bluuebunny/crossref_metadata_2025 huggingface dataset:
TCM therapies combined with chemotherapy for preventing recurrence and metastasis in postoperative II to IIIA NSCLC
Authors: Chen Shuntai , Zhang Zhenhua , Zhang Xiwen , Qi Runzhi , Jiang Juling , Zhang Xing , Xi Yupeng , Liu Rui , Guo Qiujun , Zheng Honggang , Hua Baojin
Published: February 2019

Background:

Traditional Chinese Medicine (TCM) therapies have been combined with chemotherapy for preventing Recurrence and metastasis in postoperative II to IIIA non-small-cell lung cancer (NSCLC) and the associated better disease-free survival (DFS), but its effects remain elusive. The purpose of this review is to assess the efficacy of TCM therapies as a treatment for postoperative II to IIIA NSCLC.

Methods and analysis:

Seventh databases will be searched for relevant studies from inception to the present date. We will include randomized controlled trials assessing TCM therapies combined with chemotherapy for preventing Recurrence and metastasis in postoperative II to IIIA NSCLC. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination:

Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.

PROSPERO registration number:

The protocol for this systematic review has been registered on PROSPERO under the number CRD42019116594.
A new surgical procedure for synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma
Authors: Zhao Yunpeng , Cong Bo
Published: February 2019

Rationale:

The stomach is always used to reconstruct the upper digestive tract for esophageal cancer operation. However, problems arise when the esophageal cancer and gastric cancer present at the same time. No medical literature mentioned about this surgical procedure till now.

Patient concerns:

Majority of the patients had the sensation of obstruction when swallowing because of the esophageal tumor. Gastric adenocarcinoma was found when gastroscopy was performed.

Diagnosis:

Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were confirmed by biopsy pathology.

Interventions:

We describe the new technique as: distal gastrectomy preserving the gastroepiploic vessels, Roux-en-Y gastrojejunostomy and thoracoscopic Ivor Lewis esophagectomy with chest anastomosis.

Outcomes:

Three patients accepted the surgery and recovered well without any complications. The patients did not undergo any postoperative adjuvant therapy and was doing well without any recurrence till date (23 months, 12 months, 6 months separately).

Lessons:

This procedure was less invasive and easier to perform for synchronous early-stage gastric cardiac cancer and middle or lower third thoracic esophageal cancer. We recommend the indication as: esophageal tumor was located at least 27 cm away from the incisor teeth (for R0 resection during chest anastomosis, be sure no superior mediastinal lymph nodes metastasis were found preoperation), gastric tumor was located in the distal portion of the gastric tube and evaluated for clinical stage IA.
Rehabilitation training combined acupuncture for limb hemiplegia caused by cerebral hemorrhage
Authors: Song Guang-Fu , Wu Cheng-Ji , Dong Shu-Xin , Yu Chang-Hong , Li Xin
Published: February 2019

Background:

Previous studies have reported that rehabilitation training combined acupuncture (RTA) can be used for the treatment of limb hemiplegia (LH) caused by cerebral hemorrhage (CH). However, its effectiveness is still unclear. In this systematic review study, we aim to evaluate the effectiveness and safety of RTA for LH following CH.

Methods:

We will retrieve the databases of CENTRAL, EMBASE, MEDILINE, CINAHL, AMED, CBM, and CNKI from inception to March 1, 2019 with no language restrictions. The randomized controlled trials of RTA for evaluating effectiveness and safety in patients with LH following CH will be included. Cochrane risk of bias tool will be used to measure the methodological quality for all included studies. Two authors will independently select the studies, extract the data, and assess the methodological quality of included studies. A third author will be invited to discuss if any disagreements exist between 2 authors. If more than 2 eligible studies will be included, the outcome data will be pooled, and meta-analysis will be conducted if it is possible.

Results:

This systematic review will assess the effectiveness and safety of RTA for LH caused by CH. The primary outcome includes limbs function. The secondary outcomes consist of muscle strength, muscle tone, quality of life, and any adverse events.

Conclusion:

The findings of this study will summarize the current evidence of RTA for LH caused by CH, and may provide helpful evidence for the clinical treatment.

Dissemination and ethics:

The results of this study will be published in peer-reviewed journals or will be presented on conference meeting. This work does not require ethic approval, because it will be conducted based on the published studies.

Systematic review registration:

PROSPERO CRD42019120034.
MOVI-daFIT! Intervention
Authors: Martínez-Vizcaíno Vicente , Álvarez-Bueno Celia , Cavero-Redondo Iván , Pozuelo-Carrascosa Diana P. , Garrido-Miguel Miriam , Martínez-Hortelano Jose Alberto , Martínez-Madrid Vanesa , de Medio Enrique Prada , Sánchez-López Mairena
Published: February 2019

Introduction:

High-intensity interval training (HIIT) programs have demonstrated positive effects on cardiorespiratory fitness and cardiometabolic parameters, but their impact on other health parameters (such as body mass and fat) and cognition remains unclear. This paper presents the rationale and methods of a HIIT after-school physical activity (PA) intervention (MOVI-daFIT!) on reducing fat mass and cardiovascular risk, and improving physical fitness, executive function, and academic achievement among children aged 9 to 11 years old.

Methods:

A cluster randomized controlled trial (RCT), including 10 schools from Cuenca province, Spain, was designed. Schools were randomly assigned to the MOVI-daFIT! intervention and to the control group. Children were evaluated at the beginning (September 2017) and at the end (June 2018) of the school year. Children in the intervention group were involved in 60-minute after-school sessions 4 days per week developed in the school setting. Each session consisted of 15 minutes of set-up and warm-up games, 28 minutes of games using the HIIT protocol, and 10 minutes of cool down. In addition, children in the intervention and control groups received 2 regular 50-minute physical education sessions per week, as it is compulsory by law in Spanish schools.

Conclusion:

This study will determine the effect of an after-school physical activity intervention (MOVI-daFIT!), designed as a HIIT program, on reducing fat mass and cardiovascular risk, and improving fitness and cognition, including executive function and academic achievement.
Qinwen Baidu decoction for sepsis
Authors: Wang Ping , Huang Hefei , Zhong Jingya , Cai Hairong , Huang Yonglian , Chen Dongjie , Huang Yaxiu , Li Shaoping , Cao Qifeng , Peng Xiaohong
Published: February 2019

Background:

Sepsis is the most common critical illness in the clinic, with a high incidence and mortality. Qingwen Baidu decoction (QWBDD) has been widely applied in the treatment of sepsis, however, there is no systematic review or meta-analysis of QWBDD in the treatment of sepsis. Hence, we provide a protocol of systematic review and meta-analysis to evaluate the efficacy and safety of QWBDD in the treatment of sepsis.

Methods:

The databases including Cochrane Library, PubMed, Embase, Web of Science, Cochrane Clinical Trial Database, World Health Organization International Clinical Trial Registration Platform, CNKI, CBM, VIP, and WanFang Database will be searched from the time when the respective databases were established to January 2019. All randomized controlled trials (RTCs) published in Chinese and English assessing QWBDD for sepsis will be included. Continuity data are expressed as mean difference (MD) or standard mean difference (SMD), and dichotomous data is expressed as relative risk. Analyses will be performed by using RevMan V.5.3.5 software.

Results:

This study will provide high-quality synthesis of current evidence of QWBDD in the treatment of sepsis from the following aspects, including 28-day mortality, mean arterial pressure (MAP), blood lactate, procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), acute physiology and chronic health score (APACHE-II), intensive care unit stay, mean hospital stay, mechanical ventilation time, etc.

Conclusion:

Our systematic review will provide evidence for judging whether QWBDD is an effective intervention for sepsis.

PROSPERO registration number:

PROSPERO CRD 42019123078.
Efficacy of aminocaproic acid in the control of bleeding after total knee and hip arthroplasty
Authors: Li Yihua , Wang Jianwen
Published: February 2019

Background:

To assess the effectiveness and safety of intravenous aminocaproic acid for blood management after total knee and hip arthroplasty.

Methods:

Electronic databases: PubMed (1950.1–2018.8), EMBASE (1974.1–2018.8), the Cochrane Central Register of Controlled Trials (CENTRAL, 2017.10), Web of Science (1950.1–2018.8), and CNKI (1980.1–2018.8) were systematically searched for clinical controlled trials comparing intravenous aminocaproic acid and placebo after joint arthroplasties. Heterogeneity was assessed using the chi-square test and I-square statistic. The meta-analysis was performed using STATA 12.0 (College Station, TX).

Results:

Six studies with 756 patients were included. Our meta-analysis revealed that there were significant differences between aminocaproic acid and placebo in terms of total blood loss (SMD = −0.673, 95% CI: −0.825 to −0.520, P <.001), hemoglobin reduction (SMD = −0.689, 95% CI: −0.961 to −0.418, P <.001), drain output (SMD = −2.162, 95% CI: −2.678 to −1.646, P <.001) and transfusion rates (RD = −0.210, 95% CI: −0.280 to −0.141, P <.001).

Conclusion:

Aminocaproic acid results in a significant reduction of total blood loss, postoperative hemoglobin decline and transfusion requirement in patients undergoing arthroplasties. Due to the limited quality of the evidence currently available, the results of our meta-analysis should be treated with caution.
Cannabis Oil Use by Adolescents and Young Adults With Inflammatory Bowel Disease
Authors: Hoffenberg Edward J. , McWilliams Shannon , Mikulich‐Gilbertson Susan , Murphy Brittany , Hoffenberg Analice , Hopfer Christian J.
Published: February 2019

Objectives:

The aim of the study was to describe use of oral or sublingual cannabis oil (CO) by adolescent and young adult patients with inflammatory bowel disease (IBD).

Methods:

A descriptive study of IBD patients 13 to 23 years of age seen between January 2015 through December 2017 at Children's Hospital Colorado. Information obtained included chart abstraction, electronic and interview self‐report, and serum cannabinoid levels. We compared CO users and cannabis non‐users for clinical characteristics and perceptions of risk. Users of CO provided information on routes, patterns, motivations, and perceived benefits and problems with use.

Results:

The 15 users and 67 non‐users were similar for clinical characteristics and pain and appetite scores. 9 of 15 (60%) CO users had used in the past 30 days, an average of 22 ± 9 times; and 4 used daily. A variety of strengths and CBD:THC ratios were reported. Most common perceived effect of use was on sleep quality, nausea, and increase in appetite. Of the 15 users, 6 used only CO and no additional forms of cannabis. Of these 6 CO only users, 5 reported a medical reason for use, most commonly to relieve pain.

Conclusions:

Adolescent and young adults with IBD used oral CO and many used other cannabis products as well. Users perceived some medical benefit. Care teams should strive for open communication about use until further information on safety and efficacy becomes available.
An Evaluation of Sexually Transmitted Infection and Odds of Preterm or Early-Term Birth Using Propensity Score Matching
Authors: Baer Rebecca J. , Chambers Christina D. , Ryckman Kelli K. , Oltman Scott P. , Rand Larry , Jelliffe-Pawlowski Laura L.
Published: February 2019

Background

Few studies have examined the relationship between sexually transmitted infections (STIs) and preterm birth (<37 weeks gestation) by subtype (<32 weeks, 32–36 weeks, spontaneous, provider-initiated). Here, we evaluate the odds of preterm (by subtype) and early-term (37 and 38 weeks gestation) birth in women with an STI compared with a propensity score-matched reference population.

Methods

The sample was selected from California births in 2007 to 2012. Sexually transmitted infection was defined as a maternal diagnosis of chlamydia, gonorrhea, or syphilis in the birth certificate or hospital discharge record. A reference sample of women without an STI was selected using exact propensity score matching on maternal factors. Odds of preterm and early-term birth were calculated.

Results

Sixteen thousand three hundred twelve women were identified as having an STI during pregnancy and an exact propensity score-matched control was identified for 97.2% (n = 15,860). Women with an indication of syphilis during pregnancy were at 1.6 times higher odds of having a preterm birth and, in particular, at elevated odds of a birth less than 32 weeks due to preterm premature rupture of the membranes or provider-initiated birth (odds ratios 4.0–4.2). Women with gonorrhea were at increased odds of a preterm birth, a birth less than 32 weeks, or an early-term birth (odds ratios 1.2–1.8). Chlamydia did not raise the odds of either a preterm or early-term birth.

Conclusions

Gonorrhea and syphilis increased the odds of a preterm birth. Gonorrhea also increased the odds of an early-term birth. Chlamydia did not raise the odds of an early birth.
Differences in Oculomotor Function between Children with Sensory Processing Disorder and Typical Development
Authors: Walker Kimberly , Redman-Bentley Donna , Remick-Waltman Kristy , Armstrong Dayle C.
Published: February 2019

SIGNIFICANCE

Our study revealed that children with sensory processing disorder (SPD) exhibit deficient saccades and pursuits compared with typically developing (TD) children. Optometrists have a key role in caring for patients with SPD. Optometrists are paramount in identifying, coordinating care for, and treating these children.

PURPOSE

Children with SPD exhibit poor neurological processes, which can affect oculomotor performance. The study aims are to investigate differences in oculomotor skills using the Northeastern State University College of Optometry (NSUCO) oculomotor testing in children with SPD as compared with TD children, to explore effects of age and sex of children in each group on oculomotor performance, and to compare our results to test normative values for both TD and SPD groups.

METHODS

One hundred fifty children aged 7 to 11 years were recruited from surrounding community. The Short Sensory Profile (SSP) was used to assign the children into two groups. Of the eligible children recruited, 60 were TD (SSP ≥155) and 68 had SPD (SSP ≤141). Children were excluded if they reported blindness, strabismus, deafness, ocular disease, fractures within 6 months, or physical disabilities. Gait, balance, and visual skills of all children were assessed. Visual skill evaluation included select visual efficiency and visual processing testing. The NSUCO test was included as part of the visual efficiency evaluation.

RESULTS

Results showed that children with SPD demonstrate decreased oculomotor skills on all tests compared with TD children. For the SPD group, boys scored significantly poorer than did girls in head and body movement with saccades and pursuits. Overall, TD group scores confirm the established test norms.

CONCLUSIONS

Because of significant differences in oculomotor function in children with SPD and the increasing number of children with neurosensory disorders, optometrists should consider NSUCO testing on all pediatric patients and particularly in children with SPD.
Uptake and Release of Polyvinyl Alcohol from Hydrogel Daily Disposable Contact Lenses
Authors: Phan Chau-Minh , Subbaraman Lakshman N. , Jones Lyndon W.
Published: February 2019

SIGNIFICANCE

Polyvinyl alcohol is a wetting agent that could reduce the symptoms of dry eye and contact lens discomfort. Currently, only one lens type, nelfilcon A (DAILIES AquaComfort Plus), releases polyvinyl alcohol. The concept of releasing this agent from contact lenses could be applied to other lens materials.

PURPOSE

The purpose of this study was to measure the release of polyvinyl alcohol from commercially available hydrogel daily disposable contact lenses using refractive index and iodine-borate methods.

METHODS

Etafilcon A, omafilcon A, and nelfilcon A were soaked in phosphate-buffered saline and 0.2% trifluoroacetic acid/acetonitile for 24 hours to remove residual blister pack components. The lenses were then incubated in a 10-mg/mL solution of polyvinyl alcohol for 24 hours. After the incubation period, the lenses were placed in 2 mL of phosphate-buffered saline. At specified time intervals, t = 0.5, 1, 2, 4, 8, 12, and 24 hours, the samples were evaluated using refractive index and an iodine-borate assay. Polyvinyl alcohol uptake was determined by extracting the lenses with methanol for 24 hours.

RESULTS

There were no differences in the uptake of polyvinyl alcohol between lens types (P > .05). The release of this wetting agent for all lens types followed a burst-plateau profile after the first 30 minutes (P > .05). Nelfilcon A had a slightly higher release of polyvinyl alcohol (P < .05) than did etafilcon A but was similar to omafilcon A (P > .05).

CONCLUSIONS

The results suggest that the contact lenses tested in this study have similar efficiency in delivering polyvinyl alcohol.
Flow Pattern Classification in Lymphatic Malformations by Indocyanine Green Lymphography
Authors: Kato Motoi , Watanabe Shoji , Iida Takuya , Watanabe Azusa
Published: February 2019

Background:

Lymphatic malformation is a congenital lymphatic disorder. Although a few lymphangiographic and lymphoscintigraphic studies of lymphatic malformation exist, its lymphatic flow has not been fully assessed, and a classification system has not yet been established. However, indocyanine green lymphography has been developed to safely provide a fine assessment of lymph flow in the treatment of lymphedema. In addition, indocyanine green lymphography has been shown to be helpful in detecting the lymphatic malformation inflow for the treatment of refractory microcystic type lymphatic malformation using the venous anastomosis technique. Therefore, the authors aimed to reveal the in vivo lymph flow around the lymphatic malformation using indocyanine green lymphography, and to design a classification system according to the observed patterns.

Methods:

Indocyanine green lymphography was performed in 20 sequential pediatric patients with lymphatic malformation (aged 11 months to 10 years). Most of the cases were intractable, with microcystic or mixed-type lymphatic malformation.

Results:

All patients successfully completed lymphography with clear observations. The flow patterns were classified into four types: type 1 had a strong detectable inflow; type 2 had multiple small observable inflows; type 3 had a superficial lymph flow over the lesion; and type 4 had a flow around the lymphatic malformation, without any connections to the lesion.

Conclusion:

The proposed classification system may aid in the further development of surgical treatments for lymphatic malformation.
Emotions, Bodily Changes, and the Social Environment: How Did Early Psychosomatic Medicine Consider the Social Dimension in Health and Disease?
Authors: Herrmann-Lingen Christoph , Melzer Jörg , von Boetticher Dirk
Published: February 2019

Objective

Social relationships play an important role in human health and disease processes, and the field of psychosomatic medicine currently integrates social factors in its theoretical models and clinical interventions. This article provides a historical perspective on the field of psychosomatic medicine in the United States and examines the extent to which early American psychosomatic medicine incorporated the impact of social relationships on health and disease outcomes.

Methods

We searched PubMed across all issues of Psychosomatic Medicine for key words related to emotions versus social processes. Article counts are compared for these key words. We then performed a narrative review to analyze how concepts of associations among emotional, interpersonal, and physiological variables evolved in early publications.

Results

Of 5023 articles found in Psychosomatic Medicine, 1453 contained an emotional, 936 a social search term, and 447 contained both. In the qualitative review, influences of the social environment on emotional states and physiology were recognized already in the 1930s but they only played a subordinate role in early Psychosomatic Medicine. Publications often lacked a clear working model how interpersonal events exert their impact on physiology. With increasing understanding of developmental and neural mechanisms, a more differentiated view evolved.

Conclusions

Early publications in psychosomatic medicine mainly focused on associations between emotions and physiology. However, some highlighted the importance of interpersonal and social factors. Later, the understanding of emotions, social relationships, and physiology with their developmental and neurobiological correlates have led to a fuller “biopsychosociocultural” understanding of health and disease, although more research on and within these networks is urgently needed.
Does the Tube Voltage Affect the Characterization of Coronary Plaques on 100- and 120-kVp Computed Tomography Scans
Authors: Masuda Takanori , Nakaura Takeshi , Funama Yoshinori , Sato Tomoyasu , Okimoto Tomokazu , Noda Noritaka , Matsumoto Yoriaki , Yamashita Yukari , Imada Naoyuki , Awai Kazuo
Published: February 2019

Objective

The aim of this study was to compare the diagnostic performance of 100- and 120-kVp coronary computed tomography (CT) angiography (CCTA) scans for the identification of coronary plaque components.

Methods

We included 116 patients with coronary plaques who underwent CCTA and integrated backscatter intravascular ultrasound studies. On 100-kVp scans, we observed 24 fibrous and 24 fatty/fibrofatty plaques; on 120-kVp scans, we noted 27 fibrous and 41 fatty/fibrofatty plaques. We compared the fibrous and the fatty/fibrofatty plaques, the CT number of the coronary lumen, and the radiation dose on scans obtained at 100 and 120 kVp. We also compared the area under the receiver operating characteristic (ROC) curve of the coronary plaques on 100- and 120-kVp scans with their ROC curves on integrated backscatter intravascular ultrasound images.

Results

The mean CT numbers of fatty and fatty/fibrofatty plaques were 5.71 ± 36.5 and 76.6 ± 33.7 Hounsfield units (HU), respectively, on 100-kVp scans; on 120-kVp scans, they were 13.9 ± 29.4 and 54.5 ± 22.3 HU, respectively. The CT number of the coronary lumen was 323.1 ± 81.2 HU, and the radiation dose was 563.7 ± 81.2 mGy-cm on 100-kVp scans; these values were 279.3 ± 61.8 HU and 819.1 ± 115.1 mGy-cm on 120-kVp scans. The results of ROC curve analysis identified 30.5 HU as the optimal diagnostic cutoff value for 100-kVp scans (area under the curve = 0.93, 95% confidence interval = 0.87–0.99, sensitivity = 95.8%, specificity = 78.9%); for 120-kVp plaque images, the optimal cutoff was 37.4 HU (area under the curve = 0.87, 95% confidence interval = 0.79–0.96, sensitivity = 82.1%, specificity = 85.7%).

Conclusions

For the discrimination of coronary plaque components, the diagnostic performance of 100- and 120-kVp CCTA scans is comparable.
Socioeconomic “Distressed Communities Index” Improves Surgical Risk-adjustment
Authors: Mehaffey J. Hunter , Hawkins Robert B. , Charles Eric J. , Turrentine Florence E. , Hallowell Peter T. , Friel Charles , Jones R. Scott , Tracci Megan C.
Published: February 2019

Objective:

We hypothesize the Distressed Communities Index (DCI), a composite socioeconomic ranking by ZIP code, will predict risk-adjusted outcomes after surgery.

Summary of Background Data:

Socioeconomic status affects surgical outcomes; however, the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) database does not account for these factors.

Methods:

All ACS NSQIP patients (17,228) undergoing surgery (2005 to 2015) at a large academic institution were paired with the DCI, which accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies. Developed by the Economic Innovation Group, DCI scores range from 0 (no distress) to 100 (severe distress). Multivariable regressions were used to evaluate ACS NSQIP predicted risk-adjusted effect of DCI on outcomes and inflation-adjusted hospital cost.

Results:

A total of 4522 (26.2%) patients came from severely distressed communities (top quartile). These patients had higher rates of medical comorbidities, transfer from outside hospital, emergency status, and higher ACS NSQIP predicted risk scores (all P < 0.05). In addition, these patients had greater resource utilization, increased postoperative complications, and higher short- and long-term mortality (all P < 0.05). Risk-adjustment with multivariate regression demonstrated that DCI independently predicts postoperative complications (odds ratio 1.1, P = 0.01) even after accounting for ACS NSQIP predicted risk score. Furthermore, DCI independently predicted inflation-adjusted cost (+$978/quartile, P < 0.0001) after risk adjustment.

Conclusions:

The DCI, an established metric for socioeconomic distress, improves ACS NSQIP risk-adjustment to predict outcomes and hospital cost. These findings highlight the impact of socioeconomic status on surgical outcomes and should be integrated into ACS NSQIP risk models.
Thoracoscopic Thymectomy for Large Thymic Cyst: Myasthenia Gravis With Thymoma Concealed by Thymic Cyst
Authors: Yano Motoki , Numanami Hiroki , Akiyama Takashi , Taguchi Rumiko , Furuta Chihiro , Iwakoshi Akari , Haniuda Masayuki
Published: February 2019

We herein report a case of myasthenia gravis (MG) in which thoracoscopic thymectomy was performed for a large thymic cystic lesion using a subxiphoid approach. We have previously suggested the usefulness of the subxiphoid approach in thymectomy. The indications of thoracoscopic thymectomy were recently expanded to include large thymic cystic lesions without intraoperative rupture of the lesions. The pathologic diagnosis of the lesion in the present case was multilocular thymic cyst with type A thymoma and micronodular thymoma. The postoperative complications were minimal without MG crisis. Thoracoscopic thymectomy using a subxiphoid approach seems to be an ideal procedure, even for large thymic cystic lesions. In addition, early-onset MG with a large thymic cystic lesion may suggest the presence of a small thymoma even if the lesion is not detected on a preoperative radiologic examination.
Prospective Randomized Control Study on the Efficiency and Safety of a Novel Port-site Closure Device, the EZ-close Port-site Closure System
Authors: Kim Hee Youn , Lee Seung-Ju
Published: February 2019

Aim:

The efficiency and safety of EZ-close Port-Site Closure System were investigated in comparison with those of the Carter-Thomason CloseSure System (CT) device.

Methods:

This was a prospective randomized control study. The primary outcome was the time taken to complete the closure of the port site using either the EZ or CT. The suture time (mean±SD) for the EZ group was significantly less than that of the CT group (36.8±10.1 s for the EZ group vs. 48.9±21.5 s for the CT group, P=0.004). There was no need for additional instruments in the EZ group, but in 84.6% of the patients in the CT group, a grasper was required to hold the tie (P<0.05). There was no difference in the complication rates between the 2 groups.

Conclusions:

The EZ device showed an improved efficiency and similar safety compared with that of the CT device. Its main advantage lied in enabling the surgeon to be totally self-sufficient for the whole port-site closing procedure.
Preservation of Microvascular Integrity in Murine Orthotopic Tracheal Allografts by Clopidogrel
Authors: Heim Christian , Khan Mohammad Afzal , von Silva-Tarouca Benjamin , Kuckhahn Annika , Stamminger Thomas , Ramsperger-Gleixner Martina , Nicolls Mark R. , Weyand Michael , Ensminger Stephan M.
Published: February 2019

Background.

Survival after lung transplantation is mainly limited by the development of chronic lung allograft dysfunction (CLAD). The aim of this study was to investigate if platelet inhibition by clopidogrel has a functionally relevant influence on the microvascular integrity of orthotopic tracheal allografts as an anatomic basis for the development of CLAD.

Methods.

We orthotopically transplanted C57Bl/6 (H-2b) tracheas into CBA.J (H-2k) recipients who afterwards received clopidogrel (1 mg/kg). Morphometric analysis was performed by measuring epithelial height in proportion to thickness of the lamina propria (epithelium-lamina propria ratio). Tissue oxygenation was determined using a fluorescence quenching technique, and graft perfusion monitoring was performed by laser Doppler flowmetry and lectin-binding assay. Immunohistochemistry was used for detection of CD31 and inducible nitric oxide synthase while iron deposition was shown with Prussian blue reaction. Quantitative reverse transcription polymerase chain reaction analysis was used for gene expression analysis.

Results.

Isografts maintained good oxygenation and perfusion throughout the experiment, while both were drastically reduced in allografts. Treatment with clopidogrel attenuated graft hypoxia and reduced loss of perfusion. Additionally, clopidogrel led to increased epithelium-lamina propria ratio while iron deposition was impaired. Gene expression analysis revealed elevated levels of angiogenic vascular endothelial growth factor in the clopidogrel group. Improved endothelial function was shown by immunohistochemistry (CD31, inducible nitric oxide synthase).

Conclusions.

Continuous administration of clopidogrel significantly improved tissue oxygenation, limited microvascular leakiness, and prevented airway ischemia. These data demonstrate that clopidogrel ameliorates microvascular injury during acute airway rejection, which is a known predisposing factor for the development of CLAD.
Considerations for Use of Domino Cross-auxiliary Liver Transplantation in Metabolic Liver Diseases: A Review of Case Studies
Authors: Qu Wei , Wei Lin , Zhu Zhi-Jun , Sun Li-Ying , Liu Ying , Zeng1 Zhi-Gui
Published: February 2019

Introduction.

Domino cross-auxiliary liver transplantation represents an innovative procedure for the treatment of selective noncirrhotic metabolic liver diseases.

Methods.

The treatment strategies and experiences in domino cross-auxiliary liver transplantations, including the world’s first case in 2013, are reviewed.

Results.

Six patients with noncirrhotic metabolic liver diseases receiving domino cross-auxiliary liver transplantation included the following: familial amyloidosis with multiple neuropathy (case 1), ornithine transcarbamylase deficiency (cases 3, 5, and 6), and Wilson’s disease (cases 2 and 4). Five patients achieved a favorable postoperative survival outcome and quality of life, whereas case 2 died of multiple organ failure at 3 months post liver transplant (LT). Case 1 experienced an imbalance in portal vein blood perfusion between the 2 domino livers at 6 months after LT but improved after interventional radiology treatment. Cases 3 and 4 showed domino grafts associated with hypercholesterolemia after LT, but total cholesterol levels decreased to normal ranges after dietary adjustment. Case 5 showed an effortless recovery after surgery with no complications during the follow-up period. Case 6 experienced an occult domino liver graft rejection, which resulted in graft dysfunction and eventual recurrence of the primary metabolic liver disease (ornithine transcarbamylase deficiency). A liver retransplantation may be required for this patient.

Conclusions.

Domino cross-auxiliary liver transplantation is an innovative and effective treatment for metabolic liver diseases in the patients who are strictly selected on the basis of pathophysiological and genetic criteria. Special attention to rejection monitoring and imbalance regeneration are required with this procedure.
Mesenchymal Stem Cell Therapy in Submandibular Salivary Gland Allotransplantation: Experimental Study
Authors: Almansoori Akram Abdo , Khentii Namuun , Kim Bongju , Kim Soung-Min , Lee Jong-Ho
Published: February 2019

Background.

Allotransplantation of submandibular salivary glands (SMGs) could be an alternative treatment option for severe keratoconjunctivitis sicca in noncandidates for autologous SMG transplantation. This study was conducted to evaluate the effect of allogeneic mesenchymal stem cell (MSC) therapy on the survival of allotransplanted SMGs.

Methods.

Thirty-six SMG allotransplantations (n = 6 per group) were performed in New Zealand white rabbits and randomly divided into the following groups: allograft control (Allo-Ctrl), low-dose FK506 (FK506-L), high-dose FK506 (FK506-H), allogeneic MSCs, MSCs+FK506-L, and MSCs+FK506-H. Rabbits were closely observed for 2 weeks. Gland viability and rejection were assessed by monitoring interleukin-2 levels by ELISA, sialoscintigraphy, M3-muscarinic acetylcholine receptor expression, histological evaluation, and apoptosis assay.

Results.

Intraoperatively, all glands showed patency and saliva flow except 1 gland. Sialoscintigraphy revealed significantly higher saliva production within the MSC-treated glands. Histologically, MSC-treated glands showed higher glandular tissue preservation and less acini atrophy. The MSCs+FK506-H group revealed significantly lower apoptosis percentage. The highest survival was observed in the MSCs+FK506-H group, followed by the FK506-H and MSCs+FK506-L groups, and lastly less in the FK506-L and MSCs groups.

Conclusions.

Concurrent administration of MSCs with FK506-H (0.16 mg/kg) resulted in higher survival rate with greater glandular tissue preservation and salivary secretion. MSCs with FK506-L (0.08 mg/kg) could be an alternative to FK506-H (0.16 mg/kg) in salivary gland allotransplantation.
Ex Situ Machine Perfusion of Human Donor Livers via the Surgically Reopened Umbilical Vein: A Proof of Concept
Authors: van Leeuwen Otto B. , Fujiyoshi Masato , Ubbink Rinse , Werner Maureen J.M. , Brüggenwirth Isabel M.A. , Porte Robert J. , de Meijer Vincent E.
Published: February 2019

Background.

Machine perfusion of donor livers is typically performed via the portal vein main stem. Instead, cannulation of a reopened umbilical vein could allow machine perfusion during organ procurement and subsequent implantation in the recipient without interruption of the portal venous circulation. We aimed to assess the feasibility of portal venous machine perfusion via the umbilical vein.

Methods.

During back table inspection of 5 human livers declined for transplantation, the umbilical vein was surgically reopened, dilated, and cannulated. Hypothermic and normothermic oxygenated machine perfusion (NMP) were performed using the umbilical vein for portal inflow. Three livers were perfused with hypothermic machine perfusion, 1 full liver graft underwent NMP for 4 hours, and 1 left lateral split procedure was performed under continuous NMP with portal perfusion via the umbilical vein.

Results.

In all livers, access to the portal venous system via the umbilical vein was successfully achieved with good portal flows and macroscopically homogeneous perfusion. The full liver graft that underwent NMP via the umbilical vein for 4 hours showed good lactate clearance, normalized pH, and achieved good bile production with pH >7.55. During the split procedure under continuous NMP via the umbilical vein, the left lateral segment and extended right lobe remained equally perfused, as demonstrated by Doppler ultrasound.

Conclusions.

Machine perfusion with portal perfusion via the umbilical vein is feasible. Portal venous flows were similar to those obtained after cannulation of the portal vein main stem. This technique enables continuous oxygenated perfusion of liver grafts during procurement, splitting, and implantation.
A Systematic Review for Variables to Be Collected in a Transplant Database for Improving Risk Prediction
Authors: Almasri Jehad , Tello Mouaffaa , Benkhadra Raed , Morrow Allison S. , Hasan Bashar , Farah Wigdan , Alvarez Villalobos Neri , Mohammed Khaled , Allen Jay-Sheree P. , Prokop Larry J. , Wang Zhen , Kasiske Bertram L. , Israni Ajay K. , Murad Mohammad Hassan
Published: February 2019

Background.

This systematic review was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network (OPTN).

Methods.

We identified 81 unique studies including 1 193 410 patients with median follow-up of 36 months posttransplant, reporting 108 unique risk factors.

Results.

Most risk factors (104) were recipient related; few (4) were donor related. Most risk factors were judged to be practical and feasible to routinely collect. Relative association measures were small to moderate for most risk factors (ranging between 1.0 and 2.0). The strongest relative association measure for a heart transplant outcome with a risk factor was 8.6 (recipient with the previous Fontan operation), for a kidney transplant 2.8 (sickle cell nephropathy as primary cause of end-stage renal disease), for a liver transplant 14.3 (recipient serum ferritin >500 µg/L), and for a lung transplant 6.3 (Burkholderia cepacia complex infection for 1 y or less). OPTN may consider some of these 108 variables for future collection to enhance transplant research and clinical care.

Conclusions.

Evidence-based approaches can be used to determine variables collected in databases and registries. Several candidate variables have been identified for OPTN.
Neighborhood Poverty and Sex Differences in Live Donor Kidney Transplant Outcomes in the United States
Authors: Purnell Tanjala S. , Luo Xun , Crews Deidra C. , Bae Sunjae , Ruck Jessica M. , Cooper Lisa A. , Grams Morgan E. , Henderson Macey L. , Waldram Madeleine M. , Johnson Morgan , Segev Dorry L.
Published: February 2019

Background.

Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes.

Methods.

Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005–2014 with follow-up through December 31, 2016.

Results.

Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01).

Conclusions.

Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
High Intrapatient Variability in Tacrolimus Exposure Is Not Associated With Immune-mediated Graft Injury After Liver Transplantation
Authors: van der Veer Marlotte A.A. , Nangrahary Negina , Hesselink Dennis A. , Erler Nicole S. , Metselaar Herold J. , van Gelder Teun , Darwish Murad Sarwa
Published: February 2019

Background.

A high intrapatient variability (IPV) in tacrolimus exposure is associated with impaired long-term clinical outcome after kidney transplantation. It remains to be determined if this is equally detrimental for liver transplant recipients. The objective of this study was to investigate the association between IPV in tacrolimus exposure and immune-mediated graft injury after liver transplantation.

Methods.

For 326 liver transplant recipients, transplanted between 2000 and 2015, tacrolimus IPV was calculated from at least 5 tacrolimus trough samples obtained between months 6 and 18 after liver transplantation and expressed as the coefficient of variation. Primary composite endpoint consisted of immune-mediated graft injury (chronic rejection, biopsy proven, and suspected late acute rejection) after month 6. Secondary outcomes were the association between tacrolimus IPV on (1) loss of renal function per year of follow-up and (2) cytomegalovirus viremia after month 6.

Results.

Of the 326 included liver transplant recipients, 70 patients (21.5%) reached the primary endpoint. Median tacrolimus coefficient of variation was 28%. There was no significant difference in reaching the primary composite endpoint between the low- and high-IPV groups (P = 0.068). Model for End-Stage Liver Disease score pretransplantation and the number of acute rejections were identified as independent predictors for immune-mediated graft injury (P = 0.049 and 0.016). A higher IPV in combination with a low kidney function at baseline (estimated glomerular filtration rate < 40 mL/min) was associated with greater loss of renal function per year of follow-up (P = 0.007). Tacrolimus variability was not associated with late cytomegalovirus viremia.

Conclusions.

High IPV in tacrolimus exposure beyond month 6 postliver transplantation was not associated with immune-mediated graft injury.
Corneal Stromal Transplantation With Human-derived Acellular Dermal Matrix for Pellucid Marginal Corneal Degeneration: A Nonrandomized Clinical Trial
Authors: Jiang Xiaodan , Wang Yuexin , Qiu Weiqiang , Huang Chen , Liu Ziyuan , Ding Tong , Shi Danna , Li Xuemin
Published: February 2019

Background.

To investigate the transparency, biocompatibility, and safety of human-derived acellular dermal matrix for application in corneal stromal transplantation.

Methods.

Twenty-four patients (24 eyes) with pellucid marginal corneal degeneration were enrolled, and intrastromal keratoplasty was performed with human-derived acellular dermal matrix. The ocular symptoms and signs as well as graft characteristics were evaluated at baseline and at 1 day, 1 week, and 1, 3, and 6 months postoperatively. Photography by a slit lamp, topography by Pentacam, anterior segment-optical coherence tomography, and corneal confocal microscopy were conducted at baseline and during the follow-up period.

Results.

Postoperative discomfort was relieved during the follow-up period. No abnormal ocular signs were observed at 6 months, indicating the safety of the procedure. Desirable and improved transparency of the grafts was demonstrated, and all the grafts healed without dissolution or fall at 6 months postoperatively. Reepithelization was completed, and confocal microscopy revealed that keratocytes and nerves repopulated in all the grafts at 6 months postoperatively. The thinning of the marginal corneal stroma was eliminated following the transplantation, and the curvature and corneal regularity remained stable at 6 months compared with baseline.

Conclusions.

The present study demonstrated the transparency, biocompatibility, and safety of human-derived acellular dermis matrix in intrastromal keratoplasty. With further improvements, human-derived acellular dermis matrix could be applied in central lamellar keratoplasty and ultimately solve the shortage of donor grafts.
The Abnormal Oswald Ripening of Protein Nanofiber in Myofibrillar Protein Solution
Authors: Niu Fuge , Zhang Rui , Fan Jiamei , Pan Weichun
Published: February 2019

In solutions of myofibrillar protein extracted from giant squid (Dosidicus gigas), the size-coarsening process of protein nanofiber is complex. At high temperature (25°C), nanofiber keeps growth but with two distinguishable patterns, slow rate at the initial stage with t0.2 and the fast one at the late stage with t2.3. The intersection of these two slopes is around 300 min. Meanwhile, protein concentration in solution enhances as well. These behaviors contradict to the prediction of Ostwald ripening. Thus, we call this process as abnormal. These abnormal behaviors come from the conformation change of some types of constitution protein molecules with chemical potential reduction when they dissolve from nanofiber to solution. On the other hand, low temperature (10°C) depresses this size growth. This observation suggests that temperature regulates protein molecule conformation change in nanofiber. The consequence of this abnormal Ostwald ripening process is that all protein molecules in nanofiber are redistributed. Protein molecules with the absence of conformation change in dissolution accumulate in nanofiber to cause it growing, while the rest concentrates in solution.
Rapid and dynamic nucleic acid hybridization enables enzymatic oligonucleotide synthesis by cyclic reversible termination
Authors: Hoff K. , Halpain M. , Garbagnati G. , Edwards J. , Zhou W.
Published: February 2019

Enzymatic oligonucleotide synthesis (EOS) has been attempted in many iterations for more than forty years, but chemical synthesis remains the industry standard despite hazardous waste produced, time restrictions, and length limitations of approximately 200 bases. Herein, we demonstrate that single-stranded oligos on a solid surface can transiently hybridize to neighboring strands and these structures can be recognized and extended by DNA polymerases and reverse transcriptases through a mechanism we describe as “bend and extend.” Additionally, we show that the sequence of the newly synthesized fragment can be controlled to create custom oligonucleotides. We used this enzymatic approach to synthesize 20 bases on a solid surface through a two-step cyclic reversible termination process with stepwise efficiency over 98%. In our approach, a nascent DNA strand that serves as both primer and template is extended through polymerase-controlled sequential addition of 3’-reversibly blocked nucleotides followed by subsequent cleavage of the 3’-capping group. This process enables oligonucleotide synthesis in an environment not permitted by traditional phosphoramidite methods, eliminates the need for hazardous chemicals, has the potential to provide faster and higher yield results, and synthesizes DNA on a solid support with a free 3’ end.