bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of the HIV GWG variant in the HIV infection progression in mono and HCV coinfected patients
Authors: Hebeler-Barbosa Flavia , Massolini Viviam Milanez , Watanabe Thais , Silva Giovanni Faria , Barbosa Alexandre Naime , Simões Rafael Plana , Ferrasi Adriana Camargo , de Andrade Zanotto Paolo Marinho , de Moura Campos Pardini Maria Inês , Grotto Rejane Maria Tommasini
Published: July 2019

The HIV subtype B is the most frequent in Brazil. The HIV subtype B’ codes the amino acids glicine-tryptophan-glicine (GWG) instead of glicine-proline-glicine on the tip of gp120 V3 loop. This variant was associated to a slower HIV progression in mono-infected patients; however, there is no information in coinfected patients. This study evaluated the infection progression of HIV variant B’ on the hepatitis C virus presence. RNA isolated from plasma of the 601 infected patients were used to human immunodeficiency virus (HIV) subtyping and to classify the virus according their syncytium-inducing ability. The HIV infection progression was evaluated by clinical and laboratorial data. The results showed a significant association between HIV B’ variant and CD4 count and time of AIDS in HIV mono-infected patients. Notwithstanding the fact that we did not find a direct association between GWG variant and AIDS and in HIV coinfected patients no mitigating effect due to GWG presence was found. We did observe that the association between GWG variant and CD4 counts is lost in coinfected patients. This is first work showing influence of the HIV GWG variant in coinfected patients. Nevertheless, the presence of the GWG variant can indicate a better prognostic in the mono-infected patients.
Laparoscopic resection of intestinal stromal tumors with transrectal extract specimen
Authors: Wang Xuewei , Wang Peng , Su Hao , Liang Jianwei , Zhou Haitao , Zhou Zhixiang
Published: July 2019

Rationale:

Small intestine stromal tumors (SISTs) are a type of gastrointestinal stromal tumor (GIST) that has an insidious onset. Natural orifice specimen extraction (NOSE) surgery has been gradually developed for the treatment of colorectal, stomach, small intestine, hepatobiliary, and gynecological tumors because of its safety and feasibility. This case study explored the possibility of applying the NOSE method for the treatment of SIST.

Patient Concerns:

A 59-year-old male patient was admitted to the hospital after having an irregular abdominal mass for >1 month that was detected by a medical examination. Thoracic and abdominopelvic enhanced computer tomography revealed irregular masses on the left side of the abdominal cavity.

Diagnosis:

Sist.

Interventions:

Nose (laparoscopic resection of intestinal stromal tumors with transrectal extract specimen and no abdominal auxiliary incision) surgery was performed.

Outcomes:

The patient underwent operation successfully and recuperates well with no complications.

Lessons:

Nose surgery is minimally invasive, results in patient recuperation with no complications, and is considered to be feasible for SIST treatment.
Anesthesiologists’ acquisition of hepatitis B virus infection
Authors: Tian Jingling , Tan Fang , Lai Lifei , Deng Yingqing , Chi Xinjin , Geng Hongfang , Zhu Qianqian
Published: July 2019

Occupational exposure remains a serious problem for medical staff, especially those working in operation rooms. Hepatitis B virus (HBV) is prevalent in patients undergoing surgery, and anesthesiologists are at risk of occupational acquisition of blood-borne HBV infection. To the best of our knowledge, there are no data about HBV prevalence and vaccinations, as well as attitudes toward sharp injuries and gloving among anesthesiologists in China, where the HBV prevalence is high. To clarify these, the present study was conducted.

An electronic questionnaire including HBV markers, gloving during practice, and reporting patterns of sharp injuries was created and sent to anesthesiologists.

After excluding 10 uncompleted questionnaires, 1739 questionnaires were included in the final analysis. Of all analyzed anesthesiologists, 1599 (91.9%) had experienced sharp injuries, and 1313 (75.5%) had experienced >1 sharp injury. Considering HBV vaccination histories, 1381 anesthesiologists (79.4%) received 3 vaccination doses, and only half of the immunized anesthesiologists received reminder HBV vaccination doses after work before exposure. There were 696 anesthesiologists (40.0% of all participants) who were ever exposed to HBV, and nearly two-thirds of them (440) were exposed to HBV more than once. There was a more positive attitude toward gloving and double-gloving to reduce HBV exposure.

The incidence of occupational HBV exposure among anesthesiologists is high, and its threat should be considered. HBV vaccinations and adherence to postexposure guidelines are recommended. The high prevalence of sharp injuries during anesthesia practice highlights the importance of safe anesthesia practices, such as gloving or double-gloving, especially when in contact with high-risk body fluids.
Prediction of response to immune checkpoint inhibitor therapy using 18F-FDG PET/CT in patients with melanoma
Authors: Amrane Karim , Le Goupil Delphine , Quere Gilles , Delcroix Olivier , Gouva Sylvie , Schick Ulrike , Salaun Pierre-Yves , Abgral Ronan , Alavi Zarrin , Keromnes Nathalie , Querellou Solène
Published: July 2019

We aimed to assess serial 18F-FDG PET/CT imaging according to morphological (RECIST1.1, iRECIST) and functional (PERCIST, PECRIT) criteria to predict clinical response to therapy in patients with advanced melanoma receiving immune checkpoint blocking agents.

Retrospective data collection and analysis was done for 37 patients with unresectable metastatic cutaneous melanoma eligible for immunotherapy (cycles: 4 for ipilimumab and pembrolizumab/ 6 for nivolumab).18F-FDG PET/CT imaging was performed prior to (18F-FDG PET/CT 0) and 14 weeks after ICI onset (18F-FDG PET/CT 1). Some cases during the follow-up required imaging (18F-FDG PET/CT 2). Assessment of patient response to treatment was done according to RECIST1.1, iRECIST, PERCIST and PECRIT criteria.

Among 37 assessed patients, 27 had 1 line of ICI, 8 had 2 lines of ICI and 2 patients had 3 lines of ICI: total of 49 PET/CTs. Mean time between initiation of ICI and 18F-FDG PET/CT (1 or 2) were respectively 13.82 ± 4.32 and 24.73 ± 9.53 weeks. Time between 18F-FDG PET/CT 1 and 18F-FDG PET/CT 2 was at mean +/− SD: 11.19w ± 5.59. Median PFS was 29.62 months (range 22.52–36.71) (P = .001: RECIST 1.1), (P < .0001: iRECIST), (P = .000: PERCIST), (P = .072: PECRIT). Median OS was 36.62 months (30.46–42.78) (P = .005: RECIST 1.1), (P < .0001: iRECIST), (P = .001: PERCIST), (P = .082 PECRIT).

18F-FDG PET/CT could detect eventual ICI-response in patients with metastatic melanoma undergoing ICI using iRECIST and PERCIST criteria
Squawks in interstitial lung disease prevalence and causes in a cohort of one thousand patients
Authors: Pereira Carlos A.C. , Soares Maria R. , Boaventura Rafaela , Castro Marina D.C. , Gomes Paula S. , Gimenez Andrea , Fukuda Cesar , Cerezoli Milena , Missrie Israel
Published: July 2019

Squawks are lung adventitious sounds with a mix of both musical and nonmusical components heard during the inspiratory phase. Small series have described squawks in interstitial lung diseases. Hypersensitivity pneumonitis and other diseases involving small airways can result in squawks, but new interstitial lung diseases (ILDs) involving peripheral airways are being described. A retrospective analysis was performed on 1000 consecutive patients from a database of ILD of a tertiary referral center. Squawks were recorded in 49 cases (4.9%), hypersensitivity pneumonitis (23 cases), connective tissue disease (7), microaspiration (4), pleuroparenchymal fibroelastosis (4), fibrosing cryptogenic organizing pneumonia (, 3), familial ILD (2), sarcoidosis (2), idiopathic pulmonary fibrosis (IPF; 1), bronchiolitis (2), and nonspecific interstitial pneumonia (1). One patient had a final diagnosis of IPF. There was a significant association between mosaic pattern and squawks: 20 cases with squawks (40.8%) had mosaic pattern compared with 140 (14.7%) cases without squawks (x
2 = 23.6, P < .001).

Findings indicative of fibrosis were described on high-resolution chest tomography (HRCT) in 715 cases (71.5%). Squawks were more common in patients with findings indicative of fibrosis on HRCT: 45 of 715 (6.3%) compared with 4 of 285 (1.4%) of those without findings indicative of fibrosis (x
2 = 10.46, P = .001).

In conclusion, squawks are an uncommon finding on physical examination in patients with ILD, but when present suggest fibrosing ILD associated with bronchiolar involvement. However, squawks are rare in IPF.
Lens capsular flap in the management of posterior retinal hole associated retinal detachment in high myopic eyes with previous internal limiting membrane peeling
Authors: Chen Yen-Chih , Yang Chung-May , Chen San-Ni
Published: July 2019

Rationale:

Managing retinal detachment due to posterior retinal holes is problematic since standard laser retinopexy or scleral buckling may be difficult to apply and may have brought serious complication. Another surgical method in treating posterior hole related retinal detachment is desired.

Patient concerns:

Three high myopia patients with previous vitrectomy and membrane peeling history suffered from blurred vision and retinal detachment due to posterior pole retinal holes was diagnosed.

Diagnoses:

Patient diagnosed retinal detachment due to posterior retinal holes either as paracentral retinal breaks or macular hole from both indirect ophthalmoscope exam and fundus photography

Interventions:

The patient underwent lens capsular flap insertion into all the retinal holes, along with gas tamponade or silicone oil tamponade. No laser retinopexy was performed around the retinal holes.

Outcomes:

Of 3 included patients, 1 patient had insertion of the lens capsular flap, an incomplete air-fluid exchange, and 24% sulfur hexafluoride gas tamponade. The other 2 patients, after lens capsular flap insertion, had air-fluid exchange and subretinal fluid drainage with extrusion via soft needle through superior drainage retinotomy and silicon oil tamponade. The retinal holes of all eyes were sealed with retina attached postoperatively.

Lessons:

Lens capsular flap is effective in sealing posterior retinal holes and treating the associated retinal detachment without the complication resulting from laser retinopexy, especially in eyes without sufficient internal limiting membrane (ILM) tissue due to previous ILM peeling.
Quantitative CT texture analysis for diagnosing systemic sclerosis
Authors: Milanese Gianluca , Mannil Manoj , Martini Katharina , Maurer Britta , Alkadhi Hatem , Frauenfelder Thomas
Published: July 2019

To test whether texture analysis (TA) can discriminate between Systemic Sclerosis (SSc) and non-SSc patients in computed tomography (CT) with different radiation doses and reconstruction algorithms.

In this IRB-approved retrospective study, 85 CT scans at different radiation doses [49 standard dose CT (SDCT) with a volume CT dose index (CTDIvol) of 4.86 ± 2.1 mGy and 36 low-dose (LDCT) with a CTDIvol of 2.5 ± 1.5 mGy] were selected; 61 patients had Ssc (“cases”), and 24 patients had no SSc (“controls”). CT scans were reconstructed with filtered-back projection (FBP) and with sinogram-affirmed iterative reconstruction (SAFIRE) algorithms. 304 TA features were extracted from each manually drawn region-of-interest at 6 pre-defined levels: at the midpoint between lung apices and tracheal carina, at the level of the tracheal carina, and 4 between the carina and pleural recesses. Each TA feature was averaged between these 6 pre-defined levels and was used as input in the machine learning algorithm artificial neural network (ANN) with backpropagation (MultilayerPerceptron) for differentiating between SSc and non-SSc patients.

Results were compared regarding correctly/incorrectly classified instances and ROC-AUCs.

ANN correctly classified individuals in 93.8% (AUC = 0.981) of FBP-LDCT, in 78.5% (AUC = 0.859) of FBP-SDCT, in 91.1% (AUC = 0.922) of SAFIRE3-LDCT and 75.7% (AUC = 0.815) of SAFIRE3-SDCT, in 88.1% (AUC = 0.929) of SAFIRE5-LDCT and 74% (AUC = 0.815) of SAFIRE5-SDCT.

Quantitative TA-based discrimination of CT of SSc patients is possible showing highest discriminatory power in FBP-LDCT images.
Epidermal growth factor receptor tyrosine kinase inhibitors combined with thoracic radiotherapy or chemoradiotherapy for advanced or metastatic non-small cell lung cancer: A systematic review and meta-analysis of single-arm trials
Authors: Liu Ruifeng , Wei Shihong , Zhang Qiuning , Zhang Xueliang , Luo Hongtao , Tian Jinhui , Li Yi , Ge Long , Wang Xiaohu
Published: July 2019

Background:

Preclinical in vitro experiments demonstrated that epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) might have synergistic effect in combination with radiotherapy on Non-small cell lung cancer (NSCLC), but the clinical trials showed inconsistence results in NSCLC patients with EGFR status unknow or mutations. This study aimed to determine if added TKIs to Thoracic radiotherapy (TRT) improve primary disease response rate (RR) and survival outcomes in advanced or metastatic NSCLC.

Methods:

We searched MEDLINE, EMBASE, and Cochrane Library from January 2000 to December 2017 for eligible studies where patients received concurrent EGFR TKIs and TRT or CRT. Concerned outcomes were primary tumor RR, overall survival (OS), and adverse events (AEs). The meta-analysis was performed using Stata software (version 12.0). Random effects models were used to pool outcomes across studies. Sensitivity analysis was performed to determine if the results would be different.

Results:

We found 16 prospective clinical trials with mature results for meta-analyses. Twelve studies including 446 patients reported the RR and survival outcomes of TRT combined TKIs. The CR, PR, SD, and PD, respectively, were 0.06 (95% CI 0.03–0.09, I2 = 0%), 0.44 (95% CI 0.38–0.49, I2 = 64.9%), 0.29 (95% CI 0.24–0.34, I2 = 78.4%), and 0.15 (95% CI 0.11–0.19, I2 = 84.2%). One- and 2-year OS, respectively, were 0.52 (95% CI 0.44–0.60, I2 = 38.8%) and 0.26 (95% CI 0.18–0.33, I2 = 0%). Four studies including 182 patients reported the RR and survival outcomes of CRT combined TKIs. The pooled CR, PR, SD, and PD, respectively, were 0.12 (95% CI 0.02–0.22, I2 = 69.1%), 0.41 (95% CI 0.27–0.55, I2 = 71.6%), 0.31 (95% CI 0.16–0.46, I2 = 79%), and 0.14 (95% CI −0.01–0.30, I2 = 87.8%). Only 1 study reported the survival event rate, 1- and 2-year OS, respectively, were 0.83 (95% CI 0.71–0.94) and 0.67 (95% CI 0.54–0.81). There were not severe adverse events (SAEs) reported either TRT combined TKIs or CRT combined TKIs.

Conclusion:

There is evidence, albeit of low quality, that added the TKIs to TRT or CRT may improve RR and survival outcomes in patients with EGFR mutant status unknown advanced or metastatic NSCLC relative to other studies of TKIs alone, TRT alone or CRT.
Assessment of obesity prevalence and validity of obesity diagnoses coded in claims data for selected surgical populations
Authors: Ammann Eric M. , Kalsekar Iftekhar , Yoo Andrew , Scamuffa Robin , Hsiao Chia-Wen , Stokes Andrew C. , Morton John M. , Johnston Stephen S.
Published: July 2019

In many types of surgery, obesity may influence patient selection, prognosis, and/or management. Quantifying the accuracy of the coding of obesity and other prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative healthcare data. This study assessed the validity of obesity diagnoses recorded in insurance claims data in selected surgical populations.

This was a retrospective, observational study. Deidentified electronic health record (EHR) and linked administrative claims data were obtained for US patients age ≥20 years who underwent a qualifying surgical procedure (bariatric surgery, total knee arthroplasty [TKA], cardiac ablation, or hernia repair) in 2014Q1–2017Q1 (first = index). Patients’ body mass index (BMI) as coded in the claims data (error-prone measure) during the index procedure or 180d pre-index was compared with their measured BMI as recorded in the EHR (criterion standard) to estimate the sensitivity and positive predictive value (PPV) of obesity diagnosis codes.

Among patients who underwent bariatric surgery (N = 1422), TKA (N = 8670), cardiac ablation (N = 167), or hernia repair (N = 5450), obesity was present in 98%, 63%, 52%, and 54%, respectively, based on measured BMI. PPVs of obesity diagnosis codes were high: 99.3%, 96.0%, 92.8%, and 94.1% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. The sensitivity of obesity diagnoses was: 99.8%, 46.2%, 41.3%, and 42.3% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. Among false-positive patients diagnosed as obese but with measured BMI <30, the proportion with a BMI ≥28 was 40.0%, 67.6%, 60.7%, and 65.8% for bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively.

Our data indicate that obesity is highly prevalent in many surgical populations, obesity diagnosis codes have high PPVs, but also obesity is generally undercoded in claims data. Quantifying the validity of diagnosis codes for obesity and other important prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative data. Further research is needed to determine the extent to which undercoding of BMI and obesity can be addressed through the use of proxies that may be better documented in claims data.
Applicability of readout-segmented echoplanar diffusion weighted imaging for prostate MRI
Authors: Hellms Susanne , Gutberlet Marcel , Peperhove Matti Joonas , Pertschy Stefanie , Henkenberens Christoph , Peters Inga , Wacker Frank , Derlin Katja
Published: July 2019

To evaluate readout-segmented echoplanar (rsEPI) diffusion weighted imaging (DWI) for multiparametric (mp) magnetic resonance imaging (MRI) of the prostate compared to the established single-shot echoplanar imaging (ssEPI) sequence.

One hundred ten consecutive patients with clinical suspicion of prostate cancer underwent mp prostate MRI using both, the ssEPI and the rsEPI DWI sequence. For an objective assessment, delineation of the prostate shape on both DWI sequences was compared to T2-weighted images by measuring organ diameters. Apparent diffusion coefficient (ADC) values, image contrast and contrast-to-noise ratio (CNR) were compared between the 2 sequences on a region-of-interest-based analysis. Diagnostic accuracy for quantitative ADC-values was calculated. Histopathology from MRI/ultrasound fusion-guided biopsy was used as reference standard. For a subjective assessment, 2 independent readers visually assessed image quality of both sequences using Likert-scales.

Delineation of the prostate shape was more accurate with rsEPI compared to ssEPI. ADC values in target lesions were not significantly different but significantly higher in the surrounding normal prostatic tissue of the transition zone. CNR was comparable between ssEPI and rsEPI. Sensitivity and specificity were good for both sequences with 84/84% and 82/73% with a Youden selected cut-off of ADC = 0.971∗10−3 mm2/s for rsEPI and 1.017∗10−3 mm2/s for ssEPI. Anatomic artifacts were significantly less and SNR was lower on rsEPI compared to ssEPI in the subjective analysis.

Delineation of the prostate shape was more accurate with rsEPI DWI than with ssEPI DWI with less anatomic artifacts and higher subjective SNR and image quality on rsEPI DW images. Diagnostic ability of quantitative ADC-values was not significantly different between the 2 sequences. Thus, rsEPI DWI might be more suitable for prostate MRI with regard to MRI-guided targeted biopsy and therapy planning.
Diagnostic accuracy of cervical elastography in predicting preterm delivery
Authors: Wang Bo , Zhang Yong , Chen Shuangshuang , Xiang Xiaowei , Wen Juan , Yi Mei , He Baiyun , Hu Bing
Published: July 2019

Background:

The aim of the study was to evaluate the diagnostic accuracy of cervical elastography in predicting preterm delivery (PTD).

Methods:

We searched the PubMed, EMBASE, and Cochrane databases to identify relevant studies that applied ultrasound (US) elastography to assess cervical stiffness and predict PTD. All the studies were published before December 11, 2018, and only studies published in English were collected. The cervical length (CL) was considered a comparator, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was performed to evaluate the diagnostic performance of cervical elastography in predicting PTD. Subgroup analyses were also performed.

Results:

Seven studies, including 1488 pregnant women, were included in this meta-analysis. Cervical elastography showed a summary sensitivity of 0.84 [95% confidence interval (CI): 0.68, 0.93], a specificity of 0.82 (95% CI: 0.63, 0.93), a diagnostic odds ratio of 25 (95% CI: 7, 93), and an area under the curve (AUC) of SROC of 0.90 (95% CI: 0.87–0.93). CL measurement showed that the AUC of SROC was 0.60 (95% CI: 0.56–0.64). The results of subgroup analysis showed that the summary sensitivity and specificity were different in the QUADAS-2 score subgroups.

Conclusion:

Cervical elastography is a promising and reliable method to predict PTD. Cervical elastography showed better diagnostic performance to predict PTD than CL measurement.
Solid pseudopapillary neoplasm of pancreas
Authors: Gurzu Simona , Bara Tivadar , Sincu Mihaela , Gabos Szilard , Vlad Daniela Madalina , Bara Tivadar , Beres Hanga , Jung Ioan
Published: July 2019

Rationale:

About 8384 cases of solid pseudopapillary neoplasms (SPN) of pancreas have been published in English literature, from 1933 to 2018. This is a low-grade tumor that usually occurs in children but is rare in adults and, in exceptional cases, can show extrapancreatic localization. In this paper we present 2 unusual cases of SPNs, 1 with retroperitoneal location (case 1) and 1 that was firstly diagnosed as a G1 neuroendocrine tumor (NET) and showed hepatic metastases after 13 years (case 2).

Patient concerns:

No symptoms in first case. The tumor was incidentally diagnosed, during ultrasound examination. In the second case, the metastasis was observed during regular follow-up.

Diagnoses:

The diagnosis was established based on the histological features and immunohistochemical profile that showed positivity for vimentin, nuclear β-catenin, cyclin D1, CD10, and SRY-related high-mobility group box 11 and negativity for maspin.

Interventions:

Surgical excision, in both cases.

Outcomes:

No recurrences in first case, at 5 months after diagnosis. Hepatic metastases in the second case, at 13 years after diagnosis, with portal invasion after another 15 months.

Lessons:

Without a complex immunoprofile, SPN can be misdiagnosed as NET. SPN can be a low-grade tumor but long-time follow-up is mandatory to detect delayed metastases. A correct diagnosis is necessary for a proper therapeutic management.
Effect of 106PEAR1 and 168PTGS1 genetic polymorphisms on recurrent ischemic stroke in Chinese patient
Authors: Zhao Jiali , Chen Fudi , Lu Lin , Tang Hui , Yang Ruirui , Wang Yongxiang , Du Yifeng
Published: July 2019

The impact of genetic polymorphisms on the occurrence of recurrent ischemic stroke (RIS) is not fully understood. This study was aimed to examine the relationships among the 106PEAR1 and 168PTGS1 polymorphisms and RIS.

This was a single-center, retrospective, case-control study of patients seen in consultation between March 2016 and December 2016 at the Shandong Provincial Hospital. The 106PEAR1 (G>A) and 168PTGS1 (−842A>G) polymorphisms were determined by fluorescence in situ hybridization.

There were 56 patients with RIS and 137 with initial stroke. Compared with the initial group, the RIS group showed lower LDL-C levels (P = .04). 168PTGS1 (−842A>G) did not meet the Hardy–Weinberg equilibrium. The AA genotype of the 106PEAR1 (G>A) polymorphism was more frequent in the RIS group (17.9% vs 5.8%, P = .009). The A allele also showed a higher frequency than the G allele in the RIS group (P = .02). The multivariable logistic regression analysis showed that 106PEAR1 (G>A) (OR = 3.24, 95%CI: 1.04–10.14, P = .04) and lipid-lowering agents (OR = 9.18, 95%CI: 4.48–18.84, P < .001) were independently associated with RIS.

The polymorphism at 106PEAR1 (G>A) was independently associated with RIS in Chinese patients. The assessment of genetic polymorphisms in the prediction of RIS warrants further investigation in order to improve patient management and prognosis after a first ischemic stroke.
Prediction of neonatal acidosis using the cerebroplacental ratio at different gestational weeks
Authors: Guo Lin-Na , Chai Yi-Qing , Guo Shuang , Zhang Zhi-Kun
Published: July 2019

We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.

From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41+6 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).

In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31+6 weeks, 32 to 36+6 weeks, and 37 to 41+6 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).

The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.
Total disc replacement versus fusion for lumbar degenerative diseases - a meta-analysis of randomized controlled trials
Authors: Bai Deng-yan , Liang Long , Zhang Bing-bing , zhu Tao , Zhang Hai-jun , Yuan Zhi-guo , Chen Yan-fei
Published: July 2019

Background:

Lumbar fusion is considered to the gold standard for treatment of spinal degenerative diseases but results in adjacent segment degeneration and acquired spinal instability. Total disc replacement is a relatively new alternative avoiding the occurrence of the above complications. The systematic review and meta-analysis was designed to evaluate whether total disc replacement exhibited better outcomes and safety.

Methods:

PubMed, Web of Science, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure Database(CNKI), Wangfang database, and VIP database were searched for RCTs comparing total disc replacement with lumbar fusion. All statistical analyses were carried out using the RevMan5.3 and STATA12.0 software.

Results:

Of 1116 citations identified by our search strategy, 14 RCTs met the inclusion criteria. Compared to lumbar fusion, total disc replacement significantly improved ODI, VAS, SF-36, patient satisfaction, overall success, reoperation rate, ODI successful, reduced operation time, shortened duration of hospitalization, decreased postsurgical complications. However, total disc replacement did not show a significant difference regarding blood loss, consumption of analgesics, neurologic success and device success with lumbar fusion. And charges were significantly lower for total disc replacement compared with lumbar fusion in the 1-level patient group, while charges were similar in the 2-level group.

Conclusion:

Total disc replacement is recommended to alleviate the pain of degenerative lumbar diseases, improve the state of lumbar function and the quality of life of patients, provide a high level of security, have better health economics benefits for 1-level patients.
Acupuncture for infertile women without undergoing assisted reproductive techniques (ART)
Authors: Yun Liu , Liqun Wu , Shuqi Yao , Chunxiao Wu , Liming Lu , Wei Yi
Published: July 2019

Background:

Acupuncture is widely used for infertile women without undergoing assisted reproductive techniques (ART) in China but its effect is unclear. We aim to assess whether acupuncture and its combined therapy exert a positive influence on the outcome of female fertility.

Methods:

We searched 6 databases, including Medline, EMBASE, the Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal Database (VIP), and Wan-Fang Data, from inception to June 2018. Studies of randomized controlled trials (RCTs) on women with infertility treated by acupuncture or its combined therapy were included. A meta-analysis was performed using Revman 5.3. The methodological quality of the studies was assessed through the risk of bias assessment tool by the Cochrane Collaboration.

Results:

The pregnancy rate was significantly improved with treatment (RR = 1.84, 95% CI 1.62 to 2.10, P < .00001), compared to that in the control group. Subgroup analysis showed that comparing with pure western medicine intervention, no matter intervention with acupuncture alone, with acupuncture plus western medicine, with acupuncture plus Chinese medicine, or acupuncture plus Chinese medicine and western medicine, all of these subgroups exhibited significant improvement. The subgroup according to different types of infertility showed a significant improvement in infertility caused by polycystic ovary syndrome, tubal infertility, ovulatory disorder, and other factors. In addition, the ovulation rate and endometrial thickness were significantly increased. The level of LH was obviously decreased. Moreover, with acupuncture, less adverse effects occurred. The funnel plot revealed that publication bias might exist. All trials included had unclear risks in the aspects of allocation concealment, blinding of participants and personnel, blinding of outcome assessment, selective reporting, and other bias. Only 1 study was assessed as unclear risk in random sequence generation. In the incomplete outcome data, all studies were low risk, except 1.

Conclusions:

Acupuncture and its combined therapy may be effective for treating female infertility. However, the included studies are not robust enough to draw a firm conclusion due to the not robustly sampled quality of the included studies. Future high-quality RCTs are needed to confirm our findings.
Comparative efficacy and safety of traditional Chinese patent medicine for endometriosis
Authors: Dong Shuangqian , Zhang Jianwei , Zhai Fengting , Zhao Xinglong , Qin Xiuyun
Published: July 2019

Background:

Endometriosis is a common disease of women of childbearing age. In recent years, the incidence of endometriosis has been on the rise. The main clinical manifestations are pelvic pain and infertility. In recent years, traditional Chinese patent medicine (TCMP) has played an important role in the treatment of endometriosis. So far, there is a lack of comparison among all the current common TCPMs for endometriosis. Consequently, it is indispensable to propose a network meta-analysis (NMA) protocol to discuss the strengths and weaknesses of different TCMPs.

Methods:

We will comprehensively and systematically retrieve the relevant Chinese and English databases from their inceptions to the May 2019. All randomized controlled trials (RCTs) of TCMPs for Endometriosis will be included. Two researchers will independently screen literature, extract data and assess the risk of bias of included studies. We will conduct pairwise meta-analyses and Bayesian network meta-analyses to assess all the available evidence. Data will be analyzed using STATA and WinBUGS software.

Results:

This work will compare and rank the relative efficacy of different TCPMs in the treatment of endometriosis in detail.

Conclusion:

The results of this study will provide reliable evidence for the selection of clinical treatment program and guideline development.

PROSPERO registration number:

CRD42019127781.
Impact of angiotension I converting enzyme gene I/D polymorphism on running performance, lipid, and biochemical parameters in ultra-marathoners
Authors: Chiu Yu-Hui , Lai Jiun-I , Tseng Chia-Ying , Wang Shih-Hao , Li Li-Hua , Kao Wei-Fong , How Chorng-Kuang , Chang Wen-Han , Hsieh Chin-Yi
Published: July 2019

The insertion (I) or deletion (D) polymorphism in the angiotension I converting enzyme gene, (ACE I/D, rs1799752) is associated with human exercise endurance and performance. However, most of the aforementioned studies focus on marathons, swimming, and triathlons, while the ACE polymorphism in ultra-marathoners has not yet been reported. We studied the impact of ACE I/D polymorphism in ultra-marathoners and investigated its relationship with lipid profiles, interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) levels in runners before and after ultra-marathon racing.

This observational study used data from a 100-km ultra-marathon in Taipei, Taiwan. Twenty-four male participants were analyzed for their ACE insertion/deletion polymorphism, lipid profiles, hs-CRP, IL-6 in serum immediately before and after ultra-marathon running.

In our 24 subjects analyzed, 7, 14, and 3 subjects were of I/I, I/D, and D/D genotypes, respectively. Runners with the D polymorphism (I/D and D/D) showed a trend of better performance in the 100-km ultra-marathon (measured by completion time in minutes, P = .036). In this group, the previous best marathon performance was also significantly better than the I/I group (P = .047). After adjusting for body mass index (BMI), the difference in performance was not significant. Ketone levels, IL-6, and hs-CRP levels were highly increased at immediately and 24-hour post-race. No correlation was found between different ACE polymorphisms and common biochemical parameters examined.

We report the first study in the impact of the ACE I/D (rs1799752) on ultra-marathoners. Presence of the D polymorphism in ACE gene is associated with better performance, although the BMI of the runners contribute as a major factor. There was no difference in the biochemical or lipid parameters measured among different ACE polymorphisms.
Acupoint injection for nonspecific chronic low back pain
Authors: Liao Jianglong , Wang Tao , Dong Wei , Yang Jingfan , Zhang Jun , Li Lvyu , Chen Jiankun , Li Jian , Li Deguang , Ma Yunxi , Zhang Xiaoyan , Tang Xiaoxia , Jiang Bo , Guo Ying
Published: July 2019

Objective:

The aim of this study was to evaluate the effect of acupuncture injection therapy for the patients with nonspecific chronic low back pain (CLBP) systematically.

Methods:

Four English online databases and 4 Chinese online databases will be researched systematically from their inception to December 31, 2018. Reference management software, Endnote X7, will be used to manage and screen the records. After removing the duplicate records, 2 independent reviewers will select the studies that meet the inclusion criteria. “Risk of table” recommend by Cochrane Handbook for Systematic Reviews of Interventions will be used to judge the quality of the included records. All data will be extracted by 1 reviewer and checked by another reviewer. Any disagree will be addressed via consulting a third reviewer in the above processes. Microsoft Excel will be used to manage and convert data if necessary. The missing data will be obtained via emailing the original authors of included studies. Review Manager (RevMan5.3) will be used to perform the data synthesis if enough data were collected. Otherwise, only the qualitative analysis will be performed. Based on the heterogeneity results, fixed-effect model or random-effect model will be used to estimate the overall effect of acupuncture injection therapy for patients with nonspecific CLBP. Meta-regression and subgroup analysis will be also performed to explore the sources of heterogeneity. If there are enough records included, the publish bias will be assessed by funnel plot. All procedures will be strictly performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.

Conclusion:

This review will offer clinical evidence of acupuncture injection therapy for the patients with nonspecific CLBP.

PROSPERO Research registration identifying number:

CRD42019119158
The association between statin use and survival of esophageal cancer patients
Authors: Deng Han-Yu , Lan Xiulin , Zheng Xi , Zha Panpan , Zhou Jie , Wang Ru-Lan , Jiang Rui , Qiu Xiao-Ming
Published: July 2019

Whether statin use has any impact on survival of esophageal cancer patients remains controversial. Therefore, we conducted a meta-analysis focusing on current topic for the first time.

We systematically searched the following databases for relevant studies comparing survival between statin users and non-users among esophageal cancer patients up to March 16, 2019: Pubmed, Embase, and Web of Science. We extracted data of hazard ratio (HR) with 95%confidence interval (CI) of all-cause and cancer-specific mortality for analysis. We used the STATA 12.0 software to perform this meta-analysis.

We finally included a total of 4 cohort studies involving a total of 20,435 esophageal cancer patients (5319 statin users and 15116 non-users). Our meta-analysis found that statin use after diagnosis of esophageal cancer was significantly correlated to decreased all-cause (random effects: HR = 0.81, 95%CI: 0.75–0.89, P < .001; I
2 = 68.1%) and cancer-specific mortality (fixed effects: HR = 0.84, 95%CI: 0.78–0.89, P < .001; I
2 = 46.6%) in esophageal cancer patients. When stratified by pathological subtypes, the protective effect of statin use after diagnosis of esophageal cancer was observed in both esophageal adenocarcinoma patients and esophageal squamous cell carcinoma patients. Moreover, statin use before diagnosis of esophageal cancer was also confirmed to have favorable survival benefit for esophageal cancer patients.

Statin use was significantly correlated to lower mortality risk of esophageal cancer patients regardless of the time when statins were taken and pathological subtypes of esophageal cancer. Statins may serve as promising adjunctive anticancer agents for treating esophageal cancer.
Effectiveness and safety of Chinese herbal medicine Xiaoyao san for the treatment of insomnia
Authors: Li Jiamin , Mu Zhenni , Xie Jun , Ma Tongtong , Zhang Ying , Qi Xianghua , Teng Jing
Published: July 2019

Background:

Insomnia is one of the most common sleep problems, which can impact physical and mental quality of life, resulting in a heavy social and economic burden. Xiaoyao san, a Chinese Herbal Medicine product, has been widely used as an alternative to recommended treatments for insomnia, but still lack of evidence of evidence-based medicine, which the clinical efficacy and its safety are questioned. Accordingly, we provide a protocol to evaluate the efficacy and safety of Xiaoyao san to update the search and evaluation for the best available and security treatment for insomnia.

Methods:

This review systematic and comprehensive retrieves of 8 related databases at home and abroad. Only randomized controlled trials (RCTs) of Xiaoyao san on Insomnia published in English and Chinese will be included. The quality of the included trials including randomization, allocation concealment, blinding, withdrawal, and loss of follow-up which was evaluated using internationally accepted evaluation criteria. And then systematically comprehensive analysis of the efficacy.

Results:

This review will be to assess the efficacy and safety of Xiaoyao san for insomnia.

Conclusion:

This systematic review will provide strong evidence for the effectiveness and safety of Xiaoyao san in the treatment of insomnia.

PROSPERO registration number:

CRD42019127326
Different patterns of electroencephalography during hypoglycemia in type 1 diabetes mellitus
Authors: Ryu Han Uk , Lee Seolwon , Shin Byoung-Soo , Kang Hyun Goo
Published: July 2019

Rationale:

Electroencephalographic (EEG) changes are frequently observed not only by epileptic seizures but also by metabolic encephalopathies. The EEG changes during hypoglycemia are known as mixed frequency theta to delta activity with higher amplitude than the initial background rhythm. Although there are many reports about hypoglycemia induced EEG changes, few studies of hypoglycemic EEG patterns have been evaluated between arousal and sleep stage.

Patient concerns:

A 45-year-old man who had been diagnosed as type 1 diabetes mellitus for 15 years admitted to the emergency room due to seizure attack. The EEG findings of the patient showed increased amplitude of theta slowing on both hemispheres. The abnormal EEG finding had recovered and the background frequency remarkably increased as the patient fell asleep, but reappeared when he woke up.

Diagnosis:

The patient was diagnosed as hypoglycemia with altered mentality.

Interventions:

Fifty percent dextrose fluid 50 mL was loaded and maintained with 10% dextrose water afterwards.

Outcomes:

The patient improved after medical treatment.

Lessons:

The EEG presentation of hypoglycemia involves low frequency and increased amplitude of delta-theta activity. As the previous studies, we observed medium amplitude semi-rhythmic theta slowing EEG findings on both hemispheres during arousal, indicating hypoglycemia. However, it was stabilized during sleep as background frequency increased and medium amplitude of slowing disappeared. Although there are many reports about hypoglycemia induced EEG changes, few studies of hypoglycemic EEG patterns have been evaluated between arousal and sleep stage. We report a case of different EEG patterns between arousal and sleep stage during hypoglycemia.
A fish bone induced aortic arch pseudoaneurysm in a male patient
Authors: Wang Azhen , Zhou Yun , Huang Qilin
Published: July 2019

Rationale:

Esophageal foreign body is a commonly seen in China. However, pseudoaneurysm of the aortic arch caused by ingestion of fish bones is a rare, life-threatening condition.

Patient concerns:

A 71-year-old male was admitted to the Ear, Nose, and Throat department with a 4-day history of chest pain after eating fish.

Diagnoses:

After taking out the fish bone by rigid endoscopy, magnetic resonance imaging and computerized tomography angiography (CTA) scans revealed the presence of an aortic arch pseudoaneurysm, which was likely caused by the fish bone.

Interventions:

A successful endovascular graft exclusion surgery was performed to block the aorta ulcer.

Outcomes:

The patient recovered and was discharged 20 days after hospitalization. The patient was healthy and had no fever or chest pain 4 months after discharge from the hospital.

Lessons:

Esophageal foreign bodies may lead to life-threatening impairment of the aorta or other big arteries. When esophageal foreign bodies puncture the esophageal wall, especially in the second stenosis of the esophagus, an enhanced-contrast computed tomography scan or a CTA scan may be necessary to exclude any potential impairment of the arteries.
A large pheochromocytoma requiring aortic and inferior vena caval reconstruction
Authors: Wang Jian , Yuan Ding , Lu Ya , Ma Yukui , Huang Bin , Yang Yi , Zhao Jichun
Published: July 2019

Rationale:

It is difficult to discriminate malignant pheochromocytoma (PCC) from benign PCC. The requirement of abdominal aortic and inferior vena cava reconstruction is extremely rare.

Patient concerns:

We here report a case of a large pheochromocytoma in a 56-year-old woman who complained of only hand trembling and had no hypertension or other symptoms. The operation was difficult because of a tight adhesion to the circumference of great vessels. A replacement of the aortocaval vessels with grafts was necessary to remove the tumor completely.

Diagnoses:

Ultrasonography, computed tomography (CT), and catecholamine assay revealed suspecting the retroperitoneal PCC.

Interventions:

Tumor excision and reconstruction of the abdominal aorta and inferior vena cava by externally supported polytetrafluoroethylene (ePTFE) vessels were successfully performed.

Outcomes:

A follow-up CT angiography showed no recurrence and graft vessels presented good patency after 7years. Catecholamine in urine and serum assay was normal.

Lessons:

The complete resection of the tumor and infiltrated great vessels were necessary for the long-term survival of patients with a large PCC. The ePTFE graft is a good substitute for vessel reconstruction.
Intertrochanteric fracture with low-energy trauma in a young woman with anorexia nervosa
Authors: Park Jong Seok , Lee Hong Seop , Won Sung Hun , Lee Dhong Won , Jung Ki Jin , Kim Chang Hyun , Kim Ja Hyung , Lee Won Seok , Ryu Aeli , Kim Woo Jong
Published: July 2019

Rationale:

Anorexia nervosa is a chronic psychiatric disease defined by severe weight loss, due to fear of obesity, and self-imposed semi-starvation. Of the many complications following anorexia nervosa, low bone mineral density (BMD) is a significant risk factor for fractures. Anorexia nervosa is associated with higher risk of incident fracture in females across all age groups, and in males >40 years old. Sites at highest risk of fracture include the hip/femur and pelvis in females, and vertebrae in males with anorexia nervosa.

Patient concerns:

A 29-year-old woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after falling while getting out of a taxi. During the period of anorexia nervosa, she had a body mass index (BMI) of 14.06 kg/m2 (weight, 36 kg; height, 1.60 m) and suffered from amenorrhea. At the time of presentation, she had a BMI of 19.53 kg/m2 (weight, 50 kg; height, 1.60 m) and had regular menstrual periods, indicating clinical recovery from anorexia nervosa.

Diagnoses:

Plain radiography, computed tomography, and bone scintigraphy revealed AO 31-A2.2 type right hip proximal femur intertrochanteric fracture. The BMD showed a T score of −3.9 in the hip and −3.6 at the lumbar level, indicating severe osteoporosis.

Interventions:

Osteosynthesis was performed with proximal femoral nail antirotation (PFNA) and wiring.

Outcomes:

There were no specific symptoms, such as trauma or infection, during postoperative rehabilitation and postoperative management, and she was discharged after 2 weeks. After 1 year of follow-up at our outpatient clinic, she had no complications.

Lessons:

Here, we describe an unusual case of unilateral femoral intertrochanteric fracture that occurred after clinical recovery from anorexia nervosa. This case indicated that the risk of fracture remains even after recovery of BMI. We propose that women who have clinically recovered from anorexia nervosa should be advised to undergo annual osteodensitometric analyses after consulting with specialists in other areas (psychiatry, endocrinology, eating disorders).