bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of tear film optical quality in a young short tear break-up time dry eye
Authors: Xi Lei , Qin Jiayin , Bao Yongzhen
Published: October 2019

Background:

The aim of the study was to evaluate the dynamic changes of tear film optical quality in a short tear break-up time (TBUT) dry eye by using a double-pass system.

Methods:

Thirty-five short TBUT dry eye participants and 43 control subjects without dry eye were included in this study. One eye for each subject was analyzed. The Objective Scatter Index (OSI), modulation transfer function (MTF), and strehl ratio (SR) were recorded within a 20-second period with the participants asked to blink freely, and 10 successive seconds of nonblinking immediately after a blink was recorded to analyze the tear film OSI. The mean tear film OSI in 10 successive seconds, ΔOSI, and ΔOSI/time were evaluated. The correlation between tear film OSI and MTF, and the correlation between tear film OSI and MIT were also analysed.

Results:

Short TBUT dry eye participants showed significant deterioration of MTF and SR compared to control subjects. The mean tear film OSI in 10 successive seconds was significantly higher in dry eye participants than in control subjects. The mean OSI of the tear film (0–5 seconds) and the mean OSI of the tear film (6–10 seconds) were significantly higher in dry eye participants than in control participants. Moreover, the ΔOSI was significantly higher in dry eye participants than in control participants. The tear film OSI was significantly correlated with the MTF and the SR.

Conclusions:

The tear film OSI of short TBUT dry eye participants is significantly increased in the early stage. Tear film instability in short TBUT dry eye participants has a significant effect on optical quality.
Molecular epidemiology and clinical characteristics of norovirus gastroenteritis with seizures in children in Taiwan, 2006–2015
Authors: Chen Ying Fang Elaine , Wang Chuan Yu , Chiu Cheng Hsun , Kong Shu Sing , Chang Yi Jung , Chen Shih Yen
Published: October 2019

This study examined the characteristics of norovirus (NoV) gastroenteritis associated with convulsions in children and its molecular epidemiology. From July 2006 through December 2015, NoV infection was confirmed by the genome detection using reverse transcriptase polymerase chain reaction. Viral genotyping with strain validation was achieved using sequence analyses with Basic Local Alignment Search Tool genome identification. The patients’ clinical features were assessed retrospectively, focusing on convulsive disorders. The diagnosis of encephalitis followed the International Encephalitis Consortium. Seizures occurred in 52 (20.9%) of 249 NoV infections. GII.4 Den_Haag_2006b (n = 22, 42.3%) and GII.4 Sydney 2012 (n = 10, 19.2%) were major variants correlated with convulsions. Patient with convulsions tend to have GII.4 genotype infection (P < .001), short vomiting (≤2 days) (P < .001), and no fever (P = .002). Compared to GII.4 Den_Haag_2006b, the GII.4 Sydney 2012-associated convulsions had similar manifestations except without significant winter preponderance (P = .049). The NoV infection with convulsions had less febrile course, specific genotype (GII.4) infections, and with shorter symptom of vomiting. Continuous surveillance is important for uncommon disease associated with emerging NoV strain infections. The prevention of NoV diseases requires the development of vaccines targeting highly virulent variants.
Prevalence of metabolic syndrome and its risk factors among 10,348 police officers in a large city of China
Authors: Zhang Jiayue , Liu Qian , Long Sisi , Guo Chuhao , Tan Hongzhuan
Published: October 2019

The aim of this study was to assess the prevalence of metabolic syndrome (MS) and its risk factors among the police officers in a large city of China.

A cross-sectional study was conducted in 10,348 police officers in 2017 in Changsha, a provincial capital located in central-south China. All participants underwent a physical examination to measure the compotents of MS and completed a questionnaire to collect data on potential risk factors. According to the current guidelines of China, MS was defined as the presence of any 3 of the following five traits: abdominal obesity, defined as a waist circumference ≥90 cm in men and ≥85 cm in women; fasting serum triglycerides ≥1.70 mmol/L, or drug treatment for elevated triglycerides; fasting serum high-density lipoprotein cholesterol <1.03 mmol/L, or drug treatment for low high-density lipoprotein cholesterol; blood pressure ≥130/85 mmHg, or drug treatment for elevated blood pressure; fasting plasma glucose ≥6.1 mmol/L, or 2-hour plasma glucose ≥7.8 mmol/L after a 75-g oral glucose load, or drug treatment for elevated blood glucose.

The prevalence of MS was 23.2% (95% confidence interval [CI]: 22.2%–24.2%). The main risk factors associated with MS were older age (odds ratio [OR] 1.546, 95% CI 1.431–1.670), being male (OR 11.256, 95%CI 7.147–17.726), alcohol consumption (OR 1.250, 95% CI 1.070–1.461), and tobacco use (OR 1.398, 95% CI 1.232–1.586). Exercise was associated with decreased risk of MS (OR 0.865, 95% CI 0.755–0.991).

The prevalence of MS was low in the study population. Its risk factors were similar to those identified in the general population of China. Lifestyle intervention is warranted in policemen to reduce the risk of MS and prevent diabetes and cardiovascular disease.
Evaluation of the clinical value of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction in infants
Authors: Zhang Shilin , Li Jierong , Li Chunjing , Xie Xumin , Ling Fengsheng , Liang Yongjie , Liu Guoqing
Published: October 2019

Retroperitoneal laparoscopic pyeloplasty (RLP) is 1 method for treating ureteropelvic junction obstruction (UPJO) in children, but reports are more common in children than in infants younger than 2 years old. The purpose of this study was to evaluate the clinical value of RLP for infants with UPJO.

From January 2015 to December 2017, a retrospective analysis of 22 infants aged 2 to 24 (11.95 ± 6.00) months with UPJO who were treated with RLP in our hospital was performed. During the same period, 14 infants who underwent conventional transperitoneal laparoscopic pyeloplasty (TLP) were compared with those who underwent RLP. Postoperative recovery and complications, including bleeding, infection, urinary leakage and anastomotic stenosis, postoperative resumption of oral feeding, postoperative hospitalization time and surgical success rate were evaluated. Drainage and function were assessed with isotope scan at 6 months and later during the yearly follow-up and by intravenous urography (IVU) and mercaptoacetyltriglycine (MAG3) renography.

Both groups underwent successful surgery. The operative time in the RLP group was 88 to 205 (120.59 ± 24.59) min, and there was no significant difference compared with the TLP group (P = .767). The estimated intraoperative blood loss was 2 to 10 (3.75 ± 1.59) ml, which was not significantly different between the 2 groups (P = .386). In the RLP group, the mean postoperative resumption of oral feeding was faster than that in the TLP group (3.55 ± 0.74 vs 5.50 ± 0.85 hour, P < .001), and the postoperative hospitalization time was shorter in the TLP group than in the RLP group (6.59 ± 0.50 vs 7.07 ± 0.47 day, P 
= .007 < .05). Follow-up lasted from 6 months to 3 years, and there was a significant reduction in postoperative hydronephrosis in both groups (P < .05, respectively).

RLP is a safe procedure for infants. This procedure is associated with relatively little trauma, a quick recovery and good cosmetic effects. RLP also has the advantages of relatively little interference with the abdominal cavity and sufficient operating space; thus, this technique is worth promoting.
Clinicopathological and prognostic value of preoperative plasma fibrinogen in gastric cancer patients
Authors: Cheng Fei , Zeng Chunyan , Zeng Ling , Chen Youxiang
Published: October 2019

Background:

Increasing evidence has revealed that plasma fibrinogen may serve as a prognostic indicator in multiple malignancies. However, there have been some conflicting findings on the prognostic value of plasma fibrinogen in gastric cancer (GC). We conducted a meta-analysis to explore the correlation between plasma fibrinogen and clinic outcome in GC.

Methods:

A comprehensive literature search was conducted using the Embase, the Web of Science, the Cochrane library, and PubMed databases. Combined hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to investigate the impact of elevated plasma fibrinogen on the prognosis and clinicopathological features of patients with GC.

Results:

A total of 11 studies involving 8315 patients were selected for this meta-analysis. The pooled results suggested that elevated plasma fibrinogen in GC patients was related to worse overall survival (OS) (HR = 1.57, 95% CI: 1.36–1.81, P < .001) and recurrence-free survival (RFS) (HR = 2.54; 95% CI: 1.19–5.41, P = .016). Additionally, a high level of fibrinogen was closely correlated with advanced tumor stage (OR = 2.14, 95% CI: 1.83–2.50, P < .001), lymph node metastasis (OR = 1.81, 95% CI: 1.56–2.11, P < .001), distant metastasis (OR = 1.48, 95% CI: 1.12–1.94, P = .005), deeper tumor invasion (OR = 2.25, 95% CI: 1.47–3.45, P < .001) and high carcinoembryonic antigen (OR = 1.41, 95% CI: 1.18–1.68, P < .001). However, there was no significant association between plasma fibrinogen and the differentiation grade (OR = 1.00, 95% CI: 0.86–1.17, P = .967). The Egger regression test indicated evidence of publication bias for OS.

Conclusion:

Elevated plasma fibrinogen could be a potential predictor for worse OS and RFS in GC patients and a significant risk factor associated with aggressive clinical features.
Single nucleotide polymorphisms of Toll-like receptor-4 and of autophagy-related gene 16 like-1 gene for predisposition of premature delivery
Authors: Liassides Christakis , Papadopoulos Antonios , Siristatidis Charalampos , Damoraki Georgia , Liassidou Aspasia , Chrelias Charalampos , Kassanos Dimitrios , Giamarellos-Bourboulis Evangelos J.
Published: October 2019

To investigate the impact of carriage of single nucleotide polymorphisms (SNPs) of the Toll-like receptor-4 (TLR4) and of autophagy-related gene 16-like-1 (ATG16L1) in preterm delivery (PTD).

A prospective cohort of 145 pregnant women was studied. Women were prospectively followed-up until delivery. Genotyping for rs4986790 (Asp299Gly transition) and rs4986791 (Thr399Ile transition) of TLR4 and for rs2241880 of ATG16L1 was done by PCR-restriction fragment length polymorphism. The primary study endpoint was the impact of carriage of minor alleles of TLR4 on early PTD before gestational week 32. Associations with human chorionic gonadotrophin (hCG) were also analyzed. Peripheral blood mononuclear cells were isolated from 15 healthy women and stimulated for cytokine production.

No difference in clinical characteristics was observed between women delivering full term and preterm. The frequency of early PTD was 25% among women carrying minor alleles of TLR4 and 6.8% among women carrying major alleles (P: .032). Odds ratios for PTD were 3.85 among women carrying the GG genotype of rs2241880 and major alleles of TLR4 and 0.26 among carriers of GG genotype and minor alleles of TLR4 (P: .030). The co-presence of GG genotype of rs2241880 and hCG above 70 U/L was an independent variable for PTD. Stimulated production of interleukin-6 was greater among women with GG genotypes of rs2241880.

Minor alleles of SNPs of TLR4 predispose to early PTD. The GG genotype of rs2241880 of ATG16L1 is associated with PTD when hCG is supra-elevated.
Clinico-radiologic features of molar-incisor malformation in a case series of 38 patients
Authors: Kim Jo-Eun , Hong Joon-Ki , Yi Won-Jin , Heo Min-Suk , Lee Sam-Sun , Choi Soon-Chul , Huh Kyung-Hoe
Published: October 2019

Molar-incisor malformation (MIM) is a recently defined dental abnormality of molar root and incisors, and introduced as one of the causes of periapical and periodontal abscess. The purpose of this study was to investigate the clinical and radiological features of MIM, with special emphasis on various medical history. A total of 38 patients with MIM were included in this study. Radiographic features and clinical data, including medical history, chief complaint, associated complications, treatment, and prognosis, were retrospectively investigated. On radiographs, the affected molars showed short, slender, underdeveloped roots and constricted pulp chambers. All affected incisors and canines exhibited dilacerated short roots, wedge-shaped defect on the cervical part of the crown. Complications included periodontal bone loss (52.6%), endodontic lesion (50.0%), and endodontic-periodontal lesion (28.9%). The medical histories of the patients with MIM indicate that almost all (94.7%) were hospitalized due to problems during the neonatal period. MIM may cause various dental problems, such as periapical and periodontal abscess and early loss of the affected teeth. The early diagnosis of MIM on radiographs and appropriate treatment will contribute to a favorable prognosis, especially for young and adolescent patients.
Factors associated with appendicular skeletal muscle mass among male Chinese patients with stable chronic obstructive pulmonary disease
Authors: Han Yanxia , Wu Zhenyun , Chen Yi , Kan Yanan , Geng Min , Xu Nuo , Qian Hongying , Wang Hai Fang , Niu Meie
Published: October 2019

Limbs muscle wasting is a common disorder in patients with chronic obstructive pulmonary disease (COPD) that limits daily activities and exercise intolerance, especially in males. The present study aimed to estimate the prevalence of appendicular skeletal muscle mass (ASM) in male patients with stable COPD. In addition, factors associated with parameters of ASM were also investigated.

We recruited 116 male patients with stable COPD from the outpatient clinic between September 2016 and December 2017. For each patient, we obtained demographic characteristics and measured post-bronchodilator forced expiratory volume in 1 second, symptoms, exacerbations history, and ASM. ASM was defined as the sum of the muscle masses of the 4 limbs.

Appendicular skeletal muscle mass index (ASMI) in male patients with stable COPD was 8.2 ± 0.9 kg/m2, and the prevalence of low skeletal muscle mass was 7.8% (9 of 116 patients). Multiple linear-regression analysis showed that body mass index, occupation, fat-free mass index, and the modified medical research council scale were significantly correlated with ASMI. Compared with nonexercise group, lower limb muscle mass and ASM were significantly improved in physical exercise group.

Underweight, retirement, fat-free mass depletion, and severe dyspnea are all risk factors for ASM in male patients with stable COPD. Our findings also justify the importance of exercise training in improving ASM.
Evaluation of the diagnostic performance of a decision tree model in suspected acute appendicitis with equivocal preoperative computed tomography findings compared with Alvarado, Eskelinen, and adult appendicitis scores
Authors: Kang Hyo Jung , Kang Hyuncheol , Kim Bohyun , Chae Min Seok , Ha Young Rock , Oh Seong Beom , Ahn Jung Hwan
Published: October 2019

This study evaluated the diagnostic performance of a new clinical approach based on decision tree (DT) analysis in adult patients with equivocal computed tomography (CT) findings of acute appendicitis (AA) compared with previous scoring systems.

This retrospective study of 244 adult patients with equivocal CT findings included appendicitis (AG, n = 80) and non-appendicitis (NAG, n = 164) groups. The chi-squared automatic interaction detection algorithm was for AA prediction. A receiver operating characteristic curve analysis and area under the curve (AUC) were used to compare the DT analysis with Alvarado, Eskelinen score, and adult appendicitis scores (AAS).

The following factors were selected for AA prediction: rebound tenderness severity, migration, urinalysis, symptom duration, leukocytosis, neutrophil count, and C-reactive protein levels. The DT comprised 11 final nodes with the following AA probabilities: node 1, 100% (16/16); node 2, 90% (9/10); node 3, 80% (8/10); node 4, 60.9% (14/23); node 5, 50% (3/6); node 6, 43.8% (7/16); node 7, 22.6% (12/53); node 8, 13% (10/77); node 9, 5.6% (1/18); node 10, 0% (0/12); and node 11, 0% (0/3). The AUC of the DT was higher (0.850 [95% confidence interval {CI}; 0.799–0.893]) than the Alvarado score (0.695 [95% CI; 0.633–0.752]), AAS (0.749 [95% CI; 0.690–0.802]), and the Eskelinen score (0.715 [95% CI; 0.654–0.770]). The results were statistically significant when compared with the AUCs of the Alvarado score, Eskelinen score, and AAS (P < .001, P < .001, P = .003, respectively).

The DT-based approach facilitated AA diagnosis and determination of clinical status in patients with equivocal preoperative CT findings and ambiguous results.
Correlation between right ventricular–pulmonary artery coupling and the prognosis of patients with pulmonary arterial hypertension
Authors: Nie Lin , Li Jun , Zhang Sanping , Dong Yaling , Xu Ming , Yan Menghuan , Zhang Gangcheng , Song Laichun
Published: October 2019

This study aimed to analyze the correlation between the efficiency coefficient of right ventricular–pulmonary artery coupling (η
vv) and the prognosis of patients with pulmonary arterial hypertension (PAH).

A total of 64 patients who underwent right heart catheterization (RHC) were enrolled and divided into PAH and control groups depending on the RHC results. Pressure and volumetric methods were adopted to analyze the results of RHC and cardiac magnetic resonance imaging examination. The η
vv of patients in 2 groups were calculated, and the relationship between η
vv calculated by the 2 methods and the 2-year prognosis of patients with PAH was evaluated.

The hemodynamic index and right ventricular–pulmonary artery coupling parameter of patients with PAH were significantly higher than those in the control group (P < .05). The right ventricular volume parameter in the PAH group was significantly different from that in the control group (P < .05). For patients with PAH, the end-systolic elastance/effective arterial elastance (Ees/Ea) calculated by the volumetric method was significantly related to the prognosis of patients (odds ratio = 0.192, 95% confidence interval: 0.042–0.868, P = .032). When Ees/Ea <0.67 was calculated by the volumetric method, the adverse prognosis of patients with PAH increased significantly (P < .05).

The Ees/Ea calculated by the volumetric method may be better an independent factor for the prognosis of patients with PAH.
Prediction of postoperative survival of triple-negative breast cancer based on nomogram model combined with expression of HIF-1α and c-myc
Authors: Cui Jianxiu , Jiang Hongchuan
Published: October 2019

The aims of this study were to explore the expression of hypoxia inducible factor-1α (HIF-1α) and c-myc protein in triple-negative breast cancer (TNBC) and its clinical prognostic significance, and to establish a prediction model for postoperative survival of TNBC based on nomogram.

A total of 87 patients with TNBC at the Department of Breast Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2012 to December 2015 were enrolled in this study. Immunohistochemistry was performed to detect the expression of HIF-1α and c-myc protein in breast cancer tissues. Cox regression analyses were performed to explore the correlation between HIF-1α/c-myc expression and clinical pathological parameters as well as prognosis. Receiver-operating characteristic curve was generated for cox multivariate analysis. A nomogram was generated based on the cox multivariate analysis, and a calibration curve was prepared for the nomogram to evaluate the consistency between the predicted probability of the nomogram and the actual observed probability. The stability of nomogram model was validated with an external cohort including 39 TNBC patients.

The positive expression rates of HIF-1α and c-myc protein in breast cancer tissues were 41.4% (36/87) and 55.2% (48/87), respectively. HIF-1α expression was significantly correlated with age, tumor diameter, histological grade, lymph node status, and tumor TNM stage; c-myc expression was significantly associated with tumor diameter, histological grade, lymph node status, and tumor TNM stage. Cox univariate and multivariate analyses showed that HIF-1α and c-myc protein expression, histological grade, lymph node status, and tumor TNM stage were the independent risk factors for postoperative survival in TNBC patients. The AUC of prediction model was 0.843 (0.809–0.887). The nomogram could predict the probability of 3-year disease-free survival according to each patient's condition. The calibration curve displayed good agreement of the predicted probability with the actual observed probability, indicating that the nomogram model had great value of prediction. The external validation indicated the prediction model had good stability.

HIF-1α-positive expression, c-myc positive expression, histological grade III, lymph node positive, and TNM stage III tumors suggested that TNBC patients had a poor prognosis. This prediction model can be used to predict postoperative survival of TNBC.
Idiopathic prepubertal unilateral gynecomastia
Authors: Wang Chenyu , Yu Nanze , Zhu Lin , Zeng Ang
Published: October 2019

Rationale:

Prepubertal unilateral gynecomastia is extremely rare, whose etiology and management strategy are not familiar. We would like to present a case and a literature review of unilateral prepubertal gynecomastia.

Patient concerns:

A 11-year old male patient with complaints of unilateral enlargement of breast tissue presented in our clinic, whose physical examination, biochemical, hormonal and oncologic findings were normal.

Diagnoses:

This patient was diagnosed as idiopathic unilateral prepubertal gynecomastia (IUPG) and self-abasement, social isolation and sensitive of interpersonal relationship.

Interventions:

The patient received subcutaneous mastectomy. Histopathological examinations showed idiopathic gynecomastia of ductal epithelial hyperplasia and active interstitial fibrous hyperplasia, with no evidence of any pathological finding. Immunohistochemical examination showed estrogen receptor (ER)-α positive (70%), epidermal growth factor receptor (EGFR) positive, Her-2 positive (1+), Progesterone Receptor (PR) positive (80%).

Outcomes:

A remarkable improvement was observed both in the physical and mental conditions at the post-surgical 6-month follow-up visit, showing no evidence of recurrence.

Lessons:

Further investigation is needed to clarify the pathogenesis of IUPG. All patients with IUPG should have a full endocrine and oncologic evaluation, and surgical excision may be the individually designed for each patient with the help of MRI of breast.
Does reduced E-cadherin expression correlate with poor prognosis in patients with upper tract urothelial cell carcinoma?
Authors: Tae Bum Sik , Jeong Chang Wook , Kwak Cheol , Kim Hyeon Hoe , Ku Ja Hyeon
Published: October 2019

Background:

E-cadherin has emerged as a prognostic factor of urothelial cell carcinoma. In the present work we investigate the relationship between expression of E-cadherin and clinical outcomes, following radical nephroureterectomy for upper tract urothelial cell carcinoma.

Methods:

We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify eligible studies published until July 2017.

Result:

Six studies were included in the meta-analysis, with a total of 1014 patients. The pooled hazard ratio (HR) for recurrence-free survivor was 0.69 (95% confidence interval [CI], 0.44–1.09, I
2 = 63%, P = .04). Also, reduced E-cadherin was not significantly associated with poor cancer-specific survivor (pooled HR, 1.40; 95% CI, 0.66–1.43, I
2 = 54%, P = .11). The pooled HR for overall survivor was not statistically significant (pooled HR, 0.68; 95% CI, 0.32–1.46, I
2 = 80%, P = .007). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis.

Conclusions:

Reduced E-cadherin expression did not appear to be significantly associated with disease prognosis after nephroureterectomy in the meta-analysis. However, further high quality, prospective studies are warranted to better address this issue.
The usefulness of stereotactic radiosurgery for recursive partitioning analysis class II/III lung cancer patients with brain metastases in the modern treatment era
Authors: Ha In Bong , Song Jin Ho , Jeong Bae Kwon , Jeong Hojin , Lee Yun Hee , Choi Hoon Sik , Kang Ki Mun
Published: October 2019

Stereotactic radiosurgery (SRS) is considered the initial treatment for lung cancer patients with small-sized and limited number of brain metastases. The objective of this study was to assess clinical outcomes of SRS treatment using CyberKnife (CK) for recursive partitioning analysis (RPA) class II/III patients with 1 to 3 brain metastases from lung cancer and identify which patients in the high RPA class could benefit from SRS.

A total of 48 lung cancer patients who received CK-based SRS for their metastatic brain lesions from 2010 to 2017 were retrospectively analyzed. Radiographic response was evaluated during follow-up period. Overall survival (OS) and intracranial progression-free survival (IPFS) were calculated and prognostic variables associated with OS and IPFS were evaluated.

Median follow-up time was 6.6 months. Local control rates at 6 months and 1-year following SRS were 98% and 92%, respectively. The median OS of all patients was 8 months. One-year and 2-year OS rates were 40.8% and 20.9%, respectively. In multivariate analysis, uncontrolled primary disease (P = .01) and Eastern Cooperative Oncology Group performance status of 2 or 3 (P = .001) were independent prognostic factors for inferior OS. These 2 factors were also significantly associated with inferior IPFS. In subgroup analysis according to RPA class, primary disease status was the only prognostic factor, showing statistically significant OS differences in both RPA class II and III (controlled vs uncontrolled: 41.1 vs 12.3 months in RPA class II, P = .03; 26.9 vs 4.1 months in RPA class III, P = .01).

Our results indicated that SRS could be an effective treatment option for RPA class II/III patients with brain metastases from lung cancer in the modern treatment era. SRS might be particularly considered for patients with controlled primary disease.
Treatment experience of thoracic aortic aneurysm recurrence after multiple surgeries for Marfan syndrome
Authors: Chen Huai-Dong , He Fan , Qian Xi-Ming
Published: October 2019

Rationale:

Marfan syndrome (MFS), an autosomal dominant hereditary disease, often results in structural and functional abnormalities of the aortic wall. Because of residual aortic aneurysm or aortic dissection, patients with MFS usually need repeat operations after the first operation.

Patient concerns:

A patient diagnosed with MFS who had undergone 2 surgeries because of abdominal aortic dissection aneurysm and Stanford A type aortic dissection at different times.

Diagnoses:

MFS.

Interventions:

Due to aneurysmal dilatation of the residual descending aorta, we performed the third surgery for him through using 2 artificial stent grafts to fix and package the area of the remaining vessel in our hospital.

Outcomes:

The result was good, and the patient was discharged successfully.

Lessons:

Using artificial material to repair and wrap the area of the residual vessel during the first surgery can provide an anchor area for future endovascular stent implantation and also offer a possibility for stent implantation in patients with MFS.
Predicting weaning difficulty for planned extubation patients with an artificial neural network
Authors: Hsieh Meng Hsuen , Hsieh Meng Ju , Cheng Ai-Chin , Chen Chin-Ming , Hsieh Chia-Chang , Chao Chien-Ming , Lai Chih-Cheng , Cheng Kuo-Chen , Chou Willy
Published: October 2019

This study aims to construct a neural network to predict weaning difficulty among planned extubation patients in intensive care units.

This observational cohort study was conducted in eight adult ICUs in a medical center about adult patients experiencing planned extubation.

The data of 3602 patients with planned extubation in ICUs of Chi-Mei Medical Center (from Dec. 2009 through Dec. 2011) was used to train and test an artificial neural network (ANN) model. The input features contain 47 clinical risk factors and the outputs are classified into three categories: simple, difficult, and prolonged weaning. A deep ANN model with four hidden layers of 30 neurons each was developed. The accuracy is 0.769 and the area under receiver operating characteristic curve for simple weaning, prolonged weaning, and difficult weaning are 0.910, 0.849, and 0.942 respectively.

The results revealed that the ANN model achieved a good performance in prediction the weaning difficulty in planned extubation patients. Such a model will be helpful for predicting ICU patients’ successful planned extubation.
Epileptiform EEG discharges and sevoflurane in children
Authors: Miao Mengrong , Xu Yuehua , Cong Xuhui , Zhang Liyuan , Zhang Jiaqiang
Published: October 2019

Background:

Epileptiform discharges in electroencephalogram (EEG) have been frequently reported in children undergoing sevoflurane mask induction. However, the incidence, characteristics and risk factors of these epileptiform patterns during sevoflurane anesthesia in children are poorly understood. The aim of this study is to systematically review the epileptic potential of sevoflurane in children with the EEG monitoring.

Methods:

PubMed, EMBASE, Cochrane library (Central) will be systematically searched from inception to December 2018. The effect of sevoflurane on epileptic EEG patters in children will be studied. The primary outcome will be the incidence of epileptic discharges, the characteristics and risk factors of these epileptic discharges. Meta-analysis will be calculated using R software 3.5.1.

Results:

This study will offer new evidence of the incidence, characteristics and risk factors of EEG epileptic discharges during sevoflurane anesthesia.

Conclusion:

The conclusion drawn from this systematic review will benefit the children with or without epilepsy undergoing sevoflurane anesthesia.

Ethics and dissemination:

Ethics approval is unnecessary because data of individual patients will not be included and no privacy will be involved. The results of this review will be published in a peer-reviewed journal or a conference report. Amendments of the basic protocol will be documented in the comprehensive review.

PROSPERO registration number:

PROSPERO CRD 42019122008.
An investigation of lower urinary tract symptoms and its potential associated factors in adult Chinese women with zero-inflated negative binomial regression model
Authors: Xu Tao , Zhang Lei , Li Zhiyi , Zhu Lan , Han Shaomei
Published: October 2019

Lower urinary tract symptoms (LUTS) have detrimental impact on health-related quality of life. This study has 2 aims: first to identify the optimum model for LUTS study and then to explore the potential associated factors of LUTS and bother LUTS with the optimum model among adult women in China.

The survey was conducted in 6 regions of China between February and July 2006. A modified Chinese Bristol Female LUTS questionnaire was administered. The number of LUTS was the main outcome measure. The fitting goodness was compared to identify the optimum model with likelihood ratio test statistics. Zero-inflated negative binomial (ZINB) model was used to explore the potential associated factors of LUTS and bother LUTS.

Of all 18,992 respondents, 55.5% of respondents reported one (any LUTS) or more LUTS (mixed LUTS) and 36.5% of respondents reported one or more bother LUTS. With the largest log likelihood and smallest AIC and BIC, ZINB model showed the best goodness of fit. In the ZINB model, we identified multiple associated factors for any LUTS and mixed LUTS; older age (β≥0.2), overweight [β = 0.059, 95%CI (0.016∼0.102)], obese [β = 0.143, 95%CI (0.087∼0.198)], postmenopausal status [β = 0.099, 95%CI (0.023∼0.175)], prolonged labor [β = 0.188, 95%CI (0.104∼0.272)], constipation [β = 0.309, 95%CI (0.262∼0.357)], coexisting pelvic organ prolapse (POP) [β = 0.348, 95%CI (0.224∼0.473)], diabetes (β = 0.178, 95%CI (0.100∼0.257), hypertension [β = 0.092, 95%CI (0.041∼0.143)], smoking (β = 0.192, 95%CI (0.127∼0.258) and alcohol consumption [β = 0.063, 95%CI (0.001∼0.126)] increased the odds of mixed LUTS. We identified multiple associated factors for bother LUTS and mixed LUTS; older age (β ≥ 0.1), prolonged labor [β = 0.153, 95%CI (0.031∼0.275)], constipation [β = 0.359, 95%CI (0.292∼0.426)] coexisting POP (β = 0.212, [95%CI (0.031∼0.393)], diabetes [β = 0.154, 95%CI (0.030∼0.278)], and smoking [β = 0.169, 95%CI (0.076∼0.262)] increased the odds of bother mixed LUTS.

ZINB model was the optimum model to explore the potential associated factors of LUTS. Older age, coexisting POP and constipation were both closely related to any and bother LUTS, also the severity of LUTS. Compared to nulliparity, single or multiple deliveries and women who had perineal laceration had nothing to do with the severity of LUTS.
Autologous platelet-rich plasma separation technology used in the same patient receiving 2 complicated aortic surgeries within a short time period
Authors: Chang Yi , Zhang Rongwei , Tian Ayong
Published: October 2019

Rationale:

Autologous platelet-rich plasma (PRP) separation technology has been widely used in various clinical therapies, and has achieved good results, especially in aortic surgeries.

Patient concerns:

A 50-year-old man who was diagnosed with aortic dissection (Stanford B type), a thoracoabdominal aortic aneurysm, and grade 2 hypertension underwent 2 complicated aortic surgeries within 4 months.

Diagnoses:

aortic dissection (Stanford B type).

Interventions:

PRP separation used as a blood protection measure was employed in both 2 surgeries.

Outcomes:

The patient's coagulation function recovered well after the surgeries. The amount of allogeneic blood products used in the perioperation was small.

Lessons:

PRP separation technology combined with blood salvage and warming of blood and fluid transfusion in the aortic surgery has been proved to be feasible and beneficial.
Comparison of 3-dimensional laparoscopy and conventional laparoscopy in the treatment of complex renal tumor with partial nephrectomy
Authors: Hu Mingqiu , Guan Chao , Xu Haibin , Gu Mingli , Fang Wenge , Yang Xuezhen
Published: October 2019

To compare the efficacies of 3-dimensional laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy for complex renal tumors. The complex renal tumors was defined as Preoperative Aspects and Dimensions Used for an anatomical (PADAU) ≥10, including some cT1b tumors.

This was a retrospective analysis of patients with local complex renal tumors who presented to our hospital from January 2014 to January 2018. All patients were managed with laparoscopic partial nephrectomy (LPN) or 3-dimensional partial nephrectomy (3DLPN).

There were 48 patients in the LPN group and 60 in the 3DLPN group. In the matched groups, demographic and tumor characteristics including Charlson Comorbidity Index, PADUA, based on the preoperative images, were similar. By contrast, 3DLPN achieved better results in terms of warm ischemia time (19 vs 27 minutes), operation time (105 vs 128 minutes), postoperative complications (14.9% vs 23.4%), and marginal width (0.6 cm vs 0.4 cm). We found statistically significant differences in terms of length of stay, estimated blood loss (EBL), positive surgical margin (PSM), and conversion to open or radical nephrectomy (RN). Median follow-up time was 17 and 18.5 months for the LPN and 3DLPN groups, respectively. The recovery of renal function (% change eGFR, 0 vs −8.7) was significantly different between the 3DLPN and LPN groups, whereas 12-month recurrence-free survival did not differ.

Both 3-dimensional laparoscopic nephron-sparing nephrectomy and conventional laparoscopic partial nephrectomy are safe, effective, and acceptable approaches to treating complex renal tumors, while the former may facilitate tumor resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.
Plasma metabolite profiling reveals potential biomarkers of giant cell tumor of bone by using NMR-based metabolic profiles
Authors: Wang Wei , Liu Xilin , Wu Juan , Kang Xia , Xie Qingyun , Sheng Jun , Xu Wei , Liu Da , Zheng Wei
Published: October 2019

Giant cell tumor (GCT) of bone is a locally aggressive bone tumor, which accounts for 4% to 5% of all primary bone tumors. At present, the early diagnosis and postoperative recurrence monitoring are still more difficult due to the lack of effective biomarkers in GCT. As an effective tool, metabolomics has played an essential role in the biomarkers research of many tumors. However, there has been no related study of the metabolomics of GCT up to now. The purpose of this study was to identify several key metabolites as potential biomarkers for GCT by using nuclear magnetic resonance (NMR)-based metabolic profiles.

Patients with GCT in our hospital were recruited in this study and their plasma was collected as the research sample, and plasma collected from healthy subjects was considered as the control. NMR was then utilized to detect all samples. Furthermore, based on correlation coefficients, variable importance for the projection values and P values of metabolites obtained from multidimensional statistical analysis, the most critical metabolites were selected as potential biomarkers of GCT. Finally, relevant metabolic pathways involved in these potential biomarkers were determined by database retrieval, based on which the metabolic pathways were plotted.

Finally, 28 GCT patients and 26 healthy volunteers agreed to participate in the study. In the multidimensional statistical analysis, all results showed that there was obvious difference between the GCT group and the control group. Ultimately, 18 metabolites with significant differences met the selection condition, which were identified as potential biomarkers. Through Kyoto Encyclopedia of Genes and Genomes (KEGG) and Human Metabolome Database (HMD) database searching and literature review, these metabolites were found to be mainly correlated with glucose metabolism, fat metabolism, amino acid metabolism, and intestinal microbial metabolism. These metabolic disorders might, in turn, reflect important pathological processes such as proliferation and migration of tumor cells and immune escape in GCT.

Our work showed that these potential biomarkers identified appeared to have early diagnostic and relapse monitoring values for GCT, which deserve to be further investigated. In addition, it also suggested that metabolomics profiling approach is a promising screening tool for the diagnosis and relapse monitoring of GCT patients.
Patient delay and associated factors among Chinese women with breast cancer
Authors: Zhang Huaguo , Wang Guorong , Zhang Jina , Lu Ying , Jiang Xiaolian
Published: October 2019

To examine the current situation of patient delay and to identify factors associated with patient delay among women with breast cancer in China.

A total of 283 women, aged 23 to 83 years old and with histologically confirmed breast cancer, were investigated in this cross-sectional study. The women were recruited from seven selected hospitals in Sichuan Province, China. Face-to-face interviews using a structured questionnaire were performed.

Among the 283 participants, the range of patient delay was 0.2 to 900 days with a median patient delay of 50 days. A total of 35.8% of patients waited ≥90 days to access medical treatment after symptom onset. Binary logistic regression analysis showed that the main predictors of patient delay were knowledge of breast cancer symptoms (OR = 0.716, 95%CI:0.637–0.804, P = .000), external health locus of control (OR = 1.173, 95%CI:1.087–1.266, P = .000), breast self-examination/physical examination (OR = 0.065, 95%CI: 0.007–0.590, P = .015), perceived health competence (OR = 0.873, 95%CI:0.808–0.944, P = .000), family support (OR = 0.911,95%CI:0.847–0.981, P = .013), pain stimulation (OR = 0.191, 95%CI:0.046–0.792, P = .023) and age (OR = 1.028, 95%CI:1.000–1.058, P = .049).

These factors explained 41.0% of the variance.

Information on the current situation and predictors of patient delay in Chinese women with breast cancer might provide meaning insights into the early diagnosis of breast cancer. The results of this study may help health professionals develop specific clinical practice strategies to reduce patient delay of initial treatment as a way to improve outcomes for women with breast cancer.
Efficacy of treatment regimens for advanced hepatocellular carcinoma
Authors: Chen Qi-Feng , Wu Pei-Hong , Huang Tao , Shen Lu-Jun , Huang Zi-Lin , Li Wang
Published: October 2019

Background:

This study aimed to perform a network meta-analysis to evaluate the therapeutic effect and safety of various modalities in treating advanced hepatocellular carcinoma (HCC). Typically, the modalities of interest were comprised of sorafenib, transarterial chemoembolization (TACE), sorafenib combined with TACE, TACE combined with traditional Chinese medicine (TCM), and sorafenib combined with hepatic arterial infusion chemotherapy (HAIC).

Methods:

Potentially eligible studies were systemically retrieved from the electronic databases (including PubMed and Cochrane Library) up to September 2018. The overall survival (OS) associated with the 5 modalities of interest enrolled in this study was compared by means of network meta-analysis. Meanwhile, major adverse events (AEs) were also evaluated.

Results:

The current network meta-analysis enrolled 7 published randomized controlled trials (RCTs), and the pooled results indicated that the TACE-TCM regimen displayed the highest efficacy in treating advanced HCC, followed by HAIC-sorafenib. By contrast, the TACE alone and sorafenib alone regimens had the least efficacy. Relative to other regimens of interest, the TACE-TCM regimen was associated with less incidence of treatment-associated AEs.

Conclusion:

The TACE-TCM regimen was associated with higher treatment responses in advanced HCC patients than those of the other regimens of interest.
Does long-term use of antidiabetic drugs changes cancer risk?
Authors: Liu Yi-Chun , Nguyen Phung-Anh , Humayun Ayesha , Chien Shuo-Chen , Yang Hsuan-Chia , Asdary Rahma Novita , Syed-Abdul Shabbir , Hsu Min-Huei , Moldovan Max , Yen Yun , Li Yu-Chuan (Jack) , Jian Wen-Shan , Iqbal Usman
Published: October 2019

Antidiabetic medications are commonly used around the world, but their safety is still unclear. The aim of this study was to investigate whether long-term use of insulin and oral antidiabetic medications is associated with cancer risk.

We conducted a well-designed case–control study using 12 years of data from Taiwan's National Health Insurance Research Database and investigated the association between antidiabetic medication use and cancer risk over 20 years. We identified 42,500 patients diagnosed with cancer and calculated each patient's exposure to antidiabetic drugs during the study period. We matched cancer and noncancer subjects matched 1:6 by age, gender, and index date, and used Cox proportional hazard regression and conditional logistic regression, adjusted for potential confounding factors, that is, medications and comorbid diseases that could influence cancer risk during study period.

Pioglitazone (adjusted odds ratio [AOR], 1.20; 95% confidence interval [CI], 1.05–1.38); and insulin and its analogs for injection, intermediate or long acting combined with fast acting (AOR, 1.22; 95% CI, 1.05–1.43) were significantly associated with a higher cancer risk. However, metformin (AOR, 1.00; 95% CI, 0.93–1.07), glibenclamide (AOR, 0.98; 95% CI, 0.92–1.05), acarbose (AOR, 1.06; 95% CI, 0.96–1.16), and others do not show evidence of association with cancer risk. Moreover, the risk for specific cancers among antidiabetic users as compared with nonantidiabetic medication users was significantly increased for pancreas cancer (by 45%), liver cancer (by 32%), and lung cancer (by 18%).

Antidiabetic drugs do not seem to be associated with an increased cancer risk incidence except for pioglitazone, insulin and its analogs for injection, intermediate or long acting combined with fast acting.
Supraglottic devices for airway management in awake craniotomy
Authors: Grabert Josefin , Klaschik Sven , Güresir Ági , Jakobs Patrick , Soehle Martin , Vatter Hartmut , Hilbert Tobias , Güresir Erdem , Velten Markus
Published: October 2019

Awake craniotomy is a unique technique utilized for mapping neuro and motor function during neurosurgical procedures close to eloquent brain tissue. Since active communication is required only during surgical manipulation of eloquent brain tissue and the patient is “sedated” during other parts of the procedure, different methods for anesthesia management have been explored. Furthermore, airway management ranges from spontaneous breathing to oro or nasotracheal intubation. Case reports have described the use of laryngeal masks (LMs) previously; however, its safety compared to tracheal intubation has not been assessed.

We conducted a retrospective analysis of 30 patients that underwent awake craniotomy for tumor surgery to compare the feasibility and safety of different airway management strategies. Nasal fiberoptic intubation (FOI) was performed in 21 patients while 9 patients received LM for airway management. Ventilation, critical events, and perioperative complications were evaluated.

Cannot intubate situation occurred in 4 cases reinserting the tube after awake phase, while no difficulties were described reinserting the LM (P < .0001). Furthermore, duration of mechanical ventilation after tumor removal was significantly lower in the LM group compared to FOI group (62 ± 24 vs. 339 ± 82 [min] mean ± sem, P < .0001). Postoperatively, 2 patients in each group were diagnosed with and treated for respiratory complications including pneumonia, without statistical significance between groups.

In summary, LM is a feasible airway management method for patients undergoing awake craniotomy, resulting in reduced ventilation duration compared to FOI procedure.
The landscape of vascularized composite allograft donation in the United States
Authors: Henderson Macey L.
Published: October 2019

Purpose of review

Vascularized composite allograft (VCA) donation and transplantation has now demonstrated feasibility and impact to the lives of patients suffering from devastating and traumatic injury. This review summarizes the current landscape of VCA donation in the United States.

Recent findings

VCA donations are nonlife-saving allografts, for nonlife-saving transplants – and therefore, conservative donor selection focused on the optimization of donors for the lowest risk to transplant recipients is paramount. VCA donors in the United States are a demographically and clinically diverse group that largely reflects the characteristics of the VCA candidates waiting for transplants. Public opinion about VCA donation is generally supportive, but has lower support for VCA transplants than for solid organ transplants.

As an emerging area of transplantation, VCA donation is evolving in the United States with growing interest by the public, and those suffering from catastrophic injury for which reconstructive transplantation may offer excellent outcomes and a high quality of life.