bluuebunny/crossref_metadata_2025 huggingface dataset:
Traditional Chinese Medicine Integrated with Chemotherapy for Stage II‐IIIA Patients with Non‐Small‐Cell Lung Cancer after Radical Surgery: A Retrospective Clinical Analysis with Small Sample Size
Authors: Zhao Xueyu , Dai Xiaojun , Wang Shanshan , Yang Ting , Yan Yan , Zhu Guang , Feng Jun , Pan Bo , Sunagawa Masataka , Zhang Xiaochun , Qian Yayun , Liu Yanqing
Published: July 2018

Objective. This study was designed to evaluate the clinical efficacy of combined traditional Chinese medicine (TCM) and conventional chemotherapy versus conventional chemotherapy in patients with stage II‐IIIA non‐small‐cell lung cancer (NSCLC) after radical surgery. Methods. A retrospective cohort study was conducted in patients with stage II‐IIIA NSCLC from Subei People′s Hospital and Yangzhou Traditional Chinese Medicine Hospital in Yangzhou City of Jiangsu Province from 2012 to 2016. Patients were divided into two groups: the TCM user group (patients receiving treatment with integrated TCM and conventional chemotherapy) and the non‐TCM user group (patients receiving conventional chemotherapy only). The two groups were compared for their median disease‐free survival (DFS) and median overall survival (OS). Results. A total of 67 patients with stage II‐IIIA NSCLC were enrolled between January 2012 and December 2016. The median DFS for the non‐TCM user group was 601 days (95% confidence interval [CI], 375.7‐826.3). The median DFS for TCM user group could not be calculated. However, log‐rank analysis showed that the median survival time in the TCM user group was significantly longer than that of the non‐TCM user group (P < 0.05). In addition, several significant risk factors were detected for predicting disease prognosis in patients with NSCLC, such as age, ECOG, lymphatic metastasis, and body mass index (BMI). For patients harboring these independent risk factors, the DFS of TCM user group was much longer than that of non‐TCM user group (P < 0.05). Conclusion. Adjuvant therapy with TCM may reduce the rate of tumor recurrence and metastasis and prolong DFS of patients with stage II‐IIIA NSCLC.
Targeting the Endocannabinoid System for Prevention or Treatment of Chemotherapy-Induced Neuropathic Pain: Studies in Animal Models
Authors: Masocha Willias
Published: July 2018

There is a scarcity of drugs to either prevent or properly manage chemotherapy-induced neuropathic pain (CINP). Cannabis or cannabinoids have been reported to improve pain measures in patients with neuropathic pain. For this review, a search was done in PubMed for papers that examined the expression of and/or evaluated the use of cannabinoids or drugs that prevent or treat established CINP in a CB receptor-dependent manner in animal models. Twenty-eight articles that fulfilled the inclusion and exclusion criteria established were analysed. Studies suggest there is a specific deficiency of endocannabinoids in the periphery during CINP. Inhibitors of FAAH and MGL, enzymes that degrade the endocannabinoids, CB receptor agonists, desipramine, and coadministered indomethacin plus minocycline were found to either prevent the development and/or attenuate established CINP in a CB receptor-dependent manner. The studies analysed suggest that targeting the endocannabinoid system for prevention and treatment of CINP is a plausible therapeutic option. Almost 90% of the studies on animal models of CINP analysed utilised male rodents. Taking into consideration clinical and experimental findings that show gender differences in the mechanisms involved in pain including CINP and in response to analgesics, it is imperative that future studies on CINP utilise more female models.
Pulmonary Systemic Lupus Erythematosus Mimicking a Pneumonia in a Postpartum Female
Authors: Jain Varun , Aziz Maryann , Banoub Mina G. , Neuman Jeremy T. , Sidlow Richard
Published: July 2018

The pulmonary manifestations of systemic lupus erythematosus can range in severity from mild to life threatening and can be particularly marked in women who are recently postpartum. We present below a seventeen-year-old female patient, one month postpartum, who had findings consistent with an acute infectious pneumonia whom upon further query and passage of time was diagnosed with severe pneumonitis due to systemic lupus erythematosus.
Exosomal MicroRNAs Derived from Human Amniotic Epithelial Cells Accelerate Wound Healing by Promoting the Proliferation and Migration of Fibroblasts
Authors: Zhao Bin , Li Xiaodong , Shi Xiaomin , Shi Xueqin , Zhang Wei , Wu Gaofeng , Wang Xujie , Su Linlin , Hu Dahai
Published: July 2018

Previous work in our laboratory demonstrated that exosomes derived from human amniotic epithelial cells (hAECs) accelerated wound healing by promoting the proliferation and migration of fibroblasts. It is reported that exosomes, which are carriers of the microRNAs (miRNAs) and proteins, play an important role in the regulation of cell-to-cell communication. However, it is still unclear precisely which molecule or which group of molecules carried within hAEC-derived exosomes (hAEC-Exos) mediated wound healing. Here, we explored purified hAEC-Exos together with either proteinase K (PROse) or RNase A on the effect of fibroblasts and cutaneous wound healing. Our experiments demonstrated that hAEC-Exos were positive for exosomal markers CD9, CD63, and CD81. Also, we found that hAEC-Exos could be internalized by fibroblasts and then stimulated cell migration and proliferation. However, the promotive effect of hAEC-Exos was abolished by pretreating hAEC-Exos with RNase A, not PROse. Importantly, in vivo wound healing assay showed that local injection of hAEC-Exos or PROse pretreated hAEC-Exos at skin wounds significantly accelerated wound healing. Our findings revealed an important role of exosomal miRNAs in wound healing.
Transcriptional Profiling Suggests Extensive Metabolic Rewiring of Human and Mouse Macrophages during Early Interferon Alpha Responses
Authors: Ahmed Duale , Jaworski Allison , Roy David , Willmore William , Golshani Ashkan , Cassol Edana
Published: July 2018

Emerging evidence suggests that cellular metabolism plays a critical role in regulating immune activation. Alterations in energy and lipid and amino acid metabolism have been shown to contribute to type I interferon (IFN) responses in macrophages, but the relationship between metabolic reprogramming and the establishment of early antiviral function remains poorly defined. Here, we used transcriptional profiling datasets to develop global metabolic signatures associated with early IFN-αresponses in two primary macrophage model systems: mouse bone marrow-derived macrophages (BMM) and human monocyte-derived macrophages (MDM). Short-term stimulation with IFN-α(<4 hours) was associated with significant metabolic rewiring, with >500 metabolic genes altered in mouse and human macrophage models. Pathway and network analysis identified alterations in genes associated with cellular bioenergetics, cellular oxidant status, cAMP/AMP and cGMP/GMP ratios, branched chain amino acid catabolism, cell membrane composition, fatty acid synthesis, andβ-oxidation as key features of early IFN-αresponses. These changes may have important implications for initial establishment of antiviral function in these cells.
Primary Cardiac Lymphoma: Importance of Tissue Diagnosis
Authors: Mendelson Lauren , Hsu Emily , Chung Hojune , Hsu Andrew
Published: July 2018

Primary cardiac lymphoma (PCL) is a rare disease entity that can present with severe cardiac and cardioembolic symptoms. We present a 79-year-old male with history of polymalgia rheumatica on chronic prednisone who presented with a two-week history of progressively worsening dyspnea, cough, and a 10 pound weight loss. Transthoracic echocardiogram (TTE) and computed tomography (CT) of the chest showed a large mediastinal mass with invasion of the pericardium. A biopsy of an abdominal soft-tissue mass confirmed the diagnosis of PCL. The patient was treated with two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) which was complicated by progressive heart failure requiring substitution of liposomal doxorubicin. The epidemiology, presentation, diagnosis, and treatment options of PCL are discussed.
Efficacy and Safety of Aidi Injection Combined with Transcatheter Arterial Chemoembolization on Primary Hepatic Carcinoma: A Systematic Review and Meta‐Analysis
Authors: Chen Weihao , Wang Yurong , Liang Qiuer , Cai Yunfei , Chen Xudong , Zhang Yun , Chen Ruixue , Xiao Ya , Chen Liguo
Published: July 2018

Objectives. To evaluate the efficacy and safety of Aidi injection (ADI) combined with transcatheter arterial chemoembolization (TACE) for primary hepatic carcinoma (PHCC). Methods. We conducted a literature search in EMBASE, PubMed, CENTRAL, MEDLINE, CNKI, Wanfang, and VIP databases from the earliest possible year to April 2018. Randomized controlled trials (RCTs) involving ADI combined with TACE versus TACE alone for patients with PHCC were included. The Cochrane Risk of Bias tool was applied for quality assessment. Results. 22 studies involving 1611 participants were included. The clinical response rate (RR = 1.28, 95% CI: 1.17‐1.40; P < 0.00001), KPS score (RR = 1.78, 95% CI: 1.59‐2.00; P < 0.00001), survival rate (RR = 1.27, 95% CI: 1.16‐1.39; P < 0.00001), immune function (MD = 1.24, 95% CI: 0.98‐1.51; P < 0.00001), and adverse effects (RR = 0.62, 95% CI: 0.57‐0.68; P < 0.00001) of ADI plus TACE showed significant difference when compared with TACE alone. Conclusions. ADI combined with TACE in the treatment of PHCC improved the clinical response rate and safety compared to TACE alone. However, due to poor methodological quality of many of the included RCTs, more rigorously designed and large‐scale RCTs are warranted to examine this beneficial effect in the future.
Effectiveness of Systematic Health Education Model for Type 2 Diabetes Patients
Authors: Zhang Yongwen , Chu Lanfang
Published: July 2018

Background. Health education is considered to be essential in the overall care of patients with type 2 diabetes mellitus (T2DM); systematic health education integrates individual education not only during hospitalization but also extended care outside of a hospital. To test effectiveness of the systematic health education model for T2DM, we conducted a randomized study with a control group among patients with T2DM living in Nanjing, China. Methods. 998 eligible patients completed the enrollment and were randomized to systematic health education model and conventional model groups (498 and 500 patients, resp.). The systematic health education model was based on the following aspects: image education, visitation of the exhibition hall, dissemination of educational materials, individualized medical nutrition therapy and exercise programs, WeChat group and regular health lectures, evaluation of complications, lifestyle modification, systematic treatment scheme, self-monitoring of glycemic control, monthly evaluation of the therapeutic effect, proposed improvement measures, and individualized follow-up scheme. The main outcome measures were glycated hemoglobin A1c (HbA1c), blood pressure, body mass index (BMI), and lipids during the 2-year follow-up. Results. The systematic health education model led to a favorable variation in HbA1c, LDL cholesterol, and systolic blood pressure (SBP) (P<0.05). After adjusted analysis, the HbA1c decreased by 0.67% (P<0.01) in the systematic health education model, SBP decreased by 10.83 mmHg (P<0.01), and the level of diastolic blood pressure (DBP), HDL cholesterol, and total cholesterol decreased slightly and was not significant. The BMI did not change significantly during the study in either of the two groups. Conclusions. The systematic health education model is a useful method in the treatment of T2DM because it contributes to decrease in HbA1c, LDL cholesterol, and SBP levels, as well as helps in increasing the compliance with the control criteria, except for DBP and BMI.
Thermodynamic Analysis of Supercritical CO2 Power Cycle with Fluidized Bed Coal Combustion
Authors: Geng Chenchen , Shao Yingjuan , Zhong Wenqi , Liu Xuejiao
Published: July 2018

Closed supercritical carbon dioxide (S-CO2) Brayton cycle is a promising alternative to steam Rankine cycle due to higher cycle efficiency at equivalent turbine inlet conditions, which has been explored to apply to nuclear, solar power, waste heat recovery, and coal-fired power plant. This study establishes 300MW S-CO2 power system based on modified recompression Brayton cycle integrated with coal-fired circulating fluidized bed (CFB) boiler. The influences of two stages split flow on system performance have been investigated in detail. In addition, thermodynamic analysis of critical operating parameters has been carried out, including terminal temperature difference, turbine inlet pressure/temperature, reheat stages, and parameters as well as compressor inlet pressure/temperature. The results show that rational distribution of split ratio to the recompressor (SR1) achieves maximal cycle efficiency where heat capacities of both sides in the low temperature recuperator (LTR) realize an excellent matching. The optimal SR1 decreases in the approximately linear proportion to high pressure turbine (HPT) inlet pressure due to gradually narrowing specific heat differences in the LTR. Secondary split ratio to the economizer of CFB boiler (SR2) can recover moderate flue gas heat caused by narrow temperature range and improve boiler efficiency. Smaller terminal temperature difference corresponds to higher efficiency and brings about larger cost and pressure drops of the recuperators, which probably decrease efficiency conversely. Single reheat improves cycle efficiency by 1.5% under the condition of 600°C/600°C/25Mpa while efficiency improvement for double reheat is less obvious compared to steam Rankine cycle largely due to much lower pressure ratio. Reheat pressure and main compressor (MC) inlet pressure have corresponding optimal values. HPT and low pressure turbine (LPT) inlet temperature both have positive influences on system performance.
Particle Swarm Optimization Iterative Identification Algorithm and Gradient Iterative Identification Algorithm for Wiener Systems with Colored Noise
Authors: Li Junhong , Li Xiao
Published: July 2018

This paper considers the parameter identification of Wiener systems with colored noise. The difficulty in the identification is that the model is nonlinear and the intermediate variable cannot be measured. Particle swarm optimization is an artificial intelligence evolutionary method and is effective in solving nonlinear optimization problem. In this paper, we obtain the identification model of the Wiener system and then transfer the parameter identification problem into an optimization problem. Then, we derive a particle swarm optimization iterative (PSOI) identification algorithm to identify the unknown parameter of the Wiener system. Furthermore, a gradient iterative identification algorithm is proposed to compare with the particle swarm optimization iterative algorithm. Numerical simulation is carried out to evaluate the performance of the PSOI algorithm and the gradient iterative algorithm. The simulation results indicate that the proposed algorithms are effective and the PSOI algorithm can achieve better performance over the gradient iterative algorithm.
Effects of Head-Neck Positions on the Hand Grip Strength in Healthy Young Adults: A Cross-Sectional Study
Authors: Zafar Hamayun , Alghadir Ahmad , Anwer Shahnawaz
Published: July 2018

Background.Assessment of hand grip strength is vital for the evaluation of upper limb impairments and effective exercise prescription. Present study primarily aimed to investigate the effect of head-neck positions on the hand grip strength in healthy young adults. Secondarily, the present study compared hand grip strength between left versus right hand in different head-neck positions.Methods.Healthy young adults (age 19 – 30 year; n = 40) participated in this cross-sectional study. Hand grip strength was assessed in three head-neck positions (neutral, rotation left, and rotation right) using the standard adjustable Jamar hand dynamometer.Results. Hand grip strength in both sides (left and right) was greatest in the head-neck neutral position. Hand grip strength measured in head-neck left rotation position displayed the least strength in both sides. There was no significant difference noted between left and right side hand grip strength measured in head-neck neutral and right rotation positions. However, there was a significant difference noted between left and right side hand grip strength measured in head-neck left rotation positions. There was no significant effect of head-neck positions on hand grip strength noted in both sides.Conclusions. Hand grip strength was highest in the head-neck neutral position followed by head-neck rotation to the right. However, head-neck positions did not significantly affect hand grip strength in healthy young adults. Further studies assessing the hand grip strength in different neck positions in patients with neck pain and upper limb dysfunction may have significant implications for the assessment of hand grip strength.
Isolation, Molecular Characterization and Probiotic Potential of Lactic Acid Bacteria in Saudi Raw and Fermented Milk
Authors: Bin Masalam Maged S. , Bahieldin Ahmed , Alharbi Mona G. , Al-Masaudi Saad , Al-Jaouni Soad K. , Harakeh Steve M. , Al-Hindi Rashad R.
Published: July 2018

Probiotic bacteria can confer health benefits to the human gastrointestinal tract. Lactic acid bacteria (LAB) are candidate probiotic bacteria that are widely distributed in nature and can be used in the food industry. The objective of this study is to isolate and characterize LAB present in raw and fermented milk in Saudi Arabia. Ninety‐three suspected LAB were isolated from thirteen different types of raw and fermented milk from indigenous animals in Saudi Arabia. The identification of forty‐six selected LAB strains and their genetic relatedness was performed based on 16S rDNA gene sequence comparisons. None of the strains exhibited resistance to clinically relevant antibiotics or had any undesirable hemolytic activity, but they differed in their other probiotic characteristics, that is, tolerance to acidic pH, resistance to bile, and antibacterial activity. In conclusion, the isolates Lactobacillus casei MSJ1, Lactobacillus casei Dwan5, Lactobacillus plantarum EyLan2, and Enterococcus faecium Gail‐BawZir8 are most likely the best with probiotic potentials. We speculate that studying the synergistic effects of bacterial combinations might result in a more effective probiotic potential. We suspect that raw and fermented milk products from animals in Saudi Arabia, especially Laban made from camel milk, are rich in LAB and have promising probiotic potential.
The Correlation and Regression Analysis of Physicochemical Parameters of River Water for the Evaluation of Percentage Contribution to Electrical Conductivity
Authors: Shrestha Arun Kumar , Basnet Nabin
Published: July 2018

Ten different water samples were collected from Ratuwa River and its tributaries. The laboratory test was carried out by standard procedures (APHA methods), and the measured values were compared with the Nepal standard recommended by Nepal Drinking Water Quality Standards (NDWQS). Statistical analysis also had been used to calculate the correlation coefficients and to plot the regression equations of various parameters with electrical conductivity. The aim of the study was to identify the parameters that affect the electrical conductivity and evaluate the percentage contribution of these parameters. The correlation matrix shows that color, total dissolved solids (TDS), chloride (Cl), fluoride (F), total phosphorus (TP), total alkalinity (TA), calcium (Ca), magnesium (Mg), sodium (Na), and dissolved oxygen (DO) have a significant effect on the electrical conductivity (EC). Among these parameters, TDS has the highest contribution (39.65%) followed by total alkalinity (23.5%), total hardness (19.9%), chlorine (6.5%), and calcium (5.5%) ions, respectively. However, color, TP, fluoride, and DO have almost 1.45% contribution to the electrical conductivity.
Current Evidence for the Prevention of Endophthalmitis in Anti-VEGF Intravitreal Injections
Authors: Lau P. ET. , Jenkins K. S. , Layton C. J.
Published: July 2018

Intravitreal injection of a therapeutic substance is the most common procedure performed in ophthalmology. It has a low incidence of serious complications but is associated with a small chance of endophthalmitis. Although the rate of endophthalmitis is between 0.019% and 0.09%, the associated visual morbidity is often devastating. Procedural changes have evolved over the years to improve patient comfort and reduce injection-related injury and infection. Despite the availability of published evidence, there remains considerable variations and lack of consensus in practical clinical settings. In addition, emerging literature concerning the use of speculums, the use of prophylactic topical antibiotics, and the setting of injections continues to impact the ophthalmologist’s injection practice. This article provides an up to date assessment of various aspects of the procedure such as the setting, ventilation, type of anaesthetic, and control of sterility during the procedure; including discussions on performing bilateral eye same-day injections and the use of antibiotics.
Severe Stenosis of an Anomalous Circumflex Artery Mimicking a Chronic Total Occlusion
Authors: Mawardi George , Maran Anbukarasi
Published: July 2018

The prevalence of anomalous circumflex coronary arteries is rare. Identifying the presence of an anomalous coronary is quite easy when there is no severe stenosis. However, in the presence of severe stenosis, there is limited anterograde flow, which makes it challenging to visualize the course of the stenotic artery, and it can be assumed to be a chronic total occlusion (CTO). This case demonstrates how the anomalous circumflex artery with severe stenosis masqueraded as a CTO and the patient was treated medically for several years, despite continued symptoms. The retrograde filling of an anomalous circumflex has a specific angiographic pattern which should be recognized. This case is an excellent illustration of the said angiographic pattern.
Sintering Behavior and Properties of Mo‐Cu Composites
Authors: Sun Aokui , Liu Yuejun , Wang Dezhi , Zhou Zhihua
Published: July 2018

A simple microwave‐assisted aqueous solution strategy combined with a subsequent low‐temperature hydrogen reduction process was used to prepare Mo‐Cu nanopowders. In order to systematically investigate the densification behavior and properties of Mo‐Cu composites, the densification, microstructure, hardness, electrical conductivity, thermal conductivity, and bending strength of Mo‐Cu compacts were tested after sintering at different temperatures. Results show that the sintering temperature is a critical factor in the densification process of Mo‐Cu composites. The shrinkage rate, density, and hardness of sintered composites increase as the temperature rises. However, too high sintering temperature resulted in the decrease in electrical conductivity (EC), thermal conductivity (TC), and bending strength. By optimizing all the performance indicators, high‐performance Mo‐25 wt.% Cu composites with a homogeneous microstructure accompanied with good physical and mechanical properties could be successfully obtained by sintering for 2 h at 1200°C.
The Associations between Toll-Like Receptor 9 Gene Polymorphisms and Cervical Cancer Susceptibility
Authors: Tian Sijuan , Zhang Liping , Yang Ting , Wei Xing , Zhang Li , Yu Yang , Li Yang , Cao Di , Yang Xiaofeng
Published: July 2018

This meta-analysis systematically reviews the association between Toll-like receptor 9 polymorphisms and the risk of cervical cancer. Case-control studies focused on the association were collected from the PubMed, Web of Science, Cochrane Library, Embase, MEDLINE, CNKI, VIP, and Wanfang databases from inception to July 2017. We screened the studies and assessed the methodological quality of the included studies and extracted data. A meta-analysis was performed using RevMan 5.3 and Stata 12.0 software. Pooled odds ratios and 95% confidence intervals were employed to evaluate the strength of the associations between Toll-like receptor 9 polymorphisms and cervical cancer risk. A total of 9 studies comprising 3331 cervical cancer patients and 4109 healthy controls met the inclusion criteria. Of these, 8 studies contained information about G2848A (rs352140) and 4 studies contained information about −1486T/C (rs187084). Our results revealed that the associations between rs187084 and cervical cancer risk in the dominant model (p=0.002) and heterozygous model (p=0.002) were significant, with 1.30- and 1.32-fold increases in susceptibility, respectively, compared to that in the wild-type model. However, rs352140 was not related to cervical cancer regardless of whether the subgroup analysis was conducted (p>0.05). In conclusion, there is a significant correlation between rs187084 and cervical cancer risk with the minor C allele increasing the risk of occurrence of cervical cancer. However, rs352140 is not associated with the occurrence of cervical cancer.
Teaching Residents Chest Tubes: Simulation Task Trainer or Cadaver Model?
Authors: Tan Ting Xu , Buchanan Paula , Quattromani Erin
Published: July 2018

Objective. To compare simulation task trainers (sim) with cadaver for teaching chest tube insertion to junior residents.Methods.Prospective study involving postgraduate year (PGY) one and two emergency medicine (EM) and PGY-1 surgery residents. Residents were randomized into sim or cadaver groups based on prior experience and trained using deliberate practice. Primary outcomes were confidence in placing a chest tube and ability to place a chest tube in a clinical setting during a seven-month follow-up period. Secondary outcomes include skill retention, using an objective assessment checklist of 15 critical steps in chest tube placement, and confidence after seven months.Results. Sixteen residents were randomized to cadaver (n=8) and simulation (n=8) groups. Both groups posttraining had statistically significant increase in confidence. No significant difference existed between groups for median posttraining assessment scores (13.5 sim v 15 cadaver). There was no statistically significant difference between groups for confidence at any point measured. There was moderate correlation (0.58) between number of clinical attempts reported in a seven-month follow-up period and final assessment score.Conclusion. Both sim and cadaver models are effective modalities for teaching chest tube placement. Medical education programs can use either modalities to train learners without notable differences in confidence.
Real-Time Tumor Gene Expression Profiling to Direct Gastric Cancer Chemotherapy: Proof-of-Concept “3G” Trial
Authors: Yong Wei Peng , Rha Sun Young , Tan Iain Bee-Huat , Choo Su-Pin , Syn Nicholas L. , Koh Vivien , Tan Shi-Hui , Asuncion Bernadette Reyna , Sundar Raghav , So Jimmy Bok-Yan , Shabbir Asim , Tan Chee-Seng , Kim Hyo-Song , Jung Minkyu , Chung Hyun Cheol , Ng Matthew C.H. , Tai David Wai-Meng , Lee Ming-Hui , Wu Jeanie , Yeoh Khay Guan , Tan Patrick
Published: July 2018

Purpose: The oxaliplatin plus S-1 and cisplatin plus S-1 regimens are interchangeably used in the management of advanced gastric cancer. The previously reported G-intestinal (G1) and G-diffuse (G2) intrinsic gene expression signatures showed promise for stratifying patients according to their tumor sensitivity to oxaliplatin or cisplatin.

Experimental Design: The proof-of-concept, multicenter, open-label phase II “3G” trial was done to prospectively evaluate the feasibility and efficacy of using genomic classifiers to tailor treatment in gastric cancer. Patients’ tumors were classified as “G1” or “G2” using a nearest-prediction template method, or “G3” (unclear assignment) when FDR ≥ 0.05. The first 30 patients in the “G1” cohort were assigned oxaliplatin plus S-1 (SOX) chemotherapy; thereafter, subsequently recruited “G1” patients were treated with cisplatin plus S-1 (SP) chemotherapy. “G2” patients and “G3” patients were treated with SP and SOX chemotherapy, respectively.

Results: A total of 48, 21, and 12 patients, respectively, were given “G1,” “G2,” and “G3” genomic assignments. Median turnaround time was 7 days (IQR, 5–9). Response rates were 44.8%, 8.3%, 26.7%, and 55.6% for the “G1-SOX,” “G1-SP,” “G2,” “G3” cohorts, respectively; and was higher in G1 patients treated with SOX compared with SP (P = 0.033). Exploratory analyses using the genomic classifier of Lei and colleagues validated the utility of the metabolic signature as a biomarker for predicting benefit from chemotherapy (log-rank P = 0.004 for PFS), whereas the Asian Cancer Research Group classifier did not demonstrate any predictive value.

Conclusions: This bench-to-bedside effort establishes a reasonable turnaround time for gene expression profiling and possible utility of genomic classifiers in gastric cancer treatment stratification. Clin Cancer Res; 24(21); 5272–81. ©2018 AACR.
Predictive Factors for Differentiating Pancreatic Cancer-Associated Diabetes Mellitus from Common Type 2 Diabetes Mellitus for the Early Detection of Pancreatic Cancer
Authors: Dong Xin , Lou Yan Bo , Mu Yun Chuan , Kang Mu Xing , Wu Yu Lian
Published: July 2018

Background: The purpose of this study was to find the factors that may be helpful for differentiating pancreatic cancer-associated diabetes mellitus (PC + DM) from common type 2 diabetes for the early diagnosis of pancreatic cancer. Methods: From January 2008 to August 2013, 171 patients with pancreatic cancer and new-onset diabetes were recruited for the study; 242 age- and gender-matched patients with common type 2 diabetes were also identified as control during the same period. The patient’s characteristics and laboratory parameters were compared between the 2 groups. Results: By multivariate logistic regression analysis, we found that body mass index (BMI), the age of onset of diabetes, hepatitis B virus (HBV) infection, total bilirubin (TBIL), alanine aminotransferase (ALT), creatinine (Cr), apolipoprotein-A1 (APO-A1), and white blood cell (WBC) were independent predictive factors for differentiating PC + DM from common type 2 diabetes; the areas under receiver operating characteristic curves were up to 0.815 for the combination of these 8 markers. Conclusions: These results suggest that BMI, the age of onset of diabetes, HBV infection, TBIL, ALT, Cr, APO-A1, and WBC are factors that could differentiate PC + DM from common type 2 ­diabetes and may be used for early diagnosis of pancreatic cancer.
A Case of Symptomatic Granular Cell Tumor of the Pituitary Treated with Stereotactic Radiosurgery
Authors: Faramand Andrew , Kano Hideyuki , Flickinger John C. , Gardner Paul , Lunsford L. Dade
Published: July 2018

Background: Granular cell tumors (GCT) of the pituitary are rare. Surgery is considered the primary management option. However, complete resection is often difficult, and surgery is associated with high rates of postoperative complications. Aims: To report a unique case of pituitary GCT treated with stereotactic radiosurgery (SRS). Case Description: We report a case of a 40-year-old female with endocrine dysfunction who underwent stereotactic biopsy and then SRS for the management of a suprasellar granular cell tumor. Over the ensuing 10 years, tumor regression was observed. Thirteen years after SRS, the patient remained asymptomatic; however, follow-up MRI demonstrated tumor progression. Fifteen years after SRS, the patient required endoscopic endonasal surgery after developing a new optic neuropathy. Her images demonstrated further tumor growth beyond the targeted area. Conclusion: SRS resulted in long-term tumor control without additional endocrine dysfunction, but the onset of new optic neuropathy associated with delayed tumor growth prompted surgical decompression.
Influence of Simethicone Added to the Rinse Water during Colonoscopies on Polyp Detection Rates: Results of an Unintended Cohort Study
Authors: Kutyla Marguerite , O’Connor Sam , Gurusamy Saravana Ruban , Gururatsakul Montri , Gould Kelly , Whaley Amanda , Kendall Bradley J. , Hourigan Luke , Holtmann Gerald J.
Published: July 2018

Background and Aims: Simethicone is a common antifoaming agent that is added to endoscopic rinse solutions, but data regarding its effect on polyp detection rates is lacking. In this study, we report the effect of discontinuation of this practice on polyp detection rates. Methods: Procedure data of 4,254 consecutive colonoscopies were used. Patients underwent standard bowel preparation with polyethyleneglycol (Glycoprep®). Colonoscopies were performed utilising Olympus EVIS EXERA III, CV-190 equipment, while quality data (withdraw times, polyp detection rates, quality of bowel preparation) was assessed utilising an endoscopy reporting system (Provation®). Following an educational event that highlighted that simethicone may form deposits in the channels of endoscopes, the practice to add simethicone (InfacolR, Nice Pak) to the auxiliary channel water pump was abandoned, but endoscopists were not notified about this change. After 5 days and performing 75 colonoscopies, the change of practice was identified and addition of simethicone recommenced. Results: The discontinuation of simethicone use reduced the polyp detection rate from 55% (95% CI 53–56) to 45% (95% CI 34–56, 1-sided, p = 0.028); the polyp detection rate returned to the pre-intervention levels of 55% (95% CI 52–58) upon resumption of normal practice. Conclusion: The addition of simethicone to the auxiliary water pump during colonoscopy results in a 10% increase in polyp detection rates.
Lavender Color in Linked Color Imaging Enables Noninvasive Detection of Gastric Intestinal Metaplasia
Authors: Ono Shoko , Kato Mototsugu , Tsuda Momoko , Miyamoto Shuichi , Abiko Satoshi , Shimizu Yuichi , Sakamoto Naoya
Published: July 2018

Background and Aims: Recently, there have been some reports that image-enhanced endoscopy may improve detection of gastric intestinal metaplasia (GIM). Our aim was to determine the usefulness of linked color imaging (LCI) for detection of GIM. Methods: In prospectively recruited patients, the whole antrum was observed by white light imaging (WLI) followed by LCI. When a whitish flat elevation (WFE) in WLI and a lavender color sign (LCS) in LCI were detected, target biopsies were performed after LCI. Random biopsies were performed in patients who had neither WFE nor LCS. The primary endpoint was the diagnostic accuracy of GIM per patient in WLI and LCI and the secondary endpoints were that of GIM per biopsy and interobserver agreement. Results: Data from 128 patients were analyzed and 58 patients (45.3%) had histological GIM in the antrum. The per-patient yields of WLI and LCI to detect GIM were 19.0% (11/58) and 91.4% (53/58) respectively. Diagnostic accuracies of target biopsies for GIM were 23.7% in WLI and 84.2% in LCI. Kappa values among 3 doctors were 0.60 for WFE and 0.78 for LCS respectively. Conclusion: LCI could be a new diagnostic tool for detecting GIM during routine endoscopy.
Effects of Gamisoyo-San Decoction, a Traditional Chinese Medicine, on Gastrointestinal Motility
Authors: Shin Seung Jae , Kim Doeun , Kim Ji Sun , Kim Iksung , Lee Jong Rok , Kim Sang Chan , Kim Byung Joo
Published: July 2018

Background: Gamisoyo-San decoction (GSS), a traditional Chinese medicine, has been used to treat various gastrointestinal (GI) symptoms and diseases such as functional dyspepsia. The purpose of this study was to investigate the effect of GSS on GI motility functions in mice. Methods: Percent intestinal transit rate (ITR%) and gastric emptying (GE) values were measured using Evans Blue and phenol red, respectively, in normal mice and in mice with experimentally induced GI motility dysfunction (GMD). Results: In normal mice, GSS (0.01–1 g/kg) induced higher GE values than non-treated controls. Also, GSS could increase GE in loperamide-induced and cisplatin-induced GE delay models. In addition, GSS increased ITR% in a dose-dependent manner. Loperamide decreased ITR% and GSS recovered this loperamide-induced decrease in ITR%. To examine the effect of GSS on GMD, we used acetic acid (AA)-induced and streptozotocin (STZ)-induced mouse GMD models. The AA mouse model showed a significant decrease in ITR%. However, intragastric treatment with GSS significantly recovered this inhibition. Furthermore, STZ-induced diabetic mice showed a significant reduction in ITR%, which was also significantly inhibited by GSS. Conclusion: These results demonstrate that GSS can modulate bowel activity and that it could be used as a gastroprokinetic agent in the treatment of GI motility diseases.
Magnifying Endoscopy with Narrow Band Imaging in Estimating the Invasion Depth of Superficial Esophageal Squamous Cell Carcinomas
Authors: Mizumoto Takeshi  , Hiyama Toru , Quach Duc Trong , Sanomura Yoji , Urabe Yuji , Oka Shiro , Arihiro Koji , Tanaka Shinji , Chayama Kazuaki
Published: July 2018

Background/Aim: The aim of this study was to compare the accuracy of magnifying endoscopy with narrow band imaging for the diagnosis of depth of invasion by Japan Esophageal Society (JES) classification and inter- and intraobserver agreement of JES intrapapillary capillary loop (IPCL) classification. Methods: It was a retrospective observational study that has analyzed 136 patients with esophageal malignant neoplasia with magnifying endoscopy narrow band imaging to compare JES’s IPCL classification to the histopathologic findings and to evaluate the inter- and intraobserver agreement. Results: Histopathologic examinations revealed 34 (25.7%) intraepithelial neoplasias, 70 (51.5%) squamous cell carcinomas (SCCs) in the epithelium or with invasion into the lamina propria mucosa, 21 (15.4%) SCCs with invasion into the muscularis mucosa or mild invasion into the submucosa, and 11 (8.1%) SCCs with moderate or deep invasion into the submucosa. IPCL types B1, B2, and B3 also showed high accuracies of 80.8, 83.1, and 94.1%, respectively. The kappa values for inter- and intraobserver agreements of the IPCL classifications were moderate to almost perfect. Conclusions: In the present study, the JES’s IPCL classification has good accuracy to predict the depth of SCC invasion and moderate to almost perfect intra- and interobserver agreements.
Basophil Activation Test Application in Drug Hypersensitivity Diagnosis: An Empirical Approach
Authors: Marraccini Paolo , Pignatti Patrizia , D'Alcamo Andrea , Salimbeni Rossana , Consonni Dario
Published: July 2018

Background: The diagnosis of drug hypersensitivity reactions (DHRs) is based both on clinical history and in vivo tests, such as specific IgE and cutaneous tests, when available. Objectives: The aim of this work was to evaluate the basophil activation test (BAT) as a supplementary tool for drug challenges and drug allergy diagnosis. Method: We evaluated 204 outpatients reporting DHRs. Available serum-specific IgE drugs were determined and cutaneous tests were performed when appropriate. BAT was performed immediately after blood sampling. The expression of CD63 was evaluated with flow cytometry. The test was considered positive when CD63 expression was > 5% and the stimulation index (the ratio of the percentage of CD63-expressing cells with drug exposure/percentage of CD63-expressing cells with wash buffer) was > 2. Patients who reported mild to severe reactions and those with a discrepancy between clinical history and BAT underwent a challenge test. Results: The drugs that caused adverse reactions were mainly antibiotics (49%). Non-steroid anti-inflammatory drugs (NSAID) were cited as responsible for DHRs in 37%, with the remaining 14% being due to other drugs. BAT revealed a high specificity (92%) and low sensitivity for antibiotics (40%). For the suspected reactions to penicillin, both the in vitro tests supported 94% of the diagnoses. We also observed a high specificity in the case of challenge with NSAIDs (100% specificity). Conclusions: BAT is effective in discriminating adverse drug reactions, whilst only more critical cases require integrated evaluations and more complex clinical examinations. It is relevant that the concordance of anamnesis and in vitro tests reduce the need for challenge testing, limiting them to selected cases.
Potential Difficulties in Cytological Approach of Basal Cell Adenoma of Salivary Glands: The Experience of a Single Institution
Authors: Nicola Marta , Onorati Monica , Lancia Mauro , Albertoni Milena , Di Nuovo Franca
Published: July 2018

Objective: Basal cell adenoma (BCA) is an uncommon benign epithelial neoplasm of salivary glands, which was first described by Kleinsasser and Klein in 1967 and which derives its name from the monomorphic basaloid appearance of tumor cells. This tumor represents 1–2% of all salivary gland epithelial tumors; the most common site of occurrence is the parotid gland. It usually arises in adults over 50 years of age with slight female prevalence. Study Design: We analyzed 5 cases of parotid lesions investigated by fine needle aspiration cytology at a single institution between 2002 and 2018. Results: Our series was composed by 3 women and 2 men with a mean age of 62 years. The most important cytological criteria we observed were cohesive sharp-angled clusters of regular basaloid cells, palisaded by p63-positive myoepi­thelial cells, and bordered by basement membrane-like hyaline membrane in the absence of a myxochondroid stroma. Overall features were consistent with the diagnosis of BCA. Conclusions: Our aim is to highlight the cytological features of these rare lesions improving the awareness of cytological pitfalls of salivary gland basaloid neoplasms. Moreover, the goal of this paper is to add to the literature 5 additional cases of these unusual tumors.
Modulation of Neuroinflammation by Taklisodok-um in a Spinal Cord Injury Model
Authors: Park Sunjung , Yang Eun Jin
Published: July 2018

Objective: Chronic neuroinflammation after spinal cord injury (SCI) is associated with spinal cord damage and functional impairment. In patients, SCI is associated with severe disability, an extensive rehabilitation requirement, and high cost burden. Moreover, there is no effective treatment for SCI. Taklisodok-um (TLSDU) is a traditional herbal medicine used in Korea and China to facilitate detoxification and drainage. This study investigated the therapeutic effect of TLSDU after SCI. Methods: Seven-week-old ICR mice (male, 20–30 g) underwent hemi-transection in the T9–10 segment of the spinal cord and were divided into 3 groups: sham, SCI + control treatment, and SCI + TLSDU treatment. TLSDU treatment was initiated the day after SCI surgery and administered once daily for 3 weeks at an oral dose of 1.2 mg/g. The mice were weighed for 3 weeks. At the age of 10 weeks, all mice were sacrificed and immunohistochemistry and Western blotting were performed. Results: We found that TLSDU facilitated healthy weight gain and attenuated the expression of neuroinflammatory markers. GFAP and Iba-1 expression levels were downregulated in the spinal cords of TLSDU-treated SCI mice as compared to control SCI mice. Additionally, pro-inflammatory proteins CD11b and BAX were induced in control SCI mice, but their expression was attenuated in TLSDU-treated SCI mice. Finally, we found that the expression of TLR4 signaling pathway-related proteins was downregulated in TLSDU-treated SCI mice as compared to control SCI mice. Conclusion: These findings suggest that TLSDU attenuates neuroinflammation after SCI in part by regulating TLR4 signaling at the injury site.
Improving Selection for Resection of Synchronous Para-Aortic Lymph Node Metastases in Colorectal Cancer
Authors: Yamada Kazunosuke , Tsukamoto Shunsuke , Ochiai Hiroki , Shida Dai , Kanemitsu Yukihide
Published: July 2018

Introduction: The clinical benefit of extended lymphadenectomy for synchronous extraregional lymph node metastasis, such as para-aortic lymph node (PALN) metastasis in colorectal cancer, remains highly controversial. Aim: To evaluate the clinical benefit of PALN dissection in colorectal cancer patients with synchronous PALN metastasis with or without multiorgan metastases. Methods: Thirty-six patients with pathologically positive PALN metastasis below the renal veins who underwent concurrent PALN dissection and primary colorectal cancer resection from January 1984 through September 2011 at the National Cancer Center Hospital in Tokyo, Japan, were included in this retrospective cohort study. We examined 5-year recurrence-free survival (RFS) rates in patient groups depending on the number of nodes involved (≤2 and ≥3 nodes) and on the presence or absence of other organ involvement (M1a and M1b,c categories in TNM staging). Results: The 5-year RFS rate was significantly different depending on the number of metastatic PALNs (42.1 and 0.6% for PALN ≤2 and ≥3, respectively, p = 0.01). The 5-year RFS rate was significantly better in patients in the M1a category than in patients in the M1b and M1c categories (27.6 and 0.0%, respectively, p < 0.01). Twenty-nine patients (80.6%) experienced recurrence after PALN dissection. Postoperative complications were seen in 14 (38.9%) patients. Conclusion: PALN dissection below the renal veins for patients with isolated PALN metastasis with 2 or fewer involved PALNs may be effective in improving prognosis in colorectal cancer.
Comparison of 2-Year Oncological Outcome and Early Recurrence Patterns in Patients with Urothelial Bladder Carcinoma Treated with Open or Robot-Assisted Radical Cystectomy with an Extracorporeal Urinary Diversion
Authors: Niegisch Günter , Nini Alessandro , Michalski René , Henn Alina , Mally David , Albers Peter , Rabenalt Robert
Published: July 2018

Background: Data on oncological follow-up after robotic-assisted radical cystectomy (RARC) have been reported only scarcely and individual studies have reported an increase in early recurrences and atypical recurrences. Patients and Methods: Clinical data of 89 patients with RARC were compared to 59 patients with open radical cystectomy (ORC) at a single institution. Two-year cancer-specific (2y-CSS) and 2-year overall survival (2y-OS) related to histopathological tumor stage of RARC patients calculated by Kaplan-Meier method were compared to ORC patients using log-rank test. Early clinical recurrence rate (eCR, progression ≤6 months post-cystectomy) and metastatic pattern of both groups were compared by chi-square test. Results: Median follow-up 32 months (RARC) and 47.5 months (ORC), both groups were balanced in baseline characteristics. For RARC pts, ­2y-OS and CSS-free survival rates were 80 and 90%, for ORC pts 65 and 71% (all p > 0.05). Margin status was not significantly different. eCR was observed in 10 out of 89 (11%) RARC pts and in 7 out of 59 (12%) ORC pts (p = 0.9). No difference in atypical metastases was seen between groups. Conclusion: Two-year oncological outcomes of RARC patients are comparable to ORC patients without differences regarding ePR or metastatic pattern.