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Volume 7 ， Issue 2 ， 2020
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Abstract：Background:Tuberculosis is a leading cause of death worldwide. BCG is an effective vaccine, but not widely used in many parts of the world due to a variety of issues. Mycobacterium vaccae (M. vaccae) is another vaccine used in human subjects to prevent tuberculosis. In the current study, we investigated the potential mechanisms of M. vaccae vaccination by determining differentially expressed genes in mice infected with M. tuberculosis before and after M. vaccae vaccination.Methods:Three days after exposure to M. tuberculosis H37Rv strain (5×105 CFU), adult BALB/c mice randomly received either M. vaccae vaccine (22.5 μg) or vehicle via intramuscular injection (n=8). Booster immunization was conducted 14 and 28 days after the primary immunization. Differentially expressed genes were identified by microarray followed by standard bioinformatics analysis.Results:M. vaccae vaccination provided protection against M. tuberculosis infection (most prominent in the lungs). We identified 2, 326 upregulated and 2,221 downregulated genes in vaccinated mice. These changes could be mapped to a total of 123 signaling pathways (68 upregulated and 55 downregulated). Further analysis pinpointed to the MyD88-dependent TLR signaling pathway and PI3K-Akt signaling pathway as most likely to be functional.Conclusions:M. vaccae vaccine provided good protection in mice against M. tuberculosis infection, via a highly complex set of molecular changes. Our findings may provide clue to guide development of more effective vaccine against tuberculosis.Keywords：Mycobacterium tuberculosis;Immunotherapeutic effect;Immunotherapy;Vaccae vaccine;Differentially expressed genes;Signaling pathway6|0|0Updated：2023-06-05 - Abstract：Background:The present investigation tested the efficacy of the Tennant Biomodulator, a novel pain management intervention that uses biofeedback-modulated electrical stimulation, to reduce chronic pain and its psychosocial sequelae in a sample of current and former military service members. The Tennant Biomodulator used on its most basic setting was compared to two commonly used, non-pharmacological pain treatments—traditional Chinese acupuncture and transcutaneous electrical nerve stimulation (TENS)—in a comparative efficacy, randomized, open-label trial.Methods:Participants included 100 active duty and retired service men and women with chronic pain undergoing treatment at the Brooke Army Medical Center in Texas, USA, randomly assigned to receive six, weekly sessions of either Tennant Biomodulator treatment, traditional Chinese acupuncture, or TENS, in addition to usual care. Recruitment was conducted between May 2010 to September 2013. Outcome measures were collected at intake, before and after each treatment session, and at a 1-month follow-up. Intent-to-treat analyses were used throughout, with mixed models used to investigate main effects of group, time, and group × time interactions with consideration given to quadratic effects. Outcomes measured included ratings of chronic pain, pain-related functional disability, and symptoms of post-traumatic stress disorder (PTSD) and depression.Results:On average, regardless of their treatment group, participants exhibited a 16% reduction in pain measured by the Brooke Army Medical Center’s Clinic Pain Log [F(1, 335)=55.7, P<0.0001] and an 11% reduction in pain-related disability measured by the Million Visual Analog Scale [MVAS: F(1, 84)=28.3, P<0.0001] from baseline to the end of treatment, but no one treatment performed better than the other, and the reductions in pain and pain-related disability were largely lost by 1-month follow-up. Symptoms of PTSD and depression did not change significantly as a function of time or group.Conclusions:Findings build on previous work suggesting that traditional Chinese acupuncture and TENS can reduce pain and its functional sequelae without risks associated with pharmacological pain management. The Tennant Biomodulator used on its most basic setting performs as well as these other interventions. Based on the present findings, large, randomized controlled trials on the Tennant Biomodulator are indicated. Future work should test this device using its full range of settings for pain-related psychological health.Trial registration:Clincialtrials.gov (NCT01752010); registered December 14, 2012.Keywords：Tennant biomodulator;Acupuncture;Transcutaneous electrical nerve stimulation;Chronic pain;Military service members4|0|0Updated：2023-06-05
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Abstract：Background:The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds, resulting in drop-hand syndrome. The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War.Methods:This level-II, prospective, comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017. The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension. The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension. The flexor carpi radialis was transferred to the extensor digiti communis for 2nd, 3rd, 4th, and 5th finger extension. All outcomes of thumb abduction and extension, wrist extension, wrist flexion, and finger extension were assessed.Results:There was a high level of radial nerve injury in all patients included in the study. The time from injury to treatment ranged from 1.5 months to 9 months. The mechanism of injury most commonly observed was a gunshot wound, which was observed in 8 patients (61.5%), followed by a penetrating cutting tool injury (n=3; 23.1%) and humerus fracture (n=2; 15.4%).Conclusions:In radial nerve injuries, successful results can be achieved with tendon transfer. All patients regained thumb abduction of up to approximately 60°. All the patients were able to bend the wrist, grip, and extend the fingers while in wrist flexion, neutral wrist and wrist extension positions. Although the reason for the radial injury varied, the postoperative outcomes were good for all patients, and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.Keywords：Hand;Tendon transfer;Drop-hand syndrome;Syrian civil war4|0|0Updated：2023-06-05 -
Abstract：Background:Both periodontal disease and benign prostatic hyperplasia are age-related diseases that affect millions of people worldwide. Hence, this study aimed to investigate the association between periodontal disease and the risk of benign prostatic hyperplasia.Methods:A total of 4930 participants were selected from an available health examination that was carried out in 2017, only males were considered for further analysis. All eligible males were divided into benign prostatic hyperplasia and normal groups, the benign prostatic hyperplasia group was then divided into prostate volume ≤60 g and >60 g subgroups; all their periodontal status was extracted and then into normal (CPI score of 0), periodontal disease (CPI score between 1 and 4), and periodontitis (CPI score between 3 and 4) groups. The correlation between periodontal disease and benign prostatic hyperplasia was investigated using logistic regression analyses and greedy matching case-control analysis. Subgroup analysis based on prostate volume was also performed. All analyses were conducted with SAS 9.4 software.Results:A total of 2171 males were selected for this analysis. The presence of periodontal disease significantly increased the risk of benign prostatic hyperplasia by 1.68 times (OR=1.68, 95% CI: 1.26–2.24), and individuals with periodontitis showed a higher risk (OR=4.18, 95% CI: 2.75–6.35). In addition, among matched cases and controls, this association remained robust (periodontal disease: OR=1.85, 95% CI: 1.30–2.64; periodontitis: OR=4.83, 95% CI: 2.57–9.07). Subgroup analysis revealed that periodontal disease significantly increased benign prostate hyperplasia risk as well (for prostate volume ≤60 g: OR=1.64, 95% CI: 1.22–2.20; for volume >60 g: OR=2.17, 95% CI: 1.04–4.53), and there was a higher risk in the group with a prostate volume greater than 60 g.Conclusions:Periodontal disease is significantly and positively associated with an increased risk of benign prostatic hyperplasia. Further validation studies should be performed to explore the relationship between periodontal treatment and benign prostate hyperplasia.Keywords：Benign prostate hyperplasia;Periodontal disease;Periodontitis;Risk factor;Inflammatory disease7|0|0Updated：2023-06-05 -
Abstract：Background:The U.S. Air Force physical fitness assessment (PFA) is used to determine the overall fitness of their personnel. It is currently unknown to what extent the PFA scores of Reserve Officers’ Training Corps (ROTC) cadets are affected by mandatory physical training. The purpose of this investigation was to longitudinally examine the PFAs of ROTC cadets over a four-year period, evaluate the results across class ranks, and evaluate the sensitivity of the classification of the tests.Methods:Air Force ROTC cadets performed the PFAs (abdominal circumference, 1-min pushups, 1-min sit-ups, and a 1.5-mile run) in both the spring (n=26) and fall (n=22) semesters. PFAs were compiled over a four-year period (Spring 2014 – Fall 2017) and were performed in accordance with Air Force Instruction 36–2905. A oneway repeated measures ANOVA was performed separately for the fall and spring groups for each dependent variable across the 4 years. Additionally, a one-way between groups ANOVA was performed for each dependent variable during the time point (fall 2015; n=46) with the most recorded cadets for each class rank.Results:Longitudinal assessments revealed a main effect of time (P=0.010) on abdominal circumference; cadets had a smaller abdominal circumference in their freshman year than in their senior year. A main effect of time (P=0.006) was also observed on sit-up quantity; cadets performed more sit-ups in their junior year than in their freshman year. Examining between class ranks during the same year (between-subjects ANOVA) revealed a main effect of class rank on sit-up quantity (P=0.003); the freshmen completed fewer repetitions than the sophomores (P=0.018) and the juniors did (P=0.001).Conclusions:The results indicated that only the sit-up component showed differences between class ranks. These findings suggest that the Air Force PFA may not be sensitive enough to detect changes in physical fitness or distinguish between class ranks regarding physical performance, even after years of training. This limitation may be in part due to the limited duration of training incorporated by the ROTC program (2 h per week), which provided a maintenance effect rather than improvement in physical performance. We recommend that more attention be directed to the efficacy of physical training, the sensitivity of measures included in the PFA, or both.Keywords：Class ranks;Fitness assessment;Military;Physical training;ROTC4|0|0Updated：2023-06-05 -
Abstract：Background:Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Equine-assisted interventions are emerging as an additional treatment modality, but little is known regarding the safe and effective delivery of these interventions. This study aimed to describe the following features of the body of literature concerning equine-assisted interventions among veterans: 1) veterans who have participated in equine-assisted interventions; 2) specific characteristics of equine-assisted interventions in veterans; and 3) the specific characteristics of research on equine-assisted interventions in veterans.Methods:We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017. Searches of nine databases yielded 3336 unique records, six of which met the inclusion criteria and were reviewed. Data relevant to the study aims were extracted and analyzed.Results:Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results. The detailed methods of EAI varied in the reported studies, ranging from communicating with the horse to mounted exercises. There was also great diversity in outcome measurement. The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped. Studies provided insufficient detail with respect to the description of the intervention, reasons for attrition, and the dose-response relationship.Conclusions:Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy. Targeted outcomes should be expanded, including outcomes more closely aligned with the nature of polytraumatic injuries. Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants, components of the intervention, factors contributing to attrition, and optimal dose-response relationships.Keywords：Veterans;Service-related injuries;Equine-assisted interventions;Posttraumatic stress disorder;Systematic mapping review4|0|0Updated：2023-06-05 -
Abstract：Background:The exogenous application of low-intensity electric stimulation (ES) may mimic a natural endogenous bioelectric current and accelerate the repair process of skin wounds. This study designed a novel microcurrent dressing (MCD) and evaluated its potential effects on wound healing in a rat skin defect model.Methods:First, wireless ES was integrated into a medical cotton cushion to fabricate the MCD, and its electrical property was examined by using a universal power meter. Then, animal experiments were conducted to evaluate the MCD’s effect. Forty-five rats were randomized into control (Con) group, Vaseline gauze (VG) group and MCD group. A full-thickness round skin incision 1.5 cm in diameter was made on the back of each animal. Apart from routine disinfection, the Con rats were untreated, whereas the other two groups were treated with VG or MCD. On days 3, 7 and 14 post injury, the wound areas were observed and measured using image analysis software following photography, and the skin samples were harvested from wound tissue. Then, histopathological morphology was observed routinely by hematoxylin and eosin (HE) staining; tumor necrosis factor α (TNF-α) and interleukin (IL)-1β expression were detected by Western blotting. Vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) expression were detected with immunohistochemistry.Results:The MCD generated a sf electric potential greater than 0.95 V. Animal experiments showed that the woundhealing rate in the MCD group was significantly increased compared with the Con and VG groups (P<0.05 or P<0.01). Histopathological observation revealed an alleviated inflammatory response, induced vascular proliferation and accelerated epithelization in the MCD group. Moreover, samples from the MCD group expressed reduced TNF-α and IL-1β levels and increased VEGF and EGF levels compared with those of the other two groups (P<0.05 or P<0.01). However, no significant difference was noted between the Con and VG groups at each time point.Conclusions:The MCD generates a stable and lasting ES and significantly promotes wound healing by reducing inflammation duration and increasing growth factors expression. Thus, MCD may act as a promising biomaterial device for skin wound healing.Keywords：Microcurrent dressing;Electric stimulation;Skin;Wound healing6|0|0Updated：2023-06-05 -
Abstract：Background:In the military, insufficient postural stability is a risk factor for developing lower extremity injuries. Postural stability training programs are effective in preventing these injuries. However, an objective method for the measurement of postural stability in servicemen is lacking. The primary objective of this study was to assess the influence of the number of repetitions, different foot positions and real-time visual feedback on postural stability, as well as their effects on the intrasession reliability of postural stability measurements in servicemen. The secondary objective was to assess the concurrent validity of the measurements.Methods:Twenty healthy servicemen between 20 and 50 years of age and in active duty were eligible for this quantitative, cross-sectional study. The measurements took place on a force plate, measuring the mean velocity of the center of pressure. The participants were asked to stand as still as possible in three different foot positions (wide stance, small stance, and on one leg), five times each for 45 s each time, and the measurements were performed with and without real-time visual feedback.Results:We observed a significant main effect of foot position (P<0.001), but not of visual feedback (P=0.119) or repetition number (P=0.915). Postural stability decreased in the more challenging foot positions. The ICC estimates varied from 0.809 (one repetition in wide stance) to 0.985 (five repetitions on one leg). The common variance (R2) between different foot positions without feedback varied between 0.008 (wide stance) and 0.412.Conclusions:To yield reliable data, wide-stance measurements should be conducted three times, and small-stance measurements and measurements on one leg should be conducted two times. The scores of a measurement in a particular foot position cannot predict the scores of measurements in other foot positions.Keywords：Postural stability;Center of Pressure;Servicemen;Intrasession reliability;Concurrent validity4|0|0Updated：2023-06-05
RESEARCH
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Abstract：The coronavirus disease (COVID-19) pandemic has led to a global struggle to cope with the sheer numbers of infected persons, many of whom require intensive care support or eventually succumb to the illness. The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected. To date, there is no specific anti-COVID-19 treatment. However, the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome, especially in the severe to critically ill. While many of these adjunctive drugs are being investigated in clinical trials, professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use. This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.Keywords：COVID-19;Adjunctive treatment;Chloroquine;Lopinavir-ritonavir;Remdesivir;Corticosteroids;Umifenovir;Convalescent plasma4|0|0Updated：2023-06-05 -
Abstract：Background:When lowlanders rapidly ascend to altitudes >2500 m, they may develop acute mountain sickness (AMS). The individual susceptibility, ascending velocity, time spent at altitude, activity levels and altitude reached are considered risk factors for AMS. However, it is not clear whether sex is a risk factor. The results have been inconclusive. We conducted a meta-analysis to test whether there were sex-based differences in the prevalence of AMS using Lake Louise Scoring System.Methods:Systematic searches were performed in August 2019 in EMBASE, PubMed, and Web of Science for prospective studies with AMS data for men and women. The titles and abstracts were independently checked in the primary screening step, and the selected full-text articles were independently assessed in the secondary screening step by the two authors (YPH and JLW) based on pre-defined inclusion criteria. The meta-analysis was performed using by the STATA 14.1 software program. A random-effects model was employed.Results:Eighteen eligible prospective studies were included. A total of 7669 participants (2639[34.4%] women) were tested. The results showed that there was a statistically significant higher prevalence rate of AMS in women than in men (RR=1.24, 95%CI 1.09–1.41), regardless of age or race. However, the heterogeneity was significant in the analysis (Tau2=0.0403, Chi2=50.15, df=17; I2=66.1%, P=0.000), it was main caused by different numbers of subjects among the studies (coefficient=–2.17, P=0.049). Besides, the results showed that there was no evidence of significant publication bias in the combined studies on the basis of Egger’s test (bias coefficient=1.48, P=0.052) and Begg’s test (P=0.130).Conclusions:According to this study, the statistically significant finding emerging from this study was that women have a higher prevalence of AMS. However, the authors could not exclude studies where patients were on acetazolamide. Our analysis provided a direction for future studies of the relationship of sex and the risk of AMS, such as the pathological mechanism and prevention research.Keywords：Prevalence;Sex differences;Acute mountain sickness;risk factors4|0|0Updated：2023-06-05
REVIEW
- Abstract：Locally recurrent head and neck squamous cell carcinoma (HNSCC) is often unresectable, and a repeat course of radiotherapy is associated with incremental toxicities. Boron neutron capture therapy (BNCT) is a novel targeted radiotherapy modality that can achieve a high dose gradient between cancerous and adjacent normal tissues. However, the relationships among the dose resulting from BNCT, tumor response to BNCT, and survival are not completely understood. Recently, a study published in Radiotherapy and Oncology investigated the efficacy of BNCT in the treatment of patients with locally recurrent HNSCC and the factors associated with favorable treatment response and survival. In this article, the findings, strengths and limitations of this study are discussed in depth, and the significance of the study and motivations for future research are highlighted.Keywords：Locally recurrent head and neck squamous cell carcinoma;Boron neutron capture therapy;Treatment efficacy5|0|1Updated：2023-06-05
EDITORIAL
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Abstract：High-dependency units (HDUs) provide high-level care to patients who suffer from single organ failure, with the exception of respiratory failure requiring mechanical ventilation; HDUs serve as an intermediary between general wards and Intensive Care Units. Due to military and civilian needs, our hospital has established a unique HDU for patients with liver disease in China. A Chinese military officer in the United Nations Peacekeeping Forces in South Sudan was transferred to our HDU for liver failure treatment in 2018. The patient’s disease status, nutrition, sleep habits, and psychological behaviour were monitored on different scales. The patient was provided with vascular monitoring, telemetry, pulse oximetry, drug treatment, nutritional support, sleep intervention, psychological intervention, and humanistic care by a multidisciplinary treatment team. After treatment, the patient recovered and avoided liver transplantation. Based on the experience with this HDU, this new model may create an efficient treatment process for military and civilian patients with severe liver disease at home or abroad.Keywords：High-dependency units;Liver failure;Treatment;Military patient5|0|0Updated：2023-06-05
LETTER TO THE EDITOR
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Abstract：Background:Orbital fractures are common injuries found in facial trauma. Typical etiologies of orbital fractures include motor vehicle collisions and assault. We report the case of a 32-year-old male who suffered an orbital fracture from a water balloon. Additionally, we describe the aeromedical complications that may result from this injury. Finally, we attempt to answer the question of when a patient may return to flying after sustaining such an injury through review of the literature.Case presentation:A 32-year-old male pilot with the United States Air Force was at an outdoor event with his unit when he was struck with a water balloon launched from a sling shot into his left orbit. Shortly afterwards, he had an onset of subcutaneous emphysema and was escorted to a nearby Emergency Department. Computed tomography identified an orbital fracture with associated orbital and subcutaneous emphysema. The patient was evaluated by a plastic surgeon and was determined not to be a surgical candidate. Four weeks later, he returned to flying status.Conclusions:Water balloons are thought to be safe and harmless toys. However, when coupled with sling shots, water balloons can become formidable projectiles capable of significant orbital injury including orbital fractures. These injuries are concerning to aviators, as the most common sites for fractures of the orbit are the thin ethmoid and maxillary bones adjacent to the sinuses. At altitude, gases in the sinuses may expand and enter the orbit through these fractures, which may suddenly incapacitate the flyer. It is important for flight surgeons to identify and assess these individuals to determine suitability for flying.Keywords：Boyle’s law;Orbital emphysema;Facial fracture4|0|0Updated：2023-06-05
CASE REPORT
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