bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of idiopathic hyperaldosteronism characterized by bilateral adrenal adenoma
Authors: Wang Wei , Wei Feng , Li RanHao , Tian JiaHui
Published: October 2019

Rationale:

Primary aldosteronism (PA) comprises 2 main subtypes: unilateral aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism or named as bilateral adrenal hyperplasia (BAH). An accurate discrimination between APA and BAH is crucial because the former is treated with adrenalectomy (ADX) and the latter is primarily by aldosterone antagonists. We report a case of idiopathic hyperaldosteronism characterized by BAH.

Patient concerns:

A 46-year-old woman had experienced a paroxysmal elevation of blood pressure for the past 2 months, along with an intermittent headache and mild occipital swelling and pain.

Diagnoses:

We performed clinical, laboratory, and imaging tests, as well as bilateral adrenal vein sampling (AVS) on this patient. Specifically, computed tomography scan and magnetic resonance imaging were used to characterize the properties of bilateral adrenal adenoma. Additionally, bilateral AVS was performed to distinguish unilateral from bilateral adrenal abnormality in this patient.

Interventions:

After oral administration of aldosterone antagonists, her blood pressure and potassium levels returned to normal ranges and her condition improved.

Outcomes:

Following differential diagnosis, screening, functional tests, a variety of imaging studies, and bilateral adrenal vein sampling (AVS) typing, she was finally diagnosed with idiopathic hyperaldosteronism.

Lessons:

For PA patients with lack of typical hypertension and hypokalemia performance, early identification and accurate diagnosis are of great significance for improving the prognosis of BAH. AVS plays an important role in the classification of PA subtype, especially for the cases with bilateral lesions. In regard to patients with rare bilateral adrenocortical adenoma-type aldosteronism, AVS plays a key role in choosing the appropriate treatment regimen.
An updated meta-analysis of clinical outcomes comparing minimally invasive with open transforaminal lumbar interbody fusion in patients with degenerative lumbar diseases
Authors: Chen Ying-Chun , Zhang Lin , Li Er-Nan , Ding Li-Xiang , Zhang Gen-Ai , Hou Yu , Yuan Wei
Published: October 2019

Background & Aims:

Open-transforaminal lumbar interbody fusion (O-TLIF) is regarded as the standard (S) approach which is currently available for patients with degenerative lumbar diseases patients. In addition, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has proposed and gradually obtained popularity compared with O-TLIF procedures due to its beneficial outcomes in minimized tissue injury and quicker recovery. Nonetheless, debates exist concerning the use of MI-TLIF with its conflicting outcomes of clinical effect and safety in several publications. The purpose of the current study is to conduct an updated meta-analysis to provide eligible and systematical assessment available for the evaluation of the efficacy and safety of MI-TLIF in comparison with O-TLIF.

Methods:

Publications on the comparison of O-TLIF and MI-TLIF in treating degenerative lumbar diseases in last 5 years were collected. After rigorous reviewing on the eligibility of publications, the available data was further extracted from qualified trials. All trials were conducted with the analysis of the summary hazard ratios (HRs) of the interest endpoints, including intraoperative and postoperative outcomes.

Results:

Admittedly, it is hard to run a clinical RCT to compare the prognosis of patients undergoing O-TLIF and MI-TLIF. A total of 10 trials including non-randomized trials in the current study were collected according to our inclusion criteria. The pooled results of surgery duration indicated that MI-TLIF was highly associated with shorter length of hospital stay, less blood loss, and less complications. However, there were no remarkable differences in the operate time, VAS-BP, VAS-LP, and ODI between the 2 study groups.

Conclusion:

The quantitative analysis and combined results of our study suggest that MI-TLIF may be a valid and alternative method with safe profile in comparison of O-TLIF, with reduced blood loss, decreased length of stay, and complication rates. While, no remarkable differences were found or observed in the operate time, VAS-BP, VAS-LP, and ODI. Considering the limited available data and sample size, more RCTs with high quality are demanded to confirm the role of MI-TLIF as a standard approach in treating degenerative lumbar diseases.
Genetic association between cluster of differentiation 86 variations and sepsis risk
Authors: Zou Xiaofang , Cai Jingning , Li Bin , Wu Shijian
Published: October 2019

The aim of this study was to investigate the correlation between cluster of differentiation 86 (CD86) gene rs1129055 and rs2715267 single nucleotide polymorphisms and sepsis susceptibility.

One hundred twenty-five sepsis patients and 120 healthy controls were enrolled in this case-control study. CD86 polymorphisms rs1129055 and rs2715267 were genotyped through polymerase chain reaction-restriction fragment length polymorphism approach. Chi-square test was used to analyze differences in genotype and allele frequencies of the 2 polymorphisms between case and control groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to present the association strength of the polymorphisms with sepsis susceptibility.

AA genotype and A allele frequencies of CD86 rs1129055 were significantly lower in sepsis patients than in healthy controls (P < .05), revealing their significant associations with decreased disease susceptibility (OR = 0.351, 95% CI = 0.169–0.728; OR = 0.593, 95% CI = 0.415–0.847). Nevertheless, rs2715267 had no significant association with sepsis susceptibility (P > .05).

AA genotype and A allele of CD86 polymorphism rs1129055 might be correlated with decreased sepsis susceptibility in Chinese Han population, but not rs2715267. Further study should be performed to verify our findings.
Effectiveness comparisons of traditional Chinese medicine on treating diabetic nephropathy proteinuria
Authors: Wang Lin , Wang Ya-Hui , Zhang Xian-Hui , Yang Xue-Lian , Wei Hui-Li , An Zhi-Chao , Yu Bo-Rui , Du Da-Qing , Guo Yan , Liu Hong-Fang
Published: October 2019

Background:

Diabetic nephropathy (DN) is one of the microvascular complications of diabetes mellitus. Proteinuria is the most important clinical feature of DN and an independent risk factor for the progression of DN. Therefore, reducing urinary protein is the primary goal of DN treatment. Traditional Chinese medicine (TCM) has long been widely used in the treatment of DN. Therefore, this paper conducted a meta-analysis of the clinical efficacy of TCM in the treatment of DN proteinuria, to comprehensively analyze the role of TCM in the treatment of DN.

Methods:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of DN proteinuria.

Trial registration number:

PROSPERO CRD42019139707.
CD56–chimeric antigen receptor T-cell therapy for refractory/recurrent rhabdomyosarcoma
Authors: Jiang Chiyi , Zhao Wen , Qin Maoquan , Jin Mei , Chang Lungji , Ma Xiaoli
Published: October 2019

Rationale:

Rhabdomyosarcoma (RMS) is a common soft tissue sarcoma in children with high malignancy. The prognosis of refractory recurrent RMS is extremely poor, and the 5-year survival rate is less than 20%.

Patient concerns:

We reported a 2-year-old male patient with RMS who underwent 3 operations and 2 recurrences while being treated with regular multidisciplinary therapy.

Diagnoses:

A diagnosis of embryonal rhabdomyosarcoma with primary bladder (IIIa, TNM stage 2, and medium risk group) was made.

Interventions:

After repeated recurrence, the patient was treated with chimeric antigen receptor T (CAR-T) cells, which had a safety mechanism and specifically bound the CD56 antigen in the fourth generation.

Outcomes:

The process of CAR-T cell transfusion was smooth, and there were no significant cytokine release syndrome manifestations after reinfusion. The patient was in complete remission at last follow-up visit after 3.5 years.

Conclusion:

CD56–CAR-T cell therapy is a safe and effective approach and may be an option for children with solid tumors who are nonresponsive to conventional radiotherapy and chemotherapy, or are unsuitable for hematopoietic stem cell transplantation.
Ovarian cancer metastasis to the breast 18 years after the initial diagnosis
Authors: Wang Zinan , Zhao Dezhong , Liu Ruobing , Zheng Bin
Published: October 2019

Rationale:

Ovarian cancer often metastasizes, but it is unusual to transfer to the breast as an isolated mass. In particular, it is rare for patients to have breast metastases after 18 years of diagnosis of ovarian cancer. Therefore, accurate identification of ovarian cancer mammary gland metastasis can contribute to the treatment of the disease.

Patient concerns:

This case report shows that an 82-year-old woman was diagnosed with breast metastases from ovarian cancer diagnosed 18 years ago. The patient underwent total uterine attachment, omentum, pelvic lymphadenectomy, pelvic floor tumor reduction, and chemotherapy 18 years ago.

Diagnosis:

The pathological examination revealed metastatic adenocarcinoma. Immunohistochemical (IHC) staining results were negative for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (Her-2), and thyroid transcription factor-1 (TTF-1); and positive for cytokeratin (CK) 5/6, CK7, and CA125.

Interventions:

The patient underwent breast-conserving surgery and sentinel lymph node biopsy because of breast mass in November, 2018.

Outcomes:

Currently, she has been followed for more than 1 month without any signs of recurrence.

Lessons:

Breast metastatic tumors should be distinguished from primary breast tumors to avoid any unnecessary surgery. The correct diagnosis is very important: surgical treatment of patients with secondary breast cancer may be diagnostic and palliative.
HIV-1 subtype diversity, drug resistance, and genetic transmission networks in men who have sex with men with virologic failure in antiretroviral therapy in Sichuan, China, 2011 to 2017
Authors: Yuan Dan , Du Zonglun , Zhou Junmin , Ye Li , Su Ling , Yang Hong , Yuan Fengshun , Li Yiping , Liu Honglu , Zhai Wenwen , Liang Shu , Yang Shujuan
Published: October 2019

This study sought to examine the human immunodeficiency virus type 1 (HIV-1) genetic diversity on drug resistance among men who have sex with men (MSM) with virologic failure in antiretroviral therapy (ART), and investigate linking-associated factors for genetic transmission networks.

Seven hundred and thirty-four HIV-positive MSM with virologic failure in ART were recruited into our study from 2011 to 2017. HIV-1 pol gene sequences were used for phylogenetic and genotypic drug resistance analyses. The drug resistance mutations were determined using the Stanford University HIV Drug Resistance Database. The genetic transmission networks were analyzed for CRF01_AE and CRF07_BC sequences by the genetic distance-based method.

Of 734 subjects, 372 (50.68%) showed drug resistance, in which CRF01_AE and CRF07_BC were the predominating subtypes. Drug resistance more frequently occurred in non-nucleoside reverse transcriptase inhibitors (NNRTIs) treatment (48.64%), and followed by nucleoside reverse transcriptase inhibitors (NRTIs) (36.51%) and PIs (4.03%). The most common drug resistance-associated mutations in protease inhibitors (PIs), NRTIs and NNRTIs were K20I/R, M184V/I and K103N/KN, respectively. For 283CRF01_AE sequences, 64 (22.61%) fell into clusters at a genetic distance of 0.011, resulting in 17 clusters ranging in size from 2 to 16 individuals. For 230 CRF07_BC sequences, 66 (28.69%) were connected to at least one other sequence with 0.005 genetic distances, resulting in 8 clusters ranging in size from 2 to 52 individuals. Individuals who showed drug resistance to ART were less likely to fall into clusters than those who did not. The genetic linkage was robust by the exclusion of sites associated with drug resistance.

CRF01_AE and CRF07_BC were the main strains among MSM with virologic failure in ART, and the drug resistance more frequently occurred in NNRTIs, followed by NRTIs and PIs. Genetic transmission networks revealed a complexity of transmission pattern, suggesting early-diagnosis and in-time intervention among MSM.
Whether article types of a scholarly journal are different in cited metrics using cluster analysis of MeSH terms to display
Authors: Chien Tsair-Wei , Wang Hsien-Yi , Kan Wei-Chih , Su Shih-Bin
Published: October 2019

Background:

Many authors are concerned which types of peer-review articles can be cited most in academics and who were the highest-cited authors in a scientific discipline. The prerequisites are determined by: (1) classifying article types; and (2) quantifying co-author contributions. We aimed to apply Medical Subject Headings (MeSH) with social network analysis (SNA) and an authorship-weighted scheme (AWS) to meet the prerequisites above and then demonstrate the applications for scholars.

Methods:

By searching the PubMed database (pubmed.com), we used the keyword “Medicine” [journal] and downloaded 5,636 articles published from 2012 to 2016. A total number of 9,758 were cited in Pubmed Central (PMC). Ten MeSH terms were separated to represent the journal types of clusters using SNA to compare the difference in bibliometric indices, that is, h, g, and x as well as author impact factor(AIF). The methods of Kendall coefficient of concordance (W) and one-way ANOVA were performed to verify the internal consistency of indices and the difference across MeSH clusters. Visual representations with dashboards were shown on Google Maps.

Results:

We found that Kendall W is 0.97 (χ = 26.22, df = 9, P < .001) congruent with internal consistency on metrics across MeSH clusters. Both article types of methods and therapeutic use show higher frequencies than other 8 counterparts. The author Klaus Lechner (Austria) earns the highest research achievement(the mean of core articles on g = Ag = 15.35, AIF = 21, x = 3.92, h = 1) with one paper (PMID: 22732949, 2012), which was cited 23 times in 2017 and the preceding 5 years.

Conclusion:

Publishing article type with study methodology and design might lead to a higher IF. Both classifying article types and quantifying co-author contributions can be accommodated to other scientific disciplines. As such, which type of articles and who contributes most to a specific journal can be evaluated in the future.
The value of transperineal apical prostate biopsy in predicting urethral/apical margin status after radical prostatectomy
Authors: Dai Jindong , Zhang Xingming , Zhao Jinge , Sun Guangxi , Chen Junru , Liu Jiandong , Tao Ronggui , Zeng Hao , Shen Pengfei
Published: October 2019

Purpose:

To investigate potential preoperative predictors of urethral or apical positive surgical margin (PSM) and the value of apical prostate biopsy in predicting urethral/apical margin status after radical prostatectomy (RP).

Methods:

A total of 531 patients who underwent RP during 2010 to 2017 at West China Hospital were enrolled in this retrospective study. Preoperative and postoperative factors including age, BMI, PSA, clinical T stage and biopsy Gleason score were analyzed. Univariate analysis and logistic regression were used to find out the potential predictive factors for PSM. Two logistic regression models were built to evaluate the role of apical prostate biopsy in predicting urethral/apical margin status.

Results:

The overall PSM rate was about 30.1% (160/531) and 97 of them were reported urethral/apical PSM. The incidence of urethral or apical PSM in patients with positive cores in the apical prostate was higher than those without (23.0% vs 9.9%, P < .001). We further found that the multivariable model with positive apical prostate biopsy could significantly increase the predictive value of urethral or apical PSM status (AUC: 0.744 vs 0.783, P = .016). Our analysis also showed that neo-adjuvant hormone therapy was an independent protective factor for urethral or apical PSM in patients with positive apical prostate biopsy, but not all patients.

Conclusion:

This study revealed the necessity of apical prostate biopsy to predict the risk of apical or urethral PSM. In clinical practice, neo-adjuvant hormone therapy should be given when patients with positive apical prostate biopsy to reduce the presence of PSM, especially patients with high/very high risk prostate cancer.
Low awareness and use of pre-exposure prophylaxis among adolescents and young adults in high HIV and sexual violence prevalence settings
Authors: Ajayi Anthony Idowu , Mudefi Elmon , Yusuf Mohammed Sanusi , Adeniyi Oladele Vincent , Rala Ntombana , Goon Daniel Ter
Published: October 2019

South Africa has adopted pre-exposure prophylaxis (PrEP) as a preventive strategy for populations at-risk for HIV, though uptake is low among adolescents and young adults. We examined the awareness and use of PrEP among adolescents and young adults in the Eastern Cape, South Africa.

This cross-sectional study was conducted between June and November 2018 among 772 adolescents and young adults (aged 16–24 years) selected using stratified random sampling in a South African university. An electronic self-administered questionnaire was used to elicit demographic information, behavioral, family-related characteristics, awareness and use of PrEP. Adjusted and unadjusted logistic regression models were used to examine the predictors of PrEP awareness.

The overall level of PrEP awareness was 18.8%; however, only 1.7% of participants had used PrEP, 7.5% of had seen it, 4.8% knew how much it cost, and 14.8% knew where and how to get it. In the adjusted regression analysis, only adequate family support (AOR: 2.11; CI: 1.47–3.04) and discussions of HIV and sexually transmitted infections with sexual partners (AOR: 1.78; CI: 1.19–2.67) were associated with a higher likelihood of being aware of PrEP.

The level of awareness and use of PrEP is still very low among adolescents and young adults who may need it to prevent HIV infection. Poor awareness of PrEP among adolescents and young adults in high HIV risk settings may limit its use. Thus, concerted efforts are needed to promote awareness and access to PrEP among young South African adults.
The duration of endocrine therapy and breast cancer patients’ survival
Authors: Chang Chuan-Hsun , Huang Chun-Wen , Huang Chien-Ming , Ou Tzu-Chi , Chen Chu-Chieh , Lu You-Min
Published: October 2019

As research progressed, the recommended duration of endocrine therapy for breast cancer patients has been extended from 5 to 10 years. This study aimed to investigate how the duration of endocrine medication and therapy affect survival rate in the real world. By using the National Health Insurance Research Database (NHIRD), this study examined 1002 breast cancer patients newly diagnosed between 2000 and 2005 as research subjects, and conducted follow-up until 2013. Among these subjects, 51 used aromatase inhibitors (AIs), 561 used tamoxifen, and 390 alternated between the use of tamoxifen and AIs. The mean follow-up period in this study was 9.63 years, and the mean duration of taking endocrine medication was 4.04 years. The tamoxifen group had the longest follow-up period (9.87 years), shortest endocrine therapy duration (3.29 years), and best survival rate (86.1%). Patients were divided into 3 groups based on the duration of endocrine therapy: under 2 years, 2 to 5 years, and over 5 years. It was found that patients who received medication for less than 2 years showed the lowest survival rate with statistically significant differences (P < .001). Therefore, the extension of endocrine therapy duration is critical in improving breast cancer patients’ survival rate.
Chinese Version of the Psychological Inflexibility in Pain Scale for Cancer Patients Reporting Chronic Pain
Authors: Xie Chan-Juan , Xu Xiang-Hua , Ou Mei-Jun , Chen Yong-Yi
Published: October 2019

Background

Cancer-related chronic pain is reported by many patients during treatment. There are very few Chinese tools for measuring psychological inflexibility caused by cancer pain, particularly with regard to psychological processes that might influence pain severity and function disorder during cancer treatment.

Objective

To culturally adapt the Psychological Inflexibility in Pain Scale (PIPS) to Chinese cancer patients experiencing chronic pain, including the determination of psychometric properties of the translated PIPS.

Methods

This cross-sectional study included 2 phases: (1) translation and cultural adaptation and (2) determination of psychometric properties of the translated PIPS. In total, 389 cancer patients with several types of cancer experiencing chronic pain enrolled from May to September 2018 at a tertiary cancer hospital in Yuelu District of Hunan Province, China.

Results

The Chinese PIPS version was semantically equivalent to the original. It had a 2-factor structure with satisfactory content validity (content validity index = 0.78–1.00), convergent and discriminant validity (composite reliability and average variance extracted at 0.41–0.89, P < .001), criterion-related validity (r = 0.54 and 0.41, P < .001), Cronbach’s α coefficients (α = .87), and test-retest reliability (0.9 ≤ r ≤ 0.98).

Conclusions

The Chinese PIPS version has been culturally adapted and has strong psychometric properties. The scale is a psychometrically sound assessment of psychological inflexibility that can be used for future studies of pain and pain management for cancer patients.

Implications for Practice

The study provides a vital tool for the psychological management of cancer patients with chronic pain.
An Approach to Recruitment and Retention of Certified Nursing Assistants Using Innovation and Collaboration
Authors: Gion Therese , Abitz Tracey
Published: October 2019

Turnover rates for nursing assistants (NAs) cause considerable financial cost to healthcare organizations and negatively impact the quality of care and patient satisfaction. In 1 organization, a task force was created to focus on NA recruitment and retention. The task force evolved into a committee consisting of NAs representing all inpatient settings, a nursing director and manager, and human resources. Recruitment and retention were evaluated, and collaborative strategies were initiated for improvement in recruiting and retention of the current NA workforce.
Implementation of an Innovative Nurse-Driven Resuscitation Protocol
Authors: Roberts Melanie , Miller Susan A.
Published: October 2019

Creating nurse-driven protocols empower nurses to practice at the top of their scope and provide early interventions. This article describes the development and implementation of an evidence-based, nurse-driven resuscitation protocol for cardiac surgical patients who suffer cardiac arrest using a theoretical framework and leadership-driven process. Readers will gain knowledge of the collaborative process required to develop and implement a complex practice change. Process measures, outcomes, and lessons learned are presented.
Using Six Sigma to Reduce the Utilization of Continuous Observations (1:1) for Safety Precautions
Authors: Voetelink Katherine E. , Trout Heather B. , Murphy Teresa , Rogers Mary , Harris Janelle A. , Ramagnano Sebastian
Published: October 2019

The need for continuous observation (1:1) of patients for safety precautions, including fall risk, elopement risk, confusion, and aggressive behavior, is highly variable, and it is therefore difficult to plan accurate staffing levels. The high variability in determining when 1:1 staffing for safety is indicated, and for how long, leads to resource strain and high cost to the hospital. A multidisciplinary team analyzed current processes for assigning, monitoring, and discontinuing safety 1:1 care for nonsuicidal patients using Six Sigma methodologies. The team implemented a standardized weaning process to reduce the duration of time on continuous observation and a standardized 4-hour reassessment using a behavior observation-tracking tool to validate the continued need for 1:1 coverage. The interventions resulted in reducing average monthly safety 1:1 staffing hours by 25.6% and saving an estimated $142 000 annually across 6 units. Phase 2 of the project integrated the observation-tracking tool and reassessment check-in into the hospital's electronic medical record for improved tracking and documentation.
The Shillam-Clipper Leadership Minimum Demographic Data Set
Authors: Shillam Casey R. , Clipper Bonnie , MacLean Lola
Published: October 2019

OBJECTIVE

The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies.

BACKGROUND

Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes.

METHODS

This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership.

RESULTS

The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection.

CONCLUSION

This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.
Change Over Time in Ratings of New Nurses on the Appraisal of Nursing Practice
Authors: Becker Heather , Ndlovu Chipo , Huang Ya-Ching , Rowin Toni
Published: October 2019

OBJECTIVE

To examine changes in new nurses' competencies across the 1st year of practice.

BACKGROUND

Competency assessment is a challenge for nurse residency programs and often focuses on skills checklists and confidence self-reports. The Appraisal of Nursing Practice, an observational rating based on Quality and Safety in Nursing Education standards, was developed to help evaluate an RN residency program.

METHODS

Preceptors, nurse educators, and/or unit managers from various units rated new nurse residents. Ratings were compared for 353 nurses at 3 points: within the 1st month in the program (T1), at 5 months (T2), and at month 11 (T3).

RESULTS

Competency ratings increased significantly for all subscales from T1 to T2. Ratings continued to increase significantly from T2 to T3, although at a slightly slower rate. Teamwork and evidence-based practice increased the most.

CONCLUSIONS

Future studies should explore factors affecting the trajectory in developing nursing competencies within various settings.
A 3-Tier Chemotherapy Response Score for Ovarian/Fallopian Tube/Peritoneal High-grade Serous Carcinoma
Authors: Lawson Barrett C. , Euscher Elizabeth D. , Bassett Roland L. , Liu Jinsong , Ramalingam Preetha , Zhong YanPing , Fleming Nicole D. , Malpica Anais
Published: October 2019

The chemotherapy response score (CRS) is used to score histopathologic response to neoadjuvant chemotherapy (NACT) of patients with extrauterine high-grade serous carcinoma. This study was undertaken to determine if the CRS in the omentum, adnexa or when combined correlates with (1) progression-free survival (PFS) or overall survival (OS), (2) laparoscopic score of abdominal disease, (3) Cancer antigen 125 levels, (4) BRCA status, and (5) platinum-resistant disease. A total of 158 cases were retrospectively collected that received NACT between April 2013 and February 2018 at a single institution. The 3-tier Böhm CRS system was applied to the omentum and adnexa. Survival outcomes between scored subgroups were analyzed using Cox proportional hazards regression. Spearman rank correlation analyses were used to assess CRS and clinical data. A total of 119 cases were treated only with carboplatin/paclitaxel. Omental CRS was: 1 (23 cases, 19.3%), 2 (65 cases, 54.6%), and 3 (31 cases, 26.1%), whereas adnexal CRS was: 1 (50 cases, 42%), 2 (48 cases, 40.3%) and 3 (21 cases, 17.6%). The omental CRS was significantly associated with PFS as a 2-tier score (hazard ratio [HR]=0.612, 95% confidence interval [CI]: 0.378-0.989, P=0.045) but not associated with the PFS using the 3-tier score or with OS using either system. Adnexal CRS was not associated with OS but was significantly associated with PFS using the 3-tier (HR=0.49, 95% CI: 0.263-0.914, P=0.025) and 2-tier scores (HR=0.535, 95% CI: 0.297-0.963, P=0.037). The combined score was not associated with OS but was significantly associated with PFS using the 3-tier (HR=0.348, 95% CI: 0.137-0.88, P=0.026) and 2-tier scores (HR=0.364, 95% CI: 0.148-0.896, P=0.028). No CRS system used associated with laparoscopic assessment of disease. CRS in the omentum had no significant association with platinum resistance; however, the adnexal CRS 1/2 were 3 times as likely to develop platinum resistance compared with CRS 3 (relative risk=3.94, 95% CI: 1.03-15.09, P=0.046). The CRS, when used on the omentum, adnexa, and as a combined score, was significantly associated with PFS but not with OS. Adnexal CRS 1/2 are more likely to develop platinum-resistant disease. Therefore, the use of this pathology parameter may be useful for clinical management.
Malignant Gastrointestinal Neuroectodermal Tumor
Authors: Chang Bin , Yu Lin , Guo Wen-Wen , Sheng Wei-Qi , Wang Lei , Lao Iweng , Huang Dan , Bai Qian-Ming , Wang Jian
Published: October 2019

A malignant gastrointestinal neuroectodermal tumor (GNET) is rare, and it is therefore yet to be completely understood. This study aimed to present the clinicopathologic features of GNET, including treatment information. We included 19 patients with GNET with a mean tumor size of 4.2 cm. The most common site of tumor origin was the small intestine (57.9%), followed by the stomach (15.8%), colon (10.5%), ileocecal junction (5.3%), lower esophagus (5.3%), and anal canal (5.3%). Microscopically, the tumors were composed of epithelioid cells with eosinophilic or clear cytoplasm arranged in nest, sheet-like, papillary, or pseudoalveolar patterns and/or spindle tumor cells with eosinophilic cytoplasm arranged in a fascicular pattern. Immunohistochemically, the tumor cells stained positively for S100 (19/19,100%), SOX10 (14/15, 93.3%), vimentin (17/17, 100%), synaptophysin (Syn) (7/17, 41.2%), CD56 (4/13, 30.8%), CD99 (1/5, 20%), and CD117 (1/15, 6.7%), and negatively for HMB45, Melan A, DOG1, CD34, AE1/AE3, CAM5.2, chromogranin A, smooth muscle actin, and desmin. In total, 14/15 (93.3%) cases showed split Ewing sarcoma breakpoint region 1 gene (EWSR1) signals consistent with a chromosomal translocation involving EWSR1. Within a mean follow-up of 29.7 months (range: 3 to 63 mo), 2/15 (13.3%) patients died of disease, 5 (33.3%) were alive with disease, and 8 (53.3%) had no evidence of disease. Two and 1 patients showed partial response to apatinib and anlotinib, respectively. In conclusion, GNET has distinctive morphologic, immunohistochemical, and molecular genetic features and should be distinguished from other gastrointestinal tract malignancies. Apatinib and anlotinib might be effective for the treatment of advanced GNET and could prolong patient survival.
Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression
Authors: Foster Caroline , Ayers Sara , Mcdonald Susan , Frize Graham , Chhabra Srishti , Pasvol Thomas Joshua , Fidler Sarah
Published: October 2019

Objective:

Adolescence is the only age group globally where HIV-associated mortality is rising, with poorer outcomes at all stages of the care cascade compared with adults. We examined post transition outcomes for young adults living with perinatal HIV.

Design:

Retrospective cohort analysis.

Setting:

A tertiary Youth Friendly Service London, UK.

Participants:

A total of 180 young adults living with perinatal HIV registered between 1 January 2006 and 31 December 2017 contributed 921 person-years of follow-up post transition to adult services.

Intervention:

Youth Friendly Service with multidisciplinary care and walk-in access.

Main outcome measures:

Mortality, morbidity, retention in care, antiretroviral therapy (ART) uptake and HIV-viral load suppression. Crude incidence rates are reported per 1000 person-years.

Results:

Of 180 youth registered, four (2.2%) died, 14 (7.8%) transferred care and four (2.2%) were lost to follow-up. For the 158 retained in care, the median age was 22.9 years [interquartile ranges (IQR) 20.3–25.4], 56% were female, 85% Black African, with a median length of follow-up in adult care of 5.5 years (IQR 2.9–7.3). 157 (99.4%) ever received an ART prescription, 127/157 (81%) with a latest HIV-viral load less than 200 copies RNA/ml, median CD4+ cell count of 626 cells/μl (IQR 441–820). The all-cause mortality was 4.3/1000 person-years [95% confidence interval (CI) 1.2–11.1], 10 fold the aged-matched UK HIV-negative population [0.43/1000 person-years (95% CI 0.41–0.44)]. Post transition, 17/180 (9.4%) developed a new AIDS diagnosis; crude incidence rates 18.5/1000 person-years (95% CI 10.8–29.6).

Conclusion:

While this youth-friendly multidisciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared with the general UK population.
Vitamin E is an effective treatment for nonalcoholic steatohepatitis in HIV mono-infected patients
Authors: Sebastiani Giada , Saeed Sahar , Lebouche Bertrand , de Pokomandy Alexandra , Szabo Jason , Haraoui Louis-Patrick , Routy Jean-Pierre , Wong Philip , Deschenes Marc , Ghali Peter , Klein Marina
Published: October 2019

Objective:

HIV-infected patients are at increased risk of nonalcoholic steatohepatitis (NASH). Vitamin E is recommended for treatment of NASH in the general population. However, its safety and efficacy among HIV-infected patients remain unknown.

Design:

Single-centre, phase IV, open-label, single arm clinical trial.

Methods:

HIV mono-infected patients without significant alcohol intake or viral hepatitis coinfection were included. The diagnosis of NASH was based on the co-existence of fatty liver, diagnosed by controlled attenuation parameter (CAP) at least 248 dB/m and significant hepatocyte apoptosis, defined by the serum biomarker cytokeratin 18 (CK-18) greater than 130.5 U/L. Participants were treated with 800 IU daily of oral vitamin E (alpha-tocopherol) for 24 weeks, and followed for an additional 24 weeks postdiscontinuation. Generalized linear mixed effects models were used to evaluate changes in alanine aminotransferase (ALT), CAP and CK-18 at the completion of treatment and end of follow-up, controlling for pretreatment trends.

Results:

A total of 27 patients were included. Four (15%) had a pretreatment liver biopsy, which confirmed the diagnosis of NASH in all cases. Compared with baseline, 24 weeks of vitamin E treatment improved ALT [−27 units/l; 95% confidence interval (CI) −37 to −17], CAP scores (−22 dB/m; 95% CI −42 to −1) and CK-18 (−123 units/l; 95% CI −201 to −46). Conversely, there was no change in BMI. No serious adverse event was reported and no patient was lost to follow-up.

Conclusion:

In this first clinical trial, we showed that vitamin E is an effective and well tolerated treatment for NASH in HIV-infected patients.
Impact of Significant Coronary Artery Calcification Reported on Low-Dose Computed Tomography Lung Cancer Screening
Authors: Mendoza Dexter P. , Kako Bashar , Digumarthy Subba R. , Shepard Jo-Anne O. , Little Brent P.
Published: October 2019

Background:

Coronary artery calcification (CAC) is a common and important incidental finding in low-dose computed tomography (LDCT) performed for lung cancer screening (LCS). The impact of these incidental findings on patient management is unclear.

Purpose:

The goals of our study were to determine the impact of reporting CAC on patient management and to determine whether standardized reporting of CAC affects the likelihood of future interventions.

Methods:

In this IRB-approved retrospective study, we queried our LCS database for reports of LDCT performed between January 2016 and September 2018. All reports with significant findings of CAC designated with the letter “S” for any Lung-RADS category were selected. The grading of CAC was extracted from the reports. Medical records were reviewed for each patient to determine demographics, clinical history, medications, and cardiac-related diagnostic and interventional procedures. The changes in management after the report of significant CAC on LDCT were documented. Statistical analysis with Student t test and Pearson χ2 test was performed.

Results:

A total of 756/3110 patients (mean age: 67±6.4 y; M=466, 61.6%: F=290, 38.4%) were reported to have significant CAC on LDCT for LCS. Of them, 236/756 patients (31.2%) had established coronary artery disease (CAD) at baseline, before the initial LDCT. A change in management was observed in 155/756 patients (20.5%). The most common changes in management included the following: alteration in medication regimen (n=114/155, 73.5%), stress testing (n=65/155, 41.9%), and referral to a cardiologist (36/155, 23.2%). Percutaneous coronary intervention (4, 2.6%) and surgery (3, 1.9%) were uncommon. Changes in management were more common in those without established CAD and in those whose CAC was semiquantitatively graded (35% vs. 25%, P=0.02).

Conclusion:

CAC is a common significant finding in LDCT for LCS. Reporting of CAC in patients with nonestablished CAD and semiquantitative assessment resulted in changes in management.
Elective Surgery for Diverticulitis and the Risk of Recurrence and Ostomy
Authors: Thornblade Lucas W. , Simianu Vlad V. , Davidson Giana H. , Flum David R.
Published: October 2019

Objective:

To assess the comparative risk of recurrence and ostomy after elective resection or medical therapy for uncomplicated diverticulitis, incorporating outpatient episodes of recurrence.

Background:

While surgeons historically recommended colon resection for uncomplicated diverticulitis to reduce the risk of recurrence or colostomy, no prior studies have quantified this risk when considering outpatient episodes of disease. It remains to be determined whether surgery actually decreases those risks.

Methods:

Retrospective cohort study employing an adjusted time-to-event analysis to assess the relationship of medical or surgical treatment with diverticulitis recurrence and/or receipt of an ostomy. Subjects were adults with ≥1 year continuous enrollment treated for ≥2 episodes of uncomplicated diverticulitis from a nationwide commercial claims dataset (2008–2014).

Results:

Of 12,073 patients (mean age 56 ± 14 yr, 59% women), 19% underwent elective surgery and 81% were treated by medical therapy on their second treatment encounter for uncomplicated diverticulitis. At 1 year, patients treated by elective surgery had lower rates of recurrence (6%) versus those treated by medical therapy (32%) [15% vs 61% at 5 years, adjusted hazard ratio 0.17 (95% confidence interval: 0.15–0.20)]. At 1 year, the rate of ostomy after both treatments was low [surgery (inclusive of stoma related to the elective colectomy), 4.0%; medical therapy, 1.6%].

Conclusions:

Elective resection for uncomplicated diverticulitis decreases the risk of recurrence, still 6% to 15% will recur within 5 years of surgery. The risk of ostomy is not lower after elective resection, and considering colostomies related to resection, ostomy prevention should not be considered an appropriate indication for elective surgery.
A Decade of Damage Control Resuscitation
Authors: Cole Elaine , Weaver Anne , Gall Lewis , West Anita , Nevin Daniel , Tallach Rosel , O’Neill Breda , Lahiri Sumitra , Allard Shubha , Tai Nigel , Davenport Ross , Green Laura , Brohi Karim
Published: October 2019

Objective:

The aim of this study was to identify the effects of recent innovations in trauma major hemorrhage management on outcome and transfusion practice, and to determine the contemporary timings and patterns of death.

Background:

The last 10 years have seen a research-led change in hemorrhage management to damage control resuscitation (DCR), focused on the prevention and treatment of trauma-induced coagulopathy.

Methods:

A 10-year retrospective analysis of prospectively collected data of trauma patients who activated the Major Trauma Centre's major hemorrhage protocol (MHP) and received at least 1 unit of red blood cell transfusions (RBC).

Results:

A total of 1169 trauma patients activated the MHP and received at least 1 unit of RBC, with similar injury and admission physiology characteristics over the decade. Overall mortality declined from 45% in 2008 to 27% in 2017, whereas median RBC transfusion rates dropped from 12 to 4 units (massive transfusion rates from 68% to 24%). The proportion of deaths within 24 hours halved (33%–16%), principally with a fall in mortality between 3 and 24 hours (30%–6%). Survivors are now more likely to be discharged to their own home (57%–73%). Exsanguination is still the principal cause of early deaths, and the mortality associated with massive transfusion remains high (48%). Late deaths are now split between those due to traumatic brain injury (52%) and multiple organ dysfunction (45%).

Conclusions:

There have been remarkable reductions in mortality after major trauma hemorrhage in recent years. Mortality rates continue to be high and there remain important opportunities for further improvements in these patients.
Effects of Intraoperative Fluid Balance During Liver Transplantation on Postoperative Acute Kidney Injury: An Observational Cohort Study
Authors: Carrier François Martin , Chassé Michaël , Sylvestre Marie-Pierre , Girard Martin , Legendre-Courville Lancelot , Massicotte Luc , Bilodeau Marc
Published: October 2019

Background.

Liver transplant recipients suffer many postoperative complications. Few studies evaluated the effects of fluid management on these complications. We conducted an observational cohort study to evaluate the association between intraoperative fluid balance and postoperative acute kidney injury (AKI) and other postoperative complications.

Methods.

We included consecutive adult liver transplant recipients who had their surgery between July 2008 and December 2017. Our exposure was intraoperative fluid balance, and our primary outcome was the grade of AKI at 48 hours after surgery. Our secondary outcomes were the grade of AKI at 7 days, the need for postoperative renal replacement therapy, postoperative red blood cell transfusions, time to first extubation, time to discharge from the intensive care unit (ICU), and 1-year survival. Every analysis was adjusted for potential confounders.

Results.

We included 532 transplantations in 492 patients. We observed no effect of fluid balance on either 48-hour AKI, 7-day AKI, or on the need for postoperative renal replacement therapy after adjustments for confounders. A higher fluid balance increased the time to ICU discharge, and increased the risk of dying (hazard ratio = 1.21 [1.04,1.40]).

Conclusions.

We observed no association between intraoperative fluid balance and postoperative AKI. Fluid balance was associated with longer time to ICU discharge and lower survival. This study provides insight that might inform the design of a clinical trial on fluid management strategies in this population.
Long-term Graft Survival and Graft Function Following Pregnancy in Kidney Transplant Recipients: A Systematic Review and Meta-analysis
Authors: van Buren Marleen C. , Schellekens Anouk , Groenhof T. Katrien J. , van Reekum Franka , van de Wetering Jacqueline , Paauw Nina D. , Lely A. Titia
Published: October 2019

Background.

The incidence of pregnancy in kidney transplantation (KT) recipients is increasing. Studies report that the incidence of graft loss (GL) during pregnancy is low, but less data are available on long-term effects of pregnancy on the graft.

Methods.

Therefore, we performed a meta-analysis and systematic review on GL and graft function, measured by serum creatinine (SCr), after pregnancy in KT recipients, stratified in years postpartum. Furthermore, we included studies of nulliparous KT recipients.

Results.

Our search yielded 38 studies on GL and 18 studies on SCr. The pooled incidence of GL was 9.4% within 2 years after pregnancy, 9.2% within 2–5 years, 22.3% within 5–10 years, and 38.5% >10 years postpartum. In addition, our data show that, in case of graft survival, SCr remains stable over the years. Only within 2 years postpartum, Δ SCr was marginally higher (0.18 mg/dL, 95%CI [0.05-0.32], P = 0.01). Furthermore, no differences in GL were observed in 10 studies comparing GL after pregnancy with nulliparous controls. Systematic review of the literature showed that mainly prepregnancy proteinuria, hypertension, and high SCr are risk factors for GL.

Conclusions.

Overall, these data show that pregnancy after KT has no effect on long-term graft survival and only a possible effect on graft function within 2 years postpartum. This might be due to publication bias. No significant differences were observed between pre- and postpartum SCr at longer follow-up intervals.
Clinical Presentation of Sporadic Creutzfeldt-Jakob Disease in Han-Chinese
Authors: Chen Shuai , He Shuang , Xu Yin-Yan , Teng Hai-Ying , Zhang Jie-Wen
Published: October 2019

The clinical presentation in Chinese patients with sporadic Creutzfeldt-Jakob disease (sCJD) may be unique due to the big difference in the codon 129 polymorphism of the prion protein gene (PRNP). This study retrospectively reviewed 26 cases of sCJD diagnosed in a single center in recent years. All 26 sCJD patients received brain magnetic resonance imaging scan, cerebrospinal fluid 14-3-3 protein detection, electroencephalogram, and PRNP gene screening. The codon 129 polymorphism were all homozygous MM in 26 sCJD patients. The main onset symptoms of sCJD patients were rapidly progressive dementia, visual impairment, and cerebellar ataxia. At the time of diagnosis, the incidence of myoclonus and akinetic mutism were relatively low (<50%). For auxiliary examinations, the positive rate of the typical magnetic resonance imaging (MRI) abnormalities, cerebrospinal fluid 14-3-3 protein, and electroencephalogram-periodic sharp wave complex was 96%, 64%, and 50%, respectively. As MM genotype is dominant and brain MRI is sensitive, brain MRI seems to play a major role in diagnosis of sCJD in Chinese.
Fluid dynamics of cerebrospinal fluid flow in perivascular spaces
Authors: Thomas John H.
Published: October 2019

The flow of cerebrospinal fluid along perivascular spaces (PVSs) is an important part of the brain’s system for delivering nutrients and eliminating metabolic waste products (such as amyloid-β); it also offers a pathway for the delivery of therapeutic drugs to the brain parenchyma. Recent experimental results have resolved several important questions about this flow, setting the stage for advances in our understanding of its fluid dynamics. This review summarizes the new experimental evidence and provides a critical evaluation of previous fluid-dynamic models of flows in PVSs. The review also discusses some basic fluid-dynamic concepts relevant to these flows, including the combined effects of diffusion and advection in clearing solutes from the brain.