Serum lipids and risk of atherosclerosis in xanthelasma palpebrarum: A systematic review and meta-analysis.

BACKGROUND: The association between dyslipidemia and xanthelasma palpebrarum (XP) remains controversial, and no definite evidence has indicated atherosclerosis risk in patients with XP. OBJECTIVE: The present study was a systematic review and meta-analysis to elucidate the association of serum lipid profiles and risk of atherosclerotic diseases with XP. METHODS: We systematically searched for the eligible comparative studies published before April 15, 2019, in the databases of PubMed, Web of Science, Embase, and Cochrane Library. A random-effects model was used to calculate the standard mean difference with 95% confidence interval for each pooled estimate. RESULTS: The qualitative analyses included 15 case-control studies with 854 patients with XP. Compared with the controls, the patients with XP had significantly higher serum levels of total cholesterol and low-density lipoproteins, significantly higher apolipoprotein B levels, and relatively lower apolipoprotein A1 levels, and the carotid intima-media thickness was significantly higher. CONCLUSION: Patients with XP had significantly higher serum levels of atherogenic low-density lipoproteins and bore significantly higher risk of atherosclerosis than the controls. Careful monitoring and targeted intervention for prevention of cardiovascular diseases is essential for these patients.

Comparison of Chemical Matricectomy with Trichloroacetic Acid, Phenol, or Sodium Hydroxide for Ingrown Toenails: A Systematic Review and Network Meta-Analysis.

is missing (Short communication).

Efficacy of Autologous Platelet-Rich Plasma Combined With Ablative Fractional Carbon Dioxide Laser for Acne Scars: A Systematic Review and Meta-Analysis.

BACKGROUND: Acne scars are common and challenging clinical complications of acne vulgaris. Ablative fractional carbon dioxide (CO2) laser is a well-established treatment for acne scars; however, some postlaser adverse effects have been noted. Autologous platelet-rich plasma (PRP) can improve tissue regeneration. Several studies have investigated the efficacy of combination therapy of CO2 laser and PRP for acne scars. OBJECTIVES: The authors sought to conduct a meta-analysis of the efficacy of PRP combined with ablative fractional CO2 laser for treating acne scars by examining clinical trial results. METHODS: A systematic review was performed by searching PubMed, Embase, Cochrane Library, and Web of Science, and a meta-analysis was conducted to assess the clinical outcomes after combination therapy of PRP and ablative fractional CO2 laser compared with laser alone. RESULTS: We identified 4 eligible studies for the meta-analysis, including 3 randomized controlled trials. Our results demonstrated that clinical improvement after combination therapy was significantly higher than that after laser alone (odds ratio = 2.992, P = 0.001). Regarding major side effects, patients who underwent combination therapy experienced significantly shorter duration of crust compared with CO2 laser alone (standard mean difference = -1.140, P < 0.001); relatively shorter durations of erythema and edema were also noted after combination therapy. Furthermore, patient satisfaction rates were significantly higher after combination therapy than after laser alone (odds ratio = 3.169, P = 0.002). CONCLUSIONS: The combination of autologous PRP and ablative fractional CO2 laser has synergistic positive effects on the clinical outcomes for acne scars and can accelerate the recovery of laser-damaged skin.

The impact of obstructive sleep apnea on high-sensitivity C-reactive protein in subjects with or without metabolic syndrome.

BACKGROUND: It is unclear whether obstructive sleep apnea (OSA) is independently associated with increased levels of the acute-phase reactant C-reactive protein (CRP). The purpose of this study was to evaluate the relationship between OSA and high-sensitivity CRP (hs-CRP) levels according to the presence or absence of metabolic syndrome (MetS). METHODS: This study recruited 245 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test, blood lipids examination, and hs-CRP. Severity of OSA was categorized according to the apnea-hypopnea index (AHI). RESULTS: Subjects were categorized into severe OSA group (n = 44; 17.9 %), moderate and mild OSA group (n = 117; 47.8 %), and non-OSA group (n = 84; 34.3 %). AHI had a significant association with hs-CRP (ß = 0.125, p = 0.009) adjusting for age, smoking, drinking, and MetS status. Hs-CRP was elevated with severe OSA (ß = 0.533, p = 0.005) even adjusting for BMI and MetS. Moreover, there was an independent effect for adjusted odds ratios (AORs) between the stratification of the severity for OSA and MetS. CONCLUSION: Elevated hs-CRP level is associated with severe OSA, independent of known confounders. The effect of OSA in CRP is independent of MetS was identified.

Effect of nanoparticles exposure on fractional exhaled nitric oxide (FENO) in workers exposed to nanomaterials.

Fractional exhaled nitric oxide (FENO) measurement is a useful diagnostic test of airway inflammation. However, there have been few studies of FENO in workers exposed to nanomaterials. The purpose of this study was to examine the effect of nanoparticle (NP) exposure on FENO and to assess whether the FENO is increased in workers exposed to nanomaterials (NM). In this study, both exposed workers and non-exposed controls were recruited from NM handling plants in Taiwan. A total of 437 subjects (exposed group = 241, non-exposed group = 196) completed the FENO and spirometric measurements from 2009-2011. The authors used a control-banding (CB) matrix to categorize the risk level of each participant. In a multivariate linear regression analysis, this study found a significant association between risk level 2 of NP exposure and FENO. Furthermore, asthma, allergic rhinitis, peak expiratory flow rate (PEFR), and NF-κB were also significantly associated with FENO. When the multivariate logistic regression model was adjusted for confounders, nano-TiO2 in all of the NM exposed categories had a significantly increased risk in FENO > 35 ppb. This study found associations between the risk level of NP exposure and FENO (particularly noteworthy for Nano-TiO2). Monitoring FENO in the lung could open up a window into the role nitric oxide (NO) may play in pathogenesis.

A simple therapeutic approach to pincer nail deformity using a memory alloy: measurement of response.

BACKGROUND: Pincer nail deformity (PND) is a dystrophy characterized by transverse overcurvature of the nail plate that may cause intractable pain and decrease the quality of life of patients. OBJECTIVES: To evaluated the efficacy of a superelastic nickel-titanium (SE NiTi) wire for the treatment of PND using transverse curvature improvement and subjective assessment of pain relief during and after the treatment. METHODS: SE NiTi wire was implanted over the distal tip of the nail for the treatment of PND in 43 patients (28 female, 15 male), with a total of 73 digits receiving treatment. Evaluations of improvement included measuring changes in transverse curvature of the nail and subjective assessment of pain relief throughout the follow-up period. RESULTS: In all patients, treatment of the pincer nail with implantation of SE NiTi wire achieved satisfactory results. Significant improvement (p < .05) of the transverse overcurvature of the nail was seen in all patients at 2 months, and relief of pain was determined in 100% of cases throughout our follow-up period. CONCLUSION: This simple SE NiTi wire insertion method is noninvasive and inexpensive, leaves no cosmetic disfigurement, and leads to excellent therapeutic results. Patients achieved great satisfaction. Thus, this technique should be considered the first line of treatment in the correction of mild to moderate PND.

A Review of the Systemic Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are uncommon but life-threatening diseases mostly caused by drugs. Although various systemic immunomodulating agents have been used, their therapeutic efficacy has been inconsistent. This study aimed to provide an evidence-based review of systemic immunomodulating treatments for SJS/TEN. We reviewed 13 systematic review and meta-analysis articles published in the last 10 years. The use of systemic corticosteroids and IVIg is still controversial. An increasing number of studies have suggested the effectiveness of cyclosporine and biologic anti-TNF-α in recent years. There were also some promising results of combination treatments. Further large-scale randomized controlled trials are required to provide more definitive evidence of the effectiveness of these treatments. The pathogenesis of SJS/TEN has been elucidated in recent years and advances in the understanding of SJS/TEN may inspire the discovery of potential therapeutic targets.

An engineering intervention resulting in improvement in lung function and change in urinary 8-hydroxydeoxyguanosine among foundry workers in Taiwan.

PURPOSE: To assess changes in oxidative DNA damage and lung function amongst a group of foundry workers resulting from an engineering intervention to reduce air respirable dust in their working environment. METHODS: We studied all 22 workers recruited from a typical small Taiwanese iron foundry plant before and 3 months after improvements to air exhaust control. The effectiveness of the air exhaust intervention in reducing respirable dust and SiO2 was determined by personal breathing-zone air sampling. Initial baseline biomarker measurements were taken of lung function and urinary 8-hydroxy-deoxyguanosine (8-OHdG) in all of the workers, with follow-up measurements taken 3 months after the engineering control was put in place. Generalized estimating equations were used to assess the effect of the intervention on lung function and oxidative DNA damage. RESULTS: Following the intervention, respirable dust density decreased from 2.87 ± 1.38 mg/m³ to 1.60 ± 0.70 mg/m³ (p = 0.07), and SiO2 concentration decreased from 0.43 ± 0.25 mg/m³ to 0.18 ± 0.11 mg/m³ (p < 0.05). Compared to initial baseline, significant improvements were found in lung function (FVC, FEV1, FVC%pred and FEV1%pred) amongst the workers after the engineering intervention. A significant increase in concentration of urinary 8-OHdG was observed after the engineering intervention in smokers, but not in non-smokers. CONCLUSIONS: These findings indicate that reductions in workplace respirable dust and SiO2 concentration can result in improved lung function amongst foundry workers.

Efficacy of autologous whole blood or serum therapy for chronic spontaneous urticaria: a systematic review and meta-analysis.

Background: Chronic spontaneous urticaria (CSU) is chronic wheals without identifiable exogenous stimuli. Autologous whole blood (AWB) injection and autologous serum therapy (AST) are alternative therapies for CSU that induce tolerance to circulating histamine-releasing factors. Objective: We elucidated currently available evidence for the efficacy and safety of AWB therapy and AST for CSU. Methods: We systematically searched four databases for eligible studies to perform meta-analysis. The primary outcome was the efficacy of AST or AWB therapy, and the secondary outcome was improvement after intervention based on the autologous serum skin test (ASST) status of patients. Results: Eight clinical trials, including four randomized controlled trials and 529 CSU patients, were identified. AST was not more effective than the placebo treatment in alleviating CSU symptoms at the end of treatment (p = .161), and AWB injection was also not more effective in response rates than the placebo at the end of follow-up (p = .099). Furthermore, the efficacy of AST or AWB injection for CSU and the ASST status were not significantly related. No remarkable adverse events were recorded during therapy. Conclusions: Our meta-analysis suggested that AWB therapy and AST are not significantly more effective in alleviating CSU symptoms than the placebo treatment.

The efficacy of oral acyclovir during early course of pityriasis rosea: a systematic review and meta-analysis.

BACKGROUND: Acyclovir has been reported as a potential therapy for pityriasis rosea (PR) in several clinical trials on the basis of evidence of the involvement of human herpes viruses 6 and 7. OBJECTIVE: We evaluated the efficacy of acyclovir for abating PR skin lesions within a fixed period. METHODS: We searched 4 databases for clinical trials that used oral acyclovir to treat PR and performed systematic review and meta-analysis to determine oral acyclovir's effect on skin lesions on the 14th day after commencing treatment. RESULTS: Five clinical trials including four randomized controlled trials were identified that compared the effects of oral acyclovir (n = 133) and nonacyclovir (n = 140) in patients with PR. Oral acyclovir significantly reduced erythema (odds ratio [OR] 11.30; 95% CI = 5.70-22.41; p < .01) and limited lesion formation (OR 8.67; 95% CI = 3.29-22.81; p < .01) compared with nonacyclovir treatment on the 14th day. These results were in agreement with the results of subgroup analysis of only high-dose oral acyclovir treatment and randomized controlled trials. CONCLUSION: Oral acyclovir may be a relatively safe and effective treatment in the early course of PR, and patients with PR may achieve faster symptoms control with acyclovir.

Mass, number and surface area concentrations of alpha-quartz exposures of refractory material manufacturing workers.

This study set out to assess the respirable mass, surface area, and number concentrations of the alpha-quartz content particles (C(r-m), C(r-s) and C(r-n)) to which workers were exposed in six different exposure groups, the raw material handling (n=10), crushing (n=12), mixing (n=12), forming (n=10), furnace (n=10), and packaging (n=10), in a refractory material manufacturing plant. For C(r-m), the exposure values in sequence were found as: mixing (68.1 microg/m3)>packaging (55.9 microg/m3)>raw material handling (53.3 microg/m3)>furnace (31.0 microg/m3)>crushing (29.8 microg/m3)>forming (22.4 microg/m3). We also found that ~21.2-68.2% of the above Cr-m exceeded the current TLV-TWA for the alpha-quartz content (50 microg/m3) suggesting a need for initiating control strategies immediately. We further conducted particle size-segregating samplings in four workplaces: crushing (n=3), mixing (n=3), forming (n=3), and furnace (n=3). We found that all resultant particle size distributions shared a quite similar geometric standard deviation (sigma(g); =2.24-2.92), but the process area, associated with higher mechanical energy (i.e., crushing process), contained finer alpha-quartz content particles (mass median aerodynamic diameter; MMAD=3.22 microm) than those areas associated with lower mechanical energy (i.e., mixing, forming, and furnace; MMAD=6.17, 5.95, and 8.92 microm, respectively). These results gave a ratio of C(r-m) in the above four exposure groups (i.e., crushing: mixing: forming: furnace=1.00: 2.30: 0.753: 1.04) which was quite different from those of C(r-s) (1.00: 1.74: 0.654: 0.530) and C(r-n) (1.00: 1.27: 0.572: 0.202). Our results clearly indicate the importance of measuring particle size distributions for assessing workers' free silica exposures.

Usefulness of overnight pulse oximeter as the sleep assessment tool to assess the 6-year risk of road traffic collision: evidence from the Taiwan Bus Driver Cohort Study.

Background: In order to support health service organizations in arranging a system for prevention of road traffic collisions (RTC), it is important to study the usefulness of sleep assessment tools. A cohort study was used to evaluate the effectiveness of subjective and objective sleep assessment tools to assess for the 6-year risk of both first RTC event only and recurrent RTC events. Methods: The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1650 professional drivers from a large bus company in Taiwan in 2005. The subjects were interviewed in person, completed the sleep assessment questionnaires and had an overnight pulse oximeter survey. Moreover, this cohort of drivers was linked to the National Traffic Accident Database (NTAD) and researchers found 139 new RTC events from 2005 to 2010. Primary outcomes were traffic collisions from NTAD, nocturnal oxygen desaturation index (ODI) from pulse oximeter, Pittsburg sleeping quality score, Epworth daytime sleepiness score, Snore Outcomes Survey score and working patterns from questionnaires. A Cox proportional hazards model and an extended Cox regression model for repeated events were performed to estimate the hazard ratio for RTC. Results: The RTC drivers had increased ODI4 levels (5.77 ± 4.72 vs 4.99 ± 6.68 events/h; P = 0.008) and ODI3 levels (8.68 ± 6.79 vs 7.42 ± 7.94 events/h; P = 0.007) in comparison with non-RTC drivers. These results were consistent regardless of whether ODI was evaluated as a continuous or a categorical variable. ODI4 and ODI3 levels increased the 6-year RTC risks among professional drivers even after adjusting for age, education, history of cardiovascular disease, caffeine intake, sleeping pills used, bus driving experience and shift modes. Moreover, there was an increased trend for ODI between the stratification of the number of RTCs in comparison with the non-RTC group. In the extended Cox regression models for repeated RTC events with the Anderson and Gill intensity model and Prentice-Williams-Petersen model, measurement of ODI increased hazards of the subsequent RTC events. Conclusion: This study showed that an increase in the 6-year risk of RTC was associated with objective measurement of ODI for a sign of sleep-disordered breathing (SDB), but was not associated with self-reported sleeping quality or daytime sleepiness. Therefore, the overnight pulse oximeter is an effective sleep assessment tool for assessing the risk of RTC. Further research should be conducted regarding measures to prevent against SDB among professional drivers.

Epidemiologic characteristics and outcomes of major trauma patients requiring prolonged mechanical ventilation.

The epidemiologic characteristics and outcomes of severe trauma patients requiring prolonged mechanical ventilation (PMV) remain unclear. This retrospective study aims to investigate the outcomes of PMV in this specific group. All patients with major trauma admitted to the respiratory care center (RCC) requiring PMV (duration ≥21 days between January 2014 and December 2016) were enrolled. A total of 36343 trauma patients visited our emergency department for management, and 1388 (3.82%) were admitted to the intensive care unit (ICU) after initial resuscitation. After ICU management, 93 major trauma patients required PMV, and were then transferred to the RCC. Their mean age of these 93 patients was 68.6 ±â€Š18.3 years and 65 patients (70.0%) were older than 65 years. Head/neck trauma (n = 78, 83.9%) were the most common injury, followed by thoracic trauma (n = 30, 32.2%), and extremity trauma (n = 29, 31.2%). Their median injury severity score was 25 (interquartile range [IQR] 16-27). The median length of hospital stay was 50 days (IQR, 39-62). Six patients died of ventilator-associated pneumonia for an in-hospital morality rate of 6.5%. In addition, 11 PMV patients became mechanical ventilator-dependent and were transferred to the respiratory care ward for further long-term care. In conclusion, <0.3% of trauma patients required PMV, and their in-hospital mortality rate was only 6.5%. Ventilator-associated pneumonia was the main cause of death and nosocomial infections were common in patients with long-term mechanical ventilator dependence.