bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Microbiologic Profile of Patients With Staphylococcus aureus Infection
Authors: Tambuwal Sirajo Haliru , Iliyasu Garba , Muhammad Dayyab Farouq , Habib Zaiyad Garba , Tiamiyu Abdulwasiu Bolaji , Muhammad Liman Hamid , Habib Abdulrazaq Garba
Published: January 2020

Background

Invasive Staphylococcus aureus infection (ISA) is increasingly being recognized as an important cause of morbidity and mortality in developing countries. This problem is confounded by the increasing prevalence of antibiotic-resistant S. aureus. The aim of the study was to describe the clinical presentation and antibiotic susceptibility profile of ISA infection in a tertiary hospital in North West Nigeria.

Materials and Methods

This study was a prospective cohort study carried out on patients with ISA infection who were seen at a regional referral tertiary hospital in North West Nigeria. One hundred forty patients with ISA infection were studied. Clinical evaluation and relevant laboratory investigations were conducted. Antibiotic susceptibility tests were carried out by disk diffusion method according to Clinical and Laboratory Standard Institute guidelines.

Results

The mean age of the patients was 40.7 ± 15.6 years, with male-to-female ratio of 1.4:1. Skin and soft tissue infections (108 [77.1%]) and primary bacteremia (17 [12.1%]) were the most common diagnoses. Most infections were community-acquired infections (94 [67.1%]). Risk factors were identified in 112 (80%), of which diabetes mellitus (40 [35.7%]) and chronic kidney diseases (33 [29.5%]) predominate. Eighty-two (52.2%) of the isolates were methicillin-sensitive S. aureus, and 75 (47.8%) were methicillin-resistant S. aureus (MRSA). More cases of MRSA compared with methicillin-sensitive S. aureus were seen among patients with pneumonia and primary bacteremia. The overall mortality was 25 (19.7%) at 1-month follow-up. On multiple logistic regression analysis, the only factors predictive of mortality were sepsis (odds ratio, 6.723; 95% confidence interval, 1.431–31.585) and infection with MRSA (odds ratio, 5.523; 95% confidence interval, 1.506–20.250).

Conclusions

This study shows high burden of ISA with high prevalence of MRSA. This underscores the need for antimicrobial stewardship program and strengthening of infection control practices in our hospital.
Nonpharmacologic interventions for chronic pruritus
Authors: Bonchak Jonathan G. , Lio Peter A.
Published: January 2020

Chronic pruritus, traditionally defined as itch persisting for >6 weeks, is a common affliction that can be associated with cutaneous or systemic disease, or may be idiopathic in nature. It affects patients of all ages and backgrounds and seems to have no predilection for sex or socioeconomic status. The lifetime prevalence has been estimated between 22% and 26%. It accounts for millions of outpatient clinic encounters every year. Pruritus is associated with significant morbidity ranging from sleep disturbance to suicidal ideation in both pediatric and adult patients. The pathophysiology of pruritus is complex and multifactorial. An intricate and incompletely understood interplay between cytokines, sensory neurons, and a variety of cutaneous and central nervous system receptors and effector cells are responsible for the development of itch. Scores of therapies exist, with enormous variation in efficacy, for the amelioration of itch. Drugs aimed at virtually all of the aforementioned pathogenic factors in pruritus have been trialed or are being developed. Nonpharmacologic therapies for chronic pruritus encompass a variety of methods for altering itch signaling or for changing the patient’s perception of pruritus. Although some of these interventions may be used as monotherapy, they are usually best utilized in combination with more conventional pharmacologic antipruritic therapies. This review evaluates the current understanding of the mechanisms and efficacy of these nonpharmacologic interventions and serves to expand the dermatologist's armamentarium against chronic pruritus.
Treatment of Infantile Blount's Disease (Infantile Tibia Vara) with a Novel Brace: Preliminary Results
Authors: Lehman Wallace B. , Sheikh Taha Abdel Majid , Sala Debra A. , Sanchez Jessica , Chu Alice
Published: January 2020

Introduction

Over the years, several types of braces have been used to treat the proximal tibial varus deformity of infantile Blount's disease. The purpose of this study was to evaluate the effectiveness of the JMMR Blount's KAFO (JMMR Inc, Ridgewood, NJ, USA) in correcting infantile tibia vara.

Methods

From November 2011 to June 2014, four patients with Blount's disease completed treatment with JMMR Blount's KAFOs. The dynamic quality of the brace differentiates it from the standard orthotic treatment of Blount's disease. The active movement of the swivel hinge located on the posterior of plastic lower leg cuff and the telescoping lateral ankle hinge facilitate the application of the valgus stress force below the knee. This, in turn, permits full knee and ankle motion. As the corrective forces are produced during weight bearing, the orthosis is worn only during waking hours. Prebracing and postbracing anterioposterior radiographs were reviewed by an examiner who was blinded to patient's name and date of the radiograph.

Results

The four patients (two males, two females) had a mean age of 23 months (range, 21–27) at initiation of bracing. Two were bilateral and two were unilateral. Prebracing to postbracing comparison demonstrated Langenskiöld stage improved by at least one stage and metaphyseal-diaphyseal angle decreased from a mean of 15° to 4.3°. The mean tibiofemoral angle was 19.2° varus prebracing and 0.7° valgus postbracing. The mean duration of brace use was 11 months (range, 7–15).

Conclusions

When the treatment of Blount's disease was started before 3 years of age, the JMMR Blount's KAFO corrected the tibia vara.
Metformin Potential Impact on the Growth of Vestibular Schwannomas
Authors: Feng Austin Y. , Enriquez-Marulanda Alejandro , Kouhi Ali , Ali Noor-E-Seher , Moore Justin M. , Vaisbuch Yona
Published: January 2020

Objective:

Previous work has suggested that metformin may possess antineoplastic properties. This study aims to assess the effect of metformin on the growth of sporadic vestibular schwannomas.

Methods:

A retrospective cohort study was performed on patients presenting with radiologically confirmed vestibular schwannomas to Stanford medical center between January 1990 and October 2018. Patients who received metformin during the follow-up period were included and were compared with the control group who were not receiving metformin. Tumor progression and hearing loss are primary and secondary outcomes, respectively.

Results:

A total of 149 patients were analyzed, with 42 patients receiving metformin. The mean age at presentation is 69.6 (±11.7) years. There are 69 (46.3%) females and 80 (53.7%) males and there is no significant age difference between the groups. Tumor size at presentation is similar between both groups, 8 mm (4–13) in control group and 7.5 mm (4–14) in metformin group. The average follow-up period is 34.2 months (18.3–57.8) and 30.3 months (13.6–69.8) in the metformin and control cohorts, respectively, and they are not significantly different. No significant differences between both groups were found in final American Academy of Otolaryngology - Head and Neck Surgery hearing outcome or poor audiogram outcome. Metformin users are significantly less likely to present with tumor growth at final follow-up compared with nonmetformin users (28.6 versus 49.5%, respectively; p = 0.02).

Conclusions:

This preliminary result suggests metformin may reduce vestibular schwannoma tumor growth rate and shows potential promise as a novel chemotherapeutic agent. Further studies are needed to validate this finding.
Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery according to the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score
Authors: Shiyovich Arthur , Perl Leor , Vaknin-Assa Hana , Greenberg Gabriel , Samara Abed , Kornowski Ran , Assali Abid
Published: January 2020

Background

Percutaneous coronary intervention (PCI) of unprotected left-main coronary artery (uLMCA) is increasingly performed. Although it is recommended to calculate the SYNTAX score, if uLMCA PCI is considered, data of outcomes by the SYNTAX score are scarce, particularly among patients with high score (SYNTAX ≥ 33).

Objective

To evaluate long-term outcomes of uLMCA PCI according to SYNTAX score in real-world practice.

Methods

Patients following PCI of uLMCA throughout 2006–2018, in a tertiary hospital, were included and classified into three groups according to the SYNTAX I score. The primary outcome was three-year major adverse cardiac event (MACE) comprising all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), or coronary artery bypass surgery (CABG).

Results

Overall 632 patients were analyzed, mean age 72.8 ± 11.5, males: 69%, classified as following: SYNTAX <22 (n = 225); SYNTAX 22–32 (n = 250) and SYNTAX ≥33 (n = 157). Patients with greater SYNTAX score had higher prevalence of diabetes mellitus, renal failure, peripheral arterial disease and stroke. Additionally, they had lower ejection fraction, greater EuroScore, and number of vessels involved. Procedural success rates were very high (>95%) and did not depend on the SYNTAX score. The rates of MACE and its components were significantly higher in patients with higher SYNTAX score. Multivariate analysis showed that SYNTAX score is an independent predictor of three-year MACE following uLMCA PCI [HRSYNTAX22-32 = 3 (95% confidence interval [CI]: 1.2–11.5), HRSYNTAX≥33 = 3.4 (95% CI: 1.8–13.3].

Conclusions

Despite the high success rates of uLMCA PCI in real-world patients with high SYNTAX score, the latter was significantly associated with worse three-year outcomes.
Disparities in Hepatocellular Carcinoma Surveillance
Authors: Ladhani Sanah , Ohri Ajay , Wong Robert J.
Published: January 2020

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide and remains one of the most rapidly rising cancers among the US adults. While overall HCC survival is poor, early diagnosis via timely and consistent implementation of routine HCC surveillance among at-risk individuals leads to earlier tumor stage at diagnosis, which is directly correlated with improved options for potentially curative therapies, translating into improved overall survival. Despite this well-established understanding of the benefits of HCC surveillance, surveillance among cirrhosis patients remains suboptimal in a variety of practice settings. While the exact reasons underlying the unacceptably low rates of routine HCC surveillance are complex, it likely reflects multifactorial contributions at the patient, provider, and health care system levels. Furthermore, these multilevel challenges affect ethnic minorities disproportionately, which is particularly concerning given that ethnic minorities already experience existing barriers in timely access to consistent medical care, and these populations are disproportionately affected by HCC burden in the United States. In this review, we provide an updated evaluation of the existing literature on rates of HCC surveillance in the United States. We specifically highlight the existing literature on the impact of patient-specific, provider-specific, and health care system-specific factors in contributing to challenges in effective implementation of HCC surveillance.
Comparison between abdominal ultrasound and nuclear magnetic resonance imaging detection of placenta accreta in the second and third trimester of pregnancy
Authors: Xia Hui , Ke Shu-Cheng , Qian Rong-Rong , Lin Ji-Guang , Li Yang , Zhang Xia
Published: January 2020

This study is to determine accuracy of abdominal ultrasound and nuclear magnetic resonance imaging (MRI) for placenta accreta in the second and third trimester of pregnancy and to define the most relevant features of abdominal ultrasound and MRI for placenta accreta prediction.

Between September 2012 and September 2018, 245 high risk of placenta accreta in the second trimester of pregnancy were prenatal diagnosed by abdominal ultrasound and MRI and they were followed up until the end of pregnancy.

Forty-six patients at the second trimester of pregnancy and 40 patients at the third trimester of pregnancy were confirmed as placenta accreta. For the second and third trimester of pregnancy, the sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) of abdominal ultrasound were 95.65% versus 97.50%, 91.78% versus 90.70%, 88% versus 83%, and 97% versus 99%, respectively, while the Se, Sp, PPV, and NPV of MRI were 89.13% versus 92.50%, 87.67% versus 8721%, 82% versus 77%, and 93% versus 96%, respectively. Five features having significant statistical differences between normal placentation women and placenta accreta patients in second or third trimester of pregnancy, including loss of the normal retroplacental clear space, thinning or disappearance of the myometrium, increased vascularization at the uterine serosa-bladder wall interface, and vascularization perpendicular to the uterine wall on abdominal ultrasound, and uterine bulging and dark intraplacental bands on MRI.

Abdominal ultrasound and MRI for placenta accreta in the second and third trimester of pregnancy could provide meaningful imaging evidences.
Clinical and anatomical study of foramen locations in jaw bones and adjacent structures
Authors: Wu Bo , Li Hui , Fan Yuxiang , Wang Xinhui , Li Weihang , Zhong Sheng , Ren Jiaxin , Chen Yong , Zhang Lei , Zhao Gang
Published: January 2020

This study aims to find and locate foramens exactly in maxilla and mandible in case of complications during surgeries.

Computer topographic angiography (CTA) images of 120 cases were reviewed. The measurements were performed on coronal, sagittal and axial planes after the 3 dimension volume reconstruction. The distances among foramens, bony landmarks, teeth, and facial artery were all measured with the angles as adjustments.

The incisive foramen (IF) was measured 20.55 ± 2.81 mm to margo inferior of incisor, and 45.27 ± 5.27 degree from the axial midline. The greater palatine foramen located 43.17 ± 2.55 mm from the IF, while 21.08 ± 3.75 degree from the midline in axial plane. The lesser palatine foramina located 44.56 ± 5.74 mm from the IF and 20.05 ± 3.59 degree to the midline. The Mandibular foramen (MBF) was 91.15 ± 1.86 mm horizontally to the margo inferior of incisor. The angle that the MBF-margo inferior of incisor line made with the axial midline was 31.25 ± 2.89 degree. The shortest horizontal distance from the mental foramen (MF) to the facial artery in sagittal plane was 21.90 ± 1.86 mm, while it became 13.00 ± 2.05 mm in coronary section. The horizontal distance from the MF to the margo inferior of incisor in sagittal plane was 22.04 ± 3.22 mm. It turned out to be 25.78 ± 5.23 mm between MF and mid-sagittal line in coronary section. The vertical distance was 25.20 ± 3.06 mm from the upper margin of the second premolar to the MF.

The foramens were clearly seen through CTA. Moreover, linear and angular measurements were presented, which makes it safer and wiser for surgeons to consider the biometric data before operations.
Human growth hormone level decreased in women aged <60 years but increased in men aged >50 years
Authors: Wang Ximei , Wang Shuyi , Wu Huan , Jiang Mingfei , Xue Hui , Zhu Yangqi , Wang Chenxu , Zha Xiaojuan , Wen Yufeng
Published: January 2020

To investigate the relationship amongst human growth hormone (HGH), sex, and age groups.

A cross-sectional study was conducted on a health check-up population from Wannan area of China from 2014 to 2016. The study involved 6843 individuals aged 23 to 85 years. Logistic regression analysis and smooth curve were applied to determine the relationship amongst age, sex, and HGH.

The average level of HGH in the population was 0.37 ± 0.59 ng/mL. There were significant differences in sex, age, body mass index (BMI), triglycerides (TG), total cholesterol (TC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and glucose (GLU) amongst different quartiles of HGH (P < .001). A U-shape relationship was established between HGH and age. After sex stratification, the results showed that the thresholds of age were 60 years in women, and 50 years in men, after adjusting for body mass index, triglycerides, total cholesterol, blood pressure, and blood glucose. Logistic regression showed that HGH level decreased in women aged <60 years (OR = 1.472, P < .001) and increased in men aged >50 years (OR = 0.711, P < .001). So the distributive characteristics of HGH concentration vary with sex and age group.
Curcumin
Authors: Xiang De-Biao , Zhang Kai-Qiang , Zeng Ya-Ling , Yan Qing-Zi , Shi Zhe , Tuo Qin-Hui , Lin Li-Mei , Xia Bo-Hou , Wu Ping , Liao Duan-Fang
Published: January 2020

Background

Curcumin, a controversial “panacea,” has been broadly studied. Its bioactivities including antioxidant, anti-inflammatory, and especially antineoplastic activities have been documented. However, due to its extensive bioactivities, some scientists hold a skeptical point of view toward curcumin and described curcumin as a “deceiver” to chemists. The objective of this study was to explore curcumin's another possibility as a potential supplementary leading compound to cancer treatments.

Methods

Literature searches were conducted using electronic databases. Search terms such as “curcumin,” “curcumin analogues,” and so on were used. The literatures were collected and summarized. In this article, reported targets of curcumin are reviewed. The limitations of a curcumin as a therapeutic anticancer product including low bioavailability and poor targeting are mentioned. Furthermore, modified curcumin analogues and antitumor mechanisms are listed and discussed in the aspects of cell death and tumor microenvironment including angiogenesis, tissue hypoxia status, and energy metabolism.

Results

Several possible modification strategies were presented by analyzing the relationships between the antitumor activity of curcumin analogues and their structural characteristics, including the introduction of hydrophilic group, shortening of redundant hydrocarbon chain, the introduction of extra chemical group, and so on.

Conclusions

From our perspective, after structural modification curcumin could be more effective complementary product for cancer therapies by the enhancement of targeting abilities and the improvement of bioavailability.
Cirrhosis and frailty assessment in elderly patients
Authors: Federico Alessandro , Caprio Giuseppe Gerardo , Dalise Anna Maria , Barbieri Michelangela , Dallio Marcello , Loguercio Carmelina , Paolisso Giuseppe , Rizzo Maria Rosaria
Published: January 2020

The frailty represents a key determinant of elderly clinical assessment, especially because it allows the identification of risk factors potentially modifiable by clinical and therapeutic interventions. The frailty assessment in elderly patients usually is made by using of Fried criteria. However, to assess the frailty in cirrhotic patients, multiple but different tools are used by researchers. Thus, we aimed to compare frailty prevalence in elderly patients with well-compensated liver cirrhosis and without cirrhosis, according to Fried criteria.

Among 205 elderly patients screened, a total of 148 patients were enrolled. The patients were divided into 2 groups according to the presence/absence of well-compensated liver cirrhosis.

After clinical examination with conventional scores of cirrhosis, all patients underwent anthropometric measurements, nutritional, biochemical, comorbidity, and cognitive performances. Frailty assessment was evaluated according to Fried frailty criteria.

Unexpectedly, according to the Fried criteria, non-cirrhotic patients were frailer (14.2%) than well-compensated liver cirrhotic patients (7.5%). The most represented Fried criterion was the unintentional weight loss in non-cirrhotic patients (10.1%) compared to well-compensated liver cirrhotic patients (1.4%). Moreover, cumulative illness rating scale -G severity score was significantly and positively associated with frailty status (r = 0.234,P < .004). In a multivariate linear regression model, only female gender, body mass index and mini nutritional assessment resulted associated with frailty status, independently of other confounding variables.

Despite the fact that elderly cirrhotic patients are considered to be frailer than the non-cirrhotic elderly patient, relying solely on “mere visual appearance,” our data show that paradoxically non-cirrhotic elderly patients are frailer than elderly well-compensated liver cirrhotic patients. Thus, clinical implication of this finding is that frailty assessment performed in the well-compensated liver cirrhotic patient can identify those cirrhotic patients who may benefit from tailored interventions similarly to non-cirrhotic elderly patients.
A retrospective evaluation of reliability and reproducibility of Arbeitsgemeinschaftfür Osteosynthesefragen classification and Fernandez classification for distal radius fracture
Authors: Yinjie Yan , Gen Wen , Hongbo Wan , Chongqing Xu , Fan Zhaoxiang , Yanqi Feng , Xuequn Wu , Wen Mo
Published: January 2020

This is a retrospective evaluated. The objective of this study was to test the interobserver reliability and intraobserver reproducibility of fracture classification with Arbeitsgemeinschaftfür Osteosynthesefragen (AO) system and Fernandez system used by 5 senior orthopedic surgeons.

Anteroposterior and lateral radiographs of 160 patients hospitalized for displaced distal radius fracture were examined. Independently, 5 orthopedic surgeons evaluated the radiographs according to 2 different distal radius classification systems (3 types of results). Three statistical tools were used to measure interobserver reliability and intraobserver reproducibility. The intraclass correlation coefficient and kappa coefficient (k) were used to assess both interobserver and intraobserver agreement of AO and Fernandez. Kappa value indicated poor agreement (<0), slight (0–0.20), fair (0.21–0.40), moderate (0.41–0.60), good (0.61–0.80), and perfect (0.81–1.00).

The intraobserver reproducibility of AO system (9 types) and Fernandez system were moderate with a value of 0.577 and 0.438. The intraobserver reproducibility of AO system (27 subtypes) was 0.286. The interobserver reliability of AO system (9 types) was moderate with a value of 0.469 and that of Fernandez was moderate with a value of 0.435. The interobserver reliability of AO system (27 subtypes) was 0.299.

Neither of the 2 systems can give us a satisfactory agreement between interobserver reliability and intraobserver reproducibility. In AO system, the interobserver reliability and intraobserver reproducibility of the 9 types decreased with the increase of subgroups.
The prognostic value of long non-coding RNA H19 in various cancers
Authors: Yu Hui , Li Shuo , Wu Shi-xiong , Huang Shuo , Li Shuang , Ye Linfeng
Published: January 2020

Background:

Recent studies have shown that long noncoding RNA (lncRNA) H19 is aberrantly expressed in various cancers. However, the prognostic significance of H19 in cancer patients remains to be elucidated. Here, we designed and conducted a meta-analysis to evaluate the prognostic value of this lncRNA for malignant solid neoplasms.

Methods:

Relevant publications were collected from PubMed, Cochrane Library, Web of Science, and Embase databases. The relevant survival data of patients with H19-associated cancers were downloaded from The Cancer Genome Atlas (TCGA) project. Statistically significant relationships between H19 expression levels and overall survival were analyzed by hazard ratios (HRs) and corresponding 95% confidence intervals (CIs).

Results:

A total of 15 studies with 1584 patients were ultimately included for this literature meta-analysis. An elevated level of H19 expression was found to be negatively correlated with the overall survival (OS) (HR = 1.62, 95% CI = 1.36–1.93, P < .001) in various cancers. Abnormal H19 expression was also positively correlated with poor tumor differentiation (P < .0001), more advanced clinical stage (P < .0001), earlier lymph node metastasis (P < .0001), and earlier distant metastasis (P < .05). The relationship between elevated H19 expression and overall survival was further validated by a TCGA dataset consisting of 7462 cancer patients (HR = 1.12, 95% CI = 1.03–1.22, P < .05).

Conclusion:

Our study indicates that H19 expression is closely relevant to clinical outcome and suggests that lncRNA H19 could be a crucial prognostic biomarker for certain carcinoma types.
The prevalence of gout and hyperuricemia in middle-aged and elderly people in Tibet Autonomous Region, China
Authors: Zhang Qingxi , Gong Hongqiang , Lin Chutong , Liu Qiang , Baima Yangjin , Wang Yunting , Lin Jianhao
Published: January 2020

Objective:

Gout and hyperuricemia are common public health problem. There has been no epidemiological survey of gout and hyperuricemia in Tibet Autonomous Region, the southwest of China. Therefore, we estimated the prevalence of gout and hyperuricemia in Luoma Town, Naqu City, Tibet Autonomous Region of China.

Methods:

A population-based cross-sectional survey was conducted among 1458 residents of Luoma Town, Tibet Autonomous Region, age ≥40 years. We used questionnaires in face-to-face interviews, anthropometric measurements and serum uric acid test. Hyperuricemia was defined as serum uric acid level ≥7 mg/dl in men and ≥6 mg/dl in women. The definition of gout in this study was on the basis of new 2015ACR/EULAR classification criteria.

Results:

Nine hundred eighty-nine participants completed all items of gout and 818 participants attended to be taken blood samples for serum UA levels test. The overall crude prevalence of gout and hyperuricemia was 0.30% and 1.83% respectively. It was more prevalent in men than in women (2.86% vs 0.75%, P = .034) in hyperuricemia group. Tibetan had a lower age-standardized prevalence of gout 0.26% (95% confidence interval (CI): 0%–0.60%) and hyperuricemia 2.05% (95% confidence interval (CI): 0.99%–3.44%) compared with the China Health and Retirement Longitudinal Study results.

Conclusion:

This is the first large-scale population-based survey to demonstrate the prevalence of gout and hyperuricemia of the middle-aged and elderly population in Tibet Autonomous Region, China. The prevalence of gout and hyperuricemia is relatively lower than other places in China, and that might be influenced by ethnicity, genetic and environment factors. These findings will be useful for the future researches and health care strategies.
Comparative effectiveness of tamoxifen, toremifene, letrozole, anastrozole, and exemestane on lipid profiles in breast cancer patients
Authors: He Tao , Yang Wenhao , Zhang Xinyi , Li Ping , Yang Dandan , Wu Yunhao , Fan Yuan , Xiang Mengya , Huang Qianqian , Chen Jing , Zhou Runke , Lv Qing , Chen Jie
Published: January 2020

Background:

Adjuvant endocrine therapy is a vital portion of postoperative comprehensive treatment for breast cancer patients. In recent years, studies have shown that endocrine therapy has a certain impact on the serum lipids of breast cancer patients, and the changes of lipid profiles may bring a series of problems. However, very few studies focus on this issue to date. The results of these studies are inconsistent, and the influence of different adjuvant endocrine modalities on lipid profiles still remains controversial. In order to better explore this issue, we conduct this network meta-analysis.

Method:

The protocol followed preferred reporting items for systematic reviews and meta-analyses protocols. Three main databases (PubMed, Embase, and the Cochrane Library) will be searched systematically for eligible randomized controlled trials without language restriction. In addition, a manual search of the references of relevant published studies will also be considered. Two reviewers will conduct studies selection, data extraction, and risk of bias assessment independently. The primary outcome is the variation of biochemical parameters – the serum lipid profiles (cholesterol, triglyceride, high-density lipoprotein, low low-density lipoprotein).

Results:

The results will provide useful information about the side effects of different adjuvant endocrine drugs on lipid profiles in postoperative breast cancer patients (estrogen receptor-positive and/or progesterone receptor-positive).

Conclusion:

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

Prospero Registration Number:

CRD42019129850.
Ginkgol Biloba extract as an adjunctive treatment for ischemic stroke
Authors: Ji Hongjian , Zhou Xiaohua , Wei Wenlong , Wu Wenyong , Yao Shuai
Published: January 2020

Objective:

Ginkgo biloba extract (GBE) is widely used as an adjunctive treatment for ischemic stroke. This meta-analysis aimed to evaluate the effectiveness and safety of GBE specifically for long-term users at the convalescence stage of ischemic stroke.

Methods:

MEDLINE, Cochrane Central Register of Controlled Trials, Embase Database, WHO Clinical Trials Registration Platform, Chinese National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database were searched from inception to 20 September 2018. Risk ratio (RR) and mean difference (MD) with a 95% confidence interval (CI) were used as effect estimates using RevMan software (5.3; Review Manager [RevMan], Nordic Cochrane Centre, Copenhagen, Denmark). A meta-analysis was performed where data were available. A trial sequential analysis was used to control random errors for recurrence rate and the GRADE (grading of recommendations, assessment, development, and evaluations) approach was used to assess the quality of the body of evidence. The meta-analysis design was registered on PROSPERO (CRD42018110211, http://www.crd.york.ac.uk/PROSPERO).

Results:

We identified 15 randomized clinical trials involving 1829 participants. The majority of the included trials were of high risk of bias in methodological quality. For acute ischemic stroke, adding GBE to conventional therapy led to higher Barthel index scores (MD: 5.72; 95% CI: 3.11–8.33) and lower neurological function deficit scores (MD: −1.39; 95% CI: −2.15 to −0.62). For patients in their convalescence (or sequelae) stage of ischemic stroke, GBE was superior in improving dependence (MD: 7.17; 95% CI: 5.96–8.38) and neurological function deficit scores (MD: −1.15; 95% CI: −1.76 to −0.53) compared with placebo or conventional therapy, but there was no difference in vascular events (RR: 0.70; 95% CI: 0.44–1.14), recurrence rate (RR: 0.57; 95% CI: 0.26–1.25; trial sequential analysis: conclusive) and mortality (RR: 1.07; 95% CI: 0.41–2.81).

Conclusions:

GBE appears to improve neurological function and dependence compared with conventional therapy for ischemic stroke at different stages and appears generally safe for clinical application. The lack of improvement in recurrence rate was confirmed by trial sequential analysis. Due to the generally weak evidence, further large, rigorous trials are warranted.
The effectiveness and safety of acupuncture therapy for Guillain–Barré syndrome
Authors: Fan Zhu , Liu Biyuan , Zhang Yili , Li Man , Lu Tao
Published: January 2020

Background:

Guillain–Barré syndrome (GBS) is the most common acute paralytic neuropathy. Many clinical trials indicate acupuncture provides a good effect as a complementary therapy of Western medicine for GBS. The objective of this systematic review protocol is to provide the evidence to evaluate the effectiveness and safety of acupuncture on the treatment of GBS.

Methods:

We will search relevant randomized controlled trials investigating the effect of acupuncture for GBS in following databases from start to October 2019: PubMed, Embase, the Cochrane Library, CINAHL Complete, National Digital Science Library, China National Knowledge Infrastructure, and Wanfang Database without language restriction. For articles that meet our inclusion criteria, 2 researchers will extract the data information independently, and assess the risk of bias and trial quality by the Cochrane collaboration's tool. All data will be analyzed by RevMan V.5.3.3 statistical software.

Results:

According to the Barthel index of Activities of Daily Living (ADL) and the Medical Research Council (MRC) muscle scale, the efficacy and safety of acupuncture for GBS will be determined in this study.

Conclusion:

This systemic review will provide high quality evidence to judging whether acupuncture provides benefits to treat GBS.

Prospero registration number: CRD42019158710.
Urinary fatty acid and retinol binding protein-4 predict CKD progression in severe NAFLD patients with hypertension
Authors: Tsai Yu-Lien , Liu Chih-Wei , Huang Shiang-Fen , Yang Ying-Ying , Lin Ming-Wei , Huang Chia-Chang , Li Tzu-Hao , Huang Yi-Hsiang , Hou Ming-Chih , Lin Han-Chieh
Published: January 2020

Detection of the chronic kidney disease (CKD) progression can begin early intervention to improve the prognosis of severe non-alcoholic fatty liver disease (NAFLD). This bi-directional cross-sectional study evaluates the roles of fatty acid-binding protein (FABP) and retinol binding protein (RBP4), which are produced from inflamed liver, adipose tissue and immune cells, for the prediction of CKD progression in severe NAFLD. Ninety severe NAFLD patients with hypertension and proteinuria (NAFLD+HTN+) were enrolled and divided into CKD (n = 39) and non-CKD groups (n = 51). Among 39 NAFLD+HTN+ patients, 18 cases were categorized as CKD progression group. In comparison with CKD stable group (n = 21), the positive correlation between fold change values of hepatic fibrotic score (KPa), urinary FABP4 or urinary RBP4 versus severity of albuminuria were noted among CKD progression group. On multivariate analysis, high body mass index (BMI, >25 kg/m2), high hepatic fibrosis score (>9.5 KPa), high urinary level of vascular cell adhesion molecule-1 (VCAM-1, >2239 μg/g cr), high urinary level of FABP4 (>115 ng/g cr) and high urinary level of RBP4 (>33.5 mg/g cr) are 5 independent predictors for progressive CKD during 24 months of follow-up. Synergetic effect was noted among these 5 risk factors for the prediction of CKD progression in NAFLD+HTN+ patients. The in vitro experiments revealed that both FABP4 and RBP4 directly enhanced albumin-induced ER stress and apoptosis of human renal tubular epithelial cell line HK-2 cells and human podocytes cell lines. Through clinical and experimental approaches, this study revealed new 5 synergetic predictors including high BMI, hepatic fibrosis score, urinary level of VCAM-1, urinary level of FABP4 and RBP4, for the CKD progression in severe NAFLD patients with hypertension and proteinuria.
Long-term efficacy after closure of patent foramen ovale for ischemic neurological events in young adults
Authors: Xu Liang , Pan Xuemei , Zhou Chang , Li Jie , Wang Fangyuan
Published: January 2020

Background:

The efficacy of patent foramen ovale (PFO) closure remains controversial, and it is unclear which patient groups are best benefited. We performed this meta-analysis to clarify the efficacy of PFO closure of younger patients for prevention of recurrent ischemic neurological events.

Methods:

We systematically searched for studies of PFO closure for younger patients under the age of 55, and pooled available data on PFO closure of younger vs older patients and on PFO closure of younger patients vs medical therapy. The primary endpoints were the composite outcome of recurrent ischemic neurological events [stroke and/or transient ischemic attack (TIA)]. The secondary endpoints included recurrent stroke, TIA, atrial fibrillation (AF) and bleeding events. We calculated the odds ratios (OR) and 95% confidence interval (CI) using fixed-effect and random-effect models.

Results:

Three randomized controlled trials (RCT) and 13 observational studies were eligible. Compared with older patients undergoing PFO closure, younger patients undergoing closure had a lower risk of composite outcome (OR: 0.40, 95% CI: 0.28 to .56; P < .001) and AF (OR: 0.25, 95% CI: 0.10–0.61; P = .003). Compared with medical therapy, PFO closure of younger patients reduced the risk of composite outcome (OR: 0.50, 95% CI: 0.33–0.75; P<.001); there was no statistical difference in total complications of AF and bleeding events (OR: 2.15, 95% CI: 0.15–30.37; P = .57). Separate analysis of stroke and TIA showed that PFO closure in younger patients was more effective in preventing stroke (OR: 0.45, 95% CI: 0.28–0.72; P < .001) and TIA (OR: 0.35, 95% CI: 0.21–0.58); P < .001) compared with older patients. Compared with medical therapy, PFO closure of younger patients reduced the risk of stroke (OR: 0.26, 95% CI: 0.13–0.51; P < .001); but there was no difference in the risk of TIA (OR: 1.07, 95% CI: 0.16–7.01; P = .94).

Conclusions:

Compared with PFO closure of older patients and medical therapy, PFO closure of younger patients can benefit more for the prevention of recurrent ischemic neurological events. Our results indicate that PFO closure is the best treatment strategy for younger patients under the age of 55.
Added value of 18F-fluorocholine positron emission tomography-computed tomography in presurgical localization of hyperfunctioning parathyroid glands after dual tracer subtraction scintigraphy failure
Authors: Morland David , Lalire Paul , Deguelte Sophie , Zalzali Mohamad , Richard Capucine , Dejust Sébastien , Boulagnon Camille , Ly Sang , Papathanassiou Dimitri , Delemer Brigitte
Published: January 2020

Hyperparathyroidism is a common endocrine disorder. The precise localization of causal parathyroid gland is crucial to guide surgical treatment. Several studies report the added value of 18F-fluorocholine (FCH) positron emission tomography-computed tomography (PET/CT) as second line imaging but rely on suboptimal first-line imaging using 99mTc-sestaMIBI dual phase scintigraphy. The aim of this study is to evaluate the percentage of successful parathyroid localization with FCH PET/CT after failure of a more sensitive first-line detection protocol associating neck ultrasonography and 99mTc-Pertechnetate/99mTc-sestaMIBI dual tracer subtraction scintigraphy.

We included retrospectively 47 patients who underwent a FCH PET/CT as second line imaging for biologically proven primary hyperparathyroidism from November 2016 to October 2018 in Godinot Institute (Reims, France). 99mTc-Pertechnetate/99mTc-sestaMIBI dual tracer subtraction scintigraphy and neck ultrasonography were used as first-line imaging and failed to localize the causal parathyroid lesion in all cases.

FCH PET/CT demonstrated at least 1 parathyroid target lesion in 29 patients (62%). 21/29 patients underwent surgery. Target lesions corresponded histologically to hyperfunctioning parathyroid glands for all 21 patients and surgery was followed by hyperparathyroidism biological resolution. Calcium serum levels were associated to FCH PET/CT positivity (P = .002) and a trend toward significance was seen for Parathyroid hormone (PTH) levels (P = .09).

FCH PET/CT is a promising tool in second-line parathyroid imaging. Large prospective studies and cost-effectiveness analyses are needed to precise its role.
Effectiveness of percutaneous cement injection on proximal junctional failure after posterior lumbar interbody fusion
Authors: Do Jong Geol , Kwon Jong Won , Kim Sang Jun
Published: January 2020

Proximal junctional failure (PJF) is the greatest challenge after posterior lumbar interbody fusion (PLIF). The aim of this study was to evaluate the effectiveness of percutaneous cement injection (PCI) for PJF after PLIF patients requiring surgical revision.

In this retrospective clinical study, we reviewed 7 patients requiring surgical revision for PJF after PLIF with 18 months follow-up. They received PCI at the collapsed vertebral body and supra-adjacent vertebra, with or without intervertebral disc intervention. The outcome measures were radiographic findings and revision surgery. Two different radiographic parameters (wedging rate (%) of the fractured vertebral body and local kyphosis angle) were used, and were performed before and immediately after PCI, and 18 month after the PCI.

In our study, we showed that 5 of 7 patients who experienced PJF after PLIF did not receive any revision surgery after PCI. Immediately after cement injection, the anterior wedging rate (%) and the local kyphosis angle were significantly improved (P 
= .018, P = .028). The anterior wedging rates (%) and local kyphosis angle, at pre-PCI, immediate after PCI, and at final follow-up, were not significantly different between the non-revision surgery and revision surgery groups.

Five of 7 patients who experienced PJF after PLIF did not receive revision surgery after PCI. Considering that general anesthesia and open surgery are high-risk procedures for geriatric patients, our results suggest that non-surgical PCI could be a viable alternative treatment option for PJF.

SMC2017-01-011-001. Retrospectively registered 18 January 2017.
Long-term disease control by trabectedin in a patient with dedifferentiated liposarcoma
Authors: Matsuda Shogo , Tanaka Kazuhiro , Kawano Masanori , Iwasaki Tatsuya , Itonaga Ichiro , Tsumura Hiroshi
Published: January 2020

Rationale:

Trabectedin is an antitumor drug considered to be effective for liposarcoma, leiomyosarcoma, and translocation-related sarcoma. Concerning liposarcoma subtypes, evidence of the efficacy of trabectedin for dedifferentiated liposarcoma (DDLPS) is poor, whereas it is known to have high efficacy against myxoid liposarcoma. Moreover, there are few reports of long-term trabectedin treatment of cases of DDLPS. Here, we present a case of advanced metastatic DDLPS that achieved long-term disease control by trabectedin treatment.

Patient concerns:

A 68-year-old man presented with a mass in his back. Magnetic resonance imaging showed a tumorous mass in his back which exhibited low intensity on T1-weighted and high intensity on T2-weighted images.

Diagnosis:

The mass was diagnosed as DDLPS by open biopsy.

Interventions:

The patient underwent gemcitabine+docetaxel combination therapy followed by pazopanib and eribulin; all these therapies failed to halt disease progression. Subsequently, we changed the regimen to trabectedin as fourth-line therapy.

Outcome:

The patient achieved stable disease for approximately 18 months during 11 cycles of trabectedin therapy.

Lessons:

Trabectedin should be considered as a treatment option for DDLPS even in cases of numerous failed prior chemotherapy regimens.
Squamous cell carcinoma arising from giant porokeratosis and rare postoperative recurrence and metastasis
Authors: Zhang Fang , Bai Wenzhe , Sun Shuna , Li Na , Zhang Xiaojie
Published: January 2020

Rationale:

Giant porokeratosis is considered to be a variant of porokeratosis of Mibelli (PM) by some medical scholars. Porokeratosis can develop into several epidermal malignant tumors, such as Bowen disease and basal cell carcinoma, among which squamous cell carcinoma (SCC) is the most common.

Patient concerns:

The patient was a 53-year-old man who was admitted to our hospital due to postoperative recurrence and metastasis as SCC arising from giant PM in his left leg and foot.

Diagnoses:

The pathological results are porokeratosis and well-differentiated squamous cell carcinoma. Positron emission tomography and computed tomography results show the local recurrence of the tumor with multiple lymph node metastasis.

Interventions:

This patient was transferred to orthopedic surgery for amputation of the middle and lower left thigh.

Outcomes:

Follow-up for 3 months has shown no recurrence after the surgery.

Lessons:

This report reminds us to pay close attention to the likelihood of giant porokeratosis. The physicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease.

Although the recurrence rate of SCC arising from giant PM is very low, the surgical resection region should be expanded appropriately such as the en-block resection.
Efficacy of mosapride citrate with a split dose of polyethylene glycol plus ascorbic acid for bowel preparation in elderly patients
Authors: Lee Jin , Jeong Su Jin , Kim Tae Hyung , Park Yong Eun , Choi Joon Hyuk , Heo Nae-Yun , Park Jongha , Park Seung Ha , Moon Young Soo , Kim Tae Oh
Published: January 2020

Background/Aims:

Old age is a risk factor of suboptimal bowel preparation. This study aimed to evaluate the efficacy of mosapride citrate with a split dose of polyethylene glycol (PEG) plus ascorbic acid for bowel preparation in elderly patients (aged ≥65 years) before they underwent a colonoscopy.

Materials and methods:

This prospective investigator-blinded randomized study was conducted from November 2017 to October 2018. The patients were randomly divided into 2 groups, a mosapride group (mosapride citrate with a split-dose of PEG plus ascorbic acid) or a non-mosapride group (a split-dose of PEG plus ascorbic acid alone). Mosapride citrate 15 mg (Gastin CR) was administered once with each split-dose of the bowel preparation. The bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS).

Results:

A total of 257 patients were finally included and analyzed in our study. The total BBPS score was significantly higher in the mosapride group than in the non-mosapride group (8.53 vs 8.24, P = .033). The BBPS scores of the right colon and mid-colon were 2.75 vs 2.61 (P = .044) and 2.89 vs 2.79 (P = .030), respectively. The rate of adequate bowel preparation (BBPS ≥ 6) was similar in both groups (98.4% vs 98.5%, P = .968), while the rate of excellent bowel preparation (BBPS = 9) was higher in the mosapride group than in the non-mosapride group (73.8% vs 61.1%, P = .029). The total incidence of adverse events during the administration of the bowel cleansing agent, particularly abdominal fullness, was lower in the mosapride group (11.9% vs 30.5%, P 
< .001).

Conclusion:

The administration of mosapride citrate with a split-dose of PEG plus ascorbic acid in elderly patients showed an increase in bowel preparation efficacy and reduced adverse events, particularly abdominal fullness, during the administration of a bowel cleansing agent.
Validation of “urinary tract dilation” classification system
Authors: Zhang Hui , Zhang Lijuan , Guo Nan
Published: January 2020

Aim to illuminate the correlation between fetal hydronephrosis and postnatal urological abnormalities by a new classification system—“urinary tract dilation (UTD)” grade.

Of 659 pregnancies screened by ultrasound, 34 cases were found with isolated fetal hydronephrosis, and enrolled in our study from 2017 to 2019. These 34 infants had been prospectively followed up to 6 months after birth by 3 times of urinary tract ultrasound. Hydronephrosis was graded in accordance with the UTD classification system.

Among 34 infants with isolated fetal hydronephrosis. Twenty-four (70.6%) were classified as UTD A1 grade (mild hydronephrosis), and the other 10 (29.4%) were UTD A2–3 grade (moderate to severe hydronephrosis) by antenatal evaluation. After birth, all of the 24 infants (70.6%) with UTD A1 grade had normal ultrasonic findings of urinary tract; while the other 10 cases with UTD A2–3 grade had persistent abnormalities of urinary tract by postnatal assessment, sorted as UTD P1 grade (mild hydronephrosis) in 6 cases (17.6%), UTD P2 grade (moderate hydronephrosis) in 2 cases (5.9%) and UTD P3 grade (severe hydronephrosis) in 2 cases (5.9%). The most common postnatal urological abnormality of isolated fetal hydronephrosis was vesicoureteral reflux. During the follow-up period, 7 infants (20.6%) had urinary tract infection episodes and very few obtained positive cultures of the urine. Only 2 infants (5.9%) with the diagnosis of ureterovesical junction obstruction required surgery intervention, who were both classified as UTD P3 grade. None of the children with UTD P1 and P2 grades needed operation.

The UTD classification system described the urinary tract both antenatally and postnatally, which could point out the correlation between fetal hydronephrosis and postnatal urological abnormalities. This new classification system is expected to be a good prognostic marker for fetal hydronephrosis.