bluuebunny/crossref_metadata_2025 huggingface dataset:
Contraceptive Need, Intimate Partner Violence, and Reproductive Coercion Among Women Attending a Syringe Exchange Program
Authors: Perry Rachel , Landrian Amanda , McQuade Miriam , Thiel de Bocanegra Heike
Published: December 2019

Objective:

Women who use drugs are at high risk of unintended pregnancy. This study describes contraceptive need, explores relationships between contraceptive use, intimate partner violence (IPV) and reproductive coercion, and unintended pregnancy, and assesses the acceptability of receiving contraceptive care at a syringe exchange program (SEP).

Methods:

Between August and October, 2017, written surveys were administered to 96 reproductive-aged women attending an SEP in Santa Ana, California. Data were analyzed using descriptive, bivariate, and multivariate statistics.

Results:

Most women used methamphetamines (79%) and/or heroin (74%). The majority (62%) did not use contraception during last sex with a man. Half (50%) reported a history of unintended pregnancy. Many (62%) experienced IPV or reproductive coercion in the previous 3 months. Experiencing IPV or reproductive coercion was not associated with contraceptive use or unintended pregnancy. The majority (56%) were interested in receiving contraceptive care from the SEP; history of unintended pregnancy (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.3–10.0) and depression (aOR 4.55, 95% CI 1.24–16.69) were associated with interest in contraceptive services.

Conclusions:

Our findings suggest that referrals for contraceptive care and direct provision of contraceptive methods at SEPs may be an acceptable approach to addressing the unmet family planning needs of women who use substances. Innovative approaches like these have the potential to impact the high prevalence of unintended pregnancy among this population; however, high prevalence of IPV and reproductive coercion must also be acknowledged by providers when providing counseling for contraceptive services.
Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes
Authors: Jiang Hai-Li , Lu Chang , Wang Xiao-Xin , Wang Xin , Zhang Wei-Yuan
Published: December 2019

Background:

Preterm premature rupture of membranes (PPROM) is associated with high neonatal morbidity and mortality. However, the influences of cesarean section (CS) on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated. The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.

Methods:

A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st, 2011 to December 31st, 2011. A total of 2756 singleton pregnancies complicated with PPROM were included. Adverse neonatal outcomes including early neonatal death, birth asphyxia, respiratory distress syndrome (RDS), pneumonia, infection, birth trauma, and 5-min/10-min Apgar scores were obtained from the hospital records. Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression. Numerical variables were compared by multiple linear regressions.

Results:

In total, 2756 newborns were involved in the analysis. Among them, 1166 newborns (42.31%) were delivered by CS and 1590 newborns belonged to vaginal delivery (VD) group. The CS proportion of PPROM obviously increased with the increase of gestational age (χ

2
 = 5.014, P = 0.025). Compared with CS group, VD was associated with a higher risk of total newborns mortality (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.102–5.118; P = 0.027), and a lower level of pneumonia (OR, 0.32; 95% CI, 0.126–0.811; P = 0.016). However, after multivariable adjustment and stratification for gestational age, only pneumonia was significantly related with CS in 28 to 34 weeks group (OR, 0.34; 95% CI, 0.120–0.940; P = 0.038). There were no differences regarding to other adverse outcomes in the two groups, including neonatal mortality, birth asphyxia, Apgar scores, RDS, pneumonia, and sepsis.

Conclusions:

The proportion of CS of pregnant women with PPROM was very high in China. The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.
Racial Disparities are Present in the Timing of Radiographic Assessment and Surgical Treatment of Hip Fractures
Authors: Ali Iman , Vattigunta Saisanjana , Jang Jessica M. , Hannan Casey V. , Ahmed M. Shafeeq , Linton Bob , Kantsiper Melinda E. , Bansal Ankit , Srikumaran Uma
Published: December 2019

Background

Hip fractures are associated with 1-year mortality rates as high as 19% to 33%. Nonwhite patients have higher mortality and lower mobility rates at 6 months postoperatively than white patients. Studies have extensively documented racial disparities in hip fracture outcomes, but few have directly assessed racial disparities in the timing of hip fracture care.

Questions/purposes

Our purpose was to assess racial disparities in the care provided to patients with hip fractures. We asked, (1) do racial disparities exist in radiographic timing, surgical timing, length of hospital stay, and 30-day hospital readmission rates? (2) Does the hospital type modify the association between race and the outcomes of interest?

Methods

We retrospectively reviewed the records of 1535 patients aged 60 years or older who were admitted to the emergency department and treated surgically for a hip fracture at one of five hospitals (three community hospitals and two tertiary hospitals) in our health system from 2015 to 2017. Multivariable generalized linear models were used to assess associations between race and the outcomes of interest.

Results

After adjusting for patient characteristics, we found that black patients had a longer mean time to radiographic evaluation (4.2 hours; 95% confidence interval, -0.6 to 9.0 versus 1.2 hours; 95% CI, 0.1-2.3; p = 0.01) and surgical fixation (41 hours; 95% CI, 34-48 versus 34 hours 95% CI, 32-35; p < 0.05) than white patients did. Hospital type only modified the association between race and surgical timing. In community hospitals, black patients experienced a 51% (95% CI, 17%-95%; p < 0.01) longer time to surgery than white patients did; however, there were no differences in surgical timing between black and white patients in tertiary hospitals. No race-based differences were observed in the length of hospital stay and 30-day hospital readmission rates.

Conclusions

After adjusting for patient characteristics, we found that black patients experienced longer wait times to radiographic evaluation and surgical fixation than white patients. Hospitals should consider evaluating racial disparities in the timing of hip fracture care in their health systems. Raising awareness of these disparities and implementing unconscious bias training for healthcare providers may help mitigate these disparities and improve the timing of care for patients who are at a greater risk of delay.

Level of Evidence

Level III, therapeutic study.
Folliculitis Decalvans and Lichen Planopilaris Phenotypic Spectrum—A Series of 7 New Cases With Focus on Histopathology
Authors: Egger Andjela , Stojadinovic Olivera , Miteva Mariya
Published: December 2019

Background:

Folliculitis decalvans (FD) and lichen planopilaris (LPP) are classified as neutrophilic and lymphocytic cicatricial alopecias according to the North American Hair Research Society. Recently, a clinical phenotype combining concomitant or sequential features for both was described as a FD LPP phenotypic spectrum (FDLPPPS).

Objectives:

To review the most common phenotypic presentation of FDLPPPS with a main focus on histopathology.

Methods:

We reviewed retrospectively series of 7 patients with a similar phenotypic presentation with special focus on the histologic pattern. All patients presented with concomitant features for FD and LPP and recalcitrant course unresponsive to topical and systemic immunomodulatory/anti-inflammatory agents.

Results:

The most common clinical phenotype was that of hairless patches on the vertex with lost follicular ostia and perifollicular scale and the following diagnostic findings: (1) polytrichia; (2) positive bacterial culture forStaphylococcusin over 50% of the samples isolated from pustules and hemorrhagic crusts; (3) “mixed” histologic features for primary cicatricial alopecia including multicompound follicular structures of average 2–5 follicles (follicular packs), atrophy of the follicular epithelium, lymphohistiocytic infiltrate with granulomas, and prominent plasma cells, but absence of neutrophilic infiltrate in all cases except scarce neutrophils in one; and (4) clinical improvement with adjuvant systemic antimicrobials.

Conclusions:

The FDLPPPS may be underreported and should be considered in all cases of LPP recalcitrant to treatment. Dermatologists and dermatopathologists should recognize this phenotypic spectrum to guide optimal clinical management consisting of immunomodulatory and anti-inflammatory agents along with systemic antimicrobials.
Determinants of 30-day Morbidity in Adult Cranioplasty: An ACS-NSQIP Analysis of 697 Cases
Authors: Armstrong Rachel E. , Ellis Marco F.
Published: December 2019

Background:

Cranioplasty is performed to restore the function and anatomy of the skull. Many techniques are used, including replacement of the bone flap and reconstruction with autologous or synthetic materials. This study describes the complication profile of adult cranioplasty using a prospective national sample and identifies risk factors for 30-day morbidity.

Methods:

The American College of Surgeon’s National Surgery Quality Improvement Project database for 2015–2016 was utilized. Cases were identified by current procedural terminology code, size, and type (autologous/alloplastic). χ2, Fisher exact, and ANOVA tests compared demographic differences. Univariate and multivariate logistic regressions were performed to identify risk factors for 30-day morbidity and mortality.

Results:

Six hundred ninety-seven cranioplasty cases were identified. Two cases used 2 types of cranioplasties and were counted in both groups. Five hundred forty-three cranioplasties were alloplastic, 57 were autologous, and 99 were classified as “Other.” Age, race, diabetes, ventilator dependency, congestive heart failure, hypertension, wound infection, sepsis, and bleeding disorders were identified on univariate analysis to increase complication risk. Multivariate analysis identified age of the patient, systemic sepsis, and bleeding disorders as significant risk factors for complications. There was no difference in complications between cranioplasty types. Overall and medical complications were greater in cranioplasties >5 cm (P < 0.001).

Conclusions:

Cranioplasty is a morbid procedure, with a complication rate of 27.4% and a mortality rate of 3.0% in this national sample. Factors such as age, sepsis, bleeding disorders, and size increase risk. Identification and modification of risk factors may guide operative timing and influence informed consent.
Sentinel Lymph Nodes and Precision Surgery in Gynecologic Cancer
Authors: GHONIEM KHALED , SHAZLY SHERIF A. , DINOI GIORGIA , ZANFAGNIN VALENTINA , GLASER GRETCHEN E. , MARIANI ANDREA
Published: December 2019

Besides histologic features, the presence of nodal metastasis is the most crucial prognostic factor for recurrence and survival for patients with gynecologic cancer. Conventionally, lymphadenectomy has been performed routinely to assess lymphatic metastasis. However, lymphadenectomy may be unnecessary in early-stage gynecologic cancer, because the percentage of patients with lymph node involvement is very low. The recent use of sentinel lymph node mapping has provided high feasibility, safety, and accuracy in the assessment of nodal metastasis. The National Comprehensive Cancer Network Clinical Practice Guidelines have incorporated the sentinel lymph node for nodal evaluation in vulvar, endometrial, and cervical cancers.
Examining the financial and quality performance effects of group purchasing organizations
Authors: Walker Daniel M. , McAlearney John S. , Sharma Luv , Kim Yoon Hee
Published: December 2019

Background

Hospitals frequently enter into group purchasing organizations (GPOs) to manage supply costs, yet there is mixed evidence regarding the benefit for hospitals to participate in a GPO. However, the role of GPOs on hospital operations has expanded into dimensions of quality that have not been previously examined.

Purpose

The aim of this study was to examine the effect of hospital participation in a GPO, as well as GPO network characteristics, on both financial and quality performance outcomes.

Approach

Data from multiple secondary sources regarding hospital and GPO characteristics were used to create an unbalanced panel of hospitals from 2012 to 2015. This data set was then aggregated to the GPO network level to address questions related to network characteristics, including concentration, bed size, geographic scope, and focus. We evaluated three hospital-level outcomes: supply expense, clinical processes of care score, and patient experience score. The mean of each outcome among all hospitals in a GPO in a given year was used for analyses at the network level. We used fixed and random effect models to assess the effect of hospital characteristics and network characteristics on three measures of financial and quality performance.

Results

We found no difference between GPO and non-GPO hospitals for any of the outcomes. However, analyses at the network level revealed network characteristics, including concentration, size, and scope, that affected both supply expense and patient experience scores, but not clinical processes of care.

Conclusions

These results indicate that GPO participation may be motivated for reasons beyond cost and quality performance impacts.

Practice Implications

Hospitals and GPOs should consider network characteristics, such as the concentration and geographical dispersion of the GPO network. Alternatively, GPOs may seek to develop homogeneously sized networks dispersed locally in order to best deliver both financial and quality benefits to their members.
Neuroman: Voxel Phantoms from Surface Models of 300 Head Structures Including 12 Pairs of Cranial Nerves
Authors: Park Jin Seo
Published: December 2019

For a precise simulation of electromagnetic radiation effects, voxel phantoms require detailed structures to approximate humans. The phantoms currently used still do not have sophisticated structures. This paper presents voxel and surface models of 300 head structures with cranial nerves and reports on a technique for voxel reconstruction of the cranial nerves having very thin and small structures. In real-color sectioned images of the head (voxel size: 0.1 mm), 300 structures were segmented using Photoshop. A surface reconstruction was performed automatically on Mimics. Voxel conversion was run on Voxel Studio. The abnormal shapes of the voxel models were found and classified into three types: thin cord, thin layers, and thin parts in the structures. The abnormal voxel models were amended using extended, filled, and manual voxelization methods devised for this study. Surface models in STL format and as PDF files of the 300 head structures were produced. The STL format has good scalability, so it can be used in most three-dimensional surface model software. The PDF file is very user friendly for students and researchers who want to learn the head anatomy. Voxel models of 300 head structures were produced (TXT format), and their voxel quantity and weight were measured. A voxel model is difficult to handle, and the surface model cannot use the radiation simulation. Consequently, the best method for making precise phantoms is one in which the flaws of the voxel and surface models complement each other, as in the present study.
Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review
Authors: Mohseni Michael M. , Filmalter Sara E. , Taylor Walter C. , Vadeboncoeur Tyler F. , Thomas Colleen S.
Published: December 2019

Objective:

To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners.

Design:

This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries.

Setting:

This study took place during a nationally recognized marathon affiliated with a local hospital.

Participants:

Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%).

Interventions:

This was an observational study; independent variables included demographic data and race year.

Main Outcome Measure:

The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race.

Results:

Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience.

Conclusions:

Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.
Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis and Management of Mediastinal Cyst
Authors: Aravena Carlos , Patel Jinesh , Goyal Abha , Jaber Wissam , Khemasuwan Danai , Machuzak Michael , Cicenia Joseph , Gildea Thomas , Sethi Sonali , Mehta Atul C. , Almeida Francisco A.
Published: December 2019

Background:

Foregut cysts account for >50% of cystic lesions in the mediastinum, of which bronchogenic cysts are most common. Surgical resection is the most definitive approach for its diagnosis and treatment. A recent systematic review, however, suggests that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a role in the management of bronchogenic cyst. We report our experience with EBUS-TBNA in the diagnosis and management of bronchogenic cysts.

Methods:

Medical records of patients with evidence of mediastinal cysts who underwent EBUS-TBNA between 2008 and 2016 were reviewed.

The primary aims of this study were to assess EBUS-TBNA diagnostic yield of peri-bronchial cysts and their specific type/origin and to determine its short-term and long-term drainage efficacy.

Results:

A total of 26 patients met the inclusion criteria. The cytopathology diagnosis was compatible with bronchogenic cyst in 4 cases, pleural-pericardial cyst in 3 cases, and 19 were indeterminate cysts. Successful long-term treatment occurred in 5.5% of the subjects. One patient developed inflammatory pericarditis after EBUS-TBNA.

Conclusion:

Diagnostic and therapeutic yield of EBUS-TBNA for mediastinal cysts is limited and surgical resection remains the treatment of choice.
Blood pressure monitoring in sleep: time to wake up
Authors: Kwon Younghoon , Stafford Patrick L. , Lim Diane C. , Park Sungha , Kim Sung-Hoon , Berry Richard B. , Calhoun David A.
Published: December 2019

Hypertension is a highly common condition with well-established adverse consequences. Ambulatory blood pressure monitoring has repeatedly been shown to better predict cardiovascular outcomes and mortality, compared to single office visit blood pressure. Non-dipping of sleep-time blood pressure is an independent marker for increased cardiovascular risk. We review blood pressure variability and the challenges of blood pressure monitoring during sleep. Although pathological sleep such as obstructive sleep apnea has been associated with non-dipping of sleep-time blood pressure, blood pressure is not routinely measured during sleep due to lack of unobtrusive blood pressure monitoring technology. Second, we review existing noninvasive continuous blood pressure monitoring technologies. Lastly, we propose including sleep-time blood pressure monitoring during sleep studies and including sleep studies in patients undergoing ambulatory blood pressure monitoring.
Hormone replacement therapy and lung cancer risk in women: a meta-analysis of cohort studies
Authors: Jin Chao , Lang Baoping
Published: December 2019

Background:

Discordant results about the causal relationship between hormone replacement therapy use (HRT) and lung cancer risk in women had been reported. We therefore conducted a meta-analysis of cohort studies to evaluate this association.

Methods:

The PubMed and Embase databases were searched. Fixed- or random-effects model was used to pool the study-specific relative risks (RRs) with corresponding 95% confidence intervals (CIs). Sensitivity analysis, publication bias, and subgroup analysis were performed.

Results:

A total of 13 cohort studies met the inclusion criteria. Combined results indicated that compared with nonusers, women with HRT use were at a decreased risk (RR: 0.95, 95% CI: 0.91-0.99, I2 = 30.8%, P for heterogeneity = .137). In subgroup analysis by geographic area, smoking statue, type of hormones, and histology type of lung cancer, no significant association between HRT use and lung cancer was observed in most subgroups except in those studies which reported risk estimates adjusted for age, body mass index, smoking, and other confounders (RR: 0.95, 95 CI: 0.91-0.99, I2 = 33.0%, P for heterogeneity = .214). Both Begg funnel plot and Egger test (P = .243) suggested no evidence for publication bias.

Conclusion:

Our meta-analysis suggests ever use of HRT is associated with a decreased risk of lung cancer in women.
Laryngeal adenoid cystic carcinoma
Authors: Cui Yu , Bi Lirong , Sun Le , Wang Xin , Zhu Zhanpeng
Published: December 2019

Introduction:

Laryngeal adenoid cystic carcinoma (LACC) is an extremely rare malignant neoplasm. The etiology of LACC remains unknown, and it is characterized by multiple recurrences, slow progression, and late distant metastasis. This study aimed to provide more information regarding the characteristics, diagnosis, and treatment of LACC by analyzing 3 clinical cases and reviewing the literature on this topic.

Patient concerns:

Here, we present all 3 cases of LACC within the period between 2010 and 2019. Dyspnea was the most commonly observed symptom in these patients, followed by hoarseness, pharyngeal paresthesia, and difficulty swallowing.

Diagnosis:

All patients were pathologically confirmed as LACC.

Interventions:

All the patients underwent a combined therapy of surgical resection plus external irradiation.

Outcomes:

The follow-up time was between 2 and 6 years; no local recurrence occurred in any of the 3 patients. Lung metastasis was found in 1 patient 6 years after surgery.

Conclusion:

LACC is usually a slowly progressing cancer; the main treatment methods are surgery and radiotherapy, and the adequate radiotherapy dose should usually be greater than 60 Gy. The 5-year disease-specific survival rate is high; however, distant metastasis may still occur in patients with LACC even beyond 5 years after treatment. Therefore, patients with LACC require long-term surveillance.
Acupotomy for patients with carpal tunnel syndrome
Authors: Zhou Qiaoyin , Shen Yifeng , Sun Xiaojie , Qiu Zuyun , Jia Yan , Li Shiliang
Published: December 2019

Background:

This systematic review program is designed to provide an assessment of the effectiveness and safety of needle-knife therapy for the treatment of carpal tunnel syndrome (CTS).

Methods:

A cumulative search till October 2018 will be conducted in the following 8 databases: PubMed, EMBASE, Cochrane Controlled Trials Register, MEDLINE, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, and Wanfang Database, with no language or Publication status restrictions. All randomized controlled trials (RCT) for carpal tunnel syndrome will be considered eligible. The primary outcomes will include changes in the Boston carpal tunnel questionnaire (BCTQ) and visual analogue score (VAS), as well as safety and adverse events. Study inclusion, data extraction, and quality assessment will be done independently by 2 reviewers. If no substantial heterogeneity is detected, a meta-analysis will be performed. Continuous results will be expressed as mean differences or standard average differences, while binary data will be expressed as relative risks. The deviation risk and data synthesis will be assessed using the Review Manager software.

Results:

This study will provide a high-quality synthesis of BCTQ and VAS to assess the effectiveness and safety of acupotomy for carpal tunnel syndrome patients.

Conclusion:

This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with carpal tunnel syndrome.

PROSPERO registration number:

CRD42018108787.
Platelet-rich plasma vs corticosteroids for elbow epicondylitis
Authors: Li Ang , Wang Hongbo , Yu Zhenghong , Zhang Guangquan , Feng Shiqing , Liu Liyun , Gao Yanzheng
Published: December 2019

Objective:

The aim of this meta-analysis was to compare the effectiveness of platelet-rich plasma (PRP) vs corticosteroids for treatment of patients with lateral elbow epicondylitis.

Methods:

A literature search was performed in EMBASE, Medline, the Cochrane Library and PubMed. Randomized controlled studies comparing PRP with corticosteroids for the treatment of epicondylitis were included. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the methodological quality of the included trials. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. The overall effect size of each anesthetic was calculated as the weighted average of the inverse variance of the study-specific estimates.

Results:

Seven randomized controlled trials were included in this review. The data from 2 studies were unavailable for meta-analysis, and the systematic review criteria were just achieved. Local corticosteroid injection yielded a significantly superior Disabilities of the Arm, Shoulder and Hand (DASH) score at 4 weeks (WMD, 11.90; 95% CI: 7.72 to 16.08; P < .00001; heterogeneity, χ2 = 0, I2 = 0%, P = 1.00) and 8 weeks (WMD, 6.29; 95% CI: 2.98 to 9.60; P = .0002, χ2 = 0, I2 = 0%, P = 1.00). Otherwise, it was noteworthy that a significantly lower VAS score (WMD, −2.61; 95% CI: −5.18 to −0.04; P = .05; heterogeneity, χ2 = 29.85, I2 = 97%, P < .00001) and DASH score (WMD, −7.73; 95% CI: −9.99 to −5.46; P < .00001, χ2 = 0.20, I2 = 0%, P = .66) existed in the PRP regimen than in the steroid regimen at the 24-week follow-up. More effective treatments were achieved in the PRP-treated patients than in the patients treated with corticosteroids (WMD, 3.33; 95% CI: 1.81 to 6.14; P = .000; heterogeneity, χ2 = 0.43, I2 = 0%, P = .51).

Conclusions:

Local corticosteroid injections demonstrated favorable outcomes compared with those of local PRP treatments for lateral elbow epicondylitis during the short-term follow-up period (4 weeks and 8 weeks post-treatment). Otherwise, at the long-term follow-up (24 weeks post-treatment), PRP injections had improved pain and function more effectively than corticosteroid injections.
Four reconstruction methods after laparoscopic distal gastrectomy
Authors: Ma Yanpeng , Li Fei , Zhou Xin , Wang Bingyan , Lu Siyi , Wang Wendong , Yu Shuqing , Fu Wei
Published: December 2019

Background:

There is no consensus regarding which reconstruction methods are superior after laparoscopic distal gastrectomy (LDG). This study compared four reconstruction methods after LDG for gastric cancer.

Methods:

Literature in EMBASE, PubMed, and the Cochrane Library was screened to compare Billroth I (B-I), Billroth II (B-II), Roux-en-Y (RY), and uncut Roux-en-Y (URY) anastomoses after LDG for gastric cancer. A Bayesian network meta-analysis (NMA) was conducted to compare these methods.

Results:

Eighteen studies involving 4347 patients were eligible for our NMA. The operative time in RY anastomosis was longer than that in B-I and B-II anastomoses. Blood loss and risk of gastrointestinal motility dysfunction were greater with RY anastomosis than with URY or B-I anastomosis. Furthermore, URY anastomosis was superior to the other 3 reconstruction methods for preventing food residue. For remnant gastritis, RY anastomosis was significantly superior to B-I and B-II anastomoses, whereas URY anastomosis was significantly superior to B-II anastomosis. In addition, RY and URY anastomoses were better than B-I and B-II anastomoses for preventing bile reflux.

Conclusions:

URY anastomosis tended to be a more favorable reconstruction method after LDG due to its operative simplicity and reduced long-term complications.
The use of apatinib in treating primary pleural synovial sarcoma
Authors: Chen Sumei , Zhang Ke , Wan Xianqin , Chen Yuanyuan , Ma Shenglin , Deng Qinghua
Published: December 2019

Rationale:

Apatinib is an oral tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2. It has been shown that apatinib is effective and safe for treatment of multiple solid tumors, including gastric cancer, liver cancer, non-small-cell lung cancer, and breast cancer. However, there is currently no consensus as to using Apatinib for the treatment of pleural synovial sarcoma, due to the rarity of primary pleural synovial sarcoma and lack of clinical studies as a consequence.

Patient concerns and diagnoses:

We reported here in the case of a 26-year-old Chinese woman diagnosed with pleural synovial sarcoma. She has undergone 2 surgeries, multiple regimens of chemotherapy and traditional Chinese medicine in other hospitals. Then the patient was admitted to our hospital with the compliant of chest pain and dyspnea. The medical history and available data supported the diagnosis of recurrence of pleural synovial sarcoma.

Interventions and outcomes:

Due to the lack of efficacy of previous standard treatment, the patient was given apatinib and radiotherapy to relieve the symptoms. This patient achieved stable disease with apatinib at a dose of 500 mg/day. Her progression-free survival time was more than 7 months, and her overall survival was 8.5 months. Except for hand-foot syndrome, no grade 3 or 4 side effects were observed.

Conclusions:

Apatinib may thus be an option for treatment of advanced synovial sarcoma after failure of other treatments. However, further study is needed to determine the efficacy of apatinib in pleural synovial sarcoma.
Very late-onset complete atrioventricular block following deployment of Amplatzer membranous ventricular septal defect occluder
Authors: Shao Shuran , Luo Chunyan , Zhou Kaiyu , Hua Yimin , Wang Chuan
Published: December 2019

Rationale:

Although implantation of Amplatzer membranous ventricular septal defect occluder (AVSDO) is an alternation to surgical treatment, the interventional therapy is disapproved by FDA due to high incidence of complete atrioventricular block (cAVB) post closure during early and middle term follow-up. However, long-term outcomes of the accumulating numbers of patients who had received AVSDO in the past decades, still remain an issue of concern and late occurrence of potentially catastrophic heart block long after hospital discharge is especially worrying, but rarely documented. We firstly reported a pediatric case with very late-onset cAVB occurring over ten years following transcatheter closure of PmVSD using AVSDO.

Patient concerns:

A 5-year old female received transcatheter closure of PmVSD sized 10-mm on left ventricular angiography with a 14-mm AVSDO owning to a history of recurrent lower respiratory tract infections. Post-procedure echocardiography documented no arrhythmias, residual shunt and aortic regurgitation. All electrocardiogram (ECG) recordings were completely normal and transthoracic echocardiography (TTE) examination showed the device was in the proper position and there was neither residual shunt nor valves regurgitation. Ten years after operation, the patient was re-admitted into our hospital due to recurrent syncope.

Diagnoses:

A 12-lead ECG showed cAVB with a minimal heart rate of 42 bpm. Device flattening was revealed on 2-dimensional TTE and the occluder appeared to return to its original size and shape. Computed tomography and magnetic resonance imaging of brain did not reveal any intracranial hemorrhages, ischemic changes, or space-occupying lesions. Electroencephalogram detected no epileptiform discharge. Other possible etiologies resulting in cAVB such as myocarditis, hypothyroidism and connective tissue diseases were excluded. Therefore, it was ultimately considered the cAVB was mostly likely to be associated with device closure of PmVSD using AVSDO.

Interventions:

The child was empirically treated with prednisone (1–2 mg/Kg daily).

Outcomes:

Unfortunately, no improvement was observed. A permanent pacemaker was implanted. The following course was uneventful.

Lessons:

For patients following transcatheter closure of PmVSD using AVSDO, the risk period for developing heart block after device closure appears to be much longer than we speculated. Long-term, perhaps and life-long followed up needs to be considered for this group of patients.
Can the basal serum thyroglobulin level be used to predict the recombinant human TSH-stimulated thyroglobulin level in differentiated patients with thyroid cancer?
Authors: Jeong Eugene , Yoon Joon-Kee , Lee Su Jin , Soh Euy Young , Lee Jeonghun , Kim Hyeung Kyoo , An Young-Sil
Published: December 2019

This study investigated the correlation between basal thyroglobulin (Tg) and recombinant human thyroid-stimulating hormone (rhTSH)-stimulated Tg in differentiated patients with thyroid cancer, and sought to determine whether the basal Tg level predicts the rhTSH-stimulated Tg level.

We retrospectively enrolled 177 patients with papillary thyroid cancer (mean age = 44 years; 50 males, 127 females) who received rhTSH before radioiodine therapy (RIT). Serum Tg levels were measured 7 days before the 1st rhTSH injection (basal Tg) and on the days of RIT (rhTSH-stimulated Tg). Patients were divided into 3 groups according to rhTSH-stimulated Tg cut-off levels of 2, 5, and 10 ng/mL. The correlation between basal Tg and rhTSH-stimulated Tg levels was assessed, and whether basal Tg was useful in predicting the rhTSH-stimulated Tg level was determined.

A significant positive correlation was observed between basal and rhTSH-stimulated Tg levels (|rho| = 0.48, P < .0001). The basal Tg level had significant diagnostic ability in predicting an rhTSH-stimulated Tg level of 2 ng/mL or higher, and the optimal basal Tg level for this prediction was 0.3 ng/mL (AUC = 0.77, P < .0001). A basal Tg level of 0.5 ng/mL was optimal for predicting rhTSH-stimulated Tg levels of 5 ng/mL or higher (AUC = 0.81, P < .0001), and of 10 ng/mL or higher (AUC = 0.82, P = .0171).

The basal Tg level was significantly correlated with the rhTSH-stimulated Tg level. If the basal Tg level is >0.3 or 0.5 ng/mL, then the rhTSH-stimulated Tg level can be expected to be sufficiently high to necessitate clinical examination.
The response of hepatitis B virus genotype to interferon is associated with a mutation in the interferon-stimulated response element
Authors: Guo Yanan , Lu He , Xu Lei , Idris Nur Fazleen Binti , Li Yimin , Hu Jieli , Huang Ailong , TU Zeng
Published: December 2019

Genetic variation and genotype of Hepatitis B virus (HBV) are related to the efficiency of interferon alpha (IFN-α)-based antiviral therapy. However, the correlation of variation in interferon-stimulated response element (ISRE) and HBV genotype response to IFN-α therapy remains elusive.

Differences of ISRE between genotype B and C HBV were explored using the HBV sequences retrieved from GenBank, and further investigated by ISRE region cloning and sequencing from 60 clinical samples post-IFN-α therapy. Additionally, ISRE mutants were constructed and their relation to responsiveness of IFN-α was evaluated by real-time PCR and Southern blot analysis.

ISRE pattern between genotype B and C were found based on both clinical sample sequencing and full-length sequence alignment. The primary difference is the fourth base within the ISRE region, with T and C for genotype B and C, respectively. HBV with genotype C-type ISRE had a higher replicative capability as compared to HBV with genotype B-type ISRE after IFN-α treatment in huh7 cells.

Conclusion:

Preference of ISRE between genotype B and C HBV are distinct. Single nucleotide difference (C to T) within the HBV ISRE region may link to the efficacy of IFN-α therapy to genotype B and C HBV. Therefore, this study provides a clue for the determination of IFN-α therapy response to HBV treatment.
A retrospective analysis of the treatment on abdominal aortic balloon occlusion-related thrombosis by continuous low-flow diluted heparin
Authors: Luo Rongguang , Wang Fen , Guan Yanxing , Wan Junhui , Zhang Wentao , Duan Zhifeng
Published: December 2019

Thrombosis is one of the serious complications related to prophylactic balloon occlusion of the abdominal aorta (PBOAA). This study aims to retrospectively analyze the efficacy and safety of continuous low-flow infusion of diluted heparin saline to prevent this complication related to PBOAA and further to provide the theory and evidences for using PBOAA.

A study was carried out at our hospital from March 2016 to December 2018. Women with pernicious placenta previa (PPP) were treated PBOAA to prevent massive bleeding during CS. According to whether continuous low-flow infusion of diluted heparin saline was used to prevent catheter-related thrombosis or not, they were divided into 2 groups, the test group and the control group. The incidence of thrombosis between the 2 groups was compared and the effective treatment of thrombosis was also discussed. The comparison of nonparametric values was accomplished by using Fisher exact test. Statistical significance was set at P < .05.

There were 31 women with PPP who received PBOAA during CS who were included in our study. Six of 19 women in control group (31.6%) developed thrombotic complications, while none of 12 women in test group. There were statistically significant differences in the incidence of thrombosis between the 2 groups (P = .037). There was no statistically significant difference in the amount of estimated blood loss and blood transfusion during CS between the 2 groups, nor was there statistically significant difference in the hospital days after CS (P > .05). All 6 women with thrombotic complications had no positive symptoms and thrombotic sequelae. The managements of thrombus included systemic anticoagulation, catheter-directed thrombolysis, and catheter-directed anticoagulation. One of the 6 women was lost to follow-up, and the thrombus of the other 5 women were completely dissolved. No other adverse outcomes or complications related to PBOAA were observed in all women in this study.

Continuous low-flow infusion of diluted heparin saline is a safe procedure when PBOAA is performed for patients with PPP. It can effectively reduce or even avoid thrombosis without increasing intraoperative blood loss during CS for PPP patients.
Risk factors for restless legs syndrome in hemodialysis patients in Taiwan
Authors: Tsai Li-Hung , See Lai-Chu , Chien Chu-Chun , Chen Chuan-Mei , Chang Shu-Hao
Published: December 2019

Restless legs syndrome (RLS) increases the risks of cardiovascular disease and death in hemodialysis (HD) patients. Previous studies of risk factors for RLS in HD patients have yielded varying results. We attempted to identify risk factors for RLS in HD patients in Taiwan.

This case–control study recruited 59 HD patients with RLS and 353 HD patients without RLS from the largest HD center in Taiwan during the period from April 1, 2015 through August 31, 2015. Demographic and disease characteristics, information from the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic questionnaire, and IRLSSG Severity Scale scores were collected by interview. Clinical laboratory data were abstracted from medical records and then analyzed with logistic regression and Pearson correlation analysis. A P value of less than .05 was considered to indicate statistical significance.

A dialysis duration of longer than 5 years (odds ratio [OR] = 2.32; 95% CI = 1.23–4.39; P = .002) and a low high-density lipoprotein cholesterol level (<40 mg/dL in men; <50 mg/dL in women) (OR = 2.73; 95% CI = 1.44–5.15; P = .009) were associated with increased risk of RLS. Among the 59 patients with RLS, 48 (81.3%) had moderate or severe symptoms (IRLSSG Severity Scale >10), and RLS severity was significantly correlated with dialysis duration (r = .26; P = .043).

Among HD patients, RLS was more common among those receiving dialysis for longer than 5 years and those with a low serum high-density lipoprotein cholesterol (HDL-C) level.
Identification of new genes of pleomorphic adenoma
Authors: Choi Jeong-Seok , Cho Byung Han , Kim Hong-Ju , Kim Young-Mo , Jang Jun-Hyeog
Published: December 2019

Pleomorphic adenoma is the most common salivary gland neoplasm with a variety of histologic appearances. Due to this diversity, precise preoperative diagnosis through fine needle aspiration cytology is difficult.

This study sought to identify the differentially expressed genes in pleomorphic adenoma to aid precise diagnosis and clarify the mechanism of tumorigenesis.

Suppressive subtractive hybridization was performed on pleomorphic adenoma tissues and the corresponding normal salivary gland tissues to screen of the differential expression of genes in pleomorphic adenoma.

Four known genes (microfibrillar associated protein 4 [MFAP4], dystonin [DST], solute carrier family 35 [SLC35], and potassium channel tetramerization domain containing 15 [KCTD15]) were differentially expressed in the tumors compared with the genes in normal tissues. The expression profiles were further confirmed in 15 pleomorphic adenoma and corresponding normal salivary gland tissues by quantitative real-time reverse transcription-polymerase chain reaction.

MFAP4, DST, SLC35, and KCTD15 gene expression could be potential biomarkers of pleomorphic adenoma for precise diagnosis.
Is targeted biopsy really needed when performing systematic prostate biopsy to raise the detection rate for prostate cancer in patients with prostate-specific antigen ≤10 ng/mL?
Authors: Park Jee Soo , Koo Kyo Chul , Chung Byung Ha , Lee Kwang Suk
Published: December 2019

Targeted biopsy with multiparametric magnetic resonance imaging and hypoechoic lesions on transrectal ultrasound has been implemented to increase prostate cancer detection rate.

We compared the detection abilities of systematic prostate biopsy, hypoechoic lesion-targeted biopsy (HL-TBx), and cognitive magnetic resonance imaging-targeted biopsy (MRI-TBx) in patients with suspected prostate cancer. Between September 2014 and August 2016, 193 patients with a prostate-specific antigen level of 3 to 10 ng/mL underwent HL-TBx or MRI-TBx. In patients who refused magnetic resonance imaging examination before prostate biopsy, HL-TBx was performed. We compared cancer detection rates and pathologic outcomes between systematic prostate biopsy and HL-TBx or MRI-TBx.

The cancer detection rates for HL-TBx and MRI-TBx were 40.8% and 43.8%, respectively, without a significant difference (P = .683). Of the 81 patients diagnosed with prostate cancer, most patients (77 patients, 95.1%) were diagnosed with prostate cancer by systematic prostate biopsy. The detection ability for prostate cancer was significantly better for systematic prostate biopsy than for HL-TBx or MRI-TBx (P < .001).

The detection abilities for clinically significant prostate cancer similar between HL-TBx and systematic prostate biopsy. Systematic prostate biopsy alone should be recommended for detection prostate cancer in patients with a prostate-specific antigen ≤10 ng/mL.
Antibiotics administered within 1 hour to adult emergency department patients screened positive for sepsis: a systematic review
Authors: Xantus Gabor , Allen Penny , Norman Sharon , Kanizsai Peter
Published: December 2019

Objective

The 2018 Surviving Sepsis Campaign update recommended instigating the Sepsis-6 bundle within 1 h; however, the supporting evidence is weak. The objective was to systematically review the literature to determine whether there is mortality benefit (hospital or 28/30-day survival) associated with administration of antibiotics <1 h to adult emergency department (ED) patients screened positive for sepsis using systemic inflammatory response system criteria.

Methods

A systematic review and meta-analysis were conducted. Embase, CINAHL, Medline, Pubmed, Cochrane Library and grey literature were searched for articles published between 2012 and 2019.

Results

From 232 identified articles, seven met the inclusion criteria. Due to the small number of articles that fit the inclusion criteria and the considerable heterogeneity (I
2 = 92.6%, P < 0.001), only the results of the systematic review are reported. Three of the seven studies demonstrated survival benefit for patients who screened positive for sepsis who were administered antibiotics ≤1 h after presentation to the ED. Four studies reported no statistically significant improvement in survival associated with administration of antibiotics within 1 h of ED presentation. Interestingly, two studies reported worse outcomes associated with early administration of antibiotics in patients with low acuity sepsis.

Conclusion

There is equivocal evidence of in-hospital or 28/30-day survival benefit associated with antibiotics administered ≤1 h after presentation to the ED for patients who screened positive for sepsis. Further research is needed to identify the exact patient group, which would truly benefit from initiation of antibiotics <1 h after ED presentation.
Unavailability of Endoscopic Retrograde Cholangiography Adversely Impacts Hospital Outcomes of Acute Biliary Pancreatitis
Authors: Malli Ahmad , Durkin Claire , Groce J. Royce , Hinton Alice , Conwell Darwin L. , Krishna Somashekar G.
Published: December 2019

Objectives

There is a paucity of literature assessing the impact of endoscopic retrograde cholangiopancreatography (ERCP) availability at hospitals and the management of acute biliary pancreatitis (ABP). Thus, we sought to evaluate the impact of ERCP availability on the clinical outcomes of ABP.

Methods

The Nationwide Inpatient Sample (2004–2013) was reviewed to identify adult inpatients (≥18 years) with ABP. Clinical outcomes (mortality, severe acute pancreatitis, and health care resource utilization) between hospitals that perform ERCP versus hospitals that do not perform ERCP were compared using multivariate and propensity score–matched analyses.

Results

A majority of the non-ERCP hospitals were rural (73%) in location. Multivariate analysis demonstrated that the lack of ERCP availability was independently associated with increased mortality from ABP (odds ratio, 1.83; 95% confidence interval, 1.16–2.88). A propensity score–matched cohort analysis confirmed a significant increase in mortality from ABP in non-ERCP hospitals (1.1% vs 0.53%; odds ratio, 2.08; 95% confidence interval, 1.05–4.15, P = 0.037) compared with ERCP hospitals.

Conclusions

This national survey reveals increased mortality for patients with ABP admitted to hospitals lacking ERCP services. While there is a need to increase ERCP availability in rural areas, optimizing strategies for early transfer of patients with ABP to hospitals with ERCP availability can potentially offset these limitations.