bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of nonsentinel lymph node metastasis in patients with breast cancer with metastasis in the sentinel node
Authors: Zhou Yidong , Huang Xin , Mao Feng , Lin Yan , Shen Songjie , Guan Jinghong , Zhang Xiaohui , Sun Qiang
Published: January 2019

To predict the factors related to axillary nonsentinel lymph node (NSLN) metastasis in patients with positive sentinel lymph node (SLN) of early breast cancer.

The retrospective data are collected from the patients with positive SLN who received further completion axillary lymph node dissection (cALND) in Peking Union Medical Hospital between March 2016 and December 2017. Univariate analysis was conducted on data with various clinicopathologic factors at first. Those factors with statistic significance (P < .05) in univariate analysis were then used to implement multivariate analysis and logistic regression.

There were total of 734 patients who received SLN biopsy , among whom 153 cases were included in our study. About 39.22% (60/153) of 153 paitents with positive SLN had no NSLN metastasisted to SLN. Univariate analysis showed that 3 variables were significantly correlated with NSLN involvement: tumor size (X
2 = 10.384, P = .001), SLN metastasis ratio (number of positive SLNs/number of SLNs removed × 100%) (X
2 = 10.365, P = .001) and the number of negative sentinel nodes (X
2 = 10.384, P = .006). In multivariate analysis and logistic regression, tumor size (odds ratio [OR] = 3.392, 95% confidence interval [CI]: 1.409–8.166, P = .006) and SLN metastasis ratio (OR = 3.514, 95% CI: 1.416–8.72, P = .007) were the independent risk factors. While the number of negative sentinel nodes (OR = 0.211, 95% CI: 0.063–0.709, P = .014) was the independent protective factor. The calculated risk resulted in an area under the curve of 0.746 (95% CI: 0.644–0.848), suggesting stable discriminative capability in Chinese population.

For those patients with positive SLN, larger tumor burden and SLN metastasis ratio are independent risk factors for NSLN metastasis. However, the more of the detected negative SLN, the less possibility with NSLN involvement.
Investigation and estimation of the prevalence of drug addicts in Xichang, china
Authors: Chen Kejin , Bian Chaorong , Song Benli , Gao Ge
Published: January 2019

To use a new method to estimate the prevalence of drug addicts in Xichang for the first time and to suggest that Chinese Center for Disease Control and Prevention should strengthen surveillance and intervention for them.

The Capture-Mark-Recapture (CMR) method of 3 correlated sources under the simple random sampling and its formulas detailed in this paper were applied to a survey of issues relevant to drug addicts in Xichang, China.

To view half a year as reacquisition time, the prevalence of drug users in Xichang could be 5264 in 2014, accounting for 0.7% of the resident population of the same year.

This investigation method and its formulas studied in this paper have both high reliability and high validity, being worthy of promotion in terms of estimating the prevalence of drug addicts in other parts of the world.
Apatinib with EGFR-TKIs in advanced wild gene-type NSCLC
Authors: Wu Yuan-Peng , Wu Ji-Jin , Tian Shu-Mei , Jin Tao , Li Chan , Xie Ke
Published: January 2019

Rationale:

For advanced non-small-cell lung cancer (NSCLC), targeted therapy and chemoradiotherapy are recommended as the first-line treatment. For patients with a performance status (PS) score over 2 and without gene mutation, however, only supportive treatment is provided and survival time is extremely short. We believe that more can be done to improve the patient's survival time and their quality of life.

Patient concerns and diagnoses:

A 65-year-old female came to our hospital due to “cough and pain and lack of movement in the left leg”. The diagnosis was advanced wild gene-type lung adenocarcinoma and PS score over 2.

Interventions and outcomes:

She was treated in our clinic with apatinib and erlotinib and has had no progression of the disease for 15.4 months. Except for the presence of hand-foot syndrome and diarrhea, no other serious adverse reactions were seen.

Lessons:

For patients in poor physical condition and unacceptable of chemo-radiotherapy, apatinib combined with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is a safe and effective therapeutic method for advanced wild gene-type NCSCL.
Analysis of the relationship between COMT polymorphisms and endometriosis susceptibility
Authors: Zhai Jiajia , Jiang Lei , Wen Aiping , Jia Jingde , Zhu Lili , Fan Bo
Published: January 2019

This study was aimed to explore the correlation between catechol-O-methyltransferase (COMT) gene polymorphisms and endometriosis susceptibility in Chinese Han population.

This case-control study recruited 134 endometriosis patients and 139 healthy individuals. COMT gene rs4680, rs2020917, and rs4646312 polymorphisms in the subjects were genotyped by the polymerase chain reaction-restriction fragment length polymorphism method. Association between COMT polymorphisms and endometriosis susceptibility was evaluated by χ2 test and adjusted by Logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to present the relative risk of endometriosis.

A allele of rs4680 was distinctly correlated with increased susceptibility of endometriosis (OR = 1.450, 95% CI = 1.012–2.076). However, when adjusted by the confounding factors, these associations become not significant. We failed to find any significant association between rs2020917 and endometriosis risk in the crude results. The adjusted results suggested that rs2020917 TT genotype and T allele were distinctly correlated with enhanced endometriosis risk (TT vs CC: P = .038, OR = 2.894, 95% CI = 1.060–7.903; T vs C: P = .039, OR = 1.481, 95% CI = 1.021–2.149). Besides, rs4646312 C allele was significantly correlated with endometriosis risk both in the crude (P = .027, OR = 1.502, 95% CI = 1.047–2.154) and adjusted (P = .019, OR = 1.564, 95% CI = 1.078–2.269) results.

COMT polymorphisms might predict the occurrence of endometriosis.
The safety and efficacy of acupuncture for epididymitis protocol for a systematic review
Authors: Wang Jisheng , Han Liang , Bao Binghao , Yu Xudong , Zhang Kaige , Dai Hengheng , Li Xiao , Wang Bin , Li Haisong
Published: January 2019

Background:

Epididymitis is a common disease in non-specific infections of the male reproductive system. According to the clinical incidence of acute epididymitis and chronic epididymitis, which is more common in chronic epididymitis. There are many clinical trials confirmed that acupuncture treatment can relieve pain and improve symptoms of epididymitis to some extent. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture for epididymitis.

Methods and analysis:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis.

Ethics and dissemination:

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

Registration number:

PROSPERO CRD42018111348.
Nutrient pattern analysis in critically ill patients using Omics technology (NAChO) – Study protocol for a prospective observational study
Authors: Schefold Joerg C. , Messmer Anna S. , Wenger Stefanie , Müller Lionel , von Haehling Stephan , Doehner Wolfram , McPhee Jamie S. , Fux Michaela , Rösler Kai M. , Scheidegger Olivier , Olariu Radu , Z’Graggen Werner , Rezzi Serge , Grathwohl Dominik , Konz Tobias , Takala Jukka , Cuenoud Bernard , Jakob Stephan M.
Published: January 2019

Introduction:

Intensive care unit-acquired weakness (ICU-AW) is often observed in critically ill patients with prolonged intensive care unit (ICU) stay. We hypothesized that evolving metabolic abnormalities during prolonged ICU stay are reflected by changing nutrient patterns in blood, urine and skeletal muscle, and that these patterns differ in patients with/without ICU-AW and between patients with/without sepsis.

Methods:

In a prospective single-center observational trial, we aim to recruit 100 critically ill patients (ICU length of stay ≥ 5 days) with severe sepsis/septic shock (“sepsis group”, n = 50) or severe head trauma/intracerebral hemorrhage (“CNS group”, n = 50). Patients will be sub-grouped for presence or absence of ICU-AW as determined by the Medical Research Council sum score. Blood and urine samples will be collected and subjected to comprehensive nutrient analysis at different time points by targeted quantitative mass spectrometric methods. In addition, changes in muscular tissue (biopsy, when available), muscular architecture (ultrasound), electrophysiology, body composition analyses (bioimpedance, cerebral magnetic resonance imaging), along with clinical status will be assessed. Patients will be followed-up for 180 and 360 days including assessment of quality of life.

Discussion:

Key objective of this trial is to assess changes in nutrient pattern in blood and urine over time in critically ill patients with/without ICU-AW by using quantitative nutrient analysis techniques. Peer-reviewed published NAChO data will allow for a better understanding of metabolic changes in critically ill patients on standard liquid enteral nutrition and will likely open up new avenues for future therapeutic and nutritional interventions.
The herbal drug, Bu-Zhong-Yi-Qi-Tang, for the treatment of atopic dermatitis
Authors: Jeong Mi-Kyung , Kim Young-Eun , Kim Anna , Jung Jeeyoun , Son Mi Ju
Published: January 2019

Introduction:

Bu-Zhong-Yi-Qi-Tang (BZYQT) is an herbal drug that is widely used to treat various diseases, including gastrointestinal diseases, allergic rhinitis, and atopic dermatitis (AD) in East Asian countries. BZYQT has been shown to have anti-allergic, anti-inflammatory, and immunoregulatory properties in experimental studies, and there is substantial clinical evidence of its effect on AD. This review will systematically assess the evidence of BZYQT for the treatment of AD.

Methods/design:

Eleven databases will be searched from their inception without language restriction. Randomized controlled trials that examined BZYQT or modified BZYQT for AD will be included. The selection of the studies, data abstraction, and validations will be performed independently by 2 researchers. The methodological qualities of the randomized controlled trials will be assessed using the Cochrane Collaboration tool for assessing the risk of bias.

Ethics and dissemination:

This systematic review will be published in a peer-reviewed journal and will also be disseminated electronically or in print. It will be useful to inform and guide healthcare practitioners.

Trial register number:

CRD42018105173.
Action of antimicrobial photodynamic therapy with red leds in microorganisms related to halitose
Authors: Ciarcia Ana Carolina Costa da Mota , Gonçalves Marcela Leticia Leal , Horliana Anna Carolina Ratto Tempestine , Suguimoto Ellen Sayuri Ando , Araujo Lysianne , Laselva Andreia , Mayer Marcia Pinto Alves , Motta Lara Jansinsk , Deana Alessandro Melo , Mesquita-Ferrari Raquel Agnelli , Fernandes Kristianne Porta Santos , Bussadori Sandra Kalil
Published: January 2019

Introduction:

Halitosis is the term used to describe any unpleasant odor relative to expired air regardless of its source. The prevalence of halitosis in the population is approximately 30%, of which 80 to 90% of the cases originate in the oral cavity resulting from proteolytic degradation by gram negative anaerobic bacteria. Antimicrobial photodynamic therapy (aPDT) has been widely used with very satisfactory results in the health sciences. It involves the use of a non-toxic dye, called photosensitizer (FS), and a light source of a specific wavelength in the presence of the environmental oxygen. This interaction is capable of creating toxic species that generate cell death. The objective of this controlled clinical study is to verify the effect of aPDT in the treatment of halitosis by evaluating the formation of volatile sulphur compounds with gas chromatography and microbiological analysis before and after treatment.

Materials and Methods:

Young adults in the age group between 18 and 25 years with diagnosis of halitosis will be included in this research. The selected subjects will be divided into 3 groups: G1: aPDT; G2: scraper, and G3: aPDT and scraper. All subjects will be submitted to microbiological analysis and evaluation with Oral ChromaTM before, immediately after treatment, 7, 14, and 30 days after treatment. For the evaluation of the association of the categorical variables the Chi-square test and Fisher's Exact Test will be used. To compare the means the student t test and analysis of variance (ANOVA) will be used and to analyse the correlation between the continuous variables the correlation test by Pearson will be applied. In the analyses of the experimental differences in each group the Wilcoxon test will be used. For all analyses a level of significance of 95% (P < .05) will be considered.

Discussion:

Halitosis treatment is a topic that still needs attention. The results of this trial could support decision-making by clinicians regarding aPDT using aPDT for treating halitosis.
Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia
Authors: Ryu Choongun , Choi Geun Joo , Park Yong Hee , Kang Hyun
Published: January 2019

Background:

Spinal anesthesia is the standard technique for elective cesarean section, but the incidence of maternal hypotension in this setting is reportedly about 80%, without any prophylactic management. Vasopressors are the most reliable method for counteracting the hypotension induced by spinal anesthesia. However, studies investigating the effects of vasopressors have yielded inconsistent and debatable results. Therefore, we plan to conduct a systematic review and network meta-analysis to identify the most effective vasopressor to prevent maternal hypotension, and to decrease fetal acidosis in women undergoing spinal anesthesia for elective cesarean section.

Methods:

A systematic and comprehensive search to detect all the randomized controlled studies on vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia will be performed using information in the databases, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, beginning from their inception to October 2018. We will conduct a network meta-analysis to combine the direct and indirect comparisons of the vasopressors. We will use the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of vasopressors. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool. All statistical analyses will be performed using Stata SE version 15.0.

Ethics and dissemination:

This systematic review and meta-analysis will be published in a peer-reviewed journal. Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.

Trial registration number:

The protocol for this review has been registered in the PROSPERO network (registration number: CRD42018111852).
Differences in treatment outcomes between ultrasound-guided percutaneous microwave ablation and endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma
Authors: Shen Yan , Liu Miao , He Jie , Wu Shu , Wan Yong-Lin , Ding Jun , Cai Xiao-Yan , Fu Xiao-Hong
Published: January 2019

Background:

The differences in treatment outcomes between ultrasound (US)-guided percutaneous microwave ablation (PMWA) and endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma (PTMC) remains unknown.

Methods:

An electronic search will be performed for randomized controlled trials or observational studies that reported recurrence and mortality rates in PTMC patients with US-guided PMWA or endoscopic thyroidectomy. Hazard ratios with their 95% confidence intervals will be calculated using fixed- or random-effects models according to heterogeneity.

Results:

This study will present the differences in treatment outcomes between US-guided PMWA and endoscopic thyroidectomy for patients with PTMC by pooling the results of individual studies.

Conclusion:

The results of this study would provide vigorous evidence in this issue and offer the guidance to both clinical decision-making and future research.

Ethics and dissemination:

Ethical approval is not applicable for this study.

PROSPERO registration number:

CRD42018112320.
Serum angiopoietin-2 concentrations of post-PCI are correlated with the parameters of renal function in patients with coronary artery disease
Authors: Jian Wen , Li Lang , Wei Xiao-Min , Guan Jia-Hui , Yang Guo-Liang , Gui Chun
Published: January 2019

Patients with coronary artery disease (CAD) frequently have comorbidity of chronic kidney disease (CKD). Their renal function may deteriorate because of the use of contrast agent after percutaneous coronary intervention (PCI). Angiopoietin-2 (Ang-2), which is highly expressed in the site of angiogenesis, plays an important role in both CAD and CKD. This study aimed to investigate the relation of serum Ang-2 concentrations with the renal function after PCI.

This study enrolled 57 patients with CAD undergoing PCI. Blood samples for Ang-2 were collected in the first morning after admission and within 24 to 48 h after PCI. The parameters of renal function (serum creatinine, cystatin C and eGFR) were tested on the first day after admission and within 72 h after PCI.

Overall, serum Ang-2 levels of post-PCI were significantly lower than those of pre-PCI [median, 1733 (IQR, 1100–2568) vs median, 2523 (IQR, 1702–3640) pg/mL; P < .001]. However, in patients with CKD (eGFR < 60 mL/min/1.73 m2), there was no significant difference between serum Ang-2 levels of post-PCI and those of pre-PCI [median, 2851 (IQR, 1720–4286) vs. median, 2492 (IQR, 1434–4994) pg/mL; P = .925]. In addition, serum Ang-2 levels of post-PCI, but not pre-PCI, were significantly correlated with the post-PCI parameters of renal function.

Serum Ang-2 concentrations of post-PCI are closely related to renal function in patients with CAD. It may have potential to be the early biomarker of contrast-induced nephropathy in the future.
Dural tear is associated with an increased rate of other perioperative complications in primary lumbar spine surgery for degenerative diseases
Authors: Takenaka Shota , Makino Takahiro , Sakai Yusuke , Kashii Masafumi , Iwasaki Motoki , Yoshikawa Hideki , Kaito Takashi
Published: January 2019

Prospective case-control study.

This study used a prospective multicenter database to investigate whether dural tear (DT) is associated with an increased rate of other perioperative complications.

Few studies have had sufficient data accuracy and statistical power to evaluate the association between DT and other complications owing to a low incidence of occurrence.

Between 2012 and 2017, 13,188 patients (7174 men and 6014 women) with degenerative lumbar diseases underwent primary lumbar spine surgery. The average age was 64.8 years for men and 68.7 years for women. DT was defined as a tear that was detected intraoperatively. Other investigated intraoperative surgery-related complications were massive hemorrhage (>2 L of blood loss), nerve injury, screw malposition, cage/graft dislocation, surgery performed at the wrong site, and vascular injury. The examined postoperative surgery-related complications were dural leak, surgical-site infection (SSI), postoperative neurological deficit, postoperative hematoma, wound dehiscence, screw/rod failure, and cage/graft failure. Information related to perioperative systemic complications was also collected for cardiovascular diseases, respiratory diseases, renal and urological diseases, cerebrovascular diseases, postoperative delirium, and sepsis.

DTs occurred in 451/13,188 patients (3.4%, the DT group). In the DT group, dural leak was observed in 88 patients. After controlling for the potentially confounding variables of age, sex, primary disease, and type of procedure, the surgery-related complications that were more likely to occur in the DT group than in the non-DT group were SSI (odds ratio [OR] 2.68) and postoperative neurological deficit (OR 3.27). As for perioperative systemic complications, the incidence of postoperative delirium (OR 3.21) was significantly high in the DT group.

This study demonstrated that DT was associated with higher incidences of postoperative SSI, postoperative neurological deficit, and postoperative delirium, in addition to directly DT-related dural leak.
The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma
Authors: Wang Han , Zhang Meibiao , Zheng He , Xia Xiaolong , Luo Kehui , Guo Feng , Qian Cong
Published: January 2019

Objectives:

Chronic subdural hematoma (cSDH) is a common neurological disorder in elderly and the immediate outcome of surgery is satisfied. The high reoperation rate hinders the long-term effect of surgery and the risk factor is still unclear. Some researchers reported that high recurrence rate is related to the antithrombotic (AT) drugs, which is commonly used to prevent diseases in elderly patients. In this article, we conducted a meta-analysis to determine whether AT agents increase the risk of recurrence and mortality in patients with cSDH.

Methods:

The human case–control or randomized controlled trial (RCT) studies regarding the association of cSDH and AT were systematically identified through online databases (PubMed, Cochrane, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated.

Results:

This meta-analysis included 24 studies. AT drugs significantly increased the risk of recurrence in patients with cSDH (odds ratio (OR) of 1.30, 95% confidence interval (CI), 1.11–1.52, P = .001). Further analysis demonstrated that both anticoagulation (OR of 1.41, 95% CI, 1.10–1.81, P = .006) and antiplatelet (OR of 1.23, 95% CI, 1.01–1.49, P = .03) had higher risk of recurrence, but no difference was found between them (OR of 0.80, 95% CI, 0.58–1.09, P = .16). However AT drugs did not increase the risk of mortality for patients with cSDH (OR of 1.08, 95% CI, 0.61–1.92, P = .78).

Conclusion:

AT treatment is an important risk factor of recurrence in patients with cSDH in spite of similar mortality rate. When and how to resume AT drugs is still unclear, more well-designed prospective researches are needed on this issue.

Core tip:

High recurrence is an important factor against the long-term outcome of surgery in patients with cSDH, the use of AT drugs is a potential risk factor. In this study we found that the use of AT drugs increased the risk of recurrence rather than mortality. Anticoagulation and antiplatelet showed no difference in causing cSDH recurrence.
Inflammatory myofibroblastic tumor of urinary bladder with severe hematuria
Authors: Song Daoqing , jiao Wei , Gao Ze , Liu Ningning , Zhang Shimin , Zong Yuqian , Fang Zhiqing , Fan Yidong
Published: January 2019

Rationale:

Inflammatory myofibroblastic tumor (IMT) is a rare intermediate soft tissue tumor. Rarely occurring in the urinary bladder, MTs is composed of myofibroblast differentiated spindle cells and accompanied by numerous inflammatory cells, plasma cells and/or Lymphocytes.

Patient concerns:

A 28-year-old female, with history of 2 cesarean sections 8 years ago and 2 years ago, was admitted to the emergency department for a 7-day ongoing gross hematuria with clots.

Diagnoses:

A cystoscopy showed a tumor near the bladder neck, computed tomography (CT) showed a mass and massive blood clots in the bladder. Finally, postoperative pathological examination confirmed a diagnosis of inflammatory myofibroblastic tumor of bladder.

Interventions:

The patient was given rehydration and blood transfusion to improve the general condition. Then, emergency transurethral resection of the bladder tumor was performed.

Outcomes:

No metastases to lymph nodes and other organs were found, and no tumor progression was revealed during 3-months of follow-up.

Lessons:

IMTs rarely occur in the urinary bladder. Due to the lack of specificity in clinical symptoms, it's difficult to arrive at a definite diagnosis before operation. Therefore, usually, the final diagnosis depends on histomorphological features and the immunohistochemical profile. Further case studies are required to study the biological behavior of this condition.
Predictive factors for non-small-volume central lymph node metastases (more than 5 or ≥ 2 mm) in clinically node-negative papillary thyroid carcinoma
Authors: Wang Jian-Biao , Sun Ya-Yu , Shi Liu-Hong , Xie Lei
Published: January 2019

The benefits of prophylactic central neck dissection (pCND) for treating patients with clinical node-negative (cN0) papillary thyroid carcinoma (PTC) remain controversial. Lymph node metastases have been strongly associated with local recurrence and low survival, especially in PTC patients with 5 or more or ≥2 mm metastatic lymph nodes. The following study investigates the incidence and risk factors of more than 5 or ≥2 mm metastatic lymph nodes in the central compartment.

A total of 611 patients with cN0 PTC were retrospectively analyzed. Cervical lymph nodes were harvested, and the size of metastatic lymph nodes was consequently analyzed.

Non-small-volume central lymph node metastases (NSVCLNM), defined as more than 5 or ≥2 mm metastatic lymph nodes) were detected in 67 (11.0%) patients. Male gender, age ≤36 years, multifocal lesions, extrathyroidal extension, and tumor size > 0.85 cm were independent risk factors for NSVCLNM in cN0 PTC. The sensitivity and specificity of having ≥3 risk factors for predicting NSVCLNM was 46.3% and 86.8%, respectively.

These findings suggest that pCND is a suitable treatment strategy for cN0 PTC patients with 3 or more risk factors for NSVCLNM.
Shifting therapeutic paradigms in induction and consolidation for older adults with acute myeloid leukemia
Authors: Zuckerman Tsila , Rowe Jacob M.
Published: January 2019

Purpose of review

As the age and life expectancy of the general population rise, the number of acute myeloid leukemia (AML) patients suitable for therapy is expected to dramatically increase. The population of older adults with AML, while already comprising the vast majority of AML patients, has not been specifically addressed in terms of unique age-related features, such as existence of comorbidities, frailty, and disease biology.

Recent findings

Over the past decade, major improvements in the approach to the management of older adults with AML included: incorporation of new comorbidity scores specifically oriented to this patient population that can predict individual fitness to treatment, refined knowledge of the unique mutational landscape, and incorporating new combinations and novel agents designed to target the AML biology. Particularly, the recent exciting description of age-related clonal hematopoiesis and its evolution to AML may open new avenues for intervention prior to development of full-blown leukemia.

The rising awareness of the unique biology and special needs of older adults with AML has resulted in the design of new studies aiming to target the aberrant mutations and clinical characteristics in this patient population.
Outpatient induction and consolidation care strategies in acute myeloid leukemia
Authors: Halpern Anna B. , Walter Roland B. , Estey Elihu H.
Published: January 2019

Purpose of review

Patients with acute myeloid leukemia (AML) are almost invariably kept in the hospital until resolution of cytopenias following intensive induction chemotherapy. This care approach is costly and may further contribute to the reduced qualify of life of these patients. This has raised interest in moving at least part of this care to the outpatient setting. Reimbursement challenges for inpatient administration of some of the new drugs approved for AML in the last 2 years adds to this interest.

Recent findings

Retrospective and smaller prospective studies have shown that outpatient management following intensive induction chemotherapy (’Early Hospital Discharge’) is feasible and may be well tolerated and cost-effective. Reported experience is more limited regarding administration of intensive chemotherapy in the outpatient setting.

Although of interest, barriers to the successful implementation of outpatient care models, such as limited outpatient infrastructure or geographical limitations, will have to be overcome in many cancer centers. Importantly, before wide-spread introduction, the safety and ‘efficacy’ (e.g. reduction in medical resources and/or cost and improvement in quality of life) of outpatient care strategies will need to be further evaluated in a prospective – and ideally randomized – manner across more heterogeneous types of oncology and geographical settings.
Which patients with acute myeloid leukemia in CR1 can be spared an allogeneic transplant?
Authors: Craddock Charles , Raghavan Manoj
Published: January 2019

Purpose of review

Disease relapse remains the major cause of treatment failure in adults with acute myeloid leukemia (AML) in first complete remission (CR1) treated with intensive chemotherapy alone. Allogeneic stem cell transplantation (allo-SCT) reduces the risk of disease recurrence, and thus the advent of reduced intensity-conditioning regimens coupled with increased donor availability has increased the deliverability of potentially curative transplant therapy in AML. However, allo-SCT remains associated with significant additional morbidity and mortality, and it is therefore important to identify patients whose outcome if treated with chemotherapy alone is good enough to spare them the risks associated with allo-SCT.

Recent findings

Characterization of cytogenetic and molecular abnormalities present at diagnosis coupled with dynamic assessments of measurable residual disease now permit greater accuracy in defining the relapse risk in patients treated with chemotherapy alone. At the same time, the risk of transplant-related mortality can be predicted by a number of scoring systems which assess patient comorbidity. Taken together, such assessments permit a dynamic assessment of the risks and benefits of transplantation aiding the identification of patients who are unlikely to benefit from transplantation in CR1.

Increasingly accurate risk stratification in adults with AML CR1 aids the rational utilization of allo-SCT. Future research integrating the results of serial MRD analysis in molecularly defined subtypes of AML will further improve rational selection of patients for transplant.
Prevalence and Outcome of HIV-associated Malignancies Among HIV-infected Children Enrolled into Care at Kilimanjaro Christian Medical Center 2006 to 2014: A Hospital-based Retrospective Analytical Study
Authors: Irira Michael , Ngocho James S. , Youze Joshua , Shayo Irene , Komba Venancia , Minja Linda , Karia Francis P. , Bartlett John , Mmbaga Blandina T.
Published: January 2019

Objective:

We aimed to establish the prevalence of human immunodeficiency virus (HIV)-associated malignancies in children attending a care and treatment clinic at Kilimanjaro Christian Medical Centre.

Materials and Methods:

This was a retrospective cross-sectional hospital-based study of children who attended an HIV care and treatment clinic between 2006 and 2014. Children 2 months to 17 years of age were eligible for participation. The data on social demographic and clinical characteristics were extracted from the medical record. A multivariate logistic regression model was developed to determine predictors of HIV-associated malignancies.

Results:

Medical records from 721 HIV-infected children were reviewed. The median age (interquartile range) at HIV diagnosis was 5.7 (2.0 to 9.4) years. Among them, 34 (4.7%) had HIV-associated malignancies. The most common (n=24, 70.3%) malignancy was the Kaposi sarcoma. Age at HIV diagnosis was significantly associated with HIV-associated malignancies (adjusted odds ratio, 1.2; 95% confidence interval, 1.0-1.3). Among 34 patients with HIV-associated malignancies, 11 (32.4%) died. Seven (20.6%) patients reported complete remission from their malignancies, and outcomes for 6 patients were unknown.

Conclusions:

The prevalence of HIV-associated malignancies was high and was associated with late HIV diagnosis. The Kaposi sarcoma was the commonest malignancy. Early HIV diagnosis and treatment in children might reduce HIV-associated malignancies.
An Integrative Review on Knowledge and Attitudes of Nurses Toward Palliative Care
Authors: Achora Susan , Labrague Leodoro Jabien
Published: January 2019

To effectively participate in provision of palliative care, nurses need to possess a combination of knowledge, skills, and positive attitudes in equal measure in a way that is sensitive and meaningful and in a dynamic manner. The aim of this review was to examine nurses’ knowledge and attitudes about palliative care, to identify gaps to improve care of patients and families facing death. An integrative review method guided this review. After implementation of a search strategy, data from 26 studies were analyzed and synthesized. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. Data were extracted using a common table, and themes were generated from the available peer-reviewed studies using narrative synthesis. Findings revealed knowledge deficit but favorable attitudes toward palliative care among nurses. Education and the clinical experience of nurses in palliative care influenced their knowledge and attitudes toward palliative care. There is a need for mandatory inclusion of basic palliative care content in nursing school curricula and more in-depth postgraduate curricula. In clinical practice, there is a need to reinforce palliative care education by creating expert nurse support networks to model excellence in palliative care.
Identifying and Addressing Family Caregiver Anxiety
Authors: Moss Karen O. , Kurzawa Colleen , Daly Barbara , Prince-Paul Maryjo
Published: January 2019

Family caregivers are an increasingly diverse group of individuals who provide significant amounts of direct and indirect care for loved ones with long-term chronic illnesses. Caregiver needs are vast, particularly as these relate to the caregiver's quality of life. However, caregivers are often unlikely to address their personal and health-related concerns. Unmet needs combined with the caregiving role often lead to high levels of caregiver anxiety. Unaddressed, this anxiety is likely to result in poor health and low quality of life. Nurses, along with the health care team, are well positioned to assess, monitor, intervene, and reassess anxiety levels in caregivers using standardized screening tools across care settings. This article focuses on the family caregiver anxiety symptom in community-based settings, where health care providers have unique opportunities to detect this symptom in a familiar environment and begin immediate intervention leading to promotion of quality of life for the caregiver and subsequently the care recipient. Additional research efforts should be focused on health care provider goals of care, dyadic assessments, and monitoring of caregiver needs while caring for their loved ones aging in place.
Transitional Mentor Education Program Pilot
Authors: Shermont Herminia , Pignataro Shelly , Moonan Marilyn , Memmolo Shauna , Murphy Jane M.
Published: January 2019

Nursing professional development practitioners and nursing leadership identified a need for a transitional mentoring program to assist staff nurses’ transition beyond orientation. Mentoring was identified as an effective strategy to promote professional development. The benefits of this year-long transitional mentoring program include an increase in clinical confidence, integration of stress reduction strategies, and reflective practice into daily practice. The transitional mentoring program is a beneficial strategy for enhancing professional development of both mentors and mentees.
De Novo Testicular Extranodal NK/T-Cell Lymphoma
Authors: Huang Yuhua , Shi Xiaolan , Zhong Peng , Wang Yu , Xiao Hualiang , Zhou Xiaoge , Yun Jingping
Published: January 2019

Although the testis is not uncommonly involved during the course of disease in both nasal and non-nasal extranodal NK/T-cell lymphoma (ENKTCL), only a few cases presenting initially with a testicular mass have been previously reported. These have been documented as case reports, rather than as study series. Because of its rarity, the clinicopathologic features and the prognosis of de novo testicular ENKTCL have not been well characterized. Clinicopathologic features of 21 cases of de novo testicular ENKTCL from 3 institutions in China were retrospectively analyzed with review of an additional 18 cases from the literature. De novo testicular ENKTCL accounted for 0.72% (21/2906) of all ENKTCL during the study period. The median age of patients with de novo testicular ENKTCL was 45 years (range, 21 to 79 y). Most (90.9%) cases occurred in Asians. All patients initially presented with testicular swelling and most (91.9%) had unilateral testicular masses. The majority (73.0%) of patients presented at Ann Arbor stage I/II. Expression of CD56 was found in 92.1% (35/38) of the available cases. Interestingly, aberrant expression of CD20 was found in the tumor cells in 10.3% (4/39) of cases. The majority of patients with follow-up data (24/30, 80%) had extratesticular involvement during the follow-up period (median follow-up, 6 months; range, 0.5 to 87 mo). Preferential sites of extratesticular involvement included lymph nodes, skin, contralateral testis, bone marrow, spleen, adrenal gland, and central nervous system. Of the 30 patients with survival data, 70% (22/30) of patients died of the disease. The 2-year overall survival of patients with de novo testicular ENKTCL was 23%, and the median survival was 9.5 months. Patients that presented with B symptoms showed a trend toward inferior overall survival (P=0.095). No statistical significance was found between patients with stage I/II and stage III/IV (P=0.783). De novo testicular ENKTCL tends to disseminate early, shows extremely poor outcome, and should be recognized as a highly aggressive form of ENKTCL. A portion of cases show aberrant expression of CD20, and accurate diagnosis as well as timely and optimal treatment are very important.
Pararhodobacter marinus sp. nov., isolated from deep-sea water of the Indian Ocean
Authors: Lai Qiliang , Liu Xiupian , Yuan Jun , Xie Shuchen , Shao Zongze
Published: January 2019

A taxonomic study was carried out on strain CIC4N-9T, which was isolated from deep-sea water of the Indian Ocean. The bacterium was Gram-stain-negative, catalase- and oxidase-positive, rod-shaped and non-motile. Growth was observed at salinities of 0–9% and at temperatures of 4–41 °C. The isolate was able to degrade gelatin but not aesculin. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain CIC4N-9T belonged to the genus

Pararhodobacter

, with the highest sequence similarity to the only recognized species,

Pararhodobacter aggregans

D1-19T (96.9 %). The average nucleotide identity and estimated DNA–DNA hybridization values between strain CIC4N-9T and

P. aggregans

D1-19T were 80.4 and 23.0 %, respectively. The principal fatty acids were summed feature 8 (C18 : 1
ω7c and/or C18 : 1
ω6c), C16 : 0, C18 : 1ω7c 11-methyl, C18 : 0 and C17 : 0. The G+C content of the chromosomal DNA was 66.8 mol%. The sole respiratory quinone was determined to be Q-10. Phosphatidylcholine, phosphatidylglycerol, phosphatidylethanolamine, diphosphatidylglycerol, two unknown phospholipids, four unknown aminolipids and one unknown polar lipid were present. The combined genotypic and phenotypic data show that strain CIC4N-9T represents a novel species within the genus

Pararhodobacter

, for which the name

Pararhodobacter
marinus sp. nov. is proposed. The type strain is CIC4N-9T (=MCCC 1A01225T=KCTC 52336T).
Glaciecola amylolytica sp. nov., an amylase-producing bacterium isolated from seawater
Authors: Xiao Yong-Kun , Yan Zheng-Fei , Kim Yoosung , Lee Hyun-Myung , Trinh Huan , Yang Jung-Eun , Won Kyung-Hwa , Yi Tae-Hoo , Kook Moochang
Published: January 2019

A Gram-stain-negative, aerobic, non-motile and coccus-shaped bacterium (THG-3.7T) was isolated from seawater. Growth occurred at 10–30 °C (optimum 25 °C), at pH 6–8 (optimum 7) and in the presence of 1–8 % (w/v) NaCl (optimum 4 %). Based on 16S rRNA gene sequence analysis, the nearest phylogenetic neighbours of strain THG-3.7T were identified as

Paraglaciecola mesophila

DSM 15026T (95.3 % similarity),

Glaciecola pallidula

DSM 14239T (95.2 %),

Paraglaciecola aquimarina

KCTC 32108T (95.1 %),

Paraglaciecola arctica

KACC 14537T (94.9 %),

Glaciecola nitratireducens

KCTC 12276T (94.7 %) and

Paraglaciecola psychrophila

CGMCC 1.6130T (94.7 %). 16S rRNA gene sequence similarities among strain THG-3.7T and other species were lower than 94.7 %. The polar lipids were phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, one unidentified lipid and one unidentified aminolipid. The quinone system was composed of Q-8. The major fatty acids were C16 : 0, C18 : 1
ω7c and summed feature 3 (C16 : 1
ω7c and/or iso-C15 : 0 2-OH). The DNA G+C content of strain THG-3.7T was 47.9 mol%. On the basis of the data presented, strain THG-3.7T represents a novel species of the genus

Glaciecola

, for which the name

Glaciecola
amylolytica sp. nov. is proposed. The type strain is THG-3.7T (=KACC 19478T=CCTCC AB 2017258T).
Macrophages Enforce the Blood Nerve Barrier
Authors: Malong Liza , Napoli Ilaria , White Ian J , Stierli Salome , Bossio Alessandro , Lloyd Alison C.
Published: January 2019

The specialised blood barriers of the nervous system are important for protecting the neural environment but can hinder therapeutic accessibility1,2. Studies in the central nervous system (CNS) have shown the importance of the cellular components of the neuro-vascular unit for blood-brain barrier (BBB) function. Whilst the endothelial cells (ECs) confer barrier function with specialised tight junctions (TJs) and low levels of transcytosis, pericytes and astrocytes provide complete coverage of the ECs and both deliver essential signals for the development and maintenance of the BBB3–9. In contrast, the blood-nerve barrier (BNB) of the peripheral nervous system (PNS) remains poorly defined10. Here, we show that the vascular unit in the PNS has a distinct cellular composition with only partial coverage of the BNB-forming ECs. Using a mouse model, in which barrier function can be controlled11, we show the BNB, while less tight than the BBB, is maintained by low levels of transcytosis and the TJs of the ECs, with opening of the barrier associated with increased transcytosis. Importantly, we find that while ECs of the PNS have higher transcytosis rates than those of the CNS, the barrier is reinforced by resident macrophages that specifically engulf leaked material. This identifies a distinct role for macrophages as an important component of the BNB acting to protect the PNS environment with implications for improving therapeutic delivery to this tissue.
Generating real-world tumor burden endpoints from electronic health record data: Comparison of RECIST, radiology-anchored, and clinician-anchored approaches for abstracting real-world progression in non-small cell lung cancer
Authors: Griffith Sandra D. , Tucker Melisa , Bowser Bryan , Calkins Geoffrey , Chang Che-hsu (Joe) , Guardino Ellie , Khozin Sean , Kraut Josh , Miksad Rebecca , You Paul , Schrag Deb , Abernethy Amy P.
Published: January 2019

Real-world evidence derived from electronic health records (EHRs) is increasingly recognized as a supplement to evidence generated from traditional clinical trials. In oncology, tumor-based Response Evaluation Criteria in Solid Tumors (RECIST) endpoints are collected in clinical trials. The best approach for collecting similar endpoints from EHRs remains unknown. We evaluated the feasibility of a traditional RECIST-based methodology to assess EHR-derived real-world progression (rwP) and explored non-RECIST-based approaches. In this retrospective study, cohorts were randomly selected from Flatiron Health’s database of patient-level EHR data in advanced non-small cell lung cancer. A RECIST-based approach was tested for feasibility (N=26). Three non-RECIST abstraction approaches were tested for feasibility, reliability, and validity (N=200): (1) radiology-anchored, (2) clinician-anchored, and (3) combined. RECIST-based cancer progression could be ascertained from the EHRs of 23% of patients (6/26). In 87% of patients (173/200), at least one rwP event was identified using both the radiology- and clinician-anchored approaches. rwP dates matched 90% of the time. In 72% of patients (124/173), the first clinician-anchored rwP event was accompanied by a downstream event (e.g., treatment change); the association was slightly lower for the radiology-anchored approach (67%; 121/180). Median overall survival (OS) was 17 months (95% confidence interval [CI]: 14, 19). Median real-world progression-free survival (rwPFS) was 5.5 (95% CI: 4.6, 6.3) and 4.9 months (95% CI: 4.2, 5.6) for clinician-anchored and radiology-anchored approaches, respectively. Correlations between rwPFS and OS were similar across approaches (Spearman’s rho: 0.65-0.66). Abstractors preferred the clinician-anchored approach as it provided more comprehensive context. RECIST cannot adequately assess cancer progression in EHR-derived data due to missing data and lack of clarity in radiology reports. We found a clinician-anchored approach supported by radiology report data to be the optimal, and most practical, method for characterizing tumor-based endpoints from EHR-sourced data.