bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior Vertebral Column Resection Combined With Bone Cement Augmentation of Pedicle Screw Fixation for Treatment of Severe Vertebral Compression Fractures With Kyphotic Deformity
Authors: Ma Zheng , Jiao Jianbao , Yang Dalong , Ding Wenyuan
Published: January 2020

Study Design:

This was a retrospective study.

Objective:

Severe osteoporotic vertebral compression fractures with kyphotic deformity are difficult to treat. The objective of this study was to investigate the clinical efficacy of posterior vertebral column resection (PVCR) combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity.

Summary of Background Data:

The data of patients with a severe vertebral compression fracture and kyphotic deformity treated at our university between October 2013 and October 2017 were retrospectively reviewed.

Materials and Methods:

All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction. The operative time, intraoperative blood loss, postoperative complications, and screw stability at the last follow-up in all patients were documented. The clinical benefits were evaluated by the Visual Analog Scale (VAS) score, Oswestry Dysfunction Index (ODI), Japanese Orthopedic Association (JOA) scores, and Frankel classification.

Results:

The mean Cobb angle, sagittal vertical axis, VAS score, JOA score, and ODI were 48.5±6.9 degrees, 44.0±5.7, 6.5±1.5, 11.2±2.7, and 59.0±5.7 before surgery, respectively. The average follow-up period was 28.7±3.2 months. The Frankel grade in 5 patients with neurological impairment improved from D to E after surgery. The average Cobb angles for kyphotic deformity, sagittal vertical axis, VAS score, JOA score, and ODI were 9.5±3.8 degrees, 18.3±3.5, 2.6±1.2, 20.5±3.6, and 20.7±4.0, respectively, at the last follow-up (all P<0.05 compared with before surgery).

Conclusions:

For patients with severe vertebral compression fractures and kyphotic deformity, PVCR combined with bone cement augmentation of pedicle screw fixation can restore the spine sequence to achieve good clinical efficacy. Clinical trials are necessary for confirmation.
Combinational treatment of gap junction enhancers and paclitaxel attenuates mammary tumor growth
Authors: Shishido Stephanie , Nguyen Thu Annelise
Published: January 2020

A class of substituted quinolines (PQs) acts as a gap junction enhancer with the ability to increase the gap junctional intercellular communication in breast cancer cells. This study examined the effect of a combinational treatment of PQs and the antineoplastic drug paclitaxel in a xenograft animal model. Mice were implanted with estradiol-17ß (1.7 mg/pellet) before the injection of 1 × 107 T47D breast cancer cells subcutaneously into the inguinal region of mammary fat pad. Animals were treated intraperitoneally with DMSO (control), paclitaxel (10 mg/kg), PQ (25 mg/kg), or a combinational treatment of paclitaxel and PQ. There was no significant difference between the paclitaxel-treated animals and the control group after seven injections of treatment for 2 weeks. All mice treated with PQ had a significant decrease in mammary tumor growth. The combinational treatment of paclitaxel and PQ1 or PQ7 showed a reduction in tumor growth by 2.3- and 2.2-fold, respectively, compared to paclitaxel alone after seven treatments every 2 days. Molecular analysis indicated a significant increase of gap junction proteins and caspase signaling in PQ and paclitaxel-treated tissues compared to control. Furthermore, there is evidence of an upregulation of Cyclin D1 expression in paclitaxel-treated tumors compared to control, suggesting that the neoplastic cells were highly proliferative and nonresponsive to the paclitaxel alone. We have showed for the first time an increase in the efficacy of antineoplastic drugs via the enhancement of gap junctions with PQs, a specific class of gap junction enhancers.
miR-7641 depletion suppresses proliferation of gastric cancer cells by targeting ARID1A
Authors: Yang Yan , Yin Zong Xiu , Wang Zhao Yang , Tian Shu Bo , Wang Hong Chang , Zhang Fang Xu , Li Le Ping , Zheng Chunning , Kong Shuai
Published: January 2020

Gastric cancer (GC) is lethal and there is an urgent need for improved understanding of this disease. Recent studies have reported that microRNAs (miRNAs) play increasingly important roles in the regulation of GC. In this study, we explored the target genes and effects of miR-7641 in GC. Our data showed that high miR-7641 expression was associated with low expression of ARID1A in GC tissue. miR-7641 expression promoted GC cell proliferation and colony formation. Luciferase reporter assay results confirmed that ARID1A was a target gene of miR-7641. Furthermore, downregulation of ARID1A expression caused a significant increase in GC cell proliferation. In vivo depletion of miR-7641 reduced tumor volume and weight and increased ARID1A and Ki67 expression as well as a decreased terminal-deoxynucleotidyl transferase-mediated nick end labeling in mouse tumor tissues. Conversely, ARID1A silencing reversed the suppressive effects of miR-7641 inhibitors on GC cells. Overall, these findings indicate that miR-7641 is a promising novel prognostic biomarker of GC and may represent a novel target for clinical management of GC.
Heterotopic Ossification After an Achilles Tendon Rupture Cannot Be Prevented by Early Functional Rehabilitation: A Cohort Study
Authors: Magnusson S. Peter , Agergaard Anne-Sofie , Couppé Christian , Svensson René B. , Warming Susan , Krogsgaard Michael R. , Kjaer Michael , Eliasson Pernilla
Published: January 2020

Background

Tendon loading might play a role in the development of heterotopic ossification after Achilles tendon ruptures. Early heavy loading on a healing tendon in animals has been shown to prolong the proinflammatory response, and inflammatory cells are thought to drive heterotopic ossification formation. Taken together, this suggests that early rehabilitation might influence heterotopic ossification development.

Questions/purposes

The purposes of this study were to investigate (1) whether the presence of heterotopic ossification after Achilles tendon ruptures influences clinical outcome and (2) whether early mobilization or weightbearing prevents the development of heterotopic ossification.

Methods

This was a retrospective analysis of 69 patients from a previous clinical trial. All patients were treated surgically, but with three different early rehabilitation protocols after surgery: late weightbearing and ankle immobilization, late weightbearing and ankle mobilization, and early weightbearing and ankle mobilization. Plain radiographs taken 2, 6, 12, 26, and 52 weeks postoperatively were analyzed for heterotopic ossification, which was detected in 19% of patients (13 of 69) at 52 weeks. Heterotopic ossification was measured, scored, and correlated to clinical outcomes; heel-raise index (HRI), ankle joint ROM, tendon strain, Achilles tendon rupture score (ATRS), and Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire scores at 26 and 52 weeks postoperatively.

Results

Heterotopic ossification had no adverse effects on patient-reported outcomes (ATRS or VISA-A), tendon strain, or ROM. In fact, patients with heterotopic ossification tended to have a better HRI at 52 weeks compared with patients without (mean difference 14% [95% CI -0.2 to 27]; p = 0.053). Neither the occurrence (heterotopic ossification/no heterotopic ossification) nor the heterotopic ossification severity (ossification score) differed between the three rehabilitation groups. Seventeen percent of the patients (four of 24) with early functional rehabilitation (early weightbearing and ankle joint mobilization exercise) had heterotopic ossification (score, 2-3) while late weightbearing and immobilization resulted in heterotopic ossification in 13% of the patients (score, 3-4).

Conclusions

Heterotopic ossification occurs relatively frequently after Achilles tendon ruptures but appears to have no adverse effects on functional outcomes. Furthermore, heterotopic ossification develops during the first 6 weeks after rupture, and weightbearing or ankle-joint mobilization does not prevent this from occurring.

Level of Evidence

Level III, prognostic study.
Income-based inequalities in hypertension and in undiagnosed hypertension: analysis of Health Survey for England data
Authors: Scholes Shaun , Conolly Anne , Mindell Jennifer S.
Published: January 2020

Objective:

To quantify income-based inequalities in hypertension and in undiagnosed hypertension.

Methods:

We used nationally representative data from 28 002 adults (aged 16 years and older) living in private households who participated in the cross-sectional Health Survey for England 2011–2016. Using bivariate probit regression modelling, we jointly modelled hypertension and self-reported previous diagnosis of hypertension by a doctor or nurse. We then used the model estimates to quantify inequalities in undiagnosed hypertension. Inequalities, using household income tertiles as an indicator of socioeconomic status, were quantified using average marginal effects (AMEs) after adjustment for confounding variables.

Results:

Overall, 32% of men and 27% of women had survey-defined hypertension (measured blood pressure ≥140/90 mmHg and/or currently using medicine to treat high blood pressure). Higher proportions (38% of men and 32% of women) either self-reported previous diagnosis or had survey-defined hypertension. Of these, 65% of men and 70% of women had diagnosed hypertension. Among all adults, participants in low-income versus high-income households had a higher probability of being hypertensive [AMEs: men 2.1%; 95% confidence interval (CI): −0.2, 4.4%; women 3.7%; 95% CI: 1.8, 5.5%] and of being diagnosed as hypertensive (AMEs: men 2.0%; 95% CI: 0.4, 3.7%; women 2.5%; 95% CI: 1.1, 3.9%). Among those classed as hypertensive, men in low-income households had a marginally lower probability of being undiagnosed than men in high-income households (AME: −5.2%; 95% CI: −10.5, 0.1%), whereas no difference was found among women.

Conclusion:

Our findings suggest that income-based inequalities in hypertension coexist with equity in undiagnosed hypertension.
Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors
Authors: Hyde Janet S. , Mezulis Amy H.
Published: January 2020

The odds ratio (OR) for gender differences in major depression is 1.95, averaged meta-analytically over all ages and nations. The gender difference appears by age 12, OR = 2.37, and peaks at OR = 3.02 for ages 13–15. Using the ABC (affective, biological, cognitive) model as a framework within a vulnerability-stress approach, we consider the evidence for biological vulnerabilities (genes, pubertal hormones, and pubertal timing), affective vulnerabilities (temperament), and cognitive vulnerabilities (negative cognitive style, objectified body consciousness, and rumination). The impact of stress is central to the vulnerability-stress model, and we review evidence on gender differences in stress exposure, emphasizing gender differences in sex-related traumas such as child sexual abuse and rape. Finally, we examine sociocultural factors that may contribute to the gender difference, including the media and gender inequality. An implication for research methods is that single-gender designs should be questioned. Regarding clinical implications, the vulnerabilities and stressors identified in this review should contribute to personalized interventions with depressed individuals, especially depressed women.
Historical Considerations and Innovations in the Perioperative Use of Mitomycin C for Glaucoma Filtration Surgery and Bleb Revisions
Authors: Grover Davinder S. , Kornmann Helen L. , Fellman Ronald L.
Published: January 2020

Although there is a currently a revolution in angle-based procedures, subconjunctival filtration surgery with mitomycin C (MMC) wound modification remains a vital skill for glaucoma surgeons. MMC is a potent antifibrotic agent that has been an invaluable adjunct for successful glaucoma filtration surgery for over 20 years, but it must be used judiciously to avoid serious complications, including hypotony, corneal decompensation, bleb avascularity, bleb leaks, blebitis, and endophthalmitis. The purpose of this report is to describe the historical lessons learned from MMC use, along with updated methods of MMC delivery during primary trabeculectomy, bleb needling at the slit lamp, bleb revisions in the operating room, and newer and less invasive ab-interno filtering procedures. Information for the review was gathered using an extensive search on PubMed, a review of all available peer-reviewed literature, and the authors’ personal clinical judgment and experience.
A Study of Histopathologic Evaluation and Clinical Correlation for Isolated Congenital Myogenic Ptosis and Aponeurotic Ptosis
Authors: Nalci Baytaroğlu Hilal , Kaya Bengisu , Korkusuz Petek , Hoşal Melek B.
Published: January 2020

Purpose:

To evaluate light microscopy and transmission electron microscopy findings of levator muscle/aponeurosis materials and their correlation with clinical findings in isolated congenital myogenic and aponeurotic blepharoptosis.

Methods:

Demographic and clinical data were obtained from patients. Qualitative and quantitative evaluations for muscle fiber morphology were performed using light microscopy and transmission electron microscopy on tissue samples which were obtained from the most proximal part of the aponeurosis excised during levator muscle/aponeurosis resection surgery.

Results:

Seventeen (55%) of the cases were isolated congenital myogenic ptosis, and 14 (45%) were aponeurotic ptosis. Muscle bundle splitting, cytoplasmic loss, and centrally located nuclei were observed in both groups. Muscle tissue covered 25% of the sample in 67% of the cases, 50% in 11%, 75% in 11%, and 100% in 11% in the myogenic group. In the aponeurotic group, muscle tissue covered 25% of the sample in 44.5% of the cases, 50% in 11%, and 100% in 44.5% (χ
2, p = 0.52). Myofibrillar loss areas accompanied by Z-line disorganization which were occupied by degenerated organelles were present in both groups under transmission electron microscopy, and findings were not significantly different between groups (χ
2, p > 0.05). Mean mitochondrial diameter was significantly larger in aponeurotic ptosis (Mann-Whitney U, p = 0.047). No correlation was found between functional and microscopic parameters.

Conclusion:

Decreased amount of striated muscle and the presence of fiber damage indicators were observed in both groups. Muscle fiber loss in myogenic ptosis may be a feature of muscle dysgenesis. Ultrastructural damage in aponeurotic ptosis may be explained with increased oxidative stress or long-term contractile stress. Further genetic and immunohistochemical studies will be helpful to further understand the pathogenesis of diseases.
Comparison of Positive Results With End-Point and Real-Time Polymerase Chain Reaction Assays for the Diagnosis of Pneumocystis Pneumonia
Authors: Zhou Shiwei , Kauffman Carol A. , Miceli Marisa H.
Published: January 2020

Background

The definitive diagnosis of Pneumocystis pneumonia requires direct visualization of the organism; in recent years, polymerase chain reaction (PCR) assays, although not standardized, have become widely used diagnostic tools. A concern is that newer, more sensitive PCR assays will not differentiate colonization from infection. We evaluated the clinical implications of 2 different PCR assays for the diagnosis of Pneumocystis pneumonia.

Methods

Adult patients with a bronchoalveolar lavage or sputum sample positive for Pneumocystis by PCR from February 2014 to February 2018 were studied. Samples were tested with end-point (EP) PCR before February 2017 and with real-time (RT) PCR after February 2017. A strict case definition based on host factors, clinical presentation, radiological and pathological findings, and response to therapy was used to categorize cases as proven, probable, possible, and no Pneumocystis pneumonia. Positive EP-PCR and RT-PCR results were deemed to be true positives or false positives based on this categorization of patients.

Results

Of 1693 patients tested, 153 (9%) had a positive PCR test result, and 118 met the case definitions for proven (n = 2), probable (n = 70), and possible (n = 46) Pneumocystis pneumonia., Among 35 patients with a positive PCR test result who did not the meet criteria for Pneumocystis infection and who had a verified alternative diagnosis, 8 (23%) were false positive by EP-PCR and 27 (77%) by RT-PCR (P < 0.0001). Among the 27 patients who did not have host factors that would classically place them at risk of Pneumocystis infection, RT-PCR gave significantly more false-positive results (n = 12; 44%) than did EP-PCR (n = 2; 7%; P < 0.001).

Conclusions

Reverse transcription PCR gave significantly more positive results than did EP-PCR in patients who likely were colonized only and did not have Pneumocystis infection. Host risk factors, clinical presentation, and radiological findings should be considered before ordering PCR testing for Pneumocystis.
Crossover Study of Kinematic, Kinetic, and Metabolic Performance of Active Persons with Transtibial Amputation Using Three Prosthetic Feet
Authors: Lura Derek J. , Carey Stephanie L. , Miro Rebecca M. , Kahle Jason T. , Highsmith M. Jason
Published: January 2020

Introduction

This study was a double-blinded, randomized, repeated measures test of 14 persons with a unilateral transtibial amputation (TTA) walking and running on the Vari-Flex, Elite Blade, and the Re-Flex Rotate feet, with comparisons to persons without an amputation. The goal of the study was to compare ankle flexion, ankle moment, step length, ground reaction force (GRF), and metabolic cost of similar prosthetic feet for walking and running.

Materials and Methods

Marker-based motion capture, GRF, and metabolic data were recorded, whereas participants walked and ran on a treadmill at self-selected speeds. Data were statistically analyzed for significant differences between conditions and groups using a multivariate analysis, with post hoc Tukey's test for multiple comparisons.

Results

Plantarflexion was found to be significantly lower for prosthetic conditions than the contralateral and control conditions. Control participants had a shorter step length during walking. GRFs were generally lower for control and contralateral limbs. Heart rate, oxygen uptake, and self-selected speed were higher for TTAs than controls for walking and running.

Conclusions

Differences between prosthetic feet included in this study were minimal. Although significant differences between TTAs and controls were found, these differences were confounded by the difference in self-selected speeds.
Validation of the InBody BPBIO250 oscillometric blood pressure monitor for professional office use in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard
Authors: Kollias Anastasios , Gravvani Areti , Anagnostopoulos Ioannis , Kyriakoulis Konstantinos G. , Bountzona Ioanna , Menti Ariadni , Stergiou George S.
Published: January 2020

Objective

The aim of this study was to evaluate the accuracy of the InBody BPBIO250 oscillometric upper-arm professional office blood pressure (BP) monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

Methods

Subjects were recruited to fulfil the age, gender, BP, and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22–32 (medium) and 32–42 cm (large).

Results

Ninety-seven subjects were recruited and 88 were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 1.9 ± 5.9/0.9 ± 4.9 mmHg (systolic/diastolic). For criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 4.78/4.31 mmHg (systolic/diastolic).

Conclusion

The InBody BPBIO250 professional oscillometric device for office BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use.
Multicenter experience with percutaneous coronary intervention for chronic total occlusion in Korean population: analysis of the Korean nationwide multicenter chronic total occlusion registry
Authors: Rha Seung-Woon , Choi Byoung Geol , Choi Se Yeon , Choi Cheol Ung , Gwon Hyeon-Cheol , Chae In-Ho , Kim Hyo-Soo , Park Hun Sik , Lee Seung-Hwan , Kim Moo-Hyun , Hur Seung-Ho , Jang Yangsoo
Published: January 2020

Objectives

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains challenging because of limited success and higher target vessel failure rates. Detailed safety and efficacy data for CTO-PCI from a multicenter real-world Korean registry are limited.

Methods

Since May 2007, the Korean multicenter retrospective CTO registry has enrolled 3271 patients who underwent CTO-PCI at 26 major medical centers. Baseline clinical, angiographic, and procedural characteristics and 12-month major adverse cardiac event (MACE) rates after PCI were retrospectively collected.

Results

Baseline cardiovascular risk factors included: male sex, 73.8%; prior myocardial infarction (MI), 14.8%; prior PCI, 26.6%; hypertension, 62.3%; diabetes mellitus, 34.8%; dyslipidemia, 33.3%; and current smoker, 30.9%. Pre-PCI myocardial viability testing was performed in 23.6% of patients and pre-PCI cardiac computed tomography (CT) in 17.6%. CTO arterial lesions were distributed as follows: right coronary, 41.0%; left anterior descending, 40.0%; left circumflex, 22.5%; and left main, 0.4%. Unfavorable lesion morphology was detected by angiography in 38.1%. Intravascular ultrasound guidance and the retrograde approach were utilized in 23.6 and 3.1% of CTO-PCI procedures, respectively. More than 75% of patients received drug-eluting stents (sirolimus-eluting, 26.5%; paclitaxel-eluting, 23.8%; zotarolimus-eluting, 23.4%; everolimus-eluting, 11.0%; and others, 4.0%). The overall success rate was 81.6% (2672/3271 patients). Twelve-month event rates were: total mortality, 2.4%; any MI, 0.7%; target lesion revascularization, 4.4%; target vessel revascularization, 6.7%; and total MACE, 9.4%.

Conclusions

Twelve-month success rates, safety profiles, and cumulative clinical outcomes of Korean CTO patients were favorable post-PCI. Long-term follow-up of larger study populations is necessary to validate our findings.
The prognostic value of the ratio of neutrophils to lymphocytes before and after intensity modulated radiotherapy for patients with nasopharyngeal carcinoma
Authors: Liu Jing , Wei Changwu , Tang Haijun , Liu Yun , Liu Wenqi , Lin Chengsen
Published: January 2020

This study aimed to determine the impact of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT).

Pre/post-treatment and changes in inflammatory biomarker levels of 207 patients who were diagnosed with NPC and received IMRT between January 2012 and December 2014 were analyzed, and the cellular biomarker analyses were from patient blood. ROC (receiver operating characteristic) analysis was used to decide the optimal cutoff values of NLR and changes in NLR (ΔNLR) and PLR (ΔPLR). The Kaplan–Meier and logarithmic rank methods were used to compare overall survival times between groups. Univariate analysis was used to investigate the effects of age, gender, histology, Karnofsky performance score (KPS), TNM stage, clinical stage, course of disease and lymphocyte, neutrophil and platelet counts as well as alkaline phosphatase (ALP) levels on the prognosis of NPC. The independent predictors of OS were determined by Cox multivariate regression analysis.

The optimal cut-off values of NLR, PLR, ΔNLR and ΔPLR were 2.49, 155.82, 1.80, and 100.00, respectively. These were used to classify patients into high (NLR > 2.49) and low NLR groups (NLR < 2.49); high (PLR>155.82) and low (PLR < 155.82) PLR groups; high (ΔNLR>1.80) and low ΔNLR groups (ΔNLR < 1.80); high (ΔPLR > 100.00) and low ΔPLR groups (ΔPLR < 100.00). TNM stage, clinical stage and ALP levels were highly correlated with high NLR and PLR. Cox multivariate regression analysis suggested that the ΔNLR (HR = 2.89, 95% CI: 1.33∼2.78) was independent of the characteristics for NPC.

As a novel inflammatory index, ΔNLR appears to have some predictive power for the prognosis of patients with NPC.
Acupuncture on treating angina pectoris
Authors: Wang Ji-sheng , Yu Xu-dong , Deng Sheng , Yuan Hong-wei , Li Hai-song
Published: January 2020

Background:

Coronary heart disease angina pectoris is a common clinical symptom in patients with coronary heart disease, due to coronary atherosclerotic stenosis or sputum leading to coronary insufficiency, myocardial transient ischemia, hypoxia caused by precordial pain as the main clinical manifestations Group syndrome. Coronary heart disease angina causes coronary blood flow insufficiency, cannot meet the normal activities of myocardial cells, leading to myocardial ischemia or necrosis. When the disease occurs, there is paroxysmal and crushing pain in the precordial area of the patient. Therefore, we recognize the importance of the disease and have paid enough attention. Clinical studies in recent years have found that the use of acupuncture in the treatment of angina pectoris has a good clinical application prospect. This study was conducted to study the effect of using acupuncture to treat angina pectoris.

Methods and analysis:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of angina pectoris.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of acupuncture for angina pectoris. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.

Registration number:

PROSPERO CRD42019138003.
The problem of colorectal anastomosis safety
Authors: Kryzauskas Marius , Poskus Eligijus , Dulskas Audrius , Bausys Augustinas , Jakubauskas Matas , Imbrasaite Ugne , Makunaite Gabija , Kuliavas Justas , Bausys Rimantas , Stratilatovas Eugenijus , Strupas Kestutis , Poskus Tomas
Published: January 2020

Introduction:

Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. The aim of the study is to evaluate the safety and feasibility of novel – trimodal intraoperative colorectal anastomosis testing technique.

Methods and analysis:

This multi-center prospective cohort pilot study will include patients undergoing colorectal anastomosis formation below 15 cm from the anal verge. Trimodal anastomosis testing will include testing for blood supply by ICG fluorescence trans-abdominally and trans-anally, testing of mechanical integrity of anastomosis by air-leak and methylene blue leak tests and testing for tension. The primary outcome of the study will be AL rate at day 60. The secondary outcomes will include: the frequency of changed location of bowel resection; ileostomy rate; the rate of intraoperative AL; time, taken to perform trimodal anastomosis testing; postoperative morbidity and mortality; quality of life.

Discussion:

Trimodal testing of colorectal anastomosis may be a novel and comprehensive way to investigate colorectal anastomosis and to reveal insufficient blood supply and integrity defects intraoperatively. Thus, prevention of these two most common causes of AL may lead to decreased rate of leakage.

Study registration:

Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03958500, May, 2019.
Chronic chorioretinal detachment under normal intraocular pressure in eye with uveitic glaucoma after trabeculectomy
Authors: Sakurai Yutaka , Takayama Kei , Abe Tatsuhiro , Takeuchi Masaru
Published: January 2020

Rationale:

Choroidal detachment is a major postoperative complication of trabeculectomy. Postoperative choroidal detachment occurs with low intraocular pressure (IOP), and is naturally resolved by elevation of IOP. We report a case of chronic chorioretinal detachment (CRD) in the eye with uveitic glaucoma after trabeculectomy which persisted with normal IOP resistant for medication and required surgery.

Patient concerns:

A 63-year-old man was referred to our department with uncontrolled uveitic glaucoma in his right eye. At first presentation, IOP was 62 mm Hg in the right eye with opened angle, and active ocular inflammation was presented by moderate cell infiltration to the anterior chamber.

Diagnosis:

Uveitic glaucoma.

Interventions:

Trabeculectomy with mitomycin-C combined with phacoemulsification were performed without any surgical trouble. Postoperative inflammation in the anterior segment was mild, and IOP decreased to the middle-teen.

Outcomes:

At 19 days after surgery, the depth of the anterior chamber changed to shallow and CRD occurred in the inferior quadrant area. This complication could not be resolved by additional systemic corticosteroid medication and scleral fenestration. Although IOP was maintained in middle-teen range, suture fixation of the sclera flap and additional scleral fenestration were necessary to resolve CRD at 191 days after primary surgery.

Lessons:

In uveitic eye with uncontrolled ocular hypertension, severe CRD after trabeculectomy is able to occur even with normal IOP, which requires surgical procedure in addition to the medical treatment.
FLAIR vascular hyperintensity-DWI mismatch most likely to benefit from recanalization and good outcome after stroke
Authors: Wang Yong , Zhou Zhijun , Ding Shaohua
Published: January 2020

We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).

Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.

Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ± 1.53 vs 3.49 ± 1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117–0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061–0.468; P = .001).

Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.
Correlation between expression of Ki-67 and MSCT signs in different types of lung adenocarcinoma
Authors: Yan Jingang , Wang Heping , Zhou Haiwei , He Hui , Qiu Lin , Wang Zhaoyu
Published: January 2020

To investigate the correlation between the proliferating cell nuclear antigen Ki-67 and the multislice computed tomography (MSCT) signs in different subtypes of lung adenocarcinoma.

Ninety-five patients with lung adenocarcinoma confirmed by surgical pathology and treated between January 2017 and December 2017 were included. MSCT was performed before the operation, and the characteristics of the high-resolution CT (HRCT) signs of the lesions were compared with the Ki-67 immunohistochemistry results.

The levels of Ki-67 in the 95 lung adenocarcinoma specimens were positively correlated with the malignancy of lung adenocarcinoma. Spearman correlation coefficient was 0.615. The expression of Ki-67 was positively correlated with the nodules’ diameter, density, and lobulated sign, with Spearman correlation coefficients of 0.58, 0.554, and 0.436. There was no significant correlation with spiculation and pleural retraction, with correlation coefficients of 0.319/0.381.

These findings suggest that the MSCT signs of different types of lung adenocarcinoma might be associated with the expression of Ki-67. Without replacing biopsy, the imaging features of pulmonary nodules could be comprehensively analyzed to evaluate the proliferation potential of preoperative nodules, but additional studies are needed for confirmation.
Assessment of melatonergics in prevention of delirium in critically ill patients
Authors: Zhu Yibing , Jiang Zhiming , Huang Huibin , Wang Yang , Zhang Linlin , Ren Chao , Yao Yongming , Li Wei , Du Bin , Xi Xiuming
Published: January 2020

Background:

Delirium is a commonly occurred complication in the critically ill. Melatonin is an endogenous hormone exerting multiple biological effects, mainly in regulating diurnal rhythms, also in inflammatory process and immune response. We aimed to assess the efficacy of exogenous melatonergics in prevention of delirium.

Methods:

PubMed, Cochrane Library, and Embase will be searched to identify randomized controlled trials published from 1960 to April 2019. Critically ill adult patients administrated with melatonergics will be included. The primary outcome measure will be the incidence of delirium. The secondary outcome measure will be the length of stay in intensive care unit. The pooled effects of dichotomous outcomes will be analyzed as risk ratio, and that of continuous outcomes will be analyzed using weighted mean difference. Subgroup and sensitivity analyses will be conducted. Funnel plots and/or Egger test will be done for the examination of publication bias. The quality of evidence resulting from this study will be evaluated using the GRADE methodology. Trial sequential analysis (TSA) will be done to test whether the evidence in our meta-analysis is reliable and conclusive.

Result:

The evidence to date of the melatonergics in prevention of delirium will be systematically reviewed and meta-analyzed with the GRADE level reported and TSA examined.

Conclusion:

The stronger evidence for the efficacy of melatonergics in prevention of delirium in critically ill patients will be provided for intensive care physicians.

PROSPERO registration number:

CRD42019138863.
Autoimmune hemolytic anemia in hospitalized patients
Authors: Chen Chunxia , Wang Lixin , Han Bing , Qin Li , Ying Binwu
Published: January 2020

Autoimmune hemolytic anemia (AIHA) is a rare disease in which autoantibodies target red blood cells (RBCs), leading to anemia that ranges from no symptoms to severe life-threatening hemolysis. Little is known about the severity of anemia, blood transfusion efficiency and risk of transfusion-related reactions among hospitalized AIHA patients, especially in those with incompatible RBC transfusions.

A retrospective study was conducted among hospitalized AIHA patients from January 2009 to December 2015 in a large tertiary care medical center in southwest China.

A total of 450 AIHA hospitalized patients were recruited, of whom 97.3% had warm AIHA, 30.3% had primary AIHA, and 90.7% were treated with corticosteroids. On admission, approximately 3% of patients had an hemoglobin (Hb) <30 g/L, 34% had an Hb between 30 and 59.9 g/L, and 46% had an Hb ranging from 60 to 89.9 g/L. A total of 2509.5 U RBCs were transfused to AIHA patients, and 14 transfusion-related adverse reactions were recorded, without any hemolytic transfusion reactions. With an average transfusion trigger of 52.0 ± 9.3 g/L, 59.7% of the patients received RBCs, and 55.8% of the transfusions were viewed as effective. Least incompatible RBCs were given in 39% of the transfusions, but the transfusion efficiency did not significantly decrease with these incompatible blood transfusions (P = .253). Primary AIHA patients with a nadir Hb of approximately 40 to 50 g/L during their hospital stay had the highest rate of remission and did not require a different total number of RBC transfusions (P = .068) or length of hospitalization (P = .194) compared to other groups with nadir Hb values <30 g/L, ≥30 and <40 g/L, ≥50 and <60 g/L, and ≥60 g/L.

One-third of AIHA patients suffered from severe anemia during hospitalization, and transfusions, even with incompatible RBCs, were safe and efficient. However, transfusion triggers between 40 and 50 g/L seemed to benefit the most patients by alleviating the RBC destruction caused by autoantibodies, and a restrictive transfusion strategy was beneficial in AIHA patients.
The hepatitis B core antibody positive/hepatitis B surface antigen negative pattern is associated with the increased risk of intracranial atherosclerotic stenosis
Authors: Shen Lin , Zhou Huchuan , Wei Fei , Shuai Jie
Published: January 2020

The high prevalence of hepatitis B virus (HBV) infection and intracranial atherosclerotic stenosis (ICAS) in Asia raises the question as to whether HBV infection is associated with ICAS. To answer this question, we tested the association between HBV infection and ICAS. Totally, 3072 in-hospital subjects were retrospectively enrolled. All subjects underwent computed tomography angiography (CTA) and serological testing for HBV infection. Based on the results of CTA, all subjects were categorized into 4 groups including ICAS, extracranial atherosclerotic stenosis (ECAS), ICAS/ECAS (both ICAS and ECAS), and normal. HBV infection was divided into 4 patterns including hepatitis B core antibody (anti-HBc) positive/hepatitis B surface antigen (HBsAg) positive, anti-HBc-positive/HBsAg-negative, anti-HBc-negative/HBsAg-positive, and anti-HBc-negative/HBsAg-negative. Risk factors for atherosclerosis were collected based on medical records. Multiple logistic regression models were used to determine the association between infection patterns and ICAS. We found that the anti-HBc-positive / HBsAg-negative pattern was associated with the increased risk of ICAS (OR = 1.462) and not associated with ECAS or ICAS / ECAS. The HBc-positive/HBsAg-positive pattern was not associated with ICAS, ECAS or ICAS/ECAS. In conclusions, the anti-HBc-positive/HBsAg-negative pattern was associated with the increased risk of ICAS. Anti-HBc should be employed to investigate the association between HBV infection and cerebrovascular diseases.
Accuracy of Hospital Discharge Codes in Medicare Claims for Knee and Hip Replacement Patients
Authors: Kim Hyunjee , Grunditz Jenny I. , Meath Thomas H.A. , Quiñones Ana R. , Ibrahim Said A. , McConnell K. John
Published: January 2020

Background:

Despite the importance of the hospital discharge destination field (“discharge code” hereafter) for research and payment reform, its accuracy is not well established.

Objectives:

The aim of this study was to examine the accuracy of discharge codes in Medicare claims.

Data Sources:

2012–2015 Medicare claims of knee and hip replacement patients.

Research Design:

We identified patients’ discharge location in claims and compared it with the discharge code. We also used a mixed-effects logistic regression to examine the association of patient and hospital characteristics with discharge code accuracy.

Results:

Approximately 9% of discharge codes were inaccurate. Long-term care hospital discharge codes had the lowest accuracy rate (41%), followed by acute care transfers (72%), inpatient rehabilitation facility (80%), and home discharges (83%). Most misclassifications occurred within 2 broad groups of postacute care settings: home-based and institutional care. The odds of inaccurate discharge codes were higher for Medicaid-enrolled patients and safety-net and low-volume hospitals.

Conclusions:

Inaccurate hospital discharge coding may have introduced bias in studies relying on these codes (eg, evaluations of Medicare bundled payment models). Inaccuracy was more common among Medicaid-enrolled patients and safety-net and low-volume hospitals, suggesting more potential bias in existing study findings pertaining to these patients and hospitals.
Metabolomics and adductomics of newborn bloodspots to retrospectively assess the early-life exposome
Authors: Petrick Lauren M. , Uppal Karan , Funk William E.
Published: January 2020

Purpose of review

Exposomics studies can measure health-relevant chemical exposures during a lifetime and estimate the ‘internal’ environment. However, sampling limitations make these features difficult to capture directly during the critical neonatal time period.

Recent findings

We review the use of newborn dried bloodspots (DBS) archived from newborn screening programs for exposomic analysis in epidemiological children's health studies. Emerging ‘omics technologies such as adductomics and metabolomics have been adapted for DBS analysis, and these technologies can now provide valuable etiological information on the complex interplay between exposures, biological response, and population phenotypes.

Adductomics and metabolomics of DBS can provide robust measurements for retrospective epidemiological investigations. With extensive bioarchiving programs in the United States and other countries, DBS are poised to substantially aid epidemiological studies, particularly for rare and low-frequency childhood diseases and disorders.
Health-related quality of life in renal stone formers: are we improving?
Authors: Serna Juan , Talwar Ruchika , Ziemba Justin B.
Published: January 2020

Purpose of review

Health-related quality of life (HRQOL) is a multidimensional construct measuring how disease impacts one's life. In the context of nephrolithiasis this is particularly relevant given the active and quiescent phases of the disease which may not correlate with the traditional index of stone free status. Several instruments are now available to objectively measure HRQOL in this population, including the first disease-specific instrument. Therefore, an overview of emerging data on HRQOL is provided that reviews the availability of these tools/instruments and emphasizes patient-centered care and research.

Recent findings

The common generic instruments used to measure HRQOL in any population (36-Item Short Form health survey and Patient-Reported Outcomes Measurement Information System) and the only disease-specific instrument developed to measure HRQOL in nephrolithiasis (Wisconsin Stone Quality of Life Questionnaire) are described. Emerging evidence suggests that age and sex influence renal stone formers perception of their HRQOL across a range of dimensions. Several other factors also appear to play a role, such as socioeconomic status, but these have yet to be validated in more than one study or population, and postoperative outcomes measured in terms of HRQOL are almost absent from the literature.

Physician-centric outcomes, such as stone status, are no longer the only objective and acceptable measures by which to understand the natural history of nephrolithiasis. Patient-centered approaches through the use of HRQOL are slowly emerging in research and clinical care alike. However, they remain largely in their infancy in these spheres.
The most important activities of daily functioning: the opinion of persons with lower limb amputation and healthcare professionals differ considerably
Authors: van Schaik Loeke , Hoeksema Sanne , Huvers Laura F. , Geertzen Jan H.B. , Dijkstra Pieter U. , Dekker Rienk
Published: January 2020

The aim of this study is to determine the 15 most important daily activities according to persons with lower limb amputation (LLA) and healthcare professionals. Persons with LLA (n = 125) and healthcare professionals (n = 44) filled in a questionnaire. Participants had to select 10 items out of a list of 40 items on the domains activity and/or participation. Selection criterion was what they considered to be most important to perform independently and order the selected 10 items from most to least important. Mean rank scores of the 15 highest scored items according to participants with LLA were compared with the mean rank scores given by professionals, using the Mann–Whitney U test with a Hochberg adjustment for multiple testing. Participants with LLA rated five activities as significantly more important compared to professionals: ‘driving a car’, ‘bicycling’, ‘ascending/descending stairs’, ‘heavy exercise’, and ‘preparing meals’. Healthcare professionals rated four activities as significantly more important compared to persons with LLA: ‘going to the toilet’, ‘getting in and out bed’, ‘walking around outdoors’, and ‘walking around indoors’. A significant difference in rating importance was present in 9 out of 15 activities between persons with LLA and healthcare professionals. This result makes it all the more clear how complex shared decision making can be and how important it is for healthcare professionals to communicate with the person with LLA.