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Fibrosis is the end stage of many chronic inflammatory diseases and eventually leads to organ failure. Periplaneta americana (P. americana) is referred to as "the product of flesh and blood" in traditional Chinese medicine and has a wide range of therapeutic effects. Owing to the growing interest in this insect for its application in the treatment of tissue injury-healing disorders that induce organ fibrosis, it has attracted the interest of researchers. A literature search was performed using core collections of electronic databases, such as PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang, using the keywords given below and terms such as pharmacological and biochemical details of this insect. P. americana extracts presented a wide range of therapeutic and biological activities, including antifibrotic, antiinflammatory, antioxidative, and tissue repair activities. Emerging evidence suggests that P. americana extracts may improve scarring, pulmonary fibrosis, liver fibrosis, and kidney fibrosis through the regulation of fibroblast activation, cytokine secretion, and deposition of fibrin, indicating the potential role of P. americana as a therapeutic option for organ fibrosis. P. americana is a potential therapeutic agent for treating fibrosis. Further studies are required for a more in-depth characterization of the antifibrogenic mechanism of P. americana prior to its clinical application in the treatment of organ fibrosis. (Fig. 1).

Aspirin, as an typical antiplatelet therapy for secondary stroke prevention, have been proved that can significantly reduce incidence and recurrence of cerebrovascular ischemic events. However, due to drugs biological characteristics, aspirin resistance (AR) often occurs in clinical practice, which significantly influence secondary prevention in stroke patients. The growing evidence of activating blood and removing stasis herbs medicine (Sanqi) for AR is promising. However, the efficacy and mechanism of Panax notoginseng (Sanqi) for AR in secondary stroke prevention has not been confirmed.This is a prospective 2-center, assessor and statistician blinded, randomized, controlled trial. We will allocate 106 subjects aged between 45 and 65 years old, diagnosed with aspirin semi-resistance after stroke to 2 groups randomly in a ratio of 1:1. Patients in the experimental group will be treated with conventional treatments plus Panax notoginseng (Sanqi) while the others in the control group will be treated with only conventional treatments. All will be given different medications for 30 days. Patients will be measured with the platelet aggregation rate and serum TLR4, MyD88, NF-κB, COX-2, IL-6, CRP, TXB2 level for clinical efficacy and mechanisms at baseline and the 14th, 30th day of treatment. Baseline characteristics of patients will be summarized by groups and compared with Chi-square for categorical variables, and Student's independent t test or nonparametric Mann-Whitney U test for the continuous variables. Primary and secondary outcomes will be analyzed with 2-way repeated measures Anova, and Post Hoc test.The present study aims to investigate short-term add-on efficacy and mechanism of Panax notoginseng (Sanqi) for aspirin resistance in secondary stroke prevention via TLR4/MyD88/NF-κB signaling pathway. With this, we expect to find out an appropriate partial substitute of aspirin for aspirin resistance individuals.The trial was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) with the ID ChiCTR2100045773 at April 24, 2021.

Myringoplasty is a surgical procedure to reconstruct tympanic perforation. However, repair of anterior perforations is still challenging. To analyze the anatomical and hearing outcomes of myringoplasty with a new technique of chondroperichondrial graft via endoscopy, 23 adult patients were retrospectively analyzed. All patients had anterior perforations of tympanic membranes that were repaired with a composite strip-type cartilage-perichondrium graft through a total endoscopic transcanal approach. The anatomical graft success rate at postoperative 1 month was 86.96% (20/23) and reached 100% at the 6- and 12-month follow-up. Compared to the preoperative air conduction threshold (44.7 ± 13.56 dB) and air-bone gap (ABG) (22.35 ± 6.54 dB), the postoperative air conduction threshold and ABG decreased to 33.52 ± 10.88 dB and 12.52 ± 3.94 dB, respectively (P.0001). Twenty-two (95.65%) patients had an ABG below 20 dB postoperatively. The mean ABG improvement in our cohort was 9.83 ± 5.00 dB. The functional graft success rate was 95.65% (22/23). The convenience, reliability, time, and labor savings accrued from the approach described here make it a good choice for repair of anterior perforation of tympanic membrane.

Objective: To explore the prognostic significance and underlying mechanism of TYRO protein tyrosine kinase-binding protein (TYROBP) in osteosarcoma. Methods: Firstly, the expression of TYROBP was analyzed using the t-test. The Kaplan-Meier plotter analysis and a receiver operating characteristic (ROC) curve were performed to evaluate the influence of TYROBP on overall survival (OS). Further, Cox regression analysis was conducted to predict the independent prognostic factors for OS of osteosarcoma patients, and a nomogram was constructed. Then, the relationship between TYROBP and clinicopathological characteristics was determined using statistical methods. Enrichment analyses were conducted to evaluate the biological functions of TYROBP. Finally, ESTIMATE algorithm was used to assess the association of TYROBP with immune cell infiltration. Results: TYROBP was significantly increased in osteosarcoma (all P 0.05). Functional annotation and GSEA revealed that TYROBP was mainly involved in immune-related pathways. Importantly, TYROBP positively correlated with immune scores (P Conclusions: TYROBP served as an independent prognostic biomarker for OS in osteosarcoma. High TYROBP expression might prolong the survival of osteosarcoma patients mainly through promoting antitumor immunity.

Fork head box p3 (FOXP3), the specific transcription factors of Tregs, not only in Tregs, but also expressed in cancer cells of certain malignant tumors. The histological positioning of FOXP3 in nonsmall cell lung cancer (NSCLC) and its biological significance are still unclear. This study aims to clarify the biological function of FOXP3 in NSCLC through bioinformatics analysis. Tumor immune estimation resource database was used to analyze the mRNA expression of FOXP3 in pan cancer, and to analyze the correlation between FOXP3 expression and tumor microenvironment cell infiltration. Overall survival and disease-free survival analyses were performed using a Kaplan-Meier plotter. Immunohistochemistry staining of FOXP3 was performed using human protein atalas (HPA) database, and immunofluorescence (IF) staining was used to verify gene expression and identify cell types. Protein-protein interaction (PPI) networks were drawn using STRING and visualized by Cytoscape. The functional and pathway enrichment analysis of FOXP3 used the DAVID database. In NSCLC, whether it is lung squamous cell carcinoma (P .001) or lung adenocarcinoma (P .001), FOXP3 is highly expressed in cancer tissue compared with normal tissue. Immunohistochemistry results showed that FOXP3 was mainly expressed in Tregs, but not in lung cancer tissues. IF staining showed that FOXP3 and CD3 (a marker of T cells) were co-expressed in immune cells. Moreover, survival analysis showed that high FOXP3 expression could be used as a predictor of poor overall survival (HR: 1.25, P = .00065) and disease-free survival (HR: 1.88, P = 1.1E-10) in patients with NSCLC. Next, we identified an important module containing 11 genes in the PPI network, including JUN, NFATC, STAT3, IRF4, IL2, IFGN, CTLA4, TNFRSF18, IL2A, KAT5, and FOXP3. KEGG signaling pathway was enriched in T cell receptor signaling pathway, Jak-STAT signaling pathway, cytokine-cytokine receptor interaction. Finally, we observed that FOXP3 expression correlated with infiltration of CD8 + T cells (R = 0.276, P = 5.90E-10), CD4 + T cells (R = 0.643, P = 6.81E-58), neutrophils (R = 0.525, P = 1.57E-35), and dendritic cells (R = 0.608, P = 1.35E-50) in lung adenocarcinoma, the same results were observed in lung squamous cell carcinoma. The infiltration of FOXP3-positive Tregs might promote the malignant progression of NSCLC, and targeted intervention of Tregs may be a potential treatment option for patients with NSCLC.

Lugol's iodine staining (LIS) and narrow-band imaging (NBI) are currently the most common methods applied in demarcating early esophageal squamous cell carcinoma (EESCCs) during endoscopic submucosal dissection. The purpose of the present study was to investigate the effects on clinical outcomes in comparison between LIS and NBI for the demarcation of EESCCs during endoscopic submucosal dissection. This was a single-center, retrospective, cohort study. A total of 172 patients were involved. 109 patients received demarcation of the lesion by LIS and 63 patients by NBI. Data on baseline characteristics, clinical outcomes and follow-up information were collected for analyses. The mean diameter of the lesions was 3.9 ± 1.5 cm. R0 resection rate was 89.5%. The rate of total and in-hospital adverse events was 25.6% and 9.3%. The cumulative recurrence rate was 2.9% and 3-year disease-specific survival rate was 98.3%. Compared to patients of the LIS group, patients of the NBI group showed significantly shorter procedure time (44.8 ± 32.2 v.s.57.0 ± 40.6, P = .044), lower rate of using of scopolamine butylbromide (19.0% vs 35.8%, P = 0.021), reduced number of clips used (1.3 ± 1.2 vs 1.8 ± 1.5, P = .017) and alleviated discomfort evaluated by visual analog system score after operation (4.7 ± 0.8 vs 5.5 ± 1.0, P

Background: Chronic insomnia (CI) can lead to cognitive dysfunction and bring great pain to patients’ life. There is no effective intervention for cognitive dysfunction caused by CI. Shenmen (HT7) is the first choice for insomnia treatment. However, the effect and mechanism of this acupoint on cognitive function after insomnia is not clear. Therefore, the purpose of this study is to explore whether magnetic stimulation of HT7 can improve cognitive impairment of CI by regulating prefrontal lobe and its mechanism. Methods/Design: This is a randomized controlled clinical trial. Seventy-two subjects aged 18 to 65 years old with primary insomnia and more than 3 months were randomly divided into 2 groups according to the ratio of 1:1, and 36 healthy controls were included. The control group was given sleep hygiene and cognitive therapy in behavioral cognitive therapy technology, while the experimental group was given the behavioral cognitive therapy technology intervention and magnetic stimulation of HT7 acupoint for 30 times (2 times / d, 5 times / wk for 20 days), while the healthy control group had no intervention measures. Before treatment and 20 days after treatment, we evaluated the working memory (1-back test), episodic memory (Complex Figure Test), and problem-solving ability (Hanoi tower test) processed by prefrontal lobe to explore the effect of magnetic stimulation on cognitive function of CI and its possible mechanism. At the same time, insomnia severity index was used to evaluate sleep state, Becker depression scale was used to evaluate depression, and Beck anxiety scale was used to evaluate anxiety. Chi-squared test or rank sum test was used to collect the data of patients. If P value is less than or equal to .05, the difference will be considered statistically significant. Conclusion: This study explored the effect and mechanism of magnetic stimulation of Shenmen (HT7) on cognitive function of CI, and confirmed that magnetic stimulation of HT7 can be used as an alternative therapy to improve cognitive impairment of CI. Trial Registration number: ChiCTR2000034280

In this study, micro-CT was used to observe the microscopic anatomy of the hyoid bone, examine the variation of the trabecular bone inside the hyoid bone, and investigate the internal structure of the hyoid bone. A total of 22 hyoid bones were scanned using micro-CT. The changes in the internal bone trabeculae were assessed with 3D reconstructions, and the fine anatomical structure of the hyoid bone was further analyzed. Micro-CT images showed the microstructure of various parts of the hyoid bone. There were significant differences in total volume, bone volume, bone area, bone density, and volume fraction between the body and greater horns of the hyoid bone (P .05). In addition, significant differences in the trabecular bone measurements, bone trabecular connectivity, and Euler number were found between the body and greater horns of the hyoid bone (P .05). There was noticeably ossified healing at the joint between the body and greater horns of the hyoid bone. Micro-CT can adequately display the internal structure of the hyoid bone. The identified bone structure may help clarify the physiological function of the hyoid bone. The present findings provide a theoretical basis for further studies aimed at pathological changes due to hyoid injury in clinical and forensic medicine.

Rationale: The immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome is a rare disorder that most often manifests in the early stages of life. IPEX syndrome with a late onset, presenting with severe gastritis has rarely been reported. Patient concerns: Two male adolescents presented with recurrent vomiting, severe malnutrition, and growth retardation due to severe gastritis. Diagnoses: Esophagogastroduodenoscopy of the 2 patients revealed rare presentations of severe gastritis with multiple ulcers and stenosis of the pylorus. Next-generation sequencing revealed 2 novel variants in gene FOXP3 in the patients who were diagnosed with the IPEX syndrome. Interventions: Both patients were treated with a high calorie formular enteral nutritional therapy. In addition, the pylorus of patient 1 was enlarged by balloon dilation, while patient 2 was treated with mercaptopurine and low dose prednisone. Outcomes: Symptoms and nutritional status of the patients improved after treatment. Lessons: Chronic severe gastritis with stenosis of the pylorus could be an atypical manifestation of the IPEX syndrome. The use of next-generation sequencing is highly suitable for the diagnosis of atypical IPEX syndromes.

Adjuvant chemotherapy may cause alterations in serum lipids in postoperative breast cancer (BC) patients, but the specific alterations caused by different chemotherapy regimens remain unclear. The aim of this study was to investigate the status of serum lipids pre- and post-chemotherapy and to compare the side effects of different chemotherapy regimens on serum lipid. We retrospectively analysed the lipid profiles of 1934 consecutive postoperative BC patients who received one of the following chemotherapy regimens: (1) doxorubicin and cyclophosphamide followed by paclitaxel (AC-T); (2) epirubicin and cyclophosphamide followed by paclitaxel (EC-T); (3) cyclophosphamide and paclitaxel (TC); and (4) fluorouracil, cyclophosphamide, and epirubicin (FEC). The levels of triglycerides (TG), total cholesterols (TC), and low-density lipoprotein (LDL-C) were significantly elevated in patients who received chemotherapy regimens above (P 24 was associated with abnormal lipid profiles (TG, TC, HDL-C, LDL-C) post-chemotherapy compared with BMI ≤ 24 (P

Background: Increased risk and cancer-related mortality is observed in pancreatic cancer (PC) patients with diabetes mellitus (DM). Whether using metformin as glucose-lowering therapy can result in survival benefit in this group of patients is still unclear. Methods: A meta-analysis of 21 studies that including 38,772 patients was performed to investigate the association between metformin and overall survival in patients with PC and concurrent DM. Results: A significant survival benefit was observed in metformin treatment group compared with non-metformin group (hazard ratio [HR] = 0.83, 95% confidence interval [CI]: 0.74–0.91). These associations were observed in both subgroups of Asian countries (HR = 0.69, 95% CI: 0.60–0.79) and Western countries (HR = 0.86, 95% CI: 0.76–0.95), the former was more obvious. Survival benefit was gained for patients at early stage (HR = 0.75, 95% CI: 0.64–0.85) and mixed stage (HR = 0.81, 95% CI: 0.70–0.91), but not for patients at advanced stage (HR = 0.99, 95% CI: 0.74–1.24). Similarly, survival benefit was also observed in patients receiving surgery (HR = 0.82, 95% CI: 0.69–0.94) and comprehensive treatment (HR = 0.85, 95% CI: 0.77–0.93), but not in chemotherapy group (HR = 0.99, 95% CI: 0.67–1.30). No obvious benefit was suggested when pooled by time-varying COX model (HR = 0.94, 95% CI: 0.86–1.03). Conclusions: These results suggest that metformin is associated with survival benefit in patients with PC and concurrent DM. Further randomized controlled trials and prospective studies with larger sample sizes are required to confirm our findings.

Background: Stroke is the primary cause of adult disability in China, which causes serious personal, family, and social burden. “Central peripheral central” closed-loop rehabilitation theory is proved to be an effective neural rehabilitation model. Based on this theory, repetitive transcranial magnetic stimulation (rTMS) combined with magnetic stimulation of Neiguan (PC6) and Sanyinjiao (SP6) may be an effective treatment for limb dysfunction after stroke. However, the efficacy and mechanism of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb dysfunction after stroke has not been confirmed. Methods/Design: This study is a prospective, randomized, controlled, open trial. We randomly divided 42 subjects, aged 35 to 80 years, diagnosed with ischemic stroke within 1 month, into 2 groups with a ratio of 1:1. On the basis of this medical treatment, patients in the experimental group received 1 Hz rTMS in M1 area on the contralateral side, and 3 Hz rTMS treatment at Neiguan point and Sanyinjiao point on the affected side. The control group was treated with acupuncture (body acupuncture). All patients were treated once a day and followed up for 10 days. The National Institute of Health Stroke Scale score, simplified fulg Meyer, modified Barthel index, and cortical excitability were evaluated on the day of enrollment and the 10th day of treatment respectively. The modified Barthe index was followed up on the 30th day of treatment, and the adverse reactions were recorded at any time. The mechanism of rTMS will be revealed by Barthe index before treatment, on the 10th day of treatment and on the 30th day of follow-up. The results were analyzed by spss19.0 software, and the quantitative indexes were analyzed by t test and rank sum test. χ2 test was used for non-grade counting, and rank sum test was used for grade counting. All statistical tests were performed with bilateral test. If P value is less than or equal to .05, the difference will be considered statistically significant. Conclusion: The purpose of this study was to determine the effect of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb function after stroke. Through this study, we expect to explore a new scheme for the treatment of poststroke dyskinesia, and prove that compared with rTMS and acupuncture alone, the closed-loop rehabilitation theory based on “center peripheral center” can be more efficient and safe in the treatment of poststroke limb dysfunction. Trial Registration: The trial was registered in China clinical trial registry (http://www.chictr.org.cn/index.aspx), ID: ChiCTR1900026890 (October 25, 2019)

Background: Insomnia is a common, recurrent, and tenacious sleep problem, especially the chronic insomnia. Repetitive transcranial magnetic stimulation (rTMS) at right dorsolateral prefrontal cortex (r-DLPFC) is used in chronic insomnia, and repetitive magnetic stimulation (rMS) at Shenmen (HT7) acupoint may be an alternative approach. However, the efficacy and mechanism of rMS at HT7 acupoint for chronic insomnia has not been confirmed. Methods/design: This is a 3-armed randomized positive-controlled noninferiority clinical trial. We will allocate 45 subjects aged between 18 and 65 years old, diagnosed with initial chronic insomnia over 3 months to 3 groups randomly in a ratio of 1:1:1. Patients in the experimental group will be treated with rMS at HT7 acupoint while the others in the control group will be treated with rTMS at r-DLPFC or waiting treatment. All will be given rMS at HT7 or rTMS at r-DLPFC or no treatment for 10 days, and then received 20-day follow-up. Patients will be evaluated with the insomnia severity index and Pittsburgh sleep quality index for sleep state, Beck Depression Inventory-2nd edition scores for the depression state, Beck anxiety inventory scores for the anxiety state, and Montreal Cognitive Assessment scores for the cognition state before and the 10th day of treatment, 30th day of follow-up; study on mechanisms of rMS will be revealed through the resting motor threshold diversity of the motor cortex before and the 10th day of treatment, 30th day of follow-up. Baseline characteristics of patients will be summarized by groups and compared with Chi-squared for categorical variables, and analysis of variance or Kruskal–Wallis test for the continuous variables. Primary and secondary outcomes according to the measurement times are applicable to univariate repetitive measurement deviation analysis or analysis of variance, or Kruskal–Wallis test. Conclusion: The present study is designed to preliminarily investigate short-term efficacy and mechanism of rMS at HT7 acupoint therapy on chronic insomnia, also to explore the correlation between motor cortex excitability and chronic insomnia. With this research, we are looking forward to find out an appropriate alternative and easy therapy for chronic insomnia individuals compared with rTMS at r-DLPFC. Trial Registration: The trial was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) with the ID ChiCTR1900026844 on October 24, 2019.

Aims: To investigate the association between polymorphism in the gene encoding the epidermal growth factor receptor (EGFR) and susceptibility to endometriosis among women in southwest China. Methods: A case-control study involving 201 endometriosis patients and 237 control women without endometriosis was carried out at West China Second Hospital of Sichuan University from June 2016 to December 2017. Two tag single-nucleotide polymorphisms (SNPs) of EGFR gene, rs11977660 and rs2072454 were selected, and the distribution of genotypes and alleles was compared between the 2 groups using the chi-squared test with 2-sided contingency tables. Results: Genotype at rs11977660 was significantly associated with endometriosis (P

Ileocolonoscopy is currently recognized as the gold standard for evaluating mucosal healing in patients with Crohn disease (CD). However, the ideal noninvasive marker to assess mucosal healing instead of invasive ileocolonoscopy is not available. This study aimed to determine the correlations between the mucosal healing and serological optimizing markers in CD.This retrospective study consecutively included 62 CD patients with 137 hospitalizations between March 2014 and March 2020. On the basis of the Simple Endoscopic Score for Crohn's disease (SES-CD), the CD patients were divided into mucosal healing group (SES-CD ≤ 2) and nonmucosal healing group (SES-CD > 2). We collected the results of ileocolonoscopy examination and inflammatory markers and then serological optimizing markers, including C-reactive protein/albumin ratio (CRP/ALB), platelet/albumin ratio (PLT/ALB), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. The control group consisted of 50 healthy volunteers in the corresponding period.We found that CRP/ALB, PLT/ALB, NLR, and PLR were correlated with the mucosal healing of CD, and the correlation of CRP/ALB with the mucosal healing was the highest (r = -0.64). Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of CRP/ALB (0.87) was higher than NLR (0.69), PLR (0.72), and PLT/ALB (0.81). In the efficacy of assessing the mucosal healing in CD, the sensitivity of CRP/ALB, NLR, PLR, and PLT/ALB were 91.1%, 83.9%, 73.2%, and 73.2%, respectively, and the specificity was 76.5%, 46.9%, 64.2%, and 75.3%, respectively.CRP/ALB was the most appropriate marker to assess CD mucosal healing among the serological optimizing markers.

Proteins in S100 family exhibit different expressions patterns and perform different cytological functions, playing substantial roles in certain cancers, carcinogenesis, and disease progression. However, the expression and role of S100 family members in the prognosis of hepatocellular carcinoma (HCC) remains unclear. To investigate the effect of S100 family members for the prognosis of liver cancer, we assessed overall survival (OS) using a Kaplan-Meier plotter (KM plotter) in liver cancer patients with different situation. Our results showed that 15 members of the S100 family exhibited high levels of expression and these levels were correlated with OS in liver cancer patients. The higher expression of S100A5, S100A7, S100A7A, S100A12, S100Z, and S100G was reflected with better survival in liver cancer patients. However, worse prognosis was related to higher levels of expression of S100A2, S100A6, S100A8, S100A9, S100A10, S100A11, S10013, S100A14, and S100P. We then evaluated the prognostic values of S100 family members expression for evaluating different stages of AJCC-T, vascular invasion, alcohol consumption, and the presence of hepatitis virus in liver cancer patients. Lastly, we studied the prognostic values of S100 family members expression for patients after sorafenib treatment. In conclusion, our findings show that the proteins of S100 family members exhibit differential expression and may be useful as targets for liver cancer, facilitating novel diagnostic and therapeutic strategies in cancer.

Rationale: Primitive neuroectodermal tumor (PNET) of the urinary bladder is a highly aggressive tumor with high local recurrence and distant metastasis rates in cases of incomplete excision. We report a case of a young female patient, in whom early laparoscopic radical cystectomy combined with standard lymph node dissection and a modified vincristine, doxorubicin hydrochloride, and cyclophosphamide (VAC) chemotherapy regimen was controversial. Because PNET of the urinary bladder is a rare malignancy, the standard treatment regimen has not yet been established. It is not clear whether surgery combined with postoperative chemotherapy for PNET patients may be superior to surgery alone on long term survival. Patient concerns: The patient was a 45-year-old Chinese woman who complained of lower urinary tract symptoms, including urgency, frequency, and difficulty in urination, for 2 months. Diagnoses: PNET. Interventions: The patient underwent laparoscopic radical cystectomy and standard lymph node dissection, combined with modified VAC chemotherapy regimens. Outcomes: After undergoing radical surgery in 2018, the patient completed 6 courses of adjuvant chemotherapy. Abdominal and thorax computed tomography scanning was performed 3, 6, 9, and 12 months after the surgery was completely free of tumor. The patient is still alive with no signs of recurrent disease 2 years after diagnosis. Lessons: Radical surgery and standard lymphadenectomy combined with adjuvant chemotherapy may be essential to improve the prognosis of PNET of the urinary bladder.

Background Helicobacter pylori (H pylori) infection plays a critical role in gastritis-associated diseases, gastroduodenal ulcers, and even gastric cancer. Studies have shown that probiotics may exhibit antagonistic activity against H pylori. Methods This study aimed to assess the efficacy and safety of monotherapy with Clostridium butyricum (C butyricum) and Bacillus coagulans (B coagulans) for H pylori treatment. Our research was an open-label, single-arm pilot study of H pylori eradication. Subjects diagnosed with H pylori infection as outpatients at Xijing Hospital were randomized (1:1:1) to receive 8 weeks of therapy with C butyricum (group A), B coagulans (group B), or C butyricum plus B coagulans (group C). H pylori status was assessed 1 to 2 weeks after treatment. The H pylori eradication rate according to intention-to-treat and per-protocol analyses was the primary outcome of study, and the delta over baseline score, adverse events, and compliance were the secondary outcomes. This study was registered at ClinicalTrials.gov (NCT03857425). Results A total of 150 subjects were consecutively enrolled from February 2019 to August 2019. The ITT analysis demonstrated that the 3 groups achieved similar eradication rates (18%, 20%, and 26%, respectively, P = .597). The PP analysis yielded a similar result (24.3%, 26.3%, and 32.5%, respectively, P = .703). None of the subjects reported adverse events during treatment. The 3 groups had comparable compliance rates (74% vs 76% vs 80%, P > .05). Conclusion C butyricum and B coagulans may effectively inhibit H pylori to some extent, with rare adverse events, and thus may reduce the burden of antibiotic resistance.

The purpose of this study was to investigate the relationship between glioma-associated oncogene homolog 1 (GLI1) rs2228226 and rs10783826 polymorphisms and congenital heart disease (CHD) risk in a Chinese Han population. Genotyping for our interested polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism in 106 CHD patients and 112 healthy controls. Hardy–Weinberg equilibrium status in the control group was also checked via χ2 test. Differences in genotype and allele frequencies between the case and control groups were analyzed adopting Chi-Squared test as well, and the relative risk of CHD resulting from GLI1 genetic variants was checked via calculating odds ratio (OR) and 95% confidence interval (95%CI). CC genotype of rs2228226 showed significantly higher frequency in CHD patients than in controls (P = .011), indicating that it increased the disease risk (OR = 3.257, 95%CI = 1.280–8.287). Similarly, C allele of the polymorphism elevated CHD incidence by 1.609 folds, compared with G allele (OR = 1.609, 95%CI = 1.089–2.376). However, rs10783826 was not correlated with the occurrence of CHD. GLI1 rs2228226 polymorphism may be a risk factor for CHD in Chinese Han population, but not rs10783826.

Rationale Chronic radiation enteritis, a disease secondary to radiation exposure, has been widely reported in adults. However, few studies have described chronic radiation enteritis in children. Early diagnosis is essential, and nutrition management plays an important role in pediatric chronic radiation enteritis management. Patient concerns A Chinese 3-year-10-month-old boy was admitted with vomiting, weight loss (1-2 kg) after radiotherapy for a neuroblastoma. Diagnoses The patient was diagnosed as neuroblastoma (primary site: left adrenal grand; site of metastasis: multiple bone metastasis, bone marrow invasion, intraperitoneal lymph node metastasis) in 2015. Five months after radiotherapy, he showed vomiting and weight loss with stricture in intestine and thickening intestinal wall in imaging finding. His daily intake was not sufficient and extra supplements were needed by intravenous infusion. He had a weight-for-age z score of -5.04, a weight-for-height z score of -6.19, a height-for-age z score of -2.22, and a body mass index-for-age z score of -5.87. The highest level of alanine aminotransferase was 1433 U/L. Those findings established a diagnosis of chronic radiation enteritis with intestinal failure, intestinal stenosis, severe malnutrition, and hepatic dysfunction. Interventions This patient was treated by parenteral nutrition with minimal enteral feeding. Other treatments were aiming at complications during hospitalization. Outcomes The patient weaned off parenteral nutrition finally with nutrition status and quality of life improved. There were no signs of tumor recurrence during the 4-year follow-up. Lessons Pediatric radiation enteritis is rare. Our study highlights the characteristics of pediatric chronic radiation enteritis. Nutrition therapy is an important part of the whole therapy strategy in pediatric chronic radiation enteritis.

Background In recent decades, many researches manifested that the perimenopause is a window of vulnerability for the development of both depressive symptoms and major depressive episodes. Some scholar thought that those women diagnosed with depression may be particularly sensitive to changes in the hormonal milieu experienced premenstrual, during the postpartum period or during the menopause transition in. Risk factors for depressive symptoms during the perimenopause include prior standardized mean difference (MDD), psychosocial factors, anxiety symptoms, and reproductive-related mood disturbance. However, active vitamin D (VD), exerts protective and regulatory effects on the brain dopamine system and suggests that similar to the antidepressant. Therefore, serum 25(OH)D level may be negatively correlated with the perimenopausal depression. Methods The study only selects clinical randomized controlled trials of depression in perimenopausal women. We will search each database from the built-in until October 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science. While the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Meanwhile, we will retrieve clinical trial registries and grey literature. Two researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is represented by relative risk, and the continuous is expressed by mean difference or standard mean difference, eventually the data is synthesized using a fixed effect model or a random effect model depending on the heterogeneity. The serum vitamin D level, Hamilton Depression Scale, or Beck Depression Inventory or Zung self-rating depression scale or patient health questionnare-9 were evaluated as the main outcomes. While several secondary outcomes were also evaluated in this study. The statistical analysis of this Meta-analysis was conducted by RevMan software version 5.3. Results This meta-analysis will further determine the association analysis between VD level and depression in women perimenopause. Conclusion This study determines the VD level is related to the occurrence of depression in perimenopausal women.

PURPOSE Controversy remains with using neoadjuvant chemotherapy (NAC) in patients with upper tract urothelial carcinoma (UTUC). Thus, we conducted a systematic review and meta-analysis of the peer-reviewed literature to assess the role of NAC in high-risk UTUC patients. METHODS PubMed, EMBASE, and the Cochrane Library were the main sources of relevant studies. The search terms included: "Upper urothelial carcinoma"; "UTUC"; "Urinary tract cancer"; and "Transitional cell carcinoma" combined with "Neoadjuvant chemotherapy" and "adjuvant chemotherapy". We studied the relationship of UTUC and NAC. Overall survival, recurrent-free survival, cancer-specific survival and pathological response rate in patients treated with/without NAC before radical surgery were evaluated. RESULTS Five trials were selected, and included 532 participants. Each of the included studies was retrospective. The combined analysis showed that when compared to controls, the pooled hazard ratios of overall survival, recurrence-free survival and cancer-specific survival were 0.47 (95% confidence interval [CI], 0.34-0.64; P

Objective The aim of this systematic review and meta-analysis is to calculate the pooled placebo response rate in patients with chronic constipation (CC) in randomized controlled trial (RCT) and its related factors. Method This systematic review and meta-analysis will be conducted under the guidance of Cochrane Handbook. The inclusive and exclusive criteria and search strategies for PubMed, Cochrane Library, and Embase will be introduced in this protocol. Data collection, extraction, and assessment of risk of bias will be conducted independently by 2 reviewers. The pooled placebo response rate and its 95% confidence interval (95%CI) will be calculated and the heterogeneity assessment, publication bias assessment, and subgroup analysis will be performed using R 3.6.0. This study has been registered on the PROSPERO platform (CRD42019121287). Result The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Background Adjuvant endocrine therapy is a vital portion of postoperative comprehensive treatment for breast cancer patients. In recent years, studies have shown that endocrine therapy has a certain impact on the serum lipids of breast cancer patients, and the changes of lipid profiles may bring a series of problems. However, very few studies focus on this issue to date. The results of these studies are inconsistent, and the influence of different adjuvant endocrine modalities on lipid profiles still remains controversial. In order to better explore this issue, we conduct this network meta-analysis. Method The protocol followed preferred reporting items for systematic reviews and meta-analyses protocols. Three main databases (PubMed, Embase, and the Cochrane Library) will be searched systematically for eligible randomized controlled trials without language restriction. In addition, a manual search of the references of relevant published studies will also be considered. Two reviewers will conduct studies selection, data extraction, and risk of bias assessment independently. The primary outcome is the variation of biochemical parameters - the serum lipid profiles (cholesterol, triglyceride, high-density lipoprotein, low low-density lipoprotein). Results The results will provide useful information about the side effects of different adjuvant endocrine drugs on lipid profiles in postoperative breast cancer patients (estrogen receptor-positive and/or progesterone receptor-positive). Conclusion The findings of this study will be published in a peer-reviewed journal. Prospero registration number CRD42019129850.

To evaluate the feasibility of the orthodontic traction after local resection of the condylar osteochondroma (OC). From November 2011 to September 2016, consecutive patients with condylar OC who underwent orthodontic extraction after local resection of the mass were reviewed. Clinical data and cone-beam computed tomography (CT) were obtained before treatment (T0), 1 week after surgery (T1), and at least 6-month follow-up after OC resection (T2). Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare the 3-dimensional cephalometric variables at different time points and the paired t test was used to compare changes of temporomandibular joint (TMJ) space between the 2 sides at T1 and T2. The sample consisted of 23 patients (16 females and 7 males). The mean postoperative follow-up interval was 10.9 months. No recurrence was observed during the postoperative follow-up period. Facial symmetry and occlusion were greatly improved. B deviation and the distance of gonion on the OC-affected side to the Frankfort horizontal (FH) were significantly improved from T0 to T1 and T2 (P

Background: This study was trying to investigate the association of hot food and beverage consumption and the risk of esophageal squamous cell carcinoma in Hotan, a northwest area of China with high risk of esophageal squmous cell carcinoma. Methods: A population-based case-control study was designed. For the study, 167 patients diagnosed with esophageal squamous cell carcinoma were selected from Hotan during 2014 to 2015, and 167 community-based controls were selected from the same area, matched with age and sex. Information involved of temperature of food and beverage intake was obtained by face-to-face interview. Logistic regression analyses were performed to investigate the association between temperature of food and beverage intake and the risk of esophageal squamous cell carcinoma. Results: The temperature of the food and beverage consumed by the esophageal squamous cell carcinoma patients was significantly higher than the controls. High temperature of tea, water, and food intake significantly increased the risk of esophageal squamous cell carcinoma by more than 2-fold, with adjusted odds ratio 2.23 (1.45–2.90), 2.13 (1.53–2.66), and 2.98 (1.89–4.12). Conclusions: Intake of food and beverage with high temperature was positively associated with the incidence of esophageal squamous cell carcinoma in Northwestern China.

Background: Balloon kyphoplasty (BKP) is a widely adopted minimally invasive treatment for vertebral compression fractures (VCFs), but leakage of cement is a main complication of BKP. A novel vertebral augmentation technique radiofrequency kyphoplasty (RFK) with high viscosity cement was developed in 2009. Here, we aim to evaluate whether RFK can relieve symptoms efficiently and reduce cement leakage. Methods: A literature search was performed using Pubmed, Embase, and Cochrane CENTRAL until September 30, 2016. Both randomized controlled trial (RCT) and non-RCT studies comparing RFK and BKP were included. The main outcomes included pain relief (VAS), functionality improvement (ODI), operation time, reduction of deformity (vertebral height and kyphosis angle), and incidence of cement leakage. The origin of heterogeneity was further explored by subgroup stratification. Results: A total of 6 studies involving 833 patients with VCFs were included. The reduction of VAS score in the RFK group was 3.96 points more than that in the BKP group (P = .0007) postoperatively, and the improvement persisted until 12 months after the surgery (P

Background: The aim of this study is to identify which possessed the best stem-cell-like characteristics in 3 kinds of cell in human degenerative intervertebral disc: NPSCs (nucleus pulposus-derived stem cells), AFSCs (annulus fibrosus-derived stem cells), or CESCs (cartilage endplate-derived stem cells). Methods: We separated the disc samples obtained from 15 surgically treated patients with disc degenerative diseases into nucleus pulposus, annulus fibrosus, and cartilage endplate. After cultivating, we used the cell counting kit-8 to analysis the cell activity of 3 kinds of disc tissue-derived stem cell separately; different stem cells were defined with multilineage (osteogenic, chondrogenic, and adipogenic) differentiation. We extracted the total RNA and detected the expression of different lineage differentiation-related genes with the real-time polymerase chain reaction (RT-PCR). Results: Cell morphology of NPSCs, AFSCs, and CESCs did not show significant difference. Cell proliferation capacity of NPSCs and AFSCs was stronger than that of CESCs. The differentiation outcomes showed that osteocyte-like cells were stained red by Alizarin red S, chondrocyte-like cells blue by toluidine blue, and adipocyte-like red by oil red O. The RT-PCR reflected that the expression of different lineage differentiation-related genes of AFSCs was stronger than NPSCs and CESCs. Conclusion: In conclusion, we found that the cell morphology was not significantly different among NPSCs, AFSCs, and CESCs. Both differentiation and RT-PCR tests demonstrated that AFSCs had the best stem-cell-like characteristics in the human degenerative intervertebral disc.

Background: LigaSure (LS) Small Jaw is a surgical hemostasis equipment that is newly introduced in thyroid surgery. The objective of this study is to assess the short-term efficacy and safety outcomes of LS Small Jaw compared with clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy. Methods: A literature search was performed in the PubMed and Embase databases (until June 12, 2016) that reported the comparisons between LS Small Jaw and other techniques in thyroidectomy. Quality assessments were performed according to The Cochrane Collaboration's risk of bias tool and a modification of the Newcastle-Ottawa Scale in randomized controlled trials (RCTs) and non-RCTs, respectively. All statistical analyses were conducted using RevMan 5.3. Results: Finally, 7 studies with 813 patients were included into the meta-analysis, and all included studies were comparable with moderate-to-high quality. There was significant reduced operative time in LS Small Jaw, compared with clamp-and-tie (mean difference [MD] = −17.49, 95% confidence interval [CI]: −22.20 to 12.77, P

Background: Lumbar myofascial pain is a major contributor to chronic low back pain. Acupuncture has been applied as an effective treatment for chronic low back pain worldwide. However, few critical systematic reviews focus on the effect of acupuncture on chronic low back pain caused by lumbar myofascial pain have been published. The study aims to evaluate the current evidence on the efficacy of acupuncture for chronic low back pain caused by lumbar myofascial pain. Methods: A total of 7 databases will be searched from their inception to March 2019, including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. Randomized controlled trials (RCTs) that compared the effect of acupuncture for lumbar myofascial pain will be included. The primary outcomes will be reduction of lumbar myofascial pain assessed by Visual Analog Scale (VAS). Secondary outcomes are questionnaires to evaluate the effects of treatment on patients’ daily life activities and psychological status; and adverse events. The primary and secondary outcomes will be assessed before (0 day) treatment and at 0, 7, 30, and 90 days after treatment. Data synthesis will be computed by RevManV.5.3.5 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook. Results: The results of this study will be published in a peer-reviewed journal. Conclusion: The study will provide evidence to illustrate acupuncture is an effective therapeutic intervention for chronic low back pain caused by lumbar myofascial pain. Trial registration number: PROSPERO CRD42019129735

Pneumonic-type adenocarcinoma (P-ADC) is a subtype of lung adenocarcinoma with high mortality, which often requires lobectomy surgery. Nonsurgically treated P-ADC patients usually have more advanced or complex conditions, which remain poorly understood and pose a major challenge in clinical management. We aimed to describe the clinical profiles and prognosis of non-surgically treated P-ADC patients. We enrolled 71 patients with pathologically proven P-ADC from a university hospital in China. Clinical and laboratory data were retrieved from medical record. Their median age was 62 years, including 45% men and 35% smokers. Clinical manifestations were dominated by cough, sputum, and dyspnea. Main chest imaging features included nodules, shadow, consolidation, and air bronchogram. Nearly half or more of patients showed higher levels of inflammation and cancer biomarkers including cytokeratin-19-fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA). Majority of patients were classified at the stage IIIB or IV. Palliative care was the most popular treatment option but provided a shorter overall survival compared to tyrosine kinase inhibitor therapy, standard chemotherapy, and sequential therapy while there were no significant differences in the survival among the latter 3 options. Higher serum CEA was associated with longer survival and better prognosis while higher serum CYFRA 21-1 could predict a poor prognosis. Detailed understanding the clinical characteristics and prognostic factors in nonsurgically treated P-ADC may allow the identification of patients with particular risk factors and initiation of early and specific treatment in order to optimize outcomes.

Background: This meta-analysis was conducted to assess the value of magnetic resonance spectroscopy imaging (MRSI) in the diagnosis of suspected prostate cancer (PC). Methods: We identified all the relevant papers from the EMBASE, PubMed, EBSCO, Web of Science, and Cochrane Library databases and screened the reference lists. The quality assessment of diagnostic accuracy studies-version 2 tool was used to assess the study quality. Publication bias was analyzed using Deeks’ funnel plot asymmetry test. We calculated the pooled sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratio (DOR), and 95% confidence intervals. The results were evaluated by summary receiver-operating characteristic curves (SROCs). Ultimately, a univariable meta-regression and subgroup analysis, Fagan plot, and likelihood matrix were used to analyze this review. Results: A total of 19 articles, which were based on patient-level analysis of PC, were included. These studies had a pooled sensitivity, specificity, DOR, and an area under the SROC of 0.86, 0.78, 22, and 0.89, respectively, by patient-level analysis. From the likelihood matrix, the summary negative likelihood ratio and positive likelihood ratio for MRSI diagnosis of PC were concentrated on the right lower quadrant, which neither confirmed nor excluded the diagnosis of cancer. Conclusion: MRSI has a relative application value in the diagnosis of cases of suspected PC. While MRSI is still required for diagnosis along with other clinical data and comprehensive analysis.

Although endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic fluid collections with metal stents is generally preferred over plastic stents, its superiority among different types of metal stents has not yet been well studied. We conducted this study to compare clinical outcomes and complications of a novel self-expanding biflanged metal stent (BFMS) and a traditional-shaped tubular metal stent (TMS) in treating pancreatic pseudocyst (PPC).This was a retrospective analysis on consecutive patients with PPC underwent EUS-guided transmural drainage with either TMS or BFMS in a single tertiary center with expertise in management of complex biliary and pancreatic problems. The technical and functional success rate, reintervention, complications, and recurrence rate were evaluated.From September 2013 to January 2018, 125 patients (66.4% male, median age 47 years) underwent EUS-guided transmural drainage for PPC. Among them, 49 used TMS and 76 used BFMS. All patients met the inclusion criteria that cyst diameter was >6 cm or the distance between cyst and stomach wall was shorter than 1 cm. There was no difference in technical success (98% vs 97.4%, P = 1.0) or functional success rate (87.8% vs 92.1%, P = .54) using 2 types of metal stents. However, more procedure related complications occurred in TMS than in BFMS group. TMS group had a much higher migration rate than BFMS group (14.6% vs 0, P = .001), even though there was no significant difference in bleeding, infection, or death rate between 2 groups. With similar clinical outcomes, TMS group required more additional plastic stent placement than BFMS group for better drainage.TMS and BFMS placement can both be considered as methods of endoscopic transmural PPC drainage with equal efficacy, whereas BFMS could be preferred for fewer complications or less need of additional plastic stent placement.

Rationale Diffuse large B-cell lymphoma (DLBCL) is a neoplasm of large B lymphoid cells that exhibits diffuse growth patterns. Patients may present with nodal and/or extranodal disease. The most common extranodal site is the gastrointestinal tract, while skin is less common. Patient concerns We report a case of secondary skin involvement of an original gastric DLBCL, which has achieved a complete response after treatment with chidamide. Diagnoses Initially, the diagnosis of gastric DLBCL is clear, and this patient responded well to systemic chemotherapy (rituximab + cyclophosphamide + epirubicin + vincristine + prednisone) after 8 cycles. Thirty months later, some rapidly enlarging skin nodules on his arm were found. These skin nodules were diagnosed as secondary cutaneous DLBCL based on the clinical features, positron emission tomography-computed tomography, and histomorphologic and immunohistochemical expression. Interventions Steroids, interferon-α, and radiation had little therapeutic effect. We treated the patient with chidamide at 30 mg twice per week in combination with dexamethasone. Outcomes The skin nodules regressed 3 weeks later. During the 1-year follow-up period, the patient is still in treatment with chidamide without adverse reactions. Lessons To the best of our knowledge, this is the first case of secondary skin DLBCL reported to exhibit a complete response to chidamide, which provides a novel therapeutic strategy for secondary skin DLBCL. However, more cases are still needed to further validate its efficacy.

Distinguishing lung adenocarcinoma from squamous cell carcinoma (SCC) is clinically important. Computed tomography (CT) scan is an economical, effective, noninvasive, commonly available, and quick diagnostic way for lung cancer. In this study, we aim to compare the CT characteristics in adenocarcinoma and SCC. Data from 275 cases (259 adenocarcinoma and 16 SCC) were retrospectively compared. CT characteristics, including lesion size and shape, single/multifocal lesions, location of the tumor, the margin of lobes, whether the lesion had deep lobulated margin, bronchial cut-off sign, signs of dilated bronchial arteries, signs of vascular bundle thickening, signs of short burrs, spinous processes, and pleural indentation, were compared in 148 cases (137 adenocarcinoma and 11 SCC). Patients with adenocarcinoma were more likely to be female (44.2% vs 25.0%, P = .017). Compared with SCC, adenocarcinomas were more likely to have deep lobulated margin (81.0% vs 54.5%, P = .038), less likely to have smooth lobes margin (2.7% vs 83.3%, P