bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary hypertension with massive megalosplenia
Authors: Yi Tieci , Ma Wei , Qiu Jianxing , Ding Wenhui
Published: March 2019

Rationale:

Pulmonary hypertension (PH) is a complicated disease which has complex causes and poor outcome. Many factors are involved in the increase of pulmonary artery pressure. It is often difficult to identify the specific cause of a particular patient. However, identifying the etiology is of great importance for specifying treatment strategies and improving the prognosis of patients.

Patient concerns:

A 58-year-old male was admitted because of fatigue, breath shortness for 6 months, which got worse in the last 3 months. The ultrasound cardiogram (UCG) indicated a remarkably elevated pulmonary artery systolic pressure (PASP = 82 mm Hg). He had hypertension for 15 years. Besides, his spleen was found to be enlarged since 15 years ago. Bone marrow biopsy of the patient revealed myeloproliferative neoplasm (MPN) with severe myelofibrosis (MF).

Diagnosis:

Myeloproliferative neoplasm (MPN) with severe myelofibrosis (MF) which in turn caused PH and portal vein hypertension (PVH).

Interventions:

We treated the patient with diuretics and fosinopril, and also steroids and thalidomide for his MPN/MF.

Outcomes:

Two weeks later, the pulmonary artery pressure (PAP) was remarkably decreased (PASP = 53.1 mm Hg by UCG, mean PAP = 21 mm Hg by right cardiac catheterization). Within 2 years’ follow-up, his circulatory state and hematological state remained stable.

Lessons:

It is often difficult to define the cause of PH, but it is important for making the appropriate treatment at the same time.
Effect of chronic kidney disease in ischemic cardiomyopathy
Authors: Hueb Thiago Ovanessian , Lima Eduardo Gomes , Rocha Mauricio S. , Siqueira Sergio F. , Nishioka Silvana Angelina Dório , Peixoto Giselle L. , Saccab Marcos M. , Garcia Rosa Maria Rahmi , Ramires José Antonio F. , Kalil Filho Roberto , Martinelli Filho Martino
Published: March 2019

A strong association exists between chronic kidney disease (CKD) and coronary artery disease (CAD). The role of CKD in the long-term prognosis of CAD patients with versus those without CKD is unknown. This study investigated whether CKD affects ventricular function.

From January 2009 to January 2010, 918 consecutive patients were selected from an outpatient database. Patients had undergone percutaneous, surgical, or clinical treatment and were followed until May 2015.

In patients with preserved renal function (n = 405), 73 events (18%) occurred, but 108 events (21.1%) occurred among those with CKD (n = 513) (P < .001). Regarding left ventricular ejection fraction (LVEF) <50%, we found 84 events (21.5%) in CKD patients and 12 (11.8%) in those with preserved renal function (P < .001). The presence of LVEF <50% brought about a modification effect. Death occurred in 22 (5.4%) patients with preserved renal function and in 73 (14.2%) with CKD (P < .001). In subjects with LVEF <50%, 66 deaths (16.9%) occurred in CKD patients and 7 (6.9%) in those with preserved renal function (P = .001). No differences were found in CKD strata regarding events or overall death among those with preserved LVEF. In a multivariate model, creatinine clearance remained an independent predictor of death (P < .001).

We found no deleterious effects of CKD in patients with CAD when ventricular function was preserved. However, there was a worse prognosis in patients with CKD and ventricular dysfunction.

Resgistry number is ISRCTN17786790 at https://doi.org/10.1186/ISRCTN17786790.
Primary squamous cell carcinoma of the seminal vesicle
Authors: Fang Lu , Hong Qian , Chen Lei , Wang Yi , Bi Liang-Kuan , Xie Dong-Dong , Yu De-Xin
Published: March 2019

Rationale:

Primary squamous cell carcinoma (SCC) of the seminal vesicle is extremely rare, and the clinical characteristics of this kind of malignancy are still unclear.

Patient concerns:

A 62-year-old male patient presented with complaints of sensation of rectal tenesmus and dysuria.

Diagnosis:

Ultrasonography suggested a hypoechoic mass behind the bladder, meanwhile, computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a 40 mm × 45 mm × 48 mm mixed solid/cystic tumorous lesion in the right seminal vesicle. Postoperative histology confirmed the diagnosis of primary SCC in the seminal vesicle.

Intervention:

The mass was surgically excised with a laparoscopic approach. Postoperatively, 6 cycles of chemotherapy and 50 Gy of external beam radiation were concurrently performed on this patient.

Outcomes:

No local recurrence or distant metastasis was detected within 2 years after the surgery.

Lessons:

Primary SCC of the seminal vesicle is a rare neoplasm with a poor prognosis. Clinically, it is crucial to establish early precise diagnosis and apply multimodality treatment.
Screw view model of navigation in posterior corrective surgery for adolescent idiopathic scoliosis
Authors: Yu Tong , Yang Lili , Zheng Shuang , Qu Yang , Zhang Xiwen , Kang Mingyang , Dong Rongpeng , Zhao Jianwu
Published: March 2019

Rationale:

The purpose of this study is to introduce the application of screw view model of navigation (SVMN) for adolescent idiopathic scoliosis (AIS). It is a challenge to insert pedicle screw into the vertebral body of scoliosis, and the misplaced screw may lead to neurovascular injury. In order to minimize surgical complications, we used a novel method of SVMN technology to facilitate pedicle screw insertion.

Patient concerns:

Her mother brought her to our outpatient department upon noticing the girl's different heights of shoulders and unbalance of the trunk.

Diagnoses:

She was diagnosed with AIS and syringomyelia.

Interventions:

We used an SVMN technology to assist pedicle screw insertion and correction surgery in this 20-year-old patient.

Outcomes:

This study indicates that the SVMN could obtain a satisfactory surgical effect for AIS. The Cobb angle of segmental scoliosis (T7-L2) was 55° before surgery, and 3.5° after surgery, and the rate of correction was 93.6%. The segmental kyphosis (T7-L1) was 56.8° preoperatively and 32° postoperatively with the rate of correction of 43.6%. The distance between the center sacral vertical line (CSVL) and the C7 plumb line (CPL) was reduced from 56.2 mm to 0.2 mm, and the sagittal imbalance of 35.8 mm was improved to 3.5 mm. In addition, the misplacement of pedicle screws, the volume of blood loss, the operation time, and surgical complications were also recorded. The follow-up duration was 33 months.

Lessons:

The utilization of SVMN in AIS might reduce the incidence of screw misplacement and avoid neurovascular damage, as well as a satisfactory correction. The application of SVMN for AIS is an efficacious and safe method.
Effects of phenytoin on serum levels of homocysteine, vitamin B12, folate in patients with epilepsy
Authors: Xu Yubin , Zhang Na , Xu Shanshan , Xu Hongyan , Chen Saizhen , Xia Zhelin
Published: March 2019

Background:

To determine the influence of phenytoin (PHT) monotherapy on the serum levels of homocysteine (Hcy), folate and vitamin B12 in patients with epilepsy.

Methods:

Literature retrieval was performed through PubMed, Web of Science, Embase, Cochrane Library, Chinese Wanfang Data, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database databases as of the end of March 2018. Pooled weighted mean difference (WMD) and 95% CIs were calculated using a random effect model.

Results:

A total of ten eligible studies were identified. The result revealed that the serum level of homocysteine in PHT-treated patients with epilepsy was significantly higher than that in control group (WMD = 8.47, 95% CI: 6.74 to 10.20, P < .001). In addition, the serum levels of folate (WMD = −3.51, 95% CI: −4.20 to −2.83, P < .001) and vitamin B12 (WMD = −62.23, 95% CI: −83.27 to −41.19, P < .001) were decreased significantly compared with the control group.

Conclusions:

Our meta-analysis indicates that PHT monotherapy is associated with the increase in the serum homocysteine levels and decreased levels of folate and vitamin B12, and hyperhomocysteinaemia may contribute to the acceleration of the atherosclerotic process. Therefore, the patients under these medications should be monitored plasma homocysteine.
The clinicopathologic of pulmonary adenocarcinoma transformation to small cell lung cancer
Authors: Yang Haiyan , Liu Li , Zhou Chunhua , Xiong Yi , Hu Yijuan , Yang Nong , Qu Jingjing
Published: March 2019

Transformation to small cell lung cancer (SCLC) is one of the mechanisms of resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). However, it is uncertain how it works and there is no standard treatment after the transformation. In this study, 7 patients with transformation of SCLC from advanced lung adenocarcinoma (ADC) were analyzed retrospectively and the clinical pathology, imaging characteristics and treatment were analyzed.

We identified 7 patients with primary lung ADC that showed transformation to SCLC on second biopsy during a 6-year period. Clinicopathologic information was analyzed and EGFR mutation results were performed in initial biopsy samples.

Seven patients showed transformation from ADC to SCLC, of which 6 patients were 19 del EGFR mutation, only 1 patient is L858R mutations. The imaging forms did not have the typical imaging features of primary SCLC. All patients underwent etoposide and carboplatin (EC) regimen chemotherapy after pathological transformation. However, the response rate of EC was less than primary small cell lung cancer. One of the patients was receiving EC for 4 cycles. After chemotherapy the patients performed radiation therapy and finally with erlotinib maintains treatment, the progress free survival (PFS) was more than 12 months.

NSCLC can acquire a neuroendocrine phenotype with EGFR-TKI treatment. The transmutation is more common in 19del mutation patients. A comprehensive treatment based on EC regimen chemotherapy and the maintenance with EGFR-TKI is likely to be the appropriate treatment for these patients.
Differentiation between orbital malignant and benign tumors using intravoxel incoherent motion diffusion-weighted imaging
Authors: Xu Xiao-Quan , Hu Hao , Su Guo-Yi , Liu Hu , Wu Fei-Yun , Shi Hai-Bin
Published: March 2019

To evaluate the performance of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for differentiating orbital malignant from benign tumors, and to assess the correlation between IVIM-DWI parameters and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters.

Twenty-seven patients (17 benign and 10 malignant) with orbital tumors underwent 3.0T MRI examination for pre-treatment evaluation, including IVIM-DWI and DCE-MRI. IVIM-DWI parameters (tissue diffusivity, D; pseudo-diffusion coefficient, D∗; and perfusion fraction, f) were quantified using bi-exponential fitting model. DCE-MRI parameters (Ktrans, the volume transfer constant between the plasma and the extracellular extravascular space [EES]; Ve, the volume fraction of the EES, and Kep, the rate constant from EES to blood plasma) were quantified using modified Tofts model. Independent-sample t test, receiver operating characteristic curve analyses and Spearman correlation test were used for statistical analyses.

Malignant orbital tumors showed lower D (P <.001) and higher D∗ (P = .002) than benign tumors. Setting a D value of 0.966 × 10−3 mm2/s as the cut-off value, a diagnostic performance (AUC, 0.888; sensitivity, 100%; specificity, 82.35%) could be obtained for diagnosing malignant tumors. While setting a D∗ value of 42.371 × 10−3 mm2/s as cut-off value, a diagnostic performance could be achieved (AUC, 0.847; sensitivity, 90.00%; specificity, 70.59%). Poor or moderated correlations were found between IVIM-DWI and DCE-MRI parameters (D∗ and Kep, r = 0.427, P = .027; D and Ve, r = 0.626, P <.001).

IVIM-DWI is potentially useful for differentiating orbital malignant from benign tumors. Poor or moderate correlations exist between IVIM-DWI and DCE-MRI parameters. IVIM-DWI may be a useful adjunctive perfusion technique for the differential diagnosis of orbital tumors.
Milk and yogurt intake and breast cancer risk
Authors: Chen Lu , Li Min , Li Hao
Published: March 2019

Different patterns of milk and breast cancer rates across countries suggest that several components of milk could affect breast cancer risk. However, the components of diet are complex including milk that could potentially influence risk. Some milk products such as whole milk and cheese have a high fat content which may increase risk. Moreover, milk products may contain pesticides which have carcinogenic potential. In contrast, some contents of milk such as calcium and vitamin D have been hypothesized to reduce breast cancer risk. Therefore, we performed this meta-analysis to derive a more precise estimation of the association between dairy food intake and breast cancer risk. Using the data from 8 available publications, we examined low-fat/skim milk, whole milk, and yogurt in relation to risk of breast cancer by meta-analysis. Pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the association. However the results of all milk models and the available epidemiologic evidence do not support a strong association between the consumption of milk or milk products and breast cancer risk. Further studies with larger participants worldwide are needed to validate the relationship of dairy food intake and breast cancer.
Comparison of intravitreal bevacizumab and ranibizumab used for myopic choroidal neovascularization
Authors: Hu Qiuming , Li Haoyu , Du Yi , He Jianfeng
Published: March 2019

Background:

To evaluate the effect of intravitreal bevacizumab (IVB) and ranibizumab (IVR) for the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM) by meta-analysis.

Methods:

Pertinent publications of randomized controlled trials (RCTs) were identified through systemic searches of PubMed, EMBASE, Web of science, Cochrane Library, clinicaltrials.gov, CNKI, CQVIP, and Wanfang database. All comparative studies of IVB or IVR as treatment for CNV secondary to pathologic myopia were included. Meta-analysis of these RCTs was performed using Review Manager 5.3 software. The χ2 test and I
2 values were used to analyze heterogeneity. Measurements included best-corrected visual acuity (BCVA) and central foveal thickness (CFT).

Results:

A total of 3 randomized controlled clinical trials involving 158 eyes were included, 81 eyes in IVB group and 77 eyes in IVR group. Compared with baseline, at 1, 3, 6, and 12 months after IVB or IVR treatment, BCVA was significantly increased. Change of BCVA at 1, 3, 6, and 12 months did not vary significantly between IVB and IVR group (1 month: Z = 0.30, 95% CI = −0.08 to 0.11, P = .76; 3 months: Z = 0.36, 95% CI = −0.10 to 0.15, P = .72; 6 months: Z = 0.17, 95% CI = −0.10 to 0.12, P = .86; 12 months: Z = 0.64, 95% CI = −0.15 to 0.08, P = .52).

Conclusion:

Both IVR and IVB can significantly improve BCVA of eyes with mCNV, but there was no significant difference between the 2 therapies on the treatment of mCNV.
Comparison of efficacy and safety of different fixation devices for anterior cruciate ligament reconstruction
Authors: Jin Jiaxin , Yu Liping , Wei Min , Shang Yi , Wang Xin
Published: March 2019

Background:

Anterior cruciate ligament (ACL) injury is a common ligament injury to the knee joint, and often lead to limited function, osteoarthritis after knee trauma, secondary damage to meniscus and cartilage, and impaired quality of life. ACL reconstruction is the gold standard surgical treatment for ACL injury, and ligament fixation after reconstruction is the key factor of ACL reconstruction success. However, the optimal fixation device for ACL reconstruction remains unclear. This study aims to evaluate the efficacy and safety of different fixation devices and to find the best fixation device for ACL reconstruction.

Methods:

The PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese Biomedicine Literature will be searched to identify relevant studies from inception to December 2018. We will include randomized controlled trials (RCTs) comparing the effects of different fixation devices fixed on the femoral side in arthroscopically assisted ACL reconstruction. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian network meta-analysis (NMA) will be performed using R software.

Results:

The results of this NMA will be submitted to a peer-reviewed journal for publication.

Conclusion:

This NMA will summarize the direct and indirect evidence to evaluate the effect of different fixation devices for ACL reconstruction.
Late adverse effects related to treatment in a cohort of survivors of childhood and adolescent cancer
Authors: Livinalli Annemeri , Silva Marcus Tolentino , Lopes Luciane Cruz
Published: March 2019

Taking into consideration the progress in cancer treatment, an increase in the number of adult survivors of childhood cancer is expected. These survivors will have received treatment that predisposes them to late morbidity and increased risk of early mortality. The aim of this single-center retrospective cohort study was to describe the frequency and identify risk factors associated with late adverse events related to cancer treatment in survivors of childhood and adolescent cancer.

Patients were recruited from 2010 to 2014. All possible late adverse effects identified, were classified according to CTCAE grading system version 4.0. The variables were characterized and stratified according to the presence or not of late effects. Odds ratio was used as a measure of association in bivariate analysis to identify characteristics associated with the late effects of treatment. Among 111 potentially eligible participants, 62 survivors met the inclusion criteria; 17 (27.4%) had abnormal test results observed in the systems: 8 (47%) in the endocrine and metabolic, 7 (41.2%) in the cardiovascular, 5 (29.4%) in the musculoskeletal, and 1 (5.9%) in auditory and renal systems. Frequency and severity of late adverse events were not affected by treatments employed; except for radiotherapy which was associated with a higher risk of late adverse effect occurrences.
Effects of different oral care scrubs on ventilator-associated pneumonia prevention for machinery ventilates patient
Authors: Wei Hua-ping , Yang Kelu
Published: March 2019

Background:

Ventilator-associated pneumonia (VAP) is defined as pneumonia develops in intensive care unit (ICU) patients who have been mechanically ventilated for at least 48 hours. Implementing effective oral car could reduce the incidence of VAP. However, previous studies on scrubs in oral care have failed to suggest which the best choice. Therefore, this protocol proposes to perform a network meta-analysis to evaluate the effectiveness of different oral care scrubs in preventing VAP.

Methods:

We are going to search the electronic databases: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, and Chinese Biomedical Literature Database. Study selection and data collection will be performed independently by 2 reviewers. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. Odds ratio (OR) and 95% confidence intervals (CIs) will be used to assess the incidence rate of VAP in critical patients. The evidence mapping (EM) method will be introduce as a tool intended to complement the conventional systematic review (SR) and is suitable for this issue, at the same time, R software will be used for representing the outcome of EM–SR. We shall assess the heterogeneity on the bias of the magnitude of heterogeneity variance parameter (I
2 or Cochrane Q). We are also going to conduct subgroup analysis and sensitivity analysis if needed. The application of Stata and R software will be performed the calculations.

Results:

The results of this study will be submitted to a peer-reviewed journal for publication.

Conclusion:

This network meta-analysis will provide comprehensive evidence of different scrubs in oral care for preventing VAP.

PROSPERO registration number:

CRD42018117019.
The efficacy and safety of opening-wedge high tibial osteotomy in treating unicompartmental knee osteoarthritis
Authors: Huang Si-cong , Chen Yu-fang , Liu Xue-dong , Han Yan-hong , Li Yi-qun
Published: March 2019

Background:

High tibial osteotomy (HTO) is an effective surgical technique that can stop or inhibit the progression of unicompartmental knee osteoarthritis (KOA) to avoid or postpone the need for knee arthroplasty in patients. Whether opening-wedge high tibial osteotomy (OWHTO) is superior to closing-wedge high tibial osteotomy (CWHTO) in treating unicompartmental KOA remains controversial.

Methods:

Databases (Cochrane Library, EMBASE, and PubMed) were searched from their establishment to July 1, 2018 for randomized controlled trials comparing the application of OWHTO to CWHTO in patients with unicompartmental KOA. The methodological quality of each included study was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions guideline. Review Manager 5.3.5 software (Cochrane Collaboration, Oxford, UK) was used to synthesize the final results.

Results:

The results will provide useful information about the effectiveness and safety of OWHTO in patients with unicompartmental KOA.

Conclusion:

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

PROSPERO registration number:

CRD4201811805.
Three-dimensional assessment of condylar position following orthognathic surgery using the centric relation bite and the ramal reference line
Authors: Lee Chang-Hyeon , Cho Seoung-Won , Kim Ju-Won , Ahn Hyo-Jung , Kim Young-Hee , Yang Byoung-Eun
Published: March 2019

Orthognathic surgery (OGS) is a relatively common procedure for solving functional and aesthetic problems in facial and jaw areas in patients with dentofacial deformities. The positioning of the mandibular condylar segment during OGS has an impact on the surgical outcome. This study aimed to investigate the changes in the condyle-fossa relationship three dimensionally after OGS using the centric relation (CR) bite and the ramal reference line (RRL).

Thirty-two patients with skeletal malocclusion underwent OGS. Condylar repositioning was performed using the CR bite, as previously reported. A RRL was added to the existing method and used during the surgery. Cone-beam computed tomography scans were acquired at 4 time points. Sixty-four condyles were evaluated in the coronal, sagittal, and axial views. Two groups were created according to the amount of mandible setback (SB1 vs SB2), and another 2 groups were created according to the maxillary operation (1-jaw vs 2-jaw). Each was then compared at the 4 time points. Differences between the values before (T0) and a year after surgery (T3) were also investigated. The positions of the pogonion and the menton were examined at T2 and T3 for the simple evaluation of relapse.

The change in the condylar position was significant over a time-course (P < .001) but not between T0 and T3 (P > .05). Neither the setback amount nor the maxillary operation affected the positional change (P > .05). There were no significant changes between T2 and T3 in the relapse evaluation.

This condylar repositioning method using the CR bite and a RRL showed stable results after OGS. This method is noninvasive and cost-effective and can be easily performed even by an inexperienced surgeon because it reduces errors in repositioning the condyle during OGS.
Leptin mediates the relationship between fat mass and blood pressure
Authors: Fujita Yuki , Kouda Katsuyasu , Ohara Kumiko , Nakamura Harunobu , Iki Masayuki
Published: March 2019

Animal studies have shown that leptin mediates the association between obesity and hypertension. However, only a few studies have assessed this relationship in population-based epidemiological studies. This study aimed to determine whether leptin mediates the relationship between body fat and blood pressure in school-aged children.

A cross-sectional survey was conducted among school-aged children in Hamamatsu, Japan. Body fat was measured using dual-energy X-ray absorptiometry. Height-normalized index of fat mass (fat mass index) was calculated by dividing fat mass by height squared. Serum leptin levels were measured by enzyme-linked immunosorbent assay. Multiple regression analysis was used to evaluate relationships between body fat, serum leptin levels, and blood pressure. The mediating effect of leptin on the association between body fat and blood pressure was assessed by causal mediation analysis and regression analysis.

Both fat mass index and leptin were significantly and positively associated with blood pressure. Fat mass index was also strongly associated with serum leptin levels. Body fat and blood pressure were no longer associated after adjusting for leptin. These findings suggest that the association between body fat and blood pressure is mediated by leptin. Of the total effect of fat mass index on blood pressure, the mediating effect of leptin accounted for 78.6% (P = .03) in boys and 42.2% (P = .11) in girls.

Our findings suggest that body fat is associated with blood pressure, and this association is mediated by leptin. Thus, leptin acts as a mediator that links body adiposity with blood pressure elevation in school-aged children.
The role of photobiomodulation when associated with microneedling in female pattern hair loss
Authors: da Silveira Suzana Polonca , Moita Sandra Rojas Urquizas , da Silva Silvia Vicente , Rodrigues Maria Fernanda Setúbal Destro , da Silva Daniela de Fátima Teixeira , Pavani Christiane
Published: March 2019

The female hair loss pattern was originally described as a synonym for androgenetic alopecia. It has been defined as progressive miniaturizations of the hair follicles, with a great impact on the quality of life of affected patients, causing significant psychosocial limitations. It was recently proven that photobiomodulation is a safe and effective way to treat the different types of hair loss. It was also known that microneedling is a minimally invasive dermatological procedure that is applied to a wide range of dermatological conditions, including androgenic alopecia, telogen effluvium, as well as other facial and bodily conditions.

Goal:

The aim of this study is to verify if there is an increase in the capillary density of strands of hair, when combining 660 nm red laser photobiomodulation and microneedling in addressing female pattern hair loss (FPHL).

Methods:

There will be 66 patients divided into 3 treatment groups. G1: microneedling and 660 nm red laser photobiomodulation sham; G2: 660 nm red laser photobiomodulation and microneedling sham; G3: microneedling and 660 nm red laser photobiomodulation. The treatment will consist in 36 sessions, 3 times a week for 3 consecutive months, with an insertion of microneedling every 30 days. The patients and the researchers will be blinded. The patients will be evaluated before, during, and after the treatments, by digital photography and the trichoscopy method (dermoscopic imaging of the scalp and hair).

Expected Results:

It is expected that differences will be found in the growth rates of a strand of hair in mm/d, in the density of a strand of hair in n/cm2, in the diameter of a strand of hair, as well as in the anagen/telogen ratio.

Ethics and dissemination:

This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of November 28, 2018 (CAAE: 01381718.0.0000.5511 - Acceptance Number: 3044061). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-76VCCV). This study is not yet recruiting. Issue date: February 20, 2019.
Association between interleukin-17A/F single nucleotide polymorphisms and susceptibility to osteoarthritis in a Chinese population
Authors: Jiang Lifeng , Zhou Xindie , Xiong Yan , Bao Jiapeng , Xu Kai , Wu Lidong
Published: March 2019

Interleukin-17A/F (IL-17A/F) might play a role in the pathophysiology of osteoarthritis (OA), but several studies exploring the association between IL-17A/F single nucleotide polymorphisms and OA in different populations present inconsistent results. Thus, this case–control study, involving 410 OA cases and 507 controls, was aimed to investigate such association in a Chinese population. Genotyping was performed using standard polymerase chain reaction and restriction fragment length polymorphism. It was found that AA genotype or A allele carriers of IL-17A gene rs2275913 polymorphism were associated with OA susceptibility. Stratified analyses showed IL-17A rs2275913 polymorphism was evidently associated with a significantly increased risk for OA among males, <60 years old patients, smokers, and drinkers. No significant association was observed between IL-17F gene rs763780 polymorphism and OA risk. In conclusion, IL-17A rs2275913 polymorphism is involved in the development of OA in Chinese Han population. This finding should be confirmed by a larger study from diverse ethnic populations.
Association between RUNX3 gene polymorphisms in severe preeclampsia and its clinical features
Authors: Zhang Yanping , Wang Tao , Jia Jin , Cao Wen , Ye Lei , Wang Yanyun , Zhou Bin , Zhou Rong
Published: March 2019

Preeclampsia is a complex genetic disorder and its pathogenesis remains to be investigated. Single nucleotide polymorphisms serve important roles in genetic predisposition. The present study aimed to explore the association between runt-related transcription factor 3 (RUNX3) gene polymorphisms in severe preeclampsia (SPE) and clinical features.

A total of 417 participants were enrolled in the present study. The rs2236852, rs7528484 and rs760805 polymorphisms of the RUNX3 gene were tested using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Clinical information of patients and controls was collected. Relationship between clinical feature and different genotype was analyzed.

Compared with rs2236852 GG genotype carriers, the odds ratios (OR) for the risk of SPE were 2.26 [95% confidence interval (CI), 1.24–4.12; P = .023] in AA genotype carriers. A significantly increased risk of SPE was associated with AG/AA genotypes compared with GG genotypes (OR, 1.74; 95% CI, 1.11–2.75; P = .015). AA homozygote carriers with SPE exhibited lower birth weight, shorter birth length and reduced incidence of hypoproteinemia compared with AG heterozygote carriers (P <.05). A significantly increased risk of SPE was determined to be associated with the rs7528484 CC genotype in codominant and recessive models (CC vs TT: OR, 3.70, 95% CI, 1.31–10.43, P = .01; CC vs TT/TC: OR, 3.98, 95% CI, 1.46–10.87, P = .003). Patients carrying C-allele (TC + CC) presented increased systolic pressure and an increased incidence of neonatal pneumonia compared with TT homozygote carriers (P <.05). Compared with rs760805 TT homozygote carriers, patients carrying AA homozygote exhibited significantly reduced 24 hours urinary protein levels, lower serum creatinine concentrations and a decreased incidence of neonatal asphyxia (P <.05).

The present study suggested a genetic association between RUNX3 gene polymorphisms and SPE. The data provided a novel insight to guide future investigations.
Detection of Rectal Chlamydia trachomatis in Heterosexual Men Who Report Cunnilingus
Authors: Batteiger Teresa A. , Jordan Stephen J. , Toh Evelyn , Fortenberry Lora , Williams James A. , LaPradd Michelle , Katz Barry , Fortenberry J. Dennis , Dodge Brian , Arno Janet , Batteiger Byron E. , Nelson David E.
Published: March 2019

Background

Rectal infection with Chlamydia trachomatis (CT) is frequent in women who deny receptive anal sex and is thought to arise from autoinoculation of the rectum from vaginal secretions. An alternate hypothesis is that oral sex inoculates and establishes gastrointestinal tract infection. Distinguishing these hypotheses is difficult in women. In men, autoinoculation is unlikely and heterosexual men frequently perform oral sex, but rarely participate in receptive anal exposure behaviors.

Methods

We enrolled high-risk men with and without nongonococcal urethritis who presented to a sexually transmitted infection clinic in Indianapolis, Indiana. Urine and rectal swabs were collected and tested for urogenital and rectal CT, Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG). Men completed surveys concerning symptoms, sexual orientation, and detailed recent and lifetime oral and anal sexual behaviors.

Results

Rectal CT was detected in 2/84 (2.4%) heterosexual men who reported cunnilingus, but no lifetime receptive anal behaviors. All of the men who denied receptive anal behaviors were negative for rectal NG and MG. In homosexual and bisexual men, rectal CT prevalence was high (9.7%), and rectal NG (4.8%) and MG (4.8%) were also detected.

Conclusions

We detected rectal CT infections in heterosexual men who reported cunnilingus but denied receptive anal behaviors. Oral sex may be a risk factor for rectal CT infection via oral inoculation of the gastrointestinal tract.
Treatment According to a Comprehensive Molecular Profiling Can Lead to a Better Outcome in Heavily Pretreated Patients With Metastatic Cancer
Authors: Seeber Andreas , Chahine Georges , Nasr Fadi , Dean Andrew , Miranova Mira , Jameson Gayle , Robert Nicholas , Gastl Guenther , Zwierzina Heinz
Published: March 2019

Purpose

Improvements in systemic treatment have led to a prolongation of survival and quality of life in patients with metastatic tumors in recent years. However, despite this improved standard of care, it is expected that the progression-free survival (PFS) for patients with refractory cancers will continue to decline over subsequent therapy lines. In those patients, studies and meta-analyses showed that treatment based on multiplatform molecular profiling (MMP) of tumor tissue may derive a clinical benefit. The aim of this study was to analyze if molecular-based therapy may prolong PFS compared with the PFS of the immediately prior therapy.

Methods

We pooled clinical data of 140 patients treated within 3 recently conducted pilot studies and included an additional 21 patients who were treated within the ongoing ONCO-T-PROFILE program. The PFS of the molecular-based treatment was compared with the PFS of the previous therapy using Kaplan-Meier curves.

Results

In heavily pretreated cancer patients, the PFS could be significantly improved using molecular-based treatment options (120.0 vs. 89.5 days). More than 50% of patients showed a clinical benefit from MMP-guided therapy as defined by a PFS ratio of 1.3 or greater.

Conclusions

We conclude that pretreated cancer patients can benefit from incorporation of molecular profiling, as demonstrated by not only an increase of the PFS ratio but also PFS. Further randomized trials in specific tumor subtypes may help establish specific patient populations who might benefit most from MMP guidance.
Repurposing Drugs for Cancer Radiotherapy
Authors: Khan Mohammad K. , Nasti Tahseen H. , Buchwald Zachary S. , Weichselbaum Ralph R. , Kron Stephen J.
Published: March 2019

It has long been recognized that combining radiotherapy with cytotoxic drugs such as cisplatin can improve efficacy. However, while concurrent chemoradiotherapy improves patient outcomes, it comes at costs of increased toxicity. A tremendous opportunity remains to investigate drug combinations in the clinical setting that might increase the benefits of radiation without additional toxicity. This chapter highlights opportunities to apply repurposing of drugs along with a mechanistic understanding of radiation effects on cancer and normal tissue to discover new therapy-modifying drugs and help rapidly translate them to the clinic. We survey candidate radiosensitizers that alter DNA repair, decrease hypoxia, block tumor survival signaling, modify tumor metabolism, block growth factor signaling, slow tumor invasiveness, impair angiogenesis, or stimulate antitumor immunity. Promising agents include widely used drugs such as aspirin, metformin, and statins, offering the potential to improve outcomes, decrease radiation doses, and lower costs. Many other candidate drugs are also discussed.
Factors Associated With Disease Damage in Puerto Ricans With Primary Sjögren Syndrome
Authors: Jordán-González Patricia , Gago-Piñero Ricardo , Vázquez-Sanabria Irma , Pérez-Ríos Naydi , Vilá Luis M.
Published: March 2019

Objective

The aim of this study was to determine the association of demographic parameters, clinical manifestations, disease activity, and pharmacologic therapy with disease damage in a group of Puerto Ricans with primary Sjögren syndrome (pSS).

Methods

A cross-sectional study was conducted in 100 Hispanics of Puerto Rico with pSS. Patients were 21 years or older and fulfilled the 2012 American College of Rheumatology classification criteria for pSS. Demographic factors, lifestyle behaviors, extraglandular manifestations, serologic tests, comorbidities, pharmacologic therapy, disease activity (per European League Against Rheumatism Sjögren Syndrome Disease Activity Index), and disease damage (per Sjögren Syndrome Disease Damage Index [SSDDI]) were assessed. Patients with disease damage (SSDDI ≥1) and without damage (SSDDI = 0) were compared using bivariate analysis and multivariate regression analysis adjusted for age, sex, and disease duration.

Results

The mean age of patients was 52.8 years; 94% were women. The mean disease duration was 5.9 years. Thirty-nine patients had disease damage. Disease damage was mainly attributed to pulmonary fibrosis and peripheral neuropathy. In the bivariate analysis, disease damage was associated with low C3 and C4, coronary artery disease, infections, and higher activity index and was more frequently treated corticosteroids and azathioprine. In the multivariate analysis, low C3, disease activity, and corticosteroid exposure retained significance.

Conclusions

In this population of Puerto Ricans with pSS, C3 and C4 hypocomplementemia, coronary artery disease, infections, and exposure to corticosteroids and azathioprine were associated with damage accrual. Clinicians should be aware of these factors to identify those who may require close follow-up and early therapeutic intervention.
Number of Excised Lymph Nodes Has No Impact on Relapse and Survival in Patients With Stage III Melanoma
Authors: Tas Faruk , Erturk Kayhan
Published: March 2019

Background

Even though both the involvement of regional lymph nodes and the number of metastatic lymph nodes are regarded as major determinants of survival in cutaneous melanoma, the extent of node dissection has been analyzed as an independent prognostic indicator in only a few studies. This study aims to determine how the extent of lymph node excision (EN) might predict the disease relapse and survival in melanoma.

Methods

A total of 317 patients with stage III melanoma were included in the study and reviewed retrospectively. The patients were divided into 2 groups based on the number of the excised lymph nodes: EN1 for fewer than 10 and EN2 for 10 or more lymph nodes removed.

Results

The median number of positive nodes was 1 (range, 1–32). The largest group was N1 (52.4%), which was followed by N2 (29.6%) and N3 (18%). The median number of EN was 13 (range, 1–73). The patients were allocated to EN1 and EN2 as follows: 31.9% and 68.1%, respectively. The rates of EN2 patients were 62.2%, 72.2%, and 78.2% in N1, N2, and N3, respectively. For all patients, the estimated 5- and 10-year relapse-free survival rates were 41% and 39%, respectively; and the estimated 5- and 10-year overall survival rates were 51% and 42%, respectively. Extension of lymph node excision was found to be not prognostic for relapse and survival (P = 0.55 and P = 0.88, respectively).

Conclusions

Extension of lymph node excision has no impact on relapse and survival of stage III cutaneous melanomas.
Rosai-Dorfman Disease
Authors: Karami Reem , Ghieh Fadi , Baroud Joe , Abu Sittah Ghassan
Published: March 2019

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare and benign proliferative disease that affects histiocytes. Its etiology remains unclear. Rosai-Dorfman disease primarily affects lymph nodes with many extranodal manifestations present, including cutaneous, pulmonary, ophthalmic, and gastrointestinal. Diagnosis is mainly histologic with the presence of Rosai-Dorfman cells, which demonstrate emperipolesis. We report a case of a 30-year-old man who presented with a facial cutaneous mass and was diagnosed with RDD; he underwent surgical excision. The patient experienced recurrent lesions on the surgical scar and parotid gland as well as the lower back. Treatment consisted of systemic steroids and surgical excision.
Malignant Phyllodes Tumor Recurrence in the Pleural Cavity via the Deep Inferior Epigastric Perforator Flap and Internal Mammary Vessel Bundle
Authors: Fang Chien-Liang , Hsu Chin-Hao , Tu Chin-Wen
Published: March 2019

We report a rare case that after rapid recurrence there was pathological transition from a fibroadenoma and benign phyllodes tumor to borderline and malignant phyllodes tumor. Another rare finding included tumor dissemination in the pleural cavity via reconstructed deep inferior epigastric perforator flap edge and internal mammary vessel bundle. Hence, we eliminated the use of internal mammary vessel bundle as the recipient vessel for free-flap reconstruction to avoid recurrence in the pleural cavity. Remarkably, we achieved successful reconstruction of 2 huge defects (reconstruction of breast following mastectomy and that of chest wall following en bloc excision of recurrence) using 2 different free flaps.
The Cost to Attending Surgeons of Resident Involvement in Academic Hand Surgery
Authors: Zhu William Y. , Beletsky Alexander , Kordahi Anthony , Reid Chris M. , Brandel Michael G. , Suliman Ahmed , Herrera Fernando A.
Published: March 2019

Purpose

For many types of surgical cases, there is an increase in length with the participation of a resident physician. The lost operative time productivity is not necessarily mitigated in any fashion other than to benefit the experience of the trainee. Moreover, increasing pressures to maximize productivity, coupled with diminishing reimbursements serve to disincentive resident involvement. The aim of this study was to examine the opportunity cost in the academic setting for intraoperative resident participation during specific hand surgery cases.

Methods

Retrospective analysis was performed on the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database from 2006 to 2015. Cases were identified by Current Procedural Terminology code to isolate distal radius fracture repairs, carpal tunnel releases, scaphoid fractures repairs, and metacarpal fracture repairs. Variables collected included operation time, presence or absence of resident physician, and postgraduate year level. Statistical analysis was performed using the statistical computing software R 3.4.2 (R Foundation for Statistical Computing, Vienna, Austria). Cost analysis was performed to quantify the effect of operative times in terms of relative value units (RVUs) lost.

Results

A total of 3727 cases were identified. Of those, 1264 cases were performed with a resident present. Residents participated in cases with higher total RVU (14.91 vs 13.16, P < 0.001). There was a statistically significant increase of 24.3 minutes (P < 0.001) in the mean operation time with a resident present as compared with those without. Moreover, RVU per hour in resident cases was significantly lower by 2.97 RVU per hour or 21% (P < 0.001). Using the late 2018 Medicare physician conversion factor of US $33.9996, the opportunity cost to attending physicians is US $159.20 per case.

Conclusions

Resident participation in surgical cases is paramount to the education of future trainees, particularly in the era of trainee duty hour reform. Because residents are participating in higher total RVU cases, this selection bias may be playing a role in explaining our result. Nonetheless, resident involvement for certain procedures comes at an opportunity cost to faculty surgeons. How to balance the cost to train residents in the emerging value-based health systems will prove to be challenging but requires consideration.
Where has the ‘bio’ in bio-psycho-social gone?
Authors: Schweinhardt Petra
Published: March 2019

Purpose of review

Current definitions of pain do not necessitate tissue damage. This is important because it does justice to the pain patient in whom a nociceptive source is not detectable. However, in conjunction with exciting findings regarding supraspinal pain modulation and a (perceived) failure of identifying nociceptive sources in individual patients, this might have led to a devaluation of the role of nociception for chronic pain. In this review, the relative importance of nociception versus psychological factors for chronic pain is examined by scrutinizing the example of pain present several months following surgical joint replacement for severe osteoarthritis.

Recent findings

In most patients with chronic pain due to severe osteoarthritis, removal of the putative nociceptive source leads to pain elimination/reduction, indicating that their pain depended on nociceptive input. Furthermore, the influence of psychological factors on outcomes following joint replacement for severe osteoarthritis is limited: pain catastrophizing, which is the most consistently identified psychological factor influencing outcome, explains less than 10% of the variance of pain magnitude several months after knee replacement. The influence of psychological factors might be larger for pain disability than for pain magnitude, which could skew the perception of the importance of psychological factors.

It appears that the importance of nociception relative to psychological factors is often underestimated, at least in the instance of pain present several months following surgical joint replacement for severe osteoarthritis. Because this might apply also to other chronic pain patients, in particular those without disability, research should not neglect the investigation of nociceptive mechanisms, in particular how they might be detected clinically.
Anxiety and Brain Networks of Attentional Control
Authors: Ghassemzadeh Habibollah , Rothbart Mary K. , Posner Michael I.
Published: March 2019

Advances in the study of brain networks can be applied to our understanding of anxiety disorders (eg, generalized anxiety, obsessive-compulsive, and posttraumatic stress disorders) to enable us to create targeted treatments. These disorders have in common an inability to control thoughts, emotions, and behaviors related to a perceived threat. Here we review animal and human imaging studies that have revealed separate brain networks related to various negative emotions. Research has supported the idea that brain networks of attention serve to control emotion networks as well as the thoughts and behaviors related to them. We discuss how attention networks can modulate both positive and negative affect. Disorders arise from both abnormal activation of negative affect and a lack of attentional control. Training attention has been one way to foster improved attentional control. We review attention training studies as well as efforts to generally improve attention networks through stimulation in self-regulation.