bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis
Authors: Meyer Nicholas , Faulkner Sophie M , McCutcheon Robert A , Pillinger Toby , Dijk Derk-Jan , MacCabe James H
Published: February 2020

Background

Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia and compare them with those in interepisode bipolar disorder.

Methods

EMBASE, Medline, and PsycINFO were searched for case–control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardized and absolute mean differences between patients and controls were quantified using Hedges’ g, and patient–control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect sizes between disorders.

Results

Thirty studies reporting on 967 patients and 803 controls were included. Compared with controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference [minutes] [95% confidence interval {CI}] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (mean difference = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (standardized mean difference [95% CI] = −0.86 [−1.22, −0.51] and −0.75 [−1.20, −0.29]). Effect sizes were significantly greater in schizophrenia compared with the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude.

Conclusions

In both disorders, longer overall sleep duration, but also disturbed initiation, continuity, and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes and advocate for further development of transdiagnostic interventions that target them.
Resting-state brain network topological properties and the correlation with neuropsychological assessment in adolescent narcolepsy
Authors: Fulong Xiao , Spruyt Karen , Chao Lu , Dianjiang Zhao , Jun Zhang , Fang Han
Published: February 2020

Study Objectives

To evaluate functional connectivity and topological properties of brain networks, and to investigate the association between brain topological properties and neuropsychiatric behaviors in adolescent narcolepsy.

Methods

Resting-state functional magnetic resonance imaging (fMRI) and neuropsychological assessment were applied in 26 adolescent narcolepsy patients and 30 healthy controls. fMRI data were analyzed in three ways: group independent component analysis and a graph theoretical method were applied to evaluate topological properties within the whole brain. Lastly, network-based statistics was utilized for group comparisons in region-to-region connectivity. The relationship between topological properties and neuropsychiatric behaviors was analyzed with correlation analyses.

Results

In addition to sleepiness, depressive symptoms and impulsivity were detected in adolescent narcolepsy. In adolescent narcolepsy, functional connectivity was decreased between regions of the limbic system and the default mode network (DMN), and increased in the visual network. Adolescent narcolepsy patients exhibited disrupted small-world network properties. Regional alterations in the caudate nucleus (CAU) and posterior cingulate gyrus were associated with subjective sleepiness and regional alterations in the CAU and inferior occipital gyrus were associated with impulsiveness. Remodeling within the salience network and the DMN was associated with sleepiness, depressive feelings, and impulsive behaviors in narcolepsy.

Conclusions

Alterations in brain connectivity and regional topological properties in narcoleptic adolescents were associated with their sleepiness, depressive feelings, and impulsive behaviors.
Expression of the Tas1r3 and Pept1 genes in the digestive tract of wagyu cattle
Authors: Fan Weihong , Saito Shoichiro , Matsumura Shuichi
Published: February 2020

Animals have precise recognition systems for amino acids and peptides that regulate their feeding behavior as well as metabolic responses. Because of their particular gastrointestinal structure, ruminants are expected to have unique mechanisms of amino acid regulation in the digestive tract. To better understand these mechanisms in the ruminant digestive tract, the expression of Tas1r3 and Pept1 was studied along the gastrointestinal tract of Japanese Black cattle through quantitative RT-PCR and immunohistochemistry. Tas1r3 mRNA was detected ubiquitously along the gastrointestinal tract, and the most predominant expression was observed in the reticulum. In addition, the presence of Tas1r3 receptor was confirmed in the rumen through immunohistochemistry. The expression level of Pept1 mRNA was higher in the forestomach (rumen, reticulum, and omasum) and small intestine (duodenum) than that in the tongue, and predominant expression was observed in the rumen. By contrast, a negligible amount of Pept1 mRNA was detected in the abomasum and large intestine. Further studies on the roles of Tas1r3 and Pept1 in the digestive tract, in particular, in the four components of the stomach, will help us to understand the mechanisms of amino acids regulation in ruminants and provide the basis for formulating cattle diets to improve the health and productivity of cattle.
Asymmetric Expression of Wnt/B-catenin Pathway in AIS
Authors: Xu Leilei , Dai Zhicheng , Xia Chao , Wu Zhichong , Feng Zhenhua , Sun Xu , Liu Zhen , Qiu Yong , Cheng Jack Chun-Yiu , Zhu Zezhang
Published: February 2020

Study Design.

A prospective case-control study.

Objectives.

To investigate whether the asymmetric changes are primary or secondary to spinal deformity.

Summary of Background Data.

Previous study reported significantly decreased expression ofWnt/B-cateninpathway in adolescent idiopathic scoliosis (AIS) patients. To date, there is a lack of study investigating the relationship between differentially expressedWnt/B-cateninpathway and the onset of the curve.

Methods.

Paraspinal muscles were collected from 40 female AIS patients and 20 age-matched congenital scoliosis (CS) patients. For CS patients, the samples were collected from the concave side and the convex side at the apical region. For AIS patients, the samples were collected from the proximal bilateral sides of the spine in addition to the apical region. qPCR and western blot were used to determine the expression ofLBX1,B-catenin, andPAX3, all of which are regulated by theWnt/B-cateninpathway. The relative mRNA expression level between the concave and the convex side was performed with the Studentttest. Pearson correlation analysis was used to determine the relationship between gene expression and the curve magnitude.

Results.

AIS patients were found to have remarkably lower mRNA and protein expression ofB-catenin,LBX1,andPAX3in the concave side than in the convex side at the apical region. By contrast, at the proximal region, the mRNA expression of these three genes was comparable. Moreover, no significant difference regarding mRNA expression was found between the concave side and the convex side of CS patients. There was no remarkable correlation between the mRNA expression of the three genes and Cobb angle.

Conclusion.

There exists remar kably asymmetric expression ofWnt/B-cateninpathway at the apical region of AIS, which however was comparable at the apical region of CS patients. Further investigation ofWnt/B-cateninsignaling pathway may help reveal the etiology of AIS in future study.

Level of Evidence:4
Prognostic Factors in the New Katagiri Scoring System After Palliative Surgery for Spinal Metastasis
Authors: Kobayashi Kazuyoshi , Ando Kei , Nakashima Hiroaki , Sato Koji , Kanemura Tokumi , Yoshihara Hisatake , Hirasawa Atsuhiko , Kato Fumihiko , Ishiguro Naoki , Imagama Shiro
Published: February 2020

Study Design.

Retrospective study.

Objective.

The purpose of the study was to examine survival after surgery for a metastatic spinal tumor using prognostic factors in the new Katagiri score.

Summary of Background Data.

Surgery for spinal metastasis can improve quality of life and facilitate treatment of the primary cancer. However, choice of therapy requires identification of prognostic factors for survival, and these may change over time due to treatment advances. The new Katagiri score for the prognosis of skeletal metastasis includes classification of the primary tumor site and the effects of chemotherapy and hormonal therapy.

Methods.

The subjects were 201 patients (127 males, 74 females) who underwent surgery for spinal metastases at six facilities in the Nagoya Spine Group. Age at surgery, gender, follow-up, metastatic spine level, primary cancer, new Katagiri score (including primary site, visceral metastasis, laboratory data, performance status (PS), and chemotherapy) and survival were obtained from a prospectively maintained database.

Results.

Posterior decompression (n = 29) and posterior decompression and fixation with instrumentation (n = 182) were performed at a mean age of 65.9 (range, 16–85) years. Metastasis was present in the cervical (n = 19, 10%), thoracic (n = 155, 77%), and lumbar (n = 26, 13%) spine, and sacrum (n = 1, 1%). In multivariate analysis, moderate growth (HR 2.95, 95% CI, 1.27–7.89, P < 0.01) and rapid growth (HR 4.71, 95% CI, 2.78–12.31, P < 0.01) at the primary site; nodular metastasis (HR 1.53, 95% CI, 1.07–3.85, P < 0.01) and disseminated metastasis (HR 2.94, 95% CI, 1.33–5.42, P < 0.01); and critical laboratory data (HR 3.15, 95% CI, 2.06–8.36, P < 0.01), and poor PS (HR 2.83, 95% CI, 1.67–4.77, P < 0.01) were significantly associated with poor survival.

Conclusion.

Accurate prognostic factors are important in deciding the treatment strategy in patients with spinal metastasis, and our identification of these factors may be useful for these patients.

Level of Evidence: 3
Classification and Surgical Treatment of Developmental Spinal Canal Stenosis at Atlas Level
Authors: Wang Jianhua , Zhu Changrong , Li Hongji , Xiao Zhaoming , Ma Xiang yang , Wu Zenghui , Ai Fuzhi , Xia Hong
Published: February 2020

Study Design.

A retrospective study.

Objective.

Investigate the diagnosis and surgery strategy for treatment of development spinal canal stenosis (DSSA) at atlas plane based on computerized tography (CT) image characters.

Summary of Background Data.

The occurrence of spinal canal stenosis in the atlas plane is relatively rare compared with lower cervical.

Methods.

Fifteen patients diagnosed with DSSA were included from 2014 to 2018. They are divided into four subgroups based on the character of CT images: group I (small size atlas), group II (hypertrophy of posterior arch of the atlas [PAA]), group III (incurved of PAA), and group IV (hypertrophy odontoid).

Results.

There are type I 7, type II 3, type III 2, and group IV 3 in the 15 cases. All the patients received different surgery procedures respectively: (1) posterior arch osteotomy were performed for group I/III//IV without atlantoaxial dislocation, (2) posterior arch resect and replantation were performed for group II, (3) occipital cervical fixation and fusion were added to the patients with associated atlantoaxial dislocation (AAD), (4) a new method of odontoid reduce and atlantoaxial fixation by transoral approach were performed for group IV with associated AAD. All cases underwent surgery successfully which included posterior occipitocervical fixation (OCF) + posterior arch resection (PAR) eight cases, PAR four cases, posterior arch remodeling and re-implantation (PARR) two cases, and Dens remodeling + trans-oral anterior reduction and plate fixation (DR+TARP) one case without severe complications. All patients show different improvement in the symptoms. Japanese orthopaedic association score improved from 9.2 to 14.7 in 1 year follow-up.

Conclusion.

DSSA could be easily diagnosed and divided into four subgroups according to the character of CT image, corresponding surgery strategy could receive a fine clinical result.

Level of Evidence: 4
Research progress on myocardial regeneration: what is new?
Authors: Du Chong , Fan Yi , Li Ya-Fei , Wei Tian-Wen , Wang Lian-Sheng
Published: February 2020

The regeneration capacity of cardiomyocytes (CMs) is retained in neonatal mouse hearts but is limited in adult mouse hearts. Myocardial infarction (MI) in adult hearts usually leads to the loss of large amounts of cardiac tissue, and then accelerates the process of cardiac remodeling and heart failure. Therefore, it is necessary to explore the potential mechanisms of CM regeneration in the neonates and develop potential therapies aimed at promoting CM regeneration and cardiac repair in adults. Currently, studies indicate that a number of mechanisms are involved in neonatal endogenous myocardial regeneration, including cell cycle regulators, transcription factors, non-coding RNA, signaling pathways, acute inflammation, hypoxia, protein kinases, and others. Understanding the mechanisms of regeneration in neonatal CMs after MI provides theoretical support for the studies related to the promotion of heart repair after MI in adult mammals. However, several difficulties in the study of CM regeneration still need to be overcome. This article reviews the potential mechanisms of endogenous CM regeneration in neonatal mouse hearts and discusses possible therapeutic targets and future research directions.
The Evolving Story of Laser Therapeutics for Basal Cell Carcinoma
Authors: Ahluwalia Jusleen , Avram Mathew M. , Ortiz Arisa E.
Published: February 2020

BACKGROUND

The increasing burden from basal cell carcinoma (BCC) has stimulated the development of alternative treatments for these tumors.

OBJECTIVE

This review focuses on upcoming laser treatments for BCC and highlights the limitations of these therapies.

METHODS

A PUBMED search was conducted for articles on laser therapy of BCC. Key studies involving lasers to treat BCC were reviewed. Novel approaches to BCC are also described.

RESULTS

Vascular-specific laser therapy has increasingly been studied as an addition in the therapeutic armamentarium of BCC. Although these studies demonstrate efficacy for nonaggressive BCC, optimization of this technique is ongoing to minimize scarring. A more targeted approach to the treatment of BCC, such as immunized photothermal therapy or laser-assisted chemotherapeutic delivery, may result in less scarring, while maintaining efficacy similar to that of lasers targeting tumor vasculature.

CONCLUSION

Vascular-specific laser therapies show promise in treating low-risk BCC; however, scarring is not an uncommon adverse event. Although only animal studies have been performed to date, laser-activated gold nanoparticle therapy and laser-assisted drug delivery of vismodegib are potential therapies that theoretically confer a more selective approach. Laser modalities demonstrate promise in the treatment of nonaggressive BCC, although long-term studies have yet to be published.
Impact of Cooling on Lowering the Pain Threshold in Patients Undergoing Sclerotherapy
Authors: Coelho Neto Felipe , Souza Bianca R. , Belczak Sergio Q. , de Araujo Walter J.B. , Gomes de Oliveira Rodrigo
Published: February 2020

BACKGROUND

Liquid sclerotherapy is the treatment of choice for telangiectasias. However, pain caused by the procedure is a barrier to treatment adherence by patients.

OBJECTIVE

To evaluate the use of skin cooling for the management of pain in patients undergoing liquid sclerotherapy.

METHODS AND MATERIALS

A total of 230 lower limbs from 115 patients with telangiectasias classified as C1 according to the Clinical-Etiological-Anatomical-Pathophysiological classification were included. Patients underwent liquid sclerotherapy with and without skin cooling during the procedure. Pain was assessed using a visual analog scale, applied immediately after the procedure, according to each lower limb area treated.

RESULTS

Visual analog scale pain scores were significantly lower for sclerotherapy with the use of cooling for pain management during the procedure than for sclerotherapy without cooling both in the thigh and leg (p < .0001).

CONCLUSION

The use of a cooling system is effective in reducing pain in patients undergoing liquid sclerotherapy of telangiectasias, providing more comfort to patients.
A Novel Correction Equation Avoids High-Magnitude Errors in Interpreting Therapeutic Drug Monitoring of Phenytoin Among Critically Ill Patients
Authors: Barra Megan E. , Phillips Kristy M. , Chung David Y. , Rosenthal Eric S.
Published: February 2020

Background:

Phenytoin has a narrow therapeutic index and the potential of under-treatment or toxicity. Available equations are used to correct for the impact of hypoalbuminemia on unbound (free) phenytoin levels. The authors aimed to determine the accuracy of equations used to estimate free phenytoin in hospitalized patients and assess the impact of using additional clinical data.

Methods:

Concurrently measured total and free phenytoin levels in hospitalized patients (2014–2018) were retrospectively evaluated, excluding those from patients on renal replacement therapy and valproic acid. Differences between actual and estimated free phenytoin levels by the original (Original WTZ), Anderson-modified, and Kane-modified Winter–Tozer equations were assessed using Pearson correlations and Bland–Altman analysis. Thereafter, a population-derived formula was developed and validated in a testing cohort.

Results:

In the 4-year training cohort (n = 81), the Original WTZ equation had the smallest mean difference of all equations. A higher mean difference [−0.362 mcg/mL (95% CI −0.585 to −0.138) vs. −0.054 mcg/mL (95% CI −0.186 to 0.078)] was observed in intensive care unit (ICU) patients compared with non-ICU patients. A cross-validated multivariable model improved the accuracy of free phenytoin estimation in ICU and non-ICU patients, even in the separate testing cohort (n = 52) with respective mean differences of −0.322 mcg/mL (95% CI −0.545 to −0.098) and −0.025 mcg/mL (95% CI −0.379 to 0.329) and was superior to the Original WTZ [mean difference −0.858 mcg/mL (95% CI −1.069 to −0.647) vs. −0.106 mcg/mL (95% CI −0.362 to 0.151), respectively].

Conclusions:

Free phenytoin levels in hospitalized patients cannot be accurately determined using available estimation equations, particularly in critically ill patients. Combining ICU status and other available clinical data can improve therapeutic drug monitoring and prevent high-magnitude errors, particularly when free phenytoin assays are not readily available.
Efficacy and safety of ultra-low dose 0.005% estriol vaginal gel for the treatment of vulvovaginal atrophy in postmenopausal women with early breast cancer treated with nonsteroidal aromatase inhibitors: a phase II, randomized, double-blind, placebo-controlled trial
Authors: Hirschberg Angelica Lindén , Sánchez-Rovira Pedro , Presa-Lorite Jesús , Campos-Delgado Miriam , Gil-Gil Miguel , Lidbrink Elisabet , Suárez-Almarza Javier , Nieto-Magro Concepción
Published: February 2020

Objective:

To assess the efficacy and safety of ultra-low dose 0.005% estriol vaginal gel in women with breast cancer receiving nonsteroidal aromatase inhibitors (NSAIs) and experiencing treatment-related vulvovaginal symptoms and signs.

Methods:

Women with hormone receptor-positive early breast cancer receiving NSAIs were randomized to either estriol vaginal gel or placebo for 12 weeks. Vaginal maturation, vaginal pH, and total and individual scores of symptoms and signs of vulvovaginal atrophy were assessed at baseline and at weeks 3 and 12; sexual functioning was also evaluated using the Female Sexual Functioning Index (FSFI) questionnaire, as well as circulating estrogens, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Results:

Sixty-one women with a mean age of 59 years were included: 50 received 0.005% estriol vaginal gel and 11 received placebo. Active treatment significantly improved maturation value and pH, vaginal dryness and global scores of symptoms and signs. Active treatment also increased the total FSFI score and all the FSFI domains, with the exception of pain. Small oscillations were observed in FSH and LH, which remained within the postmenopausal range. Estriol levels increased initially and normalized by week 12, and estradiol and estrone remained mostly undetectable throughout the study.

Conclusions:

Ultra-low dose 0.005% estriol vaginal gel showed efficacy in improving the symptoms and signs of vulvovaginal atrophy. These results, together with minimal oscillations in hormonal levels throughout the treatment, support the use of ultra-low dose 0.005% estriol vaginal gel as a treatment option for vulvovaginal atrophy in women with breast cancer receiving NSAIs with an indication for treatment with vaginal estrogens.

Video Summary:
http://links.lww.com/MENO/A531.
Association between hysterectomy and depression: a longitudinal follow-up study using a national sample cohort
Authors: Choi Hyo Geun , Rhim Chae Chun , Yoon Ji Young , Lee Suk Woo
Published: February 2020

Objectives:

This study investigated the influence of hysterectomy on depression using a national sample cohort from South Korea.

Methods:

We extracted data entered into the Korean Health Insurance data based form 2002 through 2013 and classified patients into a group of women who had undergone a hysterectomy (n = 9,971) and a 1:4 matched control group (n = 39,884). A Cox proportional hazards model was used to analyze the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the risk of depression in the hysterectomy group and the control group. The HR was calculated as the risk of depression in the hysterectomy group compared to that in the control group.

Results:

The incidence of depression in the hysterectomy group was 6.59 per 1,000 person-years and that in the control group was 5.70 per 1,000 person-years. The adjusted HR for depression was 1.15 in the hysterectomy group (95% CI = 1.03-1.29, P < 0.05). In a subgroup analysis, the adjusted HR for depression was 1.16 (95% CI; 1.03-1.31, P = 0.014) for patients who underwent hysterectomy without bilateral salpingo-oophorectomy. In an additional subgroup analysis, the adjusted HR for depression after hysterectomy was 1.18 (95% CI; 1.04-1.35, P = 0.012) in the younger than 50-year-old group.

Conclusion:

The incidence of depression was higher in women who underwent hysterectomy than in the matched control group.
The Effect of Auricular Acupressure on Sleep Disturbance Among Patients With Leukemia
Authors: Liu Xiao-Rong , Rana Nicole , Wong Ng-Shin , James Chabu , Lu Jue , Xu Xiao
Published: February 2020

Auricular acupressure (AA) is widely used in East Asia and Europe to manage patients with sleep disturbance. This feasibility study was performed to demonstrate the potential of AA for sleep disturbance in patients with leukemia. Thirty-two patients with leukemia with poor sleep quality received AA 3 times a day for a total of 4 weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality at baseline, at a 2-week intervention, and after a 4-week intervention. Compared with baseline scores, PSQI scores and the use of sleep medicine were significantly improved at week 2 and week 4 (P< .05). As a potential safety therapy, AA could be an alternative or complementary intervention to improve sleep quality for patients with leukemia with sleep disturbance.
INTRAOCULAR AND INTEROCULAR DIFFERENCES IN PARAFOVEAL VASCULAR DENSITY IN DIABETIC PATIENTS WITHOUT DIABETIC RETINOPATHY
Authors: Kim Yong-Kyu , An Yerim , Park Sung Pyo
Published: February 2020

Purpose:

To evaluate the associations among optical coherence tomography angiography–measured vascular density (VD), intraocular and interocular VD differences, and clinical factors in diabetic patients without diabetic retinopathy.

Methods:

We retrospectively reviewed 94 Type 2 diabetic patients without diabetic retinopathy who had undergone optical coherence tomography angiography. Vascular density and vessel skeleton density were measured in a 3-mm central zone in the total capillary plexus, superficial capillary plexus, deep capillary plexus (DCP), and choriocapillaris layers. Intraocular VD difference was determined between the superior and inferior zones, while interocular VD difference was determined between both eyes of the patient. Associations between optical coherence tomography angiography parameters and clinical factors were evaluated.

Results:

Vascular density and intraocular and interocular VD differences were significantly associated with signal strength of the image, which was related with age and lens opacity. In multivariate analysis, diabetes duration was negatively associated with skeleton density in total capillary plexus and superficial capillary plexus layers, and positively associated with intraocular VD difference in superficial capillary plexus layer. Estimated glomerular filtration rate was negatively associated with intraocular skeleton density difference in total capillary plexus layer, interocular VD, and skeleton density differences in total capillary plexus layer.

Conclusion:

Intraocular and interocular VD difference may be an easy and sensitive way to detect subtle early microvascular changes in diabetic patients.
The outbreak of COVID-19: An overview
Authors: Wu Yi-Chi , Chen Ching-Sung , Chan Yu-Jiun
Published: February 2020

In late December 2019, a previous unidentified coronavirus, currently named as the 2019 novel coronavirus#, emerged from Wuhan, China, and resulted in a formidable outbreak in many cities in China and expanded globally, including Thailand, Republic of Korea, Japan, United States, Philippines, Viet Nam, and our country (as of 2/6/2020 at least 25 countries). The disease is officially named as Coronavirus Disease-2019 (COVID-19, by WHO on February 11, 2020). It is also named as Severe Pneumonia with Novel Pathogens on January 15, 2019 by the Taiwan CDC, the Ministry of Health and is a notifiable communicable disease of the fifth category. COVID-19 is a potential zoonotic disease with low to moderate (estimated 2%–5%) mortality rate. Person-to-person transmission may occur through droplet or contact transmission and if there is a lack of stringent infection control or if no proper personal protective equipment available, it may jeopardize the first-line healthcare workers. Currently, there is no definite treatment for COVID-19 although some drugs are under investigation. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms.
Distance of the fracture from the radiocarpal surface in childhood: does it determine surgical technique? A retrospective clinical study
Authors: Jozsa Gergo , Devecseri Gertrud , Vajda Peter , Juhasz Zsolt , Varga Marcell , Juhasz Tamas
Published: February 2020

Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.

The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.

Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.

Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.

Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.
Protective effect of rhubarb combined with ulinastatin for patients with sepsis
Authors: Meng Fulei , Du Chongbo , Zhang Yuxiao , Wang Shunyao , Zhou Qingming , Wu Liping , Wang Yanli , Yang Xiufen
Published: February 2020

Background:

Sepsis is the leading cause of death in critically ill patients. Ulinastatin (UTI), a protease inhibitor, and rhubarb, used as a traditional Chinese medication, are proved to be effective in treating sepsis, but the effect of the combination therapy of these two drugs on sepsis remains unclear. This study aimed to investigate the effect of the combination treatment of UTI and rhubarb on sepsis patients.

Methods:

A total of 75 septic patients were randomly divided into control group, UTI group, Rhubarb group, and UTI plus Rhubarb group. Clinical data and score of Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected; lymphocyte subtypes in the peripheral blood were analyzed before and after the 5-day treatment in the Intensive Care Unit.

Results:

All the therapeutic interventions (UTI alone, rhubarb alone, or UTI plus rhubarb) significantly reduced the levels of C-Reactive protein, white blood cell density, lactic acid, and APACH II scores, and elevated the levels of CD4/CD8, but only UTI plus rhubarb treatment obviously decreased the level of procalcitonin.

Conclusion:

This study suggested that the combination of UTI and rhubarb may be a promising therapeutic scheme to ameliorate sepsis.
Skeletal muscle mass predicts the outcome of nivolumab treatment for non-small cell lung cancer
Authors: Tsukagoshi Mariko , Yokobori Takehiko , Yajima Toshiki , Maeno Toshitaka , Shimizu Kimihiro , Mogi Akira , Araki Kenichiro , Harimoto Norifumi , Shirabe Ken , Kaira Kyoichi
Published: February 2020

Nivolumab, a monoclonal antibody targeting programmed cell death-1, significantly prolongs survival for patients with advanced non-small-cell lung cancer (NSCLC). However, little is known about the value of predictive biomarkers. Hence, we investigated the impact of skeletal muscle (SM) mass loss on clinical outcomes in NSCLC patients undergoing nivolumab treatment. Thirty patients with histologically confirmed NSCLC treated with nivolumab were included in this study. Computed tomography was used to determine SM loss based on the SM index (SMI). The SMI is the cross-sectional area of the bilateral psoas muscles at the third lumbar vertebra, divided by height squared. The cut-off values were defined as 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Among the 30 patients, 13 (43%) had SM loss. There was no significant association between SM loss and immune-related adverse events. The SM loss group had undergone significantly more prior chemotherapy cycles (P = .04). SM loss was significantly associated with fewer nivolumab cycles (P = .01). No patients in the SM loss group achieved a partial response. Patients with SM loss had a significantly shorter progression-free survival period (P = .008) and median overall survival than those with normal SM mass (10 vs 25 months, respectively, P = .03). SM loss was an independent prognostic factor of poor survival. In conclusion, SM loss may be a predictive factor of poor outcomes in NSCLS patients undergoing nivolumab therapy.
Long non-coding RNA HANR as a biomarker for the diagnosis and prognosis of colorectal cancer
Authors: Xu Meng , Guo Xu , Wang Rong-Di , Zhang Zhi-Hang , Jia Yi-Mo , Sun Xu
Published: February 2020

Previous work suggests that the long noncoding RNA HCC associated long non-coding RNA (HANR) is associated with hepatocellular carcinoma (HCC) progression, but its significance in the context of colorectal cancer (CRC) remains to be determined. Therefore, in this study we assessed the prognostic and diagnostic value of HANR in patients suffering from CRC.

The HANR expression in 165 pairs of CRC cancer and adjacent non-cancerous prostate tissues was measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis. Student t test was conducted for intergroup comparison. Pearson correlation test was used for correlation analysis. Survival curves were carried out by the Kaplan-Meier method and evaluated using the log-rank test. Multivariable Cox proportional hazard risk regression model was performed to screen the independent factor affected the prognosis of CRC patients.

In this study, levels of HANR were significantly higher in CRC tumor samples relative to adjacent normal tissue samples (P < .001). A ROC analysis suggested HANR expression could be reliably used to differentiate between normal and CRC tumor tissue. In addition, elevated HANR expression was positively correlated with more advanced and aggressive CRC features, such as a larger tumor size (P = .003), increased invasion depth (P = .012), and more advanced TNM stage (P = .011). Survival analyses revealed that elevated HANR expression was correlated with worse overall survival (P = .002) and disease-free survival (P = .003). A multivariate analysis further confirmed the relevance of HANR as an independent predictor of CRC patient outcomes.

In summary, these results indicate that the lncRNA HANR is a promising prognostic indicator in CRC patients.
Risk factors for the development of aspiration pneumonia in elderly patients with femoral neck and trochanteric fractures
Authors: Higashikawa Toshihiro , Shigemoto Kenji , Goshima Kenichi , Usuda Daisuke , Okuro Masashi , Moriyama Manabu , Inujima Hiromi , Hangyou Masahiro , Usuda Kimiko , Morimoto Shigeto , Matsumoto Tadami , Takashima Shigeki , Kanda Tsugiyasu , Sawaguchi Takeshi
Published: February 2020

Aspiration pneumonia (AP) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of AP in elderly patients with femoral neck fractures.

We recruited 426 patients (age 84.9 ± 7.4 years) with a history of hip surgery carried out at Toyama Municipal Hospital. AP occurred in 18 out of 426 cases (4.23%). Statistical test has found significant differences in age, gender, serum albumin level, and cognitive impairment, between AP and non-AP groups. Subsequently multiple logistic regression analysis was conducted to investigate the risk factors for AP, including age, gender, serum albumin, cognitive impairment, and activities of daily living (ADL). Adjusted odds ratio showed significant differences in age, gender, and serum albumin, whereas no significant differences were found in cognitive impairment and ADL.

This study suggested that serum albumin seemed to be a risk factor for AP but were necessary to assess under adjustment of confounding factors, including age and gender. Monitoring serum albumin level seemed to be important for the postoperative management of AP, especially in elderly patients receiving surgery of femoral neck and trochanteric fractures.
Long-term survival and prognostic implications of patients with invasive breast cancer in southern Taiwan
Authors: Wu Shih-Chung , Chiang Ming-Chu , Lee Yun-Gang , Wang Mei-Wen , Li Chuan-Fang , Tung Tao-Hsin , Chen Hsiao-Hui
Published: February 2020

Our objective in this study was to determine the survival rate of patients with invasive breast cancer and identify the prognostic factors related to all-cause mortality during a 10-year follow-up.

Analysis was performed on the medical records of 2002 patients newly diagnosed with breast cancer at a medical center in southern Taiwan between 2006 and 2017. The Kaplan–Meier method and Cox regression analysis were used to estimate survival and the independence of prognostic factors associated with all-cause mortality.

Among the 2002 patients, 257 expired during the 10-year follow-up period. The overall survival rates were as follows: 3 years (91.1%), 5 years (85.6%), and 10 years (77.9%). The median survival time was 120.41 months (95% confidence interval: 118.48–122.33 months). Older age, pathologic tumor status, regional lymph node metastasis, distant metastasis, grade/differentiation, treatment modalities, and hormone therapy were significantly related to all-cause mortality.

This study identified several clinical factors related to all-cause mortality as well as its relationship to distant metastasis and poor differentiation. Early diagnosis and treatment aimed at preventing recurrence are the keys to survival.
Corneal biomechanical responses detected using corvis st in primary open angle glaucoma and normal tension glaucoma
Authors: Jung Younhea , Park Hae-Young L. , Oh Sieun , Park Chan Kee
Published: February 2020

Structural differences have been reported between primary open angle glaucoma (POAG) and normal tension glaucoma (NTG), and biomechanical differences between POAG and NTG may account for why NTG patients are more vulnerable to lower intraocular pressure (IOP). This study compared the biomechanical properties of POAG and NTG patients using the Corvis scheimpflug technology (ST) non-contact Scheimpflug-based tonometer, and determined the factors associated with these properties.

In this retrospective cross-sectional study, 46 eyes with POAG, 54 eyes with NTG, and 61 control eyes were included. A non-contact Scheimpflug-based tonometer was used to examine and compare the corneal biomechanical responses in the POAG, NTG, and normal groups. We used univariate and multivariate regression analyses to determine the factors associated with the deformation amplitude in each group.

Baseline characteristics, including age, IOP, spherical equivalent, keratometry, axial length, and central corneal thickness, were similar among the 3 groups. Severity of glaucoma, as measured by mean deviation, was similar between POAG and NTG groups. Applanation 1 velocity and deformation amplitude were significantly smaller in POAG (0.13 ± 0.02 and 1.06 ± 0.14, respectively) than NTG (0.14 ± 0.01 and 1.13 ± 0.11, respectively) and normal groups (0.14 ± 0.02 and 1.13 ± 0.10, respectively). Radius of curvature was significantly larger in the POAG group compared to the normal group. In normal controls, IOP and keratometry were significant factors related to deformation amplitude. In POAG eyes, IOP was a statistically significant predictor of deformation amplitude. In NTG eyes, however, IOP , keratometry, and axial length were statistically significant predictors of deformation amplitude.

POAG eyes showed less deformable corneas compared to NTG and normal controls. IOP was significantly correlated with deformation amplitude in all groups. However, axial length was positively correlated with deformation amplitude only in NTG eyes. Characterization of the differences in biomechanical properties between POAG and NTG may contribute to a better understanding of the underlying pathophysiologies associated with these diseases.
Venous thromboembolism prophylaxis in patients hospitalized in medical wards
Authors: Mahlab-Guri Keren , Otman Monged Shaher , Replianski Natalia , Rosenberg-Bezalel Shira , Rabinovich Irina , Sthoeger Zev
Published: February 2020

Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in acutely ill patients hospitalized in medical departments. Thromboprophylaxis with anticoagulants was shown to be safe and effective in medical patients with high risk to develop VTE. Despite guidelines recommendations, the rate of thromboprophylaxis in those patients is low. The objective of the study was to evaluate the rate of VTE risk assessment in routine medical department practice, the rate of eligible patients for thromboprophylaxis, the rate of patients who received thromboprophylaxis, and their outcome.

Medical records of consecutive patients (3000 at 2013, 1000 at 2018) hospitalized in medical department were reviewed, retrospectively, for demographic, clinical characteristics, thromboprophylaxis treatment with enoxaparin and outcome (up to 90 days following discharge). Padua score was used for VTE risk assessment. VTE diagnosis was based on clinical suspicion.

The mean patient's age (52.6% females) was 67.95 ± 21.56 years. 21% were eligible for thromboprophylaxis. Routine VTE risk assessment rate increased significantly following its incorporation into quality parameters, but the rate of treated patients was low (22% at 2013; 46% at 2018). The patients who received thromophylaxis were sicker compared to eligible patients without thromboprophylaxis. The rate of symptomatic VTE was low (0.24%; 0.12% and 0.55% for low and high VTE risk, respectively). Thromboprophylaxis did not have significant effect on the low number of VTE events. No major bleeding was observed.

Major efforts are still needed to increase the rate of thromboprophylaxis in all eligible medical patients according to the guidelines recommendations.
Moxibustion at ‘Danzhong’ (RN17) and ‘Guanyuan’ (RN4) for fatigue symptom in patients with depression
Authors: Iravani Somayeh , Cai Liwei , Ha Lue , Zhou Shuzhe , Shi Chuan , Ma Yibin , Yao Qin , Xu Ke , Zhao Baixiao
Published: February 2020

Background:

Fatigue is one of the most prevalent and debilitating symptoms of major depressive disorder (MDD). The effective management of depression-related fatigue has an important impact on the patient's abilities, functioning, and quality of life (QOL). Moxibustion has been widely used in Traditional Chinese Medicine to manage fatigue. Recent studies have also demonstrated that moxibustion is effective for treating cancer-related fatigue and chronic fatigue syndrome. However, there is not sufficient data supporting the effect of moxibustion for depression-related fatigue. Therefore, this randomized, assessor-blinded, wait-list controlled trial is designed to evaluate the effectiveness, safety, and feasibility of moxibustion treatment for depression-related fatigue.

Methods:

One hundred and seventy-six participants who meet the diagnostic criteria for depression in the International Classification of Diseases, tenth revision (ICD-10), and who also have a score of ≥1 on the 13th item of the Hamilton Depression Rating Scale-17 (HAMD-17), will be enrolled. At study entry, participants will undergo anti-depressant treatment for at least 1 month. Then those who still have a score of ≥1 on the 13th item of the HAMD-17 will be randomly allocated to either a moxibustion group or wait-list control group in a ratio of 1:1. Anti-depressants will be provided for both groups during the whole process of the study period. Participants in the moxibustion group will undergo 14 sessions of moxibustion (over 2 weeks) with anti-depressant treatment, and participants in the wait-list control group will receive only anti-depressant treatment. Subsequently, participants in the moxibustion group will be followed-up for 4 weeks. The primary outcome measure will be the Fatigue Severity Scale (FSS). The secondary outcome measure will be the HAMD-17. Safety will be assessed by monitoring adverse events during the study. Trial feasibility will also be assessed in this study.

Discussion:

The results of this study may provide evidence for the efficacy of moxibustion as an adjunct to antidepressants for depression-related fatigue, and promote a more widespread foundation for the selection of moxibustion in the clinical setting as well as for future research in moxibustion therapy.

Trial registration:

This study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR1800016905).
First-line treatment failure in childhood acute lymphoblastic leukemia
Authors: Zawitkowska Joanna , Lejman Monika , Drabko Katarzyna , Zaucha-Prażmo Agnieszka , Płonowski Marcin , Bulsa Joanna , Romiszewski Michał , Mizia-Malarz Agnieszka , Kołtan Andrzej , Derwich Katarzyna , Karolczyk Grażyna , Ociepa Tomasz , Ćwiklińska Magdalena , Trelińska Joanna , Owoc-Lempach Joanna , Niedźwiecki Maciej , Kiermasz Aleksandra , Kowalczyk Jerzy
Published: February 2020

The aim of this study was to evaluate the risk factors of relapse and treatment-related deaths in acute lymphoblastic leukemia (ALL) in children residing in Poland.

A total of 1872 patients with newly diagnosed ALL, treated according to the ALL IC-BFM 2002 protocol in 14 Polish pediatric hematology centers from 2002 to 2012 were included in the study. Three-hundred eighty-four patients experienced treatment failure. The last follow-up was 31 December, 2016.

Univariate analysis identified factors in each risk group that were significantly different between children whose treatment failed and those who remained in the first remission. Multivariate analysis demonstrated that only the age of 10 years or over at primary diagnosis in the high-risk group was an adverse prognostic factor. To facilitate the analysis, patients were divided into three groups: relapsed children who survived; relapsed children who died; children without relapse who died due to toxicity.

Our analysis showed that age older than 10 years is a particular risk factor for the failure of first-line of treatment, both in terms of relapse and treatment-related mortality.
D-Dimer level was associated with prognosis in metastatic colorectal cancer
Authors: Liu Chan , Ning Yueguo , Chen Xiaoming , Zhu Qian
Published: February 2020

D-dimer level is a direct measure of activated coagulation and has been used as a biomarker of hypercoagulability. In this study, we aimed to explore the associations between D-dimer level and the clinicopathological features and prognosis in metastatic colorectal cancer (mCRC) patients. One hundred seventy-eight patients diagnosed with mCRC from the Department of General Surgery, Jingmen First People's Hospital from September 2014 to December 2018 were collected. Data of coagulation index was evaluated and survival analysis was performed to identify the biomarker of mCRC. Among 178 cases of colorectal cancer, we found that the value of 0.55 mg/L, 5ng/ml and 40U/ml were cut-off values of D-Dimer, CEA and CA-199 for patients survival, respectively. hypercoagulability was much more frequent in patients aged ≥60 years than <60 years (P< .001) and also in patients with ECOG ≥2 points (P < .001). Moreover, those patients who have CEA >5ng/ml and CA-199>40U/ml had hypercoagulable state (P < .001). There was a significant difference in D-Dimer >0.55 mg/L and D-Dimer ≤0.55 mg/L among the number of metastatic sites (P < .01) and patients with comorbidities (P < .01). Survival analysis showed that patients with D-Dimer >0.55 mg/L have significantly unfavorable overall survival (P = .006) and progressive free survival (P = .011).