bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathological features of paraganglioma in the lumbar spinal canal
Authors: Wang Zhe-Hui , Wang Yuan-Tao , Cheng Fei , Hu Yu
Published: October 2018

Introduction:

This study aims to investigate the pathological features of a patient with paraganglioma in the lumbar spinal canal.

Case presentation:

The patient was 36 years old male with electrical pain in the waist and buttock which occurred intermittently, and was not relieved under oral use of analgesics. Immunohistochemical staining was performed to diagnose the disease. The results revealed that the size of the tumor was 3.4 × 1.6 × 1.4 cm. The hematoxylin and eosin (H&E)-stained tumor cells mainly presented with an organ-like arrangement under low power microscope, showing prominent chrysanthemum-like, pseudo glandular or pseudo papillary arrangements. The surrounding area of the nest presented with sinusoids, and fibrosis and focal calcification could be observed in the interstitial space among the lesions. Immunohistochemistry results showed that the chief cells were positive for neuron-specific enolase (NSE), Syn and CgA, and Sertoli cells were positive for S-100.

Conclusion:

Paraganglioma is a very rare malignant tumor. This tumor should be distinguished from ependymoma, meningioma and hemangioblastoma, to avoid misdiagnosis, and missed diagnosis.
Expression profiles of long noncoding RNAs and mRNAs in peripheral blood mononuclear cells of patients with acute myocardial infarction
Authors: Zhao Pingsen , Wu Heming , Zhong Zhixiong , Zhang Qifeng , Zhong Wei , Li Bin , Li Cunren , Liu Zhidong , Yang Min
Published: October 2018

Acute myocardial infarction (AMI) is the most serious type of coronary atherosclerotic diseases. The incidence of AMI in some countries increases year by year, and shows younger trend. Some study indicated that abnormal expression of lncRNAs was closely related to cardiovascular disease. The aim of this study was to examine the lncRNA expression profiles in peripheral blood mononuclear cells (PBMCs) of patients with AMI through controlled studies.

In the present study, we examined the lncRNA and mRNA expression profiles in 8 patients with AMI, with 7 NCA (noncoronary artery) subjects as controls using RNA sequencing protocol (RNA-seq) on the Illumina HiSeq 4000 platform. The differentially expressed lncRNAs were selected for bioinformatic analysis including gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG). Quantitative real time PCR (qRT-PCR) was used to confirm the differential expression of lncRNAs.

We kept about 11.29 gigabase (Gb) high-quality sequence data while the Q30 ranged from 94.39% to 95.19% for each sample. Compared to the lncRNA expression profiles of NCA controls, a total of 106 differentially expressed lncRNAs were discriminated in AMI patients, including 40 upregulated lncRNAs and 66 downregulated lncRNAs (P < .05). Among the genes corresponding to the identified mRNAs, 2905 genes are involved in biological processes, 339 in cellular components, and 501 in molecular functions. Based on the KEGG pathway analysis, the most enriched pathways corresponding to the differentially expressed lncRNAs were associated with systemic lupus erythematosus, alcoholism, oxidative phosphorylation, Parkinson's disease and viral carcinogenesis, and so on. Further, 3 upregulated and 3 downregulated lncRNAs were randomly selected for qRT-PCR verification and the results of qRT-PCR were consistent with the findings obtained from RNA sequencing analysis.

As a result, differential expression profiles of lncRNAs in AMI were identified in our study. The results suggested that lncRNAs may play important roles in the biological and pathological processes of AMI. These findings may provide useful reference for the early diagnosis and risk stratification of AMI patients. To enlarge the sample size in the next step will be needed for further research to confirm our results.
What happened to health service utilization, health care expenditures, and quality of care in patients with acute pancreatitis after implementation of global budgeting in Taiwan?
Authors: Ko Ya-Lin , Wang Jyun-Wei , Hsu Hui-Mei , Kao Chia-Hung , Lin Chun-Yi
Published: October 2018

Aim:

Acute pancreatitis is associated with significant morbidity and mortality. In the United States, more than 3,00,000 patients are admitted and about 20,000 die from acute pancreatitis per year. In Taiwan, the incidence rate of acute pancreatitis is 0.03% and the mortality rate among severe acute pancreatitis is 16.3%. The aim of the study was to evaluate the impact of the global budgeting system on health service utilization, health care expenditures, and quality of care among patients with acute pancreatitis in Taiwan.

Materials and methods:

The National Health Insurance Research Database (NHIRD) was used for analysis. Data on patients with acute pancreatitis diagnosed during the period 2000 and 2001 were used as baseline data, and data from 2004 and 2005 were used as post-intervention data. The length of stay (LOS), diagnostic costs, drug cost, therapy costs, total costs, risk of readmission within 14 days, and risk of revisiting the emergency department (ED) within 3 days of discharge before and after implementation of the global budgeting system were compared and analyzed.

Results:

Data on 2810 patients with acute pancreatitis were analyzed in this study. There was a significant difference in mean LOS before and after introduction of the global budget system (7.34 ± 0.22 days and 7.82 ± 0.22 days, respectively; P < .001)). The mean total costs before and after implementation of the global budget system were Taiwan dollars (NT$) 28,290.66 ± 1576.32 and NT$ 42,341.83 ± 2285.23, respectively. The mean rate of revisiting the ED within 3 days decreased from 9.9 ± 0.9% before adoption of global budgeting to 7.2 ± 0.6% after implementation of the system. The mean 14-day re-admission rates before and after introduction of global budgeting were 11.6 ± 1.0% and 7.9 ± 0.7%, respectively.

Conclusion:

The global budget system was associated with significantly longer length of stay, higher health care expenditures, and better quality of care in patients treated for acute pancreatitis.
Case report: Takayasu arteritis in a 3-month-old Chinese girl
Authors: Liu Haimei , Sun Li , Upadhyaya Ruchi Sanjaykumar , Chen Yitong , Ajoje Oluseye O.
Published: October 2018

Rationale:

Takayasu arteritis is a rare large vessel systemic vasculitis that predominantly affects the aorta and its main branches in women of childbearing age. Due to nonspecific symptoms during the acute phase of disease, early diagnosis is still a challenge for pediatricians.

Patient concerns:

We reported a 3-month-old girl who presented with sustained elevated levels of acutephase reactants, which could not be explained by infectious diseases and malignant diseases.

Diagnoses:

The patient's angiography showed dilatation, stenosis, and inflammation of the aorta and its branches and was diagnosed as Takayasu arteritis.

Interventions:

We prescribed glucocorticoids combined with immunosuppressive agents, which include cyclophosphamide used as an induction drug for 6 months, and mycophenolate mofetil used as a maintenance drug. Glucocorticoids gradually stopped.

Outcomes:

At present, the girl went into clinical remission with normal levels of acute-phase reactants and improvement of vascular inflammation demonstrated by angiography.

Lessons:

This case report illustrates that Takayasu arteritis can occur in children at a very early age after birth before apparent clinical symptoms.
Association between the polymorphism (rs17222919, −1316T/G) of 5-lipoxygenase-activating protein gene (ALOX5AP) and the risk of stroke
Authors: Ye Hui , Zhang Xin , Chen Zupeng , Li Xu , Zhang Tiehui , Yang Chao , Huang Lifa
Published: October 2018

Background:

The objective of this study was to evalutate the relationship between 5-lipoxygenase-activating protein gene (ALOX5AP) -rs17222919-1316T/G polymorphisms and the risk of stroke.

Methods:

Relative studies were searched in January 2018. Case–control studies with extractable data were selected. Four gene models were analyzed including, allele genetic model (G vs T), additive genetic model (GG vs TT, GT vs TT), recessive genetic model (GG vs GT + TT), and dominant genetic model (GG + GT vs TT). Effect sizes included odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed by using Q test and I
2 test. Publication bias was evaluated by using Egger method. The reliability of the results was assessed with sensitivity analysis. All the data analysis was performed with R 3.10 software.

Results:

A total of 5 studies inclusing 8492 patients were included. There were significant relationship between ALOX5AP-rs17222919-1316T/G polymorphisms and stroke under all models (P < .05) except the additive genetic model GT versus TT (P > .05). No publication bias was noted. Sensitivity analysis indicated that the results were not stable.

Conclusion:

This meta-analysis indicates that ALOX5AP-rs17222919-1316T/G may be a protective factor aginst stroke.
Risk factors of transient global amnesia
Authors: Portaro Simona , Naro Antonino , Cimino Vincenzo , Maresca Giuseppa , Corallo Francesco , Morabito Rosa , Calabrò Rocco Salvatore
Published: October 2018

Introduction:

Transient global amnesia (TGA) is characterized by a sudden onset of anterograde and retrograde amnesia, sometimes associated with mild subclinical neuropsychological deficits and vegetative symptoms, lasting for days after the episode. Migraine history, cardiovascular risk factors, and emotional stress are considered possible risk factors. TGA usually occurs during the seventh decade of life, that is, when risk factors and concomitant pathologies have a higher incidence.

Case Presentation:

We report 3 cases of TGA triggered by different causes (cardiovascular risk factors, emotional stress, and orgasm) with an unusual young onset (patient 1 was a 40-year-old woman, patient 2 was a 21-year-old woman, and patient 3 a 32-year-old man). The patients underwent neuroimaging and cardiovascular examination, and neuropsychological evaluation, without important abnormalities. TGA completely recovery within 1 to 7 days.

Conclusions:

The occurrence of different precipitating events and accurate questioning (in the absence of head trauma) seem to be key features in making the diagnosis of TGA, besides a complete neuropsychiatric and cardiovascular assessment.
Diagnostic value of ultrasonography in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome
Authors: Asano Tomoyuki , Furuya Makiko Yashiro , Fujita Yuya , Matsuoka Naoki , Sato Shuzo , Kobayashi Hiroko , Watanabe Hiroshi , Honda Aki , Migita Kiyoshi
Published: October 2018

Rationale:

Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare condition that affects the skin, bones, and joints. Diagnosis of SAPHO syndrome is established based on clinical manifestations and imaging features on radiography or magnetic resonance imaging.

Patient concerns:

We report a 44-year-old male with a 20-year history of pustulosis who presented with pain in the lower extremities. Plain radiography demonstrated hyperostosis with subperiosteal erosions in the right tibia. Magnetic resonance imaging and computed tomography showed inflammatory accumulation, whereas musculoskeletal ultrasonography clearly depicted a periosteal reaction, osteitis, and enthesitis with abnormal blood flow in the surface of the right tibia.

Diagnoses:

A diagnosis of SAPHO syndrome was made.

Interventions:

The patient was treated with combination therapy comprising prednisolone, methotrexate, and infliximab, which resulted in clinical improvement.

Outcomes:

The elevated levels of C-reactive protein and matrix metalloproteinase-3 normalized, and the abnormal ultrasonographic findings disappeared.

Lessons:

The present case report demonstrates that multiple imaging modalities are important for the definitive diagnosis of SAPHO syndrome. Ultrasonography might be a useful tool for evaluating local musculoskeletal inflammation in patients with SAPHO syndrome.
Cutaneous paresthesia after internal plate fixation of clavicle fractures and underlying anatomical observations
Authors: Ou Luanhai , Yang Liping , Zhao Jinmin , Su Wei
Published: October 2018

To assess the clinical and anatomical causes of cutaneous paresthesia after internal fixation of clavicle fractures.

This study included 135 patients who underwent internal fixation of clavicle fractures from May 2013 to June 2016 at the First and Second Affiliated Hospital of Guangxi Medical University. The incidence of postoperative supraclavicular nerve injury, the duration of numbness, and improvements after plate removal were retrospectively analyzed. Seven human cadaver specimens were subsequently dissected to analyze the supraclavicular nerve and its relationship to numbness.

Of the 135 patients who underwent internal fixation of clavicle fractures, 26 (19.3%) experienced postoperative cutaneous paresthesia, with 22 (16.3%) and 4 (2.8%) experiencing numbness and pain, respectively. The most intense numbness occurred during the first operative month. Of the 22 patients with numbness, 1 (4.5%), 1 (4.5%), and 20 (90.1%) patients reported mild, moderate, and severe numbness, respectively. Two patients described increased awareness of numbness when in contact with clothes, 2 were psychologically affected by numbness, and 20 (90.1%) reported reduced severity of numbness over time. At the last follow-up, numbness was found to persist in 2 (1.5%) patients. None of the patients was bothered by numbness. Cadaver dissection showed that the supraclavicular nerve emerged from the 1/2 posterior edge of the cervical sternocleidomastoid muscle and subsequently divided into 3 branches, with the lateral branch 2.26 ± 1.17 cm from the lateral margin of the acromion, the middle branch near the mid-clavicle, and the medial branch 2.03 ± 0.85 cm from the sternal lateral margin.

Cutaneous paresthesia is common following internal fixation of the clavicle. Anatomic analysis showed that the nerve could be easily injured during clavicle operation. Numbness improved in most patients, but persisted for up to 2 years and was even permanent in a few. Most patients considered numbness as an insignificant factor in their daily lives.
Development of a survey form through Delphi study about adverse events associated with the miniscalpel needle, for application in prospective observational studies regarding safety of miniscalpel needles
Authors: Yoon Sang-Hoon , Lee Haebeom , Kwon Chan-Young , Jeon Damin , Kim Hyunho , Jo Hee-Geun , Shin Aesook , Yun Younghee , Sul Jae-Uk , Lee Geon-Mok , Lee Jun-Hwan , Leem Jungtae
Published: October 2018

Background:

Despite the wide usage of miniscalpel-needles (MSNs), information about MSN treatment-related adverse events (AEs) is insufficient. As the definition of AE might vary among physicians, without an exact definition for pain and hemorrhage, it is difficult to provide accurate information about AEs in MSN treatment to physicians, researchers, and patients. The aim of our study is to reach a consensus about the items and definitions of AEs that should be included in the survey form for prospective observational multicenter studies to record MSN treatment-related AEs. We will especially focus on obtaining a consensus on the definition of pain and hemorrhage caused by MSN treatment.

Methods:

Our study protocol is composed of 6 steps. First, we will identify the aim of the study. Next, we will conduct a systematic review to investigate MSN treatment-related AEs reported till date in Korea. Third, we will conduct a pilot observational prospective single-center study on AEs in MSN treatment. We will develop a standardized case report form to record MSN treatment-related AEs, including the causality, severity, and details of the MSN procedure at every site. Next, based on the pilot study, the Delphi study questionnaire will be developed by a panel composed of 13 physicians. The Delphi study will have 4 rounds with open questions and 4-point Likert-scale closed questions. Through these rounds, we will develop a consensus about the items and definitions of AEs that should be included in the survey form for future multicenter studies about MSN treatment-related AEs. Following this, a face-to-face consensus meeting will be held for a final agreement of survey form. The final survey form will then be approved by the related academic society for dissemination.

Discussion:

The aim of this protocol is to develop a survey form for future prospective observational multicenter studies on MSN treatment-related AEs. This protocol will present the research methodology for developing a survey form, which will improve consistency and reliability between MSN treatment studies. We believe that this protocol can evaluate the safety of MSN treatment.

Trial registration:

Clinical Research Information Service: KCT0002849.
Bilateral costotransverse and local continuous chemotherapy approach for debridement, fixation, and fusion of contiguous multisegmental thoracic spinal tuberculosis
Authors: Yin Xinhua , Yan Liang , Yang Ming , Liu Shichang , He Baorong , Liu Zhongkai , Hao Dingjun
Published: October 2018

The study aims to evaluate the clinical efficacy of bilateral costotransverse debridement, transpedicular fixation, fusion, and local continuous chemotherapy in 20 patients of contiguous multisegmental thoracic spinal tuberculosis (CMTSTB). We analyzed 20 patients with contiguous thoracic spinal tuberculosis (TB) who underwent surgery via bilateral costotransverse debridement, fusion, posterior instrumentation, and postural drainage with local continuous chemotherapy. The clinical outcomes were evaluated in terms of kyphotic angle, bone fusion, neurologic status, erythrocyte sedimentation rate (ESR), and intraoperative and postoperative complications. All of the patients (8M/12F), averaged 45.8 ± 15.6 years old. The mean duration of postoperative follow-up was 30.7 ± 4.0 months. There was no recurrent TB infection. The values of ESR returned to normal levels at final follow-up. All patients got bony fusion within 8.1 ± 2.3 months after surgery. The average preoperative Cobb angle was 39.9° ± 8.6°, correcting to 9.8° ± 2.3° postoperatively and 10.8° ± 2.3° at the last follow-up. All patients with neurological deficit had dramatic improvement at the final follow-up. Our results showed that bilateral costotransverse surgery and local continuous chemotherapy are feasible and effective procedures in the treatment of CMTSTB. The approach can provide radical debridement, rebuild spinal stability, and cure TB.
A model predicting short-term mortality in patients with advanced liver cirrhosis and concomitant infection
Authors: Li Ying , Chaiteerakij Roongruedee , Kwon Jung Hyun , Jang Jeong Won , Lee Hae Lim , Cha Stephen , Ding Xi Wei , Thongprayoon Charat , Ha Fu Shuang , Nie Cai Yun , Zhang Qian , Yang Zhen , Giama Nasra H. , Roberts Lewis R. , Han Tao
Published: October 2018

Infection is a common cause of death in patients with advanced cirrhosis. We aimed to develop a predictive model in Child–Turcotte–Pugh (CTP) class C cirrhotics hospitalized with infection for optimizing treatment and improving outcomes.

Clinical information was retrospectively abstracted from 244 patients at Tianjin Third Central Hospital, China (cohort 1). Factors associated with mortality were determined using logistic regression. The model for predicting 90-day mortality was then constructed by decision tree analysis. The model was further validated in 91 patients at Mayo Clinic, Rochester, MN (cohort 2) and 82 patients at Seoul St. Mary's Hospital, Korea (cohort 3). The predictive performance of the model was compared with that of the CTP, model for end-stage liver disease (MELD), MELD-Na, Chronic Liver Failure–Sequential Organ Failure Assessment, and the North American consortium for the Study of End-stage Liver Disease (NACSELD) models.

The 3-month mortality was 58%, 58%, and 54% in cohort 1, 2, and 3, respectively. In cohort 1, respiratory failure, renal failure, international normalized ratio, total bilirubin, and neutrophil percentage were determinants of 3-month mortality, with odds ratios of 16.6, 3.3, 2.0, 1.1, and 1.03, respectively (P < .05). These parameters were incorporated into the decision tree model, yielding area under receiver operating characteristic (AUROC) of 0.804. The model had excellent reproducibility in the U.S. (AUROC 0.808) and Korea cohort (AUROC 0.809). The proposed model has the highest AUROC and best Youden index of 0.488 and greatest overall correctness of 75%, compared with other models evaluated.

The proposed model reliably predicts survival of advanced cirrhotics with infection in both Asian and U.S. populations.
Correlation between normal range of serum alanine aminotransferase level and metabolic syndrome
Authors: Shen Han , Lu Jing , Shi Ting-Ting , Cheng Cheng , Liu Jing-Yi , Feng Jian-Ping , Yang Jin-Kui
Published: October 2018

Serum alanine aminotransferase (ALT) is a biomarker of hepatocyte damage. However, the relationship between normal range of serum ALT level and metabolic syndrome (MetS) has not been completely understood. This study aimed to investigate the correlation between normal range of serum ALT level and MetS.

A total of 2453 participants from the Beijing Community Pre-Diabetes study were enrolled. Multiple linear regression analysis was performed to calculate the regression coefficient. Normal serum ALT levels were divided into quartiles. Logistic regression model was used to compare the relative risk of MetS, and the receiver operating characteristic (ROC) curve to calculate the optimal ALT boundary value for predicting MetS.

The frequency of MetS increased with the ALT level within the normal range. Compared with the first group, the risk of MetS was greater in the other quartiles of ALT level in males, the difference was significant for the fourth group. For females, the risk of MetS increased with ALT level within the normal range as well, with all differences showing statistical significance. The optimal ALT boundary value of the ROC curve for males and females was 24.5 and 14.5 U/L, respectively.

ALT was related to metabolic factors and used as one of the indicators to assess the morbidity risk of metabolic diseases.
Novel splice receptor-site mutation of RPGR in a Chinese family with X-linked retinitis pigmentosa
Authors: Wang Jing , Zhou Cong , Xiao Yuanyuan , Liu Hongqian
Published: October 2018

Rationale:

Retinitis pigmentosa (RP) is a group of clinically and genetically heterogeneous diseases; X-linked retinitis pigmentosa (XLRP) is the most serious type. Mutations in RP GTPase regulator (RPGR) account for over 70% of patients with XLRP.

Patient concerns:

We report a Chinese family with RP, 5 males presented with night blindness and decreased vision, and 8 females showed different severities of myopia.

Diagnoses:

Targeted exome capture sequencing was performed in 2 affected males, which revealed a novel variant (NM_000328.2, c.470-1G>A) in the RPGR gene. The mis-splicing causes a substitution of the 157th amino acid from glutamic acid to glycine and finally the 165th codon is changed to stop codon, possibly resulting in a truncated protein and/or a nonsense-mediated mRNA decay. The mutation cosegregated with the disease phenotype in the family.

Interventions:

Medication and cataract surgery.

Outcomes:

The phenotype of affected males is more serious than that of the carrier females, and the effect of clinical treatment is not very well.

Lessons:

Next-generation sequencing is a suitable method for early detection of pathogenic mutations in RP, which would be helpful for prenatal diagnosis of the disease.
Retrodiscal epidural balloon adhesiolysis through Kambin's triangle in chronic lumbar spinal stenosis
Authors: Seo Dong-Kyun , Lee Sookyung , Lee Gunn , Lee Myung-Su , Yoon Syn-Hae , Choi Seong-Soo , Shin Jin-Woo
Published: October 2018

A previous study showed that transforaminal balloon adhesiolysis via the safe triangle was effective in lumbar spinal stenosis. However, retrodiscal pathology is difficult to treat with this method. Therefore we attempted retrodiscal balloon adhesiolysis via Kambin's triangle. The design of our study is a retrospective analysis. The setting of our study is a tertiary, interventional pain management practice, speciality referral center.

The primary indication for this procedure is radicular pain arising from ipsilateral retrodiscal pathology. Medical records were reviewed of patients who received retrodiscal decompression with a transforaminal balloon inflatable catheter between January 1, 2016 and July 31, 2017. The intervention was conducted by 2 well-trained pain specialists. The introducer needle was positioned at Kambin's triangle. Adhesiolysis was performed using a balloon filled with radiocontrast media. After balloon adhesiolysis, an agent containing lidocaine and dexamethasone was injected through the introducer sheath. Numeric rating scale pain scores were obtained 1 and 3 months after the procedure.

The mean pre-procedure numeric rating scale score was 7.05 ± 1.40. After 1 and 3 months, the mean scores were 3.91 ± 2.20 and 3.77 ± 2.11, respectively. No patient had significant complications. Also, technical considerations were discussed.

Chronic pain due to lumbar central stenosis, especially ipsilateral retrodiscal pathology, can be reduced by retrodiscal balloon adhesiolysis through Kambin's triangle. Although this study is limited by its retrospective design, the results suggest that this procedure is a useful treatment due to its ease of performance and cost-effectiveness.
The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization
Authors: Chen Jun-yu , Wang Zhi-ling , Wang Zhao-yang , Yang Xing-sheng
Published: October 2018

The aim of this study was to illuminate risks factors of residual lesions, and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive margin who underwent cervical conization.

A retrospective cohort study of 218 patients with positive margin after conization, including cold knife conization (CKC) and loop electrosurgical excisional procedure (LEEP), and follow-up from 2013 through 2016. The diagnosis of residual disease and recurrence were established and confirmed by biopsy. We evaluate the correlations among residual rate, recurrence rate, and clinical parameters, such as age, menopausal status, gravity, parity, glandular involvement, thinprep cytologic test (TCT), and human papillomavirus (HPV) results. We also detect the difference between CKC and LEEP.

There was statistical difference between the positive margin rate of CKC group and LEEP regarding the surgery methods (5.8% and 12.09% separately, P < .001). Residual disease was found in 53.66% cases where 41 patients received second surgery after conization. Besides, age (P = .027), menopausal status (P = .006), and HPV infection (P = 0.018) were significantly associated with residual lesion. Among 177 cases with histopathologic follow-up, 15.91% women relapsed from 4 to 27 months. As for recurrence we found it was more frequent with HPV infection and glandular involvement (P < .001). TCT was also an independent factor in patients with recurrence of lesion. No evidence shows difference between CKC and LEEP for recurrence rate (P = .918).

The factors related to rate of residual lesion were age, menopausal status, and HPV infection. HPV infection, TCT, and glandular involvement were associated with HSIL recurrence. LEEP was as effective as CKC with regard to recurrence rate. Further large-scale studies are needed to confirm our findings.
The characteristics analysis of intestinal microecology on cerebral infarction patients and its correlation with apolipoprotein E
Authors: Wang Wenyue , Li Xu , Yao Xiuhua , Cheng Xiuli , Zhu Yu
Published: October 2018

Cerebral infarction (CI) is associated with high rates of disability, mortality, and death in China, but its mechanism is unclear. Therefore, early diagnosis of CI and determining its mechanism are very important. Intestinal microecology is thought to be related to cardiovascular and cerebrovascular diseases. We hypothesized that intestinal microecology is also related to CI and that the intestinal microecology in the stool of CI patients differs from that in healthy people.

Fecal samples of healthy subjects and CI patient (all n = 10) and we investigated the intestinal microecology of CI patient and healthy people stool by 16 seconds sequencing and analyzed relative abundance and diversity of microorganisms by unweighted pair-group method with arithmetic mean analysis (UPGMA) and principal co-ordinates analysis (PCoA). We also measured apolipoprotein E (ApoE) levels in the serum by ELISA assay and analyzed the correlation between ApoE and intestinal flora.

We found that the relative structure and diversity of intestinal microecology was significantly different between the stools of CI patients and healthy people. At the class level, Gammaproteobacteria was increased and Bacteroidia was decreased in CI patient stool. We found a correlation between ApoE in the serum and Bacteroidia and Gammaproteobacteria species.

We considered the intestinal flora can be used as an indicator of CI and the up-regulation of ApoE may be the potential mediate for intestinal microecology contribute to CI.
Economic evaluation of the impact of physician-hospital integration and physician boards on hospital expenditure per patient
Authors: Cho Na-Eun , Lee Sejoong , Lee Joonwhan David
Published: October 2018

Background:

This study aims to contribute to the ongoing policy and scholarly debate on physician-hospital integration (INT) and health care cost by providing evidence for the role of physician boards in mitigating hospital expenditure associated with INT.

Methods:

We conducted our study of the relationship between INT, physician boards, and hospital expenditure using data on hospitals in California. We obtained data from the Centers for Medicare and Medicaid Services, American Hospital Association, and California Office of Statewide Health Planning and Development from 2002 to 2006. A hospital fixed-effect ordinary least square (OLS) regression analysis was used.

Results:

Hospital expenditure was higher in a hospital with an integrated arrangement (e.g., a hospital that adopted an integrated salary model) than under other independent arrangements between physicians and hospitals, and the proportion of physician members on hospital boards negatively moderated the effect of integration on hospital expenditure.

Conclusions:

Physician boards may provide a context that affords benefits that can reduce hospital expenditures under INT. This finding highlights the importance to having a supportive organizational design when implementing INT.
Preoperative sonographic features of follicular thyroid carcinoma predict biological behavior
Authors: Lai Xingjian , Jiang Yan , Zhang Bo , Liang Zhiyong , Jiang Yuxin , Li Jianchu , Zhao Ruina , Yang Xiao , Zhang Xiaoyan
Published: October 2018

Little is known regarding biological behavior of follicular thyroid carcinomas (FTCs) according to ultrasonography features. We investigated whether there was a difference in biological behavior between benign-looking FTCs (B-FTCs) and malignant-looking FTCs (M-FTCs).

A total of 55 cases of FTC between January 2000 and December 2015 were included. B-FTCs were defined as showing none of the accepted ultrasonography criteria for malignancy, and M-FTCs were defined as showing at least one of the accepted ultrasonography criteria for malignancy. Clinicopathologic factors and sonographic features were compared between B-FTCs and M-FTCs. Based on the degree of invasiveness, FTCs were divided into minimally invasive FTCs (MI-FTCs) and widely invasive FTCs (WI-FTCs) on pathology. Sonographic features were compared between MI-FTCs and WI-FTCs.

Compared with the patients with B-FTCs (31/55, 56.4%), the patients with M-FTCs showed a significantly higher prevalence of WI-FTCs, central lymph node metastases, lateral lymph node metastases as well as extrathyroidal extension (P < .001, P = .012, P = .031, and P = .032, respectively). M-FTCs with more than one malignancy features on ultrasonography showed a significantly higher prevalence of extrathyroidal extension than M-FTCs with only one ultrasonography malignancy feature (P = .022). Compared with MI-FTCs (41/55, 74.5%), an irregular shape, a spiculated/microlobulated boundary, no peripheral halo ring, hypoechogenicity and microcalcification were more frequent in WI-FTCs (P < .001, P = .003, P = .002, P = .015, and P = .016, respectively).

Our results demonstrated that B-FTCs had better prognostic indicators than M-FTCs. Therefore, preoperative US features can serve as a useful tool for predicting biological behavior in FTC.
Is additional 5-day vasoactive drug therapy necessary for acute variceal bleeding after successful endoscopic hemostasis?
Authors: Yan Pengguang , Tian Xiao , Li Jingnan
Published: October 2018

Background:

Vasoactive drugs and endoscopic therapy have been widely used in the management of acute variceal bleeding of cirrhosis patients. The current standard regimen of vasoactive drugs is in combination with endoscopic therapy and continues for up to 5 days; however, the necessity of vasoactive drugs after endoscopic hemostasis was still controversial. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and optimal duration of adjuvant vasoactive drugs after hemorrhage control by endoscopic therapy.

Methods:

A search was conducted of PubMed, EMBASE, and Cochrane Library databases until June, 2018. Lan DeMets sequential monitoring boundary was constructed to assess the reliability and conclusiveness of our major results.

Results:

Seven studies (639 patients) and 4 studies (435 patients) were included in the analyses to evaluate the efficacy and optimal duration of adjuvant vasoactive drugs therapy, respectively. Our analyses showed that adjuvant vasoactive drugs facilitated endoscopic hemostasis and reduced very early re-bleeding rate both in sclerotherapy (risk ratio [RR] 0.51, 95% confidence interval [CI] 0.34–0.78, P = .23, I
2 = 31%) and band ligation (RR 0.48, 95% CI 0.27–0.83, P = .07, I
2 = 62%). However, the 3 to 5-day therapy duration was not superior to a shorter course in very early re-bleeding rate and mortality rate in 42 days (RR 1.77, 95% CI 0.64–4.89, P = .70, I
2 = 0%; RR 0.95, 95% CI 0.43–2.13, P = .81, I
2 = 0%, respectively).

Conclusion:

Additional 5-day vasoactive drug after endoscopic hemostasis may significantly ameliorate very early re-bleeding rate, However, the 3 to 5 days’ adjuvant regimen was not superior to a shorter course.
Primary mucosa-associated lymphoid tissue lymphoma of the hilar bile duct resulting in fluctuant jaundice
Authors: Liu Zhaobo , Zang Yunjin , Wang Xinxin , Li Ning , Lin Dongdong
Published: October 2018

Rationale

Primary mucosa-associated lymphoid tissue (MALT) lymphomas rarely originate in the hilar bile duct. Preoperative diagnosis of a primary MALT lymphoma of the hilar bile duct is difficult owing to the rarity of this disease. Differentiating between obstructive jaundice caused by MALT lymphoma of the hilar bile duct and hilar cholangiocarcinoma (the most common form of bile duct cancer) is challenging.

Patient concerns

A 57-year-old man presented to our hospital in August 2012 with fluctuant obstructive jaundice.

Diagnoses

Contrast-enhanced abdominal computed tomography and magnetic resonance cholangiopancreatography showed a hilar liver mass measuring 23 × 28 mm along with intrahepatic biliary dilatation indicating hilar bile duct obstruction with a high index of suspicion for hilar cholangiocarcinoma.

Interventions and Outcomes

Based on frozen section examination, he was intraoperatively diagnosed with chronic nonspecific inflammation. Histopathological and immunohistochemical examinations confirmed a diagnosis of malignant lymphoma, specifically classified as an extranodal marginal zone B-cell lymphoma of MALT type.

Lessons

A primary MALT lymphoma of the bile duct should be considered among the differential diagnosis in patients with a hilar tumor who present with fluctuating jaundice and are preoperatively diagnosed with suspected hilar cholangiocarcinoma, and/or an intraoperative diagnosis of chronic nonspecific inflammation (based on frozen section examination) assessed for stenosis or obstruction of the bile duct.
Horizontal Integration of Concepts
Authors: Daniel Manju , Joseph Rachel A.
Published: October 2018

Background

Horizontal integration of a prelicensure nursing curriculum is an innovative discipline-specific teaching-learning strategy for facilitating interactive learning and achievement of quality student learning outcomes.

Purpose

The purpose of this article is to describe the impact of the horizontal integration of an nursing curriculum on students' attendance, collaboration for interactive learning, course grades, and satisfaction with the course learning outcomes.

Methods

An intervention of horizontal integration of 2 courses, one on nursing research and evidence-based practice and the other on mental health nursing, in an undergraduate nursing curriculum was used.

Results

Class attendance and student collaboration improved by 60% to 65%, and final examination scores improved by 14% to 16% for students in the intervention group.

Conclusion

Horizontal integration of a nursing curriculum is a strategy that can improve class attendance, student collaboration, course grades, and student satisfaction with the course learning outcomes.
Risk of Gonococcal Infection During Vaginal Exposure is Associated With High Vaginal pH and Active Menstruation
Authors: McLaughlin Stephanie E. , Ghanem Khalil G. , Zenilman Jonathan M. , Griffiss J. McLeod
Published: October 2018

Background

An understanding of the biological reasons why 25% to 35% of women resist infection during vaginal intercourse with a man infected with Neisseria gonorrhoeae could lead to novel control measures. We sought modifiable biological bases for infection resistance by comparing women in the same core-mixing group who did or did not become infected after sexual exposure.

Methods

We enrolled 61 female contacts of index men with gonorrhea seen at Baltimore City Health Department clinics from January 2008 through May 2012. Exposure and sexual practices and histories, co-infections, physical signs on exam, patient symptom report, and menstrual history were collected.

Results

Thirty-eight (62.3%) of the exposed women developed cervical infections. Multiple logistic regression found that a vaginal pH of 4.5 or higher at presentation to clinic was significantly associated with gonococcal infection (adjusted odds ratio, 5.5; P = 0.037) in women who presented within one menstrual cycle, 35 days. In this group of women, there was a significant association between acquiring an N. gonorrhoeae cervical infection and sexual exposure during menstruation (adjusted odds ratio 12.5; P = 0.05).

Conclusions

Modification of vaginal pH could be explored as novel strategy for reducing the risk of N. gonorrhoeae infections in women.
Systematic Review of Drug Packaging Methods in Body Packing and Pushing
Authors: Cappelletti Simone , Piacentino Daria , Ciallella Costantino
Published: October 2018

A systematic review of the literature regarding drug packaging methods in body packing and materials used is presented, with the aim (a) to summarize data regarding the packaging methods adopted by drug trafficking organizations, (b) to support forensic pathologists and police forces to classify and describe drug packages, (c) to propose a new classification for drug packaging techniques, and (d) to better clarify the impact of packaging methods on radiological detectability.

Packaging methods have been described in 2981 cases, permitting us to summarize the different materials used and to propose a new classification for packaging method based on the materials used. Information concerning the affiliation of body packers and pushers with major (or not) drug trafficking organizations and techniques used to reduce the radiological detectability of the concealed drugs have also been collected.

Besides the packaging methods described over the years, our study suggests a standardized approach for the description of drug packages based on the use of different materials and packaging procedures, which provide a possible insight to the type of drug trafficking organization involved.
Transitions in synchronization states of model cilia through basal-connection coupling
Authors: Liu Yujie , Claydon Rory , Polin Marco , Brumley Douglas R.
Published: October 2018

Despite evidence for a hydrodynamic origin of flagellar synchronization between different eukaryotic cells, recent experiments have shown that in single multi-flagellated organisms, coordination hinges instead on direct basal body connections. The mechanism by which these connections lead to coordination, however, is currently not understood. Here, we focus on the model biflagellateChlamydomonas reinhardtii, and propose a minimal model for the synchronization of its two flagella as a result of both hydrodynamic and direct mechanical coupling. A spectrum of different types of coordination can be selected, depending on small changes in the stiffness of intracellular couplings. These include prolonged in-phase and anti-phase synchronization, as well as a range of multi-stable states induced by spontaneous symmetry breaking of the system. Linking synchrony to intracellular stiffness could lead to the use of flagellar dynamics as a probe for the mechanical state of the cell.
Within-host Mycobacterium tuberculosis diversity and its utility for inferences of transmission
Authors: Martin Michael A. , Lee Robyn S. , Cowley Lauren A. , Gardy Jennifer L. , Hanage William P.
Published: October 2018

Whole genome sequencing in conjunction with traditional epidemiology has been used to reconstruct transmission networks of Mycobacterium tuberculosis during outbreaks. Given its low mutation rate, genetic diversity within M. tuberculosis outbreaks can be extremely limited – making it difficult to determine precisely who transmitted to whom. In addition to consensus SNPs (cSNPs), examining heterogeneous alleles (hSNPs) has been proposed to improve resolution. However, few studies have examined the potential biases in detecting these hSNPs. Here, we analysed genome sequence data from 25 specimens from British Columbia, Canada. Specimens were sequenced to a depth of 112–296×. We observed biases in read depth, base quality, strand distribution and read placement where possible hSNPs were initially identified, so we applied conservative filters to reduce false positives. Overall, there was phylogenetic concordance between the observed 2542 cSNP and 63 hSNP loci. Furthermore, we identified hSNPs shared exclusively by epidemiologically linked patients, supporting their use in transmission inferences. We conclude that hSNPs may add resolution to transmission networks, particularly where the overall genetic diversity is low.
Multi-dimensional spectral gap optimization of order parameters (SGOOP) through conditional probability factorization
Authors: Smith Zachary , Pramanik Debabrata , Tsai Sun-Ting , Tiwary Pratyush
Published: October 2018

Spectral gap optimization of order parameters (SGOOP) (Tiwary and Berne, Proc. Natl. Acad. Sci.1132839 (2016)) is a method for constructing the reaction coordinate (RC) in molecular systems, especially when they are plagued with hard to sample rare events, given a larger dictionary of order parameters or basis functions, and limited static and dynamic information about the system. In its original formulation, SGOOP is designed to construct a 1-dimensional RC. Here we extend its scope by introducing a simple but powerful extension based on the notion of conditional probability factorization where known features are washed out to learn additional and possibly hidden features of the energy landscape. We show how SGOOP can be used to proceed in a sequential and bottom-up manner to (i) systematically probe the need for extending the dimensionality of the RC, and (ii) if such a need is identified, learn additional coordinates of the RC in a computationally efficient manner. We formulate the method and demonstrate its usefulness through three illustrative examples, including the challenging and important problem of calculating the kinetics of benzene unbinding from the protein T4L99A lysozyme, where we obtain excellent agreement in terms of dissociation pathway and kinetics with other sampling methods and experiments. In this last case, starting from a larger dictionary of fairly generic and arbitrarily chosen 11 order parameters, we demonstrate how to automatically learn a 2-dimensional RC, which we then use in the infrequent metadynamics protocol to obtain 16 independent unbinding trajectories. We believe our method will be a big step in increasing the usefulness of SGOOP in performing intuition-free sampling of complex systems. Finally, we believe that the usefulness of our protocol is amplified by its applicability to not just SGOOP but also other generic methods for constructing the RC.
Central sensitization increases the pupil dilation elicited by mechanical pinprick stimulation
Authors: van den Broeke E.N. , Hartgerink D.M. , Butler J , Lambert J , Mouraux A
Published: October 2018

High frequency electrical stimulation (HFS) of skin nociceptors triggers central sensitization, manifested as increased pinprick sensitivity of the skin surrounding the site at which HFS was applied. The aim of the present study was to compare the effects of HFS on pupil dilation and brain responses elicited by pinprick stimulation delivered in the area of increased pinprick sensitivity. In fourteen healthy volunteers HFS was applied to one of the two forearms. Before and twenty minutes after applying HFS, mechanical pinprick stimuli (64 mN and 96 mN) were delivered to the area surrounding the site at which HFS was applied as well as the contralateral control arm. During pinprick stimulation both the pupil size and electroencephalogram were recorded. HFS induced a clear and comparable increase in pinprick sensitivity for both the 64 and 96 mN stimulation intensity. Both pinprick stimulation intensities elicited a greater pupil dilation response when delivered to the area of increased pinprick sensitivity. However, this greater pupil dilation response was larger for the 64 mN compared to the 96 mN stimulation intensity. A similar pattern was observed for the negative wave of the pinprick-evoked brain potentials (PEPs), however, the increase was not significant for the 96 mN and showed only a trend towards significance for the 64 mN. These results show that there is a correspondence between the increase in pupil dilation and the increase in PEPs, but that pupil size is a more sensitive measure for detecting the effects of central sensitization than PEPs.