bluuebunny/crossref_metadata_2025 huggingface dataset:
Seminal vesicle metastasis after liver transplantation for hepatocellular carcinoma
Authors: Shen Yonghua , Nie Ling , Yao Yuling , Yuan LiQing , Liu Zhenqing , Lv Ying
Published: January 2019

Rationale:

Cancer recurrence and metastasis after liver transplantation (LT) is common in some hepatocellular carcinoma (HCC) patients. The most common sites of extrahepatic metastases are lung, regional lymph node, adrenal gland, and bone. To our knowledge, HCC metastasis to the seminal vesicle after LT has not been reported in the literature.

Patient concerns:

A 56-year-old Asian man presented at hospital with a 9-year history of orthotopic LT because of HCC. The patient underwent surgery and radiotherapy for HCC metastasis to adrenal gland and 1 year later, chemotherapy for peritoneal metastasis. A few months later, the patient presented with computed tomography (CT) image showing masses in right lobe of liver, seminal vesicle, and space occupying mass between the spleen and stomach.

Diagnoses:

Combination of clinical and pathological features revealed the seminal vesicle mass as metastasis from HCC.

Interventions:

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for liver and seminal vesicle lesions was performed and the postoperative pathology revealed malignancy. Thus, the patient underwent surgery and the diagnosis of seminal vesicle metastasis of HCC was confirmed by pathology and immunohistochemical analysis.

Outcomes:

The patient died due to systemic failure.

Lessons:

Seminal vesicle metastasis from HCC after LT is rare and there is no consensus on its treatment. Further research into the pathogenesis and therapy of seminal vesicle from HCC after LT is needed to improve outcomes in the rare disease.
Systemic immune-inflammation index is a promising noninvasive marker to predict survival of lung cancer
Authors: Zhang Yi , Chen Bo , Wang Lijuan , Wang Rong , Yang Xianjin
Published: January 2019

Background:

The prognostic value of pretreatment systemic immune-inflammation index (SII) in lung cancer has yet to be fully established.

Methods:

Relevant articles were obtained by performing a systematic search. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were used to assess the relationship between SII index and overall survival (OS) in lung cancer; the OS was calculated from the time of cancer diagnosis to the date of death due to any cause or to the last date of follow-up.

Results:

In total, 2786 patients with lung cancer from 7 studies were included in this meta-analysis. The median thresholds to define high SII was 640 (range 395.4–1600) in the analyzed studies. The pooled HR for OS was 1.77 (95% CI: 1.54–2.00, P < .001), suggesting that the patients with a high SII score had a worse OS. In addition, results from subgroup meta-analysis showed the significant prognostic significance of SII in lung cancer. Especially, the predictive value of SII was significant in the multivariable model for NSCLC (HR: 1.97, 95% CI: 1.69–2.25, P < .001; 5 studies, 1746 patients), and SCLC (HR: 1.38, 95% CI: 1.02–1.85, P < .001; 1 study, 919 patients).

Conclusion:

Our data suggest that high SII index indicates poor survival rate in lung cancer. Further researches are warranted to verify the significance of SII index in clinical practice.
Bariatric surgery in older adults
Authors: Susmallian Sergio , Raziel Asnat , Barnea Royi , Paran Haim
Published: January 2019

Obesity has become one of the most significant health problems worldwide, affecting more than one-third of the global population. The elderly population is not immune to this proportional increase in obesity. To date, there is no cure for obesity, but surgery is the most effective treatment available today.

We analyzed the results of bariatric surgery in elderly patients for a period of 3 years. Patients 65 years old and older were included in the study, 451 older adults were included. The mean age of the study group was 67.92 years old (min. 65, max. 84). The mean body mass index (BMI) was 40.32 Kg/m2 (min. 34 and max. 59). Sleeve gastrectomy (SG) was the most common procedures, and were conducted in 346 (76.72%) patients, gastric bypasses (GBPs) in 53 (11.75%) of which 33 were roux en y GBP (7.32%) and 20 mini GBPs (4.43%), gastric banding in 48 (10.64%), and duodenal switching in 4 (0.89%) cases.

There were 40 (8.86%) patients with perioperative complications, 6 (1.33%) required re-operations, 12 (2.66) patients with operative complications were treated conservatively, 8 (1.77%) re-admission 5 of them with intrabdominal abscess, and 14 (3.10%) with co-morbidities complications. More than 76% of the patients had co-morbidities, 1 year after surgery the average remission of diseases was 34.74%, the improvement was49.67% and no changes in the co-morbidities was 15.59%. There were no deaths reported in this cohort.

The mean excess body weight (EBW) loss among the patients was 70.76% (from 32% to 92%). No failure of weight loss (less than 25% of EBW loss) was observed after the first postoperative year.

Bariatric surgery offers obese elderly patients an acceptable result, and it can be offered to improve the quality of life of these patients. A new consensus conference panel is needed to set appropriate recommendations regarding criteria that limit bariatric surgery in older adults.
Migration of an intrauterine device causing severe hydronephrosis progressing to renal failure
Authors: Li Xueyan , Li Hongran , Li Chunmei , Luo Xiaohua , Song Yan , Li Shanshan , Luo Suiyu , Wang Yu
Published: January 2019

Rationale:

Intrauterine device (IUD) is commonly used in China. Its complications include uterine perforation, IUD ectopic migration, etc. However, a migrated IUD rarely leads to renal failure.

Patient concerns:

IUD insertion in the patient was followed by unexplained pain in the left renal area, without bladder irritation or dysuresia.

Diagnoses:

Hydronephrosis, renal failure, migrated IUD.

Interventions:

The patient underwent laparoscopic and retroperitoneoscopic left nephrectomy, partial ureterectomy, and migrated IUD extraction.

Outcomes:

No complications were found after 1 year of follow-up.

Lesson:

An IUD should be placed by an experienced doctor. If conditions permit, it is best to perform the procedure under the guidance of ultrasound. The patients should be advised to undergo regular check-ups after the procedure. If necessary, abdominal color Doppler examination should be performed. Importantly, patients with IUD pregnancy must be reviewed.
Work-related stress, burnout, and related sociodemographic factors among nurses
Authors: Ezenwaji Ifeyinwa O. , Eseadi Chiedu , Okide Charity C. , Nwosu Nneka Charity , Ugwoke Samuel C. , Ololo Kennedy O. , Oforka Theresa O. , Oboegbulem Angie I.
Published: January 2019

This study examined work-related stress and burnout symptoms with respect to related sociodemographic factors among nurses in Nigeria.

A representative sample of nurses (N = 393) was randomly selected from hospitals in Southeast Nigeria to take part in this cross-sectional, correlational study from June to December 2017. Participants received questionnaires by mail, which measured work stress and burnout symptoms, respectively. Data collected were analyzed using bivariate correlations and multiple regression analyses.

Among the sociodemographic factors investigated, sex was significantly correlated with work-related stress. The sociodemographic factors were not significantly associated with burnout symptoms. Stepwise multiple regression procedure produced a model that contained four sociodemographic factors and explained 4.5% of the variance in nurses’ work stress scores and 0.8% of the variance in nurses’ burnout scores. Age, work environment, and work experience did not make significant contributions to the prediction of work-related stress among the nurses. Finally, sex, age, work environment, and work experience did not make significant contributions to the prediction of burnout among the nurses.

Nurses’ sociodemographic factors, which included sex, age, work environment and work experience accounted for only a small proportion of variance in nurses’ work stress and burnout in Southeast Nigeria. The study also furthers our awareness that sex is significantly linked to work-related stress among the nurses in Southeast Nigeria. Thus, the implications of the study for administrators, research, and policy were discussed.
Prostate resected weight and postoperative prostate cancer incidence after transurethral resection of the prostate
Authors: Liu Fu-Chao , Hua Kuo-Chun , Lin Jr-Rung , Pang See-Tong , Yu Huang-Ping
Published: January 2019

To analyze whether different volumes of tissue resected during transurethral resection of the prostate (TURP) would associate with the subsequent development of prostate cancer.

This population-based retrospective cohort study recruited 49,206 patients with benign prostate hyperplasia (BPH) undergoing TURP between 2005 and 2012. Patients were recruited from the Taiwan National Health Insurance Research Database. Patients were separated into three groups, based on different volumes of tissue resected during TURP (5–15 g, 15–50 g, >50 g).

Of the 49,206 patients, 633 patients were diagnosed with new onset of prostate cancer following TURP. Older age was a risk factor contributing to the onset of prostate cancer (P = .0196) and different volumes of tissue resected were significantly related to the incidence of postoperative prostate cancer (P = .0399). The group of patients with a smaller volume of prostate resected had a higher risk of prostate cancer with a hazard ratio (HR) of 1.221 (95% confidence interval [CI]: 1.035, 1.440; P = .0179). However, the risk in the group of patients with a larger volume of prostrate resected was not significantly different, with an HR of 1.277 (95% CI: 0.981, 1662; P = .0690). The incidence of prostate cancer in Taiwanese males over 30 years of age has previously been reported to be 0.0560%; the mean incidence was 0.2282% in our present study.

This study shows that BPH patients who had a smaller volume of tissue resected during TURP show a higher incidence of prostate cancer postoperatively. Currently, no clear mechanism is shown to demonstrate the relationship between resected prostate weight and the incidence of tumors. Patients with a larger prostate volume might have lower urinary tract symptoms earlier and then seek professional help. It is possible that surgical procedures might remove the potentially carcinogenic prostate tissue and thus reduce the risk of an aggressive tumor developing in the future.
Prognostic value of total bilirubin in patients with acute myocardial infarction
Authors: Shen Hongyou , Zeng Canhui , Wu Xiaowei , Liu Shizhao , Chen Xiaomin
Published: January 2019

Background:

Experimental data obtained in animal models supported the protective role of bilirubin. However, clinical studies regarding the prognostic role of total bilirubin in patients with acute myocardial infarction (AMI) are conflicting. We, therefore, undertook this meta-analysis to evaluate the prognostic value of serum total bilirubin in AMI patients.

Methods:

Relevant studies were searched from PubMed and EMBASE databases up to April 15, 2018. Studies evaluating the outcomes in relation to serum total bilirubin in AMI patients and reporting multivariable-adjusted risk estimate of the prognostic value were eligible. The outcome measures were major adverse cardiac events (MACEs), cardiovascular death, and all-cause mortality.

Results:

Six studies involving 14,554 AMI patients were identified. Meta-analysis indicated that higher total bilirubin was associated with an increased risk of MACEs (risk ratio [RR] 1.65; 95% confidence intervals [CI] 1.25–2.19) and cardiovascular death (RR 2.12; 95%CI 1.24–3.64). However, higher serum total bilirubin did not significantly increase all-cause mortality risk (RR 1.31; 95%CI 0.75–2.28). Subgroup analyses by the types of AMI and study design supported the pooled results.

Conclusions:

Higher serum total bilirubin level is a predictor of MACEs and cardiovascular death in patients with AMI. However, interpretation of these findings should be with caution due to the impact of cardiac dysfunction after AMI.
Association between tamoxifen use and acute myocardial infarction in women with breast cancer
Authors: Lai Shih-Wei , Lin Cheng-Li , Liao Kuan-Fu
Published: January 2019

The relationship between tamoxifen use and acute myocardial infarction in women with breast cancer remains uncertain. The goal of the study was to assess whether tamoxifen use could be associated with acute myocardial infarction in women with breast cancer in Taiwan.

A population-based case–control study was conducted to analyze the database of the Taiwan National Health Insurance Program. Totally, 489 women with breast cancer aged 20 to 84 years having the first episode of acute myocardial infarction from 2000 to 2011 were found as the cases. In addition, 1718 women with breast cancer aged 20 to 84 years without any type of ischemic heart disease were selected as the matched controls. Ever use of tamoxifen was classified as the studied women who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was classified as the studied women who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval (CI) for acute myocardial infarction associated with tamoxifen use.

In a multivariable-adjusted analysis, women with acute myocardial infarction were 1.71 times more likely to be exposed to tamoxifen than those women without acute myocardial infarction (adjusted OR 1.71, 95% CI 1.38–2.13).

The odds of tamoxifen use are 1.71 times higher in women with acute myocardial infarction versus those women without acute myocardial infarction in Taiwan.
Prognostic value of PD-L1 expression in patients with pancreatic cancer
Authors: Hu Ying , Chen Wanzhen , Yan Zhanpeng , Ma Jingxia , Zhu Fangshi , Huo Jiege
Published: January 2019

Background:

Programmed cell death ligand 1 (PD-L1) expression was reported to be associated with poor prognosis in various solid tumors. However, the prognosis value of PD-L1 in pancreatic cancer remained inconclusive. We performed a meta-analysis to assess the clinical value of PD-L1 as a novel prognostic biomarker of pancreatic cancer.

Methods:

PubMed, Embase, and Web of Science were searched up to October 2018. The HRs and 95% CIs for overall survival (OS) and cancer-specific survival (CSS) according to the expressional status of PD-L1 were pooled. The combined odd ratios (ORs) and 95% CIs were utilized to assess the association between PD-L1 and clinicopathological characteristics.

Results:

A total of 9 studies with 993 patients were included. Elevated PD-L1 expression was related with poor OS (HR = 1.63, 95% CI = 1.34–1.98, P < .001) and CSS (HR = 1.86, 95% CI = 1.34–2.57, P < .001). Furthermore, high PD-L1 expression was also demonstrated to be associated with positive N stage (OR = 1.81, 95% CI = 1.21–2.71, P = .004), advanced T stage (OR = 1.86, 95% CI = 1.08–3.19, P = .025), and low differentiation (OR = 2.24, 95% CI = 1.16–4.33, P = .017). However, PD-L1 has nonsignificant correlation with M stage, gender, or age.

Conclusion:

This study suggests that PD-L1 is a potential prognostic biomarker and may be helpful to clinicians aiming to select the appropriate immunotherapy for pancreatic cancer.
The effectiveness of yoga to prevent diabetes mellitus type 2
Authors: Ramamoorthi Ramya , Gahreman Daniel , Moss Simon , Skinner Timothy
Published: January 2019

Background:

Type 2 diabetes mellitus (T2DM) is becoming a leading problem worldwide. Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached pandemic levels. Despite the significant incidence, there are limited reliable data resources and comprehensive systematic review and meta-analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM.

Objective:

The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM.

Methods:

The articles enrolled in the study will be retrieved from the online databases between 2002 and the date the searches are executed. The searches will be repeated just before the final analyses and further relevant studies for inclusion. We will conduct a bibliographic search in databases: Medline/PubMed, Scopus, Cochrane Library, EBSCO, and IndMED using keywords including prediabetes state, high risk for diabetes, metabolic syndrome, and yoga. A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies. This study protocol was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols 2015 guidelines. There will be no language restrictions.

Ethics and dissemination:

The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee. We published an outline of the protocol in the International Prospective Register of Systematic Reviews (PROSPERO) in 2018. We plan to disseminate the findings of this systematic review and meta-analysis through publication in a peer-reviewed journal and presentation at relevant conference proceedings. In addition, we believe the results of the systematic review will have implications for policy and practice. We will prepare policymaker summary using a validated format, disseminate through social media and email discussion groups.

Review registration number:

PROSPERO registration number CRD 42018106657
Analysis of acetabulum in children with developmental dysplasia of the hip by MRI scan
Authors: Zhou Ying , Ju Li , Lou Yue , Wang Bo
Published: January 2019

To review the value of acetabular magnetic resonance imaging (MRI) in children with developmental dysplasia of the hip (DDH) of different ages.

Eighty-eight medical records of children with unilateral DDH who were diagnosed and treated in our hospital between January 2010 and December 2015 were retrospectively analyzed. The affected hips were put into the case group, and the normal hips were put into the control group. All cases were further divided into 3 age groups: infant (<1 year), 16 cases; young children (1–3 years), 48 cases; and children (3–13 years), 24 cases. The differences of the acetabular depth (AD), the bony acetabular index (BAI), and the cartilaginous acetabular index (CAI) between each group were measured and compared for a linear correlation analysis. At the same time, the distribution of the acetabular cartilage in the anterosuperior, top, and posterosuperior parts (the three parts) from the two groups was measured, respectively.

Measurement results from both the case and control groups were as follows: AD was 5.46 ± 2.62 mm and 9.74 ± 2.33 mm; BAI was 33.26 ± 5.49° and 23.50 ± 5.33°; and CAI was 21.04 ± 6.16° and 12.71 ± 4.83°. Differences from the two groups were statistically significant (t = 11.94, 13.78, 9.16, P < .05); BAI and CAI were linearly correlated (r = 0.86, 0.75, P < .05). The AD in infant, young children, and children groups from the case group were 4.26 ± 0.42 mm, 4.79 ± 1.74 mm, and 7.31 ± 2.74 mm, respectively, which was statically significant as well (F = 11.37, P < .05). Under the same grouping criteria, BAI was recorded as 29.04 ± 5.11°, 34.56 ± 4.27°, and 33.12 ± 5.69°; CAI was recorded as 16.62 ± 5.50°, 21.79 ± 6.33°, and 20.91 ± 6.40° separately. There was a linear correlation (r = 0.78, 0.65, P < .05) between BAI and CAI in young children and children groups. The distribution of acetabular cartilage in the above-mentioned three parts from both young children and children groups was statistically significant (P < .05).

MRI is a satisfactory imaging modality to children with DDH of different ages for the assessment of AD, BAI, CAI, and acetabular cartilage in multiple locations. It can provide ample imaging reference to clinical evaluation of the acetabulum development in DDH.
Efficacy and safety of behavioral therapy for premature ejaculation
Authors: Bao Binghao , Shang Jianwei , Wang Jisheng , Dai Hengheng , Li Xiao , Zhang Kaige , Li Haisong , Wang Bin
Published: January 2019

Background:

Premature ejaculation (PE) is the one of the most prevalent male sexual dysfunction, there has not been specific medicine or therapy for the disease. As an effective treatment for premature ejaculation is a behavioral therapy and is widely used worldwide. The purpose of this study is to evaluate the efficacy and safety of behavioral therapy in patients who suffer from PE.

Method:

We will search all randomized controlled trials (RCTs) from the following electronic databases, by September 30, 2018, such as PubMed, EMBASE, the Cochrane Library, Web of Science database, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), and Wanfang Database. We will also collect clinical trial registries, dissertations, grey literature, reference lists of studies, systematic reviews, and conference abstracts. The primary outcomes include the Intravaginal Ejaculatory Latency Time (IELT). Besides, Premature Ejaculation Diagnostic Tool (PEDT), Arabic index of Premature Ejaculation (AIPE), Index of Premature Ejaculation (IPE) will be the secondary outcomes. Two people will review these articles, extract the data information, and assess the quality of studies separately. RevMan (version 5.3) and EndNote X7 will be used for meta-analysis.

Results:

This study will generate a comprehensive review of current evidence of behavioral therapy for premature ejaculation.

Conclusion:

The study will provide updated evidence to evaluate the efficacy and safety of behavioral therapy for premature ejaculation.

Ethics and dissemination:

It is not necessary for this systematic review to acquire an ethical approval. This review will be reported in a peer-reviewed journal.

PROSPERO registration number:

PROSPERO CRD42018111339.
Autologous platelet-rich plasma infusion improves clinical pregnancy rate in frozen embryo transfer cycles for women with thin endometrium
Authors: Chang Yajie , Li Jingjie , Wei Li-na , Pang Jiahui , Chen Jianhui , Liang Xiaoyan
Published: January 2019

Background:

Adequate thickness of the endometrium has been well recognized as a critical factor for embryo implantation. This was a prospective cohort study to investigate the benefits of platelet-rich plasma (PRP) for women with thin endometrium who received frozen embryo transfer (FET) program in a larger number of patients and explore the underlying mechanism.

Methods:

In this study, we investigated the effects of PRP in women with thin endometrium in FET program. 64 patients with thin endometrium (<7 mm) were recruited. PRP intrauterine infusion was given in PRP group during hormone replacement therapy (HRT) cycle in FET cycles.

Results:

After PRP infusion, the endometrium thickness in PRP group was 7.65 ± 0.22 mm, which was significantly thicker than that in control group (6.52 ± 0.31 mm) (P <.05). Furthermore, PRP group had lower cycle cancellation rate when compared to control group (19.05% vs. 41.18%, P <.01). The implantation rate and clinical pregnancy rate in PRP group were significantly higher than those in control group (27.94% vs 11.67%, P <.05; 44.12% vs 20%, P <.05, respectively). PRP blood contained 4 folds higher platelets and significantly greater amounts of growth factors including platelet-derived growth factor (PDGF)-AB, PDGF-BB, and transforming growth factor (TGF)-β than peripheral blood (P <.01).

Conclusions:

PRP plays a positive role in promoting endometrium proliferation, improving embryo implantation rate and clinical pregnancy rate for women with thin endometrium in FET cycles.
Spontaneous closure of an iatrogenic coronary artery fistula during recanalization of a chronic total occlusion lesion
Authors: Yu Xue , Wang Xinyue , Zhang Ruisheng , Xu Feng , Ji Fusui
Published: January 2019

Rationale:

Coronary perforation leading to fistula directed to the right ventricle is a rare complication of percutaneous coronary intervention (PCI). The reported outcomes vary from a stable state to rapid deterioration.

Patient concerns:

An 86-year-old man was diagnosed with non-ST elevation myocardial infarction, and arranged to PCI procedure for the chronic total occluded right coronary artery (RCA) after coronary angiography. The guide wire went through the occluded lesion and got to the distal part of the suspected “post lateral artery”, which later proved to be in the right ventricle (RV). After dilating with a 2.0 mm balloon, large amount of contrast medium leaked out from the lesion; therefore, we suspected a perforation into the pericardium.

Intervention:

Protamine was intravenously injected to convert the effect of heparin and the 2.0 mm balloon in diameter was dilated for about 1 h to obstruct the ejected blood flow shunting into the pericardium, but the leakage persisted. Nevertheless, the patient remained stable, and we were unable to detect an effusion in the pericardium.

Diagnosis:

By analyzing the angiogram and echocardiogram, we found that the contrast did not leak into the pericardium, but into the right ventricle (RV) chamber. An iatrogenic coronary artery fistula (ICAF) from the RCA to the RV was confirmed. We thus terminated the procedure.

Outcomes:

Coronary computed tomography (CT) angiography was performed 2 days after the PCI and no abnormal shunt was found. There was no abnormal Doppler signal in the RV, either. The patient was soon discharged, and there have been no complaints of discomfort during the 10-month follow-up.

Lessons:

ICAFs from coronary to the RV always have favorable outcomes. Even like the one in this case that caused medium leakage could seal spontaneously without any additional management. Echocardiography or coronary CT angiography could be chosen as imaging options to follow-up ICAFs.
Periprosthetic metastasis following total hip arthroplasty in a patient with lung carcinoma
Authors: Zhan Haibo , Gao Tian , Yu Xiaolong , Zhang Bin , Zeng Jin , Dai Min
Published: January 2019

Rationale:

Periprosthetic osteolysis secondary to septic loosening and aseptic loosening is a well-described phenomenon associated with artificial hip arthroplasty. Periprosthetic bone loss as a result of metastatic infiltration is an uncommon cause of early, progressive loosening of joint replacement prosthesis and is rarely described in the literature.

Patient concerns:

The present study describes a 70-year-old male patient who was diagnosed with pulmonary squamous cell carcinoma 5 years after total hip arthroplasty (THA) and developed a metastasis from squamous cell carcinoma in the periprosthetic neosynovial tissue 1 year after formal chemotherapy. The main complaint was hip pain with limited activity for about 3 months.

Diagnoses:

Expansive bone destruction and periprosthetic osteolysis at the right femoral trochanter were identified through X-ray and 99mTc bone scan. The diagnosis of pulmonary squamous cell carcinoma metastasis was finally confirmed on the basis of postoperative pathological examination.

Interventions:

The patient underwent open surgery with proximal femoral prosthesis revision and tumor prosthesis resection to completely remove the tumor tissue and relieve pain.

Outcomes:

The patient was completely relieved of pain at discharge 2 weeks after surgery and experienced no complications. However, the patient died of respiratory failure due to disease progression 3 months after surgery.

Lessons:

We believe that clinicians should maintain a high index of suspicion and consider metastatic disease in differential diagnosis of cases of aseptic loosening, particularly if the patient has a history of malignant disease and the osteolytic lesion involves the outer cortex. In addition, patients with a known history of malignancy should be screened with a pre-operative bone scan to rule out any metastatic infiltration and regularly followed up at short intervals to detect any early bone loss.
Elective nodal irradiation provides a superior therapeutic modality for lymph node positivity esophageal squamous cell carcinoma patients receiving definitive radiotherapy versus involved-field irradiation
Authors: Li Qiaofang , Zhu Shuchai , Li Shuguang , Deng Wenzhao
Published: January 2019

This retrospective study was conducted to evaluate the efficacy and safety of elective nodal irradiation (ENI) and involved-field irradiation (IFI) for esophageal squamous cell carcinoma (ESCC) patients treated with intensity-modulated radiotherapy (IMRT).

From January 2006 to December 2012, 644 patients (ENI = 157, IFI = 487) with stage I to IVa ESCC (AJCC 2010) at our institution were analyzed. Propensity score matching (PSM) was used to identify 471 (ENI = 157, IFI = 314) well-balanced patients for comparison. Overall survival (OS) was the primary outcome of the study.

After PSM, the median OS was 26.8 (95% confidence interval [CI], 17.9–35.7) for the ENI arm versus 21.5 (95% CI: 17.9–25.1) months in the IFI arm. The 1-, 3-, 5-year OS were 77.1%, 42.0%, and 26.1% for the ENI arm versus 73.2%, 32.2%, and 19.0% for the IFI arm (P = .020). ENI was a significant independent predictor of 5-year OS (1.301 [1.052–1.609]; P = .015). Furthermore, patients with stage I/II ESCC or lymph node (LN) positivity in the ENI arm had significantly better 5-year OS than their counterparts in the IFI arm. In addition, for LN positivity patients treated with definitive radiotherapy alone, ENI tended to prolong OS compared with IFI (P = .035). The 2 arms were comparable in toxicities.

Using IMRT, ENI is superior to IFI in improving OS of ESCC patients, with acceptable toxicities that were comparable to those to IFI, especially for LN positivity ESCC patients treated with definitive irradiation alone. These results should be confirmed in a large randomized study comparing these 2 modalities.
Risk factors for bone metastasis in patients with primary lung cancer
Authors: Niu Yujie , Lin Yiting , Pang Hailin , Shen Weiwei , Liu Lili , Zhang Helong
Published: January 2019

Background:

Bone metastases (BM) are prevalent among lung cancer (LC) patients. Although some studies revealed associated factors for BM, each of these papers focused on a few factors. Few studies have identified the potential risk factors through a systematic review.

Methods:

We searched through PubMed, MEDLINE, Web of Science, EMBASE, Cochrane Library and Cochrane Central Register

of Controlled Trials for literature from January 1990 to November 2017. The types of literature included case–control studies, cohort studies, randomized controlled trials and systematic reviews.

Results:

From included 12 studies, we identified that lower blood calcium, T4 stage, N3 stage, P-stage III, nonsquamous, bone sialoprotein expression, elevated carcino-embryonic antigen levels were risk factors for bone metastasis in lung cancer patients.

Conclusion:

We identified that T4 stage, N3 stage, and positive bone sialoprotein expression associated with an increased risk of bone metastasis. Further studies are needed to assess these relationships and to establish the risk prediction model of bone metastasis.
Long noncoding RNA X-inactive specific transcript as a prognostic factor in cancer patients
Authors: Chen Jinbo , Yang Xiong , Gong Dongkui , Cui Yu , Hu Jiao , Li Huihuang , Liu Peihua , Li Chao , Cheng Xu , Liu Longfei , Chen Hequn , Zu Xiongbing
Published: January 2019

Background/aims:

Emerging evidence showed the long noncoding RNA X-inactive specific transcript (lncRNA XIST) may play a crucial role in various cancers. However, its prognostic value in cancer patients remains controversial. Therefore, we performed an in-depth meta-analysis to investigate the potential clinical value of lncRNA XIST as a prognostic marker for cancer patients.

Methods:

A comprehensive literature search was performed from PubMed, Embase and the Cochrane Central Search Library by January 2018. Pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (95% Cl) were calculated to evaluate the prognosis as well as clinicopathological parameters of XIST, respectively.

Results:

A total of 18 retrospective studies with 1351 cancer patients were included. Current meta-analysis revealed that elevated lncRNA XIST expression was associated with poor overall survival (OS) (HR = 2.14, 95% CI = 1.26–3.64; P = .005) and disease free survival (DFS) (HR = 4.52, 95% CI = 1.42–14.37; P = .011). The clinicopathological parameters analysis demonstrated that increased XIST expression was significantly associated with tumor size (OR = 2.93, 95% CI = 2.24–3.84; P < .001), clinical stage (OR = 2.73, 95% CI = 1.62–4.58; P < .001) and lymph node metastasis (OR = 2.44, 95% CI = 1.74–3.42; P < .001). In addition, subgroup analysis based on cancer type revealed that lncRNA XIST expression correlated with distant metastasis in digestive cancer (OR = 2.90, 95% CI = 1.80–4.68; P < .001).

Conclusion:

The current meta-analysis results indicated lncRNA XIST expression level could serve as a prognostic predictor and biomarker in multiple cancers.
Clinical and radiological outcomes of a cervical cage with integrated fixation
Authors: Lonjon Nicolas , Favreul Emmanuel , Huppert Jean , Lioret Eric , Delhaye Manuel , Mraidi Ramzi
Published: January 2019

Cervical cages with integrated fixation have been increasingly used in anterior cervical discectomy and fusion (ACDF) to avoid complications associated with anterior cervical plates. The purpose of this paper is to provide 2-year follow-up results of a prospective study after implantation of a cervical cage with an integrated fixation system.

This was a prospective multicenter outcome study of 90 patients who underwent ACDF with a cage with integrated fixation. Fusion was evaluated from computed tomography images (CT-images) by an independent laboratory at 2-year follow-up (FU). Clinical and radiological findings were recorded preoperatively and at FU visits and complications were reported.

At 24 months, the fusion rate was 93.4%. All average clinical outcomes were significantly improved at 2 years FU compared to baseline: neck disability index (NDI) 18.9% vs 44.4%, visual analog scale (VAS) for arm pain 18.2 mm vs 61.9 mm, VAS for neck pain 23.9 mm vs 55.6 mm. Short form-36 (SF-36) scores were significantly improved. One case of dysphagia, which resolved within 12 months, and 1 reoperation for symptomatic pseudarthrosis were reported. Subsidence with no clinical consequence or reoperation was reported for 5/125 of the implanted cages (4%). There was also 1 case of per-operative vertebral body fracture that did not require additional surgery. Superior and inferior adjacent discs showed no significant change of motion at 2-year FU compared to baseline. Disc height index (DHI) and lordosis were enhanced and these improvements were maintained at 1 year.

The ACDF using cages with an integrated fixation system demonstrated reliable clinical and radiological outcomes and a high interbody fusion rate. This rate is comparable to the rate reported in recent series using other implants with integrated fixation, but the present device had a lower complication rate.
Surgical treatment for primary premature ejaculation with an inner condom technique
Authors: Wang Hai , Bai Ming , Zhang Hai-Lin , Zeng Ang
Published: January 2019

To explore a novel surgical treatment for primary premature ejaculation using an inner condom technique.

A total of 20 males with premature ejaculation, who admitted our andrology clinic from June 2016 to July 2017, were enrolled. By surgery, an inner condom made of acellular dermal matrix (ADM) was transferred to the subcutaneous pocket of the penis. The prolongation of intravaginal ejaculatory latency time (IELT) after the surgery was examined. The perioperative complications were also studied.

The surgical intervention significantly increased the average IELT in patients, from 0.67 to 2.37 min (P = .009). No serious perioperative complications and adverse psychosexual effects were seen. Patients could resume sexual activity 6 weeks after the surgery.

The novel inner condom using ADM is an effective and safe surgical treatment for males with premature ejaculation. The efficacy of this new treatment modality warrants further investigation in independent cohorts.
Nail bed solitary neurofibroma
Authors: Pertea Mihaela , Grosu Oxana-Mădălina , Terinte Cristina , Poroch Vladimir , Velenciuc Natalia , Lunca Sorinel
Published: January 2019

Rationale:

Nail bed solitary neurofibroma is an extremely rare tumor, with only 9 cases recorded in the literature so far.

Patient concern:

We present the case of a 42-year-old female patient, with a history of a slowly growing tumor in the nail bed of the left index and no clinical features of type I neurofibromatosis.

Diagnosis:

Nail bed solitary neurofibroma.

Intervention:

The tumor was surgically removed and the pathology examination established the diagnosis of neurofibroma.

Outcomes:

The postoperative outcome was good, with no recurrence 12 months after surgery.

Lessons:

We present the rarity of this type of tumor localized in the nail bed, taking into consideration the only 9 cases recorded in the literature. Nail bed solitary neurofibroma should be also included in the differential diagnosis of a nail bed tumor.
Madelung disease
Authors: Gao Hui , Xin Zhi-Ying , Yin Xin , Zhang Yu , Jin Qing-Long , Wen Xiao-Yu
Published: January 2019

Rationale:

Madelung disease (MD), a rarely reported disease, also known as benign symmetric lipomatosis, a disorder resulting from alcoholic abuse. It's largely under-recognized and under-reported, possibly because of unawareness of the condition by physicians.

Patient concerns:

A 45-year-old Chinese man presented with intermittent fatigue and abdominal distension and progressive bilateral breast enlargement. He has been a heavy drinker for ten years before onset of the disease with an average daily alcohol intake of more than 120 g/day.

Diagnosis:

Due to the patient's symptoms, laboratory test results, radiographic findings, he was diagnosed with MD.

Interventions:

We treated him with abstinence from alcohol and supportive therapy.

Outcomes:

The patient is now in stable condition, with improvement in symptoms during follow-up.

Lessons:

Doctors, confronted with progressive bilateral breast enlargement in a patient with alcoholic liver disease, should be aware of the underreported MD. Recognition of this syndrome could help doctors establish diagnosis and emphasize the importance of alcohol abstinence as the mainstay of management.
Pregnancy-related acquired hemophilia A initially manifesting as pleural hemorrhage
Authors: Qian Lili , Ge Hangping , Hu Pingping , Zhu Ni , Chen Junfa , Shen Jianping , Zhang Yu
Published: January 2019

Rationale:

Acquired hemophilia A is a rare hemorrhagic disease in which the body produces specific antibodies that attack factor VIII, resulting in bleeding that is mainly mucocutaneous and associated with soft tissue and the gastrointestinal system. Approximately 50% of this disease derives from basic diseases, such as autoimmune diseases, cancer, and pregnancy.

Patient concerns:

We report a 35-year-old postpartum female with acquired hemophilia A who initially presented with pleural hemorrhage.

Diagnoses:

In this patient activated prothrombin time (PT) and activated partial thromboplastin time (APTT) were found, and the factor VIII activity was 12.6%, furthermore Bethesda assay showed a FVIII antibody titer of 7.4 Bethesda units (BUs).

Interventions:

The treatment requires a 2-pronged approach: treatment of the bleeding and elimination of the inhibitor.

Outcomes:

After hemostatic agents were used and inhibitors were eradicated, the patient achieved complete remission without relapse.

Lessons:

It is essential to recognize the development of disease earlier in pregnant woman.
RET fusion in advanced non-small-cell lung cancer and response to cabozantinib
Authors: Wang Yucong , Xu Yinghui , Wang Xu , Sun Chao , Guo Ye , Shao Guoguang , Yang Zhiguang , Qiu Shi , Ma Kewei
Published: January 2019

Rationale:

Lung cancer is a series of gene-driven disease. EGFR, ALK, and ROS1 are 3 major driver genes that play an important role in lung cancer development and precision management. Additionally, rare genetic alterations continue to be discovered and may become novel targets for therapy. The RET gene is one of such rare genetic alteration of non-small cell lung cancer (NSCLC). In this report, we present a RET-positive case that benefited from cabozantinib treatment.

Patient concern:

A 50-year-old male patient was diagnosed with lung adenocarcinoma 2 years ago, at that time he received palliative surgery of pulmonary carcinoma and completed 4 cycles of chemotherapy with gemcitabine and cisplatin. Six months later, he was hospitalized in our cancer center due to the disease recurrence, presenting with pleural metastasis.

Diagnosis:

Gene alteration was examined using the intraoperative specimen by PCR method, and KIF5B/RET gene fusion was detected. Therefore, the patient was diagnosed with late-stage lung adenocarcinoma with RET gene mutation.

Interventions:

The patient received treatment with cabozantinib from June 2017.

Outcomes:

Cabozantinib was administered (140 mg orally, once daily) for approximate 9 months, and his disease achieved stable disease (SD). During that period, there were no severe adverse events (AE), except for a grade II rash (CTCAE 4.0).

Lessons:

We found that the RET fusion gene is a novel driver molecular of lung adenocarcinoma in patients without common mutations in such genes as EGFR, ALK, and ROS1. This case report supports a rationale for the treatment of lung adenocarcinoma patients with a RET fusion and provides alternative treatment options for these types of NSCLC patients.
Multiple infections by EBV, HCMV and Helicobacter pylori are highly frequent in patients with chronic gastritis and gastric cancer from Southwest Mexico
Authors: Del Moral-Hernández Oscar , Castañón-Sánchez Carlos Alberto , Reyes-Navarrete Salomón , Martínez-Carrillo Dinorah N. , Betancourt-Linares Reyes , Jiménez-Wences Hilda , de la Peña Sol , Román-Román Adolfo , Hernández-Sotelo Daniel , Fernández-Tilapa Gloria
Published: January 2019

The chronic inflammation and damage to the gastric epithelium induced byHelicobacter pylori(H. pylori) are the main risk factors for gastric cancer development. Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) induce chronic inflammation and have been found in gastric tumors. The objectives this observational study were to determine the frequency of multiple infections byHelicobacter pylori, Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) and to relate the infection by EBV and HCMV withH. pylori vacA/cagAgenotypes in patients with chronic gastritis or gastric cancer. DNA fromH. pylori, EBV and HCMV was detected by PCR in biopsies from 106 Mexican patients with chronic gastritis and 32 from gastric cancer. ThecagAstatus and thevacAgenotypes ofH. pyloriwere determined by PCR. In chronic gastritis and gastric cancer EBV was found in 69.8% and 87.5%, HCMV in 52.8% and 53.1%, andH. pyloriin 48.1% and 40.6%, respectively. In chronic gastritis, 53% ofH. pylori+patients were EBV+and 33% were both EBV+/HCMV+; in gastric cancer, 92.3% ofH. pylori-infected individuals were EBV+and 46.1% were EVB+/HCMV+. All the intestinal- and mixed-type tumors and the 83.3% of diffuse-type tumors were EBV+. No significant differences were found between single infections or coinfections with the diagnosis or the cancer type. TheH. pylorigenotypes were not related to EBV or HCMV infection. The frequency of dual infections byH. pylori, EBV and HCMV is higher in patients from southwest Mexico than other populations. It is likely that these pathogens act synergistically to induce inflammation and gastric cancer.
A computer-aided diagnosis system using artificial intelligence for the diagnosis and characterization of breast masses on ultrasound
Authors: Park Hee Jeong , Kim Sun Mi , La Yun Bo , Jang Mijung , Kim Bohyoung , Jang Ja Yoon , Lee Jong Yoon , Lee Soo Hyun
Published: January 2019

To evaluate the value of the computer-aided diagnosis (CAD) program applied to diagnostic breast ultrasonography (US) based on operator experience.

US images of 100 breast masses from 91 women over 2 months (from May to June 2015) were collected and retrospectively analyzed. Three less experienced and 2 experienced breast imaging radiologists analyzed the US features of the breast masses without and with CAD according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and categories. We then compared the diagnostic performance between the experienced and less experienced radiologists and analyzed the interobserver agreement among the radiologists.

Of the 100 breast masses, 41 (41%) were malignant and 59 (59%) were benign. Compared with the experienced radiologists, the less experienced radiologists had significantly improved negative predictive value (86.7%–94.7% vs 53.3%–76.2%, respectively) and area under receiver operating characteristics curve (0.823–0.839 vs 0.623–0.759, respectively) with CAD assistance (all P < .05). In contrast, experienced radiologists had significantly improved specificity (52.5% and 54.2% vs 66.1% and 66.1%) and positive predictive value (55.6% and 58.5% vs 64.9% and 64.9%, respectively) with CAD assistance (all P < .05). Interobserver variability of US features and final assessment by categories were significantly improved and moderate agreement was seen in the final assessment after CAD combination regardless of the radiologist's experience.

CAD is a useful additional diagnostic tool for breast US in all radiologists, with benefits differing depending on the radiologist's level of experience. In this study, CAD improved the interobserver agreement and showed acceptable agreement in the characterization of breast masses.
Hemodynamic changes after infusion of intravenous lipid emulsion to treat refractory hypotension caused by glyphosate-surfactant herbicide poisoning
Authors: Lee Min-Jeong , Min Young Gi
Published: January 2019

Rationale:

Glyphosate-surfactant herbicides (GlySH) are non-selective herbicides that are extensively used worldwide. A recent case report on GlySH poisoning suggested successful resuscitation upon using intravenous lipid emulsion (ILE) for refractory hypotension. The efficacy of ILE in GlySH poisoning remains unproven due to a lack of randomized controlled trials, and further evidence is required to clarify the mechanism by which ILE may reverse hypotension in GlySH poisoning.

Patient concerns:

A 46-year-old man presented to the emergency department 45 min following ingestion of approximately 200 cc of GlySH. On arrival, his vital signs were as follows: blood pressure, 82/50 mmHg and pulse, 85 beats/min. Hypotension did not respond to fluid resuscitation and norepinephrine infusion; his cardiac output (CO) was 4.5 L/min and systemic vascular resistance (SVR) was 604 dynes·s·cm−5 with blood pressure of 63/35 mmHg.

Diagnosis:

GlySH poisoning presented with refractory hypotension.

Interventions:

A bolus (100 mL) of ILE was infused with subsequent infusion of 400 mL over 4 h.

Outcomes:

A few minutes following the bolus of ILE, his blood pressure increased to 101/54 mmHg with CO of 6.5 L/min and SVR of 701 dynes·s·cm−5. Blood pressure, CO, and stroke volume increased gradually over next 8.5 h. His clinical status improved gradually, and norepinephrine could be tapered on hospital day (HD) 3. The patient was discharged at HD 10 without sequelae.

Lessons:

ILE could be used as a rescue treatment in case of a poor response to conventional fluid and vasopressor therapy. The underlying mechanism of rescue with ILE might be a positive inotropic effect.