Comparison Clinical Effects of Hypertonic Dextrose and Steroid Injections on Chronic Subacromial Bursitis: A Double-Blind Randomized Controlled Trial.

OBJECTIVE: The aim of the study is to determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy for chronic subacromial bursitis patients. DESIGN: Fifty-four patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder Pain and Disability Index and visual analog scale were the primary outcomes. RESULTS: The steroid group ( n = 26) exhibited significant visual analog scale score improvements comparing with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group ( n = 28) exhibited visual analog scale score improvements at weeks 6 and 12. The steroid group displayed significant Shoulder Pain and Disability Index score improvements compared with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group exhibited significant score decreases at weeks 2 and 6. Compared with the dextrose prolotherapy group, the steroid group demonstrated significantly greater decreases in visual analog scale scores at weeks 2 and 6; the steroid group showed significantly greater decreases in Shoulder Pain and Disability Index scores at weeks 2, 6, and 12. CONCLUSIONS: Both hypertonic dextrose prolotherapy and steroid injections can provide short-term improvements of pain and disability among chronic subacromial bursitis patients. Moreover, steroid injections showed better effectiveness than hypertonic dextrose prolotherapy in ameliorating pain and improving function.

Mobility, educational, and social performance of children with learning problems in Taiwan: A 3-year follow-up study.

AIM: This study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability. METHOD: We included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System-Child version to investigate performance at follow-up for at least 3 years. RESULTS: These participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement. INTERPRETATION: This cross-diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects. WHAT THIS PAPER ADDS: Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.

Movilidad y desempeño educativo y social de niños con problemas de aprendizaje en Taiwán: un estudio de seguimiento de 3 años OBJETIVO: Este estudio evaluó el desempeño de los niños con problemas de aprendizaje en Taiwán utilizando el Banco de Datos de Personas con Discapacidad de Taiwán. MÉTODO: Para el análisis incluimos 3854 niños (2343 varones, 1511 mujeres; edad media [DE] 9 años 11 meses [2 años 4 meses]) con trastorno específico del aprendizaje (SLD), trastorno por déficit de atención/hiperactividad (TDAH), autismo, epilepsia, o trastornos intelectuales. Utilizamos la Escala de Funcionamiento del Sistema de Evaluación de la Discapacidad-versión infantil para investigar el desempeño en el seguimiento durante al menos 3 años. RESULTADOS: Estos participantes demostraron una mejora en todos los dominios de la Clasificación Internacional del Funcionamiento, de la Discapacidad, y de la Salud (CIF) incluida la movilidad, el aprendizaje, la participación social y la vida diaria. Los niños con SLD (p = 0,3) y epilepsia (p = 0,442) no demostraron una mejora significativa en el aprendizaje, mientras que aquellos con TDAH (p < 0,001), autismo (p < 0,001) y discapacidad intelectual (p < 0,001) sí lo hicieron. Los niños con epilepsia mostraron el mayor deterioro y la menor mejora. INTERPRETACIÓN: Este estudio de desempeño en niños con distintos diagnósticos indicó que los niños con autismo o TDAH recibieron una educación más estructural. Sin embargo, las estrategias educativas para las personas con SLD o epilepsia requerían mejoras. Finalmente, la SLD posiblemente esta poco diagnosticada en niños, y los niños con epilepsia se ven afectados en múltiples aspectos del desempeño.

Mobilidade e desempenho educacional e social das crianças com dificuldades de aprendizagem em Taiwan: Um estudo de acompanhamento de 3 anos OBJETIVO: Este estudo avaliou o desempenho de crianças com problemas de aprendizagem usando o Banco de Dados de Pessoas com Deficiência em Taiwan. MÉTODO: Foram incluídas 3.854 crianças (2.343 homens, 1.511 mulheres; idade média [SD] de 9 anos e 11 meses [2 anos e 4 meses] com transtorno específico de aprendizagem (TEA), transtorno de déficit de atenção/hiperatividade (TDAH), autismo, epilepsia ou deficiência intelectual para análise. Utilizou-se uma Escala de Funcionamento do Sistema de Avaliação de Incapacidade-Criança para investigar o desempenho no acompanhamento por pelo menos 3 anos. RESULTADOS: Esses participantes demonstraram melhora em todos os domínios do Classificação Internacional de Funcionalidade, Saúde e Incapacidade, incluindo para mobilidade, aprendizagem, participação social e vida diária. As crianças com TEA (p = 0,3) e epilepsia (p = 0,442) não apresentaram melhora significativa no aprendizado, enquanto aquelas com TDAH (p < 0,001), autismo (p < 0,001) e deficiência intelectual (p < 0,001) apresentaram melhora significativa. Crianças com epilepsia apresentaram maior comprometimento e menor melhora. INTERPRETAÇÃO: Este estudo de diagnóstico cruzado de problemas de aprendizagem indicou que as crianças com autismo ou TDAH receberam mais educação estrutural. No entanto, as estratégias de educação para aqueles com TEA ou epilepsia exigia melhora. Finalmente, o TEA é possivelmente subdiagnosticado em crianças, e crianças com epilepsia são afetadas em múltiplos aspectos.

Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy.

Critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. The acromial index (AI) is the distance from the glenoid plane to the acromial lateral border and is divided by the distance from the glenoid plane to the lateral aspect of the humeral head. Although both are used for predicting shoulder diseases, research on their accuracy in predicting supraspinatus tendinopathy in patients with shoulder pain is limited. Data were retrospectively collected from 308 patients with supraspinatus tendinopathy between January 2018 and December 2019. Simultaneously, we gathered the data of 300 patients with shoulder pain without supraspinatus tendinopathy, confirmed through ultrasound examination. Baseline demographic data, CSA, and AI were compared using the independent Student's t test and Mann-Whitney U test. Categorical variables were analyzed using the chi-square test. A receiver operating characteristic curve (ROC) analysis was performed to investigate the accuracy of CSA and AI for predicting supraspinatus tendinopathy, and the optimal cut-off point was determined using the Youden index. No statistical differences were observed for age, sex, body mass index, evaluated side (dominant), diabetes mellitus, and hyperlipidemia between the groups. The supraspinatus tendinopathy group showed higher CSAs (p < 0.001) than did the non-supraspinatus tendinopathy group. For predicting supraspinatus tendinopathy, the area under the curve (AUC) of ROC curve of the CSA was 76.8%, revealing acceptable discrimination. The AUC of AI was 46.9%, revealing no discrimination. Moreover, when patients with shoulder pain had a CSA > 38.11°, the specificity and sensitivity of CSA in predicting supraspinatus tendinopathy were 71.0% and 71.8%, respectively. CSA could be considered an objective assessment tool to predict supraspinatus tendinopathy in patients with shoulder pain. AI revealed no discrimination in predicting supraspinatus tendinopathy in patients with shoulder pain.

Acromioplasty reduces critical shoulder angle in patients with rotator cuff tear.

Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.

Effect of arm sling application on gait and balance in patients with post-stroke hemiplegia: a systematic review and meta-analysis.

Hemiplegic shoulder pain and impairment are common poststroke outcomes, for which arm slings constitute long-used treatments. Although multiple studies have suggested association between gait pattern and sling application, results have varied. Accordingly, we conducted this meta-analysis to determine how arm sling use affects the gait and balance of patients with poststroke hemiplegia. The PubMed, Embase, and Cochrane Library databases were searched until April 21, 2021, for randomized or quasi-randomized controlled trials evaluating the effect of arm slings on gait or balance in patients with poststroke hemiplegia. The primary outcome was walking speed; the secondary outcomes were functional balance tests or walking evaluation parameters for which sufficient analytical data were available in three or more studies. Nine studies with a total of 235 patients were included, all of which were within-patient comparisons. Six studies reported significant between-group differences in walking speed with and without the use of arm slings. Patients wearing arm slings had higher walking speed (standardized mean difference = - 0.31, 95% confidence interval [CI] = - 0.55 to - 0.07, P = 0.01, n = 159; weighted mean difference = - 0.06, 95% CI - 0.10 to - 0.02, P = 0.001, n = 159). Our findings suggest that arm sling use improves gait performance, particularly walking speed, in patients with poststroke hemiplegia.

Enhanced Radiosensitization for Cancer Treatment with Gold Nanoparticles through Sonoporation.

We demonstrate the megavoltage (MV) radiosensitization of a human liver cancer line by combining gold-nanoparticle-encapsulated microbubbles (AuMBs) with ultrasound. Microbubbles-mediated sonoporation was administered for 5 min, at 2 h prior to applying radiotherapy. The intracellular concentration of gold nanoparticles (AuNPs) increased with the inertial cavitation of AuMBs in a dose-dependent manner. A higher inertial cavitation dose was also associated with more DNA damage, higher levels of apoptosis markers, and inferior cell surviving fractions after MV X-ray irradiation. The dose-modifying ratio in a clonogenic assay was 1.56 ± 0.45 for a 10% surviving fraction. In a xenograft mouse model, combining vascular endothelial growth factor receptor 2 (VEGFR2)-targeted AuMBs with sonoporation significantly delayed tumor regrowth. A strategy involving the spatially and temporally controlled release of AuNPs followed by clinically utilized MV irradiation shows promising results that make it worthy of further translational investigations.

Nonbismuth concomitant quadruple therapy for Helicobacter pylori eradication in Chinese regions: A meta-analysis of randomized controlled trials.

AIM: To evaluate the applicability of nonbismuth concomitant quadruple therapy for Helicobacter pylori (H. pylori) eradication in Chinese regions. METHODS: A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the efficacy of nonbismuth concomitant quadruple therapy between sequential therapy or triple therapy for H. pylori eradication in Chinese regions. The defined Chinese regions include China, Hong Kong, Taiwan, and Singapore. The primary outcome was the H. pylori eradication rate; the secondary outcome was the compliance with therapy. The PubMed, Embase, Scopus, and Cochrane databases were searched for studies published in the period up to March 2016 with no language restriction. RESULTS: We reviewed six randomized controlled trials and 1616 patients. In 3 trials comparing concomitant quadruple therapy with triple therapy, the H. pylori eradication rate was significantly higher for 7-d nonbismuth concomitant quadruple therapy than for 7-d triple therapy (91.2% vs 77.9%, risk ratio = 1.17, 95%CI: 1.09-1.25). In 3 trials comparing quadruple therapy with sequential therapy, the eradication rate was not significant between groups (86.9% vs 86.0%). However, higher compliance was achieved with concomitant therapy than with sequential therapy. CONCLUSION: The H. pylori eradication rate was higher for nonbismuth concomitant quadruple therapy than for triple therapy. Moreover, higher compliance was achieved with nonbismuth concomitant quadruple therapy than with sequential therapy. Thus, nonbismuth concomitant quadruple therapy should be the first-line treatment in Chinese regions.