bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of Zaoren Anshen capsules in the treatment of insomnia
Authors: Chen Bo-Wei , Yi Jian , Sun Bei , Jia Ping , Zhang Wen-Jiang , Liu Bai-Yan
Published: February 2020

Background:

Zaoren Anshen capsules (ZRAS) have been widely used to treat patients with insomnia. However, the efficacy and safety of ZRAS for insomnia treatment is not entirely clear. Therefore, it is necessary to clarify the effect of ZRAS for the treatment of insomnia by a systematic meta-analysis.

Methods:

We searched PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and WanFang databases and performed a manual search to retrieve relevant articles (available through January 2019) describing randomized controlled trials (RCTs) of ZRAS for the treatment of insomnia. The quality of the selected articles was assessed with the Cochrane risk-of-bias tool. A meta-analysis of the selected articles was performed with RevMan 5.3 software.

Results:

A total of 13 articles including 1175 patients were included in the study. Overall, our results showed that ZRAS was slightly higher than that of the conventional Western medicine for insomnia in terms of clinical efficacy rate; but there was no statistical difference between the 2 groups (relative risk [RR] = 1.03, 95% confidence interval [CI] = [0.97, 1.09], P = .34). However, it should be noted that ZRAS treatment causes far fewer adverse reaction than treatment with conventional Western medicine (RR = 0.20, 95% CI = [0.14, 0.28], P < .00001).

Conclusion:

Our results suggested that ZRAS is an effective and safe treatment for insomnia, especially in adverse reaction. However, multi-regional and well-designed RCTs studies are needed in the future to validate the results.
A large nabothian cyst causing chronic urinary retention
Authors: Wu Zhao , Zou Bingyu , Zhang Xun , Peng Xue
Published: February 2020

Rationale:

Nabothian cysts are mucus-filled cervical cysts that are usually asymptomatic unless they become very large. Chronic urinary retention is the persistent inability to empty the bladder despite maintaining an ability to urinate. Chronic urinary retention caused by a large, deep nabothian cyst has not been reported previously.

Patient concerns:

A 46-year-old woman presented with chronic urinary retention and a cervical cyst that gradually increased in size.

Diagnosis:

Based on histopathological evidence, our patient was diagnosed with a nabothian cyst.

Interventions:

A hysterectomy was performed.

Outcomes:

The urinary symptoms of the patient resolved after she performed clean, intermittent self-catheterizations for 5 days after the operation. She was discharged on postoperative day 6.

Lessons:

Large nabothian cysts are rare but may account for some unusual symptoms including unexplained urinary difficulties in women. We recommend treating symptomatic nabothian cysts with local cystectomies or hysterectomies.
Prevalence and predictors of peripherally inserted central venous catheter associated bloodstream infections in cancer patients
Authors: Lee Jae Hwan , Kim Min Uk , Kim Eung Tae , Shim Dong Jae , Kim Il Jung , Byeon Jong Hyun , Kim Hyun Beom
Published: February 2020

Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.

This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.

During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434–53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257–23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082–7.530; P = .019] were associated with PICC-CLABSI.

PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care.
Selective serotonin reuptake inhibitors for functional independence and depression prevention in early stage of post-stroke
Authors: Zhou Shaojiong , Liu Shuo , Liu Xiaoqiang , Zhuang Weiduan
Published: February 2020

Background:

The efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) for functional independence and depression prevention in early stage of post-stroke (within 1 month after stroke onset) are still unclear.

Methods:

Relevant randomized controlled trials (RCTs) comparing early SSRIs therapy with placebo were sought from PubMed, Cochrane Library, Medline, and Embase. Primary outcomes were functional independence and depression occurrence. Secondary outcomes contained the improvement of Fugl-Meyer motor scale (FMMS) score and adverse events. We used fixed or random effects model to pooled effect estimates. And we chose risk ratio (RR) or mean differences (MDs) with the 95% confidence intervals (CIs) for data analysis.

Results:

We included 10 RCTs with total 5370 patients. The outcome of functional independence showed no significant difference between SSRIs and placebo group (RR, 1.28; 95% CI, 0.96–1.72; P = .10; I
2 = 92%). However, depression occurrence differed significantly between these 2 groups, which favored SSRIs group (RR, 0.78; 95% CI, 0.67–0.90; P = .001; I
2 = 23%). In addition, we observed that the side effects of SSRIs were seizure and nausea. Except psychiatric disorders/insanity rate was less in SSRIs group than placebo group (RR, 0.66; 95% CI, 0.48–0.90; P = .009) (I
2 = 0%), other adverse events were revealed non-significant in our meta-analysis.

Conclusions:

Our meta-analysis revealed that early SSRIs therapy were effective to prevent post-stroke depression. However, SSRIs did not improve patient's post-stroke functional independence. In addition to increase the occurrence of seizure and nausea, SSRIs were relatively safe.
The association between methods of biopsy and survival following breast cancer
Authors: Kong Yek-Ching , Bhoo-Pathy Nirmala , O’Rorke Michael , Subramaniam Shridevi , Bhoo-Pathy Nanthini T. , See Mee-Hoong , Jamaris Suniza , Teoh Kean-Hooi , Bustam Anita Z. , Looi Lai-Meng , Taib Nur Aishah , Yip Cheng-Har
Published: February 2020

Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (P
interaction < .001). Following multivariable analysis, excision biopsy was consistently associated with lower risk of mortality compared to FNAC in women receiving adjuvant radiotherapy (adjusted hazard ratio: 0.81, 95%CI: 0.66–0.99), but not in those who did not receive adjuvant radiotherapy (adjusted hazard ratio: 0.87, 95%CI: 0.65–1.17). While the risk of mortality was not different between patients undergoing FNAC and CNB when radiotherapy is administered, in the absence of radiotherapy, CNB was associated with higher risk of mortality than FNAC (adjusted hazard ratio: 1.57, 95%CI: 1.16–2.12). Given that our results contradict with findings of previous clinical studies assessing the prognostic impact of method of biopsy in women with breast cancer, further studies are warranted.
Saliva cortisol, melatonin levels and circadian rhythm alterations in Chinese primary school children with dyslexia
Authors: Huang Yanhong , Xu Chongtao , He Meirong , Huang Wenlong , Wu Kusheng
Published: February 2020

Cortisol is the main end product of hypothalamic-pituitary-adrenal gland (HPA axis), and melatonin (MT) has a regulating effect on HPA axis, and both are closely related to individual behavior and cognitive function. We aimed to evaluate cortisol and MT roles on children dyslexia in this study.

A total of 72 dyslexic children and 72 controls were recruited in this study. Saliva samples were collected in the morning, afternoon, and night, respectively. The levels of saliva cortisol and MT were measured by enzyme-linked immunosorbent assay method. Differences of cortisol and MT levels between dyslexic and normal children were compared, and the variation trend was also analyzed by dynamic monitoring in 3 time points.

The levels of salivary cortisol and MT in children with dyslexia were all lower than those in normal children whether in the morning (7:30-8:30 am ), at afternoon (15:30-16:30 pm ) or at night (21:30-22:30 pm ) (all P < .001). Compared with normal children, the circadian rhythm variations of salivary cortisol and MT in dyslexic children disappeared and became disordered. The salivary cortisol and MT levels in children with dyslexia were declined throughout the day; and the circadian rhythm was disordered or disappeared.

The results suggest that cortisol and MT levels and their circadian rhythm may affect children dyslexia, but the mechanisms need further exploration.
Stent insertion with high-intensity focused ultrasound ablation for distal biliary obstruction secondary to pancreatic carcinoma
Authors: Yang Shu-Ying , Liu Fen , Liu Yi , Xia Feng-Fei , Fu Yu-Fei
Published: February 2020

We determined the clinical effectiveness and long-term outcomes in patients with distal biliary obstruction (DBO) secondary to pancreatic carcinoma (PC) who were treated by self-expanded metallic stent (SEMS) insertion with or without high-intensity focused ultrasound (HIFU) ablation.

From January 2014 to December 2018, consecutive patients with DBO secondary to PC underwent SEMS insertion with or without HIFU ablation in our center. The long-term outcomes were compared between the 2 groups.

During the included period, 75 patients underwent SEMS insertion with (n = 34) or without (n = 41) HIFU ablation in our center. SEMS insertion was successfully performed in all patients. Liver function was significantly improved after SEMS insertion in both groups. An average of 2.9 HIFU treatment sessions per patient were performed. Twenty patients (stent + HIFU group: 7; stent-only group: 13) experienced stent dysfunction (P = .278). The clinical response rate to HIFU ablation was 79.4%. The median stent patency was significantly longer in the stent with HIFU group than in the stent-only group (175 vs 118 days, P = .005). The median survival was significantly longer in the stent with HIFU group compared with the stent-only group (211 versus 136 days, P = .004). An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 (hazard ratio: 0.300; P = .002) and subsequent HIFU ablation (hazard ratio: 0.508; P = .005) were associated with prolonged survival.

HIFU ablation following stent insertion can prolong the stent patency and survival for patients with DBO secondary to PC.
Lower number of plasma exchange sessions and glomerular filtration rate decline are associated with second relapses in patients with myasthenia gravis
Authors: Premuzic Vedran , Bilic Ervina , Sepec Branimir Ivan , Hancevic Mirea , Bilic Hrvoje , Sitas Barbara , Sprljan Alfirev Rujana , Jelakovic Bojan
Published: February 2020

The aims were to determine the impact of dysphagia and glomerular filtration rate (GFR) in the prediction of myasthenia relapse and analyse whether different number of plasma exchange sessions could prolong the time before future relapse.

This was a retrospective, longitudinal follow-up study with 60 enrolled patients. The patients were followed-up for a total of 50 months.

Patients without relapses had significantly higher GFR and higher number of plasma exchange sessions when compared to patients with relapses. Mean time before next myasthenia relapse was significantly longer in patients with GFR ≥ 60 mL/min. Time before next and number of following myasthenia relapses were significantly higher in patients with symptoms of dysphagia.

Decline in GFR levels is strongly associated with the presence of dysphagia and independently impacts the onset of myasthenia relapses. Timely initiation of plasmapheresis therapy and adequate hydration of patients with prolonged dysphagia should be one of the treatment goals for clinicians treating this disease.
Comparison of endoscopic surgery and Lichtenstein repair for treatment of inguinal hernias
Authors: Lyu Yunxiao , Cheng Yunxiao , Wang Bin , Du Weibing , Xu Yueming
Published: February 2020

Background:

This study aimed to identify the best procedure for addressing inguinal hernias by comparing results after transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), and Lichtenstein repairs using a network meta-analysis.

Methods:

We conducted a systematic search of MEDLINE, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov up to September 1, 2018 for randomized controlled trials (RCTs) comparing the TAPP, TEP, and Lichtenstein procedures. The study outcome were the hernia recurrence, chronic pain, hematoma, seroma, wound infection, operation time, hospital stay, and return-to-work days.

Results:

Altogether, 31 RCTs were included in the meta-analysis. The results of this network meta-analysis showed there were no significantly differences among the 3 procedures in terms of hernia recurrence, chronic pain, hematoma, seroma, hospital stays. Lichtenstein had a shorter operation time than TAPP+TEP [MD (95%Crl)]: 12 (0.51–25.0) vs 18 (6.11–29.0) minutes, respectively) but was associated with more wound infections than TEP: OR 0.33 (95%Crl 0.090–0.81). Our network meta-analysis suggests that TAPP and TEP require fewer return-to-work days [MD (95%CI)]: − 3.7 (−6.3 to 1.3) vs −4.8 (−7.11 to 2.8) days.

Conclusion:

Our network meta-analysis showed that there were no differences among the TAPP, TEP, and Lichtenstein procedures in terms of safety or effectiveness for treating inguinal hernias. However, TAPP and TEP could decrease the number of return-to-work days. A further study with more focus on this topic for inguinal hernia is suggested.
Analysis and strategy research on quality of nursing work life
Authors: Wang Lei , Wang Xuerui , Liu Shuang , Wang Binquan
Published: February 2020

Quality of Working Life (QWL) was developed in 1970s as a new theory on a basis of social-technical system theory. In 2004, Brooks considered that quality of nursing work life is a degree to which the registered nurses are able to satisfy important personal needs through their experiences in their work organization's goal. Quality of Nursing Work Life plays an important role in nursing management.

The purpose of the project was to identify factors associated with nursing work life quality.

A convenience sample of 3498 nurses from five tertiary general hospitals in Shanxi, Shandong, and Liaoning provinces in China was surveyed regarding quality of work life, working conditions, stress at work, general being, and job and career satisfaction (JCS).

The mean overall quality of work life score was found to be 3.40 ± 0.61 (on a scale of 1–5, with 5 being the highest), while the working conditions and stress at work received lower scores. The general well-being of females (3.49 ± 0.74) was higher than that of males (3.35 ± 0.87). We also found a statistically significant difference of JCS of different department groups (P = .004).

The quality of working life of nurses was found to be in the middle range, with room for improvement. Nurse managers have an opportunity to implement measures to improve the quality of working life for nurses in China.
Health Profile and Health Care Access of Mexican Migration Flows Traversing the Northern Border of Mexico
Authors: Martinez-Donate Ana P. , Verdecias Niko , Zhang Xiao , Jesús Eduardo Gonzalez-Fagoaga , Asadi-Gonzalez Ahmed A. , Guendelman Sylvia , Amuedo-Dorantes Catalina , Rangel Gudelia
Published: February 2020

Background:

The health of Latino migrants is most often studied with samples of immigrants settled in the United States or returned migrants in Mexico. We examine health outcomes and health care access of Mexican migrants traversing the Mexican border region to gain a better understanding of migrant health needs as they transition between migration phases.

Methods:

We used data from a 2013 probability survey of migrants from Northbound and Southbound migration flows in Tijuana, Mexico (N=2412). Respondents included Northbound migrants with and without US migration experience, Southbound migrants returning home from the United States or the Mexican border region, and migrants returning to Mexico via deportation. Descriptive statistics and regression models were estimated to characterize and compare their health status, behavioral health, and health care access across migration phases.

Results:

Northbound migrants with US migration experience, Southbound migrants from the United States, and deported migrants had worse levels of health insurance, health care utilization, and diabetes than Northbound migrants without US migration experience. Southbound migrants returning from the border reported worse self-rated health and deportees had higher odds of reported substance use compared with Northbound migrants without US migration experience.

Conclusions:

Mexican migrants’ health profile and health care access vary significantly across migration flows and generally are worse for migrants with US migration experience. The results add to our understanding of Mexican migrant health along the migration continuum and can inform services in sending, receiving, and intermediate communities.
Incorporating Prescription Drugs Into Affordable Care Act Risk Adjustment
Authors: Pope Gregory C. , Pearlman Andrew , Ingber Melvin J. , Kautter John , Drury Kelly , Amin Krutika , Wrocklage James
Published: February 2020

Background:

The 2010 Patient Protection and Affordable Care Act reformed the individual and small group health insurance markets and established a risk adjustment program to create a level playing field for competition. A new set of predictive models for measuring enrollee risk across plans was developed for the Patient Protection and Affordable Care Act-reformed markets, referred to as the Department of Health and Human Services Hierarchical Condition Category (HHS-HCC) models. Beginning in 2018, selected prescription drug classes were added to the models as risk markers.

Objective:

We describe the motivations, concerns, methodology, and results of adding prescription drug utilization to the HHS-HCC models.

Methods:

Separate HHS-HCC models are estimated by enrollee age and plan actuarial value. We defined and added 10 prescription drug classes, called RXCs, to the HHS-HCC adult models.

Results:

Using selected RXCs alongside demographic and diagnostic indicators yielded modest overall improvement in HHS-HCC models’ predictive power. Also, adding RXCs captures the higher costs of enrollees taking certain expensive pharmaceuticals and allows imputation of diagnoses for enrollees utilizing a drug but lacking the associated diagnosis.

Conclusions:

Including selected drugs in risk adjustment improved the models’ predictive power. In addition, inclusion of selected drugs may discourage insurers from using formulary and drug benefit design to avoid enrollment of patients taking high-cost drugs, such as for HIV, multiple sclerosis, and rheumatoid arthritis, and improve access for enrollees taking these drugs. Adding RXCs also may improve plan risk measurement for plans with less complete diagnosis reporting.
Autosomal recessive hypercholesterolemia: update for 2020
Authors: D’Erasmo Laura , Di Costanzo Alessia , Arca Marcello
Published: February 2020

Purpose of review

This review summarizes the current knowledge regarding autosomal recessive hypercholesterolemia (ARH) and provides new insight into the natural history and therapeutic management of this lipid disorder.

Recent findings

Novel homozygous and compound heterozygous ARH-causing mutations have been reported in the literature, to date. The long-term follow-up of a cohort of ARH patients demonstrated that, despite intensive treatment with conventional lipid-lowering therapies, their low-density lipoprotein (LDL) cholesterol levels remain far from target and this translates into a poor cardiovascular prognosis. ARH is also associated with increased risk of developing aortic valve stenosis. However, lomitapide, a microsomal triglyceride transfers protein inhibitor, may represent a new opportunity for the effective treatment of ARH.

ARH is an ultrarare disorder of LDL metabolism caused by mutations in the LDLRAP1 gene. It is inherited as a recessive trait and causative mutations, though heterogeneous, are all predicted to be loss-of-function. Recent investigations have demonstrated that ARH can be considered a phenocopy of homozygous familial hypercholesterolemia, where the risk of atherosclerotic cardiovascular diseases and aortic valve stenosis remains elevated despite conventional therapies. The combination of lomitapide with the conventional LDL-C-lowering medications appears to be a promising approach to treat this condition.
The transmanubrial osteomuscular-sparing approach: a valuable adjunct to the head and neck surgical armamentarium
Authors: Piazza Cesare , Duranti Leonardo , Giannini Lorenzo
Published: February 2020

Purpose of review

To describe and popularize the transmanubrial osteomuscular-sparing approach (TOSA) outside its original thoracic surgical field of application, based on the consideration that it could be of interest for the management of a number of head and neck cases in both elective and emergent scenarios.

Recent findings

The main advantages of TOSA compared with transclavicular techniques are its superb exposure of anatomic structures located at the level of the cervicothoracic junction, and superior postoperative aesthetic and functional outcomes. Recently, a number of studies have described the association of TOSA with other minimally invasive approaches, such as video-assisted thoracoscopic surgery and robotic hybrid approaches, with the aim of avoiding association of the transmanubrial route with anterior/posterior thoracotomies, or more extended surgeries, such as the trapdoor or hemiclamshell procedures.

TOSA, even though originally conceived to reduce the morbidity ensuing from classic transclavicular approaches for management of Pancoast tumors, may well play an important role in a number of head and neck surgical conditions, including those related to mediastinal goiter and thyroid cancer, management of stenosis and lesions of the thoracic trachea and esophagus, treatment of the junction between innominate, internal jugular, and subclavian veins, epiaortic arteries, thoracic duct, brachial plexus, and low sympathetic chain. Whenever comprehensive control of vascular and nonvascular structures of the upper mediastinal inlet is required, TOSA should be planned and performed by combining the expertise of cooperating professionals.
From head and neck lipoma to liposarcoma: a wide spectrum of differential diagnoses and their therapeutic implications
Authors: Barisella Marta , Giannini Lorenzo , Piazza Cesare
Published: February 2020

Purpose of review

To overview the array of differential diagnoses among lipomatous tumours of the head and neck with special focus on their evaluation, three-dimensional assessment, and their available treatments.

Recent findings

The head and neck is an infrequent localization for lipomatous tumours, even though they represent the most common mesenchymal lesions. Lipoma, spindle cell/pleomorphic lipoma (SC/PL), atypical lipomatous tumour/well differentiated liposarcoma (ALT/WDLPS), de-differentiated liposarcoma (DDLPS), myxoid liposarcoma (MLPS), and pleomorphic liposarcoma (PLPS) are the most distinctive histotypes. Lipoma and SC/PL present alterations of chromosomes 12 and 13, ALT/WDLPS and DDLPS both show the Mouse Double Minute 2 amplification, whereas MLPS presents a CHOP gene fusion. Diagnosis of PLPS is purely morphological as there is no pathognomonic genetic alteration identified to date. Radiological assessment can be challenging for the presence of nonadipose components within the lesion. Surgery is the mainstay of treatment, even though achieving true radicality in terms of a large cuff of healthy tissue surrounding the tumour is not always realistic in the head and neck. Adjuvant radiation, eventually in combination with systemic chemotherapy, has been shown to improve overall survival in patients with positive margins, high-grade, deep, and more than 5 cm lesions. Further studies should be aimed at the evaluation of the role of hadron therapy, as well as targeted drugs against overexpressed proteins.

Adequate differential diagnosis of the histotypes collected under the umbrella term of head and neck lipomatous tumours plays a fundamental role in treatment and follow-up of these lesions and requires specific expertise with referral to high-volume centres.
Perineural invasion in head and neck squamous cell carcinoma: background, mechanisms, and prognostic implications
Authors: Saidak Zuzana , Lailler Claire , Clatot Florian , Galmiche Antoine
Published: February 2020

Purpose of review

Perineural invasion (PNI) is a pathological feature frequently observed in head and neck squamous cell carcinoma (HNSCC). The difficulties of pathological standardization and the lack of a simple validated experimental model to study PNI render its analysis complex. Here, we aim to summarize the recent advances in the understanding of the biology of PNI in HNSCC and their potential clinical implications.

Recent findings

PNI is a multistep process leading to a dialogue between cancer cells and nerve fibers in HNSCC. Recent studies have identified some of the active molecular mechanisms involved in PNI. Comprehensive studies addressing the transcriptional regulation of PNI bring interesting perspectives for a standardized molecular diagnosis of PNI and a better assessment of its contribution to the aggressiveness of HNSCC.

Perineural invasion is a complex process that reflects specific tumor biology. In addition to unveiling new fundamental concepts about the tumor microenvironment, research on PNI promises to identify new biomarkers, enabling progress in therapeutic development against HNSCC.
Controversies in the surgical management of sporadic medullary thyroid carcinoma
Authors: Fussey Jonathan Mark , Bradley Patrick J. , Smith Joel A.
Published: February 2020

Purpose of review

Medullary thyroid carcinoma (MTC) represents a wide spectrum of tumours with differing biology, behaviour and natural history. The only current available curative treatment is surgery in the form of thyroidectomy with or without ipsilateral or bilateral neck dissection. There is a lack of consensus in the available published guidelines on the optimum extent of initial surgery, and there is significant variation in clinical practice. This review focuses on the most recently published evidence.

Recent findings

Many patients with limited disease do not receive total thyroidectomy and central neck compartment dissection as recommended by international guidelines. Despite this, 5-year disease-specific survival is over 90% in those without distant metastases at presentation. Over 20% of patients may harbour occult lateral compartment nodal metastases, and baseline calcitonin alone (>1000 pg/ml) is not a good predictor of nodal metastasis. Although delayed lateral neck compartment dissection results in similar survival outcomes to prophylactic neck dissection for clinically node-negative patients, there is an underappreciated psychological effect of having biochemical evidence of persistent disease following limited surgery.

No single currently available prognostic indicator is sufficient to predict disease behaviour and evidence of occult nodal metastases. In clinically ad radiologically node-negative patients, the extent of neck dissection at initial operation, therefore, needs to be planned and executed on an individual patient basis.
Arenobufagin Inhibits the Phosphatidylinositol 3-kinase/Protein Kinase B/Mammalian Target of Rapamycin Pathway and Induces Apoptosis and Autophagy in Pancreatic Cancer Cells
Authors: Wei Xiaolu , Yang Jian , Mao Yingqiu , Zhao Haiyu , Si Nan , Wang Hongjie , Bian Baolin
Published: February 2020

Objective

The aim of the study was to investigate the effects of arenobufagin on pancreatic carcinoma in vitro and in vivo and its molecular mechanism.

Methods

The proliferation of pancreatic cancer cells was detected by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Transmission electron microscopy was used to observe the formation of autophagic vacuoles after arenobufagin treatment. Hoechst 33258 and monodansylcadaverine fluorescence staining were performed to evaluate cell apoptosis and autophagy. Annexin V–fluorescein isothiocyanate/propidium iodide double-staining and JC-1 staining assays were used to evaluate apoptosis-related changes. Reverse-transcription polymerase chain reaction and western blotting were carried out to examine the expression of apoptosis- and autophagy-related markers after arenobufagin treatment. A tumor xenograft nude mouse model was established to evaluate arenobufagin efficacy in vivo.

Results

Arenobufagin effectively inhibited the proliferation of SW1990 and BxPC3 cells and induced cell arrest, apoptosis, and autophagy. Arenobufagin upregulated the expression of apoptotic- and autophagy-related proteins while downregulated the expression of phosphatidylinositol 3-kinase family proteins. Furthermore, arenobufagin also exerted inhibitory effects on tumor growth in xenograft nude mice.

Conclusions

Arenobufagin inhibits tumor growth in vivo and in vitro. The mechanism underlying arenobufagin action may involve induction of autophagy and apoptosis through the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin pathway.
Real-World Dosing Patterns and Outcomes of Patients With Metastatic Pancreatic Cancer Treated With a Liposomal Irinotecan Regimen in the United States
Authors: Barzi Afsaneh , Miksad Rebecca , Surinach Andy , Corvino Frank A. , Wang Siqi , Torres Aracelis Z. , Mamlouk Khalid , Pulgar Sonia , Valderrama Adriana , Bekaii-Saab Tanios , Ahn Daniel
Published: February 2020

Objectives

Liposomal irinotecan (nal-IRI) is a topoisomerase inhibitor proven to improve survival in metastatic pancreatic cancer (mPC). This study describes real-world characteristics of patients treated with nal-IRI for mPC.

Methods

Patients 18 years or older diagnosed with stage IV mPC and treated with nal-IRI were selected retrospectively from a deidentified electronic health record database of more than 2 million US cancer patients. Demographics, clinical and dosing characteristics, and treatment outcomes were collected.

Results

Of 257 total patients, 145 (57%) received nal-IRI as first- or second-line therapy. Median nal-IRI treatment duration was 51 days, longer when nal-IRI was used as first/second versus as third-line therapy or later (62 vs 44.5 days). Seventy patients (27.2%) experienced dose modification. Median time to treatment discontinuation was 2.3 versus 1.6 months for first-/second- versus third-line therapy or later, respectively. Median overall survival from nal-IRI initiation was 5.6 versus 4.1 months for first-/second- versus third-line therapy or later, respectively. Prior irinotecan treatment, baseline serum albumin less than 40 g/L, and baseline neutrophil-to-lymphocyte ratio greater than 5 were associated with reduced overall survival.

Conclusions

This is the first large US study of real-world US mPC patients treated with nal-IRI. These results, comparable to the NAPOLI-1 trial, can help inform future studies and the efficacy of nal-IRI in mPC therapy.
Glucose-Dependent FOXM1 Promotes Epithelial-to-Mesenchymal Transition Via Cellular Metabolism and Targeting Snail in Human Pancreatic Cancer
Authors: Kyuno Takuro , Kohno Takayuki , Konno Takumi , Yamaguchi Hiroshi , Kyuno Daisuke , Imamura Masafumi , Kimura Yasutoshi , Kojima Takashi , Takemasa Ichiro
Published: February 2020

Objectives

Transcription factor Forkhead box protein M1 (FOXM1) plays critical roles in the progression of cancer including epithelial-to-mesenchymal transition (EMT). The aim of this study is to characterize the regulatory mechanisms of FOXM1 in EMT via pancreatic cancer metabolism.

Methods

We investigated the regulation of EMT via mitochondrial respiration by FOXM1 using pancreatic cancer cell lines HPAC and PANC-1 and normal human pancreatic duct epithelial cells.

Results

Forkhead box protein M1 and Snail were strongly expressed in HPAC and PANC-1. Epithelial-to-mesenchymal transition–modulated claudin-1 level was lower in PANC-1 than in HPAC. In both cell lines in low-glucose medium, FOXM1 and Snail were decreased and claudin-1 was increased. Knockdown of FOXM1 increased claudin-1 and decreased Snail in both cell lines. Low-glucose medium and downregulation of FOXM1 inhibited the cell migration in both cell lines. In both cell lines, mitochondrial respiration was at higher levels in low-glucose medium than in high-glucose medium. Downregulation of FOXM1 induced mitochondrial respiration in high-glucose medium. In normal human pancreatic duct epithelial cells, FOXM1 and Snail were low and claudin-1 was highly expressed, whereas overexpression of FOXM1 decreased claudin-1.

Conclusions

Glucose-dependent FOXM1 promoted EMT via Snail and pancreatic cancer metabolism.
Mitigating Risks of Swallowed Button Batteries
Authors: Lerner Diana G. , Brumbaugh David , Lightdale Jenifer R. , Jatana Kris R. , Jacobs Ian N. , Mamula Petar
Published: February 2020

Despite ongoing efforts of the national Button Battery Task Force (BBTF), cases of major morbidity and mortality continue to be reported at a higher rate after ingestion of higher voltage and larger button batteries. Initiation of sucralfate or honey shortly after some button battery ingestions is crucial to prevent further injury while awaiting emergent removal. Endoscopic acetic acid irrigation post removal of button battery may halt deeper injury. Gastroenterologists need to be aware of the updates to the National Capital Poison Center algorithm for button battery ingestion.
Predictors of In-Hospital Mortality in Thrombotic Thrombocytopenic Purpura in Children in the United States: A Population Analysis
Authors: Umapathi Krishna Kishore , Thavamani Aravind , Puliyel Mammen
Published: February 2020

Background:

Despite proven efficacy and increased availability of therapeutic plasma exchange, thrombotic thrombocytopenic purpura (TTP) is associated with significant morbidity and mortality.

Study Design and Methods:

This study utilized the Kids’ Inpatient Database and National Inpatient Sample (2003 to 2016) to study predictors of in-hospital mortality in hospitalized TTP patients. Adjusted odds ratios of death with various putative risk factors were calculated using multiple regression analysis.

Results:

Among 1568 hospitalizations with TTP as primary admission diagnosis who underwent therapeutic plasma exchange, 69 deaths were identified (all-cause mortality, 0.04%; median time-to-death, 6 wk). Overall, hospitalizations rates were fairly similar across the study period. The overall incidence of TTP related hospitalizations is 1.51 per 100,000 hospitalizations. A total of 69 deaths were reported with an all-cause in-hospital mortality rate of 0.04% (69/1568). The median time-to-death was 6 weeks. The majority of deaths occurred in age 16 to 20 years (58%), females (56.5%), and African American (42.9%) as shown in Table 2. Mean age for nonsurvivors was 14 years and the mean age of 15 years for survivors (P=0.01). Younger age, male sex, African-American ethnicity, malignancy, sepsis, acute kidney injury, platelet transfusion was significantly associated with mortality in patients with TTP.

Conclusions:

Early and targeted therapy for high risk individuals should be used to guide management of TTP patients for improved survival outcomes.
Liver Stiffness Measurement by Vibration Controlled Transient Elastography Does Not Correlate to Hepatic Iron Overload in Children With Sickle Cell Disease
Authors: Costa Peter , Rudolph Bryan , Kogan-Liberman Debora , Manwani Deepa , Silver Ellen J. , Ovchinsky Nadia
Published: February 2020

Background:

Children with sickle cell disease (SCD) are at risk of liver injury because of sickle cell hepatopathy and iron overload from chronic transfusions (CT). The authors examine the association between iron overload and liver stiffness measurement (LSM) by vibration controlled transient elastography (VCTE), which has been shown to correlate with fibrosis.

Methods:

Patients 21 years of age and less with SCD had VCTE performed; those who received CT underwent magnetic resonance imaging T2* for iron quantification.

Results:

The authors enrolled 42 patients, 17 (40%) of whom received CT. There was no difference in LSM between patients who underwent CT (5.5±1.5 kPa) and those who did not (5.2±2.3 kPa) (P=0.923). There was no correlation between iron quantification and LSM (r=−0.077, P=0.769). However, children 12 years of age and older had abnormal LSM when compared with a reference range (P=0.013).

Conclusion:

VCTE is a noninvasive technology that is feasible in children with SCD. LSM values were elevated in older children but did not correlate with iron overload, suggesting that fibrosis may not be affected by iron overload alone. Though additional data are needed, LSM may be a useful test for the progression of liver disease in SCD regardless of iron burden.
The Adverse Impact of Thalassemia Major on Adolescents’ Oral Health-related Quality of Life
Authors: Ebeid Fatma S.E. , Khan Nisreen I.H.
Published: February 2020

Background:

Adolescents with beta-thalassemia major (βTM) had unfavorable quality of life (QOL).

Objectives:

To assess oral health status of adolescents with βTM and its impact on their oral health-related QOL (OHRQoL).

Subjects and Methods:

Forty adolescents with βTM were recruited and compared with 40 age-matched and sex-matched healthy adolescents. Intraoral examination including dental caries assessment, oral hygiene index simplified (OHI-S), and Angle classification were performed. OHRQoL questionnaires were filled-out using child perception questionnaire-short form16.

Results:

Although the majority of adolescents with βTM had dental problems and convinced by their need for dental treatment, nearly half of them never brushed their teeth nor visited dental office. Patients showed higher frequency of class II malocclusion (P=0.017) and higher percentage of poor simplified debris index (DI-S) and OHI-S grade (P=0.008, 0.037, respectively). The median of DI-S and OHI-S were significantly higher in adolescents with βTM (P=0.009, 0.037, respectively). Adolescents with βTM had worse emotional well-being total score (P=0.049) than controls. Patients with poor oral hygiene had the worse total OHRQoL score (P=0.03). The total OHRQoL score showed significant positive correlation with oral hygiene; DI-S, calculus index-S, and OHI-S (P=0.028, 0.038, and 0.045, respectively).

Conclusion:

βTM had a negative impact on the emotional well-being aspect.
Coinheritance of Triplicated Alpha-Globin Gene and Beta-Thalassemia Mutations in Adulthood: Ten Years of Referrals in Northern Greece
Authors: Theodoridou Stamatia , Balassopoulou Angeliki , Boutou Effrossyni , Delaki Evangelia-Eleni , Yfanti Eleni , Vyzantiadis Timoleon-Achilleas , Vetsiou Evangelia , Voskaridou Ersi , Vlachaki Efthymia
Published: February 2020

Greece is a country of ~11 million people, where hemoglobinopathies are the most common genetic diseases. The reported data describe the clinical phenotype of cases with coinheritance of triplicated α-globin (anti-α3.7 kb) and β-globin gene mutations in Northern Greece, that were referred within the last 10 years, in The Adult Thalassemia Unit of “Hippokration” Hospital, Thessaloniki, Northern Greece. The description of specific genotypes of the β-globin gene mutations in coinheritance with the triplicated α-globin gene (anti-α3.7 kb) and correlation with the hematologic and clinical data in adulthood may be useful in the evaluation of pediatric patients’ prognosis and in genetic counseling of couples at risk.
An Evaluation of Bone Health Parameters in Regularly Transfused Beta-Thalassemia Major Patients
Authors: Kothimira Vamsi K. , Kumar Arun , Richhele Lala R. , Sood Neelam , Gulati Anil
Published: February 2020

As beta-thalassemia major patients need regular blood transfusions due to the severe hemoglobin deficiency, the occurrence of related bone defects with simultaneous fluctuations in the biochemical and hematologic parameters is seen. The hospital-based cross-sectional observational study was done to determine and correlate the bone mineral density (BMD) with biochemical parameters and hematologic parameters in 50 regularly transfused beta-thalassemia major patients of older than 6 years of age. Descriptive statistics were analyzed with SPSS version 20.0 software. A P<0.05 was considered as statistically significant. The prevalence of suboptimal BMD at lumbar spine was 86% and at femur neck was 74%. A statistically significant correlation of BMD was found with mean pretransfusion hemoglobin values, serum calcium levels, and serum vitamin D levels (P<0.05). It was concluded that continuous monitoring of the BMD, biochemical, and hematologic parameters in regularly transfused beta-thalassemia major patients may help assess the ongoing deficiencies; helping to maintain timely and regular blood transfusions with supplementation of calcium, vitamin D to ensure good bone health.
Line Associated Thrombosis in Pediatric Patients With NF-κB Pathway Variants
Authors: Michniacki Thomas F. , Atchison Christie , Walkovich Kelly , Sankar Amanda , McGrath Mary , Weyand Angela C.
Published: February 2020

Our report explores the complex role that nuclear factor-kappa B (NF-κB) plays in thrombosis formation, inflammation, and immunity; while additionally demonstrating that patients with NF-κB pathway pathogenic variants appear to carry a substantial thrombotic risk, particularly when secondary thrombotic risk factors are present. We propose that prophylactic anticoagulation should be strongly considered in such patients during high-risk situations and provide additional hematologic management strategies for those with NF-κB pathway alterations. We hope our work also calls to attention the potential need for a broader assessment of venous thromboembolism risk in patients with immune dysregulation to better delineate which patient populations may benefit from anticoagulation prophylaxis.
Characteristics of Blood Transfusion During Induction Remission in Children With Acute Lymphoblastic Leukemia: A Single-Center Retrospective Investigation
Authors: Sun Jun-Bo , Lu Ying-Yu , Huang Ling-Ling , Yu Qian-Qian , Tu Song-Ji , Xie Zhi-Wei
Published: February 2020

Objective:

To investigate the allogeneic blood transfusion (ABT) characteristics of children with acute lymphoblastic leukemia (ALL) in different risk stratification during vincristine, daunorubicin, L-asparaginase and prednisone (VDLP) induction remission.

Subjects and Methods:

By referring to electronic medical records, the demographic characteristics, diagnosis, test, and treatment information including ABT were collected. According to the risk stratification of the CCCG-ALL-2015 protocol, ABTs between groups were compared, and the differences were statistically analyzed.

Results:

One hundred sixty-three newly treated children with ALL were enrolled in this study, who received 643.5 U of red blood cells and 377.6 U of platelets (PLTs) during the VDLP. The amount of ABT in the intermediate-risk (IR) group (n=102) was significantly higher than that in the low-risk group (n=61), which were reflected in the red blood cells in the first half of VDLP (P=0.033) and the PLTs in the second half of VDLP (P<0.001). Meanwhile, the PLT counts in the IR group were significantly lower in the same period. The time node was bounded by the minimal residual disease test on the 19th day.

Conclusions:

Children in the IR group or with unsatisfactory induction may need more ABTs during the VDLP, and the relatively low PLT counts seem to contribute to this. The results of this study can provide a basis for patient blood management, as well as a reference for studying the long-term effects of ABT on children with ALL.
Trajectories of Self-reported Physical Functioning and Symptoms in Lung Cancer Survivors
Authors: Medysky Mary E. , Dieckmann Nathan F. , Winters-Stone Kerri M. , Sullivan Donald R. , Lyons Karen S.
Published: February 2020

Background

Lung cancer survivors are at risk of accelerated declines in physical functioning attributed to cancer treatment. However, it is unknown whether patients experience the same rate of functional decline and how symptoms may contribute to different trajectories.

Objectives

The aims of this study were to identify interindividual differences in the pattern and rate of change in self-reported functioning in lung cancer survivors and examine whether and how symptoms are related to physical functioning over time.

Methods

This was a secondary data analysis in 72 lung cancer survivors. Multilevel modeling was used to estimate trajectories of self-reported physical functioning over 1 year and assess the relation between functioning, fatigue, depressive symptoms, and pain severity across time.

Results

Within the sample, average physical functioning did not significantly decrease (coefficient, −0.46; 95% confidence interval [CI] = −2.85 to 0.94) over time. However, among individual lung cancer survivors, baseline physical functioning varied significantly (SD, 20.76; 95% CI, 16.84–25.59) and changed at significantly different rates over 1 year (SD, 3.50; 95% CI, 2.13–5.68). Fatigue, assessed over 1 year, was the only significant symptom predictor of physical functioning changes over time (coefficient = 1.03; 95% CI, 0.79–1.27).

Conclusions

In this sample of lung cancer survivors, not all survivors experienced the same rate of self-reported functional decline and those with lower levels of fatigue reported better physical functioning.

Implications for Practice

Nurses should recognize that some lung cancer survivors may have faster rates of functional declines than others, which may be related to fatigue severity. Early identification and management of fatigue could help avoid or delay future disability.