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12% were underestimated and the Japan Esophageal Society classification (JES) was better than Inoue (Accuracy 75.48% VS 58.67%, P  less then  0.05). For ≥ SM2, 38.86% were underdiagnosed and the diagnostic accuracy of Arima classification was significantly higher than the other two (P  less then  0.05). Our study showed that the new criteria had higher diagnostic sensitivity than the widely used classification (JES) for differentiating ≥ SM2 staging cancer from EP-SM1 (0.77 VS 0.50, P  less then  0.05). CONCLUSIONS IPCL was valuable for diagnosing SESCC staging. However, ≥ MM would be underestimated easily. Our study revealed that the diagnostic sensitivity for ≥ SM2 staging tumors was significantly improved by the new standard.BACKGROUND Individuals with low back pain (LBP) often turn to complementary and alternative medicine (CAM) to seek relief. The purpose of this study was to determine mention of CAM in LBP clinical practice guidelines and assess the quality of CAM recommendations using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. METHODS A systematic review was conducted to identify LBP guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines providing CAM recommendations were assessed with the AGREE II instrument. RESULTS From 181 unique search results, 22 guidelines on the treatment and/or management of LBP were found, and 17 made recommendations on CAM therapy. With regard to scaled domain percentages, this overall guideline scored higher than the CAM section for 4 of 6 domains (overall, CAM) (1) scope and purpose (88.6%, 87.1%), (2) clarity of presentation (83.0%, 73.2%), (3) stakeholder involvement (57.0%, 41.7%), (4) rigor of development (47.2%, 44.7%), (5) editorial independence (34.8%, 34.8%) and (6) applicability (31.8%, 21.8%). CONCLUSIONS The majority of LBP guidelines made CAM recommendations. The quality of CAM recommendations is significantly lower than overall recommendations across all domains with the exception of scope and purpose and editorial independence. This difference highlights the need for CAM recommendation quality improvement. Future research should identify CAM therapies which are supported by sufficient evidence to serve as the basis for guideline development. These slides can be retrieved under Electronic Supplementary Material.The aim of this study was to investigate the effect of bisphosphonates on preventing osteoporotic hip fracture in patients with or without prior major osteoporotic fracture. Randomized controlled trials (RCTs) and observational studies (OSs) based on electronic health records were used to assess bisphosphonate efficacy and were searched using PubMed, Scopus, and the Cochrane Library databases. Eight RCT studies and 14 OSs were extracted from the studies and quantitatively combined by random-effects meta-analysis. The odds ratio (OR) for all hip fractures in RCTs of 0.66, with a 95% confidence interval (CI) of 0.55-0.79, was lower than that in the OSs (OR 0.83; CI 0.74-0.94). The OR in patients with prior fracture was significantly reduced by bisphosphonates in both RCTs and OSs. Conversely, significant fracture reduction was not apparent in patients without prior fracture. A moderate relationship between prior major fracture rates and OR in hip fractures was defined. In patients with an average age of over 80 years, similar results were confirmed. In this meta-analysis, the efficacy of bisphosphonates was significant in patients with prior major fracture, recommending to prescribe for such patients. Their effect in patients without prior fracture, in contrast, remains unclear.Feline infectious peritonitis (FIP) is a fatal disease in wild and domestic cat species. Fasoracetam Although several drugs are expected to be useful as treatments for FIP, no drugs are available in clinical practice. In this study, we evaluated the therapeutic effect of combined use of adalimumab (an anti-human-TNF-alpha monoclonal antibody, ADA) and itraconazole (ICZ), which are presently available to veterinarians. The neutralizing activity of ADA against fTNF-alpha-induced cytotoxicity was measured in WEHI-164 cells. Ten specific pathogen-free (SPF) cats were inoculated intraperitoneally with type I FIPV KU-2. To the cats that developed FIP, ADA (10 mg/animal) was administered twice between day 0 and day 4 after the start of treatment. ICZ (50 mg/head, SID) was orally administered daily from day 0 after the start of treatment. ADA demonstrated dose-dependent neutralizing activity against rfTNF-alpha. In an animal experiment, 2 of 3 cats showed improvements in FIP clinical symptoms and blood chemistry test results, an increase in the peripheral blood lymphocyte count, and a decrease in the plasma alpha 1-AGP level were observed after the beginning of treatment. One of the cats failed to respond to treatment and was euthanized, although the viral gene level in ascites temporarily decreased after the start of treatment. ADA was found to have neutralizing activity against rfTNF-alpha. The combined use of ADA and ICZ showed a therapeutic effect for experimentally induced FIP. We consider these drugs to be a treatment option until effective anti-FIPV drugs become available.PURPOSE An intermediate cervical plexus block (CPB) targets the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. The phrenic nerve descends obliquely on the surface of the anterior scalene muscle beneath the prevertebral fascia after originating from the C3-C5 ventral rami. Therefore, the phrenic nerve can be affected by a local anesthetic during an intermediate CPB, depending on the permeability characteristics of the prevertebral fascia. This study investigated whether an intermediate CPB affects the phrenic nerve, inducing hemidiaphragmatic paresis. METHODS In this prospective observational study, 20 patients undergoing single-incision transaxillary robot-assisted right thyroidectomy were enrolled. The intermediate CPB (0.25% ropivacaine 0.2 ml/kg) was performed at the C4-5 intervertebral level carefully, without penetrating the prevertebral fascia, before the patient emerged from general anesthesia. Diaphragmatic motions of the block side were measured by M-mode ultrasonography at three time points before anesthesia (baseline) and at 30 and 60 min after the intermediate CPB.