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To investigate the clinical efficacy of Percutaneous Kyphoplasty (PKP) in male and female patients.The clinical data of patients treated with PKP in our hospital from January 2018 to October 2020 were analyzed retrospectively. These patients were divided into female group and male group according to gender differences. The visual analogue scale (VAS) and activity function score (LAS) were recorded before operation, immediately after operation and 1 year after operation, and postoperative complications such as cement leakage and recurrent vertebral fracture were recorded. The above observation indexes between the 2 groups were statistically compared.A total of 171 patients (118 in female group and 53 in male group) were included. There was no other difference between the 2 groups except that thoracic vertebral fracture was more common in women (P .05). The VAS of female group and male group were (7.14 ± 0.61) and (7.11 ± 0.51) before operation, (3.05 ± 0.66) and (2.89 ± 0.64) after operation, 1 year after operation (1.10 ± 0.50) and (1.02 ± 0.37). There was no difference in each period between the 2 groups (P .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P .05); The activity scores of female group and male group were (3.08 ± 0.48) and (3.07 ± 0.43) before operation, (1.86 ± 0.42) and (1.85 ± 0.50) after operation, 1 year after operation (1.01 ± 0.92) and (1.02 ± 0.14). There was no difference in each period between the 2 groups (P .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P .05). Postoperative cement leakage was revealed in 21 cases (12.28%), 16 cases (13.56%) in female group and 5 cases (9.43%) in male group, which was no significant difference between the 2 groups. During the 1-year follow-up, postoperative recurrent vertebral fracture was revealed in 4 cases (2.34%), 2 cases (1.69%) in the female group and 2 case (3.77%) in the male group, which was also no significant difference between the 2 groups.Patients treated with PKP can immediately get pain relief and activity function improvement. PKP is a safe and effective minimally invasive surgery for both female and male patients.

This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = -0.698, P.05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P.05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P.05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.

At present, to a large extent, we do not know the safety and benefits of minimally invasive surgery for elderly patients, especially the focus population of patients aged 90 and over.We analyzed 189 consecutive patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty (PKP) between January 2018 and June 2021 at our institution. We divided them into the advanced age group aged 90 years or over (group A, n = 14) and the younger group under 90 years (group Y, n = 175). Clinical and complication indicators were evaluated and compared between the 2 groups.A significant difference was observed in the procedure time, bleeding volume, and bone mineral density between the 2 groups during an average follow-up of 22 months. However, no significant difference was revealed in clinical and complication indicators between the 2 groups, and the pain and activity function of the 2 groups were significantly improved compared with those before PKP.Apparently, our results show that PKP is safe and beneficial for patients aged 90 years or older.

To compare the incidence of fracture between sandwich vertebra and ordinary adjacent vertebra after percutaneous kyphoplasty (PKP).We analyzed 225 consecutive patients with osteoporotic vertebral compression fractures who underwent PKP between January 2016 and December 2020 at our medical institution. The sandwich vertebrae was located between 2 cement-augmented vertebra and was followed for at least 12 months. The clinical data of patients with sandwich vertebra and ordinary adjacent vertebra were recorded, and the incidence of postoperative fracture between sandwich vertebra and ordinary adjacent vertebra was compared.The mean continuous follow-up time was 31.30 ± 18.04 months in patients with sandwich vertebra and 25.85 ± 7.96 months in patients with ordinary adjacent vertebra. It should be noted that the incidence of sandwich vertebral fractures was 10.00%, which was not statistically higher than 3.26% for ordinary adjacent vertebral fractures. However, a significant difference was observed in the cement volume of single vertebral body, procedure time, and bleeding.Although the volume of cement in a single vertebral body is less and the procedure time and bleeding are more, the incidence of sandwich vertebral fracture is not higher than that of ordinary adjacent vertebral body.

Background Type 2 diabetes mellitus (T2D) and osteoporosis (OP) often coexist, and both are systemic metabolic diseases and seriously increase the risk of fragility fracture. However, there is no specific Western medicine for the treatment of T2D with OP (T2DOP). As reported in clinical and experimental studies, traditional Chinese medicine (TCM) based on principle of tonifying-kidney, strengthening-spleen, and invigorating blood circulation (Bushen-Jianpi-Huoxue) (BSJPHX) has significant efficacy against T2DOP. This protocol will be designed for a systematic review and meta-analysis to assess the efficacy and safety of TCM BSJPHX principle in the treatment of T2DOP. Methods All relevant randomized controlled trials (RCTs) related to TCM therapies conducted in BSJPHX principle for T2DOP will be searched in the 8 electronic databases: PubMed, Cochrane Library, Wed of Science, EMBASE, Chinese National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Literatures Database (CBM), Chinese Scientific Journal Database (VIP), Wanfang Database, from inception to October 2020. The main outcomes will contain: fasting blood glucose (FPG), 2 hours postprandial blood glucose (2hPG), glycosylated hemoglobin (HbA1c), serum calcium, bone mineral density (BMD), TCM syndrome integral, and the additional outcomes will consist of visual analog scale (VAS), and adverse events. Two reviewers will independently carry out literature search, data selection and synthesis, and literature quality assessment. In case of any dispute, it will be settled by group discussion. Assessment of risk of bias, reporting bias, and data synthesis would be performed with Review Manager software (Rev-Man 5.3). Result This study will collate and summarize the various current evidences of TCM BSJPHX principle for T2DOP. Conclusion This study will offer convincing evidence for judging the efficacy and safety of TCM BSJPHX principle for T2DOP. Prospero registration number CRD42020218877.

There has been a highly active area in the pain management of osteoarthritis (OA) over the past 2 decades. The study aims to unmask the global status and trends in this field. Publications on pain management of OA from 2000 to 2019 were retrieved from the Web of Science (WOS) database. The data were analyzed using bibliometric statistical methodology. The software VOS viewer was used for bibliographic coupling, co-authorship, co-citation, co-occurrence analysis and to investigate the publication trends in pain management of OA. A total of 8207 researches in amount were included. The relative research interests and number of publications indicated a rising trend. The USA made the greatest contribution to this field, with the most publications, total citations and the highest H-index, while Sweden had the highest average citation per publication. The most contributive organization was Boston University. The journal OA and Cartilage published the most relative articles. Researches could be grouped into 5 clusters based on co-occurrence network map: Health and Epidemiology; Sport Medicine; Clinical Study; Mechanism Research and Medical Technology and Science. Medical Technology and Science was predicted as the next research topic in this field. The number of publications about pain management of OA would be increasing based on current global trends. The USA made the largest contribution to this field. The development of Medical Technology and Science may be the next popular topics in the pain management of OA research.

Background: There has been a paucity of cohort trials directly comparing multiple cannulated screws (MCS) and sliding hip screws (SHS) in femoral neck fractures at any level. Thus, a well-conducted clinical trial with an adequate sample size is urgently needed. We undertake a retrospective study to compare outcomes in patients who undertake MCS or SHS fixation for femoral neck fractures. Methods: A retrospective review of femoral neck fractures performed with SHS or MCS between February 2016 and June 2018 was conducted with Institutional Review Board approval in the First Affiliated Hospital of Dali University of Orthopedic Trauma. All cases were performed by a single surgeon. Of these, we included 180 patients (90 hips) that were performed surgery in treatment of femoral neck fractures. All patients received the same standardized postoperative multimodal pain protocol and the same postoperative rehabilitation program. The primary endpoint was Harris Hip Score. Secondary outcome measures include operation time, length of hospital stay, incision length, patient satisfaction, and postoperative complications. Multivariate linear and regression analyses was used to identify independent predictors of outcome. A P-value of

Background: An increasing body of studies has investigated that genetic polymorphisms in microRNA (miRNA) may be related to susceptibility to rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, some results remain controversial. Thus, a meta-analysis was embarked on assessing whether some miRNA polymorphisms are associated with the risk of RA and SLE. Methods: Relevant studies were acquired on PubMed, Web of Science, Cochrane Library, CNKI, and Embase electronic databases from inception to December 2019. The strength of the association of miRNA polymorphisms with the risk of RA and SLE was assessed by odds ratios (ORs) and 95% confidence intervals (CIs). Results: Eligible 20 articles (36 studies) involving 5 miRNAs were enrolled in the meta-analysis. For RA, the polled result showed that there was no significant relationship between miR-146a rs2910164 and RA, but subgroup analysis based on ethnicity demonstrated that CC genotype may be a genetic protect factor for RA in Caucasians (CC vs CG+GG, OR = 0.825, 95% CI: 0.684–0.996, Pz = .045, Ph = .166). Besides, statistical significance of miR-499 rs3746444 (T/C) with susceptibility to RA was observed as well in the overall population, and the association was only significant in Caucasians but not Asians. For SLE, the associations of miR-146a rs2431697 T allele/T-carrier with increased risk of SLE were observed. Conclusions: Our results highlight that miR-499 rs3746444 may contribute to RA susceptibility, particularly in Caucasians. In addition, CC genotype in miR-146a rs2910164 may act as a protector of RA in Caucasians. For SLE, miR-146a rs2431697 (C/T) is most likely to the increased the risk of SLE. These findings do not support the genetic association between miR-196a2 rs11614913 and RA/SLE susceptibility, as well as the association of miR-146a rs2910164, miR-146a rs57095329, miR-499 rs3746444 with SLE.

Background: Reported studies have shown that expression levels of microRNAs (miRNAs) are related to survival time of patients with heart failure (HF). A systematic review and meta-analysis were conducted to study circulating miRNAs expression and patient outcome. Methods: Meta-analysis estimating expression levels of circulating miRNAs in HF patients from January 2010 until June 30, 2018, through conducting online searches in Pub Med, Cochrane Database of Systematic, EMBASE and Web of Science and reviewed by 2 independent researchers. Using pooled hazard ratio with a 95% confidence interval to assess the correlation between miRNAs expression levels and overall survival. Results: Four relevant articles assessing 19 circulating miRNAs in 867 patients were included. In conclusion, the meta-analysis results suggest that HF patients with low expression of serum miR-1, miR-423-5p, miR-126, miR-21, miR-23, miR-30d, miR-18a-5p, miR-16-5p, miR-18b-5p, miR-27a-3p, miR-26b-5p, miR-30e-5p, miR-106a-5p, miR-233-3P, miR-301a-3p, miR-423-3P, and miR-128 have significantly worse overall survival (P

Background: The purpose of this study was to compare the hemodynamic parameters of symptomatic and asymptomatic abdominal aortic aneurysms (AAAs) to explore the risk factors for AAA rupture. Methods: We conducted a retrospective analysis of 26 patients with symptomatic small AAAs and 60 patients with asymptomatic small AAAs. Computational fluid dynamics methods were used to compare hemodynamic characteristics between the symptomatic and asymptomatic groups and to evaluate risk factors for the occurrence of symptomatic AAAs. Results: The maximum diameters in the symptomatic and asymptomatic groups were 49.7 ± 4.94 mm and 48.4 ± 4.55 mm, respectively. Wall shear stress values at turbulent flow regions in the symptomatic and asymptomatic groups were 0.0098 ± 0.0084 Pa versus 0.0174 ± 0.0068 Pa, respectively. Shear stress values at the site with maximal blood flow impact force in the symptomatic and asymptomatic groups were 1.13 ± 0.466 Pa and 2.04 ± 0.42 Pa, respectively. The areas of the intra-luminal thrombus in the section with the maximum diameter in the symptomatic and asymptomatic groups were 952.19 ± 413.53 mm2 versus 646.63 ± 296.88 mm2, respectively. Conclusion: The wall shear stress in the symptomatic group was lower than that in the asymptomatic group.

In this study, we aimed to develop a reliable nomogram to estimate individualized prognosis for patients with distal bile duct cancer (DBDC) and compare the predictive value with the American Joint Committee on Cancer staging system. Data of 1110 patients diagnosed with DBDC were recruited from the Surveillance, Epidemiology, and End Results database between 1973 and 2015. All patients were randomly divided into the training (n = 777) and validation (n = 333) cohorts, respectively. Multivariate Cox regression was performed to identify the independent risk factors. The Akaike information criterion was used to select covariates for constructing a nomogram. The predictive ability of the nomogram was assessed by concordance index (C-index) and area under receiver operating characteristic curve (AUROC) compared to tumor-node-metastasis (TNM) staging system. A nomogram integrating 8 risk factors was developed with a higher C-index than that of the TNM staging system (training data set, 0.70 vs 0.61; validation data set, 0.71 vs 0.57). The AUROCs of the nomogram for 1-year and 3-year overall survival (OS) predication were 0.76 and 0.78 in the training cohort, 0.78 and 0.77 in the validation cohort. However, AUROCs of the TNM stage for predicting 1-year and 3-year OS were all below 0.60. Calibration curves showed the optimal agreement in predicating OS between nomogram and actual observation. In addition, this nomogram can effectively distinguish the OS between low and high-risk groups divided by the median score (P

Primary adrenal lymphoma (PAL) is a rare entity of lymphoma with dismal prognosis using systemic chemotherapy. More clinical reports are needed to guide the treatment for PAL. We performed a retrospective analysis of 20 patients diagnosed with PAL who presented to our center between January 2005 and January 2014. Median age at presentation was 48 years (range: 27–73) with a male-to-female ratio of 7:3. Bilateral and right-sided adrenal involvement were seen in 11 of 20 and 7 of 20 patients, respectively. Adrenal insufficiency (AI) was seen in 6 of 10 evaluated patients. Diffuse large B cell lymphoma (DLBCL) was the most common immunophenotype (85.0%). Two patients died due to rapid disease progression before treatment. Two patients received autologous stem cell transplantation as consolidation therapy. All patients received prophylactic intrathecal chemotherapy. The estimated 5-year overall survival (OS) and progression-free survival (PFS) were 52.5% [95% confidence interval (95% CI: 28.2–72.0)] and 53.2% (95% CI: 29.0–72.5), respectively. These findings suggest that PAL should always be considered in differential diagnosis of adrenal mass with AI. Despite the contrasting previous reports, long-term prognosis of PAL is not necessarily inferior to that of non-Hodgkin lymphoma in general.

Endometriosis is associated with dysmenorrhea, chronic pelvic pain, and infertility. The specific mechanism of endometriosis remains unclear. The aim of this study was to apply a bioinformatics approach to reveal related pathways or genes involved in the development of endometriosis. The gene expression profiles of GSE25628, GSE5108, and GSE7305 were downloaded from the gene expression omnibus (GEO) database. Differentially expressed gene (DEG) analysis was performed using GEO2R. The database for annotation, visualization, and integrated discovery (DAVID) was utilized to analyze the functional enrichment, gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway of the differentially expressed genes. A protein-protein interaction (PPI) network was constructed and module analysis was performed using search tool for the retrieval of interacting genes and cytoscape. A total of 119 common differentially expressed genes were extracted, consisting of 51 downregulated genes and 68 upregulated genes. The enriched functions and pathways of the DEGs and hub genes include DNA strand separation, cellular proliferation, degradation of the extracellular matrix, encoding of smooth muscle myosin as a major contractile protein, exiting the proliferative cycle and entering quiescence, growth regulation, and implication in a wide variety of biological processes. A bioinformatics approach combined with cell experiments in this study revealed that identifying DEGs and hub genes leads to better understanding of the molecular mechanisms underlying the progression of endometriosis, and efficient biomarkers underlying this pathway need to be further investigated.

Rationale Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. Patient concerns A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. Diagnosis Emergency brain computed tomography revealed massive pneumocephalus. Interventions Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. Outcomes Repeated computed tomography showed complete resolution of the pneumocephalus after five days. Lessons Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.

BACKGROUND The potential treatment effects and safety of Yu ping feng san (YPFS) for pediatric allergic rhinitis (PAR) patients have yet to be studied systematically. OBJECTIVES To assess the effects and safety of YPFS for treat pediatric patients, allergic rhinitis. METHODS We systematically searched PubMed, EMBASE (Excerpta Medical Database), Cochrane library, Chinese Cochrane Centre's Controlled Trials Register platform, Wanfang Chinese Digital Periodical and Conference Database, China National Knowledge Infrastructure Database, and VIP Chinese Science, from inception dates to November 1, 2019. Randomized controlled trials (RCTs) were included. The risk of bias in the trials was assessed in accordance with the Cochrane Handbook, version 5.1.0. RevMan 5.3 software was used to perform a meta-analysis. Grading of Recommendations Assessment, Development and Evaluation methodology was applied to evaluate the evidence quality for each outcome. The quality of evidence for each outcome measurement was low for 4 outcomes and very low for 5 outcomes. RESULTS A total of 10 RCTs involving 1069 participants (3-15 years old) fulfilled the inclusion criteria. After exclusion, 8 RCTs were pooled for efficacy assessment. The overall efficacy evaluation result did not show benefit for the experimental group (relative risk 0.32, CI 95% 0.24-0.45; P = .98;) Investigation of variation of serum IgA, immunoglobulin E, IgG in three studies in 2 groups returned no statistical significance. YPFS gave relatively better safety (relative risk 0.29, CI 95% 0.14-0.58; P = .0005; Fig. S8, http://links.lww.com/MD/F751) and lower recurrence rates than did Western medical therapy. CONCLUSIONS Current evidence cannot support the routine use of YPFS for treatment of PAR. This may be due to poor-quality study-design limitations of the included YPFS studies. Our data showed that the use of YPFS for PAR is relatively safe compared to Western medical therapy, but a conclusion could not be drawn because only 5 studies were analyzed. Every study suffered from some methodological limitation. Therefore, further large, rigorously-designed studies are necessary to determine conclusively the utility of YPFS in PAR.

Rationale Intravenous pyogenic granuloma (IVPG) is a special type of pyogenic granuloma, and its preoperative diagnosis is difficult. We report a rare case of IVPG that develops in the lumen of the internal jugular vein (IJV). Here, we analyze the imaging characteristics of present case and summarize the imaging characteristics of previous reported cases. Patient concerns A 44-year-old man who presented with a growth in the IJV without any symptoms. Diagnoses A diagnosis of IVPG was made, based on the pathological examination after surgery. Interventions The patient underwent surgery to excise the vein segment containing the neoplasm. Outcomes The patient did not present with any complications in the postoperative follow-up period. Lessons For clinician, IVPG's preoperative diagnosis is difficult. Although histopathology remains the gold standard for diagnosis, the combination of multiple types of imaging examinations is necessary to rule out the differential diagnoses of IVPG.

Background: The objective of this study is to examine the effectiveness and safety of electroacupuncture (EA) in the treatment of urinary incontinence (UI) in patients with spinal cord injury (SCI). Methods: All potential studies will be retrieved from the electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, CBM, and China National Knowledge Infrastructure from origin of each database up to January 31, 2020. Additionally, we will check other resources, such as Google scholar, dissertations, conference proceedings, and reference lists of included studies. No language and publication date limitations will be considered in the literature resources search. All randomized controlled trials using EA for the treatment of UI in patients with SCI will be included. Two independent investigators will perform study selection, data extraction and study quality assessment. If any conflicts occur, we will invite a third investigator to solve them. Cochrane risk of bias will be used for study quality assessment, and RevMan 5.3 software will be employed for statistical analysis. Results: This study will summarize the most recent evidence to assess the effectiveness and safety of EA for the treatment of UI in patients with SCI. Conclusion: The results of this study will provide helpful evidence to determine whether EA is effective and safety for the treatment of UI in patients with SCI or not. PROSPERO registration number: PROSPERO CRD42020165562.

Background: Ankylosing spondylitis (AS) is a very tricky orthopedic disorder. If such condition cannot be managed fairly well, it may significantly affect quality of life and even leads to disability among such population. A variety of studies have reported that alendronate is utilized for the treatment of AS. However, their results are still contrary, and no systematic review has addressed on this topic. Thus, this study will systematically assess the efficacy and safety of alendronate for the treatment of patients with AS. Methods: A comprehensive literature search will be performed from the below electronic databases from their commencement to the January 31, 2020 without language and publication status limitations: PubMed, Embase, Cochrane Library, Web of Science, Allied and Complementary Medicine Database, WANGFANG, and China National Knowledge Infrastructure. Only randomized controlled trials focusing on the alendronate for the treatment of patients with AS will be considered for inclusion in this study. Two authors will independently select all identified records, extract essential data from all included studies, and appraise study quality for each eligible trial using Cochrane risk of bias. If any differences occur, another experienced author will be invited to solve them by discussion and a consensus decision will be made. We will implement RevMan 5.3 software to analyze the extracted data. Results: This study will summarize high-quality randomized controlled trials to assess the efficacy and safety of alendronate for the treatment of patients with AS through primary outcome of bone densitometry; and secondary outcomes of pain intensity, quality of life, disease activity, functional status, and adverse events. Conclusion: This study will provide evidence to help determine whether alendronate is an effective and safe management for patient with AS or not. Study registration: INPLASY202040153.

Background Post-stroke shoulder-hand syndrome (PSSHS) is one of the most common sequelae in patients with stroke. Previous studies have reported that extracorporeal shock wave (EPSW) has been used to treat this condition effectively. However, its conclusions are still inconsistent. Therefore, this study will provide evidence to systematically assess the effectiveness and safety of EPSW for the treatment of PSSHS. Methods We will comprehensively search relevant randomized controlled trials (RCTs) assessing the effectiveness and safety of EPSW for the treatment of PSSHS in the following databases from their start to February 1, 2020 without language and publication date limitations: Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. For trials that meet all inclusion criteria, 2 researchers will independently extract the data from them and appraise study quality by Cochrane risk of bias. Any differences will be solved by discussion with the help of another researcher. All data will be performed and analyzed using RevMan 5.3 software. Results We will summarize up-to-date high quality RCTs to evaluate the effectiveness and safety of EPSW for the treatment of PSSHS. Conclusions This study will provide a comprehensive evidence summary to determine whether EPSW is effective and safety for the treatment of PSSHS or not. Prospero registration number PROSPERO CRD42020175630.

Background: Heart failure with reduced ejection fraction (HFrEF) has contributed to an increasing number of deaths and readmissions over the past few decades. Despite the appearance of standard treatments, including diuretics, β-receptor blockers and angiotensin-converting enzyme inhibitor (ACEI), there are still a large number of patients who have progressive deterioration of heart function and, inevitably, end-stage heart failure. In recent years, new medications for treating chronic heart failure have been clinically applied, but there is controversy surrounding drug selection and whether patients with HFrEF benefit from these medications. Therefore, we aimed to compare and rank different new pharmacological treatments in patients with HFrEF. Methods: We performed a network meta-analysis to identify both direct and indirect evidence from relevant studies. We searched MEDLINE, EMBASE, and PsycINFO through the OVID database and CENTRAL through the Cochrane Library for clinical randomized controlled trials investigating new pharmacological treatments in patients with HFrEF published up to September 30, 2018. We included trials of ivabradine, levosimendan, omega-3, tolvaptan, recombinant human B-type natriuretic peptide (rhBNP), isosorbide dinitrate and hydralazine (ISDN/HYD) and angiotensin-neprilysin inhibition (LCZ696). We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool. Based on these items, more than half of the entries were judged as having an overall low to moderate risk of bias; the remaining studies had a high or unclear risk of bias. The outcomes investigated were left ventricle ejection fraction (LVEF %), heart rate (HR) and serum level of B-type natriuretic peptide (BNP). We performed a random-effects network meta-analysis within a Bayesian framework. Results: We deemed 32 trials to be eligible that included 3810 patients and 32 treatments. Overall, 32 (94.1%) trials had a low to moderate risk of bias, while 2 (5.9%) trials had a high risk of bias. The quality of the included studies was rated as low in regard to allocation concealment and blinding and high in regard to other domains according to the Cochrane tools. As for increasing LVEF%, levosimendan was better than placebo (–3.77 (–4.96, –2.43)) and was the best intervention for improving ventricle contraction. As for controlling HR, n3-PUFA was better than placebo (4.01 (–0.44, 8.48)) and was the best choice for regulating HR. As for decreasing BNP, omega-3 was better than placebo (941.99 (–47.48, 1952.89) and was the best therapy for improving ventricle wall tension. Conclusions: Our study confirmed the effectiveness of the included new pharmacological treatments for optimizing the structural performance and improving the cardiac function in the management of patients with HFrEF and recommended several interventions for clinical practice.

Background Previous clinical trials have reported that physical therapy (PT) can be used for the treatment of frozen shoulder (FS). However, its effectiveness is still inconclusive. In this systematic review study, we will aim to evaluate the effectiveness and safety of PT alone for the treatment of FS. Methods The following electronic databases will be searched from the inception to the present to identify any eligible studies focusing on PT for the treatment of FS. These databases comprise of Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and 4 Chinese databases of Chinese Biomedical Literature Database, China National Knowledge Infrastructure (which includes the database China Academic Journals), VIP Information, and Wanfang Data. All randomized controlled trials (RCTs) of PT for FS will be considered for inclusion without language restrictions. Cochrane risk of bias tool will be used to assess the methodological quality for all included RCTs. Results The effectiveness and safety of this study will be assessed by shoulder pain intensity, shoulder function, quality of life, and any adverse events. Conclusion The findings of this study may provide most recent evidence on the effectiveness and safety of PT for patients with FS.

Rationale Central venous catheterization is a common tool used to monitor central venous pressure and administer fluid medications in patients undergoing surgery. The loss of a broken guide wire into the circulation is a rare and preventable complication. Here, we report a peculiar case of a missed guidewire puncturing the aortic arch and cerebrum. Patient concerns A 53-year-old man with complaints of an intermittent headache and right swollen ankle following central venous catheterization. Diagnoses Using computed tomography; the patient was diagnosed with the loss of a guide wire in his body. The guide wire had migrated to the brain and punctured the vascular wall of the aortic arch. Interventions Due to the risks of surgery, the patient was advised to have a follow-up visit once every 3 months. Outcomes At present, the patient could live like a normal person, although he suffers from intermittent headaches. Lessons The loss of a guide wire is a completely preventable complication, provided that a hold on the tip of the wire is maintained during placement, and the correct safety measurements and protocols are followed.

Background Previous clinical studies have reported that extracorporeal shock wave (EPSW) monotherapy can effectively treat avascular necrosis of femoral head (ANFH). However, no systematic review has been conducted to assess its effectiveness and safety for patients with ANFH. Therefore, this study will systematically assess the effectiveness and safety of EPSW monotherapy for patients with ANFH. Methods In this study, the following electronic databases will be searched from their inceptions to the present: Cochrane Library, EMBASE, PUBMED, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. This study will include randomized controlled trials for assessing the effectiveness and safety of EPSW monotherapy for patients with ANFH. Two independent authors will perform study selection, data extraction, and methodology assessment. RevMan 5.3 software will be used for statistical analysis. Results This systematic review will provide latest summary evidence of EPSW monotherapy for patients with ANFH through assessing the outcome measurements. The primary outcome is pain intensity, which can be measured by visual analog scale or relevant measurement tools. The secondary outcomes are functional status of attacked femoral head, as assessed by Western Ontario and McMaster Universities Osteoarthritis Index, or other relevant scales; quality of life, as evaluated by The 36-Item Short Form Health Survey, or related instruments; and adverse events. Conclusion The results of this study may provide the latest evidence for assessing the effectiveness and safety of EPSW for the treatment of ANFH. Dissemination and ethics This study does not require ethical approval, because no individual data will be involved in this systematic review. The findings of this study will be published through a peer-reviewed journal. Systematic review registration PROSPERO CRD42019124665.

Background Previous clinical trials have reported that etoricoxib has been utilized to treat ankylosing spondylitis (AS) effectively. However, no study systematically investigated the efficacy and safety of etoricoxib for patients with AS. In this systematic review, we will assess the efficacy and safety of etoricoxib for AS. Methods The following electronic databases will be searched from inception to the February 1, 2019: Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database. This study will include randomized controlled trials that explore the efficacy and safety of etoricoxib for AS. The primary outcome is pain intensity, as measured by any pain scales, such as Numerical Rating Scale. The secondary outcomes consist of AS function, as measured by Bath Ankylosing Spondylitis Functional Index, or other tools; quality of life, as assessed by Ankylosing Spondylitis Quality of Life questionnaire or any other relevant instruments; as well as adverse events. Two authors will independently carry out the study selection, data extraction, and risk of bias assessment. Statistical analysis will be performed by using RevMan 5.3 software. Results This systematic review will provide a detailed summary of present evidence related to the efficacy and safety of etoricoxib for patients with AS. Conclusion The results of this study may provide management guidance for AS treated by etoricoxib. Dissemination and ethics This systematic review dose not needs ethical approval, because it will not analyze individual patient data. The findings of this study are expected to publish through a peer-reviewed journal. Systematic review registration CRD42019124768.

Rationale:We present a rare case of multiple tuberculous mycotic aneurysm. Multiple aneurysms caused by tuberculosis (TB) are difficult to treat. Here, we discuss a treatment modality using a microcore stent graft.Patient concerns:A 73-year-old man with pain in the back and on the right side

Atherosclerotic diseases may include femoropopliteal artery stenosis or occlusion. Percutaneous transluminal angioplasty (PTA) is an effective and minimally invasive treatment strategy for atherosclerotic femoropopliteal artery stenosis/occlusion disease. Balloon angioplasty is a widely used technique in the management of occlusive disease in almost all arterial segments. We enrolled 111 diabetics with long femoropopliteal lesions, among which 54 received PTA with paclitaxel-coated balloon (the Paclitaxel group), and 57 with standard balloon catheters (the Control group). The primary outcome was set as angiographic late lumen loss (LLL) within 6 months; the secondary angiographic outcome was binary restenosis. Clinical outcomes included Rutherford clarification, ankle-brachial index (ABI) and rate of clinically driven target lesion revascularization (TLR). Two groups had similar basal clinical features, angiographic and procedural characteristics. Compared to controls, the Paclitaxel group had a significantly lower 6-month LLL rate, 12-month binary restenosis rate, 12-month TLR, lower Rutherford grades at 3 and 6 months, and higher ABI at 3 months. For all factors which might influence outcomes, fasting blood glucose was negatively correlated with ABI; the blood urea nitrogen (BUN) was positively related with the Rutherford clarification grades. In addition, the coronary heart disease (CHD) and smoking histories were positively correlated with residual stenosis after treatment. Collectively, the paclitaxel-coated balloon angioplasty can yield more favorable angiographic and clinical outcomes than standard uncoated balloon angioplasty, even in the more challenging lesions (the long and occlusive femoropopliteal lesions) in diabetics, when it had a similar safety profile to the traditional balloon. Blood glucose, BUN, CHD, and smoking imply poor curative effects.

Background: The receptor for advanced glycosylation end products (RAGE) has been widely linked to diabetic atherosclerosis, but its effects on coronary artery disease (CAD) and ischemic stroke (IS) remain controversial. The Gly82Ser polymorphism is located in the ligand-binding V domain of RAGE, suggesting a possible influence of this variant on RAGE function. The aim of the present study is to clarify the association between the RAGE Gly82Ser polymorphism and susceptibility to CAD and IS. Methods: Eligible studies were identified through a comprehensive literature search. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the association of Gly82Ser polymorphism with CAD and IS risk. Fixed- or random-effects model was used depending on the heterogeneity between studies. A funnel plot and Egger linear regression test were applied to assess publication bias. We also performed subgroup analyses to investigate potential sources of heterogeneity. Results: A total of 16 eligible articles containing 18 studies were analyzed. The pooled analysis indicated that the Gly82Ser polymorphism significantly increased CAD risk in recessive and homozygous genetic models (SS vs GS + GG: OR = 1.34, 95% CI = 1.09–1.64; SS vs GG: OR = 1.38, 95% CI = 1.12–1.71). A significant association between the Gly82Ser polymorphism and IS risk was observed in all tested models except the heterozygous genetic model (GS + SS vs GG: OR = 1.20, 95% CI = 1.04–1.38; SS vs GS + GG: OR = 2.20, 95% CI = 1.74–2.78; SS vs GG: OR = 2.23, 95% CI = 1.72–2.91; S vs G: OR = 1.32, 95% CI = 1.05–1.65). Subgroup analysis suggested an association between CAD and IS risk and the Gly82Ser polymorphism in the Chinese population, but not in the non-Chinese population. Conclusions: The current meta-analysis suggests that the RAGE Gly82Ser polymorphism is associated with an increased risk of CAD and IS, especially in the Chinese population. However, better-designed studies with larger sample sizes are needed to validate the results.

Background: Previous clinical studies have reported that extracorporeal shock wave (EPSW) is an effective treatment for patients with tennis elbow (TE). However, no systematic review has assessed its effectiveness and safety for the treatment of TE. Methods: In this systematic review, we will search the potential eligible literature from the following electronic databases: Central, Embase, MEDLINE, CINAHL, and CNKI from inception to the present. All literatures of randomized controlled trials of EPSW for TE will be considered without language restrictions. Two reviewers will independently select the studies, extract the data, and evaluate the methodology quality. All disagreements between those 2 reviewers will be resolved by a third reviewer involved through discussion. Outcome data will be pooled by RevMan 5.3 software if the heterogeneity is reasonable. Reporting bias will also be conducted if more than 10 included studies can be reached. Results: This systematic review will evaluate the clinical effectiveness and safety of EPSW for TE. Conclusion: The findings of this study will summarize the current evidence of EPSW on TE outcomes and may provide guidance for both clinical practice and further studies. Dissemination and ethics: This systematic review does not need ethical approval, because it does not utilize the individual patient data. Its findings are expected to publish in peer-reviewed journals. Systematic review registration: PROSPERO CRD42019119687.

Introduction: Esophageal fistula is a serious and common complication of radiotherapy for esophageal cancer. Therefore, early diagnosis and treatment is necessary. Because of side effect of barium esophagography, it cannot be used to screening esophageal fistula during radiotherapy. Meglumine diatrizoate is an ionic contrast agent, its adverse reactions were rarely seen when it was used in the body cavity. The purpose of this trial is identified the sensitivity and specificity of oral meglumine diatrizoate in an esophagogram for screening esophageal fistula during radiotherapy. Methods/design: This trial was a prospective, multicenter, diagnostic clinical trial. A total of 105 patients with esophageal cancer will swallowed meglumine diatrizoate and underwent a radiographic examination weekly during radiotherapy, medical personnel observed the esophageal lesions to determine whether an esophageal fistula formed. If an esophageal fistula was observed, esophagofiberoscopy and/or computer tomography was used to further confirm the diagnosis. And the sensitivity and specificity of meglumine diatrizoate should be calculated for screening esophageal fistula during radiotherapy. Discussion: To our knowledge, this study protocol is the first to identify the sensitivity and specificity of oral meglumine diatrizoate in an esophagogram for screening esophageal fistula during radiotherapy. If oral meglumine diatrizoate can be used to screening esophageal fistula, more patients will benefit from early detection and treatment.

Unmanipulated human leukocyte antigen (HLA)-mismatched/haploidentical blood and marrow transplantation is an established treatment for patients without HLA-matched related or unrelated donors. However, the prognostic significance of early lymphocyte recovery in this transplant setting is not defined. In this study, we investigated the association of day 30 absolute lymphocyte count (ALC-30) with outcome after unmanipulated HLA-mismatched/haploidentical transplantation. We prospectively analyzed the relationship between ALC-30 and transplant outcomes in 206 patients with hematologic malignancies receiving T-cell-replete transplantation from HLA-mismatched/haploidentical related donors. Multivariate analysis showed that ALC-30 above the cutoff value of 300 cells/microL was associated with improved overall survival (hazard ratio [HR], 0.258; 95% confidence interval [CI], 0.141-0.472; p < 0.0001); improved cancer-free survival (HR, 0.289; 95% CI, 0.166-0.501; p < 0.0001); reduced relapse (HR, 0.370; 95% CI, 0.161-0.853; p = 0.020); and decreased transplant-related mortality (HR, 0.211; 95% CI, 0.097-0.457; p < 0.0001). Our results suggest that the recovery of ALC-30 might have an influence on transplant outcomes following unmanipulated HLA-mismatched/haploidentical transplantation.

Genetic etiology hypothesis is widely accepted in the development of congenital scoliosis (CS). The delta-like 3 (DLL3) gene, a member of the Notch signaling pathway, was implicated to contribute to human CS. In this study, a case–control association study was conducted to determine the association of single nucleotide polymorphism (SNP) in the DLL3 gene with CS in a Chinese Han Population. Five known tagging SNPs of the DLL3 gene were genotyped among 270 Chinese Han subjects (128 nonsyndromic CS patients and 142 matched controls). CS patients were divided into 3 types: type I—failure of formation (29 cases), type II—failure of segmentation (50 cases), and type III—mixed defects (49 cases). The 5 SNPs were analyzed by the allelic and genotypic association analysis, genotype–phenotype association analysis, and haplotype analysis. Allele frequencies of 5 tagging SNPs (SNP1: rs1110627, SNP2: rs3212276, SNP3: rs2304223, SNP4: rs2304222, and SNP5: rs2304214) in CS cases and controls were comparable and there were no available inheritance models. The SNPs were not associated with clinical phenotypes. Moreover, the 5 makers in the DLL3 gene were found to be in strong linkage disequilibrium (LD). Both global haplotype and individual haplotype analyses showed that the haplotypes of SNP1/SNP2/SNP3/SNP4/SNP5 did not correlate with the disease (P >0.05). Together, these data suggest that genetic variants of the DLL3 gene are not associated with CS in the Chinese Han population.