Effects of silymarin supplementation on blood lipids: A systematic review and meta‐analysis of clinical trials

Dyslipidemia is a leading cause of endothelial dysfunction and cardiovascular disease. Several studies used silymarin as an herbal supplement in hyperlipidemic subjects. The aim of the present systematic review and meta‐analysis was to examine the effect of silymarin supplementation on blood lipids. PubMed, Scopus, Ovid (Cochrane library), ISI Web of Science, and Google Scholar were systematically searched until March 2018 to find intervention studies that examined the impact of silymarin supplementation on blood lipids in adults. Changes in blood lipids and potential sources of between‐study variation were extracted. We run a subgroup analysis to determine potential sources of inter‐study heterogeneity. Ten clinical trials fulfilled the eligibility criteria. Meta‐analysis indicated that silymarin supplementation in combination with other treatments (not silymarin alone) reduced total cholesterol (change: ?25.45 mg/dl; 95% confidence interval [CI] [?47.89, ?3.01 mg/dl]) and low‐density lipoprotein (change: ?28.25 mg/dl; 95% CI [?53.09, ?3.42 mg/dl]). Also, silymarin increased high‐density lipoprotein concentration (change: 4.82 mg/dl; 95% CI [2.01, 7.63 mg/dl]). Blood concentration of triglyceride was significantly after silymarin supplementation in comparison with controls (change: ?22.55 mg/dl; 95% CI [?44.32, ?0.78 mg/dl]). Present systematic review and meta‐analysis revealed that silymarin supplementation in combination with other treatments had a favorable effect on blood lipids.     

Comparative Study of Experimental and Modeling of Fly Ash-Based Concrete

The application of supplementary cementitious materials (SCMs) in concrete has been reported as the sustainable approach toward the appropriate development. This research aims to compare the result of compressive strength (C-S) obtained from the experimental method and results estimated by employing the various modeling techniques for the fly-ash-based concrete. Although this study covers two aspects, an experimental approach and modeling techniques for predictions, the emphasis of this research is on the application of modeling methods. The physical and chemical properties of the cement and fly ash, water absorption and specific gravity of the aggregate used, surface area of the cement, and gradation of the aggregate were analyzed in the laboratory. The four predictive machine learning (PML) algorithms, such as decision tree (DT), multi-linear perceptron (MLP), random forest (RF), and bagging regressor (BR), were investigated to anticipate the C-S of concrete. Results reveal that the RF model was observed more exact in investigating the C-S of concrete containing fly ash (FA), as opposed to other employed PML techniques. The high R2 value (0.96) for the RF model indicates the high precision level for forecasting the required output as compared to DT, MLP, and BR model R² results equal 0.88, 0.90, and 0.93, respectively. The statistical results and cross-validation (C-V) method also confirm the high predictive accuracy of the RF model. The highest contribution level of the cement towards the prediction was also reported in the sensitivity analysis and showed a 31.24% contribution. These PML methods can be effectively employed to anticipate the mechanical properties of concretes.     

Unusual sites of metastatic involvement: intracardiac metastasis from laryngeal carcinoma

Cardiac metastatic squamous cell laryngeal carcinoma is rare.We report the case of a 49-year-old man with recurrent squamouslaryngeal carcinoma presenting with right leg acute ischaemiaand large mobile right and left cardiac masses. The patienthas history of laryngeal squamous cell cancer surgically treatedwith total laryngectomy, thyroidectomy, and tracheostomy 2 yearsago. He was admitted to our intensive care unit with acute rightleg pain, left sided chest pain, hypotension 92/55, and tachycardia112 bpm. On physical exam, he had a faint pulse of his rightPosterior Tibial artery with a cold foot, but no discoloration.Heart sounds were normal with no murmur. Initial workup showeda Troponin of 0.27. An electrocardiogram showed sinus tachycardia,with inverted T waves in the Infero-lateral leads. Emergentsurgical thrombectomy was done on his right leg with restorationof arterial blood flow to the affected limb. An echocardiogramshowed a preserved left ventricular function with multiple areasof echogenic masses in all four cardiac chambers located atthe annulus of the tricuspid valve, the right ventricular freewall and along the inter-ventricular septum. No intracardiacshunt was detected by contrast study. Computed tomography scanof the heart confirmed the presence of multiple exophytic intracardiacmasses within the left atrium, the right ventricle, interventricularseptum, and lateral free wall of the left ventricle. Immunohistochemicalstaining with cytokeratin of the emboli was consistent withmalignant squamous cell carcinoma consistent with metastasesof his known laryngeal squamous cell cancer.     

Clinical impact of circulating oncogenic MiRNA-221 and MiRNA-222 in glioblastoma multiform

Journal of Neuro-Oncology - Approach selection paradigm for tuberculum sellae meningiomas (TSMs) is still a point of discussion. The trans-eyebrow supraorbital keyhole approach (TSKA) is a...     

Fragmented QRS complex is an independent predictor of plaque burden in patients at intermediate risk of coronary artery disease

ObjectiveWe aimed to evaluate the relationship between fragmented QRS complex and plaque burden in patients presented with typical chest pain and deemed to have intermediate pretest probability of CAD using coronary computed tomography angiography (CCTA).MethodsWe studied electrocardiograms (ECGs) obtained from 172 subjects (47.5 ± 9.5 years, 125 were men) presented with chest pain and had intermediate pretest probability for CAD. The presence was found and evaluation of CAD was performed with CCTA.ResultsSeventy four (43%) of the study cohort had CCTA-documented CAD. Meanwhile the frequency of fQRS in our cohort was (57%). 70 (71.4%) patients with fQRS had CAD compared with only 4 (5.4%) patients without fQRS (p < 0.001). The number of leads with fQRs was correlated with the calcium score (p < 0.005), segment stenosis score, segment involvement score, total plaque score (TPS), and E/e ratio (p < 0.001, for all). Multivariate analysis demonstrated that fQRS was a strong independent predictor for CAD (or = 2.15, p < 0.001). ROC analysis showed that the number of leads ≥3 was the optimal number for predicting CAD (AUC = 0.89, sensitivity 88%, and specificity 83%, p < 0.001).ConclusionFragmented QRS was seen more often in patients with high plaque burden. We suggest that fQRS might provide a useful noninvasive prognosticator for subjects with intermediate pretest probability of CAD for further investigation.     

CLINICAL EFFECTIVENESS OF KINESIOLOGICAL TAPING ON PAIN AND PAIN‐FREE SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A RANDOMIZED,DOUBLE BLINDED,PLACEBO‐CONTROLLED TRIAL

Background:

Kinesiological taping (KT) is commonly used to improve symptoms associated with musculoskeletal disorders. However, review of the literature revealed minimal evidence to support the use of KT in treatment of shoulder disorders and controversy exists regarding the effect of KT in patients with shoulder impingement syndrome (SIS).

Objective:

The purpose of this study was to investigate the effect of KT on pain intensity during movement, pain experienced during the night (nocturnal pain), and pain‐free shoulder range of motion (ROM) immediately after taping, after three days and after one week, in patients with SIS.

Design:

Randomized, Double blinded, Placebo‐controlled design.

Participants:

A total of 30 patients with SIS participated in this study. Patients were assigned randomly to a control (N = 15) and an experimental group (N = 15).

Methods:

The patients in the experimental group received a standardized therapeutic KT. The standardized, placebo neutral KT was applied for control group. KT was applied two times with a three day interval, remaining on during the 3 day interval. Both groups followed the same procedures. Pain‐free active ROM during shoulder abduction, flexion, and elevation in the scapular plane was measured. Visual analogue scale (VAS) for pain intensity during movement or nocturnal pain and was assessed at baseline, immediately after KT, after three days, and one week after KT.

Results:

The result of repeated measures ANOVA showed a significant change in pain level during movement, nocturnal pain, and pain‐free ROM (p = 0.000) after KT in the experimental group. In the ANCOVA, controlling for pre‐test scores, change in pain level at movement (p = 0.009) and nocturnal pain (p = 0.04) immediately after KT was significantly greater in the experimental group than in control group. There was no significant difference in ROM measures (p > 0.05) between groups immediately after KT. No significant differences were found between the two groups in the after one week measurements of pain intensity and shoulder ROM.

Conclusion:

The KT produces an immediate improvement in the pain intensity at movement and nocturnal pain in patients with SIS.

Level of Evidence:

1     

Relationship Between Hip Extensor Strength and Back Extensor Length in Patients With Low Back Pain: A Cross-Sectional Study

ObjectiveThe purpose of this study was to examine the relationship between hip extensor strength and back extensor length in patients with low back pain (LBP) and healthy controls.MethodsIn 266 patients with LBP and 215 matched controls, back extensor length and hip extensor strength were measured and compared in the 2 groups using an independent t test. The Pearson correlation coefficient was used to determine correlation between these 2 variables. Multivariate logistic regression was used to test the risk of sustaining LBP with having these muscle insufficiencies.ResultsA significant difference in hip extensor strength was found between patients with LBP and controls (P < .001). Back extensor length was different in healthy men compared with the patients with LBP (P < .001) but was not significant between women with and without LBP (P = .34). The results showed a significant relationship between back extensor length and hip extensor strength in men with LBP (r = 0.6, P = .01). Multivariate logistic regression revealed that having a weak hip extensor (P = .001) or shortened back extensor (P = .01) could increase the risk of LBP occurrence.ConclusionThe findings support the assumptions of the presence of muscle imbalance of hip extensor weakness and back extensor tightness in male patients with LBP and that each muscle impairment may contribute to LBP.