bluuebunny/crossref_metadata_2025 huggingface dataset:
Quercetin induces apoptosis and enhances gemcitabine therapeutic efficacy against gemcitabine-resistant cancer cells
Authors: Liu Zhi-jie , Xu Wei , Han Jing , Liu Qing-yan , Gao Li-feng , Wang Xiao-hui , Li Xiu-li
Published: April 2020

Quercetin, an abundant flavonoid found in various fruits and vegetables, displays multiple biological activities, including anticancer effects. Therefore, quercetin is receiving increasing attention as a potential adjuvant anticancer treatment. Gemcitabine (GEM) resistance is a major issue for clinicians and patients with advanced cancers, making it crucial to determine ways to bolster its effects. In this study, we explored the anticancer effects and mechanistic actions of quercetin in GEM-resistant cancer cells. Pancreatic cancer (BxPC-3, PANC-1) and hepatocellular carcinoma (HepG2, Huh-7) cell lines were studied. Proliferation assays showed that quercetin had cytotoxic effects on GEM-resistant cell lines (HepG2 and PANC-1), and flow cytometric analysis indicated a significant pro-apoptotic effect on these cell lines. GEM treatment, in combination with quercetin, resulted in increased anticancer effects compared with GEM alone. Quercetin led to S phase arrest in GEM-resistant cell lines, and western blot analysis revealed tumour protein p53 upregulation and cyclin D1 downregulation. This study provides mechanistic insight into the anticancer effects of quercetin and suggests that quercetin adjuvant treatment may benefit patients who are resistant to GEM therapy.
The Efficacy, Safety, and Optimal Regimen of Corticosteroids in Sepsis: A Bayesian Network Meta-Analysis
Authors: Zhang Shi , Chang Wei , Xie Jianfeng , Wu Zongsheng , Yang Yi , Qiu Haibo
Published: April 2020

Objectives:

Conventional systematic reviews have indicated that corticosteroids might result in a slight reduction in mortality in sepsis. However, the efficacy, safety, and optimal regimen of different corticosteroids partly remain unknown. In this study, we conducted a Bayesian network meta-analysis for a head-to-head comparison of the therapeutic efficacy and safety of currently used corticosteroids in sepsis.

Design:

A Bayesian network meta-analysis for a head-to-head comparison of the therapeutic efficacy and safety of currently used corticosteroids in sepsis.

Setting:

A total of 35 eligible randomized controlled trials of corticosteroid use in sepsis.

Patients:

The present Bayesian network meta-analysis included 8,859 patients with sepsis.

Interventions:

Randomized controlled trials were screened from PubMed, Embase, and the Cochrane Library up to December 28, 2019. A head-to-head comparison of the therapeutic efficacy and safety between the different categories of corticosteroids from the trials was conducted by Bayesian network meta-analysis. An empirical Bayesian meta-regression and a post hoc Bayesian network meta-analysis were performed to explore the appropriate dose and therapeutic duration of steroids for sepsis.

Measurements and Main Results:

A total of 35 randomized controlled trials including 8,859 patients with sepsis were enrolled in the final analysis. Bayesian network meta-analysis revealed that methylprednisolone and dexamethasone might be more effective in reducing short-term mortality in sepsis than placebo: methylprednisolone versus placebo (relative risk, 0.65, 95% credible interval 0.40–0.93), dexamethasone versus placebo (relative risk, 0.42, 95% credible interval, 0.24–0.84). Hydrocortisone and hydrocortisone plus fludrocortisone were superior to placebo in days to shock resolution (e-Table 5, Supplemental Digital Content 1, http://links.lww.com/CCX/A150): hydrocortisone versus placebo (mean difference, –1.70, 95% credible interval, –2.83 to –0.92), hydrocortisone plus fludrocortisone versus placebo (mean difference, –2.54, 95% credible interval, –4.19 to –0.84). Hydrocortisone was superior to placebo in reducing the length of stay in the ICU (mean difference, –1.43, 95% credible interval, –3.36 to –0.15). Methylprednisolone was superior to placebo in improving ventilation-free days (mean difference, 7.71, 95% credible interval, 1.15–14.42). In addition, further analysis indicated that the optimal therapeutic dosage was 200–400 mg per day of hydrocortisones or equivalents (relative risk, 0.83, 95% credible interval, 0.64–0.98), and the appropriate therapeutic duration was 4–7 days (relative risk, 0.78; 95% credible interval, 0.57–0.96).

Conclusions:

This study provided moderate evidence that the dosage of 200–400 mg per day of hydrocortisone or equivalent for 4–7 days was most likely to benefit septic patients.
Correlations Between Auricular Tenderness and Symptoms in Korean Adults
Authors: Lee Eun Jin
Published: April 2020

The purpose of this study was to examine the correlation between auricular tenderness and subjective symptoms. A descriptive correlational study design was followed, which was also the second analysis of a randomized controlled trial. This study was performed in the Republic of Korea from September 2013 to February 2017. The Patient Health Questionnaire-9, the Constipation Assessment Scale, and the Nicotine Dependence Syndrome Scale were used. One hundred thirty-three participants displayed ear tenderness, whereas 84 participants did not. Adults with auricular tenderness reported more symptoms, such as sputum, rhinitis, constipation, stress, mood swings, and depressive symptoms compared with adults without (with tenderness: 4.14 ± 2.94, without tenderness: 2.92 ± 2.45; t = 3.32, P = .001). Finally, auricular acupressure points were positively correlated with various symptoms such as sputum, constipation, nicotine addiction, stress, cough, and rhinitis. Auricular palpation could be used to detect a disease at an early stage.
SUB-RETINAL PIGMENT EPITHELIUM MULTILAMINAR HYPERREFLECTIVITY AT THE ONSET OF TYPE 3 MACULAR NEOVASCULARIZATION
Authors: Miere Alexandra , Sacconi Riccardo , Amoroso Francesca , Capuano Vittorio , Jung Camille , Bandello Francesco , Souied Eric H. , Querques Giuseppe
Published: April 2020

Purpose:

To report the prevalence and treatment outcomes of eyes with sub-retinal pigment epithelium (sub-RPE) multilaminar hyperreflectivity at the onset/clinical detection of Type 3 macular neovascularization (MNV) secondary to exudative age-related macular degeneration.

Methods:

Retrospective analysis of consecutive patients diagnosed with Type 3 MNV secondary to age-related macular degeneration was performed. Eyes presenting with sub-RPE multilaminar hyperreflectivity on structural optical coherence tomography at the onset of Type 3 MNV were included in this study. An age-, sex-, and stage-matched control group was composed of eyes affected by Type 3 MNV without sub-RPE multilaminar hyperreflectivity. Prevalence and treatment outcomes after anti–vascular endothelial growth factor injections at 1-year follow-up were analyzed in both groups.

Results:

Nineteen treatment-naïve eyes of 19 patients (8 men/11 women, mean age 83 ± 8 years old) presenting with sub-RPE multilaminar hyperreflectivity before or at the onset/clinical detection of Type 3 MNV were included from a cohort of 162 eyes with treatment-naïve Type 3 MNV. This accounts for an estimated prevalence of 11.7% (5.8–15.2, 95% confidence intervals). No significant differences were disclosed between cases studied and the control group (143 eyes of 143 patients) in age, sex, best-corrected visual acuity at baseline, and number of injections. Best-corrected visual acuity did not improve during the 1-year follow-up in patients showing sub-RPE multilaminar hyperreflectivity (P = 0.45), whereas best-corrected visual acuity significantly increased in the control group (P < 0.001). The presence of sub-RPE multilaminar hyperreflectivity in the context of Type 3 MNV was significantly associated with regressive calcific drusen (P < 0.001) and multiple Type 3 lesions/eye (P < 0.001).

Conclusion:

The detection of multilaminar hyperreflectivity at the onset/clinical detection of Type 3 MNV suggests that chronic exudation (i.e., the “onion-sign”) in the sub-RPE space (i.e., focal sub-RPE neovascularization) may precede the onset/clinical detection of Type 3 MNV. Sub-retinal pigment epithelium multilaminar hyperreflectivity at the onset of Type 3 MNV may be an important predictor of poor visual outcome in these eyes.
A Retrospective Study of Treatment Outcomes and Prognostic Factors of Intense Pulsed Light Therapy Combined With Meibomian Gland Expression in Patients With Meibomian Gland Dysfunction
Authors: Tang Yun , Liu Ruixing , Tu Ping , Song Wenjing , Qiao Jing , Yan Xiaoming , Rong Bei
Published: April 2020

Objectives:

To evaluate clinical changes after intense pulsed light and meibomian gland expression (IPL/MGX) treatment in meibomian gland dysfunction (MGD) patients, and to identify ideal candidates, and the therapeutic window, for IPL/MGX.

Methods:

This retrospective study reviewed the medical records of 44 MGD patients (44 eyes). The IPL/MGX treatment was applied on the eyelids three times at intervals of 4 weeks. Age, sex, relevant ocular history, Standard Patient Evaluation of Eye Dryness (SPEED), Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), corneal fluorescein staining score (CFSS), meiboscore, meibomian gland loss score (MGLS), meibomian glands yielding secretion score (MGYSS), meibomian glands yielding clear secretion (MGYCS), and meibomian glands yielding liquid secretion (MGYLS) were analyzed.

Results:

Standard Patient Evaluation of Eye Dryness, OSDI, TBUT, CFSS, MGYSS, MGYLS, and MGYCS were significantly improved after three IPL/MGX treatments, but the meiboscore and MGLS remained unchanged. In patients who had better treatment outcomes (improvement in MGYSS >7), younger age (36.0, 22.5 vs. 53.0, 25.0 years; P=0.012), a longer TBUT (8.0, 4.5 vs. 6.0, 3.0 sec; P=0.010), better meiboscore (1.0, 0.5 vs. 2.0, 1.0; P=0.012), and less gland loss (19.8%, 20.3% vs. 41.1%, 30.2%; P=0.008) before IPL/MGX were noted. Sex, relevant ocular history, SPEED, OSDI, MGYSS, MGYLS, and MGYCS before IPL/MGX showed no significant differences between patients with an improvement in MGYSS >7 versus those with an improvement of ≤7. Meibomian glands yielding secretion score changes in patients who had a meiboscore of 0 to 1 and MGYSS of 0 before IPL/MGX (12.0, 10.0) were significantly higher than those who had a meiboscore of 2 to 3 and MGYSS of 0 (6.5, 9.3; P=0.031), or a meiboscore of 0 to 1 and MGYSS >0 (5.0, 11.5; P=0.041).

Conclusions:

Improved dry eye symptoms, TBUT, corneal staining, and meibomian gland secretion were observed in MGD patients after IPL/MGX. Patients in the early stages of MGD maybe benefited most from IPL/MGX treatment.
Comparisons of Cornea Cold, a New Corneal Storage Medium, and Optisol-GS
Authors: Ho Joanne W. , Jung Hoon , Chau Mimi , Kuchenbecker James A. , Banitt Michael
Published: April 2020

Purpose:

This study compares the quality of donor corneal tissue stored in Optisol-GS and Cornea Cold.

Methods:

Seventeen pairs of donor corneas were obtained from an eye bank. One of each pair was stored in Cornea Cold or Optisol-GS. Endothelial cell loss (ECL), central corneal thickness (CCT), and endothelial cell density (ECD) were measured at 7 and 21 days of storage. Qualitative metrics were evaluated by using a slit lamp.

Results:

At days 7 and 21, there were no observed differences in qualitative corneal health of the samples. There were no statistical differences in the mean ECL at 7 and 21 days between the 2 groups (P = 0.07 and P = 0.50, respectively). At 7 days, the mean CCT was 644 ± 52 μm in the Cornea Cold group and 591 ± 64 μm in the Optisol-GS group (P = 0.001). At 21 days, CCT was 714 ± 55 μm in the Cornea Cold group and 708 ± 58 μm in the Optisol-GS group (P = 0.70). The mean ECD was not statistically different between the groups (P = 0.56 at 7 days and P = 0.14 at 21 days).

Conclusions:

Storage of corneal donor tissue in the Optisol-GS and Cornea Cold storage media resulted in statistically comparable ECL and ECD for up to 21 days. CCT was higher in Cornea Cold at 7 days, but this discrepancy disappeared at 21 days.
Orbital Schwannoma—Management and Clinical Outcomes
Authors: Yong Kai-Ling , Beckman Timothy J. , Cranstoun Matthew , Sullivan Timothy J.
Published: April 2020

Purpose:

To evaluate the clinical features, management, and outcomes of orbital schwannomas.

Methods:

Retrospective study analyzing 20 orbital schwannomas in 18 patients managed in an orbital service over 26 years. Clinical, radiological, histological, and surgical procedural data were analyzed.

Results:

Mean age of the study population was 40.89 ± 20.84 years. The most common nerve of origin was frontal nerve (50%), and majority of patients (70%) had a superior and/or posteriorly located tumor. Five patients (27.8%) had optic neuropathy at presentation, and 3 of them showed improved vision after intervention. Surgical resection was performed for all except for 1 patient who underwent fractionated stereotactic radiotherapy. Six subjects had extension of tumor into the cavernous sinus, and 3 of them underwent combined neurosurgical intervention with stereotactic neuronavigation. Outcomes were largely favorable with majority achieving complete excision. Two out of 6 incomplete resections experienced regrowth requiring second surgical intervention. Surgical complications include decreased vision, diplopia, ptosis, and mydriasis.

Conclusion:

Orbital schwannomas are uncommon slow-growing tumors which can result in visual loss. Prognosis can be favorable even in presence of pre-operative optic neuropathy if there is early intervention. Schwannomas confined to the orbit can usually be completely excised with good outcomes. Schwannomas extending intra-cranially may undergo incomplete excision to preserve vital structures, leaving residual disease, but generally have satisfactory results. Stereotactic neuronavigation and frozen section are useful intra-operative tool to aid management and minimize complications. Fractionated radiotherapy can be considered as an alternative or adjunctive treatment for patients not amenable for surgical resections.
Incidence and Risk Factors of Moderate to Severe Postoperative Pain Following the Placement of Primary and Secondary Orbital Implants: A Prospective Observational Study
Authors: Zhu Yanling , Li Zuohong , Chen Wenshi , Fan Peiting , Yang Shiying , Liu Xuehua , Guo Wenjun , Gan Xiaoliang
Published: April 2020

Purpose:

To prospectively explore the incidence and risk factors of moderate to severe pain after primary and secondary orbital implantation following evisceration or enucleation surgery.

Methods:

One hundred eighteen patients under general anesthesia for orbital implantation were enrolled in this study. In 91 patients, primary orbital implantation followed evisceration, and in 27 patients, the implantation was secondary after previous evisceration or enucleation surgery. Medical interventions for all participants were followed by standardized surgical, anesthetic, and analgesic protocols. Postoperative pain (POP) intensity was quantified by an 11-point numerical rating scale within 72 hours after the surgery, numerical rating scale ≥4 was considered moderate to severe POP. Multivariate logistic regression was utilized to identify the risk factors related to the development of POP.

Results:

Thirty-five patients (29.7%) displayed moderate to severe POP, particularly within 6 to 24 hours after surgery, which peaked at 24 hours. Of these patients, 26 patients who were unable to tolerate the pain received additional doses of analgesics during in-hospital stay. Logistic regression model revealed that preoperative anxiety (odds ratios = 4.890; p = 0.002), congenital microphthalmia (odds ratios = 14.602; p = 0.038), and surgical time longer than 60 minutes (odds ratios = 5.586; p = 0.001) were significantly associated with moderate to severe POP after orbital implantation.

Conclusions:

Orbital implantation after evisceration or enucleation surgery is likely to cause moderate to severe pain intensity in the early postoperative period. Preoperative anxiety, prolonged surgical time, and congenital microphthalmia were the risk factors.
Topical Corticosteroid Use Associated With Increased Degree of Ptosis and Rate of Ptosis Repair Failure
Authors: Dermarkarian Christopher R. , Williams Katherine J. , Sweeney Adam R. , Allen Richard C. , Yen Michael T.
Published: April 2020

Purpose:

To compare the degree of ptosis and the risk of ptosis repair failure among patients with and without a history of topical corticosteroid use.

Methods:

Retrospective, case-controlled study examining topical corticosteroid use among adults with ptosis who underwent external levator advancement/resection (ELR) or Müller muscle conjunctival resection with at least 3 months postoperative follow-up. Comparative statistical analyses of surgical outcomes were performed amongst patients with and without history of topical corticosteroid use.

Results:

A total of 240 patients (406 eyelids) met study criteria, of which 36 patients (44 eyelids) had history of topical corticosteroid use. Mean preoperative margin reflex distance was 0.20 mm and 0.58 mm for topical corticosteroid and non-corticosteroids users (p = 0.01). Mean preoperative levator function was 9.78 mm and 10.38 mm for topical corticosteroid and non-corticosteroid users (p = 0.02). The rate of ptosis repair failure was 30% and 16% in patients with and without a history of topical corticosteroid use (odds ratio 2.25, 95% confidence interval 1.10–4.55; p = 0.03). The rate of recurrence per surgical type in eyelids with and without history of topical corticosteroid use was: external levator advancement/resection 11/27 (41%) and 48/266 (18%) (odds ratio = 3.12, confidence interval 1.36–7.15 0; p = 0.01); Müller muscle conjunctival resection 2/17 (12%) and 9/96 (9%) (odds ratio 1.29, confidence interval 0.25–6.56; p = 0.76).

Conclusions:

Topical corticosteroid use is associated with more severe presenting ptosis and increased rates of ptosis repair failure. Compared to Müller muscle conjunctival resection, there is a significantly higher rate of ptosis repair failure in patients undergoing external levator advancement/resection.
Validity and Reliability Study of the Turkish Version of Multiple Sclerosis Self-Management Scale
Authors: Erbay Öznur , Usta Yeşilbalkan Öznur , Yüceyar Nur , Baklan Meltem , Karadakovan Ayfer , Tekindal Mustafa Agah
Published: April 2020

OBJECTIVE

This study aimed to establish the equivalence, reliability, and validity of the Multiple Sclerosis Self-Management Scale Turkish Version (MSSM-T).

METHODS

This methodological study consisted of 240 multiple sclerosis (MS) patients who were followed in an outpatient clinic of a university hospital between October 2016 and April 2017. Data were collected using the demographic characteristics form and the 24-item MSSM-T. Language equivalence, content validity, and construct validity methods were used for the validity of the scale; internal consistency, item analysis, and test-retest methods were used for the reliability. Explanatory factor analysis was used for construct validity, and principal component analysis and varimax rotation were used in the analysis of factor structure.

RESULTS

The item-total correlations for the Turkish version were found to be sufficient (between 0.238 and 0.674). The Cronbach α reliability coefficient was 0.85, indicating high reliability. The test-retest reliability coefficient was 0.84, indicating high consistency. The Turkish version was found to have 5 factors for the 24 items (F1, healthcare provider relationship/communication; F2, knowledge and information about MS; F3, treatment adherence/barriers; F4, maintaining health behavior; and F5, social/family support), which accounted for the 62.584% of the characteristics in question.

CONCLUSION

The MSSM-T is valid and reliable in determining the self-management behaviors of patients with MS for Turkish patients.
Transitioning to non-insulin therapy in a patient receiving high dose insulin
Authors: Mishriky Basem M. , Cummings Doyle M. , Mendez Carlos E. , Patil Shivajirao P. , Powell James R.
Published: April 2020

In people with type 2 diabetes with evidence of obesity-related insulin resistance, use of insulin to treat hyperglycemia has not been shown to reduce macrovascular complications, despite widespread use for many years. However, newer classes of diabetes medications, designed to address the prevalent pathophysiologic defect of type 2 diabetes, have emerged. Consequently, in many patients, reduction of insulin doses or even total elimination is possible after the addition of these newer agents. The authors suggest a cautious approach in which people with type 2 diabetes and established cardiovascular disease who are on high insulin doses (>1.0 unit/kg/day) be treated with diabetes medications that showed evidence of cardiovascular benefit (such as glucagon-like peptide-1 receptor agonists [GLP-1RAs]), on whom close monitoring is crucial because they may be at particular risk for developing hypoglycemia. This approach can be labor intensive and may be challenging for busy primary care providers for who may have limited time to evaluate and follow the patient. The authors present a case report of adding a GLP-1RA to high insulin doses. If the hemoglobin A1c is <8.0% when GLP-1RA is added, insulin doses should be reduced by 20%. Patients should be monitored at least every 4 weeks initially until it is confirmed there is no hypoglycemia risk. If glycemic targets (defined as fasting or preprandial glucose level between 80 and 130 mg/dl) are consistently achieved, providers may consider proactively reducing insulin doses by 10–20% to avoid hypoglycemia. The authors recommend creating appropriate goals and expectation before initiating this process.
The Incidence of Hemorrhagic Complications Was Lower With the Guide Sheath Than With the Conventional Forceps Biopsy Method
Authors: Horinouchi Hirohisa , Asano Fumihiro , Okubo Kenichi , Okada Yoshinori , Ohsaki Yoshinobu , Komase Yuko , Hashizume Toshinori , Kohno Mitsutomo , Aoe Motoi
Published: April 2020

Background:

The Japan Society for Respiratory Endoscopy performed a nationwide survey to evaluate the current status and complications of bronchoscopy. Data on deaths due to bronchoscopy, complications after bronchoscopy, and particularly, complications of forceps biopsy were surveyed.

Methods:

The survey form was mailed to 532 facilities accredited by the society. The numbers of procedures, complications, and deaths were investigated.

Results:

The response rate was 79.1% (421 facilities). Deaths attributable to diagnostic bronchoscopy occurred in 11 (0.011%) of 98,497 cases.

In regards to forceps biopsy, the guide sheath method was applied in 23,916 cases and the conventional method in 31,419 cases was done with conventional method. Complications of forceps biopsy developed in 1019 cases in total, with an incidence rate of 1.84%. The most frequent complication was pneumothorax (0.70%), followed by pneumonia/pleurisy (0.46%) and hemorrhage (0.45%). The incidence of hemorrhagic complication was significantly lower in the guide sheath group than in the non-guide sheath group (0.29% vs. 0.58%; P<0.001). The overall incidence of complications (1.63% vs. 2.00%; P=0.002) and the mortality rate (0% vs. 0.02%; P=0.04) were significantly lower in the guide sheath group.

Conclusion:

The incidence of hemorrhagic complications in forceps biopsy of peripheral pulmonary lesions was lower when the guide sheath method was applied. It is necessary to increase the awareness for safety control in diagnostic bronchoscopy for new procedures.
Ethanolamine Oleate for Bronchopleural Fistula
Authors: Alcaraz Sandra R. , García Maria Del Mar , Giménez Andrés , Fernández Cleofé , Sesma Julio , Bolufer Sergio , Martín Concepción
Published: April 2020

Background:

Bronchopleural fistula (BPF) is a severe complication of pulmonary resection associated with high morbidity and mortality. Treatment options include both surgical and endoscopic procedures. The size of the fistula and the functional status of the patient are decisive factors in the choice of treatment. The aim of this study is to describe the experience of using ethanolamine oleate (EO) in endoscopic treatment for BPFs.

Methods:

A prospective observational, descriptive study, involving patients with subcentimeter BPF and treated with EO. The diagnosis of the fistula was confirmed by flexible bronchoscopy. Patients under conscious sedation received a perifistular injection of EO with a Wang 22-G needle. The procedure was repeated every to 2 weeks until definitive closure.

Results:

Eight patients were included: in 7 (87.5%), the fistula was a complication of lung cancer surgery. The number of sessions needed before the resolution of the BPF was from 1 to 4. Only 1 patient received 4 sessions. Complete closure was obtained in 6 patients (75%). None of the fistulas reopened, and there were no serious complications.

Conclusion:

Sclerosis with EO through endoscopic injection enables the closure of small (<1 cm) BPFs after a limited number of sessions and with scarce morbidity. These results suggest that EO could be a valid treatment option for selected patients.
A 17-gene expression-based prognostic signature associated with the prognosis of patients with breast cancer
Authors: Qian Jin-Xian , Yu Min , Sun Zhe , Jiang Ai-Mei , Long Bo
Published: April 2020

Identification of reliable predictive biomarkers for patients with breast cancer (BC).

Univariate Cox proportional hazards regression model was conducted to identify genes correlated with the overall survival (OS) of patients in the TCGA-BRCA cohort. Functional enrichment analysis was conducted to investigate the biological meaning of these survival related genes. Then, patients in TCGA-BCRA were randomly divided into training set and test. Least absolute shrinkage and selection operator (LASSO) penalized Cox regression model was performed and the risk score of BC patients in this model was used to build a prognostic signature. The prognostic performance of the signature was evaluated in the training set, test set, and an independent validation set GSE7390.

2519 genes were demonstrated to be significantly associated with the OS of BC patients. Functional annotation of the 2519 genes suggested that these genes were associated with immune response and protein synthesis related gene ontology terms and pathways. 17 genes were identified in the LASSO Cox regression model and used to construct a 17-gene signature. Patients in the 17-gene signature low risk group have better OS and event-free survival compared with those in the 17-gene signature high risk group in the TCGA-BRCA cohort. The prognostic role of the 17-gene signature has been confirmed in the validation cohort. Multivariable Cox proportional hazards regression model suggested the 17-gene signature was an independent prognostic factor in BC.

The 17-gene signature we developed could successfully classify patients into high- and low-risk groups, indicating that it might serve as candidate biomarker in BC.
Ingested a fish bone-induced ileal perforation
Authors: Song Junchuan , Yang Weijin , Zhu Yuewen , Fang Yongchao , Qiu Jiandong , Qiu Jianshen , Lin Lan , Wu Weihang , Lin Chen , Wang Yu
Published: April 2020

Introduction:

Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone.

Case presentation:

A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago.

Diagnosis:

Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body.

Interventions:

Partial intestinal resection and manual ileum end anastomosis were performed.

Outcomes:

The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain.

Conclusion:

An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.
Association between CD24 Ala/Val polymorphism and multiple sclerosis risk
Authors: Yang Wan , Zhou Wang , Zhang Bo-Kang , Kong Ling-Suo , Zhu Xing-Xing , Wang Rui-Xiang , Yang Yue , Chen Yun-Fei , Chen Lan-Ren
Published: April 2020

Background:

The aim of this study was to explore the association between CD24 Ala/Val polymorphism and susceptibility of multiple sclerosis (MS).

Methods:

A comprehensive literature search for relevant studies was performed on google scholar, PubMed, Web of science, Embase, the Chinese National Knowledge Infrastructure and the Chinese Biology Medicine. This meta-analysis was conducted using the STATA 11.0 software and the pooled odds ratio with 95% confidence interval was calculated.

Results:

Seven case-control studies were included in this meta-analysis. The results showed significant association between CD24 Ala/Val polymorphism and susceptibility to MS. Stratified analysis by areas also showed significant association in Asians. However, no association was found in Europeans.

Conclusion:

This study suggested that the CD24 Val allele was associated with an increased risk of MS and larger-scale studies of populations are needed to explore the role of CD24 Ala/Val polymorphism during the pathogenesis of MS.
Gait pattern analysis and clinical subgroup identification: a retrospective observational study
Authors: Kyeong Sunghyon , Kim Seung Min , Jung Suk , Kim Dae Hyun
Published: April 2020

To identify basic gait features and abnormal gait patterns that are common to different neurological or musculoskeletal conditions, such as cerebral stroke, Parkinsonian disorders, radiculopathy, and musculoskeletal pain.

In this retrospective study, temporal-spatial, kinematic, and kinetic gait parameters were analyzed in 424 patients with hemiplegia after stroke, 205 patients with Parkinsonian disorders, 216 patients with radiculopathy, 167 patients with musculoskeletal pain, and 316 normal controls (total, 1328 subjects). We assessed differences according to the condition and used a community detection algorithm to identify subgroups within each condition. Additionally, we developed a prediction model for subgroup classification according to gait speed and maximal hip extension in the stance phase.

The main findings can be summarized as follows. First, there was an asymmetric decrease of the knee/ankle flexion angles in hemiplegia and a marked reduction of the hip/knee range of motion with increased moment in Parkinsonian disorders. Second, three abnormal gait patterns, including fast gait speed with adequate maximal hip extension, fast gait speed with inadequate maximal hip extension, and slow gait speed, were found throughout the conditions examined. Third, our simple prediction model based on gait speed and maximal hip extension angle was characterized by a high degree of accuracy in predicting subgroups within a condition.

Our findings suggest the existence of specific gait patterns within and across conditions. Our novel subgrouping algorithm can be employed in routine clinical settings to classify abnormal gait patterns in various neurological disorders and guide the therapeutic approach and monitoring.
Relationship between multiple lifestyle behaviors and health-related quality of life among elderly individuals with prediabetes in rural communities in China
Authors: Hu Zhao , Qin Lulu , Kaminga Atipatsa Chiwanda , Xu Huilan
Published: April 2020

Evidence of the effect of lifestyle behaviors on health-related quality of life (HRQoL) is scarce or ambiguous. The objective of the present study was to explore the associations between multiple lifestyle behaviors and HRQoL among the elderly individuals with prediabetes.

Four hundred thirty-four elderly individuals with prediabetes were included in this cross-sectional study. The Medical Outcomes Study 36-Item Short Form Health Survey Questionnaire (SF-36) was used to assess HRQoL. Multiple lifestyle behaviors, including smoking, alcohol consumption, physical activity, dietary habits, daily sedentary time and sleep duration were self-reported. The associations between HRQoL and multiple lifestyle behaviors were examined using a multivariate linear regression analysis.

Lower-risk physical activities (β =3 .19, 95% CI: 1.32, 5.64), dietary habits (β = 2.60, 95% CI: 1.50, 4.72), and sedentary time (β = 2.49, 95% CI: 1.21, 4.81) were positively associated with the physical health component score (PCS) for HRQoL. Meanwhile, a lower-risk behavior, such as sleep duration (β = 2.64, 95% CI: 1.77, 4.51), was associated with a higher mental health component score (MCS) for HRQoL after adjusting for socio-demographic factors, chronic diseases, anthropometric data and all other lifestyle behaviors. Engaging in a greater number of lower-risk lifestyle behaviors was positively correlated with a better HRQoL.

Multiple lifestyle behaviors were associated with HRQoL among the elderly individuals with prediabetes in rural areas. These results highlight the need for multiple lifestyle behavioral interventions to maintain and improve HRQoL in the elderly individuals with prediabetes.
Prognostic factors for neurological outcomes in Korean targeted temperature management recipients with return of spontaneous circulation after out-of-hospital cardiac arrests
Authors: Kim Jae Guk , Shin Hyungoo , Choi Hyun Young , Kim Wonhee , Kim Jihoon , Moon Shinje , Kim Bongyoung , Ahn Chiwon , Lee Juncheol
Published: April 2020

Targeted temperature management (TTM) is recommended for comatose patients after out-of-hospital cardiac arrests (OHCAs). Even after successful TTM, several factors could influence the neuroprotective effect of TTM. The aim of this study is to identify prognostic factors associated with good neurological outcomes in TTM recipients.

This study used nationwide data during 2012 to 2016 to investigate prognostic factors associated with good neurological outcomes in patients who received TTM after the return of spontaneous circulation (ROSC). Multivariate logistic regression analysis was conducted to analyse the factors that may affect the neurological outcomes in the TTM recipients.

The study included 1578 eligible patients, comprising 767 with good and 811 with poor neurological outcomes. Multivariable analyses showed that OHCA in public places (OR, 1.599; 95% CI, 1.100–2.323, P 
= .014), initial shockable rhythms (OR, 1.721; 95% CI, 1.191–2.486, P 
= .004), pre-hospital ROSCs (OR, 6.748; 95% CI, 4.703–9.682, P < .001), bystander cardiopulmonary resuscitation (CPR) (OR, 1.715; 95% CI, 1.200–2.450, P 
= .003), and primary coronary interventions (PCIs) (OR, 2.488; 95% CI, 1.639–3.778, P < .001) were statistically significantly associated with good neurological outcomes. Whereas, increase of age (OR, 0.962; 95% CI, 0.950–0.974, P < .001) and conventional cooling (OR, 0.478; 95% CI, 0.255–0.895, P 
= .021) were statistically significantly associated with poor neurological outcome.

This study suggests that being younger, experiencing OHCA in public places, having initial shockable rhythm, pre-hospital ROSC, and bystander CPR, implementing PCIs and applying intravascular or surface cooling devices compared to conventional cooling method could predict good neurological outcomes in post-cardiac arrest patients who received TTM.
Prognostic role of galectins expression in patients with hepatic cancer
Authors: Shao Qi , He Jing , Chen Zhiming , Wu Changping
Published: April 2020

Objective:

The objective of this study was to illustrate the prognostic value of diversified galectins in patients with hepatic cancer via meta-analysis.

Methods:

We conducted a systematic search on PubMed, Embase, The Cochrane Library, Web of Science, the Chinese National Knowledge Infrastructure (CNKI) database, and Wanfang Data for studies that reported associations between galectin expression and the prognosis for hepatic cancer patients, from the inception of each database to March 20, 2019. The combined hazard ratio (HR) and 95% confidence interval (CI) were estimated to investigate the prognosis.

Results:

We collected 11 studies of 1957 patients in our meta-analysis. The pooled results indicated that overall galectin expression was not correlated with OS (HR = 1.23, 95% CI = 0.84–1.79, P = .29) or DFS/RFS (HR = 0.808, 95% CI = 0.376–1.735, P = .42) in liver cancer patients. In stratified analyses, we observed that high galectin-1 and galectin-3 expression was significantly associated with poor OS. The pooled HR of galectin-4 and galectin-9 was correlated with improved OS.

Conclusion:

Our results indicate that the high expression of galectin-1 and -3 and the low expression of galectin-4 and -9 may be predictive prognostic factors for poor OS in liver cancer patients.
Role of Xingnaojing Injection in treating acute cerebral hemorrhage
Authors: Ma Xiao , Wang Tao , Wen Jianxia , Wang Jian , Zeng Nan , Zou Wenjun , Yang Yuxue
Published: April 2020

Background:

Xingnaojing injection (XNJi) is widely used for acute cerebral hemorrhage. However, the efficacy of XNJi for acute cerebral hemorrhage has not been comprehensively proved by systematic analysis yet. Therefore, it is essential to evaluate the efficacy and safety of XNJi in an evidence-based method.

Methods:

Six databases were searched with XNJi used for acute cerebral hemorrhage in randomized controlled trials (RCTs). Meta-analysis was performed by Review Manager 5.3. The efficacy rate, brain edema, cerebral hematoma, neurological deficit score, hs-crp, Glasgow Coma Scale (GCS), and activities of daily living (ADL) were systematically evaluated. The Cochrane risk of bias was used to evaluate the methodological quality of eligible studies.

Results:

This study is registered with PROSPERO (CRD42018098737). Twenty-nine studies with a total of 2638 patients were included in this meta-analysis. Compared with conventional treatment, XNJi got higher efficacy rate (OR = 3.37, 95% CI [2.65, 4.28], P < .00001). Moreover, XNJi showed significant enhancement of efficacy rate via subgroup analysis in course and dosage. In addition, XNJi demonstrated significant improvement in Chinese stroke scale (CSS) and National Institutes of Health Stroke Scale (NHISS) (mean difference [MD] = −4.74, 95% CI [−5.89, −3.60], P < .00001; MD = −4.45, 95% CI [−5.49, −3.41], P < .00001), GCS (MD = 2.72, 95% CI [2.09, 3.35], P < .00001). It also remarkably decreased the level of hs-crp (MD = −6.50, 95% CI [−7.79, −5.21], P < .00001), enhanced ADL (MD = 20.38, 95% CI [17.98, 22.79], P < .00001), and alleviated hematoma and edema (MD = −2.53, 95% CI [−4.75, −0.31] P < .05; MD = −1.74 95% CI [−2.42, −1.07] P < .00001) compared with conventional treatment.

Conclusion:

XNJi is effective in treating acute cerebral hemorrhage with significant improvement of CSS, NHISS and impairment of hs-crp, hematoma, and edema compared with conventional treatment. Moreover, XNJi got remarkable efficacy at the dose of 20, 30, 60 mL and from 7 to 28 days. No serious adverse reactions occurred. These results were mainly based on small-sample and low-quality studies. Therefore, more rigorous, large-scale RCTs were further needed to confirm its efficacy, safety, and detailed characteristic of application.
Blood-based FTIR-ATR spectroscopy coupled with extreme gradient boosting for the diagnosis of type 2 diabetes
Authors: Guang Peiwen , Huang Wendong , Guo Liu , Yang Xinhao , Huang Furong , Yang Maoxun , Wen Wangrong , Li Li
Published: April 2020

Timely diagnosis of type 2 diabetes and early intervention and treatment of it are important for controlling metabolic disorders, delaying and reducing complications, reducing mortality, and improving quality of life. Type 2 diabetes was diagnosed by Fourier transform mid-infrared (FTIR) attenuated total reflection (ATR) spectroscopy in combination with extreme gradient boosting (XGBoost). Whole blood FTIR-ATR spectra of 51 clinically diagnosed type 2 diabetes and 55 healthy volunteers were collected. For the complex composition of whole blood and much spectral noise, Savitzky–Golay smoothing was first applied to the FTIR-ATR spectrum. Then PCA was used to eliminate redundant data and got the best number of principle components. Finally, the XGBoost algorithm was used to discriminate the type 2 diabetes from healthy volunteers and the grid search algorithm was used to optimize the relevant parameters of the XGBoost model to improve the robustness and generalization ability of the model. The sensitivity of the optimal XGBoost model was 95.23% (20/21), the specificity was 96.00% (24/25), and the accuracy was 95.65% (44/46). The experimental results show that FTIR-ATR spectroscopy combined with XGBoost algorithm can diagnose type 2 diabetes quickly and accurately without reagents.
Traditional Chinese medicine Danggui Shaoyao San for the treatment of Alzheimer's disease
Authors: You Yu , Liu Xinglong , You Yanyan , Liu Dan , Zhang Chunjiang , Chen Yunhui , Zhang Tiane
Published: April 2020

Background:

Alzheimer's disease (AD) is the most common cause of dementia. Traditional Chinese formula Danggui Shaoyao San (DSS) has been considered a potential therapeutic approach for AD. However, no systemic review regarding its efficacy and safety has been conducted. Herein, we propose a protocol for the study that aims to evaluate the efficacy and safety of DSS in patients with AD.

Methods:

Sixteen electronic databases including PubMed, EMBASE, Cochrane database, Web of science, Chinese National Knowledge Infrastructure, VIP, Wanfang database, China Biomedical Literature Database, Chinese Clinical Trial Registry System, Koreanstudies Information Service System, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, DBpia, Korean Traditional Knowledge Portal, Japanese CiNii databases and J-STAGE databases will be searched from the inception up to February 29, 2020. Randomized controlled trials (RCTs) that meet the pre-specified eligibility criteria will be included. RevMan software (V.5.3.5) will be used to perform data synthesis following data extraction and publication risk assessment. Subgroup and sensitivity analysis will be performed according to the condition of included RCTs. The primary outcomes include changes in the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), and Activities of Daily Living scale (ADL). Additional outcomes are clinical effective rate and adverse event rate. The Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the strength of the evidence.

Results:

This study will provide a well-reported and high-quality synthesis of RCTs on the efficacy and safety of DSS for the treatment of AD.

Conclusion:

This systematic review protocol will be helpful for providing evidence of whether DSS is an effective and safe therapeutic approach for patients with AD.

Ethics and dissemination:

Ethical approval is not necessary as this protocol is only for systematic review and does not involve privacy data or conduct an animal experiment. This protocol will be disseminated by a peer-review journal or conference presentation.

Systematic review registration:

PROSPERO CRD42020150450.
Efficacy and safety of shenqi compound for the treatment of diabetic macroangiopathy
Authors: Hu Zhipeng , Yang Maoyi , Xie Chunguang , Gao Hong , Fu Xiaoxu , Xie Hongyan , Liu Ya
Published: April 2020

Background:

Diabetic macroangiopathy is a further complication of diabetes mellitus and is the leading cause of death for diabetic patients. Shenqi compound (SC) is a traditional Chinese medicine formula widely used in the treatment of diabetes and diabetic macroangiopathy. At present, there is only 1 systematic review on SC in the treatment of diabetes. However, no meta-analysis has evaluated the efficacy and safety of SC on diabetic macroangiopathy.

Methods and analysis:

Three English database and four Chinese medical databases will be searched from its inception to February 2020. Then 2 methodological trained researchers will screen the qualified articles by reading the title, abstract, and full texts according to an established inclusion and exclusion criteria. The assessment of risk of bias will be conducted by using the Cochrane collaboration's tool. We will conduct meta-analyses for fasting blood glucose (FBG), postprandial blood glucose (PBG), glycated hemoglobin (HbA1c), and other outcomes. The heterogeneity of data will be evaluated by Cochrane χ
2 and I

2
tests. We establish 3 hypotheses before the subgroup analysis actually starts: disease status at baseline, duration of intervention, type of concomitant medication. We will conduct sensitivity analysis to evaluate the stability of the results, funnel plot analysis, and Egger test to evaluate the publication bias, and assessment for the quality of evidence by the Grading of Recommendations Assessment, Development, and Evaluate system (GRADE).

Results:

The results will be published at a peer-reviewed journal.

Conclusion:

In this study, we will systematically evaluate the evidence of SC in the treatment of diabetic macroangiopathy. Our research is supposed to provide evidence-based support for clinical practice.
Prognostic significance of E-cadherin expression in prostatic carcinoma
Authors: Zhang Xiwen , Zhang Zhenhua , Chen Shuntai , Jiang Juling , Qi Runzhi , Mi Xue , Zhang Xing , Xi Yupeng , Zheng Honggang , Hua Baojin
Published: April 2020

Background:

Increasing studies were performed to explore the prognostic value of E-cadherin in prostatic carcinoma, however, with inconsistent results. Hence, this systematic review is aimed to evaluate the prognostic role of E-cadherin in patients with prostatic carcinoma (PCa).

Methods:

A comprehensive literature search in all available databases will be conducted to identify eligible studies. We will employ hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the correlations between E-cadherin expression and overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), progression-free survival (PFS) and clinicopathological features. Meta-analysis will be performed using Review Manager (Revman) 5.3.5 software (Cochrane Community, London, United Kingdom) and STATA 14 software (version 14.0; Stata Corp, College Station, TX).

Results:

This study will provide a high-quality synthesis of current evidence of the correlations between snail expression and OS, DFS/RFS, PFS and clinicopathological features.

Conclusion:

The study will provide updated evidence to assess whether the expression of E-cadherin is in association with poor prognosis in patients with PCa.

Ethics and dissemination:

It is not necessary for ethical approval because individuals cannot be identified. The protocol will be disseminated in a peer-reviewed journal or presented at a relevant conference.

Prospero registration number:

This systematic review protocol has been registered in the PROSPERO network (No. CRD42019128353).