Botulinum Toxin for Drooling in Adults with Diseases of the Central Nervous System: A Meta-Analysis.

(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with botulinum toxin type A. (2) Methods: The Cochrane Library, MEDLINE, and Embase were all searched for studies that fit the inclusion criteria. The patients in the studies had to be adults (>18 years old), and the studies had to be randomized placebo-controlled trials, controlled trials, or prospective studies. Each study had to have enough quantifiable data available for meta-analysis. The primary outcome measure was the Drooling Severity and Frequency Scale (DSFS). (3) Results: The meta-analysis comprised three studies. A statistically significant difference in DSFS score between the treatment and control groups was observed in the meta-analysis, with an overall standardized mean difference of -0.9377 (95% CI, -1.2919 to -0.5836; p < 0.0001). A total of seven studies were ineligible for inclusion in the meta-analysis and were only assessed as qualitative data. All qualitative studies showed a significant reduction in DSFS score a few weeks or months after the injection of botulinum toxin. (4) Conclusions: Botulinum toxin type A is safe and effective as a treatment for drooling in adult patients with central nervous system diseases.

The effectiveness of dextrose prolotherapy in plantar fasciitis: A systemic review and meta-analysis.

BACKGROUND: Dextrose prolotherapy (DPT) is considered to be a type of regenerative therapy and is widely used in various musculoskeletal disorders. Plantar fasciitis is a common cause of heel pain that affects the quality of life of many people. We aimed to evaluate the effectiveness and safety of DPT for plantar fasciitis. METHODS: PubMed, Embase, and the Cochrane Library were searched from their respective inception dates to June 2021. Only randomized controlled trials comparing DPT and other interventions for plantar fasciitis were included in this review. Standardized mean differences (SMDs) with 95% confidence intervals were calculated for comparison. The outcome measurements included visual analog score, numeric rating scale, Foot Function index, Revised Foot Function index, American Orthopedic Foot and Ankle Score, and plantar fascia thickness. Post-treatment duration was classified as short-term (1-2 months), medium-term (3 months), or long-term (6 months). RESULTS: Six studies with 388 adult patients diagnosed with plantar fasciitis were included for the meta-analysis. In terms of pain scores improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.163, 95%CI: -2.17 to -0.156) and the medium-term (SMD: -1.394, 95%CI: -2.702 to -0.085). DPT was inferior to corticosteroid injection in the short-term (SMD: 0.781, 95%CI: 0.41 to 1.152). For functional improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.51, 95%CI: -2.96 to -0.059), but inferior to corticosteroid injection (SMD: 0.526, 95%CI: 0.161 to 0.89) and extracorporeal shock wave therapy in the short-term (SMD: 0.484, 95%CI: 0.145 to 0.822). Randomized controlled trials showed a better pain improvement in the long-term for patients treated with DPT compared to corticosteroid (P = .002) and exercise control (P < .05). No significant differences were found between patients treated with DPT and patients treated with platelet-rich plasma. CONCLUSION: Dextrose prolotherapy was a safe and effective treatment option for plantar fasciitis that may have long-term benefits for patients. The effects were comparable to extracorporeal shock wave therapy or platelet-rich plasma injection. Further studies with standardized protocols and long-term follow-up are needed to address potential biases.

End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation.

BACKGROUND: The role of end-expiratory lung volume (EELV) during a spontaneous breathing trial (SBT) in patients who were tracheostomized and on prolonged mechanical ventilation is unclear. This study aimed to assess EELV during a 60-min SBT and its correlation with weaning success. METHODS: Enrolled subjects admitted to a weaning unit were measured for EELV and relevant parameters before and after the SBT. RESULTS: Of the 44 enrolled subjects, 29 (66%) were successfully liberated, defined as not needing mechanical ventilation for 5 d. The success group had fewer subjects with chronic kidney disease (41% vs 73%, P = .044), stronger mean ± SD maximum inspiratory pressure (41.6 ± 10.4 vs 34.1 ± 7.1 cm H2O; P = .02) and mean ± SD maximum expiratory pressure (46.9 ± 11.7 vs 35.3 ± 16.9 cm H2O; P = .01) versus the failure group. Toward the end of the SBT, the success group had a significant increase in the mean ± SD EELV (before vs after: 1,278 ± 744 vs 1,493 ± 867 mL; P = .040) and a decrease in the mean ± SD rapid shallow breathing index (83.8 ± 39.4 vs 66.3 ± 29.4; P = .02), whereas there were no significant changes in these 2 parameters in the failure group. The Cox regression analysis showed that, at the beginning of SBT, a greater difference between EELV with a PEEP of 0 cm H2O and with a PEEP of 5 cm H2O was significantly correlated to a higher likelihood of weaning success. Toward the end of the SBT, a greater EELV level at a PEEP of 0 cm H2O was also correlated with weaning success. Also, the greater difference of EELV at a PEEP of 0 cm H2O between the beginning and the end of the SBT was also correlated with a shorter duration to weaning success. CONCLUSIONS: The change in EELV during a 60-min SBT may be of prognostic value for liberation from prolonged mechanical ventilation in patients who had a tracheostomy. Our findings suggest a model to understand the underlying mechanism of failure of liberation from mechanical ventilation in these patients.

Improving the US hospital reimbursement: how patient satisfaction in HCAHPS reflects lower readmission.

PURPOSE: The purpose of this paper is to examine whether patient readmission rates are associated with patient satisfaction and Medicare reimbursement rates in the US hospitals. DESIGN/METHODOLOGY/APPROACH: The Hospital Compare database was obtained from the Centers for Medicare and Medicaid Services (CMS) in the US. A total of 2,711 acute care hospitals were analyzed for this present study. The data included patient satisfaction surveys, hospital 30-days readmission ratios for heart failure and pneumonia patients and related payments. Exploratory factor analysis was applied in the first stage to operationalize constructs for scale development. Partial least squares (PLS) modeling analysis via Smart-PLS was utilized for testing the hypotheses. FINDINGS: Results indicated that data provided from the Hospital Compare database for the acute care hospitals accurately reflect quality outcomes. Nevertheless, the Medicare Hospital Readmissions Reduction Program (HRRP) did not penalize the hospitals when patients reported lower satisfaction via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. ORIGINALITY/VALUE: The findings suggest that a high-readmission rate is not associated with lower payment. Such results appear to conflict with the goals of value-based purchasing programs, which seek to penalize hospitals financially for higher readmission rates.

Pre-extubation functional residual capacity and risk of extubation failure among patients with hypoxemic respiratory failure.

Hypoxemic respiratory failure is usually accompanied with a certain extent of consolidation and alveolar derecruitment, which may still be present even after the patients have achieved the status of readiness to extubate. Functional residual capacity (FRC) is an indicator of lung aeration. This study aimed to evaluate whether pre-extubation FRC is associated with the risk of extubation failure in patients with hypoxemic respiratory failure. We prospectively included 92 patients intubated for hypoxemic respiratory failure. We used a technique based on a nitrogen multiple breath washout method to measure FRC before the planned extubation. The median FRC before extubation was 25 mL/kg (Interquartile range, 20-32 mL/Kg) per predicted body weight (pBW). After extubation, 20 patients (21.7%) were reintubated within 48 hours. The median FRC was higher in the extubation success group than in the extubation failure group (27 versus 21 mL/Kg, p < 0.001). Reduced FRC was associated with higher risk of extubation failure (odds ratio, 1.14 per each decreased of 1 mL/Kg of FRC/pBW, 95% CI, 1.05-1.23, p = 0.002). In conclusion, pre-extubation FRC is associated with the risk of extubation failure. Reduced FRC may be incorporated into the traditional risk factors to identify patients at high risk for extubation failure.

Acute Respiratory Distress Syndrome in Patients Discharged From a Tertiary Hospital in Taiwan: Long-Term Survival and Prognostic Factors.

BACKGROUND: Acute respiratory distress syndrome (ARDS) carries significant morbidity and mortality. No previous studies have investigated the long-term outcomes of ARDS patients in Taiwan. OBJECTIVE: This study aimed to investigate the survival of ARDS patients after discharge from the hospital in Taiwan. METHODS: Medical records from 150 ARDS patients discharged alive from the intensive care unit from January 2004 to June 2009 were reviewed. Survival of these patients was followed for 5 years, and prognostic factors were identified. RESULTS: Cumulative survival rates were 81.4% at 6 months, 79.0% at 1 year, 67.2% at 2 years, and 45.7% at 5 years. Independent prognostic factors influencing both 1- and 5-year survival rates were age, previous lung disease, and disposition after discharge. For 5-year survival, renal disease was also an independent risk factor. DISCUSSION: The mortality rate of ARDS survivors after intensive care unit discharge is still high in Taiwan. Three independent risk factors were found to affect the overall survival of these patients.

Three-dimensional Doppler ultrasonography in assessing nodal metastases and staging head and neck cancer.

OBJECTIVES/HYPOTHESIS: This study built a simple prediction system by three-dimensional (3D) Doppler ultrasonography to evaluate the metastases of cervical lymph nodes and the preoperative initial stage of head and neck cancer. STUDY DESIGN: Retrospective review of cervical lymph node ultrasound features and prospective nodal staging of head and neck cancer. METHODS: One hundred thirty-nine suspicious cervical lymph nodes, receiving 3D Doppler ultrasonography, were used to establish a predictive model. Then nodal metastasis was initially staged from 27 patients with head and neck cancer by this model. RESULTS: The prediction system was constructed by major (internal matting, vascularity pattern) and minor (age ≥ 40 years, short/long ratio ≥ 0.5) sign categories. Cervical lymph node was regarded as metastasis with the presence of one major and any of the other factors. The predictive model resulted in sensitivity of 91.9%, specificity of 88.2%, and accuracy of 89.2%. Then we evaluated the initial staging of patients with head and neck cancer by this model, and the rate of correct N staging was 92.6%. CONCLUSIONS: According to this prediction system, 3D Doppler ultrasonography definitely provides a rapid and reliable method for initial staging of head and neck cancer.

MRI-derived tumor thickness: an important predictor of outcome for T4a-staged tongue carcinoma.

The objectives of this paper are to evaluate the heterogeneity of magnetic resonance imaging (MRI)-derived tumor thickness within tumors of the same T4a-staged tongue carcinoma and to elucidate the effects of tumor thickness on treatment outcomes. A sequential and prospectively maintained head and neck cancer database was retrospectively searched for newly diagnosed tongue carcinoma treated with surgery between 2003 and 2006. Fifty-eight patients with newly diagnosed T4a-staged tongue carcinoma were included in this study. Tumor thickness was obtained from preoperative magnetic resonance imaging. The mean MRI-derived tumor thickness was 22.29 mm. The patients with long tumor thickness (>26 mm) were associated with a significantly poor disease-specific survival (P = 0.015). The 2-year disease-specific survival rates were 72% in patients with short tumor thickness and only 27% in patients with long tumor thickness within the same T4a-staged disease. A substantial variation in MRI-derived tumor thickness was present within the same T4a-staged tongue carcinoma, and tumor thickness represented an important prognostic factor.

[A discourse on female nurse job stress and reproductive hazards].

The negative effects of job stress on female reproduction have been receiving greater attention due to rapidly falling fertility rates in recent years. Nurses represent the greatest number of workers in the healthcare system. Nearly all are female and most are of reproductive age. Over half of nurses perceive nursing as a high-pressure occupation, making job stress an important issue. Long-term job stress affects mental and reproductive health. The International Nursing Association's advocacy of high quality, positive medical environments in 2007 highlighted the importance of improving workplace quality. This article reviews references and discusses job stress and its relationship to reproductive hazards for female nurses. We hope it provides valuable information and encourages government and related organizations to improve the medical working environment, recognize job stress in a timely manner, and provide health promotion strategies to reduce reproductive hazards and promote nurse health.

Primary tumor volume measured by FDG PET and CT in nasopharyngeal carcinoma.

BACKGROUND: The prognostic value of CT-derived primary tumor volume in patients with nasopharyngeal carcinoma (NPC) has been demonstrated in our previous serial studies. The purpose of the present study is to compare the primary tumor volume measured by FDG PET and traditional CT in NPC, and to ascertain their prognostic value. MATERIALS AND METHODS: From 2007 to 2008, 32 patients with newly diagnosed NPC were prospectively studied. All patients underwent a CT scan, followed by a FDG PET/CT scan. CT-derived primary tumor volume (VolumeCT) was measured using the summation-of-area technique. PET-volume was measured using 3 methods: delineating the contour of tumor with the threshold of standardized uptake value (SUV) ≧2.5 (Volume2.5), ≧40% of maximal SUV (Volume40%), and ≧50% of maximal SUV (Volume50%). The primary tumor volumes derived from the 4 methods, VolumeCT, Volume2.5, Volume40%, and Volume50%, were compared. Univariate Cox regression was used to identify the above parameters as prognosticators. RESULTS: The volumes derived from the VolumeCT, Volume2.5, Volume40%, and Volume50% methods were 16.48 ± 12.46 cm(3), 25.87 ± 16.96 cm(3), 13.66 ± 6.90 cm(3), and 8.25 ± 4.52 cm(3), respectively. There was decent correlation between VolumeCT and Volume2.5 (r = 0.64, P = 0.0001), and Volume2.5 was systemically larger than VolumeCT. No significant difference was noted between VolumeCT and Volume40% (P = 0.24), but the correlation was poor (r = 0.15, P = 0.39). For VolumeCT and Volume50%, the difference was significant (P = 0.0006) and the correlation was poor (r = 0.23, P = 0.20). Larger tumor volumes presented as VolumeCT, Volume2.5, and Volume50% were associated with shorter overall survival. CONCLUSION: PET-derived primary tumor volumes are substantially different from CT-derived tumor volumes, only decent correlation is noted between VolumeCT and Volume2.5. Volume2.5 and Volume50% seem to be reasonable alternatives for VolumeCT in predicting the patient outcomes.

Primary tumor volume is an independent predictor of outcome within pT4a-staged tongue carcinoma.

BACKGROUND: We evaluated the heterogeneity of primary tumor volume (PTV) within tumors of the same pT4a-staged tongue carcinoma and to elucidate the effects of PTV on treatment outcomes in patients with pT4a-staged tongue carcinoma. METHODS: Fifty-eight patients with newly diagnosed pT4a-staged tongue carcinoma who received surgery were enrolled onto this study. Magnetic resonance imaging-derived PTV was measured by the summation-of-area technique. RESULTS: The mean PTV was 24.55 ml, with a range of 5.32 to 119.64 ml. The receiver operating characteristic curve was applied, and the optimal cutoff volume was 23 ml. Large PTV was associated with a significantly poor disease-specific survival (P = 0.010) by the log rank test. The Cox regression model also revealed that large PTV (P = 0.026) and positive lymphatic node metastasis (P = 0.004) were statistically significant in the prognosis of T4a-staged tongue carcinoma. CONCLUSIONS: A substantial variation of PTV was present within the same pT4a-staged tongue carcinoma, and PTV represented an important prognostic factor. In the light of these findings, we suggest that taking the PTV into account in pT4a-staged tongue carcinoma would better refine the newest revised T classification, and the treatment strategies may be different.

The defence technique in Tai Chi Push Hands: a case study.

Developed from traditional Chinese martial arts, Tai Chi exercise includes different forms and interactive Push Hands but biomechanical analyses have focused on the former only. To analyse the techniques of Push Hands, an experienced master was asked to defend pushing by four opponents. Movements were videotaped and digitized using a motion analysis system. Surface electrodes were used to record the electromyographic activity of ten muscle groups. Two force plates were used to measure the ground reaction force on each foot. Inexperienced individuals performed the same procedure to serve as the control group. The results indicate that the master adopted a postural adjustment to maintain balance. A clear shift of body weight from the front to the rear foot and mediolateral displacement of the centre of gravity was observed. Low electromyographic activity was observed in the upper body muscle groups, while high electromyographic activity was observed in the right rectus femoris and very high activity in the left rectus femoris during the defence. All inexperienced participants lost their balance in resisting pushing. It is concluded that the Tai Chi defensive technique includes a subtle postural adjustment that slightly changes the pushing force direction, and allows the rear leg to resist the incoming force.

Characteristics of undiagnosed liver abscesses on initial presentation at an emergency department.

Liver abscesses often present with nonspecific symptoms and laboratory examination abnormalities, resulting in missed diagnoses at emergency departments (ED). The purpose of this study was to determine if there are differences in presentation and prognosis between patients in whom liver abscess is diagnosed at an ED or once the patient has been transferred to a ward. Patients with a liver abscess who were discharged from our hospital between 2005 and 2007 were retrospectively reviewed. We compared the clinical characteristics between patients with liver abscess diagnosed at an ED or in a ward. Patients with liver abscess diagnosed at an ED had more abdominal pain (73.4%vs. 42.9%, p < 0.001), longer duration of symptoms before hospitalization (5.5 days vs. 3.8 days, p = 0.034) and fewer respiratory tract symptoms (12.5%vs. 24.5%, p = 0.05). Fewer cases with abnormal chest X-rays also existed for these patients (4.7%vs. 14.7%, p = 0.048). Cases not diagnosed at ED had delayed diagnoses for 4.41 +/- 3.16 days. Rates of mortality (6.3%vs. 8.2%, p = 0.740), shock (19.5%vs. 20.4%, p = 0.896), and length of hospital stay (19.6 days vs. 22.4 days, p = 0.173) were not significantly different between the patients diagnosed at an ED and those diagnosed later in a ward. Most information collected at the ED could not be used to aid diagnosis. Only abdominal pain was highly associated with liver abscess diagnosed at the ED. Undiagnosed liver abscess presented less abdominal pain and more symptoms or examination abnormalities related to infection of the respiratory and urinary tracts. Abdominal sonography should be performed more frequently at EDs to exclude liver abscess from differential diagnosis. However, further diagnosis and treatment while the patient with liver abscess is attending a ward does not affect prognosis.

Expression of bcl-2 correlates with poor prognosis and modulates migration of nasopharyngeal carcinoma cells.

BACKGROUND: The role of bcl-2 expression, bcl-2 inhibitor HA14-1, and matrix metalloproteinase (MMP)-2 is still unclear in nasopharyngeal carcinoma (NPC). METHODS: From 1996 to 2000, 145 patients with newly diagnosed NPC who were treated with high dose radiotherapy were enrolled. The relationship between bcl-2 expression, TNM stage, and disease-specific survival was analyzed. Furthermore, the NPC cell line HONE-1 was used to confirm the relationship between bcl-2 and cell metastasis. RESULTS: Among the 145 patients, 47 (32.4%) of them were bcl-2 positive. The expression of bcl-2 was significantly correlated with neck lymph node metastasis (p=0.006), and patients with negative bcl-2 expression had better disease-free survival (p=0.007). A Cox regression model revealed that only bcl-2 expression (p=0.023) and stage IV (p=0.043) were statistically significant in the prognosis of NPC. In vitro analysis also showed that treatment with the bcl-2 inhibitor HA14-1 exerted an inhibitory effect on migration and expression of MMP-2 in HONE-1 cells. CONCLUSIONS: Bcl-2 expression represents an important and easily assayed prognostic factor, and it may play an important role in lymph node metastasis. Inhibition of the migration mediated by MMP-2 may be a key feature for the prevention of cancer metastasis.

Temperature effect on the dynamic behavior of tricarboxylic acid derivatives in two-dimensional network structures.

The temperature effect on the adsorption behavior and the dynamic behavior of TCMB 2D network structure on the Au(111) substrate has been investigated. From the calculation of the adsorbed energy between the molecule and the Au(111) substrate, it can be found that there are significant changes in adsorbed energy as the temperature increase; moreover, different migration features are appeared at different specific temperature, owing to the deformation of the 2D network structure changed. The mean square displacement (MSD) and diffusion coefficient are calculated to study the migration property and dynamical behavior of 2D TCMB networks at specific temperatures.

Symptoms treatment for allergic rhinitis using diode laser: results after 6-year follow-up.

Allergic rhinitis is a very common chronic disease. The purpose of this study was to measure the outcome of treating allergic rhinitis with diode laser, over a long-term follow-up of 6 years. Forty-two consecutive patients with newly diagnosed allergic rhinitis that was refractive to conservative medical therapies were enrolled in the study. Treatment was with a diode laser (wavelength 805 nm, laser parameter 12 W, in 'contact' mode) under local anesthesia between September 1999 and May 2000. A quality of life questionnaire was used after a follow-up period of 6 years to assess the outcome of diode laser surgery. All 42 patients suffered from either perennial or persistent-type allergic rhinitis. Twenty-five out of 42 patients (60%) replied to the questionnaire 6 years after laser surgery. The mean operation time was 1 min 28 s for each patient. No complications were observed (e.g., major bleeding), and no nasal packing was necessary. Statistical analysis revealed significant improvements in symptom score, medication score and total score 6 years after laser surgery. A total of 60% of the patients described improvements in symptom scores, and 68% of the patients described improvements in total score 6 years after laser treatment. It was evident that the effectiveness of laser surgery persisted through the 6 years of follow-up. Long-term follow-up after 6 years confirmed that diode laser surgery for allergic rhinitis is a useful procedure that has a long-lasting effect and can be performed in an outpatient surgery under local anesthesia. Minimal discomfort, long-term effectiveness and short operation time are other reasons why this treatment should be selected for patients with allergic rhinitis that is refractive to conservative management.

The mechanisms that enable arm motion to enhance vertical jump performance-a simulation study.

The reasons why using the arms can increase standing vertical jump height are investigated by computer simulations. The human models consist of four/five segments connected by frictionless joints. The head-trunk-arms act as a fourth segment in the first model while the arms become a fifth segment in the second model. Planar model movement is actuated by joint torque generators. Each joint torque is the product of three variable functions of activation level, angular velocity dependence, and maximum isometric torque varying with joint angle. Simulations start from a balanced initial posture and end at jump takeoff. Jump height is maximized by finding the optimal combination of joint activation timings. Arm motion enhances jumping performance by increasing mass center height and vertical takeoff velocity. The former and latter contribute about 1/3 and 2/3 to the increased height, respectively. Durations in hip torque generation and ground contact period are lengthened by swinging the arms. Theories explaining the performance enhancement caused by arms are examined. The force transmission theory is questionable because shoulder joint force due to arm motion does not precisely reflect the change in vertical ground reaction force. The joint torque/work augmentation theory is acceptable only at the hips but not at the knees and ankles because only hip joint work is considerably increased. The pull/impart energy theory is also acceptable because shoulder joint work is responsible for about half of the additional energy created by arm swings.

Prognostic impact of bcl-2 expression on advanced nasopharyngeal carcinoma.

BACKGROUND: Our aim was to evaluate the prognostic impact of bcl-2 expression on patients with advanced nasopharyngeal carcinoma (NPC). METHODS: One hundred five patients with advanced NPC treated with high-dose radiotherapy were included. The relationship between bcl-2 expression, TNM stage, and disease-specific survival was analyzed. RESULTS: Within the same stage III and IV, patients with negative bcl-2 expression had better disease-free survival. The disease-free survival of patients with stage IV NPC with negative bcl-2 expression was paradoxically better than that of patients with stage III NPC with positive bcl-2 expression. In the advanced NPC, the disease-free survival of patients with stage III cancer was better than that of patients with stage IV cancer (p = .06); in contrast, patients with bcl-2-positive tumors had a worse disease-free 5-year survival (p = .02). The Cox regression model revealed that only bcl-2 expression was statistically significant (p = .03). CONCLUSION: In advanced staged NPC, bcl-2 expression represented an important prognostic factor.