bluuebunny/crossref_metadata_2025 huggingface dataset:
Spotlight on Consent: Lessons from the SPOTLIGHT Trial for Acute Intracerebral Hemorrhage
Authors: Fitzpatrick Tess , Shamy Michel , Dewar Brian , Spence Julie , Demchuk Andrew M. , Hill Michael D. , Flaherty Matthew L. , Gladstone David J.
Published: March 2020

Background SPOTLIGHT was a Canadian multicentre, placebo-controlled, randomized trial of emergency treatment with recombinant Factor VIIa for patients with acute intracerebral hemorrhage that enrolled a subset of eligible patients via deferral of consent. We investigated attitudes towards deferral of consent among participants and their legally-authorized representatives (LARs). Methods All participants or LARs approached for enrolment in SPOTLIGHT were invited to complete an 11-item questionnaire within the first 4 days of enrolment, and again at 90 days. Results Eight out of 50 participants in SPOTLIGHT (16%) were enrolled via deferral of consent. Ten LARs for participants (20%) completed the initial survey and 6 completed the 90 day follow-up survey. Ninety percent of respondents agreed with the process of deferral of consent both in principle and specifically for the SPOTLIGHT trial. Participants were more likely to support deferral of consent for low-risk or time-sensitive interventions, or in situations with no alternative treatment options. Conclusions The majority of respondents were supportive of using deferral of consent to enrol participants into SPOTLIGHT and acute stroke trials.
Association between nonalcoholic fatty liver disease and extrahepatic cancers: a systematic review and meta-analysis
Authors: Liu Shou-Sheng , Ma Xue-Feng , Zhao Jie , Du Shui-Xian , Zhang Jie , Dong Meng-Zhen , Xin Yong-Ning
Published: March 2020

Background NAFLD was tightly associated with various diseases such as diabetes, cardiovascular disease, kidney disease and cancer. Previous studies had investigated the association between NAFLD and various extrahepatic cancers, but the conclusions were remains to be improved. The aim of this study was to investigate the association between NAFLD and various extrahepatic cancer comprehensively. Methods Electronic databases PubMed, EMBASE, Medline, and the Cochrane Library were searched for observational studies published from 1996 to January 2020. Observational studies that reflected the association between NAFLD and extrahepatic cancers were included in this study. The pooled OR/HR/IRR of the association between NAFLD and various extrahepatic cancers were analyzed. Results A total of 26 studies were included for investigating the association between NAFLD and various extrahepatic cancers. As the result shown, the pooled OR values of the risk of colorectal cancer and adenomas in patients with NAFLD were 1.72 (95%CI: 1.40-2.11) and 1.38 (95%CI: 1.22-1.56), respectively. The pooled OR values of the risk of intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma in patients with NAFLD were 2.40 (95%CI: 1.75-3.31) and 2.24 (95%CI: 1.58-3.17), respectively. The pooled OR value of the risk of breast cancer in patients with NAFLD was 1.68 (95%CI: 1.44-1.97). In addition, NAFLD was also tightly associatied with the risk of gastric cancer, pancreas cancer, prostate cancer, and esophagus cancer. Conclusions NAFLD could significantly increase the development risk of colorectal adenomas and cancer, intrahepatic and extrahepatic cholangiocarcinoma, breast cancer, gastric cancer, pancreas cancer, prostate cancer, and esophagus cancer.
Sex-based difference in influence of A blood group on increased risk of coronary artery disease among Chinese adults: a propensity score matching analysis
Authors: Song Yanbin , Cai Gaojun , Yang Qichao , Li Feng , Lu Wei
Published: March 2020

Background

ABO blood group is a risk factor for coronary artery disease (CAD), but whether it is more strongly associated with CAD in Chinese individuals is less clear. The aim of this current study was therefore to investigate the association among patients hospitalized for primary coronary angiography and to explore the potential mediator of plasma lipids.

Methods

A total of 1079 patients, including 698 with- and 381 without newly diagnosed CAD, were retrospectively enrolled from November 2012 to December 2018. Clinical characteristics, plasma lipid levels and ABO blood groups were recorded and analyzed. Characteristics of the patients with and without CAD were compared after propensity score matching analysis (346 vs. 346). Correlation analysis was performed to assess the relationship between ABO types and clinical variables. Logistic regression analysis was constructed to determine the association of ABO blood group with CAD.

Results

There was not significant difference in the distribution of ABO types between CAD and non-CAD group in overall population. However, propensity-matched analysis showed that CAD in the women subgroup presented more frequently with blood group A, but not non-CAD (60.2% versus 44.1%, P =0.014). The statistically significant difference was not observed among men (37.5% versus 30.3%, P =0.157). When compared with non-A blood group, the A blood group had not a greater difference in lipid profiles among women ( P all>0.05). Correlation analysis performed in women revealed that CAD was significantly correlated with A type (r= 0.171, P = 0.003). After adjustment for age, hypertension, cigarette smoking, drinking and lipid profiles, logistic regression analysis showed that blood group A was an significant predictor for CAD in women (OR=2.152, 95% CI 1.285~3.605, P =0.004) .

Conclusion

Cumulatively, the present study indicated that blood group A was a significantly risk factor for coronary artery disease in Chinese women.
Discrimination between clinical significant and insignificant prostate cancer with Apparent diffusion coefficient – A systematic review and meta analysis
Authors: Meyer Hans-Jonas , Wienke Andreas , Surov Alexey
Published: March 2020

Background Multiparametric MRI has become a corner stone in diagnosis of prostate cancer (PC). Diffusion weighted imaging and the apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. The present analysis sought to compare ADC values of clinically insignificant with clinical significant PC based upon a large patient sample. Methods MEDLINE library and SCOPUS databases were screened for the associations between ADC and Gleason score in PC up to May 2019. The primary endpoint of the systematic review was the ADC value of PC groups according to Gleason score. In total 27 studies were suitable for the analysis and included into the present study. The included studies comprised a total of 1633 lesions. Results Clinically relevant PCs (Gleason score 7 and higher) were diagnosed in 1078 cases (66.0%) and insignificant PCs (Gleason score 5 and 6) in 555 cases (34.0%). The pooled mean ADC value of the clinically significant PC was 0.86x10-3 mm2/s [95% CI 0.83-0.90] and the pooled mean value of insignificant PC was 1.1 x10-3 mm2/s [95% CI 1.03-1.18]. Clinical significant PC showed lower ADC values compared to non-significant PC. The pooled ADC values of clinically insignificant PCs were no lower than 0.75 ×10-3 mm2/s. This value may be proposed as a threshold for distinguishing clinically significant from insignificant PCs. Conclusions We evaluated the published literature comparing clinical insignificant with clinically prostate cancer in regard of the Apparent diffusion coefficient values derived from magnetic resonance imaging. We identified that the clinically insignificant prostate cancer have lower ADC values than clinically significant, which may aid in tumor noninvasive tumor characterization in clinical routine.
Modeling and Forecasting the Macroeconomic Driver of Time-Varying Coffee Price Volatility in Ethiopia
Authors: Abebe Teshome Hailemeskel
Published: March 2020

Recently, modeling and forecasting of high frequency data (such as daily price) volatility using GARCH-MIDAS attracts the attention of many researchers. Thus, the objective of this study is to model and forecast the average daily coffee price volatility using GARCH-MIDAS model over the sample period from January 01, 2010 to June 30, 2019. The GARCH-MIDAS component model decomposes the conditional variance into short run component which follows a mean-reverting unit GARCH process and long run component which consider different frequency macroeconomic indicators (in this study GDP, interest rate, trade openness and money supply) via mixed interval data sampling (MIDAS) specification. Unit root test results show the return series are stationary at level, while macroeconomic variables are stationary at first difference except interest rate, which is stationary at level. From the result of estimated GARCH-MIDAS component model, all selected indicators are crucial in explaining the long-term component price volatility.The Conrad &Schienleregression based result shows the absence of model specification. Moreover, the estimated GARCH-MIDAS component model with money supply as a main driver is used for out-sample forecast. Finally, the DM test statistic used for comparing the forecasting performance of GARCH-MIDAS component model against the standard GARCH model.The result shows that multiplicative GARCH-MIDAS component model provide an explanation for stylized facts that cannot be captured by standard GARCH model.
Dual-Trigger Improves the Outcomes of in Vitro Fertilization Cycles in Older Patients with Diminished Ovarian Reserve: a retrospective cohort study
Authors: Chern Chyi-Uei , Li Ju-Yueh , Tsui Kuan-Hao , Wang Peng-Hui , Wen Zhi-Hong , Lin Li-Te
Published: March 2020

Background: Dual-trigger for final oocyte maturation has been applied on the women with poor ovarian response or diminished ovarian reserve. However, the results were controversial. The Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) stratification is a set of newly established criteria for low prognosis patients. The aim of this study was to examine the effectiveness of dual trigger for final oocyte maturation on the in vitro fertilization (IVF) outcomes of patients who fulfill the POSEIDON group 4 criteria.Methods: This retrospective cohort study investigated 384 cycles fulfilling the POSEIDON group 4 criteria. The patients underwent IVF treatment using the gonadotropin-releasing hormone (GnRH) antagonist protocol. The study group contained 194 cycles that received dual trigger (human chorionic gonadotropin [hCG] plus GnRH agonist) for final oocyte maturation. The control group included 114 cycles where final oocyte maturation was performed with only hCG. Baseline characteristics and cycle parameters, as well as IVF outcomes of both groups were compared.Results: Baseline characteristics were similar between the dual trigger group and the control group. In terms of IVF outcomes, the dual trigger group demonstrated significantly higher number of retrieved oocytes, metaphase II oocytes, fertilized oocytes, day-3 embryos, and top-quality day-3 embryos. A statistically significant improvement in clinical pregnancy rate and live birth rate was also observed in the dual trigger group. Regardless of whether the patients were aged < 40 or ≥ 40 years, those receiving dual trigger had increased numbers of oocytes retrieved, fertilized oocytes, day-3 embryos, top-quality day-3 embryos than those with hCG-only trigger. Clinical pregnancy rate and live birth rate were significantly increased in the < 40-year old group whilst not significantly increased in those ≥ 40 years.Conclusions: Our data suggests that dual trigger for final oocyte maturation might improve clinical pregnancy rates and live birth rates of IVF cycles in patients fulfilling the POSEIDON group 4 criteria.
High prevalence of t895 and t9364 spa types of methicillin-resistant Staphylococcus aureus in a tertiary-care hospital in México: Different lineages of Clonal Complex 5
Authors: Negrete-González C , Turrubiartes-Martínez E , Galicia-Cruz OG , Noyola DE , Martínez-Aguilar G , Pérez-González LF , González-Amaro R , Niño-Moreno P
Published: March 2020

BACKGROUND Staphylococcus aureus is a leading cause of broad-spectrum infections both, in the community and within the healthcare settings. The methicillin-resistant Staphylococcus aureus (MRSA) variant has became a global issue of public health. The aim of this study was to examine the clinical and molecular characteristics of Staphylococcus aureus isolates and to define the population structure and distribution of major MRSA clones present in a tertiary-care hospital in Mexico. RESULTS From April 2017 to April 2018, 191 isolates of Staphylococcus aureus were collected. The frequency of MRSA was 26.7%, these strains exhibited resistance to clindamycin (85.3%), erythromycin (86.2%), levofloxacin (80.3%), and ciprofloxacin (86.3%). The majority of MRSA strains harbored the SCCmec type II (39/51); the t895 (29/51) and t9364 (6/51) were the most common spa types in both, hospital-associated MRSA and community associated MRSA isolates. The clones ST5-MRSA-II-t895 (New York /Japan clone) and ST1011-MRSA-II-t9364 (New York /Japan-Mexican Variant clone) were the most frequent. Finally, different lineages of Clonal Complex 5 (90.6%) and Clonal Complex 8 (9.1%) were identified in this study. CONCLUSION Our study provides valuable information about the epidemiology of MRSA in a city of the central region of Mexico, and this is the first report on the association between the t895 and t9364 spa types and the ST5 and ST1011 lineages, respectively.
Effect of Deletion of Gene Cluster involved in Synthesis of Enterobacterial Common Antigen on Virulence and Immunogenicity of Live Attenuated Salmonella Vaccine when Delivering Heterologous Streptococcus pneumoniae Antigen rPspA
Authors: Liu Qing , Shen Xuegang , Bian Xiaoping , Kong Qingke
Published: March 2020

Background: Enterobacterial common antigen (ECA) is a family-specific surface antigen shared by all members of the Enterobacteriaceae family. Previous studies showed that the loss of ECA results in Salmonella attenuation, indicating its usefulness as a vaccine candidate for Salmonella infection, but no studies have shown whether the mutation resulting from the deletion of the ECA operon in conjunction with other mutations could be used as an antigen vehicle for heterologous protein antigen delivery.Results: In this study, we introduced a nonpolar, defined ECA operon deletion into wild-type S. Typhimurium χ3761 and an attenuated vaccine strain χ9241, obtaining two isogenic ECA operon mutants, namely, χ12357 and χ12358, respectively. A number of in vitro and in vivo properties of the mutants were analyzed. We found that the loss of ECA did not affect the growth, lipopolysaccharide (LPS) production and motility of S. Typhimurium wild type strain χ3761 and its attenuated vaccine strain χ9241 but significantly affected the virulence when administered orally to BALB/c mice. Furthermore, the effects of the ECA mutation on the immunogenicity of a recombinant S. Typhimurium vaccine strain χ9241 when delivering the pneumococcal antigen rPspA were determined. The result showed that the total anti-PspA IgG level of χ12358 (pYA4088) was slightly lower than that of χ9241 (pYA4088), but the protection rate was not compromised.Conclusions: ECA affects virulence and benefits the Th2 immunity of Salmonella Typhimurium, therefore, it is feasible to use a reversibly ECA mutant mode to design future Salmonella vaccine strains for heterologous protective antigens.
Rapid Rehabilitation Surgery Program In Perioperative Management Of Radical Cystectomy And Ileal Conduit Diversion
Authors: Chen Hualei , Zhuo Xiaoan , Che Xianping , Gu Jun
Published: March 2020

Background: To evaluate the clinical effect of rapid rehabilitation surgery in the perioperative period of radical resection of bladder cancer by using the comparison with traditional perioperative treatment scheme. Methods：In this study, 80 patients who underwent bladder cancer with bladder cancer from August 2010 to October 2017 were collected, and the rapid rehabilitation Surgical treatment program and traditional treatment plan were adopted respectively during perioperative period, and the hospitalization cost, first exhaust time and after operation were compared between the two groups of patients. Clinical indexes such as hospitalization time and the incidence of postoperative complications to evaluate the application of both in the perioperative period of the radical ileum bladder surgery for bladder cancer. Results：Both groups of patients were cured and discharged. Compared with the traditional control group, the first exhaust time of the patients in the rapid recovery group was significantly earlier (3.10±0.45 D vs 3.88±0.91d P<0.05), the hospitalization cost (4.80±0.56 million vs 5.62±0.76 million P<0.05), and the length of hospital stay (8.8 6±1.23 d vs 14.47±3.58d P<0.05). However, there was no significant difference in the number of complications between the two groups (6 vs P>0.05). Conclusions：It is safe and effective to have rapid rehabilitation surgery for the perioperative period of radical resection of bladder cancer, and the rapid rehabilitation Surgical treatment program has the advantage of shortening the length of hospital stay and reducing the cost of hospitalization compared with the traditional treatment plan, which is beneficial to the recovery of patients after operation.
Anti-proliferative activities of Byrsocarpus coccineus using ovarian cancer cell lines
Authors: Ukwade Caroline , Ebuehi Osaretin , Adisa Rashidat , Singh Santos , Singh Rajesh
Published: March 2020

Background: Ovarian cancer is one of the most lethal tumors of gynecologic malignancies, due to lack of early detection, and a high rate of metastasis. The standard treatment is surgery and cytotoxic chemotherapy, but due to its cost and side effects, medicinal plants are widely used in developing countries. Byrsocarpus coccineus plant preparation, has been administered to patients traditionally in the management of tumour in Nigeria. In this study, we investigated the anti-proliferative effects of B. coccineus ethanol leaf extract against OVCAR3 and SW626 ovarian cancer cell lines. After treatment of the two cell lines with the extracts, analyses were carried out to determine inhibition of proliferation and expression of cell cycle markers, pro-apoptotic and anti-apoptotic markers. Results: Results showed that B. coccineus ethanol leaf extract, significantly inhibited cell migration and colony formation in OVCAR3 and SW626 treated cells in a dose-dependent manner. Results also show that B. coccineus ethanol leaf extract modulated the expression of p53 gene, cell cycle progression, anti-apoptotic and pro-apoptotic genes. Conclusions: These results suggest that B. coccineus have anti-proliferative properties and could induce apoptosis. Further investigation will be carried out to isolate bioactive compounds for the treatment of ovarian cancer.
Oral intermittent Vitamin D substitution: Influence of pharmaceutical form and dosage frequency on medication adherence: A randomized clinical trial
Authors: Rothen Jean-Pierre , Rutishauser Jonas , Walter Philipp N , Hersberger Kurt E , Arnet Isabelle
Published: March 2020

Background: To assess adherence to and preference for vitamin D substitution with different pharmaceutical forms and frequencies of administration.Methods: A focus group of stakeholders aimed at preparing the design of an interventional, randomized, cross-over study with 2 x 2 groups obtaining monthly or weekly vitamin D products in liquid or solid form for 3 months each. Dosage corresponds to cumulated amount of recommended 800 IU daily (5.600 IU weekly / 24.000 IU monthly). Main inclusion criteria were a vitamin D serum value <50 nmol/l and age ≥18 years. Primary endpoint was adherence, secondary endpoints were preferences and vitamin D serum levels. Results: The focus group reached consensus for preference of a monthly administration of solid forms to adults. Full datasets were obtained from 97 participants. Adherence was significantly higher with monthly (79.5 – 100.0%) than weekly (66.4 – 98.1 %) administration. Vitamin D levels increased significantly (p<0.001) in all participants. An optimal value of >75 nmol/l was achieved by 32% after 3 months and by 50% after 6 months. Preferred formulation was solid form (tablets, capsules) for 71% of participants, and preferred dosage frequency was monthly for 39% of participants.Conclusions: Monthly oral vitamin D in solid form lead to the highest adherence, and is preferred by the participants. However, only one third of study participants achieved values in the optimal range of >75 nmol/l cholecalciferol using weekly or monthly administration providing an average daily cholecalciferol dose of 800 IU.
Perceived Health and Stress among Primary Care visitors - a comparative cross-sectional study between Greece and Scandinavia
Authors: Koppner Jenny , Chatziarzenis Marios , Faresjö Tomas , Theodorsson Elvar , Thorsell Annika , Nilsson Staffan , Olsen Ole , Faresjö Åshild
Published: March 2020

Background: Health behavior varies highly across European countries, and stress and stress-related disorders are commonly seen in European Primary Health Care. Greece has suffered deeply from the 2008 international financial crisis, whereas Scandinavian countries were less affected. Several reports of increasing mental health issues and poorer perceived health among the Greek population have been published. Self-reported health and stress are established public health indicators. A novel physiological marker of long-term stress, cortisol in hair, is at hand and applied in this study. Here, our aim was to study perceived health, including mental health, and self-reported and biological stress in Greece compared to Scandinavia. Methods: A cross-sectional comparative study of adult (18-65) Primary Health Care visitors from semi-rural areas in Greece (n=84) and Scandinavia (n=140). Data collection encompassed a questionnaire with a variety of health and stress indicators and hair samples for analyzes of cortisol levels. Results: The Greek sample reported significantly poorer overall health (p<0.0001) than the Scandinavians and significantly higher perceived stress (p<0.0001). The Greeks were also less hopeful of the future (p<0.0001), and to a larger extent fulfilled the HAD criteria for depression (p<0.0001) and anxiety (p=0.002). There were no significant differences in cortisol levels between the study-groups. The strongest predictors explaining ill health in logistic regressions were being Greek (p=0.001) and feeling hopeless about the future p=0.001, OR= 6.00 (CI; 2.10-14.88). Strong predictors in logistic regressions for high perceived stress were anxiety: high (p=<0.0001) and medium, (p=0.0001), as well as medium depression (p=0.02). Participants with either low or high cortisol levels, and those that reported ill health, had elevated self-reports of high stress, but these did not reach statistical significance.Conclusions: The results suggest that Greek adult Primary Health Care visitors perceived their health more negatively than the Scandinavians, including a higher presence of depression, anxiety, and a lower hope for the future. The Greeks also reported higher perceived stress, not reflected in higher cortisol levels. These findings could be interpreted against the background of socio-cultural differences in northern and southern Europe, and might also reflect the economic crisis that the Greek population experienced at that time.
The impact of the stretching force of incision on early clinical results after primary total knee arthroplasty (TKA)
Authors: Gong Long , Yanlei Wang , Ping Yi , Yan Sun , Jipeng Song , Mingsheng Tan
Published: March 2020

Background：A variety of surgical approaches are used in primary total knee arthroplasty (TKA), including medial parapatellar, sub-vastus, mid-vastus, lateral, and less invasive techniques. Previous studies demonstrated that there existed widely varied degrees of anterior knee soft-tissue stretching in patients undergoing primary TKA. However, the impact of incision stretching on TKA’s results failed to be investigated.Methods：1210 patients accepted primary and unilateral TKA at the authors’ affiliated institutions between Jan. 2011 and Dec. 2015. We recorded and analyzed the following data, including each patient's characteristics, incision stretching index (IS index), perioperative information, and follow-up assessments. By trisecting the IS index, patients were grouped and compared about visual analogue scale (VAS) pain scores as the primary outcome, knee circumference, knee range of motion (ROM), sensory testing, and the strength of quadriceps. Results：1089 patients undergoing primary and unilateral TKA in our two institutions were screened for final analysis, and 121 ones were excluded. The mean IS index was 22.6 (range: 19.7-24.8). VAS pain score, knee circumference, ROM, area of abnormal sensation, and the strength of quadriceps among group IS A, IS B, and IS C were significantly different (P<0.05). With the increase in the IS index, VAS pain score, knee circumference, area of abnormal sensation, and incision problems were significantly increased (P<0.05), while ROM and the strength of quadriceps decreased (P<0.05). Also, no significant difference in PJI and deep vein thrombosis (DVT) among groups was observed (P>0.05). Conclusions： There was a significant impact of incision stretching on clinical outcomes after TKA. Decreased incision stretching, which mainly depended on the length in full extension of the knee, can improve postoperative pain relief, surgical swelling, ROM, sensory disturbance of the knee, and the strength of quadriceps with reduced risk of incision complications.
Straight stem and threaded cup total hip arthroplasty systems in patients under 60 years of age: outdated or still a benchmark? A report on a cohort of 75 patients after 28.8-30.2 years of follow-up
Authors: Pisecky Lorenz , Allerstorfer Jakob , Schauer Bernhard , Hipmair Günter , Hochgatterer Rainer , Böhler Nikolaus , Gotterbarm Tobias , Klotz Matthias
Published: March 2020

Purpose: The goal of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup. Methods: Between 1986 and 1987, 75 hips of 75 patients (mean age: 53.35±6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. 44 patients had died over the last 30 years. The remaining 31 patients (mean age: 82.9±6.4years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out. Results: At a mean follow-up of 29.5 (28.8-30.2), 4 patients (5.3%) were lost to follow up. For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner due to wear. The mean time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revisons were septic loosenings (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), total wear of liner including cup (1 case). Conclusion: The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-longterm follow up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.
Long-term survival after resection of pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: case report and review of literature
Authors: Tohyama Taiji , Sakamoto Katsunori , Tamura Kei , Nakamura Taro , Watanabe Jota , Wakisaka Hiroyuki , Takada Yasutsugu
Published: March 2020

Background: The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection. Case presentation: A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria on liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. Pharyngeal polypectomy was performed, followed by neck lymph node dissection 2 years thereafter. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib. Conclusion: It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment including radical resection.
Efficacy of Different Drugs in Treating Urinary Schistosomiasis: Systematic Review and Network Meta-analysis
Authors: Fang Huilong , Guo Xuli , Tang Chuwei , Chen Fuchun , Badr Ahmed , Luo Feng , Wang Junjie
Published: March 2020

Background: Praziquantel is the current pillar for morbidity control of schistosomiasis. Artesunate and its derivatives, widely used for malaria treatment, also display antischistosomal activities. This review compares the efficacy of three drugs, namely praziquantel (PZQ), artesunate, and metrifonate in urinary schistosomiasis. Methods: Databases were searched for articles comparing the effectiveness of any of the three drugs to other medications or controls in urinary schistosomiasis in children aged 18 or less. Stata software was opted to generate the network meta-analysis. Efficacy (Cure rate and egg reduction rate) was the main outcome measure. Pairwise and network meta-analysis were used to report Odds Ratios (ORs) with either 95% confidence interval (CI) for direct comparisons or 95% credible intervals (CrI) for indirect comparisons. Results: The SUCRA plot for cure rate revealed that PZQ (SUCRA= 40.4%) was the fourth effective drug after albendazole 400mg (SUCRA= 71.5), metrifonate 5 mg (SUCRA= 62.2%), and metrifonate 10 mg (SUCRA= 59.7). PZQ was only superior to metrifonate 7.5 mg. ORs were PZQ 40 mg (OR 0.48; 95% CI -3.55 to 4.51; p-value 0.816), artesunate 6 mg (OR 0.06; 95% CI -5.67 to 5.79; p-value 0.983), metrifonate 5 mg (OR -1.65; 95% CI -7.52 to 4.21; p-value 0.581), metrifonate 10 mg (OR -1.76; 95% CI -8.86 to 5.34; p-value 0.628), and metrifonate 7.5 mg (OR -2.40; 95% CI -9.78 to 4.98; p-value 0.524). A similar plot for egg reduction rate showed an exclusive superiority of PZQ 40 mg (SUCRA= 94.4%), followed by metrifonate 10mg (SUCRA= 82.3%) and niridazole 25mg plus metrifonate 10mg (SUCRA= 48.6%). Conclusions: Our network analysis revealed that PZQ 40 mg was the most efficient drug in reducing egg count, whereas albendazole 400mg showed the highest cure rates.
Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: A systematic review
Authors: Okusanya Babasola , Asaolu Ibitola O. , Ehiri John E. , Kimaru Linda Jepkoeach , Okechukwu Abidemi , Rosales Cecilia
Published: March 2020

Medical cannabis (MC) is currently being used as an adjunct to opiates given its analgesic effects and potential to reduce opiate addiction. This review assessed if MC used in combination with opioids to treat non-cancer chronic pain would reduce opioid dosage.
TgROP18 Targets IL20RB for Host Defence Related-STAT3 Activation During T. gondii Infection
Authors: Kong Ling , Jiang Dan , He Cheng , Xia Jing , We Haixia , Zhou Lijuan , Peng Hong-Juan
Published: March 2020

Background: Toxoplasma gondii is an opportunistic protozoan infecting almost one third of the world’s population. T. gondii rhoptry protein 18 (TgROP18) is a key virulence factor determining parasite’s acute virulence and secreted into host cells during infection. We previously identified the interaction of TgROP18 and host cell immune-related receptor protein IL20RB, and observed the activation of STAT3 in human keratinocytes (HaCaT) cells infected by the rop16 knockout RH strain, though TgROP16 is regarded responsible for host STAT3 activation during T. gondii invasion. Therefore, we hypothesize TgROP18 can activate host STAT3 through binding to IL20RB.Methods: CRISPR-CAS9 technology was used to generate the ROP16 and ROP8 double knockout RH strain, RH-∆rop16∆rop18. SDS-PAGE and western blot was used to detect STAT3 activation in different T. gondii tachyzoites infected, recombinant ROP18 or IL-20 treated HaCaT cells with high endogenous IL20RB expression. FRET and Co-immunoprecipitation (Co-IP) was used to detect the protein-protein interaction. Results: We observed that TgROP18 was involved in a synergic activation of host JAK/STAT3 pathway together with TgROP16 in human HaCaT cells infected with T. gondii or treated with recombinant TgROP18 protein, stimulating host proinflammatory immune responses such as expression of TNF-a. The effect of recombinant ROP18 on STAT3 phosphorylation was presented in a dose-dependent manner. Additionally, TgROP18 was identified to target IL20RB on its extracellular domain. When we treated different cell lines with the recombinant ROP18, STAT3 phosphorylation could only be observed in the cells with endogenous IL20RB expression, such as HaCaT cells. Conclusions: These findings indicated that TgROP18-IL20RB interaction was involved in STAT3 activation upon T. gondii invasion, which is associated with host cell defence.
The predictive value of PI-RADS v2 score in high-grade prostate cancer: a multicenter retrospective study
Authors: Chen Song , Yang Yun , Peng Tianchen , Yu Xi , Deng Haiqing , Guo Zhongqiang
Published: March 2020

Background: To explore the predictive value of PI-RADS v2 in high-grade prostate cancer and establish a prediction model combined with prostate cancer related biomarkers. Material and Methods: A total of 316 patients with newly discovered prostate cancer at Zhongnan Hospital of Wuhan University and Renmin Hospital of Wuhan University from December 2017 to August 2019 were enrolled in this study. The clinic information as age, tPSA, fPSA, prostate volume, Gleason score and PI-RADS v2 score have been collected. Univariate analysis was performed based on every variable to investigate the risk factors of high-grade prostate cancer. ROC curves were generated for the risk factors to distinguish the cut-off point. Logistic regression analyses were used to investigate the independent risk factors of high-grade prostate cancer. Nomogram prediction model was generated based on multivariate logistic regression analysis. The calibration curve, ROC curve, leave-one-out cross validation and independent external validation were performed to evaluate the discriminative ability, accuracy and stability of the nomogram prediction model. Results: Of 316 patients, a total of 187 patients were diagnosed as high-grade prostate cancer. Univariate analysis showed tPSA, fPSA, prostate volume, PSAD and PI-RADS v2 score were significantly different between the high- and low-grade prostate cancer patients. Univariate and multivariate logistic regression analyses showed only tPSA, prostate volume and PI-RADS v2 score were the independent risk factors of high-grade prostate cancer. The nomogram could predict the probability of high-grade prostate cancer, with a sensitivity of 79.4% and a specificity of 77.6%. The calibration curve displayed good agreement of the predicted probability with the actual observed probability. AUC of the ROC curve was 0.840 (0.797-0.884). Leave-one-out cross validation indicated the nomogram prediction model could classify 81.4% cases accurately. External data validation was performed with a sensitivity of 80.6% and a specificity of 77.3%, the Kappa value was 0.5755. Conclusions: PI-RADS v2 score had the value in predicting high-grade prostate cancer, the nomogram prediction model may help early diagnose the high risk prostate cancer.
Anlotinib suppresses MLL-rearranged acute myeloid leukemia cell growth through inhibiting SETD1A/AKT-mediated DNA damage response
Authors: Chen Jinzhu , Feng Juan , Fang Zhihong , Ye Jing , Chen Qinwei , Chen Qiuling , Chen Kai , Xiong Xiaoming , Pu Xuan , Li Guoweo , Song Haihan , Xu Bing
Published: March 2020

Background: Leukemias driven by chromosomal translocation of the mixed-lineage leukemia gene (MLL) are highly prevalent in hematological malignancy. The poor survival rate and lack of an effective targeted therapy for patients with MLL-rearranged (MLL-r) leukemias emphasize an urgent need for improved knowledge and novel therapeutic approaches for these malignancies. In this study, we investigated the potential effectiveness and mechanism of Anlotinib, a novel receptor tyrosine kinase inhibitor, in MLL-r acute myeloid leukemia(AML). Methods: MLL-r AML cell lines were treated with different concentration of Anlotinib, then cell viability, apoptosis and cell cycle were analyzed. Next, the anti-leukemia effect of Anlotinib was further evaluated in vivo in a xenograft model of AML-carrying MLL-rearrangement. Finally, we performed RNA-seq analysis, Gene Set Enrichment Analysis (GSEA) and western bolting to explore the underlying mechanism of the anti-leukemia effect of Anlotinib. Results: Our findings revealed that Anlotinib significantly suppresses the growth, promotes robust apoptosis and induces G2/M arrest in MLL-r AML cells. Moreover, Anlotinib effectively inhibited the growth of MLL-r AML cells in a xenograft murine model. In mechanism, we find that the inhibitive role of Anlotinib in MLL-r AML could be largely attributed to the dysfunction of DNA damage and repair. Furthermore, we confirmed that Anlotinib impaired DNA damage response via inhibiting SETD1A and AKT.
Quantitative CT-based Structural Alterations of Segmental Airways in Cement Dust-Exposed Subjects
Authors: Kim Taewoo , Cho Hyun Bin , Kim Woo Jin , Lee Chang Hyun , Chae Kum Ju , Choi So-Hyun , Lee Kyeong Eun , Bak So Hyeon , Kwon Sung Ok , Jin Gong Yong , Choi Jiwoong , Park Eun-Kee , Lin Ching-Long , Hoffman Eric A , Choi Sanghun
Published: March 2020

Background Dust exposure has been reported as a risk factor of pulmonary disease, leading to alterations of segmental airways and parenchymal lungs. This study aims to investigate alterations of quantitative computed tomography (QCT)-based airway structural and functional metrics due to cement-dust exposure.Methods To reduce confounding factors, subjects with normal spirometry without asthma and pneumonia histories were only selected, and a propensity score matching was applied to match age, sex, height, and smoking status. Thus, from a larger data set (N=609), only 46 cement dust-exposed subjects were compared with 184 non-cement dust-exposed subjects. QCT imaging metrics of airway hydraulic diameter ( D h ), wall thickness (WT), and bifurcation angle ( θ ) were extracted at total lung capacity (TLC) and functional residual capacity (FRC), along with their deformation ratios between TLC and FRC.Results In TLC scan, dust-exposed subjects showed a decrease of D h (airway narrowing) especially at lower-lobes ( p <0.05), an increase of WT (wall thickening) at all segmental airways ( p <0.05), and an alteration of θ at most of the central airways ( p <0.001) compared with non-dust-exposed subjects. Furthermore, dust-exposed subjects had smaller deformation ratios of WT at the segmental airways ( p <0.05) and θ at the right main bronchi and left main bronchi ( p <0.001), indicating airway stiffness.Conclusions Dust-exposed subjects with normal spirometry demonstrated airway narrowing at lower-lobes, wall thickening at all segmental airways, a different bifurcation angle at central airways, and a loss of airway wall elasticity at lower-lobes. The airway structural alterations may indicate different airway pathophysiology due to cement dusts.
An 8- year-old Behcet Disease girl initially presenting with bilateral retrobulbar optic neuritis
Authors: Jari Mohsen , Mohammadi Taiebeh , Taheri Ensieh
Published: March 2020

Background: Behçet disease(BD) is a polygenic and chronic autoinflamatory multisystem vasculitis. Acute optic neuritis has been rarely reported in patients with BD, especially in children.Case presentation :We reported an 8-year-old girl with suddenly visual loss and color vision impairment.The patient has a history of recurrent oral aphthous ulcers, genital ulcers and chronic abdominal pain.On ophthalmic examination, anterior and posterior chambers and funduscopy of both eyes were normal.The results of laboratory tests for infectious and rheumatic diseases were normal. Brain magnetic resonance imaging and the result of cerebrospinal fluid analysis for oligoclonal bands autoantibodies were normal too. Pathergy skin test and human leukocyte antigen ( HLA) B5 and HLA-B51 were positive.The patient was recognized as a case of BD-related bilateral retrobulbar optic neuritis and was treated by corticosteroid , azathioprine, colchicine and infliximab.Conclusion: Retrobulbar optic neuritis may be first manifestation of BD.
A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa
Authors: Brijkumar Jaysingh , Johnson Brent , Zhao Yuan , Edwards Alex , Moodley Pravi , Pathan Khairoonisa , Pillay Selvan , Castro Kenneth , Sunpath Henry , Kuritzkes Dan , Moosa Yunus , Marconi Vincent
Published: March 2020

Background: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. Methods: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data.Results: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p<0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p<0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation.Conclusions: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
Complicated hospitalization due to influenza: Results from the Global Hospital Influenza Network for the 2017–2018 season
Authors: Lina Bruno , Georges Alexandre , Burtseva Elena , Nunes Marta C. , Andrew Melissa K. , McNeil Shelly A. , Ruiz-Palacios Guillermo M. , Feng Luzhao , Kyncl Jan , Vanhems Philippe , Ortiz Justin R. , Paget John , Reiner Robert C.
Published: March 2020

Background: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017–2018 season and examine factors associated with complicated hospitalization among patients admitted with laboratory-confirmed influenza illness.Methods: Patients at hospitals participating in the GIHSN admitted <48 h with symptoms consistent with influenza infection and ≤7 days of symptom onset were eligible. Enrolled patients were tested by reverse transcription-polymerase chain reaction to confirm influenza virus infection. “Complicated hospitalization” was defined as a need for mechanical ventilation, admission to an intensive care unit, or in-hospital death. In each of three age strata (<15, 15 to <65, and ≥65 years), factors associated with complicated hospitalization in influenza-positive patients were identified by mixed effects logistic regression and those associated with length of hospital stay using a linear mixed-effects regression model.Results: The study included 12,803 hospitalized patients at 14 coordinating sites in 13 countries, of which 4,306 (34%) tested positive for influenza. Influenza viruses B/Yamagata, A/H3N2, and A/H1N1pdm09 strains dominated and cocirculated, although the dominant strains varied between sites. Complicated hospitalization occurred in 10.6% of influenza-positive patients. Factors independently associated with complicated hospitalization in influenza-positive patients included chronic obstructive pulmonary disease (15 to <65 years and ≥65 years), diabetes (15 to <65 years), male sex (15 to <65 years), hospitalization during the last 12 months (15 to <65 years), and current smoking (≥65 years). Chronic obstructive pulmonary disease (15 to <65 years), diabetes (15 to <65 years), and hospitalization during the last 12 months (<15 years) were independently associated with a longer hospital stay. The proportion of patients with complicated influenza and the length of hospital stay did not differ between influenza A and B.Conclusions: Complicated hospitalizations occurred in over 10% of patients hospitalized with influenza virus infection. Factors commonly associated with complicated or longer hospitalization differed by age group but commonly included COPD, diabetes, and hospitalization during the last 12 months.