bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre and post-liver transplant outcome of cirrhotic patients with acute on chronic liver failure
Authors: Iacob Speranta , Ghioca Mihaela , Csiki Irma Eva , Tomescu Dana , Droc Gabriela , Hrehoret Doina , Brasoveanu Vlad , Pietrareanu Corina , Iacob Razvan , Gheorghe Cristian , Popescu Irinel , Gheorghe Liana
Published: October 2020

Acute on chronic liver failure (ACLF) is a dynamic syndrome, but frequently associated with a high 1 month mortality rate. This is the first study applying the new European Association for the Study of the Liver- chronic liver failure consortium criteria to explore mortality on the waiting list (WL) and early after liver transplantation (LT) in a cohort of Romanian cirrhotic patients that improved or recovered after an episode of ACLF.

To assess frequency and waitlist mortality for different grades of ACLF.

An observational study was conducted; 257 patients with liver cirrhosis included on the WL between 2015 and 2017 were analyzed. The cumulative incidence of waitlist mortality or removal was calculated for combination of competing events using multivariable competing risks regression.

ACLF-1 occurred in 12.07%, ACLF-2 in 7.39% and ACLF-3 in 8.56% of patients. Median Model for End Stage Liver Diseases (MELD) score at the moment of ACLF was 29. The main event while on the WL was death, followed by ACLF; patients with ACLF-3 had a significantly greater subhazard ratio for mortality of 2.25 (1.55–3.26) compared to patients with ACLF-1 or 2. LT proved to be associated with a significantly lower risk of death on the WL at 6 months after inclusion. One and 12 months post-transplant survival of patients with or without ACLF was similar (P = .77).

Occurrence of an ACLF episode while on the WL is associated with a significantly high mortality rate, as well as MELD score at inclusion on the WL, renal and liver failure, presence of hepatic encephalopathy. Overall patient short and long term survival after LT is similar to non-ACLF patients in good selected cases.
Prevalence of vitamin D deficiency and insufficiency among 460,537 children in 825 hospitals from 18 provinces in mainland China
Authors: Yang Chunsong , Mao Meng , Ping Li , Yu Dan
Published: October 2020

This study was conducted to estimate the 25-hydroxyvitamin D (25 (OH)D) levels and explore factors related to vitamin D deficiency/insufficiency. This was a multicenter, hospital-based, cross-sectional observational study. Children admitted to hospitals for health examination were included for vitamin D measurement and the 25(OH)D concentration results were categorized into 3 groups: deficiency (<30 nmol/L), insufficiency (30–50 nmol/L), and sufficiency (>50 nmol/L). Four lakh sixty thousand five hundred thirty-seven children in 825 hospitals from 18 provinces participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 6.69%, 15.92%, and 77.39%, respectively. Vitamin D deficiency was the most severe in the central region, followed by the north, and southwest regions; however, data for the western region were lacking.

Logistic regression showed that vitamin D status was worse in girls, newborns, and those visiting the hospital in the winter. In conclusion, the prevalence of vitamin D deficiency is high among Chinese children and adolescents. Studies on population estimates, cost-effective screening strategies, and interventions for high-risk cases are needed.
Identification of therapeutic targets and mechanisms of tumorigenesis in non-small cell lung cancer using multiple-microarray analysis
Authors: Zhao Dan , Mu Hai-Jun , Shi Hai Bing , Bi Hong Xia , Jiang Yun Fei , Liu Guo Hua , Zheng Hong Yan , Liu Bo
Published: October 2020

Lung cancer is the most commonly occurring cancer attributed to the leading cause of cancer-related deaths globally. Non-small cell lung cancer (NSCLC) comprises 85% to 90% of lung cancers. The survival rate of patients with advanced stage NSCLC is in months. Moreover, the underlying molecular mechanisms still remain to be understood.

We used 2 sets of microarray data in combination with various bioinformatic approaches to identify the differentially expressed genes (DEGs) in NSCLC patients.

We identified a total of 419 DEGs using the Limma package. Gene set enrichment analysis demonstrated that “Citrate cycle (TCA cycle),” “RNA degradation,” and “Pyrimidine metabolism” pathways were significantly enriched in the NSCLC samples. Gene Ontology annotations of the 419 DEGs primarily comprised “glycosaminoglycan binding,” “cargo receptor activity,” and “organic acid binding.” Kyoto Encyclopedia of Genes and Genomes analysis revealed that DEGs were enriched in pathways related to “Malaria,” “Cell cycle,” and “IL-17 signaling pathway.” Protein protein interaction network analysis showed that the hub genes constituted of CDK1, CDC20, BUB1, BUB1B, TOP2A, CCNA2, KIF20A, CCNB1, KIF2C, and NUSAP1.

Taken together, the identified hub genes and pathways will help understand NSCLC tumorigenesis and develop prognostic markers and therapeutic targets against NSCLC.
Clinical analysis of 132 cases COVID-19 from Wuhan
Authors: Li Hai-yan , Wang Jin-wei , Xu Li-wei , Zhao Xu-ling , Feng Jia-xi , Xu You-zu
Published: October 2020

Numerous cases of pneumonia from a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China during December 2019.

We determined the correlations of patient parameters with disease severity in patients with COVID-19.

A total of 132 patients from Wuhan Fourth Hospital who had COVID-19 from February 1 to February 29 in 2020 were retrospectively analyzed.

Ninety patients had mild disease, 32 had severe disease, and 10 had critical disease. The severe/critical group was older (P < .05), had a higher proportion of males (P < .05), and had a greater mortality rate (0% vs 61.9%, P < .05). The main symptoms were fever (n = 112, 84.8%) and cough (n = 96, 72.7%). Patients were treated with antiviral agents (n = 94, 71.2%), antibiotics (n = 92, 69.7%), glucocorticoids (n = 46, 34.8%), intravenous immunoglobulin (n = 38, 27.3%), and/or traditional Chinese medicine (n = 40, 30.3%). Patients in the severe/critical group received mechanical ventilation (n = 22, 16.7%) or high-flow nasal can-nula oxygen therapy (n = 6, 4.5%). Chest computed tomography (CT) indicated bilateral pneumonia in all patients. Relative to the mild group, the severe/critical group had higher levels of leukocytes, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, B-type natriuretic peptide (BNP), liver enzymes, and myocardial enzymes (P < .05), and decreased levels of lymphocytes and blood oxygen partial pressure (P < .05).

The main clinical symptoms of patients from Wuhan who had COVID-19 were fever and cough. Patients with severe/critical disease were more likely to be male and elderly. Disease severity correlated with increased leukocytes, CRP, PCT, BNP, D-dimer, liver enzymes, and myocardial enzymes, and with decreased lymphocytes and blood oxygen partial pressure.
Correlation between self-perceived burden and self-management behavior in elderly stroke survivors
Authors: Ren Xiao-Ran , Wei Yuan-Yuan , Su Xiang-Ni , Hua Yan , Shao Pei , Xiao Ting , Wang Jing , Ni Chun-Ping , Guo Hong-Xia
Published: October 2020

The aim of this study was to assess the levels of self-perceived burden (SPB) and self-management behavior in elderly stroke survivors during the first 3 months after acute stroke, and to explore the correlation between them.

A total of 203 consecutive hospitalized elderly patients diagnosed with stroke were recruited. Self-perceived Burden Scale and Stroke Self-management Scale in 1 month (T1) and 3 months (T2) post-stroke were assessed and compared.

The score of SPB in elderly stroke survivors was 28.96 ± 5.50 and 27.25 ± 6.17 at T1 and T2, respectively. Stroke self-management scale scored 165.93 ± 9.82 at T1 and 167.29 ± 10.60 at T2. In the first 3 months post-stroke, the physical burden was dominant (T1 14.73 ± 3.07, T2 14.40 ± 3.13), and the behavior of stroke symptoms and signs monitoring (T1 27.58 ± 6.56, T2 28.64 ± 6.43) and rehabilitation exercise management (T1 21.40 ± 3.28, T2 20.74 ± 3.15) was the worst. SPB was negatively correlated with self-management behavior (T1 r = -.202, T2 r = -.511).

Elderly stroke survivors experienced a medium level of SPB and self-management behavior in the first 3 months post-stroke. There is a positive relationship between reduced SPB and improved self-management behavior. Addressing the characteristics and correlations as well as development of targeted interventions for SPB decreasing is beneficial to improving self-management behavior for elderly survivors.
Predicting article citations using data of 100 top-cited publications in the journal Medicine since 2011
Authors: Kuo Yu-Chi , Chien Tsair-Wei , Kuo Shu-Chun , Yeh Yu-Tsen , Lin Jui-Chung John , Fong Yao
Published: October 2020

Background:

Publications regarding the 100 top-cited articles in a given discipline are common, but studies reporting the association between article topics and their citations are lacking. Whether or not reviews and original articles have a higher impact factor than case reports is a point for verification in this study. In addition, article topics that can be used for predicting citations have not been analyzed. Thus, this study aims to

Methods:

We searched PubMed Central and downloaded 100 top-cited abstracts in the journal Medicine (Baltimore) since 2011. Four article types and 7 topic categories (denoted by MeSH terms) were extracted from abstracts. Contributors to these 100 top-cited articles were analyzed. Social network analysis and Sankey diagram analysis were performed to identify influential article types and topic categories. MeSH terms were applied to predict the number of article citations. We then examined the prediction power with the correlation coefficients between MeSH weights and article citations.

Results:

The citation counts for the 100 articles ranged from 24 to 127, with an average of 39.1 citations. The most frequent article types were journal articles (82%) and comparative studies (10%), and the most frequent topics were epidemiology (48%) and blood and immunology (36%). The most productive countries were the United States (24%) and China (23%). The most cited article (PDID = 27258521) with a count of 135 was written by Dr Shang from Shandong Provincial Hospital Affiliated to Shandong University (China) in 2016. MeSH terms were evident in the prediction power of the number of article citations (correlation coefficients  = 0.49, t = 5.62).

Conclusion:

The breakthrough was made by developing dashboards showing the overall concept of the 100 top-cited articles using the Sankey diagram. MeSH terms can be used for predicting article citations. Analyzing the 100 top-cited articles could help future academic pursuits and applications in other academic disciplines.
Efficacy of infliximab, cyclosporine and tacrolimus on ulcerative colitis
Authors: Jia Xuemei , Guo Ruitong , Hu Zhenbiao , Liu Jianxin , Liu Jianping , Li Bolin , Yang Qian , He Jianming
Published: October 2020

Background:

Positioning infliximab (IFX), cyclosporine and tacrolimus (TAC) for treating ulcerative colitis (UC) is in great debate.

Methods:

A literature search identified studies that investigated IFX vs. cyclosporine or IFX vs TAC in UC patients. Short-term remission, short-term, 1-year and 3-year colectomy rate were employed as primary end-points to assess efficacy. Odds ratios (ORs) with 95% confidence intervals (CIs) were analyzed.

Results:

Overall, 15 studies comprised 596 patients in IFX group and 866 in calcineurin inhibitors group (644 received cyclosporine and 222 received TAC). No significant difference was seen between IFX and calcineurin inhibitors with regard to short-term remission. IFX led to a lower short-term (OR: 0.59, 95% CI: 0.43–0.82, P:.001), 1-year (OR: 0.53, 95% CI: 0.38–0.73, P < .001), 3-year colectomy (OR: 0.41, 95% CI: 0.20–0.84, P:.02) than calcineurin inhibitors. IFX led to a lower short-term (OR: 0.51, 95% CI: 0.36–0.71, P < .001), 1-year (OR: 0.53, 95% CI: 0.37–0.74, P:.003) colectomy and a trend of lower 3-year colectomy (OR: 0.49, 95% CI: 0.22–1.06, P:.07) than cyclosporine while no significant difference was seen between IFX and TAC. Results of network meta-analysis showed that the order was cyclosporine, TAC and IFX from high rate to low with regard to short-term and 1-year colectomy.

Conclusion:

IFX treatment leads to a lower short-term, 1-year colectomy rate and a trend of lower 3-year colectomy rate in UC patients than cyclosporine while no significant difference is seen between IFX and TAC. TAC may be superior than cyclosporine with regard to efficacy based on indirect comparisons. Randomized trials with fixed protocol are warranted to identify the optimal medical strategy in patients with UC.
Diagnosis and treatment of advanced HER2-positive breast cancer in young pregnant female
Authors: Tang Tiantian , Liu Yueping , Yang Chao , Ma Li
Published: October 2020

Rationale:

The incidence of pregnancy-associated breast cancer (PABC) is increasing nowadays, and its diagnosis and treatment remain complicated due to the consideration of the fetus. The available data on PABC are primarily derived from case reports since there are ethical restrictions on conducting randomized clinical trials. In the present work, we reported a case of the human epidermal growth factor receptor 2 (HER2)-positive PABC and described the diagnosis and treatment for such type of breast cancer.

Patient concerns:

A 27-year-old patient was admitted to our hospital with the complaints of right breast mass for 3 days, and she was a first-time pregnant woman with a single live intrauterine fetus at 26 + 3 weeks of gestation. Physical examination of the right breast revealed a palpable and hard mass with obscure boundaries (5.0 cm × 4.0 cm) in the upper outer quadrant. Significant axillary lymph nodes (2.0 cm) were also present.

Diagnosis:

PABC.

Intervention:

To protect the fetus, breast ultrasonography was used to test her breast mass, a core needle biopsy was adopted to confirm the diagnosis, and abdominal ultrasound and chest X-ray were used to evaluate the metastasis. The patient was scheduled for neoadjuvant therapy using bi-weekly pirarubicin in combination with cyclophosphamide (AC) without anti-HER2 therapy for consideration of the fetus's safety. After 4 cycles of AC, the patient delivered a healthy male infant. After the delivery, all the treatments were carried out according to the standard recommendation for HER2 + breast cancer as non-pregnant patients.

Outcomes:

After the surgery, the disease-free survival for the patient was 12 months until brain metastasis was diagnosed. She was still undergoing second-line anti-HER2 therapy and currently in a stable situation. Besides, the child was also healthy so far.

Lessons:

The methods for the diagnosis and treatment of PABC that result in teratogenesis should be avoided to protect the fetus. Mammogram and chest X-ray were safe approaches for the fetus. Moreover, chemotherapy-based on pirarubicin in combination with cyclophosphamide had no risk to the fetus.
Synchronous diagnosis of anaplastic large cell lymphoma and multiple myeloma in a patient
Authors: Shi Xiaofeng , Wu Jiannong , Jiang Qian , Zhang Shuo , Chen Wanru , Yu Xianqiu , Liu Yichen , Chen Min , Peng Jie , Li Tiantian , Zhu Yan , Xi Xiaodong
Published: October 2020

Rationale:

Synchronous development of both anaplastic large cell lymphoma (ALCL) and multiple myeloma (MM) in a patient is rare. To our knowledge, until now only one case has been reported. Treatment needs to cover both and is a challenge. Here we reported another case and discussed the diagnosis and treatment.

Patient concerns:

This is a 63-year old woman who presented with a mass in upper abdominal skin. Positron emission tomography/computed tomography (PET/CT) showed the high metabolism in left abdominal skin and left axillary lymph nodes. Histopathologic and immunohistochemical evaluation identified the cutaneous mass as an ALK-negative ALCL. Bone marrow smear showed increased plasma cells which expressed CD38, CD138, and cLambda concomitantly. The increased monoclonal immunoglobulin IgD λ was detected by immunofixation electrophoresis.

Diagnoses:

Diagnosis of both ALCL and MM was confirmed.

Interventions:

The patient successively received 6 cycles of B-CHOD regimen, one cycle of ID regimen, 2 cycles of DHAX regimen, one cycle of L-DA-EPOCH and autologous stem cell transplantation (ASCT). Then lenalidomide was performed as a maintenance therapy.

Outcomes:

Both ALCL and MM achieved complete remission.

Lessons:

We reported a very rare case with synchronous development of ALCL and MM, in whom a good therapeutic response to chemotherapies followed by ASCT has been observed.
Medical management of septic arthritis of sternoclavicular joint
Authors: Kwon Hea Yoon , Cha Boram , Im Jae Hyoung , Baek Ji Hyeon , Lee Jin-Soo
Published: October 2020

Rationale:

Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess.

Patient concerns:

Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall.

Diagnosis:

Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture.

Intervention:

She was treated with 6 weeks of antibiotic therapy.

Outcomes:

After antibiotic treatment, she was successfully treated without recurrence.

Lessons:

Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.
Association between abdominal aortic aneurysms and alcohol-related diseases
Authors: Li Ling-Yuan , Chien Wu-Chien , Wang Jen-Chun , Tzeng Nian-Sheng , Chung Chi-Hsiang , Lin Chih-Yuan , Tsai Shih-Hung
Published: October 2020

Heterogeneous associations exist between alcohol consumption and the initial presentation of cardiovascular diseases (CVDs). Studies regarding the association between abdominal aortic aneurysms (AAAs) and alcohol consumption are still limited and controversial. We hypothesize that patients with alcohol-related diseases are susceptible to AAA formation due to the presence of overlapping epidemiological factors and molecular mechanisms. We aimed to use a nationwide population-based retrospective cohort study to evaluate the association between alcohol-related diseases and AAA.

The data were extracted from the National Health Insurance Research Database (NHIRD) in Taiwan. The study outcome assessed was the cumulative incidence of AAA in patients with alcohol-related diseases during a 14-year follow-up period.

Our study included 22,878 patients who had alcohol-related diseases; these patients with alcohol-related diseases had a significantly higher cumulative risk of developing AAA 5 years after the index date than did the 91,512 patients without alcohol-related diseases. Patients with alcohol-related diseases also exhibited a significantly increased incidence of AAA compared with the incidence among patients without alcohol-related diseases, according to Cox regression analysis and Fine & Gray's competing risk model (adjusted hazard ratio = 2.379, 95% confidence interval = 1.653 -3.424, P < .001). In addition, male gender, older age, and chronic kidney disease were also associated with an increased risk of developing AAA. An interaction model showed that males with alcohol-related diseases had a 10.4-fold higher risk of AAA than did females without alcohol-related diseases.

We observed an association between alcohol-related diseases and AAA even after adjusting for several comorbidities and medications in a nationwide population database.
Lower expression of LINC00092 in lung adenocarcinoma might mean poorer prognosis
Authors: Wang Xin , Wang Xianwei , Huang Guichuan , Chen Yi
Published: October 2020

The mechanisms that underlie long non-coding RNA 00092 (LINC00092) in lung adenocarcinoma (LUAD) remain unclear. In this study, by mining the Cancer Genome Atlas and Gene Expression Omnibus databases and using bioinformatics tools, we try to elucidate the function of LINC00092 in LUAD.

The the Cancer Genome Atlas and gene expression Omnibus microarray datasets were used to analyze and evaluate the expression of LINC00092 in LUAD and its clinical significance. Clinical samples were collected and the relative expression level of LINC00092 were identified by quantitative real time polymerase chain reaction. The LINC00092 related genes were identified by Multi Experiment Matrix, The Atlas of ncRNA in Cancer and the database of RNA-Binding Protein specificities. The predicted genes were then sent to the Gene Ontology enrichment and the Kyoto Encyclopedia of Genes and Genomes pathway analysis.

The expression of LINC00092 was significantly decreased in LUAD tissues compared to non-tumor tissues (standard mean difference =-1.10, 95% confidence interval: –1.87 to –0.32, P < .001, random). Low expression of LINC00092 was associated with the poor overall survival (hazard ratio = 1.32, 95% confidence interval: 1.08–1.62, P < .05, fixed) and high pathological stage (P < .05). The relative expression level of LINC00092 in clinical samples were significantly lower in LUAD tissues compared with adjacent normal tissues. (P < 0.05) 61 LINC00092 related genes were identified; the Kyoto Encyclopedia of Genes and Genomes analysis showed that the most significant signaling pathways were: NF-κB, HIF-1 and ErbB signaling pathways.

In this study, we found that the decrease of LINC00092 expression was involved in LUAD tumorigenesis and metastasis, and the depletion of LINC00092 was associated with a poor prognosis in patients with LUAD. The mechanisms that underlie LINC00092 in LUAD might be related to the NF-κB, HIF-1 and ErbB signaling pathways.
A delayed diagnosis of late-onset pulmonary hemorrhage in a toddler with Henoch-Schönlein purpura after regression of skin rash
Authors: Duan Hongyu , Hua Yimin , Zhou Kaiyu , Li Yifei , Wang Chuan
Published: October 2020

Rationale:

Pulmonary hemorrhage is a rare but fatal complication of Henoch-Schönlein purpura (HSP), and more easily ignored in children than in adults due to the absence of clinically evident hemoptysis. Moreover, despite being sporadically reported, given that pulmonary hemorrhage may develop after regression and even disappearance of skin rash, the asynchronous progression of skin and lung lesions poses escalating challenges in the timely diagnosis. We herein presented a delayed diagnosis of late-onset pulmonary hemorrhage in a child with HSP after regression of purpuric rash.

Patient concerns:

A 6-year and 3-month child with a history of self-resolved purpuric rash three weeks ago, presented acutely with cough and dyspnea but without fever.

Diagnoses:

The decreased hemoglobin and diffuse ground-glass opacities of both lungs on CT scan weren’t comprehensively evaluated. The child was initially misdiagnosed as pneumonia.

Interventions:

Antibiotic treatment was initiated. However, no improvement of respiratory status was found following aggressive combination therapy. Bronchoscopy was subsequently performed.

Outcomes:

An diffuse alveolar hemorrhage with low inflammatory profile was noted after a bronchoscopy. Considering the history of HSP, the diagnosis of HSP-associated pulmonary hemorrhage was ultimately confirmed and the patient received corticosteroids with satisfactory results.

Lessons:

Pulmonary hemorrhage could occur in children with HSP at late onset of disease after regression of skin rash. New-onset respiratory symptoms in patients with a history of HSP should heighten suspicion for pulmonary hemorrhage, particularly if presenting with lack of fever, sudden drop of hemoglobin, new pulmonary infiltrates and unresponsiveness to antibiotics therapy. Bronchoscopy should be performed early to confirm the diagnosis, specifically for children.
Effectiveness of underwater endoscopic mucosal resection versus conventional endoscopic mucosal resection for 10 to 20 mm colorectal polyps
Authors: Liu Yi , Shi Min , Ren Jun , Zhou Xiao-li , Liu Song
Published: October 2020

Background:

Endoscopic mucosal resection (EMR) is a standard method commonly for removing 10 to 20 mm colorectal polyps. While the incidence of residual or recurrent after conventional EMR is remarkably high. Underwater endoscopic mucosal resection (UEMR) as an alternative technique to conventional EMR for removing colorectal polyps has high adenoma detection and complete resection rates, improves patient comfort, decreases sedation needs, eliminates the risks associated with submucosal injection, and reduces snare and diathermy-induced mucosal injury. We will conduct a comprehensive systematic review and meta-analysis to compare the effectiveness of these two therapies in the management of 10 to 20 mm colorectal polyps.

Methods:

PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database and Chinese Biomedical Literature Database will be searched from inception of databases to November 2020 without language limitation. Two reviewers will independently conduct article selection, data collection, and assessment of risk of bias. Any disagreement will be resolved by discussion with the third reviewer. Review Manager Software 5.3 will be used for meta-analysis. The Cochrane risk of bias tool will be used to assess the risk of bias.

Results:

This study will provide a systematic synthesis of current published data to compare the effectiveness of UEMR and conventional EMR for 10 to 20 mm colorectal polyps.

Conclusions:

This systematic review and meta-analysis will provide clinical evidence as to whether UEMR is more effective and safer than conventional EMR for 10 to 20 mm colorectal polyps.

Study registration number:

INPLASY2020100006.
The suitable fixation for unstable intertrochanteric fractures
Authors: Bo Yu , Qin Yue , Zang Yuan , Yang Haibo
Published: October 2020

Background:

Normally taking the surgery is the standard treatment, between sliding hip screw (SHS) and utilizing proximal femoral nail antirotation (PFNA) for intramedullary fixation, it is still not certain which one work better for this type of fracture. Our purpose for this study was to determine the optimum choice of implant for a patient with an unstable intertrochanteric fracture.

Methods:

In our hospital, a reflective analysis was conducted of all unstable intertrochanteric fractures treated with either a SHS or PFNA fixation between February 2015 and February 2018. The rules of choosing patients were the following: older age of more than 60, unstable intertrochanteric fractures, and willingness to take clinical and radiographic follow-up researches for over 12 months. In this case, patients bearing former hip surgery at any side were removed from the candidates. Demographic characteristics collected effective information including gender, date of operation, and other relevant information. Postoperative outcome measures included operation time, total blood loss amount, validated mobility score, surgery-related syndrome, and tip-apex length. The patients were re-examined at three time periods: 3 weeks, 3 months, and 1 year. The result of P < .05 was considered to be statistically significant.

Results:

We were able to directly compare the outcomes of PFNA vs SHS techniques and might reveal a better technique in treatment of an unstable intertrochanteric fracture.

Trial registration:

This study protocol has been registered in Research Registry (researchregistry6057).
Identification of crucial genes associated with lung adenocarcinoma by bioinformatic analysis
Authors: Dai Jing-Jing , Zhou Wu-Bi , Wang Bing
Published: October 2020

Lung cancer is the world's most common malignancies and ranks first among all cancer-related deaths. Lung adenocarcinoma (LUAD) is the most frequent histological type in lung cancer. Its pathogenesis has not yet been fully elucidated, so it is of great significance to explore related genes for elucidating the molecular mechanism involved in occurrence and development of LUAD.

To explore the crucial genes associated with LUAD development and progression, microarray datasets GSE7670, GSE10072, and GSE31547 were acquired from the Gene Expression Omnibus (GEO) database. R language Limma package was adopted to screen the differentially expressed genes (DEGs). The clusterProfiler package was used for enrichment analysis and annotation of the Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathways for DEGs. The Search Tool for the Retrieval of Interacting Genes database (STRING) was used to construct the protein interaction network for DEGs, while Cytoscape was adopted to visualize it. The functional module was screened with Cytoscape's MCODE (The Molecular Complex Detection) plugin. The crucial genes associated with LUAD were identified by cytoHubba plugin. Kaplan–Meier plotter online tool was used to perform survival analysis of the hub gene.

Three hundred twenty-one DEGs in total were screened, of which 105 were upregulated and 216 were downregulated. It was found that some GO terms and pathways (e.g., collagen trimer, extracellular structure organization, heparin binding, complement and coagulation cascades, malaria, protein digestion and absorption, and PPAR signaling pathway) were considerably enriched in DEGs. UBE2C, TOP2A, RRM2, CDC20, CCNB2, KIAA0101, BUB1B, TPX2, PRC1, and CDK1 were identified as crucial genes. Survival analysis showed that the overexpression of UBE2C, TOP2A, RRM2, CDC20, CCNB2, KIAA0101, BUB1B, TPX2, and PRC1 significantly reduced the overall survival of LUAD patients. One of the crucial genes: UBE2C was validated by immunohistochemistry to be upregulated in LUAD tissues.

This study screened out potential biomarkers of LUAD, providing a theoretical basis for elucidating the pathogenesis and evaluating the prognosis of LUAD.
Retrospective study of clinical and pathologic features of pulmonary papillary adenoma
Authors: Zhou Pengcheng , Yu Wei , Wang Li , Xia Qianming , Chen Keling
Published: October 2020

Pulmonary papillary adenoma is extremely rare. The limited number of published articles describing pulmonary papillary adenoma emphasize that it is always detected by physical examination, is difficult to diagnose, and has malignant potential. To further expand our understanding of this disease, we report on 15 cases of pulmonary papillary adenoma diagnosed from 2013 to 2019 in our hospital.

The clinical and pathological data of 15 cases of pulmonary papillary adenoma were collected from the medical record system of our hospital. All the clinical data were checked by 2 independent researchers. All pathology outcomes were independently reassessed by 2 pathologists. A review of the relevant literature was performed.

Of 15 patients identified, 6 were men and 9 were women, and the average age at disease onset was 61.3 years. Chest computed tomography (CT) indicated pneumonia, an isolated nodule, bronchiectasis, a mass, ground glass opacity, and local interstitial fibrosis under the pleura. Thirteen cases had benign histopathology upon microscopy and immunohistochemistry examination: a papillary morphology, grade 2 or 3 papillary branches, and a slender nipple axis composed of fibers and vessels. More than 80% of the papillary epithelial cells were columnar or cubic, and single-layered or pseudostratified, with a round nucleus at the bottom of the cell. The cytoplasm was rich in mucus and neutral mucopolysaccharides. Except the above-mentioned features, there was also local epithelial dysplasia, carcinogenesis, and interstitial infiltration in two cases. The 2 patients with a cancerous mass underwent surgical resection, whereas the other patients were kept under surveillance. While one patient with cancer is deceased, follow-up indicates that the remaining patients have experienced a good outcome.

Pulmonary papillary adenoma is very rare in clinical practice, and its clinical manifestations and CT images are not specific. Some cases may be cancerous and surgical resection should be the preferred treatment.
Successful Localization and Resection of Small Pancreatic Cystic Insulinoma Using Intraoperative Near-Infrared Fluorescence Imaging
Authors: Kou Hao-Wei , Yu Ming-Chin , Chong Sio-Wai , Hsu Heng-Yuan , Chou Hsu-Huan , Lee Chao-Wei , Chen Tse-Ching , Huang Song-Fong
Published: October 2020

Pancreatic cystic insulinoma is an uncommon tumor. Perioperative localization remained challenging if the tumor is atypical with cystic feature or in small size. Near-infrared (NIR) imaging is a technique by injecting fluorescent dye intravenously, which accumulates to the target lesion and creating signal by laser sources. The signal helps surgeons to identify the lesion during operation, but little experience has been reported regarding the use of imaging NIR technique for localizing cystic insulinoma. We present a 29-year-old female patient with a symptomatic pancreatic cystic insulinoma (1.2 cm) as assessed by clinical symptom, laboratory evidence, and magnetic resonance cholangiopancreatography. With an aid of NIR imaging technique, this cystic tumor was localized easily at operation. Also, the fluorescence imaging visualized the tumor part, guided us to identify the safe margin, and preserved the normal pancreatic structure. Pathologic report confirmed that the tumor was a well-differentiated cystic insulinoma. This case demonstrates that pancreatic cystic insulinoma in small size can be intraoperatively localized by NIR imaging, a relatively safe and easy technique.
Effects of Fluid Resuscitation on the Occurrence of Organ Failure and Mortality in Patients With Acute Pancreatitis
Authors: Liu Lili , Wang Chao , Luo Tiancheng , Li Lei
Published: October 2020

Objectives

Acute pancreatitis (AP) is a serious gastroenterological condition requiring urgent fluid resuscitation and emergent intensive care. However, the benefit of fluid resuscitation is inconsistent. Therefore, this study aimed to examine the effects of fluid resuscitation on the occurrence of organ failure and mortality in patients with AP.

Methods

The data were retrospectively extracted from the Medical Information Mart for Intensive Care III 2002–2012 database. The fluid resuscitation and fluid balance were calculated at 12, 24, 36, and 48 hours after intensive care unit admission. Multivariate analysis models were used.

Results

A total of 317 patients with AP were included. Odds of organ failure increased significantly with increased fluid input at 0 to 12 hours [adjusted odds ratio (aOR), 1.124; 95% confidence interval (CI), 1.015–1.244] and with increased fluid balance at 36 to 48 hours (aOR, 1.184; 95% CI, 1.009–1.389). Odds of in-hospital mortality increased significantly with increased fluid balance at 24 to 36 hours (aOR, 1.201; 95% CI, 1.052–1.371). Odds of 30-day mortality increased significantly with increased fluid balance at 24 to 36 hours (aOR, 1.189; 95% CI, 1.039–1.361).

Conclusions

Increased fluid balance was associated with increased risk of organ failure and mortality. Increased fluid output may decrease mortality.
Inhibition of CHRM3 Alleviates Necrosis Via the MAPK-p38/miR-31-5p/RIP3 Axis in l-Arginine–Induced Severe Acute Pancreatitis
Authors: Luan Jing , Kou Jiayuan , Huang Ning , Tao Yuxi , Shi Shuoxi , Wu Xing , Sun Yumiao , Meng Dehao , Xu Jiaran , Zhou Xiaoxi , Murtaza Ghulam , Bobkov Artem , Qiao Yu , Gao Xu , Ma Ning
Published: October 2020

Objectives

Pancreatic acinar necrosis is a typical feature in the early phase of severe acute pancreatitis (SAP). Muscarinic acetylcholine receptor M3 (CHRM3) has been reported to play important roles in promoting insulin secretion and tumor cell proliferation, but its effect on necrosis remains unknown. This study revealed the important role of CHRM3 in regulating l-arginine–induced SAP and the molecular mechanisms.

Methods

To verify the function of CHRM3, pancreatic tissues and primary acinar cells of CRISPR/Cas9-mediated Chrm3 knockout mice were used in CHRM3 knockdown experiments, and to ascertain the CHRM3 overexpression, PLV-EGFP-Chrm3 plasmids were transfected in acinar cells in vitro.

Results

In l-arginine–induced SAP, CHRM3 is activated and regulates SAP through the mitogen-activated protein kinase/p38 pathway. Moreover, the expression of miR-31-5p decreased in the SAP model both in vitro and in vivo. Mir-31-5p effects the necrosis of acinar cells in SAP by upregulating the target gene RIP3, and miR-31-5p is a downstream miRNA of CHRM3.

Conclusions

Necrosis in l-arginine–induced SAP is promoted by CHRM3 through the mitogen-activated protein kinase–p38/miR-31-5p/RIP3 axis.
Is Ultrasound Elastography Useful in Predicting Clinically Relevant Pancreatic Fistula After Pancreatic Resection?
Authors: Marasco Giovanni , Ricci Claudio , Buttitta Francesco , Dajti Elton , Ravaioli Federico , Ingaldi Carlo , Alberici Laura , Serra Carla , Festi Davide , Colecchia Antonio , Casadei Riccardo
Published: October 2020

Objectives

Ultrasound (US) elastography has been proposed for the non-invasive prediction of clinically relevant pancreatic fistula (CR-POPF) in patients undergoing pancreatic resection. We aimed to perform a systematic review with meta-analysis to assess the diagnostic value of US elastography in predicting CR-POPF.

Methods

MEDLINE via PubMed, Ovid Embase, Scopus, and Cochrane Library databases, and abstracts of international conference proceedings were searched up to April 20, 2020. Studies assessing the performance of abdominal US elastography in predicting CR-POPF in patients undergoing pancreatic resection were included. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies.

Results

Five studies, including 247 patients who underwent partial pancreatic resection of whom 72 patients experiencing CR-POPF, were selected. All studies performed US elastography in different pancreatic sites. The pooled mean strain value was lower in pancreatic segments of patients experiencing CR-POPF than in those without, with a pooled weighted mean difference of −0.187 (95% confidence intervals, −0.303 to −0.071; P = 0.002). There was low heterogeneity between studies (I2 = 7.6%), and all studies were at “high risk” or “unclear risk” of bias.

Conclusions

This study provides evidence that US elastography values are statistically significantly lower in patients experiencing CR-POPF.
Racial and Socioeconomic Disparities in the Treatments and Outcomes of Pancreatic Cancer Among Different Treatment Facility Types
Authors: Zhu Fan , Wang Haoyu , Ashamalla Hani
Published: October 2020

Objectives

The aim of this study was to investigate racial and socioeconomic disparities for patients with pancreatic cancer across different facility types.

Methods

The National Cancer Database was queried for pancreatic cancer cases from 2004 to 2015. Along with propensity score matching analysis, multivariate logistic and Cox model were used to assess effects of facility type, race, elements of socioeconomics on receipt of treatment, time to treatment, and overall survival, separately.

Results

Among 223,465 patients, 44.6%, 42.1%, and 13.3% were treated at academic, community, and integrated facilities, respectively. Private insurance was associated with more treatment (odds ratio, 1.41; P < 0.001) and better survival [hazards ratio (HR), 0.84; P < 0.001]. Higher education was associated with earlier treatment (HR, 1.09; P < 0.001). African Americans had less treatment (odds ratio, 0.97; P = 0.04) and delayed treatment (HR, 0.89; P < 0.001) despite later stage at diagnosis. After adjusting for socioeconomic status, African Americans had similar survival (HR, 0.99; P = 0.11) overall and improved survival (HR, 0.95; P = 0.016) at integrated facilities.

Conclusions

Higher socioeconomic status was associated with better treatment and survival. After adjusting for socioeconomic disparities, race did not affect survival. Less racial disparity was observed at integrated facilities.
Neutrophil Gelatinase–Associated Lipocalin Protects Acinar Cells From Cerulein-Induced Damage During Acute Pancreatitis
Authors: Bhatia Rakesh , Muniyan Sakthivel , Thompson Christopher M. , Kaur Sukhwinder , Jain Maneesh , Singh Rakesh K. , Dhaliwal Amaninder , Cox Jesse L. , Akira Shizuo , Singh Shailender , Batra Surinder K. , Kumar Sushil
Published: October 2020

Objectives

Elevated neutrophil gelatinase–associated lipocalin (NGAL) is a promising marker for severe acute pancreatitis (SAP) and multiple organ failure, suggesting systemic and local contributions during pancreatitis. We investigated the role of NGAL locally on acinar cell biology.

Methods

Western blot, reverse transcriptase–polymerase chain reaction, and immunohistochemistry analysis were performed to analyze the levels of NGAL receptors, apoptotic and regeneration markers, and 4-hydroxynonenal (4HNE) levels, 3-[4,5-Dimethylthiazole-2-yl]-2, 5-diphenyltetrazolium bromide assay, and annexin V/propidium iodide staining were used to evaluate cell viability, and effect on endothelial cells was accessed by endothelial permeability assay.

Results

Cerulein treatment at 20 μM for 12 hours significantly reduced acinar cell viability by 40%, which was rescued by NGAL at 800 and 1600 ng/mL concentrations, observed during mild and SAP, respectively. Mechanistically, NGAL significantly reduced the levels of reactive oxygen species and 4HNE adduct formation in a 24p3R-dependent manner and upregulated the expression of acinar cell regeneration markers, like CDK-2, CDK-4, and C-myc. However, SAP levels of NGAL significantly increased endothelial permeability and downregulated the levels of ZO-1, and cerulein treatment in NGAL knockout mice showed increased levels of 4HNE adducts.

Conclusions

Neutrophil gelatinase–associated lipocalin rescues intracellular reactive oxygen species during pancreatitis and promotes survival and regeneration of acinar cells.
Spanish Experience of Pulmonary Rehabilitation Efficacy for Patients Affected by the Novel SARS-CoV-2 (COVID-19)
Authors: Ballesteros Reviriego Gonzalo , Planas Pascual Bernat , Rojo Ruiz Alberto , Sánchez Romero Eleuterio A. , Corbelini Camilo , Villafañe Jorge Hugo
Published: October 2020

At present, coronavirus disease 2019 (COVID-19) is raging around the world. In Spain, the percentage of intensive care unit (ICU) patients is very high, as well as the mortality rate. This article discusses a 38-year-old woman admitted to the ICU for acute respiratory failure secondary to SARS-CoV-2 infection. Early physiotherapy improved lung secretion removal, respiratory mechanics outcomes, gas exchange, and muscle strength without adverse effects. Regarding the lack of information about physiotherapy effects in this context, these data are essential to demonstrate the feasibility of early physiotherapy in such patients who are young as well as older.
Analysis of the Relationship Between Cognitive Decline and Physical Function in Older Adults Who Participated in Health Measurement Events Using Classification and Regression Tree (CART)
Authors: Itotani Keisuke , Ueda Yuya , Murata Shunsuke , Saito Takashi , Ono Rei
Published: October 2020

Objective:

To investigate various factors related to cognitive decline and analyze combination of factors and priority.

Methods and Results:

We measured the demographic data, physical, cognitive, and executive functions of 219 older adults who were divided into 2 groups (a no cognitive decline group and a cognitive decline group). We performed classification and regression tree (CART) analysis using the cognitive decline as dependent variables.

Conclusions:

By CART, it was revealed that the combination of walking speed less than 1.01 m/s and Trail Making Test part A 107.47 seconds or more is a combination of strongest factors for cognitive decline. The classification accuracy was 92.2% by CART.
Sensitivity analysis of an electrophysiology model for the left ventricle
Authors: Del Corso Giulio , Verzicco Roberto , Viola Francesco
Published: October 2020

Modelling the cardiac electrophysiology entails dealing with the uncertainties related to the input parameters such as the heart geometry and the electrical conductivities of the tissues, thus calling for an uncertainty quantification (UQ) of the results. Since the chambers of the heart have different shapes and tissues, in order to make the problem affordable, here we focus on the left ventricle with the aim of identifying which of the uncertain inputs mostly affect its electrophysiology. In a first phase, the uncertainty of the input parameters is evaluated using data available from the literature and the output quantities of interest (QoIs) of the problem are defined. According to the polynomial chaos expansion, a training dataset is then created by sampling the parameter space using a quasi-Monte Carlo method whereas a smaller independent dataset is used for the validation of the resulting metamodel. The latter is exploited to run a global sensitivity analysis with nonlinear variance-based indices and thus reduce the input parameter space accordingly. Thereafter, the uncertainty probability distribution of the QoIs are evaluated using a direct UQ strategy on a larger dataset and the results discussed in the light of the medical knowledge.
A model of the transition to behavioural and cognitive modernity using reflexively autocatalytic networks
Authors: Gabora Liane , Steel Mike
Published: October 2020

This paper proposes a model of the cognitive mechanisms underlying the transition to behavioural and cognitive modernity in the Upper Palaeolithic using autocatalytic networks. These networks have been used to model life’s origins. More recently, they have been applied to the emergence ofcognitivestructure capable of undergoingculturalevolution. Mental representations of knowledge and experiences play the role of catalytic molecules, the interactions among them (e.g. the forging of new associations or affordances) play the role of reactions, and thought processes are modelled as chains of these interactions. We posit that one or more genetic mutations may have allowed thought to be spontaneously tailored to the situation by modulating the degree of (i) divergence (versus convergence), (ii) abstractness (versus concreteness), and (iii) context specificity. This culminated in persistent, unified autocatalytic semantic networks that bridged previously compartmentalized knowledge and experience. We explain the model using one of the oldest-known uncontested examples of figurative art: the carving of the Hohlenstein–Stadel Löwenmensch, or lion man. The approach keeps track of where in a cultural lineage each innovation appears, and models cumulative change step by step. It paves the way for a broad scientific framework for the origins of both biological and cultural evolutionary processes.