bluuebunny/crossref_metadata_2025 huggingface dataset:
The correlational study about neutrophil-to-lymphocyte ratio and exercise tolerance of chronic obstructive pulmonary disease patients
Authors: Yuan Lindong , Li Lili , Yu Tong , Yang Ziyun , Jiang Tingting , Ma Qiuxia , Qi Jun , Shi Yan , Zhao Peige
Published: August 2020

To study the relationship between neutrophil to lymphocyte ratio (NLR) and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD).

235 patients with COPD were selected as the study subjects. Complete blood count, C reactive protein (CRP), pulmonary function tests, the 6-minute walk distance (6MWD), Modified Medical Respiratory Council, the COPD assessment test, and clinical COPD questionnaire were tested. Heart rate, oxygen saturation, and Borg scale were tested before or after 6MWD test.

By the median of NLR, the subjects were divided into 2 groups, NLR ≥4.5 group and NLR <4.5 group. The white blood cell count (WBC), CRP and deoxygenation saturation in the NLR ≥4.5 group were higher than those in the NLR <4.5 group, while the age, body mass index (BMI), 6MWD, and heart rate variation were lower than those in the NLR <4.5 group. CRP, WBC, and deoxygenation saturation had positive effects on NLR, BMI, 6MWT, and heart rate variation had negative effects on NLR. The Pearson correlation analysis showed NLR was positively correlated with WBC, CRP, BMI index, 6MWT, and deoxygenation saturation, while it was negatively correlated with BMI and heart rate variation.

NLR might associate with exercise tolerance and cardiorespiratory reserve of COPD patients, and could be used as an indicator of muscle function in COPD patients.
The association of serum vascular endothelial growth factor levels and psoriasis vulgaris
Authors: Gong Juan , Yang Hua , Qi Dongwei , Tang Xueyong
Published: August 2020

Background:

In recent years, more and more attention has been paid to the role of skin microcirculation in the pathogenesis of psoriasis. The vascular network of the skin is mainly distributed in the dermis and the subcutaneous fat layer join. The microvessels are composed of terminal arterioles, arteriovenous capillaries, and postcapillary venules. Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of psoriasis by promoting angiogenesis. The purpose of this study is to evaluate the relationship between serum VEGF and psoriasis vulgaris.

Methods:

Embase, CENTRAL, PubMed, China Biology Medicine Database, China National Knowledge Database, Wan Fang Database, and Chong Qing VIP Database will be searched to collect case-control studies and cohort studies and evaluate the relationship between serum VEGF and psoriasis vulgaris. The search time limits will be from the establishment of the database to December 2020. Two researchers will independently screen the studies, extract data, and evaluate the risk of bias of the studies. The Meta-analysis will be carried out with the RevMan5.3 software. The quality of all included studies will be evaluated by the Newcastle-Ottawa scale.

Results:

This study will evaluate the relationship between serum VEGF and the pathogenesis of psoriasis vulgaris.

Conclusion:

This study will provide a theoretical basis for the pathogenesis of psoriasis vulgaris.

OSF registration number:

DOI 10.17605/OSF.IO/6DV8P
Diagnostic value of radionuclide in bone metastasis after breast cancer surgery
Authors: Lian Qi-xin , Zhao Wei , Li Gang , Jin Lian-jin , Nie Hao-jie
Published: August 2020

Background:

The objective of this study is to evaluate the accuracy of radionuclide in diagnosis of bone metastasis (BM) after breast cancer surgery (BCS).

Methods:

The electronic databases (Cochrane Library, MEDLINE, EMBASE, Web of Science, CBM, and CNKI) will be systematically and comprehensively searched until June 1, 2020 for eligible studies that reported the diagnosis of radionuclide in BM after BCS. In addition, we will also identify grey literatures, such as conference abstracts, and reference lists of included studies. All process of study identification, data extraction, and study methodological quality evaluation will be performed by 2 independent authors. All divergences will be settled by a third author through discussion. All data analysis will be carried out by RevMan 5.3 software (London, UK).

Results:

This study will scrutinize the most recent evidence of radionuclide in detection of BM after BCS.

Conclusion:

This study may provide evidence of accuracy of radionuclide in diagnosis of BM following BCS.

Study registration number:

PROSPERO CRD42020187646.
Clinical symptoms between severe and non-severe COVID-19 pneumonia
Authors: Zheng Peng , Bao Lei , Yang Wei , Wang Jian-jiang
Published: August 2020

Background:

Coronavirus disease 2019, (COVID-19) is a major problem in public health in the world. Up to June, 2020, the number of infections arising to 8,690,000 and cause 410,000 deaths all over the world. Identification the clinical symptoms from non-severe to severe is important for clinician. This meta-analysis aimed to compare the clinical symptoms between severe and non-severe COVID-19 pneumonia.

Methods:

Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure database, Wanfang Database and Chinese Biomedical Literature Database were searched from its inception to June 21, 2020. We only included severe versus non-severe COVID-19 pneumonia patients and pooled results were summarized by STATA 12.0 software.

Two researchers independently selected the study and assessed the quality of the included studies. The heterogeneity was measured by I2 tests (I2 < 50 indicates little heterogeneity, I2≥50 indicates high heterogeneity). Publication bias was ruled out by funnel plot and statistically assessed by Begg test (P > .05 as no publication bias).

Results:

Results will be published in relevant peer-reviewed journals.

Conclusion:

Our study aims to systematically present the clinical symptoms between non-severe and severe of COVID-19 patients, which will be provide clinical guidance for COVID-19 patients.
Effect of prediabetes on the long-term all-cause mortality of patients undergoing percutaneous coronary intervention
Authors: Shi Rui , Diao Kai-yue , Shi Ke , Gao Yue , Huang Shan , Guo Ying-kun , Yang Zhi-gang
Published: August 2020

Background:

Prediabetes is an abnormal metabolic state that develops prior to the onset of diabetes with proven to common comorbid states of coronary artery disease. However, whether prediabetes worsens prognosis after percutaneous coronary intervention remains controversial. The aim of this study is to summarize previous cohort studies and to specify the impact of prediabetes on the long-term outcomes after percutaneous coronary intervention.

Methods:

This meta-analysis will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines for conducting and reporting meta-analysis data. Pubmed, Embase and Google scholar will be systematically searched, and supplemented with manual searches of the included reference lists to identify cohort studies. Pooled effects on the discontinuous variables will be expressed by adjusted hazard ratios with 95% confidence intervals. All analyses will be performed with Stata 15.0 (StataCorp LP, College Station, TX).

Results:

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

Conclusion:

This systematic review will provide new information and help enhance clinical decision-making on management of these patients.

Registration number:

INPLASY202060079.
Compound glycyrrhizin combined with antihistamines for chronic urticaria
Authors: Cao Wei , Xiao Xianjun , Zhang Leixiao , Liu Ying , Wang Lu , Zou Zihao , Cao Yue , Li Chunxiao , Zheng Qianhua , Zhou Siyuan , Li Ying
Published: August 2020

Background:

To investigate the efficacy and safety of compound glycyrrhizin (CG) combined with antihistamines in the treatment of chronic urticaria (CU).

Methods:

We will use computers to search all databases including Medline, Embase, Pubmed, Web of Science and Cochrane Central Register of Controlled Trials and China's 4 databases: China National Knowledge Infrastructure Database, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database. Find data from creation date to July 2020. In addition, we will manually search the list of medical journals as a supplement. The scope of the search included randomized controlled clinical studies related to CG combined with antihistamines for CU. The primary outcome is the disease activity control. Secondary outcomes include response rate, adverse events, and recurrence rates. The Cochrane RevMan V5.3 Deviation Assessment Tool will be used to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The average difference, standard mean difference, and binary data will be used to represent continuous results.

Results:

This study will comprehensively review the existing evidence on CG combined with antihistamines for CU.

Conclusion:

This systematic review will provide a basis for judging the effectiveness and safety of CG combined with antihistamines in the treatment of CU.

Systematic review registration:

PROSPERO, CRD42020156153
Metastatic large cell neuroendocrine lung cancer to the foramen magnum
Authors: Zou Peng , Liu Jian , Cheng Guang , Wang Kai , Li Ao , Li Sanzhong , Wang Yangang , Zou Xifeng , Ji Xituan , Gao Dakuan , Liu Weiping , Jiang Xiaofan
Published: August 2020

Rationable:

Large cell neuroendocrine carcinoma of the lung is rare, especially in the area of the foramen magnum. No previous studies have reported metastatic large cell neuroendocrine lung cancer to the foramen magnum. This paper will be the first time to report this special case.

Patient concerns:

A case of a 37-year-old woman presented with headache that had developed 20 days previously. Imaging examination revealed a circular abnormal signal at the posterior margin of the foramen magnum.

Diagnoses:

The patient we report was diagnosed with a metastatic intracranial tumor.

Interventions:

The patient underwent occipital craniotomy. Pathological results showed metastatic neuroendocrine carcinoma of the brain. Whole body PET-CT examination showed that fusiform soft tissue shadows could be seen near the hilum of the lower lobe of the left lung.

Outcomes:

The final bronchoscopy pathological results showed the large cell neuroendocrine carcinoma of the lung. The patient underwent further chemotherapy and radiotherapy in the oncology department.

Lessons:

Diagnosis and treatment of large cell neuroendocrine carcinoma of the lung are difficult. The prognosis is poorer, and effective treatment is urgently needed.
Long-term outcomes of upfront concurrent chemoradiotherapy followed by P-GDP regimen in newly diagnosed early stage extranodal nasal-type NK/T cell lymphoma
Authors: Zhu Fang , Liu Tao , Pan Huaxiong , Xiao Yin , Li Qiuhui , Liu Xinxiu , Chen Wangbing , Wu Gang , Zhang Liling
Published: August 2020

The optimal treatment strategy of newly diagnosed stage I/II, extranodal nasal-type natural killer/T cell lymphoma (NKTCL) remains unclear. This prospective phase II trial was conducted to explore the short-term and the long-term efficacy and safety of upfront concurrent chemoradiotherapy (CCRT) followed by pegaspargase, gemcitabine, dexamethasone, cisplatin (P-GDP) regimen in patients newly diagnosed with early stage NKTCL.

Thirty patients newly diagnosed with stage I/II NKTCL were enrolled from January 2013 to December 2016, and treated as the following strategy: upfront CCRT with cisplatin weekly (25 mg/m2) for 5 weeks, followed by 3 cycles of P-GDP regimen chemotherapy (pegaspargase 2500IU/m2capped at 3750IU, intramuscular on day 4, gemcitabine 850 mg/m2intravenous on days 1 and 8; dexamethasone 40 mg/day intravenous on days 1 to 4; and cisplatin 20 mg/m2intravenous on days 1–3) 3 weeks after the completion of CCRT. The objective response rate (ORR) and the complete response (CR) rate were the primary endpoints, and the secondary endpoints were the overall survival (OS), progression-free survival (PFS), and the adverse event (AE).

The median follow-up period was 51.5 months (range, 5–78months). The ORR was 93.3% (28/30) and all these 28 patients attained CR at the end of the treatment. Two patients suffered from lymphoma associated hemophagocytic syndrome (LAHS) during the period of consolidation chemotherapy and died within 2 months. The 5-year OS was 93.3%, and the 5-year PFS was 89.4%Mucositis was the most common grades 3/4 nonhematologic AEs (10%, 3/30) of CCRT. During the P-GDP chemotherapy, vomiting (6.7%, 2/30), neutropenia (43.3%, 13/30) and thrombocytopenia (23.3%, 7/30) were the major grades 3/4 toxicities during chemotherapy. No treatment-related deaths occurred.

The upfront CCRT followed by P-GDP regimen chemotherapy is an effective and well-tolerated first-line treatment strategy for patients diagnosed with early stage NKTCL. Further investigation of larger sample size is warranted.
Effects of spore powder of ganoderma lucidum on CaSR and apoptosis-related proteins in hippocampus tissue of epilepsy following dementia
Authors: Qin Li-hong , Wang Chen , Jiang Xiao-xue , Song You , Feng Yao , Qin Li-wei , Zhang Shu-ping
Published: August 2020

Background:

This study will investigate the effects of Spore Powder of Ganoderma Lucidum (SPGL) on CaSR and apoptosis-related proteins (ARP) in hippocampus tissue of epilepsy following dementia.

Methods:

This study will retrieve all potential studies from both electronic databases (Cochrane Library, EMBASE, MEDLINE, CINAHL, AMED, and CNKI) and other literature sources to assess the effects of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. We will search all literature sources from the inception to the present. All eligible case-control studies will be included in this study. Two authors will independently carry out literature selection, data collection, and study quality evaluation. Any divergence will be resolved by another author through discussion. RevMan 5.3 software will be employed for data analysis.

Results:

This study will summarize existing evidence to assess the effects of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia.

Conclusions:

The findings of this study may provide helpful evidence of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia.

Systematic review registration:

INPLASY202070041.
Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck
Authors: Liu Binfeng , Li Ang , Wang Jialin , Wang Hongbo , Zhai Gongwei , Ma Haohao , Lian Xiaoyu , Zhang Bo , Liu Liyun , Gao Yanzheng
Published: August 2020

Background:

This meta-analysis was performed to incorporate newly published, high-quality randomized controlled trials (RCTs) to determine the effects of cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck.

Methods:

The following electronic databases were extensively searched from the inception of the database through December 2018: EMBASE, Medline, the Cochrane Library, and Web of Science. RCTs focusing on the outcomes of cemented and uncemented hemiarthroplasty were reviewed and screened for eligibility. We used the Cochrane Collaboration's Review Manager Software to perform meta-analyses. Two independent reviewers extracted the data and assessed the study quality and bias risk through the Cochrane Collaboration tool. Use fixed effect model or random effect model to pooled data. Cochran's Q statistic was used to evaluate heterogeneity, and I2 statistic was used to quantify heterogeneity.

Results:

Fifteen RCTs were enrolled (n = 3790) (uncemented hemiarthroplasty group = 1015; cemented hemiarthroplasty group = 1037) (mean age ranged from 70–85.3 years; all patients > 65 years). The meta-analysis showed that cemented hemiarthroplasty has a longer operating time (weighted mean difference, 8.03; 95% confidence interval (CI) 4.83–11.23; P < .00001), less pain (odds ratio, 0.48; 95% CI 4.83–11.23; P = .02), lower mortality 1-year (odds ratio, 0.78; 95% CI 0.62–0.98; P = .03) and fewer implant-related complications (odds ratio, 0.20; 95% CI 0.13–0.30; P < .00001) than Uncemented hemiarthroplasty. However, there are still some limitations in our study, such as the uniformity of the surgery administration programme and rehabilitation scheme, and the small sample size of the included studies.

Conclusions:

Cemented hemiarthroplasty for elderly patients with displaced fracture of femoral neck may acquire better functional results.
Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen
Authors: Fukuda Masafumi , Nabeta Masakazu , Muta Takanori , Cho Tomonori , Shimamatsu Yutaka , Shimotsuura Yasutaka , Fukami Kei , Takasu Osamu
Published: August 2020

Introduction:

FOLFOX therapy is the main chemotherapy regimen for colorectal cancer. Peripheral neuropathy, hematotoxicity, and digestive symptoms are known to be the most frequent adverse events. Hyperammonemia and lactic acidosis rarely occur simultaneously during treatment with FOLFOX therapy; the number of case reports is limited worldwide. We report a case of disturbance of consciousness, considered to be caused by hyperammonemia and lactic acidosis that occurred during treatment with mFOLFOX6 therapy that was administered as postoperative adjuvant treatment for rectal cancer.

Patient concerns:

This case was of a 71-year-old man who had been receiving oral treatment for chronic kidney disease and diabetes mellitus. Laparoscopic low anterior resection and artificial anal construction surgery were performed for stage III rectal cancer. As adjuvant postoperative therapy, mFOLFOX6 therapy was started but was followed by a disturbance of consciousness.

Diagnoses:

Results of the blood tests revealed notable hyperammonemia (ammonia level, 1,163 μg/dl) and lactic acidosis (pH 7.207; lactate, 17.56 mmol/L); however, imaging diagnosis did not reveal intracranial lesions that could cause disturbance of consciousness.

Interventions:

For hyperammonemia, branched-chain amino acid agents and Ringers solution supplementation were administered. For acidosis, 7% sodium hydrogen carbonate was administered as treatment.

Outcomes:

The disturbance of consciousness improved within 12 hours of initiating the treatment, and the patient was discharged with no sequelae on 7th day after hospitalization.

Conclusion:

In patients with chronic kidney disease, FOLFOX regimen may confer risks of hyperammonemia and lactic acidosis.
Treatment in disproportionately minority hospitals is associated with an increased mortality in end-stage liver disease
Authors: Brahmania Mayur , Alotaibi Ammar , Mooney Owen , Rush Barret
Published: August 2020

Background

Racial and ethnic disparities are a barrier in delivery of healthcare across the USA. Care for minority patients tends to be clustered into a small number of providers at minority hospitals, which has been associated with worse clinical outcomes in several conditions. However, the outcomes of treatment in patients with end-stage liver disease (ESLD) at predominately minority hospitals are unknown. We investigated the burden of the problem.

Methods

We utilized the nationwide in-patient sample (NIS) to conduct a retrospective nationwide cohort analysis. All patients >18 years of age admitted with ESLD were included in the analysis. A multivariate logistic regression model was used to study the mortality rate among patients with ESLD treated at minority hospitals compared to nonminority hospitals.

Results

A total of 53 281 467 hospitalizations from the 2008 to 2014 NIS were analyzed. There were 163 470 patients with ESLD that met inclusion criteria. In-hospital mortality rates for all races were 8.0 and 8.1% in black and Hispanic minority hospitals, respectively, compared to 7.3% in nonminority hospitals (P < 0.01). On multivariate analysis, treatment of ESLD in black and Hispanic minority hospitals was associated with 11% [odds ratio (OR), 1.11; 95% confidence interval (CI), 1.03–1.20; P < 0.01] and 22% (OR, 1.22; 95% CI, 1.09–1.37; P < 0.01) increased odds of death, respectively, compared to treatment in nonminority hospitals regardless of patient’s race.

Conclusion

Patients with ESLD treated at minority hospitals are faced with an increased mortality rate regardless of patient’s race. This study highlights another quality gap that needs improvement to affect overall survival among patients with ESLD.
The defining of the reference range of liver stiffness and fat attenuation parameter for healthy Chinese children
Authors: Zeng Fansen , Wang Haiyan , Li Xufang
Published: August 2020

Aims

We aimed to establish the basal reference levels of liver stiffness and accumulated fat in healthy Chinese children.

Methods

To obtain the liver stiffness measurement (LSM) and the fat attenuation parameter (FAP) levels, the transient elastography (FibroTouch) was used in pediatric patients aged 0 to 18 years. The patients were divided into groups as follows: newborns/infants (0–2 years), preschool children (3–5 years), elementary school children (6–11 years), and adolescents/teenagers (12–18 years). The weight, height and fasting liver function tests were performed. FibroTouch and abdominal ultrasonography were performed.

Results

The livers of 521 out of 1362 children (329 male; median age, 4.6 years; age range 0.2–17.6 years) were examined with the FibroTouch. The LSM reference range was 1.5–5.9 kPa, and the FAP reference range was 159.6–217.1 dB/m in healthy children from 0 to 18 years of age. The median LSM value was higher in males than that in females (3.5 vs. 3.2 kPa, respectively; P = 0.01).

Conclusion

For healthy children from 0 to 18 years in southern China, the LSM reference range was 1.5–5.9 kPa, and the FAP reference range was 159.6–217.1 dB/m. The LSM values were age-dependent in children from 3 to 18 years old, and the FAP values were age-independent in children from 0 to18 years old.
Effectiveness of combined therapy radiofrequency ablation/transarterial chemoembolization versus transarterial chemoembolization/radiofrequency ablation on management of hepatocellular carcinoma
Authors: El dorry Ahmed Kaml , Shaker Mohammed Kamal , EL-Fouly Nevien Fouad , Hussien Ahmed , El-Folly Runia Fouad , El Fouly Amr Hafez , Abd El Tawab Karim
Published: August 2020

Background

One of the most widespread cancer-associated death worldwide is Hepatocellular carcinoma. Concerning hepatic malignant tumor staging system known as Barcelona clinic of liver cancer, a superior curative response could be carried out by combined techniques [radiofrequency ablation (RFA) and transarterial chemoembolization (TACE)] for stage B comparing with TACE alone as palliative monotherapy.

Objectives

To discuss the merging effect of RFA followed by TACE and vice versa on objective response, overall survival, local recurrence and tumor-free survival.

Patients and methods

Sixty-eight cases included with hepatic tumor on top of chronic liver disease post-viral infection and divided into two groups according to different combined treatment modality; first cohort included 34 patients treated with TACE followed by RFA, while the second one included 34 patients treated with RFA followed by TACE for two lesions or single medium-sized lesion stage.

Results

Complete response and objective response rates were 91% and 82% after TACE/RFA and 100% and 91% after RFA/TACE, respectively. Regarding Milan criteria, there was significant downstaging after RFA/TACE (P < 0.05). First and second overall survival rates were 85% and 65% after TACE/RFA versus 100% and 74%, respectively, after RFA/TACE (P > 0.05). Kaplan–Meier curve as regards disease-free survival rate, median time were 17.1 months [95% confidence interval (CI) 12.2–22.0] in TACE/RFA and 23.2 (95% CI 18.1–28.2) months in RFA/TACE (P > 0.05).

Conclusion

RFA/TACE showed effective complete response, downstaging, disease-free survival and overall survival for the treatment of hepatic malignant tumors.
The value of 99mTc-labeled galactosyl human serum albumin single-photon emission computerized tomography/computed tomography on regional liver function assessment and posthepatectomy failure prediction in patients with hilar cholangiocarcinoma
Authors: Huang Xin , Chen Yingmao , Shao Mingzhe , Li Can , Zhang Aiqun , Dong Jiahong , Xiang Canhong
Published: August 2020

Background

The aim was to evaluate the value of 99mTc-labeled galactosyl human serum albumin (99mTc-GSA) with single-photon emission computerized tomography (SPECT) in the preoperative assessment of regional liver function and prediction of posthepatectomy liver failure (PHLF) in patients with hilar cholangiocarcinoma (hCCA).

Methods

Patients with hCCA who underwent 99mTc-GSA SPECT/computed tomography (CT) before hepatectomy were included. The liver functional parameters of functional liver density (FLD) and predictive residual index (PRI) were calculated based on 99mTc-GSA SPECT/CT. PHLF was defined according to the International Study Group of Liver Surgery criteria. Univariate and multivariate analyses were used to analyze the risk factors for PHLF. The prediction of PHLF was calculated using receiver operating characteristic curve.

Results

A total of 34 patients were included, 23 of whom underwent preoperative biliary drainage. FLD was significantly higher in patients with drained lobes than that in patients with undrained lobes (0.615 ± 0.190 versus 0.500 ± 0.211, P < 0.05). Sixteen patients suffered PHLF. The ratio of future remnant to total morphological liver volume, future remnant FLD, and PRI differed significantly in patients with and without PHLF according to univariate analysis. PRI was identified as the only independent factor for prediction of PHLF according to multivariate analysis. With a PRI of 0.78, it was possible to predict PHLF with a sensitivity of 83% and a specificity of 93%.

Conclusions

99mTc-GSA SPECT/CT can accurately assess regional liver function and is better able to predict PHLF than conventional methods in patients with hCCA.
68Ga-DOTATATE and 123I-mIBG as imaging biomarkers of disease localisation in metastatic neuroblastoma: implications for molecular radiotherapy
Authors: Gains Jennifer E. , Aldridge Matthew D. , Mattoli Maria Vittoria , Bomanji Jamshed B. , Biassoni Lorenzo , Shankar Ananth , Gaze Mark N.
Published: August 2020

Purpose

Iodine-131-labelled meta-iodobenzylguanidine (131I-mIBG) and lutetium-177-labelled DOTATATE (177Lu-DOTATATE) are used for molecular radiotherapy of metastatic neuroblastoma. These are taken up by the noradrenaline transporter (NAT) and the somatostatin receptor subtype 2 (SSTR-2), respectively. Scintigraphy of iodine-123-labelled meta-iodobenzylguanidine (123I-mIBG) and gallium-68 DOTATATE (68Ga-DOTATATE) PET are used to select patients for therapy. These demonstrate the extent and location of tumour, and avidity of uptake by cells expressing NAT and SSTR-2, respectively. This study compared the similarities and differences in the anatomical distribution of these two imaging biomarkers in an unselected series of patients with metastatic neuroblastoma undergoing assessment for molecular radiotherapy.

Methods

Paired whole-body planar 123I-mIBG views and 68Ga-DOTATATE maximum intensity projection PET scans of metastatic neuroblastoma patients were visually compared. The disease extent was assessed by a semiquantitative scoring method.

Results

Paired scans from 42 patients were reviewed. 68Ga-DOTATATE scans were positive in all patients, 123I-mIBG scans were negative in two. In two patients, there was a mismatch, with some lesions identified only on the 123I-mIBG scan, and others visible only on the 68Ga-DOTATATE scan.

Conclusion

68Ga-DOTATATE and 123I-mIBG scans yield complementary information. For a more comprehensive assessment, consideration could be given to the use of both 123I-mIBG and 68Ga-DOTATATE imaging scans. Because of the heterogeneity of distribution of molecular targets revealed by these techniques, a combination of both 131I-mIBG and 177Lu-DOTATATE molecular radiotherapy may possibly be more effective than either alone.
18F-FDG PET/CT for primary staging of patients with testicular germ cell tumors: the predictors of 18F-FDG PET positivity and prognostic value of PET derived metabolic parameters
Authors: Aydos Uğuray , Tahtaci Gözde , Özgür Akdemir Ümit , Özet Ahmet
Published: August 2020

Purpose

The aim of this study was to investigate the role of histopathologic and biochemical parameters for predicting 18F-FDG PET positivity for primary staging in patients with newly diagnosed testicular germ cell tumors (TGCT). It was also aimed to evaluate the prognostic value of PET derived metabolic features in this patient group.

Materials and methods

The imaging findings of 51 patients who were diagnosed as TGCT and underwent 18F-FDG PET/CT for primary staging after surgery between 2009 and 2019 were evaluated retrospectively. In terms of the presence of 18F-FDG uptake consistent with metastasis, the patients were divided into two groups as ‘PET-positive’ and ‘PET-negative’. In ‘PET-positive’ patients, highest maximum standardized uptake values of metastatic lesions, whole-body total metabolic tumor volumes (wb-TMTV) and total lesion glycolysis (wb-TLG) were extracted. Pathological tumor types, pathological T stages (pT), tumor marker (TM) levels (AFP, hCG, LDH) after orchiectomy and overall survival (OS) times in months were also recorded. The predictive value of variables for OS was evaluated using the Kaplan-Meier survival analysis.

Results

PET positivity was observed in 28% of pT1 and in 83.3% in pT2-T3 tumors (P < 0.001). In the logistic regression analysis to predict ‘PET positivity’, pT stage and ≥2 elevated TMs were found as independent significant predictors. Survival analysis demonstrated that wb-TMTV, wb-TLG and TMs were significantly associated with prognosis for OS.

Conclusion

The likelihood of PET positivity was significantly higher in patients with elevated TMs and pT2-T3 stages compared to those with normal TMs and pT1 tumors. PET derived quantitative metabolic-volumetric parameters can be used as biomarkers to identify patients with poor prognosis in TGCT.
Preoperative detection of sentinel lymph nodes with hybrid SPECT/computed tomography imaging may improve the accuracy of sentinel lymph node biopsies in patients with early stages of cancer of the oesophagus or gastro-oesophageal junction
Authors: Gabrielson Stefan , Tsai Jon A. , Celebioglu Fuat , Nilsson Magnus , Rouvelas Ioannis , Lindblad Mats , Bjäreback Annie , Tomson Artur , Axelsson Rimma
Published: August 2020

Objectives

The aim of this study was to investigate the sentinel lymph node biopsy (SLNB) method in patients with cancer of the oesophagus or gastro-oesophageal junction (GOJ) guided by preoperative hybrid single-photon emission tomography/computed tomography (SPECT/CT) lymphoscintigraphy.

Methods

Thirty-nine patients with stage T1–T3, any N-stage, M0 cancer of the oesophagus or GOJ planned for curatively intended esophagectomy underwent preoperative SPECT/CT lymphoscintigraphy following endoscopically guided submucosal injection of radiocolloid and intraoperative radio-guided SLNB using a hand-held gamma scintillation device.

Results

The detection rate in preoperative SPECT/CT imaging was 88%. The median number of detected SLN stations in preoperative imaging was 1 (range 0–4). At least one suspected SLN was identified in all intraoperative SLNP procedures. In six cases, no lymph nodes were identified in the SLNB. In six cases, the SLNB was false negative. The sensitivity for successful SLNB procedures was 20%, the specificity was 100% and the accuracy was 75%.

Conclusions

Preoperative SLN mapping using SPECT/CT yields a high number of detected SLN stations compared to previous studies using planar imaging. The accuracy of the SLNB method in patients with predominantly ≥T3-stage tumours and with a history of previous neoadjuvant treatment is poor, and the method is not recommended in these patient groups.
Polyp Progression in Paediatric Patients With Familial Adenomatous Polyposis: A Single-centre Experience
Authors: Anele Chukwuemeka C. , Xiang Jinpo , Martin Isabel , Hawkins Menna , Clark Susan K. , Faiz Omar D. , Latchford Andrew , Hyer Warren
Published: August 2020

Objectives:

Prophylactic colectomy at a premalignant stage is the cornerstone of management of familial adenomatous polyposis (FAP). Before surgery, colonoscopy surveillance is recommended in children with FAP. This study aimed to examine the natural history of FAP in children by evaluating adenoma progression and factors influencing timing of colectomy.

Method: Patients with FAP younger than 18 years at first surveillance colonoscopy and who had undergone more than 1 colonoscopy were identified. Demographic, endoscopic, genetic, and surgical data were retrieved. Cumulative adenoma (polyp) counts were obtained while accounting for any polypectomies during the study period. The rate of polyp progression and factors influencing the timing of colectomy were evaluated.

Results:

Eighty-four patients (50% boys; mean age at first colonoscopy 13 years [standard deviation 1.97]) were identified, of which 83 had a family history of FAP. At first colonoscopy, 67 (79%) had <100 adenomas and 29 (35%) had colonic polyps identified despite rectal sparing. The median rate of polyp progression per patient was 12.5 polyps/year (range 0–145). Of the 45 (54%) patients who had undergone surgery, 41 (91%) underwent colectomy with ileorectal or ileodistal sigmoid anastomosis. Polyp progression did not alter the choice of surgical intervention in any patient.

Conclusion:

Our results suggest that adenoma number remains relatively stable in the majority of children under surveillance. Tailored surveillance intervals according to phenotype are a more appropriate strategy as recommended by recently published guidelines.
Abnormal Bilirubin Metabolism in Patients With Sodium Taurocholate Cotransporting Polypeptide Deficiency
Authors: Yan Yan Yan , Wang Meng Xuan , Gong Jing Yu , Liu Lang Li , Setchell Kenneth D.R. , Xie Xin Bao , Wang Neng Li , Li Wenhui , Wang Jian-She
Published: August 2020

Objectives:

The aim of the study was to explore the significance of sodium taurocholate cotransporting polypeptide (NTCP) deficiency and its clinical features in Chinese children presenting with isolated persistent hypercholanemia.

Methods:

The exon and adjacent regions of SLC10A1, the gene encoding NTCP, were sequenced in 33 Chinese children presenting with isolated hypercholanemia. Clinical history and medical data were reviewed. Growth milestones were compared with the national standard. The serum direct bilirubin concentration at last follow-up was compared with age- and sex-matched controls.

Results:

A variant, c.800C>T, p. S267F of SLC10A1 was detected in all subjects; 30 patients were homozygotes and 3 were compound heterozygotes. Nine patients presented with transient neonatal cholestasis, and 1 with a persistent mild conjugated hyperbilirubinemia. The serum direct bilirubin level in NTCP-deficient patients was significantly higher than age- and sex-matched controls even after the neonatal cholestasis stage (2.85 ± 1.50 vs 1.49 ± 0.70 μmol/L, P 
= 0.00008). No growth delay or other severe long-term clinical consequences were observed.

Conclusions:

NTCP deficiency is the exclusive or major cause of isolated hypercholanemia in Han Chinese children, with c.800C>T the major contributing genetic variation. The defect may affect bilirubin metabolism and present as transient neonatal cholestasis and/or persistent mild conjugated hyperbilirubinmia, but with no apparent long-term clinical consequences.
The Role of Cannabinoid Receptor Type 2 in the Bone Loss Associated With Pediatric Celiac Disease
Authors: Tortora Chiara , Punzo Francesca , Argenziano Maura , Di Paola Alessandra , Tolone Carlo , Strisciuglio Caterina , Rossi Francesca
Published: August 2020

Objectives:

In this study, we investigated the role of the cannabinoid receptor type 2 (CB2) in the bone loss associated with celiac disease (CD) evaluating the effect of its pharmacological modulation on osteoclast activity. We previously demonstrated a significant association between the CB2 Q63R variant and CD, suggesting it as a possible disease biomarker. Moreover, CB2 stimulation is beneficial for reducing osteoclast activity in several bone pathologic conditions.

Methods:

In vitro osteoclasts(OCs) were differentiated from peripheral blood mononuclear cells of healthy donors, CD children at diagnosis and after 1 year of gluten-free diet (GFD) and characterized by real-time PCR and western blot for the expression of CB2 and specific osteoclastic markers, TRAP and Cathepsin K. TRAP assay and Bone Resorption assay were performed to evaluate osteoclast activity before and after 48 h exposure to CB2 selective drugs (JWH-133 and AM630) and Vitamin D.

Results:

We found in CD patients an osteoclast hyperactivation and low levels of CB2. CB2 stimulation with JWH-133 agonist is more effective than Vitamin D in reducing osteoclast activity whereas CB2 blockade with AM630 increases osteoclast activation. The anti-osteoporotic effect of JWH-133 decreases when used in co-treatment with vitamin D. GFD reduces osteoclast activity without restore CB2 expression.

Conclusions:

CB2 could be a molecular marker to predict the risk of bone alterations in CD and a pharmacological target to reduce bone mass loss in patients who need a direct intervention on bone metabolism, in addition to the GFD.
Activated CD8 T‐cell Hepatitis in Children With Indeterminate Acute Liver Failure
Authors: Chapin Catherine A. , Melin‐Aldana Hector , Kreiger Portia A. , Burn Thomas , Neighbors Katie , Taylor Sarah A. , Ostilla Lorena , Wechsler Joshua B. , Horslen Simon P. , Leonis Mike A. , Loomes Kathleen M. , Behrens Edward M. , Squires Robert H. , Alonso Estella M. ,   Pediatric Acute Liver Failure Study Group
Published: August 2020

Objectives:

In many pediatric acute liver failure (PALF) cases, a diagnosis is not identified, and the etiology is indeterminate (IND‐PALF). Our pilot study found dense CD8 T‐cell infiltrates and increased T‐cell clonality in liver specimens from IND‐PALF patients. We aimed to validate these findings in a multicenter cohort with investigators blinded to diagnosis.

Methods:

PALF Study Group registry subjects with IND‐PALF (n = 37) and known diagnoses (DX‐PALF) (n = 18), ages 1 to 17 years, with archived liver tissue were included. Liver tissue slides were stained for T cells (CD8 and CD4), B cells (CD20), macrophages (CD163), perforin, and tissue resident‐memory T cells (Trm, CD103), and scored as minimal, moderate, or dense. Lymphocytes were isolated from frozen liver tissue for T‐cell receptor beta (TCRβ) sequencing.

Results:

Dense hepatic CD8 staining was found in significantly more IND‐PALF (n = 29, 78%) compared with DX‐PALF subjects (n = 5, 28%) (P = 0.001). IND‐PALF subjects were more likely to have dense or moderate perforin (88% vs 50%, P = 0.03) and CD103 (82% vs 40%, P = 0.02) staining compared with DX‐PALF subjects. TCRβ sequencing of 15 IND‐PALF cases demonstrated increased clonal overlap compared with 6 DX‐PALF cases (P = 0.002).

Conclusions:

Dense infiltration of effector Trm CD8 T cells characterizes liver tissue from IND‐PALF subjects. Increased clonality suggests the T‐cell expansion is antigen(s)‐driven as opposed to a nonspecific inflammatory response. These findings support CD8 staining as a new biomarker of the activated CD8 T‐cell PALF phenotype. Future studies are needed to characterize potential antigens, host risk factors, and inflammatory pathways with the goal of developing targeted therapies.
Examining Social Determinants of Health in Childhood Asthma Management
Authors: Horner Sharon D.
Published: August 2020

Purpose

Social determinants of health (SDoHs) influence how well a family manages children's asthma. The aim of this study was to examine the influence of SDoHs on family asthma management.

Design

A cross-sectional exploratory study was conducted with 292 children in grades 2 to 5 who had current asthma and their parents to examine associations between SDoHs and the families' asthma management, quality of life, and healthcare utilization.

Methods

Data were collected from both child and parent. Social determinants of health include the child's race/ethnic group, age, gender, and asthma severity and the family's socioeconomic status and language spoken in the home, and the school was the community-level variable. Parents and children completed asthma management and quality-of-life scales and parents reported on the children's emergency department visits and hospitalizations for asthma.

Results

Worse quality of life was reported by families with lower socioeconomic status and African American children. Asthma severity was associated with parents' asthma management but not children's asthma self-management. Families who spoke Spanish at home had the lowest socioeconomic status yet performed significantly more asthma management than English-speaking families.

Conclusions

The findings highlight factors the clinical nurse specialist should address in educational interventions.
Ultrasonographic Optic Nerve Sheath Diameter Measurement to Detect Intracranial Hypertension in Children With Neurological Injury: A Systematic Review
Authors: Bhargava Vidit , Tawfik Daniel , Tan Yuan Jin , Dunbar Trevor , Haileselassie Bereketeab , Su Erik
Published: August 2020

Objectives:

Ultrasound measured optic nerve sheath diameter is a noninvasive, nonirradiating tool for estimating intracranial hypertension. The objective of this systematic review and meta-analysis is summarization of the current evidence for accuracy of ultrasound measured optic nerve sheath diameter in detecting intracranial hypertension in pediatric patients.

Data Sources:

Medical subject heading terms were used to search MEDLINE, Embase, Google Scholar, Web of Science, and the Cochrane Library for relevant citations. Publications from January 1, 2000, to June 30, 2019, were included in the search strategy.

Study Selection:

Studies were included if they involved patients less than 18 years, where ultrasound measured optic nerve sheath diameter was compared to conventional, nonophthalmic tests for intracranial hypertension. Studies were excluded if there was insufficient data to compute a sensitivity/specificity table. Case reports, case series, and manuscripts not published in English were also excluded.

Data Extraction:

The initial search returned 573 citations. Of these, 57 were selected for review.

Data Synthesis:

Eleven citations were included in the final meta-analysis. A bivariate random-effects meta-analysis was performed, which revealed a pooled sensitivity for ultrasound measured optic nerve sheath diameter of 93% (95% CI, 74–99%), a specificity of 74% (95% CI, 52–88%), and a diagnostic odds ratio of 39.00 (95% CI, 4.16–365.32). The area under the curve of the hierarchical summary receiver operating characteristic curve was 0.90 (95% CI, 0.87–0.93). Subgroup analyses of the test’s performance evaluating new-onset intracranial hypertension and in comparison to invasively measured intracranial pressure were performed. The test performance in these instances was similar to findings in the primary analysis.

Conclusions:

We are unable to identify a threshold value in ultrasound measured optic nerve sheath diameter for the determination of intracranial hypertension in children. Even though the ultrasound measured optic nerve sheath diameter measurement is highly sensitive to the presence of increased intracranial pressure, the test has only moderate specificity. Therefore, other confirmatory methods and further investigation is necessary in the clinical care of children. The technique is likely not sufficiently precise for clinical use in the absence of other confirmatory methods, and further investigation is necessary to determine clinical protocols for its use in children.
The Use of Clevidipine for Hypertension in Pediatric Patients Receiving Mechanical Circulatory Support
Authors: Wu May , Ryan Kathleen R. , Rosenthal David N. , Jahadi Ozzie , Moss Jeffrey , Kwiatkowski David M.
Published: August 2020

Objectives:

Limited data exist regarding the management of hypertension in pediatric patients on mechanical circulatory support. Hypertension is a known risk factor for stroke and low cardiac output in patients requiring mechanical circulatory support and a narrow therapeutic window of blood pressure is often targeted. Traditional short-acting infusions to treat hypertension, such as sodium nitroprusside, may lead to accumulation of toxic metabolites in patients with renal dysfunction. Our primary objective was to describe use of clevidipine, a continuous short-acting calcium channel blocking medication, for blood pressure control in pediatric patients on mechanical circulatory support.

Design:

Single-center retrospective cohort study.

Setting:

A 26-bed quaternary cardiovascular ICU in a university-based pediatric hospital in California.

Patients:

Mechanical circulatory support patients admitted to cardiovascular ICU who received clevidipine infusions between October 1, 2016, and March 31, 2019.

Interventions:

Clevidipine infusion.

Measurements and Main Results:

Data from a cohort of 38 patients who received a total of 45 clevidipine infusions were reviewed. The cohort had a median age of 2.7 years and included neonates. No patient had record of hypotensive events, code events, or received low-dose epinephrine or code-dosed epinephrine related to a clevidipine infusion. Median duration of clevidipine infusion was 4.1 days (1.5–9.2 d). Eleven patients transitioned from clevidipine to enteral antihypertensive agents, and 26 clevidipine infusions were administered as a single agent without sodium nitroprusside. Seven patients were switched from sodium nitroprusside to clevidipine to avoid cyanide toxicity, a majority of whom had elevated serum creatinine.

Conclusions:

In this pediatric cardiac cohort, clevidipine infusions were effective at hypertension management and were not associated with hypotensive or code events. This report details the largest cohort and longest duration of clevidipine administration within a pediatric population and did not demonstrate hypotensive events, even among neonatal populations. Clevidipine may be a reasonable cost-effective alternative antihypertensive medication compared to traditional short-acting agents.