animals, but alpha-linolenic acid/linoleic acid (ALA/LNA) ratios were rarely studied in aquatic animals. In this study, sub-adult grass carp (Ctenopharyngodon idella) were fed diets fed diets containing six varying ALA/LNA ratios (0.03, 0.47, 0.92, 1.33, 1.69, and 2.15) for 9 weeks and the total value of n3 + n6 (1.98) was kept constant for all six treatments. The results indicated optimal ALA/LNA ratio improved growth performance, changed fatty acid composition in grass carp muscle, and promoted glucose metabolism. Additionally, optimal ALA/LNA ratio improved chemical attributes by increasing crude protein and lipid contents, and technological attributes by increasing pH24h value and shear force in grass carp muscle. The signaling pathways related to fatty acid metabolism and glucose metabolism (LXRα/SREBP-1, PPARα, PPARγ, AMPK) might be responsible for these changes. Dietary optimal ALA/LNA ratio based on PWG, UFA and glucose contents was 1.03, 0.88 and 0.92, respectively.

A new insight on copper: Promotion of collagen synthesis and myofiber growth and development in juvenile grass carp (Ctenopharyngodon idella).

Copper (Cu) is a trace element, essential for fish growth. In the current study, in addition to growth performance, we first explored the effects of Cu on collagen synthesis and myofiber growth and development in juvenile grass carp (Ctenopharyngodon idella). A total of 1080 fish (11.16 ± 0.01 g) were randomly divided into 6 treatments (3 replicates per treatment) to receive five doses of organic Cu, which were Cu citrate (CuCit) at 0.99 (basal diet), 2.19, 4.06, 6.15, and 8.07 mg/kg, and one dose of inorganic Cu (CuSO4·5H2O at 3.15 mg/kg), for 9 weeks. The results showed appropriate Cu level (4.06 mg/kg) enhanced growth performance, improved nutritional Cu status, and downregulated Cu-transporting ATPase 1 mRNA levels in the hepatopancreas, intestine, and muscle of juvenile grass carp. Meanwhile, collagen content in fish muscle was increased after Cu intake, which was probably due to the following pathways: (1) activating CTGF/TGF-ß1/Smads signaling pathway to regulate collagen transcription; (2) upregulating of La ribonucleoprotein domain family 6 (LARP6) mRNA levels to regulate translation initiation; (3) increasing proline hydroxylase, lysine hydroxylase, and lysine oxidase activities to regulate posttranslational modifications. In addition, optimal Cu group increased myofiber diameters and the frequency of myofibers with diameter >50 µm, which might be associated with upregulation of cyclin B, cyclin D, cyclin E, proliferating cell nuclear antigen, myogenic determining factor (MyoD), myogenic factor 5, myogenin (MyoG), myogenic regulatory factor 4 and myosin heavy chain (MyHC) and downregulation of myostatin mRNA levels, increasing protein levels of MyoD, MyoG and MyHC in fish muscle. Finally, based on percentage weight gain (PWG), serum ceruloplasmin (Cp) activity and collagen content in fish muscle, Cu requirements were determined as 4.74, 4.37 and 4.62 mg/kg diet (CuCit as Cu source) of juvenile grass carp, respectively. Based on PWG and Cp activity, compared to CuSO4·5H2O, the efficacy of CuCit were 131.80% and 115.38%, respectively. Our findings provide new insights into Cu supplementation to promote muscle growth in fish, and help improve the overall productivity of aquaculture.

Successful epicardial ablation of idiopathic mitral annular ventricular tachycardia from the great cardiac vein.

This case report describes idiopathic ventricular tachycardia (VT) originating from the anterolateral site of mitral annulus. Radiofrequency (RF) energy application at an endocardial site of mitral annulus could not eliminate the tachycardia. The earliest epicardial activation preceding the onset of the QRS complex by 34 ms was found at the great anterior cardiac vein just opposite to the endocardial ablation catheter, pace mapping provided an identical (12/12) match with the VT morphology at the site, and RF ablation effectively eliminated the VT from the great cardiac vein within the coronary venous system.

Clinical Study of a Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Different Parameters in the Treatment of Chloasma: A Randomized-Controlled Trial.

Objective: To explore the clinical efficacy of a Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with different parameters in the treatment of chloasma. Methods: In this study, 30 patients with chloasma, symmetrically distributed on the left and right sides of the face and who were treated with a Fayton Q-switched 1064 nm Nd:YAG laser, were recruited. The patients were randomly selected for the treatment of facial lesions on the left and right sides of the face using a spot diameter of 9 mm and an energy density of 0.8 J/cm2 on one side, and, on the opposite side, a spot diameter of 6 mm with an energy density of 1.2 J/cm2. The laser frequency was 5 Hz and treatment was conducted once every 7-10 days and repeated eight times as a course of treatment. At the end of the course of treatment, as well as 1, 3, and 6 months after treatment, front-facing images and 45° left- and right-side images were taken, respectively. The curative effect of the treatment was evaluated using the Melasma Area Severity Index (MASI) score. Results: The results of this study showed that the total effective rate of a Fayton Q-switched 1064 nm Nd:YAG laser in the treatment of chloasma was 60%. Conclusions: Using a Q-switched 1064 nm Nd:YAG laser represents a safe and effective approach for the treatment of chloasma. The therapeutic effects of the parameter sets, that is, a spot diameter of 9 mm and an energy density of 0.8 J/cm2, and a spot diameter of 6 mm with an energy density of 1.2 J/cm2, were similar. The treatment time and average effective times of the latter were relatively shortened. Clinical Trial Registration number researchregistry6799.

Bilateral ultrasound-guided transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block for cesarean delivery anesthesia.

The ultrasound-guided transversus abdominis plane block and ilioinguinal-iliohypogastric nerve block have been shown to provide pain relief after abdominal surgery. A combination of the 2 blocks may provide acceptable surgical anesthesia for cesarean delivery. We describe 4 women who had contraindications to neuraxial anesthesia, who underwent cesarean delivery with ultrasound-guided bilateral transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block using 40 mL 0.5% ropivacaine. Breakthrough pain during the delivery of the fetus was treated with small doses of IV ketamine and propofol. We suggest that this technique may be an alternative to local anesthesia for cesarean delivery in clinical practice.

Chronic kidney disease and the outcomes of fibrinolysis for ST-segment elevation myocardial infarction: A real-world study.

BACKGROUND: In low-resource regions, fibrinolytic therapy is often the only option for ST-elevation myocardial infarction (STEMI) patients as primary percutaneous coronary intervention (PCI) is often not available and patients are hardly transferred to a medical center with PCI capacity within the first 120 minutes. Chronic kidney disease (CKD) is one of the most frequently encountered complications of STEMI. However, the evidence for the efficacy of fibrinolytic therapy in STEMI patients with CKD is still limited. The aim of this study is to test whether CKD modifies the association between fibrinolytic therapy and short-term major adverse cardiovascular events (MACEs) among patients with STEMI. METHODS AND FINDINGS: This is a real-world study analyzing the data from 9508 STEMI patients (mean age: 64.0±12.4 years; male: 70.1%) in the third phase of Clinical Pathways in Acute Coronary Syndromes program (CPACS-3), which is a large study of the management of acute coronary syndromes (ACS) in 101 county hospitals without PCI capacity in China. CKD was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1·73 m2 at the admission. The primary outcome is short-term MACEs, including all-cause death, recurrent myocardial infarction, or nonfatal stroke. Patients were recruited consecutively between October 2011 and November 2014. Out of them, 1282 patients (13.5%) were classified as having CKD. Compared with non-CKD patients, CKD patients were less likely to receive fibrinolytic therapy than non-CKD patients (26.4% vs. 38.9%, P<0.001), more likely to experience a failed fibrinolytic therapy (32.8% vs. 16.9%), and had a higher risk of short-term MACEs (19.7% vs. 5.6%). After full adjustment, use of fibrinolytic therapy was associated with a significantly lower risk of short-term MACEs in non-CKD patients (relative risk [RR] = 0.87, 95% confidence interval [CI]: 0.76-0.99), but not in CKD patients (P for interaction = 0.026). Further analysis stratified by the success of fibrinolysis showed that compared with patients who did not receive fibrinolytic therapy, patients with successful fibrinolysis had a lower risk of short-term MACEs that was similar between patients with (RR = 0.71, 95% CI: 0.55-0.82) and without CKD (RR = 0.67, 95% CI: 0.55-0.92), while patients with unsuccessful fibrinolysis had a similarly higher risk in CKD patients (RR = 1.25, 95% CI: 1.09-1.43) and non-CKD patients (RR = 1.30, 95% CI: 1.13-1.50). CONCLUSIONS: CKD reduced the likelihood of successful fibrinolysis and increased the risk of short-term MACEs in patients with STEMI. Attention should be paid to how to improve the success rate of fibrinolytic therapy for STEMI patients with CKD. TRIAL REGISTRATION: The CPACS-3 study was registered on www.clinicaltrials.gov (NCT01398228).

Multidimensional analyses of the effect of exercise on women with depression: A meta-analysis.

BACKGROUND: The proportion of women is higher than men in depression. This is mainly due to women's physiological regulation is different from men, especially in puberty, menstruation, pregnancy, menopause, among others. Therefore, treating depressive women is still a health challenge. Besides, recent studies of exercise therapy have a more outstanding performance in treating depression, especially in contrast to drug therapy and psychotherapy. Its main advantages are convenience, quickness, no side effects, real-time, and long-term effectiveness. OBJECTIVE: The aim of this study was to systematically review the clinical efficacy of exercise on women with depressive symptoms. METHODS: Searching PubMed, The Cochrane Library, and Embase databases to collect randomized controlled trials about exercise in the treatment of depressive women. After literature screening, data extraction, and literature quality evaluation, the meta-analysis of acquirement data was performed with RevMan5.3 software. RESULTS: A total of 2294 patients were included in 25 different articles totally. Meta-analysis shows that compared with the control group, exercise could relieve female depression (standard mean difference [95% confidence interval, CI] = -0.64 [-0.89 to -0.39], Z = 4.99, P < .001). Subgroup analysis shows that different types of exercise have significant effects in improving depression symptoms. Exercise therapy has better effect on depressive patients induced by physiology or disease than ordinary depressive patients. CONCLUSION: Exercise can significantly improve depressive symptoms in women.

Thromboembolic and bleeding risk of periprocedural bridging anticoagulation: A systematic review and meta-analysis.

The risk and benefit of periprocedural heparin bridging is not completely clarified. We aimed to assess the safety and efficacy of bridging anticoagulation prior to invasive procedures or surgery. Heparin bridging was associated with lower risks of thromboembolism and bleeding compared to non-bridging. PubMed, Ovid and Elsevier, and Cochrane Library (2000-2016) were searched for English-language studies. Studies comparing interrupted anticoagulation with or without bridging and continuous oral anticoagulation in patients at moderate-to-high thromboembolic risk before invasive procedures were included. Primary outcomes were thromboembolic events and bleeding events. Mantel-Haenszel method and random-effects models were used to analyze the pooled risk ratio (RR) and 95% confidence interval (CI) for thromboembolic and bleeding risks. Eighteen studies (six randomized controlled trials and 12 cohort studies) were included (N = 23 364). There was no difference in thromboembolic risk between bridged and non-bridged patients (RR: 1.26, 95% CI: 0.61-2.58; RCTs: RR: 0.71, 95% CI: 0.23-2.24; cohorts: RR: 1.45, 95% CI: 0.63-3.37). However, bridging anticoagulation was associated with higher risk of overall bleeding (RR: 2.83, 95% CI: 2.00-4.01; RCTs: RR: 2.24, 95% CI: 0.99-5.09; cohorts: RR: 3.09, 95% CI: 2.07-4.62) and major bleeding (RR: 3.00, 95% CI: 1.78-5.06; RCTs: RR: 2.48, 95% CI: 1.29-4.76; cohorts: RR: 3.22, 95% CI: 1.65-6.32). Bridging anticoagulation was associated with increased bleeding risk compared to non-bridging. Thromboembolism risk was similar between two strategies. Our results do not support routine use of bridging during anticoagulation interruption.

[Experience in treatment of Eisenmenger's syndrome by heart-lung transplantation].

OBJECTIVE: To summarize the experience in treatment of Eisenmenger's syndrome by heart-lung transplantation (HLT). METHODS: Two cases of congenital heart disease with Eisenmenger's syndrome, aged 20 and 22, underwent bicaval orthotopic HLT. Modified St. Thomas cardioplegic solution and modified LPD solution were used to preserve the donor heart and lung. After removing the heart and lung of the recipient and thorough hemostasis in thoracic cavity and mediastinal septum, the donor heart and lung was implanted, and trachea, superior/inferior vena cava and aortic artery were anastomosed gradually. Intensive care against infection, rejection and other complications were performed after operation. RESULTS: The operations were successful. Tracheal anastomotic stenosis happened in one case seven months after HLT and was cured by sleeve resection of the stenosed trachea segment. Acute rejection happened in one case 10 days after HLT and was cured by stoss therapy. Both patients recovered to normal life and work. CONCLUSION: The success of HLT is related to perfect organ preservation, precise surgical performance and proper peri-operative treatment.

Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd:YAG 1064-nm Laser Combined with Itraconazole.

BACKGROUND: Onychomycosis is a fungal infection of the nail plate and subungual area. In this study, we examined the efficacy of laser treatment using self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser combined with oral medication. METHODS: Self-controlled strategies were followed in this study. The patients received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG 1064-nm laser treatment at the nails of the unilateral limb once a week for a total of four times. A total of 84 affected nails were divided into Group A (mild to moderate) and Group B (severe) according to disease severity. Affected nails with the same Scoring Clinical Index for Onychomycosis scores were selected to compare the therapeutic effects of the pure medication treatment group and the combination treatment group with a 24-week follow-up period. RESULTS: In Group A, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%, respectively, while those in the combination treatment group were 100%, 95.2%, and 90.5%, respectively. The differences between groups were not significant (8th week: χ2 = 4.421, P> 0.05; 16th week: χ2 = 2.043, P> 0.05; 24th week: χ2 = 0.00, P > 0.05). In Group B, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%, respectively, while those in the combination treatment group were 95.2%, 90.5%, and 100%, respectively. The differences between groups at the 8th and 24th weeks of follow-up were statistically significant (8th week: χ2 = 6.929, P< 0.05; 24th week: χ2 = 13.125, P < 0.05). CONCLUSIONS: For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.

Changes in serum alanine aminotransferase levels in telbivudine versus lamivudine treatment for chronic hepatitis B: a meta-analysis.

OBJECTIVE: A meta-analysis to compare the efficacy and safety of telbivudine (TBV) and lamivudine (LAM) in patients with chronic hepatitis B (CHB), assessed via changes in serum alanine aminotransferase (ALT) levels. METHOD: The electronic literature databases PubMed®, Embase®, Web of Science, Cochrane Library, CISCOM, CINAHL, Google Scholar, China BioMedicine and China National Knowledge Infrastructure were searched for relevant studies. The effect of TBV and LAM treatment on serum ALT was assessed using standard mean differences (SMDs) and 95% confidence intervals (CI). RESULTS: The meta-analysis included six studies (TBV n = 202; LAM, n = 208). Post-treatment ALT levels were significantly lower than pretreatment values for both TBV and LAM (TBV: SMD = 3.00, 95%CI 1.91, 4.09; LAM: SMD = 2.33, 95%CI 1.58, 3.07). Post-treatment ALT was significantly lower after treatment with TBV than LAM (SMD = 0.58, 95%CI 0.21, 0.94). CONCLUSION: Both LAM and TBV are effective in normalizing ALT levels in patients with CHB, but TBV may be a better choice due to its lower rates of drug resistance.

Catheter ablation of idiopathic premature ventricular contractions and ventricular tachycardias originating from right ventricular septum.

BACKGROUND: Idiopathic premature ventricular contractions (PVCs) and ventricular tachycardias (IVTs) originating from the subtricuspid septum and near the His bundle have been reported. However, little is known about the prevalence, distribution, electrocardiographic characteristics and the efficacy of radiofrequency catheter ablation (RFCA) for the ventricular arrhythmias arising from the right ventricular (RV) septum. This study aimed to investigate electrocardiographic characteristics and effects of RFCA for patients with symptomatic PVCs/IVTs, originating from the different portions of the RV septum. METHODOLOGY/PRINCIPAL FINDINGS: Characteristics of body surface electrocardiogram and electrophysiologic recordings were analyzed in 29 patients with symptomatic PVCs/IVTs originating from the RV septum. Among 581 patients with PVCs/IVTs, the incidence of ventricular arrhythmias originating from the RV septum was 5%. Twenty (69%) had PVCs/IVTs from the septal portion of the tricuspid valvular RV region (3 from superoseptum, 15 from midseptum, 2 from inferoseptum), and 9 (31%) from the septal portion of the basal RV (1 from superoseptum, 4 from midseptum, 4 from inferoseptum). There were different characteristics of ECG of PVCs/VT originating from the different portions of the RV septum. Twenty-seven of 29 patients with PVCs/IVTs arising from the RV septum were successfully ablated (93.1% acute success). CONCLUSIONS/SIGNIFICANCE: ECG characteristics of PVCs/VTs originating from the different portions of the RV septum are different, and can help regionalize the origin of these arrhythmias. The septal portion of the tricuspid valvular RV region was the preferential site of origin. RFCA was effective and safe for the PVCs/IVTs arising from the RV septum.