Clinical efficacy of ultrasound-guided stellate ganglion block combined with extracorporeal shock wave therapy on limb spasticity in patients with ischemic stroke.

INTRODUCTION: To observe the clinical efficacy of ultrasound-guided stellate ganglion block (SGB) + extracorporeal shock wave therapy (ESWT) for limb spasticity in patients with ischemic stroke. METHODS: A total of 60 patients with post-stroke limb spasticity in our hospital were selected and randomly divided into four groups (n = 15). In the control group, patients received routine rehabilitation training. Based on routine rehabilitation training, SGB group patients underwent ultrasound-guided SGB, ESWT group patients received ESWT, and SGB + ESWT group patients received ultrasound-guided SGB combined with ESWT. The total treatment course was one month. The Modified Barthel Index (MBI) score, Fugl-Meyer Assessment and upper limb rehabilitation training system were applied to evaluate the activities of daily living, upper limb motor function and upper limb performance before and after treatment. Finally, the improvement after treatment was compared among different groups. RESULTS: After treatment, compared with the control group, the MBI score and the upper limb score based on Fugl-Meyer Assessment in the SGB, ESWT, and SGB + ESWT groups were significantly increased (P < 0.05). Furthermore, compared with the SGB and ESWT groups, SGB + ESWT exhibited a higher upper limb function score (P < 0.05), while the MBI score was not significantly different (P > 0.05). In terms of upper limb performance ability, patients in the SGB, ESWT and SGB + ESWT groups had better fitting degree, participation and exertion of exercise than those in the control group, and the SGB + ESWT group patients had the same movement trajectory as robots. CONCLUSION: Ultrasound-guided SGB and ESWT can reduce the muscle tension of patients, alleviate spasticity, promote the motor function of the upper limb, and improve the working performance of patients. However, the effect of SGB combined with ESWT is better.

Efficacy and Time Sensitivity of Amniotic Membrane treatment in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-analysis.

INTRODUCTION: Diabetic foot ulcers (DFUs) are complex chronic wounds which have a major long-term impact on the morbidity, mortality and quality of patients. The objective of this study was to assess the efficacy and time sensitivity of human amnion/chorion membrane treatment in patients with chronic DFUs. METHODS: The Cochrane Library, PubMed, Embase and Web of Science databases were systematically searched to identify relevant articles up to 10 April 2017. All randomized controlled trials (RCTs) comparing human amnion/chorion membrane + standard therapy and standard therapy alone in patients with DFUs were included in the analysis. Eligible studies were reviewed and data extracted into standard form. The Cochrane Collaboration's tool for assessing the risk of bias was used. Review manager version 5.3 software was used for statistical analysis. Data were analyzed using a random effect model. RESULTS: Overall, the initial search of the four databases identified 352 published studies; of these, seven RCTS were ultimately included in the meta-analysis. The overall test effect in the group assessed at 4 weeks was Z = 4.14 [P < 0.0001; odds ratio (OR) 0.05; 95% confidence interval (CI) 0.01-0.21]. The overall test effect in the group assessed at 6 weeks was Z = 4.28 (P < 0.0001; OR 0.07; 95% CI 0.02-0.23). The overall effect in the group assessed at 12 weeks was Z = 4.96 (P < 0.00001; OR 0.10; 95% CI 0.04-0.24. The results showed that patients receiving amniotic membrane + standard therapy had far fewer incomplete healing wounds than those receiving standard of care alone. Assessment of the wound healing state at 4 and 6 weeks revealed that the wound healing state was almost the same, but there was a net difference of wound healing state at 12 weeks. CONCLUSION: Human amnion/chorion membrane + standard of care treatment heals DFUs significantly faster than standard of care alone. When using the amnion in patients with DFUs, the optimal times to assess progress in wound healing should be 4 and 12 weeks.

Abnormal spontaneous brain activity in type 2 diabetes with and without microangiopathy revealed by regional homogeneity.

PURPOSE: To investigate whether global spontaneous brain activity changes in type 2 diabetes mellitus (T2DM) patients and these changes vary according to the degree of microangiopathy. MATERIALS AND METHODS: T2DM patients with (M(+), n=26) and without (M(-), n=22) microangiopathy as well as 28 healthy nondiabetic subjects were enrolled in this study. All the subjects completed a resting-state functional magnetic resonance imaging (rs-fMRI) examination and neuropsychological assessment. Regional homogeneity (ReHo) values, representing spontaneous brain activity, were calculated and compared between M(+) and M(-) T2DM patients and nondiabetic controls. RESULTS: In both M(+) and M(-) T2DM patients, ReHo values were decreased in the occipital lobe, temporal lobe, postcentral gyrus, and cerebellum, while increased in the bilateral precuneus, superior/middle frontal gyrus, and insula. Compared with the M(-) group, M(+) patients showed decreased ReHo values in the left cuneus and superior occipital gyrus. The ReHo values in the lingual gyrus/calcarine cortex and MTG were related to clinical parameters in T2DM patients. CONCLUSION: The abnormalities of spontaneous brain activity revealed by ReHo values in both M(+)and M(-) T2DM patients may provide insights into the neurological pathophysiology underlying diabetes-related cognitive impairments. M(+) patients showed more decreased brain activity related to severely impaired function of visual processing and visual memory.

[Long-term Performance and Bacterial Community Composition Analysis of AGS-SBR Treating the Low COD/N Sewage at Low DO Concentration Condition].

This study utilized the sequencing batch activated sludge reactor (SBR) inoculated aerobic granular sludge (AGS) to treat the low COD/N ratio (<4.0) domestic wastewater under low DO (0.5-1.0 mg·L-1) concentration condition. Long-term performance of simultaneous nitrogen and phosphorus removal and bacterial community composition of AGS-SBR were studied. The results showed that the AGS-SBR system had good and stable decontamination abilities in its 180-day operation. The average removal rates of COD, NH4+-N, TN and TP were 87.17%, 95.21%, 77.05%, and 91.11%, respectively. At the same time, the AGS showed good settling performance, and always kept its integrated and compact structure. No obvious granular sludge disintegration phenomenon occurred in 180 days. Meanwhile, by using Illumina 16S rRNA gene MiSeq sequencing, we investigated the bacterial abundance in AGS-SBR reactor. Proteobacteria, Firmicutes, Chlorobi, Chloroflex, and Bacteroidetes were the dominant microbial communities in the simultaneous nitrogen and phosphorus removal reactor. Denitratisoma, Planctomycetaceae, Thauera, Comamonas, Nitrosomonas and Nitrospira were suggested to be the primary organisms responsible for the nitrogen removal. Clostridium and Anaerolinea were the main bacterial communities of phosphorus removal.

[Rapid Start-up of Simultaneous Nitrification and Denitrification Coupled Phosphorus Removal Process and Its Performing Characteristics].

In this study, simultaneous nitrification and denitrification (SND) coupled Phosphorus removal process through gradually decreasing DO concentration was investigated by treating wastewater with a low COD/TN ratio (C/N = 3 : 1-4: 1) in a sequencing batch reactor (SBR) inoculated with aerobic granular sludge (AGS). Successful SND coupled Phosphorus phenomenon occurred after 20d at the DO concentration of 0.50-1.0 mg x L(-1). In the following 40 days, the average removal rates of COD, NH4(+) -N, TN and TP were 84.84% , 93.51%, 77.06% and 85.69%, and the NO3(-) -N and NO2(-) -N average accumulations in the effluent were only 4.01 mg x L(-1) and 3.17 mg x L(-1), respectively. The AGS had complete forms and good settling performances, and the sludge volume index (SVI) was about 55.22 mL x g(-1) at the end of starting-up stage. The results of different nitrogen sources showed that the removal rate of TN was in the order of NH4(+) -N > NO2(-) -N > NO3(-) -N, and the removal rate of TP was in the order of NO3(-) -N > NO2(-) -N > NH4(+) -N. The nitrogen and phosphorus removal of wastewater were mainly realized by simultaneous nitrification and denitrification and denitrifying phosphorus removal, respectively.

On the status of ß-cell dysfunction and insulin resistance of breast cancer patient without history of diabetes after systemic treatment.

To estimate the status of ß-cell dysfunction and insulin resistance of breast cancer (BC) patient without history of diabetes mellitus (DM) after systemic treatment through an oral glucose tolerance test (OGTT) and insulin releasing test (IRT). All the 128 BC patients without history of DM after systemic treatment underwent OGTT and IRT test. Fasting and 2-h glucose levels were measured to confirm undiagnosed DM and prediabetes. Insulin sensitivity was estimated by homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index and disposition index (IGI/HOMA-IR). Insulin secretion was estimated by the insulinogenic index (IGI) [Δ insulin/Δ glucose (30-0 min)]. Insulin concentrations during the OGTT and IRT at baseline were used to derive the patterns of insulin secretion curve (pattern 1, pattern 2, pattern 3, pattern 4 and pattern 5), which were used to estimate the risk of developing DM. Of 128 BC patients without history of DM after systemic treatment, there were 46 cases (35.9%) of NGT, 60 cases (46.9%) of prediabetes and 22 cases (17.2%) of DM. The BMI of prediabetes and DM were higher than NGT groups with statistical significance. After adjusted for BMI, IGI was significantly lower in DM group but not significantly different between NGT group and prediabetes group. HOMA-IR, Matsuda index and disposition index were significantly different in DM group compared with NGT group and prediabetes and also significantly different between NGT and prediabetes groups. The total rates of patterns 4 and 5 in NGT and prediabetes groups were 15.3% (10.9 and 4.4%) and 48.3% (31.6 and 16.7%), respectively. ß-Cell dysfunction and insulin resistance may appear in BC patients after systemic treatment. BC patients have high risk in development of DM even in NGT and prediabetes groups confirmed by OGTT.

[Therapeutic effect of metformin for clomiphene-resistant infertility patients with polycystic ovary syndrome: a systematic analysis].

OBJECTIVE: To evaluate the efficacy of metformin (MTF) in treatment of clomiphene (CC)-resistant patients with polycystic ovary syndrome (PCOS). METHODS: The published articles of randomized controlled trial (RCT) of comparison of MTF combined with CC and CC alone in treatment of CC-resistant PCOS were searched in PubMed, EMBASE, OVID, EBSCO databases and Cochrane Library, and these studies were screened under inclusion and exclusion criteria. The quality of included studies and extract data of comparison of ovulation rates and pregnancy rates were evaluated. And the Meta-analysis using statistic software RevMan 5.0 was completed. RESULT: Total of 333 patients in total 8 trials were included. Meta analysis showed that MTF plus CC led to a significantly higher clinical ovulation rate (OR = 7.31, 95%CI: 2.57 - 20.76, P < 0.05) and pregnancy rate (OR = 7.93, 95%CI: 2.45 - 25.63, P < 0.05) than that of CC alone. CONCLUSION: MTF can increase ovulation and pregnancy rates of CC-resistant PCOS women.