Anatomical Variations in the Sinoatrial Nodal Artery: A Meta-Analysis and Clinical Considerations

ResultsSixty-six studies (n = 21455 hearts) were included in the meta-analysis. The SANa usually arose as a single vessel with a pooled prevalence of 95.5% (95%CI:93.6–96.9). Duplication and triplication of the artery were also observed with pooled prevalence of 4.3% (95%CI:2.8–6.0) and 0.3% (95%CI:0–0.7), respectively. The most common origin of the SANa was from the right coronary artery (RCA), found in 68.0% (95%CI:55.6–68.9) of cases, followed by origin from the left circumflex artery, and origin from the left coronary artery with pooled prevalence of 22.1% (95%CI:15.0–26.2) and 2.7 (95%CI:0.7–5.2), respectively. A retrocaval course of the SANa was the most common course of the artery with a pooled prevalence of 47.1% (95%CI:36.0–55.5). The pooled prevalence of an S-shaped SANa was 7.6% (95%CI:2.9–14.1).ConclusionsThe SANa is most commonly reported as a single vessel, originating from the RCA, and taking a retrocaval course to reach the SAN. Knowledge of high risk anatomical variants of the SANa, such as an S-shaped artery, must be taken into account by surgeons to prevent iatrogenic injuries. Specifically, interventional or cardiosurgical procedures, such as the Cox maze procedure for atrial fibrillation, open heart surgeries through the right atrium or intraoperative cross-clamping or dissection procedures during mitral valve surgery using the septal approach can all potentiate the risk for injury in the setting of high-risk morphological variants of the SANa.     

Adaptation of the Transverse Carpal Ligament Associated with Repetitive Hand Use in Pianists

The transverse carpal ligament (TCL) plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL’s mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI) imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV). ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p < 0.05). Additionally, the increased SWV was location dependent for both pianist and non-pianist groups (p < 0.05), with the rTCL having a significantly greater SWV than the uTCL. Between groups, the rTCL SWV of pianists was 22.2% greater than that of the non-pianists (p < 0.001). This localized increase of TCL SWV, i.e. stiffening, may be primarily attributable to focal biomechanical interactions that occur at the radial TCL aspect where the thenar muscles are anchored. Progressive stiffening of the TCL may become constraining to the carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome.     

Finite element analysis for transverse carpal ligament tensile strain and carpal arch area

Mechanics of carpal tunnel soft tissue, such as fat, muscle and transverse carpal ligament (TCL), around the median nerve may render the median nerve vulnerable to compression neuropathy. The purpose of this study was to understand the roles of carpal tunnel soft tissue mechanical properties and intratunnel pressure on the TCL tensile strain and carpal arch area (CAA) using finite element analysis (FEA). Manual segmentation of the thenar muscles, skin, fat, TCL, hamate bone, and trapezium bone in the transverse plane at distal carpal tunnel were obtained from B-mode ultrasound images of one cadaveric hand. Sensitivity analyses were conducted to examine the dependence of TCL tensile strain and CAA on TCL elastic modulus (0.125–10 MPa volar-dorsally; 1.375–110 MPa transversely), skin-fat and thenar muscle initial shear modulus (1.6–160 kPa for skin-fat; 0.425–42.5 kPa for muscle), and intratunnel pressure (60–480 mmHg). Predictions of TCL tensile strain under different intratunnel pressures were validated with the experimental data obtained on the same cadaveric hand. Results showed that skin, fat and muscles had little effect on the TCL tensile strain and CAA changes. However, TCL tensile strain and CAA increased with decreased elastic modulus of TCL and increased intratunnel pressure. The TCL tensile strain and CAA increased linearly with increased pressure while increased exponentially with decreased elastic modulus of TCL. Softening the TCL by decreasing the elastic modulus may be an alternative clinical approach to carpal tunnel expansion to accommodate elevated intratunnel pressure and alleviate median nerve compression neuropathy.     

Test of a new technique for the diagnosis of carpal tunnel syndrome.

Several new techniques for carpal tunnel syndrome diagnosis have been developed in the last few years. This work tests a technique that compares the distal motor latency of the median nerve to the second lumbrical muscle (2L) with the distal motor latency of the ulnar nerve to the interossei muscle (INT). Results from 40 normal hands give the superior limit of the normal difference (2L-INT) as 0. 26 ms (&xmacr;+3 SD). In 55 hands with different levels of carpal tunnel syndrome, this new technique was more sensitive and accurate than the conventional test which uses the distal motor latency of the median nerve to the abductor pollicis brevis muscle (APB), especially in the less severe cases. With the absence of the compound muscle action potentials of the APB muscle caused by severe thenar atrophy, it is much easier to obtain the potential from the 2L muscle. We concluded that this is a sensitive, simple, rapid, and non-invasive new technique, and therefore, it should be incorporated as part of the routine ENMG procedures for carpal tunnel syndrome diagnosis.     

Volar/dorsal compressive mechanical behavior of the transverse carpal ligament

Mechanical insult to the median nerve caused by contact with the digital flexor tendons and/or carpal tunnel boundaries may contribute to the development of carpal tunnel syndrome. Since the transverse carpal ligament (TCL) comprises the volar boundary of the carpal tunnel, its mechanics in part govern the potential insult to the median nerve. Using unconfined compression testing in combination with a finite element-based optimization process, nominal stiffness measurements and first-order Ogden hyperelastic material coefficients (μ and α ) were determined to describe the volar/dorsal compressive behavior of the TCL. Five different locations on the TCL were tested, three of which were deep to the origins of the thenar and hypothenar muscles. The average (± standard deviation) low-strain and high-strain TCL stiffness values in compression sites outside the muscle attachment region were 3.6 N/mm (±2.7) and 28.0 N/mm (±20.2), respectively. The average stiffness values at compression sites with muscle attachments were notably lower, with low-strain and high-strain stiffness values of 1.2 N/mm (±0.5) and 9.7 N/mm (±4.8), respectively. The average Ogden coefficients for the muscle attachment region were 51.6 kPa (±16.5) for μ and 16.5 (±2.0) for α, while coefficients for the non-muscle attachment region were 117.8 kPa (±86.8) for μ and 17.2 (±1.6) for α. These TCL compressive mechanical properties can help inprove computational models, which can be used to provide insight into the mechanisms of median nerve injury leading to the onset of carpal tunnel syndrome symptoms.     

In Vivo Study of Transverse Carpal Ligament Stiffness Using Acoustic Radiation Force Impulse (ARFI) Imaging

The transverse carpal ligament (TCL) forms the volar boundary of the carpal tunnel and may provide mechanical constraint to the median nerve, leading to carpal tunnel syndrome. Therefore, the mechanical properties of the TCL are essential to better understand the etiology of carpal tunnel syndrome. The purpose of this study was to investigate the in vivo TCL stiffness using acoustic radiation force impulse (ARFI) imaging. The shear wave velocity (SWV) of the TCL was measured using Virtual Touch IQ^TM software in 15 healthy, male subjects. The skin and the thenar muscles were also examined as reference tissues. In addition, the effects of measurement location and ultrasound transducer compression on the SWV were studied. The SWV of the TCL was dependent on the tissue location, with greater SWV values within the muscle-attached region than those outside of the muscle-attached region. The SWV of the TCL was significantly smaller without compression (5.21 ± 1.08 m/s) than with compression (6.62 ± 1.18 m/s). The SWV measurements of the skin and the thenar muscles were also affected by transducer compression, but to different extents than the SWV of the TCL. Therefore to standardize the ARFI imaging procedure, it is recommended that a layer of ultrasound gel be maintained to minimize the effects of tissue compression. This study demonstrated the feasibility of ARFI imaging for assessing the stiffness characteristics of the TCL in vivo, which has the potential to identify pathomechanical changes of the tissue.     

Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review

BackgroundThe global burden of hypertension and other non-communicable diseases (NCDs) is rapidly increasing, and the African continent seems to be the most affected region in the world. The prevalence of hypertension in Nigeria forms a substantial portion of the total burden in Africa because of the large population of the country currently estimated to be over 170 million.ObjectiveThe purpose of this systematic review is to summarise up to date data on the prevalence and distribution of hypertension in Nigeria from prevalence studies.MethodsA search of the following databases: PubMed, EMBase and WHO cardiovascular InfoBase from 1968 till date was conducted to identify studies which provide estimates of prevalence of hypertension in Nigeria.ResultsThe search yielded a total of 1748 hits from which 45 relevant studies met the inclusion criteria for the review. The overall crude prevalence of hypertension ranged from 0.1% (95%CI:-0.1 to 0.3) to 17.5% (95% CI: 13.6 to 21.4) in children and 2.1% (95%CI: 1.4 to 2.8) to 47.2% (95%CI: 43.6 to 50.8) in adults depending on the benchmark used for diagnosis of hypertension, the setting in which the study was conducted, sex and ethnic group. The crude prevalence of hypertension ranged from 6.2% (95%CI: 4.0 to 8.4) to 48.9% (95%CI: 42.3 to 55.5) for men and 10% (95%CI: 8.1 to 12) to 47.3% (95%CI: 43 to 51.6%) for women. In most studies, prevalence of hypertension was higher in males than females. In addition, prevalence across urban and rural ranged from 9.5% (95%CI: 13.6 to 21.4) to 51.6% (95%CI: 49.8 to 53.4) and 4.8% (95%CI: 2.9 to 6.7) to 43% (95%CI: 42.1 to 43.9) respectively.ConclusionsThe prevalence of hypertension is high among the Nigerian population. Appropriate interventions need to be developed and implemented to reduce the preventable burden of hypertension especially at Primary Health Care Centres which is the first point of call for over 55% of the Nigerian population.     

A prospective study to assess the outcome of steroid injections and wrist splinting for the treatment of carpal tunnel syndrome

Surgery is the definitive treatment for carpal tunnel syndrome. Conservative treatments, such as wrist splinting and steroid injections, are also effective for the relief of carpal tunnel symptoms, but their use remains controversial because they only offer long-term relief in a minority of patients. A prospective study was performed to assess the role of steroid injections combined with wrist splinting for the management of carpal tunnel syndrome. A total of 73 patients with 99 affected hands were studied. Patients presenting with known medical causes or muscle wasting were excluded. Diagnosis was made clinically and electrodiagnostic studies were performed only when equivocal clinical signs were present. Each patient received up to three betamethasone injections into the carpal tunnel and wore a neutral-position wrist splint continuously for 9 weeks. After that period, symptomatic patients received an open carpal tunnel release, and those who remained asymptomatic were followed up regularly for at least 1 year. Patients who relapsed were scheduled for surgery. At a minimum follow-up of 1 year, seven patients (9.6 percent) with 10 affected hands (10.1 percent) remained asymptomatic. This group had a significantly shorter duration of symptoms (2.9 months versus 8.35 months; p = 0.039, Mann-Whitney test) and significantly less sensory change (40 percent versus 72 percent; p = 0.048, Fisher's exact test) at presentation when compared with the group who had surgery. It is concluded that steroid injections and wrist splinting are effective for relief of carpal tunnel syndrome symptoms but have a long-term effect in only 10 percent of patients. Symptom duration of less than 3 months and absence of sensory impairment at presentation were predictive of a lasting response to conservative treatment. It is suggested that selected patients (i.e., with no thenar wasting or obvious underlying cause) presenting with mild to moderate carpal tunnel syndrome receive either a single steroid injection or wear a wrist splint for 3 weeks. This will allow identification of the 10 percent of patients who respond well to conservative therapy and do not need surgery.     

Prevalence of Clostridium difficile Infection among Solid Organ Transplant Recipients: A Meta-Analysis of Published Studies

Several factors including antibiotic use, immunosuppression and frequent hospitalizations make solid organ transplant (SOT) recipients vulnerable to Clostridium difficile infection (CDI). We conducted a meta-analysis of published studies from 1991-2014 to estimate the prevalence of CDI in this patient population. We searched PubMed, EMBASE and Google Scholar databases. Among the 75,940 retrieved citations, we found 30 studies coded from 35 articles that were relevant to our study. Based on these studies, we estimated the prevalence of CDI among 21,683 patients who underwent transplantation of kidney, liver, lungs, heart, pancreas, intestine or more than one organ and stratified each study based on the type of transplanted organ, place of the study conduction, and size of patient population. The overall estimated prevalence in SOT recipients was 7.4% [95%CI, (5.6-9.5%)] and it varied based on the type of organ transplant. The prevalence was 12.7% [95%CI, (6.4%-20.9%)] among patients who underwent transplantation for more than one organ. The prevalence among other SOT recipients was: lung 10.8% [95% CI, (5.5%-17.7%)], liver 9.1 % [95%CI, (5.8%-13.2%)], intestine 8% [95% CI, (2.6%-15.9%)], heart 5.2% [95%CI, (1.8%-10.2%)], kidney 4.7% [95% CI, (2.6%-7.3%)], and pancreas 3.2% [95% CI, (0.5%-7.9%)]. Among the studies that reported relevant data, the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)]. In summary, CDI is a significant complication after SOT and preventive strategies are important in order to reduce the CDI related morbidity and mortality.     

神经传导测定技术对腕管综合征病情评估的价值

目的:近年来腕管综合征发病率逐年升高,然而其慢性、隐匿性不易引起人们的重视,发现时往往已造成较大的危害。本文探讨腕管综合征的神经传导测定对病情评估的临床价值,旨在为患者腕管综合征早期发现和后续治疗提供进一步的临床参考依据。方法:选取我院124例确诊的腕管综合征患者。其中无大鱼际肌萎缩者有64例,并选取平均年龄相近的64例正常人作为对照(组A);有大鱼际肌畏缩者60例,并选取平均年龄相近的60例正常人作为对照(组B)。A、B组均经行神经电图检查,握力测定和两点辨别觉测定,分析神经传导速度改变与感觉、运动功能减退程度的关系。结果:A、B两组患者均有不同程度的神经传导改变:在A组患者神经传导改变中,运动和感觉传导速度(MCV和SCV)轻度下降,运动和感觉电位波幅(CMAP和SNAP)轻度下降,潜伏期(ML)轻度延长;在B组患者神经传导中,运动和感觉传导速度(MCV和SCV)明显下降,运动和感觉电位波幅(CMAP和SNAP)明显下降,潜伏期明显延长。结论:腕管综合征患者不同的临床表现有不同程度的神经电图表现,因此神经电图对神经传导的测定结果对腕管综合征患者的病情有良好的评估价值,值得临床推广。     

Prevalence of Dyslipidaemia and Associated Risk Factors in a Rural Population in South-Western Uganda: A Community Based Survey

BackgroundThe burden of dyslipidaemia is rising in many low income countries. However, there are few data on the prevalence of, or risk factors for, dyslipidaemia in Africa.MethodsIn 2011, we used the WHO Stepwise approach to collect cardiovascular risk data within a general population cohort in rural south-western Uganda. Dyslipidaemia was defined by high total cholesterol (TC) ≥ 5.2mmol/L or low high density lipoprotein cholesterol (HDL-C) <1 mmol/L in men, and <1.3 mmol/L in women. Logistic regression was used to explore correlates of dyslipidaemia.ResultsLow HDL-C prevalence was 71.3% and high TC was 6.0%. In multivariate analysis, factors independently associated with low HDL-C among both men and women were: decreasing age, tribe (prevalence highest among Rwandese tribe), lower education, alcohol consumption (comparing current drinkers to never drinkers: men adjusted (a)OR=0.44, 95%CI=0.35-0.55; women aOR=0.51, 95%CI=0.41-0.64), consuming <5 servings of fruit/vegetable per day, daily vigorous physical activity (comparing those with none vs those with 5 days a week: men aOR=0.83 95%CI=0.67-1.02; women aOR=0.76, 95%CI=0.55-0.99), blood pressure (comparing those with hypertension to those with normal blood pressure: men aOR=0.57, 95%CI=0.43-0.75; women aOR=0.69, 95%CI=0.52-0.93) and HIV infection (HIV infected without ART vs. HIV negative: men aOR=2.45, 95%CI=1.53-3.94; women aOR=1.88, 95%CI=1.19-2.97). The odds of low HDL-C was also higher among men with high BMI or HbA1c ≤6%, and women who were single or with abdominal obesity. Among both men and women, high TC was independently associated with increasing age, non-Rwandese tribe, high waist circumference (men aOR=5.70, 95%CI=1.97-16.49; women aOR=1.58, 95%CI=1.10-2.28), hypertension (men aOR=3.49, 95%CI=1.74-7.00; women aOR=1.47, 95%CI=0.96-2.23) and HbA1c >6% (men aOR=3.00, 95%CI=1.37-6.59; women aOR=2.74, 95%CI=1.77-4.27). The odds of high TC was also higher among married men, and women with higher education or high BMI.ConclusionLow HDL-C prevalence in this relatively young rural population is high whereas high TC prevalence is low. The consequences of dyslipidaemia in African populations remain unclear and prospective follow-up is required.     

Hepatitis C Virus Epidemiology in Djibouti,Somalia, Sudan,and Yemen: Systematic Review and Meta-Analysis

Objectives

To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen.

Methods

Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five.

Results

We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%–1.9%), 1.0% (95%CI: 0.3%–1.9%) and 1.9% (95%CI: 1.4%–2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%–0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%–28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%–4.9%) in Somalia and 0.6% (95%CI: 0.4%–0.8%) in Sudan.

Conclusion

National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.     

Surface landmarks to locate the thenar branch of the median nerve: an anatomical study

The thenar branch of the median nerve can be injured during carpal tunnel release. The purpose of this study was to identify surface landmarks to consistently predict the location of the thenar branch of the median nerve. Surface landmarks were marked and incised in 28 cadaveric hands. The incisions were made along the longitudinal line of the third web space and the horizontal cardinal line from the hamate hook to the ulnar border of the thumb. The origin of the thenar branch was determined in relation to these longitudinal and horizontal vectors. The origin of the thenar nerve branch was consistently observed in the radial proximal quadrant formed by the aforementioned longitudinal and horizontal vectors. The thenar branch origin was observed to be an average of 8.6 +/- 1.9 mm radial to the longitudinal axis along the third web space. The origin of the thenar branch was observed to be an average of 6.3 +/- 2.0 mm proximal to the horizontal axis between the hamate hook and the ulnar border of the thumb. The thenar branch was observed precisely at the intersection of the longitudinal vector from the second web space to the scaphoid tubercle and the horizontal vector from the hamate hook to the radial edge of the proximal metacarpophalangeal crease in all 28 cadaveric hands. On the basis of these 28 cadaveric dissections, the location of the thenar branch of the median nerve can be predicted by the intersection of the longitudinal vector from the second web space to the scaphoid tubercle and the horizontal vector from the hamate hook to the radial aspect of the metacarpophalangeal crease.     

Accuracy of i-Scan for Optical Diagnosis of Colonic Polyps: A Meta-Analysis

Backgroundi-Scan is a novel virtual chromoendoscopy system designed to enhance surface and vascular patterns to improve optical diagnostic performance. Numerous prospective studies have been done to evaluate the accuracy of i-Scan in differentiating colonic neoplasms from non-neoplasms. i-Scan could be an effective endoscopic technique for optical diagnosis of colonic polyps.ObjectiveOur aim of this study was to perform a meta-analysis of published data to establish the diagnostic accuracy of i-Scan for optical diagnosis of colonic polyps.MethodsWe searched PubMed, Medline, Elsevier ScienceDirect and Cochrane Library databases. We used a bivariate meta-analysis following a random effects model to summarize the data and plotted hierarchical summary receiver-operating characteristic (HSROC) curves. The area under the HSROC curve (AUC) serves as an indicator of the diagnostic accuracy.ResultsThe meta-analysis included a total of 925 patients and 2312 polyps. For the overall studies, the area under the HSROC curve was 0.96. The summary sensitivity was 90.4% (95%CI 85%-94.1%) and specificity was 90.9% (95%CI 84.3%-94.9%). In 11 studies predicting polyps histology in real-time, the summary sensitivity and specificity was 91.5% (95%CI 85.7%-95.1%) and 92.1% (95%CI 84.5%-96.1%), respectively, with the AUC of 0.97. For three different diagnostic criteria (Kudo, NICE, others), the sensitivity was 86.3%, 93.0%, 85.0%, respectively and specificity was 84.8%, 94.4%, 91.8%, respectively.ConclusionsEndoscopic diagnosis with i-Scan has accurate optical diagnostic performance to differentiate neoplastic from non-neoplastic polyps with an area under the HSROC curve exceeding 0.90. Both the sensitivity and specificity for diagnosing colonic polyps are over 90%.     

肌电图检查评估腕管综合征手术效果的临床分析

目的:探讨采用肌电图检查评估腕管综合征的手术治疗效果。方法:选取35例(患侧手共39侧)临床确诊为腕管综合征并接受腕管切开减压术治疗的患者,于手术前后分别行肌电图检查,应用正中神经传导检查和拇短展肌针极肌电图检查,分析患者手术前和手术后腕部正中神经功能的变化情况。结果:手术后,患者正中神经感觉传导潜伏期异常率(33%)、正中神经运动传导潜伏期异常率(36%)较手术前(72%、74%)明显下降(P0.05),正中神经感觉传导波幅(7.40±5.05)较手术前(4.86±3.60)显著降低(P0.001),拇短展肌静息状态下失神经电位的异常率(69%)、重收缩时募集电位异常率(13%)均较手术前(85%、26%)明显下降(P0.05)。患者手术前后正中神经感觉传导速度和运动传导速度对比差异无统计学意义(P0.05)。结论:腕管切开减压术可解除正中神经卡压状态,明显恢复正中神经功能,增强拇短展肌肌力,临床治疗效果好。肌电图检查可为腕管综合征患者手术治疗效果的评估提供客观的依据。     

A Systematic Review and Meta-Analysis of the Efficacy of Anti-Toxoplasma gondii Medicines in Humans

No effective drug and definitive “gold standard” treatment for Toxoplasma gondii (T. gondii) infection has been available so far, though some medicines have been commonly used in the treatment of T. gondii infection, such as spiramycin, azithromycin, traditional Chinese medicine (TCM), pyrimethamine- sulfadiazine (P-S), trimethoprim-sulfamethoxazole (TMP-SMX), and pyrimethamine-clindamycin (P-C). A systematic review and meta-analysis were performed to compare the efficacies of these conventional medicines in the treatment. Cohort studies for the treatment of acute T. gondii infection were searched from PubMed, Google Scholar, ect. All the cases number for different group extracted from each included literature were input to meta-analysis 3.13 software to calculate the pooled negative conversion rate (NCR), cure rate (CR) or vertical transmission rate based on their sample size and weight. The pooled NCR with 95% confidence intervals (CI) was used to evaluate the overall rate of a diagnosis positive result conversion to a negative result after treatment, which of spiramycin, azithromycin and TCM were 83.4% (95%CI, 72.1%-90.8%), 82.5% (95%CI, 75.9%-87.6%), and 85.5% (95%CI, 71.3%-93.3%) respectively, with no statistical difference between them. The pooled CR with 95% CI was used to evaluate the overall rate of complete disappearance of clinical symptoms for toxoplasmic encephalitis after therapy, which of P-S, TMP-SMX, and P-C were 49.8% (95%CI, 38. 8% -60.8%), 59.9% (95%CI, 48.9%-70.0%), and 47.6% (95%CI, 24.8%-71.4%) respectively, with no statistical difference between them. Primary T. gondii infection in pregnancy was treated mainly with spiramycin alone or combined with other drugs, and the pooled rate of vertical transmission was about 9.9% (95%CI, 5.9%-16.2%) after therapy. Toxoplasmic encephalitis in AIDS patients was usually treated with sulfonamides combined with other drugs and the pooled CR was 49.4% (95%CI, 37.9%-60.9%).     

Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial

ObjectiveTo assess the effect of a 40 mg methylprednisolone injection proximal to the carpal tunnel in patients with the carpal tunnel syndrome.DesignRandomised double blind placebo controlled trial. SettingOutpatient neurology clinic in a district general hospital.ParticipantsPatients with symptoms of the carpal tunnel syndrome for more than 3 months, confirmed by electrophysiological tests and aged over 18 years.InterventionInjection with 10 mg lignocaine (lidocaine) or 10 mg lignocaine and 40 mg methylprednisolone. Non-responders who had received lignocaine received 40 mg methylprednisolone and 10 mg lignocaine and were followed in an open study.ResultsAt 1 month 6 (20%) of 30 patients in the control group had improved compared with 23 (77%) of 30 patients the intervention group (difference 57% (95% confidence interval 36% to 77%)). After 1 year, 2 of 6 improved patients in the control group did not need a second treatment, compared with 15 of 23 improved patients in the intervention group (difference 43% (23% to 63%). Of the 28 non-responders in the control group, 24 (86%) improved after methylprednisolone. Of these 24 patients, 12 needed surgical treatment within one year.ConclusionA single injection with steroids close to the carpal tunnel may result in long term improvement and should be considered before surgical decompression.

Key messages

• Corticosteroid injections into the carpal tunnel may damage the nerve, and any treatment benefits may be of short duration
• A single injection with steroids proximal to the carpal tunnel improves 77% of patients with the carpal tunnel syndrome at one month after treatment
• This single injection is still effective at one year in half of the patients
• Injections proximal to the carpal tunnel have no side effects and are easier to carry out than injections into the carpal tunnel

     

The predictive efficacy of tumor mutation burden in immunotherapy across multiple cancer types: A meta-analysis and bioinformatics analysis

PurposeTo explore the predictive efficacy of tumor mutation burden (TMB) as a potential biomarker for cancer patients treated with Immune checkpoint inhibitors (ICIs).MethodsWe systematically searched PubMed, Cochrane Library, Embase and Web of Science for clinical studies (published between Jan 1, 2014 and Aug 30, 2021) comparing immunotherapy patients with high TMB to patients with low TMB. Our main endpoints were objective response rate (ORR), durable clinical benefit (DCB), overall survival (OS) and progress-free Survival (PFS). Moreover, we downloaded simple nucleotide variation (SNV) data of 33 major cancer types from the TCGA database as non-ICIs group, and compared the high TMB patients’ OS between the non-ICIs group and meta-analysis results.ResultsOf 10,450 identified studies, 41 were eligible and were included in our analysis (7713 participants). Compared with low TMB patients receiving ICIs, high TMB yielded a better ORR (RR = 2.73; 95% CI: 2.31–3.22; P = 0.043) and DCB (RR = 1.93; 95% CI: 1.64–2.28; P = 0.356), and a significantly increased OS (HR =0.24; 95% CI: 0.21–0.28; P < 0.001) and PFS (HR = 0.38; 95% CI: 0.34–0.42; P < 0.001). Furthermore, compared with non-ICIs group from the TCGA database, immunotherapy can improve OS in some cancer types with high TMB and better prognosis, including colorectal cancer, gastric cancer, lung cancer, melanoma and pan-cancer.ConclusionTMB is a promising therapeutic and prognostic biomarker for immunotherapy, which indicates a better ORR, DCB, OS and PFS. If there is a standard for TMB assessment and cut-off, it could improve the management of different cancers.     

Prevalence of Diabetic Retinopathy in Mainland China: A Meta-Analysis

Background

Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first meta-analysis to investigate the pooled prevalence of DR in mainland China.

Methodology/Principal Findings

We conducted a search of all English reports on population-based studies for the prevalence of DR using Medline, EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the pooled general population was 1.3% (95%CI: 0.5%–3.2%), 1.1% (95%CI: 0.6%–2.1%), and 0.1% (95%CI: 0.1%–0.3%), respectively, but was 23% (95%CI: 17.8%–29.2%), 19.1% (95%CI: 13.6%–26.3%), and 2.8% (95%CI: 1.9%–4.2%) in the diabetic group. The prevalence rate of DR in the pooled rural population was higher than that in the urban population, 1.6% (95%CI: 1.3%–2%), and the diabetic population, 29.1% (95%CI: 20.9%–38.9%). The prevalence of DR was higher in the Northern region compared with the Southern region.

Conclusions/Significance

The prevalence of DR in mainland China appeared a little high, and varied according to area. NPDR was more common. This study highlights the necessity for DR screening in the rural areas of China.     

Prevalence of Post-Stroke Cognitive Impairment in China: A Community-Based,Cross-Sectional Study

International hospital-based studies have indicated a high risk of cognitive impairment after stroke, evidence from community-based studies in China is scarce. To determine the prevalence of post-stroke cognitive impairment (PSCI) and its subtypes in stroke survivors residing in selected rural and urban Chinese communities, we conducted a community-based, cross-sectional study in 599 patients accounting for 48% of all stroke survivors registered in the 4 communities, who had suffered confirmed strokes and had undergone cognitive assessments via the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Hachinski Ischemia Scale (HIS). Detection of PSCI was based on scores in these neuropsychological scales. Factors potentially impacting on occurrence of PSCI were explored by comparing demographic characteristics, stroke features, and cardiovascular risk factors between patients with and without PSCI. The overall prevalence of PSCI was 80.97% (95%CI: 77.82%-84.11%), while that of non-dementia PSCI (PSCI-ND) and post-stroke vascular dementia (PSD) was 48.91% (95%CI: 44.91%-52.92%) and 32.05% (95%CI: 28.32%-35.79%), respectively. Prior stroke and complications during the acute phase were independent risk factors for PSCI. The risk of recurrent stroke survivors having PSCI was 2.7 times higher than for first-episode survivors, and it was 3 times higher for those with complications during the acute phase than for those without. The higher prevalence of PSCI in this study compared with previous Chinese studies was possibly due to the combined effects of including rural stroke survivors, a longer period from stroke onset, and different assessment methods. There is an urgent need to recognize and prevent PSCI in stroke patients, especially those with recurrent stroke and complications during the acute phase.