bluuebunny/crossref_metadata_2025 huggingface dataset:
Drivers of Inpatient Costs After Colorectal Surgery Within a Publicly Funded Healthcare System
Authors: Springer Jeremy E. , Doumouras Aristithes G. , Saleh Fady , Lee Jennie , Amin Nalin , Cadeddu Margherita , Eskicioglu Cagla , Hong Dennis
Published: May 2019

BACKGROUND:

The morbidity and mortality associated with colorectal resections are responsible for significant healthcare use. Identification of efficiencies is vital for decreasing healthcare cost in a resource-limited system.

OBJECTIVE:

The purpose of this study was to characterize the short-term cost associated with all colon and rectal resections.

DESIGN:

This was a population-based, retrospective administrative analysis.

SETTINGS:

This analysis was composed of all colon and rectal resections with anastomosis in Canada (excluding Quebec) between 2008 and 2015.

PATIENTS:

A total of 108,304 patients ≥18 years of age who underwent colon and/or rectal resections with anastomosis were included.

MAIN OUTCOME MEASURES:

Total short-term inpatient cost for the index admission and the incremental cost of each comorbidity and complication (in 2014 Canadian dollars) were measured. Cost predictors were modeled using hierarchical linear regression and Monte Carlo Markov Chain estimation.

RESULTS:

Multivariable regression demonstrated that the adjusted average cost of a 50-year–old man undergoing open colon resection for benign disease with no comorbidities or complications was $9270 ((95% CI, $7146–$11,624; p = <0.001). With adjustment for complications, laparoscopic colon resections carried a cost savings of $1390 (95% CI, $1682–$1099; p = <0.001) compared with open resections. Surgical complications were the main driver for increased cost, because anastomotic leaks added $9129 (95% CI, $8583–$9670; p = <0.001). Medical complications such as renal failure requiring dialysis ($16,939 (95% CI, $15,548–$18,314); p = <0.001) carried significant cost. Complications requiring reoperation cost $16,313 (95% CI, $15,739–$16,886; p = <0.001). The costliest complication cumulatively was reoperation, which exceeded $95 million dollars over the course of the study.

LIMITATIONS:

Inherent biases associated with administrative databases limited this study.

CONCLUSIONS:

Medical and surgical complications (especially those requiring reoperation) are major drivers of increased resource use. Laparoscopic colorectal resection with or without adjustment for complications carries a clear cost advantage. There is opportunity for considerable cost savings by reducing specific complications or by preoperatively optimizing select patients susceptible to costly complication. See Video Abstract at http://links.lww.com/DCR/A839.
Fecal Incontinence Symptoms and Impact in Older Versus Younger Women Seeking Care
Authors: Meyer Isuzu , Blanchard Christina T. , Markland Alayne D. , Gibson Elena G. , Richter Holly E.
Published: May 2019

BACKGROUND:

The differential impact of aging on fecal incontinence symptom severity and condition-specific quality of life remains unclear.

OBJECTIVE:

The purpose of this study was to characterize differences in symptom distress, quality of life, and anorectal physiology assessments in older versus younger women with fecal incontinence.

DESIGN:

This was a cross-sectional study.

SETTINGS:

This study was conducted at a tertiary genitorectal disorder clinic.

PATIENTS:

Women presenting for fecal incontinence evaluation between 2003 and 2016 were classified as older or younger based on age ≥65 or <65 years.

MAIN OUTCOME MEASURES:

The main outcomes were symptom-specific quality of life and distress measured by validated questionnaires (the Modified Manchester Health Questionnaire containing the Fecal Incontinence Severity Index); anorectal physiology and anatomy were assessed by manometry and endoanal ultrasound.

RESULTS:

Of 879 subjects, 286 and 593 were classified as older and younger (mean ages, 71.4 ± 5.3 y and 51.3 ± 10.5 y). Solid stool leakage was more frequent in older women (83.2% vs 76.7%; p = 0.03), whereas liquid stool leakage (83.2% vs 82.8%; p = 0.88) and fecal urgency (76.9% vs 78.8%; p = 0.54) did not differ between groups. Mean symptom severity scores were similar between groups (28.0 ± 11.9 and 27.6 ± 13.5; p = 0.69); however, there was greater negative impact on quality of life among younger women (46.3 ± 22.0 vs 51.8 ± 21.8; p < 0.01). Multivariable linear regression controlling for pertinent covariates revealed younger age as an independent predictor for worse condition-specific quality-of-life scores (p < 0.01). Squeeze pressures were similar between groups, whereas younger women had greater resting pressures and higher rates of sphincter defects (external, 7.7% vs 20.2%; internal, 12.2% vs 26.8%; both p < 0.01).

LIMITATIONS:

This study was limited by its lack of patient obstetric history and the duration of their incontinence symptoms.

CONCLUSIONS:

Characteristics differ between older and younger women seeking care for fecal incontinence. The differential impact and age-related phenotypes may provide useful information for patient counseling and developing management algorithms for women with fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A910.
Tacrolimus Can Be Reliably Measured With Volumetric Absorptive Capillary Microsampling Throughout the Dose Interval in Renal Transplant Recipients
Authors: Vethe Nils T. , Gustavsen Marte T. , Midtvedt Karsten , Lauritsen May E. , Andersen Anders M. , Åsberg Anders , Bergan Stein
Published: May 2019

Background:

Therapeutic drug monitoring is standard practice for the immunosuppressant tacrolimus (Tac). Venous blood sampling at outpatient clinics is time-consuming and impractical with regard to obtaining trough concentrations on clinical visit days. Home-based blood sampling may be patient friendly and pave the way for limited sampling strategies for the prediction of total drug exposure. The aim was to establish a Tac assay for dried capillary microsamples, ensuring reliable measurements during the full dose interval in renal transplant recipients.

Methods:

An assay based on volumetric absorptive microsampling and liquid chromatography tandem mass spectrometry was validated. The agreement between capillary microsamples and liquid venous samples was investigated in stable renal recipients on twice-daily Tac dosing. Sampling throughout the 12-hour dose interval was examined at 2 separate days, at least 1 week apart, for each participant. Two sets of samples were obtained at each time point, one delivered directly to the laboratory and one sent through mail.

Results:

Twenty-seven renal transplant recipients were included, of whom 26 were investigated twice. Tac was efficiently extracted from the dried microsamples (mean recovery 94%–103%). The between-series mean accuracy was 88%–98% with coefficients of variation ≤5.0% (≤11% at the lower limit of quantification), measurement range 0.70–60 mcg/L. The mean difference between parallel microsamples was 5%–7%. Overall, the mean differences between dried microsamples and liquid samples were −3.1% when mailed (n = 679) and −4.2% when directly delivered (n = 682). Less than 8% were outside ±20%. The microsamples were stable for 1 month at ambient temperature.

Conclusions:

The microsample method demonstrated acceptable performance. Tac concentrations can be reliably quantified throughout the dose interval by using volumetric absorptive microsampling in renal transplant recipients, and the results are not influenced by postal shipment.
Disease-specific Preference-based Measure of Glaucoma Health States: HUG-5 Psychometric Validation
Authors: Kennedy Kevin , Podbielski Dominik , Nanji Keean , Muratov Sergei , Ahmed Ike , Xie Feng
Published: May 2019

Purpose:

Glaucoma is the second leading cause of irreversible blindness in the world, with 60 million people worldwide estimated to suffer from the condition. Health utility is an important outcome measure of treatment effect in economic outcomes. The available tools for the measurement of health utility in glaucoma patients do not support a preference-based algorithm required to estimate health utility. To resolve this gap in the literature, the HUG-5 (Health Utility for Glaucoma—5 dimensions) was developed. The objective of the present study was to validate the HUG-5 with accepted measures of health state and vision-specific quality of life.

Materials and Methods:

The HUG-5 measures patient self-reported levels of visual discomfort, mobility, daily life activities, emotion, and social activities, as affected by the progression and management of glaucoma. To evaluate the psychometric properties, the HUG-5 was assessed for construct validity between similar and dissimilar dimensions of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and the EuroQol’s 5 Dimensions. The HUG-5 was evaluated for test-retest reliability after a 2-week period. The HUG-5 composite distributions of mild/moderate and advanced glaucoma patients were tested for differences to measure sensitivity.

Results:

A total of 124 patients with glaucoma were administered the NEI-VFQ-25, the HUG-5, and the EuroQol’s 5 Dimensions. The HUG-5 demonstrated construct validity, with convergent and discriminant support for visual discomfort, mobility, daily life activities, emotional distress, and social activities. The HUG-5 concurrently measured health-related quality of life associated with best-eye visual field loss (r=0.63, P<0.001). The HUG-5 measured health state consistently with test-retest reliability (intraclass correlation=0.91, P<0.001). The HUG-5 was established to be sensitive in detecting differences between patients with mild/moderate glaucoma and those with advanced glaucoma with a rank-sum test with continuity correction (W=693.5, P<0.001).

Conclusions:

This study demonstrates promising results for the HUG-5’s response range and relationship with the NEI-VFQ-25 and best-eye visual field loss, highlighting the value of disease-specific preference-based scoring systems in measuring health state changes in glaucoma patients.
Evaluating the Laser Output of the Micropulse P3 Laser Delivery Device Following Repeated Use
Authors: Lun Katherine , Suwandono Maya E. , Koh Victor , Chew Paul T.
Published: May 2019

Precis:

Repeated use of the Micropulse P3 (MP3) probe during micropulse transscleral cyclophotocoagulation is associated with an increase in laser output over time.

Purpose:

The purpose of this study was to examine the laser efficacy of the MP3 probe following repeated use.

Methods:

This was an observational study carried out using Cyclo G6 Glaucoma Laser System with 6 MP3 laser delivery probes. Each probe was fired for 100 seconds, every 10 minutes until the probe was deactivated. The laser output was measured using a laser power meter. Maximum observed laser power output was also noted.

Results:

All probes were deactivated after 90 minutes (9 cycles) of use. Mean laser output of all 6 probes was determined, and results suggested an increase in output with time. When examining the differences in total laser output for each cycle, no significant differences were observed for the first 4 cycles, but not for the remaining 5 cycles, wherein the increased laser outputs were found to be significantly different from baseline (cycle 1).

Conclusion:

Findings suggest a possible increase in laser output with repeated use, especially after 4 cycles, and clinicians need to be cautious if they intend to use the probes repeatedly.
Motor adaptation varies between individuals in the transition to sustained pain
Authors: Summers Simon J. , Chipchase Lucy S. , Hirata Rogerio , Graven-Nielsen Thomas , Cavaleri Rocco , Schabrun Siobhan M.
Published: May 2019

Musculoskeletal pain is associated with altered motor control that, despite short-term benefit, is hypothesised to have long-term consequences, contributing to the development of chronic pain. However, data on how motor control is altered when pain is sustained beyond a transient event are scarce. Here, we investigated motor adaptation, and its relationship with corticomotor excitability, in the transition to sustained muscle pain. Twenty-eight healthy individuals were injected with nerve growth factor into the right extensor carpi radialis brevis muscle on days 0 and 2. Motor adaptation and corticomotor excitability were assessed on day −2, before injection on days 0 and 2, and again on days 4 and 14. Motor adaptation was quantified during a radial–ulnar movement as kinematic variability of wrist flexion–extension and pronation–supination, and as electromyographic (EMG) variability of extensor carpi radialis brevis activity. Pain, muscle soreness, and functional limitation were assessed from days 0 to 14. Pain, muscle soreness, and functional limitation were evident at days 2 and 4 (P < 0.001). Electromyographic variability reduced at days 4 and 14 (P < 0.04), with no change in kinematic variability (P = 0.9). However, data revealed variation in EMG and kinematic variability between individuals: some displayed increased motor variability, whereas others a decrease. Individuals who displayed an increase in EMG variability after 4 days of pain also displayed an increase in corticomotor excitability (r = 0.43, P = 0.034). These findings suggest individual adaptation of the motor system in the transition to sustained pain that could have implications for clinical musculoskeletal pain disorders.
The Lived Experience of Antiretroviral Therapy for Pregnant Women: Antiretroviral Therapy Adherence as a Balancing Act
Authors: Shore Jessica E. , Paun Olimpia , Vonderheid Susan C.
Published: May 2019

We explored 10 pregnant women's experiences with antiretroviral therapy (ART) adherence using a qualitative approach. Semistructured interviews were conducted with pregnant ethnic minority women living with HIV and receiving integrated HIV/obstetric care at a Midwestern academic medical center in the United States. Data were analyzed using an interpretive phenomenology approach to identify major themes. We found an overarching theme: ART Adherence as a Balancing Act (striving to adhere to ART while having to simultaneously navigate daily challenges). We also identified four interrelated subthemes: struggles, support, motivators, and reminders. Findings highlight the need for clinicians to be sensitive to the emotional burdens of living with HIV while pregnant, a constant factor affecting quality of life and adherence. Having conversations about barriers and facilitators to adherence and encouraging women to identify strategies that support adherence are needed rather than focusing solely on pill counts and viral load.
Oral vs intravenous tranexamic acid in total-knee arthroplasty and total hip arthroplasty
Authors: Chen Xuanhuang , Zheng Feng , Zheng Zugao , Wu Xianwei , Wu Changfu
Published: May 2019

Background:

This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA).

Methods:

PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables.

Results:

A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD = 0.06, 95% confidence interval [CI] = −0.01 to 0.13, P = .09), transfusion rate (OR = 0.78, 95% CI = 0.54–1.13, P = .19), total blood loss (MD = 16.31, 95% CI = −69.85 to 102.46, P = .71), total Hb loss (MD = 5.18, 95% CI = −12.65 to 23.02, P = .57), length of hospital stay (MD = -0.06, 95% CI = −0.30 to 0.18, P = .63), drain out (MD = 21.04, 95% CI = −15.81 to 57.88, P = .26), incidence of deep vein deep vein thrombosis (RD = 0.00, 95% CI = −0.01 to 0.01, P = .82) or pulmonary embolism (RD = 0.00, 95% CI = −0.01 to 0.01, P = .91). The sample size of this study was small and several included studies were with relatively low quality.

Conclusion:

Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.
Measuring of quality of care in patients with stroke and acute myocardial infarction
Authors: Cho Kyoung Hee , Nam Chung Mo , Lee Sang Gyu , Kim Tae Hyun , Lee Seon-Heui , Park Eun-Cheol
Published: May 2019

Ischemic stroke, hemorrhagic stroke, and acute myocardial infarction (AMI) are diseases with golden hour. This study aimed to identify and compare factors that affect in-hospital mortality in patients with stroke and AMI who admitted via the emergency department.

This study used the Korean National Health Insurance claims data from 2002 to 2013. The study sample included 7693 patients who had an ischemic stroke, 2828 patients who had a hemorrhagic stroke, and 4916 patients with AMI who were admitted via the emergency departments of a superior general hospital and general hospital, did not transfer to another hospital or come from another hospital, and were aged ≥20 years. This study was analyzed by using Cox's proportional hazards frailty model.

Five hundred (6.5%) of 7693 patients with ischemic stroke, 569 (20.1%) of 2828 patients with hemorrhagic stroke, and 399 (8.1%) of 4916 patients with AMI were dead. The clinical factors were associated with in-hospital mortality such as age, CCI, hypertension, and diabetes of patient characteristics. In treatment characteristics, performing PCI and weekday admission was associated with in-hospital mortality (aHR, 0.43; 95% CI, 0.27–0.67; aHR, 1.42; 95% CI, 1.14–1.77, respectively). In hospital characteristics, the volume, the proportion of transferred patient to other hospital and ratio of beds per one nurse was associated with in-hospital mortality.

Clinical factors of patient characteristics, intervention such as performing PCI and reducing ICP of treatment characteristics, and the volume, transferred rate, and the number of nurse of hospital characteristics were associated with in-hospital mortality.
Post-debulking circulating tumor cell as a poor prognostic marker in advanced stage ovarian cancer
Authors: Kim Miseon , Suh Dong Hoon , Choi Jin Young , Bu Jiyoon , Kang Yoon-Tae , Kim Kidong , No Jae Hong , Kim Yong Beom , Cho Young-Ho
Published: May 2019

Circulating tumor cells (CTCs) have received enormous attention as a novel biomarker in various malignant diseases. We investigated the clinical association between the presence of perioperative CTCs and survival outcomes in women with ovarian cancer. In a total of 30 women who were scheduled to undergo a surgical treatment for ovarian cancer, peripheral blood samples were obtained before and after surgery. CTCs were isolated and counted using the optimized tapered-slit filter (TSF) platform. The association between the presence of perioperative CTCs and tumor features was evaluated. The impact of the presence of perioperative CTCs on progression-free survival (PFS) and overall survival (OS) rates were analyzed using a Kaplan–Meier method. The median age was 58 (range, 24–77) years, and the median follow-up period was 31.5 (range, 1–41) months. Overall, the CTC detection rate was not significantly different before and after surgery (76.7% vs 57.1%, P = .673). The presence of postoperative CTCs was not significantly associated with 3-year PFS (29.1% vs 58.3%, P = .130) and OS (84.4% vs 80.0%, P = .559) rates in the whole study population. In advanced stage, PFS rate in patients with postoperative CTCs had lower PFS rates than those without postoperative CTCs, although there was no statistical significance (18.8% vs 57.1%, P = .077). Postoperative CTC was more frequently detected in women who had lymph node involvement than those who did not (7/7 [100%] vs 3/10 [30.0%], P = .010). The presence of postoperative CTCs as detected using the TSF platform seems to be associated with poorer PFS rates in women with ovarian cancer of advanced stage. Further study with a larger population is warranted to validate our study findings.
Probiotic supplements for relieving stress in healthy participants
Authors: Zhang Ning , Liao Xing , Zhang Yanan , Li Menglin , Wang Weiguang , Zhai Shuangqing
Published: May 2019

Background:

Psychological stress is a ubiquitous subjectively negative emotional experience, but excessive psychological stress has adverse effects on the happiness in our lives and physical and mental health, and may cause many health problems. Studies have found that probiotics have a certain role in alleviating negative emotions, reducing abnormal behaviors, improving cognitive function, and also showing the great potential of probiotics in relieving psychological stress. At present, many clinical trials have been carried out to intervene in populations with psychological stress with probiotic supplements, but there still lack of targeted systematic review and meta-analysis.

Methods and analysis:

The Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Psycoinfo, Cumulative Index to Nursing and Allied Health Literature will be searched to obtain the eligible randomized controlled trials published up to March 1, 2019. Meanwhile, the references to relevant publications will also be reviewed to identify other studies, and will re-search before finial summary for analysis. EndNote X7 will be used as a document manager for duplicate checking and screening of literature. The risk of bias will be assessed and the date of included studies will be analyzed by Revman V5.3.5.

Results:

The primary outcome will be subjective stress level, general mild psychiatric symptoms of participants. The secondary outcome will be cortisol level and adverse effects likely to be related to treatment.

Conclusion:

The systematic review and meta-analysis will provide evidence to assess the efficacy and safety of probiotics in relieving psychological stress.

PROSPERO registration number:

PROSPERO CRD42019122930.
Impact of renal dysfunction on surgical outcomes in patients with aortic dissection
Authors: Fan Pei-Yi , Chen Chao-Yu , Lee Cheng-Chia , Liu Kuo-Sheng , Wu Victor Chien-Chia , Fan Pei-Chun , Chang Ming-Yang , Chang Jason Chih-Hsiang , Tian Ya-Chung , Chen Shao-Wei
Published: May 2019

Preoperative renal dysfunction is associated with mortality in patients who undergo coronary artery bypass graft and valve surgery. However, the role of preoperative renal dysfunction in type A aortic dissection (TAAD) remains unclear. This study aimed to evaluate the impact of preoperative renal dysfunction on the outcome of surgical intervention in patients with TAAD.

We retrospectively studied the outcomes of 159 patients with TAAD who were treated at a tertiary referral hospital between 2005 and 2010. The demographics and surgical details of patients were analyzed according to their renal function. Risk factors for outcomes were analyzed using multivariable logistic regression. Thirty-two of the patients (20.1%) had preoperative serum creatinine of 1.5 mg/dL or more. The multivariable logistic regression model revealed independent risk factors of in-hospital mortality to be renal dysfunction (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.64–8.77), preoperative shock (OR, 8.75; 95% CI, 2.83–27.02), and bypass time (OR, 1.008; 95% CI, 1.003–1.013). In addition, patients with renal dysfunction exhibited a lower 90-day survival rate than did patients without the condition (P of log-rank test = .005).

Preoperative renal dysfunction may have a critical role in the surgical outcomes of patients with TAAD. Additional large-scale investigations are warranted.
Clinical efficacy of orthopilot navigation system versus conventional manual of total hip arthroplasty
Authors: Jia Jianguo , Zhao Qun , Lu Pei , Fan Guiyong , Chen Hao , Liu Chaoqun , Liu Jinlian , Chen Sheng , Jin Zhengshuai
Published: May 2019

Background:

To compare the clinical efficacy between Orthopilot navigation system and conventional manual surgery in total hip arthroplasty (THA).

Methods:

Electronic databases were searched to identify randomized controlled trials (RCTs) investigating Orthopilot navigation system versus conventional manual in patients undergoing THA. Outcome measurements include anteversion angle, inclination angle, preoperative leg length discrepancy, postoperative leg length discrepancy and femoral offset. Statistical software Stata 12.0 was used for data-analysis.

Results:

A total of 5 studies were finally included in this meta-analysis. The results showed that the conventional manual group have a less anteversion angle than that in Orthopilot navigation system group (weighted mean difference (WMD) = 4.67, 95% confidence interval (CI) = 3.53, 5.82, P = .000). And pooled analysis showed that the inclination angle in Orthopilot navigation group was less than that in conventional manual group (WMD = −4.19, 95% CI = −8.00, −0.37, P = .031). There was no significant difference between the preoperative leg length discrepancy and postoperative leg length discrepancy (P > .05). Orthopilot navigation system compared with conventional manual procedure was associated with decreased of femoral offset by 2.76 (WMD = −2.76, 95%CI = −3.90, −1.62, P = .000).

Conclusion:

Both Orthopilot navigation system and conventional THA result in significant improvements in patient function with similar overall complication rates and have their own edges in cup position.
Post-traumatic stress disorder in living donors after pediatric liver transplantation
Authors: Zhang Yimao , Wang Junxiang , Jin Shuguang , Xiang Bo , Yang Jiaying , Li Kewei , Huang Bing , Lai Wei , Yan Lunan , Zhao Jichun
Published: May 2019

Liver transplantation can lead to post-traumatic stress disorder (PTSD) in recipients, but the risk factors associated with PTSD in living donors are unknown. To investigate this progression in pediatric living donors, a cross-sectional investigation was carried out.

All participants completed 2 questionnaires: a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36). Clinical and demographic data were collected from medical records and self-report questionnaires. Univariate analysis was conducted to identify statistical differences.

The prevalence of full PTSD (all symptom clusters) and partial PTSD (2 out of 3 symptom clusters) was 12.1% and 31.1%, respectively. Those with an educational status of elementary school (P = .001), who were donors to their children (P = .008), who were in the first 6 months after transplant (P < .001), or were involved in transplants where the recipients had severe complications (P = .02) were more likely to have higher PTSD-SS scores than other groups. The non-PTSD group had a higher health-related quality-of-life score compared with the full and partial PTSD groups in the domains of physical function, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. In addition, the occurrence of PTSD was related to a poorer quality of life.

The occurrence of PTSD was common in living donors after pediatric liver transplantation. Those with a lower educational status, who were donors to their children, were in the first 6 months after transplant, or were involved in transplants where the recipients had severe complications were most likely to experience PTSD. Post-traumatic stress symptom severity was significantly associated with a poorer quality of life after transplant.
Pathological response and serum VEGF changes during chemoradiotherapy for esophageal carcinoma
Authors: Wang Jian , Yu Jing-Ping , Ni Xin-Chu , Sun Zhi-Qiang , Sun Wei , Nie Bin , Sun Su-Ping , Wang Jian-Lin
Published: May 2019

The aim of this study was to observe pathological response and change in serum vascular endothelial growth factor (VEGF) in esophageal carcinoma (EC) during chemoradiotherapy (CRT).

Eighty-nine patients diagnosed with EC were treated with radiotherapy at the Department of Radiotherapy of the Second People's Hospital of Changzhou between May 2008 and December 2014, including 65 patients with CRT. Gastroscopy and pathological examination were conducted 4 weeks afterwards. The pathological responses were classified as complete response (CR) and non-CR. Serum samples were collected from the patients before radiotherapy, during week 4 of radiotherapy, and 1 week after radiotherapy. The VEGF changes were classified as increase, stable, and decrease.

The median overall survival (OS) and median progression-free survival (PFS) in the pathological CR group was significantly longer than that of the non-CR group (P < .001). The 1-, 3-, and 5-year OS rates in the non-CR group were lower than that in the CR group (P < .05). Moreover, the 1-, 3-, and 5-year PFS rates in the non-CR group were lower than that in the CR group (P < .05). VEGF serum level was decreased during and after radiotherapy compared with pre-radiotherapy, and the differences were statistically significant (P < .05). The 1-, 3-, and 5-year OS rates in the increased group were lower than that in the decreasing group (P < .05). Moreover, the 1-, 3-, and 5-year PFS rates in the increasing group were lower than that in the decreasing group (P < .05). Pathological response (P < .05), serum VEGF trend (P < .05), and tumor-node-metastasis stage (P < .05) in response to CRT were factors that influenced patient prognosis.

Pathological response and serum VEGF change during CRT can predict prognosis of nonsurgical patients with EC. Monitoring these changes is of significance in individualized treatment.
What is the position of pulmonary arterial hypertension-specific drug therapy in patients with Eisenmenger syndrome
Authors: Li Qiang , Kuang Hong-Yu , Wu Yu-Hao , Lu Tie-Wei , Yi Qi-Jian
Published: May 2019

Background:

It is commonly reported a limitation of therapeutic strategy in Eisenmenger syndrome (ES) historically. This qualitative systematic review is conducted to evaluate the safety and efficacy of pulmonary arterial hypertension-specific drug therapy (PAH-SDT) for ES patients for a clinical therapeutic strategy based on evidence.

Methods:

PubMed, EMBASE, and the Cochrane Library databases have been systematically reviewed up to January 2019. Two reviewers independently conducted a literature search, quality evaluation, and data extraction. The occurrence of death, deterioration, and adverse events (AEs) has respectively been described as a count or percentage. Meta-analysis was conducted by Stata 15.1, and weighted mean differences (WMD) with 95% confidence intervals (CI) were recorded for continuous data. Randomized-effect model or fixed-effect model was applied according to the heterogeneity test.

Results:

Fifteen citations recruiting 456 patients associated with ES were eventually pooled, which involved 4 RCTs, 6 prospective studies, and 5 retrospective studies. Within the first year, it indicated PAH-SDT significantly ameliorated exercise capacity in 6-minute walk distance (6MWD) (I
2 = 60.5%; WMD: 53.86 m, 95% CI [36.59, 71.13], P < .001), functional class (FC) (WMD = –0.71, 95% CI [–0.98, –0.44], P < .001) and Borg dyspnea index (WMD = –1.28, 95% CI [–1.86, –0.70], P < .001), in addition to hemodynamics, especially mean pulmonary arterial pressure by 5.70 mmHg (WMD = –5.70 mmHg, 95% CI [–8.19, –3.22], P < .001) and pulmonary vascular resistance by 4.20 wood U (WMD: –4.20, 95% CI [–7.32, –1.09], P = .008), but unsatisfactory effects in oxygen saturation at exercise (P = .747). In a prolonged medication, bosentan, a dual ERA, has been proved acting an important role in improving exercise tolerance of patients with ES (6MWD: I
2 = 47.5%; WMD: 88.68 m, 95% CI [54.05, 123.3], P < .001; FC: I
2 = 0.0%; WMD = –0.65, 95% CI [–1.10, –0.19], P = .006). While a nonsignificant change of 6MWD was noted in a long-term therapy of ambrisentan (P = .385). There existed rare evidence about the efficacy and safety of macitentan, phosphodiesterase-5 inhibitors (PDE5i), and prostanoids in a prolonged medication. Most AEs were recorded as mild to moderate with PAH-SDT, but about 4.3% individuals treated with endothelin receptor antagonists (ERAs) suffered from serious ones, and 3.9% suffered from death.

Conclusions:

This systematic review and meta-analysis proved PAH-SDT as a safe and effective role in ES in an early stage. However, in a long-term treatment, bosentan has been supported for a lasting effect on exercise tolerance. A further multicenter research with a large sample about pharmacotherapy of ES is necessary.
Open reduction and plate fixation compared with non-surgical treatment for displaced midshaft clavicle fracture
Authors: Qin Miao , Zhao Shishun , Guo Wenlai , Tang Li , Li Hangyu , Wang Xuejie , Zhu Zhe , Sun Tianwen
Published: May 2019

Backgrounds:

There is no consensus concerning whether surgery or non-surgical treatment is preferred for displaced midshaft clavicle fracture. We performed a meta-analysis of randomized controlled trials (RCTs) to compare healing effects and cosmetic results between surgery and non-surgery.

Methods:

We retrieved RCTs regarding open reduction and plate fixation (ORPF) and non-surgical method for the treatment of displaced midshaft clavicle fracture published before June 2018 from PubMed, EMBASE and Cochrane Library. The difference between the two treatments was comparatively discussed in aspects of nonunion, malunion, functional outcome, cosmetic results, and complications.

Results:

Nine RCTs were included. The results showed that ORPF is advantageous over the non-surgical treatment in terms of nonunion rate (RR, 0.11[95%CI, 0.06–0.23]), malunion rate (RR, 0.16[95%CI, 0.08–0.35]), appearance dissatisfaction rate (RR, 0.35[95%CI 0.23–0.55]), and shoulder appearance defect rate (RR, 0.06[95%CI, 0.02–0.17]). The non-surgical treatment showed lower rate of complication (RR, 1.60[95%CI, 1.02–2.53]) and no significant differences were found between the 2 treatment groups with respect to functional outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire score) (MD, −4.17[95%CI, −9.35 to 1.01]).

Conclusions:

This meta-analysis updated previous results. The current findings suggested that ORPF yielded better efficacy than conservation treatment for displaced midshaft clavicle fracture from perspectives of fracture healing and appearance.
Endoscopic and microscopic findings of gastrointestinal tract in Henoch–Schönlein purpura
Authors: Han Yeeun , Jin So-Young , Kim Dong Won , Jeen Yoon Mi , Kim Yon Hee , Choi In Ho
Published: May 2019

Asia has the highest incidence of Henoch–Schönlein purpura (HSP). Although 50% to 75% of patients with HSP manifest gastrointestinal (GI) symptoms, endoscopic, and pathologic findings of HSP have been rarely reviewed in Asia.

Patients diagnosed with HSP who had undergone endoscopic biopsy from GI tract (GIT) in Soonchunhyang University Seoul Hospital from 2000 to 2018 were evaluated and 25 cases with 44 biopsies from upper GI tract (U-GIT) or lower GI tract (L-GIT) were enrolled. Their clinical and endoscopic findings and histologic findings of endoscopic biopsy were reviewed.

Of the 25 patients, 15 were males and 10 were females. There were 6 children and 19 adults. The most common GI symptom was abdominal pain (20/25), followed by loose stool or diarrhea (9/25). Biopsied sites included 19 from U-GIT (9 stomach and 10 duodenum) and 25 from L-GIT (7 terminal ileum, 1 cecum, 4 ascending, 1 transverse, 2 descending, 7 sigmoid, and 3 rectum). Erythema/petechia was the most common endoscopic finding in U-GIT, while erosion/ulceration was the most common one in L-GIT. In U-GIT, extravasted red blood cell (RBC) (14/19) was the most common histologic finding, while leukocytoclastic vasculitis (LCV)/capillarities were identified in 7 specimens, including 5 duodenum samples. In endoscopic investigations of L-GIT, erosion/ulceration (9/14) was predominantly identified. The most common histologic finding was also extravasted RBC (22/25), while LCV/capillarities were noted in 10 specimens, including 5 specimens from terminal ileum.

The HSP commonly involves GIT. Histologic findings of our cases were not significantly different from results of previous studies in Western countries. However, endoscopic and pathologic characteristics of HSP have been rarely reviewed in Asia. Herein, we share experience of endoscopic biopsy of GIT in patients with HSP.
Migration of a double J stent into the inferior vena cava
Authors: Jiang Changyi , Fu Shi , Chen Jian , Chen Yong , Chen Deqiang , Mishra Prashant , Ni Xiaohui , Ke Changxing
Published: May 2019

Introduction:

Intravascular migration of a double J stent into the inferior vena cava is an uncommon complication. The management of such complication is less reported in the literature. This study aimed to reveal the diagnosis and treatment process of migration of a double J stent into the inferior vena cava.

Patient concerns:

A 53-year-old male patients was transferred to our hospital because of migration of a double J stent into the inferior vena cava after left-side pyelolithotomy.

Diagnosis:

In accordance with manifestations on computed tomography urography, the patient was diagnosed with migration of a double J stent into the inferior vena cava.

Interventions:

Percutaneous nephroscope under C-arm guidance was performed to remove the migrated stent. After the operation, the patient was treated with continued anticoagulants and antibiotics.

Outcomes:

The migrated stent was removed successfully without any complications, and a new double J stent was placed and its location was confirmed under C-arm. The patient was discharged in good condition and the follow-up was uneventful.

Conclusion:

Intravascular migration of a double J stent into the inferior vena cava is an uncommon complication. Radiologic imaging after placement of ureteral stent is critical for prevention of this complication. Percutaneous nephroscope under C-arm guidance is a safe and effective approach to remove the migrated DJS in the IVC.
Effectiveness and safety of lactobacilli in children with functional constipation
Authors: Yang Wenhao , He Tao , Zhang Weijian , Gu Li , Tu Renyuan , Liu Hanmin
Published: May 2019

Background:

Constipation is one of the most common diseases in children and it is also a significant healthcare burden, more than many other common childhood diseases. For some children, 1st-line treatment cannot relieve their constipation and their constipation symptoms maybe continue to adolescence. So, alternative treatment options such as lactobacilli are needed. However, the effectiveness and safety of lactobacilli is still unclear. To investigate this question, we conduct a systematic review and meta-analysis.

Methods:

The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Three main databases (PubMed, Embase, and the Cochrane Library) will be searched to December 20, 2018 for randomized controlled trials investigating the effects and safety of lactobacilli for constipation in children with no language restrictions. In addition, a manual search of the references of relevant published studies will also be considered.

Two independent reviewers will conduct studies selection, data extraction, and risk of bias assessment. The primary outcome is defecation frequency, treatment success (bowl movement >3 times per week). The 2nd outcome is stool consistency, incidence of abdominal pain, patients using laxatives, and adverse events.

Results:

The results will provide useful information about the effect and safety of lactobacilli for constipation in children.

Conclusion:

The findings of this study will be published in a peer-reviewed journal.

PROSPERO registration number:

CRD42019125913
Giant cell carcinoma of the lung presenting as an isolated cyst containing air
Authors: Wang Meifang , Liu Yuquan , Qian Xin , Li Dan , You Hui , Wei Na , Tang Yijun
Published: May 2019

Introduction:

Pulmonary sarcomatoid carcinomas (PSCs) are rare tumors within the sarcomatoid carcinoma group. Giant cell carcinoma of the lung (GCCL) is a rare type of PSCs that consists entirely of highly pleomorphic tumor giant cells; the prognosis is poor.

Patient concerns:

A patient presented with a single cyst and was diagnosed with GCCL. The patient was a 59-year-old male who was admitted to the hospital with a cough. A chest computerized tomography (CT) scan showed a single, thin-walled cyst containing air in the left upper lobe of the lung. Bronchoscopy revealed chronic bronchitis. The initial diagnosis was pulmonary infection and the patient was treated with antibiotics. The cyst wall increased in thickness, and the cyst eventually formed a cavity.

Diagnosis:

Surgery was performed, and a diagnosis of GCCL was established. The stage was pT1bN1M0 (equal to stage IIB).

Interventions:

The patient underwent video-assisted thoracoscopic surgery and 4 cycles of adjuvant chemotherapy consisting of cisplatin and docetaxel. After 9 months, the patient occurred mediastinal lymph node metastasis, and received radiotherapy (60Gy/30F).

Outcomes:

His prognosis was good without progression (complete response) based on serial CT scans over 9 months of follow-up evaluations, then the patient occurred mediastinal lymph node metastasis. The patient lived during 30 months of follow-up, after which he was lost to follow-up.

Conclusion:

A solitary pulmonary parenchymal cystic lesion usually suggests an infectious disease or congenital abnormality; however, a cystic lesion is occasionally encountered in GCCL.
Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease
Authors: Stasi Elisa , De Santis Stefania , Cavalcanti Elisabetta , Armentano Raffaele
Published: May 2019

Rationale:

Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.

Patient concerns:

We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.

Diagnoses:

The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.

Interventions and outcomes:

The patient underwent surgical resection and is disease free at 6 years follow-up.

Lessons:

This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.
Haptic fracture and dislocation of polyimide intraocular lens after neodymium:YAG laser capsulotomy
Authors: Kim Jae Suk , Kang Min Ji , Jeong Kyeong Do , Hwang Je Hyung
Published: May 2019

Rationale:

We report a case of haptic fracture of polyimide intraocular lens (IOL) and its dislocation after neodymium:YAG (Nd:YAG) laser capsulotomy. To the best of our knowledge, this is the first report of both the fracture and dislocation of the IOL after laser posterior capsulotomy.

Patient concerns:

A 78-year-old male was referred to our clinic with a history of decreased visual acuity after Nd:YAG laser posterior capsulotomy in the right eye. A dislocated IOL was observed on slit lamp examination.

Diagnosis:

On slit-lamp examination, dislocated IOL with intact anterior capsulorrhexis margin was observed in the right eye.

Interventions:

We removed the dislocated IOL and fixed a 3-piece IOL (Acrysof MN60AC, Alcon Laboratories, Inc) in the ciliary sulcus under retrobulbar anesthesia.

Outcomes:

After the operation, the observed uncorrected distance visual acuity (UCVA) was 20/20 and the measured intraocular pressure (IOP) was 18 mmHg; the IOL was fixed in the ciliary sulcus.

Lessons:

Three-piece, silicone-polyimide haptics in IOLs can get fractured after Nd:YAG laser capsulotomy. Thus, it is suggested that sufficient haptic dilation should be ensured while performing Nd:YAG laser capsulotomy in patients with polyimide haptics. Moreover, a small-sized capsulotomy is likely to be helpful in such patients.
Epidemiology of sepsis in Taiwan
Authors: Chen Yen-Jung , Chen Fu-Lun , Chen Jin-Hua , Wu Man-Tzu Marcie , Chen Yen-Ling , Chien Du-Shieng , Ko Yu
Published: May 2019

To investigate the epidemiology trend and characteristics of sepsis-related hospitalizations in Taiwan, and to compare the differences among different severity levels of sepsis.

This study is a retrospective national claim database analysis. Hospitalized adult patients with sepsis between 2010 and 2014 were identified from the Two-Million-Sample Longitudinal Health and Welfare Database (LHWD) by the International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM). The patients were divided into 3 severity groups based on their medical records during hospitalization.

The study results showed that in Taiwan, there were 643 new cases of sepsis in 100,000 Taiwanese. The mortality of all septic patients in Taiwan was 287 per 100,000 people, and the case fatality was 29.2%. It was found that the mortality and incidence of sepsis in Taiwan have increased year by year, but there has been no significant change over time. In addition, demographic variation exists in the epidemiology of sepsis. In all the rates investigated, the men's were higher than the women's and the elderly's were higher than the youths’. The analysis results also showed that the respiratory system was the most common site of organ failure in septic patients.

The incidence and mortality of any severity level of sepsis were 643, and 287 per 100,000 people in Taiwan, respectively, and the average case fatality was 29.2% during the study period (2010–2014). The respiratory system was the major infected site and site of organ dysfunction, especially in the more severe levels.