bluuebunny/crossref_metadata_2025 huggingface dataset:
Significant association of SYNTAX score on release of cardiac biomarkers in uncomplicated post-revascularization procedures among patients with stable multivessel disease
Authors: de Azevedo Diogo Freitas Cardoso , Hueb Whady , Lima Eduardo Gomes , Rezende Paulo Cury , Linhares Filho Jaime Paula Pessoa , de Carvalho Guilherme Fernandes , Martins Eduardo Bello , Nomura Cesar Higa , Strunz Celia Maria Cassaro , Serrano Junior Carlos Vicente , Ramires Jose Antonio Franchini , Kalil Filho Roberto
Published: February 2020

This study investigated the relationship between angiographic complexities of coronary artery disease (CAD) assessed by SYNTAX Score synergy between percutaneous coronary intervention with taxus and cardiac surgery score (SYNTAX Score) and cardiac biomarker elevation after revascularization procedures.

This is a post-hoc analysis of the medicine, angioplasty or surgery study V study of patients with stable CAD. High-sensitivity troponin 1 (hs-TnI) and creatinine kinase-muscle/brain (CK-MB) were assessed before and after cardiovascular procedures. Baselines SYNTAX Scores (SXScores) were calculated by blinded investigators to patient characteristics.

Of the 202 patients studied, the mean SXScore was 21.25 ± 9.24; 40.10 ± 7.09 in the high SXScore group and 19.06 ± 6.61 in low/mid SXscore group (P < .0001). Positive correlations existed between SXScore and median peaks after procedural hs-TnI (r = 0.18, P = .009) and CK-MB (r = 0.24, P = .001) levels. In patients with high SXScores (≥33), the median peaks of post-procedural hs-TnI (P = .034)and CK-MB (P = .004) levels were higher than in low/mid SXScore group (<33).The release of hs-TnI at 6 (P = .002), 12 (P = .008), and 24 hours (P = .039) was higher in high SXScore group than in low/mid SXscore group (<33) as was the release of CK-MB at 6 (P < .0001), 12 (P < .0001), 24 (P = .001), 36 (P = .007), 48 (P = .008), and 72 hours (P = .023). After multivariable analysis, high SXScore was a significant independent predictor of release of CK-MB and hs-TnI peaks higher than the median.

The increase in release of cardiac biomarkers was significantly associated with the extent of atherosclerosis identified by the SYNTAX Score.
Wide resection of soft tissue sarcomas after unplanned primary procedures
Authors: Kang Jian , Xu Ming , Wang Bing , Yu Xiuchun
Published: February 2020

Unplanned resection of soft-tissue sarcomas (STS) predispose the patients to recurrences and metastases, secondary wide resection is usually warranted.

To investigate the outcomes of re-excision of STS after unplanned initial resection.

The records of 39 patients undergoing re-excision of STS after unplanned initial resection from January 2006 through December 2015 were retrospectively investigated.

There were 17 males and 22 females, the mean age was 45.7 years. Most initial unplanned resections were performed in rural hospitals by surgeons from general surgery department, dermatology department, plastic surgery department, and orthopedic department. Thirty-five patients underwent secondary wide resections in our department. Histopathological findings indicated positive margins after primary surgeries in 18 patients. Until the conclusion of 37.2-month follow-up, 7 patients developed metastasis, 3 had local recurrence, and 7 were dead. Positive margins were associated with increased metastases and lower survival rates (P < .05). There was no significant difference in recurrences between the 2 groups.

Unplanned initial resection of STS often lead to unfavorable prognosis. Primary wide resections are warranted for this disease entity.
Effect of sustained inflations and intermittent positive pressure ventilation on bronchopulmonary dysplasia or death among neonatal
Authors: Guo Yue , Jiang Yan , Tang Hanbo , Fan Wenjuan , Ai Chenchen , Liu Ping
Published: February 2020

Background:

Sustained Inflations (SI) and Intermittent Positive Pressure Ventilation (IPPV) are two interventions to prevent Bronchopulmonary dysplasia (BPD). The aim of this study is to assess the effect of these two interventions.

Methods:

The databases of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) will be comprehensively searched from inception to September 2019. All RCTs and quasi-RCTs which compare the efficacy of SI vs IPPV among preterm infants are eligible. We will assess the methodological quality using the Cochrane Handbook version 5.1.0. A meta-analysis will be performed using RevMan 5.3 software and the results will be presented using risk ratios (RRs) and 95% confidence intervals (CIs).

Conclusions:

This study will provide strong evidence for assessing the effect of SI and IPPV on BPD or death among preterm infants.

PROSPERO registration number:

CRD42019135816.
Combined use of circulating tumor cells and salivary mRNA to detect non–small-cell lung cancer
Authors: Gu Xianwen , He Junfeng , Ji Guanglei
Published: February 2020

Liquid biopsy is an emerging technique for noninvasive detection of various cancers. Majority of liquid biopsy tests still, however, use solitary type of biomarkers with unsatisfactory sensitivity and specificity. To this end, a combined approach of circulating tumor cells (CTCs) and salivary mRNA biomarkers was evaluated for discriminating non–small-cell lung cancer (NSCLC) from healthy controls.

Our study included a discovery phase to find multiple biomarkers, and an independent validation phase to confirm the applicability of the selected biomarkers. In the discovery phase, CTC level in blood and 5 mRNA biomarkers in saliva (i.e., CCNI, Epidermal growth factor receptor [EGFR], FGF19, FRS2, and GREB1) were measured for 140 NSCLC patients and 140 healthy controls, followed by developing a predictive model. Next, this panel of biomarkers was applied to another patient cohort consisted of 60 patients with NSCLC and 60 healthy controls in the validation phase.

We found that our novel biomarker panel could differentiate patients with NSCLC from healthy controls with high sensitivity (92.1%) and high specificity (92.9%) in the discovery phase. In the validation phase, we achieved sensitivity of 88.3% and specificity of 90.0%.

To our best knowledge, it is the first time that a combined use of CTC and salivary mRNA biomarkers were applied for noninvasive detection of NSCLC.
Efficacy and safety of ucha-shinki-hwan on korean patients with cold hypersensitivity in the hands and feet
Authors: Ko Youme , Sun Seung-Ho , Go Ho-Yeon , Lee Jin-Moo , Jang Jun-Bok , Sung Hyun-Kyung , Jang Bo-Hyoung , Jeon Chan-Yong , Ko Seong-Gyu
Published: February 2020

Background:

Cold hypersensitivity in the hands and feet (CHHF) is a common complaint in Asian female population especially in Korea. Due to the symptoms of CHHF the quality of individual's daily life can be degraded. Ucha-Shinki-Hwan (UCHA) is widely used in the treatment of various diseases including CHHF by harmonizing Yin and Yang, and improving the vitality of whole body. However, the efficacy of UCHA as a treatment option of CHHF has not been assessed in trials. Thus, we aimed to investigate the efficacy and safety of UCHA in Korean women with CHHF through this trial.

Methods:

This study will be an exploratory, randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. Korean women aged 19 to 59 years who complaint with CHHF will be enrolled from 5 university affiliated Korean medicine hospitals. A total of 164 subjects will be randomly assigned to a treatment group (UCHA) or a placebo group at a 1:1 ratio. The subjects will receive 2.5 g of either UCHA or placebo three times a day for 8 weeks. The primary outcome will be evaluated with the visual analog scale score of CHHF. The secondary outcome measures will be changes in skin temperature in extremities as measured by using a thermometer and the Korean version of the World Health Organization Quality of Life Scale Abbreviated Version.

Discussion:

This study will be the first trial to explore the efficacy and safety of UCHA for CHHF patient. This will provide meaningful clinical information on herbal medicine treatment of CHHF and a clinical evidence for planning a full randomized clinical trial.

Disclosures and acknowledgments:

The authors report no competing interests.

Trial registration:

This study is registered at ClinicalTrials.gov, ID: NCT03790033. Registered on (31 December 2018)

Protocol version:

The final approved version of the trial protocol is V1.3. (25 January 2019)
Comparison of endoscopic naso-gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute suppurative cholecystitis
Authors: Mu Peilei , Yue Ping , Li Tianya , Bai Bing , Lin Yanyan , Zhang Jinduo , Wang Haiping , Liu Ying , Yao Jia , Meng Wenbo , Li Xun
Published: February 2020

Introduction:

Transitional drainage, which is followed by cholecystectomy plays a key role in the management of acute cholecystitis, especially in high-risk surgical patients. Endoscopic naso-gallbladder drainage (ENGBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients who need temporary drainage. There is a lack of prospective comparison on the relevant outcomes of the two drainage methods during the period of drainage, especially the subsequent cholecystectomy.

Methods:

This is a randomized controlled two-arm non-blind single center trial. Patients with acute cholecystitis undergo emergent or early cholecystectomy and need drainage will be randomly assigned to group PTGBD or ENGBD. Pain score is defined as the primary endpoint, whereas several secondary endpoints, such as the rates of technical success, clinical remission, open conversion of cholecystectomy will be determined to elucidate more detailed differences between two groups. The general feasibility, safety, and quality checks required for high-quality evidence will be adhered to.

Discussion:

This study would provide the first type A evidence concerning the comparison of ENGBD versus PTGBD in surgically high-risk patients with acute cholecystitis, it will be the first trial designed to determine the impact of two drainage methods on not only peri-drainage but also peri-LC.

Trial registration:

NCT03701464. Registered on October 10, 2018.
Therapeutic efficacy of shenmai injection as an adjuvant treatment in dilated cardiomyopathy
Authors: Gao Kai , Song Yan-Ping , Song Anna , Chen Hao , Zhao Lin-Tao , Zhang Hai-Wang
Published: February 2020

Background:

Shenmai injection (SMI) is a Traditional Chinese Medicine patent prescription consisting of extractions from ophiopogonis radix and ginseng radix rubra. Clinical studies showed that SMI combined with conventional medicine treatment (CMT) can enhance the therapeutic efficacy for dilated cardiomyopathy (DCM). However, there is still a lack of comprehensive and systematic evidence, which urgently requires us to verify its therapeutic efficacy. Hence, we provide a protocol for systematic review and meta-analysis.

Methods:

The systematic search on the MEDLINE/PubMed, China National Knowledge Infrastructure (CNKI), Wanfang database, VIP database, the Cochrane Library, Embase and Chinese Biomedical Database (CBM) in Chinese and English language with dates ranging from the earliest record to August 8, 2019. Next, the quality of each trial was assessed according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Then, the outcome data were recorded and pooled by RevMan 5.3 software.

Results:

The systematic review and meta-analysis aims to review and pool current clinical outcomes of SMI for the adjuvant treatment of DCM.

Conclusion:

This study will provide a high-quality evidence of SMI for the adjuvant treatment on DCM patients.

PROSPERO Registration Number:

CRD42019146369.
A meta-analysis of randomized controlled trials of the addition of lubiprostone to bowel preparation before colonoscopy
Authors: Li Peng , He Xue-Qian , Dong Jie , Du Jing
Published: February 2020

Aim:

Adequate bowel preparation is essential to the quality of colonoscopy. We performed a meta-analysis to determine the efficacy and safety of the addition of lubiprostone to the bowel preparation process prior to colonoscopy.

Methods:

Online databases, namely, PubMed, MEDLINE and Cochrane Library, were searched for randomized controlled trials that assessed the additive effect of lubiprostone on the quality of colon preparation in patients undergoing colonoscopy. Each included study was evaluated by the Jadad score to assess the quality of the study. The primary outcome was bowel preparation efficacy, defined as the proportion of patients with an excellent or poor preparation. The secondary outcomes included the length of the colonoscopy, polyp detection, and any adverse effects.

Results:

In total, 5 articles published between 2008 and 2016 fulfilled the selection criteria. The addition of lubiprostone to the bowel cleansing process significantly increased the proportion of patients with an excellent preparation (risk ratio [RR] = 1.68, 95% confidence interval (CI): 1.40–2.02, P < .00001) but did not decrease the procedural time or increase the polyp detection rate (mean difference = -0.52, 95% CI: -3.74–2.69, P = .75; RR = 1.16, 95% CI: 0.96–1.42, P = .13, respectively). There was no significant difference in the proportion of patients with any adverse events.

Conclusion:

The addition of lubiprostone to the bowel preparation regimen prior to colonoscopy is effective and safe.
A Bayesian classification model for discriminating common infectious diseases in Zhejiang province, China
Authors: Li Fudong , Shen Yi , Lv Duo , Lin Junfen , Liu Biyao , He Fan , Wang Zhen
Published: February 2020

To develop a classification model for accurately discriminating common infectious diseases in Zhejiang province, China.

Symptoms and signs, abnormal lab test results, epidemiological features, as well as the incidence rates were treated as predictors, and were collected from the published literature and a national surveillance system of infectious disease. A classification model was established using naïve Bayesian classifier. Dataset from historical outbreaks was applied for model validation, while sensitivity, specificity, accuracy, area under the receiver operating characteristic curve (AUC) and M-index were presented.

A total of 146 predictors were included in the classification model, for discriminating 25 common infectious diseases. The sensitivity ranged from 44.44% for hepatitis E to 96.67% for measles. The specificity varied from 96.36% for dengue fever to 100% for 5 diseases. The median of total accuracy was 97.41% (range: 93.85%–99.04%). The AUCs exceeded 0.98 in 11 of 12 diseases, except in dengue fever (0.613). The M-index was 0.960 (95%CI 0.941–0.978).

A novel classification model was constructed based on Bayesian approach to discriminate common infectious diseases in Zhejiang province, China. After entering symptoms and signs, abnormal lab test results, epidemiological features and city of disease origin, an output list of possible diseases ranked according to the calculated probabilities can be provided. The discrimination performance was reasonably good, making it useful in epidemiological applications.
Pituitary adenoma secondary to primary hypothyroidism
Authors: Du Jianyang , Ji Hang , Jin Jiaqi , Gao Shuai , Yan Xiuwei , Hu Shaoshan
Published: February 2020

Rationale:

Primary hypothyroidism is characterized by loss of thyroxine feedback inhibition and overproduction of thyrotropin-releasing hormone, which might result in reactive pituitary hyperplasia. However, pituitary adenoma secondary to primary hypothyroidism is extremely rare and usually underdiagnosed, and the pathogenic mechanism remains unclear. Herein, we reported two cases with pituitary adenoma secondary to primary hypothyroidism.

Patient concerns:

Case 1: A 35-year-old man presented to the local clinic with a 2-year history of fatigue, puffiness in the bilateral lower extremities and facial region, and coarseness of facial features. Additionally, his relatives also supplemented that he suffered from hypomnesis and hypophrenia.

Case 2: A 56-year-old, postmenopausal woman presented to the local clinic with fatigue, dry skin, and sluggishness.

Diagnoses:

The pathological diagnosis of two patients was plurihormonal pituitary adenoma.

Interventions:

A microscopical tumorectomy was performed when the two patients were admitted to our hospital. Thyroid hormone replacement therapy (thyroxine 50 μg/day) was prescribed after microsurgery.

Outcomes:

After 32 months (Case 1) or 43 months (Case 2) follow-up respectively, there was no recurrence, and the symptoms were completely relieved.

Lessons:

Pituitary hyperplasia caused by primary hypothyroidism responds well to thyroid hormone replacement therapy. It is worth noting that repeated detection of serum T3, T4, and thyroid-stimulating hormone (TSH) should be performed 3 months after replacement therapy. If the results showed that TSH level decreased partly, while thyroid function did not improve significantly, long-term increased secretion of pituitary TSH adenoma should be considered. And microsurgical resection via a transsphenoidal approach could be ordered. If the optic nerve or optic chiasm were pressed by the adenoma, microsurgery should be performed to relieve the pressure immediately. And then, thyroxine tablet substitute therapy should be performed after surgery.
The comparative efficacy of supervised- versus home-based exercise programs in patients with ankylosing spondylitis
Authors: Liang Hui , Xu Lingli , Tian Xu , Wang Shuya , Liu Xiaoling , Dai Yi , Kang Li , Chen Lisai , Jin Lifen , Li Qin , Chen Weiqing
Published: February 2020

Objectives:

The aim of this meta-analysis is to investigate the comparative efficacy between supervised- and home-based programs in patients with ankylosing spondylitis (AS).

Method:

A systematic search in PubMed, Web of Science, EMBASE, and the Cochrane Library was electronically performed by 2 independent investigators in order to capture all potential studies comparing supervised- with home-based in patients with AS from inception to April 2018. After extracted essential information, apprised risk of bias, statistical analysis was performed with Review Manager (RevMan) software (version 5.3.0). The protocol was registered at PROSPERO platform with an identifier of CRD42018097046.

Results:

A total of 7 studies comprising 271 patients were included finally. Meta-analyses showed that, compared to home-based program, supervised-based program was associated with reduced bath ankylosing spondylitis metrology index (BASMI) scores (mean difference [MD], -0.45; 95% confidence interval [CI], -0.73, -0.17), bath ankylosing spondylitis disease activity index (BASDAI) scores (MD, -0.48; 95% CI, -0.88, -0.08), and bath ankylosing spondylitis functional index (BASFI) scores (MD, -0.78; 95% CI, -1.19, -0.37). However, depression scores (standard mean difference, -0.22; 95% CI, -0.58, 0.14) between the 2 groups showed no significant defference.

Conclusions:

Both supervised- and home-based programs can benefit to reduce BASMI, BASDAI, and BASFI scores in AS patients. However, short-term, supervised exercise program may be more effective than home-based exercises at decreasing disease activity with AS.
Circulating myokine levels in different stages of glucose intolerance
Authors: Park Kahui , Ahn Chul Woo , Park Jong Suk , Kim YuSik , Nam Ji Sun
Published: February 2020

Type 2 diabetes is the fastest growing metabolic disease in the world. Recently, muscle is considered an endocrine organ which secretes various peptides that play an important role in insulin resistance and metabolic syndrome. We assessed 4 different myokines, irisin, interleukin-13 (IL-13), follistatin-related protein-1 (FSTL-1), and fractalkine, in normal, prediabetes, and diabetes patients.

A total of 126 participants who visited Gangnam Severance Hospital were enrolled and divided into normal, prediabetes, and diabetes groups based on oral glucose tolerance test and hemoglobin a1c. A cross-sectional study was conducted to measure and compare serum levels of irisin, IL-13, FSTL-1, and fractalkine among the groups.

Irisin level showed a tendency to increase in prediabetes group compared to normal group (P < .1) but showed a significant decrease when comparing diabetes from prediabetes group (P < .001). IL-13 decreased in diabetes group compared to prediabetes and normal group (P < .001, P < .05, respectively). FSTL-1 of diabetes group was lower than that of prediabetes group (P < .05), and fractalkine was higher in diabetes group compared to that of prediabetes and normal group (P < .01, P < .01, respectively).

Irisin, IL-13, and FSTL-1 levels were reduced in diabetes group compared to normal or prediabetes group while fractalkine showed a progressive increase from normal to diabetes group. Further studies are warranted to study the roles of various myokine in diabetes through a larger prospective study.
Evaluation of the gestational diabetes mellitus diagnostic criteria recommended by the international association of diabetes and pregnancy study group for long-term maternal postpartum outcomes in mainland China
Authors: Miao Zhi-Rong , Wu Hong-Hua , Zhang Yang-Zi , Sun Wei-Jie , Lu Di-Fei , Yang Hui-Xia , Zhang Jun-Qing , Guo Xiao-Hui
Published: February 2020

The gestational diabetes mellitus (GDM) diagnostic criteria recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG) were established based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and have been the most commonly used criteria for determining GDM worldwide. Although individuals from mainland China were not included in the HAPO study, the IADPSG criteria have been used in China since 2011. However, the appropriateness of the criteria for evaluating maternal postpartum outcomes in mainland China are unknown. We conducted this study to determine whether the IADPSG criteria are appropriate for Chinese patients for evaluating long-term maternal postpartum outcomes.

Eighty-four patients who were diagnosed with hyperglycemia during pregnancy and had delivery in Peking University First Hospital from February 2007 to December 2009 were enrolled in the study. For patients in Group A, GDM was diagnosed using both the National Diabetes Data Group (NDDG) and the IADPSG criteria, while patients in Group B, gestational impaired glucose tolerance (GIGT) was diagnosed using the NDDG criteria while GDM was diagnosed based on the IADPSG criteria. Anthropometric data, glucose metabolism, lipid profiles, β cell function, and insulin resistance index were evaluated and compared to baseline after 5- to 6-year postpartum period.

Patients in group A had significantly higher oral glucose tolerance test (OGTT) fasting, 2-hour and 3-hour plasma glucose levels compared to patients in group B at 24 to 28 weeks of gestation (P < .05). No significant differences were observed between the groups for anthropometric data, postpartum abnormal glucose metabolism (50.91% vs 44.83%, P = .596), type 2 diabetes mellitus (T2DM) (16.36% vs 3.45%, P = .167), lipid profiles, β cell function (homeostasis model assessment β-cell function index (HOMA-β) 1.04 vs 0.99, P = .935) and insulin resistance (homeostasis model assessment insulin resistance index (HOMA-IR) 2.01 vs 1.69, P = .583).

Patients diagnosed with GDM using either the NDDG or IADPSG criteria had abnormal glucose levels and lipid metabolism after delivery. Patients with mild hyperglycemia had similar postpartum β-cell functional impairment and insulin resistance to those with moderate hyperglycemia during pregnancy. Hence, with respect to maternal long-term postpartum outcomes, the IADPSG diagnostic criteria for GDM could be appropriate for patients in mainland China.
Burnout level and job satisfaction in Chinese pediatrics residents
Authors: Ji Li , Xiaowei Zhang , Ling Kuang , Yao Fu , Qingkun Song , Jun Zhao
Published: February 2020

To study the prevalence of burnout and job satisfaction in Chinese pediatrics residents.

Prospective participants were invited via a WeChat group to participate from October 1, 2018 to January 31, 2019. The Maslach Burnout Inventory-Human Services Survey was used to measure physician burnout, and the Minnesota Satisfaction Questionnaire was used to measure job satisfaction.

A total of 380 residents (81.1% response rate) from 35 pediatric residency programs completed the cross-sectional web-based survey. Of the responders, 233 (61.3%) exhibited high levels of career burnout. Residents 24 to 29 years of age were less likely to report burnout than residents ≥30 years of age (50.9% vs74.7%; P < .05). In addition, residents with an annual income less than 80,000 RMB seem to have higher burnout levels (66.2%). Residents who reported that they felt sleep deprived had significantly higher rates of burnout than those who did not (P < .01). Logistic regression showed that age ≥30 years (odds ratio [OR] 3.74 [1.57–7.66], P < .01) and sleep deprivation (OR 4.11 [2.19–7.35], P < .01) were the 2 independent risk factors associated with burnout.

Burnout is highly prevalent among Chinese pediatrics residents who also reported poor job satisfaction.
Efficacy and safety of TCM Yangxin Anshen Therapy for insomnia
Authors: Li Feizhou , Xu Bo , Shi Heyuan , Zhang Tong , Song Ziyu , Chen Yanhua , Liu Ling , Wang Ping
Published: February 2020

Background:

Traditional Chinese Medicine (TCM) has gradually drawn the attention of clinicians as an alternative choice for insomniacs and TCM Yangxin Anshen Therapy (TYAT) is a crucial therapy of treating insomniacs. The purpose of this study was to evaluate the efficacy and safety of TYAT for insomnia.

Methods:

Seven electronic databases were searched from inception to July 2019. Two authors independently identified Randomized Controlled Trials (RCTs), extracted data and assessed risk of bias by Cochrane risk bias assessment tool. Comprehensive meta-analysis was conducted with the Review Manager for eligible and appropriate studies.

Results:

Fourteen trials (1549 participants) were finally included in this study. The included studies were of moderate-to-high quality. Twelve trials reported the specific methods of random sequence generation, and 4 of them used the allocation concealment. Blinding of participants and personnel were used in 7 studies, and blinding of outcome assessment was performed in 3 studies. The main meta-analysis showed:

Conclusion:

TYAT is an effective alternative therapy for insomnia, and its clinical application appears safe. The conclusions of this paper have a certain reference value for further research and clinical practice.

Trial registration number:

PROSPERO CRD 42019135115.
Inferior Vena Cava Ultrasound in Children: Comparing Two Common Assessment Methods*
Authors: de Souza Tiago H. , Giatti Marina P. , Nogueira Roberto J. N. , Pereira Ricardo M. , Soub Ana C. S. , Brandão Marcelo B.
Published: February 2020

Objectives:

Inferior vena cava ultrasound has been used as a predictor of fluid responsiveness in children. Two ultrasonographic modes can be used to measure the respiratory variation of inferior vena cava diameter: M-mode and B-mode. Inconsistencies in measurements between the modes can result in inaccuracies in commonly used indices that assess fluid responsiveness. Our primary objective was to determine whether there are differences in the ultrasound-based measurements between these two modes of evaluation, which would impact respiratory variation of inferior vena cava diameter calculation. Our secondary objective was to assess inferior vena cava displacements during the respiratory cycle as a possible mechanism for measurement differences between the modes.

Design:

Prospective observational study.

Setting:

PICU of a tertiary care teaching hospital.

Patients:

Seventy-three children under controlled ventilation (median age of 16 mo and weight of 10 kg).

Interventions:

The inferior vena cava diameters were measured using a longitudinal view using B- and M-mode ultrasound. Two respiratory variation of inferior vena cava diameter indices were evaluated: distensibility and respiratory variation. Maximum craniocaudal and mediolateral displacements of the inferior vena cava were measured using the B-mode ultrasound.

Measurements and Main Results:

Maximum diameters of the inferior vena cava were similar between the B- and M-modes (7.90 vs 7.90 mm, respectively; p = 0.326), but minimum diameters were smaller when measured by M-mode (6.36 vs 5.00 mm; p = 0.003). When calculated by data obtained from M-mode, respiratory variation of inferior vena cava diameter indices presented significantly higher values compared to B-mode measures (p ≤ 0.001, for both). Median inferior vena cava displacements were 5.00 mm (interquartile range, 3.68–6.26 mm) in the craniocaudal and 0.80 mm (interquartile range, 0.12–1.23 mm) in the mediolateral directions.

Conclusions:

There is a significant difference between measurements of the minimum inferior vena cava diameter observed in M- and B-mode ultrasound during the respiratory cycle in children under controlled ventilation. This results in imprecise respiratory variation of inferior vena cava diameter indices. Displacements of the inferior vena cava during the respiratory cycle may influence the reliability of ultrasonographic measurements, particularly in M-mode.
The Association of Illness Uncertainty and Hope With Depression and Anxiety Symptoms in Women With Systemic Lupus Erythematosus: A Cross-sectional Study of Psychological Distress in Systemic Lupus Erythematosus Women
Authors: Cui Chunying , Li Yifei , Wang Lie
Published: February 2020

Background

Depression and anxiety are commonly observed psychological symptoms in patients diagnosed with systemic lupus erythematosus (SLE). This study aimed to explore the possible factors that influence depression and anxiety symptoms development in SLE women.

Methods

This cross-sectional study was conducted between October 2017 and December 2018 in Liaoning, China. Questionnaires including Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Mishel Uncertainty in Illness Scale for Adults, and Herth Hope Scale were completed by 205 participants. Factors related to depression and anxiety were examined using hierarchical multiple regression analysis, while the effect of hope was examined using structural equation model.

Results

The prevalence of depression and anxiety symptoms in female SLE patients was 79.5% and 86.8%, respectively. Illness uncertainty was strongly positively correlated with depression and anxiety symptoms. In contrast, hope was negatively associated with depression and anxiety symptoms. Up to 66.6% and 59.4% of the variance explained by all the variables was 66.6% in depression symptoms and 59.4% in anxiety symptoms. Interestingly, hope was able to alter the relationship of illness uncertainty with depression and anxiety symptoms.

Conclusions

While illness uncertainty can increase depression and anxiety symptoms, hope can reduce these symptoms. Therefore, hope-based targeted interventions should be employed to prevent and treat depression and anxiety symptoms among SLE women.
The Impact of Facial Growth in Unilateral Cleft Lip and Palate Treated With 2 Different Protocols
Authors: Wong Ling Siew , Lu Ting Chen , Hang Duong Thi Diem , Chen Philip Kuo-Ting
Published: February 2020

Background and Aim

It is well known that palatoplasty can often cause disturbances in maxillary growth. The use of a single-layer vomer flap for the early closure of the hard palate is controversy among surgeons. The aim of this study is to compare the 10-year facial growth of 2 surgical protocols in the treatment of patients with unilateral cleft lip and palate performed by a single surgeon.

Methods

This retrospective analysis includes 43 nonsyndromic patients with complete unilateral cleft lip with or without a vomer flap for the closure of the hard palate during cleft-lip repair. Lateral cephalograms were obtained at the age of 5, 7, and 9 years old, and angular measurements were used to assess patient's facial growth. The Mann-Whitney U test was used to compare 2 treatment protocol groups.

Result

A total of 23 patients in protocol 1 group (16 male, 7 female) and 20 patients in protocol 2 group (10 male, 10 female) were included. At the age of 5 and 7, there was no significant difference of maxillary and mandibular growth in both groups. At the age of 9 years, all the angular measurement revealed statistical significance with SNA (P = 0.02), SNB (P = 0.05), ANB (P < 0.01), and SNPg (P = 0.05).

Conclusions

The present study has shown that early anterior palate repair for 3-month-old cleft patients have better maxillary growth and less mandibular prognathism.
The Usage of Pedicled or Free Muscle Flaps Represents a Beneficial Approach for Periprosthetic Infection After Knee Arthroplasty
Authors: Moog Philipp , Tinwald Iris , Aitzetmueller Matthias , Bauer Anna-Theresa , Megerle Kai , Machens Hans-Günther , Laszlo Kovacs L. , Kuekrek Haydar
Published: February 2020

Introduction

Periprosthetic joint infection (PJI) is a severe complication after a total knee replacement that is primarily associated with soft tissue defects. Finding an appropriate therapy for PJI is a major challenge because of the lack of guidelines and research comparing treatment options.

Methods

In this study, we retrospectively compared 78 patients who had a knee prosthetic infection within a mean follow-up period of 24 months. Group A received a soft tissue coverage in addition to orthopedic surgical therapy with or without a component replacement (CR) of the prosthesis. Group B received the same orthopedic treatment without plastic surgery for soft tissue coverage.

Results

Only 21% of the patients in group A received a CR compared with 70% in group B (P = 0.0001). In group A, 83% did not have a recurrent infection, and in group B, 57% of the patients had no further infection and regained joint function (P = 0.0376). In group A, only 15% of the patients who received a CR had a significant complication within the follow-up period of 2 years, whereas in group B, 75% of patients exhibiting a major complication (P = 0.0048*).

Conclusions

Soft tissue coverage improves the outcome after PJI of the knee with soft tissue defects. Patients who simultaneously needed plastic surgery for defect coverage and orthopedic surgery for CR had the lowest number of complications overall. Based on the results of this study, a therapy algorithm could be identified considering the soft tissue defect grade leading to the lowest major complication rates and maximizing the outcome of knee prosthesis infection therapies.
The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults
Authors: Patel Kepal N. , Yip Linwah , Lubitz Carrie C. , Grubbs Elizabeth G. , Miller Barbra S. , Shen Wen , Angelos Peter , Chen Herbert , Doherty Gerard M. , Fahey Thomas J. , Kebebew Electron , Livolsi Virginia A. , Perrier Nancy D. , Sipos Jennifer A. , Sosa Julie A. , Steward David , Tufano Ralph P. , McHenry Christopher R. , Carty Sally E.
Published: February 2020

Objective:

To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy.

Background:

Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US.

Methods:

The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content.

Results:

These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation.

Conclusions:

Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
Retrospective Analysis of Primary Suturing of the Internal Orifice of Perianal Fistula During FiLaC Procedure
Authors: Serin Kursat R. , Hacim Nadir A. , Karabay Onder , Terzi Mustafa C.
Published: February 2020

Purpose:

We aimed to evaluate the results of the fistula-tract laser closure associated with primary closure of internal orifice.

Materials and Methods:

The surgical objective was to seal the fistula tract using laser energy and closing internal orifice with purse-string suture. Between January 2017 and December 2018, 35 consecutive patients who underwent the laser closure plus internal orifice suturing included. In all 35 patients, the laser procedure was applied then internal orifice was primarily closed with 2-0 polyglactin suture after the debridement of necrotic tissue.

Results:

Among 35 patients (11 female, 24 male), mean age was 43.9±12.9 years. Median follow-up was 11 months (6.0 to 17.6 mo). According to the Park classification; 21 patients (60%) had intersphincteric fistula, 12 (34%) had transsphincteric fistula, 2 (6%) had suprasphincteric or extrasphincteric fistula. There were low/simple and high/complex fistula in 21 (60%) and 14 patients (40%), respectively. Overall, 15/35 (42.9%) patients showed complete healing, 12/35 (34%) had slight drainage with minimal symptoms, 8/35 (22%) patients had persistent symptomatic drainage, and there was no patient with painful symptomatic drainage. On the basis of the Jorge-Wexner continence score, there was no significant difference in patients before and after the procedure. The perfect continence rate was achieved in 32 patients (91%).

Conclusion:

Although the absence of major and minor complications after Fistula Laser Closure (FiLaC) procedure seemed to be a major advantage, we thought that closure of the internal opening by primary suturing has no positive effect on the healing of the perianal fistula.
Late Onset Invasive Pulmonary Aspergillosis in Lung Transplant Recipients in the Setting of a Targeted Prophylaxis/Preemptive Antifungal Therapy Strategy
Authors: Herrera Sabina , Davoudi Setareh , Farooq Ali , Tikkanen Jussi , Foroutan Farid , Kumar Deepali , Humar Atul , Rotstein Coleman , Singer Lianne G. , Keshavjee Shaf , Husain Shahid
Published: February 2020

Background.

Invasive pulmonary aspergillosis (IPA) is a significant cause of morbidity and mortality in lung transplant recipients (LTRs). It is unclear how a targeted prophylaxis/ preemptive antifungal therapy strategy impacts the incidence of IPA beyond the first-year posttransplant.

Methods.

This is a retrospective cohort of LTRs from January 2010 to December 2014. We included all LTRs who survived beyond the first year and followed them until death or 4 years postoperatively. Incidence of probable/proven IPA and Aspergillus colonization were assessed as per International Society for Heart and Lung Transplantation (ISHLT) criteria. Patients with risk factors, positive Aspergillus cultures, or galactomannan (GM) received targeted prophylaxis/preemptive therapy within the first-year posttransplant.

Results.

During the study period, 350 consecutive LTRs underwent 1078 bronchoscopies. Positive bronchoalveolar lavage for GM or Aspergillus cultures was reported for 15% (52/350) of LTRs between 2 and 4 years after transplantation. Among them, the median time to positive Aspergillus culture or GM positivity was 703 days (interquartile range, 529–754 d). The incidence rate of IPA and Aspergillus colonization was 30 of 1000 patient-y, and 63 of 1000 patient-y, respectively. The mortality rate was significantly higher in patients with IPA than without IPA (107/1000 patient-years versus 18/1000 patient-years; P < 0.0001). Rate of first-year colonization and IPA was 33% and 9%, respectively. Among the 201 patients who had a negative bronchoscopy during the first year posttransplant, only 6 (3%) developed IPA during the follow-up.

Conclusions.

A targeted prophylaxis/preemptive therapy strategy within the first-year posttransplant resulted in 4% incidence of IPA at 4-years after transplantation. However, IPA was associated with higher mortality.
Probabilistic reconstruction of measles transmission clusters from routinely collected surveillance data
Authors: Robert Alexis , Kucharski Adam J. , Gastanaduy Paul A. , Paul Prabasaj , Funk Sebastian
Published: February 2020

Pockets of susceptibility resulting from spatial or social heterogeneity in vaccine coverage can drive measles outbreaks, as cases imported into such pockets are likely to cause further transmission and lead to large transmission clusters. Characterising the dynamics of transmission is essential for identifying which individuals and regions might be most at risk.

As data from detailed contact tracing investigations are not available in many settings, we developed a R package called o2geosocial to reconstruct the transmission clusters and the importation status of the cases from their age, location, genotype, and onset date.

We compared our inferred cluster size distributions to 737 transmission clusters identified through detailed contact-tracing in the United States between 2001 and 2016. We were able to reconstruct the importation status of the cases and found good agreement between the inferred and reference clusters. The results were improved when the contact-tracing investigations were used to set the importation status before running the model.

Spatial heterogeneity in vaccine coverage is difficult to measure directly. Our approach was able to highlight areas with potential for local transmission using a minimal number of variables and could be applied to assess the intensity of ongoing transmission in a region.
Composition of the Lipid Droplets of the Bovine Corpus Luteum
Authors: Talbott Heather A. , Plewes Michele R. , Krause Crystal , Hou Xiaoying , Zhang Pan , Rizzo William B. , Wood Jennifer R. , Cupp Andrea S. , Davis John S.
Published: February 2020

2.

Establishment and maintenance of pregnancy is dependent on progesterone synthesized by luteal tissue in the ovary. Our objective was to identify the characteristics of lipid droplets (LDs) in ovarian steroidogenic cells. We hypothesized that LDs are a major feature of steroidogenic luteal cells and store cholesteryl esters. Bovine luteal tissue was used for whole tissue analysis. Further analyses were performed on isolated ovarian steroidogenic cells: granulosa and theca cells of the follicle, and small/large luteal cells. Isolated luteal LDs were collected for lipid/protein analyses. Luteal tissue contained perilipins 2/3/5, hormone-sensitive lipase and abhydrolase domain containing 5. Luteal tissue was enriched in TGs compared to other tissues, except of adipose tissue. Large and small luteal cells were distinguished from follicular cells by the presence of LDs and LD-associated proteins. Furthermore, LDs from large luteal cells were numerous and small; whereas, LDs from small luteal cells were large and less numerous. Isolated LDs contained nearly all of the TGs and cholesteryl esters present in luteal tissue. Isolated luteal LDs were composed primarily of TG, with lesser amounts of cholesteryl esters, diglyceride and other phospholipids. Bovine luteal tissue LDs are distinct from LDs in other bovine tissues, including follicular steroidogenic cells.
High Sucrose Diets Contribute to Brain Angiopathy with Impaired Glucose Uptake, and Psychosis-related Higher Brain Dysfunctions in Mice
Authors: Hirai Shinobu , Miwa Hideki , Tanaka Tomoko , Toriumi Kazuya , Kunii Yasuto , Shimbo Hiroko , Sakamoto Takuya , Hino Mizuki , Izumi Ryuta , Nagaoka Atsuko , Yabe Hirooki , Nakamachi Tomoya , Shioda Seiji , Dan Takashi , Miyata Toshio , Nishito Yasumasa , Suzuki Kazuhiro , Miyashita Mitsuhiro , Tomoda Toshifumi , Hikida Takatoshi , Horiuchi Junjiro , Itokawa Masanari , Arai Makoto , Okado Haruo
Published: February 2020

Metabolic dysfunction is thought to contribute to the severity of psychiatric disorders; however, it has been unclear whether current high-simple-sugar diets contribute to pathogenesis of these diseases. Here we demonstrate that a high-sucrose diet during adolescence induces psychosis-related behavioral endophenotypes, including hyperactivity, poor working memory, impaired sensory gating, and disrupted interneuron function in mice deficient for glyoxalase-1 (Glo1), an enzyme involved in detoxification of sucrose metabolites. Further, the high-sucrose diet induced microcapillary impairments and reduced brain glucose uptake in brains ofGlo1deficient mice. Aspirin protected against this angiopathy, enhancing brain glucose uptake, and preventing abnormal behavioral phenotypes. Similar vascular damage to our model mice was found in the brains of randomly collected schizophrenia and bipolar disorder patients, suggesting that psychiatric disorders are associated with angiopathy in the brain caused by various environmental stresses, including metabolic stress.
Pre-existing resistant proviruses can compromise maintenance of remission by VRC01 in chronic HIV-1 infection
Authors: Saha Ananya , Dixit Narendra M.
Published: February 2020

Broadly neutralizing antibodies (bNAbs) of HIV-1 hold promise of eliciting long-term HIV-1 remission. Surprisingly, the bNAb VRC01, when administered concomitantly with the cessation of successful antiretroviral therapy (ART), failed rapidly in chronic HIV-1 patients. We hypothesized that the failure was due to VRC01-resistant strains that were formed before ART initiation, survived ART in latently infected cells, and were reactivated during VRC01 therapy. Current assay limitations preclude testing this hypothesis experimentally. We developed a mathematical model based on the hypothesis and challenged it with available clinical data. The model integrated within-host HIV-1 evolution, stochastic latency reactivation and viral dynamics with multiple dose VRC01 pharmacokinetics. With a virtual patient population, model predictions quantitatively captured data from two independent clinical trials. Accordingly, we attributed VRC01 failure to single-mutant VRC01-resistant proviruses in the latent reservoir triggering viral recrudescence, particularly during trough VRC01 levels. Accounting for pre-existing resistance may help bNAb therapies maximize HIV-1 remission.
Distributed Subnetworks of Depression Defined by Direct Intracranial Neurophysiology
Authors: Scangos KW , Khambhati AN , Daly PM , Owen LW , Manning JR , Ambrose JB , Austin E , Dawes HE , Krystal AD , Chang EF
Published: February 2020

Quantitative biological substrates of depression remain elusive. We carried out this study to determine whether application of a novel computational approach to high spatiotemporal resolution direct neural recordings may unlock the functional organization and coordinated activity patterns of depression networks. We identified two subnetworks conserved across the majority of individuals studied. The first was characterized by left temporal lobe hypoconnectivity and pathological beta activity. The second was characterized by a hypoactive, but hyperconnected left frontal cortex. These findings identify distributed circuit activity associated with depression, link neural activity with functional connectivity profiles, and inform strategies for personalized targeted intervention.