Effects of branched-chain amino acids supplementation on patients undergoing hepatic intervention: a meta-analysis of randomised controlled trials.

The benefits of branched-chain amino acid (BCAA) administration after hepatic intervention in patients with liver diseases remain unclear. We conducted a systematic review and meta-analysis to evaluate the effects of BCAA on patients undergoing hepatectomy, trans-arterial embolisation and radiofrequency ablation. Relevant randomised controlled trials (RCT) were obtained from PubMed, EMBASE and Cochrane Library databases. A meta-analysis was performed to calculate the pooled effect size by using random-effects models. The primary outcomes were survival and tumour recurrence. The secondary outcomes were hospital stay, nutrition status, biochemistry profile, complication rate of liver treatment and adverse effect of BCAA supplementation. In total, eleven RCT involving 750 patients were included. Our meta-analysis showed no significant difference in the rates of tumour recurrence and overall survival between the BCAA and control groups. However, the pooled estimate showed that BCAA supplementation in patients undergoing hepatic intervention significantly increased serum albumin (mean difference (MD): 0·11 g/dl, 95 % CI: 0·02, 0·20; 5 RCT) at 6 months and cholinesterase level (MD: 50·00 U/L, 95 % CI: 21·08, 78·92; 1 RCT) at 12 months and reduced ascites incidence (risk ratio: 0·39, 95 % CI: 0·21, 0·71; 4 RCT) at 12 months compared with the control group. Additionally, BCAA administration significantly increased body weight at 6 months and 12 months and increased arm circumference at 12 months. In conclusion, BCAA supplementation significantly improved the liver function, reduced the incidence of ascites and increased body weight and arm circumference. Thus, BCAA supplementation may beneficial for selected patients undergoing liver intervention.

Increasing and high prevalence of moderate to severe obstructive sleep apnea in acute ischemic stroke in Taiwan.

STUDY OBJECTIVES: The prevalence of obstructive sleep apnea (OSA) after stroke is variable, likely due to the time of examination and patient population. Although risk factors for OSA are well established, those for OSA in patients with ischemic stroke have not yet been fully identified. Therefore, we examined the prevalence of OSA and identified risk factors for OSA in the acute stage of ischemic stroke in the Taiwanese population. METHODS: A total of 103 patients with acute ischemic stroke were screened for OSA by performing polysomnography. The demographic and clinical data, Epworth Sleepiness Scale score, and other stroke risk factors were recorded. Sleep parameters, namely sleep efficiency, sleep stages, apnea-hypopnea index, and oxygen desaturation index were recorded. Logistic regression analysis was conducted to determine clinical and demographic risk factors for moderate to severe OSA in patients with stroke. RESULTS: We determined that 91.2% of the patients had OSA in the acute stage of ischemic stroke, and 70% of the patients had moderate to severe OSA. Multivariate logistic regression analysis revealed that patients aged ≥65 years had a significantly higher risk of moderate to severe OSA (adjusted OR: 3.04, 95% CI: 1.20-7.69, p < 0.05) compared with patients with ischemic stroke aged <50 years. CONCLUSION: OSA is highly prevalent among patients with ischemic stroke in the acute stage, and those aged ≥65 years had a significantly increased risk of moderate to severe OSA. In clinical practice, routine PSG screening of OSA may be necessary among older patients with stroke.

Effect of various photobiomodulation regimens on breast cancer-related lymphedema: A systematic review and meta-analysis.

Breast cancer-related lymphedema (BCRL) is common among patients who have completed their cancer treatment. Although low-level laser therapy (LLLT) has been explored as a treatment option for BCRL, we could not find a regimen that is more effective than others. This meta-analysis aimed to organize existing research and determine the optimal combination of LLLT parameters for BCRL treatment. Studies were collected from four online databases: Embase, Ovid Medline, Cochrane, and Cinahl. The collected studies were reviewed by two of the authors. We focused on the aspects of the treatment area, treatment regimen, and total treatment sessions across the included studies. The comparisons between LLLT and non-LLLT were performed through a meta-analysis. Post-treatment QOL was significantly better in the axillary group. The group treated "three times/week with a laser density of 1.5-2 J/cm2" had significantly better outcomes in terms of swelling reduction, both immediately post-treatment and at 1-3 months follow-ups. The group with > 15 treatment sessions had significantly better post-treatment outcomes regarding reduced swelling and improved grip strength. According to these results, LLLT can relieve the symptoms of BCRL by reducing limb swelling and improving QOL. Further exploration found that a treatment approach targeting the axilla, combined with an increased treatment frequency, appropriate laser density, and extended treatment course, yielded better outcomes. However, further rigorous, large-scale studies, including long-term follow-up, are needed to substantiate this regimen.

Changes in self-harm- and violence-related urgent psychiatric consultation in the emergency department during the different stages of the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic significantly affected emergency department (ED) visits and urgent psychiatric consultation (UPC) seeking behavior in EDs. Our study explored the changes in UPCs during and after the pandemic peak. METHODS: This retrospective observational study evaluated UPCs in the ED of a referral medical center in Taiwan, where treated both physical and psychiatric complaints. We defined the COVID-19 pandemic peak period as calendar week 4-18, 2020. The corresponding baseline as calendar week 4-18, 2019, and the slack period as week 4-18, 2021. The total number of UPCs, patient demographic data such as sex and age of the patients seen, the referral system (whether police or emergency medical service [EMS] or other sources), and the chief complaint (self-harm or violence) were recorded. RESULTS: Compared with the baseline period, a significant decline in UPCs was observed in the pandemic peak period, and a rebound was observed in the slack period, with the median [IQR] Q1, Q3 values of 22 [18, 26], 12 [10, 17]), and 16 [15, 23], respectively. We observed significantly few men (34.9% vs 45.2%) and less violence (10.2% vs 17.6%) in the peak period compared with in the baseline period, but no significant difference was found compared with the slack period. Throughout the pandemic, younger patients (41.8 ± 17.4 in 2019, 39.2 ± 18.5 [p = 0.121] in 2020, and 35.6 ± 17.2 [p < 0.001] in 2021), higher proportions of police/EMS referral (38.7% in 2019, 41.9% [p = 0.473] in 2020, and 51.9% [p = 0.001] in 2021) and self-harm-related complaints (57% in 2019, 62.4% [p = 0.233] in 2020, and 64.9% [p = 0.049] in 2021) was noted among UPC seekers during the pandemic. However, the proportion of violence-related UPCs (17.6% in 2019, 10.2% [p = 0.023] in 2020, and 12.3% [p = 0.072] in 2021) declined. CONCLUSIONS: This study found that UPCs changed throughout the pandemic. This result raises the concern that mental health needs are masked during the pandemic.

Does coracoclavicular augmentation additional to hook plate fixation provide benefits in acute unstable acromioclavicular dislocation? A meta-analysis.

BACKGROUND: Acromioclavicular joint (ACJ) dislocation is a common shoulder injury. In treating acute unstable ACJ dislocation, a hook plate (HP) is a straightforward and popular option for ensuring proper reduction and rigid fixation while promoting AC and coracoclavicular (CC) ligament healing. Surgeons typically remove the HP to prevent subacromial impingement and acromial osteolysis; however, concerns about redislocation after implant removal remain. Therefore, additional CC augmentation may be helpful in combination with HP fixation. The aim of this meta-analysis is to compare the outcomes and complications of HP fixation with or without additional CC augmentation for acute unstable ACJ dislocation. METHODS: We searched the PubMed, EMBASE, and Web of Science databases for relevant case-control studies. The primary outcomes were patient-reported outcome measures; the secondary outcomes were pain measured using a visual analog scale (VAS), CC distance (CCD), and complications. Continuous data were assessed using weighted standardized mean differences (SMDs) with 95% confidence intervals (CIs), and dichotomous data were evaluated with Mantel-Haenszel odds ratio (ORs) with 95% CIs. RESULTS: We analyzed one randomized control trial and four case-control studies comparing HP fixation with or without CC augmentation. A total of 474 patients with Rockwood type III or V ACJ dislocation were included. We found no differences in Constant-Murley score (SMD, - 0.58, 95% CI - 1.41 to 0.26; P = 0.18), American Shoulder and Elbow Surgeons score (SMD, 0.21, 95% CI - 0.10 to 0.52; P = 0.19), University of California at Los Angeles shoulder rating scale score (SMD, - 0.02, 95% CI - 1.27 to 1.23; P = 0.97), or VAS pain score (SMD, 0.36, 95% CI - 0.16 to 0.88; P = 0.17) between groups. The CC augmentation group had lower odds of osteolysis (OR, 0.27, 95% CI 0.10 to 0.74; P = 0.01) and a shorter CCD (SMD, - 0.29, 95% CI - 0.57 to - 0.01; P = 0.04). CONCLUSION: HP fixation with CC augmentation is preferable for acute unstable ACJ dislocations. Although CC augmentation did not provide additional benefits related to functional outcomes or pain, it resulted in greater reduction maintenance after implant removal and a 73% lower risk of acromial osteolysis. TRIAL REGISTRATION: PROSPERO ( CRD42021271118 ).

Extracorporeal Shock Wave Therapy Shows Superiority Over Injections for Pain Relief and Grip Strength Recovery in Lateral Epicondylitis: A Systematic Review and Network Meta-analysis.

PURPOSE: To examine the efficacy of extracorporeal shock wave therapy (ESWT) and injection therapies by synthesizing direct and indirect evidence for all pairs of competing therapies for lateral epicondylitis. METHODS: PubMed, EMBASE, and Web of Science databases were searched for all appropriate randomized controlled trials (RCTs), assessing the effect of ESWT or injection therapies. The primary outcome was short-term (≤3 months) and medium-term (>3 months but ≤12 months) pain, while the secondary outcomes were grip strength and patient-reported outcome measures. All outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs) and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to determine a hierarchy of treatments. Sensitivity analysis was performed to eliminate potential therapeutic effects of normal saline (NS) and exclude trials that included patients with acute lateral epicondylitis (LE). RESULTS: 40 RCTs were included to evaluate ESWT and five different injection therapies, including corticosteroids (CSs), autologous whole blood, platelet-rich plasma (PRP), botulinum toxin A (BoNT-A), and dextrose prolotherapy (DPT). DPT (-.78 [-1.34 to -.21]), ESWT (.57 [-.89 to -.25]), PRP (-.48 [-.85 to -.11]), and BoNT-A (-.43 [-.84 to -.02]) outperformed placebo for short-term pain relief; ESWT (-.44 [-.85 to -.04]) outperformed placebo for medium-term pain relief. DPT was ranked as the most optimal short-term and medium-term pain reliever (SUCRA, 87.3% and 98.6%, respectively). ESWT was ranked as the most optimal short-term and medium-term grip strength recovery (SUCRA; 79.4% and 86.4%, respectively). CONCLUSIONS: DPT and ESWT were the best two treatment options for pain control and ESWT was the best treatment option for grip strength recovery. CSs were not recommended for the treatment of LE. More evidence is required to confirm the superiority in pain control of DPT among all these treatment options on LE. LEVEL OF EVIDENCE: Level I, meta-analysis of Level I randomized controlled trials.

Comparison of nerve conduction study and transcranial magnetic stimulation for early diagnosis and prognosis prediction of idiopathic facial palsy.

OBJECTIVE: Multiple electrophysiologic studies have been conducted in the evaluation of facial neuropathy. In our study, the diagnostic and prognostic values of nerve conduction studies (NCSs) and transcranial magnetic stimulation (TMS) were compared for idiopathic unilateral facial neuropathy. METHOD: We recruited patients with newly diagnosed idiopathic unilateral facial neuropathy and performed a blink reflex test, facial NCSs, and TMS. The amplitude of facial compound muscle action potential (CMAP) and motor evoked potential (MEP) between the affected and unaffected sides of the face was compared. RESULT: A total of 30 patients were enrolled in the final analysis. TMS yielded a better detection rate, and MEP reduction rate was significantly higher than CMAP reduction rate, early in the course of the disease. Poor prognosis was positively associated with the CMAP reduction rate. The cutoff value of the CMAP reduction rate in the prediction of poor prognosis was established as 0.42. CONCLUSION: Facial TMS could detect idiopathic unilateral facial neuropathy with a high sensitivity when used as an early diagnostic tool. Facial NCS could predict prognosis, and the CMAP reduction rate was significantly associated with poor short-term prognosis.

Effectiveness of Different Wound Dressings in the Reduction of Blisters and Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis.

BACKGROUND: The optimal type of dressing in the setting of total joint arthroplasty (TJA) remains uncertain. The aim of this network meta-analysis was to compare various wound dressings and identify the optimal type of dressings for blister reduction and prevention of periprosthetic joint infection (PJI) in patients after TJA. METHODS: Studies comparing 2 or more dressing groups after TJA (hip or knee) were systematically searched on PubMed, Embase, and Scopus. Two authors performed the study selection, risk of bias assessment, and data extraction. Both outcomes were assessed using odds ratios (OR) with 95% confidence intervals (CI) and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to determine a hierarchy of dressings. A sensitivity analysis was performed to reduce the effect of intransitivity between studies. RESULTS: A total of 21 studies, consisting of 12 dressing types in 7293 TJAs, were included in the final analysis. The highest incidence of blisters occurred when using negative-pressure wound therapy (OR 9.33, 95% CI 3.51-24.83, vs gauze). All dressings ranked better than gauze in infection rate except for hydrofiber (OR 1.46, 95% CI 0.02-112.53) and fabric dressings (OR 1.46, 95% CI 0.24-9.02). For blister reduction, alginate (SUCRA = 87.7%) and hydrofiber with hydrocolloid (SUCRA = 92.3%) were ranked as the optimal dressings before and after a sensitivity analysis, respectively. Antimicrobial dressing (SUCRA = 83.7%) demonstrated the most efficacy for preventing PJI. CONCLUSION: Based on the evidence from our analysis, an antimicrobial dressing is the optimal dressing to prevent PJI. If negative-pressure wound therapy is used, surgeons should be aware of an increased incidence of blister formation. Further studies should focus on the alginate versus hydrofiber and hydrocolloid dressing to determine the optimal dressing to reduce blisters.

Brain Computed Tomography in Stimulant Poisoning with Altered Consciousness.

BACKGROUND: Stimulant poisoning frequently causes altered mental status (AMS) and can result in severe cerebral vascular complications. The role of noncontrast brain computed tomography (CT) in acute stimulant-poisoned patients presenting with AMS remains unclear. OBJECTIVES: We examined the results and impacts of brain CT in acute stimulant-poisoned patients with AMS. METHODS: We performed a retrospective single-center study that included all adult patients who presented to the emergency department with stimulant poisoning and AMS (Glasgow coma scale [GCS] score <15) between January 1, 2010 and December 31, 2017. Patients who had concomitant head trauma or who presented with focal neurologic symptoms were excluded. The primary outcome was the rate of acute abnormalities on brain CT. The secondary outcomes were to identify factors that affected the decision to perform brain CT in stimulant-poisoned patients with AMS and whether obtaining the brain CT scan itself affected the patients' prognoses. RESULTS: The analysis included 66 patients, of whom 6 died from the poisoning. Noncontrast brain CT was performed in 31 patients and none had acute abnormalities. Patients who underwent brain CT were found to have worse GCS scores, higher body temperatures, higher intubation rates, higher admission rates, longer admission periods and intensive care unit stays, and a higher mortality rate. After adjusting for the propensity score, performing brain CT itself did not independently affect the patients' clinical outcomes. CONCLUSIONS: Nontrauma stimulant-poisoned patients presenting with AMS and without focal neurologic symptoms were unlikely to have acute abnormalities on brain CT. Patients who underwent brain CT scans had worse consciousness and greater disease severity.

Decreased cerebral blood flow and improved cognitive function in patients with end-stage renal disease after peritoneal dialysis: An arterial spin-labelling study.

OBJECTIVES: The aim of this study was to evaluate the relationship between cognitive impairment and brain perfusion using arterial spin labelling (ASL) in end-stage renal disease (ESRD) patients undergoing PD. METHODS: ESRD patients undergoing PD were recruited. Laboratory screening, neuropsychological tests and ASL magnetic resonance imaging (MRI) were conducted prior to and after 6 months of PD. Age- and sex-matched normal subjects without ESRD served as the control group. Comparisons of regional CBF between ESRD patients before or after undergoing PD and normal controls were performed. Correlations between biochemical, neuropsychological and CBF data were also conducted to evaluate the relationships. RESULTS: ESRD patients showed poor performance in many of the neuropsychological tests; PD improved cognition in some domains. Pre-PD patients had higher mean CBF than post-PD patients and normal controls, but no significant difference was found between the normal controls and post-PD patients. Negative correlations were observed pre-PD (regional CBF in left hippocampus vs. perseverative responses, r = -0.662, p = 0.014), post-PD (mean CBF vs. haemoglobin level, r = -0.766, p = 0.002), and before and after PD (change in CBF in the left putamen vs. change in haematocrit percentage, r = -0.808, p = 0.001). CONCLUSION: Before PD, ESRD patients had increased cerebral perfusion that was related to poorer executive function, especially in the left hippocampus. Post-PD patients performed better in some cognitive test domains than pre-PD patients. The degree of anaemia, i.e., haemoglobin level or haematocrit percentage, might predict cognitive impairment in PD patients. KEY POINTS: • In this study, ESRD patients before PD had cerebral hyperperfusion that was related to poorer executive function. • Post-PD patients performed better in some cognitive test domains than pre-PD patients did. • The degree of anaemia might predict cognitive impairment in PD patients.

Comparative Effectiveness of Different Nonsurgical Treatments for Patellar Tendinopathy: A Systematic Review and Network Meta-analysis.

PURPOSE: To investigate the functional improvement and pain reduction of different nonsurgical treatments for patellar tendinopathy (PT), a systematic review with network meta-analysis was performed. METHODS: Studies were comprehensively searched for without language restrictions in the CENTRAL, MEDLINE, EMBASE, Web of Science, Physiotherapy Evidence Database, and SPORTDiscus databases from inception to May 2018. Randomized controlled trials about nonsurgical treatments for PT were included. The outcome measurements were the Victorian Institute of Sports Assessment (VISA) scale and pain scores (such as the visual analog scale or Numerical Rating Scale). Study quality was evaluated using the Physiotherapy Evidence Database score. Direct comparisons were performed using pairwise meta-analysis, whereas network meta-analysis was performed using a frequentist method in a multivariate random-effects model. RESULTS: Eleven studies with 430 affected patellar tendons were included in the systematic review. The summary mean difference of improvement in the VISA scale versus the control group for corticosteroid injection was -23.00 (95% confidence interval [CI] -36.73 to -9.27), for leukocyte-rich platelet-rich plasma (LR-PRP) was 13.22 (95% CI 2.37-24.07), for focused extracorporeal shockwave therapy (ESWT) was -1.28 (95% CI -6.25 to 3.68), for radial ESWT was -6.68 (95% CI -20.20 to 6.84), for ultrasound was -0.70 (95% CI -11.23 to 9.83), for autologous blood injection was -0.60 (95% CI -9.30 to 8.10), for dry needling was 17.51 (95% CI -2.57 to 37.60), for topical glyceryl trinitrate was -0.90 (95% CI -13.07 to 11.27), and for skin-derived tendon-like cells was 10.40 (95% CI -1.59 to 22.39). LR-PRP (Surface Under the Cumulative Ranking curve [SUCRA] = 87.5%) or dry needling (SUCRA = 90.5%) was most likely to be ranked the best in terms of improvement on the VISA scale. Compared with the control group, the summary mean difference of the change in pain score for corticosteroid injection was 0.80 (95% CI -3.48 to 5.08), for LR-PRP was -1.87 (95% CI -3.28 to -0.46), for focused ESWT was 0.13 (95% CI -0.68 to 0.93), for radial ESWT was 0.03 (95% CI -1.92 to 1.98), for ultrasound was -0.20 (95% CI -1.49 to 1.09), for autologous blood injection was 0.60 (95% CI -0.73 to 1.93), for dry needling was -0.37 (95% CI -2.71 to 1.97), and for topical glyceryl trinitrate was -0.50 (95% CI -2.55 to 1.55). The treatment most likely to be ranked the best in terms of change in pain score was LR-PRP (SUCRA = 94.9%). CONCLUSIONS: The network meta-analysis demonstrated that LR-PRP has the greatest functional improvement and pain reduction for PT compared with other treatment options. However, the treatment effect estimates can be biased by the possible intransitivity and should not be overestimated. LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.

Music intervention for pain and anxiety management of the primiparous women during labour: A systematic review and meta-analysis.

AIMS: To determine the effect of music on the management of pain and anxiety in primiparous women during labour. BACKGROUND: Music is cost-effective intervention in clinical practice to reduce pain, stress, and anxiety. However, a systematic review with meta-analysis for investigating its effects during labour is still lacking. DESIGN: A systematic review with meta-analysis. DATA SOURCES: MEDLINE, EMBASE, and CINAHL databases. REVIEW METHODS: Randomized controlled trials or quasi-experimental trials concerning the effects of music among primiparous women who were expected to give normal spontaneous delivery were searched and screened up to 31 July 2017. The recruited trials for this review were compliant with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: A total of 392 primiparous pregnant women (197 in the music intervention group and 195 in the routine care group) from five studies were included in this review. Music as an intervention seemed to lower the pain scores for primiparous women during labour, but the effect was not statistically significant. However, there was a significant benefit of music intervention compared with routine care for primiparous women during labour. In the sensitivity analysis, music intervention showed significant effect on the improvement of pain and anxiety for primiparous women during labour. CONCLUSION: Music intervention may be an effective intervention for the management of pain and anxiety for primiparous women during labour.

Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players.

PURPOSE: Only few studies have investigated medial epicondyle (MEC) lesions, particularly in the 12-18 age group. To the best of our knowledge, no study has compared ultrasonography (US), radiography and magnetic resonance imaging (MRI) in detecting MEC lesions. The aims of this study were to examine the value of US for detecting MEC lesions and to investigate correlations among diagnostic tools. METHODS: A prospective, comparative study was performed. Young baseball players from southern Taiwan were recruited, and basic characteristics, as well as passive range of motion (pROM) of the upper extremities, were recorded. Screening US was performed to identify MEC lesions, and players with MEC lesions received follow-up plain radiography and MRI. RESULTS: A total of 299 young baseball players were screened using US, and 28 of 299 players with possible MEC lesions were identified with a positive predictive value (PPV) of 88% according to MRI findings. The MEC lesions were primarily comprised of unfused ossicles and bony fragmentation. Other diagnoses, including UCL strain and medial epicondylitis, were also found by MRI in players with abnormal US screening results. The pROM of shoulder external rotation (ER) of the throwing hand was significantly reduced in players with MEC lesions (p = 0.006). CONCLUSIONS: Bony cortical discontinuity or fragmentation over the MEC warrants further research, and US provides good PPV for types of MEC lesions. Decreased shoulder ER may relate to MEC lesions and should be taken into consideration. The use of US may facilitate early detection and intervention. LEVEL OF EVIDENCE: IV, Cross-sectional study.

Effectiveness of ultrasonography screening and risk factor analysis of capitellar osteochondritis dissecans in adolescent baseball players.

BACKGROUND: Capitellar osteochondritis dissecans (COCD) is a common elbow injury in young baseball athletes. It may be asymptomatic at the early stage and may progress if left untreated. This study investigated the effectiveness of ultrasonography (US) screening for COCD in adolescent baseball players and identified risk factors of COCD. METHODS: A cross-sectional analysis study was conducted among baseball athletes aged 12 to 18 years. US screening of the throwing elbow was performed in all participants, and additional magnetic resonance imaging (MRI) was arranged for those with abnormal screening results. The prevalence of COCD was calculated according to MRI results. The US findings were compared with MRI findings. Data for characteristics, joint range of motion, and quality of pain were collected and analyzed using a logistic regression model to identify the risk factors of COCD. RESULTS: A total of 299 adolescent baseball players were screened, and 17 were found to have COCD according to US findings. MRI was performed in 15 of these 17 players, and the MRI findings further confirmed COCD in 10 players (66.7%). The presence of elbow pain while at rest, body height, and age at introduction to baseball were predictors of COCD. CONCLUSIONS: Although the effectiveness of diagnosing stage 1 COCD is satisfactory, US is a helpful tool for detecting stage 2 and higher-stage COCD. Elbow resting pain, lower body height, and introduction to baseball at a younger age are risk factors for COCD.

Risk factors associated with newly psychiatric disorder in spinal cord injury: A retrospective cohort study.

AIM AND OBJECTIVES: To predict the risk factors related to newly diagnosed psychiatric disorders resulting from spinal cord injuries (SCIs). BACKGROUND: SCIs are a common result of devastating accidents; they can have an essential negative impact on the psychological health of those so afflicted. Psychiatric disorders commonly occur worldwide and are often associated with pain and disability; however, few studies have investigated the risk factors of psychiatric disorders among persons with SCIs. DESIGN: A retrospective cohort study design with data obtained from the Taiwan Health Insurance Research Database (THIRD). THIRD involves the claims data on recipients recorded in the Taiwan National Health Insurance (TNHI), which was set up in 1995 and covers about 99% of the 23 million persons in Taiwan. METHODS: We used THIRD to predict the risk factors related to newly diagnosed psychiatric disorders among victims of spinal cord injury. RESULTS: The majority of persons with SCI were men (51.2%), and their average age was 52.8 years. All 5,828 newly diagnosed psychiatric disorders were included from 1997-2009 in 64,907 SCI in the THIRD data set. These results demonstrated notable differences in hazard risk (HR); the injured persons were inspected for the level of SCI, age, hypertension and chronic obstructive pulmonary disease (HR: 1.637, 95% CI: 1.452-1.844, p < .0001; HR: 1.005, 95% CI: 1.002-1.009, p = .0019; HR: 0.724, 95% CI: 0.642-0.816; HR: 1.267, 95% CI: 1.105-1.454, p = .0007; HR: 1.368, 95% CI: 1.183-1.582, p < .0001, respectively); the persons with SCI exhibited significant independent associations with psychiatric disorders. CONCLUSIONS: The results revealed that the level of SCI, female gender and age, respectively, affects the incidence of newly diagnosed psychiatric disorder related to SCI. RELEVANCE TO CLINICAL PRACTICE: This study showed that psychiatric disorders may be associated with the development of SCI, and that this risk was more predominant in females with SCI. Our results are of direct clinical relevance as they are meant to assist clinical assessment, counselling, guidance of symptomatic monitoring and early clinical intervention.

Pelagostrobilidium liui n. sp. (Ciliophora, Choreotrichida) from the Coastal Waters of Northeastern Taiwan and an Improved Description of Pelagostrobilidium minutum Liu et al., 2012.

The number of somatic kineties in Pelagostrobilidium ranges from 4 to 6 according to the present state of knowledge. This study investigates Pelagostrobilidium liui n. sp. using live observation, protargol stain, and small subunit rDNA data sequencing. Pelagostrobilidium liui n. sp. is characterized by having a spherical-shaped body, four somatic kineties, with kinety 2 spiraled around the left side of body, about six elongated external membranelles, and invariably no buccal membranelle. It differs from its most similar congener, Pelagostrobilidium minutum Liu et al., , in (i) cell shape; (ii) macronucleus width; (iii) oral apparatus; (iv) anterior orientation of kinety 2; (v) location where kinety 2 commences; (vi) arrangement of kinety 1; (vii) distance between the anterior cell end and the locations where kineties commence; and (viii) the presence of 12 different bases (including two deletions) in the small subunit rDNA sequences. The diagnosis of P. minutum Liu et al., is also improved to include the following new characteristics: invariably four somatic kineties; kineties 2 and 4 alone commence at the same level; kinety 2 originates from right anterior cell half on ventral side, extends sinistrally posteriorly, over kinety 1, around left posterior region, terminates near posterior cell end on dorsal side; kinety 1 commences below anterior third of kinety 2.

Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients.

AIM: The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients. BACKGROUND: The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before. DESIGN: A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies. DATA SOURCES: Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015. REVIEW METHODS: This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies. RESULTS: There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test. CONCLUSIONS: This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.

[The Effectiveness of Different Corticosteroid Injections in Patients With Carpal Tunnel Syndrome: A Bayesian Network Meta-Analysis].

BACKGROUND: Corticosteroid injection is one of the interventions used to alleviate the symptoms of carpal tunnel syndrome. The consistency across domestic and overseas studies of the results of corticosteroid injections in terms of easing carpal tunnel syndrome has not previously been analyzed. PURPOSE: This meta-analysis explored the symptom severity and functional status of different corticosteroid injection strategies in treating patients with carpal tunnel syndrome. METHODS: A systematic review was performed, keywords including: carpal tunnel syndrome, corticosteroid [Title/Abstract], placebo, disability, and pain intensity were used to query electronic databases, including Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest, PubMed database. All of the articles that were indexed on these databases, met the inclusion criteria, and were published prior to June 2015 were extracted for analysis. A standardized critical appraisal tool from the "Cochrane Handbook Systematic Reviews of Intervention" to assess the risk of bias tool was used to assess methodological quality. WinBUGS software was used to conduct the meta-analysis. RESULTS: The 10 articles that were qualified and used in the present study contained a total of 633 participants. Median symptom severity was -1.16 (95%CrI [-1.95, .38]) on the symptom severity scale for ultrasound-guided in-plane injection among patients with carpal tunnel syndrome. The surface under the cumulative ranking curve (SUCRA) achieved 95%. The median MD was -.74 (95%CrI [-2.0, .52]) on the functional status scale for ultrasound-guided in-plane injection among patients with carpal tunnel syndrome. The (SUCRA) achieved 78%. The results indicate that the three injection methods reduced the severity and improved the functional status in comparison with the placebo, ultrasound-guided in-plane corticosteroid injection. CONCLUSIONS: Corticosteroid injections alleviate symptom severity and promote functional status in patients with carpal tunnel syndrome. Ultrasound-guided in-plane injections demonstrated greater effectiveness. The network meta-analysis provides a reference for rehabilitation nursing.

A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome.

BACKGROUND: Local corticosteroid injections are commonly used to improve the short-term symptomatic severity and the functional status of the hands affected by carpal tunnel syndrome. We conducted a systematic review and Bayesian network-meta-analysis to compare the clinical effectiveness of local corticosteroid injections using different injection approaches. METHODS: Electronic literature in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science, and other sources were searched to identify clinical studies comparing different injection approaches with each other or placebo for carpal tunnel syndrome. Two review authors conducted selection of studies, data extraction, and assessment of risk of bias independently. Random-effects models were used to conduct the pairwise meta-analysis and the Bayesian network meta-analysis. RESULTS: Overall, 10 studies with 633 patients were included in the systematic review. Among the injection approaches, local corticosteroid injections using the ultrasound-guided in-plane injection (Ulnar-I) approach was the best treatment strategy for clinical response (median OR versus placebo 128.30, 95% CrI 9.76 to 2299.00), change in symptom severity scale (median MD versus placebo -1.16, 95% CrI -1.95 to -0.38) , and change in functional status scale (median MD versus placebo -0.74, 95% CrI -2.00 to 0.52) at short-term follow-up period in the network meta-analysis. Local corticosteroid injections using other injection approaches were better than placebo for clinical response (for the PI approach, median OR versus placebo 8.85, 95% CrI 3.00 to 33.15; for the DI approach, median OR versus placebo 7.00, 95% CrI 0.53 to 118.80) , change in symptom severity scale (for the Ulnar-O approach, median MD versus placebo -0.78, 95% CrI -1.43 to -0.16; for the PI approach, median MD versus placebo -0.58, 95% CrI -0.95 to -0.22), and change in functional status scale (for the Ulnar-O approach, median MD versus placebo -0.63, 95% CrI -1.67 to 0.43; for the PI approach, median MD versus placebo -0.46, 95% CrI -1.11 to 0.21) at short-term follow-up period. The quality of studies is good. CONCLUSIONS: According to our analyses, the ultrasound-guided in-plane injection (Ulnar-I) approach was the most effective treatment among the injection approaches for carpal tunnel syndrome.