bluuebunny/crossref_metadata_2025 huggingface dataset:
Obturator hernia
Authors: Park Jinyoung
Published: August 2020

Obturator hernia is a relatively rare type of abdominal hernia, in which abdominal contents protrude through the obturator canal, a condition that can lead to small bowel obstruction. Its rarity and nonspecific signs and symptoms make a preoperative diagnosis difficult. The present study analyzed the clinical manifestations, diagnostic methods and operative treatment outcomes in patients with obturator hernia.

Between January 2012 and October 2019, 1028 adults underwent surgical repair of abdominal wall hernia at the Department of Surgery, Kyungpook National University Hospital. The medical records of eleven patients who were treated for small bowel obstruction due to obturator hernia were retrospectively evaluated. Patient characteristics, clinical presentation, preoperative radiological diagnosis, operative findings, treatment, complications, and outcomes were recorded.

All 11 patients were elderly women, with a mean age of 80.2 years (range, 71–87 years). Their mean body mass index was 17.9 kg/m2 (range, 11.9–22.2 kg/m2). Symptoms at presentation were abdominal pain and vomiting, with a mean duration of symptoms prior to admission of 5.6 days (range, 1–15 days). Based on abdominopelvic computed tomography (CT) scans, all 11 patients were preoperatively diagnosed with obturator hernia, followed by laparoscopic exploration or laparotomy as soon as possible. Of the 11 patients, 6 (54.5%) had left-sided, four (36.4%) had right-sided, and one (9.1%) had bilateral obturator hernias. Three patients (27.3%) required resection of the ileum due to perforation or strangulation. All underwent simple closure of the hernia defect with interrupted or purse-string sutures. Ten patients recovered uneventfully, whereas one had wound seroma and ileus. Recurrence has not been observed in the 8 surviving patients.

Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in emaciated elderly women with chronic disease. Early surgical intervention without delay is imperative to avoid postoperative morbidity and mortality associated with intestinal strangulation due to obturator hernia. Obturator hernia can be sufficiently repaired with simple suture closure without mesh.
A meta-analysis comparing stereotactic body radiotherapy vs conventional radiotherapy in inoperable stage I non-small cell lung cancer
Authors: Li Can , Wang Li , Wu Qian , Zhao Jiani , Yi Fengming , Xu Jianjun , Wei Yiping , Zhang Wenxiong
Published: August 2020

Background:

Stereotactic body radiotherapy (SBRT) superseded conventional radiotherapy (CRT) for the treatment of patients with inoperable early stage non-small cell lung cancer (NSCLC) over a decade ago. However, the direct comparisons of the outcomes of SBRT and CRT remain controversial. This meta-analysis was performed to compare the survival and safety of SBRT and CRT in patients with inoperable stage I NSCLC.

Methods:

We systematically searched the Cochrane Library, Embase, PubMed, Web of Science, Ovid MEDLINE, ScienceDirect, Scopus and Google Scholar for relevant articles. Overall survival (OS), progression-free survival (PFS), lung cancer-specific survival (LCSS), local control rate (LCR) and adverse effects (AEs) were the primary outcomes.

Results:

We identified 11,110 articles, 17 of which were eventually included in this study; these 17 articles had 17,973 patients (SBRT: 7395; CRT: 10,578). Compared to CRT for the treatment of inoperable stage I NSCLC, SBRT had superior survival in terms of OS (hazard ratio [HR]: 0.66, 95% confidence interval [CI]: 0.62-0.70, P < .00001), LCSS (HR: 0.42 [0.35-0.50], P < .00001), and PFS (HR: 0.34 [0.25-0.48], P < .00001). The 4-year OS rate (OSR); 4-year LCSS rate (LCSSR); 3-year local control rate (LCR); 5-year PFS rate (PFSR) with SBRT were all higher than those with CRT. With regard to all-grade AEs, the SBRT group had a significantly lower rate of dyspnea, esophagitis and radiation pneumonitis; no significant difference was found in grade 3-5 AEs (risk ratio [RR]: 0.68 [0.30-1.53], P = .35).

Conclusions:

With better survival and a lower rate of dyspnea, esophagitis and radiation pneumonitis than CRT, SBRT appears to be more suitable for patients with inoperable stage I NSCLC.
Association of glutathione S-transferase M1 and T1 genotypes with asthma
Authors: Su Xinming , Ren Yuan , Li Menglu , Kong Lingfei , Kang Jian
Published: August 2020

Background:

We performed an updated meta-analysis to clarify the relationship between glutathione S-transferase Mu and theta (GSTM1 and GSTT1, respectively) null/positive genotypes and asthma.

Methods:

We performed a literature search using PubMed and Web of Science databases in August 2019. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the role of GSTM1 and GSTT1 genotypes in the risk of asthma.

Results:

Overall, we found a significant association with asthma risk in the general population for both the GSTM1 genotype (OR = 1.21; 95% CI: 1.07–1.35; P < .001; I
2 = 69.5%) and the GSTT1 genotype (OR = 1.61; 95% CI: 1.30–2.00; P < .001; I
2 = 83.6%). Moreover, significant associations between both genotypes and asthma risk were also found by age stratification. Furthermore, for GSTM1 we found significant associations in populations living in Asia, Europe, and Russia, but not in Africa. Conversely, for GSTT1, we found a significantly increased risk in populations living in Asia, Europe, Africa, and Russia. In addition, a significant association was found for both genotypes with a sample size <500, but not a sample size >2000.

Conclusion:

Our meta-analysis provides evidence that GSTM1 and GSTT1 genotypes could be used as asthma-associated biomarkers.
Loss-of-function mutation of PCSK9 as a protective factor in the clinical expression of familial hypercholesterolemia
Authors: Bayona Ane , Arrieta Francisco , Rodríguez-Jiménez Carmen , Cerrato Francisco , Rodríguez-Nóvoa Sonia , Fernández-Lucas Milagros , Gómez-Coronado Diego , Mata Pedro
Published: August 2020

Rationale:

Proprotein convertase subtilisin/kexin 9 or PCSK9 is a protein whose main function is to regulate the number of low-density lipoprotein receptors (LDLR) present on the cell surface. Loss-of-function mutations in PCSK9 have been related to low LDL-cholesterol levels and a decrease in the risk of cardiovascular events.

Patient concerns:

We present the case of a 27-year-old woman, offspring of a patient with familial homozygous hypercholesterolemia, who presented with mild-moderate hypercholesterolemia.

Diagnosis:

Genetic analysis was performed by next generation sequencing using a customized panel of 198 genes. Sanger sequencing was used to confirm the presence of the variants of interest. The genetic analysis showed a pathogenic heterozygous mutation in LDLR [exon 6:c.902A>G:p(Asp301Gly)], as well as a loss-of-function heterozygous variant in PCSK9 [exon1:c.137 G>T:p.(Arg46Leu)]. The genetic analysis of the index case's mother revealed compound heterozygosity for 2 different mutations in LDLR [c.902A>G:p.(Asp301Gly); c.1646G>T:p.(Gly549Val)] in exon 6 and in exon 11, respectively, and the same loss-of-function variant in PCSK9 that had been found in her daughter [(PCSK9:exon1:c.137G>T:p.(Arg46Leu)]. The maternal grandfather of the index case presented the same genetic variants as his granddaughter.

Interventions:

The index case did not receive any specific treatment for hypercholesterolemia. The loss-of-function variant in PCSK9 protected her from higher LDL-cholesterol levels, provided she kept partial activity of the LDLR. In her mother, instead, a PCSK9 inhibitor was tried but failed to achieve lipid control. The reason for this may be the complete absence in LDL receptor activity. LDL apheresis was started afterwards, resulting in adequate lipid level control.

Outcomes:

To the date, the index case has achieved to maintain adequate total and LDL-cholesterol levels without any other intervention. She has had no known cardiovascular complication.

Lessons:

Loss-of-function mutations in PCSK9 could protect from developing more severe forms of hypercholesterolemia. The finding of these mutations (LDLR-PCSK9) in three consecutive generations could imply an adaptive mechanism against the development of hypercholesterolemia.
Combined bursal aspiration and corticosteroid injection for rotator cuff tear patients unresponsive to conservative management
Authors: Lee Dong Gyu , Cho Jang Hyuk
Published: August 2020

Rationale:

Subacromial-subdeltoid (SASD) bursitis is characterized by bursal distension caused by fluid collection, commonly resulting from rotator cuff tears. Aspiration of the bursal fluid associated with rotator cuff tears tends to be overlooked. The effects of combined bursal aspiration and corticosteroid injection on full-thickness tears of the rotator cuff with SASD bursitis have not been previously reported.

Patient concerns:

We report the cases of 3 patients with shoulder pain caused by rotator cuff tears with marked amounts of fluid in the SASD bursa. The patients experienced intractable pain despite previous conservative management, including corticosteroid injection.

Diagnoses:

Physical examination and imaging studies revealed rotator cuff tears with remarkable quantities of fluid in the SASD bursa.

Interventions and outcomes:

The patients underwent ultrasound (US)-guided aspiration of the bursal fluid and intra-articular corticosteroid injection, following which, all patients experienced reduced shoulder pain for several months.

Lessons:

Combined aspiration of fluid in the SASD bursa and intra-articular corticosteroid injection in the rotator cuff tear is recommended, especially in cases with untreated shoulder pain unresponsive to previous conservative management.
Triple metachronous primary cancer of uterus, colon, and breast cancer
Authors: Li Guanqiao , Yao Jia , Wu Tangna , Chen Yaxiong , Wang Zhenping , Wang Yiming , Wang Fen , Zhong Rui , Yang Shiping
Published: August 2020

Rationale:

Triple or more primary malignancies are rare, with only 23 previous cases including breast cancer reported in the English language studies between January 1990 and December 2019.

Patient concerns:

The patient was a 67-year-old woman with a mass in her right breast. She had a previous history of uterine and colon cancer. Both ultrasonography and mammography revealed a Breast Imaging Reporting and Data System (BI-RADS) category 3 breast lesion, in which proliferative nodules are more likely. Given her previous history of 2 malignancies, her doctors strongly recommended a biopsy.

Diagnosis and interventions:

The biopsy pathology suggested intraductal breast cancer. Mastectomy and sentinel lymph node biopsy were performed. The postoperative pathological diagnosis was invasive ductal carcinoma, grade II, stage I. The sample was positive for estrogen receptor and progesterone receptor and negative for cerbB-2. No radiotherapy or chemotherapy was administered except for endocrine therapy. A follow-up at 19 months showed no breast recurrence or distant metastases.

Outcomes:

No recurrence or distant metastasis occurred within the 19-month, 11-year, and 20-year follow-ups for breast, colon, and uterine cancers, respectively.

Lessons:

To our knowledge, this is the first review of triple or more primary malignancies including breast cancer. These malignancies occur predominantly in older female patients. The most prevalent tumors of triple or more primary malignancies including breast cancer occur in the colon, uterus, and lung. A favorable prognosis is associated with early-stage malignancies.
Effectiveness and safety of adjunctive traditional Chinese medicine therapy for constipation after cancer chemotherapy
Authors: Dai Qianxiang , Yan Hang , Wu Xiaoping , Liu Yuan , Huang Fei , Dong Xing
Published: August 2020

Background:

As an alternative for constipation after cancer chemotherapy, Chinese medicine has gradually attracted the attention of clinicians based on the theory of syndrome differentiation and treatment. However, due to the lack of evidence-based medical evidence, the author designed the program to evaluate the effectiveness and safety of Chinese medicine.

Methods:

From the beginning to August 2020, 8 electronic databases will be searched. Two of our researchers will independently conduct research selection, data extraction, and risk assessment of bias. We will use Review Manager 5.3 software for meta-analysis and heterogeneity assessment. In addition, we will use the grading of recommendations assessment, development, and evaluation to evaluate the evidence quality.

Results:

This study will demonstrate an evidence-based review of traditional Chinese medicine (TCM) for constipation after cancer chemotherapy.

Conclusion:

The study will provide clear evidence to assess the effectiveness and side effects of TCM for constipation after cancer chemotherapy.

Trial registration number:

INPLASY202070027
Clinical importance of respiratory muscle fatigue in patients with cardiovascular disease
Authors: Taya Masanobu , Amiya Eisuke , Hatano Masaru , Saito Akihito , Nitta Daisuke , Maki Hisataka , Hosoya Yumiko , Minatsuki Shun , Tsuji Masaki , Sato Tatsuyuki , Murakami Haruka , Narita Koichi , Konishi Yuto , Watanabe Shogo , Yokota Kazuhiko , Haga Nobuhiko , Komuro Issei
Published: August 2020

Patients with cardiovascular diseases frequently experience exertional dyspnea. However, the relationship between respiratory muscle strength including its fatigue and cardiovascular dysfunctions remains to be clarified.

The maximal inspiratory pressure/maximal expiratory pressure (MIP/MEP) before and after cardiopulmonary exercise testing (CPX) in 44 patients with heart failure and ischemic heart disease were measured. Respiratory muscle fatigue was evaluated by calculating MIP (MIPpost/MIPpre) and MEP (MEPpost/MEPpre) changes.

The mean MIPpre and MEPpre values were 67.5 ± 29.0 and 61.6 ± 23.8 cm H2O, respectively. After CPX, MIP decreased in 25 patients, and MEP decreased in 22 patients. We evaluated the correlation relationship between respiratory muscle function including respiratory muscle fatigue and exercise capacity evaluated by CPX such as peak VO2 and VE/VCO2 slope. Among MIP, MEP, change in MIP, and change in MEP, only the value of change in MIP had an association with the value of VE/VCO2 slope (R = −0.36, P = .017). In addition, multivariate analysis for determining factor of change in MIP revealed that the association between the change in MIP and eGFR was independent from other confounding parameters (beta, 0.40, P = .017). The patients were divided into 2 groups, with (MIP change < 0.9) and without respiratory muscle fatigue (MIP change > 0.9), and a significant difference in peak VO2 (14.2 ± 3.4 [with fatigue] vs 17.4 ± 4.7 [without fatigue] mL/kg/min; P = .020) was observed between the groups.

Respiratory muscle fatigue demonstrated by the change of MIP before and after CPX significantly correlated with exercise capacity and renal function in patients with cardiovascular disease.
Efficacy and safety of Huaier granules combined with chemotherapy for gastric cancer
Authors: Hou Daorui , Xiong Jian , Yang Liangjun , Xiong Lu
Published: August 2020

Background:

Huaier granules, the aqueous product of Huaier (Trametes robiniophila Murr.) extract, are a broad-spectrum anti-tumor drug and have been widely used for the treatment of gastric cancer (GC). The aim of this study is to systematically investigate the efficacy and safety of Huaier granules combined with chemotherapy in the treatment of GC.

Methods:

Three English databases and four Chinese databases will be searched from its inception to July 2020. Two methodological trained researchers will select the qualified studies for data extraction independently. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The RevMan 5.2 and stata 14.0 software will be applied for statistical analyses. Statistical heterogeneity will be computed by CochraneX2andI2tests. Sensitivity analysis will be conducted to evaluate the stability of the results. The publication bias will be evaluated by funnel plots and Egger's test. The quality of evidence will be assessed by the GRADE system.

Results:

The results of our research will be published in a peer-reviewed journal.

Conclusion:

The conclusion of our systematic review will provide evidence to judge whether Huaier granules combined with chemotherapy is an effective intervention for patient with GC.

OSF registration number:

10.17605/OSF.IO/9BVJD.
Efficacy and safety evaluation of acupoint embedding for patients with ulcerative colitis
Authors: Lu Jinhua , Zhou Jun , Wang Lu , Zhong Chun , Chen Xu , Jia Bo
Published: August 2020

Background:

Ulcerative colitis is a recurring digestive disease characterized by inflammation in the intestinal tract, which seriously affects the life of the patient. In recent years, it has played a role in obesity, osteoporosis, and gastrointestinal disorders, and has received more and more attention. However, there are no clear conclusions about its effectiveness and safety in the treatment of UC.

Method and analysis:

This systematic review will collect 7 databases, including Web of science, Pubmed, Embase, VIP, Wanfang, CNKI, and the Chinese Biomedical Literature Database (CBM), to collect all eligible RCTs from database inception to December 31, 2019. The 2 researchers will rigorously follow the selection process, including study screening, data extraction, and quality assessment. The primary outcome is clinical effectiveness. The main software used in this study is Review Manager V5.3 software.

Result:

This study will provide a meaningful and comprehensive evaluation on the effectiveness and safety of acupoints embedding for UC.

Conclusion:

This meta-analysis was designed to provide clinicians with valid evidence regarding acupoint embedding for UC.

INPLASY registration number:

INPLASY202040166.
Effect and safety of intravenous versus oral acetaminophen after unicompartmental knee replacement
Authors: Li Xiaoming , Guo Donghui , Wang Hengjun , Zhou Tingting
Published: August 2020

Background:

Due to the soft tissue injury and large amount of bone destruction involved, undesirable postoperative pain remains a challenge for both patients and surgeons after unicompartmental knee replacement (UKR). However, there are no studies comparing the effectiveness of oral and intravenous acetaminophen as part of a standard multimodal perioperative pain regimen after UKR. Thus, this prospective randomized study was conducted to compare pain control outcomes with postoperative oral versus intravenous acetaminophen use in adults undergoing UKR.

Methods:

The institutional review board of the Traditional Chinese Medicine- western Medicine Hospital of Cangzhou approved the study protocol. This blinded and randomized study was carried out in accordance with the principles of the Helsinki Declaration. We included patients who were scheduled for UKR with an American Society of Anesthesiologists status of I to III, who were mentally competent, and who were able to give consent for enrolment in the study. Patients were randomly assigned on a 1:1 basis to receive either intravenous acetaminophen or oral acetaminophen. We ensured that the patients, care providers, and outcome assessors were blinded to the group assignment during the study period. Primary outcomes were postoperative pain at rest and during motion (knee flexion of 45°) measured using a visual analog scale score. Secondary outcomes included morphine consumption at 24, 48, and 72 hours after surgery, length of hospital stay, range of motion, daily ambulation distance, and adverse events occurrence. All statistical analyses were performed using SPSS 25.0. Differences associated with a P value of <.05 were considered statistically significant.

Results:

It was hypothesized that patients receiving intravenous acetaminophen would exhibit similar postoperative outcomes compared with patients receiving oral acetaminophen.

Trial registration:

This study was registered in Research Registry (researchregistry5825).
Effects of herb-partitioned moxibustion for diarrhoea-predominant irritable bowel syndrome
Authors: Wang Fen , He Shuxing , Yan Jian , Mai Lianren , Yang Liangjun
Published: August 2020

Background:

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional intestinal disease characterized by abdominal pain and diarrhea. Herb-partitioned moxibustion (HPM), a characteristic external therapy, is effective in treating IBS-D. However, no systematic review has been carried out to assess the efficacy and safety of HPM for IBS-D. The aim of this study will systematically evaluate the efficacy and safety of HPM for the treatment of patients with IBS-D.

Methods:

We will perform the comprehensive literature search in both English and Chinese electronic database including PubMed, Embase, Cochrane Library, Web of Science database, Medline, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, Wanfang database, Chongqing VIP information, and SinoMed from their inception to July 2020. All randomized controlled trials of HPM for the treatment of IBS-D will be included. RevManV5. 3 will be applied to analyze the data.

Results:

This study will provide high-quality synthesis of current evidence of effectiveness and safety on HPM for patients with IBS-D.

Conclusion:

The conclusion of our systematic review will provide evidence to judge whether HPM is an effective intervention for IBS-D.

Trial registration number:

10.17605/OSF.IO/3JXCZ.
Delayed emergence from propofol anesthesia in a patient with Lesch-Nyhan syndrome
Authors: Lee Jungwon , Jung Sung Mee , Jeon Sungmin
Published: August 2020

Rationale:

Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder presenting with uric acid overproduction, neurocognitive disability, and behavioral disturbances. Inhalational anesthesia has been frequently used in LNS patients undergoing surgery. Characteristic compulsive self-injurious behavior and high risk of emesis may hinder inhalational induction. Propofol may be beneficial for these patients because of its easy and rapid titration for anesthetic depth during induction, early recovery from anesthesia, and antiemetic effect as well as uricosuric effect.

Patient concerns:

A 16-year-old male adolescent was scheduled for percutaneous nephrolithotomy. He exhibited poorly controlled muscle, self-injurious behaviors and intellectual disability.

Diagnosis:

The patient presented with neurodevelopmental delay in the first year of life, and was diagnosed with LNS, with a substitution of phenylalanine to leucine in hypoxanthine-guanine phosphoribosyltransferase (HPRT) 1 gene on the X-chromosome at 3 years of age.

Interventions:

Total intravenous anesthesia was used for induction and maintenance of anesthesia with propofol and remifentanil using target-controlled infusion.

Outcomes:

Time to recovery of consciousness was prolonged after uneventful surgery. Serum uric acid levels gradually increased during postoperative period.

Lessons:

Propofol anesthesia using target-controlled infusion does not provide significant clinical advantages in rapid emergence from anesthesia and management of hyperuricemia in LNS patients undergoing urological surgery.
Acupuncture for the treatment of marrow suppression after chemotherapy
Authors: Geng Guoyan , Yin Zihan , Sun Mingsheng , Xu Guixing , Chen Jiao , Liang Fanrong , Zhao Ling
Published: August 2020

Background:

Cancer continues to be a severe global health problem and the leading cause of death worldwide. Chemotherapy as the main treatment has various side effects, of which marrow suppression is the most common one. Acupuncture had shown clinical effects for marrow suppression after chemotherapy in many studies. However, the efficacy and safety of acupuncture therapy for marrow suppression after chemotherapy remains unclear.

Objective:

This protocol aims to evaluate the efficacy and safety of acupuncture for marrow suppression after chemotherapy according to the existing randomized controlled trials.

Methods and analysis:

The randomized controlled trials on acupuncture therapy for marrow suppression after chemotherapy will be searched in the database of Embase, PubMed and Cochrane Library, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and related registration platforms (WHO ICTRP, Clinical Trials, and Chinese Clinical Trial Register [ChiCTR]), Grey Literature Database from inception to 1 August 2020. The primary outcomes will be assessed using white blood cell (WBC) count, platelet count, hemoglobin count and the number of neutrophils (N). Review Manager V.5.3 software will be applied for statistical analyses. We will measure the risk of bias of the included studies with Cochrane Collaboration Risk of Bias Tool. Finally, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) will be used to grade the overall quality of evidence. And we will use the intra-group correlation coefficient to assess the consistency of reviewers.

Result:

This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in marrow suppression after chemotherapy.

Conclusion:

The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control marrow suppression after chemotherapy.

PROSPERO registration number:

PROSPERO CRD42020163336
Effect of enhancer of zeste homolog 2 mutations on the prognosis of patients with myelodysplastic syndrome
Authors: Huang Xinyue , Wang Xiaoxue
Published: August 2020

Background:

Gene mutations with important prognostic roles have been identified in patients with myelodysplastic syndrome (MDS). Overall, it is not yet fully clear whether enhancer of zeste homolog 2 (EZH2) is affected and contributes to the disease in MDS patients. Thus, we performed a meta-analysis to investigate the effects of EZH2 mutations on the prognosis of patients with MDS.

Methods:

We searched English-language databases (PubMed, Embase, and Cochrane Library) for studies published on the effects of EZH2 mutations in MDS patients. The study had to include at least 1 of the following indices as therapeutic evaluation data: overall survival (OS), transformation time to leukemia, and International Prognostic Scoring System risk. Revman, version 5.2 software was used for all statistical processing. We calculated the risk ratio and the 95% confidence interval (CI) of continuous variables, and determined the hazard ratio and 95% CI of time-to-event data.

Results:

We included 5 studies with a total enrolment of 994 patients. There was a significant adverse effect on OS in the EZH2-mutation group compared to the unmutated group (hazard ratio = 2.47, 95% CI: 1.37–4.47, P < .00001), while the heterogeneity was relatively high (I
2 = 68%). There was no significant correlation between EZH2 mutations and IPSS risk (low/int-1 vs int-2/high) (odds ratio: 0.69, 95% CI: 0.14–3.39, P = .65), with significant heterogeneity (I
2 = 78%). The analysis did not show significant publication bias in the studies.

Conclusion:

This meta-analysis indicated an adverse effect of EZH2 mutations with regard to OS in patients with MDS. However, larger cohort trials are still needed to better understand the prognostic impacts of EZH2 mutations on MDS patients.
Klatskin tumor diagnosed concurrently with IgG4 related sclerosing cholangitis
Authors: Hwang Ha Won , Park Jin-Seok , Jeong Seok , Lee Don Haeng , Choi Suk Jin
Published: August 2020

Rationale:

IgG4-related disease (IgG4-RD) is a systemic disease that can involve various organs and is characterized by the infiltrations of IgG4-positive plasma cells and lymphocytes, fibrosis, and elevated serum IgG4 levels. IgG4-related sclerosing cholangitis (IgG4-RSC) is a subtype of IgG4-RD. No certain relationship between IgG4-RSC and cholangiocarcinoma has been established as yet, and there have been few reports of the simultaneous diagnosis of IgG4-RSC and cholangiocarcinoma.

Patient concerns:

A 76-year-old male visited our gastroenterology department due to the recent occurrence of pruritus and jaundice.

Diagnosis:

Computed tomography (CT) scan showed ductal wall swelling and enhancement from both intrahepatic duct confluence to the common bile duct, upper biliary dilatation, and accompanying autoimmune pancreatitis (a sub type of IgG4-RD). Biopsy of the distal common bile duct by endoscopic retrograde cholangiopancreatography (ERCP) resulted in a diagnosis of IgG4-RSC. Subsequently, adenocarcinoma was identified by repeated cytology of bile juice. Finally, Klatskin tumor type IIIA and IgG4-RSC were concurrently diagnosed.

Interventions:

IgG4-RSC was treated with steroid and Klatskin tumors by gemcitabine + cisplatin chemotherapy.

Outcomes:

The jaundice had improved and CT showed substantial improvement of the intrahepatic duct dilatation.

Lessons:

IgG4-RSC and cholangiocarcinoma are easily confused, but their treatments are quite different, and thus, care must be taken during diagnosis. Furthermore, these 2 diseases may co-exist. Therefore, even if IgG4-RSC is diagnosed first, the possibility of accompanying cholangiocarcinoma should be thoroughly investigated.
Sertoli-Leydig Cell Tumors of the Ovary With Follicular Differentiation Often Resembling Juvenile Granulosa Cell Tumor
Authors: Ordulu Zehra , Young Robert H.
Published: August 2020

Thirty-eight ovarian Sertoli-Leydig cell tumors that contained follicles are described; in 33 of them follicles imparted a microscopic appearance resembling that of the juvenile granulosa cell tumor. The average age of the patients (28 y), frequency of androgenic manifestations (40%), and dominant histopathologic features were all typical of Sertoli-Leydig cell tumor, mostly (80%) of intermediate differentiation. The remaining tumors were poorly differentiated; none were well differentiated. The follicles that mimicked juvenile granulosa cell tumor accounted for ∼5% to 40% of the tumor volume. They typically arose out of the characteristic lobules seen in Sertoli-Leydig cell tumors of intermediate differentiation. There appeared to be a gradual loosening of the stroma imparting a pale appearance to the lobules and on that background follicles emerged. The follicles were mostly relatively regular and round to oval with basophilic or eosinophilic secretion and when fully formed perfectly mimicked juvenile granulosa cell morphology. In 18 of these cases, and 5 others, follicles were present that had a nonspecific morphology and had a random, nonlobule-associated distribution. The presence of a juvenile granulosa-like appearance often raised consideration of the diagnosis of a sex cord-stromal tumor of mixed forms (so-called gynandroblastoma) but a multifocal origin within lobules of otherwise typical Sertoli-Leydig cell tumors, and overall tumor characteristics indicates aberrant differentiation within the latter tumor of a nature only sporadically noted in the prior literature. Such neoplasms should, in our opinion, not be placed in the grouping of a sex cord-stromal tumor of mixed forms but rather in the Sertoli-Leydig category.
Non-trivial avalanches triggered by shear banding in compression of metallic glass foams
Authors: Lin H. , lu C. , Wang H. Y. , Dai L. H.
Published: August 2020

Ductile metallic glass foams (DMGFs) are a new type of structural material with a perfect combination of high strength and toughness. Owing to their disordered atomic-scale microstructures and randomly distributed macroscopic voids, the compressive deformation of DMGFs proceeds through multiple nanoscale shear bands accompanied by local fracture of cellular structures, which induces avalanche-like intermittences in stress–strain curves. In this paper, we present a statistical analysis, including distributions of avalanche size, energy dissipation, waiting times and aftershock sequence, on such a complex dynamic process, which is dominated by shear banding. After eliminating the influence of structural disorder, we demonstrate that, in contrast to the mean-field results of their brittle counterparts, scaling laws in DMGFs are characterized by different exponents. It is shown that the occurrence of non-trivial scaling behaviours is attributed to the localized plastic yielding, which effectively prevents the system from building up a long-range correlation. This accounts for the high structural stability and energy absorption performance of DMGFs. Furthermore, our results suggest that such shear banding dynamics introduce an additional characteristic time scale, which leads to a universal gamma distribution of waiting times.
The AdS
5
× S
5
superstring
Authors: Schwarz John H.
Published: August 2020

The duality between the type IIB superstring theory in an AdS
5
 × S
5
background with
N
units of five-form flux and

N

=
4

super Yang–Mills theory with a
U
(
N
) gauge group has been studied extensively. My version of the construction of the superstring world-sheet action is reviewed here.
A transformation between stationary point vortex equilibria
Authors: Krishnamurthy Vikas S. , Wheeler Miles H. , Crowdy Darren G. , Constantin Adrian
Published: August 2020

A new transformation between stationary point vortex equilibria in the unbounded plane is presented. Given a point vortex equilibrium involving only vortices with negative circulation normalized to −1 and vortices with positive circulations that are either integers or half-integers, the transformation produces a new equilibrium with a free complex parameter that appears as an integration constant. When iterated the transformation can produce infinite hierarchies of equilibria, or finite sequences that terminate after a finite number of iterations, each iteration generating equilibria with increasing numbers of point vortices and free parameters. In particular, starting from an isolated point vortex as a seed equilibrium, we recover two known infinite hierarchies of equilibria corresponding to the Adler–Moser polynomials and a class of polynomials found, using very different methods, by Loutsenko (Loutsenko 2004
J. Phys. A: Math. Gen.
37
, 1309–1321 (doi:10.1088/0305-4470/37/4/017)). For the latter polynomials, the existence of such a transformation appears to be new. The new transformation, therefore, unifies a wide range of disparate results in the literature on point vortex equilibria.
Feedback control of chaotic systems using multiple shooting shadowing and application to Kuramoto–Sivashinsky equation
Authors: Shawki Karim , Papadakis George
Published: August 2020

We propose an iterative method to evaluate the feedback control kernel of a chaotic system directly from the system’s attractor. Such kernels are currently computed using standard linear optimal control theory, known as linear quadratic regulator theory. This is however applicable only to linear systems, which are obtained by linearizing the system governing equations around a target state. In the present paper, we employ the preconditioned multiple shooting shadowing (PMSS) algorithm to compute the kernel directly from the nonlinear dynamics, thereby bypassing the linear approximation. Using the adjoint version of the PMSS algorithm, we show that we can compute the kernel at any point of the domain in a single computation. The algorithm replaces the standard adjoint equation (that is ill-conditioned for chaotic systems) with a well-conditioned adjoint, producing reliable sensitivities which are used to evaluate the feedback matrix elements. We apply the idea to the Kuramoto–Sivashinsky equation. We compare the computed kernel with that produced by the standard linear quadratic regulator algorithm and note similarities and differences. Both kernels are stabilizing, have compact support and similar shape. We explain the shape using two-point spatial correlations that capture the streaky structure of the solution of the uncontrolled system.
Impact of fluctuation in frequency of human immunodeficiency virus/simian immunodeficiency virus reactivation during antiretroviral therapy interruption
Authors: Wu Yuhuang , Pinkevych Mykola , Xu Zhuang , Keele Brandon F. , Davenport Miles P. , Cromer Deborah
Published: August 2020

Antiretroviral therapy (ART) provides effective control of human immunodeficiency virus (HIV) replication and maintains viral loads of HIV at undetectable levels. Interruption of ART causes rapid recrudescence of HIV plasma viremia due to reactivation of latently HIV-infected cells. Here, we characterize the timing of both the initial and subsequent successful viral reactivations following ART interruption in macaques infected with simian immunodeficiency virus (SIV). We compare these to previous results from HIV-infected patients. We find that on average the time until the first successful viral reactivation event is longer than the time between subsequent reactivations. Based on this result, we hypothesize that the reactivation frequency of both HIV and SIV may fluctuate over time, and that this may impact the treatment of HIV. We develop a stochastic model incorporating fluctuations in the frequency of viral reactivation following ART interruption that shows behaviours consistent with the observed data. Furthermore, we show that one of the impacts of a fluctuating reactivation frequency would be to significantly reduce the efficacy of ‘anti-latency' interventions for HIV that aim to reduce the frequency of reactivation. It is therefore essential to consider the possibility of a fluctuating reactivation frequency when assessing the impact of such intervention strategies.
Global change in the functional diversity of marine fisheries exploitation over the past 65 years
Authors: Trindade-Santos Isaac , Moyes Faye , Magurran Anne E.
Published: August 2020

Overexploitation is recognized as one of the main threats to global biodiversity. Here, we report a widespread change in the functional diversity of fisheries catches from the large marine ecosystems (LMEs) of the world over the past 65 years (1950 to 2014). The spatial and temporal trends of functional diversity exploited from the LMEs were calculated using global reconstructed marine fisheries catch data provided by the Sea Around Us initiative (including subsistence, artisanal, recreational, industrial fisheries, and discards) and functional trait data available in FishBase. Our analyses uncovered a substantial increase in the functional richness of both ray-finned fishes (80% of LMEs) and cartilaginous species (sharks and rays) (75% of LMESs), in line with an increase in the taxonomic richness, extracted from these ecosystems. The functional evenness and functional divergence of these catches have also altered substantially over the time span of this study, with considerable geographic variation in the patterns detected. These trends show that global fisheries are increasingly targeting species that play diverse roles within the marine ecosystem and underline the importance of incorporating functional diversity in ecosystem management.
New insight into the soft anatomy and shell microstructures of early Cambrian orthothecids (Hyolitha)
Authors: Li Luoyang , Skovsted Christian B. , Yun Hao , Betts Marissa J. , Zhang Xingliang
Published: August 2020

Hyoliths (hyolithids and orthothecids) were one of the most successful early biomineralizing lophotrochozoans and were a key component of the Cambrian evolutionary fauna. However, the morphology, skeletogenesis and anatomy of earliest members of this enigmatic clade, as well as its relationship with other lophotrochozoan phyla remain contentious. Here, we present a new orthothecid,
Longxiantheca mira
gen. et sp. nov. preserved as part of secondarily phosphatized small shelly fossil assemblage from the lower Cambrian Xinji Formation of North China.
Longxiantheca mira
retains some ancestral traits of the clade with an undifferentiated disc-shaped operculum, a simple conical conch with apical septa and a two-layered microstructure of aragonitic fibrous bundles. The operculum interior exhibits impressions of soft tissues, including muscle attachment scars, mantle epithelial cells and a central kidney-shaped platform interpreted as a support structure in association with its presumptive feeding apparatus. The muscular system in orthothecids appears to be similar to that in hyolithids, suggesting a consistent anatomical configuration among the total group of hyoliths. The new finding of shell secreting cells demonstrates a mantle regulating the mode of growth for the operculum. Investigations of shell microstructures support the placement of hyoliths as total group molluscs with an unsettled position within the phylum Mollusca.
Correlated and decoupled evolution of adult and larval body size in frogs
Authors: Phung Tung X. , Nascimento João C. S. , Novarro Alexander J. , Wiens John J.
Published: August 2020

The majority of animal species have complex life cycles, in which larval stages may have very different morphologies and ecologies relative to adults. Anurans (frogs) provide a particularly striking example. However, the extent to which larval and adult morphologies (e.g. body size) are correlated among species has not been broadly tested in any major group. Recent studies have suggested that larval and adult morphology are evolutionarily decoupled in frogs, but focused within families and did not compare the evolution of body sizes. Here, we test for correlated evolution of adult and larval body size across 542 species from 42 families, including most families with a tadpole stage. We find strong phylogenetic signal in larval and adult body sizes, and find that both traits are significantly and positively related across frogs. However, this relationship varies dramatically among clades, from strongly positive to weakly negative. Furthermore, rates of evolution for both variables are largely decoupled among clades. Thus, some clades have high rates of adult body-size evolution but low rates in tadpole body size (and vice versa). Overall, we show for the first time that body sizes are generally related between adult and larval stages across a major group, even as evolutionary rates of larval and adult size are largely decoupled among species and clades.
Zebra stripes, tabanid biting flies and the aperture effect
Authors: How Martin J. , Gonzales Dunia , Irwin Alison , Caro Tim
Published: August 2020

Of all hypotheses advanced for why zebras have stripes, avoidance of biting fly attack receives by far the most support, yet the mechanisms by which stripes thwart landings are not yet understood. A logical and popular hypothesis is that stripes interfere with optic flow patterns needed by flying insects to execute controlled landings. This could occur through disrupting the radial symmetry of optic flow via the aperture effect (i.e. generation of false motion cues by straight edges), or through spatio-temporal aliasing (i.e. misregistration of repeated features) of evenly spaced stripes. By recording and reconstructing tabanid fly behaviour around horses wearing differently patterned rugs, we could tease out these hypotheses using realistic target stimuli. We found that flies avoided landing on, flew faster near, and did not approach as close to striped and checked rugs compared to grey. Our observations that flies avoided checked patterns in a similar way to stripes refutes the hypothesis that stripes disrupt optic flow via the aperture effect, which critically demands parallel striped patterns. Our data narrow the menu of fly-equid visual interactions that form the basis for the extraordinary colouration of zebras.
Opinions 100, 101 and 102
Authors: Arahal David R.
Published: August 2020

The International Committee on Systematics of Prokaryotes has formally made final decisions, taking into account the conclusions of the Judicial Commission, on three pending Requests for an Opinion, thereby allowing the corresponding Opinions to be issued. According to Opinion 100, the request for the recognition of strain A1-86 (=DSM 17629=NCIMB 14373) as the neotype strain of

Eubacterium rectale

(Hauduroy et al. 1937) Prévot 1938 (Approved Lists 1980) is denied, ruling that a neotype does not need to be designated for

E. rectale

because strain VPI 0990 (=ATCC 33656=CIP 105953) is considered to be a duplicate isolate of the same strain as VPI 0989 (=ATCC 25578) and may serve as its nomenclatural type. Opinion 101 approves the request that strain ATCC 25946 (=DSM 14877) serves as the type strain of

Melittangium lichenicola

instead of strain ATCC 25944, formally correcting the Approved Lists of Bacterial Names. Opinion 102 concludes that strain Cc m8 (=DSM 14697=CIP 109128=JCM 12621) is an established neotype strain for the species

Myxococcus macrosporus

, replacing the designated type strain Windsor M271, and that strain Mx s8 (=DSM 14675=JCM 12634) is an established neotype strain for the species

Myxococcus stipitatus

, replacing the designated type strain Windsor M78, with some additional considerations about the nature of the type material replaced and about the name

Corallococcus

(

Myxococcus

) macrosporus.
Agriterribacter humi gen. nov., sp. nov., a novel bacterium of the family Chitinophagaceae isolated from soil of a farming field
Authors: Lee Jae-Chan , Whang Kyung-Sook
Published: August 2020

A Gram-stain-negative bacterium, designated strain YJ03T, was isolated from a spinach farming field soil at Shinan in Korea. Strain YJ03T was found to be an aerobic, non-motile and non-spore-forming bacterium which can grow at 10–33 °C (optimum, 25–28 °C), at pH 6.6–9.5 (optimum, pH 7.0–7.5) and at salinities of 0–1.0 % (w/v) NaCl (optimum, 0 % NaCl). Sequence similarities of the 16S rRNA gene of strain YJ03T with the closely related relatives were in the range 93.9–92.2 %, and the results of phylogenomic analysis indicated that strain YJ03T was clearly separated from species of the genera in the family

Chitinophagaceae

, showing average nucleotide identity values of 68.8–64.3 %. The predominant isoprenoid quinone was identified as MK-7 and the major fatty acids were iso-C15 : 0, iso-C17 : 0 3-OH and an unidentified fatty acid with an equivalent chain-length of 13.565. The major polar lipids were diphosphatidylglycerol, phosphatidylethanolamine, four unidentified aminolipids and six unidentified lipids. The G+C content of the genome was determined to be 41.8 mol%. On the basis of phenotypic and chemotaxonomic properties and phylogenetic and phylogenomic analyses using 16S rRNA gene sequences and whole-genome sequences in this study, strain YJ03T is considered to represent a novel species of a new genus in the family

Chitinophagaceae

, for which the name Agriterribacter humi gen. nov., sp. nov., is proposed. The type strain of Agriterribacter humi is YJ03T (=KACC 19548T=NBRC 113195T).