bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic impact of the Controlling Nutritional Status score following curative nephrectomy for patients with renal cell carcinoma
Authors: Zheng Yangqin , Bao Lianmin , Wang Wenhan , Wang Qinquan , Pan Yue , Gao Xiaomin
Published: December 2018

We aimed to evaluate the prognostic significance of the preoperative Controlling Nutritional Status (CONUT) score in patients with renal cell carcinoma (RCC), and then compared its accuracy of the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) as predictors of survival.

We included 635 patients who underwent nephrectomy for RCC from January 2004 to July 2014. The X-tile program was used to determine the optimal cut-off values for CONUT score, PNI, NLR, and PLR.

The median follow-up duration after surgery was 48.40 (29.30–80.10) months. The optimal cutoff values were 2 for CONUT score, 48 for PNI, 3.5 for NLR and 204.7 for PLR by X-tile program with cancer-specific survival (CSS) as end-point. Higher CONUT score, NLR and PLR, and lower PNI were statistically associated with worse OS and CSS in the univariate analysis. Multivariate analysis showed that higher CONUT score was an independent predictor for OS (HR = 3.012; 95% CI, 1.525–5.948; P = .001) and CSS (HR = 3.001; 95% CI, 1.290–6.984; P = .011), and CONUT score was superior to PNI, NLR, and PLR according to the HR.

Therefore, preoperative CONUT score can be a strong independent predictor in RCC patients after nephrectomy.
Baseline 18F-FDG PET/CT as predictor of the pathological response to neoadjuvant therapy in esophageal cancer
Authors: Domachevsky Liran , Kashtan Hanoch , Brenner Baruch , Nidam Meital , Morgenstern Sara , Kundel Yulia , Groshar David , Bernstine Hanna
Published: December 2018

The type of pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer predicts overall survival (OS).

We aimed to assess early 18F-FDG positron emission tomography/computed tomography parameters in predicting the pathological response to neoadjuvant treatment.

The cohort included consecutive patients with locally advanced esophageal cancer who underwent baseline 18F-FDG positron emission tomography/computed tomography between September 2006 and February 2015. Positron emission tomography variables of maximum and average standardized uptake values (SUVmax, SUVaverage), metabolic tumor volume (MTV), and total lesion glycolysis were recorded in addition to computed tomography volume. MTV was calculated using cut-off values of 42%, 50% and 60% (MTV 0.42, 0.5, and 0.6) of the tumoral SUVmax. Receiver operating characteristic (ROC) analysis was used to determine sensitivity and specificity.

Sixty-one patients (44 male, 17 female) fulfilled the inclusion criteria. Only MTV values of 13.6 mL (MTV 0.42) and 7.4 mL (MTV 0.5) remained significant on ROC analysis, with an area under the curve of 0.690 (confidence interval 0.557–0.823, p = .02] and 0.664 (confidence interval 0.527–0.802, P = .048), respectively in differentiating patients with a complete (n = 44) or incomplete (n = 17) pathological response.

MTV at presentation is associated with the pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer.
Obstructive ileus caused by metal staples 6 years after the initial surgery
Authors: Lee Chul Seung , Kim Min Ki
Published: December 2018

Rationale:

Complete small bowel obstruction (SBO) is a common surgical emergency often resulting from adhesive bands installed after a surgical procedure. However, SBO caused by surgical staples used in a previous operation is unusual. Herein, we report a rare case of adhesive ileus induced by surgical staples.

Patient's concerns:

A 58-year-old woman visited our Emergency Department with right lower quadrant (RLQ) pain and vomiting. The patient had undergone laparoscopic total hysterectomy with the Endo GIA stapler for uterine myoma 6 years prior.

Diagnoses:

Computed tomography (CT) revealed a closed-loop obstruction with volvulus involving the distal ileum.

Interventions:

After suspected failure of conservative therapy with fluid resuscitation and Levin tube decompression, emergency laparoscopic surgery was performed. A fibrous band around the surgical staples considered to have been used in a previous operation was observed which extended to the greater omentum, through which a segment of the bowel formed a closed-loop obstruction around the right ovary.

Outcomes:

The patient's symptoms resolved and a follow-up on post-operative day 14 showed no symptoms.

Lessons:

Surgeons using surgical staples should be aware that adhesion may occur when the staples are exposed to the abdominal cavity, which can lead to the risk of SBO several years after surgery. Thus, staples should not be exposed to the abdominal cavity, or anti-adherent substances should be used to minimize the possibility of such complications.
Dark chocolate modulates platelet function with a mechanism mediated by flavan-3-ol metabolites
Authors: Montagnana Martina , Danese Elisa , Angelino Donato , Mena Pedro , Rosi Alice , Benati Marco , Gelati Matteo , Salvagno Gian Luca , Favaloro Emmanuel J. , Del Rio Daniele , Lippi Giuseppe
Published: December 2018

Cocoa is a rich source bioactive compounds, i.e., flavan-3-ols, and its consumption has been associated with several beneficial effects, such as the positive modulation of the hemostasis targeted by the platelet function. However, these phenolic compounds have a very low bioavailability and extensively undergo phase I and II metabolism, with the appearing into the bloodstream of (epi)catechin conjugates and phenyl-γ-valerolactones and their conjugates, at different times.

The aims of this study were to explore the effect of dark chocolate on platelet function and to investigate the relationship between this interplay and flavan-3-ol derived metabolites.

Eighteen healthy male volunteers ingested 50 g of 90% cocoa chocolate within 5 minutes. Blood samples were collected immediately before chocolate ingestion (T0) and 4 hours afterwards (T1). Platelet function analyzer (PFA)-100 closure time was assessed using collagen/adenosine-5′-diphosphate (COL/ADP) and collagen/epinephrine (COL/EPI) cartridges. Plasma flavan-3-ol metabolites were identified and quantified by means of liquid chromatography coupled to a triple quadrupole mass spectrometer (UHPLC-ESI-MS/MS).

Results evidenced a significant increase of COL/ADP-induced PFA-100 closure time, but not COL/EPI, 4 hours after ingestion of dark chocolate. Total plasma structurally-related (epi)catechin metabolite (SREM) concentration significantly increased at T1, together with 4 out of the 6 detected metabolites. Total phenyl-γ-valerolactone concentrations remained unchanged. Spearman correlations evidenced a strong correlation between COL/ADP closure time and SREMs, mainly led by (epi)catechin-sulfate isomers.

These data confirm that the potential beneficial effect of dark chocolate on primary hemostasis may be mediated by flavan-3-ol circulating metabolites.
Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer
Authors: Lee Banghyun , Kim Kidong , Park Youngmi , Lim Myong Cheol , Bristow Robert E.
Published: December 2018

Background:

In cervical cancer, the impact of hospital volume of laparoscopic radical hysterectomy (LRH) has not been investigated systematically as in ovarian cancer.

The aim of this study was to investigate the impact of hospital care volume of LRH on treatment outcomes of patients with cervical cancer.

Methods:

The PubMed, Embase, and Cochrane Library databases were searched with the terms “cervical cancer,” “radical hysterectomy,” and “laparoscopy.” The selection criteria included studies presenting operative outcomes and/or perioperative complications of LRH from high-volume hospitals (HVHs) (≥15 cases/year) and low-volume hospitals (LVHs) (<15 cases/year). Fifty-nine studies including 4367 cases were selected. Linear regression analysis weighted by the average annual case number in each study was performed to evaluate differences between the groups.

Results:

In HVH, a higher number of lymph nodes (24.5 vs 21.1; P = .037) were retrieved by LRH in older women (48.4 vs 44.5 years; P = .010) with tendencies of shorter operation time (224.4 vs 256.4 minutes; P = .096) and less blood loss (253.1 vs 322.2 mL; P = .080). Compared with LVH, HVH had fewer patients with stage IA disease (13.8 vs 24.4%; P = .003) and more patients with stage IIA disease (15.3 vs 7.1%; P = .052) with comparable 5-year overall survival (93.1 vs 88.6%; P = .112).

Conclusion:

HVH is a prognostic factor for operative outcome and perioperative complications in patients with cervical cancer undergoing LRH. The exact effect of hospital volume on survival outcome needs to be evaluated.
Perforation of small intestine secondary to metastatic lung adenocarcinoma
Authors: Wang Jian , Chen Yimeng , Zhang Sisi , Chen Qingyong
Published: December 2018

Rationale:

About 50% of patients with a diagnosis of nonsmall cell lung carcinoma exhibit metastatic disease at the time of diagnosis. The preferential sites of extrapulmonary spread are the lymph nodes, liver, brain, adrenal glands, and bones; gastrointestinal tract perforation secondary to metastatic lung cancer is extremely rare.

Patient concerns:

A 60-year-old male nonsmoker patient presented with a 20-day history of facial, neck, and right upper limb edema. Physical examination revealed a 3.5 cm mass in his right chest. Computed tomography (CT) revealed a 4 cm mass near the right lung hilum.

Diagnosis:

Biopsy of the right chest wall mass revealed low differentiated lung adenocarcinoma. Additionally, retroperitoneal lymphadenopathy, pericardial effusion, metastases in the mediastinum, bilateral adrenal gland, and right thoracic wall nodule, as well as multiple bone metastases were also found.

Interventions:

Since the patient was diagnosed with multiple metastatic lung cancer, chemotherapy was started. One week after chemotherapy, he experienced a sudden acute abdominal pain. Abdominal CT examination indicated the possibility of intestinal perforation. Hence, the patient underwent an emergency operation. During the surgical procedure, 2 perforations of size 1×1 cm2 were discovered at 110 cm and 140 cm of the jejunum from Treitz's ligament. Then, an intestinal resection and end-to-end anastomosis were performed. The pathological diagnosis of the resected specimen revealed that it was a metastatic lung adenocarcinoma of small intestine.

Outcomes:

The patient died 10 days after operation and 19 days following the cancer diagnosis due to septic shock.

Lessons:

Gastrointestinal tract metastasis from the lung is uncommon, but the survival rate is extremely low; therefore, it should be considered as a possibility in patients who present with any of the gastrointestinal symptoms.
Anaplastic pancreatic cancer diagnosed with endoscopic ultrasound guided fine needle aspiration showing hypervascular tumor
Authors: Fujimoto Takehide , Inatomi Osamu , Mizuno Ryo , Shintani Shuhei , Nishida Atsushi , Bamba Shigeki , Sugimoto Mitsushige , Andoh Akira
Published: December 2018

Rationale:

Pancreatic ductal carcinoma is a hypovascular tumor, and characteristic findings are observed on imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), in most cases.

Patient concerns:

Here we report a case of anaplastic carcinoma of the pancreas (ACP) with characteristics of hypervascular tumor diagnosed by endoscopic ultrasound guided fine needle aspiration (EUS-FNA). A 70-year-old woman was admitted to hospital because of exacerbation of diabetes. Contrast-enhanced CT revealed a hypervascular tumor at the head of the pancreas.

Diagnosis:

EUS-FNA was performed. Osteoclast-like giant cells and tumor cells with polymorphic nuclei were found on pathological examination and she was diagnosed with ACP.

Interventions:

Although it was a surgical indication at the time of diagnosis, the tumor rapidly worsened. Oral administration of TS-1 (tegafur/gimeracil/oteracil) was initiated. Chemotherapy was discontinued after the end of 2 courses because the tumor had increased prominently on CT.

Outcomes:

She died approximately a year since the onset of the illness.

Lessons:

ACP occasionally exhibits the characteristics of a hypervascular tumor and may require differentiation from other pancreatic tumors, such as neuroendocrine tumor. Therefore, pathological diagnosis by EUS-FNA at an early stage is important to determine treatment strategies.
Dazhu Hongjingtian (Herba Rhodiolae) for unstable angina pectoris
Authors: Fan Yu , Gu Xuyu , Zhang Heng
Published: December 2018

Background

Dazhu Hongjingtian (DZHJT), also named Herba Rhodiolae, has been frequently introduced for patients with angina pectoris in China. However, the add-on effect of DZHJT in unstable angina pectoris (UAP) has not been systematically evaluated. The purpose of this protocol is to provide the methods used to assess the efficacy and safety of DZHJT as adjuvant therapy for management of UAP.

Methods

We will extensively search for eligible studies in PubMed, Emase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and VIP databases up to October 2018. Only randomized controlled trials comparing DZHJT in combination with Western medicine vs Western medicine alone were selected.

The primary outcomes are above 50% reduction in frequency of angina attacks and weekly frequency of angina attacks reduction. The secondary outcomes are the blood rheology parameters (whole-blood viscosity, plasma viscosity, and fibrinogen) and adverse events. We will use RevMan V.5.0 software to perform meta-analysis.

Results

The pooled results will provide a high-quality of evidence of DZHJT as adjuvant therapy in patients with UAP.

Conclusion

This systematic review and meta-analysis will provide up-to-date evidence to evaluate DZHJT as adjuvant therapy in patients with UAP.

PROSPERO registration number

PROSPERO CRD42018111885.
Increased nerve twigs in small intestinal mucosa with programmed cell death-ligand 1 and somatostatin receptor type 2A expression in recurrent Crohn disease
Authors: Caruso Maria Lucia , Di Pinto Federica , Ignazzi Antonia , Coletta Sergio , Valentini Anna Maria , Cavalcanti Elisabetta , De Michele Francesco
Published: December 2018

Rationale:

Inflammatory bowel disease (IBD) patients manifest symptoms of disturbed gut function, such as neural sensory-motor changes. Programmed cell death-ligand 1 (PD-L1), normally present in neural tissue, exists in close apposition to the mucosal immune system and intestinal epithelium, and a bi-directional communication is known to occur at these interfaces. Somatostatin has been shown to suppress the inflammatory reaction, and has been used in several clinical trials to treat inflammatory disorders, such rheumatoid arthritis. Recently, somatostatin receptor type 2A, that regulates neurotransmission, proliferation, and apoptosis, has been recognized in IBD. Although prominent abnormalities in the morphology of the enteric nervous system have been observed in idiopathic IBD, they are more marked in Crohn disease.

Patient concerns:

A 55-year-old woman with recurrent Crohn disease, just surgically treated for ileal resection, have a stenotic complication.

Interventions:

At surgery 5 cm of preterminal ileum with stenosis and anastomotic ileocolic block was removed.

Diagnoses:

The histopathology showed a recurrent Crohn in fistulo-stenotic phase; the stenosis was mainly sustained by mass-forming, ganglioneuromatous hyperplasia. Normally very rare, fine nerve twigs extend up into mucosa but we found a new-formed fibrillary network, extending into the inflammation area at the subepithelial luminal site of the mucosa, that was positive to PD-L1 and somatostatin receptor type 2A (SSTR2A) immunostaining but not visualized in routinary stained slides.

Outcomes:

After surgery the patient was semestrally followed with clinical endoscopic evaluation that results uneventfully.

Lessons:

Our case shows that before surgery neuromatous abnormalities can be predicted by immunostained new-formed twigs in the mucosa.
Associations between DNAH1 gene polymorphisms and male infertility
Authors: Yang Xiao , Zhu Dongliang , Zhang Hongguo , Jiang Yuting , Hu Xiaonan , Geng Dongfeng , Wang Ruixue , Liu Ruizhi
Published: December 2018

Genetic abnormalities could account for 10% to 15% of male infertility cases, so increasing attention is being paid to gene mutations in this context. DNAH1 gene polymorphisms are highly correlated with astheno-teratozoospermia, but limited information has been reported on pathogenic variations in DNAH1 in the Chinese population. We explored 4 novel variations of the DNAH1 gene in Chinese infertile patients. Mutation screening of the DNAH1 gene was performed on 87 cases of asthenozoospermia with targeted high-throughput sequencing technology; another 200 nonobstructive azoospermia cases were further analyzed to investigate the prevalence of DNAH1 variations. The effects of the variations on protein function were further assessed by bioinformatic prediction. For carriers of DNAH1 variations, genetic counseling should be considered. Assisted reproductive technologies should be performed for these individuals and microsurgery should be considered for patients with azoospermia. DNAH1 variations were identified in 6 of 287 patients. These included 8 heterozygous variations in exons and a splicing site. Among these, 4 variations (g.52400764G>C, g.52409336C>T, g.52430999_52431000del, g.52412624C>A) had already been registered in the 1000 Genomes and Exome Aggregation Consortium databases. The other 4 novel variations (g.52418050del, g.52404762T>G, g.52430536del, g.52412620del) were all predicted to be pathogenic by in silico analysis. The variations g.52418050del and g.52430999_52431000del were detected in 1 patient who was more severe than another patient with the variation g.52430999_52431000del. Physicians should be aware of genetic variants in male infertility patients and DNAH1 mutations should be considered in patients with asthenospermia or azoospermia.
Impact of coronary plaque geometry on plaque vulnerability and its association with the risk of future cardiovascular events in patients with chest pain undergoing coronary computed tomographic angiography—the GEOMETRY study
Authors: Ratiu Mihaela , Chitu Monica , Benedek Imre , Benedek Theodora , Kovacs Istvan , Rat Nora , Rezus Ciprian
Published: December 2018

Introduction:

Coronary computed tomography angiography (CCTA) has emerged as a valuable noninvasive imaging tool for assessing atheromatous plaque morphology and composition, and several CCTA features have been validated as reliable indicators of the plaque-associated risk. However, the role of lesion geometry as a CCTA feature of plaque vulnerability has not been investigated so far.

Material and methods:

Here we present the study protocol of the GEOMETRY trial, a prospective, single center, cohort study in which we aim to investigate the relationship between plaque geometry (as expressed by cross-sectional and longitudinal plaque eccentricity) and the risk for major adverse cardiac events (MACE) during 2 years of follow-up, in order to validate plaque eccentricity as a new CCTA marker of coronary plaque vulnerability. One thousand patients with suspected coronary artery disease (CAD) and pretest probability of CAD between 15% and 85%, who undergo CCTA and in whom CCTA identifies the presence of at least 1 significant coronary plaque (producing a luminal narrowing of at least 50%) will be enrolled in the study. Based on the results of complex image post-processing and plaque analysis, patients will be divided into 2 groups: group 1—patients in whom CCTA analysis identifies only non-eccentric coronary plaque; and group 2—patients in whom CCTA analysis reveals the presence of at least 1 eccentric significant coronary plaque producing a significant luminal narrowing. Study outcomes will consist in the rate of major cardiovascular events and the rate of plaque progression during follow-up.

The study is funded by the Romanian Ministry of European Funds, the Romanian Government and the European Union, as part of the research grant number 103544/2016 – PlaqueIMAGE (contract number 26/01.09.2016).

Conclusion:

In conclusion, GEOMETRY will be the first CCTA-based study that will investigate the impact of geometric distribution of coronary atheromatous plaque on the future risk of cardiovascular events and on the rate of plaque progression, introducing and validating a new potential feature of plaque vulnerability represented by plaque geometry.
Fascia iliaca compartment block versus intravenous analgesic for positioning of femur fracture patients before a spinal block
Authors: Hsu Yuan-Pin , Hsu Chin-Wang , Bai Chyi-Huey , Cheng Sheng-Wei , Chen Chiehfeng
Published: December 2018

Background:

Fascia iliaca compartment block (FICB) provides an analgesic option for positioning before spinal anesthesia in patients suffering from a femur fracture. The evidence supporting FICB is still not well established. The aim of our study is to assess the efficacy and safety of FICB comparing with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture.

Methods:

PubMed, Embase, and Scopus databases were interrogated from their inceptions to September 2017. We included randomized controlled studies reported as full text, those published as abstracts only and unpublished data, if available. Data were independently extracted by 2 reviewers and synthesized using a random-effects model.

Main Results:

Three studies comprising 141 participants showed that FICB compared to IVA led to a significant between-group standard mean differences in quality during positioning within 30 minutes before spinal anesthesia (standardized mean difference (SMD) −2.02, 95% confidence interval (CI): −2.43 to −1.61, I
2 = 0%) and time for spinal anesthesia (pooled mean difference (PMD) −2.86 minutes, 95% CI −3.70 to −2.01, I
2 = 0%). Two studies with 101 participants suggested that FICB is superior to IVA on opioid requirements 24 hours postoperatively (pooled odds ratio (POR): 0.11, 95% CI: 0.03 to 0.35, I
2 = 13%). There were no significant differences in complications or hemodynamic effects

Conclusions:

Comparing with IVA, FICB can provide significantly better quality during positioning of femur fracture patients for a spinal block and a shorter time for spinal anesthesia. FICB is safe method.
A case report on complete cure of recurrent primary canaliculitis by 4-snip punctoplasty and canalicular curettage
Authors: Kim Min Ho , Ra Ho
Published: December 2018

Rationale:

For the treatment of primary canaliculitis, 1,2,3-snip punctoplasty and canalicular curettage are commonly used; however, a recurrence rate of 6.6% to 22% has been reported. Herein, we describe a case of recurrent primary canaliculitis that was completely cured by 4-snip punctoplasty and canalicular curettage.

Patient concerns:

A 53-year-old woman was admitted to our hospital with chief complaints of epiphora, discharge, eyelid flare up, and swelling near the inferior lacrimal punctum in the left eye, which initially presented 6 months earlier.

Diagnosis:

Based on the aforementioned symptoms, the patient was initially diagnosed with bacterial conjunctivitis at a local ophthalmologic clinic and used antibiotic eye drops for 6 months. However, her symptoms did not improve and they worsened at 2 weeks prior to admission. She was subsequently diagnosed with chronic dacryocystitis and referred to our hospital for surgical treatment. Slit lamp examination results showed conjunctival congestion in the inner corner of the left eye, along with eyelid flare up, swelling near the inferior lacrimal punctum, and yellowish discharge and concretion from the lacrimal punctal orifice. Furthermore, punctal regurgitation was not observed in the lacrimal sac compression test. Thus, the patient was diagnosed with primary canaliculitis on the basis of her clinical symptoms and laboratory findings.

Interventions:

Based on the diagnosis of primary canaliculitis, 1-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks. Overall, the patient's symptoms improved after surgery, but epiphora and yellowish discharge from the lacrimal punctal orifice developed again 2 months after surgery during outpatient follow-up. Based on the diagnosis of recurrent primary canaliculitis, 4-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks.

Outcomes:

Over a 6-month follow-up period, the symptoms disappeared completely and no other findings were observed.

Lessons:

Four-snip punctoplasty and canalicular curettage are simple clinical procedures that can minimize the recurrence rate of primary canaliculitis. Hence, 4-snip punctoplasty and canalicular curettage should be considered as the 1st-line treatment for primary canaliculitis and recurrent cases.
Comparison the efficacy of hemorrhage control of Surgiflo Haemostatic Matrix and absorbable gelatin sponge in posterior lumbar surgery
Authors: Ma Litai , Dai Lijuan , Yang Yi , Liu Hao
Published: December 2018

Objective:

To compare the hemostatic effect of hematostatic agent Surgiflo and absorbable gelatin sponge (AGS) in posterior lumbar surgery.

Methods:

A total of 60 cases were recruited during August 2016 and June 2017 according to the inclusion and exclusion criteria. Patients were randomly allocated to the Surgiflo Haemostatic Matrix (SHM) group or the AGS group (AGS) by computer-generated randomization codes. The success rates of hemostasis for 3 minutes and 5 minutes, the time of operation, the amount of intraoperative bleeding, the volume of autogenously blood transfusion, the amount of blood during hemostasis, the amount of blood transfusion, and BP, RBC, HCT, HB of preoperative, 2 to 3 days, and 5 to 7 days following operation were recorded to compare. Daily drainage and all adverse events after operation were also compared.

Results:

All the patients were followed up for at least 1 month. The RBC and HCT of the AGS group before operation were lower than those in the control group (P = .039, P = .029), but there was no difference after operation (P >.05). In the control group, 19 cases were successfully hemostatic in 3 minutes, 4 cases were successful in 5 minutes, and 7 cases were combined with hemostasis. In the SHM group, it was 22, 3, and 5 cases respectively. There was significant difference in blood loss during hemostatic process between the 2 groups (P <.001). There was no difference in the amount of blood loss and autologous blood transfusion between the 2 groups, and there was no difference in the operation time between the 2 groups. In the AGS group, allogeneic blood was infused in 1 case during operation, and no allogeneic blood was infused in the other patients. The drainage volume on the 1st day and the 2nd to 4th day after operation in the AGS group was less than that in the control group (P = .015, P = .010).

Conclusion:

Compared with AGS, SHM could decrease the blood loss during hemostatic process and the postoperative drainage volume in posterior operation of lumbar degenerative disease. SHM is a safe and effective hemostatic agent in lumbar posterior surgery.
Gender specific effect of CETP rs708272 polymorphism on lipid and atherogenic index of plasma levels but not on the risk of coronary artery disease
Authors: Cai Gaojun , Shi Ganwei , Huang Zhiying
Published: December 2018

Numerous studies have shown a relationship between cholesteryl ester transfer protein (CETP) polymorphism in the synthesis of high-density lipoprotein cholesterol (HDL-C) and the coronary artery disease (CAD) susceptibility, but the results have remained inconsistent. In addition, there was no study exploring the relationship between CETP polymorphisms and atherogenic index of plasma (AIP) levels.

We conducted a case-control study to evaluate the relationship between CETP rs708272 polymorphism and CAD risk and lipid levels in Chinese Han population. 556 CAD patients and 414 controls undergoing coronary angiography were consecutively enrolled in the hospital-based study. Polymerase chain reaction-ligase detection reaction (PCR-LDR) method was used to detect the different genotypes at rs708272.

No significant association between CETP rs708272 polymorphism and CAD risk was observed in different genetic models. In the whole population, participants with TT genotype had higher HDL-C levels (1.17 ± 0.31 mmol/L vs 1.09 ± 0.29 mmol/L, P = .001) and lower AIP levels (0.08 ± 0.35 vs 0.16 ± 0.31, P = .004) compared to those with CC genotype, after adjusting for age, gender, smoking, essential hypertension (EH), and DM. The T allele carriers had higher HDL-C levels than the T allele non-carriers (1.13 ± 0.29 mmol/L vs 1.09 ± 0.29 mmol/L, P = .023). Furthermore, subgroup analyses based on gender were carried out. In males, the results showed that participants with TT genotype had significant higher HDL-C levels and lower AIP levels compared with CC genotype (P <.05). In addition, males with CT+TT genotypes had higher HDL-C levels and lower AIP levels than those with CC genotypes (HDL-C: CT+TT 1.11 ± 0.31vs CC 1.06 ± 0.30 mmol/L, P = .041; AIP: CT+TT 0.12 ± 0.32vs CC 0.16 ± 0.31, P = .034, respectively). However, there were no significant associations between lipid levels and CETP rs708272 polymorphism in females, after adjusting for confounders.

CETP rs708272 polymorphism has a gender-specific effect on lipid and AIP levels but not on the risk of CAD.
Hyperamylasemia may indicate the presence of ovarian carcinoma
Authors: Guo Song , Lv Hongtao , Yan Li , Rong Fengnian
Published: December 2018

Rationale:

Reports of malignant ovarian tumor with hyperamylasemia are very rare. We present a patient with hyperamylasemia who was diagnosed with a malignant ovarian tumor.

Patient concerns:

A 46-year-old woman was hospitalized complaining of a 2-day history of abdominal discomfort and fever. On physical examination, she showed abdominal distention and tenderness, with rebound pain. Laboratory evaluation showed significantly elevated serum amylase levels. Computed tomography (CT) revealed a solid mass with uneven density in the pelvis.

Diagnoses:

Based on her clinical symptoms and hyperamylasemia, she was suspected to have acute pancreatitis at first. However, the final pathology showed advanced serous papillary ovarian carcinoma.

Interventions:

She underwent initial therapy for acute pancreatitis, followed by laparotomy once her symptoms had disappeared. A tumor mass with maximum diameter 12 cm was detected originating from the right ovary, and the patient underwent hysterectomy, bilateral salpingo-oophorectomy with omentectomy, and appendectomy. On the 14th day after the surgery, she received 5 courses of chemotherapy with paclitaxel and carboplatin. However, distant metastasis before the 6th course of chemotherapy were detected by CT, she was therefore changed to a chemotherapy regimen containing gemcitabine and capecitabine.

Outcomes:

The final pathology showed advanced serous papillary ovarian carcinoma. On the 14th day after the surgery, she received 5 courses of chemotherapy with paclitaxel and carboplatin. However, her serum CA125 levels rose again before the 6th course of chemotherapy, and CT of the abdomen and pelvis revealed multiple abnormal-density lesions in the peritoneum and pelvic cavity. We considered these to be metastases, and the patient was deemed unresponsive to her previous chemotherapy. She was therefore changed to a chemotherapy regimen containing gemcitabine and capecitabine, and remained on this regimen at the time of writing.

Lessons:

Ovarian carcinoma should be considered as a possibility in patients with hyperamylasemia after ruling out other potential common causes. The final diagnosis depends mainly on the clinical manifestation, laboratory results, and CT examination, though pathology is mandatory to confirm the diagnosis. The main treatment is surgical excision.
Influence of thermal ablation of hepatic metastases from gastric adenocarcinoma on long-term survival
Authors: Tang Kezhong , Liu Yanmo , Dong Linping , Zhang Bo , Wang Lantian , Chen Jian , Chen Guofeng , Tang Zhe
Published: December 2018

The objectives of this systematic review and pooled analysis were to examine long-term survival, morbidity, and mortality following thermal ablation of gastric cancer hepatic metastases and to identify prognostic factors that improve survival.

Patients with hepatic metastases from gastric cancer are traditionally treated with palliative chemotherapy. Surgical resection is an alternative treatment of hepatic metastases. Whether patients can obtain benefit from thermal ablation of hepatic metastases is still controversial.

A systematic literature search was undertaken (1990–2018). Publications were included if they studied more than 7 patients undergoing thermal ablation for hepatic metastasis from gastric cancer in the absence of peritoneal disease or other distant organ involvement. The primary outcome was the hazard ratio (HR) for overall survival. Comparison between thermal ablation and systematic chemotherapy or hepatic resection had been carried out. The influence of liver metastasis-related factors, such as <3 cm versus >3 cm, single versus multiple and metachronous versus synchronous upon survival was also assessed.

The median survival of thermal ablation for the 12 studies included was 22.93[20.45–25.41] months. Procedures were associated with a median 30-day morbidity of 6% (0%–23%) and with no mortality. The median 1-year, 2-year, 3-year, and 5-year survival were 79.14%, 39.79%, 28.45%, and 19.46%, respectively. Thermal ablation of hepatic metastasis was associated with improved overall survival compared with systematic chemotherapy (HR = 2.12; 95% CI 0.77–3.47; P=.000). Meta-analysis confirmed the additional survival benefit of size <3 cm (HR = 1.46; 95% CI 1.03–1.88; P = .002) and receiving chemotherapy after thermal ablation (HR = 2.14; 95% CI 1.05–3.23; P = .000).

A use of RFA/ microwave ablation (MWA) as a liver-directed treatment may provide greater survival benefit than chemotherapy and is an alternative option for the treatment of liver-only metastases from gastric cancer. With the appropriate selection of patients, such as tumors <3 cm in diameter, thermal ablation may provide better prognosis than hepatic resection of hepatic metastasis with lower morbidity and mortality. Postoperation chemotherapy should be provided to patients with GLM who received thermal ablation.
A new scoring model predicting macroscopic vascular invasion of early-intermediate hepatocellular carcinoma
Authors: Liu Yao , Sun Le , Gao Fangyuan , Yang Xue , Li Yuxin , Zhang Qun , Zhu Bingbing , Niu Shuaishuai , Huang Yunyi , Hu Ying , Feng Ying , Jiang Yuyong , Wang Xianbo
Published: December 2018

Macroscopic vascular invasion cannot be properly predicted in advance in hepatocellular carcinoma patients based on clinical characteristics and imaging features.

To develop a predictive scoring model of macroscopic vascular invasion in hepatocellular carcinoma patients after transcatheter arterial chemoembolization combined with radiofrequency ablation based on specific laboratory and tumor indicators.

A predictive scoring model, which estimates the incidence of macroscopic vascular invasion at 1-year follow-up, was constructed based on a derivation cohort of 324 patients with hepatocellular carcinoma; a validation cohort of 120 patients was prospectively included. The prognostic value of the scoring model was determined by concordance index, time-dependent receiver operating characteristics, and calibration curves.

Cox multivariate analysis of the derivation cohort identified prothrombin time, aspartate aminotransferase, and Barcelona clinic liver cancer (BCLC) staging as independent predictive factors of macroscopic vascular invasion. The areas under the receiver operating characteristic curves of the predictive scoring model were 0.832 and 0.785 in the derivation and validation cohorts, respectively, and the calibration curves fitted well. Kaplan–Meier analysis showed that the incidence of macroscopic vascular invasion was significantly higher in the high-risk group (score 0–2) than in the low-risk group (score 3–4) in both the derivation and validation cohorts (P < .0001 and P = .0008, respectively).

The predictive scoring model enables the accurate prediction of macroscopic vascular invasion incidence 1 year in advance in hepatocellular carcinoma patients who undergo transcatheter arterial chemoembolization combined with radiofrequency ablation.
The impact of lymphovascular invasion in patients with prostate cancer following radical prostatectomy and its association with their clinicopathological features
Authors: Jiang Wei , Zhang Lijin , Wu Bin , Zha Zhenlei , Zhao Hu , Jun Yuan , Jiang Yuefang
Published: December 2018

Objective:

Numerous studies have shown that lymphovascular invasion (LVI) is linked to biochemical recurrence (BCR) in prostate cancer (PCa) patients following radical prostatectomy (RP). However, the actual clinicopathological impacts of LVI remain unclear. Thus, we performed a meta-analysis to evaluate the pathologic and prognostic impacts of LVI in PCa patients.

Methods:

Following the guidance of the PRISMA statement, relevant studies were collected systematically from the PubMed, EMBASE, and Web of Science databases to identify relevant studies published before June 2018. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to investigate the association of LVI with BCR and clinicopathological features.

Results:

A total of 20 studies including 25,570 patients (106–6678 per study) with PCa were incorporated into this meta-analysis. Overall pooled analysis suggested that LVI was associated with a higher BCR risk both in univariate (pooled HR=1.50, 95% CI: 1.34–1.68, P <.001) and multivariate analyses (pooled HR=1.25, 95% CI: 1.17–1.34, P <.001). In addition, LVI was closely correlated with extraprostatic extension (yes vs no: OR = 4.23, 95% CI: 1.86–9.61, P <.001), pathological GS (≥7 vs <7: OR = 5.46, 95% CI: 2.25–13.27, P <.001), lymph node metastases (yes vs no: OR = 18.56, 95% CI: 7.82–44.06, P <.001), higher pathological stage (≥ T3 vs < T2: OR = 6.75, 95% CI: 5.46–8.36, P <.001), positive surgical margin (positive vs negative: OR = 2.42, 95% CI: 1.57–3.72, P <.001) and seminal vesicle invasion (yes vs no: OR = 5.72, 95% CI: 2.45–13.36, P <.001).

Conclusions:

This study suggests that LVI in histopathology is associated with a higher risk of BCR and advanced clinicopathological features in PCa patients and could serve as a poor prognostic factor in patients who underwent RP.
Association between MDM2 rs2279744, MDM2 rs937283, and p21 rs1801270 polymorphisms and retinoblastoma susceptibility
Authors: Cao Qixin , Wang Yun , Song Xiaohui , Yang Weihua
Published: December 2018

Retinoblastoma (Rb) is the most common intra-ocular malignancy in children. The association of rs2279744, and rs937283 in MDM2 gene, and p21 rs1801270 polymorphism and RB development have been demonstrated. To provide a comprehensive assessment of and to clarify associations between the 3 SNPs (MDM2 rs2279744, MDM2 rs937283, and p21 rs1801270) and the risk of RB, we performed a meta-analysis of all the eligible case-control studies. We searched English databases include PubMed, Embase, Google Scholar, and Cochrane Library, using an upper date limit of January 1, 2018. The association between MDM2 rs2279744, MDM2 rs937283, and p21 rs1801270 polymorphisms and the risk of RB were estimated by calculating a pooled OR and 95% CI under a homozygote comparison, heterozygote comparison, dominant model, and recessive model. The statistical power analysis was performed using G∗Power. Our meta-analysis showed a significant association between RB susceptibility and MDM2 rs2279744 recessive model (OR = 1.427, 95%CI: 1.107-1.840, P = .006, I2 = 0%). Moreover, a significant link was observed between RB risk and MDM2 rs937283 homozygote comparison (OR = 0.471, 95%CI: 0.259-0.858, P = .014, I2 = 0%) and recessive model (OR = 0.587, 95%CI: 0.410-0.840, P = .004, I2 = 0%). However, no significant relationship between the p21 rs1801270 polymorphism and RB susceptibility was detected in any of the 4 models (P > .05). In conclusion, we found that significant association between the MDM2 rs2279744 polymorphism and increased RB risk, while MDM2 rs937283 polymorphism was associated with significantly decreased RB risk. However, as to the P21 rs1801270 polymorphism, a statistically significant association was not identified for RB.
Primary extra-nodal non-Hodgkin lymphoma in buttock soft tissue
Authors: Li Xiang Meng , Zhang Hai Song , Dai Xiao Li , Shi Jian Hong
Published: December 2018

Rationale:

Primary extra-nodal non-Hodgkin lymphoma (PE-NHL) arising in the region of the buttocks is rare. After reviewing the literature from the last 20 years, we found only 3 reported lymphomas originating from soft tissue of the buttocks. In our case, positron emission tomography/computed tomography (PET/CT) was performed for the first time, both before and after treatment, to determine the initial stage of PE-NHL and the curative effects of treatment.

Patient concerns:

We report the case of a 71-year-old woman who was admitted to our hospital due to pain, skin redness, rising skin temperature, and swelling in the right hip.

Diagnoses:

After an initial misdiagnosis of local infection, a histological examination and PET/CT were performed which revealed evidence of non-Hodgkin marginal zone B cell lymphoma of Ann Arbor stage II.

Interventions:

Following unsuccessful treatment with cephalosporin, the patient was successfully treated with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.

Outcomes:

Comparison of the PET/CT scans taken before and after treatment showed that the lesion size had decreased, as had the fluorodeoxyglucose (FDG) uptake seen in the subcutaneous tissue of the right buttock with standardized uptake value max (SUVmax) 11.6 versus 2.5, respectively. Subsequently, no relapse or distant metastasis has been detected.

Lessons:

Young doctors should suspect PE-NHL in similar cases. PET/CT is valuable in the diagnosis and treatment of PE-NHL, as well as for accurately determining PE-NHL stage and aggressiveness.
Impact of healthcare reform on the payer mix among young adult emergency department utilizers across the United States (2005–2015)
Authors: Bush Haley , Gerber Lynn H. , Stepanova Maria , Escheik Carey , Younossi Zobair M.
Published: December 2018

Before the patient protection and affordable care act (ACA), young adults (20 to 34) had the highest uninsured rates in the United States (US) and frequently sought care in emergency departments (EDs).

We aimed to determine if there was a measurable effect of expanded coverage, specifically the dependent coverage provision and Medicaid expansion, on the payer mix of young adults in EDs.

We performed a retrospective cross-sectional study of ED utilization among young adults across the US using the national hospital ambulatory medical care survey (NHAMCS) (2005–2015).

We examined the effect of health reform changes on the prevalence and odds of having an insurance type among ED utilizers (19–30) in 3 time periods (2005–2010), (2011–2013), and (2014–2015). Additionally, we compared the national and ED payer mix proportions among 19 to 25 and 26 to 30-year-olds.

Our results indicate significant proportional changes in the national and ED payer mix relative to a pre-ACA time period. The 2 greatest changes to the national payer mix were the reduction in the proportion of uninsured/self-payers and the increase in the proportion covered by Medicaid. Furthermore, the dependent coverage provision was effective in increasing the proportion of those (19–25) utilizing private insurance coverage. Lastly, there is now a lower proportion of uninsured young adults in the ED, and an increased proportion of those covered by Medicaid.

The change in payer mix among young adults has potential long-term consequences for the provision of emergency department services in the U.S.
Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient
Authors: Kim Jung Hee , Baek Jong Hyun
Published: December 2018

Rationale:

Patent ductus arteriosus (PDA) ligation by open surgery is more difficult and dangerous in elderly patients than in infants. Nowadays, simple and safe interventional catheterization technology is used for the closure of uncomplicated isolated PDAs. Therefore, an alternative less invasive therapeutic option must be developed to treat complicated PDA.

Patient concerns:

A 53-year-old woman presented with gradually exacerbated dyspnea on effort and continuous cardiac murmurs.

Diagnosis:

Transthoracic echocardiography (TTE) and contrast-enhanced 3D computed tomography (CT) were performed and revealed a conically shaped large PDA with calcification.

Interventions:

We used a nontouch exclusion technique with thoracic endovascular repair (TEVAR) for the treatment of this rare complicated PDA. The patient had an adequate proximal landing zone, and a tapered stent graft (S&G, Bio 34–30 mm × 110 mm, Korea) was used.

Outcomes:

Aortography after stent graft implantation revealed complete occlusion of PDA and no endoleaks. The procedure was successful, and the patient showed no vascular or other complications during follow-up.

Lessons:

TEVAR is a less invasive solution for pathologies of the thoracic aorta, such as aortic dissection or aneurysm. TEVAR is an established, simple, and safe method for repairing the thoracic aorta and can be a new alternative to other transcatheter techniques for complicated PDAs in elderly patients.
Anti-TIF1γ antibody predicted malignancy of thymic tumor with dermatomyositis as an “autoimmune tumor marker”
Authors: Karino Kohei , Fujieda Yuichiro , Kawamura Takuya , Abe Nobuya , Shimoyama Shuhei , Kono Michihito , Kato Masaru , Yasuda Shinsuke , Atsumi Tatsuya
Published: December 2018

Rationale:

An association between inflammatory myopathy and malignancy has been recognized particularly in patients positive for anti-transcription intermediary factor 1γ (TIF1γ) antibody. We report a case of anti-TIF1γ antibody positive dermatomyositis (DM) associated with thymic carcinoma which radiographically mimicked benign tumor.

Patient concerns:

A 72-year-old man presented typical characteristic cutaneous manifestations and proximal muscle weakness with elevated levels of myogenic enzymes. An anterior mediastinal tumor was detected by computed tomography (CT) scan and radiographically assessed to be benign with distinct borders and little enhancement.

Diagnoses:

DM with anti-TIF1γ antibody and thymic carcinoma.

Interventions:

Thymic carcinoma was completely resected by surgery. DM was induced into remission with glucocorticoid treatment.

Outcomes:

The serum level of myogenic enzyme remained within normal range under low-dose glucocorticoid maintenance. No evidence of carcinoma recurrence with CT scan was observed at 1-year follow up.

Lessons:

The present case indicated that anti-TIF1γ antibody would play a role as the “autoimmune tumor marker” in patients with inflammatory myopathy.