bluuebunny/crossref_metadata_2025 huggingface dataset:
Embryonic Stem Cell-like Population within Venous Malformation Expresses the Renin–Angiotensin System
Authors: Tan Elysia M.S. , Brasch Helen D. , Davis Paul F. , Itinteang Tinte , Tan Swee T.
Published: April 2019

Background:

We have recently demonstrated the presence of a NANOG+/pSTAT3+/OCT4+/SOX2+/SALL4+/CD44+ embryonic stem cell (ESC)-like subpopulation localized to the endothelium and a NANOG+/pSTAT3+/SOX2+/CD44+ subpopulation outside of the endothelium, within subcutaneous VM (SCVM) and intramuscular VM (IMVM). We have also shown the expression of components of the renin-angiotensin system (RAS): (pro)renin receptor (PRR); angiotensin converting enzyme (ACE), angiotensin II receptor 1 (ATIIR1) and angiotensin II receptor 2 (ATIIR2), in both SCVM and IMVM. This study investigated whether the ESC-like subpopulations within SCVM and IMVM expressed the RAS.

Methods:

Formalin-fixed paraffin-embedded sections of two representative samples from each of the seven SCVM and seven IMVM patients included in our previous studies underwent dual immunofluorescence (IF) immunohistochemical (IHC) staining for ESC marker OCT4 or SOX2 with PRR, ACE, ATIIR1, and ATIIR2.

Results:

IF IHC staining demonstrated the expression PRR by the OCT4+ cells on the endothelium and outside the endothelium in SCVM and IMVM. ACE was expressed by the SOX2+ cells, predominantly in the endothelium in SCVM and IMVM. ATIIR1 was expressed by the SOX2+ cells on the endothelium and outside the endothelium in SCVM and IMVM. ATIIR2 was expressed by the OCT4+ endothelium and outside the endothelium in SCVM and IMVM.

Conclusions:

Components of the RAS are expressed by ESC-like subpopulations within both SCVM and IMVM. These primitive subpopulations may be a novel therapeutic target by manipulation of the RAS using existing medications.
Soft-tissue Filler–associated Blindness: A Systematic Review of Case Reports and Case Series
Authors: Chatrath Vandana , Banerjee Pooja S. , Goodman Greg J. , Rahman Eqram
Published: April 2019

Background:

With the increase in the use of soft-tissue fillers worldwide, there has been a rise in the serious adverse events such as vascular compromise and blindness. This article aims to review the role of fillers in causing blindness and the association between hyaluronic acid (HA) filler and blindness.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to report this review.

Results:

A total of 190 cases of blindness due to soft-tissue fillers were identified, of which 90 (47%) cases were attributed to autologous fat alone, and 53 (28%) cases were caused by HA. The rest of the cases were attributed to collagen, calcium hydroxylapatite, and other fillers.

Conclusions:

Autologous fat was the most common filler associated with blindness despite HA fillers being the most commonly used across the globe. However, the blindness caused by other soft-tissue fillers like collagen and calcium hydroxylapatite was represented. It was also evident through the review that the treatment of HA-related blindness was likely to have better outcomes compared with other fillers due to hyaluronidase use.
Which Stitch? Replacing Anecdote with Evidence in Minor Hand Surgery
Authors: Rochlin Danielle H. , Sheckter Clifford C. , Curtin Catherine M.
Published: April 2019

There is currently no consensus on the optimal suture type for palmar skin closure following open carpal tunnel release and trigger finger release. We performed a retrospective analysis of patients in the Palo Alto Veterans Affairs (PAVA) Health Care System who underwent these procedures over a 2-year period to compare 30-day wound outcomes following closure with poliglecaprone 25 (Monocryl), nylon, and chromic gut suture. Out of 312 PAVA cases (133 carpal tunnel release, 179 trigger finger release), incisions closed with Monocryl were significantly less likely to develop dehiscence (Monocryl 2.1%, nylon 10.5%, chromic 10.3%; P = 0.006) and infection (Monocryl 1.6%, nylon 7.4%, chromic 13.8%; P = 0.003), or lead to additional wound-related encounters (Monocryl 8.0%, nylon 16.8%, chromic 24.1%; P = 0.012). On multivariable logistic regression, suture type and diabetes were independent predictors of 30-day wound complications and extra encounters. At PAVA, compared with Monocryl, closures with nylon and chromic were significantly more likely to dehisce and/or become infected [nylon: odds ratio (OR), 5.0; 95% CI, 1.9–13.3 and chromic: OR, 9.3; 95% CI, 2.7–32.4; P = 0.002], and to be associated with an additional encounter (nylon: OR, 2.4; 95% CI, 1.1–5.3 and chromic: OR, 4.5; 95% CI, 1.6–12.9; P = 0.007). This has led to using Monocryl as the standard closure for these cases at PAVA.
Insulin Resistance–Related Proteins Are Overexpressed in Patients and Rats Treated With Olanzapine and Are Reverted by Pueraria in the Rat Model
Authors: Yang Ni , Li Shihong , Liu Shouqing , Lv Yifan , Yu Liangyu , Deng Yahui , Li Huqun , Fang Maosheng , Huo Yunxiang , Li Weiyong , Peng Shiyong
Published: April 2019

Background

Olanzapine, a commonly used second-generation antipsychotic, causes severe metabolic adverse effects, such as elevated blood glucose and insulin resistance (IR). Previous studies have proposed that overexpression of CD36, GGPPS, PTP-1B, GRK2, and adipose triglyceride lipase may contribute to the development of metabolic syndrome, and Pueraria could eliminate the metabolic adverse effects. The study aimed to investigate the association between olanzapine-associated IR and IR-related proteins (IRRPs) and determine the role of Pueraria in protection against the metabolic adverse effects of olanzapine.

Methods

The expression levels of IRRPs were examined in schizophrenia patients and rat models with long-term olanzapine treatment. The efficacy of Pueraria on anti-IR by reducing the expression of IRRPs was comprehensively evaluated.

Results

Our study demonstrated that in schizophrenia patients chronically treated with olanzapine, the expression levels of IRRPs in patients with a high IR index significantly increased, and these phenomena were further confirmed in a rat model. The expression levels of IRRPs were reduced significantly in Pueraria-treated IR rat models. The body weight, blood glucose, and IR index were restored to levels similar to those of normal controls.

Conclusions

The IRRPs are closely related to IR induced by olanzapine, and Pueraria could interfere with olanzapine-associated IR and revert overexpressed IRRPs. These findings suggest that IRRPs are key players in olanzapine-associated IR and that Pueraria has potential as a clinical drug to prevent the metabolic adverse effects of olanzapine, further improving compliance of schizophrenia patients.
Characterization of the Safety and Pharmacokinetic Profile of d-Methadone, a Novel N-Methyl-d-Aspartate Receptor Antagonist in Healthy, Opioid-Naive Subjects
Authors: Bernstein Galina , Davis Kelly , Mills Catherine , Wang Lu , McDonnell Michael , Oldenhof John , Inturrisi Charles , Manfredi Paolo L. , Vitolo Ottavio V.
Published: April 2019

Purpose/Background

N-methyl-d-aspartate (NMDA) receptor (NMDAR) antagonists are potential agents for the treatment of several central nervous system disorders including major depressive disorder. Racemic methadone,l-methadone, andd-methadone all bind the NMDAR with an affinity similar to that of established NMDAR antagonists, whereas onlyl-methadone and racemic methadone bind to opioid receptors with high affinity. Therefore,d-methadone is expected to have no clinically significant opioid effects at therapeutic doses mediated by its NMDAR antagonism.

Methods

We conducted 2 phase 1, double-blind, randomized, placebo-controlled, single- and multiple-ascending-dose studies to investigate the safety and tolerability of orald-methadone and to characterize its pharmacokinetic profile in healthy opioid-naive volunteers.

Results

d-Methadone exhibits linear pharmacokinetics with dose proportionality for most single-dose and multiple-dose parameters. Single doses up to 150 mg and daily doses up to 75 mg for 10 days were well tolerated with mostly mild treatment-emergent adverse events and no severe or serious adverse events. Dose-related somnolence and nausea occurred and were mostly present at the higher dose level. There was no evidence of respiratory depression, dissociative and psychotomimetic effects, or withdrawal signs and symptoms upon abrupt discontinuation. An overall dose-response effect was observed, with higher doses resulting in larger QTcF (QT interval corrected using Fridericia formula) changes from baseline, but none of the changes were considered clinically significant by the investigators. Mild, dose-dependent pupillary constriction of brief duration occurred particularly at the 60-mg dose or above in the single-ascending-dose study and at the dose of 75 mg in the multiple-ascending-dose study. No detectable conversion ofd-methadone tol-methadone occurred in vivo.

Conclusions

These results support the safety and continued clinical development ofd-methadone as an NMDAR antagonist for the treatment of depression and other central nervous system disorders.
A research on the protein expression of p53, p16, and MDM2 in endometriosis
Authors: Sang Lin , Fang Qian-Jin , Zhao Xing-Bo
Published: April 2019

This study aims to examine the expression of p53, p16, and murine double minute 2 (MDM2) protein in normal endometrium and endometriosis, in order to discuss the role of p53, p16, and MDM2 protein and apoptosis in the pathogenesis and development of endometriosis, and provide a theoretical basis for clinical diagnosis and treatment.

The immunohistochemical streptavidin-biotin peroxidase method was used to detect the expression of p53, p16, and MDM2 in tissue samples obtained from 30 women with pathologically confirmed ovarian endometriosis and 29 women with pathologically confirmed normal endometrium. The relationship between p53, p16, and MDM2 expression and apoptosis was analyzed.

In normal endometrium, the positive rate of p53 in the secretory phase was higher than that in the proliferative phase (P < .05). Furthermore, the positive rate of p53 in normal endometrium was higher than that in ovarian endometriosis (P < .05). There was a significant difference between normal endometrium and ovarian endometriosis.

The positive rate of p16 in normal endometrium was higher than that in ovarian endometriosis (P < .05). Furthermore, there was a significant difference between normal endometrium and ovarian endometriosis. The positive rate of MDM2 in normal endometrium was lower than that in ovarian endometriosis (P < .05).

In ovarian endometriosis, the expression of p53 and p16 was positively correlated with each other (r = 0.611, P < .01). However, the expression of p53 and MDM2 was negatively correlated with each other (r = −0.541, P < .01). Furthermore, the expression of p16 and MDM2 might not be relevant in the endometriosis (r = 0.404, P > .05).

As important apoptosis regulatory genes, p53, p16, and MDM2 might be involved in the pathogenesis and development of endometriosis.
CT findings and clinical features of Epstein–Barr virus-associated lymphoepithelioma-like gastric carcinoma
Authors: Liang Pan , Ren Xiu-chun , Gao Jian-bo , Chen Kui-sheng
Published: April 2019

Epstein–Barr virus (EBV)-associated lymphoepithelioma-like gastric carcinoma (LELGC) is a rare primary stomach tumor, which has overlapping imaging features with mass forming gastric carcinoma (GC). The aim of our study was to present the computed tomography (CT) findings and clinical features of EBV-associated LELGC to increase awareness of this entity.

The CT findings and clinical features of 4 patients with pathologically documented EBV-associated LELGC were retrospectively analyzed.

Among the 4 patients, 3 were male, and 1 was female. The medium age was 51 years old. All cases were single lesions including 1 was in the gastric cardia, 1 was in the gastric body, and 2 were in the gastric antrum. A focal thickening of the gastric wall was conducted, with a large thickness-to-length ratio. The low-density stripe of the normal gastric wall abruptly terminated at the edge of the lesion. The CT images of 4 cases showed inhomogeneous density with the radiodensity values ranging from 25 to 48 HU. In addition, an ulcer was demonstrated with an irregular base and slightly raised borders in all cases. Enhancement after injection of contrast material was heterogeneous enhancement (n = 3) or homogeneous (n = 1). After enhancement, obvious enhancement was seen in 1 case, moderate enhancement was seen in 3 cases, with the peak value of the tumor in the portal phase. No evidence of lymph node involvement and distant invasion was observed.

Although LELGC is quite rare, it should be considered in differential diagnosis of early GC, advanced GC, and lymphoma. The relatively typical CT appearance, combined the age and sex of patients, can suggest the diagnosis of LELGC.
Efficacy of vitamin D supplementation on glycemic control in type 2 diabetes patients
Authors: Hu Zhiwei , Chen Jin’an , Sun Xinjuan , Wang Lei , Wang Aiping
Published: April 2019

Background:

Conflicting evidence exists on the effect of vitamin D supplementation on glucose metabolism in subjects with type 2 diabetes (T2D). Therefore, this meta-analysis focuses on the relationship between vitamin D intervention and glycaemic control in subjects with T2D.

Methods:

We reviewed available randomized controlled trials (RCTs) studies from the establishment time of each database to March 31, 2018. Stata 13.0 software was used to evaluate the included literature.

Results:

Finally, a total of 19 RCT studies involving 747 intervention subjects and 627 placebo controls were included in this meta-analysis. Meta-analysis results showed that compared with the control group, the short-term vitamin D supplementation group had a decline in hemoglobin A1c (HbA1c), insulin resistance, and insulin. The Standard Mean Difference (SMD) (95% CI [95% confidence interval]) of HbA1c, insulin resistance, and insulin were −0.17 (−0.29, −0.05), −0.75 (−0.97, −0.53), −0.57 (−0.78, −0.35), respectively with all P value <.05. But there were no significant differences in long-term follow-up vitamin D intervention.

Conclusion:

Vitamin D supplementation in T2D patients can improve HbA1c, insulin resistance, and insulin in short-term intervention, suggesting that vitamin D can be considered as a therapeutic agent along with the other treatments for T2D.
Thoracic trauma: a descriptive review of 4168 consecutive cases in East China
Authors: Zhang Shengchao , Tang Meiwen , Ma Jianghua , Yang Juhua , Qin Xuan , Jin Wei , Qian Jin , Li Feng , Cheng Yunfeng , Chen Hao
Published: April 2019

Thoracic trauma in China was scarcely reported. This study aimed to summarize the clinical profiles and to analyze the management approaches of patients with traumatic thoracic injury.

Data for consecutive patients with thoracic trauma from January 2003 to January 2018 were retrospectively collected and analyzed. Patients’ profiles and clinical outcomes were compared between those patients treated with a dedicated thoracic trauma team and those without.

The study included 4168 patients with mean age of 49.0 years, of whom 82.1% were male. Traffic accident accounted for 42.7% of the injuries. Most of the patients (66.8%) had rib fractures. Associated injuries were present in 48.3% of the patients; of them 86.0% were extremity fractures. Majority of the patients were managed without surgical procedures other than tube thoracostomy (33.2%). ICU service was needed in 12.0% of the patients. Patients treated with thoracic trauma team were older (53.59 ± 16.8 year vs 45.1 ± 18.0 year, P < .001), less male (78.3% vs 85.2%, P < .001), with higher injury severity scores (17.5 ± 10.1 vs 13.7 ± 8.2, P < .001), required more ventilator support (48.3% vs 25.3%, P < .001) and underwent more tube thoracostomy and other surgeries (43.8% vs 24.2%, and 34.4% vs 14.1%, respectively, all P < .001), yet with a shorter hospital stay (11.7 ± 9.0 days vs 12.7 ± 8.8 days, P < .001), and numerically lower ICU usage and mortality when compared to those without.

Thoracic trauma in China usually affects mid-age males. Traffic accident is the top one etiology. The most common type of thoracic injuries is rib fracture. Associated injuries occur frequently. Nonoperative treatment and tube thoracostomy are effective for majority of the patients. A multidisciplinary approach with a dedicated thoracic trauma team could improve the treatment for these patients.
Surgical treatment for acute ischial tuberosity avulsion fracture
Authors: Liu Heng , Li Qiang , Shi Yi , Zhang Yiqun , Xu Kai , Qin Wenheng , Liu Zhengjun , Liu Wei , Peng Bo , Dou Shilu , Zhao Changfu , Zhao Kunchi , Zhang Qiao
Published: April 2019

Rationale:

Ischial tuberosity avulsion fracture (ITAF) is a very rare sports injury, and there is currently no consensus on its diagnosis and treatment. Although conservative treatment is adequate for most patients, those with large displacement of the fracture need surgical management.

Patient concerns:

A 13-year-old male athlete experienced tearing pain in the right hip during a sprint. Radiographic examination showed an avulsion fracture of the right ischial tuberosity.

Diagnosis:

Right ITAF.

Interventions:

On the 3rd day of injury, the patient was treated with open reduction and internal fixation of ITAF under general anesthesia.

Outcomes:

The patient received a systematic postoperative exercise in 2 weeks, and the fracture healed 4 weeks later. After 8 months, the patient returned to the field to participate in the competition.

Lessons:

Early surgical treatment can bring about good results in the treatment of ITAF with large displacement. The longitudinal incision and subgluteal approach is an ideal choice for the operative procedure.
Ultrasonographic assessment of an induration caused by extravasation of a nonvesicant anticancer drug
Authors: Abe-Doi Mari , Murayama Ryoko , Yabunaka Koichi , Tanabe Hidenori , Komiyama Chieko , Sanada Hiromi
Published: April 2019

Rationale:

Induration may occur after an anticancer drug extravasation in patients who recurrently receive chemotherapy because of reduced choice of an appropriate vein for inserting a peripheral intravenous catheter, resulting in catheter placement difficulty. Although induration affects treatment, its size, shape, or hardness remains unclear in the conventional observation method using palpation and inspection. Here, we report our observation results in using ultrasonography to assess the induration that occurred after an anticancer drug extravasation as a new assessment method.

Patient concerns:

A 58-year-old woman with cervical cancer who complained of pain during the administration of a nonvesicant anticancer drug via a peripheral intravenous catheter. The medical staff's examination showed a swollen site; therefore, the catheter was replaced.

Diagnosis:

Induration occurred on the site after an extravasation. Over 6 months later, pigmentation and induration, which can easily be confirmed through palpation, persisted.

Interventions:

The subcutaneous tissue in the induration site was observed using ultrasonography (B-mode and elastography).

Outcomes:

The subcutaneous tissue might have degenerated the tissues surrounding the vein, making it thinner. Moreover, the hardness of the subcutaneous tissue was approximately 7 times than that of the surrounding tissues.

Lessons:

Induration that affects the vein form and its surrounding tissues should be prevented, and ultrasonography is an effective method to objectively observe the site where extravasation occurred.
The experience of inflammatory bowel disease patients with healthcare
Authors: Marín-Jiménez Ignacio , Casellas Francesc , Cortés Xavier , García-Sepulcre Mariana F. , Juliá Berta , Cea-Calvo Luis , Soto Nadia , Navarro-Correal Ester , Saldaña Roberto , de Toro Javier , Galindo María J. , Orozco-Beltrán Domingo
Published: April 2019

To assess inflammatory bowel disease (IBD) patients’ experience of chronic illness care and the relationship with demographic and healthcare-related characteristics.

This cross-sectional survey used the Instrument to Evaluate the EXperience of PAtients with Chronic diseases (IEXPAC) questionnaire to identify parameters associated with a better healthcare experience for IBD patients. IEXPAC questionnaire responses are grouped into 3 factors - productive interactions, new relational model, and patient self-management, scoring from 0 (worst) to 10 (best experience). Scores were analyzed by bivariate comparisons and multiple linear regression models.

Surveys were returned by 341 of 575 patients (59.3%, mean age 46.8 (12.9) years, 48.2% women). Mean (SD) IEXPAC score was 5.9 (2.0); scores were higher for the productive interactions (7.7) and patient self-management factors (6.7) and much lower for the new relational model factor (2.2). Follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines were associated with higher (better) overall patient experience score, and higher productive interactions and self-management factor scores. A higher productive interactions score was also associated with patients receiving medication subcutaneously or intravenously. Higher new relational model scores were associated with follow-up by a nurse, affiliation to a patients’ association, receiving help from others for healthcare, a lower number of medicines and a higher educational level.

In patients with IBD, a better overall patient experience was associated with follow-up by a nurse, being seen by the same physician, and being treated with a lower number of medicines.
Effects of positive end-expiratory pressure on intraocular pressure and optic nerve sheath diameter in robot-assisted laparoscopic radical prostatectomy
Authors: You Ann Hee , Song Young , Kim Do-Hyeong , Suh Jiwoo , Baek Ji Won , Han Dong Woo
Published: April 2019

Background:

There has been no study of the effect of post end-expiratory pressure (PEEP) on intraocular or intracranial pressure during pneumoperitoneum with steep Trendelenburg positioning. We investigated the effects of 5 cmH2O of PEEP on intraocular pressure and optic nerve sheath diameter as a surrogate for intracranial pressure in robot-assisted laparoscopic radical prostatectomy.

Methods:

Fifty patients scheduled for robot-assisted laparoscopic radical prostatectomy were divided into a zero-PEEP (ZEEP) group and a 5 cmH2O of PEEP (PEEP) group. Intraocular pressure, optic nerve sheath diameter, and respiratory and hemodynamic parameters were measured before induction (T0), 10 minutes after induction of general anesthesia in the supine position before CO2 insufflation (T1), 5 minutes (T2), and 30 minutes (T3) after steep Trendelenburg positioning with pneumoperitoneum, after desufflation of pneumoperitoneum in the supine position (T4), and after 30 minutes in the recovery room postoperatively (T5).

Results:

There was no significant difference in intraocular pressure or optic nerve sheath diameter between the groups during the study. The partial pressure of arterial oxygen and dynamic lung compliance at T1, T2, T3, and T4 were significantly higher in the PEEP than in the ZEEP group. There was no difference in mean arterial pressure or heart rate between groups at any time.

Conclusion:

Applying 5 cmH2O of PEEP did not increase intraocular pressure or optic nerve sheath diameter during pneumoperitoneum with steep Trendelenburg positioning in robot-assisted laparoscopic radical prostatectomy. These results suggest that low PEEP can be safely applied during surgery with pneumoperitoneum and steep Trendelenburg positioning in patients without preexisting eye disease and brain pathology.
Effectiveness of tenofovir or telbivudine in preventing HBV vertical transmission for pregnancy
Authors: Zeng Jianyong , Zheng Caixia , Li Hua
Published: April 2019

To evaluate the efficacy and safety of telbivudine (LdT) and tenofovir (TDF) for preventing hepatitis B virus (HBV) vertical transmission for HBV-positive pregnant women.

Pregnant women (n = 145) from January 2013 to June 2017 were enrolled when they met inclusion criteria, which included HBV DNA ≥1.0 × 107 copies/mL and increased alanine aminotransferase (ALT) levels. Groups A (n = 58) and B (n = 51) were treated with LdT and TDF, respectively. Group C (n = 36) received no antiviral treatment. All infants were vaccinated with hepatitis B immunoglobulin and HBV vaccine. Vertical transmission of HBV was indicated by the presence of hepatitis B surface antigen (HBsAg) in infants 6 months and 12 months after birth.

There is no difference of clinical characteristics of patients among the 3 groups. Serum HBV DNA levels of the 3 groups were similar at baseline (Group A vs. Group B vs. Group C, 7.88 ± 0.65 vs. 7.91 ± 0.75 vs. 7.69 ± 0.53 P = .25). In addition, the after anti-HBV treatment in Groups A and B were significantly decreased. Also, the serum HBV DNA levels in both Groups A and B were lower than that of Group C (P < .01, both). The HBV infection rate in Group A treated with LdT was not different from Group B treated with TDF. The dynamic changes of serum ALT level were similar. ALT levels were similar among the 3 Groups (P = .171), while there is statistically significant difference between A and C, and between B and C before delivery (P < .01). For the infants, there were no significant differences among body weight, height, head circumference, or Apgar score. However, the HBsAg positivity rates of infants in Groups A, B, C at postpartum 24 weeks and 48 weeks was 0%, 0%, and 11.1%, respectively (P < .001).

Administration of LdT or TDF to HBV-infected mothers are effective and safe to block mother-to-infant HBV transmission.
Utility of point-of-care Gram stain by physicians for urinary tract infection in children ≤36 months
Authors: Yodoshi Toshifumi , Matsushima Masato , Taniguchi Tomohiro , Kinjo Saori
Published: April 2019

Urinary tract infection (UTI) in children requires early diagnosis and treatment to prevent repeated UTI and renal scarring. This study aimed to evaluate the usefulness of the point-of-care Gram stain by physicians for suspected UTI in children at Okinawa Chubu Hospital as a rapid diagnostic test.

A single-center, retrospective study was undertaken between January 2011 and December 2015. Patients aged 36 months or younger who were reviewed had suspected UTI in the emergency room or outpatient clinic. Urine culture, urinalysis, and point-of-care Gram stain were performed on a single specimen. Patients with structural or functional urological defects requiring routine catheterization were excluded. We compared the diagnostic performance among the rapid diagnostic tests (i.e., pyuria, point-of-care Gram stain, or both). Kappa statistics were used to evaluate the agreement between the results of point-of-care Gram stain and morphotypes of urine culture with the 95% CI (bias corrected bootstrap interval). We also analyzed which antibiotics were more susceptible to the bacteria of urine culture results, selected by the results of point-of-care Gram stain or empirical treatment based on the Japanese guidelines by McNemar test.

Of 1594 patients reviewed in the study, 1546 were eligible according to our inclusion criteria. Using urine culture as the gold standard for UTI, the sensitivity and specificity of pyuria were 73.2% and 95.1%, whereas those of the point-of-care Gram stain were 81.4% and 98.2%, respectively. The concordance rate between the morphotypes of bacteria detected by point-of-care Gram stain and those of urine culture was 0.784 (kappa coefficient) (95% CI 0.736–0.831). Furthermore, the proportion of “susceptible” in the minimum inhibitory concentration of pathogen-targeted treatment based on the point-of-care Gram stain was higher than that of empirical therapy (exact McNemar significance probability: .0001).

Our analysis suggests that the point-of-care Gram stain is a useful rapid diagnostic tool for suspected UTI in young children. Pathogen-targeted treatment based on the point-of-care Gram stain would lead to better antibiotic selection compared with empirical therapy.
Efficacy and safety of basic fibroblast growth factor in the treatment of burns
Authors: Zhan Da-Chuan , Shen Yong-Shuai , Zhao Yue-Rong , Meng Fan-Jun
Published: April 2019

Background:

To systematically evaluate the efficacy and safety of basic fibroblast growth factor (bFGF) in the treatment of burns and to provide evidence-based medical information for clinicians to choose the appropriate treatment measures for burns.

Methods:

Seven databases, including PubMed, the Cochrane Library, Embase, the Chinese Biomedical Literature Database, the Wanfang Database, the China National Knowledge Infrastructure Internet, and the Chongqing Chongqing Weipu Chinese Science and Technology Journal Full-text Database (VIP), were searched by computer. Randomized controlled trials on bFGF in the treatment of burns were collected, and the search was conducted by using a combination of subject terms (MeSH) and free words. The search time limit was from the establishment of each database until January 2019. Two researchers independently screened the literature and extracted the data. According to the evaluation criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions version 5.3.0, they conducted a rigorous bias risk assessment for the included studies, and Stata 12.0 software was used for meta-analysis.

Results:

System evaluation and meta-analysis were carried out strictly in accordance with the requirements of the Cochrane Handbook for Systematic Reviews of Interventions version 5.3.0 on meta-analysis and provided a high-quality evaluation of the efficacy and safety of bFGF in the treatment of burns.

Conclusion:

This study provided conclusions from evidence-based medicine and a scientific basis for the efficacy and safety of bFGF in the clinical treatment of burns.

Ethics and dissemination:

This study was not a clinical trial and therefore did not require ethical approval. The results of this study will be published in an SCI academic journal related to this study in the form of a public publication.

PROSPERO registration number:

CRD42019124778.
Rationale and design of the randomized, multicenter, open-label, controlled POLBOS 3 trial aimed to compare regular drug-eluting stents versus the dedicated coronary bifurcation sirolimus-eluting BiOSS LIM C stent
Authors: Gil Robert J. , Pawłowski Tomasz , Legutko Jacek , Lesiak Maciej , Witkowski Adam , Gąsior Mariusz , Kern Adam , Bil Jacek
Published: April 2019

Introduction:

Coronary bifurcations are encountered in about 15% to 20% of percutaneous coronary interventions (PCIs). They are considered technically challenging and associated with worse clinical outcomes than nonbifurcation lesions. The BiOSS LIM C is a dedicated bifurcation balloon expandable stent made of cobalt-chromium alloy (strut thickness 70 μm) releasing sirolimus (1.4 μg/mm2) from the surface of a biodegradable coating comprised of a copolymer of lactic and glycolic acids.

Conclusion:

The aim of the randomized, multicenter, open-label, controlled POLBOS III trial is to compare BiOSS LIM C with limus second-generation drug-eluting stents (DES) in the treatment of non-left main stem coronary bifurcations (ClinicalTrials.gov NCT03548272).
Effect of irradiation with intravascular laser on the hemodynamic variables of hypertensive patients
Authors: Isabella Adriana Paula Jordão , Silva Jéssica Tayane Costa , da Silva Tamiris , Rodrigues Maria Fernanda Setúbal Destro , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansiski , Bussadori Sandra Kalil , Pavani Christiane , Silva Daniela de Fátima Teixeira da
Published: April 2019

Background:

High blood pressure (HBP) is a multifactorial clinical condition, with a high morbidity and mortality rate and low rates of control. Due to its high prevalence, it is necessary to search for methods which aim to improve the quality of life of hypertensive patients. Studies have shown that low level laser therapy (LLLT) is capable of inducing a photobiological response within the cells which modifies the micro and macrovascular response; this accompanies evidence showing the systemic effects of intravascular laser irradiation of blood (ILIB). In the hypothesis that the use of LLLT can influence blood pressure levels, and perhaps facilitate adherence to treatment, this study aims to present a clinical research protocol with the goal of determining the effect of photobiomodulation in relation to changes in the hemodynamic parameters of hypertensive and normotensive patients.

Method:

Forty-four participants, frequent attendees of an ambulatory university clinic, will be subdivided into 4 groups, and then submitted to protocol sessions of ILIB. The technique is noninvasive and consists of a laser which is attached to a bracelet which has been specifically developed for the light beam to be transcutaneously carried over the radial artery. Before the procedure, at the end of the photobiomodulation cycles, and 1 month after the end of therapy, blood samples will be collected for the evaluation of C-reactive protein, interleukin 6, and nitric oxide, to be analyzed by immunoturbidimetric, ELISA, and Griess reactions, respectively.

Analysis of results:

Results will be analyzed using descriptive and inferential statistics and will be compiled into tables and/or graphs, with the help of SPSS version 24.0 with the adopted significance level for all tests being α = 0.05.

Discussion:

The treatment of HBP involves both pharmacological and nonpharmacological therapy. Animal studies with photobiomodulation have previously shown hypotensive effects. Gaps in the literature exist regarding the applicability of this nonpharmacological therapy in humans. This study aims to consider the possibility of offering nonpharmacological therapy to hypertensive patients with the goal of increasing adherence to the treatment as well as minimizing morbidity and mortality caused by hypertension.
HDL from an Alzheimer's disease perspective
Authors: Button Emily B. , Robert Jérôme , Caffrey Tara M. , Fan Jianjia , Zhao Wenchen , Wellington Cheryl L.
Published: April 2019

Purpose of review

We review current knowledge regarding HDL and Alzheimer's disease, focusing on HDL's vasoprotective functions and potential as a biomarker and therapeutic target for the vascular contributions of Alzheimer's disease.

Recent findings

Many epidemiological studies have observed that circulating HDL levels associate with decreased Alzheimer's disease risk. However, it is now understood that the functions of HDL may be more informative than levels of HDL cholesterol (HDL-C). Animal model studies demonstrate that HDL protects against memory deficits, neuroinflammation, and cerebral amyloid angiopathy (CAA). In-vitro studies using state-of-the-art 3D models of the human blood–brain barrier (BBB) confirm that HDL reduces vascular Aβ accumulation and attenuates Aβ-induced endothelial inflammation. Although HDL-based therapeutics have not been tested in clinical trials for Alzheimer's disease , several HDL formulations are in advanced phase clinical trials for coronary artery disease and atherosclerosis and could be leveraged toward Alzheimer's disease .

Evidence from human studies, animal models, and bioengineered arteries supports the hypothesis that HDL protects against cerebrovascular dysfunction in Alzheimer's disease. Assays of HDL functions relevant to Alzheimer's disease may be desirable biomarkers of cerebrovascular health. HDL-based therapeutics may also be of interest for Alzheimer's disease, using stand-alone or combination therapy approaches.
Loss of Menin Expression by Immunohistochemistry in Pancreatic Neuroendocrine Tumors
Authors: Samdani Rashmi T. , Wasylishen Amanda R. , Halperin Daniel M. , Dasari Arvind , Yao James C. , Rashid Asif , Estrella Jeannelyn S.
Published: April 2019

Objectives

Molecular characterization of sporadic pancreatic neuroendocrine tumors (PanNETs) demonstrates frequent alterations in MEN1. As the role of menin immunohistochemistry as a potential biomarker is being developed, knowledge of whether the pattern of menin expression is the same in primary tumors and distant metastases may help in patient care. Therefore, we compared patterns of menin expression in matched primary tumors and metastases.

Methods

We evaluated loss of menin nuclear expression by immunohistochemistry in 44 matched samples of primary and metastatic PanNETs and concordance in staining pattern between primary and metastatic tumors.

Results

Menin nuclear expression was lost in 18 (41%) of 44 primary tumors and 17 (39%) of 44 metastases. Concordant loss of menin expression was observed in 41 cases (93%); discordance was observed in 3 cases (7%; 95% confidence interval, 1.4%–18.7%), including 2 with loss in the primary tumor but not the metastasis.

Conclusions

The concordance of menin staining between primary tumor and metastasis in most cases suggests that menin loss is an early event in PanNET tumorigenesis. The discordant expression observed in a small subset may be a source of menin-directed therapy failure; thus, repeat assessment of metastases may be helpful for treatment selection.
Orexin-A Stimulates Insulin Secretion Through the Activation of the OX1 Receptor and Mammalian Target of Rapamycin in Rat Insulinoma Cells
Authors: Chang Xiaocen , Suo Linna , Xu Na , Zhao Yuyan
Published: April 2019

Objectives

The study aimed to investigate the involvement of the mammalian target of rapamycin (mTOR) signaling pathway in orexin-A/OX1 receptor–induced insulin secretion in rat insulinoma INS-1 cells.

Methods

Rat insulinoma INS-1 cells were grown and treated with various concentrations of orexin-A, with or without OX1 receptor–selective antagonist SB674042 or the phosphatidylinositol 3-kinase/mTOR antagonist PF-04691502. Insulin release experiments, Western blot analysis, and statistical analysis were conducted using INS-1 cells.

Results

Our results showed that treating cells with orexin-A increased the expression of the OX1 receptor and the phosphorylation of mTOR in a concentration-dependent manner. An increase in insulin secretion was also observed for cells treated with orexin-A. We further demonstrated that the increase in insulin secretion was dependent on the activation of the OX1 receptor and mTOR signaling pathway by using the OX1 receptor–selective antagonist SB674042 or the phosphatidylinositol 3-kinase/mTOR antagonist PF-04691502, which abolished the effects of orexin-A treatment.

Conclusions

Our results concluded that orexin-A/OX1 receptor stimulates insulin secretion by activating AKT and its downstream target, mTOR. Therefore, orexins may regulate the energy balance for cell survival with the involvement of mTOR in this process.
Retrocolic Gastrojejunostomy After Pancreaticoduodenectomy
Authors: Miyazaki Yoshihiro , Oda Tatsuya , Shimomura Osamu , Enomoto Tsuyoshi , Akashi Yoshimasa , Hisakura Katsuji , Ohara Yusuke , Kimura Sota , Hashimoto Shinji , Ohkohchi Nobuhiro
Published: April 2019

Objectives

Delayed gastric emptying (DGE) is a critical complication after pancreaticoduodenectomy (PD). Antecolic gastrojejunostomy has long been adopted as standard procedure because it is thought to reduce DGE. However, we have used retrocolic gastrojejunostomy (retro-GJ) for more than 10 years and have not observed high DGE rates. We aimed to clarify whether our retro-GJ approach produced comparable outcomes in preventing DGE.

Methods

A total of 211 patients who underwent pylorus-resecting PD with retro-GJ at our institution between 2005 and 2016 were retrospectively analyzed. The incidence rate of DGE and the length of postoperative hospital stay were assessed.

Results

The overall incidence of DGE with our retro-GJ procedure was 13% (n = 28), and the rate of clinically relevant DGE (grade B or C based on the International Study Group of Pancreatic Surgery criteria) was 4% (n = 8). The median postoperative hospital stay was 17 days (interquartile range, 13–25 days). Major complications (Clavien-Dindo grade ≥III) occurred in 37% (n = 79) of patients and were not associated with the occurrence of clinically relevant DGE (P = 0.47).

Conclusions

Our retro-GJ approach after PD with gastrojejunostomy, which involves careful positioning at the left-sided inframesocolic point, satisfactorily prevents DGE.
Predicting Survival of Small Intestine Neuroendocrine Tumors
Authors: Kelly Susheian , Aalberg Jeffrey , Agathis Alexandra , Phillips Katherine , Haile Sara , Haines Kenneth , Kang Kim Michelle , Divino Celia M.
Published: April 2019

Objective

Neuroendocrine tumors (NETs) comprise 41.8% of small intestine malignancies. The NET nomogram is a 15-item prognostic tool that includes relevant factors for guiding management decisions. This is the first external validation of this tool among American patients at a tertiary treatment center.

Methods

Patients who underwent surgical intervention from 2005 to 2017 were screened by retrospective chart review. Nomogram scores were calculated following the methods outlined by Modlin et al (Neuroendocrinology. 2010;92:143–157). Validation assessed the association between nomogram scores and survival using Wilcoxon test and Cox regression.

Results

Among the 121 patients selected, the NET nomogram significantly predicted survival as a continuous variable (P < 0.01) and when dichotomized using 83 points to distinguish low-risk versus high-risk groups (P < 0.01). However, the nomogram was not universally applicable as even at our specialty center, variables such as chromogranin A and urinary 5-hydroxyindoleacetic acid are not routinely collected, whereas others, like tumor grade, do not reflect the most recently updated classifications.

Conclusion

The NET nomogram accurately identified patients at low and high risk of death. However, revision to update prognosticators could improve its usefulness for predicting survival of small intestine NETs.
Retrospective Matched-Cohort Analysis of Acute Pancreatitis Induced by 5-Aminosalicylic Acid–Derived Drugs
Authors: Meczker Ágnes , Mikó Alexandra , Gede Noémi , Szentesi Andrea , Párniczky Andrea , Gódi Szilárd , Hegyi Péter
Published: April 2019

Objectives

This study aimed to compare the clinical course of 5-aminosalicylic acid–derived, drug-induced acute pancreatitis (5-ASA–DIAP) to acute pancreatitis (AP) caused by other etiologies.

Methods

A cohort of patients with 5-ASA–DIAP was established through literature search. As a control AP (CAP) group, a cohort was generated from a registry. Data on the diagnostic procedure, symptoms, enzyme elevation, imaging, severity, and recovery parameters were collected. Causality was assessed using the Naranjo algorithm.

Results

Twenty-nine articles were included, which describe 36 patients with fifty-one 5-ASA–DIAP episodes (60.78% female, 39.22% male). There were 88.2% mild, 3.92% moderate, and 7.84% severe cases of AP in the 5-ASA–DIAP group, and 70.6%, 25.5%, and 3.92% such cases in the CAP population, respectively. Symptoms improved significantly faster (mean ± SE, 2.5 ± 0.34 vs 3.74 ± 0.42 days; P = 0.018); however, pancreatic enzyme levels normalized significantly more slowly (6.27 ± 1.53 vs 3.63 ± 0.61 days, P = 0.008) in the 5-ASA–DIAP cohort compared with the CAP group. This study confirms that there are no diagnostic differences between 5-ASA–DIAP and AP of other etiologies.

Conclusions

Fewer moderate but more severe cases were found in the 5-ASA–DIAP group; therefore, 5-ASA–DIAP must be taken as seriously as AP of other etiologies.
The Analgesic Efficacy of Forced Coughing During Cervical Punch Biopsy: A Prospective Randomized Controlled Study
Authors: Akavia Tal Goldstein , Segev Yakir , Balan Edith , Siegler Efraim
Published: April 2019

(Abstracted from Aust N Z J Obstet Gynaecol 2018;58:681–685)

Cervical punch biopsies are a common procedure performed routinely in ambulatory health care facilities and are usually performed without local anesthesia. Use of local anesthesia injections alleviates the pain associated with the procedure, but has numerous disadvantages, including risk of allergies or intravascular injection, pain from the injection itself, and lengthening procedure time.
Acupuncture in Obstetrics and Gynecology
Authors: Bishop Katherine C. , Ford Anne C. , Kuller Jeffrey A. , Dotters-Katz Sarah
Published: April 2019

Importance

Acupuncture is a key component of therapy in traditional Chinese medicine. Only in the last few decades has acupuncture become popular in the United States. The mechanism behind acupuncture's effects on the body and brain has not been completely elucidated, but there is evidence that acupuncture has effects on the endocrine, immune, and sympathetic and parasympathetic nervous systems. It may also act through electrical and mechanical signaling through the connective tissue and fascia. Despite this uncertainty, the positive effects of acupuncture have been well established.

Objective

In this review, we discuss the basic concepts of traditional Chinese medicine and acupuncture and examine the evidence regarding the use of acupuncture in obstetrics and gynecology.

Evidence Acquisition

We conducted a literature review of acupuncture in obstetrics and gynecology using PubMed.

Results

The available data demonstrate that acupuncture is beneficial in the treatment of labor pain, back pain in pregnancy, and dysmenorrhea. It is unclear if acupuncture is effective for hyperemesis, chemotherapy-induced nausea and vomiting, and menopausal hot flushes, or if moxibustion is effective in correcting breech presentation. There are limited but positive data regarding menopause-related sleep disturbances, depression in pregnancy, and overactive bladder. Acupuncture is not beneficial for improving outcomes in in vitro fertilization.

Conclusions and Relevance

Acupuncture is an increasingly popular therapy with many potential applications in obstetrics and gynecology. A general understanding of the basic principles of acupuncture and the safety and efficacy of its practice is necessary for the general obstetrician and gynecologist to make informed recommendations to patients.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify the basic concepts of traditional Chinese medicine and how it differs from Western medicine; describe common obstetrical and gynecologic issues that can be successfully treated with acupuncture; and distinguish the main issues in designing acupuncture studies regarding blinding, choosing a control group, and identifying areas of potential bias.
Real-World Retention Rates After Intravesical OnabotulinumtoxinA for Idiopathic Overactive Bladder
Authors: Liberman Daniel , Milhouse Olufenwa , Johnson-Mitchell Marta , Siegel Steven W.
Published: April 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2018;24:404–407)

Intravesical onabotulinumtoxinA (BoNT-A) is used for treatment of idiopathic overactive bladder (iOAB) when conservative measures and medications fail to improve symptoms. After intravesical BoNT-A, the risk of incomplete bladder evacuation (IBE) requiring catheterization is well established.