bluuebunny/crossref_metadata_2025 huggingface dataset:
A National Survey of Quality Improvement Education in Physician Assistant Programs
Authors: Berkowitz Oren , Goldgar Constance , White Susan E. , Warner Mary L.
Published: February 2019

Purpose

Quality improvement (QI) is emerging as a leadership and career track for physician assistants (PAs). Information on how PA programs teach QI is sparse. This study aimed to define how PA programs are providing education in QI through a national program survey.

Methods

Curriculum survey questions were deployed as a part of the 2014–2015 Physician Assistant Education Association program survey. Questions were grouped into 4 categories: QI champion, pedagogy, integration strategy, and curriculum content. Differences between groups were analyzed, and logistic regression models were built to explore associations.

Results

All 194 (100%) PA programs responded to the survey. There were 137 (70.6%) programs that were teaching QI. The median number of total instructional hours was 12 (interquartile range = 16, overall range = 109). There were 37 (27%) programs that were categorized as having a “mature curriculum.” Mature curricula were significantly associated with a QI champion who is an expert from an outside department/institution (odds ratio [OR], 5.05; 95% confidence interval [CI], 1.14–22.33) and with programs that have a QI capstone or thesis project (OR, 3.66; 95% CI, 1.14–11.72) whose educational hours correlated more with experiential learning (r = 0.51, P < .01), small group sessions (r = 0.42, P = .01), and web-based modules (r = 0.36, P = .03).

Conclusion

Quality improvement is an important skill set for PAs, but nearly one-third of PA programs do not have a QI curriculum. Mature curricula were associated with more experiential learning and project-based learning (including capstone/thesis). This study captured many elements of QI education for PAs, which can be used by programs to develop and improve their curricula.
Physician factors in utilizing haemodynamic data in patient care
Authors: Boerma Evert Christiaan , Bootsma Inge Tjitske
Published: February 2019

Purpose of review

To focus on the missing link between accuracy and precision of monitoring devices and effective implementation of therapeutic strategies.

Recent findings

Haemodynamic monitoring is generally considered to be an essential part of intensive care medicine. However, randomized controlled trials fail to demonstrate improved outcome unequivocally as a result of hemodynamic monitoring. This absence of solid proof renders doctors to hesitance to apply haemodynamic monitoring in clinical practise. Profound understanding of the underlying mechanisms, adequate patient selection and timing, meaningful representation and software-supported interpretation of data all play an important role. Furthermore, protocol adherence and human behaviour seem to form the often missing link between a solid physiologic principle and clinically relevant outcome. Introduction of haemodynamic monitoring should therefore not be limited to theoretical and practical issues, but also involve integration strategies. By learning from others, we might be able to implement haemodynamic monitoring in such a way that it has potential to modify the course of a disease.

The clinical success of haemodynamic monitoring goes far beyond accuracy and precision of monitoring devices. Understanding of the factors influencing the effective implementation of therapeutic strategies plays an important role in the meaningful introduction of haemodynamic monitoring.
Analysis of bone mass and its relationship with body composition in school-aged children and adolescents based on stage of puberty and site specificity
Authors: Song Cui , Zhu Min , Zheng Rongfei , Hu Yujuan , Li Rong , Zhu Gaohui , Chen Long , Xiong Feng
Published: February 2019

The aim of this study was to better understand the relationship of bone mass with body composition based on different stages of puberty and to illuminate the contribution of site-specific fat mass and lean mass (FM and LM) compared with bone mass in school-aged children and adolescents in Chongqing, China.

A total of 1179 healthy subjects of both sexes were recruited. Bone mineral content (BMC), bone mineral density (BMD), bone area, and both FM and LM were measured by dual-energy X-ray absorptiometry (DXA). The fat mass and lean mass indexes (FMI and LMI, respectively) were calculated as the FM (kg) and LM (kg) divided by the height in meters squared, respectively.

Most of the bone mass indicators were significantly higher for postpubertal boys than for girls at the same stage (P < .001). The proportion of subjects with normal bone mass increased, while the proportion of subjects with osteopenia and osteoporosis decreased with increased body weight regardless of gender and puberty stage (P < .01). FM and LM were significantly positively related to bone mass regardless of gender and puberty stage (P < .0001). FMI and LMI were significantly positively related to bone mass in most conditions (P < .05 and P < .0001, respectively). Four components of the FM and LM were linearly and significantly associated with BMD and BMC for TB and TBHL. Among them, the head fat mass and head lean mass showed the greatest statistical contribution.

In the process of assessing bone status, we recommend measuring fat and lean masses, including the fat and lean masses of the head.
Perineural cyst with intracystic hemorrhage following aneurysmal subarachnoid hemorrhage
Authors: Cho Keun-Tae , Nam Kiyeun
Published: February 2019

Rationale:

Most perineural cysts are asymptomatic and discovered incidentally at the time of imaging. Although enlargement of the perineural cyst (PC) through a ball-valve mechanism and resultant compression of the adjacent neural or bony structures are known to be a source of pain in PCs, the reason why asymptomatic PCs become symptomatic is unclear. The authors report a case of PC, which was presumed to become symptomatic after subarachnoid hemorrhage without enlargement of the pre-existing PC.

Patient concerns:

A 47-year-old woman complained of lumbosacral pain after neck clipping for a ruptured cerebral aneurysm.

Diagnoses:

Magnetic resonance imaging (MRI) revealed a PC with intracystic hemorrhage at the S2 level. In comparison with the size of the PC on computed tomography performed 3 years ago, there was no change in the size. Electrodiagnostic studies performed 6 weeks after the onset of the pain showed subacute right S2 radiculopathy.

Interventions:

With conservative treatment, her pain gradually diminished.

Outcomes:

When the lumbosacral pain improved, follow-up MRI showed that a fluid-fluid level within the PC disappeared.

Lessons:

Hemorrhage from the subarachnoid space, such as spontaneous aneurysmal SAH, into the pre-existing PC can cause an asymptomatic PC to become symptomatic without getting enlarged. Stretching of the nerve root due to hemorrhage or irritation of the nerve root due to an inflammatory reaction to blood products can make asymptomatic PCs symptomatic without enlargement of PCs.
Association between the level of serum soluble ST2 and invasively measured aortic pulse pressure in patients undergoing coronary angiography
Authors: Kim Hack-Lyoung , Lee Jung Pyo , Lim Woo-Hyun , Seo Jae-Bin , Zo Joo-Hee , Kim Myung-A , Kim Sang-Hyun
Published: February 2019

Despite the well-documented value of ST2 in heart failure and myocardial infarction, the role of ST2 in vascular biology has not yet been well defined. This study was performed to investigate the association between serum soluble ST2 (sST2) and invasively measured aortic pulse pressure (APP). A total of 167 consecutive patients with suspected coronary artery disease (CAD) (65.1 ± 9.8 years; men, 65.9%) referred for invasive coronary angiography was prospectively enrolled. APP was measured at the ascending aorta with a pig-tail catheter, and arterial blood samples for the measurement of sST2 were collected before coronary angiography. Serum sST2 levels were quantified by radioimmunoassay. Most of the patients (73.9%) had significant CAD (stenosis ≥ 50%) on coronary angiography. Patients with higher APP (≥76 mmHg) showed a significantly higher sST2 level compared to those with lower APP (<76 mmHg) (31.7 ± 13.9 ng/mL vs 26.2 ± 10.2 ng/mL, P < .001). In simple correlation analysis, there was a significant positive correlation between sST2 levels and APP (r = 0.413, P < .001). In multiple linear regression analysis, sST2 had an independent association with APP even after controlling for potential confounders (β = 0.331, P < .001). The serum sST2 level may be independently associated with invasively measured APP in patients undergoing coronary angiography. The result of this study gives insight into the role of sST2 in aortic stiffening, and suggests that the sST2 level may be a useful marker of aortic stiffness.
Endoscopic versus surgical treatment for pancreatic pseudocysts
Authors: Farias Galileu F.A. , Bernardo Wanderley M. , De Moura Diogo T.H. , Guedes Hugo G. , Brunaldi Vitor O. , Visconti Thiago A. de C. , Gonçalves Caio V.T. , Sakai Christiano M. , Matuguma Sergio E. , Santos Marcos E.L. dos , Sakai Paulo , De Moura Eduardo G.H.
Published: February 2019

Objective:

This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP).

Methods:

The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization.

Results:

There was no significant difference between treatment success rate (risk difference [RD] −0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD −0.02; 95% CI [−0.04,0.08]; P = .48), general adverse events (RD −0.05; 95% CI [−0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [−0.04,0.07]; P = .58) between surgical and endoscopic treatment.

Regarding time of hospitalization, the endoscopic group had better results (RD: −4.23; 95% CI [−5.18, −3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: −4.68; 95% CI [−5.43,−3.94]; P < .00001).

Conclusion:

There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.
Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients
Authors: Chen Ying-Chun , Zhang Lin , Li Er-Nan , Ding Li-Xiang , Zhang Gen-Ai , Hou Yu , Yuan Wei
Published: February 2019

Objective:

To contrast the effects and complications in unilateral and bilateral percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures in elderly patients.

Methods:

Multiple databases were adopted to search relevant studies, and the articles eventually satisfied the criteria were included. All the meta-analyses were conducted with the Review Manager 5.2. To estimate the quality of each article, risk of bias table was performed.

Results:

Finally, 627 patients were enrolled in 9 studies and ultimately met the eligibility criteria. The unilateral and bilateral surgical samples were 314 and 313, respectively. The meta-analysis showed no significant difference in Visual Analog Scale/Score (VAS) (MD = −0.05, 95% confidence interval [CI] [−0.24, 0.13], P = .57), Oswestry Disability Index (ODI) score (MD = 0.03, 95% CI [−0.57, 0.62], P = .93) and cement leakage (OR = 1.00, 95% CI [0.67, 1.50], P = 1.00) between unilateral group and bilateral group. The surgery time of unilateral PVP is much less than that of bilateral PVP (MD = −8.42, 95% CI [−13.17, −3.66], P = .0005). Patients with bilateral PVP surgery have been injected more cement than patients with a unilateral surgery (MD = −2.56, 95% CI [−2.79, −2.33], P <.00001).

Conclusion

This study demonstrated unipedicular approach is the preferred surgical technique for treatment of osteoporotic vertebral fracture (OVF) compared with bilateral PVP since unipedicular approach injects less cement and cost less surgery time.
Partial thickness cornea tissue from small incision lenticule extraction
Authors: Wang Yuhong , Li Xiaofeng , Huang Weiyi , Liu Jinkun , Xu Yazhang , Chen Meizhu , Wang Qian
Published: February 2019

Objective:

The aim of the present study was to observe the feasibility and effect of cornea slice acquired from femtosecond laser surgery, small incision lenticule extraction (SMILE) as patch graft for the prevention of drainage tube exposure and to compare with the sclera.

Methods:

The research is a prospective comparative randomized study. Patients who received Ahmed glaucoma valve implantation surgery from August 2015 to January 2017 at the Xiamen Eye Center were randomly divided into 2 groups. Group A (corneal group) included 131 cases (135 eyes), receiving the 3 layers of allogeneic cornea slices as graft. Group B (scleral group) included 124 cases (127 eyes), using the sclera as allograft. The appearance, graft, conjunctiva melting, and tube exposure were the primary observation points.

Results:

After followed up for 6 to 20 months, a thinner appearance was seen in 3 eyes (2.2%) in the corneal graft group and 7 eyes (5.5%) in the scleral group. Conjunctiva melted and drainage tube exposed in 0 eyes (0%) in the corneal graft group and 2 eyes (1.6%) in the scleral group. One eye needed repair surgery. There was no statistical difference between the 2 groups (P > .05). After surgery, the intraocular pressure was reduced significantly in both groups (P < .05). The white sclera slice could be seen under the conjunctiva, thereby affecting the cosmetic appearance.

Conclusion:

The cornea slice acquired from SMILE surgery can effectively prevent drainage tube exposure. Moreover, it is easy to acquire, safe, and cheaper, giving the patient a better cosmetic appearance.
Top 100 cited articles on rheumatoid arthritis
Authors: Yin Xiangjun , Cheng Fafeng , Wang Xueqian , Mu Jie , Ma Chongyang , Zhai Changming , Wang Qingguo
Published: February 2019

Background:

Rheumatoid arthritis (RA) is a worldwide health issue; although the prospects for most patients are favorable, many still do not respond to the current therapies. Numerous articles related to RA have been published in the past 3 decades; an analysis of the most cited articles in this field was undertaken to identify important articles regarding RA related to pathogenesis, diagnosis, and treatment.

Methods:

We searched the Web of Science and collected the general information of the top 100 cited articles. The citation number, publication year, authorship, impact factor (IF) of the journal in the publication year, country origins, article types, and funding source were evaluated.

Results:

The total citations of the top 100 articles varied from 11,922 to 556 and were published between 1985 and 2014. These articles were published in 24 journals, led by Arthritis and Rheumatism (n = 33), followed by the New England Journal of Medicine (n = 15). Most of the articles (n = 80) were produced by ≥5 authors. They were from 34 countries, and the United Stated contributed to most of the articles (n = 58), followed by the United Kingdom (n = 42). The article types were divided into clinical study (n = 55), review (n = 17), meta-analysis (n = 4), clinical guideline (n = 10), and basic science (n = 14). Eighty-seven percent of the articles were supported either by public organizations or medical companies.

Conclusion:

This study provided insights into the development of publications and their citations of RA in the past 3 decades. Clinical studies or clinical guidelines published in high-impact journals were more likely to be cited in the field of RA. The latest publications may not be included in the top 100 cited articles, as the more recent studies have not had sufficient time to accumulate the number of citations.
Case report of a child bearing a novel deleterious splicing variant in PIGT
Authors: Mason Samantha , Castilla-Vallmanya Laura , James Con , Andrews P. Ian , Balcells Susana , Grinberg Daniel , Kirk Edwin P. , Urreizti Roser
Published: February 2019

Rationale:

Trio family-based whole exome sequencing (WES) is a powerful tool in the diagnosis of rare neurodevelopmental diseases, even in patients with the unclear diagnosis. There have been previous reports of variants in the phosphatidylinositol glycan anchor biosynthesis class T (PIGT) gene associated with multiple congenital anomalies, with a total of 14 affected individuals across 8 families.

Patient concerns:

An 18-month-old boy of Greek ancestry presented with global developmental delay, generalized tonic-clonic seizures, hypotonia, renal cysts, esotropia, bilateral undescended testes, bilateral vesicoureteric reflux, marked cardiac dextroposition, bilateral talipes equinovarus, and dysmorphic features.

Diagnosis:

WES revealed 2 compound heterozygous variants in the PIGT gene, c.[494-2A>G]; [547A>C]/p.[Asp122Glyfs∗35]; [Thr183Pro]. The splicing mutation was demonstrated to lead to the skipping of exon 4.

Interventions:

Seizures, infections, and other main symptoms were treated.

Outcomes:

The patient died at 2 years of age before the molecular diagnosis was achieved. Genetic counseling has been offered to the family.

Lessons:

Most of the clinical features of the patient are in agreement with the previously described PIGT cases corroborating the usefulness of WES as a diagnostic tool.
Anesthetic management in a spinal cord-injured parturient woman with a left hip resection and secondary scoliosis
Authors: Liu Hui , Lin Xuemei , Diao Min , Ma Yushan
Published: February 2019

Rationale:

Pregnancy after spinal cord injury, hip resection, leg amputation, and scoliosis is an uncommon event. Given the specific pathophysiological changes in this patient, an aesthetic management presented a particular challenge. The effects on the physiological changes associated with pregnancy, aesthetic methods, blood loss, autotransfusion from uterine contractions and thrombotic risk had to be considered.

Patient concerns:

A 25-year-old female earthquake survivor was admitted at 36.4 weeks of pregnancy for preterm labor. She had suffered from a spinal cord injury and complex trauma and had subsequently undergone left hip resection, bilateral amputations, and multiple surgical procedures during the previous 6 years. Additionally, she had developed severe scoliosis due to her weight-bearing posture.

Diagnoses:

High amputation after earthquake injury; Scoliosis; Vulvar reconstruction; Intrauterine pregnancy (35.6 weeks) with a single live fetus with possible premature delivery.

Interventions:

We administered general anesthesia during a cesarean section for the parturient woman. Both the central venous pressure and pleth variability index were used to continuously evaluate intraoperative fluid management and blood loss.

Outcomes:

Delivery and patient recovery were uneventful.

Lessons:

Anesthetic management of a pregnant woman with a spinal injury, scoliosis, left total leg and right below-knee amputations, and left hip resection requires considerable attention. Advances in medical technology have provided clinicians with insights into managing patients with this condition.
Risk factors of thromboembolism in nonvalvular atrial fibrillation patients with low CHA2DS2-VASc score
Authors: Yan Shuangbing , Li Qing , Xia Zhen , Yan Sujuan , Wei Yichun , Hong Kui , Wu Yanqing , Li Juxiang , Cheng Xiaoshu
Published: February 2019

The risk of thromboembolism in patients with CHA2DS2-VASc score of 0 to 1 was low, and the anticoagulant therapy was not recommended. Although the CHA2DS2-VASc score was low, there were still many patients suffered from thrombotic events and stroke. We aim to investigate the risk factors of thrombotic events in nonvalvular atrial fibrillation (NVAF) patients with low CHA2DS2-VASc score.

We retrospectively enrolled 595 consecutive NVAF patients with low CHA2DS2-VASc score (male: CHA2DS2-VASc = 0, female: CHA2DS2-VASc = 1). The general clinical data, blood biochemical data, and echocardiography results of the 595 patients were collected. Multivariate logistic regression models were used to evaluate risk factors of thrombosis. Receiver operating characteristic curve was used to identify the optimal cut-off value of the independent risk factors. A P value of <.05 (2-sided) was considered to be statistically significant.

In multivariate analysis, lipoprotein (a) (Lp(a)) plasma level and left atrium diameter (LAD) were positively related to thromboembolism in NVAF patients with CHA2DS2-VASc score of 0 to 1 after adjustment for age, gender, and other variables (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01–1.03; OR = 1.13, 95% CI: 1.06–1.18). Lp(a) exerted a significant predictive value with area under the curve (AUC) of 0.62 (95% CI: 0.55–0.68, P < .01). The optimal cut-off value for Lp(a) predicting thrombotic events was 27.2 mg/dL (sensitivity 45.7%, specificity 73.4%). LAD showed a significant predictive value with AUC of 0.71 (95% CI: 0.64–0.78, P < .01). The optimal cut-off point for LAD predicting thrombotic events was 43.5 mm (sensitivity 47.1%, specificity 85.8%).

High Lp(a) plasma level and left atrial dilatation might be independent risk factors of thrombotic events for NVAF patients with low CHA2DS2-VASc score.
Prognostic significance of neutrophil–lymphocyte ratio and carbohydrate antigen 19-9 in patients with gallbladder carcinoma
Authors: Liu Fei , Hu Hai-Jie , Ma Wen-Jie , Yang Qin , Wang Jun-Ke , Li Fu-Yu
Published: February 2019

The neutrophil–lymphocyte ratio (NLR) is an immune response-related indicator and it is associated with poor prognosis of various cancers. The carbohydrate antigen19-9 (CA19-9) is a tumor-associated antigen and it has prognostic relevance in gallbladder carcinoma (GBC). We aimed to analyze whether preoperative NLR and serum CA19-9 were associated with outcomes of GBC patients after surgery with curative intent.

Between January 2010 and May 2015, 90 resectable GBC patients who underwent curative surgery in our institution were included. All final diagnoses were confirmed by pathologic examination. The demographics, clinical, and histopathology data were analyzed. The Cox regression proportional hazard model and Kaplan–Meier method were used to assess prognostic factors.

The cutoff values of 4.33 and 250.90 U/mL were defined as high NLR and high CA19-9, respectively. The univariate analyses showed that TNM stage, lymph node metastasis, the degree of tumor differentiation, margin status, combined hepatectomy, CA19-9, NLR, and PNI were all associated with overall survival (P < .05). According to the multivariable analysis, NLR (hazard ratio (HR) 3.840, 95% confidence interval (95% CI): 2.122–6.947, P < .001), CA19-9 (HR 2.230, 95% CI: 1.297–3.835, P = .004), TNM stage (HR 3.864, 95% CI: 1.819–8.207, P < .001), lymph node metastasis (HR 1.679, 95% CI: 1.005–2.805, P = .048), and margin status (HR 1.873, 95% CI: 1.063–3.300, P = .030) were independent prognostic factors. The median survival time in low NLR and CA19-9 group was better than high NLR and CA19-9 group (P < .05).

The preoperative NLR and serum CA19-9 are associated with prognosis of patients with GBC. High NLR and high CA19-9 were predictors of poor long-term outcome among patients with GBC undergoing curative surgery.
Effectiveness of an orally administered steroid gel at preventing restenosis after endoscopic balloon dilation of benign esophageal stricture
Authors: Yan Xiue , Nie Dan , Zhang Yaopeng , Chang Hong , Huang Yonghui
Published: February 2019

Background:

Restenosis occurs in 10% to 30% of patients after endoscopic balloon dilation (EBD) of benign esophageal stricture. This study aimed to investigate whether an orally administered steroid/gel mixture would inhibit restenosis after EBD for benign esophageal stricture.

Methods:

This retrospective analysis included patients with benign esophageal stricture treated with EBD at the Peking University Third Hospital, China (September 2005 to October 2017). The patients were divided into an EBD alone group (EBD only) and EBD/OHA group (EBD plus oral hydrocortisone sodium succinate/aluminum phosphate gel mixture). Patients were followed-up for 3 months. EBD was repeated for persistent dysphagia. The outcome measures included the restenosis rate and the number of additional EBD sessions required during follow-up. Any side effects were noted.

Results:

Thirty-two patients were included (EBD alone group, n = 12; EBD/OHA group, n = 20). Baseline demographic and clinical characteristics (including age, sex, etiology, stricture location, and diameter of narrowest segment) did not differ between groups. Restenosis rate was significantly lower in the EBD/OHA group than in the EBD alone group (5/20, 25.0% vs 8/12, 66.7%; P = .025). The median number of EBD sessions required was numerically lower in the EBD/OHA group (median, 1.0; interquartile range, 1.0–1.8) than in the EBD alone group (median 2.0, interquartile ranged 1.0–2.5), but statistical significance was not attained (P = .071). The only side effects occurred in the EBD/OHA group: hypokalemia in 4/20 (20.0%) and apathy/somnolence in 1/20 (5.0%).

Conclusions:

An orally administered steroid/gel mixture might reduce the incidence of restenosis after EBD for benign esophageal stricture, but it requires confirmation by prospective trials.
Prognostic miRNA classifiers in t cell acute lymphoblastic leukemia
Authors: Sabarimurugan Shanthi , Madurantakam Royam Madhav , Kumarasamy Chellan , Kodiveri Muthukaliannan Gothandam , Samiappan Suja , Jayaraj Rama
Published: February 2019

Background:

The prognostic value of microRNA (miRNA) expression in T-cell acute lymphoblastic leukemia (T-ALL) has generated significant research interest in recent years. However, most diagnostic and prognostic studies with regards to miRNA expression have been focused on combined B cell and T cell lymphoblastic leukemia. There are very few studies reporting the prognostic effects of miRNA expression on T-ALL. Therefore, a pioneer systematic review and meta-analysis was proposed to explore the possibilities of miRNAs as viable prognostic markers in T-ALL. This study is intended to be useful as a guideline for future research into drug evaluation and targeting miRNA as a biomarker for the treatment and prognosis of T-ALL.

Methods:

The systematic review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The study search will be conducted by using Cochrane, EMBASE, Medline, Science Direct, and SCOPUS bibliographic databases. The reference lists of included studies will be manually searched to further bolster the search results. A combination of keywords will be used to search the databases.

Discussion:

To explore the effect of miRNA on prognosis, forest plots will be generated to assess pooled HR and 95% CI. Upregulation, downregulation, and deregulation of specific miRNAs will be individually noted and used to extrapolate patient prognosis when associated with risk factors involved in T-ALL. Subgroup analysis will be carried out to analyze the effect of deregulation of miRNA expression on patient prognosis. A fixed or random-effects model of meta-analysis will be used depending upon between-study heterogeneity. This systematic review and meta-analysis will identify and synthesize evidence to determine the prognosis of miRNA in T-ALL and suggest the possible miRNA from meta-analysis results to predict as a biomarker for further detection and treatment of T-ALL.
Sarcomatous carcinoma in biliary system
Authors: Zhang Ning , Li Yatong , Zhao Mengyun , Chang Xiaoyan , Qu Qiang , He Xiaodong
Published: February 2019

Sarcomatous carcinoma in biliary system, including sarcomatous intrahepatic cholangiocarcinoma (SIC) and sarcomatous choledochal carcinoma (SCC), is extremely rare and malignant.

This retrospective study included 5 patients with SIC and 4 patients with SCC. Their basic characteristics, preoperative lab tests, preoperative imaging features, perioperative status, and follow-up information have been collected and analyzed.

Lesions at different locations induced various preoperative symptoms. The history of choledocholithiasis or hepatolithiasis was remarkable in patients with SIC. Cancer antigen 19-9 appeared to be a key factor for both SIC and SCC. However, preoperative lab tests or imaging features could not distinguish SIC from intrahepatic cholangiocarcinoma, or SCC from choledochal carcinoma. Surgical treatments for all 9 patients were successful. Efficacy of adjuvant chemotherapy was not ideal. The prognosis of sarcomatous biliary carcinoma was enormously poor.

Sarcomatous carcinoma in biliary system is extremely rare and malignant. Chronic inflammation could be critical in the currently unknown occurrence mechanism. Further research is urgently needed to improve the prognosis.
Hypermethylation of tumor suppressor genes is a risk factor for poor prognosis in ovarian cancer
Authors: Feng Li-yuan , Chen Chang-xian , Li Li
Published: February 2019

Objective:

DNA methylation is the earliest and most studied epigenetic modification in cancer. The literature reported that the abnormal methylation level of multiple genes was associated with poor prognosis in ovarian cancer. However, due to a small sample size, the results reported in the literature vary widely. In this study, the correlation between aberrant methylation level of genes and poor prognosis of ovarian cancer was reviewed in order to clarify the role of DNA methylation in the prognosis of ovarian cancer.

Methods:

A systematic research of PubMed, EMbase, Cochrane Library, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Wanfang databases, and EMBASE was performed, and calculated the hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) and its 95% confidence interval.

Results:

HR of the OS obtained of target genes was 2.32 (95% CI: 1.54–3.48, P = .000); HR of the PFS obtained of target genes was 1.318 (95% CI: 0.848–2.050, P = .220). HR of OS achieved by tumor suppressor genes was 3.09 (95% CI 1.80 − 5.30, P = .000).

Conclusion:

Hypermethylation of tumor suppressor genes indicate poor prognosis of ovarian cancer.
Spontaneous and transient hyperglycemia before sleep in a patient with glaucomatous blindness and diabetes
Authors: Sun Zhan-Zhan , Xia Fang , Du Si-na , Li Wei
Published: February 2019

Rationale:

The peak of blood glucose was during 9 pm to 3 am. There is a stable, spontaneous and short-term abnormal increase of blood glucose. The pathophysiological mechanism is unknown. It is speculated that the cause might be the imbalance of the glucose-regulating hormone that is caused by the disorder of the biological clock system.

Patient concerns:

The case was a 73-year old man with bilateral glaucoma (only mild light perception) and was hospitalized to establish a viable hypoglycemic plan. He received 4 shots of insulin enhancement, oral meditation, pre-mixed insulin treatment during the 22 days. However, his blood glucose had been spontaneously increased from 9 pm to 3 am which was the highest of the day, and then resumed by itself. Insulin intervention was effective.

Diagnosis:

Glaucomatous blindness and diabetes, spontaneous and transient hyperglycemia before sleep.

Interventions:

We used insulin aspart 3u when we found hyperglycemia three times at 9 pm and it was effective. Without intervention, blood sugar will automatically improve in the morning.

Outcomes:

During the late night and early morning, there is a stable, spontaneous and short-term transit abnormal increase in blood glucose, which suggests the complexity of blood glucose adjustment.

Lessons:

Due to the case specialty, we could not do the systematic review of the study. However, it improves the awareness of the abnormal periodically increase of blood glucose during the special periods, and provides with a reference for clinical research of dawn and dusk phenomenon. Multi-point blood glucose monitoring or dynamic blood glucose monitoring throughout the day is of great significance for the detection of special types of hyperglycemia.
Prevalence of depression in myocardial infarction
Authors: Feng Limin , Li Lifeng , Liu Wennan , Yang Jianzhou , Wang Qing , Shi Le , Luo Mingchi
Published: February 2019

Background:

Depression is common in the aftermath of myocardial infarction (MI) and may not only lead to impaired long-term quality of life, but also cause increased mortality among patients with MI. The reported prevalence of depression among patients with MI varied considerably across studies, for which a pooled prevalence was obtained in the only 1 meta-analysis conducted in March 2004. Subsequently, numerous relevant studies have been published, indicating the need for an update on the pooled prevalence. Therefore, this study was aimed at updating the pooled prevalence of depression among patients with MI.

Methods:

A comprehensive literature search in 3 electronic databases, PubMed, Embase, and PsycINFO, was performed in April 2018. The heterogeneity across studies was examined by the Cochran's Q test and quantified by the I
2 statistic. If significant heterogeneity was observed, meta-regression analyses and subgroup analyses were performed to identify the source of heterogeneity. Publication bias was assessed by a funnel plot and verified by the Egger's and Begg's tests.

Results:

Nineteen eligible studies conducted in 10 countries were included, which consisted of 12,315 patients with MI, among whom 3818 were identified with depression. High heterogeneity was observed across the eligible studies (I
2 = 98.4%), with the reported prevalence of depression ranging from 9.17% to 65.88%. The pooled prevalence of depression among patients with MI was 28.70% (95% CI: 22.39–35.46%) by a random effects model. Subgroup analyses showed that the pooled prevalence differed significantly by region, tool used to identify depression, study quality, sex, race, anterior MI, and diabetes status (P < .05). Meta-regression analyses did not identify any moderators of heterogeneity, and the heterogeneity was high within most subgroups. Nonetheless, for unmarried subjects, the heterogeneity was low (I
2 = 19.5). The Egger's test and the Begg's test indicated no evidence of publication bias (P > .05).

Conclusions:

Given the high pooled prevalence of depression found in this study and the association between depression and adverse health outcomes among patients with MI, more psychological resources including early assessment and effective treatment of depression should be allocated to patients with MI.
CONSORT—Assistive technology-180° rotating eating spoon improves the ability of eating of self-care patients with upper extremity dyskinesia
Authors: Sun Jin-Xia , Li Li-Fang , Zhao Yu-Long , Lu Gui-Wei
Published: February 2019

Objective:

This study aims to develop an assistive technology-180° rotating feeding spoon that could improve the ability of eating of self-care patients with upper extremity dyskinesia.

Methods:

The Brunnstrom 6-stage rating of hemiplegia was adopted. During the different recovery stages of the upper limbs, the patients orally ate using a feeding spoon with a non-rotatory head and a 180° rotating feeding spoon. The ability of these patients to eat by themselves was observed, and the basic activity of daily living (BADL) was assessed using the Barthel index (BI).

Results:

The Brunnstrom assessment scale was used to analyze the results of the patient's upper limb function examination, and the results revealed that the 180° rotating feeding spoon could assist patients with different degrees of upper limb dysfunction when eating independently.

Conclusions:

The 180° rotating feeding spoon can assist patients with upper limb dysfunction when eating independently. For patients with different degrees of upper limb dysfunction, the spoon can provide different degrees of aid.
Acupoint catgut embedding for the treatment of obesity in adults
Authors: Wu Xianming , Mo Qian , He Ting , Zhi Na , Huang Yu , Yang Shuo
Published: February 2019

Background:

Obesity is the biggest chronic health problems among adults worldwide and the main predisposing factor in many types of systemic diseases such as hypertension, diabetes, and so on. In clinical reports on Traditional Chinese Medicine, acupoint catgut embedding has been shown to improve various clinical indicators for diseases including obesity and body mass index (BMI), but the safety of this and method has not been assessed.

Methods:

This systematic review searched the following 8 databases between from January 2015 to December 2018: the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Wan-fang Database, the China Doctoral Dissertations Full-text Database and the China Master's Theses Full-text Database, and will manually searched the list of medical journals as a supplement. RCTs containing acupoint catgut embedding method for the treatment of obesity will be included. By reading the titles, abstracts and full texts, the 2 reviewers will independently complete the studies selection, data extraction, and quality assessment. The bias risk assessment, data synthesis, and subgroup analysis were performed using Revman 5.1 software.

Results:

The primary outcome measures include weight, improvement rate, secondary outcome measures include BMI, waist circumference, hip circumference, waist-to-hip ratio, fat percentage, and so on. The safety assessment includes the incidence of adverse events. The results will be displayed as the risk ratio of the dichotomous data, the standardized mean difference or weighted mean difference for the continuous data.

Conclusion:

This systematic review will retrieve clinical randomized controlled trials (RCT) on acupoint catgut embedding for obesity in 8 databases, aiming to describe and update existing evidence on the efficacy and safety of acupoint catgut embedding for obesity in adults.

PROSPERO registration number:

CRD42018098793.
Clinicopathological characteristics of renal solitary fibrous tumor
Authors: Fu Weijin , Bing Qin , JingJing Zeng , Lijian Lu , Zhibin Xie , Qijian Ding , Jiwen Cheng
Published: February 2019

To analyze the clinical characteristics, treatment modalities and outcomes of adult renal solitary fibrous tumors (SFT) treated at a single institution. Demographic, diagnostic, surgical, and pathological findings of patients who had undergone radical nephrectomy (RN) due to renal SFT were collected from the database of a single institution and were retrospectively reviewed. Ten patients (6 men and 4 women) were diagnosed with renal SFT in our institution between January 1, 2000 and December 31, 2016. The mean age was 50.9 ± 8.2 years (range, 38–63 years). Of the 10 patients, 6 were asymptomatic, 2 presented with flank pain, 1 presented with abdominal discomfort, and 1 presented with haematuria. Computed tomography scans were obtained for all patients. Open RN was performed on 6 patients, and laparoscopic RN was performed on 4 patients. The mean tumor size was 10.23 ± 4 cm (range, 5.3–19 cm). Pathological diagnosis revealed that the tumors in 8 patients were benign, while those in the other 2 patients were malignant renal SFT. No recurrence occurred during a mean follow-up period of 47.3 ± 21.5 months (range, 16–85 months). Renal SFT is extremely rare, and its diagnosis may be challenging because of a lack of typical imaging manifestations. RN is a safe treatment modality for benign or low-grade malignant renal SFT, ensuring favorable outcomes.
Long-term progression-free survival of hepatocellular carcinoma with synchronous diffuse peritoneal metastasis treated by CRS+HIPEC
Authors: Ji Zhong-He , An Song-Lin , Li Xin-Bao , Liu Gang , Li Yan
Published: February 2019

Rationale:

Hepatocellular carcinoma (HCC) with peritoneal metastasis (PM) is rare. There has been no standard treatment for this severe disease, and the conventional palliative therapy could only reach an overall survival of 6 to 14 months

Patient concerns:

A 38-year-old male with a chief complain of “abdominal distension and diagnosis of HCCPM for 3 months”, was suffering from severe diarrhea and moderate anemia.

Diagnosis:

Diagnostic laparoscopic exploration with biopsy and the following pathology confirmed the diagnosis of HCC with PM.

Interventions:

The patient was treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) followed by 6 cycles of intraperitoneal chemotherapy and 6 cycles of intravenous chemotherapy.

Outcomes:

Till January 15, 2019, the patient has progression-free survival for over 22 months.

Lessons:

CRS plus HIPEC combined adjuvant intraperitoneal and intravenous chemotherapy may improve progression-free survival for some HCC with PM patients and should be considered as an option for such patients.
Acupuncture for uterine fibroids
Authors: Liu Tong , Yu Jiani , Kuang Weichuan , Wang Xiaoyin , Ye Jiang , Qiu Xiaojia , Xi Wen , Zeng Yao , Zou Hanhong , Liu Yue
Published: February 2019

Background:

Uterine fibroids represent the most common gynecological benign tumors in reproductive females. Acupuncture has been applied as a therapeutic modality in China to treat uterine fibroids. However, currently, few critical systematic reviews regarding the effect of acupuncture on uterine fibroids have been published. Our proposed review aims to evaluate the current evidence on the efficacy of acupuncture for uterine fibroids.

Methods:

A total of 7 databases were searched from their inception to December 2018, including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. The primary outcomes will be reduction in uterine volume and number of fibroids. Secondary outcomes are pelvic or low-back pain, assessed by Visual Analog Scale (VAS); Irregular menstrual periods; Low-abdominal pressure symptoms such as frequent or urgent urination, or constipation and adverse events. Data synthesis will be computed by RevManV.5.3.5 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook.

Results:

This study will provide high-quality evidence of acupuncture for uterine fibroids.

Conclusion:

The conclusion of this systematic review will provide evidence to judge whether acupuncture is an effective therapeutic intervention for patients with uterine fibroids.

Trial registration number:

PROSPERO CRD42019120484.
Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures
Authors: Lin Feng Fei , Chen Yi Fan , Chen Bin , Lin Chao Hui , Zheng Ke
Published: February 2019

Background:

The purpose of this meta-analysis was to compare the effectiveness and safety of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures.

Methods:

We searched PUBMED, EMBASE, Cochrane Library, and Google Scholar from their inception to February 2016. All RCTs comparing cemented with uncemented hemiarthroplasty for displaced femoral neck fractures were eligible. The participants who underwent primary hemiarthroplasty for unilateral femoral neck fracture were older than 55 and the mean age of more than 75 years old. For the trials before 2006 used old designed prostheses, so we excluded trails before 2006 which used old designed prostheses. Outcomes of interest include postoperative hip function, Harris hip score (HHS), mortality, reoperation rate, complications, operation time, intraoperative blood loss. Two reviewers independently evaluated the included studies and extracted data into RevMan. Quality Assessments were classified by agreement of 2 authors based on the Cochrane tool.

Results:

Seven trials were eligible. Postoperative hip function at 12 months cemented hemiarthroplasty was better than that in uncemented hemiarthroplasty (OR = 0.52, 95% CI, 0.31–0.88; P = .01). Postoperative fractures rates in cemented hemiarthroplasty were lower than that in uncemented hemiarthroplasty (OR = 0.09, 95% CI, 0.02–0.38; P = .001). Also, the interoperative fracture rates in cemented hemiarthroplasty were lower than that in uncemented hemiarthroplasty (OR = 0.29, 95% CI, 0.13–0.68; P = .004). Shorter operation time was achieved in uncemented hemiarthroplasty than that in cemented hemiarthroplasty (WMD = 8.22 min, 95% CI, 5.57–10.86 min; P<.00001). There was no significant difference between the 2 groups with HHS, mortality, wound infection, dislocation, general complications, reoperation rate, and intraoperative blood loss.

Conclusion:

The available evidence indicates that compared with uncemented hemiarthroplasty cemented hemiarthroplasty achieved better postoperative hip function, less postoperative, and interoperative fractures in displaced femoral neck fracture. Uncemented hemiarthroplasty achieved shorter operation time. There was no difference between the 2 groups with HHS at 1 year, mortality, and complications.
Effects of climate factors on hemorrhagic fever with renal syndrome in Changchun, 2013 to 2017
Authors: Zhao Qinglong , Yang Xiaodi , Liu Hongjian , Hu Yixin , He Minfu , Huang Biao , Yao Laishun , Li Na , Zhou Ge , Yin Yuan , Li Meina , Gong Ping , Liu Meitian , Ma Juan , Ren Zheng , Wang Qi , Xiong Wenjing , Fan Xinwen , Guo Xia , Zhang Xiumin
Published: February 2019

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by hantaviruses (HVs). Climate factors have a significant impact on the transmission of HFRS. Here, we characterized the dynamic temporal trend of HFRS and identified the roles of climate factors in its transmission in Changchun, China.

Surveillance data of HFRS cases and data on related environmental variables from 2013 to 2017 were collected. A principal components regression (PCR) model was used to quantify the relationship between climate factors and transmission of HFRS.

During 2013 to 2017, a distinctly declining temporal trend of annual HFRS incidence was identified. Four principal components were extracted, with a cumulative contribution rate of 89.282%. The association between HFRS epidemics and climate factors was better explained by the PCR model (F = 10.050, P <.001, adjusted R2 = 0.456) than by the general multiple regression model (F = 2.748, P <.005, adjusted R2 = 0.397).

The monthly trends of HFRS were positively correlated with the mean wind velocity but negatively correlated with the mean temperature, relative humidity, sunshine duration, and accumulative precipitation of the different previous months. The study results may be useful for the development of HFRS preventive initiatives that are customized for Changchun regarding specific climate environments.