bluuebunny/crossref_metadata_2025 huggingface dataset:
Indices of left ventricular voltage on electrocardiogram are closely associated with serum cardiac troponin I levels in normotensive Japanese individuals
Authors: Mizoguchi Tatsuya , Sugiura Tomonori , Dohi Yasuaki , Takase Hiroyuki , Fujii Satoshi , Seo Yoshihiro , Ohte Nobuyuki
Published: May 2020

The high-sensitivity cardiac troponin I (hs-cTnI) in serum can increase due to an increase in left ventricular (LV) overload in individuals with hypertension. Since LV voltage on an electrocardiogram (ECG) reflects LV load, it is possible that LV voltage is closely associated with hs-cTnI in individuals without hypertension. This study investigated the association between LV voltage indices and serum hs-cTnI levels in normotensive Japanese individuals.

Subjects who visited the Enshu Hospital for a health check-up were screened for their eligibility. Subjects with renal dysfunction, cancer, active inflammatory disease, or a history of cardiovascular events were excluded, as were subjects with obvious ST segment or T wave abnormality, Wolff–Parkinson–White syndrome, pacemaker implantation, or frequent arrhythmia in the ECG. Exclusion of individuals with hypertension left 803 subjects (54.8 ± 11.3 years) for final inclusion. The R wave voltage in lead V5 (RV5 voltage), the Sokolow–Lyon voltage (a sum of the QRS wave (a complex wave consists of Q, R, and S wave) of the S wave voltage in lead V1 and the R wave voltage in lead V5), and the Cornell product (a product of QRS duration and QRS voltage) were evaluated by ECG as LV voltage indices. Laboratory measurements included serum hs-cTnI levels. Possible associations between indices of LV voltage on ECG and serum hs-cTnI levels were cross-sectionally investigated in the normotensive subjects.

The median values [interquartile range] of hs-cTnI and BNP were and 2.1 [1.4–3.0] and 13.8 [7.7–24.9] pg/mL, respectively. Multivariate regression analysis identified that the levels of hs-cTnI, but not BNP, were significantly associated with RV5 voltage (β 0.090, P = .0087), Sokolow–Lyon voltage (β 0.112, P = .0009), and Cornell product (β 0.101, P = .039) after adjustment for possible confounding factors. Moreover, the RV5 voltage, Sokolow–Lyon voltage, and Cornell product were significantly associated with the hs-cTnI levels after adjustment for possible confounding factors including ECG findings (β 0.109, P = .0075; β 0.125, P = .0010; and β 0.096, P = .0116, respectively).

Indices of LV voltage in ECG had close associations with serum hs-cTnI levels in normotensive subjects. These findings support that the ECG findings of LV voltage have significant associations with slight myocardial micro-damage even in normotensive subjects.
Effectiveness of the integrated care model Salut+Social in patients with chronic conditions
Authors: Gavaldà-Espelta Ester , del Mar Lleixà-Fortuño Maria , Baucells-Lluis Jordi , Ferré-Ferraté Maria , Mora-López Gerard , Tomàs-Navarro Begoña , Curto-Romeu Claudia , Lucas-Noll Jorgina , Aguilar Martin Carina , Gonçalves Alessandra Queiroga , Ferré-Grau Carmen
Published: May 2020

Introduction:

Integrated care models aim to provide solutions to fragmentation of care by improving coordination. This study will evaluate the effectiveness of a new integrated care model (Salut 
+ 
Social), which will promote the coordination and communication between social and healthcare services in southern Catalonia (Spain) to improve quality of life, adherence to treatment and access to medical services for patients with chronic conditions, and also to reduce caregiver burden. Additionally, we will evaluate the experience of caregivers, health professionals and social workers with the new model implemented.

Methods and analysis:

A clinical trial using mixed methodology will be carried out. The intervention consists of improving the coordination between the social and healthcare sectors during a 6-month period, by means of information and communication technology (ICT) tools that operate as an interface for the integrated care model. The study subjects are primary care patients with chronic health and social conditions that can benefit from a collaborative and coordinated approach. A sample size of 141 patients was estimated. Questionnaires that assess quality of life, treatment adherence, medical service and caregiver burden will be used at baseline and at 6, 9, and 12 months after the beginning of the study. The principal variable is quality of life. For statistical analysis, comparisons of means and proportions at different time points will be performed. A discussion group and semi-structured interviews will be conducted with the aim of improving the care model taking into account the opinions of professionals and caregivers. A thematic content analysis will be carried out.

Ethics and dissemination:

This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (code P17/100). Articles will be published in international, peer-reviewed scientific journals.

Trial registration:

Clinical-Trials.gov: NCT04164160.
The prognostic and clinicopathological significance of RBM3 in the survival of patients with tumor
Authors: Gao Guangyu , Shi Xinya , Long Yuming , Yao Zhen , Shen Jiaofeng , Shen Liqin
Published: May 2020

Background:

RNA-binding motif protein 3 (RBM3) plays an important role in carcinogenesis and tumor progression. However, the prognostic role of RBM3 in human carcinomas remains controversial. Therefore, we took a meta-analysis to research the association between the overall survival of patients with cancer and the expression of RBM3.

Methods:

Systematic literature research identified 17 potentially eligible studies comprising 4976 patients in ten different cancer types. Two researchers independently screened the content and quality of studies and extracted data. Correlations of RBM3 expression and survival were analyzed and the hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated.

Results:

In the pooled analysis, overexpression of RBM3 was related to improved overall survival (OS), recurrence-free survival (RFS), and disease-free survival (DFS) in patients with cancer having a pooled HR of 0.61 (HR = 0.61; 95% CI: 0.47–0.69), 0.57 (HR = 0.60; 95% CI: 0.50–0.71) and 0.54 (HR 0.54; 95% CI: 0.38–0.78). Besides, subgroup analysis proved that overexpression of RBM3 was related to improved OS in colorectal cancer (HR = 0.61, 95% CI: 0.43–0.86), melanoma (HR = 0.32, 95% CI: 0.20–0.52), and gastric cancer (HR = 0.51, 95% CI: 0.35–0.73). However, subgroup analysis according to tumor type revealed that overexpression of RBM3 was not related to better OS in breast carcinoma (HR = 0.52, 95% CI: 0.17–0.61).

Conclusions:

Our results indicated that RBM3 overexpression was significantly predictive of better prognosis in various human cancers. For certain tumors, overexpression RBM3 might be a marker of improved survival in humans with cancer, except for breast cancer.
Comparative efficacy of antiangiogenic treatment for newly diagnosed glioblastoma
Authors: Li Runting , Li Chao , Cai Zhaolun , Li Lianwang , Wei Liudong , Qian Zenghui , Zhou Dabiao
Published: May 2020

Background:

Glioblastoma is the most common malignant primary brain tumor which has highly expressed vascular endothelial growth factor. To date, various antiangiogenic drugs have been investigated in clinical trials but with no overall conclusion, especially for newly diagnosed glioblastoma (nGBM). In this study, Bayesian network meta-analysis will be used to conduct a comprehensive analysis of the results of different clinical trials, and assess the efficacy of different antiangiogenic drugs on nGBM.

Methods:

In order to find more comprehensive information about the application of antiangiogenic drugs in nGBM patients, we searched the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. We also reviewed their reference lists to avoid omissions. Cochrane risk of bias tool (V.1.4.3) and Stata (V.15.0) will be used to assess the methodological quality of this review.

Results:

This study will provide reliable evidence for different antiangiogenic therapies in nGBM patients.

Conclusion:

We will evaluate the relative effectiveness of different antiangiogenic drugs and rank each intervention in nGBM patients through prognosis to provide decision-making reference on which method to choose for clinicians.

Protocol registration number:

CRD42019146537
Anterior communicating artery complex fenestration combined with tandem aneurysm: a case report and literature review
Authors: Liu Haibing , Hong Jingfang , Wang Shousen , Wei Liangfeng
Published: May 2020

Introduction:

Clinically, anterior communicating artery complex fenestration combined with fenestration-related aneurysms is rare, and combination of this condition with tandem aneurysms is even rarer.

Patient concerns:

A case of a 43-year-old man with spontaneous subarachnoid hemorrhage.

Diagnosis:

A computed tomography angiography examination revealed a fenestrated anterior communicating artery complex combined with 2 aneurysms. Then, a digital subtraction angiography examination was performed to further determine the diagnosis, which showed a complex anatomical structure of the local tissue. After the aneurysms ruptured, they were partially wrapped by a hematoma and compressed, which increased the difficulty of surgery.

Interventions:

An endovascular interventional therapy method was chosen, and a simple coil was successfully inserted through the blood vessel into the tandem aneurysms to maintain the integrity of the anatomical structure.

Outcomes:

The patient recovered well postoperatively. An imaging review after the operation did not show the aneurysms, and the upper and lower branches were patent.

Conclusion:

Therefore, endovascular treatment is an appropriate choice for arterial fenestration combined with tandem aneurysms, once the aneurysms have ruptured.
Efficacy of needle-knife combined with etanercept treatment regarding disease activity and hip joint function in ankylosing spondylitis patients with hip joint involvement
Authors: You Yuquan , Cai Meimei , Lin Junsheng , Liu Lianqun , Chen Changxian , Wang Yong , Cai Yaping
Published: May 2020

This study aimed to assess the efficacy of needle-knife (NK) combined with etanercept (NKCE) in attenuating pain, inflammation, disease activity, and improving hip joint function in ankylosing spondylitis (AS) patients with hip joint involvement.

Totally, 90 patients with active AS involving unilateral hip joint were enrolled and randomly assigned in 1:1:1 ratio to receive NKCE, NK or conventional drugs (control). The ESR, CRP, hip joint pain Visual Analogue Scale (VAS) score, bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), modified Harris hip score (mHHS), and range of motion (ROM) of affected hip joint were assessed at baseline (W0), after 1-week treatment (W1) and after 24-week treatment (W24).

ESR and CRP were decreased in NKCE group compared with NK and control groups, while was not attenuated in NK group compared with control group. Regrading pain and disease activity, NKCE group presented a reduction in hip pain VAS score and BASDAI compared with NK and control groups, and NK group showed a decrease in hip pain VAS score and BASDAI compared with control group. Besides, BASFI was lowered in NKCE and NK groups compared with control group, but similar between NKCE and NK groups. mHHS and hip ROM were raised in NKCE and NK groups compared with control group, but similar between NKCE and NK groups.

NKCE decreases hip pain, inflammation, disease activity and improves hip joint function in AS patients with hip joint involvement.
Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
Authors: Ayuse Takao , Yamguchi Naoyuki , Hashiguchi Keiichi , Sanuki Takuro , Mishima Gaku , Kurata Shinji , Hosogaya Naoki , Nakashima Sawako , Pinkham Max , Tatkov Stanislav , Nakao Kazuhiko
Published: May 2020

Background:

For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic submucosal dissection (ESD), intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous sedation, even at mild to moderate depth of anesthesia, there is always a risk of upper airway obstruction due to a relaxation of the upper airway muscles.

With the advent of Nasal High Flow (NHF) devices that allow humidified high flow air through the nasal cavity, can be used as a respiratory management method in the context of anesthesia. AIRVO is commonly used for patients with obstructive sleep apnea and other respiratory disorders. This device uses a mild positive pressure load (several cmH2O) that improves carbon dioxide (CO2) washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia.

This study aims to maintain upper airway patency by applying NHF with air (AIRVO) as a respiratory management method during intravenous anesthesia for patients undergoing an ESD. In addition, this study investigates whether the use of an NHF device in this context can prevent intraoperative hypercapnia and hypoxemia.

Methods/design:

This study design employed 2 groups of subjects. Both received intravenous anesthesia while undergoing an ESD, and 1 group also used a concurrent nasal cannula NHF device. Here we examine if the use of an NHF device during intravenous anesthesia can prevent hypoxemia and hypercapnia, which could translate to improved anesthesia management.

Efficacy endpoints were assessed using a transcutaneous CO2 monitor. This device measured the changes in CO2 concentration during treatment. Transcutaneous CO2 (PtcCO2) concentrations of 60 mmHg or more (PaCO2 > 55 mmHg) were considered marked hypercapnia. PtcCO2 concentrations of 50 to 60 mmHg or more (equivalent to PaCO2 > 45 mmHg) were considered moderate hypercapnia.

Furthermore, the incidence of hypoxemia with a transcutaneous oxygen saturation value of 90% or less, and whether the use of NHF was effective in preventing this adverse clinical event were evaluated.

Discussion:

The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ESD under anesthesia, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use of this device.

Trial registration:

The study was registered the jRCTs 072190022.

URL https://jrct.niph.go.jp/en-latest-detail/jRCTs072190022
Primary hepatoid carcinoma of the ovary
Authors: Choi Won-Ku , Cho Dong-Hyu , Yim Chang-Yeol , Lee Na-Ri
Published: May 2020

Introduction:

Hepatoid carcinoma of the ovary (HCO) is a rare disease that originates from the ovarian surface epithelium. It is histologically characterized as hepatocellular carcinoma (HCC) with a hepatocyte-rich granular cytoplasm.

Patient concerns:

A 65-year-old female patient was admitted with complaints of indigestion, abdominal bloating, and pain.

Diagnosis:

The patient showed an elevated level of serum alpha-fetoprotein (AFP) with abdominal bloating and pain. After surgery and histopathology analysis, she was finally diagnosed with HCO, Figo stage IC.

Interventions:

After cytoreductive surgery, she underwent adjuvant chemotherapy with carboplatin and paclitaxel. Although the disease was diagnosed at an early stage, it recurred 6 months after completion of adjuvant chemotherapy. Elevation of serum AFP level and removal of a mass from the lumbar vertebra confirmed the recurrence of this disease. Subsequently, the patient underwent radiation therapy and palliative chemotherapy.

Outcomes:

She died 31 months after the diagnosis due to disease progression.

Conclusion:

The aggressive nature of HCO was clearly observed in this case despite early diagnosis and treatment. Further studies are needed to understand the proper treatment and prognostic factors of HCO.
Skeletal muscle metastasis as a first site of recurrence of cervical cancer
Authors: Omokawa Nagisa , Mabuchi Seiji , Iwai Kana , Kawahara Naoki , Kawaguchi Ryuji , Sugimoto Sumire , Ohbayashi Chiho , Honoki Kanya , Nagai Akira , Kobayashi Hiroshi
Published: May 2020

Rationale:

Cervical cancer primarily spreads through direct invasion or via local lymphatics, and hematogenous metastasis is infrequent. Previous reports have shown that lung, liver, and bone are the organs most frequently affected by hematogenous metastasis of cervical cancer, while skeletal muscle is very rarely involved.

Patient concerns:

A 75-year-old Japanese woman presented with a painful muscular mass in her right lower abdomen. Five years ago, she was treated for her International Federation of Gynecology and Obstetrics stage IB2 cervical adenocarcinoma with radical surgery plus adjuvant chemotherapy.

Diagnoses:

The patient was diagnosed with isolated oblique muscle metastasis from cervical adenocarcinoma as a first site of recurrence.

Interventions:

The patient was treated with salvage surgery consisting of partial resection of the oblique muscle and ilium. The tumor was completely excised with an adequate surgical margin by a partial resection of the oblique muscle and ilium

Outcomes:

The patient is currently free of disease at 10 months after the development of recurrent disease.

Lessons:

We describe a rare case of isolated oblique muscle metastasis as a first site of recurrence of the International Federation of Gynecology and Obstetrics stage IB2 cervical adenocarcinoma, which was successfully treated with surgery. Although skeletal muscle metastasis is rare, this condition should be considered during the follow-up period, especially when patients complain of muscular pain with insidious progression. The present case and our literature review highlighted the possibility that loco-regional treatment may be curative for selected recurrent cervical cancer developed in skeletal muscles.
Incidental detection of a retained left atrial catheter via intraoperative transesophageal echocardiography in a patient undergoing tricuspid valve replacement
Authors: Pyeon Taehee , Bae Hong-Beom , Choi Jeong Il , Kim Taeyeong , Kim Joungmin
Published: May 2020

Rationale:

A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years.

Patient concerns:

A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago.

Diagnosis:

A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE.

Interventions:

The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded.

Outcomes:

After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications.

Lessons:

TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.
The outcomes of post-traumatic arthritis vs osteoarthritis following primary total knee arthroplasty
Authors: Li Jin-Quan , Hao-Xu  , Sun Ze-Gan , Huang Qing-Song , Yao Xiao-Dong
Published: May 2020

Background:

Total knee arthroplasty (TKA) for treatment of end-stage post-traumatic arthritis (PTA) has specific technical difficulties and complications. The aim of this study was to examine the outcome of TKA after PTA and to compare it with a cohort osteoarthritis (OA).

Methods:

A retrospective review of patients undergoing primary TKA at a single university hospital from 2013 to 2016 was performed. A minimum follow-up of 4 years was required. Patients in the study group were matched 1:2 with patients in the cohort group based on the following criteria: age at time of TKA (±3 years), body mass index (±3 points), sex, and American Society of Anesthesiologists score (±1 point). Outcome measures included surgical time, intraoperative complications, Oxford Knee Score, range of motion, postoperative complications, and revision.

Results:

This clinical trial is expected to determine whether PTA is associated with increased risks of complications and revision or reduced functional outcomes following TKA.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5455).
Clinical study of XiangShaLiuJunZi decoction combined with S-1 as maintenance therapy for stage III or IV gastric carcinoma and colorectal carcinoma
Authors: Hong Xiao-Cui , Liang Qi-Lian , Luo Xing-Bo , Hu Ke-Hui , Yang Hai-Xia , Ou Wen-ting , Zhang Hui-Jie
Published: May 2020

Introduction:

S-1, a new oral fluorouracil chemotherapeutical drug, has been increasingly used in clinical maintenance after first-line chemotherapy for stage III or IV gastric carcinoma (GC) and colorectal carcinoma (CRC) for its own advantages. XiangshaLiujunzi Decoction (XSLJZD), a classic traditional Chinese medicine (TCM) formula with effects of alleviating the adverse reactions of chemotherapy and improving the quality of life of cancer patients has been gradually confirmed, with no more reports about the maintenance therapy mode of combination of chemotherapeutic drugs and TCM. We designed the study of XSLJZD combined with S-1 in the maintenance therapy of Stage III or IV GC and CRC, and hoped that this research program will go further and comprehensively evaluate its efficacy and safety.

Objectives:

The aim of this study was to determine the efficacy and safety of XSLJZD combined with S-1 in the maintenance therapy of stage III or IV GC and CRC.

Methods:

This study is an open, single-center, randomized study. Patients with stage III or stage IV GC and CRC will be randomized (1:1) into S-1group, S-1 combined with XSLJZD group for 5 years of maintenance therapy. The primary endpoint was progression-free survival, and secondary end point was overall survival and Quality of Life Assessment (QOLA), which include an improvement in symptoms before and after treatment, Karnofsky Performance Status, and adverse events assessment.

Discussion:

This study will provide meaningful clinical information about the combination of chemotherapeutic drugs S-1 with TCM in the maintenance therapy of stage III or IV GC and CRC.

Trial registration:

Chinese Clinical Trial Registry: ChiCTR-INR-16008575.
Bacillus coagulans (PROBACI) in treating constipation-dominant functional bowel disorders
Authors: Chang Chen-Wang , Chen Ming-Jen , Shih Shou-Chuan , Chang Ching-Wei , Chiau Jen-Shiu Chiang , Lee Hung-Chang , Lin Yang-Sheng , Lin Wei-Chen , Wang Horng-Yuan
Published: May 2020

Bacillus coagulans (PROBACI) bacteria have been examined for efficacy against infectious or inflammatory bowel diseases. The aim of this observational and cross-sectional study was to evaluate the effects of PROBACI against various functional bowel symptoms.

Thirty-eight enrolled patients (36.5 ± 12.6 years) with functional bowel disorders in a gastrointestinal clinic were administered PROBACI (300-mg formulation containing 1 × 109 colony-forming units of B coagulans) twice/day over a 4-week period. Abdominal pain, abdominal distention, and global assessment were evaluated using a 5-point visual analog scale. The defecation characteristics, discomfort level, and effort required for defecation were recorded. The gut-microbiota composition in terms of the Firmicutes/Bacteroidetes ratio was analyzed by 16S-ribosomal RNA gene sequencing with stool samples at days 0, 14, and 28 post-treatment.

The 38 patients achieved significant improvements in abdominal pain (2.8 ± 0.5 to 3.3 ± 0.7, P = .0009), abdominal distention (2.5 ± 0.7 to 3.2 ± 0.8, P = .0002), and global assessment (2.7 ± 0.6 to 3.6 ± 0.7, P = .0001) from days 0 to 14. Compared with the diarrhea group, the constipation group achieved greater improvements in terms of discomfort during defecation (2.5 ± 0.7 to 3.1 ± 0.7, P = .02) and normalization of defecation style (50% vs 7.1%, P = .007) by day 28. A difference was observed in the Firmicutes/Bacteroidetes ratio between the constipation-dominant group (118.0) and diarrhea-dominant group (319.2), but this difference was not significant.

PROBACI provided control of abdominal pain, less discomfort during defecation, and a more normalized defecation style, especially in the constipation-dominant group.
Percutaneous cholecystostomy – An option in selected patients with acute cholecystitis
Authors: Søreide Jon Arne , Fjetland Anja , Desserud Kari F. , Greve Ole Jakob , Fjetland Lars
Published: May 2020

While urgent percutaneous cholecystostomy (PC) was introduced as an alternative to acute surgical treatment for acute cholecystitis (AC), the current place of PC in the treatment algorithm for AC is challenged. We evaluate demographics and outcomes of PC in routine clinical practice in a population-based cohort.

Retrospective evaluation of consecutive patients treated with PC for AC between 2000 and 2015. The severity of cholecystitis was graded according to the 2013 Tokyo Guidelines.

One hundred forty-nine patients were included (82; 55% males) (median age of 72.5 years; range, 21–92). The Tokyo Guidelines criteria of 2013 (TG13) severity grade distribution was 4%, 61.7%, and 34.2% for grades I, II, and III, respectively. No difference was observed between males and females with regard to age, American Society of Anesthesiologists (ASA) score, comorbidities, or previous history of cholecystitis. PC was successfully performed in all but 1 patient, and complications were few and minor. Less than half (48.3%) of all patients subsequently received definitive surgical treatment, mostly (83.3%) laparoscopy. No or minor complications were encountered in 58 (80.6%) patients. Operated patients were significantly younger (P = <.001) and had lower ASA scores (P = .005), less comorbidities (P < .001), and had more seldomly a severe grade 3 cholecystitis (P < .001) than non-operated patients.

PC is useful in selected patients with AC. However, since only a half of the patients eventually received definitive surgical treatment, a better routine decision-making based on proper criteria may enable an improved allocation of the individual patient for tailored treatment according to the disease severity, the patient's comorbidity burden, and also to the treatment options available at the institution to prevent overutilization of a non-definitive treatment approach. Comprehension of this responsibility should be acknowledged by hospitals with an emergency surgical service, although the clinical decision-making remains a challenge of the responsible surgeon on call.
Fatal outcome of autosomal recessive polycystic kidney disease in neonates with recessive PKHD1 mutations
Authors: Jung Jiwon , Seo Go Hun , Kim Yoo-Mi , Han Young Mi , Park Ji Kwon , Kim Gu-Hwan , Lee Joo Hoon , Park Young Seo , Lee Byong Sop , Kim Ellen Ai-Rhan , Lee Pil-Ryang , Lee Beom Hee
Published: May 2020

Autosomal recessive polycystic kidney disease (ARPKD) is the most common inherited childhood-onset renal disease, with underlying ciliopathy, and varies widely in clinical severity. The aim of this study was to describe the most severe form of ARPKD, with a fatal clinical course, and its association with mutations in polycystic kidney and hepatic disease 1 (fibrocystin) (PKHD1). Clinical, imaging, pathological, and molecular genetic findings were reviewed in patients prenatally affected with ARPKD and their families.

Five unrelated Korean families, including 9 patients, were analyzed. Among the 9 patients, 2 fetuses died in utero, 6 patients did not survive longer than a few days, and 1 patient survived for 5 months with ventilator support and renal replacement therapy. A total of 6 truncating mutations (all nonsense) and 4 missense mutations were detected in a compound heterozygous state, including 4 novel mutations. The most severe phenotypes were shared among all affected patients in each family, irrespective of mutation types.

Our data suggest a strong genotype–phenotype relationship in ARPKD, with minimal intra-familial heterogeneity. These findings are important for informing future reproductive planning in affected families.
Bilateral radial collateral ligament rupture in a shoemaker
Authors: Li Yueying , Wu Guangzhi , Cui Shusen , Zhang Zhan , Gu Xiaosong
Published: May 2020

Introduction:

Rupture of the radial collateral ligament (RCL) of the index metacarpophalangeal (MCP) joint is mostly related to acute local mechanical causes, which severely affect the stability of the MCP joint. However, few cases of chronic bilateral job-related RCL injury have been reported in the literature. There is no consensus on the knowledge of the disease to date. Here, we present an extremely rare case of chronic bilateral RCL injury.

Patient concerns:

A 58-year-old female shoemaker presented with chief complaints of swelling and pain in the radial aspect of the MCP joint of bilateral index fingers since 2 years. There was no history of acute RCL injury. The persistent pain was aggravated while gripping, pulling, buttoning, and twisting.

Diagnosis:

Based on the combination of physical examination, X-ray, and ultrasonic and magnetic resonance imaging, the patient was diagnosed with bilateral tear of the RCLs and joint dislocation of the index MCP joint. Eventually, intra-operative findings confirmed the diagnosis.

Intervention:

The patient underwent bilateral index MCP joint fusion followed by immobilization for 6 weeks. Functional therapy was started after immobilization.

Outcomes:

The patient's chief complaints were significantly alleviated after the operation. At the 12-month follow-up, the patient returned to a full level of activity as a shoemaker without any complications.

Conclusion:

Compared to acute RCL rupture of the index MCP joint, occupation may play an important role in the diagnosis of chronic RCL rupture of the index MCP joint. Our report will provide more diagnostic and treatment experience to deal with this type of injury.
A rare transitory change of the De Winter ST/T-wave complex in a patient with cardiac arrest
Authors: Liu Li , Wang Dan
Published: May 2020

Rationale:

The De Winter ST/T-wave complex is a rare and special electrocardiogram (ECG) manifestation in some patients with a total or subtotal occlusion in the proximal left anterior descending (LAD) coronary artery. It mainly appears as an ST-segment superior oblique depression instead of an ST elevation. However, a transitory change of the De Winter ST/T-wave complex has not been reported previously.

Patient concerns:

A 40-year-old man developed sudden precordial dull and unrelieved pain. One hour later, he suddenly lost consciousness when he arrived at the emergency department. After successful cardiopulmonary resuscitation (CPR), 2 ECGs were taken at 22-minute interval, which showed completely different manifestations. The first ECG showed acute inferior-wall ST elevation myocardial infarction (STEMI), while the second ECG showed a De Winter ST/T-wave complex, which indicated acute anterior-wall myocardial infarction.

Diagnosis:

The patient was diagnosed with acute myocardial infarction.

Interventions:

The patient responded to urgent treatment by percutaneous coronary intervention (PCI).

Outcomes:

It was confirmed that the case was consistent with the main characteristics of a De Winter ST/T-wave complex after PCI. The first ECG was a rare transitory change of the De Winter ST/T-wave complex. The patient was well recovered and discharged.

Lessons:

The De Winter ST/T-wave complex is an extremely dangerous and rare ECG manifestation that is not widely recognized at present. Although the mechanism is not very clear, it should be considered as indicating an equivalent risk of STEMI because it may suggest total or subtotal occlusion in the proximal LAD coronary artery. It is believed that in the near future, the mechanism of ECG including its transitory changes, will be fully revealed.
Comparison of high tone therapy and transcutaneous electrical nerve stimulation therapy in chemotherapy-induced polyneuropathy
Authors: Schaffler-Schaden Dagmar , Sassmann Robert , Johansson Tim , Gampenrieder Simon P. , Rinnerthaler Gabriel , Lampl Kathrin , Herfert Juergen , Lenzhofer Christiane , Landkammer Yvonne T. , Rieder Florian , Greil Richard , Flamm Maria , Niebauer Josef
Published: May 2020

Introduction:

Chemotherapy-induced peripheral neuropathy (CIPN) is a worldwide concern in patients receiving neurotoxic agents for cancer therapy. High tone external muscle stimulation is a promising therapeutic approach to alleviate symptoms of CIPN.

Methods:

This pilot study aims to investigate whether the application of home-based high-tone external muscle stimulation therapy (HTEMS) improves symptoms of CIPN. The trial is planned as a therapist- and assessor-blinded, 1:1 randomized controlled study. A total of 50 patients with chemotherapy-induced peripheral polyneuropathy will be included. All patients will perform therapy at home. Study participants will be allocated randomly to the HTEMS therapy (intervention group) or to the transcutaneous electrical nerve stimulation (TENS, control group), respectively, following a standardized therapy schedule. Compliance of participants can be verified by reading out the tool box. Outcomes will be evaluated at baseline and after 8 weeks of home-based therapy. The primary outcome includes improvement of CIPN according to the patient-reported EORTC QLQ-CIPN 20 questionnaire. Secondary outcomes are the patient-reported change in health-related quality of life and clinician-reported changes of vibration sensibility, tendon reflexes, temperature sensibility, perception of touch, and strength of the lower leg muscles. Further a safety- and process evaluation will be performed.

Discussion:

This pilot RCT aims to evaluate the impact of home-based HTEMS as compared to TENS in CIPN. There is a need for an effective treatment for CIPN and the results of this study are expected to possibly identify a novel and effective treatment strategy in the future.
Efficacy of baby shampoo and commercial eyelid cleanser in patients with meibomian gland dysfunction
Authors: Aryasit Orapan , Uthairat Yuwarat , Singha Penny , Horatanaruang Orasa
Published: May 2020

Background:

To compare the efficacy between Johnson's baby shampoo top-to-toe (No More Tears formula) and OCuSOFT Lid Scrub Original Foaming Eyelid Cleanser (OSO) in patients with grade 2 meibomian gland dysfunction (MGD).

Methods:

Sixty participants with grade 2 MGD were enrolled and analyzed based on intention to treat basis in a prospective, randomized, single-blind trial for eye scrub using either diluted baby shampoo or OSO. The data collection included the Ocular Surface Disease Index (OSDI) questionnaire, compliance, and complications. The eye examinations were according to the Tear Film and Ocular Surface Society at baseline and at post-treatment weeks 4 and 12.

Results:

The mean (±SD) age of the 60 patients who presented with grade 2 MGD was 48.0 ± 13.8 years and 75.0% were females. The OSDI scores of these participants between pre-treatment and post-treatment weeks 4 and 12 improved significantly in both groups (all P < .001). The mean (±SD) differences of the improvement of OSDI score from baseline were not statistically significantly different between the baby shampoo and OSO groups at post-treatment weeks 4 and 12 (P = .57 and P = .54, respectively). The compliance and complications were also not statistically significant between the 2 groups.

Conclusions:

Eyelid scrub using either baby shampoo or OSO and warm compresses could significantly reduce eye irritability and uncomfortable symptoms in grade 2 MGD patients. In this study, the efficacy, compliance, and complications between the 2 groups were not statistically significantly different.
Opening label, dynamic prospective cohort study on the small focus less than 1.0 cm shown by type B ultrasound in breast
Authors: Shi Aiping , Dong Yi , Xie Xinpeng , Du Haiying , Yang Ming , Fu Tong , Song Dong , Han Bing , Zhao Gang , Li Sijie , Du Ye , Jia Hongyao , Wu Di , Fan Zhimin
Published: May 2020

Background:

A consensus has not been achieved regarding the treatment of small nonpalpable breast lesions, and the purpose of this study was to prospectively investigate nonpalpable lesions less than 1.0 cm in diameter to explore the risk factors for such lesions and determine appropriate treatment of such kind of lesions.

Methods:

A total of 1039 patients with small lesions less than 1.0 cm in diameter who underwent mammography and ultrasound from 2009 to 2010 in our institution were prospectively enrolled. Among them, 80 patients underwent biopsy, whose lesions grew by more than 30% of its original size, with an unclear boundary or irregular shape. All patients were followed-up for an average of 24 months, and lesions identified as high-risk types, such as cancer or atypical hyperplasia, of tumors on pathological examination were labeled “meaningful lesions.” Then relevant factors affecting the detection of meaningful lesions were analyzed.

Results:

In total, 40 meaningful lesions including 2 breast cancers were detected, accounting for 3.8% and 0.2% of all patients, respectively. Univariate analysis identified smoking (P = .030), irregular shape (P = .018), unclear boundary (P = .024), and vascularization (P = .023) as risk factors for the detection of meaningful lesions (P < .05). On multivariate analysis, smoking and irregular shape were further identified as independent risk factors for the detection of meaningful lesions.

Conclusion:

The overall incidence of cancer among nonpalpable lesions with a diameter less than 1.0 cm is low. Biopsies are strongly recommended for patients who are smokers or who have small lesions with an irregular shape, whereas regular follow-up observation is likely safe for other patients with small, non-palpable breast lesions.
Analysis of genes associated with prognosis of lung adenocarcinoma based on GEO and TCGA databases
Authors: Yu Ye , Tian Xuemei
Published: May 2020

Backgrounds:

Lung adenocarcinoma (LUAD) is one of the most common malignancies, and is a serious threat to human health. The aim of the present study was to assess potential biomarkers for the prognosis of LUAD through the analysis of gene expression microarrays.

Methods:

The gene expression data for GSE118370 was downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between normal lung and LUAD samples were screened using the R language. The DAVID database was used to analyze the functions and pathways of DEGs. The STRING database was used to the map protein–protein interaction (PPI) networks, and these were visualized with the Cytoscape software. Finally, the prognostic analysis of the hub gene in the PPI network was performed using the Kaplan–Meier tool.

Results:

A total of 406 downregulated and 203 upregulated DEGs were identified. The GO analysis results revealed that downregulated DEGs were significantly enriched in angiogenesis, calcium ion binding and cell adhesion. The upregulated DEGs were significantly enriched in the extracellular matrix disassembly, collagen catabolic process, chemokine-mediated signaling pathway and endopeptidase inhibitor activity. The KEGG pathway analysis revealed that downregulated DEGs were enriched in neuroactive ligand-receptor interaction, hematopoietic cell lineage and vascular smooth muscle contraction, while upregulated DEGs were enriched in phototransduction. In addition, the top 10 hub genes and the most closely interacting modules of the top 3 proteins in the PPI network were screened. Finally, the independent prognostic value of each hub gene in LUAD patients was analyzed through the Kaplan–Meier plotter. Seven hub genes (ADCY4, S1PR1, FPR2, PPBP, NMU, PF4, and GCG) were closely correlated to overall survival time.

Conclusion:

The discovery of these candidate genes and pathways reveals the etiology and molecular mechanisms of LUAD, providing ideas and guidance for the development of new therapeutic approaches to LUAD.
Monocyte–lymphocyte ratio is a valuable predictor for diabetic nephropathy in patients with type 2 diabetes
Authors: Huang Qinghua , Wu Hui , Wo Mingyi , Ma Jiangbo , Fei Xianming , Song Yingxiang
Published: May 2020

Diabetic nephropathy (DN) is serious threat to human health. Therefore, early prediction of its occurrence is important. This study aimed to assess the predictive significance of monocyte–lymphocyte ratio (MLR) for DN.

A total of 301 patients with type 2 diabetes (T2D), including 212 T2D patients without diabetic-related complications and 99 DN patients, were enrolled. Peripheral white blood cells were measured before treatment to calculate MLR, and the risk factors and predictive significance for T2D and DN were assessed.

T2D patients without diabetic-related complications had higher MLR than control patients (P < .01). However, MLR was significantly higher in DN patients than in T2D patients without diabetic-related complications (P < .001). According to MLR quartiles, higher MLR in DN patients was correlated with higher serum creatinine, estimated glomerular filtration rate, and urinary albumin excretion (UAE) levels (P < .01 or P < .001). Furthermore, MLR was positively correlated with UAE level (R
2 = 0.5973; P < .01) and an independent predictor for DN (odds ratio: 7.667; 95% confidence interval [CI]: 3.689–21.312; P < .001). The area under the receiver-operating characteristic (ROC) curve for MLR was 0.874 (95%CI: 0.830–0.918, P < .001). When the optimal cutoff value was 0.23, the sensitivity and specificity of MLR for DN prediction were 0.85 and 0.74, respectively.

The present findings suggest that MLR is a powerful independent predictor for DN.
Baihu Jia Renshen Decoction for type 2 diabetic mellitus
Authors: Tian Yuan , Zhong Wen , Zhang Yuan , Zhou Linyue , Fu Xiaoxu , Wang Lizhen , Yang Yan , Xie Chunguang
Published: May 2020

Background:

Diabetes mellitus (DM) is one of the main health problems that perplex people all over the world. The prevalence of DM is still increasing in spite of the great efforts have been made to control DM in recent years. Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, accounting for about 90% of all DM cases. Traditional Chinese medicine has been used on treatment of DM and diabetic complications in China for many years. Baihu Jia Renshen Decoction (BJRD) is one of the oldest classic prescriptions of traditional Chinese medicine that applied in the field of diabetes’ treatment. BJRD is proved to be effective after years of clinical practice and basic research. The application of BJRD improves the overall clinical efficacy of T2DM. Therefore, a systematic review is necessary to provide available evidence for BJRD in therapy of T2DM.

Methods:

Different studies from various databases will be involved in this study. Only randomized controlled trials of T2DM patients diagnosed with World Health Organization 1999 diagnostic criteria will be included. We will search the literature in the databases from China Conference Paper Database, manual searching. Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Internet), WanFang, VIP (Chongqing VIP), and CBM (China Biomedical Literature CDROM Database). The primary outcomes include 2 hour plasma glucose, fasting plasma glucose, hemoglobin A1c, homeostasis model assessment of insulin resistance, and fasting plasma insulin. The secondary outcomes include clinical efficacy and adverse events. Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.

Results:

This study will synthesize and provide high-quality evidence based on the data of the currently published BJRD for the treatment of T2DM, in terms of 2 hour plasma glucose, fasting plasma glucose, hemoglobin A1c, homeostasis model assessment of insulin resistance and fasting plasma insulin, clinical efficacy, and safety.

Conclusion:

This systematic review aims to evaluate the benefits and harms of BJRD for the treatment of T2DM reported in randomized controlled trials, and provide more options for clinicians and patients to treat T2DM.

Registration number:

INPLASY202040006.