bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Outcomes of Metastatic Breast Cancer in Patients Having Imaging Liver Pseudocirrhosis with or without Evident Varices
Authors: Ma Wei-Li , Chang Dwan-Ying , Lin Ching-Hung , Liu Kao-Lang , Liang Po-Chin , Lien Huang-Chun , Hu Chan-Chuan , Huang Ling-Yun , Yeh Yi-Chun , Lu Yen-Shen
Published: October 2022

Background

Pseudocirrhosis is an imaging finding of malignancies with liver metastasis with or without clinical liver cirrhosis-related portal hypertension (pHTN). This study defined evident pHTN by the presence of esophageal or gastric varices and compared patients’ outcomes of metastatic breast cancer with imaging-diagnosed pseudocirrhosis with or without varices.

Methods

The medical records from patients with metastatic breast cancer and pseudocirrhosis between 2005 and 2017 were retrospectively analyzed. Survival outcomes were compared based on endoscopic evidence of esophageal or gastric varices.

Results

Among 106 patients with pseudocirrhosis, 33 (31%) had de novo stage IV disease, and 66 (62%) had hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Eighty-one (76%) had initial metastases in both hepatic lobes, and 32 (30%) had esophageal or gastric varices. The median overall survival (OS) was 5 and 13 months in patients with and without varices (P = .002). The median OS in patients with HER2-positive, HR-positive/HER2-negative, and triple-negative subtype was 16, 9, and 2 months, respectively (P = .001). Patients with varices usually had cirrhotic complications, including gastrointestinal bleeding, hyperbilirubinemia, hyperammonemia, and coagulopathy. Despite their challenging clinical conditions, 7 patients with varices had OS exceeding 1 year. In multivariate analysis, evident varices (P = .007) and triple-negative subtype (P = .013) were associated with poor OS.

Conclusions

Patients with pseudocirrhosis and evident varices had a significantly shorter median OS, and were usually associated with clinical cirrhosis-related complications. To maximize OS, early identification and meticulous supportive care are warranted.
Contraceptive use in South and South-East Asian region: assessment of sustainable development goal 3.7 through indicator 3.7.1
Authors: Biswas Raaj Kishore , Farzana Maysha , Bhar Sunil , Bhowmik Jahar
Published: October 2022

Background

Sustainable Development Goal (SDG) 3.7 concerns modern contraception use among women of reproductive ages. This study evaluated the progress of indicator 3.7.1 in 11 selected countries in South and South-East Asia and assessed the contribution of women’s education to modern contraceptive use.

Methods

Generalized linear models for complex surveys were fitted to Demographic and Health Survey (DHS) data from 40 surveys conducted in Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor Leste between 1990 and 2017, followed by a meta-analysis through forest plots.

Results

Modern contraceptive coverage in most of the selected countries climbed or remained stationary over the past decades. In four countries, <50% of women used contraception. In no country was contraception used by ≥80% women. Higher education was associated with 13% higher odds of modern contraceptive use (95% confidence interval: 1.07, 1.18) among women compared to primary level or no education.

Discussion

Completion of primary education is insufficient to broaden the coverage of modern contraceptive use. Greater national level effort from the selected countries is needed to lift the education levels of women to meet SDG 3.7 by 2030.
ESTIMATION OF INDOOR AND OUTDOOR EFFECTIVE DOSES AND LIFETIME CANCER RISK FROM GAMMA DOSE RATES IN AND AROUND MANDYA DISTRICT, KARNATAKA
Authors: Shashikumar T S , Ramachandra M N , Chandrashekar  , Gowda Shivalinge
Published: October 2022

Indoor and outdoor gamma-ray dose rates have been measured in and around Mandya district (12° 20″ N and 77° 20″ E). The measurements were carried out from 45 locations of Mandya district at 1 m above the ground surface for radiometric, geophysical and environmental surveys using a lightweight portable radiation dosemeter ER‑709. The indoor and outdoor absorbed gamma dose rate in air varied from 66.12±0.8 to 131.89±5.5 nGy per h with a geometrical mean value of 97.79±2.6 nGy per h and 45.94±0.7 to 80.39±2.6 nGy per h with a geometrical mean value of 58.75±1.5. The indoor and outdoor effective doses vary from 0.32 to 0.65 mSv per y with a geometric mean value of 0.48 mSv per y and 0.06 to 0.10 mSv per y with a geometric mean value of 0.07 mSv per y which is slightly higher when compared with the worldwide average of the effective doses. The indoor and outdoor excess lifetime cancer risk (ELCR) of residents along the different locations varies from 1.14 × 10−3 to 2.26 × 10−3 with a geometric mean value of 1.68 × 10−3 and 0.20 × 10−3 to 0.35 × 10−3 with a geometric mean value of 0.25 × 10−3 which is similar to the worldwide average of the ELCR.
DESIGN, CONSTRUCTION AND TEST OF GAMMA IONIZATION CHAMBERS
Authors: Zhang Weihua , Zhang Yi , Sun Mingyan , Zhu Meiling , Huang Xianchao , Tong Teng , Li Daowu
Published: October 2022

Ionization chamber is considered as the golden standard for the dosemeter. This work fabricated one graphite-walled and two polymethyl methacrylate (PMMA)-walled ionization chambers, tested respectively and compared their characteristic parameters. The performance of graphite-walled chamber was similar to that of the PMMA-walled chamber. The relative energy response of ionization chambers was lower than 4% from 50 keV to 50 MeV based on the FLUKA code simulation results. The experimental data showed that the ionization chambers performed well in linearity and repeatability. Assuming the chambers sensitive volume and HV bias was constant, the measured maximum saturation absorbed dose of ionization chambers changed with the diameter variation of chambers anode based on the comparison results of two PMMA-walled ionization chambers.
Acclimation of interacting leaf surface traits affects foliar water uptake
Authors: Chin Alana R O , Guzmán-Delgado Paula , Kerhoulas Lucy P , Zwieniecki Maciej A
Published: October 2022

Absorption of water across the surfaces of leaves is an ecologically important aspect of tree physiology. Variation in foliar water uptake capacity depends on environmental conditions when traits associated with the uptake pathway respond to climatic signals. Using a series of experiments, we verify that water enters Sequoia sempervirens (D. Don) Endl. leaves by crossing the cuticle, and show that surface-trait acclimation alters the kinetic parameters of foliar water uptake. Under our experimental conditions, the cuticle was the primary pathway for water entry into the leaf. Exposure to climatic variation may induce surface acclimations, such as increased waxiness, that reduce water-film formation over stomata at the expense of dry-season foliar uptake rates. We found that water uptake is negatively associated with the interaction of leaf-surface wax coverage and stomatal density, and provide an accessible protocol to measure these key traits in Sequoia. Linking absorptive pathways and trait acclimation to physiological performance can provide a foundation for range-wide or genomic investigations of forest interactions with water and a mechanism-centered means to monitor canopy hydraulic parameters over time.
Subspecies at crossroads: the evolutionary significance of genomic and phenotypic variation in a wide-ranging Australian lizard (Ctenotus pantherinus)
Authors: Prates Ivan , Doughty Paul , Rabosky Daniel L
Published: October 2022

Many subspecies were described to capture phenotypic variation in wide-ranging taxa, with some later being found to correspond to divergent genetic lineages. We investigate whether currently recognized subspecies correspond to distinctive and coherent evolutionary lineages in the widespread Australian lizard Ctenotus pantherinus based on morphological, mitochondrial and genome-wide nuclear variation. We find weak and inconsistent correspondence between morphological patterns and the presumed subspecies ranges, with character polymorphism within regions and broad morphological overlap across regions. Phylogenetic analyses suggest paraphyly of populations assignable to each subspecies, mitonuclear discordance and little congruence between subspecies ranges and the distribution of inferred clades. Genotypic clustering supports admixture across regions. These results undermine the presumed phenotypic and genotypic coherence and distinctiveness of C. pantherinus subspecies. Based on our findings, we comment on the operational and conceptual shortcomings of morphologically defined subspecies and discuss practical challenges in applying the general notion of subspecies as incompletely separated population lineages. We conclude by highlighting a historical asymmetry that has implications for ecology, evolution and conservation: subspecies proposed in the past are difficult to falsify even in the face of new data that challenge their coherence and distinctiveness, whereas modern researchers appear hesitant to propose new subspecies.
Achieving and Sustaining Change Through Capacity Building Train-the-Trainer Health Initiatives in Low- and Middle-Income Countries: A Systematic Review
Authors: Snowden Bobbi , Lahiri Shaon , Dutton Rebecca , Morton Lindsay
Published: October 2022

Introduction:

Given the anticipated health challenges, forecasted deficiencies in the global health workforce, and steady demands to work through resource constraints, effective and efficient training approaches to build capacity are direly needed. Although train-the-trainer (T3) is not a new approach, there has been considerable interest in using it to develop and sustain capacity, particularly in low- and middle-income countries. This systematic review aimed to better understand the factors to achieve and sustain change across multiple countries and levels through T3 approaches.

Methods:

A literature search was conducted of six scholarly, peer-reviewed, and gray literature databases. Data were extracted for the study method, design, characteristics, and implicit or explicit factors related to maximizing the likelihood of achieving and sustaining change. An existing conceptual framework for T3 interventions in global health guided the thematic analysis. The framework consisted of five factors pertinent to capacity building T3 initiatives: Talent, Resources, Alignment, Implementation, and Nurture and Development.

Results:

Twenty-two studies met the inclusion criteria. The T3 training spanned all geographical regions, but interventions were most prevalent in sub-Saharan Africa (46%). Nearly all studies (68%) quantitatively examined change at the individual level (95%), but some studies also explored change at the organizational (77%) and institutional (23%) levels. Implementation and Nurture/Development were the two most salient factors in achieving and sustaining change. The greatest hindrances involved Resources and Context, an additional theme that the data identified.

Discussion:

The findings and recommendations from this first systematic review exploring antecedents influencing change through health-related T3 interventions can inform training and capacity-building investments, improve existing T3 initiatives, and steer planning for future approaches.
Comparative effects of rosuvastatin and atorvastatin on the risk of new-onset diabetes mellitus in patients with acute coronary syndrome receiving percutaneous coronary intervention: a retrospective cohort study
Authors: Jia Cunhui , Tian Rui , Zong Mengzhi , Luan Fangyun , Wang Wenjun , Li Chuanbao
Published: October 2022

Background

Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels. However, the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus (NODM). Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) within 18 months of follow-up.

Methods

A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June 2017. The survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the endpoint. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk factors of NODM.

Results

In total, 220 patients received rosuvastatin and 168 atorvastatin. The cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance, compared with that in the atorvastatin group (7.27% vs. 12.50%, respectively; log-rank P = 0.08). Using Cox proportional hazards models, baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM (HR: 4.56; 95% CI: 2.83–7.36; P < 0.01).

Conclusion

Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.
Central blood pressure estimation in type 1 diabetes: impact and implications of peripheral calibration method.
Authors: Helleputte Simon , Spronck Bart , Sharman James E. , Van Bortel Luc , Segers Patrick , Calders Patrick , Lapauw Bruno , De Backer Tine
Published: October 2022

Objective:

Peripheral blood pressure (BP) waveforms are used for noninvasive central BP estimation. Central BP could assist in cardiovascular risk assessment in patients with type 1 diabetes mellitus (T1DM). However, correct calibration of peripheral BP waveforms is important to accurately estimate central BP. We examined differences in central BP estimated by radial artery tonometry depending on which brachial BP (SBP/DBP vs. MAP/DBP) is used for calibration of the radial waveforms, for the first time in T1DM.

Methods:

A cross-sectional study in T1DM patients without known cardiovascular disease. Radial artery BP waveforms were acquired using applanation tonometry (SphygmoCor) for the estimation of central SBP, central pulse pressure (PP) and central augmentation pressure, using either brachial SBP/DBP or MAP/DBP for the calibration of the radial pressure waveforms.

Results:

Fifty-four patients (age: 46 ± 9.5 years; T1DM duration: 27 ± 8.8 years) were evaluated. Central BP parameters were significantly higher when brachial MAP/DBP-calibration was used compared with brachial SBP/DBP-calibration (7.5 ± 5.04, 7.5 ± 5.04 and 1.5 ± 1.36 mmHg higher central SBP, central PP and central augmentation pressure, respectively, P < 0.001).

Conclusion:

In patients with T1DM, there are significant differences in central BP values estimated with radial artery tonometry, depending on the method used for calibration of the radial waveforms. Brachial MAP/DBP-calibration resulted in consistently higher central BP as compared to using brachial SBP/DBP, leading to patient re-stratification. Hence, the accuracy of noninvasive estimation of central BP by radial tonometry is dependent on calibration approach, and this problem must be resolved in validation studies using an invasive reference standard to determine which method best estimates true central BP.
Progressive solid facial edema: A neglected clue to cutaneous angiosarcoma
Authors: Miao Qiu-Ju , Geng Yi , Wang Yi-Fei , Xu Xiu-Lian
Published: October 2022

Introduction:

Cutaneous angiosarcoma (CAS), a rare and highly aggressive tumor derived from vascular endothelial cells, has quite poor prognosis and the clinical presentations are occasionally atypical and inconspicuous, frequently leads to the delayed diagnosis.

Case presentation:

We here described an unusual, initial presentation of CAS manifested as solid facial edema and induration, which appeared asymptomatic, unilateral and gradually spread. The histopathological and histochemical results helped confirm the diagnosis and Paclitaxel combined with Bevacizumab was taken for two cycles which had acquired significant relief but suspended for the poor tolerance.

Discussion:

Apart from typical skin lesions observed as single or multiple erythematous to violaceous plaques, papules or nodules that tend to ulcerate or bleed, the CAS occasionally mimics other diseases such as cellulites, rosacea, rhinophyma and , also as we reported, that initiated as inconspicuous but progressive facial edema.

Conclusion:

The field of CAS therapy has been growing rapidly nowadays whereas the survival rate has not yet improved significantly. Early diagnosis is necessary and CAS should be considered when it comes to patients presented with progressive solid facial edema after ruling out common causes.
Exosome-mediated cell–cell communication within pancreatic cancer tumor microenvironment: a narrative review
Authors: Qin Cheng , Zhao Bangbo , Wang Yuanyang , Li Tianhao , Li Zeru , Li Tianyu , Zhao Yutong , Wang Weibin
Published: October 2022

The significance of exosomes has emerged in a variety of physiological processes and diseases. Pancreatic cancer remains one of the most lethal diseases at present. Recently, increasing evidence has suggested that exosomes are vital for mediating the elaborate interaction of highly heterogeneous cell clusters within the pancreatic tumor microenvironment, contributing to activating pancreatic stellate cells and cancer-associated fibroblasts, compromising immune cells, and enhancing angiogenesis. Besides their natural and intrinsic roles, exosomes may provide a novel potential way for pancreatic cancer management and therapy as well. Thus, exosomes not only mediate cellular communication during pancreatic cancer progression but also serve as a promising player in precise pancreatic cancer management and treatment. To comprehensively summarize the role of exosomes in pancreatic cancer, we searched the PubMed database and reviewed all relevant original studies.
A spadework for integrative medicine based critical pathways for facial palsy: Web-based survey from traditional Korean medicine doctors
Authors: Kim Jung-Hyun , Goo Bonhyuk , Nam Sang-Soo
Published: October 2022

Patients affected with facial palsy consult both traditional Korean medicine doctors and conventional medicine doctors. Considering that the optimal approach varies depending on the progress of the disease, there is a need for facial palsy management through integrated medical care. However, no critical pathway has been developed to manage facial palsy from an integrated medical perspective. The aims of this study were to (a) explore treatment utilization status and awareness for facial palsy; (b) understand possible traditional Korean medicine modalities; and (c) suggest interventions to be included in integrated medical service for treating facial palsy. Regarding existing papers in relevant field, draft of questionnaire was firstly established. Eight-person development committee was comprised and reviewed the draft and modified the items of questionnaire. As an independent committee, the authors of present study have rechecked the validity and reliability of modified items of questionnaire. A questionnaire was developed comprising 21 items, including demographic characteristics, clinical statement, recognition, and demands and directions to improve the quality of newly developing critical pathways. Using the services of the Association of Korean Medicine and Medistream, the questionnaire was sent via a web-based survey to traditional Korean medicine doctors. A total of 1017 valid questionnaires were collected from traditional Korean medicine doctors. Of the total doctors who responded, over 75% stated that they utilized integrated medical systems in various forms. Acupuncture, herbal medicine, and thermal therapy were presented as key traditional Korean medicine treatments to be included in the critical pathway for the establishment of integrated medical services. Conversely, corticosteroids, antivirals, and blood sugar management were chosen to be critical among conventional medical treatments. Considering the responses collected in the present study and the progressive nature of facial palsy, various interventions in both conventional and traditional Korean medicine services need to be included in relevant critical pathways. If the critical pathway developed based on the present study is established, relevant clinical practice guidelines could be made available in an integrated medical system.
Cuproptosis-related gene signatures for predicting prognosis of lung adenocarcinoma
Authors: Ye Wei , Huang Yuenuo , Li Xingxing
Published: October 2022

Lung cancer (LC) is a common malignancy with high mortality rate, and lung adenocarcinoma (LUAD) is one of the common pathological types. Cuproptosis is a recently discovered new type of cell death dependent on mitochondria. However, the role of cuproptosis in LUAD is unknown. We obtained LUAD transcriptome data from the Cancer Genome Atlas (TCGA). Long-stranded non-coding RNA (LncRNAs) based on cuproptosis prognosis associated with LUAD were constructed for prognostic multi-LncRNA characterization. We divided TCGA-LUAD into training set and validation set to prove feasibility, and all samples were divided into high-risk group or low risk group. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to evaluate potential biological functions and explore the relationship between risk models and immunity. We identified 3 differentially expressed LncRNAs associated with LUAD prognosis and constructed prognostic model. Kaplan–Meier (K-M) analysis revealed prognostic model and LUAD prognosis. Our risk assessment model has a good reliability in predicting the prognosis of LUAD and was able to improve predictive ability of tumor mutational burdern. Single sample gene enrichment analysis (ssGSEA) revealed risk subgroups were associated with immune-related functions. The prognostic model based on cuproptosis lncRNA has important value in predicting the survival of LUAD patients.
Examining the relation between self-realization and burnout levels of nurses
Authors: Cetinkaya Senay , Gunes N. Ecem Oksal
Published: October 2022

Self-realization involves the realization of one’s aims, revealing his/her potential, self-satisfaction, personal accomplishment, and scientific inventions. It is important to know nurses’ self-realization levels and the variables that affect it, because self-fulfillment is necessary for the personal and professional development of nurses. This study was conducted to determine the relation between self-realization and burnout levels of nurses. The study is a cross-sectional study that was conducted on 136 nurses who worked at Çukurova University, Faculty of Medicine Hospital in Adana, Turkey. The data were collected with the Personal Information Form and the “Self-realization” sub-dimension of the “Healthy Lifestyle Behaviors Scale” and the “Maslach Burnout Scale.” The analyses of the data were made in the SPSS demo packet Program with percentages, averages, variance analysis, Student t test, and Mann–Whitney U test. The Ethical Board Approval and Institutional Approval were obtained for the study. The self-realization score average of the nurses was 32.93 ± 6.43. The self-realization scores of the nurses who preferred their jobs willingly were found to be higher, and their burnout levels were found to be lower. It was also determined that female nurses experienced more emotional burnout compared to male nurses. In the present study, it was determined that the personal accomplishment score averages were higher and the desensitization and emotional burnout score averages, which are among the burnout scale sub-dimensions, were lower in those who had higher self-realization scores.
Anti-aging protein klotho was associated with vitamin B12 concentration in adults
Authors: Choi Ju-Young , Min Jin-Young , Min Kyoung-Bok
Published: October 2022

Previous studies have reported that serum klotho and vitamin B12 levels are valuable aging-related markers. However, studies supporting the association between serum klotho and vitamin B12 levels are lacking. We investigated the association between serum klotho and vitamin B12 concentrations in adults in the United States. The analytic study sample was 2065 aged 40 to 79 who participated in the 2011 to 2014 National Health and Nutrition Examination Survey (NHANES). Serum klotho and vitamin B12 collected from adults who consented to the use of their samples in the future. The participants were divided into 2 groups based on estimated glomerular filtration rate (eGFR) levels (high: ≥90 mL/min/1.73 m2 or low: <90 mL/min/1.73 m2). Of the 2065 participants, the log-transformed klotho concentration was significantly correlated with log-transformed vitamin B12 in the high eGFR group, but not in the low eGFR group. After adjusting for all potential covariates, there was a significant association between klotho and vitamin B12 concentrations in the high eGFR groups (beta = 0.100, SE = 0.040). In contrast, there was no significant relationship between klotho and vitamin B12 concentrations in the low eGFR group (beta = 0.012, SE = 0.019). Serum klotho concentration was significantly associated with vitamin B12 increases in US adults with high kidney function. Vitamin B12 concentration may be an important marker of klotho concentration in older adults.
Syphilitic osteomyelitis in a patient with HIV and cognitive biases in clinical reasoning: A case report
Authors: Kamegai Kohei , Yokoyama Shuhei , Takakura Shunichi , Takayama Yoshihiro , Shiiki Soichi , Koyama Hirofumi , Narita Masashi
Published: October 2022

Rationale:

Diagnosing multifactorial, multidimensional symptoms unexplained by presumptive diagnosis is often challenging for infectious disease specialists.

Patient concerns:

We report a rare case of a 30-year-old Japanese bisexual man with a history of virally suppressed human immunodeficiency virus and syphilis infections who developed chest pain and an erosive lesion under the lower midline jaw.

Diagnosis:

Imaging examinations revealed erosive lesions on the sternum and left the ninth rib. Biopsy and polymerase chain reaction testing of sternal tissue specimens were noncontributory. However, due to elevated rapid plasma regain levels, a diagnosis of syphilitic osteomyelitis and gumma of the jaw was made.

Interventions:

The patient was treated with 5 weeks of intravenous ceftriaxone and then with 8 weeks of oral amoxicillin.

Outcome:

After the antibiotic treatment, bone pain disappeared. We conducted a literature review on syphilitic osteomyelitis, and all of the articles included were case reports. Approximately half of the 46 patients with syphilitic osteomyelitis had HIV coinfection, and 10 (22%) patients lacked signs of early syphilis. Given its rarity, clinical data to establish appropriate guidelines for diagnosing and treating syphilitic osteomyelitis are still lacking. Cognitive biases, such as anchoring, cognitive overload bias, and premature closure, may contribute to diagnostic delays.

Lessons:

In cases of idiopathic multiple bone lesions, syphilis must always be ruled out, and clinicians should guard against cognitive pitfalls when diagnosing rare diseases.
Thoracic perfusion of lobaplatin combined with endostar for treating malignant pleural effusions: A meta-analysis and systematic review
Authors: Wang Cheng-Qian , Liu Fei-Yu , Wang Wei
Published: October 2022

Introduction:

Lobaplatin is a new platinum-based cytotoxic chemotherapeutic agent. Endostar is an endogenous angiogenic inhibitor with implicated anti-tumor activity. This study was to investigate the efficacy and safety of thoracic perfusion of lobaplatin combined with endostar in the treatment of malignant pleural effusions (MPE).

Methods:

We searched the databases of Pubmed, the Cochrane Library, Embase, WanFang Data, and CNKI to select the studies regarding the efficacy and safety of lobaplatin combined with endostar to treat MPE. A total of 10[3–12] randomized controlled trials with 651 patients were included.

Results:

The objective response rate (P < .001, odds ratio = 4.08) and disease control rate (P < .001, odds ratio = 3.69) of lobaplatin combined with endostar were significantly higher than lobaplatin alone. In addition, lobaplatin combined with endostar remarkably promoted the quality of life of patients (P < .001, odds ratio = 3.93) compared with lobaplatin alone. Lobaplatin combined with endostar also promoted the quality of life of patients (P < .05, odds ratio = 2.56) compared with cisplatin combined with endostar. At the same time, the leukopenia rate (P < .05, odds ratio = .40) and the incidence of nausea and vomiting (P < .05, odds ratio = .38) of lobaplatin combined with endostar were significantly lower than that of cisplatin combined with endostar.

Conclusions:

The efficacy of lobaplatin combined with endostar was superior to lobaplatin alone. The safety was higher than cisplatin combined with endostar through thoracic perfusion in treating MPE, which indicated that lobaplatin combined with endostar could be the effective agent for controlling MPE.
Portal and mesenteric venous calcification in patient with advanced cirrhosis
Authors: Pan Bing , Lyu ShaoCheng , He Qiang
Published: October 2022

Rationale:

The incidence of portal and mesenteric venous calcifications in patients with cirrhosis has rarely been reported. It is also very difficult to determine the vascular lesions in preoperative imaging examination. The liver cirrhosis patients associated with portal venous calcification have high postoperative complications and mortality, but poor prognosis.

Patient concerns:

We present a patient (45-year-old male), who was admitted to the hospital with liver cirrhosis and portal hypertension associated symptoms.

Diagnoses:

Abdominal imaging computed tomography confirmed the presence of calcification in the portal vein system.

Interventions:

The patient underwent allogeneic liver transplantation.

Outcomes:

The patient died 2 days after liver transplantation.

Lessons:

Calcification in the portal vein system is extremely rare, and always occurs in patients with long-standing liver cirrhosis with portal hypertension gastroesophageal varices and splenomegaly. The presence of portal vein calcification on computed tomography may be a sign of portal vein thrombosis, which may result in a difficult transplantation, and poor prognosis.
Clinicopathological and prognostic value of lncRNAs expression in gastric cancer: A field synopsis of observational studies and databases validation
Authors: Xu Xiaona , Duan Fujiao , Ng Shiutin , Wang Haili , Wang Kaijuan , Li Yilin , Niu Guanghui , Xu Erping
Published: October 2022

Background:

The purpose of this study was to evaluate existing evidence in the field of long non-coding RNAs (lncRNAs) and prognosis of gastric cancer.

Methods:

A comprehensive literature search was performed through the electronic database. The combined hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of overall survival (OS), disease-free survival (DFS), or progression free survival (PFS) were calculated to assess the strength of the association. Kaplan–Meier (KM) plotter was used to verify lncRNA HOX transcript antisense RNA (HOTAIR) expression and OS.

Results:

Overall, a significant correlation between high lncRNAs expression and poor OS was explored in patients with gastric cancer (HR = 1.78, P < .001). Subgroup analysis based on statistical methods indicated the high expression of lncRNAs in log-rank (HR = 1.87, P < .001) and multivariate analysis (HR = 1.71, P < .001) were all significantly correlated with the poor OS. Clinicopathological parameters analysis showed the lncRNA expression were significantly associated prognosis, including TNM stage, tumor size, pathological differentiation, lymph nodes metastasis, distance metastasis, invasion depth and Lauren’s classification. It was consistent with the verification results of bioinformatics database for lncRNA HOTAIR (P < .001).

Conclusion:

Our study confirmed the expression of lncRNAs and clinicopathological features may serve as effective indicators of prognosis in patients with gastric cancer.
Bilateral verses bilateral with tri-segmental endoscopic drainage using metal stents for high-grade malignant hilar biliary obstructions: A multicenter, randomized controlled trial: BRAVE study (BRAVE study)
Authors: Matsumoto Kazuyuki , Mitsuhashi Toshiharu , Kawamoto Hirofumi , Ishida Etsuji , Fujii Masakuni , Akimoto Yutaka , Seki Hiroyuki , Ishihara Yuki , Ogawa Taiji , Yamazaki Tatsuhiro , Fujii Yuki , Kato Hironari
Published: October 2022

Introduction:

Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to manage hilar malignant biliary obstruction (HMBO) more effectively in comparison to unilateral drainage. An increased drainage area is predicted to prolong stent patency and patient survival. However, few reports have described the utility of trisegmental drainage and the benefits of using trisegmental drainage remain unknown. Thus, we launched a randomized clinical trial (RCT) to compare the clinical outcomes between bilateral and trisegmental drainage using SEMSs in patients with high-grade HMBO.

Methods and analysis:

This study was conducted as a multicenter randomized control trial (RCT) in 8 high-volume medical centers in Japan, and will prove the non-inferiority of bilateral drainage to trisegmental drainage. Patients with unresectable HMBO with Bismuth type IIIa or IV who pass the inclusion and exclusion criteria will be randomized to receive bilateral or trisegmental drainage at a 1:1 ratio. At each center, the on-site study investigators will obtain informed consent from the candidates, and will use an electronic data capture system (REDCap) to input necessary information, and register candidates with the registration secretariat. The primary endpoint is the rate of non-recurrent biliary obstruction (RBO) at 180 days after SEMSs placement. A −10% non-inferiority margin is assumed in the statistical analysis of the primary endpoint. Secondary endpoints include the rate of technical and clinical success, time to recurrent biliary obstruction (TRBO), causes of RBO, procedure-related adverse events (AEs), procedure time, TRBO with or without endoscopic sphincterotomy, overall survival, and the technical and clinical success rates at reintervention.

Discussion:

If the non-inferiority of bilateral drainage is demonstrated, it is predicted that the procedure time will be shortened and the medical cost will be reduced, which will be beneficial to the patient and the medical economy.

Trial registration:

Registered in Japan Registry of Clinical Trial-Registration (trial number. jRCTs062220038). This version number 1. Protocol dated Jun 23, 2022.
Exploration of hub genes involved in PCOS using biological informatics methods
Authors: Zhou Fei , Xing Yuling , Cheng Tiantian , Yang Linlin , Ma Huijuan
Published: October 2022

Background:

The aim of this study was to find underlying genes and their interaction mechanism crucial to the polycystic ovarian syndrome (PCOS) by analyzing differentially expressed genes (DEGs) between PCOS and non-PCOS subjects.

Methods:

Gene expression data of PCOS and non-PCOS subjects were collected from gene expression omnibus (GEO) database. GEO2R were used to calculating P value and logFC. The screening threshold of DEGs was P < .05 and | FC | ≥ 1.2. GO annotation and Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway enrichment analysis was performed by using DAVID (2021 Update). The protein-protein interaction (PPI) network of DEGs was constructed by using the STRING database, and the hub genes were recognized through Hubba plugin of Cytoscape software.

Results:

PCOS and non-PCOS subjects shared a total of 174 DGEs, including 14 upregulated and 160 downregulated genes. The GO biological processes enriched by DEGs mainly involved actin cytoskeleton organization, positive regulation of NF-κB signaling pathway, and positive regulation of canonical Wnt signaling pathway. The DEGs were significantly enriched in cytoplasm, nucleus and cytosol. Their molecular functions mainly focused on protein binding, calmodulin binding and glycerol-3-phosphate dehydrogenase activity. The PI3K/Akt signaling pathway and glycosaminoglycan biosynthesis were highlighted as critical pathways enriched by DEGs. 10 hub genes were screened from the constructed PPI network, of which EGF, FN1 and TLR4 were mainly enriched in the PI3K/Akt signaling pathway.

Conclusion:

In this study, a total of 174 DEGs and 10 hub genes were identified as new candidate targets for insulin resistance (IR) in PCOS individuals, which may provide a new direction for developing novel treatment strategies for PCOS.
Medication use during pregnancy and birth defects in Hunan province, China, during 2016–2019: A cross-sectional study
Authors: Zou Wei , Xie Shuting , Liang Changbiao , Xie Donghua , Fang Junqun , Ouyang Bo , Sun Li , Wang Hua
Published: October 2022

Safety of drug use during pregnancy attracts attentions from clinicians, pregnant woman, and even the total society. However, the studies about medication use during pregnancy and the followed birth defects (BDs) are rare in Chinese. To study condition about medication use during pregnancy and the followed BDs in Hunan province of China, here a cross-sectional study was carried out. All women using medication during pregnancy and delivering fetuses with BDs in Hunan province, China, during 2016 to 2019 were employed in this study. The descriptive analysis was carried out with Excel 2010, and the data analyses were performed by using Chi-Squared test in SPSS 16.0. After filtering, a total of 752 cases were included. In these fetuses, the males are more than females (P < .05). The severe BDs, leading to death or uncorrectable lifelong deformity, were observed for 346 times, and the other (minor) BDs were observed for 593 times. The most used drugs, categorized into pregnancy C, D, or X degrees by food and drug administration (FDA) or pharmaceutical manufacturers, mainly included anti-hyperthyroidism drugs, anti-epilepsy drugs, preventing miscarriage drugs, etc. This population-based data highlight the potential high risks for BDs from the aspect of drug use during pregnancy in Hunan province of China, and drugs with more safety, less kinds, and lower doses should be the better choice for pregnant women.
Traumatic lateral atlantoaxial dislocation combined with a type II odontoid fracture in a patient with ankylosing spondylitis: A case report
Authors: Eun Jongpil , Oh Youngmin
Published: October 2022

Rationale:

Traumatic lateral atlantoaxial dislocation (AAD) combined with an odontoid fracture is extremely rare. The standards applicable to management of the traumatic lateral AAD are still in flux due to the infrequency of this injury.

Patient concerns:

We present a unique case of traumatic lateral AAD combined with a type II odontoid fracture in a patient with ankylosing spondylitis (AS).

Diagnosis:

Spinal computed tomography showed ankylosis of the entire spine from the sacroiliac joint to the cervical spine. On the cervical X-ray the head was rotated to the right with anterior subluxation of the C1 and odontoid tip relative to C2. The coronal computed tomography (CT) scan also revealed left lateral dislocation of C1 on C2 with a horizontal translation of the odontoid tip. On the axial and sagittal CT scan, the left C1 lateral mass was displaced anteriorly and locked by C2 body

Interventions:

We performed occipito-cervical fusion (OCF) after successful manual reduction under general anesthesia.

Outcomes:

The patient’s recovery from surgery was uneventful and without complication. At the 3 year follow-up the patient was asymptomatic and reportedly satisfied with the surgery.

Lessons:

Traumatic AAD with an odontoid fracture is an exceedingly uncommon cervical spine injury. A lateral subluxation with a type II odontoid fracture in a patient with AS is rarer still, so much so that this type of subluxation was not classifiable using any of the previously developed classification systems. In this patient with AS, posterior OCF with internal fixation was necessary to avoid hardware failure, particularly in light of the intensive stress caused by AS.
Comparison of hallux valgus deformed ballerinas and sedentary individuals in terms of balance parameters
Authors: Ozkunt Okan , Kaya Ozcan , Kurt İrem
Published: October 2022

Background:

We aimed to compare static and dynamic balance parameters and health quality parameters in ballerina and non-ballerina adolescents with hallux valgus deformity.

Methods:

Forty five volunteer female adolescent ballet students between the ages of 7 and 17, with hallux valgus were recruited. Group 1 = in the control group, 31 sedentary adolescents with hallux valgus were included. Group 2 = Romberg test and Flamingo test were used for static balance. The SEBT (Star Excursion Balance Test) was used to measure dynamic balance.

Results:

Age, sex, and body mass index (BMI) characteristics were similar between ballerina and control groups (P < .05). The Romberg test stands upright with closed eyes, with a significant difference 47.22 in group 1 and 38.13 in group 2. In contrast there was a significant difference between the two groups in the Romberg test single limb with eyes open and closed. For open eyes single limb test mean score was 55.06 in ballerinas and 44.2 in sedentary group, similarly single limb test with closed eyes mean score was 25.68 in group 1 and 18.67 in group 2.

Conclusion:

In conclusion, the results of this study show that ballerinas have better single-limb and closed-eye balance than sedentary individuals with HV deformities.
The use of machine learning for investigating the role of plastic surgeons in anatomical injuries: A retrospective observational study
Authors: Lim Nam Kyu , Park Jong Hyun
Published: October 2022

While plastic surgeons have been historically indispensable in the reconstruction of posttraumatic defects, their role in trauma centers worldwide has not been clearly defined. Therefore, we aimed to investigate the contribution of plastic surgeons in trauma care using machine learning from an anatomic injury viewpoint. We conducted a retrospective study reviewing the data for all trauma patients of our hospital from March 2019 to February 2021. In total, 4809 patients were classified in duplicate according to the 17 trauma-related departments while conducting the initial treatment. We evaluated several covariates, including age, sex, cause of trauma, treatment outcomes, surgical data, and severity indices, such as the Injury Severity Score and Abbreviated Injury Scale (AIS). A random forest algorithm was used to rank the relevance of 17 trauma-related departments in each category for the AIS and outcomes. Additionally, t test and chi-square test were performed to compare two groups, which were based on whether the patients had received initial treatment in the trauma bay from the plastic surgery department (PS group) or not (non-PS group), in each AIS category. The department of PS was ranked first in the face and external categories after analyzing the relevance of the 17 trauma-related departments in six categories of AIS, through the random forest algorithm. Of the 1108 patients in the face category of AIS, the PS group was not correlated with all outcomes, except for the rate of discharge to home (P < .0001). Upon re-verifying the results using random forest, we found that PS did not affect the outcomes. In the external category in AIS, there were 30 patients in the PS group and 56 patients in the non-PS group, and there was no statistically significant difference between the two groups when comparing the outcomes. PS has contributed considerably to the face and external regions among the six AIS categories; however, there was no correlation between plastic surgical treatment and the outcome of trauma patients. We investigated the plastic surgeons’ role based on anatomical injury, using machine learning for the first time in the field of trauma care.
Antibodies against Toxoplasma gondii positive in serum and aqueous humor to diagnose clinically suspected ocular toxoplasmosis: A case report
Authors: Niu Lixia , Wang Sufang , Li Yunyun , Liu Jun
Published: October 2022

Introduction:

Previously, diagnosis of ocular toxoplasmosis is based on clinical symptoms and Toxoplasma serology. Checking serological indicators often cannot reflect the real intraocular situation, and may even mislead clinicians to make wrong judgments.

Patient concerns:

A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of decreased vision for about 5 days in his right eye.

Diagnosis:

Aqueous humor sample analysis found Toxoplasma DNA detectable, and Toxoplasma immunoglobulin G (IgG) and immunoglobulin M (IgM) to be positive. His serum Toxoplasma IgG was also positive (10.04 IU/mL; reference range: 0 to 7.2 IU/mL). Therefore, the final diagnose was ocular toxoplasmosis involving his right eye.

Interventions:

Oral prednisone 60 mg/day and azithromycin 0.25 g/day were started. Oral antibiotic treatment for toxoplasma was continued for 4 weeks, and prednisone followed by weekly stepwise tapering in steps of 10 mg/day.

Outcomes:

The BCVA and fundus of right eye remained stable after treatment at follow-up.

Conclusions:

This article reported a case of ocular Toxoplasma gondii infection diagnosis by serum and aqueous humor antibody tests. We provide some additional information on the T gondii infection diagnosis.
Analysis of predictors after partial splenic embolization for thrombocytopenia with liver cirrhosis
Authors: Ishikawa Toru , Ohashi Kazuki , Kodama Erina , Kobayashi Takamasa , Azumi Motoi , Nozawa Yujiro , Iwanaga Akito , Sano Tomoe , Honma Terasu
Published: October 2022

Blood transfusion, splenectomy, and partial splenic embolization (PSE) are generally performed for thrombocytopenia in patients with cirrhosis. Recently, thrombopoietin (TPO) agonists have become available, and investigations of patients who would benefit from them are necessary. Therefore, it is important to understand the fluctuations in cytokine levels associated with PSE. Therefore, fluctuations in platelet-associated immunoglobulin G (PAIgG), interleukin 6 (IL-6), and TPO levels with PSE were analyzed in this study. The study included 110 patients with liver cirrhosis and thrombocytopenia, with the aim of improving platelet counts. Fluctuations in PAIgG, IL-6, and TPO levels were investigated. The average splenic embolization ratio was 58.0% in patients with PSE. The platelet count rose significantly from 6.95 [5.40, 8.60] × 104/mL to 14.05 [10.43, 18.05] × 104/mL (P < .01), IL-6 rose significantly from 3.56 [2.53, 7.33] pg/mL to 18.90 [9.17, 32.95] pg/mL (P < .01), TPO rose significantly from 0.82 [0.52, 1.21] fmol/mL to 1.58 [0.97, 2.26] fmol/mL (P < .01), and PAIgG decreased significantly from 64.20 [38.33, 118.75] ng/107 cells to 37.50 [22.25, 70.00] ng/107 cells (P < .01). On multivariate analysis of factors related to the rate of platelet increase with PSE, primary biliary cholangitis (B = 0.475, P < .01), splenic embolization ratio (B = 0.75, P < .01), IL-6 change ratio (B = 0.019, P < .01), and PAIgG change ratio (B = −0.325, P < .01) were significant. When attempting to improve thrombocytopenia with PSE, adequate splenic embolization needs to be obtained together with improvements in IL-6, PAIgG, and TPO levels. With unsatisfactory improvement in thrombocytopenia, TPO agonist administration was considered.