bluuebunny/crossref_metadata_2025 huggingface dataset:
Antitumor activity of a hydrogel loaded with lipophilic bismuth nanoparticles on cervical, prostate, and colon human cancer cells
Authors: Cabral-Romero Claudio , Solís-Soto Juan M. , Sánchez-Pérez Yesennia , Pineda-Aguilar Nayely , Meester Irene , Pérez-Carrillo Esther , Nakagoshi-Cepeda Sergio E. , Sánchez-Nájera Rosa I. , Nakagoshi-Cepeda María A.A. , Hernandez-Delgadillo Rene , Chellam Shankararaman , García-Cuéllar Claudia M.
Published: November 2019

The objective of this study was to analyze the antitumor activity of a hydrogel loaded with lipophilic bismuth nanoparticles on human cervical, prostate, and colon cancer cell lines. The effect of lipophilic bismuth nanoparticles on the viability of cancer cell lines (HeLa, DU145, and HCT-116) and non-cancer lung fibroblasts (HLF; LL 47[MaDo]) was determined with the MTT cell viability assay and compared with known antineoplastic drugs. The biocompatibility at an organismal level was verified in a murine model by histological examination. A lipophilic bismuth nanoparticle hydrogel at 50 µM time-dependently inhibited the growth of the three cancer cell lines, in a time-dependent way. A 1-hour exposure to 250 µM lipophilic bismuth nanoparticle hydrogel, inhibited the growth of the three cancer cell lines. The in-vitro efficacy of lipophilic bismuth nanoparticle was similar to the one of docetaxel and cisplatin, but without inhibiting the growth of non-cancer control cells. Histology confirmed the biocompatibility of lipophilic bismuth nanoparticles as there were no signs of cytotoxicity or tissue damage in any of the evaluated organs (kidney, liver, brain, cerebellum, heart, and jejunum). In conclusion, a lipophilic bismuth nanoparticle hydrogel is an innovative, low-cost alternative for the topical treatment of cervicouterine, prostate, and colon human cancers.
Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis
Authors: Weng Cheng-Hua , Liu Zhi-Chun
Published: November 2019

Objective:

In recent years, an increasing number of drugs have been proved to be associated with the induction of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This article reviews the latest research progress on drug-induced AAV.

Data sources:

We conducted a comprehensive and detailed search of the PubMed database. The search terms mainly included drug-induced, ANCA, and vasculitis.

Study selection:

We summarized the original articles and reviews on drug-induced AAV in recent years. The extracted information included the definition, epidemiology, associated drugs, pathogenesis, clinical features, diagnosis, treatment, and prognosis of drug-induced AAV. We also focused on the differences between drug-induced AAV and primary vasculitis.

Results:

The offending drugs leading to drug-induced AAV are almost from pharmacologic categories and we need to be vigilant when using these drugs. The pathogenesis of drug-induced AAV might be multifactorial. The formation of neutrophil extracellular traps is an important mechanism for the development of drug-induced AAV. The clinical features of drug-induced AAV are similar to those of primary AAV. Understanding the difference between drug-induced AAV and primary AAV is helpful to identify drug-induced AAV. Stopping the offending drug at once after diagnosis may be sufficient for those patients with mild symptoms. Immunosuppressive therapy should only be used in patients with vital organs involvement.

Conclusions:

Patients with drug-induced AAV usually have a good prognosis if they stop using the offending drug immediately. Recent advances in research on AAV are expected to help us better understand the pathogenesis of drug-induced AAV.
Lung transplantation in China between 2015 and 2018
Authors: Hu Chun-Xiao , Chen Wen-Hui , He Jian-Xing , Jiang Ge-Ning , Li Xiao-Shan , Wei Dong , Wu Bo , Zhang Ji , Wang Chen , Chen Jing-Yu
Published: November 2019

Background:

Lung transplantation (LT) has been demonstrated as the only effective therapy for patients with end-stage lung diseases. Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require well-organized programs and registry data collection based on the large population. This study aimed to summarize and analyze the data of LT development in China.

Methods:

We retrospectively collected and analyzed data from the China Lung Transplantation Registry (CLuTR). Key data were reported from the registry with transplant types, indications, donor and recipient characteristics, outcomes and survival. The survival <30 days, 1-year and 3-year survival rates were estimated with risk factors identified.

Results:

CLuTR contained data from 1053 lung transplants performed through January 1st, 2015 to December 31st, 2018 reported by 18 registered transplant centers. The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis. The total <30 days, 1-year and 3-year survival rates in CLuTR were 81.45%, 70.11%, and 61.16% with discrepancy by indications. Large proportion of recipients who were more than 60 years old required higher standard of care. Infection-related complications resulted in more death events in the early post-surgery periods. New York Heart Association grading at listing, extra-corporeal membrane oxygenation usage peri-transplantation, allograft dysfunction (primary graft dysfunction >Grade 0), renal insufficiency (estimated glomerular filtration rate <60 mL·min–1·1.73 m–2), were independently associated with a higher risk for 3-year mortality in the entire cohort.

Conclusions:

Facing more end-stage of lung diseases and comorbidities, this study analyzed the outcomes and survival of LT recipients in China. Further prospectively stratified analyses with longer follow-up will be needed.
Cardiovascular Disorders Mediated by Autonomic Nervous System Dysfunction
Authors: Khemani Pravin , Mehdirad Ali A.
Published: November 2019

Cardiovascular disorders, such as orthostatic hypotension and supine hypertension, are common in patients with neurodegenerative synucleinopathies such as Parkinson disease (PD), and may also occur in other conditions, such as peripheral neuropathies, that result in autonomic nervous system (ANS) dysfunction. Dysfunction and degeneration of the ANS are implicated in the development of orthostatic and postprandial hypotension and impaired thermoregulation. Neurogenic orthostatic hypotension (nOH) results from sympathetic failure and is a common autonomic disorder in PD. Supine hypertension may also occur as a result of both sympathetic and parasympathetic dysfunction in conjunction with nOH in the majority of patients with PD. Management of supine hypertension in the setting of nOH can be counterintuitive and challenging. Additionally, the presence of other noncardiovascular comorbidities, such as diabetes mellitus and peripheral edema, may further contribute to the burden of disease. ANS dysfunction thus presents major healthcare implications and challenges for neurology and cardiovascular practices, necessitating an integrated neurology and cardiology management approach.
Launching a Mohs Surgery Program
Authors: Wysong Ashley , Sutton Adam
Published: November 2019

BACKGROUND

There is a paucity of data or publications in the literature on best practices for opening a new Mohs surgery unit.

OBJECTIVE

The goal of this article is to be a “how to” guide for starting a Mohs and dermatologic surgery practice.

MATERIALS AND METHODS

Two academic Mohs surgeons share their personal experiences and data from the literature.

RESULTS

Topics discussed include picking a location and identifying space, equipment, staffing, regulatory practices, policies and procedures, marketing and outreach, patient experience, building culture, clinic efficiency, and vision.

CONCLUSION

Although opening a new Mohs surgery unit is challenging, it can be rewarding to have the opportunity to develop best practices and systems that create a wonderful working environment and allow for exceptional care of patients.
Transmission Modeling with Regression Adjustment for Analyzing Household-based Studies of Infectious Disease
Authors: Crawford Forrest W. , Marx Florian M. , Zelner Jon , Cohen Ted
Published: November 2019

Background:

Household contacts of people infected with a transmissible disease may be at risk due to this proximate exposure, or from other unobserved sources. Understanding variation in infection risk is essential for targeting interventions.

Methods:

We develop an analytical approach to estimate household and exogenous forces of infection, while accounting for individual-level characteristics that affect susceptibility to disease and transmissibility. We apply this approach to a cohort study conducted in Lima, Peru, of 18,544 subjects in 4,500 households with at least one active tuberculosis (TB) case and compare the results to those obtained by Poisson and logistic regression.

Results:

HIV-coinfected (susceptibility hazard ratio [SHR] = 3.80, 1.56–9.29), child (SHR = 1.72, 1.32–2.23), and teenage (SHR = 2.00, 1.49–2.68) household contacts of TB cases experience a higher hazard of TB than do adult contacts. Isoniazid preventive therapy (SHR = 0.30, 0.21–0.42) and Bacillus Calmette–Guérin (BCG) vaccination (SHR = 0.66, 0.51–0.86) reduce the risk of disease among household contacts. TB cases without microbiological confirmation exert a smaller hazard of TB among their close contacts compared with smear- or culture-positive cases (excess hazard ratio = 0.88, 0.82–0.93 for HIV− cases and 0.82, 0.57–0.94 for HIV+ cases). The extra household force of infection results in 0.01 (95% confidence interval [CI] = 0.004, 0.028) TB cases per susceptible household contact per year and the rate of transmission between a microbiologically confirmed TB case and susceptible household contact at 0.08 (95% CI = 0.045, 0.129) TB cases per pair per year.

Conclusions:

Accounting for exposure to infected household contacts permits estimation of risk factors for disease susceptibility and transmissibility and comparison of within-household and exogenous forces of infection.
TEN-YEAR EPIDEMIOLOGY OF RETINOPATHY OF PREMATURITY TREATMENT IN TAIWAN
Authors: Kang Eugene Yu-Chuan , Hsu Kuang-Hung , Chu Shih-Ming , Lien Reyin , Wang Nan-Kai , Lai Chi-Chun , Chen Kuan-Jen , Hwang Yih-Shiou , Lin Ciao-Ming , Wu Wei-Chi
Published: November 2019

Purpose:

To understand the epidemiology of retinopathy of prematurity (ROP) requiring treatment in Taiwan from 2002 to 2011.

Methods:

This retrospective cross-sectional study enrolled 11,180 premature patients with a length of stay >28 days who survived during hospitalization. The incidence of the first ROP treatment was analyzed.

Results:

Among ROP patients (n = 4,096), 6.5% (n = 265) received treatment. The most frequently performed treatment was laser administration (n = 199), followed by intravitreal anti–vascular endothelial growth factor (VEGF) injection (n = 38), scleral buckle or pars plana vitrectomy (n = 14), and cryotherapy (n = 14). The incidence of ROP requiring treatment increased during the study period, as did the use of intravitreal anti-VEGF injection. Shifts in the treatment modality from cryotherapy and scleral buckle/pars plana vitrectomy to laser treatment after 2003 and from laser treatment to intravitreal anti-VEGF injection after 2010 were observed.

Conclusion:

In Taiwan, the incidence of the use of intravitreal anti-VEGF injection for treating ROP increased between 2002 and 2011. Laser treatment was less frequently used than intravitreal anti-VEGF injection in 2011.
RELATIONSHIP BETWEEN PREOPERATIVE FOVEAL MICROSTRUCTURE AND VISUAL ACUITY IN MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Noda Hiroshi , Kimura Shuhei , Morizane Yuki , Toshima Shinji , Hosokawa Mio Morizane , Shiode Yusuke , Doi Shinichiro , Takahashi Kosuke , Hosogi Mika , Fujiwara Atsushi , Shiraga Fumio
Published: November 2019

Purpose:

To visualize foveal microstructures in macula-off rhegmatogenous retinal detachment using swept source optical coherence tomography preoperatively and postoperatively and to investigate the relationship between foveal microstructures and postoperative visual acuity.

Methods:

We retrospectively analyzed 42 eyes of 42 consecutive patients diagnosed with macula-off rhegmatogenous retinal detachment who underwent anatomically successful repair surgery and were followed up for 6 months. We used swept source optical coherence tomography to investigate the relationship between preoperative and postoperative continuity of both the external limiting membrane (ELM) and ellipsoid zone (Ez) and preoperative and postoperative best-corrected visual acuity.

Results:

Both preoperative ELM and Ez were continuous in 9 eyes (21%; ELM+/Ez+ eyes), only the ELM was continuous in 25 eyes (60%; ELM+/Ez− eyes), and neither was continuous in 8 eyes (19%; ELM−/Ez− eyes). Postoperative best-corrected visual acuity in ELM+/Ez+ eyes (−0.05 ± 0.04 logarithm of the minimum angle of resolution units, Snellen equivalent 20/18) was significantly better than that in both ELM+/Ez− (0.16 ± 0.16, 20/29; P = 0.03) and ELM−/Ez− (0.86 ± 0.37, 20/145; P < 0.001) eyes. Postoperative best-corrected visual acuity was significantly better in ELM+/Ez− than in ELM−/Ez− eyes (P < 0.001).

Conclusion:

In macula-off rhegmatogenous retinal detachment, preoperative continuity of the ELM and Ez may be a predictor of postoperative best-corrected visual acuity.
AUTOIMMUNE RETINOPATHY MIMICKING HERITABLE RETINAL DEGENERATION IN A PATIENT WITH COMMON VARIABLE IMMUNE DEFICIENCY
Authors: Wiley Luke A. , Binkley Elaine M. , DeLuca Adam P. , Workalemahu Grefachew , Tatro Nicole J. , Luse Meagan A. , Kennedy Elizabeth L. , Folk James C. , Scheetz Todd E. , Ballas Zuhair K. , Tucker Budd A. , Mullins Robert F. , Han Ian C. , Stone Edwin M.
Published: November 2019

Purpose:

1) To describe a case of autoimmune retinopathy mimicking heritable photoreceptor degeneration in a patient with common variable immune deficiency and 2) to investigate the humoral and cell-mediated branches of the immune system in this patient to better understand the mechanism of immune-mediated photoreceptor damage in this disease.

Methods:

Retrospective chart review with evaluation of multimodal imaging, genotype analysis, and investigation of circulating autoantibodies and T-cell response to retinal antigens.

Results:

A 40-year-old woman with bilateral, progressive vision loss was referred for evaluation of a possible inherited retinal degeneration. She was found to have asymmetric peripheral visual field constriction, cystoid macular edema, vitreous cells, and bone spicule–like pigmentary changes in both eyes. An extensive workup for underlying infectious or inflammatory causes was unrevealing, and molecular analysis for heritable retinal degeneration failed to identify a plausible disease-causing genotype. Screening for antiretinal antibodies showed the presence of multiple antiretinal antibodies, consistent with a diagnosis of autoimmune retinopathy. Immunologic workup demonstrated markedly decreased levels of serum IgA and IgG, consistent with common variable immune deficiency. T-cells isolated from the patient showed increased proliferation when stimulated with human retinal proteins, supporting a role for both cell- and humoral-mediated autoimmunity. Treatment with mycophenolate mofetil and intravenous immunoglobin therapy slowed the progression of disease and resulted in preservation of her central vision.

Conclusion:

Autoimmune retinopathy can be seen in common variable immune deficiency and has clinical findings similar to heritable photoreceptor degeneration. Both the humoral and cellular immune responses are involved in the pathophysiology. Immune modulatory therapy has stabilized the disease course in this patient and may play an important role in the management of autoimmune retinopathy.
Chronic noncancer pain is not associated with accelerated brain aging as assessed by structural magnetic resonance imaging in patients treated in specialized outpatient clinics
Authors: Sörös Peter , Bantel Carsten
Published: November 2019

Chronic pain is often associated with changes in brain structure and function, and also cognitive deficits. It has been noted that these chronic pain-related alterations may resemble changes found in healthy aging, and thus may represent accelerated or premature aging of the brain. Here, we test the hypothesis that patients with chronic noncancer pain demonstrate accelerated brain aging compared with healthy control subjects. The predicted brain age of 59 patients with chronic pain (mean chronological age ± SD: 53.0 ± 9.0 years; 43 women) and 60 pain-free healthy controls (52.6 ± 9.0 years; 44 women) was determined using the software brainageR. This software segments the individual T1-weighted structural MR images into gray and white matter and compares gray and white matter images with a large (n = 2001) training set of structural images, using machine learning. Finally, brain age delta, which is the predicted brain age minus chronological age, was calculated and compared across groups. This study provided no evidence for the hypothesis that chronic pain is associated with accelerated brain aging (Welch t test, P = 0.74, Cohen's d = 0.061). A Bayesian independent-samples t test indicated moderate evidence in favor of the null hypothesis (BF01 = 4.875, ie, group means were equal). Our results provide indirect support for recent models of pain-related changes of brain structure, brain function, and cognitive functions. These models postulate network-specific maladaptive plasticity, rather than widespread or global neural degeneration.
Infusing the Principles of Trauma-Informed Care Into Emergency Nursing: A Comprehensive Approach to Change Practice
Authors: Cochran Courtney B.
Published: November 2019

The emergency department is a frequent entry point into the healthcare system for victims of violence. Currently, a knowledge deficit and clinical practice gap exists among emergency nurses regarding their consistent ability to implement a trauma-informed approach in their interactions with forensic clients. Emergency nurses at all levels of professional development, senior undergraduate nursing students, new graduate nurses, and experienced nurses should be well informed regarding the prevalence of violence, basic clinical forensic nursing practice, and the principles of trauma-informed care. A comprehensive approach is required to both identify and address the trauma associated with violence. Through reflecting on Benner's Novice to Expert framework, strategies are proposed for the implementation of a comprehensive plan. An inclusive approach to the implementation of the principles of trauma-informed care into emergency nursing may ultimately lead to a transformation in culture in which nurses ask, “What has happened to you?” instead of “What is wrong with you?”
New-onset seizure activity in a transplant patient on immunosuppressive therapy
Authors: Gersch Kathryn , Spencer Taylor R.
Published: November 2019

The evaluation of new-onset seizure activity must raise a much broader differential than just epilepsy. This case study highlights that broad differential and identifies an important, but less common, cause of seizure activity in specific patient populations. Information is summarized from recent primary research, case series, literature reviews, and meta-analyses. In the appropriate clinical context, the diagnosis of posterior reversible encephalopathy syndrome (PRES) should be considered as a cause of seizures. Posterior reversible encephalopathy syndrome is a neurotoxic syndrome characterized by posterior cerebral edema on imaging and triggered by a variety of inciting or predisposing factors. This article reviews suggestions for the identification and management of PRES. Because of the myriad factors, nurse practitioners should be familiar with PRES and may encounter it through primary care, emergency or urgent care, hospitalist medicine, or a variety of specialty roles.
Outcomes of Venovenous Extracorporeal Membrane Oxygenation When Stratified by Age: How Old Is Too Old?
Authors: Deatrick Kristopher B. , Mazzeffi Michael A. , Galvagno Samuel M. , Tesoriero Ronald B. , Kaczoroswki David J. , Herr Daniel L. , Dolly Katelyn , Rabinowitz Ronald P. , Scalea Thomas M. , Menaker Jay
Published: November 2019

The purpose of this study was to evaluate survival to hospital discharge for patients on venovenous extracorporeal membrane oxygenation (VV ECMO) when stratified by age. We performed a retrospective study at single, academic, tertiary care center intensive care unit for VV ECMO. All patients, older than 17 years of age, on VV ECMO admitted to a specialized intensive care unit for the management of VV ECMO between August 2014 and May 2018 were included in the study. Trauma and bridge-to-lung transplant patients were excluded for this analysis. Demographics, pre-ECMO and ECMO data were collected. Primary outcome was survival to hospital discharge when stratified by age. Secondary outcomes included time on VV ECMO and hospital length of stay (HLOS). One hundred eighty-two patients were included. Median P/F ratio at time of cannulation was 69 [56–85], and respiratory ECMO survival prediction (RESP) score was 3 [1–5]. Median time on ECMO was 319 [180–567] hours. Overall survival to hospital discharge was 75.8%. Lowess and cubic spline curves demonstrated an inflection point associated with increased mortality at age >45 years. Kaplan-Meier analysis demonstrated significantly greater survival in patients <45 years of age (p = 0.0001). Survival to hospital discharge for those <age 45 years was 84.6%. Comparatively, survival to hospital discharge for those ≥45 years was significantly lower (67.0%; p = 0.009), as was survival for those 55 years (57.1%; p = 0.001) and patients age ≥65 years (16.7%; p = 0.003). Patients 65 years of age and older treated with VV ECMO support for respiratory failure have low rates of survival to discharge. We have shown that age is an independent predictor of survival to discharge and beginning at age 45 years, in-hospital mortality increases incrementally. Moving forward we believe criteria and scoring systems for VV ECMO should include age as a variable.
Study on the treatment of pancreatic cancer with integrated traditional Chinese and Western medicine
Authors: Jiang Juling , Liu Rui , Zhang Zhenhua , Zhang Xiwen , Qi Runzhi , Chen Shuntai , Zhang Xing , Xi Yupeng , Guo Qiujun , Zheng Honggang , Hua Baojin
Published: November 2019

Introduction:

Pancreatic cancer is one of the most lethal malignancies worldwide. Most patients are diagnosed at an advanced stage, which leads to a poor prognosis and a low survival rate. At present, treatment options for pancreatic cancer are limited, so it is vital to explore new treatments and strategies. Traditional Chinese medicine (TCM) is an important method for cancer prevention and treatment in China. We will conduct a multicenter, prospective cohort study to evaluate the survival and quality of life of patients with advanced pancreatic cancer treated with integrated traditional Chinese and Western medicine, further refine the core pathogenesis of TCM for pancreatic cancer, form a core prescription, and provide clinical data support for the clinical plan of integrated treatment of pancreatic cancer using Chinese and Western medicine; this will aid in the development of the best comprehensive treatment plan for patients.

Methods and analysis:

This study will recruit patients with stage 3 to 4 pancreatic cancer in 12 medical units from April 2019 to June 2020. Patients will be divided into a Western medicine treatment group and an integrated traditional Chinese and Western medicine treatment group, with a total of 148 patients. Overall survival is the main efficacy index, while the secondary efficacy indexes are progression-free survival, tumor markers, TCM symptom grading scale, quality of life assessment, Eastern Cooperative Oncology Group (ECOG) score, and imaging assessment. A follow-up will be performed every 6 weeks ±1 week. The end point is the death of the patient or the end of the study (October 31, 2021). Statistical analysis will be performed using Statistical Packages of Social Sciences software (SPSS).

Ethics and dissemination:

This work was supported by Beijing Municipal Science and Technology Commission and approved by the ethics committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (Approval No. 2019-016-KY). All patients will sign a written informed consent prior to data collection. The results will be disseminated through peer-reviewed journals and conference presentations and will be openly shared after completion of the trial.

Trial Registration:

The trial was registered with the Chinese Clinical Trials Registry (ChiCTR1900022632, pre-registration).
Safety and efficacy of laparoscopic gastrectomy in obese patients with gastric cancer
Authors: Liu Maoxing , Xing Jiadi , Arslan Ahmet , Tan Fei , Fan Yingcong , Xu Kai , Qi Xinyu , Yao Zhendan , Zhang Nan , Zhang Chenghai , Yang Hong , Cui Ming , Su Xiangqian
Published: November 2019

The present study aimed to investigate the safety and short-term outcome of laparoscopy-assisted distal radical gastrectomy in treating gastric cancer among obese patients.

Perioperative outcomes were compared between 67 gastric cancer patients with a body mass index (BMI) ≥25 kg/m2 (obese group) and 198 ones with BMI <25 kg/m2 (non-obese group). All the cases underwent laparoscopic radical resection between April 2009 and October 2013.

The value of BMI was 27.3 ± 2.67 kg/m2 in the obese group and 21.3 ± 2.64 kg/m2 in non-obese group. There were no significant differences between 2 groups in age, sex, presence of diabetes, tumor size, number of metastatic lymph nodes, or metastatic lymph node ratio. Postoperative complications did not differ between the 2 groups (P > .05). There were significant differences between the 2 groups in operation time (non-obese: [234.2 ± 67.1] minutes vs obese group: [259.4 ± 78.5]; P = .017), postoperative hospital stay (obese group [19.7 ± 14.8] day vs non-obese [15.4 ± 7.1], P = .002), and retrieved lymph nodes ([27.6 ± 11.0] day vs non-obese [31.9 ± 12.5] day, P = .002).

Obesity may prolong operation time and postoperative hospital stay, and cause less retrieved lymph nodes, but does not increase the incidence of postoperative complications. The experienced center can properly conduct laparoscopic assisted radical gastrectomy in obese patients.
Effect of annual influenza vaccination on reducing lung cancer in patients with chronic obstructive pulmonary disease from a population-based cohort study
Authors: Chen Kuan-Yuan , Wu Sheng-Ming , Liu Ju-Chi , Lee Kang-Yun
Published: November 2019

Chronic obstructive pulmonary disease (COPD) patients are at a higher risk of development of lung cancer. Frequent exacerbations of COPD trigger the disease course to chronic inflammation which likely plays a role in the pathogenesis of lung cancer. Previous studies showed influenza virus infection is one of important causes for exacerbations of COPD. Therefore, the aim of this study was to know whether influenza vaccination could reduce the incidence of lung cancer in patients with COPD.

This cohort study enrolled patients (≥55 years old) with a recorded diagnosis of COPD between January 1, 2000 and December 31, 2012 by using the Taiwan Health Insurance Database. A propensity score was calculated to reduce vaccine therapy selection bias. Cox proportional hazard regressions were used to investigate the association between the influenza vaccination and lung cancer incidence after adjusting for known confounding factors. Besides, we categorized the patients into 4 groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2–3, ≥4) to evaluate the dose-dependent effect on reducing lung cancer occurrence of lung cancer in COPD patients.

Our study comprised of 28,752 eligible individuals from the COPD cohort database. Among them, 51% (14,630) received influenza vaccination; the rest (49%) of the COPD patients did not receive influenza vaccination. We observed that COPD patients receiving influenza vaccination had a lower risk of lung cancer (adjusted HR = 0.40, 95% CI (0.35–0.45), P < .001). We also founded comparable protective effect in both sexes and all age groups (55–64, 65–74, ≥75) regardless of influenza seasonality. Furthermore, dose-dependent protective effect could be seen after stratifying patients according to the total number vaccinations, the adjusted HRs for lung cancer risk were 0.48 (0.40–0.54) and 0.24 (0.20–0.29) for patients who received 2 to 3 and ≥4 vaccinations during the follow-up period.

This population-based cohort study demonstrated that annual influenza vaccination administration could reduce incidence of lung cancer in COPD patients.
Diffusion-weighted image improves detectability of magnetic resonance cholangiopancreatography for pancreatic ductal adenocarcinoma concomitant with intraductal papillary mucinous neoplasm
Authors: Kawakami Satoshi , Fukasawa Mitsuharu , Shimizu Tatsuya , Ichikawa Shintaro , Sato Tadashi , Takano Shinichi , Kadokura Makoto , Shindo Hiroko , Takahashi Ei , Hirose Sumio , Fukasawa Yoshimitsu , Hayakawa Hiroshi , Nakayama Yasuhiro , Yamaguchi Tatsuya , Inoue Taisuke , Maekawa Shinya , Kawaida Hiromichi , Motosugi Utaroh , Onishi Hiroshi , Enomoto Nobuyuki
Published: November 2019

The present study is aimed to clarify the utility of magnetic resonance cholangiopancreatography (MRCP) and the additional value of diffusion-weighted imaging (DWI) in diagnosing pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN).

This retrospective study involved 38 patients with PDAC concomitant with IPMN and 114 patients (control) who were randomly selected from 320 patients with IPMN without PDAC and were matched with cases for magnetic resonance imaging (MRI) strength (1.5 T/3.0 T). Two radiologists reviewed the 2 MR image sets with relevant clinical information blinded, first MRCP alone and then combined MRI set including DWI. Diagnostic capability and interobserver agreement were assessed by using receiver operating characteristics curve (Az) analysis and weighted κ statistics.

Az values for the 2 observers were 0.834 and 0.821 for MRCP alone and 0.964 and 0.926 for the combined MRI (P < .001 and P < .001), respectively. The sensitivity of MRCP alone was 61% (23/38), with both observers failing to diagnose PDACs located at the end of tail or away from the pancreatic duct. Meanwhile, with combined MRI, sensitivity was significantly increased for both observers (61% to 92%, P = .002; 61% to 87%, P = .004). Moreover, the interobserver agreement was higher with combined MRI (κ = 0.85) than MRCP alone (κ = 0.59).

MRCP and DWI might be a superior option with a higher diagnostic capability of PDAC concomitant with IPMN than MRCP alone, especially for tumors away from the pancreatic duct.
The relationship of MicroRNA-21 and plaque stability in acute coronary syndrome
Authors: He Wangwei , Zhu Liyuan , Huang Yu , Zhang Yinfen , Shen Weimin , Fang Lihuan , Li Jun , Wang Zhuo , Xie Qiang
Published: November 2019

Acute coronary syndrome (ACS) leads to clinical symptoms such as chest pain, dyspnea, and arrhythmia. The occurrence of ACS is mainly related to the vulnerable plaques in the coronary arteries. MicroRNA-21 (miR-21) is widely expressed in cardiovascular disease and considered as a marker of myocardial infarction, but its role in vulnerable atherosclerotic plaque of ACS is poorly studied. The cases of ACS and control group were selected in 2 years. Our results revealed that miR-21 was highly positively correlated with the maximum lipid core area, the number of diseased vessels, the number of macrophages, the number of vulnerable plaques, and negatively correlated with the thickness of fiber caps. In the high expression group, the number of coronary artery lesions, the number of vulnerable plaques, the core area of lipid pools and the number of macrophages were significantly higher than those in the low expression group and the middle expression group. But the high expression group of the thickness of the fiber cap was significantly lower than that of the low expression group and the medium expression group. These studies show that miR-21 is an important factor leading to vulnerable plaque instability in ACS, and it can be a predictor of acute adverse events in coronary heart disease.
Hemangioblastoma arising from duramater
Authors: Bian Bingyang , Zhang Bei , Zhou Hongli , Tian Junwei , Wang Zhuo , Wang Jiping
Published: November 2019

Rationale:

Hemangioblastoma (HB) is a benign tumor that is typically located in the subtentorial region of the brain. HB that originates from dura mater is extremely rare.

Patient concerns:

Herein, we reported a single case of a patient who presented with dizziness and headache lasting for 1 year that progressively aggravated within 1 month.

Diagnosis:

After admission, the patient underwent head magnetic resonance (MR); a nodular long T1-T2 signal was found on the right side of parietal falx cerebri; the lesion appeared with high intensity on FLAIR and DWI, and with isointensity on ADC map. In addition, significant homogeneous enhancements were observed on the enhanced scan. According to clinical and imaging features, the lesion was diagnosed as meningioma. However, after performing tumor resection by craniotomy, the diagnosis of HB is clear. Additional pathological examination data were found: Ki-67(+1%), NSE(-), CD31(+), CD34(+), CD56(+), S-100(-), α-inhibin(+), Vimentin(-), EGFR-), GFAP(-), CK-pan(-), EMA(-), PR(-).

Interventions:

The mass with abundant blood supply was removed.

Outcomes:

Ten days after operation, the patient was discharged from hospital and no signs of recurrence were observed three months later.

Lessons:

To sum up, obvious high signal intensity in T2WI sequence and homogeneous enhancement are main characteristics that differentiate dural hemangioblastoma from meningioma lesion.
Prospective evaluation of phosphorus-32 radiation synovectomy in patients with severe and chronic rheumatoid arthritis unresponsive to conventional medical treatment
Authors: Amini Azam , Yahyanezhad Shiva , Velez Erik , Gholamrezanezhad Ali , Fotoohi Morteza , Jafari Esmail , Assadi Majid
Published: November 2019

Objectives

To determine the efficacy of Phosphorus-32 radiation synovectomy in the treatment of patients with severe rheumatoid arthritis (RA) unresponsive to systematic or local medical therapy.

Methods

Twenty-three knees in 16 patients with severe chronic RA were prospectively treated by intra-articular installation of Phosphorus-32 and evaluated at 1, 3, 6, and 12 months. The Western Ontario and McMaster Universities Arthritis index (WOMAC), visual analog scale (VAS), Health Assessment Questionnaire (HAQ), pain scale, and grade of joint effusion and tenderness were assessed. At the 12-month time interval, the treated knees were classified into four categories: excellent response (no symptoms), good response (significant reduction of symptoms), moderate response (slight decrease), and poor response (no change or worsening).

Results

Excellent response or good response was observed in 13/23 (56.5%) of the treated knees, moderate response in 2/23 (8.7%) of the treated knees, and poor response in 8/23 (34.8%) of the treated knees. The grades of effusion and tenderness were significantly decreased one-month posttreatment (P< 0.05); however, these changes did not persist at other time intervals (P > 0.05). There was a significant improvement in the HAQ, WOMAC, VAS, and pain scores at all time points compared with baseline, including at the 12-month time interval (P < 0.05).

Conclusion

Phosphorus-32 radiosynovectomy is an effective therapeutic treatment for patients with RA of the knee unresponsive to conventional pharmacotherapy.
Implementing recovery resources in trauma care: impact and implications
Authors: Simske Natasha M. , Breslin Mary A. , Hendrickson Sarah B. , York Kenneth P. , Vallier Heather A.
Published: November 2019

Objectives:

To identify resources that patients perceive as helpful to their recovery and to characterize the impact of the Trauma Survivor Network (TSN), a program committed to enhancing recovery through education and engagement.

Design:

Prospective cohort study.

Setting:

Level 1 trauma center.

Patients/Participants:

Four hundred eighty-five patients with musculoskeletal injuries. Two hundred eleven were exposed to TSN resources (Group 1). One hundred thirty-five patients were treated during the same period with no exposure (Group 2, control). One hundred thirty-nine patients were treated 1 to 3 months prior to TSN implementation (Group 3, control).

Intervention:

TSN resources including educational materials, family classes, peer survivor visits, coaching, online services, and support groups.

Main outcome measure:

A survey to assess hospital experience and perceptions about recovery.

Results:

On a Likert scale from 0 to 5, patients were highly satisfied (mean 4.24), with no differences based on TSN exposure. Patients exposed to TSN programming reported greater perceived likelihood of recovery: mean 3.73 vs 3.41 vs 3.38, Group 1 vs Group 2 vs Group 3 (P = .05) and regarding return to daily activities: 3.69 vs 3.49 vs 3.10, P = .003. Fifty-three percent of Group 1 patients exposed to TSN programming utilized peer relationships and 42% read the educational materials provided. Support groups were also popular, with 26% of patients attending at least 1 session. Patients who recalled utilization of TSN services were overall highly satisfied with these services, mean 4.42.

Conclusion:

Patients were overall highly satisfied with their hospital stay, with those exposed to TSN services reporting greater perceived likelihood of recovery and return to daily activities. Development of nontraditional services, including peer visitation and support groups, appears to enhance expectations about recovery.
Genotypic resistance profiles of HIV-2-infected patients from Cape Verde failing first-line antiretroviral therapy
Authors: Moranguinho Inês , Borrego Pedro , Gonçalves Fátima , Gomes Perpétua , Rocha José , Barreto Jorge , Taveira Nuno
Published: November 2019

The pol gene from HIV-2-infected patients from Cape Verde experiencing virologic failure was sequenced and drug resistance mutations were determined. Most patients were taking a first-line regimen of zidovudine (AZT), lamivudine (3TC) and lopinavir/ritonavir (LPV/r). Resistance mutations were found in most patients (11/17; 64.7%) especially I82F (4/7; 57.1%) and M184V (10/17; 58.8%). Resistance to all reverse transcriptase and protease inhibitors was found in 58.8% (10/17) of the patients. Integrase inhibitors are warranted to treat these patients.
Understanding HIV Program Effects: A Structural Approach to Context Using the Transportability Framework
Authors: Mehrotra Megha L. , Petersen Maya L. , Geng Elvin H.
Published: November 2019

Background:

Implementation science focuses on evaluating strategies for delivering evidence-based interventions to improve HIV prevention and treatment. The effectiveness of these implementation strategies is often context-dependent and reconciling the desire to produce generalizable knowledge in the face of these contextual interventions is a central challenge for implementation science researchers.

Methods:

We provide an overview of the causal transportability theory and conceptualize context under this framework. We review how causal graphs can be used to illustrate the assumptions necessary to apply the results of a study to a new context, and we illustrate this approach using an example of a community adherence group intervention that aims to improve retention in HIV care. Finally, we discuss several key insights highlighted by the transportability theory that are relevant to implementation science researchers.

Results:

By adopting causal transportability to consider how context may affect the success of an implementation strategy, researchers can formally diagnose when the results of a study are likely to generalize to a given setting. Moreover, selection diagrams can highlight what additional measurements would be needed in a target population to estimate the effect of an implementation strategy in that target population without having to repeat the initial study.

Conclusions:

Transportability translates intuition about context-dependent interventions and external validity into actionable and testable insight.
A Simple Combination Approach for Costal Cartilage Augmentation Rhinoplasty
Authors: Qiao Congzhen , Yu Wenxin , Gao Wei , Qiu Yajing , Lin Xiaoxi
Published: November 2019

Autologous costal cartilage graft is optimal for augmentation rhinoplasty but with complications including markedly visible graft margins and dorsal contour irregularities. Therefore, the authors introduced the diced costal cartilage graft to smoothen the margins of bilateral spreader graft for nasal dorsum augmentation. A total of 6 patients were recruited for this augmentation rhinoplasty. The pre- and postoperative photographs were taken for improvement evaluation. During a mean follow-up of 15 months, none of the patients developed major complications that may require removal or revision of the costal cartilage grafts. Five patients (80%) were very satisfied with the aesthetic outcome. This simple algorithm facilitates the substantial augmentation and removes the visibility of dorsal graft in the costal cartilage rhinoplasty for the East Asian population.
Identifying the drivers of multidrug-resistant Klebsiella pneumoniae at a European level
Authors: Kachalov Viacheslav N. , Nguyen Huyen , Balakrishna Suraj , Salazar-Vizcaya Luisa , Sommerstein Rami , Kuster Stefan P. , Hauser Anthony , Wiesch Pia Abel zur , Klein Eili , Kouyos Roger D.
Published: November 2019

Beta-lactam- and in particular carbapenem-resistant Enterobacteriaceae represent a major public health threat. Despite strong variation of resistance across geographical settings, there is limited understanding of the underlying drivers.

To assess these drivers, we developed a transmission model of cephalosporin- and carbapenem-resistant Klebsiella pneumoniae. The model is parameterized using antibiotic consumption and demographic data from eleven European countries and fitted to the resistance rates for Klebsiella pneumoniae for these settings. The impact of potential drivers of resistance is then assessed in counterfactual analyses.

Based on reported consumption data, the model could simultaneously fit the prevalence of extended-spectrum beta-lactamase-producing and carbapenem-resistant Klebsiella pneumoniae (ESBL and CRK) across eleven European countries over eleven years. The fit could explain the large between-country variability of resistance in terms of consumption patterns and fitted differences in hospital transmission rates. Based on this fit, a counterfactual analysis found that reducing nosocomial transmission and antibiotic consumption in the hospital had the strongest impact on ESBL and CRK prevalence. Antibiotic consumption in the community also affected ESBL prevalence but its relative impact was weaker than nosocomial consumption. Finally, we used the model to estimate a moderate fitness cost of CRK and ESBL at the population level.

This work highlights the disproportionate role of antibiotic consumption in the hospital and of nosocomial transmission for resistance in gram-negative bacteria at a European level. This indicates that infection control and antibiotic stewardship measures should play a major role in limiting resistance even at the national or regional level.

Significance Statement

As beta-lactam resistant gram-negative bacteria represent one of the most critical threats in the ongoing antibiotic resistance crisis, it is crucial to identify the underlying drivers and appropriate measures to curb their spread. By combining a transmission model with epidemiological data at a European level, we can explain the strong differences of extended-spectrum beta-lactamase-producing and carbapenem-resistant Klebsiella pneumonia across countries and their often-rapid temporal increase. We find that among potentially modifiable drivers, inpatient antibiotic consumption and nosocomial transmission rates have the strongest impact on resistance. This implies that infection control and antibiotic stewardship in hospitals are crucial for preventing antibiotic resistance in gram-negatives even beyond individual hospitals as they may affect resistance prevalence at the level of entire countries.
Machine learning predicts immunoglobulin light chain toxicity through somatic mutations
Authors: Garofalo Maura , Piccoli Luca , Romeo Margherita , Barzago Maria Monica , Ravasio Sara , Foglierini Mathilde , Matkovic Milos , Sgrignani Jacopo , De Gasparo Raoul , Prunotto Marco , Varani Luca , Diomede Luisa , Michielin Olivier , Lanzavecchia Antonio , Cavalli Andrea
Published: November 2019

In systemic light chain amyloidosis (AL), pathogenic monoclonal immunoglobulin light chains (LCs) form toxic aggregates and amyloid fibrils in target organs. Prompt diagnosis is crucial to avoid permanent organ damage. However, delays in diagnosis are common, with a consequent poor patient’s prognosis, as symptoms usually appear only after strong organ involvement. Here, we present LICTOR, a machine learning approach predicting LC toxicity in AL, based on the distribution of somatic mutations acquired during clonal selection. LICTOR achieved a specificity and a sensitivity of 0.82 and 0.76, respectively, with an area under the receiver operating characteristic curve (AUC) of 0.87. Tested on an independent set of 12 LCs sequences with known clinical phenotypes, LICTOR achieved a prediction accuracy of 83%. Furthermore, we were able to abolish the toxic phenotype of an LC by in silico reverting two germline-specific somatic mutations identified by LICTOR and by experimentally assessing the loss of in vivo toxicity in a Caenorhabditis elegans model. Therefore, LICTOR represents a promising strategy for AL diagnosis and reducing high mortality rates in AL.
Co-incubation of dsRNA reduces proportion of viable spores of Ascosphaera apis, a honey bee fungal pathogen
Authors: Tauber James P. , Einspanier Ralf , Evans Jay D. , McMahon Dino P.
Published: November 2019

There are viral, fungal, bacterial and trypanosomal pathogens that negatively impact the individual and superorganismal health of the western honey bee. One fungal pathogen, Ascosphaera apis, affects larvae and causes the disease chalkbrood. A previous genome analysis of As. apis revealed that its genome encodes for RNA interference genes, similar to other fungi and eukaryotes. Here, we examined whether As. apis-targeting double-stranded RNA species could disrupt the germination of As. apis. We observed that when spores were co-incubated with As. apis-targeting dsRNA, fewer spores were activated for germination, suggesting an uptake of exogenous genetic material at the very onset of germination and consequent damage to essential transcripts needed for germination. Overall, these results indicate that the causative agent of chalkbrood disease, As. apis, can be successfully targeted using an RNAi-based strategy.