bluuebunny/crossref_metadata_2025 huggingface dataset:
Immature platelet fraction: A useful marker for identifying the cause of thrombocytopenia and predicting platelet recovery
Authors: Jeon Kibum , Kim Miyoung , Lee Jiwon , Lee Jee-Soo , Kim Han-Sung , Kang Hee Jung , Lee Young Kyung
Published: February 2020

Introduction:

The assessment of bone marrow thrombopoietic activity in patients with thrombocytopenia is necessary to achieve an accurate diagnosis and administer effective treatment. We evaluated the discriminatory power of the immature platelet fraction (IPF) in differentiating hyperdestructive/consumptive thrombocytopenia from hypoproductive thrombocytopenia and its potential use as a predictive marker for platelet recovery.

Methods:

In this observational study, platelet indices, including IPF, were measured in 105 healthy individuals, 27 patients with hyperdestructive/consumptive thrombocytopenia (all with immune thrombocytopenic purpura [ITP]), and 35 patients with hypoproductive thrombocytopenia (5 with aplastic anemia and 30 with cancer who were undergoing chemotherapy) using a Sysmex XN-3000 hematology analyzer.

Results:

The platelet distribution width, mean platelet volume, platelet large cell ratio, IPF, and absolute immature platelet count (AIPC) were significantly higher in the hyperdestructive/consumptive thrombocytopenia group than in the hypoproductive thrombocytopenia group (P < .001). The IPF showed the highest difference between the two patient groups (200%). Receiver operating characteristics analysis that showed the IPF had the largest area under the curve among all the platelet indices analyzed; its cut-off value was 2.3%. The IPF decreased 3 to 4 days in advance of platelet count elevation in patients with ITP, whereas the delta AIPC increased 3 days in advance. Furthermore, the IPF and delta AIPC increased 5.5 days and 8.5 days, respectively, before platelet counts increased up to 130.0 × 109/L in cancer patients receiving chemotherapy.

Conclusion:

These data demonstrated that the IPF and delta AIPC are both excellent indicators of the etiology of thrombocytopenia and predictive markers for platelet recovery.
Traditional chinese medicine for diabetic retinopathy
Authors: Pang Bing , Li Qing-Wei , Qin Ya-Li , Dong Guang-Tong , Feng Shuo , Wang Jia , Tong Xiao-Lin , Ni Qing
Published: February 2020

Background:

Traditional Chinese medicine (TCM) has been used to treat diabetic complications including diabetic retinopathy for many years.

Objectives:

This review was performed to systematically assess the efficacy and safety of TCM for treating non- proliferative diabetic retinopathy (NPDR).

Methods:

Retrieval from 7 electronic databases was conducted to determine eligible trials published until March 1, 2018. Randomized controlled trials of NPDR that comparing compound Chinese medicine containing the therapeutic method of activating blood and remove stasis versus controls were included for analysis. Primary outcomes were progression of retinopathy. Secondary outcomes included visual acuity, mean defect of visual field, micro-aneurysms, hemorrhage areas, exudates, capillary nonperfusion areas, hemorheological indicators, oscillatory potentials (Ops), glycated haemoglobin (HbA1c), and adverse events. Data extraction and quality assessment were performed. Results expressing as risk ratios (RRs) or mean differences (MD) were analyzed with a fixed- or random- effect model. I
2 statistics were used to assess heterogeneity.

Results:

A total of 33 trials and 3373 participants were included. Findings revealed that no included studies reported the progression of retinopathy. Compared with conventional medicine, TCM was significantly better at improving visual acuity (MD, −0.10; 95% confidence interval [CI] −0.16 to −0.05) and Ops (MD, −4.68, 95% CI −8.51 to −0.85), and reducing the mean defect of visual field (MD, −1.43; 95%CI, −2.17 to −0.68), micro-aneurysms (MD, −4.51; 95% CI, −6.23 to −2.79), hemorrhage areas (MD, −0.62; 95% CI, −1.06 to −0.19), plasma viscosity (MD, −0.10; 95% CI, −0.20 to 0.00), and HbA1c (MD, −0.22; 95% CI, −0.42 to −0.03). Compared with placebo, TCM was also associated with a decline in the number of microaneurysms (MD, −4.35; 95% CI, −6.25 to −2.45), exudates (MD, −0.17; 95% CI −0.31 to −0.03), capillary nonperfusion areas (MD, −0.18; 95% CI, −0.31 to −0.04), and HbA1c (MD, −0.88; 95% CI, −1.44 to −0.32). Compared with blank groups, TCM was superior at decreasing the mean defect of visual field (MD, −0.87; 95% CI −0.95 to −0.79) and the numbers of micro-aneurysms (MD, −3.35; 95% CI, −4.73 to −1.97). Adverse events were also assessed.

Conclusion:

Activating blood compound Chinese herbal medicine could help to improve visual acuity, micro-aneurysms and HbA1c. Further trials are needed to provide more reliable evidence.
Carbon monoxide breath test assessment of mild hemolysis in Gilbert's syndrome
Authors: Kang Ling-Ling , Ma Yong-Jian , Zhang Hou-De
Published: February 2020

Background:

Mild hemolysis is difficult to determinate by traditional methods, and its role in Gilbert's syndrome (GS) is unclear. The main aims were to inspect the erythrocyte (RBC) survival in GS by using Levitt's carbon monoxide (CO) breath test and to assess its contribution to unconjugated hyperbilirubinemia.

Methods:

Fifty subjects with GS and 1 with type-II Crigler–Najjar syndrome (CN2) received RBC lifespan measurement with Levitt's CO breath test. Mean RBC lifespan was compared with normal referral value. Correlations of serum total bilirubin (TB) with RBC lifespan, blood panel data, demographic factors, and uridine diphosphate glucuronosyltransferase (UGT1A1) mutation load were calculated by Spearman analysis. Susceptibility factors for mild hemolysis were analyzed by multivariate regression analysis.

Results:

The mean RBC lifespan of the GS subjects was significantly shorter than the normal reference value (95.4 ± 28.9 days vs 126 days; t = −7.504, P < .01), with 30.0% below the lower limit of the normal reference range (75 days). The RBC lifespan of the participant with CN2 was 82 days. Serum TB correlated positively with UGT1A1 mutation load (γ = 0.281, P = .048), hemoglobin (γ = .359, P = .010) and hematocrit (γ = 0.365, P = .010), but negatively with RBC lifespan (γ = −0.336, P = .017). No significant susceptibility factors for mild hemolysis were found.

Conclusions:

The results indicate that mild hemolysis indeed, exists in a portion of patients with GS and might serve as an important contributor to unconjugated hyperbilirubinemia in addition to UGT1A1 polymorphism. Further studies on the mechanism and the potential risks in various medical treatments might be wanted.
Surfactant protein A expression and distribution in human lung samples from smokers with or without chronic obstructive pulmonary disease in China
Authors: Liu Zhizhen , Chen Siyang , Xu Yongjian , Liu Xiansheng , Xiong Pian , Fu Yu
Published: February 2020

Cigarette smoking is considered the main risk factor for chronic obstructive pulmonary disease (COPD), although the mechanism remains unknown. surfactant protein A (SP-A) is thought to protect the lung from smoking-induced damage, but related studies performed in China are scarce. The aim of the study is to assess alterations of SP-A expression and distribution in lung samples from Chinese smokers with or without COPD.

This cross-sectional study assessed 45 men in Wuhan Tongji Hospital after lobectomy for lung cancer in June 2010 to September 2010. Peripheral lung specimens were collected from control nonsmokers without airflow obstruction (nonsmoking group, n = 15), smokers without airflow obstruction (smoking group, n = 15), and patients with COPD (COPD group, n = 15). SP-A expression levels in lung tissue samples and its distribution in lung cells, type II pneumocytes (PNII), and alveolar macrophages (MACR) were determined by immunoblotting and immunohistochemistry.

SP-A levels were significantly decreased in the COPD group (1.00 ± 0.25) compared with the smoking (2.31 ± 0.64) and nonsmoking (8.03 ± 2.80) groups; the smoking group also showed significantly reduced levels compared with the nonsmoking group (P < .05). PNII expressing SP-A were less abundant in the COPD group (39.3% ± 7.1%) compared with the smoking group (76.2% ± 29.8%), whereas SP-A+ MACR were more abundant (92.4% ± 7.1% vs 68.5% ± 20.2%) (all P < .05). Among the 30 smokers, forced expiratory volume in one second (% predicted) was positively correlated with SP-A levels (r = 0.739) and the rate of SP-A+ PNII (r = 0.811), and negatively correlated with the rate of SP-A+ MACR (r = −0.758) (all P < .05).

Changes in SP-A expression and distribution in lung tissues may be involved in COPD pathogenesis in smokers.
Effects of early virtual reality-based rehabilitation in patients with total knee arthroplasty
Authors: Gianola Silvia , Stucovitz Elena , Castellini Greta , Mascali Mariangela , Vanni Francesco , Tramacere Irene , Banfi Giuseppe , Tornese Davide
Published: February 2020

Background:

Virtual reality (VR)-based rehabilitation is a promising approach for improving recovery in many conditions to optimize functional results, enhancing the clinical and social benefits of surgery.

Objective:

To assess the efficacy of an early rehabilitation performed by the VR-based rehabilitation versus the traditional rehabilitation provided by physical therapists after primary total knee arthroplasty (TKA).

Methods:

In this randomized controlled clinical trial, 85 subjects met the inclusion criteria and were randomized 3 to 4 days after TKA to an inpatient VR-based rehabilitation and a traditional rehabilitation. Participants in both groups received 60 minutes/day sessions until discharge (around 10 days after surgery). The primary outcome was the pain intensity. The secondary outcomes were: the disability knee, the health related quality of life, the global perceived effect, the functional independent measure, the drugs assumption, the isometric strength of quadriceps and hamstrings, the flexion range of motion, and the ability to perform proprioception exercises. Outcomes were assessed at baseline (3–4 days after TKA) and at discharge.

Results:

VR-based or traditional rehabilitation, with 13% of dropout rate, shown no statistically significant pain reduction between groups (P = .2660) as well as in all other outcomes, whereas a statistically significant improvement was present in the global proprioception (P = .0020), in favor of the VR-based rehabilitation group.

Conclusions:

VR-based rehabilitation is not superior to traditional rehabilitation in terms of pain relief, drugs assumptions and other functional outcomes but seems to improve the global proprioception for patients received TKA.

Level of evidence

: Therapy, level 1b. CONSORT-compliant.

Trial registration

: http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT02413996.
Efficacy and safety of oral traditional Chinese patent medicine in treatment of liver stagnation and spleen deficiency of depression
Authors: Yu Ying , Zhang Gong , Han Tao , Huang Hailiang
Published: February 2020

Background:

Depression is a kind of chronic and recurrent mental disorder, the main clinical characteristics of the patients are marked and persistent depression. At the same time, it is often accompanied by chronic physical disease, cognitive impairment, and functional damage, which is one of the common diseases that seriously threaten human health. At present, 3 kinds of oral Chinese patent medicine have clinical comparability in the treatment of depression of liver stagnation and spleen deficiency, but there is no evidence for clinical efficacy and safety. Therefore, this study aims to integrate the clinical related syndromes of direct and indirect comparison by using systematic evaluation and network meta-analysis (NMA). According to the data, the different Chinese patent medicines with the same evidence body for the treatment of the disease are collected, analyzed, and sequenced in a quantitative and comprehensive way, and then the advantages and disadvantages of the efficacy and safety between different Chinese patent medicines are screened out to get the best choice scheme, thus providing reference value and evidence-based theoretical evidence for the clinical optimization of drug selection.

Methods:

Comprehensive retrieval of China National Knowledge Infrastructure, Chinese scientific journal database (VIP), China biological feature database (CBM) and WANFANG Data Chinese electronic database and the Cochrane Library, PubMed, Web of Science, and EMBASE foreign database. Search and publish the clinical randomized controlled trials of these 3 Chinese patent medicines combined with fluoxetine compared with fluoxetine. The retrieval time is from the establishment of the database to October 31, 2019. The 2 first authors will screen the literatures that meet the inclusion criteria, extract the data independently according to the predesigned rules, and evaluate the literature quality and bias risk of the included research according to the Cochrane 5.1 manual standard. R and Aggregate Data Drug Information System software were used for data consolidation and NMA to evaluate the ranking probability of all interventions.

Results:

This result will show that the best oral Chinese patent medicine to assist the treatment of liver stagnation and spleen deficiency depression provides reliable evidence.

Conclusion:

This study will provide systematic evidence-based medicine evidence for TCM assisted treatment of depression of liver stagnation and spleen deficiency type, and help clinicians, patients with depression and decision-makers to make more effective, safer, and economic optimal treatment plan in the decision-making process.

PROSPERO registration number:

CRD42019115695.
Optical coherence tomography and fractional flow reserve guided treatment of woven coronary artery anomaly presenting as acute myocardial infarction
Authors: Wang Fangfang , Han Jiangli , Guo Lijun
Published: February 2020

Rationale:

Woven coronary artery is a very rare congenital anomaly which may lead to acute coronary syndrome in previous literatures. At present, there is no consensus on the treatment of this coronary artery abnormality.

Patient concerns:

A 48-year-old male was admitted to the other hospital because of persistent chest pain. The electrocardiogram showed an ST-segment elevation in the v1-v5 lead and the patient was diagnosed with acute anterior myocardial infarction. Coronary angiography revealed 2 lumens in the proximal segment of the left anterior descending artery. Then the patient was transferred to our hospital for further diagnosis and treatment.

Diagnoses:

The patient was diagnosed with acute myocardial infarction and woven coronary. Transthoracic echocardiography showed left ventricular anterior wall segmental motor abnormalities.

Interventions:

Optical coherence tomography (OCT) and fractional flow reserve (FFR) guided percutaneous coronary intervention was performed successfully.

Outcomes:

During the follow-up period of 4 years, the patient remained asymptomatic and no adverse events.

Lessons:

Although the significance of blood flow limitation in one of the lumens detected by FFR is unclear, this strategy of OCT and FFR-guided treatment in woven coronary artery combined with acute coronary events still shows its feasibility.
Serum non-high-density lipoprotein cholesterol is associated with the risk of sudden sensorineural hearing loss
Authors: Wang Saibin , Ye Qian , Pan Yibin
Published: February 2020

The aim of this study was to investigate the association between the non-high-density lipoprotein cholesterol (non-HDL-C) with sudden sensorineural hearing loss (SSHL) and the predictive value of non-HDL-C for SSHL.

A total of 324 patients with SSHL and 972 well-matched controls were enrolled from 2009 to 2012 in Korea. The association of serum non-HDL-C with the risk of SSHL was evaluated using multivariate regression analysis, smooth curve fitting after adjusting for potential confounders. The discrimination ability of non-HDL-C in predicting SSHL was determined by calculating the area under the curve (AUC), and its clinical usefulness was evaluated by decision curve analysis. This was a secondary analysis of a case–control study.

There was a non-linear relationship between the serum non-HDL-C and the incidence of SSHL. After adjustment for potential confounders, the incidence of SSHL rose significantly with ascending quartiles of serum non-HDL-C (using Q1 as the reference group, the OR [95% CI] of Q2, Q3, and Q4 were 4.34 [2.43–7.74], 7.08 [3.99–12.56], and 20.88 [11.86–36.75], respectively [Pfor trend <.0001]). The discrimination ability of serum non-HDL-C in predicting SSHL was 0.747 (95% CI, 0.717–0.776), and the AUC was 0.733 (95% CI, 0.705–0.777) in the internal validation.

Elevated serum non-HDL-C was strongly associated with increased risk of SSHL, and it may play a role as a useful biomarker in predicting the risk of SSHL.
A case report of right coronary artery agenesis diagnosed by computed tomography coronary angiography
Authors: Forte Ernesto , Punzo Bruna , Agrusta Marco , Salvatore Marco , Spidalieri Gianluca , Cavaliere Carlo
Published: February 2020

Introduction:

Single coronary artery is a rare condition characterized by the origin of a coronary that supplies the entire heart from a single coronary ostium.

Patient concerns:

A 45-year-old woman with an altered exercise testing was addressed to a computed tomography coronary angiography (CTCA) to rule out coronary artery disease (CAD).

Diagnosis:

CTCA examination showed the absence of the right coronary artery (RCA). The left anterior descending artery and the left circumflex artery (LCX) presented regular origin and course and LCX provided the posterior interventricular artery and the posterolateral artery.

Interventions:

As CTCA highlighted the absence of potentially life-threatening features related to coronary anomaly, no surgical treatment was advised.

Outcomes:

The patient was dismissed, kept under pharmacological control and monitored over time.

Conclusion:

CTCA is the first-choice imaging modality in patients with ECG abnormalities properly allowing the differential diagnosis between CAD and congenital heart disease.
Ulinastatin reduces postoperative bleeding and red blood cell transfusion in patients undergoing cardiac surgery
Authors: Yao Yun-Tai , Fang Neng-Xin , Liu Ding-Hua , Li Li-Huan
Published: February 2020

Background:

Ulinastatin is a type of glycoprotein and a nonspecific wide-spectrum protease inhibitor like antifibrinolytic agent aprotinin. Whether Ulinastatin has similar beneficial effects on blood conservation in cardiac surgical patients as aprotinin remains undetermined. Therefore, a systematic review and meta-analysis were performed to evaluate the effects of Ulinastatin on perioperative bleeding and transfusion in patients who underwent cardiac surgery.

Methods:

Electronic databases were searched to identify all clinical trials comparing Ulinastatin with placebo/blank on postoperative bleeding and transfusion in patients undergoing cardiac surgery. Primary outcomes included perioperative blood loss, blood transfusion, postoperative re-exploration for bleeding. Secondary outcomes include perioperative hemoglobin level, platelet counts and functions, coagulation tests, inflammatory cytokines level, and so on. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio and 95% CI. Statistical significance was defined as P < .05.

Results:

Our search yielded 21 studies including 1310 patients, and 617 patients were allocated into Ulinastatin group and 693 into Control (placebo/blank) group. There was no significant difference in intraoperative bleeding volume, postoperative re-exploration for bleeding incidence, intraoperative red blood cell transfusion units, postoperative fresh frozen plasma transfusion volumes and platelet concentrates transfusion units between the 2 groups (all P > .05). Ulinastatin reduces postoperative bleeding (WMD = −0.73, 95% CI: −1.17 to −0.28, P = .001) and red blood cell (RBC) transfusion (WMD = −0.70, 95% CI: −1.26 to −0.14, P = .01), inhibits hyperfibrinolysis as manifested by lower level of postoperative D-dimer (WMD = −0.87, 95% CI: −1.34 to −0.39, P = .0003).

Conclusion:

This meta-analysis has found some evidence showing that Ulinastatin reduces postoperative bleeding and RBC transfusion in patients undergoing cardiac surgery. However, these findings should be interpreted rigorously. Further well-conducted trials are required to assess the blood-saving effects and mechanisms of Ulinastatin.
The 360° circumferential opening of Schlemm's canal in normal individuals detected by enhanced depth imaging optical coherence tomography
Authors: Jing Sili , Chen Zhiqi , Chen Wei , Zhang Hong , Wang Junming
Published: February 2020

We aimed to observe the opening status and morphological parameters of Schlemm's canal (SC) in normal eyes using enhanced depth imaging optical coherence tomography (EDI-OCT).

Consecutive EDI-OCT scans were used to examine the right eye of 20 normal individuals. EDI-OCT was performed clockwise for 8 regions (at the 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00 and 10:30 o’clock positions). Image processing and analysis in java software was used to measure the area, perimeter, and diameter of SC. Twenty-one serial scans of each region were evaluated and a total of 168 images were included in the analyses of each eye.

The SC was detected in 100.0% of the sections. The distribution of individual measurements of SC was highly variable. The mean values of SC size significantly differed among the different clock-face positions. The mean values of the area, perimeter, and diameter of SC in the 9:00 o’clock position were the lowest, and those at the 7:30 o’clock position were the highest (P < .05). There was no obvious association between intraocular pressure and SC size at any clock position.

Although SC tends to open circumferentially in normal individuals, the distribution of individual measurements is highly variable. Morphological manifestation of SC measured by EDI-OCT is a useful way to evaluate the circumferential opening status of SC.
Two surgical strategies for treating multilevel cervical spondylotic myelopathy combined with kyphotic deformity
Authors: Yeh Kuang-Ting , Chen Ing-Ho , Lee Ru-Ping , Yu Tzai-Chiu , Peng Cheng-Huan , Liu Kuan-Lin , Wang Jen-Hung , Wu Wen-Tien
Published: February 2020

This study compared the surgical outcomes of two surgical methods for treating multilevel cervical spondylotic myelopathy (MCSM) combined with cervical kyphotic deformity (CKD): (1) the ELTA method consisted of expansive open-door laminoplasty (EOLP) followed by three-segment anterior cervical discectomy fusion (ACDF), and (2) the LAPI method consisted of long-segment ACDF followed by long-level posterior instrumented fusion (PIF). Surgical treatment of CKD combined with MCSM remains challenging. Surgical considerations should include adequate spinal cord decompression and restoration of satisfactory cervical sagittal alignment (CSA). In certain situations, a solid PIF structure is vital to prevent failure.

We included 105 patients who underwent the aforementioned surgical methods for MCSM combined with CKD from January 2013 to December 2017. The minimum follow-up period was 1 year. Comparative analysis was performed to compare the two surgical strategies’ preoperative and postoperative functional outcomes, including a visual analog scale for neck pain, neck disability index, the Japanese Orthopedic Association cervical myelopathy score, and the Nurick score, as well as the CSA radiographic outcomes, including C2-7 Cobb angle, C2-7 sagittal vertical axis, and C7 slope. The risk factors related to reduced improvement in functional status were analyzed.

A total of 63 patients underwent ELTA and 42 patients underwent LAPI. Improvements in functional outcomes were considerable in both groups. The mean C2-7 Cobb angle was restored from 7.4° ± 2.1° kyphosis to 8.8° ± 4.7° lordosis in the ELTA group and from 15.3° ± 4.2° kyphosis to 15.8° ± 8.1° lordosis in the LAPI group. The maximal correction angle was 22.6° in the ELTA group and 42.6° in the LAPI group.

Although changes in CSA seemed to be significantly correlated with improvements of functional status, the ELTA and LAPI methods were both effective for treating MCSM combined with CKD, when appropriately selected. The ELTA method was indicated for MCSM patients who had a low degree of CKD, whereas the LAPI method was indicated for MCSM patients who had poor function scores and a high degree of CKD.
Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report
Authors: Han Yeon Jae , Jang Yong Jun , Park Geun-Young , Joo Young Hoon , Im Sun
Published: February 2020

Introduction:

Injection laryngoplasty is a common procedure for patients with vocal fold dysfunction, but the literature on its benefits has been mainly focused on those related to structural lesions or laryngeal nerve involvement. Stroke patients may be at increased risk of aspiration due to insufficient vocal fold motion. However, how injection laryngoplasty can be of benefit in stroke patients has not been reported yet.

Patient concerns:

Six chronic stroke patients with long-standing swallowing difficulties and who showed severe aspiration despite long-term swallowing rehabilitation.

Diagnosis:

Laryngoscope evaluation revealed insufficient glottic closure as the cause of aspiration.

Interventions:

Injection laryngoplasty was done per-orally under local anaesthesia with calcium hydroxylapatite (Radiesse Voice, 1–1.5 mL) in an office setting. Respiratory pressures and peak cough flows were assessed at baseline and at 2 weeks follow-up.

Outcomes:

At 2 weeks, the mean peak cough flow (Δ = +95.09 L/min) increased significantly after the procedure. The maximal expiratory (Δ = +18.40 cm H2O) and inspiratory (Δ = +20.20 cm H2O) pressures also improved, indicating that injection laryngoplasty was effective in augmenting respiratory and cough parameters. All cases showed improvement in the Functional Oral Intake Scale (Δ = +4). Feeding tubes were successfully removed.

Conclusion:

Injection laryngoplasty proved to be both successful and safe in improving glottic closure with immediate results in those who had failed to show a positive response after long-term swallowing rehabilitation. The positive and dramatic clinical outcomes were observed through changes in the coughing force. Our case series support the use of injection larygnoplasty as a powerful adjunctive treatment method to prevent aspiration pneumonia in post-stroke patients with vocal fold insufficiency. Pre- and post-injection peak cough flow changes may reflect improvement in glottic closure and indicate the safety of swallowing with reduced risk of aspiration.
Dominative role of MMP-14 over MMP-15 in human urinary bladder carcinoma on the basis of its enhanced specific activity
Authors: Kudelski Jacek , Młynarczyk Grzegorz , Darewicz Barbara , Bruczko-Goralewska Marta , Romanowicz Lech
Published: February 2020

Background:

Human urinary bladder cancer is one of the most common cancers worldwide with the mortality rate of approximately 165,000 people annually. The modulation of extracellular matrix is a crucial event in the metastatic spread, among others in angiogenesis. It is initiated and prolonged by the cascade of matrix metalloproteinases. MMP-14 and MMP-15 are associated with a high degree of malignancy, aggressiveness, and survival prognosis by the activation of other matrix metalloproteinases (MMPs). This study was aimed at evaluating the expression and the activity of selected transmembrane metalloproteinases at different stages of human urinary bladder cancer.

Methods:

Western blot and enzyme linked immunosorbent assay (ELISA) method were used to evaluate the expression and content of MMPs and TIMP-1. The activity of studied enzymes was determined with fluorometric method.

Results:

Both transmembrane metalloproteinases are found in healthy or cancerous tissue in high molecular complexes of human urinary bladder. MMP-14 dominates over MMP-15, particularly in high-grade urinary bladder cancer. Their contents significantly change with the grade of bladder tumor. The amount of MMP-14 increases with increasing grade of tumor. MMP-15 content decreases in high-grade bladder cancer. With increasing grade of urinary bladder cancer their actual activity (per kg of total protein content) is varying in different ways. In all examined tissues, the specific activity of MMP-15 (per kg of the enzyme content) is much higher in comparison to MMP-14. Human urinary bladder cancer contains higher TIMP-1 amounts than control tissue but with the decrease with an increase in tumor grade.

Conclusion:

Comparison of investigated enzymes’ activity and the inhibitor content suggests it opposite effects, higher suppression of MMP-14 than MMP-15 activity in low-grade bladder cancer and reverse TIMP-1 action in high-grade cancer. The MMP-14 activity determination in urinary bladder cancer tissue may be used as a predictor of a risk of metastasis.
Comparison of the short-term outcomes between totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy for gastric cancer: a meta-analysis
Authors: Liao Gang , Wang Ziwei , Zhang Wei , Qian Kun , Mariella MAC Sandrie , Li Hui , Huang Zhen
Published: February 2020

Background:

Totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG) are two common surgical approaches for upper and middle gastric cancer. Which surgical approach offers more advantages is still controversial due to a lack of evidence from randomized controlled trials (RCTs). This meta-analysis was conducted to compare the short-term outcomes between the two surgical approaches.

Methods:

A systematic literature search was performed to evaluate short-term outcomes between TLTG and LATG, including overall postoperative complications, anastomosis-related complications, time for anastomosis, operation time, intraoperative blood loss, harvested lymph nodes, proximal margin, distal margin, time to first flatus, time to first diet, and postoperative hospital stay. Short-term outcomes were pooled and compared by meta-analysis using RevMan 5.3. Mean differences (MDs) or risk ratios (RRs) were calculated with 95% confidence intervals (CIs). P < .05 was considered statistically significant.

Results:

A total of 9 cohort studies fulfilled the selection criteria. The total sample included 1671 cases. The meta-analysis showed no significant difference between the two surgical approaches in overall postoperative complications (RR = 1.02, 95% CI = 0.82 to 1.26, P = .87),anastomosis-related complications (RR = 0.64, 95%CI = 0.39 to 1.03, P = .06),time for anastomosis (MD = −5.13, 95% CI = −10.54 to 0.27, P = .06),operation time (MD = −10.68, 95% CI = −23.62 to 2.26, P = .11), intraoperative blood loss (MD = −25.58, 95% CI = −61.71 to 10.54, P = .17), harvested lymph nodes (MD = 1.61, 95% CI = −2.09 to 5.31, P = .39), proximal margin (MD = −0.37, 95% CI = -0.78 to 0.05, P = .09), distal margin (MD = 0.79, 95% CI = −0.57 to 2.14, P = .25), time to first flatus (MD = 0.01, 95% CI = −0.13 to 0.15, P = .87), time to first diet (MD = −0.22, 95% CI = -0.45 to 0.02, P = .07), and postoperative hospital stay (MD = −0.51, 95% CI = −1.10 to 0.07, P = .09).

Conclusions:

TLTG is a safe and feasible surgical approach for upper and middle gastric cancer, with short-term outcomes that are similar to LATG. Nevertheless, high-quality, large-sample and multicenter RCTs are still required to further verify our conclusions.
Is Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis?
Authors: Matsubayashi Carolina Ogawa , Ribeiro Igor Braga , de Moura Diogo Turiani Hourneaux , Brunaldi Vitor Ottoboni , Bernardo Wanderley Marques , Hathorn Kelly E. , de Moura Eduardo Guimarães Hourneaux
Published: February 2020

The objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability.
Glucagon‐like Peptide 2 Concentrations Vary in Zambian Children During Diarrhoea, in Malnutrition and Seasonally
Authors: Besa Ellen C. , Chandwe Kanta , Banda Rosemary , Munalula Likando , Kalomo Lydia , Amadi Beatrice , Kelly Paul
Published: February 2020

Objectives:

Glucagon‐like peptide 2 (GLP‐2) is a 33 amino acid peptide hormone released from enteroendocrine L‐cells following nutrient ingestion. It has been shown to exert trophic effects on the gut. We set out to measure GLP‐2 concentrations in blood in children with diarrhoea and malnutrition.

Methods:

GLP‐2 levels were measured in blood samples collected from 5 different groups of children (n = 324) at different time points: those with acute diarrhoea, during illness and 3 weeks after recovery; persistent diarrhoea and severe acute malnutrition; controls contemporaneous for diarrhoea; stunted children from the community; and controls contemporaneous for the stunted children. Stool biomarkers and pathogen analysis were carried out on the children with stunting.

Results:

GLP‐2 concentrations were higher during acute diarrhoea (median 3.1 ng/mL, interquartile range 2.1, 4.4) than on recovery (median 1.8, interquartile range 1.4, 3.1; P = 0.001), but were not elevated in children with persistent diarrhoea and severe acute malnutrition. In stunted children, there was a progressive decline in GLP‐2 levels from 3.2 ng/mL (1.9, 4.9) to 1.0 (0.0, 2.0; P < 0.001) as the children became more stunted. Measures of seasonality (rainfall, temperature,Food Price Index, and Shiga toxin‐producing Escherichia coli) were found to be significantly associated with GLP‐2 concentrations in multivariable analysis. We also found a correlation between stool inflammatory biomarkers and GLP‐2.

Conclusions:

In diarrhoea, GLP‐2 levels increased in acute but not persistent diarrhoea. Malnutrition was associated with reduced concentrations. GLP‐2 displayed seasonal variation consistent with variations in nutrient availability.
Viscosity of Commercial Food‐based Formulas and Home‐prepared Blenderized Feeds
Authors: Hron Bridget , Rosen Rachel
Published: February 2020

Objective:

The aim of the study was to quantify the differences in viscosity of over a range of commercial food‐based formulas and home‐prepared blenderized feeds used for enteral feeding in the clinical management of gastroesophageal reflux and gastroesophageal reflux–related aspiration in children with oropharyngeal dysphagia.

Methods:

The viscosity of commercial and home blends was measured using digital rotational viscometer and International Dysphagia Diet Standardization Initiative Syringe Flow Test. Additional testing was performed to determine the impact of added cereal, water flushes, and freezing/thawing on formula viscosity.

Results:

There were significant variations in viscosity between commercial blends with values ranging from extremely to mildly thick by Syringe Flow Test. The highest centipoise (cP) value was 13,847 and the lowest 330 and 438 cP. Dilution of 240 mL of commercial blend with 30, 60, and 90 mL of water resulted in a decrease in viscosity of 31%, 62%, and 85%, respectively. Exposure to 1 freeze/thaw cycle decreased viscosity by as much as 59% to 80% depending on the blend. Thickening conventional pediatric formulas with rice or oatmeal did not achieve consistency equivalent to most blenderized feeds.

Conclusions:

Commercial food‐based formulas and home prepared blends vary greatly in viscosity, ranging from thin to extremely thick liquids, with the majority achieving viscosity greater than thickened formula. Viscosity is reduced by addition of free water and with freezing and thawing. These data can inform the clinical choice of feeding regimen depending on the goals of nutritional therapy.
Social Media Usage Among Nurses
Authors: Lefebvre Cedric , McKinney Kara , Glass Casey , Cline David , Franasiak Ryan , Husain Iltifat , Pariyadath Manoj , Roberson April , McLean Andrew , Stopyra Jason
Published: February 2020

OBJECTIVE

This study aims to examine the existing perceptions and social media practices of nurses in a large academic medical center.

BACKGROUND

Limited data are available about the perceptions and social media practices among healthcare providers. An understanding of the social networking landscape within the nursing profession is necessary to inform policy and develop effective guidelines.

METHODS

This was a single-center prospective observational study involving nurses at a large academic medical center. Nurses completed an anonymous questionnaire regarding their personal use and perceptions of social media in the context of clinical medicine.

RESULTS

A total of 397 nurses participated in the study survey. Overall, 87% of participants reported using a general social media account currently. Increasing age was associated with decreasing frequency of social media use.

CONCLUSION

Social media usage is common among nurses. Social media perceptions and practices among nurses vary considerably. Well-informed policy and targeted education are needed to guide social media use among healthcare workers.
Optimization of Immunophenotypic Panel to Differentiate Upper From Lower Gastrointestinal Adenocarcinomas: Analysis of New and Traditional Markers
Authors: Chauhan Aastha , Sanchez-Avila Monica , Manivel Juan , Dachel Susan , Larson Wendy , Hanson Brian , Gravely Amy , Mesa Hector
Published: February 2020

Adenocarcinomas of the esophagus (EAC), stomach [gastric adenocarcinoma (GAC)], and colorectal carcinoma (CRC) frequently show similar morphology because upper gastrointestinal tumors (GITs) usually evolve from pathologies involving intestinal metaplasia. Upper and lower GIT may also show overlapping immunophenotypes when using the traditional CK7, CK20, and CDX2 panel, which in patients presenting with metastatic disease of unknown origin may lead to misdirected diagnostic workup and/or therapy. We compared the phenotype of upper and lower GIT using an expanded immunohistochemical panel that included the traditional and newer gastrointestinal markers: SATB2, DcR3, MUC5AC, and MUC6. The panel was applied to resection specimens from 40 CRC, 40 GAC, and 40 EAC. A panel using SATB2, CK7, and CDX2 provided the best discriminating power for separating upper from lower GIT and was applied to 101 biopsies including 17 EAC, 17 GAC, 19 CRC, 18 pancreatic adenocarcinomas, 15 cholangiocarcinomas, and 15 lung adenocarcinomas. The phenotype CK7+/CDX2+/SATB2− was moderately sensitive and highly specific of upper GIT, the phenotype CK7−/CDX2+/SATB2+ was highly sensitive and specific for lower GIT, the phenotypes CK7+/CDX2−/SATB2− and CK7+/CDX2−/SATB2+ favored pancreatobiliary or lung primaries. Less frequent phenotypes showed substantial overlap. Although strong diffuse expression of SATB2 was characteristic of CRC, weak and/or focal expression was present in one third or more of upper gastrointestinal, cholangiocarcinomas, and lung adenocarcinomas. DcR3, MUC5AC, and MUC6 improved specificity, but showed poor sensitivity, suggesting they should be used as second tier markers.
Brief Report: Sex Differences in Outcomes for Individuals Presenting for Third-Line Antiretroviral Therapy
Authors: Godfrey Catherine , Hughes Michael D. , Ritz Justin , Coelho Lara , Gross Robert , Salata Robert , Mngqibisa Rosie , Wallis Carole L. , Mumbi Makanga. E. , Matoga Mitch , Poongulali Selvamuthu , Van Schalkwyk Marije , Hogg Evelyn , Fletcher Courtney V. , Grinsztejn Beatriz , Collier Ann C. ,   on behalf of the A5288 team
Published: February 2020

Background:

Sex differences in studies of antiretroviral (ART) drug exposure and treatment outcomes support the hypothesis that some ART combinations may not be well tolerated in women. We evaluated disparities in outcomes between men and women participating in ACTG A5288, an interventional strategy trial for individuals failing a protease inhibitor–based second-line ART regimen in low- and middle-income countries.

Methods:

Participants were assigned to one of 4 cohorts (A-D) based on resistance profiles and ART history. Cohort A had no lopinavir/ritonavir (LPV/r) resistance and stayed on their second-line regimen, and cohorts B, C, and D had increasing resistance and accessed novel ART regimens. In this secondary analysis, we evaluated sex differences in the primary endpoint, HIV-1 RNA ≤200 copies/mL at week 48; confirmed virologic failure ≥1000 copies/mL (VF); and clinical outcomes and adverse events (intent-to-treat).

Results:

Women made up 258/545 (47%) of the study population. More women than men were assigned to cohort A. Median follow-up was 72 weeks. Fewer women than men had HIV-1 RNA ≤200 copies/mL at week 48: 39% vs. 49% in cohort A and 83% vs. 89% in cohorts B, C, and D combined. More women experienced VF, grade ≥3 signs and symptoms, but similar grade ≥3 diagnoses or laboratory abnormalities.

Conclusions:

More women than men entered the study with a resistance profile suggesting that their second-line regimen could have been effective in maintaining virologic suppression. The more frequent occurrence of grade ≥3 signs and symptoms in women suggests that tolerability issues were under recognized in women on protease inhibitor–based therapy.
A Universal Protocol for Abdominal CT Examinations Performed on a Photon-Counting Detector CT System
Authors: Zhou Wei , Michalak Gregory J. , Weaver Jayse M. , Gong Hao , Yu Lifeng , McCollough Cynthia H. , Leng Shuai
Published: February 2020

Objective

The aims of this study were to investigate the feasibility of using a universal abdominal acquisition protocol on a photon-counting detector computed tomography (PCD-CT) system and to compare its performance to that of single-energy (SE) and dual-energy (DE) CT using energy-integrating detectors (EIDs).

Methods

Iodine inserts of various concentrations and sizes were embedded into different sizes of adult abdominal phantoms. Phantoms were scanned on a research PCD-CT and a clinical EID-CT with SE and DE modes. Virtual monoenergetic images (VMIs) were generated from PCD-CT and DE mode of EID-CT. For each image type and phantom size, contrast-to-noise ratio (CNR) was measured for each iodine insert and the area under the receiver operating characteristic curve (AUC) for iodine detectability was calculated using a channelized Hotelling observer. The optimal energy (in kiloelectrovolt) of VMIs was determined separately as the one with highest CNR and the one with the highest AUC. The PCD-CT VMIs at the optimal energy were then compared with DE VMIs and SE images in terms of CNR and AUC.

Results

Virtual monoenergetic image at 50 keV had both the highest CNR and highest AUC for PCD-CT and DECT. For 1.0 mg I/mL iodine and 35 cm phantom, the CNRs of 50 keV VMIs from PCD-CT (2.01 ± 0.67) and DE (1.96 ± 0.52) were significantly higher (P < 0.001, Wilcoxon signed-rank test) than SE images (1.11 ± 0.35). The AUC of PCD-CT (0.98 ± 0.01) was comparable to SE (0.98 ± 0.01), and both were slightly lower than DE (0.99 ± 0.01, P < 0.01, Wilcoxon signed-rank test). A similar trend was observed for other phantom sizes and iodine concentrations.

Conclusions

Virtual monoenergetic images at a fixed energy from a universal acquisition protocol on PCD-CT demonstrated higher iodine CNR and comparable iodine detectability than SECT images, and similar performance compared with DE VMIs.
Incidental 18F-Fluorocholine Uptake in an Esophageal Diverticulum
Authors: Araz Mine , Cinel Murat , Soydal Cigdem , Ozkan Elgin , Kucuk N. Ozlem
Published: February 2020

18F-fluorocholine has recently emerged as a very sensitive agent for seeking parathyroid adenomas. We represent a case with esophageal diverticulum incidentally detected on 18F-fuorocholine PET/CT, which should be kept in mind as a reason of false positivity in primary hyperparathyroidism.
68Ga-PSMA PET/CT in Recurrence Prostate Cancer. Should We Perform Delayed Image in Cases of Negative 60 Minutes Postinjection Examination?
Authors: Kunikowska Jolanta , Kujda Szymon , Królicki Leszek
Published: February 2020

We report a case of a 59-year-old man with prostate adenocarcinoma, Gleason score 9 after prostatectomy and adjuvant radiotherapy. The patient showed biochemical recurrence. On standard 68Ga-PSMA PET/CT examination, 60 minutes postinjection, the PET/CT images showed only trace accumulation in the ureters. To identify lesions close to the ureters, imaging of the pelvis was performed 2 hours postinjection. The delayed image showed clearly visible increased uptake in a right internal iliac lymph node that was normal-sized by CT. The patient underwent radiotherapy with planning based on the 68Ga-PSMA PET/CT image. Follow-up testing showed prostate-specific antigen level reduction to 0.04 ng/mL.
The Current Status of the Autologous Fat Grafting for Pediatric Craniofacial Patients
Authors: Anderson Casey , Hamidian Jahromi Alireza , Miller Emily J. , Konofaos Petros
Published: February 2020

Since its first introduction, autologous fat grafting (AFG) has undergone multiple refinements and has become a common treatment option within plastic surgery. It is a safe, quick, economical, and minimally invasive method for volume augmentation and is finding its own indications in the pediatric craniofacial surgery patients. Because there is currently a paucity of literature regarding the use of AFG in the pediatric population compared with the adults, the authors performed a systematic review of the literature using PubMed, Cochrane Library databases, and the Journal of Plastic and Reconstructive Surgery using the terms of fat grafting/lipofilling, fat grafting, and craniofacial surgery to include articles that contained pediatric patients. While reviewing AFG in the pediatric craniofacial patients, indications, technique, and challenges were specifically evaluated and an algorithm of approach was proposed. In current practice, the choice of microvascular free flap versus AFG is one of the surgeon preferences on a case-by-case basis. With the low complication rate and ease of use, selection of AFG for the repair of soft tissue defects in pediatric craniofacial patients is increasing and may come to surpass use of traditional invasive methods such as free flaps. It should also be considered as a useful adjunct to other concurrent invasive procedures, that is, bony adjustments.