Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis: a systematic review and Meta-analysis.

OBJECTIVE: To assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) combined with sodium hyaluronate (HA) for the treatment of knee osteoarthritis (KOA). METHODS: PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, and SinoMed were searched from inception to July 2020. The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews. The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis. The heterogeneity among the articles was evaluated using I2. RESULTS: A total of 17 studies, comprising 2000 individuals, were included in this Meta-analysis. The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA. Statistical analysis of clinical efficacy showed that [relative risk (RR) = 1.21, 95% confidence interval (CI) (1.12, 1.30), P < 0.01]. Statistical analysis of visual analog scale showed that [standardized mean difference (SMD) = －2.84, 95%CI (－4.01, －1.66), P < 0.01]. Western Ontario and McMaster University osteoarthritis index statistical analysis showed that [SMD = －1.57, 95% CI (－2.52, －0.61), P < 0.01]. Lysholm score statistical analysis showed that [SMD = 1.71, 95% CI (0.98, 2.44), P < 0.01]. In addition, only minor side effects, such as redness and swelling of the skin, were observed. CONCLUSIONS: Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive, well-tolerated, safe, and effective method to improve pain and functionality in patients with KOA. However, tightly controlled, randomized, large multicenter trials are warranted to validate the current findings.

Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications.

Background: Stigma related to mental illness (and its treatment) is prevalent worldwide. This stigma could be at the structural or organizational level, societal level (interpersonal stigma), and the individual level (internalized stigma). Vulnerable populations, for example, gender minorities, children, adolescents, and geriatric populations, are more prone to stigma. The magnitude of stigma and its negative influence is determined by socio-cultural factors and macro (mental health policies, programs) or micro-level factors (societal views, health sectors, or individuals' attitudes towards mentally ill persons). Mental health stigma is associated with more serious psychological problems among the victims, reduced access to mental health care, poor adherence to treatment, and unfavorable outcomes. Although various nationwide and well-established anti-stigma interventions/campaigns exist in high-income countries (HICs) with favorable outcomes, a comprehensive synthesis of literature from the Low- and Middle-Income Countries (LMICs), more so from the Asian continent is lacking. The lack of such literature impedes growth in stigma-related research, including developing anti-stigma interventions. Aim: To synthesize the available mental health stigma literature from Asia and LMICs and compare them on the mental health stigma, anti-stigma interventions, and the effectiveness of such interventions from HICs. Materials and Methods: PubMed and Google Scholar databases were screened using the following search terms: stigma, prejudice, discrimination, stereotype, perceived stigma, associate stigma (for Stigma), mental health, mental illness, mental disorder psychiatric* (for mental health), and low-and-middle-income countries, LMICs, High-income countries, and Asia, South Asian Association for Regional Cooperation/SAARC (for countries of interest). Bibliographic and grey literature were also performed to obtain the relevant records. Results: The anti-stigma interventions in Asia nations and LMICs are generalized (vs. disorder specific), population-based (vs. specific groups, such as patients, caregivers, and health professionals), mostly educative (vs. contact-based or attitude and behavioral-based programs), and lacking in long-term effectiveness data. Government, international/national bodies, professional organizations, and mental health professionals can play a crucial in addressing mental health stigma. Conclusion: There is a need for a multi-modal intervention and multi-sectoral coordination to mitigate the mental health stigma. Greater research (nationwide surveys, cultural determinants of stigma, culture-specific anti-stigma interventions) in this area is required.

Proteomic and bioinformatic analysis of human endometrium from polycystic ovarian syndrome with and without insulin resistance.

Objective: The aim of this study was to investigate the endometrial proteomic profiles of patients with polycystic ovary syndrome (PCOS) with and without insulin resistance (IR). Method of Study: We collected 40 endometrial samples, including PCOS-IR (n = 21), PCOS-non-IR (n = 12), and control (n = 7). Data-independent acquisition (DIA)-based proteomics method is used to identify the expressed proteins among the three groups. The correlation between pregnancy outcomes and identified proteins was analyzed by Lasso regression. Results: A total of 5331 proteins were identified, while 275 proteins were differentially expressed in the PCOS vs. control group and 215 proteins were differentially expressed in the PCOS-IR vs. PCOS-non-IR group. Platelet degranulation, neutrophil degranulation, and very long-chain fatty acid catabolic processes have been found to play important roles in the endometrium of patients with PCOS-IR. Lasso regression analysis found that ACTR1A, TSC22D2, CKB, ABRAXAS2, and TAGLN2 were associated with miscarriage in patients with PCOS. ACTR1A and CKB were higher in the PCOS-IR group and were positively correlated with HOMA-IR (p < .05). Conclusion: In this study, a panel of proteins was found to be differently expressed in the endometrium. ACTR1A and CKB may be considered as PCOS-IR candidate biomarkers.

Factors Associated With Preference of Psychological Intervention and Mental Status Among Chinese Teachers During Coronavirus Disease 2019: A Large Cross-Sectional Survey.

Aims: The authors sought to explore the psychological distress of teachers during COVID-19 pandemic and their preference for psychological intervention. The overarching goal was to gain insight on how to build an effective psychological support system for teachers during and after the pandemic. Methods: The mental health condition of teachers (N = 18,521) was assessed online by using a questionnaire consisting of standard instruments PHQ-15, GAD-7, PHQ-2, PC-PTSD, and additional questions about sleep disturbance, suicidality and preference of psychological intervention methods. Results: 35.5% of Chinese teachers reported sleep disturbance, 25.3% complained somatic discomfort, 17.7% had anxiety symptoms, 4.0% had depression, 2.8% had self-injury or suicidal thoughts. Women are more likely to have somatic symptoms, sleep disturbance and depression. There were age differences for anxiety, somatic symptoms and suicidal thoughts. High percentages of university teachers reported moderate to severe anxiety, somatic symptoms, depression and sleep disturbance. The most preferred psychological intervention is the self-practice of stress management skills (N = 11,477, 62.0%). Teachers with moderate and severe symptoms are more likely in need of hotline and online counseling and those with serious suicidal thoughts are three times more likely to use a telephone hotline. Conclusions: During the COVID-19 outbreak, the major reported psychological distresses among Chinese teachers are anxiety, sleep disturbance and somatic symptoms. There were gender, age and school setting differences. Females, teachers over 45 years old and those who work at universities tend to be more vulnerable. Different teachers chose different interventions, mostly based on the severity of their symptoms.

Minimizing the risk to human health due to the ingestion of arsenic and toxic metals in vegetables by the application of biochar, farmyard manure and peat moss.

Mining activity releases toxic metals (TMs) into the soil ecosystem and creates serious problems for the environment and human beings due to their adverse eco-toxilogical impacts. Currently, several remediation techniques can be used to immobilize TMs within contaminated soil. The present study focuses on the application of different organic amendments biochar (B), farmyard manure (FYM) and peat moss (PTM) - at different application rates (1%, 2% and 5%) in mining-impacted agricultural soil to immobilize TMs (Ni, Cr, As, Zn, Cd and Pb) and minimize their bioaccumulation in pea (Pisum sativum) and chili (Capsicum annuum) and the associated human health risk. Among the organic amendments, the treatments at the 5% application rate of B, FYM and PTM significantly (p ≤ 0.001) reduced the bioavailability of TM concentrations in amended soil and increased pea and chili plants' and fruits' biomasses when compared with the control. Moreover, risk assessments showed that B, FYM and PTM decreased the daily intake and health risk associated with the consumption of vegetables effectively for individual TMs compared with the control. The highest application rate of 5% significantly (p ≤ 0.001) reduced the average daily intake of TMs and their health risk, as compared to 1% and 2%, for both adults and children. The health risk index (HRI ˂ 1) values were lower (and within safety limits) for adults and children consuming vegetables grown on organic-amended soils. The results indicate that the B5% treatment of this mining-impacted agricultural soil was the most efficient at increasing plant and fruit biomasses and reducing the bioavailability, bioaccumulation and daily intake of TMs and their potential health risk through consumption of vegetables such as pea and chili, as compared to FYM, PTM and the control treatment.

Ecological and health risk assessment of potentially toxic elements in the major rivers of Pakistan: General population vs. Fishermen.

Large amounts of potentially toxic elements (PTEs) have, and continue to be, released into the freshwater ecosystems of Pakistan. However, there is limited information available on the ecological risk of PTEs from sediments and fish consumption, for both the general population and fishermen, at the national scale in Pakistan. In this study, water, sediments and fish samples were collected from major rivers (Chenab, Upper Indus, Lower Indus and Kabul) across Pakistan and analyzed through Inductively Coupled Plasma Mass Spectrometer (ICP-MS), Inductively Coupled Plasma Atomic Emission Spectroscopy ICP-AES and Atomic Fluorescence Spectrometry (AFS), respectively. Ecological risk analysis of sediments revealed that Cd posed a high ecological risk in the Upper Indus and Chenab, a considerable risk in the Lower Indus, and moderate risk in the Kabul. The target hazard quotient of As through fish tissue consumption exceeded safety levels for fishermen at all the rivers, where Cd exceeded at Upper Indus and Chenab, and Pb for Chenab fishermen only. For the general population, PTE ingestion through fish tissues was within the safety limits at all rivers. Meanwhile, the total target hazard quotient in all three rivers exceeded the safety limit, representing a high risk for the fishermen of Pakistan. The results show that ecological risk and target hazard quotient assessment not only provides valuable information for future research in terms of PTE contamination in the major rivers of Pakistan, but also all the metal pollutants from rivers finally reach to Arabian Sea, therefore might pose a risk to marine ecosystem at national and international scale.

Levels, dietary intake, and health risk of potentially toxic metals in vegetables, fruits, and cereal crops in Pakistan.

Food safety is a major concern worldwide and human beings are frequently exposed to potentially toxic metals (PTMs) through consumption of vegetables, fruits, and cereal crops grown in contaminated areas. The present study investigates the concentrations of PTMs such as chromium (Cr), nickel (Ni), zinc (Zn), arsenic (As), cadmium (Cd), and lead (Pb) in the foodstuffs (fruits, vegetables, and cereals) collected from different markets of Khyber Pakhtunkhwa, Pakistan. Samples of fruits (banana, tangerine, apple, and guava), vegetables (tomato, onion, potato, pea, and lady finger), and cereals (rice, kidney beans, and chick peas) were acid-extracted and analyzed using ICP-MS. The concentrations of Cr, Zn, Pb, As, and Cd in fruits (54, 50, 50, 45, and 4% samples, respectively), vegetables (53, 43, 63, 80, and 46%), and cereals (37, 62, 25, 70, and 25%) exceeded their respective permissible limits set by FAO/WHO (2001). The results showed that the highest mean concentration was observed for Ni (14.95 mg/kg), Pb (0.57 mg/kg), and Cd (0.27 mg/kg) in vegetables followed by fruits and cereals. However, the highest mean concentration of As (0.44 mg/kg) was observed in cereal crops followed by vegetables and fruits. The individual health risk of PTMs via consumption of fruits, vegetables, and cereals were found within safe limits for adults and children. Nevertheless, the total HRI values (fruits + vegetables + cereals) for Ni, As, and Cd for both adults and children were observed > 1 and may posed potential risk for the community consuming these foodstuffs on a daily basis. Graphical abstract ᅟ.

Attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments.

The aim of this study was to investigate the attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. A questionnaire designed to record attitudes toward the current forensic psychiatric assessment procedures and the disposal of mentally ill offenders was developed and distributed via a mobile App. A total of 134 community members and 132 psychiatrists voluntarily completed the questionnaire. Most of responders agreed that the department of public-security has the right to apply for a forensic psychiatric assessment but should not be held solely by that department. Community members were less significantly confident in the validation of forensic psychiatric opinions than were the psychiatrists. A significantly higher proportion of community members than psychiatrists considered that offenders judged Not Criminally Responsible on Account of Mental Disorder (NCRMD) should be punished as would be sane people. In addition, only a minority of responders supported that NCRMD should not be held criminally responsible. Our results indicate that both groups have comments on the current distribution of right of startup of forensic psychiatric assessments. Compared to psychiatrists, community members have lower confidence in the validation of forensic psychiatric assessment and have stricter attitudes toward the disposal of offenders with psychiatric disorders.

Fabrication of metallic nanopatterns with ultrasmooth surface on various substrates through lift-off and transfer process.

The smooth surface of the metallic nanostructure is essential for the propagation of surface plasmon polaritons. In this paper, we present a novel method to fabricate the metallic nanopatterns with ultra-smooth surface on various substrates. By using a silica film as the sacrificial layer, we show that the prefabricated metallic nanopatterns produced by electron beam lithography and film deposition can be hydrolyzed and transferred onto a designated substrate. The ultra-smooth surface morphology of nanopatterns has been characterized and verified by scanning electron microscopy and atomic force microscopy. More importantly, we demonstrate that this method can successfully produce a variety of nanostructures with high product yield, even onto the uneven substrate. The results indicate that our proposed method is a promising and versatile means to fabricate multiplicate smooth metallic nanostructure on various substrates for the application of nanophotonic devices.

Electro-acupuncture versus sham electro-acupuncture for auditory hallucinations in patients with schizophrenia: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of electro-acupuncture with that of sham electro-acupuncture for auditory hallucinations in patients with schizophrenia partially responsive or non-responsive to risperidone. DESIGN: Patient- and assessor-blinded randomized controlled trial. SETTING: Hospital-based practice. PARTICIPANTS: Schizophrenia patients with auditory hallucinations who are partially responsive or non-responsive to risperidone monotherapy (n = 60). INTERVENTIONS: All patients were randomly allocated to a real electro-acupuncture group or a sham electro-acupuncture group and treated for 30 sessions within six weeks. MAIN OUTCOME MEASURES: The primary outcome measure was the Psychotic Symptom Rating Scales Auditory Hallucination Subscale. Secondary outcomes included the Positive and Negative Syndrome Scale and side-effects. A clinical response was defined as >20% reduction score (from baseline) on the total score of the Psychotic Symptom Rating Scales Auditory Hallucination Subscale. RESULTS: Sixty patients were selected for randomized real electro-acupuncture treatment (n = 30) or sham electro-acupuncture treatment (n = 30). Patients in the real electro-acupuncture group experienced greater improvement in the Psychotic Symptom Rating Scales Auditory Hallucination Subscale total score, physical characteristics factor score and the Positive and Negative Syndrome Scale positive symptom score than the sham electro-acupuncture group at both week 4 and week 6. The clinical response rates in the real electro-acupuncture group and sham electro-acupuncture group were 43.3% (n = 30) and 13.3% (n = 30), respectively (chi(2) = 6.648, P =0.027). There was no significance between-group difference in side-effects. CONCLUSION: Electro-acupuncture might provide improvement in auditory hallucinations and positive symptom for patients with schizophrenia partially responsive or non-responsive to risperidone monotherapy.