bluuebunny/crossref_metadata_2025 huggingface dataset:
Normal tension glaucoma in obstructive sleep apnea syndrome
Authors: Chuang Lan-Hsin , Koh Yeo-Yang , Chen Henry S.L. , Lo Yu-Lun , Yu Chung-Chieh , Yeung Ling , Lai Chi-Chun
Published: March 2020

This study characterized and evaluated normal tension glaucoma (NTG) in obstructive sleep apnea syndrome (OSAS).

In this retrospective, cross-sectional study, all participants were examined with polysomnography (PSG). Functional parameters of standard automated perimetry (SAP) were recorded. Structural parameters in optical coherence tomography angiography (OCTA) included peripapillary superficial vessel density (VD RPC), peripapillary whole-layer (VD NH), and superficial and deep macular area VD. Participants were categorized into perimetric and nonperimetric groups by SAP result. Low reliability of SAP and signal strength index <50 in OCTA were excluded.

Severity of OSAS was graded by apnea-hypopnea index (AHI) in PSG. Those with moderate/severe OSAS (AHI ≥ 15, n = 39) had longer neck circumference and shorter ocular axial length than mild OSAS (AHI < 15, n = 14). Furthermore, there was significantly higher AHI and larger neck circumference in the NTG perimetric group (n = 27) than in the control group (n = 26; p < 0.001 and p = 0.047, respectively). Superficial and deep-layer peripapillary and macular area VD significantly decreased in the perimetric group. Overall, structural and functional parameters show that VF PSD was negatively correlated with VD NH and VD RPC (p = 0.007, p = 0.015); and VF MD was positively correlated with VD NH (p = 0.029), but not significantly to VD RPC (p = 0.106).

OSAS is a risk factor of NTG. With aid of OCTA, whole-layer retinal capillary dropout supports that the vascular dysregulation of OSAS leads to NTG.
Effect of sub-hypothermia blood purification technique in cardiac shock after valvular disease surgery
Authors: Fang Jihui , Xu Ming , Liu Bin , Wang Bo , Ren Haibo , Yang Haitao , Dong Yaling , Song Laichun , Xiao Hongyan
Published: March 2020

To observe the effect of sub-hypothermia (HT) blood purification technique in the treatment of cardiac shock after heart valve disease.

The patients were randomly divided into normothermic (NT) continuous blood purification (CBP) group (NT group) and HT CBP group (HT group). Observe the cardiac index (CI), the oxygen delivery (DO2) and oxygen consumption (VO2) ratio, Acute Physiology and Chronic Health Evaluation III(APACHE III) score, multiple organ dysfunction syndrome (MODS) score, dynamic monitoring of electrocardiograph, blood loss with or without muscle tremors, intensive care unit stay, mechanical ventilation time, CBP time, and the cases of infection and mortality at 0 day, 1 day, 2 day, 3 day; all above indicators were compared between 2 groups.

Ninety-five patients were randomly assigned into HT group (48 cases) and NT group (47 cases); there were no significant differences between the 2 groups for age, gender, pre-operative cardiac function, cardiothoracic ratio, and type of valve replacement (P > .05). There were no significant differences among the 1 day, 2 day, 3 day after recruited for CI, DO2/VO2 ratio, APACHE III score, MODS score (P > .05). But in HT group, DO2/VO2 ratio had been significantly improved after treatment for 1 day (2.5 ± 0.7 vs 1.8 ± 0.4, P = .024), and CI (3.0 ± 0.5 vs 1.9 ± 0.7, P = .004), APACHE III score (50.6 ± 6.2 vs 77.5 ± 5.5 P = .022), MODS score (6.0 ± 1.5 vs 9.3 ± 3.4, P = .013) also had been significantly improved after treatment for 3 days. In clinical outcomes, there were no significant differences between 2 groups for blood loss (617.0 ± 60.7 ml vs 550.9 ± 85.2 ml, P = .203), infection ratio (54.17% vs 53.19%, P = .341), the incidence of ventricular arrhythmia (31.25% vs 36.17%, P = .237), and muscle tremors (14.58% vs 8.51%, P = .346), while there were significant differences between 2 groups for intensive care unit stay (6.9 ± 3.4 days vs 12.5 ± 3.5 days, P = .017,), mechanical ventilation time (4.2 ± 1.3 days vs 7.5 ± 2.7 days, P = .034,), CBP time (4.6 ± 1.4 days vs 10.5 ± 4.0 days, P = .019), mortality (12.50% vs 23.40%, P = .024). But the incidence of bradycardia in HT group was much higher than the NT group (29.16% vs 14.89%, P = .029).

HT blood purification is a safer and more effective treatment than NT blood purification for patients who suffered from cardiac shock after valve surgery.
The genetic association between LMP2 and LMP7 polymorphisms and susceptibility of insulin dependent diabetes mellitus
Authors: Xu Yang , Liu Guotao , Zhou Yv , Lu Zengzhen , Shi Zhaorui , Wang Jun
Published: March 2020

Background:

Insulin dependent diabetes mellitus (IDDM) is a kind of heterogeneous disease caused by the interaction of polygene inheritance and environmental factors. The LMP2 and LMP7 are 2 loci in LMP gene, and although genetic association between LMP2 and LMP7 polymorphisms were reported, the results are inconclusive. The aim of this study was to investigate the association between LMP2 and LMP7 polymorphisms and IDDM risk.

Methods:

An exhaustive search was performed out through the electronic databases including PubMed, Embase, and Chinese National Knowledge Infrastructure (CNKI). The pooled odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength association between LMP2 CfoI and LMP7 G37360T polymorphisms and IDDM risk.

Results:

A total of 7 studies with 707 cases and 821 controls were included in the present study. The results indicated that the dominant model of LMP2 CfoI was significantly associated with IDDM in Asian population (OR = 1.96, 95% CI: 1.24–3.10, P = .004). In addition, the allelic and dominant models of LMP7 G37360T were associated with IDDM in Caucasian population (allelic model: OR = 0.69, 95% CI: 0.56–0.85, P = .0005; dominant model: OR = 0.67, 95% CI: 0.50–0.89, P = .007).

Conclusions:

The dominant model of LMP2 CfoI might be a risk factor for IDDM in Asian population. Whereas, the allelic and dominant models of LMP7 G37360T might be protective factors for IDDM in Caucasian population.
Triphasic dynamic contrast-enhanced computed tomography predictive model of benign and malignant risk of gallbladder occupying lesions
Authors: Tao Jinqiu , Zhang Yanqiu , Chen Huihui , Wang Shaohe , Sun Qi , Zhang Wenjie , Liu Qiaoyu , Mai Xiaoli , Yu Decai
Published: March 2020

Gallbladder occupying lesions are common diseases of biliary system. Among them, gallbladder cancer is difficult to diagnose due to the indistinguishable early symptoms, thus posing a great risk to the population. This study aims to establish a computed tomography (CT) prediction model for distinguishing benign and malignant lesions of gallbladder occupying lesions.

The study included 211 patients with benign or malignant gallbladder occupying lesions who have taken resection in the Nanjing Drum Tower Hospital from January 2009 to December 2017. Clinical data collected includes age and sex; CT data includes tumor location, tumor maximum diameter, tumor form, venous phase portal venous CT value, abdominal aortic CT value, plain phase CT value, arterial phase CT value, venous phase CT value, delayed phase CT value, ΔCT1, ΔCT2, ΔCT3, ΔCT4, ΔCT5, ΔCT6, and ΔCT7. Calculation of odds ratio between benign and malignant gallbladder occupying lesions using single factor screening variables and multivariate logistic regression was done to establish a model and calculate the areas under receiver operating characteristic curves of the model.

Multivariate logistic regression analysis showed that age, tumor maximum diameter, tumor form, venous phase portal venous CT value, ΔCT2, ΔCT4, and ΔCT6are the main characteristic index for differential diagnosis of benign and malignant risk of gallbladder occupying lesions.

Patients’ age, tumor maximum diameter, tumor form, venous phase portal venous CT value, ΔCT2, ΔCT4, and ΔCT6are independent risk factors for judging the benign and malignant of gallbladder occupying lesions. The model established exhibited a potential diagnostic value for distinguishing the malignant properties of gallbladder occupying lesions.
The impacts of the number of prefreeze and postthaw blastomeres on embryo implantation potential
Authors: Wang Yu-jiang , Liu Wen-juan , Fan Lin , Li Zi-tao , Huang Yu-qiang , Chen Chuang-qi , Liu Dun , Zhang Xi-qian , Liu Feng-hua
Published: March 2020

To systematically analyze the potential of embryo implantation through comparison between the number of surviving blastomeres, the growth, and implantation rate.

Retrospective analysis on implantation rate and the growth of prefreeze-postthaw embryos with different blastomeres in 1487 frozen embryo transfer cycles.

In groups of postthaw embryos without damage, implantation rate and the average number of blastomere growth increased significantly with increasing number of blastomeres. The implantation rate and the number of blastomeres of embryos with 8-8c (the number of blastomeres in prefreeze embryo-the number of blastomeres in postthaw embryo) continued to grow at a significantly higher rate than that of 5-5c and 6-6c (P < .05). In groups of embryos with the same number of blastomeres before freezing and with partial damage after resuscitation, the implantation rates were lower and the average numbers of blastomere growth reduced as the number of damaged blastomeres increased. For embryos with good quality before freezing, 1 to 3 damaged blastomeres in postthawed embryos did not affect the development and implantation rate. Both implantation rate and growth rate of embryos with 8-6c were significantly higher than those of embryos with 6-6c (P < .05).

The number of surviving blastomeres and growth in frozen-thawed embryos could be important index to predict embryo development potential and clinical outcome of implantation. For embryos with good quality, a small amount of damaged blastomeres would not weaken embryo development potential and implantation rate after being thawed.
Nomograms predict survival outcomes for distant metastatic pancreatic neuroendocrine tumor
Authors: Li Gang , Tian Mao-lin , Bing Yun-tao , Wang Hang-yan , Yuan Chun-hui , Xiu Dian-rong
Published: March 2020

As a rare malignant tumor, pancreatic neuroendocrine tumor (pNET) has very low incidence. However, most of the pNET patients would develop the distant metastasis, which significantly reduces patients’ survival rate. Therefore, it is very important to construct a prognostic model of pNET patients with distant metastasis based on a large database to guide clinical application and treatment. The aim of this study is to establish nomograms for cancer-specific survival (CSS) and overall survival (OS) of patients with distant metastatic pNET based on the Surveillance, Epidemiology, and End Results (SEER) database.

SEER were reviewed and the patients with pNET diagnosed between 1973 and 2015 were selected. After screening, a total of 624 cases were included in the study. Patients were randomly divided into a training cohort (n = 416) and a validation cohort (n = 208). Cox proportional hazard analysis revealed that age at diagnosis of ≥80 years, year of diagnosis, histological grade, and primary site surgery were independent factors both for CSS and OS. The nomograms indicated good accuracy in predicting 1-, 3-, and 5-year survival, with a C-index of 0.777 (95% confidence interval [CI], 0.743–0.811) for CSS and 0.772 (95% CI 0.738–0.806) for OS in training cohort. In the validation cohort, the C-index was 0.798 (95% CI 0.755–0.841) for CSS and 0.797 (95% CI 0.753–0.841) for OS. The calibration curves showed satisfactory consistency between predicted and actual survival.

The study establishes excellent prognostic nomograms for CSS and OS for pNET patients with distant metastasis. They can be used to accurately predict survival rate, and provide useful information to physicians and patients.
Nucleobindin 2 expression is an independent prognostic factor for bladder cancer
Authors: Cho Jeong Man , Moon Kyong Tae , Lee Ho Jung , Shin Soon Cheol , Choi Jae Duck , Kang Jeong Yoon , Yoo Tag Keun
Published: March 2020

Nucleobindin 2 (NUCB2) has been reported to play an important role in both tumorigenesis and cancer progression. This study aimed to examine the clinical significance of NUCB2 expression urothelial carcinoma of the bladder (UCB).

The expression level of NUCB2 and its correlation with clinicopathological parameters was analyzed in 225 UCB tissues by immunohistochemistry. Kaplan–Meier analysis and Cox proportional hazards regression models were used to investigate the correlation between NUCB2 expression and the prognosis of UCB patients. High NUCB2 expression of UCB patients significantly correlated with aggressive clinicopathological features. Patients with high NUCB2 had shorter overall survival and recurrence-free survival in Kaplan–Meier survival curve (P = .018 and P = .001, respectively).

Our results show that high expression of NUCB2 associated with aggressive clinicopathological feature and predicted unfavorable prognosis in patients with UCB might serve as feasible biomarker for clinical outcome of UCB patients after surgery and potential therapeutic target in the future.
Identification of potential prognostic long non-coding RNA for predicting survival in intrahepatic cholangiocarcinoma
Authors: Zhang Zeyu , Wang Zhiming , Huang Yun
Published: March 2020

Intrahepatic cholangiocarcinoma (ICC) is an aggressive biliary epithelial tumor with poor prognosis. There are increasing evidences that long non-coding RNAs (lncRNAs) are dysregulated in multifarious tumors, revealing potential significant role of lncRNAs in tumorigenesis.

We used the ICC dataset retrieved from The Cancer Genome Atlas and the Gene Expression Omnibus database to obtain the lncRNAs expression profiles and identify potential prognostic lncRNAs for predicting the prognosis in ICC. Univariate and multivariate Cox regression analyses were performed to construct a prognostic index (PI). Furthermore, coexpression analysis and functional assessment were performed to initially investigate the function of these prognostic lncRNAs.

A total of 255 differentially expressed lncRNAs (DElncRNAs) were identified among two RNA sequencing dataset of a total 63 ICC patients with 98 samples using R platform. Thirteen of 255 DElncRNAs were identified as prognostic lncRNAs and used for a PI. Patients with high PI were associated with poor prognostic (P= .0064), and the Cox regression showed consistent result (P = .042). The time-dependent receiver operating characteristic analysis showed the PI performed well in ICC survival prediction with an area under curve of 0.921, 0.801, and 0.717 for 1-, 3-, and 5-year survival, respectively.

In conclusion, we included 13 identified prognostic DElncRNAs and constructed a prognostic signature/PI. ICC patient with higher PI was associated with poorer prognosis. However, the clinical role as well as biological functions of constructed PI and these prognostic DElncRNAs need to be verified in future study.
Traditional Chinese medicine combined with conventional therapy for female kidney stone
Authors: Du Hong , Lei Yi , Gao A-Ni , Sun Xiao-Min , Song Rui , Yu Xu-Dong , Deng Sheng , Si Hong-Mei , Chen Jia
Published: March 2020

Introduction:

Kidney stone is caused by abnormal accumulation of crystalline substances in the kidneys. Kidney stone is one of the urinary system diseases with a high incidence. In this study, we will use the research method of randomized controlled trials to explore the effects of Traditional Chinese medicine combined with western medicine on renal function and urine metabolism in women with kidney stones. We hope that the results of this study will provide more evidence-based medical evidence for TCM to treat kidney stones, and also provide patients with more treatment options.

Methods/design:

This pragmatic randomized controlled trial will recruit 100 patients who are diagnosed with kidney stone. Simple randomization to conventional drug treatment with a 1:1 allocation ratio will be used. The participants will continue to receive ESWL treatment and TCM therapy. The selection of outcomes will be evaluated by the overall effectiveness of clinical efficacy.

Discussion:

This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of Traditional Chinese medicine for patients with Female kidney stone.
Potential mechanisms and serum biomarkers involved in sex differences in pulmonary arterial hypertension
Authors: Li Chan , Zhang Zeyu , Xu Qian , Wu Ting , Shi Ruizheng
Published: March 2020

Pulmonary arterial hypertension (PAH) is a disease associated with high mortality, but notable sex differences have been observed between males and females. For this reason, further research on the mechanisms underlying sex differences in PAH is required to better understand and treat the disease. This study mainly focused on gene expression levels to investigate potential differences in the pathogenesis and progression of PAH between the male and female sexes.

Sex-specific differentially expressed genes (DEGs) were analyzed using the Gene Expression Omnibus datasets GSE117261 and GSE38267. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted, and a protein-protein interaction (PPI) network was established based on the identified DEGs to predict potential mechanisms involved in the observed sex differences in the pathogenesis of PAH.

We identified 26 female- and 53 male-specific DEGs from lung tissue and 498 female-specific DEGs in blood samples. No male-specific DEGs were identified from blood samples. GO and KEGG pathway analyses revealed that female-specific DEGs in lung tissue were enriched in inflammatory response and cytokine-cytokine receptor interaction, whereas male-specific DEGs were mainly enriched in cellular chemotaxis and the nuclear factor of kappa light polypeptide gene enhancer in B-cell (NF-kappa B) signaling pathway. Lipocalin 2 (LCN2) was the only gene that was differentially expressed in both the lung tissue and the blood of female patients.

In conclusion, inflammation and immunity may play key roles in the pathogenesis of female PAH, and LCN2 may act as a serum biomarker of female PAH, whereas the pathogenesis in males is more complicated.
Physical and psychological effects of different temperature-controlled breast prostheses on patients with breast cancer during rehabilitation: a randomized controlled study (CONSORT)
Authors: Qiu Jiajia , Tang Lichen , Huang Lijin , Hou Shengqun , Zhou Jie
Published: March 2020

Background:

Breast loss causes negative influence on women physically, psychologically, and socially. Breast prosthesis can improve patient's figure externally, increase self-confidence, thus improving quality of life (QOL). Prospective study of different breast prostheses has not yet been performed in China. Our objective was to evaluate the QOL of patients wearing different types of breast prostheses and to compare the physical and psychological effects of different temperature-controlled breast prostheses on patients.

Methods:

Thirty patients with breast cancer were recruited through the Yankang E-follow-up Platform at the Department of Breast Surgery of Fudan University, Shanghai Cancer Center and were randomized into either intervention or control group. Random number tables were used in this study for randomization. In the first 6 weeks of the study, self-adhesive breast prostheses and conventional breast prostheses had been used in the intervention and control group, respectively. In the later 6 weeks, the breast prostheses used were switched into another kind. Several dimensional parameters including skin conditions, breast prosthesis knowledge, breast prosthesis knowledge, QOL, and body image were examined by different questionnaires in the end of both 6th and 12th week.

Results:

There were no significant difference in QOL and body image between the 2 groups during 6th and 12th week. At the 6th week of the study, patients of the intervention group preferred to the self-adhesive breast prosthesis, indicating that the self-adhesive breast prosthesis seemed more likely to feel like part of their body, while prosthesis cleaning remaining their biggest concern. At the end of 12th week, in comparison with the number at 6th week, more patients in both groups were willing to choose self-adhesive breast prosthesis.

Conclusions:

We conclude that women are satisfied with the temperature-controlled breast prosthesis and are more willing to choose self-adhesive breast prostheses although cleaning remains a problem. In China, patients still lack information about breast prostheses. Therefore, specialist breast nurses should provide comprehensive information about breast prostheses, assist patients in selecting suitable breast prostheses, collect feedback about the prostheses, and reduce each patient's physical and mental discomfort.
Endocrine therapies in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative, pretreated, advanced breast cancer
Authors: Lee Cho-Hao , Kang Yi-No , Ho Ching-Liang , Lin Chin , Chen Po-Huang , Wu Yi-Ying , Huang Tzu-Chuan
Published: March 2020

Background:

Recently, many endocrine therapies have become available for hormone receptor-positive, human epidermal growth factor receptor 2-negative, pretreated, advanced breast cancer. Direct comparisons of these novel treatments to assess their added value, however, are lacking

Methods:

Our aim was to synthesize available evidence to compare all current endocrine treatments for hormone receptor-positive / human epidermal growth factor receptor 2-negative advanced breast cancer. We performed a systematic review to identify available randomized controlled trial evidence. We searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Clinical Trials. Two trials presented at international oncology congresses (American Society of Clinical Oncology [ASCO]) were added to include the most recent evidence. A frequent network meta-analysis was used, and the surface under cumulative ranking area (SUCRA) was calculated to determine the best treatment

Results:

In total, 32 trials and 12,726 patients were identified, including 27 arms. Compared with fulvestrant 500 mg alone, novel target inhibitors combined with fulvestrant or exemestane had significantly prolonged progression-free survival with hazard ratios ranging from 0.62 to 0.82. Fulvestrant 500 mg plus palbociclib 125 mg and exemestane 25 mg plus entinostat 5 mg similarly extended progression-free survival (hazard ratio: 0.64 and 0.62 with SUCRA values of 91% and 92%, respectively). The exemestane 25 mg plus everolimus 10 mg combination had the best clinical benefit rate (risk ratio: 1.84, SUCRA: 91%) and overall response rate (risk ratio: 6.05, SUCRA: 97%)

Conclusions:

On the basis of this analysis, the 2 combinations of exemestane plus everolimus and fulvestrant plus palbociclib were the best treatment options
Effect of vitamin K1 on survival of patients with chronic liver failure
Authors: Xiong Zhuang , Liu Yangyang , Chang Tianying , Xu Xiaohao , Huo Shaokai , Deng Houbo , Liu Tiejun , Leng Yan
Published: March 2020

The effectiveness of vitamin K1 for the treatment of liver failure has been controversial, and no studies have investigated the effect of vitamin K1 on the risk of death and coagulation function in patients with chronic liver failure. This study aimed to explore the effect of vitamin K1 on death risk and international normalized ratio in patients with chronic liver failure.

From December 2013 to August 2017, this retrospective cohort study screened patients hospitalized for chronic liver failure (n = 80) who received routine treatment. The patients were categorized into the vitamin K1 and control groups according to whether they had received intramuscular injection of vitamin K1 on the basis of conventional treatment. Baseline data were analyzed with χ2 test and independent sample t-test; the survival curve of 48 weeks was created with Kaplan–Meier estimator. Correlation between death event and vitamin K1, age, sex, albumin (ALB), total bilirubin (TBIL), and alkaline phosphatase (ALP) was determined with the Cox proportional risk regression model.

Fifty-seven Chinese patients were finally included in the analysis. Patients treated with vitamin K1 had a lower risk of death (hazards ratio [HR] 0.37, P = 0.009) than the control group (P = 0.006). Men had a higher risk of death (HR 2.97, P = 0.005). Age, ALB, TBIL, and ALP had a certain correlation with risk of death. Vitamin K1 reduced the international normalized ratio levels [P < 0.01 (95% confidence interval 0.000–0.002)].

Vitamin K1 may reduce the risk of death in patients with chronic liver failure. Male sex, age, ALB, TBIL, and ALP are potential risk factors for increased risk of death in these patients. Based on these findings, vitamin k1 can be used in patients with chronic liver failure. Prospective studies are still needed, however, to validate the role of vitamin K1 in the chronic liver failure.
Endovascular coiling versus surgical clipping for the treatment of unruptured cerebral aneurysms
Authors: Kang Xiao-kui , Guo Sheng-fu , Lei Yi , Wei Wei , Liu Hui-xin , Huang Li-li , Jiang Qun-long
Published: March 2020

Background:

Endovascular coiling and surgical clipping are routinely used to treat unruptured cerebral aneurysms (UCAs). However, the evidence to support the efficacy of these approaches is limited. We aimed to analyze the efficacy of endovascular coiling compared with surgical clipping in patients with UCAs.

Method:

A systematic search of 4 databases was conducted to identify comparative articles involving endovascular coiling and surgical clipping in patients with UCAs. We conducted a meta-analysis using the random-effects model when I2> 50%. Otherwise, a meta-analysis using the fixed-effects model was performed.

Results:

Our results showed that endovascular coiling was associated with a shorter length of stay (WMD: −4.14, 95% CI: (−5.75, −2.531), P < .001) and a lower incidence of short-term complications compared with surgical clipping (OR: 0.518; 95% CI (0.433, 0.621); P < .001), which seems to be a result of ischemia complications (OR: 0.423; 95% CI (0.317, 0.564); P < .001). However, surgical clipping showed a higher rate of complete occlusion after surgery, in both short-term (OR: 0.179, 95% CI (0.064, 0.499), P = .001) and 1-year follow-ups (OR: 0.307, 95% CI (0.146, 0.646), P = .002), and a lower rate of short-term retreatment (OR: 0.307, 95% CI (0.146, 0.646), P = .002). Meanwhile, there was no significant difference in postoperative death, bleeding, and modified Rankin Scale (mRS) > 2 between the 2 groups.

Conclusions:

The latest evidence illustrates that surgical clipping resulted in lower retreatment rates and was associated with a higher incidence of complete occlusion, while endovascular coiling was associated with shorter LOS and a lower rate of complications, especially ischemia.
Comparison of stereotactic body radiation therapy with and without sorafenib as treatment for hepatocellular carcinoma with portal vein tumor thrombosis
Authors: Que Jenny , Wu Hung-Chang , Lin Chia-Hui , Huang Chung-I , Li Li-Ching , Ho Chung-Han
Published: March 2020

Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for unresectable hepatocellular carcinoma (HCC) patients. However, the treatment outcomes for patients with portal vein tumor thrombosis (PVTT) remain poor. In this study, we evaluate the efficacy of SBRT with and or without sorafenib for advanced HCC with PVTT.

Fifty four HCC patients with PVTT treated with SBRT using the Cyberknife system was retrospectively analyzed between January 2009 and June 2016. Of these, sorafenib combined with SBRT was administered to 18 patients and SBRT alone was administered to 36 patients. SBRT was designed to target the liver tumor and tumor thrombosis, with a radiation dose of 36 to 45 Gy (median 40 Gy) given in 3 to 5 fractions.

The mean follow-up period for SBRT with sorafenib and SBRT alone was 13.22 ± 10.07 months and 15.33 ± 22.01 months, respectively. The response rate was comparable in both groups. Complete response and partial response rates were 77.77% for SBRT with sorafenib and 75.00% without sorafenib (P = .43). The median progression-free survival rate was 6 months (2–11 months) versus 3 months (2–5.6 months) (P = .24) and the 1- and 2-year progression-free survival rates were 25.7% and 15.2% versus 11.1% and 8.3% (P = .1225). The median, 1- and 2-year overall survival rates (OSR) were 12.5 months, 55.6% and 17.7% versus 7 months (5–13.5 months), 33.3% and 11.1% (P = .28), for SBRT with sorafenib versus SBRT alone groups, respectively.

The result of our study shows that SBRT with sorafenib administered group resulted in a higher median, progression-free, and OSR for HCC patients with PVTT. However, the trends did not attain statistical significance. A large-scale randomized study is needed to assess the benefits of SBRT with sorafenib administration for patient with PVTT.
Association between blood lipid level and embryo quality during in vitro fertilization
Authors: Wang Shanshan , Wang Jun , Jiang Yiqun , Jiang Weihua
Published: March 2020

The aim of this study was to investigate the relationship between blood lipid level and the parameters of embryo morphology of in vitro fertilization (IVF).

A total of 488 patients undergoing conventional IVF were divided into pregnant (n = 286) and nonpregnant (n = 202) groups. Levels of triglycerides (TG), total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoprotein (LDL), lipoprotein (a), lipoprotein (b), and embryo outcomes were studied. Spearman correlation was performed to analyze the correlation between blood lipid levels and embryo quality in pregnant group.

The normal fertilization rate and number of good quality embryos were higher than nonpregnant group (P < .05). TG, TC, and LDL levels were negatively correlated with number of normal fertilized oocytes, while TG, TC, and Lp(b) were negatively correlated with number of good quality embryos. TG level was negatively correlated with number of oocytes and cleavage embryos while HDL and Lp(a) were positively correlated with number of oocytes, normal fertilized oocytes and cleavage embryos (P < .05).

TG, TC, LDL, and Lp(b) levels had negative correlation with embryo quality, while HDL and Lp(a) had positive correlation with the embryo quality. Our present findings showed blood lipid levels may provide certain reference for the prediction of IVF pregnancy outcome.
Closed reduction with crossed Kirschner wire fixation for displaced supracondylar femoral fractures in young children
Authors: Li Jin , Ma Jiewen , Guo Xikai , Yue Changjie , Chen Kailei , Wang Jing , Tang Xin
Published: March 2020

Supracondylar femoral fractures are uncommon in children, but may result in various deformities. Though many approaches have been used to manage them, there is no literally approved standard yet.

From 2015 to 2017, 12 young children at the average age of 2.5 years old (range 3.6–1.6) with displaced supracondylar fractures were admitted to our department and received closed reduction with crossed Kirschner wire (K-wire) fixation as treatment. After the surgeries, we performed follow-up to every patient at the average length of 26 months (range 24–30) and used the Knee Society Score scale to evaluate the outcome.

Fracture healing was observed within 10 weeks for all patients and walking was resumed between 10 to 13 weeks. No patient reported a valgus deformity more than 10°, neurovascular injury or knee infection. The average limb length discrepancy was 0.4 cm at the end of our follow-up. Every patient had perfect score on the Knee Society Score scale.

Our study suggests that closed reduction with percutaneous crossed Kirschner wire is a favorable method for displaced supracondylar femoral fractures in young children.
The burden of chronic obstructive pulmonary disease in open heart surgery—a retrospective cohort analysis of postoperative complications
Authors: Szylińska Aleksandra , Kotfis Katarzyna , Listewnik Mariusz , Brykczyński Mirosław , Marra Annachiara , Rotter Iwona
Published: March 2020

Chronic obstructive pulmonary disease (COPD) has a major impact on mortality and morbidity in patients undergoing cardiac surgery. Mortality risk increases by 50% in patients who were re-intubated or required prolonged mechanical ventilation after the operation. The aim of this study was to assess the impact of COPD on the prediction of postoperative complications and outcome including intensive care unit (ICU) and hospital stay, postoperative morbidity and mortality in patients undergoing all types of cardiac surgery.

We performed a retrospective cohort analysis of prospectively collected data from a tertiary cardiac surgery department of a university hospital between 2014 and 2016. We divided patients undergoing cardiac surgery into 2 sub-groups – the first – with a clinical diagnosis of COPD (n = 198) and the second comprised all other non-COPD patients (n = 2980).

Among patients with COPD a longer intubation time (P = .039), longer ICU stay (P < .001) and longer hospitalization time (P = .006) was noted as compared with non-COPD patients. Patients with COPD required reintubation more often than non-COPD patients, reintubation occurring twice, 19 (9.60%) versus 144 (4.83%) P = .002, reintubation occurring 3 or more times, 7 (3.54%) versus 34 (1.14%) P = .006. Mortality within 30 days after surgery was higher in patients with pulmonary problems before surgery (P = .003). Multivariable logistic regression analysis corrected for interfering variables showed an increased risk of postoperative bronchoconstriction (odds ratio [OR] = 4.40, P = .002), respiratory failure (OR = 1.67, P = .018), atrial fibrillation (OR = 1.45, P = .023), and use of hemofiltration (OR = 1.60, P = .029) for patients with COPD.

Patients with COPD undergoing all types of cardiac surgery are at increased risk of respiratory complications and mortality. The occurrence of COPD was associated with longer ICU and hospital stay. In COPD patients, undergoing cardiac surgery, treatment strategies aimed at preventing reintubation and early weaning mechanical ventilation must be employed to reduce postoperative complications.
Probiotics, prebiotics, and synbiotics supplementation in prediabetes: protocol for a systematic review and meta-analysis
Authors: Du Xuqin , Xie Chunguang , Shi Lipeng , Gao Hong , Yang Chan , Liu Qionghui
Published: March 2020

Background:

The prevalence of prediabetes and diabetes is increasing rapidly, and 5% to 10% of prediabetic patients will develop diabetes every year. Diabetes causes major health problems as well as a large economic burden. Human studies have demonstrated the beneficial effects of probiotics, prebiotics, and synbiotics supplementation in prediabetes. However, there are no systematic reviews that explore the therapeutic efficacy of probiotics, prebiotics, and synbiotics supplementation in patients with prediabetes. Therefore, we aim to synthesize the existing evidence evaluating the effectiveness and safety of probiotics, prebiotics, and synbiotics supplementation in prediabetic patients.

Methods:

We will search PubMed, EMBASE, Cochrane Library, Web of Science, the Clinical Trials.gov website, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Data Knowledge Service Platform from inception to August 2020. Additionally, the search will be conducted in multiple languages. Search terms are keywords and medical subject headings related to prediabetes, probiotics, prebiotics, and synbiotics. The primary outcomes are differences in glycated hemoglobin and fasting blood glucose. The secondary outcomes are differences in fasting insulin, homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index, and adverse events. The meta-analysis will be performed using the Revman5.3.0 software provided by the Cochrane Collaboration.

Results:

Our study will systematically evaluate the effectiveness and safety of probiotics, prebiotics, and synbiotics supplementation in prediabetes.

Conclusion:

The findings of this study will provide the best available evidence for probiotics, prebiotics, and synbiotics in the treatment of prediabetes, and provide a strong basis for clinical treatment.
Changes in Health Care Access, Behaviors, and Self-reported Health Among Low-income US Adults Through the Fourth Year of the Affordable Care Act
Authors: Griffith Kevin N. , Bor Jacob H.
Published: March 2020

Background:

Health care access increased for low-income Americans under the Affordable Care Act (ACA). It is unknown whether these changes in access were associated with improved self-reported health.

Objective:

Determine changes in health care access, health behaviors, and self-reported health among low-income Americans over the first 4 years of the ACA, stratified by state Medicaid expansion status.

Design:

Interrupted time series and difference-in-differences analysis.

Subjects:

Noninstitutionalized US adults (18–64 y) in low income households (<138% federal poverty level) interviewed in the Behavioral Risk Factor Surveillance System 2011–2017 (N=505,824).

Measures:

Self-reported insurance coverage, access to a primary care physician, avoided care due to cost; self-reported general health, days of poor physical health, days of poor mental health days, and days when poor health limited usual activities; self-reported health behaviors, use of preventive services, and diagnoses.

Results:

Despite increases in access, the ACA was not associated with improved physical or general health among low-income adults during the first 4 years of implementation. However, Medicaid expansion was associated with fewer days spent in poor mental health (−1.1 d/mo, 95% confidence interval: −2.1 to −0.5). There were significant changes in specific health behaviors, preventive service use, and diagnosis patterns during the same time period which may mediate the relationship between the ACA rollout and self-reported health.

Conclusion:

In nationally-representative survey data, we observed improvements in mental but not physical self-reported health among low-income Americans after 4 years of full ACA implementation.
Suitability of food in a rehabilitation hospital for patients with neurologic dysphagia
Authors: Trček Kavčič Marjeta , Ogrin Maja , Vidmar Gaj
Published: March 2020

Texture-modified food is a common strategy in dysphagia management for increasing safety of swallowing. It is essential for the patient to receive the prescribed diet based on clinical and instrumental examination of swallowing in order to be able to benefit from rehabilitation and avoid complications. Variations in terminology and definitions regarding texture-modified food and liquids demonstrate the need for international standardized terminology. We aimed to assess suitability of texture-modified diets used at a rehabilitation hospital in terms of the International Dysphagia Diet Standardization Initiative guidelines. A texture-modified main dish was analyzed for 5 days (15 samples of pureed and 10 samples of minced texture) at lunch time by 2 trained assessors using International Dysphagia Diet Standardization Initiative-recommended testing methods. The majority of pureed and minced food samples did not suit the comparable International Dysphagia Diet Standardization Initiative levels. The results underline the need for implementing the International Dysphagia Diet Standardization Initiative guidelines in order to provide an appropriate texture-modified diet for patients with neurogenic dysphagia and support dysphagia management within inpatient rehabilitation.
The dose of robot-assisted gait therapy may influence functional recovery in a multidisciplinary rehabilitation program: an exploratory retrospective study
Authors: Straudi Sofia , Severini Giacomo , Da Roit Marco , Pizzongolo Laura Di Marco , Martinuzzi Carlotta , Basaglia Nino
Published: March 2020

Robot-assisted gait training (RAGT) has been introduced in clinical practice to increase training intensity in patients with neurological disorders. In this observational study, we investigated the effect of the number of RAGT sessions on functional recovery in a heterogeneous cohort of patients. We included patients with a diagnosis of gait impairment due to a neurological disease. A set of demographic, clinical, functional and training parameters was collected for each participant. Each patient received RAGT with an exoskeleton (Lokomat; Hocoma, Volketswil, Switzerland) as part of a multidisciplinary rehabilitation program. We stratified the patients as good responders and poor responders and investigated the effect of varying the number of RAGT sessions with a series of logistic regression models. A total of 143 patients were included in this analysis (good responders = 65, poor responders = 78). Good responder patients spent more days in the hospital (P < 0.01) and underwent a higher number of RAGT sessions (P = 0.04) compared to poor responder patients. Logistic regression models estimated that adding six RAGT sessions mildly increased (by approximately 4%) the probability of a patient becoming a good responder. The rehabilitation phase (subacute/chronic) appeared to be the main determinant of the probability of being a good responder, and stroke patients appeared to be more sensitive to changes in the number of RAGT sessions. Our results seem to confirm previous observations that robotic therapy increases the intensity of rehabilitation, possibly leading to a greater functional recovery in subacute patients with greater impairment.
Relaxation Therapy for Depression
Authors: Jia Yong , Wang Xiaowei , Cheng Yuanjuan
Published: March 2020

We conducted this updated meta-analysis to evaluate the effects of relaxation therapy for depression. We searched PubMed, MEDLINE, PsycINFO, the Cochrane Library, Web of Science, and CINAHL for randomized controlled trials evaluating the effects of relaxation therapy in patients with depression. Finally, 14 studies were included in this meta-analysis. The efficacy of the intervention was evaluated using depression scale scores. We found that there was no significant difference between the effects of relaxation therapy and psychotherapy on decreasing self-rated depressive symptoms (standardized mean difference [SMD] = 0.19; 95% confidence interval [CI], −0.11 to 0.48). In addition, eight trials compared relaxation therapy with no treatment, waiting list, or minimal treatment and showed that the relaxation group reported lower levels of self-reported depression scores postintervention (SMD = −0.57; 95% CI, −0.98 to −0.15). Therefore, this meta-analysis showed that relaxation might reduce depressive symptoms, and the effect is not worse than that of psychotherapy.
Temperament, Character, and Subjective Well-Being in Croatian War Veterans Suffering From Posttraumatic Stress Disorder
Authors: Jakšić Nenad , Aukst Margetić Branka , Šimunović Filipčić Ivona , Šagud Marina , Jakovljević Miro
Published: March 2020

Subjective well-being is decreased in war-affected populations. However, no previous research has investigated the role of temperament and character dimensions in life satisfaction among war veterans with posttraumatic stress disorder (PTSD). This study enrolled 148 Croatian male war veterans being treated for combat-related PTSD. The participants completed the Beck Depression Inventory–Second Edition, Satisfaction with Life Scale, and Temperament and Character Inventory–Revised. Two multivariate regression analyses with life satisfaction as a dependent variable and temperament and character dimensions, respectively, as predictor variables, were performed. Temperament dimensions harm avoidance and novelty seeking as well as character dimensions self-directedness and cooperativeness were unique predictors of life satisfaction, while controlling for the influence of depressive symptoms, education level, and employment status. Given the influence of personality dimensions on life satisfaction, the routine assessment of these dimensions might help to establish the individually tailored treatment among war veterans with PTSD.
A Critical Review of Behavioral and Emotional Disinhibition
Authors: Huey Edward D.
Published: March 2020

The theory of “disinhibition” has been very influential in psychiatry and neurology for over a century. Disinhibition has been used to explain clinical findings in many neurological and psychiatric disorders including dementia, traumatic brain injury, attention deficit hyperactive disorder, substance abuse, impulsivity in personality disorders, and neurodevelopmental disorders. In addition, disinhibition has been used as a unifying theory to link clinical observations with cognitive findings, and even cellular findings. This review discusses the origins and history of the theory of disinhibition and its strengths and weaknesses in four domains: face validity, consistency with other brain mechanisms, consistency with evolutionary mechanisms, and empiric support. I assert that the vagueness of the theory, inconsistency with other brain mechanisms, and lack of empiric support limit the usefulness of this theory. Alternative approaches, based on findings in other motor, language, and cognitive functions, are discussed.
Effect of Combined Clinical Practice Guideline and Electronic Order Set Implementation on Febrile Infant Evaluation and Management
Authors: McCulloh Russell J. , Commers Tessa , Williams David D. , Michael Jeffrey , Mann Keith , Newland Jason G.
Published: March 2020

Objective

Management of febrile infants 60 days and younger for suspected serious infection varies widely. Clinical practice guidelines (CPGs) are intended to improve clinician adherence to evidence-based practices. In 2011, a CPG for managing febrile infants was implemented in an urban children's hospital with simultaneous release of an electronic order set and algorithm to guide clinician decisions for managing infants for suspected serious bacterial infection. The objective of the present study was to determine the association of CPG implementation with order set use, clinical practices, and clinical outcomes.

Methods

Records of febrile infants 60 days and younger from February 1, 2009, to January 31, 2013, were retrospectively reviewed. Clinical documentation, order set use, clinical management practices, and outcomes were compared pre-CPG and post-CPG release.

Results

In total, 1037 infants pre-CPG and 930 infants post-CPG implementation were identified. After CPG release, more infants 29 to 60 days old underwent lumbar puncture (56% vs 62%, P = 0.02). Overall antibiotic use and duration of antibiotic use decreased for infants 29 to 60 days (57% vs 51%, P = 0.02). Blood culture and urine culture obtainment remained unchanged for older infants. Diagnosed infections, hospital readmissions, and length of stay were unchanged. Electronic order sets were used in 80% of patient encounters.

Conclusions

Antibiotic use and lumbar puncture performance modestly changed in accordance with CPG recommendations provided in the electronic order set and algorithm, suggesting that the presence of embedded prompts may affect clinician decision-making. Our results highlight the potential usefulness of these decision aids to improve adherence to CPG recommendations.