The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: The aim of the study was to investigate the efficacy of extracorporeal shock wave therapy on myofascial pain syndrome in the neck and shoulder compared with that of other treatments. DATA SOURCES: PubMed, Embase, and Web of Science were systematically searched until May 30, 2019, to select randomized controlled trials. REVIEW METHODS: The randomized controlled trials comparing extracorporeal shock wave therapy with sham extracorporeal shock wave therapy or other treatments for patients with myofascial pain syndrome in the neck and shoulder patients were included. Two reviewers independently identified eligible studies. The Cochrane Handbook was used to evaluate the methodological quality of the included randomized controlled trials. Main outcomes associated with pain intensity, pressure pain threshold, and neck disability were selected. The study was registered with PROSPERO (Registration Number CRD 42019137459). RESULTS: A total of 11 randomized controlled trials were finally included. The results indicated that extracorporeal shock wave therapy had a large effect size on improving pain intensity (standardized mean difference [SMD] = 0.67, 95% confidence interval = 0.11 to 1.23, P = 0.02) and pressure pain threshold (SMD = 1.19, 95% confidence interval = 0.27 to l2.12, P = 0.01) at postintervention. However, there was no significant effect on neck disability at postintervention (SMD = 0.03, 95% confidence interval = -0.76 to 0.83, P = 0.93). After the subgroup analyses on the type of extracorporeal shock wave therapy, focused extracorporeal shock wave therapy had a significant effect on improving pain intensity (SMD = 0.75, 95% confidence interval = 0.13 to 1.36, P = 0.02) and pressure pain threshold (SMD = 1.70, 95% confidence interval = 0.21 to 3.18, P = 0.03) at postintervention in comparison with that of other treatments. CONCLUSIONS: Extracorporeal shock wave therapy is superior to other treatments in terms of alleviating the pain intensity and pressure pain threshold of patients with myofascial pain syndrome in the neck and shoulder at postintervention. In particular, focused extracorporeal shock wave therapy shows significant improvement in pain relief. However, radical extracorporeal shock wave therapy for myofascial pain syndrome treatment still remains unclear.

Effectiveness of Hydrotherapy on Balance and Paretic Knee Strength in Patients With Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: The aim of the study was to compare the effects of hydrotherapy and land-based conventional therapy on postural balance and knee strength in stroke patients. DESIGNS: A comprehensive search was done via databases (PubMed, EMBASE, and Web of Science) until April 12, 2019, to select randomized controlled trials. The methodological quality was assessed by the PEDro scale. Berg Balance Scale was pooled as the primary outcome and Forward Reach Test, Timed Up and Go test, and paretic knee flexor and knee extensor torque as secondary outcomes. RESULTS: Eleven articles were included. Pooled results showed that hydrotherapy was more beneficial in stroke patients on Berg Balance Scale (mean difference = 1.60, 95% confidence interval = 1.00 to 2.19), Forward Reach Test (mean difference = 1.78, 95% confidence interval = 0.73 to 2.83), Timed Up and Go test (mean difference = -1.41, 95% confidence interval: -2.44 to 0.42), and knee extensor torque (mean difference = 6.14, 95% confidence interval = 0.59 to 11.70) than conventional therapy. In subgroup analysis according to stroke-onset duration, hydrotherapy for chronic stroke patients exhibited significant effectiveness on Berg Balance Scale (mean difference = 1.61, 95% confidence interval = 1.00-.21); no significant effect was observed in subacute stroke patients (mean difference = 1.04, 95% confidence interval = -2.62 to 4.70). CONCLUSION: Stroke patients showed improvement in postural balance and paretic knee extensor strength with hydrotherapy. Hydrotherapy exhibited significant effects on improving postural balance in chronic patients than in subacute patients.

A Case Report of Overlapping Miller Fisher Syndrome, Guillain-Barré Syndrome, and the Bickerstaff Brainstem Encephalitis.

INTRODUCTION: Patients with overlapping Miller Fisher syndrome (MFS), Guillain-Barré syndrome (GBS), and the Bickerstaff brainstem encephalitis (BBE) have rarely been reported, and the diverse clinical features and sequelae are challenging for physicians. Through this case report, we present the clinical course, treatment, recovery, and sequelae of an overlapping MFS, GBS, and BBE syndrome and provide a review of the literature. CASE REPORT: A 76-year-old woman was initially presented with diplopia, ophthalmoplegia, and ataxia, but she later developed weakness of limbs, respiratory failure, deterioration of consciousness, and cognitive impairment. After IV immunoglobulin and corticosteroid therapy, she began to recover consciousness and from the weakness from day 18. After 8 months of rehabilitative therapy, she was able to swallow food without difficulty, but she still cannot walk without assistance, showed cognitive impairment, and the tracheostomy remained in place because of persistent respiratory muscle weakness. CONCLUSIONS: As the clinical course of MFS-GBS-BBE overlapping syndrome is variable, involving not only the peripheral but also the central nervous system, the establishment of a comprehensive therapeutic strategy is warranted.

Rapid, Objective and Non-invasive Diagnosis of Sudomotor Dysfunction in Patients With Lower Extremity Dysesthesia: A Cross-Sectional Study.

OBJECTIVE: To determine whether patients with lumbosacral (LS) radiculopathy and peripheral polyneuropathy (PPNP) exhibit sudomotor abnormalities and whether SUDOSCAN (Impeto Medical, Paris, France) can complement nerve conduction study (NCS) and electromyography (EMG). METHODS: Outpatients with lower extremity dysesthesia underwent electrophysiologic studies and SUDOSCAN. They were classified as normal (group A), LS radiculopathy (group B), or PPNP (group C). Pain severity was measured by the Michigan Neuropathy Screening Instrument (MNSI) and visual analogue scale (VAS). Demographic features, electrochemical skin conductance (ESC) values on hands and feet, and SUDOSCAN-risk scores were analyzed. RESULTS: There were no statistical differences in MNSI and VAS among the three groups. Feet-ESC and hands-ESC values in group C were lower than group A and B. SUDOSCAN-risk score in group B and C was higher than group A. With a cut-off at 48 microSiemens of feet-ESC, PPNP was detected with 57.1% sensitivity and 94.2% specificity (area under the curve [AUC]=0.780; 95% confidence interval [CI], 0646-0.915). With a SUDOSCAN-risk score cut-off at 29%, NCS and EMG abnormalities related to LS radiculopathy and PPNP were detected with 64.1% sensitivity and 84.2% specificity (AUC=0.750; 95% CI, 0.674-0.886). CONCLUSION: SUDOSCAN can discriminate outpatients with abnormal electrophysiological findings and sudomotor dysfunction. This technology may be a complementary tool to NCS and EMG in outpatients with lower extremity dysesthesia.

Characteristics of Patients Injured in Road Traffic Accidents According to the New Injury Severity Score.

OBJECTIVE: To investigate the clinical characteristics of patients involved in road traffic accidents according to the New Injury Severity Score (NISS). METHODS: In this study, medical records of 1,048 patients admitted at three hospitals located in different regions between January and December 2014 were retrospectively reviewed. Only patients who received inpatient treatments covered by automobile insurance during the period were included. Accidents were classified as pedestrian, driver, passenger, motorcycle, or bicycle; and the severity of injury was assessed by the NISS. RESULTS: The proportion of pedestrian traffic accident (TA) was the highest, followed by driver, passenger, motorcycle and bicycle TA. The mean NISS was significantly higher in pedestrian and motorcycle TAs and lower in passenger TA. Analysis of differences in mean hospital length of stay (HLS) according to NISS injury severity revealed 4.97±4.86 days in the minor injury group, 8.91±5.93 days in the moderate injury group, 15.46±11.16 days in the serious injury group, 24.73±17.03 days in the severe injury group, and 30.86±34.03 days in the critical injury group (p<0.05). CONCLUSION: The study results indicated that higher NISS correlated to longer HLS, fewer home discharges, and increasing mortality. Specialized hospitals for TA patient rehabilitation are necessary to reduce disabilities in TA patients.

Production of chromopyrrolic acid by coexpression of inkOD in a heterologous host Streptomyces albus.

Two ink genes, inkO and inkD, responsible for the earliest steps of K252a biosynthetic pathway, from Nonomurea longicantena JCM 11136 were heterologously coexpressed in Streptomycesalbus J1074. The resultant strain accumulated compound that was purified by HPLC and studied by NMR. Coexpression of inkOD yielded chromopyrrolic acid, the key intermediate in an indolocarbazole biosynthesis.

Inhibition of the pathogenicity of Magnaporthe grisea by bromophenols, isocitrate lyase inhibitors, from the red alga Odonthalia corymbifera.

Magnaporthe grisea is a fungal pathogen of rice that forms appressoria that penetrate the outer cuticle of the rice plant. Data from recent studies indicate that M. grisea isocitrate lyase (ICL), a key enzyme in the glyoxylate cycle, is highly expressed during appressorium-mediated plant infection. Bromophenols isolated from the red alga Odonthalia corymbifera exhibited potent ICL inhibitory activity and blocked appressoria formation by M. grisea in a concentration-dependent manner. In addition, these compounds protected the rice plants from infection by M. grisea. Rice plants infected with wild-type M. grisea Guy 11 exhibited significantly lower disease severity with bromophenol treatment than without, and the treatment effect was comparable to the behavior of the Deltaicl knockout mutant I-10. The protective effect of bromophenols and their strong inhibition of appressorium formation on rice plants suggest that ICL inhibitors may be promising candidates for crop protection, particularly to protect rice plants against M. grisea.

Genetic organization of the biosynthetic gene cluster for the indolocarbazole K-252a in Nonomuraea longicatena JCM 11136.

Indolocarbazole metabolite K-252a is a natural product that was previously reported as a potent protein kinase C inhibitor with in vitro and in vivo potency. From a biosynthetic viewpoint, this compound possesses structurally interesting features such as an unusual furanosyl sugar moiety, which are absent in the well-studied staurosporine and rebeccamycin. A cosmid library from genomic DNA of Nonomuraea longicatena JCM 11136 was constructed and screened for the presence of genes to be involved in the biosynthesis of indolocarbazole K-252a. Using as a probe an internal fragment of vioB, a Chromobacterium violaceum gene encoding a multifunctional enzyme that catalyzes tryptophan decarboxylation and condensation reaction in violacein biosynthesis, we isolated a DNA region that directed the biosynthesis of K-252a when introduced into the heterologous expression host Streptomyces albus. Sequence analysis of 45 kb revealed genes for indolocarbazole core formation, glycosylation, and sugar methylation, as well as a regulatory gene and two resistance/secretion genes. The cloned genes should help to elucidate the molecular basis for indolocarbazole biosynthesis and generate new indolocarbazole analogues by genetic engineering.